child health test 3
Renal System Assessment
-Physical examination- palpating the bladder -History taking- UTI'S, calculi, stasis, retention, pregnancy, STD, bladder cancer medications that can impact function- antibiotics, anticholinergics, antispasmodics surgeries, pattern of elimination, hygiene
The nurse is developing a plan of care for a child who is undergoing chemotherapy treatment. Which of the following nursing interventions would NOT be included the plan of care?
Assess rectal temperature Q 4 hours
Renal Development and Function in Infancy
Glomerular filtration and absorption low in infancy until age 1-2 Newborn is unable to concentrate urine effectively Newborn unable to reabsorb sodium and water Newborn produces very dilute urine
Which of the following clinical manifestations are associated with acute glomerulonephritis? Select all that apply.
Hematuria Decreased urine output Hypertension Fatigue
chemo therapy drugs and be administered
IV or PO
petaling a cast
If the edging is rough and rubbing on the skin, put material over it
nursing care managment for CL/CP
Noisy feeders burp after every ounce, or at least 2-3 times during the feeding some liqueid may enter nasal cavity during feeding- dont be alarmed
Positive Trendelenburg Sign
Pelvis sags on nonaffected side affected hip can not bear weight Superior Gluteal Nerve Injury
The nurse is developing a plan of care for a child who has been diagnosed with nephrotic syndrome. Which of the following interventions should be included in the plan of care? Select all that apply.
Restrict client's fluid intake Administer corticosteroids Limit client's sodium intake
The nurse is administering intravenous chemotherapy to a child who has been diagnosed with cancer. The nurse notices that the child has begun to show symptoms of a possible reaction to the chemotherapy drug. What should the nurse do first?
Stop the chemotherapy infusion
Which of the following is the most common cause of acute glomerulonephritis in children?
Streptococcus
Myleosuppression
Suppression of bone marrow function, which can result in dangerously reduced numbers of red blood cells, white blood cells, and platelets
what causes CO2 to increas with metabolic alkalosis partially compensated
The lungs decrease the respiratory rate, increasing CO2
The parents of a newborn diagnosed with cleft palate ask the nurse when their child's palate will be repaired. What is the best response by the nurse?
The palate is typically repaired when the baby is at least 6 months old.
therpaeutic managment for DDH
VARIES with age of child and degree of dysplasia
Which of the following clinical manifestations are associated with nephrotic syndrome? Select all that apply.
Weight gain Correct answer: Proteinuria Correct answer: Lethargy
The nurse is preparing to admit a child who has been diagnosed with dehydration. Which of the following assessment findings should the nurse anticipate? Select all that apply.
Weight loss Correct answer: Decreased urine output Poor skin turgor
sequential compression device
a plastic, air filled sleeve that is placed around the leg and inflates and deflates regularly to help improve circulation, reduce fluid build up, and prevent blood clots
Tracheoesophageal fistula is best described by which of the following statements?
A passageway joining the trachea and esophagus present at birth.
three degrees of DDH
Acetabular dysplasia Subluxation Dislocation
Which form of leukemia is most common in children?
Acute lymphoblastic leukemia
The nurse is caring for a child after the surgical correction of scoliosis. Which of the following nursing interventions should be included in the plan of care?
Administer pain medication Perform neurovascular assessment Assist client with ambulation
Which of the following interventions should be included in the plan of care for a 12 month old whose cleft palate was repaired 12 hours ago?
Administer pain medication on a regular schedule, as opposed to an as-needed schedule
The nurse is caring for a child who is severely dehydrated and has begun to exhibit clinical manifestations of shock. Which of the following nursing interventions should the nurse implement? Select all that apply.
Administer supplemental oxygen Assess for changes in LOC Administer intravenous fluids
t Question 8 is unpinned. Click to pin. Question at position 8 Esophageal atresia is best described by which of the following statements?
An incomplete passageway from the mouth to the stomach present at birth.
superficial first degree burns
epidermis red, dry blanches with pressure painful heal in 4-5 days with no scarring
partial thickness 2nd degree burns
epidermis and dermis red, moist, swollen blisters, blanches with pressure takes about 2 weeks to heal with minimal to no scarring painful
full thickness 3rd and 4th degree burns
epidermis, dermis, hypodermis, tendons, nerves, muscles black, charred, non blanching, edema, possible bone exposed no pain skin grafting necessary, extensive scars, contractures and limited function may occur
how often should immobile client be repositioned
every 2 hours
clean intermittent catherization with NTD
every four hours during the day and once at night
polyhydramnios
excessive amniotic fluid
patho of cleft palate
failed fusion of the hard and soft palates may involve soft palate, hard palate, or both
neurogenic bladder
failure of the bladder to store urine or empty itself of urine
patho of Cleft lip
failure of the maxillary processes to fuse with the nasal elevations, with or without CP is the most common birth defect in the US, can occur unilaterally (one side) or bilaterally (both)
neural tube defect
failure of the neural to close
It is likely that a child with ewing sarcoma will need to have the affected extremity amputated.
false
Neuroblastoma is a type of brain tumor.
