Pediatric Exam #3

Nursing care management: -Major nursing responsibilities in anaphylaxis include anticipating which children are likely to develop a reaction, recognizing the early signs, and intervening appropriately. -If the child is not breathing, CPR is initiated and emergency medical services are summoned. If the cause can be determined, measures are implemented to slow the spread of the offending substance. An IV infusion is established immediately. 0Emergency medications are given intravenously whenever possible; however, epinephrine may be given intramuscularly. NURSING ALERT: Epinephrine -Intramuscular administration of epinephrine (0.01 mg/kg up to 0.3 mg) is the first line of therapy, and administration should never be delayed. -As in any shock state, the airway is the first concern, followed by assessment of breathing and then circulation (ABCs).

What is Anaphylaxis?

ASD is an abnormal opening between the right and left atria that causes an increased flow of oxygenated blood into the right side of the heart. -Right atrial and ventricular enlargement occurs. -Infant may be asymptomatic or may develop HF -Manifestations of decreased cardiac output may be present. Management: -Defect may be closed during a cardiac catheterization -Open repair with cardiopulmonary bypass may be performed and usually is performed before school age.

What is Atrial Septal Defect?

Description: -Cryptorchidism is a condition in which one or both testes fail to descend through the inguinal canal into the scrotal sac. Assessment: -Testes are not palpable or easily guided into the scrotum. Interventions: -Monitor during the first 6 months of life to determine whether spontaneous descent occurs. -Surgical correction is commonly done at 6 months of age and before 12 months, depending on the pediatric surgeon's preference.

What is Cryptorchidism?

-Usually diagnose Type 1 between 10-12 years of age Diet: -Instruct children and parents to carry a source of glucose, such as glucose tablets, with them at all times to treat hypoglycemia if it occurs. -Incorporate the diet into the individual child's needs, likes and dislikes, lifestyle, and cultural and socioeconomic patterns.

What is Diabetes Mellitus and the diet recommended?

Description: -Gradual progressive degeneration of muscle fibers resulting in wasting and weakness Respiratory failure is common cause of death Treatment is supportive: -Airway maintenance -Ventilator support -Orthopedic procedures for deformities Primary goal: Maintain function in unaffected muscles as long as possible Characteristics: -Onset between ages 3 and 7 years -Manifestations: Progressive muscle weakness, wasting, and contractures -Hypertrophic (LARGE; tip-toe walk) calf muscles in most patients -Progressive generalized weakness in adolescence -Death from respiratory or cardiac failure Genetic counseling for family Teach child self-help skills (at appropriate level, assistive devices w/ occupational therapy to help dress; wheelchair)

What is Duchenne Muscular Dystrophy?

Screen 9-11 years of age and then again 17-21 years old Statin therapy: give in the evening -Side effects of statins: muscle cramps -Lifestyle Interventions: chicken, fish, veggies whole grains, exercise, physical activity

What is Hyperlipidemia?

Blood glucose level of less than 70 mg/dL -Results from too much insulin, not enough food, or excessive activity. S/S: headache, nausea, sweating, tremors, lethargy, hunger, confusion, slurred speech, tingling around mouth, and anxiety Interventions: -Administer glucose immediately (such as ½ cup of fruit juice or other acceptable item); rapid-releasing glucose is followed by a complex carbohydrate and protein, such as a slice of bread or a peanut butter cracker. -If the child becomes unconscious, squeeze cake frosting or glucose paste onto the gums and retest the blood glucose level in 15 minutes (monitor the child closely); if the reading remains low, administer additional glucose. -If the child remains unconscious, the administration of glucagon may be necessary. -In the hospital, prepare to administer dextrose intravenously if the child is unable to consume an oral glucose product. Food Items to Treat Hypoglycemia: -½ cup of orange juice or sugar-sweetened carbonated bey-erage -8 oz of milk -1 small box of raisins -3 or 4 hard candies -4 sugar cubes (1 Tbsp of sugar) -3 or 4 Life Savers candies -1 candy bar -1 tsp honey -2 or 3 glucose tablets -Regular cola -Fruit snacks

What is Hypoglycemia?

Assessment: Increased ICP: WARNING: The child's level of consciousness provides the earliest indication of an improvement or deterioration of the neurological condition. -Common causes: trauma, bleeding, infections (bacterial meningitis) Early signs: a.) Slight change in vital signs b.) Slight change in level of consciousness c.) Infant: Irritability, high-pitched cry, bulging fontanel, increased head circumference, dilated scalp veins, Macewen's sign (cracked-. pot sound on percussion of the head), setting sun sign (Drooping of the eyelids) (sclera visible above the iris) d.) Child: Headache (upon awakening), nausea, Forceful (projectile) vomiting, visual disturbances (diplopia), seizures WARNING: immobilize the neck and spine after a head injury if a cervical or other spinal injury is suspected. When a spinal cord injury is ruled out, elevate the head of the bed, to 30 degrees, if not contraindicated and as prescribed to facilitate venous drainage. Interventions: -Keep stimuli to a minimum; attempt to minimize crying in an infant. -Initiate seizure precautions -Monitor prescribed in venous fluids carefully to avoid increasing any cerebral edema and to minimize the possibility of overhydration. -Assess wounds and dressings for the presence of drainage, and monitor for nose or ear drainage, which could indicate leakage of cerebrospinal fluid (CSF). -Avoid suctioning through the nares because of the possibility of the catheter entering the brain through a fracture, which places the child at high risk for a secondary infection. -strict I&O's -monitor for aspiration -neuro checks -don't blow nose; no sneezing Medications: antibiotics, corticosteroids, antiepileptics (lorazepam, ativan), Barbiturates (controversial), Paralytic agents (safety checks are so important) WARNING: Drainage from the nose or ear needs to be tested for the presence of glucose. Drainage that is positive for glucose (as tested with reagent strips) indicates leakage of CSF. The PHCP must be notified immediately if the drainage tests positive for glucose.

What is ICP?

(e.g., Lantus) -Takes 6-14 h to start working. -It has no peak or a very small peak 10-16 h after injection. -The insulin stays in the blood between 20 and 24 h.

What is Long-acting insulin?

Assessment: -Depend on location and stage -Firm, nontender, irregular mass in the abdomen -Neurological impairment -Respiratory obstruction -Paralysis -Periorbital edema -Exophthalmos -Supraorbital ecchymosis Interventions: -Chemotherapy and radiation -Surgery to remove as much as possible -Irradiation postoperatively

What is Neuroblastoma?

(e.g., NovoLog) -Reaches the blood within 15 min after injection. -The insulin peaks 30-90 min later and may last as long as 5 h.

What is Rapid-acting insulin?

Description: 1.) Wilms' tumor is the most common intra abdominal and kidney tumor of childhood; it may manifest unilaterally and localized or bilaterally, sometimes with metastasis to other organs. 2.) The peak incidence is 3 years of age. 3.) Occurrence is associated with a genetic inheritance and with several congenital anomalies. 4.) Therapeutic management includes a combined treatment of surgery (partial to total nephrectomy) and chemotherapy with or without radiation, depending on the clinical stage and the histological pattern of the tumor. Assessment: 1.) Swelling or mass within the abdomen (mass is characteristically firm, nontender, confined to one side, and deep within the flank) 2.) Urinary retention or hematuria, or both 3.) Anemia (caused by hemorrhage within the tumor) 4.) Pallor, anorexia, and lethargy (resulting from anemia) 5.) Hypertension (caused by secretion of excess amounts of renin by the tumor) 6.) Weight loss and fever 7.) Symptoms of lung involvement such as dyspnea, shortness of breath, and pain in the chest, metastasis has occurred Preoperative interventions: 1.) Monitor vital signs, particularly blood pressure. 2.) Avoid palpation of the abdomen; place a sign a bedside that reads "Do Not Palpate Abdomen" 3.) Measure abdominal girth at least once daily. Postoperative interventions: 1.) Monitor temperature and blood pressure closely. 2.) Monitor for signs of hemorrhage and infection. 3.) Monitor strict intake and urine output closely. 4.) Monitor for abdominal distention; monitor bowel sounds and other signs of gastrointestinal activity because of the risk for intestinal obstruction. WARNING: Avoid palpation of the abdomen in a child with Wilms' tumor and be cautious when bathing, moving, or handling the child. It is important to keep the encapsulated tumor intact. Rupture of the tumor can cause the cancer cells to spread throughout the abdomen, lymph system, and bloodstream. PROVIDE SUPPORT TO PARENTS BC WILL EXPERIENCE GUILT AND REGRET

What is Wilms' Tumor?

d.) "Has the child had a sore throat or a throat infection in the last few weeks?"

Which question would the nurse ask the parents of a child suspected of having glomerulonephritis? a.) "Did your child fall off a bike onto the handle-bars?" b.) "Has the child had persistent nausea and vomit-ing?" c.) "Has the child been itching or had a rash anytime in the last week?" d.) "Has the child had a sore throat or a throat infection in the last few weeks?"

c.) Intravenous infusion of factor VIlI

A 10-year-old child with hemophilia A has slipped on the ice and bumped the knee. The nurse would prepare to administer which prescription? a.) Injection of factor X b.) Intravenous infusion of iron c.) Intravenous infusion of factor VIlI d.) Intramuscular injection of iron using the Z-track method

-Only be given if indicated by the serum potassium level and if adequate renal function is evident (Urinating? Needs to be checked before) and is usually necessary when administering a potassium-losing diuretic such as furosemide -Encourage foods that the child will eat that are high in potassium, as appropriate, such as bananas, baked potato skins, peanut butter, and leafy greens.

Administering Potassium Supplements?

d.) Fruity breath odor and decreasing level of consciousness Develops when severe insulin deficiency occurs. Very high Hyperglycemia then occurs and causes these symptoms.

An adolescent client with Type 1 diabetes mellitus is admitted to the ED for treatment of diabetic ketoacidosis. Which assessment findings would the nurse expect to note? a.) Sweating and tremors b.) Hunger and hypertension c.) Cold, clammy skin and irritability d.) Fruity breath odor and decreasing level of consciousness

a.) Cough The most common opportunistic infection is Pneumocystis jiroveci pneumonia, which occurs most frequently between the ages of 3 and 6 months, when HIV status may be indeterminate. Cough is a common sign of this infection

An infant of a birth parent infected with human immunodeficiency virus (HIV) is seen in the clinic each month and is being monitored for symptoms indicative of HIV infection. With knowledge of the most common opportunistic infection of children infected with HIV, the nurse assesses the infant for which sign? a.) Cough b.) Liver failure c.) Watery stool d.) Nuchal rigidity

b.) Reposition the infant frequently. Pressure ulcers can occur on the back and side of the head

An infant with a diagnosis of hydrocephalus is scheduled for surgery. Which is the priority nursing intervention in the preoperative period? a.) Test the urine for protein. b.) Reposition the infant frequently. c.) Provide a stimulating environment. d.) Assess blood pressure every 15 minutes.

c.) Patent ductus arteriosus

Assessment findings of an infant admitted to the hospital reveal a machinery-like murmur on auscultation of the heart and signs of heart failure. The nurse reviews congenital cardiac anomalies and identifies the infant's condition as which disorder? a.) Aortic stenosis b.) Atrial septal defect c.) Patent ductus arteriosus d.) Ventricular septal defect

Discharge Teaching for the Child and Parents: -Remove the dressing on the day after the procedure, and cover the site with an adhesive bandage for a minimum of 2 days. A new bandage would be applied each day -Keep site clean and dry -Avoid tub baths for 2 to 3 days. May shower one day postoperatively -Observe for redness, edema, drainage, bleeding, and fever and report any of these signs immediately -Avoid strenuous activity (First 3 days) -The child may return to school -Avoid crowds, activities where can be hit in the chest -Provide a diet -Administer acetaminophen or ibuprofen for pain, discomfort, or fever -Keep follow-up appointment with the pediatrician

Discharge Teaching for the Child and Parents for a Cardiac Catheterization?

