NURS 6500 Final Exam

primary VUR results from?

a congenital abnormalities at the vesicoureteral junction that results in incompetence of the valve

The nurse is conducting a presentation for a group of nurses who work with adolescents. The group discusses dysmenorrhea. Which statement is most accurately related to dysmenorrhea?

a contributing factor in dysmenorrhea is the increased secretion of prostaglandins

The nurse is reinforcing teaching with the caregiver of 5-year-old twins regarding urinary tract infections (UTIs). The caregiver is puzzled about why her daughter has had three urinary tract infections but her son has had none. She reports that their diets and fluid intake is similar. Which statement would be accurate for the nurse to tell this mother?

a girls urethra is much shorter and straighter than a boy's so it can be contaminated fairly easily

secondary VUR results from?

related to other structural or functional problems such as: neurogenic bladder bladder dysfunction bladder outlet obstruction

management of clef lip/palate

repaired surgically around the age of 2 to 3 months and cleft palate at 6 to 9 months early repair of the lip restores a normal appearance to the child's face and may improve parent-infant bonding

treatment for pyloric stenosis

requires surgical intervention pyloromytomy is performed to cut the muscle of the pylorus and relieve the gastric outlet obstruction

aplastic anemia

failure of the bone marrow to produce cells is characterized by bone marrow aplasia and pancytopenia (decreased number of all blood cells)

clinical manifestations of HIV/AIDs

failure to thrive recurrent bacterial infections opportunistic infections chronic or recurrent diarrhea recurrent or persistent fever developmental delay prolonged candidiasis

T or F: In order to determine the extent of the limitation in the child with slipped capital femoral epiphysis (SCFE), gently perform passive range of motion

false

T or F: scoliosis usually causes back pain.

false

risk factors for DDH

family history female gender oligohydramnios or breech birth native american or european descent

complications of clef lip and palate include?

feeding difficulties altered dentition delayed or altered speech development and otitis media

etiology of idiopathic scoliosis

is not known genetic factors growth abnormalities bone, muscle, disc or CNS disorders may contribute infantile: occurs in the first 3 years of life juvenile: diagnosed between ages 4 and 10 years or prior to adolescent adolescent: age 11-17 years

common s/s of iron deficiency anemia

irriratiblity HA dizziness weakness SOB pallor fatigue

slipped capital femoral epiphysis (SCFE)

is a condition in which the femoral head dislocates from the neck and shaft of the femur at the level of the epiphyseal plate the epiphysis slips downward and backward the left hip is more often effected

renal failure

is a condition in which the kidneys cannot concentrate urine conserve electrolytes or excrete waste products

anemia

is a condition in which the level of RBC is lower than the age-appropriate normal value

vesicoureteral reflux (VUR)

is a condition in which the urine from the bladder back flows back up the ureters this reflux of urine occurs during bladder contraction with voiding may occur in one or both ureters if reflux occurs when the urine is infected the kidney is exposed to bacteria and pyelonephritis may result

Hirschsprung disease (congenital ganglionic megacolon)

is a disorder of motility of the intestinal track resulting in obstruction characterized by failure to pass a stool (meconium) within the first 24 hours of life this is due to lack of ganglion cells in the intestine which causes inadequate motility in part of the intestine

spinal muscular atrophy

is a genetic motor neuron disease that affects the spinal nerve's ability to communicate with the muscles it is inherited via an autosomal recessive mechanism

hemophilia

is a group of X-linked recessive disorders that result in deficiency in one of the coagulation factors in the blood x-linked are transmitted by carrier mothers to their sons, so usually only males are affected by hemophilia

sickle cell disease

is a group of inherited hemoglobinopahties in which the RBCs do not carry the normal adult hemoglobin but instead carry a less effective type

intussusception

is a process that occurs when a proximal segment of bowel "telescopes" into a more distal segment, causing edema, vascular compromise, and partial or total bowel obstruction

legg-calve-perthese disease

is a self limiting condition that involves avascular necrosis of the femoral head it most often affects boys between 4 and 8 years of age but it can occur as early as 18 months and up until skeletal maturity

failure to thrive

is a term used to describe inadequate growth in infant and children child fails to demonstrate appropriate weight gain over a prolonged period much more common in children with special needs

encopresis

is a term used to describe soiling of fecal contents in the underwear beyond the age of expected toilet training

appendicitis

is an acute inflammation of the appendix most common cause of emergent abdominal surgery in children and peaks in prevalence in the 2nd decade of life if left untreated the appendix may rupture

UTI

is an infection of the urinary tract, most commonly affecting the bladder most often occurs bc of bacteria ascending to the bladder via the urethra

acute renal failure is defined as?

a sudden, often reversible, decline in renal function that results in the accumulation of metabolic toxins as well as fluid and electrolyte imbalance

chronic diarrhea is diarrhea that lasts for more than?

2 weeks this type of diarrhea is not usually caused by serious illnesses

s/s of pyloric stenosis

forceful non bilious vomiting unrelated to feeding position hunger soon after vomiting episodes weight loss due to vomiting progressive dehydration with subsequent lethargy possible family hx

muscle involvement of duchenne

generalized weakness muscle wasting limb and trunk first

common sites for fractures

FA and wrist

common s/s of VUR

fever dysuria frequency to void nocturia hematuria back, abdomen or flank pain

onset of duchenne

early childhood (3-6 years)

complications of aplastic anemia include?

severe overwhelming infection hemmorahge death

acute diarrhea in children is most commonly caused by ?