false
primary purposes of traction
fatigue the involved muscle and reduce muscle spasms so bone can be realigned position the distal and proximal bone ends in desired realignment to promote proper healing immobilize the fracture site until realignment has been achieved and sufficient healing has taken place to permit casting or splinting
social isolation with nephrotic sydrome
fatigue, lack of energy, causing them to not have normal activity level, immunosupression due to use of corticosteroids long term, change in appearance due to large amount or edema
neural tube
fetal structure from which the brain and spinal cord form
how to restore and maintain fluid volume with burns
fluid administration monitor urinary output daily weighs monitor electrolyte levels
nursing managment for acute post-strep glomerulonephritis
fluid restrictions low sodium low potassium diet administer meds- diuretic, antihypertensives, antibiotics (persistent) daily weights strict I&O
nursing care managment for child with nephrotic syndrome
fluid restrictions due to edema low sodium diet administer meds- prednison (COrticosteroid), albumin because its decreased, diuretics to pull out extra fluid , strict I&O, daily weight, management of edema
therpeutic managment for burns
fluid resuscitation wound care prevention of infection restoration of function
albumin has an osmotic force as sodium where albumin goes water follows,
fluid shifts when the protein shifts, with third spacing occurring resulting in hypovolemia
Prevention of neural tube defects
folic acid for women of child bearing age
for fluid calculation it is 100 ml/kg
for the first 10 kg of body weight
fo fluid calculation it is 20 ml/kg
for the rest of the weight
for fluid calculation it is 50 ml/kg
for the second kg of body weight
third spacing allows the child to have
generalized edema, noticeable all over body
etiology of cancer
genetics chromosomal abnormlities immunodeficiency environmental radiation maternal smoking prolonged exposure to sun
Pathophysiology of acute post-strep glomerulonephritis
glomeruli has become inflamed with filtering capability impaired accumulation of na and other waste products in the blood may be primary or secondary to a systemic disorder most common cases are post infectious range from minimal to severe
Nephrotic sydrom patho
glomeruli membrane becomes permeable to proteins, albumin spills into urine (proteinuria), serum albumin decreases, fluid shifts to interstatial fluid,
therapeutic managment of diabetes
glucose control preventing complications promoting normal growith and development promote positive adjustment to disease and self managment
in partial compenstion the CO2 and HCO3 will always
go in the same direction
Which of the following are common side effects of cancer treatment?
hair loss anorexia stomatitis constipation
after cast application
handle wet casts with palms of hands only to prevent indentations of cast which can create pressure areas petal the casT routine skin assessment do not get wel keep elevated 5 P'S
Positioning for shock
head flat, legs elevated, promoting return of blood back to the heart
clinical manifestations of acute post-strep glomerulonephritis
hematuria- tea or cola colored urine (blood) proteinuria decreased urinary output irritability, fatigue, lethargy hypertension headache loss of appetite pale edema- begins periorbital, more noticeable in the morning, transitions to lower extremeties including genetalia, more noticeable in evening
type of diet for immobilization
high protein, adequate fiber, vitamin and mineral supplements
Iv sites must be assessed
hourly for signs of infiltration
lack of insulin leads to
hyperglycemia
what cuses respiratory alkalosis
hyperventiltion increased respirtions blowing off CO2 at faster rate than breathing in
what causes respiratory acidosis
hypoventilation- decreased respirations retaining CO2
Which of the following types of shock is most common in children?
hypovolemic
type of shock most common in children
hypovolemic shock
most common type of scoliosis in adolescents
idiopathic
what will lumbar puncture determine
if there is metastasis of the tumor
due to a large amount of the infants body being water
if they become dehydrated they are going to lose weight
healthy funcitonal glomeruli is
impermeable to protein, particularly albumin
Vasopressors
improve cardiac output
fluid and electrolyte imbalances are much more common
in children than adults and occur more frequently and rapidly
family should be prepared that hair may fall out
in clumps patchy baldness
with shock dopamine will
increase cardiac output, and improve renal function
phases of chemotherapy treatment for leukemia in the correct order.
induction consolidation maintenance CNS prophylaxis
chemo IV agents have to be watched closely for
infiltration
CL/CP therapeutic management
initial correction/repair may happen in first year of life treatment to fully repair may continue into adulthood focus on surgically repairing the defect, prevention of complications, promoting normal growth
irreversible shock
irreversible damage to vital organs, weak thready pulse, anuria, hypotension, lethargy, periodic breathing or apnea, obtuned, stupor, or coma
by the time a diagnosis is made for neuroblastoma
it has metastasized, prognosis is poor
In which of the following organs is wilm's tumor located?
kidney
Which organ compensates to regain homeostasis when a client is experiencing respiratory acidosis or alkalosis?
kidneys
fluid for burns in first 24 hours
lactated ringers
minimal change nephrotic syndrome clinical manifestations
large protenuria, hypoalbumenia, generalized edema, significant weight gain, dark frothy urine, dcreased urinary output, pale, irritable, fatigue, lethargic, poor appetite
scoliosis
lateral curvature of the spine greater than 10 degrees congenital, neuromuscular, idiopathic most commonly identified during preadolescence growth spurt early detection, referral, and treatment is important
Children with spina bifida are at high risk for
latex allergies due to repeated exposure during procedures, have a latex environment, educate parents about nonmedical objects that contain latex (pacifiers, pool toys) also urinary tract infections
bone marrow biopsy is related to what cancer
leukemia
effects of immobilization
loss of muscle strength, edurance, and muscle mass loss of joint mobility- joint stiffness and contractures demineralization of the bone- osteoporosis dependent edema DVT Pneumonia constipation- fecal impaction less mobility hypercalemia due to immobility do absorping calcium and releasing into bloodstream rean calculi- deue to hypercalcemia due to immobility skin break delayed growth and development
Hypoalbuminemia
low albumin levels in the blood
Which of the following diagnostic tests is used to determine if cancer has metastasized to the central nervous system?