-Monitor for respiratory distress (full 1 minute) -Monitor apical pulse (full 1 minute), and monitor for dysrhythmias -Monitor strict intake and output (Weight diapers as appropriate) -Daily weight same time everyday and edema -Elevate the head of the bed in a semi-Fowler's position -Provide rest and decrease environmental stimuli -Administer cool humidified oxygen as prescribed -Administer medications as prescribed, which may include digoxin, diuretics, and afterload reducers such as angiotensin-converting enzyme (ACE) inhibitors -Restrict sodium for their diet

Interventions for CHF?

Interventions: -Monitor temperature frequently -Assess heart sounds and heart rate and rhythm -Assess extremities for edema, redness, and desquamation -Examine eyes for conjunctivitis -Monitor mucous membranes for inflammation -Monitor strict intake and output -Administer soft foods and liquids that are neither too hot nor too cold -Weigh child daily -Provide passive range-of-motion exercises to facilitate joint movement -Administer acetylsalicylic acid (moderate to high dose) as prescribed for its antipyretic and anti platelet effects (additional anticoagulation may be necessary if aneurysms are present) -Administering immunoglobulin therapy and can give aspirin therapy

Interventions for Kawasaki Disease?

c.) Conjunctival hyperemia

On assessment of a child admitted with a diagnosis of acute-stage Kawasaki disease; the nurse expects to note which clinical manifestation of the acute stage of this disease? a.) Cracked lips b.) Normal appearance c.) Conjunctival hyperemia d.) Desquamation of the skin

(can be caused from using diuretics (Furosemide)) -Muscle weakness and cramping, confusion, irritability, restlessness, and inverted T waves or prominent U waves on the electrocardiogram -Therapeutic Range: 3.5-5.0 mEq/L -If s/s are present and the child is also being administered digoxin, monitor closely for digoxin toxicity, because hypokalemia potentiates digoxin toxicity

S/S Hypokalemia?

Short Term Therapy: -Increased appetite, weight gain, rounding of the face, and behavior changes. Long-term Therapy: -May result in hirsutism, growth retardation, cataracts, hypertension, gastrointestinal bleeding, bone demineralization, infection, and hyperglycemia. -Reduced kidney function -high blood sugar -Bone demineralization (softening) especially for musculoskeletal patients -Rounding of face, hair loss -Gastric bleeding

Side effects of the steroids?

-Crackles and wheezes -Cough -Dyspnea -Grunting (infants) -Head bobbing (infants) -Nasal flaring -Orthopnea -Periods of cyanosis -Retractions -Tachypnea

Signs and symptoms of Left-sided Heart Failure?

-Ascites -Hepatosplenomegaly -Jugular vein distention -Oliguria -Peripheral edema, especially dependent edema, and periorbital edema -Weight gain

Signs and symptoms of Right-sided Heart Failure?

d.) Fluid overload

The clinic nurse instructs parents of a child with sickle cell anemia about the precipitating factors related to sickle cell crisis. Which, if identified by the parents as a precipitating factor, indicates the need for further instruction? a.) Stress b.) Trauma c.) Infection d.) Fluid overload

c.) Activity intolerance

The clinic nurse reviews the record of a child just seen by the pediatrician and diagnosed with suspected aortic stenosis. The nurse expects to note documentation of which clinical manifestation specifically found with this disorder? a.) Pallor b.) Hyperactivity c.) Activity intolerance d.) Gastrointestinal disturbances

d.) Partial thromboplastin time

The nurse analyzes the laboratory results of a chin When hemophilia. The nurse understands that which result will most likely be abnormal in this child? a.) Platelet count b.) Hematocrit level c.) Hemoglobin level d.) Partial thromboplastin time

d.) "I can send my child to day care with a fever as long as it is a low-grade fever."

The nurse provides home care instructions to the parent of a child with acquired immunodeficiency syndrome (AIDS). Which statement by the parent indicates the need for further teaching? a.) "I will wash my hands frequently." b.) "I will keep my child's immunizations up to date." c.) "I will avoid direct unprotected contact with my child's body fluids." d.) "I can send my child to day care with a fever as long as it is a low-grade fever."

c.) "Have the child perform simple isometric exercises during this time."

The parents of a child with juvenile idiopathic arthritis call the clinic nurse because the child is experiencing a painful exacerbation of the disease. The parents ask the nurse if the child can perform range-of-motion exercises at this time. The nurse would make which response? a.) "Avoid all exercise during painful periods." b.) "Range-of-motion exercises must be performed every day." c.) "Have the child perform simple isometric exercises during this time." d.) "Administer additional pain medication before performing range-of-motion exercises."

Acute episodes or cyanosis and hypoxia (hypercyanotic episode), called blue spells or test spells, occur when the infant's oxygen requirements exceed the blood supply, such as during periods of crying, feeding, or defecating -Can also be caused from another cardiac defect; worsening heart failure -TETRALOGY OF FALLOT What to do during a Blue Spell of Tetralogy of Fallot? 1.) Places the infant in a knee-chest position 2.) Administers oxygen 100% as prescribed 3.) Administers morphine sulfate as prescribed 4.) Administering fluids intravenously as prescribed

What are Hypercyanotic spells?

Description: -This central nervous system defect results from failure of the neural tube to close during embryonic development. -Failure of tube to close during embryo's early development (Approx 3-4 weeks after conception) Prevention: women in childbearing years should ingest foods high in folic acid (Dark green leafy vegetables, Beans, Peanuts, Sunflower seeds, Fresh fruits, fruit juices) -Women of childbearing age -Supplementation: Folic acid, 0.4 mg/day = 400 mcg Types: Spina bifida occulta (no sac) benign: -Dimple with a tuft of hair on lower spine -When vertebrae didn't fuse Meningocele: -A protruding sac (visible outside of skin) will see spinal fluid and meninges Myelomeningocele: -Most severe; contains meninges and also nerves ICU, need surgical management (the M's) Interventions: -Need to be in prone position to avoid trauma or injury to sac -Keep clean and avoid fecal or urinary contamination -Cover with sterile moist dressing to prevent tearing of nerves; change as soon as soiled -Measuring head circumference: for pressure (monitoring signs for ICP and all interventions apply besides the normal positioning) -Encourage parental bonding -Monitoring for S/S of infection Latex Allergy: Expected exposure frequency association with some foods and a latex allergy -Bananas, kiwi, avocado, chestnuts

What are Neural Tube Defects?

Mediterranean descent and need blood transfusions

What is Thalassemia?

a.) Limited range of motion in the affected hip

A 1-month-old infant is seen in a clinic and is diagnosed with developmental dysplasia of the hip. On assessment, the nurse understands that which finding would be noted in this condition? a.) Limited range of motion in the affected hip b.) An apparent lengthened femur on the affected side c.) Asymmetrical adduction of the affected hip when the infant is placed supine with the knees and hips flexed d.) Symmetry of the gluteal skinfolds when the infant is placed prone and the legs are extended against the examining table

b.) Bone marrow biopsy showing blast cells

A 4-year-old child is admitted to the hospital for abdominal pain. The parents report that the child has been pale and excessively tired and is bruising easily. On physical examination, lymphadenopathy and hepatosplenomegaly are noted. Diagnostic studies are being performed because acute lymphocytic leukemia is suspected. The nurse determines that which laboratory result confirms the diagnosis? a.) Lumbar puncture showing no blast cells b.) Bone marrow biopsy showing blast cells c.) Platelet count of 350,000 mm° (350 × 10°/L) d.) White blood cell count of 4500 mm» (4.5 * 10°/L)

b.) "I can use lotion or powder around the cast edges to relieve itching." Lotions or powders can become sticky or caked and cause skin irritation

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

d.) Bradycardia

A 5-year-old child arrives at the emergency department, and the child's parents state that the child fell off a bunk bed. A head injury is suspected. The nurse checks the child's airway status and assesses the child for early and late signs of increased intracranial pressure (ICP). Which is a late sign of increased ICP? a.) Nausea b.) Irritability c.) Headache d.) Bradycardia

c.) "I know it must hurt, but if you tell me when it does, I will try to make it hurt a little less."

A 6-year-old child with human immunodeficiency virus (HIV) infection has been admitted to the hospital for pain management. The child asks the nurse if the pain will ever go away. The nurse would make which best response to the child? a.) "The pain will go away if you lie still and let the medicine work." b.) "Try not to think about it. The more you think it hurts, the more it will hurt." c.) "I know it must hurt, but if you tell me when it does, I will try to make it hurt a little less." d.) "Every time it hurts, press on the call button and I will give you something to make the pain go all away."

c.) "The flowers from your garden are beautiful, but cannot be placed in the child's room at this time."

A 6-year-old child with leukemia is hospitalized and is receiving combination chemotherapy. Laboratory results indicate that the child is neutropenic, and protective isolation procedures are initiated. The grandparent of the child visits and brings a fresh bouquet of flowers picked from the garden and asks the nurse for a vase for the flowers. Which response would the nurse provide to the grandparent? a.) "I have a vase in the utility room, and I will get it for you." b.) "I will get the vase and wash it well before you put the flowers in it." c.) "The flowers from your garden are beautiful, but cannot be placed in the child's room at this time." d.) "When you bring the flowers into the room, place them on the bedside stand as far away from the child as possible."

d.) Nighttime (nocturnal) enuresis is usually out grown without therapeutic intervention.

A 7-year-old child is seen in a clinic, and the pediatrician documents a diagnosis of nighttime (nocturnal) enuresis. The nurse would plan to provide which information to the parents? a.) Nighttime (nocturnal) enuresis does not respond to treatment. b.) Nighttime (nocturnal) enuresis is caused by a psychiatric problem. c.) Nighttime (nocturnal) enuresis requires surgical intervention to improve the problem. d.) Nighttime (nocturnal) enuresis is usually out grown without therapeutic intervention.

d.) "Most children infected with HIV develop symptoms within the first 9 months of life, and some become symptomatic sometime before they are 3 years old."