a virus but it may also be related to bacterial or parasitic enteropathogens viruses injure the absorptive surface of mature villous cells resulting in decreased fluid absorption and disaccharide deficiency

congenital nephrotic syndrome

is an inherited disorder, it is rare and occurs primarily in females the prognosis is poor though some success has occurred with early aggressive treatment and with the advances in kidney transplantation in infants

diarrhea

is either an increase in the frequency or decrease in the consistency of stool can either be acute or chronic

scoliosis

is lateral curvature of the spine that exceeds 10 degrees it may be congenital, associated with other disorders or idiopathic

Which of the following are ways to prevent HIV infection in children. Select all that apply. a. offer all pregnant women HIV testing b. HIV positive pregnant women should be treated with antiretroviral drugs c. discourage breast feeding of HIV positive women d. avoid zidovudine therapy in children born to HIV positive mothers

a, b, c

Which of the following are risk factors for lead poisoning? a. living in a home built before 1978 b.exposure to lead pottery c.living with parents who work in certain manufacturing jobs (battery, cable makers) d. exposure to to folk remedies e. playing with toys made in 1980

a, b, c, d

Which of the following drugs are included in the treatment of juvenile idiopathic arthritis? a. NSAIDS b. corticosteroids c. methotrexate d. acetaminophen e. etanercept

a, b, c, e

idiopathic nephrotic syndrome

is most commonly occurring type in children and is also called minimal change nephrotic syndrome

Which of the following are associated with Legg-Calve Perthes disease? a. Painless limp b. avascular necrosis of the femoral head c. most often affects males between 4 and 8 years old d. viral etiology e. over time the femoral head reforms f. treatment usually includes anti-inflammatory medications, brace, avoidance of contact sports.

a, b, c, e, f

complications of GERD

esophagitis esophageal stricture barret esophagus anemia laryngitis recurrent pneumonia asthma

nursing care for a pt with pyloric stenosis

Perioperative fluid management and correcting abnormal electrolyte values Provide emotional support to the family before surgery Teach them about the surgical procedure and what to expect postoperatively After surgery, infants usually resume oral feedings after 1 to 2 days.

about 30 to 50% of children diagnosed with UTI have?

VUR

s/s of appendicitis

Vague abdominal pain in the initial stages, localizing to the RLQ over a few hours N/V Small volume, frequent, soft stools often confused with diarrhea Fever usually low grade unless perforation occurs

functional constipation may be defined by the presence of at least two of the following over the course of 1 month

-less than three bowel movements weekly -at least one episode of fecal incontinent weekly after toilet trained -excessive stool retention history -hard or painful bowel movements -large fecal rectal mass -stool passage of a volume to clog a toilet -stool withholding behavior (retentive posturing)

nursing care for a child hospitalized with failure to thrive

-observe parent-child interactions especially during feeding - develop an appropriate feeding schedule -provide feedings as prescribed -weigh the child daily and maintain strict records of I & O -educate the parents about proper feeding techniques -provide extensive support to alleviate parenteral anxiety

nursing care for contipation

-teach the parents how to assess for signs fo constipation and withholding behaviors -educate about dietary changes high fiber diets help to regulate bowel activity -increase fluid intake

the expected urine output in the infant is?

0.5 to 2mL/kg/hr

normal Hgb level of adolescent

11-15

the renal system reaches functional maturity at around ___ years of age.

2

For children over 1 year of age, limit cow's milk intake to __ oz. per day

24

What is the risk that a child will be born with sickle cell disease if both parents are carriers?

25%

if the parents are both carriers for sickle cell anemia what are the chances they will have a child with the disease?

25%

expected urine output for a 1 year old

400 to 500mL per day

if the parents are carriers for sickle cell anemia what are the chances they will have a child who is also a carrier?

50%

MCNS most often has its onset in children by?

6 years of age

average urine output for a teenager

800 to 1,400 mL per day

how many times a day does an infant or toddler void

9 to 10 times

in ____, the femoral head has an abnormal relationship to the acetabulum. Frank dislocation of the hip may occur in which there is no contact between the femoral head and acetabulum.

DDH

s/s of failure to thrive

Diarrhea Malabsorption Vomiting Infants or children with feeding issues present with nipple, spoon, or food refusal Disinterest in feeding or difficulty progressing from liquid to textured food

which microorganism most commonly causes UTIs

E. coli which is usually found in the perineal and anal region close to the urethra opening other organisms include klebsiella, staphylococcus, proteus, pseudomonas, haemophilus

therapeutic management of aplastic anemia in children involves?

HSCT from a human leukocyte antigen-matching sibling donor if one is not available immunosuppressive therapy or high dose cyclophosphamide can be given

complications of cerebral palsy

Mental impairments, seizures growth problems impaired vision or hearing abnormal sensation or perception and hydrocephalus

s/s of nephrotic syndrome

N/V recent weight gain history or periorbital edema upon waking, progressing to generalized edema weakness or fatigue irritability or business

A nurse caring for a child wearing a brace to correct scoliosis provides patient and family teaching for home care of the brace. Which of the following would the nurse most likely include in the teaching plan? Select all that apply. a. "Be sure to avoid sitting in one position for long periods of time." b. "Loosen the brace during meals if necessary." c. "Schedule wearing the brace during waking hours for best therapeutic results." d. "Wear a 100% cotton T-shirt under the brace to absorb moisture." e. "Take a shower instead of a bath to stimulate the skin." f. "Gradually decrease wearing time so the skin can develop tolerance."

a, b, d

Which of the following are complications of sickle cell anemia? select all. a. pain crises b. acute chest syndrome c. increased visual acuity d. delayed growth and development

a, b, d

Common s/s of HIV infection might include which of the following? a. failure to thrive b. recurrent infections c. constipation d. recurrent fevers e. prolonged candidiasis

a, b, d, e

when administering iron supplements in infants, which of the following should be included? select all that apply. a. place liquid iron behind the teeth b. teach parents iron can cause diarrhea c. increase dietary fiber d. limit cow's milk e. teach parents stools might be lighter in color

a, c, d

The nurse is caring for an infant boy with grade IV vesicoureteral reflux. Which finding would lead the nurse to suspect that hydronephrosis is present?

abdominal mass

The nurse is caring for a child who receives dialysis via an AV fistula. Which finding indicates an immediate need to notify the physician?

absence of a thrill

fractures in children result most frequently from?

accidental trauma

teaching for pts with IBD

adequate nutrition high protein and high carbohydrate provide information about common medication if the child has an ostomy help with self esteem issues and care of the ostomy the disease can cause children to want to skip school bc of issues with the bathroom so the nurse may need a letter to be written to allow bathroom privileges child may experience stunted growth and delayed puberty provide emotional support

nursing care for intussusception

administer IV fluids and antibiotics before the diagnostic lab and radiograph studies offer emotional support to the parents as they may be fatigued after dealing with a crying child and quite anxious about surgery provide appropriate pre/post op education to the family

s/s of constipation

altered stooling patterns (size, frequent, amount, color) pain with defecation withholding behaviors posture to try to withhold the stool such as leg crossing squatting or hiding in the corner complaints of abdominal pain diarrhea leakage soiling of undergarments abdomen distended or rounded

intussusception is usually diagnosed with?

an air or barium enema

sick cell anemia is transmitted via?

an autosomal recessive inheritance pattern the recessive genes for sickle cell are passed on from both parents who have the gene for Hgb AS (sick cell trait)

What is idiopathic thrombocytopenia purport thought to be caused by?

an immune response following a viral infection that produces anti-platelet antibodies

complications of nephrotic syndrome include

anemia infection poor growth peritonitis thrombosis renal failure

complications of acute renal failure

anemia hyperkalemia hypertension pulmonary edema cardiac failure altered LOC

traction

another common method of immobilization may be used to reduce and immobilize a fracture to align an injured extremity and to allow the extremity to be restored to its normal length

treatment of yegg-calve perthes disease includes

anti-inflammatory medication to decrease muscle spams around the hip joint and to relieve pain activity limitation may be prescribed, and sometimes bracing, casting, or traction is recommended to contain the femoral head serial x-ray follow up determines progress of the disease

UTIs may be treated with?

antibiotics at home

management of VUR

antibiotics prophylaxis hygiene and voiding practices are used to assist with the prevention of UTI serial urine cultures are used to determine recurrence of UTI biannual, annula or biennial radionuclide VCUGS are performed to determine the status of VUR

significant anemia may occur when the RBCs sickle. sickling may be triggered by?

any stress or traumatic event such as infection, fever, dehydration, physical exertion, excessive cold exposure, or hypoxia

post op nursing management for hypospadias

assess urinary drainage from the urethral stent or drainage tube which allows from discharge of urine without stress along the surgical site ensure the urinary drainage remains carefully taped with the penis in an upright position to prevent stress on the urethral incision the penile dressing is usually a compression type to decrease edema and bruising administer antibiotics as prescribed assess pain

A nurse has admitted a 3-year-old female diagnosed with a urinary tract infection. When developing the plan of care, what should the nurse do first?

assess usual voiding patterns

A symptom often seen in acute glomerulonephritis is edema. The most common site the edema is first noted is in which area of the body?

eyes

if a patient has DDH on assessment what would the nurse expect to see?

asymmetry of thigh and gluteal folds unequal knee height related to femur shortened hip abduction positive trendelenbrug sign (note pelvis/hips drops when leg is raised) feel for "clunk" when adduction and depression of femur dislocates hip (barlow test) feel for "clunk" when the dislocated hip is dislocated hip is abducted and relocated (ortolani sign)

when is a hypospadias usually repaired?

at 6 months and 1 year the goal is for either the condition to provide for an appropriately placed meatus that allows for normal voiding and ejaculation

The nurse is caring for a 2-year old with myelomeningocele. When teaching about care related to neurogenic bladder, what response by the parent would indicate that additional teaching is required? a. "Routine catheterization will decrease the risk of infection from urine staying in the bladder." b. "I know it will be important for me to catheterize my child for the rest of her life." c. "I will make sure that I always use latex-free catheters." d. "I will wash the catheter with warm soapy water after each use."

b

The nurse is caring for a 6-year-old with juvenile idiopathic arthritis. The mother states that she has trouble getting her daughter out of bed in the morning and she and the health care provider believe the girl's behavior is due to a desire to avoid going to school. What is the best advice by the nurse? a. Refer the girl to a psychologist for evaluation of school phobia related to chronic illness. b. Administer a warm bath every morning before school. c. Give the child her prescribed NSAIDs 30 minutes before getting out of bed. d. Allow her to stay in bed some mornings if she wants.

b

the nurse is caring for a 4 y.o with a suspected UTI. what would be the most appropriate thing to say to the child when obtaining a urine specimen from him? a. i will need a urine sample b. let your mom help you go pee pee in this little cup c. please go think in this cup right now d. please go tinkle in this cup instead of the toilet

b

the nurse is caring for an 8 y.o child experiencing nocturnal enuresis with no physiologic cause. the child states, "I am embarrassed and I wish I could stop this right now" how will the nurse respond? a. you will grow out of it eventually you just need to be patient b. there are several things we can do to help you achieve this goal c. you are not alone there are almost 5 million people that have enuresis d. you can wear pull ups to bed, since they look like underwear no one will know

b

Therapeutic management of children with sickle cell anemia includes which of the following? Select all that apply a. limiting oral fluids b. oxygen during pain crises c. prevention of infection d. prophylactic antibiotics

b, c, d

Skin care after cast removal includes: (select all that apply) a. scrub the skin to remove the brown flaky skin b. soak with warm water daily c. allow the child to gently scratch the skin d. apply moisturizing lotion e. encourage activity

b, c, d, e

When caring for a child with a cast the nurse will perform frequent checks to identify signs of compromise including: a. shortened capillary refill b. increased pain c. pale skin color d. cool skin e. decreased pulse

b, c, d, e

Iron deficiency anemia has a peak prevalence in children between which two age groups? a. 0-3 months b. 12-24 months c. 24-36 months d. 5-10 years e. puberty

b, e

what are ways to diagnosis hirschsrpung disease

barium enema may reveal intestinal narrowing rectal suction biopsy will demonstrate an absence of ganglion cells

why is it difficult to examine an infants abdomen when pyloric stenosis is suspected?

bc of the infants extreme irritability a pacifier or nipple dipped in glucose water may soothe the infant long enough to perform the abdominal examination

why do girls most commonly have UTIs

bc the females have shorter urthetra which allows bacteria to have access to the bladder the urethra is also located quiet close to the vagina and anus in females allowing spread of bacteria from those areas

complete fracture

bone breaks in two pieces

A 7-year-old child with cerebral palsy has been admitted to the hospital. Which information is most important for the nurse to obtain in the history? a. Age that the child learned to walk b. Parents' expectations of the child's development c. Functional status related to eating and mobility d. Birth history to identify cause of cerebral palsy

c

The nurse is caring for a child with cerebral palsy who requires a wheelchair to attain mobility. Which intervention would help the child achieve a sense of normality? a. Encourage follow-through with physical therapy exercises. b. Restrict the child to a special needs classroom. c. Encourage after-school activities within the limits of the child's abilities. d.Ensure the school is aware of the child's capabilities.

c

a child has maintained the 5th percentile for height and 50th percentile for weight at 2 month through 18 month visit. how would you describe the child's growth? a. failure to thrive b. average growth c. short height, average weight d. average height, underweight

c

the nurse is caring for a child admitted with acute glomerulonephritis. which clinical manifestation would likely have been noted in the child with this diagnosis? a. loose dark stools b. strawberry red tongue c. tea colored urine d. jaundice

c

a pt with hemophilia if bleeding or injury occurs what will be prescribed?

factor administration which will return the clotting factors to a normal level for a period of time factor replacement should be given before any surgeries or other procedures that can lead to bleeding such as IM injection and dental care

pelvic inflammatory disease can?

cause sterility in the female primarily by causing scarring in the fallopian tubes that prohibits the passage of the fertilized ovum into the uterus

A term used to describe a range of nonspecific clinical symptoms characterized by abnormal motor pattern and postures caused by nonprogressive abnormal brain function.

cerebral palsy

___ is a disorder caused by abnormal development or damage to, the motor areas of the brain, resulting in neurologic lesions. It is difficult to establish an exact location of the neurologic lesion but it causes a disruption in the brain's ability to control movement and posture.

cerebral palsy

fractures occur frequently in?

children and adolescent

encopresis is often seen as a result of?

chronic constipation and withholding of stool as stool is withheld in the rectum, the rectal muscle can stretch over time and this stretching of the rectum causes fecal impactions

the newborn with hypospadias should not undergo ___ until after the repair of the urethral meatus.

circumcision in some extreme cases the may need to use some of the excess foreskin while reconstructing the meatus

appendicitis is due to a?

closed loop obstruction of the appendix it is thought that the obstruction is due to fecal material impacted into the relatively narrow appendix this causes a increase in the intraluminal pressure resulting in mucosal edema, bacterial overgrowth and eventual perforation due to fecal material in the appendix, perforation causes inflammatory fluid and bacterial contents to leak into the abdominal cavity resulting in peritonitis

children with nephrotic syndrome are at an increased risk for?

clotting (thromboembolism) bc of the decresased intravascular volume development of serious infection such as: pneumococcal pneumonia sepsis spontaneous peritonitis

buckle fracture

compressions injury; the bone buckles rather than breaks

as stool passes through the colon, water is reabsorbed into the colon, resulting in a formed stool by the time it reaches the rectum. At this point, the anal spinchter relaxes to allow the passage of stool from the anus. In ____ the relaxation does not occur

constipation

what are some risk factors iron deficiency anemia

cows milk consumption before 12 months maternal anemia during pregnancy prematurity low birth weight infant consumption of low iron formula

A child needs to collect urine for 24 hours. The nurse explains to the parents and child that this test assesses glomerular filtration rate and how the kidneys are functioning. What results would be expected in this type of test?

creatinine clearance

inflammatory bowel disease

crohns disease and ulcerative colitis causes are unknown may be due to abnormal or unctonrolled genetically determined immunologic or inflammatory response to an environmental antigenic trigger possibly a virus or bacterium

when is surgical correction for scoliosis indicated?

curves greater than 45 degrees it is achieved with rod placement and bone grafting

A boy with Duchenne muscular dystrophy is admitted to the pediatric unit. He has an ineffective cough. Lung auscultation reveals diminished breath sounds. What is the priority nursing intervention? a. Apply supplemental oxygen. b. Notify the respiratory therapist. c. Monitor pulse oximetry. d. Position for adequate airway clearance.

d

The nurse is caring for orthopedic children who are in the postoperative period following spinal fusion. What is the most appropriate activity to delegate to unlicensed assistive personnel? a. Ambulate the children twice daily to promote mobility. b. Encourage commode use to promote bowel function. c. Provide diversionary activities, as the children must stay flat on their backs. d. Assist with log-rolling the children every 2 hours.

d

the nurse is providing education to the parents of a child diagnosed with VUR. which would be included in the parental education? a. this occur only when there is an obstruction of the uteropelvic junction b. this is diagnosed by abdominal x-ray c. this is typically treated with a kidney transplant d. this occurs when there is back flow of urine into the bladder and sometimes the kidneys

d

anemia may result from?

decreased production of RBC or loss and destruction of RBCs

in children acute renal failure most commonly occurs as a result of?

decreased renal perfusion as occurs in hypovolemic and septic shock

constipation

defined as failure to achieve complete evacuation of the lower colon

nursing care for hirschsprung disease

depending on extent of the disease the child may require colostomy or ileostomy the nurse should perform ostomy care and measure stool output s/s of enterocolitis which is a possible complication if enterocolitis is suspected immediately notify the HCP, maintain bowel rest and administer IV fluids and antibiotics to prevent the development of shock and possibly death

nursing assessment of a child with aplastic anemia

determine history of exposure to myelosupppresive medications or radiation therapy obtain a family, environmental, and infectious disease history may lead to HA and fatigue on physical exam note ecchymoses, petechiae, or purport, oral ulceration, tachycardia, or tachypnea

when acute renal failure continues to progress it becomes chronic also known as end stage renal disease ___ and ___ are treatment modalities used for ESRD.

dialysis and kidney transplantation

secondary amenorrhea can be the result of?

discontinuing contraceptives, a sign of pregnancy, the result of physical or emotional stress, or a symptom of and underlying medical condition

clinical findings of hirschsprung disease

distended abdomen often no stool is present in the rectum the nurse should perform a rectal exam to assess the presence typically a child with this disease will have forceful expulsion of fecal material when a finger is withdrawn intestinal narrowing

the process of GER occurs

during episodes of transient relaxation of the lower esophageal spinchter, which can occur during swallowing, crying or other valsalva maneuvers that increase intra abdominal pressure -delayed esophageal clearance and gastric emptying -highly acidic gastric contents -hiatal hernia -neurologic disease may also contribute to the reflux

nursing care for GERD

elevate the HOB and keeping the infant or child upright for 30 min after feeding smaller more frequent feedings thickening of the formula with products such as rice or oatmeal cereal can significantly help keep the formula and gastric contents down

A school nurse is trying to prevent poststreptococcal glomerulonephritis in children. What would be the best way to prevent this?

encourage the child to take all the antibiotics if diagnosed with strep throat

nursing management for dietary interventions of the child with iron deficiency anemia

ensure that iron defieict infants are fed only formula fortified with iron breast fed infants include beginning iron supplementation around the age of 4 or 5 months

yegg-calve perthes disease the etiology is unknown, but interruption of the blood supply to the?

femoral head results in bone death, and the spherical shape of the femoral may be lost swelling of the soft tissues around the hip may occur as new blood vessels develop, the area is supplied with circulation, allowing bone resorption and deposition to take place during this period of revascularization which takes 18 to 24 months the bone is soft and more likely to fracture overtime the femoral head reforms

s/s of enterocolitis (complication of Hirschsprung disease)

fever abdominal distention chronic diarrhea explosive stools rectal bleeding or straining

treatment for vaso-occlusive episodes of SCA

focuses on pain control oxygen admin is necessary during episodes of crisis to prevent further sickling adequate hydration with IV fluids close monitoring of Hgb, Hct, and reticulocytes

when is a brace used for scoliosis and how is chosen?

for curves of 25 to 45 degrees bracing may be sufficient to decrease progression fo the curve the choice of the brace will depend on the location and severity of the curve

in ducheene muscular dystrophy the absence of dystrophin leads to?

generalized weakness of voluntary muscles and the weakness progresses over time the hips, thighs, pelvic, and shoulders are affected initially as the disease progresses all voluntary muscles as well as cardiac and respiratory are affected

type 2 SMA werdnig-hoffman disease (less than 6 months of age onset) s/s

generalized weakness; cannot sit without support weak cry difficulty sucking, swallowing, and breathing

In 1879, neurologist Sir William Richard Gowers described the most significant ________ sign as the characteristic patterns observed in patients with Duchenne muscular dystrophy wherein they 'climb up' their thighs with the aid of their hands to overcome the weakness of their pelvic and proximal lower limb muscles.

gower's

VUR is graded according to its severity, grade 1 which is characterized by? to grade 4 which is characterized by?

grade 1 is minor dilation of the proximal ureter grade 4 is severe dilation of the ureter and pelvic of the kidneys

The nurse is caring for a child on a pediatric unit who has hemodialysis three times per week due to renal failure. On the days between dialysis treatment, which meal would be acceptable for the child?

grilled chicken, apple slices, and flavored water

The nurse is assessing a hospitalized child diagnosed with nephrotic syndrome. What set of assessments is most important for the nurse to complete to help identify hypoalbuminemia in this child?

heart rate and blood pressure

anemia caused by the alteration or destruction of the RBCs is termed?

hemolytic anemia

___ is very important in the treatment of sickle cell disease, promote hemodilution and circulation of red cells through blood vessels.

hydration

The nurse is caring for a child diagnosed with hydronephrosis. Which manifestation is consistent with complications of the disorder?

hypertension

fluid overload from acute renal failure may lead too?

hypertension pulmonary edema congestive HF hyperkalemia metabolic acidosis hyperphosphatemia uremia

___ scoliosis with majority of cases occurring during adolescence is the most common scoliosis.

idiopathic

teaching post op hypospadias

if the child is being discharged with a urinary catheter teach the parents how to care for the catheter and drainage system have parents demonstrate the ability to irrigate the catheter should a mucus plug occur tub baths are generally prohibited until it is time to remove the penile dressing roughhousing ride on toys or any activity involving straddling is not allowed for 4 week

protein loss in nephrotic syndrome tends to be albumin. Hypoalbuminenmia results in?

in a change in osmotic pressure and fluid shifts from the bloodstream into the interstitial tissue (causing edema) this decrease in blood volume triggers the kidneys to respond by conserving sodium and water leading to further edema the liver sense the protein loss and increases production (hyperlipidemia develops)

greenstick fracture

incomplete fracture of the bone

nephrotic syndrome occurs as a result of?

increased glomerular basement membrane permeability which allows abnormal loss of protein in the urine occurs in 3 forms 1. congenital 2. idiopathic 3. secondary

patho behind nephrotic syndrome

increased glomerular permeability results in the passage of larger plasma proteins this results in excess loss of protein (albumin) in the urine (proteinuria) and decreased protein and albumin (hypoalbuminemia) in the bloodstream

dyskinetic cerebral palsy (abnormal involuntary movements) s/s

infant is limp and flaccid uncontrolled, slow, worm like writhing or twisting movements affects all four extremities and possible involvement of face, neck and tongue movements increase during periods of stress dysarthria and drooling may be present

UTI presents differently in infants than it does in children infants may exhibit? children may exhibit?

infant: fever irritability vomiting failure to thrive jaundice children: fever vomiting dysuria frequency hesitancy urgency pain

what is a pavlik harness used for?

infants with DDH younger than 6 months may be treated with this it reduces and stabilizes the hip by preventing hip extension and adduction and maintaining the hip in flexion and abduction

risk factors for diarrhea

ingestion of undercooked meats foreign travel day care attendance well water use

in chronic SCFE the pain is usually

insidious onset of pain and limp

When assessing a child with hydronephrosis, what would the nurse expect to find? Select all that apply.

intermittent hematuria abdominal mass

anemia related to nutritional deficiency includes?

iron defieicny folic acid deficiency pernicious anemia

clef lip and palate

is the most common congenital craneofacial anomaly it occurs early in pregnancy the tissue that forms the lip ordinarily fuses by 5 to 6 weeks of gestation and the palate closes between 7 and 9 weeks of gestation therefore if either the lip or palate does not fuse then the infant is born with a cleft

etiology of SCFE

is unknown but it thought that during the teenage growth spurt the femoral growth plate weakens and become less resistant to stressors hormonal alterations during this period may also play a role

hemophilia is classified according to the severity of the disease ranging from mild to severe. the more severe the disease the more likely ?

it is that there will be bleeding episodes when bleeding occurs, the vessels constrict and a platelet plug forms, but because of the deficient factor the fibrin will not solidify, and thus bleeding continues

the loss of production of RBCs can be due to?

lack of dietary intake of the nutrients needed to produce the cells alterations in cell structure malfunctioning tissue (bone marrow)

anemia may also results from toxin exposure (______ poisoning) or as an adverse reaction to a medication known as?

lead poisoning, aplastic anemia

The nurse is concerned about the pediatric client's immune system after taking corticosteroids. Which laboratory study is the nurse most correct to assess?

leukocyte count

type 1 SMA( prenatal onset) s/s

loss of or decreased fetal movement later in pregnancy at birth severe hypotonia joint contractures may be present

management of IBD

medication is used to control inflammation and symptoms (aminosalicylates, antibiotics, immunomodulations, immumnosuppresives, and anti-tumor necrosis antibody therapy) failure to respond to medication therapy may result in surgical intervention ulcerative colitis they get a total protocolectomy with resulting ostomy crohns disease they get surgery to relieve obstruction, drain abscess or relieve intractable symptoms

causes of aplastic anemia

most cases are acquired thought to be an immune mediated response environmental toxins, viruses, myelosuppresive drugs, or radiation

spastic cerebral palsy s/s

most common form poor control of posture, balance and movement exaggeration of deep tendon reflexes hypertonicity of affected extremities continuation of primitive reflexes in some children failure to progress to protective reflexes

cerebral palsy

most common movement disorder of childhood is a term used to describe a range of nonspecific clinical symptoms characterized by abnormal motor patterns and postures caused by non progressive abnormal brain function most children will develop symptoms in infancy or early childhood

treatment for UTI

mostly treated with either oral or IV antibiotics urine culture and sensitivity determines the appropriate antibiotic a 7 to 14 day course is usually prescribed adequate fluid intake to flush the bacteria from the bladder

primary signs of cerebral palsy

motor impairments such as spasticity muscle weakness ataxia (lack of coordination of muscle movements during involuntary movements such as walking or picking up objects)

Which condition is a risk factor for the development of pelvic inflammatory disease (PID)?

multiple sexual partners

is supplemental iron given to children with sickle cell anemia?

no bc the anemia is not caused by iron deficiency folic acid is given orally to stimulate RBC synthesis

risk factors for SCFE

obesity age 9 to 16 yrs african American or polynesia sedentary lifestyle rapid growth spurt male gender

nursing interventions for SCFE

observe ambulation, noting trendelenbrug gait assess for pain that is in the hip or that is referred to groin, medial thighs or knee note decreased ROM in the affected hip with external rotation enforce bed rest and activity restriction teach the family about weight bearing is usually resumed about one week after the surgery

physical exam of a pt with iron deficiency anemia should consists of?

observe the child for fatigue or lethargy inspect the skin for pallor note spooning of the nails evaluate the HR for tachycardia auscultate the heart for a flow murmur palpate the abdomen for splenomegaly

normally both testes will descend prior to birth. In the event this does not happen the child will be?

observed for the first 6 months of life

What are two tests to check for DDH?

ortolani and barlow

The nurse is caring for the parents of a newborn who has an undescended testicle. Which comment by the parents indicates understanding of the condition?

our son's condition may resolve on its own

s/s of anemia

pallor fatigue irritability

what causes intussusception

pathologic point such as: meckel diverticulum duplication cysts, polyps, hemangioma, tumors, or the appendix

the ___ is successful in the treatment of DDH in majority of the infants younger than 6 months of age if it is used on a full time basis and applied properly.

pavlik harness

ataxic cerebral palsy (affects balance and depth perception) s/s

poor coordination unsteady gait wide based gait motor milestones and language skills delayed

A parent asks the nurse, "What is precocious puberty?" The nurse's response should be based on which statement?

precocious puberty is early sexual development

the goal of therapeutic management of VUR is?

prevention of pyelonephritis and subsequent renal scarring which may contribute to the development of HTN later in life

teaching points to prevent bleeding in the child with hemophilia

protect the toddler with soft helmets, padding on the knees, carpets in the home, and softened or covered corners children should stay active: swimming, baseball, basketball, and bicycling avoid intense contact sports such as football, wrestling, soccer avoid trampoline use and riding all terrain vehicles

the vast majority of childhood fractures would heal well with splinting only but casting of these fractures is performed to?

provide further comfort to the child and to allow for increasing activity while the fracture is healing and to allow for increases activity while the fracture is healing

nursing care for appendicitis

provide pre and post op care and child and family education a non ruptured, non gangrenous appendix usually requires no antibiotic therapy so provide routine postsrugical care suppurative or gangrenous (non perforated) appendix administer 48 to 72 hours of ordered antibiotics to decrease the risk of postoperative infection the child with perforated appendix may require 7 to 14 days of IV antibiotic therapy provide family teaching bc the child is often discharged home while still receiving IV antibiotic therapy

type 2 SMA (6-18 months of age onset) s/s

proximal muscles are more affected; that is, thighs are weaker than lower legs, legs tend to be weaker than arms respiratory muscle may be involved scoliosis may occur

untreated bladder infection may allow reflux of infected urine up the ureters to the kidneys and result in?

pyelonephritis a more serious infection

if the nurse can palpate a hard, moveable, "olive" mass in the RUQ what might this signify?

pyloric stenosis

grade 1 and 2 VUR usually resolve spontaneously but grade 3 and 4 are associated with?

recurrent UTIs hydronephrosis progressive renal damage

s/s of GERD

recurrent vomiting or regurgitation weight loss or poor weight gain hoarseness/sore throat heartburn or chest pain abdominal pain dysphagia poor dentition caused by acid erosion chronic cough, wheezing, stridor, asthma, apnea

development dysplasia of the hip

refers to abnormalities of the developing hip that include dislocation, subluxation and dysplasia of the hip joint

vertical transmission of HIV

refers to perinatal in utero or during birth transmission or via breast milk may also be referred to as mother to child transmission

horizontal transmission of HIV

refers to transmission via non sterile needles (as in intravenous drug use or tattooing or via intimate sexual contact

GERD

reflux of gastric contents back into the esophagus or oropharynx

in pts with sickle cell anemia how does pain result?

results as circulation is decreased to the area also can occur in any part of the body but is most common in joints causes increased metabolic need by resulting in tachycardia and sometimes tachypnea which leads to further sickling

nursing management for aplastic anemia

safety is the biggest concern with aplastic anemia it is important to prevent injury in order to avoid hemorrhage stool softeners may be used to prevent anal fissures associated with constipation

there are several types of hemolytic anemia which are?

sick cell disease and thalassemia

plastic or bowing deformity

significant bending without breaking of the bone

__ is an application of a pulling force on an extremity or body part. Used to minimize or prevent trauma to the spinal cord; fracture reduces ion, dislocations, correction of deformities.

skeletal or cervical traction

A genetic motor neuron disease that affects the spinal nerves' ability to communicate with the muscles. It is inherited via an autosomal recessive mechanism.

spinal muscular atrophy

This condition occurs when a parent or sibling inadvertently injures a child while pulling their arm causing the ligament surrounding the radial head to stretch, displacing the radial head, causing the ligament to become trapped in the joint.

subluxation of the radial head nursemaids elbow

in acute SCFE the pain is usually

sudden in onset and results in inability to bear weight

s/s of intussusception

sudden onset of intermittent, cramps abdominal pain severe pain (children usually draw up their knees and scream) vomiting diarrhea currant-jelly stools, gross blood, hemoccult-positive stools lethargy sausage shaped mass in the upper mid abdomen

treatment for appendicitis

surgical emergency accomplished via a minimally invasive laparoscopic technique

type 4 SMA (age not strictly defined, typically greater than 30 years of age) s/s

symptoms are mild, all motor milestones achieved ambulation maintained

nephrotic syndrome may occur secondary to another condition such as?

systemic lupus erythematosus henoch-schonlein Purpura diabetes

An adolescent girl and her caregiver present at the pediatrician's office. The adolescent reports severe abdominal pain. A diagnosis of pelvic inflammatory disease (PID) is made. The nurse notes in the child's chart that this is the third time she has been treated for PID. The most appropriate action by the nurse would be to:

take the child to a private room and interview her regarding her sexual history and partners

The nurse is caring for a child admitted with acute glomerulonephritis. Which clinical manifestation would likely have been noted in the child with this diagnosis?

tea colored urine

if a child has to take iron supplements what are some teaching points

teach parents to precisely measures the amount of iron to be administered parents should place the liquid behind the teeth as the iron in liquid can stain the teeth can also cause constipation may need stool softeners increase their child's fluid intake and adequate dietary fiber to avoid constipation

The nurse is caring for a 5-month-old boy with an undescended left testis. What would the nurse identify as indicative of true cryptorchidism?

testis cannot be milked down inguinal canal

iron deficiency anemia occurs when?

the body does not have enough iron to produce Hgb

if hypospadias is left untreated what can occur?

the boy may not be capable of appropriately aiming a urinary stream from a standing position may result in erectile dysfunction or interference with the deposition of sperm during intercourse, leaving the man infertile

A pediatric client is scheduled for an intravenous pyelogram (IVP) of the kidney this afternoon. Which of the following situations would require immediate attention by the nurse?

the child does not have intravenous access

nursing management of a child with iron deficiency promoting safety

the child is at risk for changes in neurologic functioning related to decreased oxygen supply to the brain which can lead to fatigue and inability to eat enough walking, sitting, standing may be impaired provide close observation of the anemic child assists the older child with ambulation educate the parents on how to protect the child from injury

The nurse is collecting data for a child diagnosed with acute glomerulonephritis. What would the nurse likely find in this child's history?

the child recently had an ear infection

hypertrophic pyloric stenosis

the circular muscles of the pyrlourous become hypertrophied causing thickness in the luminal side of the pyloric canal this thickness creates a gastric outlet obstruction causing non bilious vomiting that presents between weeks 3 and 6 of life

Which goal of therapy would be appropriate for a nurse to establish with a client's family and a client who has a diagnosis of enuresis?

the client remains continent throughout the night

the s/s of GERD are often seen as a result of?

the damaging components of the refluxate (the pH of gastric contents, bile acids, and pepsin) the longer the pH of refluxate is below 4, the higher the suspicion of GERD

GER occur frequently during?

the first year of life and is considered benign and usually resolves by 12 to 18 months of age common in premature infants

path behind ducheene muscular dystrophy

the gene mutation results in the absence of dystrophin, a protein that is critical for maintenance of muscle cells the gene is X-linked recessive, meaning that mainly boys are affected and they receive the gene from their mothers (woman are carriers but have no symptoms)

A nurse is conducting a discussion group with parents of children who have genitourinary disorders. As part of the discussion, the nurse reviews the major functions of the kidneys. The nurse determines that the teaching was successful based on which statement by the group?

the kidneys help control BP, so our child's blood pressure needs to be checked often

hypospadias occurs when

the mental opening is on the ventral surface of the penis rather than at the end of the penis the newborn with this condition is not circumcisded at birth bc the excess skin may be needed to reconstruct the meatus during surgical repair

ducheenne muscular dystrophy

the most common neuromuscular disorder of childhood, results in shortened life expectancy

by the age 3 the average number of voids per day is?

the same as an adult 3 to 8

who is at most risk for UTI

the sexually active female adolescent bc bacteria may be forced into the urethra by pressure from intercourse

in sickle cell anemia as the cells sick, the blood becomes more viscous because?

the sickled cells clump together and prevent normal blood flow to the tissues of that area the sickle shaped RBCs cannot pass through the smaller capillaries and venues of the circulatory system this vaso-occlusive process leads to local tissue hypoxia followed by ischemia and may result infarction

medical management of nephrotic syndrome usually involves?

the use of corticosteroids IV albumin may be used in severely edematous child diuretics may also be required in the edematous phase

treatment for duchenne muscular dystrophy

there is no cure the use of corticosteroids may slow the progression of the disease it is thought that prednisone helps by protecting muscle fibers from damage to the sarcolemma

difference of kidneys in an infant?

they are less able to concentrate urine and reabsorb amino acids, placing the infant and young toddler at increased risk for dehydration during times when fluid loss or decreased fluid intake occurs

A nurse is providing education to parents of a child diagnosed with vesicoureteral reflux (VUR). Which would be included in the parental education?

this occurs when there is back flow of urine into the bladder and sometimes the kidneys

the goal of therapeutic management for DDH is?

to maintain the hip joint in reduce so that the femoral head and acetabulum can develop properly

the primary goal of managing hemophilia is?

to prevent bleeding this is best accomplished by instructing the child to avoid activities with a high potential for injury (football, riding, skateboarding) encourage activity with the least contact (running, swimming)

after an infant had surgery for hypospadias double diapering is used for?

to protect the urethra and stent or catheter after surgery it also helps keep the area clean and free from infection the inner diaper contains stool and the outer diaper contain urine allowing the separation between the bowel and bladder output

most cases of intussusceptions occur in what age group?

toddlers 1 to 2 years of age

RBC function

transport oxygen from the lungs to the tissues

hypospadias is a?

urethral defect in which the opening is on the ventral surface of the penis rather than at the end of the penis

other factors that contribute to the development of a UTI

urinary stasis which allows bacteria to grow rapidly decreased fluid intake bc the bacteria become more concentrated if the urine is alkaline bacteria are able to flourish

bladder capacity of an infant

usually 30mL

since most cases of diarrhea are acute and viral in nature, therapeutic management of diarrhea is?

usually supportive maintaining fluid balance and nutrition probiotic supplementation may be useful in prevention of diarrhea but have not been shown to be effective in its treatment

complications of sickle cell anemia include

vaso-occlusive pain crises stroke sepsis ACS spleen sequestration reduced visual acuity related to decreased retinal blood flow chronic leg ulcers cholestasis and gallstones delayed growth and development

A nurse has just admitted a client with symptoms of vulva inflammation, pain, odor, and pruritus. Based on these findings, the nurse could conclude that this client will be diagnosed with which condition?

vulvovaginitis

as Hgb levels decrease the oxygen carrying capacity of the blood is decreased, resulting in ?

weakness and fatigue

type 3 SMA kugelberg-welander disease (after 18 months of age; child has started walking or has taken at least five independent steps) s/s

weaknesss that is most severe in the shoulders, hips, thighs, and upper back respiratory muscles may be involved scoliosis may occur

In caring for a child with nephrotic syndrome, which intervention will be included in the child's plan of care?

weighing on the same scale each day

The nurse is caring for a 2-year-old girl with suspected vulvovaginitis. The nurse suspects the cause as Candida albicans based on which finding?

white cottage cheese-like discharge

inheritance of duchenne

x-linked recessive affects only males

are fractures in a newborn suspicious?

yes unless there was birthing trauma fractures are very unusually in children who cannot yet walk