366 exam 3

Which can occur in untreated DDH? (select all that apply) 1. duck gait 2. pain 3. osteoarthritis in adult hood 4. osteoporosis in adult hood 5. increased flexibility of the hip join in adult hood

1, 2, 3

Management of traumatic injury

RICE or ICE rest ice compression elevation

symmetrical lymphadenopathy can be found in what disease?

Rubella

When would a rash appear in measles? what would this rash look like?

3 - 4 days after prodromal symptoms macularpapular starts face - body confluent - discrete brownish appearance, and fine desquamation over area of extensive involvement

Therapeutic management of encopresis

eliminate milk and dairy products increase high-fiber foods increase fluids lubricants to relieve fecal impaction osmotic laxatives magnesium hydroxide toilet ritual to encourage normal defecation pattern behavioral therapy to reduce fear of painful defection

secondary encopresis

fecal incontinence occurring in child older than 4 years after a period of fecal continence

prodromal symptoms of measles

fever conjunctivitis runny nose sore throat dry cough KOPLIK SPOTS

When should the first meconium be passed from a newborn?

first 24-36 hours of life

epiphysis injury

fracture where the growth plate is

what is russel traction?

hip is flexed, knee is in a sling bed skin traction normally for femurs

Lordosis

inward lumbar spine - involve cervical spine normal in toddlers caused by fat in obese children predisposing cause for management

What is the most serious concern for rubella?

it is teratogenic to fetuses

Rash phase of chicken pox

itchy macule - papule - vesicle - crust

What are PT/OT management for OA?

joint protection maintain muscle strength AVOID load bearing restore joint function exercise - programs that limits stressing affected joints prevent further disability

Autoimmune inflammatory disease

juvenile idiopathic arthritis arthritis in 1 or more joints for 6 weeks or longer no cure NSAIDS needed

Therapeutic management for osteomyelitis

long term IV antibiotics through a central line - 4-6 weeks to 4 months immobility: spinting or casting & PT

what symptoms can be expected with Rubella?

low grade fever headache/ malaise lymphadenopathy exanthema: - macular/papular -craniocaudal -1-3 days

How long do you an Ice an injury to bone?

no more than 30 minutes, rest for an hour, then do it again with then first 24 hours

post op care for CP

no sharp objections in mouth special nipple feeders breastfeeding is allowed

DX of CP

- neurological exam - HX - CT - MRI (strong predictor) - brain ultrasound - EEG (seizures)

priority nursing actions for extremity fracture

1. assess extent of injury and immobilize the affected extremity 2. if a compound fracture exists, cover the wound with a sterile dressing (clean if sterile unavailable) 3. elevate injured extremity 4. apply cold to injured area 5. continue to monitor neurovascular status 6. transport to nearest ED

Plan of care for a child with juvenile idiopathic arthritis

1. facilitate social and emotional development. 2. administration of medications such as NSAIDS 3. assist child with ROM exercises and instruct in prescribed exercises. 4. encourage normal performance of activities of daily living 5. instruct parent and child in use of hot or cold packs, splinting, and position the affected join in a neutral position during painful episodes

Fat embolism nursing actions

1. notify HCP 2. administer oxygen 3. administer IV fluids 4. monitor vital signs and respiratory status 5. prepare for inutbationa nd mechanical ventilation if necessary as indicted by ABG values 6. follow up on results with dx test such as chest x-ray or CT scan 7. document

When should a child start receiving the Hib vaccine?

2 months 4 months 6 months 12-15 months

Which vaccines should the first dose be administered at 12 - 15 months and the second dose at 4 - 6 years of age? 1. IPV and PCV 2. Hib and Hep B 3. Varicella and MMR 4. DTaP and MMR

3

Parents bring their 2-week old infant to a clinic for treatment after a diagnosis of clubfoot made at birth. Which statement by the parents indicates a need for further teaching regarding this disorder? 1. treatment needs to be started as soon as possible 2. I realize my infant will require follow-up care until fully grown 3. I need to bring my infant back to the clinic in 1 month for a new cast 4. I need to come to the clinic every week with my infant for the casting

3 treatment for clubfoot is started ASAP after birth. serial manipulation and casting are performed at least weekly. if sufficient correction is not achieve in 3-6 months, surgery usually is indicated. because clubfoot can recur, all children with clubfoot require long-term interval follow-up until they reach skeletal maturity to ensure an optimal outcome