lumbar puncture
The most common complication of osteosarcoma is metastasis to which of the following organs?
lungs
Which organ compensates to regain homeostasis when a client is experiencing metabolic acidosis or alkalosis?
lungs
organ most sensitive to shock
lungs
EA/TEF therapeuticc management
maintain patent airway prevent aspiration immediately NPO IV fluids position to facilitate drainage of secretions Suction to clear airway Surgical correction
primary responsibility of the kidneys
maintain the composition and volume of the body fluids in equilibrium
nursing care management for DDH
maintenance of the pavlik harness or cast promote growth and dvelopment educate parents about pavlik harness and other devices post surgical procedure- same as care of any in a cast
most common consequences of GI dysfunction
malabsorption poor growth fluid and electrolyte disturbance malnutrition
with traction nurses does not
manipulate traction
nursing care focus with immobilization
maximize physical mobility promote adequate nutrition promote effective elimination promote skin integrity maximize self care promote development prevent injury provide support and eucation to the child and family assess skin for redness or breakdown perform ROM exercises keep dkin clean and dry encourage fluid intake monitor intake and output encourage courghing deep breathing use of incentive spirometer apply sequential compression devices monitor peripheral pulses and skin temp monitor breath sounds monitor for sings of pulmonary embolism monitor calcium levels provide nutritional support
major complications of leukemia
metastasis to blood, blone, CNS, spleen, liver hepatosplenomegaly alterations in growth and development infection hemorrhage
to prevent gingival bleeding oral muccositis stomatitis
meticulus mouth care soft bristle toothbrush bland moist soft diet frequent mouth rinses
with scoliosis curves less than 25 degress are considered
mild and if non progressive then treatment not required
when removing an old dressing for burns
moisten it
with diet and exercise in diabetes
monitor carbohydrates intake consistent food intake regular physical activities
post operative care of NTD
monitor vital signs pain management observe for s/s of infection prone positon, some allow side lying monitor for increased ICP
osteosarcoma
most common bone cancer in children most common sites are long bones
minimal change nephrotic syndrome
most common in children non identifiable cause
fractures in children
most common in forearm and wrist since periosteum is ticker and more elastic bones are more flexible causing them to yield to the force encountered with trauma, plastic/bowing deformity, buckle, and greenstick fractures heal quicker, result in less disability and deformity than adults the younger the child, the quicker the healing process in children younger than 2 should be further investigated
acute post-strep glomerulonephritis
most common type in children typically often group A beta hemolytic strep most common in early school age children and uncommon younger than 2 almostall do recover completely without any complications
patho of hypertrophic pyloric stenosis
muscle of the pyloric sphincter becomes thickened resulting in narrowing of pyloric canal results in compensatory dilation, hypertrophy, and hyper peristalsis of the stomach not congenital, develops in first few weeks of life etiolgoy unknown
fluid administration rate ml/hr
must be included in input/output
therapeutic managment for neuroblastoma
must be surgically removed chemo, radiation
esophageal stricture
narrowing of the esophagus, poor feeding, choking, dysphagia, drooling, regurgitations of undigested food
barlow maneuver
newborn hip evaluation - adduction of hip - evaluates for congenital dislocation, causes the hip to dislocate, downward motion
pain control with burns
non traumatic ongoing and prior to dressing change or debridement nonpharmacologic along with pharmacologic
spina bifida occulta
not externally visible no protrusion of the spinal cord of meninges benign, asymptomatic, no neurogical signs Lumbosacral area may be noticeable dimpling, abnormal patches of hair, or discoloration of skin skin at the site of defect
treatment options for scoliosis
observation with regular clinical evaluation and x rays orthotic intervention (bracing) surgical correction
post op care cleft palate
observe for signs of airway obstruction, hemmorrhage, laryngeal spasm assess vital signs and O2 sats monitor for potential airway compromise clear liquids for 24 hours followed by clear liquid diet for 2 weeks soft diet may be encouraged for 6 weeks open cups for liquids avoid spoons, straws, hard tipped sippy cups elbow restraints pain managment
nursing care managment for fractures
obtain health history cold therapy to reduce swelling in first 48 hours elevated injured extremity assess 5 p's- pain, pallor, parethesia, paralysis, pulses pain management provide family education
ewing sarcoma pathophysiology
occurs in bone or soft tissue surrounding the bone most common site are pelvis, legs, arms most common sits of metastasis lungs, bone, bone marrow
signs and symtoms of neuroblastoma
often parents first to notice a swollen and asymmetric abdomen
The parents of a child who is receiving radiation therapy ask the nurse if they can wash off the purple markings on the child's skin when they give him a bath. What is the best response by the nurse?