A birthing parent with human immunodeficiency virus (HIV) infection brings a 10-month-old infant to the clinic for a routine checkup. The pediatrician has documented that the infant is asymptomatic for HIV infection. After the checkup the parent tells the nurse about being so pleased that the infant will not get HIV infection. The nurse would make which most appropriate response to the parent? a.) "I am so pleased also that everything has turned out fine." b.) "Because symptoms have not developed, it is unlikely that your infant will develop HIV infection. " c.) "Everything looks great, but be sure to return with your infant next month for the scheduled visit." d.) "Most children infected with HIV develop symptoms within the first 9 months of life, and some become symptomatic sometime before they are 3 years old."

d.) Notify the primary health care provider (PHCP) Could be a sign that the child might be developing compartment syndrome. This is an emergency situation and the PHCP needs to be notified immediately

A child has a right femur fracture caused by a motor vehicle crash and is placed in skin traction temporality until surgery can be performed. During assessment, the nurse notes that the dorsalis pedis pulse is absent on the right foot. Which action would the nurse take? a.) Administer an analgesic b.) Release the skin traction c.) Apply ice to the extremity d.) Notify the primary health care provider (PHCP)

c.) Capillary refill is less than 2 seconds Indicators that fluid volume deficit is resolving would be capillary refill less than 2 seconds, specific gravity of 1.003 to 1.030, urine output of at least 1 mL/kg/hr, and adequate tear production

A child has fluid volume deficit. The nurse performs an assessment and determines that the child is improving and the deficit is resolving if which findings are noted? a.) The child has no tears b.) Urine specific gravity is 1.035 c.) Capillary refill is less than 2 seconds d.) Urine output is less than 1 mL/kg/kr

d.) Providing a quiet atmosphere with dimmed lighting Would decrease the stress on the cerebral tissue and neuron responses.

A child is diagnosed with Reye's syndrome. The nurse creates a nursing care plan for the child and would include which intervention in the plan? a.) Assessing hearing loss b.) Monitoring urine output c.) Changing body position every 2 hours d.) Providing a quiet atmosphere with dimmed lighting

d.) Check the primary health care provider's (PHCP's) prescriptions for the amount of weight to be applied The nurse would maintain the correct amount of weight as prescribed, ensure that the weights hang freely, check the ropes for fraying and ensure that they are on the pulleys appropriately, monitor the neurovascular status of the involved extremity, and monitor for signs and symptoms of complications of immobilization

A child is placed in skeletal traction for treatment of a fractured femur. The nurse creates a plan of care and would include which intervention? a.) Ensure that all ropes are outside the pulleys b.) Ensure that the weights are lightly resting on the floor c.) Restrict diversional and play activities until the child is out of the traction d.) Check the primary health care provider's (PHCP's) prescriptions for the amount of weight to be applied

a.) Notify the surgeon. Because either position can increase ICP and the risk of bleeding. The HOB needs to be elevated. Increasing IV fluids can also increase ICP.

A child undergoes surgical removal of a brain tumor During the postoperative period, the nurse notes that the child is restless, the pulse rate is elevated and the blood pressure has decreased significantly from the baseline value. The nurse suspects that the child is in shock. Which is the most appropriate nursing action? a.) Notify the surgeon. b.) Place the child in a supine position. c.) Place the child in Trendelenburg's position. d.) Increase the flow rate of the intravenous fluids.

d.) Notify the primary health care provider (PHCP). Warns attention because of the possibility of superior mesenteric artery syndrome

A child who has undergone spinal fusion for scoliosis complains of abdominal discomfort and begins to have episodes of vomiting. On further assessment, the nurse notes abdominal distention. On the basis of these findings, the nurse would take which action? a.) Administer an antiemetic. b.) Increase the intravenous fluids. c.) Place the child in a left lateral position. d.) Notify the primary health care provider (PHCP).

d.) Deferoxamine

A child with B-thalassemia is receiving long term blood transfusion therapy for the treatment of the disorder. Chelation therapy is prescribed as a result of too much iron from the transfusions. Which medication would the nurse anticipate being prescribed? a.) Dalteparin b.) Meropenem c.) Metoprolol d.) Deferoxamine

d.) "Did the child have a sore throat or fever within the last two months?" RF characteristically manifest 2 to 6 weeks after an untreated or partially treated group A beta-hemolytic streptococcal infection of the upper respiratory tract.

A child with rheumatic fever will be arriving at the nursing unit for admission. On admission assessment, the nurse would ask the parents which question to elicit assessment information specific to the development of rheumatic fever? a.) "Has the child complained of back pain?" b.) "Has the child complained of headache?" c.) "Has the child had any nausea or vomiting?" d.) "Did the child have a sore throat or fever within the last two months?"

d.) Normal saline infusion Rehydration is the initial step in resolving diabetic ketoacidosis and normal saline is the initial IV rehydration fluid

A child with type 1 diabetes mellitus is brought to the ED by the parents, who state that the child has been complaining of abdominal pain and has been lethargic. Diabetic ketoacidosis is diagnosed. Anticipating the plan of care, the nurse prepares to administer which type of intravenous (IV) infusion? a.) Potassium infusion b.) NPH insulin infusion c.) 5% dextrose infusion d.) Normal saline infusion

d.) The presence of Reed-Sternberg cells in the lymph nodes

A diagnosis of Hodgkin's disease is suspected in a 12-year-old child. Several diagnostic studies are performed to determine the presence of this disease. Which diagnostic test result will confirm the diagnosis of Hodgkin's disease? a.) Elevated vanilly|mandelic acid urinary levels b.) The presence of blast cells in the bone marrow c.) The presence of Epstein-Barr virus in the blood d.) The presence of Reed-Sternberg cells in the lymph nodes

c.) Cloudy CSF, elevated protein, and decreased glucose levels

A lumbar puncture is performed on a child suspected to have bacterial meningitis, and cerebrospinal fluid (CSF) is obtained for analysis. The nurse reviews the results of the CSF analysis and determines that which results would verify the diagnosis? a.) Clear CSE, decreased pressure, and elevated protein level b.) Clear CSE, elevated protein, and decreased glucose levels c.) Cloudy CSF, elevated protein, and decreased glucose levels d.) Cloudy CSE, decreased protein, and decreased glucose levels

d.) When drawing blood for electrolyte level testing

A pediatrician has prescribed oxygen as needed for an infant with HF. Which situation would likely increase the oxygen demand, requiring the nurse to administer oxygen to the infant? a.) During sleep b.) When changing the infant's diapers c.) When a parent is holding the infant d.) When drawing blood for electrolyte level testing

d.) Checks the amount of urine output In hypotonic dehydration, electrolyte loss exceeds water loss. Potassium chloride would never be administered in the presence of oliguria or anuria. If the urine output is less than 1 to 2 mL/kg/hr, potassium chloride would not be administered.

A pediatrician prescribes an intravenous (IV) solution of 5% dextrose and half-normal saline (0.45%) with 40 mEq of potassium chloride for a child with hypotonic dehydration. The nurse performs which priority assessment before administering this IV prescription? a.) Obtains a weight b.) Takes the temperature c.) Takes the blood pressure d.) Checks the amount of urine output

d.) p24 antigen assay This, virus culture of HIV, or polymerase chain reaction is used for infants Western blot = antibodies CD4+ tells how well the immune system is working A chest x-ray evaluates for the presence of other manifestations from HIV, such as pneumonia

A pediatrician prescribes laboratory studies for the infant of a birthing parent positive for human immunodeficiency virus (HIV). The nurse anticipates that which laboratory study will be prescribed for the infant? a.) Chest x-ray b.) Western blot c.) CD4+ cell count d.) p24 antigen assay

d.) Eat a small box of raisins or drink a cup of orange juice before soccer practice

A school-age child with type 1 diabetes mellitus has soccer practice, and the school nurse provides instructions regarding how to prevent hypoglycemia during practice. Which would the school nurse tell the child to do? a.) Eat twice the amount normally eaten at lunch-time b.) Take half the amount of prescribed insulin on practice days c.) Take the prescribed insulin at noontime rather than in the morning d.) Eat a small box of raisins or drink a cup of orange juice before soccer practice

Can lead to: -DVT's; Pneumonia; Pressure Injury; Children played with to stimulate learning (could lead to psychological issues with not being able to get up); Developmental regression Care Management: -Other body systems affected -Neurologic or electrolyte impairments -Skin monitoring and care -DVT prevention -High protein, high-calorie foods -Encourage activity as able -Play therapy -Move child out of room

Care of the Immobilized child?

-Education regarding known carcinogens Prevention: -Breast self-exams, Testicular self-exams, Pap smear, Tanning beds, -Smoking, sunscreen Carcinogens: Education smoking, diet, alcohol, asbestos, pesticides -Genetic Screening Early recognition: -Unexplained Fever and pain common in childhood, leading to easily missed problem -Unexplained loss of energy (Fatigue) -Sudden vision changes -Excessive, rapid weight loss (Anorexia) -Bruising -Pain -H/A especially upon awakening

Cardinal signs of cancer in children: Prevention?

-Administer 1 hour before or 2 hours after feedings -Do not mix medication with foods or fluid -If a dose is missed and more than 4 hours has elapsed, administer the missed dose -If the child vomits, do not administer a second dose -If more than 2 consecutive doses are missed, notify the pediatrician; do not increase or double the dose for missed doses -If the child has teeth, give water after the medication; if possible; brush the teeth to prevent tooth decay from the sweetened liquid -Administering orally with syringe

Home Care Instructions for Administering Digoxin?

Therapeutic management: -Treatment should be instituted immediately and consists of administration of high doses of appropriate antibiotics intravenously for 2 to 8 weeks. -Frequent echocardiograms are done to monitor for vegetations, valve function, and ventricular function. Heart surgery to repair or replace the affected valve may be necessary. Prevention involves: -Administration of prophylactic antibiotic therapy to high-risk patients prior to dental procedures that are associated with the risk of entry of organisms -Drugs of choice for prophylaxis, given 1 hour prior to the procedure, include amoxicillin, ampicillin, and clindamycin in penicillin-allergic patients. Nursing care management: -Early diagnosis and treatment are important in preventing further cardiac damage, embolic complications, and growth of resistant organisms.

How do we treat Bacterial Endocarditis?

d.) Red blood cells that are microcytic and hypochromic

Laboratory studies are performed for a child suspected to have iron-deficiency anemia. The nurse reviews the laboratory results, knowing that which result indicates this type of anemia? a.) Elevated hemoglobin level b.) Decreased reticulocyte count c.) Elevated red blood cell count d.) Red blood cells that are microcytic and hypochromic

Gastrointestinal Tract: Anorexia: -Encourage fluids and foods as best tolerated. -Provide small, frequent meals. -Monitor for weight loss. -Administer appetite stimulants as ordered. Nausea, vomiting: -Administer antiemetics around the clock. -Monitor for dehydration. -Offer foods they enjoy, small frequent feedings Mucosal ulceration: -Provide soothing oral hygiene and prescribed mouth rinses. -Topical anesthetic may be prescribed. -Oral lozenges to keep mouth moist Diarrhea and Constipation: -Administer antispasmodics and antidiarrheal preparations as prescribed. -Monitor for dehydration. -High fiber foods and toilet training for constipation Skin: Alopecia (hair loss): -Introduce the idea of a wig or head wraps to a child. -Provide scalp hygiene. -Stress the need for head covering in cold weather. Dry or moist desquamation: -Keep skin clean. -Wash skin daily, using a mild soap sparingly. -Do not remove skin markings for radiation. -Avoid exposure to the sun and other extreme temperature changes. -For dryness, apply lubricant as prescribed. Urinary Bladder: Cystitis: -Encourage fluid intake and frequent voiding. -Monitor for hematuria. Bone Marrow: Myelosuppression: -Monitor for fever. -Administer antibiotics as prescribed. -Avoid use of suppositories, enemas, and rectal temperatures. -Institute neutropenic or bleeding precautions as needed -Monitor for signs of anemia. Infection—Monitor for septic shock: -Fever absolute neutrophil count lower than 500/mm3 -Can't have flowers, fresh fruits and vegetables -Handwashing, sign on the door -WILL NOT BE GETTING THE LIVE VACCINES (Varicella, MMR)

Managing Side Effects of Radiation and Chemotherapy?