Which instruction would be highest priority for the mother of an infant receiving his first oral rotavirus vaccine? 1. call the physician if he develops a fever or cough 2. call the physician if he develops fever, redness, or swelling at the injection site 3. call the physician if he develops a bloody stool or diarrhea 4. call the physician if he develops contraption and irritability

3 There is a very small incidence of infants developing intussusception, signaled by the onset of blood stool or diarrhea after receiving oral rotavirus vaccine PO liquid vaccine not an injection Rotavirus schedule: - 2 months - 4 months - 6 months CON: severe immunodeficiency, history of intussusception not a catch up vaccine no need to give to a 1 year old because they are beyond the risk

The parents of a child with juvenile idiopathic arthritis call the clinic nurse because the child is experiencing a painful exacerbation of the disease. The parents ask the nurse if the child can perform ROM. exercises at this time. The nurse should make which response? 1. avoid all exercise during painful periods 2. ROM exercise must be performed every day 3. have the child perform simple isometric exercises during this time 4 administer additional pain meds before performing ROM exercises

3 during painful episodes of juvenile idiopathic arthritis, hot or. old packs and splitting and positioning the affected joint in a neutral position help reduce the pain. although resting the extremity is appropriate, beginning simple isometric or tensing exercises as soon as the child is able is important. these exercises do not involve joint movement.

The nurse is assisting a HCP examining a 3 wk old infant with developmental hip dysplasia. What test or sign should the nurse expect the HCP to assess? 1. babinki's sign 2. moro reflex 3. ortolan's maneuver 4. palmar-plantar grasp

3. in developmental hip dysplasia, the head of the femur is seated improperly in the acetabulum or hip socket of the pelvis. ortolani's maneuver is a test to asses for hip instability and can be done only before 4 weeks of age. the examiner abducts the thigh and applies gentle pressure forward over the greater trochanter. a "clicking" sensation indicates a dislocated femoral head moving into the acetabulum.

how long does it take for a fiber glass cast to usually dry?

30 min

a child is receiving a series of hep B vaccine and arrives at the clinic with his parent for the second dose. before administering the vaccine, the nurse should ask the child and parent about a history of severe allergy to which substance? 1. eggs 2. penicillin 3. sulfonamides 4. a previous dose of hep B vaccine or component

4

A parent brings her 4-month old infant to a well baby clinic for immunizations. The child is up to date with the immunization schedule. The nurse should prepare to administer which immunizations to this infant? 1. varicella, hep b vaccine 2. DTap, MMR, IPV 3. MMR, Hib, DTaP 4. DTaP, Hib, IPV, pneumococcal vaccine (PCV), Rotavirus vaccine (RV)

4 DTaP, Hib, IPV, PCV, and RV are administered at 4 months of age. DTap is administered at 2,4, and 6 month; at 15 to 18 months of age; and at 4-6 years. Hib and PCV are administered at 2, 4, and 6 months of age and at 12-15 months. IPV is administered at 2, 4, and 6 months of age and at 4-6 years. The first dose of MMR vaccine is administered at 12-15 months of age; second dose at 4-6 years of age. The first dose of Hep B is at birth, second at 1 month of age, and third at 6 months. Varicella-zoster is administered at 12-15 months of age and gain at 4-6 years

What would be the nurse's best response if the foster mother of a 15-month-old with an unknown immunization history comes to the clinic requesting immunizations? 1. your foster child will not receive any immunizations today 2. your foster child will review the MMR, Hib, IPV, and hep B vaccines 3. your foster child could have harmful effects if we revaccinate with prior vaccines 4. your foster child will receive only the Hib and DTaP vaccines today

4 vaccines routinely due at 15 months include Hib and DTaP. to catch up missed immunizations, the nurse would need the child's immunization record to verify what he has receive Hib schedule: 1st - 2 months 2nd - 4 months 3rd - 6 months (based on brand) final: 12 - 15 months DTaP schedule: (5 series) - 2 months - 4 months - 6 months - 15-18 months - 4-6 years there are usually no harmful effects to a child with unknown immunization status if revaccinated

A child has a right femur fracture caused by a motor vehicle crash and is placed in skin traction temporarily until surgery can be performed. During assessment, the nurse notes that the dorasalis pedis pulse is absent on the right foot. Which action should the nurse take? 1. administer analgesic 2. release the skin traction 3. apply ice to the extremity 4. notify the health care provider