ou should not wash off the markings, they are needed for the radiation therapy
nursing managment for burns
oxygenation and ventilation restoring and maintaing fluid volume airway edema may be delayed prevent hypothermia cleanse the burn
lab values with metabolic alkalosis partially compensated
pH 7.45 HCO3 increased CO2 increased
lab values for partially compensated metabolic acidosis
pH decreased HCO3 decreased CO2 decreased
respirtory acidosis partilly compensated
pH decresed CO2 increased HCO3 increased
respiratory alkalosis partially compensated
pH incresed CO2 decreased HCO3 decreased
signs and symptoms of osteosarcoma
pain limp limited movement of affected extremity swelling or tenderness at the site of the tumor
postoperative care for scoliosis
pain management neurological assessment of extremitites log roll assessment of skin and sskin care encourage early ambulation
Post op nursing care management for EA/TEF
pain managmenet administer total parenteral nutrition resume oral feedings in aproximately 1 week closely observe the initial attempt at oral feeding
signs and symptoms of cancer in children
pain, swelling at location of tumor pallor unusual bleeding excessive bleeding fatigue or malaise excessive, rapid weight loss abdominal mass swollen lymph nodes recurring fever, frequent infections LOC/ behavior changes visual disturbances bone fractures
clinical manifestations for hypertrophic pyloric stenosis
palpable olive shapped mass in RUQ nonbilious projectile vomiting after feeding hungry and irritable visible gastric peristalsis resembling waves if not diagnosed early can lead to dehydration, metabolic alkalosis and failure to thrive
with wilm's tumor do not
palpate the abdomen because it is very soft and can very easily start to seed leading to metastasis
nursing care managment for external fixations
partial weight bearing allowed full weight bearing not allowed until complete healing has occcurred assess and maintain skin integrity assess for s/s of infection provide pin care prevent injury 5 P's elevate extremityh provide education to child and family
Which of the following devices would be used to treat developmental dysplasia of the hip?
pavlik harness
with limb salvage procedure provide education about
phantom limb pain stump care crutch walking prosthetics
what to do for nose bleed
pinch nose and tilt head forward
congential nephrotic syndrome
present at birth, hereditary
nursing care management of NTD
prevent infection- assess and maintain intactness of sac, prevent trauma, apply sterile, moist dressing, prone position Assess LOC and degree of neurologic involvement Promote urinary elimination- neurogenic bladder, clean intermittent catherization, teaching self cauterization bowel elimination- panned or timed enemas promote adequate nutrition
with pyloric stenosis the thickened muscle around the pylorus
prevents food ffrom entering the small intestine
lymphoblastic
primarily effect lymphoid cells, normally grow into lymphocytes
myelogenous
primarily effect myloid cells, normally grow into RBC's, granulocytes, and monocytes, platelets
chronic leukemia
progression is slow, cells retain some of normal function
radiation therapy management
protect skin from sunlight and sudden changes in temp wear loose fitting clothing over sight use extremity as tolerated
post op care for cleft lip
protect the operative site, avoid prone positon supervise child to ensure suture line is not damaged, may apply elbow restraints infant may return to breast or bottle feeding may require syringe feeding initially pain managment proper cleaning fo suture line monitor for infection and bleeding
most common type of EA and TEF in children
proximal esophagus ends in a blind pouch distal end forms a fistula with a trachea
therapeutic management for hypertrophic pyloric stenosis
pyloromyotomy (laparoscopic) Pre op: fluid and electrolyte therapy fluid replacement may delay surgery continuous vomiting may need to decompress stomach with NG
acute leukemia
rapidly progressing, cells are without normal function
goal of radiation therapy
reduce the size of tumor
therpeutic managment of fractures
reestablish alighment and length of one retain alignment and length of bone (immobilization) resotre function of the injured extremity prevent further injury
NURSING CARE MANAGMENT FOR DIABETES
regulating glucose- blood glucose monitoring, carb counting, food intake, activity level, insulin administrations monitor for s/s of hyperglycemia hypoglycemia Educate the family
what does reduction mean with fractures
relignment for proper healing
goal of cancer surgery
remove all traces of tumor
Wilm's tumor
renal tumor unilateral, only one kidney grows rapidly, large at time of diagnosis
children in indoor fire or chemical fire have a greater risk for
respiratory failure
A nurse in the emergency department is caring for a 12-year-old child who is a victim of a house fire. The child has sustained deep partial-thickness and full-thickness burns to his arms, chest, and face. Which of the following is the priority assessment for this child?
respiratory status
clinical signs of hypovolemic shock
respiratory- normal to increased heart rate- tachycardia breath sounds- normal pulse pressure- narrow peripheral pulse weak urine output- decreased, irritable early capillary refill delayed <2 seconds pale cool skin
pre op nursing care managment of hypertrophic pyloric stenosis
restore fluid and electrolyte balance NPO monitor iv fluids strict I&O document frequency and description of vomit assess vital signs look for signs and symptoms of dehydration maintain/monitor NG tube assess and record NG drainage offer family support
scald burns
result of contact with hot liquids
hypovolemic shock
result of exvessive blood loss or fluid loss
how are corticosteroids helpful with nephrotic syndrome
reversing the permeability of the glomeruli, will no longer allow protein in
meningocele
sac contains meninges and CSF, spinal cord is normal, little to no neurological deficits
myelomeningocele
sac contains meninges, CSF, and nerves most severe form of NTD spinal cord often ends at the point of the defect, absent motor or sensory function beyond that point paralysis, orthopedic deformities, bowel and bladder incontinence associated with hydrocephalus
where are scoliosis screening often done
school
secondary nephrotic sydrome
secondary to another disease process
family teaching for EA/TEF
semi upright position small, frequent feedings observe for adequate swallowing TEACH S/S of respiratory distress safeguard against swallowing foreign object
external fixation
series of pins and wires surgically inserted into bone then attached to an external frame
Which of the following is a major complication of dehydration?