-Follow-up care is essential for recovery S/S: -Irritability that may last for 2 months after the onset of the symptoms -Peeling of the hands and feet -Pain in the joints that may persist for several weeks -Stiffness in the morning, after naps, and in cold temperatures -Record the temperature (because fever is expected) until the child has been afebrile for several days -Notify the pediatrician if the temperature is 101F or higher -Salicylates such as acetylsalicylic acid (ASPIRIN) may be prescribed -The child needs to avoid contact sports, if age appropriate, if taking aspirin or anticoagulants -Avoid administration of measles, mumps, and rubella (MMR) or varicella vaccine to the child for 11 months after intravenous immunoglobulin therapy, if appropriate

Parent Education For Kawasaki Disease?

c.) "I need to bring my infant back to the clinic in 1 month for a new cast." Serial manipulation and casting are performed at least weekly

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

b.) The inactivated influenza vaccine will be given yearly.

The clinic nurse is instructing the parent of a child with human immunodeficiency virus (HIV) infection regarding immunizations. The nurse would provide which instruction to the parent? a.) The hepatitis B vaccine will not be given to the child. b.) The inactivated influenza vaccine will be given yearly. c.) The varicella vaccine will be given before 6 months of age. d.) A Western blot test needs to be performed and the results evaluated before immunizations.

a.) "I will clean up any spills from the diaper with diluted alcohol." Need to use a bleach solution

The home care nurse provides instructions regarding basic infection control to the parent of an infant with human immunodeficiency virus (HIV) infec-tion. Which statement, if made by the parent, indicates the need for further instruction? a.) "I will clean up any spills from the diaper with diluted alcohol." b.) "I will wash baby bottles, nipples, and pacifiers in the dishwasher." c.) "I will be sure to prepare foods that are high in calories and high in protein." d.) "will be sure to wash my hands carefully before and after caring for my infant."

a.) Initiate bleeding precautions.

The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse notes that the platelet count is 19,500 mm? (19.5 x 10°/L). On the basis of this laboratory result, which intervention would the nurse include in the plan of care? a.) Initiate bleeding precautions. b.) Monitor closely for signs of infection. c.) Monitor the temperature every 4 hours. d.) Initiate protective isolation precautions.

a.) Time the seizure. c.) Stay with the child. e.) Move furniture away from the child.

The nurse is creating a plan of care for a child who is at risk for seizures. Which interventions apply if the child has a seizure? Select all that apply. a.) Time the seizure. b.) Restrain the child. c.) Stay with the child. d.) Place the child in a prone position. e.) Move furniture away from the child. f.) Insert a padded tongue blade in the child's mouth.

d.) Small blue-white spots with a red base found on the buccal mucosa

The nurse caring for a child diagnosed with rubeola (measles) notes that the pediatrician has documented the presence of Koplik's spots. On the basis of this documentation, which observation is expected? a.) Pinpoint petechiae noted on both legs b.) Whitish vesicles located across the chest c.) Petechiae spots that are reddish and pinpoint on the soft palate d.) Small blue-white spots with a red base found on the buccal mucosa

c.) Bacteriuria This anatomical characteristic facilitates entry of bacteria into the urine

The nurse collects a urine specimen preoperatively from a child with epispadias who is scheduled for surgical repair. When analyzing the results of the urinalysis, which would the nurse most likely expect to note? a.) Hematuria b.) Proteinuria c.) Bacteriuria d.) Glucosuria

d.) Suctioning equipment and oxygen

The nurse creates a plan of care for a child at risk for tonic-clonic seizures. In the plan of care, the nurse identifies seizure precautions and documents that which item(s) needs to be placed at the child's bedside? a.) Emergency cart b.) Tracheotomy set c.) Padded tongue blade d.) Suctioning equipment and oxygen

d.) Remove excess clothing and blankets

The nurse has just administered ibuprofen to a child with a temperature of 102F. The nurse would also take which action? a.) Withhold oral fluids for 8 hours b.) Sponge the child with cold water c.) Plan to administer salicylate in 4 hours d.) Remove excess clothing and blankets

d.) "I'll let my child decide when to return to play activities." Is a condition in which one or both testes fail to descend through the inguinal canal into the scrotal sac. Surgical correction may be necessary. All vigorous activity need to be restricted for 2 weeks after surgery to promote healing and prevent injury. Letting the 2-year-old decide when to return to activity may cause injury and prevent healing

The nurse has provided discharge instructions to the parents of a 2-year-old child who underwent an orchiopexy to correct cryptorchidism. Which statement by the parents indicates a need for further instruction? a.) "I'll check my child's temperature." b.) "I'll give medication so that my child will be comfortable." c.) "I'll check my child's voiding to be sure there's no problem." d.) "I'll let my child decide when to return to play activities."

b.) "We can apply lotion or powder to the incision if it is itchy"

The nurse has provided home care instructions to the parents of a child who is being discharged after cardiac surgery. Which statement made by the parents indicates a need for further instruction? a.) "A balance of rest and activity is important" b.) "We can apply lotion or powder to the incision if it is itchy" c.) "Activities in which our child could fall need to be avoided for 2 to 4 weeks" d.) "Large crowds of people need to be avoided for at least two weeks after surgery"

c.) "Has any family member had a sore throat within the past few weeks?" Presents 2 to 6 weeks after an untreated or partially treated group A beta hemolytic streptococcal infection of the respiratory tract.

The nurse is assessing a child admitted with a diagnosis of rheumatic fever. Which significant question would the nurse ask the child's parent during the assessment? a.) "Has your child had difficulty urinating?" b.) "Has your child been exposed to anyone with chicken pox?" c.) "Has any family member had a sore throat within the past few weeks?" d.) "Has any family member had a gastrointestinal disorder in the past few weeks?"

c.) Nasotracheal suction as needed.

The nurse is assigned to care for an 8-year-old child with a diagnosis of a basilar skull fracture. The nurse reviews the pediatrician's prescriptions and would contact the pediatrician to question which prescription? a.) Obtain daily weight. b.) Provide clear liquid intake. c.) Nasotracheal suction as needed. d.) Maintain a patent intravenous line.

c.) Ortolani's maneuver Is a test to assess for hip instability and can be done only before 4 weeks of age. The examiner abducts the thigh and applies gentle pressure forward over the greater trochanter. A "clicking" sensation indicates a dislocated femoral head moving into the acetabulum.

The nurse is assisting a primary health care provider (PHCP) in the examination of a 3-week-old infant with developmental dysplasia of the hip. What test or sign would the nurse expect the PFICP to assess? a.) Babinski's sign b.) The Moro reflex c.) Ortolani's maneuver d.) The palmar-plantar grasp

a.) An intense fiery red edematous rash on the cheeks

The nurse is caring for a child diagnosed with erythema infectiosum (fifth disease). Which clinical manifestation would the nurse expect to note in the child? a.) An intense fiery red edematous rash on the cheeks b.) Pinkish-rose maculopapular rash on the face, neck, and scalp c.) Reddish and pinpoint petechiae spots found on the soft palate d.) Small bluish-white spots with a red base found on the buccal mucosa

b.) Cover the bladder with a nonadhering plastic wrap Protects the exposed bladder from drying while still allowing the drainage of urine

The nurse is caring for an infant with a diagnosis of bladder exstrophy. To protect the exposed bladder tissue, the nurse would plan which intervention? a.) Cover the bladder with petroleum jelly gauze b.) Cover the bladder with a nonadhering plastic wrap c.) Apply sterile distilled water dressings over the bladder mucosa. d.) Keep the bladder tissue dry by covering it will dry sterile gauze.

a.) Weighing the diapers

The nurse is closely monitoring the intake and output of an infant with HF who is receiving diuretic therapy. The nurse would use which most appropriate method to assess the urine output? a.) Weighing the diapers b.) Inserting a urinary catheter c.) Comparing intake with output d.) Measuring the amount of water added to formula

a.)Easy bruising occurs. b.) Gum bleeding occurs. c.) It is a hereditary bleeding disorder. d.) Treatment and care are similar to that for hemophilia. f.) The disorder causes platelets to adhere to damaged endothelium.

The nurse is conducting staff in-service training on von Willebrand's disease. Which would the nurse include as characteristics of von Willebrand's disease? Select all that apply. a.)Easy bruising occurs. b.) Gum bleeding occurs. c.) It is a hereditary bleeding disorder. d.) Treatment and care are similar to that for hemophilia. e.) It is characterized by extremely high creatinine levels. f.) The disorder causes platelets to adhere to damaged endothelium.

a.) Vomiting

The nurse is monitoring a 3-year-old child for signs and symptoms of increased intracranial pressure (ICP) after a craniotomy. The nurse would plan to monitor for which early sign or symptom of increased ICP? a.) Vomiting b.) Bulging anterior fontanel c.) Increasing head circumference d.) Complaints of a frontal headache

a.) Notify the surgeon. Indicates the presence of cerebrospinal fluid and needs to be reported to the surgeon immediately

The nurse is monitoring a child for bleeding after surgery for removal of a brain tumor. The nurse checks the head dressing for the presence of blood and notes a colorless drainage on the back of the dressing. Which action would the nurse perform immediately? a.) Notify the surgeon. b.) Reinforce the dressing. c.) Document the findings and continue to monitor. d.) Circle the area of drainage and continue to monitor

c.) Tachycardia

The nurse is monitoring an infant with Congenital Heart Disease closely for signs of heart failure (HF). The nurse would assess the infant for which early sign of HF? a.) Pallor b.) Cough c.) Tachycardia d.) Slow and shallow breathing

a.) Pallor b.) Edema c.) Anorexia d.) Proteinuria

The nurse is performing an assessment on a child admitted to the hospital with a probable diagnosis of nephrotic syndrome. Which assessment findings would the nurse expect to observe? Select all that apply. a.) Pallor b.) Edema c.) Anorexia d.) Proteinuria e.) Weight loss f.) Decreased serum lipids

d.) Maintain respiratory isolation precautions for at least 24 hours after the initiation of antibiotics.

The nurse is planning care for a child with acute bacterial meningitis. Based on the mode of transmission of this infection, which precautionary intervention would be included in the plan of care? a.) Maintain enteric precautions. b.) Maintain neutropenic precautions. c.) No precautions are required as long as antibiotics have been started. d.) Maintain respiratory isolation precautions for at least 24 hours after the initiation of antibiotics.

a.) Restrict fluids as prescribed. Is thought to be associated with with bacterial toxins, chemicals, and viruses that result in acute kidney injury in children.

The nurse is planning care for a child with hemolytic-uremic syndrome who has been anuric and will be receiving peritoneal dialysis treatment. The nurse would plan to implement which measure? a.) Restrict fluids as prescribed. b.) Care for the arteriovenous fistula. c.) Encourage foods high in potassium. d.) Administer analgesics as prescribed.

c.) Swimming

The nurse is preparing home care instructions for the parents of a 10-year-old child with hemophilia. Which sport activity would the nurse suggest for this child? a.) Soccer b.) Basketball c.) Swimming d.) Field hockey

b.) Administer the iron through a straw.