4 an absent pulse to an extremity of the affected limb after a bone fracture could mean that the child is developing or experiencing compartment syndrome. This is an emergency and the HCP should be notified immediately. administering analgesics would not improve circulation. the skin traction should not be released without an HCP prescription. ICE is only applied to decrease swelling and when perfusion is adequate

Bend fracture

45 angle before break

When is cleft palate (CP) surgery performed

6 - 18 months

Therapeutic management for fractures

reduction immobilization restore function to injured part preventions CSM - neuromuscular checks (color, sensation, movement)

What is reduction management for a fracture?

regain alignment and length of bone fragments

what drug puts you at risk for osteoporosis, decrease osteoblast activity and increased osteoclast activity?

steroids

What is Buck's traction?

straight pull on the affected extremity skin traction

chronic autoimmune disease: inflammation and multi-organ system damage

systemic lupus erhthrematosus (SLE)

what is immobilization for a fracture

to retain alignment and length

Recommended supplements for nutritions and bone health

Calcium: 1,000-1200 mg/day Vitamin D: 600 mg/day

at what age do you screen children for scoliosis?

Girls: 10 -12 years old Boys: 13-14 years old

Therapeutic management for septic arthritis

IV therapy immobility pain managment surgical intervention PT

surgery for GERD

Nissen fundoplication can be used for hiatal hernia

Therapeutic management for diarrhea

Oral rehydration - pedialyte, small amounts avoid juice, or gelatin, carbonated or caffeinated drinks IV fluids and NPO sates if severe

How is osteoporosis screened?

ultrasonometer dual energy x-ray absorptionmetry (DXA)

triggers for SLE

UV light estrogen pregnancy

clinical manifestations of CP

abnormal: - posture -reflexes -muscle tone -motor skills: developmental/performance -associated disability -seizures

Treatment for Roseola infantum

antipyretics for fever

staph aureus

bacteria that causes MRSA and infection of joints

Septic arthritis

bacterial infection in the joint

additional symptoms of OI

blue sclera hearing loss discolored teeth

Therapeutic management for scoliosis

bracing exercising surgical intervention

Risk factors for DDH

breach multiples oligo swaddling adduction

buckle fracture

bulging at fracture site

Treatment for mild symptoms of GERD

burp q 1-2 hr hold upright for 30-60 min after feeds raise head of crib 30 degrees may use special formula or thicken formula with rice cereal (1 tsp to 1tbsp of rice cereal per ounce of formula)

nursing care for a baby with OI

caution when repositioning and holding NO squeezing promote safety and avoid fractures

primary encopresis

child has not achieved fecal continence by age 4

Which would be the nurse's best response if a mother asks if her baby still needs the Hib vaccine because he already had Hib? 1. "yes, it is recommended that the baby still get the Hib vaccine' 2. "no, if he has had Hib, he will not need to receive the vaccine.' 3. "let me take a nasal swab first; if it is negative, he will receive the Hib vaccine.' 4. "the physician will order a blood test, and depending on results, your child may need the vaccine."

1 The infant needs the Hib vaccine to ensure protection against many serious infections caused by Hib , such as bacterial meningitis, bacterial pneumonia, epiglottis, septic arthritis, and sepsis.

a 1 month old infant is seen in a clinic and is diagnosed with developmental hip dysplasia on assessment, the nurse understands that which finding should be noted in this condition? 1. limited range of motion in the affected hip 2. an apparent lengthened femur on the affected side 3. asymmetrical adduction of the affected hip when the infant is placed supine with the knees and hips flexed 4. symmetry of the gluteal skin folds when the infant is placed prone and the legs are extended against the examining table

1 asymmetrical and restricted abduction of the affected hip, when the child is placed supine with knees and hips flexed , would be an assessment finding in developmental hip dysplasia. other findings include and apparent short femur on the affected side, asymmetry of the gluteal skin folds, and limited ROM in the affected extremity

The parents of a 12-month-old with HIV are concerned about his receiving routine immunizations. what will the nurse tell them about immunizations? 1. your child will not receive routine immunizations today 2. your child will receive the recommended vaccines today 3. your child is not severely immunocompromised, but I would still be concerned about his receiving them 4. your child may develop infections if he gets his routine immunizations. your child will not be immunized today