shock
decompensated shock
signs more obvious, tachypnea, oliguria, cool clammy extremities, poor capillary refill, decreased bp, pronounced tachycardia, change in LOC (drowsiness, confusion)
nursing care managment for child with club foot
skin assessment circulatory assessment teach parents to observe the skin and look for problems with circulation teah parents the importance of complying with treatment plan encourage parents to facilitate normal growth and development as best as possible and within the limitations
fluid edema in chldren can lead to
skin break down if the child is not active
After cast removal
skin will be covered with dead skin cells and oily secretions soak in warm water, may take several days avoid scrubbing or pulling off deak skin decreased muscle mass expected resume routine activity to regain strength and normal appearance
POST op care for pyloromyotomy
small frequent feedings of water and pedialyte 4-6 hours after surgery can then start formula feeding about 24 hours post op normal schedule should resume about 48 hours post op some vomiting due to edema may occur
the primary osmotic force that controls fluid movement in our body
sodium
tracheomalacia
softening/ weakening of the trachea, barking cough, stridor, wheezing, recurrent respiratory tract infections, cyanosis, apnea
In cancer WBC'S are suppressed
specifically neutrophils, which are most abundant type, major fighters
long term problems from CL/CP
speech impairment requirng speech therapy, usually with cleft palate additional surgeeries recurrent otitis media secondary to CP dental anomalies- missing teeth, misaligned teeth
most common type of NTD
spina bifida
newborns to 6 months DDH
splinting with hips flexed and abducted (pavlik harness) training the hip until condition is corrected Pavlik harness worn continuously for about 3 months
with EA/TEF the oral feedings begin with
sterile water or pedialyte followed by small, frequent, feedings of formula/ breastmilk
how to cleanse burns
stop the burning process, remove charred clothing, rinse with cool water, do not break blisters, debridement, dressing change
neutropenic precautions
strict handwashing no live flowers or fresh fruit/vegetables client must wear mask when outside of room
pre op nursing care management for EA/TEF
suction the child's airway elevate HOB at least 30 degress respiratory assessment airway managment Fluid and electrolyte management
signs of pulmonary embolism
sudden dyspnea, chest pain, respiratory distress
The mother of a 2-year-old child calls the pediatric clinic and tells the nurse that the child accidently touched the mother's curling iron this morning. The mother describes the child's burn as red, dry, and painful. Which type of burn has this child most likely sustained?
superficial
The nurse is caring for a 4 month old who just had a cleft lip repair. In which position should the child be placed?
supine
curves greater than 45 degrees typically require
surgery
therpeutic managment for cancer
surgery chemo radiation bone marrow transplant (hematopoietic stem cell transplant)
if the curve does not respond to bracing
surgery is needed
6-24 months treatment options for DDH
surgical closed reduction spica cast for 12 weeks
therapeutic of neural tube defect
surgical closure soone after birth within 24-72 hours, much sooner if sac is leaking CSF or danger of sac rupturing Goal- prevent infection and minimize further loss of function
older than 2 treatment options for DDH
surgical open reduction casting rehabilitation measures
open reduction
surgical opening in the skin
therapeutic managment of wilm's
surgical removal of tumor and affected kidney chemo and radiation
treatment of osteosarcoma
surgical removal- radical amputation (affected removed), limb salvage procedure (remove only affected portion) replace with prosthetic chemo
with EA/TEF the chid can not
swallow the amniotic fluid like nnormally leading to the mother having polydraminos
The nurse is caring for a child who has been diagnosed with metabolic acidosis. Which of the following assessment findings should the nurse anticipate?
tachypnea
The nurse is caring for pediatric client whose lab values indicate respiratory alkalosis. Which of the following is the most likely cause of this imbalance?
tachypnea
The nurse is caring for a child who has been diagnosed with ewing sarcoma of the left leg. Which of the following assessment findings should the nurse anticipate? Select all that apply.