The nurse is preparing to instruct the parents of a child with iron-deficiency anemia regarding the administration of a liquid oral iron supplement. Which instruction would the nurse give the parents? a.) Administer the iron at mealtimes. b.) Administer the iron through a straw. c.) Mix the iron with cereal to administer. d.) Add the iron to formula for easy administration.

c.) "I need to apply lotion under the brace to prevent skin breakdown."

The nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by the parents indicates a need for further instruction? a.) "I will encourage my child to perform prescribed exercises." b.) "I will have my child wear soft fabric clothing under the brace." c.) "I need to apply lotion under the brace to prevent skin breakdown." d.) "I need to avoid the use of powder because it will cake under the brace."

a.) Restrict fluid intake. f.) Give meperidine, 25 mg intravenously, every 4 hours for pain.

The nurse is reviewing a pediatrician's prescriptions for a child with sickle cell anemia who was admitted to the hospital for the treatment of vasoocclusive crisis. Which prescriptions documented in the child's record would the nurse question? Select all that apply. a.) Restrict fluid intake. b.) Position for comfort. c.) Avoid strain on painful joints. d.) Apply nasal oxygen at 2 L/minute. e.) Provide a high-calorie, high-protein diet. f.) Give meperidine, 25 mg intravenously, every 4 hours for pain.

d.) "Circumcision has been delayed to save tissue for surgical repair." Abnormal placement of the urethral orifice of the penis. Will not be circumcised, because the dorsal foreskin tissue will be used for surgical repair of the hypospadias

The nurse is reviewing a treatment plan with the parents of a newborn with hypospadias. Which statement by the parents indicates their understanding of the plan? a.) "I need to be cautious when straddling my infant on a hip." b.) "Vital signs need to be taken daily to check for bladder infection." c.) "Catheterization will be necessary when my infant does not void." d.) "Circumcision has been delayed to save tissue for surgical repair."

c.) Rigid extension and pronation of the arms and legs Options b and d describe decorticate (flexion) posturing

The nurse is reviewing the record of a child with increased intracranial pressure from a head injury and notes that the child has exhibited signs of decerebrate posturing. On assessment of the child, the nurse expects to note which characteristic of this type of posturing? a.) Flaccid paralysis of all extremities b.) Adduction of the arms at the shoulders c.) Rigid extension and pronation of the arms and legs d.) Abnormal flexion of the upper extremities and extension and adduction of the lower extremities

a.) Meningitis This shows a positive Kernig's sign, noted in Meningitis

The nurse notes documentation that a child is exhibiting an inability to flex the leg when the thigh is flexed anteriorly at the hip. Which condition does the nurse suspect? a.) Meningitis b.) Spinal cord injury c.) Intracranial bleeding d.) Decreased cerebral blood flow

b.) Generalized edema

The nurse performing an admission assessment on a 2-year-old child who has been diagnosed with nephrotic syndrome notes that which most common characteristic is associated with this syndrome? a.) Hypertension b.) Generalized edema c.) Increased urinary output d.) Frank, bright red blood in the urine

c.) A chronic disability characterized by impaired muscle movement and posture

The parents of a child recently diagnosed with cerebral palsy ask the nurse about the limitations of the disorder. The nurse responds by explaining that the limitations occur as a result of which pathophysiological process? a.) An infectious disease of the central nervous system b.) An inflammation of the brain as a result of a viral illness c.) A chronic disability characterized by impaired muscle movement and posture d.) A congenital condition that results in moderate to severe intellectual disabilities

b.) Keep small toys and sharp objects away from the cast. e.) Elevate the extremity on pillows for the first 24 to 48 hours after casting to prevent swelling f.) Contact the primary health care provider (PHCP) if the child complains of numbness or tingling in the extremity.

The nurse prepares a list of home care instructions for the parents of a child who has a plaster cast ap. plied to the left forearm. Which instructions would be included on the list? Select all that apply. a.) Use the fingertips to lift the cast while it is drying. b.) Keep small toys and sharp objects away from the cast. c.) Use a padded ruler or another padded object to scratch the skin under the cast if it itches. d.) Place a heating pad on the lower end of the Cast and over the fingers if the fingers feel cold e.) Elevate the extremity on pillows for the first 24 to 48 hours after casting to prevent swelling f.) Contact the primary health care provider (PHCP) if the child complains of numbness or tingling in the extremity.

b.) "The child does not experience pain at the primary tumor site." Most common bone cancer in children.

The nurse provides a teaching session to the nursing staff regarding osteosarcoma. Which statement by a member of the nursing staff indicates a need for further instruction? a.) "The femur is the most common site of this sarcoma." b.) "The child does not experience pain at the primary tumor site." c.) "Limping, if a weight-bearing limb is affected, is a clinical manifestation." d.) "The symptoms of the disease in the early stage are almost always attributed to normal growing pains."

d.) "We need to maintain droplet precautions and a quiet environment for at least 2 weeks." Pertussis is transmitted by direct contact or respiratory droplets from coughing.

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

d.) "If my child vomits after medication administration, I will repeat the dose"

The nurse provides home care instructions to the parents of a child with heart failure regarding the procedure for administration of digoxin. Which statement made by the parent indicates the need for further instruction? a.) "I will not mix the medication with food" b.) If more than one dose is missed, I will call the pediatrician" c.) "I will take my child's pulse before administering the medication" d.) "If my child vomits after medication administration, I will repeat the dose"

d.) Anti-streptolysin O titer Evidence of a recent streptococcal infection is confirmed by this positive test

The nurse reviews the laboratory results for a child with a suspected diagnosis of rheumatic fever, knowing that which laboratory study would assist in confirming the diagnosis? a.) Immunoglobulin b.) Red blood cell count c.) White blood cell count d.) Anti-streptolysin O titer

b.) "I noticed the urine was the color of cola lately."

The nurse reviews the record of a child who is suspected to have glomerulonephritis. Which statement that relates to this diagnosis would the nurse expect to hear from the child's parents? a.) "The pediatrician said the kidneys are working well" b.) "I noticed the urine was the color of cola lately." c.) "I'm so glad they didn't find any protein in the urine." d.) "The nurse who admitted my child said the blood pressure was low"

c.) Give the child a teaspoon of honey f.) Prepare to administer glucagon subcutaneously if unconsciousness occurs Hypoglycemia is if less than 70

The nurse would implement which interventions for a child older than 2 years with type 1 diabetes mellitus who has a blood glucose level of 60 mL/dL (3.4 mmol/L)? Select all that apply a.) Administer regular insulin b.) Encourage the child to ambulate c.) Give the child a teaspoon of honey d.) Provide electrolyte replacement IV e.) Wait 30 minutes and confirm the blood glucose reading f.) Prepare to administer glucagon subcutaneously if unconsciousness occurs

b.) A child of Mediterranean descent

The nursing student is presenting a clinical conference and discusses the cause of B-thalassemia. The nursing student informs the group that a child at greatest risk of developing this disorder is which of these? a.) A child of Mexican descent b.) A child of Mediterranean descent c.) A child whose intake of iron is extremely poor d.) A breast-fed/chest fed child of a parent with chronic anemia

a.) Palpating the abdomen for a mass This is the most common abdominal and kidney tumor of childhood. If suspected, would not be palpated by the nurse. Excessive manipulation can cause seeding of the tumor and spread of the cancerous cells.

The parent of a 4-year-old child tells the pediatric nurse that the child's abdomen seems to be swollen. During further assessment, the parent tells the nurse that the child is eating well and that the activity level of the child is unchanged. The nurse, suspecting the possibility of Wilms' tumor, would plan to avoid which during the physical assessment? a.) Palpating the abdomen for a mass b.) Assessing the urine for the presence of hematuria c.) Monitoring the temperature for the presence of fever d.) Monitoring the blood pressure for the presence of hypertension

c.) To bring the child to the clinic to be seen by the pediatrician The most common complication is septic meningitis which are these side effects

The parent of a child with mumps calls the health care clinic to tell the nurse that the child has been lethargic and vomiting. What instruction would the nurse give to the parent? a.) To continue to monitor the child b.) That lethargy and vomiting are normal with mumps c.) To bring the child to the clinic to be seen by the pediatrician d.) That there is nothing to be concerned about a long as there is no fever

c.) Encourage the child to drink fluid Liquids are essential to help with the clearing the ketones

The parents of a 6-year-old child who has type 1 diabetes mellitus call a clinic nurse and tell the nurse that the child has been sick. The parents report that the child's urine is positive for ketones. The nurse would instruct the parents to take which action? a.) Hold the next dose of insulin b.) Come to the clinic immediately c.) Encourage the child to drink fluid d.) Administer an additional dose of regular insulin

Pre Procedure Nursing Interventions: -Assess accurate height and weight, because this helps with selection of the correct catheter size and correct medication/dosing -Obtain a history of the presence of allergic reaction to iodine -Assess for symptoms of infection, including diaper rash -Assess and mark bilateral pulses, including the dorsalis pedis and posterior tibial (need to check pulses distal to catheter insertion site) -Assess baseline oxygen saturation Post Procedure Nursing Interventions: -Monitor findings on the cardiac monitor and oxygen saturation 4 hours after procedure -Assess pulses below the catheter site for presence, equality, and symmetry -Assess the temperature and color of the affected extremity and report coldness, which may indicate arterial obstruction -Monitor vital signs frequently, usually every 15 minutes 4 times, every half-hour 4 times, and then every hour 4 times -Assess the pressure dressing for intactness and signs of hemorrhage -Check the bedsheets under the extremity for blood, which indicates bleeding from the entry site -If bleeding is present, apply continuous, direct pressure at or directly above the cardiac catheter entry site and report it immediately -Immobilize the affected extremity in a flat position for at least 4 to 6 hours for venous entry site and 6 to 8 hours for arterial entry site -Hydrate the child via oral or IV route -Administer acetaminophen or ibuprofen for pain or discomfort as prescribed

What are pre and post op interventions for a Cardiac Catheterization?

Febrile Seizures: Transient (very brief) -Greater than 5 minutes should seek medical attention -Do not take children to hospital in car while seizing and call 911 if seizure is longer than 5 min -Rare after 5 years of age Precautions: -Suction -Padded rails -Oral airway at bedside -Wearing identification bracelet, making sure teachers, coaches are aware of condition Emergency Management of Actively Seizing: -Timing it -Protect head -Put them on their side 1st -Nothing in their mouth -No restraints -Push tables and beds out of the way -Observe, document Status Epilepticus: -Seizure activity that is 30 minutes or longer -Emergency because of lack of oxygen to the brain Interventions: -Giving them an anticonvulsant (diazepam or lorazepam (aka ativan)) to stop seizing activity immediately -Can administer buccal, rectal, or nasally if no IV access -Need to make sure established airway, check vitals, pulse ox, abg's Safety: Wearing identification bracelet, making sure teachers, coaches are aware of condition

What are seizures?

1.) Pulselessness 2.) Paresthesia 3.) Pain 4.) Paralysis 5.) Pallor 6.) Pressure Have to let HCP know if any of these are present because at risk for nerve damage

What are the 6 P's?

-Two RN's need to sign off -Vital signs before and 15 min after started -Stay with patient first 15 min of blood being administered -Cross matching -Y tubing with filter -0.9 normal saline with blood -Infuse within 4 hours If a reaction of any type is suspected, stop the transfusion, take vital signs, maintain a patent IV line with normal saline and new tubing, notify the practitioner, and do not restart the transfusion until the child's condition has been medically evaluated.

What are the Blood Administration Guidelines?

Compensated: When vital organ function is maintained by intrinsic mechanisms and the child's ability to compensate is effective, cardiac output and systemic arterial BP are usually normal or increased. However, blood flow is generally uneven or maldistributed in the microcirculation. Early Signs: -Apprehensiveness -Irritability -Unexplained tachycardia -Normal blood pressure (BP) -Narrowing pulse pressure -Thirst -Pallor -Diminished urinary output -Reduced perfusion of extremities Hypotensive: As shock progresses, perfusion in the microcirculation becomes marginal despite compensatory adjustments, and the signs are more obvious and indicate early decompensation. Hypotensive shock may be differentiated from compensated shock by evaluating BP; the child in hypotensive shock will have a low BP, but hypotension is a late finding. Signs: -Confusion and somnolence -Tachypnea -Moderate metabolic acidosis -Oliguria -Cool, pale extremities -Decreased skin turgor -Poor capillary filling Irreversible: As hypotensive shock progresses along a physiologic continuum, clinical signs indicate a progression of circulatory damage. With the progression of shock, there is damage to vital organs (e.g., the heart or brain) of such magnitude that the entire system is disrupted regardless of therapeutic intervention. Signs: -Thready, weak pulse -Hypotension -Periodic breathing or apnea -Anuria -Stupor or coma

What are the Clinical Manifestations of Shock?

Assessment: Acute Stage: -Fever -Conjunctival hyperemia -Mucositis (cracked red lips and a "strawberry tongue") -Extremity changes, including swelling of the hands and feet and erythema of the palms and soles -Rash -Enlargement of cervical lymph nodes -Increased irritability -Arthritis -Cardiovascular findings, including tachycardia and gallop sounds Subacute Stage: Begins with resolution of fever and continues until outward clinical manifestations have resolved -Cracking lips and fissures -Desquamation of the skin on the tips of the fingers and toes -Joint Pain -Cardiac Manifestations -Thrombocytosis (hypercoagulability) Convalescent Stage: Child appears normal, but signs of inflammation may be present, and lab values may be abnormal

What are the different assessment stages for Kawasaki Disease?

-Hypovolemic Shock -Distributive Shock -Cardiogenic Shock -Obstructive Shock

What are the different types of shock?

Infection of the glomerular -Associated with the strep -Could be from not treating or not taking full antibiotic therapy -Usually only a one-time occurrence Manifestations: -oliguria -Slight to moderate protein and amount of blood in urine -Generalized and peripheral edema -coca cola urine -Irritable -Lethargic Treatment: -Antibiotics -Anti-hypertension --Monitoring BP -Put on seizure precautions because of hypertensive encephalopathy -Daily weight, I&O's -Diuretics for edema --Assessing pitting edema, abdominal girth -Low sodium- Nothing canned, fried, lunch meats Fluid restrictions -Concerned for high potassium if they're not urinating

What is Acute Glomerulonephritis?

Is an infection of the inner lining of the heart (endocardium), generally involving the valves. Clinical Manifestations of Infective Endocarditis: -Onset usually insidious -Unexplained fever (low grade and intermittent) -Anorexia -Malaise -Weight loss Characteristic findings caused by extracardiac emboli formation: • Splinter hemorrhages (thin black lines) under the nails • Osler nodes (red, painful intradermal nodes found on pads of phalanges) • Janeway lesions (painless hemorrhagic areas on palms and soles) • Petechiae on oral mucous membranes May be present: • Heart failure • Cardiac dysrhythmias • New murmur or change in previously existing one

What is Bacterial Endocarditis?

Clinical manifestations: nuchal rigidity, photophobia, headache, stiff neck, fever, malaise, fatigue, lethargy, anorexia -Kernig Sign: When patient is in supine position hip and knee is flexed at 90 degrees, when try to straighten the leg = pain in the hamstring -Brudzinski's Sign: lying supine, passively flex the neck and when the HCP does it, the pt has an involuntary lifting of the leg due to meningeal irritation -History to point toward this diagnoses: at risk population (confined space like dorms or nursing homes), droplet precaution, contact precautions -Room Assignment: Away from nurses station and cluster care Complications- hydrocephalus, brain abscess, increased ICP Diagnosis: -Lumbar puncture (cloudy could = bacterial infection bc of increase in protein and white blood cell count) -Nurse: Help with positioning and preparation (side lying also to help with an aspiration risk) Treatment: antibiotics depends on infection (IV and fluids), oxygen, reduce ICP (HOB elevated, calm dark environment), At risk for seizures!! -Parents at bedside to keep them calm -Padded side rails, suction (cautious), oral airway -PPE important??

What is Bacterial Meningitis?

Description: -Invasive diagnostic procedure to determine cardiac defects -Provides information about oxygen saturation of blood in the great vessels and heart chambers -May be done for diagnostic, interventional, or electrophysical reasons -May be carried out on an outpatient basis Risks include: hemorrhage from the entry site, clot formation and subsequent blockage disitally; and transient dysrhythmias General anesthesia is usually unnecessary

What is Cardiac Catheterization?

Description: -Made of plaster or fiberglass to provide immobilization of bone and joints after a fracture or injury Interventions: -Examine the cast for pressure areas. -Ensure that no rough casting material remains in contact with the skin; petal the cast edges with waterproof adhesive tape or moleskin as necessary to ensure a smooth cast edge. -Monitor the extremity for circulatory impairment, such as pain greater than that expected for the type of injury, edema, rubor, pallor, numbness and tingling, coolness, decreased sensation or mobility, diminished pulse, or signs of compartment syndrome. -Notify the PHCP if circulatory impairment occurs. -Prepare for bivalving or cutting the cast if circulatory impairment occurs; prepare for emergency fasciotomy if cast removal does not improve the neurocirculatory compromise. -Instruct parents and child not to stick objects down the cast. -Monitor for "hot spots. -Teach parents and child to keep the cast clean and dry. -Instruct parents and child in isometric exercises to prevent muscle atrophy. -No powders/lotions -Don't take it off

What is Casting?

Description: -Disorder characterized by impaired movement, posture, and/or muscle tone, resulting from an abnormality in the extrapyramidal or pyramidal motor system -Have varying degrees of symptoms and causes (like trauma during birth) Associated impairments—Seizures; hearing or vision impairment; attentional, behavioral, communicative, and/or cognitive deficits; oral motor and speech function Therapeutic Management: Speech therapy, occupational therapy, physical therapy, education, and recreation -To promote socialization experiences: still treat them developmentally appropriate -Transportation: need special car seats, walkers? Mobilizing devices: -Ankle-foot braces: May be worn Pharmacologic agents: To treat pain related to spasms and seizures -Antiepileptic such as dilantin -Could also have constant tension of muscle (Medication to help: diazepam = muscle spasms) Safety and Support of Family: -Support groups Feeding: risk for aspiration -Upright, assisted feeding, small, frequent feedings, supporting the jaw because of instability; specific spoons (occupational therapists)

What is Cerebral Palsy?

Description: Can be diagnosed in utero -Complex deformity of the ankle and foot that includes forefoot adduction, midfoot supination, hindfoot varus, and ankle equinus; defect may be unilateral or bilateral. -The goal of treatment is to achieve a painless plantigrade (able to walk on the sole of the foot with the heel on the ground) and stable foot. Interventions: -Treatment begins as soon after birth as possible. -Manipulation and casting are performed weekly for about 8 to 12 weeks because of the rapid growth of early infancy; a splint is then applied if casting and manipulation are successful. -Surgical intervention may be necessary if normal alignment is not achieved by about 6 to 12 weeks of age. Monitor for pain, and monitor the neurovascular status of the toes. WARNING: contact the primary health care provider (PHCP) immediately if signs of neurovascular impairment are noted in a child with a cast or brace.

What is Clubfoot?

Is localized narrowing near the insertion of the ductus arteriosus -Blood pressure is higher in the upper extremities than in the lower extremities; bounding pulses in the arms, weak or absent femoral pulses, and cool lower extremities may be present -Need to do BP checks in all 4 extremities -Signs of HF might occur in infants -S/S of decreased cardiac output may be present Children may experience headaches, dizziness, fainting, and epistaxis resulting from hypertension Management: -May be done via balloon angioplasty in children; restenosis can occur (When an artery that was opened with a stent or angioplasty becomes narrowed again) Surgical Management: -Mechanical ventilation and medications to improve cardiac output are often necessary before surgery -Resection of the coarcted position with end-to-end anastomosis of the aorta or enlargement of the constricted section, using a graft, may be required -Because the defect is outside of the heart, cardiopulmonary bypass is not required, and a thoracotomy incision is used

What is Coarctation of Aorta: (Obstructive Defects)?

Screens at birth Primary congenital hypothyroidism is characterized by low levels of circulating THs and raised levels of TSH at birth -Thyroid is underfunctioning so the TSH to try and stimulate the thyroid is going to be extremely high while you're actual TH level will be low because there is a malfunction -TSH- levels are high Signs and symptoms: -Mental decline; Constipation; Sleepiness -Large babies greater than 40 weeks (common) -Hypothermia -Myxedematous skin changes: --Dry skin --Sparse hair --Puffiness around eyes (periorbital edema) -Older children: --bradycardia, lethargy, sleepiness Treatment: -Oral thyroid hormone replacement (levothyroxine/ synthroid) --Take in the morning before you eat -May administer in increasing amounts over 4 to 8 weeks to avoid symptoms of hyperthyroidism -Compliance with medication regimen: Crucial -Children to take responsibility for medication regimen as soon as they are able

What is Congenital hypothyroidism?

The inability of the heart to pump a significant amount of blood to meet the metabolic and oxygen needs of the body -In infants and children, inadequate cardiac output most commonly is caused by congenital heart defects (shunt, obstruction, or a combination of both) that produce an excessive volume or pressure load on the myocardium. Goals of Treatment: To improve cardiac function, remove accumulated fluid and sodium, decrease cardiac demands, improve tissue oxygenation, and decrease oxygen consumption; depending on the cause, surgery may be required. Assessment of Early Signs: -Tachycardia, especially during rest and slight exertion -Tachypnea -Profuse scalp diaphoresis, especially in infants -Fatigue and irritability -Sudden weight gain -Respiratory distress

What is Congestive Heart Failure?

Description: 1.) Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. 2.) In leukemia, proliferating immature white blood cells (WBCs), also known as blast cells, depress the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). Treatment involves: -Chemotherapy and possibly radiation and hematopoietic stem cell transplantation. ---Inform the parents and child that hair loss may occur from chemotherapy (hair regrows in about 3 to 6 months and may be a slightly different color or texture). ---WARNING: Monitor a child receiving chemotherapy closely for signs of infection. Children receiving chemotherapy may not present with typical signs and symptoms of infection because the immune system is suppressed. Infection is a major cause of death in the immunosuppressed child. Protecting the Child from Bleeding: -Measure abdominal girth; an increase can indicate internal hemorrhage. -Instruct the child to use a soft toothbrush and avoid dental floss. -Provide soft foods that are cool to warm in temperature. -Avoid injections, if possible, to prevent trauma to the skin and bleeding. -Apply firm and gentle pressure to a needlestick site for at least 10 minutes. -Pad side rails and sharp corners of the bed and furniture. -Discourage the child from engaging in activities involving the use of objects that can cause injury. -Instruct the child to avoid constrictive or tight clothing. -Use caution when taking the blood pressure to prevent skin injury. -Instruct the child to avoid blowing the nose. -Avoid the use of rectal suppositories, enemas, and rectal thermometers. -Examine all body fluids and excrement for the presence of blood. -Count the number of pads or tampons used if the adolescent is menstruating. -Instruct the child about the signs and symptoms of bleeding. -Instruct parents to avoid administering nonsteroidal anti-inflammatory drugs and products that contain aspirin to the child.

What is Leukemia?

Description: Dislocation of the hip -Problems related to abnormal development of the hip that may develop during fetal life, infancy, or childhood; in these problems, the head of the femur is seated improperly in the acetabulum, or hip socket, of the pelvis. -Degrees of developmental dysplasia of the hip Clinical Manifestations: -Shortening of the limb on the affected side (Galeazzi sign, also known as Allis sign) -Restricted abduction of the hip on the affected side when the infant is placed supine with knees and hips flexed (limited range of motion in the affected hip) -Unequal/Extra gluteal folds when the infant is prone and legs are extended against the examining table -Positive Ortolani's test: Ortolani's maneuver is a test to assess for hip instability. The examiner abducts the thigh and applies gentle pressure forward over the greater trochanter. A "clicking" sensation indicates a dislocated femoral head moving into the acetabulum. -Positive Barlow's test: The examiner adducts the hips and applies gentle pressure down and back with the thumbs. In hip dysplasia, the examiner can feel the femoral head move out of the acetabulum. Treatment: -Splinting of the hips with a Pavlik harness to maintain flexion and abduction and external rotation; the harness is worn continuously for 23 hours per day until hip is stable, usually within 6 to 12 weeks; it is removed only for bathing purposes -The child is then placed in a hip spica cast for 6 to 12 weeks until the hip is stable; then a flexion-abduction brace is continued for 6 weeks.

What is Developmental Dysplasia of the Hips (DDH)?

Description: Diabetic ketoacidosis is a life-threatening condition. -Hyperglycemia that progresses to metabolic acidosis occurs. -The blood glucose level is greater than 300 / mg/dL (greater than 17.14 mmol/L), and urine and serum ketone tests are positive. WARNINGS: Manifestations of diabetic ketoacidosis include signs of hyperglycemia, Kussmaul's respirations, acetone (fruity) breath odor, increasing lethargy, and decreasing level of consciousness. Interventions: -Correct dehydration with IV infusions of 0.9% or 0.45% saline as prescribed. -Correct hyperglycemia with IV regular insulin administration as prescribed. -ONLY 0.9% CAN BE USED WITH REG INSULIN -Monitor potassium level closely, because when the child receives insulin to reduce the blood glucose level, the serum potassium level changes; if the potassium level decreases, potassium replacement may be required. -The child needs to be voiding adequately before administering potassium; if the child does not have an adequate output, hyperkalemia may result. -Monitor the child closely for signs of fluid overload. -IV dextrose is added as prescribed when the blood glucose reaches an appropriate level. -Treat the cause of hyperglycemia.

What is Diabetic Ketoacidosis?

-Assess apical heart rate for 1 minute before administration -Withhold digoxin if the apical pulse is less than 90 to 110 beats per minute in infants and young children and less than 70 beats per minute in older children (preschooler and school age) and less than 60 for adolescents TOXICITY LEVELS: S/S: Anorexia, poor feeding, nausea, vomiting, bradycardia, and dysrhythmias First sign- vomiting and spitting up Therapeutic Range: 0.8-2 ng/mL

What is Digoxin?

Inflammatory process of CNS with altered function of brain and spinal cord Variety of causative organisms: -Most common- direct invasion of the CNS by a virus or postinfectious involvement of the CNS after a viral disease -Vector reservoir in the United States: mosquitoes and ticks -Mosquito and tick prevention: -Bug spray, Long pants and shirt, avoiding heavily wooded areas, standing water is a breeding ground for mosquitoes S/S: Similar to meningitis -Malaise -Fever -Headache/dizziness -Stiff neck -Nausea/vomiting -Ataxia -Speech difficulties -Photophobia Medications: -Corticosteroids -ICP Monitoring -Seizure Precautions -Are in ICU Diagnosis: -CT, MRI of the brain, Lumbar punctures (to rule out Bacterial Meningitis)

What is Encephalitis?

Description: 1.) The nose, especially the septum, is a highly vascular structure, and bleeding usually results from direct trauma, foreign bodies, and nose picking or from mucosal inflammation. 2.) Recurrent epistaxis and severe bleeding may indicate an underlying disease. Emergency Treatment: -Assists the child to sit up and lean forward -Applies continuous pressure to the nose with the thumb and forefinger for at least 10 minutes -Inserts cotton or wadded tissue into each nostril, and applies ice or a cold cloth to the bridge of the nose if bleeding persists -Arranges for transport of the child to the emergency department if the bleeding cannot be controlled; packing or cauterization of the bleeding vessel may be indicated

What is Epistaxis?

GIVE AT NIGHT AND ONCE THEY ACHIEVED APPROPRIATE GROWTH HEIGHT FROM PROVIDER CAN STOP TREATMENT

What is Growth Hormone Deficiency?

Description: 1.) HIV infects CD4* T cells; a gradual decrease in CD4+ T-cell count occurs, and this results in a progressive immunodeficiency. The risk for opportunistic infections is present. -Leads to AIDS -Consent before testing!! HIV is transmitted through blood, semen, vaginal secretions, and human milk; the incubation period is months to years. --Body fluids Except for spit and sweat Tests for Human Immunodeficiency Virus (HIV): Enzyme-linked immunosor-bent assay (ELISA): Age-Appropriate Use: Greater than or equal to 18 months Test Determines: Response of antibodies to HIV Special Considerations: If used and found to be positive in infants less than or equal to 18 mo, indicates only that birth parent is infected because birthing parent antibodies are transmitted transplacentally; follow-up with another diagnostic test (HIV differential assay) Western blot: Age-Appropriate Use: Greater than or equal to 18 months Test Determines: Presence of HIV antibodies Special Considerations: Not used to diagnose HIV. May be used to confirm a positive ELISA Polymerase chain reaction: Age-Appropriate Use: Less than 18 months Test Determines: Presence of proviral DNA Special Considerations: Very accurate for diagnosing infants 1-4 mo of age Assessment: -Malnutrition -Short stature -Cardiomyopathy Goal: -Slow virus growth -Prevent/treat opportunistic infections -Nutritional support -Symptomatic treatment -Antiretroviral Drugs (Strict Adherence!!!) Care Management: -Piercings/tattoos go to clean places -Safe sex practices

What is HIV transmission?

Concussion: bruise on the brain -Can be varying levels, need to be evaluated by their pediatrician every time they receive a head injury Warning signs if there is a fractured skull because takes an extreme amount of pressure to break it Submersion injury (near drowning): preventing! -Complications: aspiration, hypoxia, aspiration pneumonia of they survive -Care for patients with head trauma Emergency Management: -Check brachial first in infants and carotid for older children CAB circulation, airway, breathing -Stabilized to prevent further trauma and stay until they get to the hospital

What is Head injury / skull fracture?

Description: 1.) Hemophilia refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins. 2.) Identifying the specific coagulation deficiency is important so that definitive treatment with the specific replacement agent can be implemented, aggressive replacement therapy is initiated to prevent the chronic crippling effects from joint bleeding. The primary treatment is replacement of the missing clotting factor; additional medications, such as agents to relieve pain or corticosteroids, may be prescribed, depending on the source of bleeding from the disorder. Assessment: 2.) Epistaxis (nosebleeds) 3.) Joint bleeding causing pain, tenderness, swelling, and limited range of motion (hemarthrosis) 4.) Tendency to bruise easily 5.) Results of tests that measure platelet function are normal; results of tests that measure clotting factor function may be abnormal. Prolonged PTT 6.) Can usually determine pretty quickly in a newborn; this can be from circumcision, cutting the umbilical cord, injections, etc. 7.) Excessive menstrual bleeding Interventions: 1.) Monitor for bleeding, and maintain bleeding precautions. Bleeding Precautions: -Avoid contact sports, hold pressure on IV or injection, soft bristle toothbrush 2.) Prepare to administer factor VIII concentrates, either produced through genetic engineering (recombinant) or derived from pooled plasma, as prescribed. Control joint bleeding by immobilization, elevation, and application of ice; apply pressure (15 minutes) for superficial bleeding. 8.) Instruct the child and parents about the signs of internal bleeding. Manifest with pain swelling tenderness Instruct parents regarding activities for the child, emphasizing the avoidance of contact sports and the need for protective devices while learning to walk; assist in developing an appropriate exercise plan. Recommend noncontact activity like swimming 11.) Instruct the child to wear protective devices such as helmets and knee and elbow pads when participating in sports such as bicycling and skating. 12.) Wear medical alert bracelet

What is Hemophilia?

Assessment: -Most common finding is enlarged, firm, nontender, movable lymph nodes in the supraclavicular or cervical area; PAINLESS -Persistent nonproductive cough -Enlarged retroperitoneal nodes -Abdominal pain Systemic symptoms: -Low-grade or intermittent fever -Anorexia -Nausea -Weight loss -Night sweats -Pruritus Interventions: -Treat with Chemo and Radiation -More worried about quality of life -Worry about infertility

What is Hodgkin's Lymphoma?

Description: -An imbalance of CSF absorption or production that is either the result of congenital complication or an acquired condition such as tumors, hemorrhage, infections, or trauma -Results in head enlargement and increased ICP Treatment: Most often surgical -Ventriculoperitoneal shunt Shunt Malfunction: -Look for infection at surgical sites -Antibiotics -Two surgical sites Look at abdomen: assess bowel sounds, palpation, abdominal circumference -I's and O's; daily weights -Seizure precautions because concerned for ICP (look for signs of increased ICP for complications of this) Treatment for shunt infection: HIGH DOSE ANTIBIOTICS -As the child grows, may need to get shunt replacement to fit them -No contact sports -Protective helmet

What is Hydrocephalus?

Elevated blood glucose level >200 mg/dL S/S: polydipsia, polyuria, polyphagia, blurred vision, weakness, weight loss, and syncope Interventions: Instruct the parents to notify the PHCP when the following occur: -Blood glucose results remain elevated (usually >200 mg/ dL [>11.4 mmol/L]) -Moderate or high ketonuria is present -Child is unable to take food or fluids -Child vomits more than once -Illness persists Sick day rules for diabetic child: -Always give insulin, even if the child does not have an appetite, or contact the PHCP for specific instructions. -Test blood glucose levels at least every 4 hours. -Test for urinary ketones with each voiding. -Follow the child's usual meal plan. -Encourage liquids to aid in clearing ketones. -Encourage rest, especially if urinary ketones are present. -Notify the PHCP if vomiting; fruity odor to the breath; deep, rapid respirations; a decreasing level of consciousness; or persistent hyperglycemia occurs.

What is Hyperglycemia?

Prevention: Nutrition, physical activity Interventions: diet modifications: fruits, veggies, watch sodium intake, lean meats Screening at 3 years for bp (app cuff size and placement): ->95-99% percentile = Prehypertension and need to come back for 3 separate occasions -Diuretic use WITH CAUTION because of the increased risk of dehydration

What is Hypertension?

(e.g., Novolin N) -Reach the blood 2-6 h after injection. -The insulins peak 4-14 h later and stay in the blood for about 14-20h.

What is Intermediate-acting insulins?

In iron-deficiency anemia, iron stores are depleted, resulting in a decreased supply of iron for the manufacture of hemoglobin in red blood cells; red blood cells are microcytic and hypochromic. Decreased oxygen carrying Diagnostic: history and physical + CBC: -Cold, arrhythmias, pale, passing out (syncope), history of anemia or sickle cell anemia Treatment: Treatment of underlying cause: -Transfusion after hemorrhage if needed -Nutritional intervention for deficiency anemias High Iron Foods: Dark, green leafy vegetables, fruits, veggies, red meat, liver, beans, legumes, nuts, whole grains, egg yolks -Anything but dairy basically Nursing Care Management: Iron Supplementation: -Tarry stools, stain teeth (rinse mouth, brush teeth after, use oral syringe), don't take with milk or antacids, take with citrus juice or vitamin C multivitamin because vitamin C helps with the absorption of iron, administer on empty stomach (juice is fine just no food), if experience GI upset with it let them take with food because they still need to take it to get some iron

What is Iron Deficiency Anemia?

-Occurs btw 1-3 yrs of age -Focus on joint preservation and motility -Heat compresses and passive ROM exercises -Hard to diagnose -Lab elevations Treatment: -Nsaids (kidney function, bleeding (tarry stools, coffee ground emesis), GI upset (take with food)) -Corticosteroids --Velcro to make day of life easier for them (consult occupational therapy)

What is Juvenile Idiopathic Arthritis?

Description: -Also known as mucocutaneous lymph node syndrome; is an acute systemic inflammatory illness -The cause is UNKNOWN, but it may be associated with an infection from an organism or toxin -Cardiac involvement is the most serious complication; aneurysms can develop

What is Kawasaki Disease?

Description: Nephrotic syndrome is a kidney disorder characterized by massive proteinuria, hypoalbuminemia (hypoproteinemia), hyperlipidemia, and edema. -The primary objectives of therapeutic management are to reduce the excretion of urinary protein, maintain protein-free urine, reduce edema, prevent infection, and minimize complications. Assessment: -Weight gain in the child -Periorbital and facial edema most prominent in the morning -Leg, ankle, labial, or scrotal edema -Decrease in urine output; urine dark and frothy -Ascites (fluid in abdominal cavity) -Lethargy, anorexia, and pallor -Massive proteinuria -Initially occurs between 2-3 years of life but wax and wanes Diet: -Strict I&O's, low sodium diet with Fruits, veggies, lean proteins Treatment: -Cortocosteriods: to help with inflammation -Supportive care -Small frequent feedings -Measuring abdominal growth -Normal protein intake -Low salt -Skin assessments because a lot of edema = skin breakdown -Diuretics (furosemide watch potassium levels, dietary) -I's and O's

What is Nephrotic Syndrome?

Assessment: -Disease usually diffuse rather than nodular -Very widespread disease with a lot of symptoms usually -Cell type undifferentiated or poorly differentiated -Dissemination: Occurs early, often, and rapidly -Mediastinal involvement and invasion of meninges Interventions: Therapeutic management—NHL: -Aggressive irradiation and chemotherapy -Induction, consolidation, and maintenance and some intrathecal chemotherapy Care management—NHL: -Primary focus on managing effects of chemotherapy

What is Non Hodgkin's lymphoma?

Found mostly in lower extremities near growth plate Clinical Finding: -Primarily in the femur Therapeutic management: -Surgery and chemotherapy -Surgery for biopsy and to save or amputate limb -Limb salvage includes prosthetic bone placement -Chemotherapy to decrease tumor size Care management: -Depends on surgical approach (amputation vs. salvage) -Allow child to ask questions—Expect grief response -Answer questions but do not offer extensive information -Inform child of chemotherapy effects -Phantom limb pain may develop

What is Osteosarcoma?

Is failure of the fetal ductus arteriosus (shunt connecting the aorta and the pulmonary artery) to close within the first weeks of life (birth) -A characteristic machinery-like murmur is present -An infant may be asymptomatic or may show signs of HF -A widened pulse pressure (Difference between systolic and diastolic) and bounding pulses are present (4+) -S/S of decreased cardiac output are present Management: -Indomethacin, a prostaglandin inhibitor, may be administered to close a patent ductus in premature infants and some newborns ---Stimulates closure!!!! -The defect may be closed during cardiac catheterization, or the defect may require surgical management -Prostaglandin E may be used to keep the PDA open in ductal-dependent cardiac defect

What is Patent Ductus Arteriosus: (Defects with Increased Pulmonary Blood Flow)?

Inability to retract the foreskin Normal finding, usually resolves without intervention Care management: -Phimosis managed with steroid cream -Extreme cases need surgery with circumcision -Proper hygiene -Do not forcefully retract foreskin

What is Phimosis?

Narrowing at the entrance to the pulmonary artery -Resistance to blood flow causes right ventricular hypertrophy and decreased pulmonary blood flow; the right ventricle may be hypostatic -A characteristic murmur is present -Infants or children may be asymptomatic -Newborns with severe narrowing may be asymptomatic -If pulmonary stenosis is severe, HF occurs -S/S of decreased cardiac output may occur Management: -Dilation of the narrowed valve may be done during cardiac catheterization

What is Pulmonary Stenosis?

Acute infection of the CNS -It is caused by virus transmitted by saliva of infected animal (skunks, raccoons, bats) -Virus multiplies in muscles, and infection is fatal if untreated -Incidence in humans is highest among those <15 years old -Wash the site and go to ED

What is Rabies?

First sign of Renal Failure = Decreased Urinary Output Electrolytes to Monitor: -Potassium: 3.5-5.0 -BUN -Creatine Medications: -Potassium supplement guidelines (look at CHF bullet point) -Diuretics -Steroid Therapy -Antihypertensives Management: -Strict I and O's -Looking at lab studies Renal diet: -low sodium, lean protein,

What is Renal Failure?

Potential association exists between aspirin therapy for fever and development of Reye's syndrome and the development of influenza and varicella before it -AFFECTS BRAIN AND LIVER -Diagnose with a liver biopsy -Can lead to encephalopathy of the brain -Concerned for post-op bleeding -Monitor neuro status, provide ventilation, iv fluids, strict I&O's, foley care

What is Reye's Syndrome?

Strep throat!! Description: -Is an inflammatory autoimmune disease that affects the connective tissues of the heart, joints, skin (subcutaneous tissues), blood vessels, and central nervous system -The most serious complication is rheumatic heart disease, which affects the cardiac valves, particularly the mitral valve CAN GIVE: SALICYLIC ACID AND ASPIRIN Rheumatic Fever manifests 2 to 6 weeks after an untreated or partially treated group A beta-hemolytic streptococcal infection of the upper respiratory tract (recent sore throat?)

What is Rheumatic Fever?

Curvature of the spine start screening in adolescents Not curable unless they have surgery where they put rods in their back; go with a brace of some sort; does not cure but prevents further curvature from occurring Management with a brace: -Braces are not curative but may slow the progression of the curvature to allow skeletal growth and maturity. -Inspect the skin for signs of redness or breakdown. -Keep the skin clean and dry, and avoid lotions and powders, because these cake and lead to skin breakdown. -Advise the child to wear soft, non irritating clothing under the brace. -Instruct in prescribed exercises (exercises help maintain and strengthen spinal and abdominal muscles during treatment). -Encourage verbalization about body image and other psychosocial issues. -Wear the brace every day for approximately 23 out of 24 hours a day; have enough time to shower and perform hygiene before putting it back on -Peer involvement body image issues: wear a jacket or cardigan to hide the brace; can dress it up with stickers WARNING:The potential for altered role performance, body image disturbance, fear, anger, and isolation exists for a child with a disabling condition and a condition that requires a body brace

What is Scoliosis?

(e.g., Novolin R) -Usually reaches the blood within 30 min after injection. -The insulin peaks 2-4 h later and stays in the blood for about 4-8 h.

What is Short-acting (regular) insulin?

(soft tissue) therapy RICE (rest, ice, compression, elevation) -Ice is only appropriate if there is no presence of a fracture; max 30 minutes at a time with cloth in between skin -Dislocation: in area of joints -Hip dislocation is a big concern for lack of blood supply Cast/splint/immobilizer

What is a Sprain/Strain?

Prevention: -Avoiding bubble baths, fluids, wipe front to back, frequent urination, 100% cotton underwear Diagnostic: urinary bag on diaper (Urine culture and sensitivity) Treatment: -Antibiotics (Need to do urinalysis to determine what bacteria is present to treat with a certain antibiotic)

What is a UTI?

Description: Sickle cell anemia constitutes a group of diseases termed, hemoglobinopathies, in which hemoglobin A is partly or completely replaced by abnormal sickle hemoglobin S. -It is caused by the inheritance of a gene for a structurally abnormal portion of the hemoglobin chain. -Risk factors include having parents heterozygous for hemoglobin S or being of African American descent. Situations that precipitate sickling include: fever, dehydration, and emotional or physical stress; any condition that increases the need for oxygen or alters the transport of oxygen can result in sickle cell crisis (acute exacerbation), rest and minimize using energy, infection Clinical Manifestations: -PAIN -Increase RBC destruction -Cellular death -Vascular inflammation -Local hypoxia -Abnormal adhesive cells that blocks the blood vessels Interventions: 1.) Maintain adequate hydration and blood flow through oral and intravenously (IV) administered fluids. Electrolyte replacement is also provided as needed; without adequate hydration, pain will not be controlled. 2.) Administer oxygen (to help with comfort and calming effect) and blood transfusions as prescribed to increase tissue perfusion; exchange transfusions, which reduce the number of circulating sickle cells and the risk of complications, may also be prescribed. 3.) Administer analgesics as prescribed (around the clock). Morphine!! DO NOT GIVE DEMEROL (kids and old people) because the liver struggles to process it and can cause seizures 4.) Assist the child to assume a comfortable position so that the child keeps the extremities extended to promote venous return; elevate the head of the bed no more than 30 degrees, avoid putting strain on painful joints, and do not raise the knee gatch of the bed. 5.) Encourage consumption of a high-calorie, high-protein diet, with folic acid supplementation. 7.) Administer antibiotics as prescribed to prevent infection. 8.) Monitor for signs of complications, including increasing anemia, decreased perfusion, and shock (mental status changes, pallor, vital sign changes). -Stress, fever, dehydration, infection 10.) Ensure that the child receives pneumococcal and meningococcal vaccines and an annual influenza vaccine, because of susceptibility to infection secondary to functional asplenia. 12.) