CARDIOVASCULAR/HEME&ONCOLOGY/IMMUNE/INTEGUMENTARY/MUSCULAR/RESPIRATORY-Pediatrics

Compartment syndrome

(6 Ps) of compartment syndrome include: pain, pressure, paresthesia, pallor, pulselessness, and paralysis.

tinea capitis (ringworm of the scalp) and is newly prescribed griseofulvin oral suspension and 1% selenium sulfide shampoo

(ringworm of the scalp) is a contagious fungal infection that lives on the surface of the scalp, resulting in scaly, pruritic, erythematous, circular patches with hair loss. The infection is transmitted via direct contact with infected persons, pets, or objects (eg, hairbrushes, bedding, towels, hats). Treatment may include 1% selenium sulfide shampoo applied several times each week in combination with an antifungal medication (eg, griseofulvin oral suspension) that the client must take for several weeks to months. Keratin-producing cells absorb griseofulvin, causing resistance to the fungus; because the fungus requires keratin (protein in hair and skin cells) to live and grow, it is not able to reproduce. To ensure that infected keratin is shed completely, treatment with griseofulvin should not be discontinued early, even if symptoms (eg, itching, scaling) decrease

patent ductus arteriosus (PDA).

A systolic murmur with a machine sound and poor feeding are expected. PDA commonly resolves within 48 hours and requires no intervention in full-term newborns.

3-year-old child coughs at night and at times until he vomits. The symptoms have not improved over the past 2 months despite multiple over-the-counter cough medications. What should the nurse explore related to a possible etiology

ASK ABOUT : Common triggers include indoor contaminants (eg, tobacco smoke, pet dander, cockroach feces), outdoor contaminants (eg, air pollution), and allergic disease (eg, hay fever, food allergies). Asthma is a chronic inflammatory disease of the lungs in genetically susceptible children. Frequent cough, especially at night, is the warning signal that the child's airway is very sensitive to stimuli; it may be the only sign in "silent" asthma. Pediatric asthma can present as night coughing until the child vomits

When a low oxygen saturation with apparent artifact in the pulse plethysmographic waveform is observed, the nurse should discern the accuracy of the reading to prevent unnecessary treatment. If the pulse oximeter reading is accurate, the nurse should perform a thorough physical assessment and intervene as appropriate.

After ensuring that the probe has been properly applied and positioned to provide an accurate reading, the nurse should perform a thorough physical assessment and intervene as appropriate. The first action of the nursing process is assessment. The nurse should first evaluate the accuracy of the reading by evaluating the pulse plethysmographic waveform. Waveforms that are irregular or erratic may contain artifact caused by a loose, misapplied, or damaged pulse oximeter or by client movement

self-care management of acne vulgaris

Antibacterial soaps dry the skin and are ineffective. The client should gently wash the face with a mild facial cleanser. Using noncomedogenic skin care products (ie, products that do not clog pores) to avoid creating new lesions. Maintaining a healthy lifestyle (eg, moderate exercise, balanced diet, adequate sleep) to reduce stress and promote healing. Refraining from squeezing, picking, and vigorously scrubbing lesions to prevent additional inflammation and worsening the acne Treatment includes topical and oral medications such as tretinoin (Retin-A), benzoyl peroxide, isotretinoin (Accutane), and oral contraceptives. Antibacterial soaps are harsh and ineffective, increase the pH of the skin, and can dry the skin (Option 1). The client should instead gently wash the face with a mild facial cleanser.

hemophilia A

Avoid medications such as ibuprofen and aspirin that have platelet inhibition properties (Option 4). Avoid intramuscular injections; subcutaneous injections are preferred. Avoid contact sports and safety hazards; noncontact activities (eg, swimming, jogging, tennis) and use of protective equipment (eg, helmets, padding) are encouraged (Option 5). Dental hygiene is necessary to prevent gum bleeding, and soft toothbrushes should be used. MedicAlert bracelets should be worn at all times

mechanical ventilation by means of an endotracheal tube. Several hours later, the nurse enters the room and finds the client in respiratory distress. It is most important

By assessing the client's lung sounds, the nurse can quickly determine if ET placement has been compromised LUNG SOUNDS FIRST!

sickle cell disease is admitted with a diagnosis of crisis. The client's current prescription is morphine 2 mg intravenous push every 4 hours prn. The client appears comfortable while watching television and tells the nurse "I have severe intolerable pain," and rates it a "10."