tenderness pain swelling
we describe the type of dehydration based on
the amount of sodium that is in the plasma
decreased level of protein in the blood hypoproteinemia
the body increases the production of lipids and proteins this leads to increased level of cholesterol (hyperlipidemia)
when the child goes into remission
the bone marrow biopsy will usually show less than 2% blasts
since extremity is not being used in cast
the bones are immobile and are not absorbing calcium propery so it is being released in bloodstream, causing hypercalcemia leading to kidney stones
what causes partially compensated metabolic alkalosis
the child is vomitting, decreases the acid, increasing the base
hypotonic dehydration
the child lost more salt than water, sodium level is decreased
hypertonic dehydration
the child lost more water than salt, the sodium level is increased
what causes HCO3 to decrese with respiratory alkalosis partially compensated
the kidneys excrete it, to bring the level down
what causes HCO3 to increase
the kidneys work to compensate, kidneys will retain it
Isotonic dehydration
the loss of salt and water is equal, they have a normal sodium level
what causes co2 to decrease with partially compensated metabolic acidosis
the lungs compensate by increases respirations to help decrease CO2
the younger the child
the more immature their kidney function is
the type of dehydration determines
the type of fluid that would be used to get back to normal levels
we can not vasodilator the vessels if
there is no volume to circulate
if the client platelets drop below a certain number
there is usually a standing order
due to the large amount of water than children have in their body
they are going to have more of an imbalance
children have underdeveloped kidney function
they are unable to effectively concentrate or dilute urine necessary, inefficient in excreting waste
children have increased fluid requirements
they excrete more urine and require more fluids
with isolated cleft lip managment
they have difficulty getting an adequate seal have special nipples with wide base, breastfeeding less difficult, squeeze cheeks together during feedings
diagnositic procedures for acute post-strep glomerulonephritis
throat culture- determines child has active strep infection urinalysis BUN, creatinine- degree of renal impairment antistreptolysine tider
never apply ice
to a burn
lower extremity cast
to immobilize ankle or knee
graft vs host disease
when a recipient's immune system is destroyed and receives a new one, the donor's mature T cells attack and reject the recipient's healthy tissue
SURGICAL correction of CL typically happens
when child is around 2-3 months old
compartment syndrome
when swelling starts to develop around tissues of affected fracture site, and then it starts to impede circulation acting as a turniquet, a medical emergency
diagnostic evaluation for scoliosis
when viewed from behind child may exhibit asymmetry of shoulder, height, scapular, or flank shap, or hip height To exam, child should bend forward at the waist with trunk parallel to the floor, arms hanging freely X-ray
closed reduction
without opening the skin
diagnostic evaluation of fractures
x rays- used to diagnose, taken after reduction and during healing process to confirm satisfactory progress
The mother of an infant who is scheduled to undergo surgical correction of hypertrophic pyloric stenosis asks the nurse how her infant will be fed after surgery. What is the best response by the nurse?
"Your baby will be fed by mouth from a bottle or breast just as he normally would."
The nurse is caring for pediatric client whose lab values indicate respiratory acidosis. Which of the following is the most likely cause of this imbalance?
Decreased respiratory rate
normal urinalysis findings
PH- 5-9 Specific gravity- 1.001- 1.035 protein <20 no glucuose, ketones, Hgb, WBC, RBC yellow, amber, clear, odorless,
post op nursing care management of hypertrophic pyloric stenosis
assess for vomiting administer and monitor IV fluids pain management monitor I&O assess vital signs supervise feedings
nursing care management for wills tumor
assess remaining kidney assess side affects of radiation or chemo provide education for no contact sports, UTI prevention, report signs of GU issues
nursing management for a dehydrated child
assessment, get history, vital signs, weight, capillary refill, intake/output strict, encourage oral fluid intake, iv fluids, preparing the child and parents
surgial correction of CP typically happens
at 6-9 months of age early repair may restrict skeletal growth of childs midface delaying the repair after first words can lead to significant speech problems
for cancer how long should one wait for live vaccine
at least 3 months after completion
diagnosis of EA/TEF
attempt to insert an NG and when you try it doesnt go anywhere Xrays bronchoscopy polyhydraminos
type 1 diabetes
autoimmune response damages cells of pancreas
priority after discharge for cancer
avoid crowded areas limit exposure to friends practice good hand washing
neurological problems from chemo
constipation- stool softners, mild laxatives, physical activity weakness numbness changes in gait changes in fine motor jaw pain
children recieivng cancer treatment should avoid
contact sports
therapeutic management of clubfoot
correction of deformity maintenance of the correction until normal alignment is regained follow up observation to prevent recurrence
teaching of food restrictions with EA/TEF
cut solid food into small pieces teach child to chew food thoroughly give frequent sips of liquid avoid food such as whole hotdogs or large pieces of meat that may become lodged in the esophagus
An adolescent who is undergoing radiation therapy for ewing sarcoma of the leg asks the nurse if it is okay for her to suntan. What is the best response by the nurse?
"It is best that you not suntan while you are receiving radiation therapy."
The nurse is preparing a 4-year-old child who sustained partial-thickness burns to his lower arm and hand for discharge. Which of the following statements made by the child's parents indicate the nurse's discharge teaching has been effective?
"We will apply a thin layer of antibiotic ointment to the burns when we change the dressing."
how long should child be monitored after chemo when assessing for anaphylaxis
1 hour
expected urinary output for child
1 ml/kg/hr
normal specific gravity
1.005-1.030
When are boys screened for scoliosis?
13-14 years 1x
when are girls screened for scoliosis
10 and 12
maintenance fluid calculation formula
100ml(first 10kg) + 50ml(second 10kg) + 20ml(rest of kg) divided by 24
normal HCO3
22-26 Base
How many ml/hr of continuous intravenous fluid should the nurse expect to administer to a child who weighs 5.6 kg?