1 the nurse acknowledges a client's fears and then discusses the concerns to clarify any misconceptions. immunizations and influenza vaccine are recommended to prevent infection. Immunocompromised HIV - infected children should not review the varicella and MMR live vaccines recommended immunizations for 12 month olds include varicella and MMR, not for immunocompromised children

which statement is true of shaken baby syndrome? 1. there may be absence of external signs of injury 2. shaken babies usually do not have retinal hemorrhage 3. shaken babies usually do not have signs of subdural hematoma 4. shaken babies have signs of external head injury

1 there may be absence of external signs of injury in shaken baby syndrome because the injury can cause retinal hemorrhage and subdural hematoma

The nurse tells the parent that other conditions can be associated with congenital clubfoot. (select all that apply). 1. myelomenigocele 2. cerebral palsy 3. diastrophic dwarfism 4. breech position in utero 4. prematurity 5. FAS

1, 2, 3 breech position is not associated with clubfoot. is is associated with DDH

The nurse on the pediatric floor is receiving a child with the possible diagnosis of septic arthritis of the elbow. which would the nurse expect on assessment? (select all that apply). 1. resistance to bending the elbow 2. n/v 3. fever 4. brushing of the elbow 5. swelling of the elbow 6. a history of nursemaid's elbow as a toddler

1, 2, 3, 4

When planning care for child with OI, the nurse should prevent which of the following? (select all that apply) 1. positional contracures and deformities 2. bone infection 3. muscle weakness 4. osteoporosis 5. misalignment of lower extremity joints

1, 3, 4, 5

Which would the nurse expect to assess on a 3-week-old infant with developmental dysplasia of the hip (DDH)? 1. excessive hip abduction 2. femoral lengthening of an affected leg 3. asymmetry of gluteal and thigh folds 4. pain when lying prone

3 femoral shortening is more present on the affected side asymmetrical thigh and gluteal folds are frequently present

Cast care includes:

1. keep elevated 2. wet plaster dry in 24-72 hr (synthetic in 20 min) 3. handle with palms of hand not fingertips until dry 4. turn extremity q 1-2 hr unless contraindicated to allow air circulation and promote drying of the acst 5. use hair dryer on cool setting to dry plaster (No heat because it can burn skin) 6. monitor closely for circulatory impairment 7. petal the cast or apply moleskin to the edges to protect the clients skin; maintain smooth edges around the cast to prevent crumbling 8. monitor signs of infection 9. open drain exists, HCP will make cutout window for assessment of wound for care 10. do not stick ANY objects inside the cast 11. teach the client to keep cast clean and dry 12. isometric exercises to prevent muscle atrophy

4 nursing priorities for traction

1. weights kept hanging freely 2. maintain ropes over midline 3. maintain pt. alignment (avoid turning) 4. assess skin throughout (i.e. mepilex)

meningococcal vaccine (Menactra) schedule

11- 12 year 16 years

When should the MMR and Varicella vaccine be administered?

12-15 months 4-6 years

When should the hep A vaccine be given?

12-15 months 6-18 months after first dose

A child is admitted to the pediatric unit with the diagnosis of systemic lupus erythemaotosus (SLE). on assessment, the nurse expects the child to have: 1. leukemia 2. malar rash 3. weight gain 4. heart failure

2 The "butterfly" or malaria, rash is the most common manifestation of SLE

The clinic nurse is instructing the parent of a child with HIV infection regarding immunizations. the nurse should provide which instruction to the parent? 1. The hep B vaccine will not be given to the child 2. The inactivated influenza vaccine will be given yearly 3. The varicella vaccine will be given before 6 months of age 4. a western blot test needs to be performed and the results evaluated before immunization

2 immunizations against common childhood illnesses are recommended for all children exposed to or infected with HIV. the inactivated influenza vaccine that is given IM will be administered. the hep B vaccine is administered according to the recommended immunization schedule. Varicella-zoster virus vaccine should not be given because it is a live virus vaccine; varicella zoster immunoglobulin may be prescribed after chickenpox exposure.

A 4 y/o child sustains a fall at home. After an x-ray examination, the child is determined to have a fractured arm and a plaster cast is applied. The nurse provides instructions to the parents regarding care for the child's cast. Which statement by the parents indicates a need for further instruction? 1. " the cast may feel warm as the cast dries." 2. " I can use lotion or powder around the cast edges to relive itching." 3. "a small amount of white shoe polish can touch up a soiled white cast." 4. " If the cast becomes wet, a blow drier set on the cool setting may be used to dry the cast."

2 parents need to be instructed not to use lotion or powders on the skin around the cast edges or inside the cast. lotions or powders can becomes tricky or caked and cause skin irritation

an 18-month-old is discharged from the hospital after having a febrile seizure secondary to exanthema subitem (roseola). on discharge, the mother asks the nurse if her 6-year-old twins will get sick. which teaching about the transmission of roseola would be most accurate? 1. the child should be isolated in the home until the vesicles have dried. 2. the child does not need to be isolated from the older siblings 3. administer acetaminophen to the older siblings to prevent seizures 4. monitor older children for seizure development

2 the rash is pink and maculopapular, not vascular. the incubation period is 5-15 days and more commonly seen in children 6 months to 3 years of age.

Which would be the priority intervention for a child suspected of having varicella (chickenpox)? 1. contact precautions 2. contact and droplet precautions 3. droplet respiratory precautions 4. universal precautions and standard precuations

2 varicella (chickenpox) is highly contagious. contact and droplet respiratory precautions should be started immediately because the primary source of transmission is secretions of the reparatory tract (droplet) and also by contaminated objects

When should the TDaP vaccine be given?

2 months 4 months 6 months 15-18 months 4-6 years

When should the inactivated poliovirus vaccine (IPV) be given?

2 months 4 months 6 months 4-6 years

When counseling the parents of a child with OI, the nurse should include which fo the following? (select all that apply). 1. discourage future children because the condition is inherited 2. provide education about the child's physical limitations 3. give the parents a letter signed by the primary care provider explaining OI 4. provide info on contacting the OI foundation 5. encourage the parents to treat the child like their other chidlren 6. encourage use of calcium to decrease risk of fractures

2, 3, 4 no support for the use of additional calcium, children with OI use be treated with careful handling and cannot be allowed to participate in all activities that unaffected sibling are allowed. OI can be confused with child abuse. a letter is important for emergency stressors

The clinic nurse is assessing a child who is scheduled to receive a live virus vaccine (immunization). what are the general contraindications associated with receiving a live virus vaccine? (select all that apply). 1. the child has symptoms of a cold 2. the child had a previous anaphylactic reaction tot he vaccine 3. the mother reports that the child is having intermittent episodes of diarrhea 4.the mother reports that the child has not had an appetite and has been fussy. 5. The child has a disorder that caused a severely deficient immune system. 6. the mother reports that the child has recently been exposed to an infectious disease.

2, 5 The general contraindications for receiving live virus vaccines include a previous anaphylactic reaction to a vaccine or a component of a vaccine. IN addition, live virus vaccines generally are not administered to individuals with a severely deficient immune system, individuals with a severe sensitivity to gelatin, or pregnant women. a vaccine is administered with caution to an individual with a moderate or severe acute illness, with or with out fever.

The nurse prepares a list of home care instructions for the parents of a child who has a plaster cast applied to the left forearm. Which instructions should be included on the list? (select all that apply). 1. use the fingertips to lift the cast while it is drying 2. keep small toys and sharp objects away form the cast 3. use a padded ruler or another padded object to scratch the skin under the cast if it itches 4. place a heating pad on the lower end of the cast and over the fingers if the fingers feel cold 5. elevate the extremity on pillows for the first 24-48 hrs after casting to prevent swelling 6. contact the HCP if the child complains of numbness or tingling in the extremity

2, 5, 6 while the cast is drying, the palms of the hands are used to life the cast. if the fingertips are used, indentations in the cast could occur and cause constant pressure on the underlying skin. small toys and sharp objects are kept away from the cast, and non objects (including padded objects) are placed inside the cast because of the risk of altered skin integrity. the extremity is elevated to prevent swelling, and the HCP is noticed immediately if any signs of neurovascular impairment develop. a heating pad is not applied to the cast or fingers. cold fingers could indicate neuron vascular impairment and the HCP should be notified

Which is the nurses's best repose to the mother of a 2-month old who is going to get IPV immunization when the mother tells the nurse the older brother is immunocompromised? 1. your baby should not be immunized because your immunocompromised sone could develop polio 2. your baby should drive the oral poliovirus instead so your immune compromised son does not get sick 3. you should separate your 2-moth-old child from the immunocompromised son for 7-14 days after the IPV 4. your baby can be immunized with the IPV; he will not be contagious

4 IPV does not contain live poliovirus, so the virus cannot be transmitted to the immunocompromised sibling oral polio vaccine contains weakened poliovirus; rarely, the virus can be tramitted to someone immunocompromised the infants sibling can and should be immunized as recommended. the infant will not shed the poliovirus IPV schedule: - 2 months - 4 months - 6-18 months - 4-6 years CON: allergy to neomycin, streptomycin, polymyxin B

Which clinical assessment of a neonate with bacterial meningitis would would arrant immediate intervention? 1. irritability 2. rectal temperature of 100.6 3. quite than usual 4. respiratory rate of 24 breaths per minute

4 a normal neonates respiratory rate is 30-60 breaths per minute. neonates respiratory system are immature, and the rate may initially double in response to illness. if no immediate interventions are begun when there is reparatory distress, a neonates respiratory rate will slow down, develop worsening respiratory distress, and, eventually, respiratory arrest. neonates with slower or faster respiratory rates are true emergency cases; they require identification of the cause of distress

an infant receives a DTaP immunization at a well-baby clinic. The parent returns home and calls the clinic to report that the infant has developed swelling and redness at the site of injection. Which intervention should the nurse suggest to the parent? 1. monitor the infant for a fever 2. bring the infant back tot he clinic 3. apply a hot pack to the injection site 4. apply a cold pack to the injection site

4 on occasion, tenderness, redness, or swelling may occur at the site of the DTaP injection. The can be relieved with cold packs for the first 24 hours., followed by warm or cold compress if the inflammation persists. Bringing the infant back tot he clinic is unnecessary. option 1 may be an appropriate intervention but is not specific to the subjection of the question.

The nurse provides home care instructions to the parent of a child hospitalized with pertussis who is in the convalescent stage and is being prepared for discharge. Which statement by a parent indicates a need for further instruction? 1. "we need to encourage our child to drink fluids." 2. " coughing spells may be triggered by dust or smoke." 3. "vomiting may occur when our child has coughing episodes." 4. " we need to maintain droplet and a quiet environment for at least 2 weeks."

4 pertussis is transmitted by direct contact or respiratory droplets from coughing. the communicable period occurs primarily during the catarrhal stage. respiratory precautions are not required during the convalescent phase.

A child is placed in skeletal traction for treatment of a fractured femur. The nurse develops a plan of care and includes which intervention? 1. Ensure that all ropes are outside the pulleys. 2. Ensure that the weights are resting lightly on the floor. 3. Restrict diversional and play activities until the child is out of traction. 4. Check the health care provider's (HCP's) prescriptions for the amount of weight to be applied

4. when a child is in traction, the nurse would check the HCP's prescription to verify the prescribed amount of traction weight. The nurse would maintain the correct amount of weight as prescribed, ensure that the weight hand freely, check the ropes for fraying and ensure that they are on the pulleys appropriately, monitor the neurovascular status of the involved extremity, and monitor for signs and symptoms of immobilization. The nurse would provide theoretic and diverse play activities for the child.

Post op care for cleft lip

Protect suture line with Logan bow pain medication and holding to minimize crying elbow/cuff restraints - remove one at a time upright position or in infant seat, if possible clean suture line gently after feedings no pacifiers gentle aspiration of mouth and nasopharyngeal secretions may be necessary to prevent aspiration and respiratory complication

What are the 5 P's?

Pulselessness Pallor Pain Paresthesia Paralysis

at what age is roseola infant most common ?

children younger than 3 (primarily 6-15 months)

Talipes Equinovarnus

clubfoot

complete

compound

green stick fracture

compression where break is

Kyphosis

convex thoracic spine caused by posture bracing or surgical fusion for management

When is surgical intervention needed for scoliosis?

curvature > 45 degrees - spinal fusion

Diagnosis for DDH

ortolan and Barlow maneuvers/asymmetric gluteal folds

progression of symptoms for roseola infatum

persistent high fever 3-4 days fever breaks rash occurs discrete macular and maculopapular rash starts on trunk and spreads to neck, face, and extremities

what should you assess when a patient is in traction?

weights hang freely ropes are in pulleys and freely moveable only raise the head of foot of the bed with a physician order neurovascular assessments (q 4?) assess skin impairment

When should children begin receiving the influenza vaccine?

yearly after 6 months of age