CALL HCP to increase PCA DOSE These individuals usually need large doses of narcotics as prior treatment has led to drug tolerance; they may also metabolize the drugs differently. Using only external cues to judge a client's pain is invalid as these clients have often learned how to distract themselves from focusing on the pain. Use of continuous PCA is recommended for relief rather than prn administration. have excruciating pain and need large doses of narcotics. The most effective method is PCA of morphine or hydromorphone (Dilaudid).

vomiting, and severe right lower quadrant pain. The child's white blood cell count is 17,000/mm3 (17.0 x 109/L). Which statement by the child is of most concern

CONCERN-PAIN STOPPED once the appendix ruptures, pain is relieved only temporarily and will return with full-blown peritonitis and sepsis. Appendicitis is a serious condition that usually requires emergency surgery due to the risk of appendix rupture. The pain results from swelling and inflammation of the appendix.

after surgical repair of a congenital heart defect. Which finding by the nurse should be reported immediately t

Chest tubes may be placed during cardiac surgery to help drain fluid and air and to ensure room for lung expansion. The chest tube and chamber should be assessed every hour for color and quantity of drainage. Drainage >3 mL/kg/hr for 3 consecutive hours or >5-10 mL/kg in 1 hour should be reported immediately to the health care provider (Option 1). This could indicate postoperative hemorrhage and requires immediate intervention. Cardiac tamponade can develop rapidly in children and can be life-threatening. This child weighs 4 kg and an output of 50 mL in 1 hour is excessive.

possible Duchenne muscular dystrophy

Classic signs include Gower sign/maneuver (placing hands on the thighs to push up to stand), enlarged calves, walking on tiptoes, and frequent tripping/falling. is an X-linked recessive disorder characterized by progressive replacement of muscle tissue with connective tissue.

child who just had a tracheostomy

Clients should always carry two spare tracheostomy tubes, one the same size and one a size smaller. If the tube is not easily replaced or is meeting resistance, the smaller tube should be used

boating accident in which they were thrown into the water. The children are now 6 hours post admission to the clinical observation unit. Which client should the nurse evaluate first

Clients who have sustained submersion injury should be evaluated immediately and observed for at least 6 hours for new or worsening respiratory failure. Changes in respiratory pattern or rate, oxygen saturation, and level of consciousness can signal impending respiratory failure, which can be life threatening. Additional Information

Recently had surgery to repair tetralogy of Fallot. Which of the following signs of heart failure should the nurse teach the parents to report

Clinical manifestations of heart failure include signs of poor perfusion (eg, pale, cool extremities; reduced urinary output) and fluid overload (eg, periorbital edema, rapid weight gain) Pale, cool extremities due to reduced perfusion to the systemic circulation (Option 1) Periorbital edema (puffiness around the eyes) and rapid weight gain due to systemic venous congestion and fluid retention Reduction in the number of wet diapers due to reduced perfusion to the kidneys. Insufficient flow into the pulmonary vasculature causes the right ventricle to work harder, leading to right ventricular hypertrophy and a subsequent reduction in right ventricular function and cardiac output. The decrease in forward blood flow causes blood to back up into venous circulation, resulting in heart failure.

slight redness, and 2 vesicles at the injection site. What instruction would be appropriate

Covering the vesicles with clothing or a small bandage will reduce the risk of transmission from any exudate. Once the vesicles have dried, or crusted, a dressing is no longer necessary. varicella immunization is administered to prevent infection of varicella zoster, commonly known as chickenpox. Side effects of the immunization include discomfort, redness, and a few vesicles at the injection site.

Kawasaki disease received IV immunoglobulin (IVIG) 2 months ago. The child is in the clinic for follow-up and scheduled immunizations. Which vaccine should be delayed?

DO NOT GIVE MMR AND VARICELLA Live vaccines (eg, varicella, MMR) should be delayed for up to 11 months after IVIG administration as IVIG therapy may decrease the child's ability to produce the appropriate amount of antibodies to provide lifelong immunity.

child with asthma how to use a metered-dose inhaler (MDI)

EXHALE!!! FIRST!! The proper method of delivering a dose via MDI includes the following steps: First shake MDI and attach it to the spacer. Exhale completely to optimize inhalation of the medication. Place lips tightly around the mouth piece. Deliver a single puff of medication into spacer. Take a slow, deep breath and hold it for 10 seconds to allow for effective medication distribution. After the dose, rinse mouth with water to remove any left-over medication from oral mucous membranes. Spit out the water to ensure no medication is swallowed.

most likely to alert the nurse to the presence of right hip developmental dysplasia

EXTRA GLUTEAL FOLDS ON THE RIGHT SIDE The presence of extra inguinal or thigh folds Laxity of the hip joint on the affected side. Hip laxity/instability is tested through the Barlow and Ortolani maneuvers. However, these tests must only be performed by an experienced health care provider to avoid further hip injury. If DDH is not treated, these signs disappear after age 2-3 months due to the development of muscle contractures.