23.3
for fluid whar is the total ml/kg divided by
24 to get hourly weight
clinical manifestations of EA/TEF
3 C'S coughing, choking, and cyanosis forthy saliva in nose and mouth, drooling, coughing and gagging with feedings, return of formula through nose and mouth, cyanosis and apnea because of aspirations, stomach distended with air
clinical manifestations of diabetes
3 P's polyuria polydipsia polyphagia blurred vision headache weight loss
when should expect hair growth after chemo
3-6 months
when should antiemitic be administered with chemo
30 mins- 1 hour before and as scheduled for at least 24-48 hours afterward
Normal CO2
35-45 acid
How many ml/hr of continuous intravenous fluid should the nurse expect to administer to a child who weighs 19 kg?
60.4
percentage of childs body that is water
65%
Norml pH
7.35-7.45
How many ml/hr of continuous intravenous fluid should the nurse expect to administer to a child who weighs 30 kg?
70.8
percentage of infants body that is water
75%
Labs for cancer
CBC chemistry panel (kidneyk liver, acid-base, electrolytes) urinalysis lumbar puncture
Signs of infiltration
Cool to touch, redness/blanching, paleness, edema (swelling), painful
Which of the following accurately explains why infants and young children experience fluid and electrolyte imbalances more easily than adults? Select all that apply.
Infants and young children excrete more urine than adults Infants and young children have a greater need for fluid because a larger percentage of their body weight is water Infants and young children have a larger body surface area than adults
A child with partial thickness burns to both legs is admitted to the pediatric unit. Which description is most accurate for the appearance of this child's burns?
Moist, red, with blisters
with anemia in cancer treatment
RBC'S are suppressed monitor HgB Regulate activity level as neccessary transfuse packed RBC's as needed
signs of wilms tumor
abdominal mass and swelling parents typically discover
ortolani maneuver
abduct the legs to feel "clunk" of femur slipping intoacetabulum, upward motion
developmental dyssplasia of the hip
abnormal development of the hip may develop at any time during fetal life, infancy, and childhood risk factors- femal gender, family history, breech intrauterine position, high birth weight idiopathic- no neurological defects tetratologic- involves nueromuscular defects
percutaneous heelcord tenotomy
achilles tendon servered may be necessary with clubfoot may be in cast for 12 weeks
vomit is a
acid
if the pH is less than 7.35 it is
acidosis
with ewing sarcoma before surgery discourage
active play or weight beiging on affected extremity to prevent fracture at tumor site
Nurses must be trained or have experience in
administering chemo
Children in which age group are most often affected by scoliosis?
adolescent
Osteosarcoma most commonly occurs in which of the following age groups?
adolescent
Which of the following is the most common location for a neuroblastoma to form?
adrenal gland
the glomerulonephritis has most often started
after child has had previous infection and it is the bodies autoimmune response to that
if the pH is more than 7.45 it is
alkalotic
pathophysilogy of cancer
alteration in cellular regulation resulting in out of control cell growth
leukemia results in
anemia neutropenia thrombocytopenia
most useful diagnostic test for glomerulonephritis
antistreptolysine tider ASO, detects streptotoccal antibodies, elevated comfirms this
periorbital
area around the eye, more noticeable in the morning
Which type of fracture is most common in children?
arm
to avoid hemorrhage do not give in cancer treatment
aspirin gibe tylenol instead
emergency assessment of a burned child
assess airway, note if patent, maintainable or unmaintainable, evaluate skin color, respiratory effort, symmetry of breathing, determine pulse strength, perfussion status, heart rate, extent and location of edema
nursing care managment of traction
assess child and traction apparatus physcician will apply and manipulate traction skin care at pin sites, assess for s/s of infection assess for skin breakdown pain managment assess 5 P's promote growth and development
before cast application
assess for abraisions, cuts or other ckin alterations, check for items that may cause constriction or swelling
poop is a
base
neuroblastoma
begin as neuroblast in the fetus, most mature, other form into tumor
Which of the following diagnostic tests is used to determine the staging of cancer?
biopsy
definitive method for determining cancer
biopsy
carbonaceous sputum
black colored, may indicate airway injury
glucose control
blood glucose moitor hemoglboin A1C
type 2 diabetes
body reistance to insulin or inadequate insulin secretion to meet body's demands
countertraction on proximal bone fragment achieved by
body weight
signs and symptoms of leukemia
bone pain headache weight loss nausea/vomitting abdominal pian unusal bleeding/bruising pallor fatigue recurrent infection fever with unknown cause
malunion
bony break that is not aligned correctly
with scoliosis 25-45 degree
bracing may be best option
Which of the following clinical manifestations would NOT be associated with shock?
bradycardia
suspect airway injury from burn or smoke inhalation if these are present
burns around the nose, mouth, or eyes, carbonaceous (black) sputum, hoarseness or stridor
bracing does not correct current curve
but prevents progression
teaching about brace
can only be removed for bath/shower skin care
nephrotic sydrome in children can be a
chronic condition with repalpse so they may not meet developmental milestones due to being hospitalized frequently
burns in pediatrics
common but preventable young children are at highest risk most do not result in death 60-80% are scald burns
fracture complications
compartment syndrome nonunion malunion infection kidney stones pulmonary emboli
stages of hypovolemic shock
compensated, decomensated, irreversible
patho of esophageal atresia and tracheoesophageal fistula
congenital defect where the esophagus fails to develop as a continuous passage the esophagus and trachea fail to separate May occur separately or together
clubfoot
congenital deformity of the ankle and foot foot points downward and inward cause unknown bilateral in 50% of cases more common in males
nursing care management for scoliosis
consideration for growth and development- provide positive reinforcement, encourage socialization with peers, encourage self care and independence, potential social isolation, dealing with pain, body image
patho of burns
damaged vessels lead to increased permeability and vasodilation leaking of fluid from vasculature- third spacing and edema fluid loss 5-10 times greater fluid loss continues until skin is healed or grafted
a specific gravity more than 1.030 may indicate
dehydration
children are very susceptible to
dehydration and a major complication is shock
poor glucose control may lead to
delayed wound healing recurrent infections retinopathy neuropathy nephropathy cardiovasuclar disease DKA
after completion of casting with club foot
denis brown bar with ponseti shoes, paces the feet in abduction and worn for an extended period of time
deep partial thickness 2nd degree burns
dermis, epidermis, hypodermis yellow, white, waxy, leathery non blanching decreased pain, may feel pain around area take up to 8 weeks to heal with no visible scarring may require surgery or skin grafting
what can biopsy assist with
determining if malignant or benign classification or staging bone marrow location of origin
The nurse is caring for pediatric client whose lab values indicate metabolic acidosis. Which of the following is the most likely cause of this imbalance?
diarrhea
what causes metabolic acidosis partially compensated
diarrhea, pooped out all of base, leaving only acid
with Myelomeningocele
do not let the sack rupture, protect the sac
preferred first line drug for shock
dopamine
physical assessment findings for a child who is experiencing dehydration
dry mucous membranes, no tears, sunken fontanels, sluggish capillary refill, pale, lethargic, irritable, poor skin turgor, decreased urinary output, increased specific gravity, weight loss, irregular respirations
diagnostic evaluation for DDH
early treatment before 2 months old achieves greater success the longer treatment is delayed, the more severe deformity the more difficult the treatment Orolani and barlow maneuver asymmetric thigh and gluteal folds limited hip abduction shortening of leg on affected side positive trendelenburg sign
greatest weapon of cancer
early detection and treatment
facial cues while feeding signaling the need for a break with CL/CP
elevated eyebrows wrinkled forehead watery eyes
How can neural tube defects be detected prenatally?
elevated levels of alpha-fetoprotein in mothers blood and ultrasound
nonunion
total failure of healing of a fracture
complications with EA/TEF
tracheomalacia, esophageal stricture
Which of the following signs would be diagnostic of developmental dysplasia of the hip?
trendelenberg
most tumor surgeries are successful when
tumor is encapsulated/localized (confined to site of origin)
children with cleft palate standardly receive
tympanostomy tubes due to recurrent otitis media
INSULIN therapy
type 1 diabetes rapid, short, immediate, long insulin pump
oral hypoglycemic meds
type 2 used if diet and exercise are not effective type and action vary if not effective insulin will be required
feeding is much more difficult with Cleft palate
unable to achieve adequation suction, may need modified bottles or specialized feeding system, breastfeeding effective
Which of the following are clinical manifestations of leukemia? Select all that apply.
unexplained fever unusual bleeding weight loss bone pain
Which of the following assessment findings are associated with cancer?
unusual bleeding fatigue recurring fever
with nephrotic sydrome we should make sure that the child is
up and active
nursing care managment of CL/CP
upright position for feeding
spica cast
used to immobilize hip and knee
casts
used to immobilize the joints above and below the site of injury to maintain bone alignment and prevent displacement
upper extremity cast
used to immobilize wrist or elbow
prep care for scoliosis
various test including blood test, blood replacement may be needed, developmentally appropriate preparation
fluid before
vasodilators
the client must have adequate volume before we give
vasodilators
medications possibly given for shock
vasopressors, dopamine, vasodilators
major goals of treatment for shock
ventilation, replacing volume that was lost, improve pumping action of the heart
nursing interventions for shock
ventiliation, administer oxygen, administer and monitor fluids, administer medications, monitor vital signs, monitor I/O, assess LOC
spina bifida cystica
visible with an external saclike protrusion most often at lumbar or lumbosacral region
compensated shock
vital organ function maintained, early signs are subtle, apprehension, thirst, irritability, pallor, normal bp, narrowing pulse pressure, mild tachycardia, diminshed urine output
The nurse is caring for an infant who has been diagnosed with hydrocephalus. Which of the following assessment findings should the nurse anticipate?
vomiting irritability lethargy poor feeding
The nurse is caring for pediatric client whose lab values indicate metabolic alkalosis. Which of the following is the most likely cause of this imbalance?
vomitting
If the IV is infiltrated
we must remove it immediately
due to use of corticosteroids leading to immunosupression
we need to have extra infection precautions
when assessing pallor of extremity
we will look at the color of the extremity, if pale circulation is not adequate
when assess for parathesia of extremity
we will look for numbness and tingling
to determine if interventions are effective with nephrotic syndrome
we will see a decrease in weight
ponseti method
weekly manipulation and stretching of the foot with cast changes cast changes then occur every 2 weeks casting continues until maximum correctionis achieved serial casting
one of the very first signs of dehydration in children
weight loss
traction
weights applied to the distal bone fragment Produces equlibrium at the fractrue site to regain and maintain alignment