nosebleed

Epistaxis (nosebleed) is a nasal condition typically occurring from local injury (eg, nose-picking) or irritation. Initial epistaxis management includes calming the client; tilting the head forward; applying direct, continuous nasal pressure for 5-15 minutes; and applying cold packs to the nasal bridge.

idiopathic arthritis (JIA) are discussing appropriate physical activities

Exercise and physical activity for the child with JIA are important to prevent joint deformity and maintain muscle strength and endurance. The best activities are those that are low impact; these can be weight bearing or non-weight bearing. Examples include swimming, riding a stationary bike, throwing or kicking a ball, and yoga.

asthma. The nurse notes mild wheezing and coughing.

FIRST!! PEF! must determine the severity of a client's condition before implementing an intervention. By assessing this client's peak expiratory flow, the nurse can determine the severity of the asthma symptoms. CHECK RR AND LUNG SOUNDS Symptoms of an asthma exacerbation include wheezing, chest tightness, dyspnea, cough (may be nocturnal, dry, or productive), and retractions. A cough is often the earliest sign of an asthma exacerbation in children. Bronchospasm leads to CO2 trapping and retention. The bronchospasm forces the client to work harder to exhale and the expiratory phase becomes prolonged.

end-stage leukemia who is on comfort care and is unresponsive. The child's parent asks, "How can you tell if my child is in pain?"

Facial grimacing Leg movement, tension, or bending up toward the chest Activity, including squirming, arching, jerking Crying or moaning Difficulty consoling or comforting the child difficult to assess for pain in the nonverbal client, particularly if the person is unresponsive at the end of life. The FLACC scale is an accurate method of assessing pain in the nonverbal child. provide teaching on signs that should prompt the parent to administer as-needed pain medication

had a tonsillectomy

GIVE ACETAMINOPHEN-pain med. EXPECT BAD BREATH MONITOR SWALLOWING-frequent close observation for signs of bleeding (eg, frequent swallowing) as well as avoidance of routine oral suctioning and the use of straws. Expected findings include white, fluid-filled exudate in the throat with halitosis, low-grade fever, and referred ear pain.

atrial septal defect (ASD). Which assessment finding does the nurse expect?

HEART MURMUR The nurse would expect to hear a murmur with an atrial septal defect. This defect is an abnormal opening between the right and left atria, allowing blood from the higher pressure left atrium to flow into the lower pressure right atrium. The back-and-forth flow of blood between the 2 chambers causes a vibration that is heard as a murmur on auscultation. ASD has a characteristic systolic murmur with a fixed split second heart sound. Some clients may also have a diastolic murmur.

reports palpitations

HOLD BREATH; BEAR DOWN Supraventricular tachycardia refers to a rapid heart rate of 200-300/min with no variation in rate during activity. The nurse should anticipate instructing the client to perform vagal maneuvers (eg, Valsalva) first if the client is stable.

Inability to hear any breath sounds or wheezing in an acute asthma client ("silent chest")

In the case of severe obstruction (from airway narrowing as a result of bronchial constriction, airway swelling, and copious mucus), wheezing/breath sounds are not heard due to lack of airflow.

"I would rather continue to have cancer than lose all of my hair."

Interaction with peers who are experiencing similar health issues can help alleviate anxiety. Clients should be offered opportunities to discuss fears and experiences with peers in a supportive environment (eg, "teen rooms")

chronic allergic rhinitis that is triggered by dust and pollen

Interventions include installing high-efficiency particulate air (HEPA) filters, keeping windows closed, applying hypoallergenic pillow and mattress covers, eliminating carpet, mopping and vacuuming regularly with a HEPA filter vacuum, and damp-dusting furniture frequently.

developmental dysplasia of the hip (DDH) Pavlik harness

LIGHTLY MASSAGE UNDER SKIN DAILY dressing the child in a shirt and knee socks, keeping the skin dry, regularly assessing for skin breakdown, massaging the skin to promote circulation, and applying diapers under the straps.

infant with osteogenesis imperfecta admitted with a new fracture. The client also has old fractures in multiple stages of healing but no bruising, abrasions, or redness of the skin.

MANUAL B/P Osteogenesis imperfecta (OI) (brittle bone disease) is a rare genetic condition resulting in impaired synthesis of collagen by osteoblasts. Collagen allows bone to be somewhat flexible while still maintaining strength. Impaired collagen causes bones to be frail and easily fractured. Clinical manifestations can range from mild defects to lethal disease in utero. OI is usually transmitted by autosomal dominant inheritance. The nurse's priority for a client with OI is careful handling to minimize additional fractures. Care of the infant with OI includes: Checking blood pressure manually to avoid cuff over-tightening, which may occur with automatic blood pressure cuffs (Option 3) Lifting the infant by slipping a hand under the broadest areas of the body (eg, back, buttocks) so the pressure is distributed Repositioning the infant frequently using supportive devices and gel padding to avoid molding of the soft bones of the skull

left-to-right-sided heart shunt, which findings would the nurse expect

Manifestations include heart murmur, poor weight gain, diaphoresis with exertion, and signs of heart failure.

Duchenne muscular dystrophy

NO THROW RUGS MD is the replacement of muscle fibers with connective tissue, resulting in lower-extremity weakness. It is important to eliminate floor clutter to prevent injury. Clients are encouraged to participate in regular gentle recreation-based exercises and swimming to avoid disuse muscle atrophy and social isolation. There is no effective cure. Most children are wheelchair bound by adolescence and die by age 20-30 from respiratory failure. It is important to avoid floor clutter (eg, throw rugs) and prevent falls/injury The condition is X-linked recessive (ie, carried by females and affects males) and is due to lack of a protein called dystrophin needed for muscle stabilization. Disease onset is age 2-5 years. Muscles of the proximal lower extremities and pelvis are affected first. Calf muscles hypertrophy (pseudohypertrophy) initially in response to proximal muscle weakness and are later replaced by fat and connective tissue. The Gower sign involves the use of one's hands to rise from a squat or from a chair to compensate for proximal muscle weakness.

caring for dying children

Nurses who care for dying children experience many of the same feelings that the child's family does, resulting in stress that may lead to compassion fatigue. To remain positive in the caring role, nurses must implement appropriate coping strategies to enhance self-care and grief resolution. Attending a memorial service can demonstrate care for the grieving family while also providing closure for the nurse. Other helpful strategies for coping include: taking time off from work if distancing is needed, utilizing personal and professional support systems (eg, spouse, employee assistance programs, experienced mentors), and maintaining good health through adequate rest, regular exercise, and proper nutrition.

reduce the incidence of hypercyanotic spells

Offering a pacifier Swaddling or holding the infant during procedures or times of stress. Providing frequent smaller feedings to reduce frustration due to hunger and limit sucking fatigue. Providing a calm environment, particularly on waking. Soothing and quieting the infant when crying or distressed During an acute tet spell, the infant may be placed in the knee-chest position to improve pulmonary blood flow by increasing systemic vascular resistance; older children may assume a squatting position. Intermittent oxygen can also be used to treat the spell, if necessary.

sickle cell crisis. The client is short of breath and vomiting and has severe generalized body and joint pains. Which assessment finding requires the most immediate

PRIORITY!! Splenic sequestration crisis is a potentially life-threatening emergency of sickle cell disease. A rapidly enlarging spleen and hypotension. Splenic sequestration crisis occurs when a large number of "sickled" cells get trapped in the spleen, causing splenomegaly. This is a life-threatening emergency as it can lead to severe hypovolemic (hypotensive) shock. The classic assessment finding is a rapidly enlarging spleen.

bronchiolitis due to respiratory syncytial virus (RSV)

Parents should be instructed to use saline nose drops and then suction the nares with a bulb syringe to remove secretions prior to feedings and at bedtime. Bronchiolitis is a common viral illness of childhood that is usually caused by RSV. It typically begins with viral upper respiratory symptoms (eg, rhinorrhea, congestion) that progress to lower respiratory tract symptoms such as tachypnea, cough, and wheezing. Bronchiolitis is a self-limited illness and supportive care is the mainstay of treatment. Most children can be managed in the home environment. Breastfeeding should be continued and additional fluids offered if there is a risk of dehydration due to frequent coughing and vomiting

impetigo

Performing handwashing before and after touching the infected area (Option 1) Isolating the infected person's clothing and linens and washing them in hot water. Keeping the infected person's fingernails short and clean to prevent bacteria from collecting under them and to deter scratching. Avoiding close contact with others for 24-48 hours after initiation of antibiotic therapy Keeping the infected area covered with gauze when in contact with others (eg, while at school) commonly occurring in children during hot, humid weather. Impetigo is characterized by itchy, burning, red pustules that rupture to form honey-colored crusts.

developing hip dysplasia. Which intervention should the nurse encourage to help reduce the risk

Proper swaddling technique - infants should be swaddled with their hips bent up (flexion) and out (abduction), allowing room for hip movement (Option 3) Choosing infant carriers or car seats with wide bases - infant seats should allow for proper hip positioning in an abducted manner Avoiding any positioning device, seat, or carrier that causes hip extension with the knees straight and together

Permanent tooth knocked out during gym class. Which action by the nurse is appropriate?

RE - INSERT Dental avulsion (ie, tooth separated from the mouth) of a permanent tooth is a dental emergency. The priority nursing action is to rinse and reinsert the tooth into the gingival socket and hold it in place (eg, with a finger) until stabilized by a dentist (Option 1). Reimplantation within 15 minutes of injury re-establishes blood supply, increasing the probability of tooth survival. If the tooth cannot be reinserted it should be kept moist by submerging it in commercially prepared solution (eg, Hanks Balanced Salt Solution), cold milk, sterile saline, or as a last resort—due to bacteria—saliva (eg, holding it under the tongue).

femorally inserted balloon angioplasty of a congenital pulmonic stenosis in the cardiac catheterization laboratory. Which finding should the nurse report

SEVERE DIAPER RASH This could delay the procedure if the rash is in the groin area where access is planned for a femorally inserted arterial cannula. Yeast or bacteria may be present on the rash and could be introduced into the bloodstream with the arterial stick. Pulmonic stenosis causes increased pressure in the right side of the heart as the ventricle tries to push blood through the narrowed pulmonary area to the lungs. In severe pulmonic stenosis, higher pressure in the right side of the heart causes unoxygenated blood to travel to the left side through the foramen ovale (or other congenital defect) and into the systemic circulation, leading to chronic hypoxia and cyanosis and requiring repair (interventional catheterization or surgery

burned from accidentally spilling boiling water on it, and the parent calls the clinic.

SOAK WITH COOL H20 REMOVE CLOTH IF NOT STUCK ON SKIN COVER WITH DRY, CLEAN CLOTH Caring for a burn in the home setting includes gently soaking the area with cool water; removing clothing or jewelry if not stuck to the skin; covering the affected area with clean, dry cloth/bandages; and avoiding application of medication or substances to the wound.

patent ductus arteriosus

The child will be acyanotic but will have a machine-like murmur heard on both systole and diastole. When fetal circulation changes to pulmonary circulation outside the womb, the ductus arteriosus should close spontaneously. This closure is caused by increased oxygenation after birth. If a PDA is present, blood will shunt from the aorta back to the pulmonary arteries via the opened ductus arteriosus. be treated with surgical ligation or IV indomethacin to stimulate duct closure.

atopic dermatitis (eczema)

The goal of management is to reduce scratching with key measures such as giving tepid baths, moisturizing skin with emollients, wearing soft cotton clothing, and keeping nails trimmed short.

newly diagnosed with hemophilia will include

The most frequent sites of bleeding are the joints (80%), especially the knee. Hemarthrosis can occur with minimal or no trauma, with episodes beginning during toddlerhood when the child is active and ambulatory. Over time, chronic swelling and deformity can occur. risk for permanent joint destruction due to frequent bleeds into the joint spaces. Assisting clients with decreasing the incidence of bleeding episodes and prompt treatment when bleeding occurs can help minimize joint destruction.

routine immunizations. Which situation would be most important for the nurse to clarify with the provider

The nurse should always assess for allergies to vaccine components (eg, neomycin, gelatin, yeast) and screen for an allergy to latex (eg, lips swelling from contact with bananas, kiwis, or latex balloons). Severely immunocompromised children (eg, corticosteroid therapy, chemotherapy, AIDS) generally should not receive live vaccines (eg, varicella-zoster vaccine, measles-mumps-rubella, rotavirus, yellow fever) Passive immunization may be the only option for children with severe immunosuppression or those unable to mount an antibody immune response. Local reactions, minor illness, exposure to an infectious source, and allergies to nonvaccine components are not contraindications to immunization.

10-year-old with cystic fibrosis

The parents should encourage physical activity as tolerated, which helps to thin secretions and remove them from airways and improves muscle strength and lung capacity. Cystic fibrosis causes increased viscosity of exocrine gland secretions. Clients require pancreatic enzyme supplements with meals and snacks; a diet high in carbohydrates, protein, and fat; and increased salt intake during times of significant perspiration. Clients should also incorporate chest physiotherapy and exercise into their daily routine.

most likely help increase hemoglobin levels

The richest dietary sources of iron include meat, fish, and poultry. Consuming fruits or juices high in vitamin C may enhance the absorption of iron. However, foods high in vitamin C (eg, tomatoes, potatoes, strawberries) may boost iron absorption when consumed with iron-rich foods.

developmental dysplasia of the hip (DDH) is being fitted for a Pavlik harness

The straps are assessed every 1-2 weeks by the health care provider (HCP) and adjusted as necessary to account for infant growth. However, parents should not alter the strap placements at home as incorrect positioning can lead to damage to the nerves or vascular supply of the hip. Care of the infant wearing a Pavlik harness includes the following: Assess skin 2-3 times daily for redness or breakdown under the straps (Option 3) Dress the child in a shirt and knee socks under the harness to protect the skin Apply diapers underneath the straps to keep the harness clean and dry Leave the harness on at all times, unless otherwise indicated by the HCP. DDH is instability or dislocation of the hip joint that may be present at birth or develop during the first few years of life. Nonsurgical treatment methods such as the Pavlik harness are most successful when initiated during the first 6 months of life. After this time, surgery is generally required

dyspnea, high fever, irritability, and open-mouthed drooling with leaning forward.

This is a pediatric emergency and should be managed with endotracheal intubation; however, intubation of such clients is difficult, and preparation for possible tracheostomy is also standard. The complications of epiglottitis are serious and include sudden airway obstruction.

new mother as she is breastfeeding her infant. The infant has been diagnosed with tetralogy of Fallot. During feeding, the infant becomes cyanotic and is having difficulty breathing. What should be the nurse's first

To relieve a hypercyanotic episode, or "tet spell," the nurse should place the infant or child in the knee-chest position. hypercyanotic episode, or "tet spell," which is an exacerbation of tetralogy of Fallot that can happen when a child cries, becomes upset, or is feeding. The child should first be placed in a knee-to-chest position. Flexion of the legs provides relief of dyspnea as this angle improves oxygenation by reducing the volume of blood that is shunted through the overriding aorta and the ventricular septal defect.

nurse assess first

VSD with GRUNTING Clinical manifestations of VSD include a systolic murmur auscultated near the sternal border at the third or fourth intercostal spaces, and hallmark CHF signs (eg, diaphoresis, tachypnea, dyspnea). The client is currently showing signs of increased respiratory exertion (eg, grunting) and requires further assessment for CHF Ventricular septal defect (VSD) is a congenital abnormality in which a septal opening between ventricles causes left-to-right shunting, leading to excess blood flow to the lungs. This places the client at risk for congestive heart failure (CHF) and pulmonary hypertension.

routine vaccinations to a child diagnosed with hemophilia.

Vaccinations are administered subcutaneously whenever possible to prevent intramuscular hematoma (Option 2). The smallest gauge needle is used, and firm, continuous pressure is applied at the site for 5 minutes. Nonsteroidal anti-inflammatory agents including aspirin are avoided due to the risk of bleeding.

playing outside in the snow and the child's feet now appear red and swollen. What is the best response

WARM H20 STAT!!! NEXT-->Once re-warming has been effective, the child should be seen by an HCP as soon as possible The recommendation for re-warming is immersion of the affected area in warm water (104 F [40 C]) for about 30 minutes or until the area turns pink in cases of frostbite. The face and ears can be re-warmed with the application of warm facecloths. The clinical indications of a cold injury include redness and swelling of the skin (chilblains or pernio) and blanched skin with hardness of the affected area (frostbite). For any cold injury, it is important to re-warm the area as soon as possible to restore blood flow and reduce the risk of permanent tissue damage.

best activity for a school-aged child hospitalized for vaso-occlusive sickle cell crisis

WATCHING A FAVORITE MOVIE Age-specific nonpharmacologic strategies should also be implemented to manage pain and help limit the amount of needed narcotic analgesia. For a school-aged child, such activities include distraction (watching TV, listening to music, reading), relaxation, guided imagery, warm soaks, positioning, and gentle massage.

Kawasaki disease. The nurse informs the parent that the presence of which symptom should be immediately reported

When children with KD are discharged home, parents are instructed to monitor them for fever by checking the temperature (orally or rectally) every 6 hours for the first 48 hours following the last fever. Temperature should also be checked daily until the follow-up appointment. If the child develops a fever, the health care provider should be notified as this may indicate the acute phase of KD recurrence. The child may require additional treatment with IV immunoglobulin to prevent development of coronary artery aneurysms and occlusions.

Coarctation of the aorta (COA)

abnormal aortic narrowing that results in decreased cardiac output. The client will exhibit elevated pulse pressure in the upper extremities and diminished pressures in the lower extremities

acute asthma exacerbation.

acute attack will experience chest tightness, wheezing, uncontrollable coughing, rapid respirations, retractions, and anxiety and panic. Treatment of an acute attack can include nebulized breathing treatment with a short-acting beta-agonist medication such as albuterol, and oral or IV corticosteroids. Oxygen saturation is the best indicator of treatment effectiveness as it reflects gas exchange. xygen saturation and peak expiratory flow are the best indicators of treatment effectiveness during an acute asthma attack.

hemophilia A;Which prescription should the nurse carry out first?

administration of factor VIII is a priority as the client's body cannot form a clot without it. Hemophilia is a bleeding disorder caused by a deficiency in coagulation proteins. Treatment consists of replacing the missing clotting factor and teaching the client about injury prevention. Clients with hemophilia who are injured should be monitored closely for bleeding (eg, intracranial bleeds, bleeding into joints). Signs of an intracranial bleed include lethargy, headache, irritability, and vomiting. An intracranial bleed is lethal if unchecked, so administration of factor VIII to a client with hemophilia A is the first order of action, followed by a CT scan.

cystic fibrosis

chest physiotherapy performed usually before meals. to avoid a full stomach and resultant regurgitation or vomiting

Tetralogy of Fallot (TOF)

cyanotic congenital heart defect commonly manifested by signs of irritability and clubbing of fingers due to oxygen saturation chronically remaining between 65-85% until the client can undergo surgical repair. Further evaluation of the client's oxygenation is necessary but not urgently required.

trisomy 21 (Down syndrome)

documenting the assessment finding would be the appropriate action for the nurse to complete at this time. often associated with the cardiac anomaly AV canal defect. Assessment typically includes a loud murmur that requires no immediate action when vital signs are stable. Surgery will correct the anomaly when the neonate grows in size and can tolerate the invasive procedure better.

infant CPR

eg, assess brachial pulse) and retrieval of automatic external defibrillator (ie, after 2 min of CPR during an unwitnessed collapse with a single rescuer) During an unwitnessed collapse, a single rescuer should shout for nearby help, activate the emergency response system (eg, call emergency services via mobile device if located outside a health care setting), and then provide approximately 2 minutes of CPR at a rate of at least 100 compressions/min before retrieving the AED

Common side effects of immunizations

instructed to apply a warm compress to the injection site and taught how to correctly calculate the dose of acetaminophen or ibuprofen needed for these symptoms. Common side effects of immunizations include a mild fever and soreness and redness at the injection site.

epiglottitis are preventable

majority of cases of epiglottitis are caused by Haemophilus influenza type B (HiB), which is covered under the standard vaccinations given during the 2- and 4-month visits. Epiglottitis is rarely seen in vaccinated children.

Lateral curvature to the spine

may indicate scoliosis, which is one of the most commonly diagnosed spinal deformities and is characterized by lateral curvature of the spine and spinal rotation. Although scoliosis may result from congenital or pathologic conditions, it is most often determined to be idiopathic (of unknown cause). It is commonly first noticed during periods of rapid growth, particularly during early adolescence in girls. Screenings may occur in schools or at well-child office visits for girls age 10-12 and for boys age 13-14. Early detection and prompt treatment may reduce the need for surgical intervention.

Epiglottitis

medical emergency as the child can rapidly progress from being asymptomatic to having a completely occluded airway. Emergency intubation equipment should be readily available. medical emergency due to Haemophilus influenzae, causes severe inflammatory obstruction above and around the glottis. Throat inspection should not be done until emergency intubation is readily available (if necessary).

cystic fibrosis. Which of the following potential complications

monitor for priority concerns, including development of respiratory infections, chronic hypoxemia, nutritional deficiencies, and abnormal growth (failure to thrive).

An S3 heart

normal finding in children rapid filling of the left ventricle, is considered normal when heard in children. This sound is heard in diastole immediately after S2 as a dull, low-pitched sound. S3 is heard louder in the mitral or apical area, which distinguishes it from a split S2 that is heard best in the pulmonic area.

Hypercyanotic episodes (ie, "tet" spell)

occur when unoxygenated blood enters the systemic circulation, resulting in cyanosis and hypoxemia. Tet spells usually occur during stressful or painful procedures; on waking; and with hunger, crying, and feeding. Tetralogy of Fallot is a complex heart defect that results in decreased pulmonary blood flow, mixing of oxygenated and unoxygenated blood, and inadequate blood flow into the left side of the heart.

Aspiration of a foreign body

occurs most often in the toddler age group. Swallowing of objects such as buttons, small parts of toys, or food particles can be life-threatening and result in airway obstruction due to the small diameter of the airway. Manifestations include choking, gagging, cyanosis, and inability to speak when the object is lodged in the larynx.

drooling with distressed respirations and inspiratory stridor. What action should the nurse take first?

position of comfort without any invasive or anxiety-provoking procedures (eg, phlebotomy, pharyngeal examination, epiglottal cultures) until the airway is secure with intubation or a surgical airway. Edema can develop rapidly (as quickly as a few minutes) and obstruct the airway by occluding the trachea. There has been a 10-fold decrease in its incidence due to the widespread use of the Hib (Haemophilus influenzae type B) vaccine. The classic symptoms include a high-grade fever with toxic appearance, severe sore throat, and the 4 Ds—dysphonia (muffled voice), dysphagia (difficulty swallowing), drooling, and distressed respiratory effort. The tripod position opens the airway and helps air flow. The child should be allowed to assume a position of comfort (usually sitting rather than lying down). The priority nursing response is to protect the airway.

vomiting and diarrhea for 4 days. Which prescription from the health care provider is the priority

priority is intravenous rehydration. Severe dehydration occurs more rapidly in infants and young children due to a higher percentage of body water. Signs of severe dehydration include increased capillary refill time, increased heart rate, and increased respiratory rate. When severe dehydration occurs in an infant

atopic dermatitis

priority management is to prevent scratching as this would promote formation of new lesions and predispose to secondary infections. Atopic dermatitis (eczema) is a chronic skin disorder manifested in infants by pruritus, dry skin, and red, crusted, scaly lesions. Important measures to prevent scratching include cutting and filing nails short, placing gloves or cotton stockings over the hands, not wearing rough fabrics or woolen clothing, and applying moisturizer. These measures would have an immediate effect in preventing scratching.

has stopped breathing. Identify the area where the nurse should check the client's pulse

the brachial artery is used to detect a pulse in an unresponsive client age <1 year. placing 2 or 3 fingers halfway between the shoulder and elbow on the medial aspect of the arm. The pulse should be assessed for 5-10 seconds to determine its presence and quality before CPR is initiated. The brachial pulse is preferred in infants as the brachial artery is close to the surface and is easily palpable. The carotid pulse can be difficult to assess due to a child's shorter neck. Extending an infant's neck to attempt to palpate the carotid pulse can cause injury. This pulse is recommended for clients age >1 year. The femoral pulse may be used for all clients; however, it is often not easily accessible for palpation due to diapers and clothing. The radial pulse is used in responsive clients age >1 year. It is not a recommended method of pulse detection in an unresponsive client as a weak or thready pulse is difficult to palpate at this location.

Kawasaki disease and should give priority

the child should be monitored for symptoms of heart failure (eg, decreased urinary output, additional heart sounds, tachycardia, difficulty breathing. Kawasaki disease causes inflammation of the arterial walls and can lead to scarring of the coronary arteries or development of coronary aneurysms. Treatment consists of aspirin and substantial infusion of IV gamma globulin. The affected child must be monitored for signs of heart failure.

Genu varum (bowlegs)

the lateral bowing of the legs, is common in toddlers as they learn to walk. The condition resolves by 18-24 months after they develop strength in their legs and lower back. After 2 years, normal alignment will again progress to valgus deformity until age 4 and then will return to normal adult alignment by age 7. All of this is a normal physiologic alignment.

In neonatal and infant resuscitation, the resuscitator's fingers/thumbs

the resuscitator's fingers/thumbs are placed at the middle third of the sternum, slightly below the nipple line. The xiphoid portion of the sternum should not be compressed because this may damage the liver. During compressions, the sternum is compressed approximately one-third of the anteroposterior chest diameter at a rate of 100-120/min (compression-ventilation ratio: 30:2 for 1 rescuer and 15:2 for 2 rescuers). The thumbs or fingers should not be lifted from the sternum during the relaxation phase.

high-frequency chest wall oscillation (HFCWO) vest for chest physiotherapy.

treatments should occur 1 hour before or 2 hours after eating to avoid gastrointestinal upset (eg, nausea, vomiting). CPT can be performed by percussing (ie, clapping) the chest with a cupped hand or by wearing an inflatable high-frequency chest wall oscillation (HFCWO) vest. The HFCWO vest inflates and deflates rapidly, causing vibration over the chest wall and mobilizing secretions into the large airways that the child can expectorate. The HFCWO vest's rapid vibrations may induce nausea and vomiting in some clients. Therefore, the client should avoid meals and snacks 1 hour before, during, or 2 hours following CPT to prevent gastrointestinal upset (Option 1). The nurse may suggest other more appropriate ways to ensure compliance with CPT, such as allowing the child to watch a favorite television show or reading the child a story while wearing the HFCWO vest.

circular chest shape

with the front-to-back (anteroposterior) diameter approximately equal to the side-to-side (lateral) diameter is an expected finding in a healthy infant. The chest is more oval and the lateral diameter is greater than the anteroposterior diameter by age 2.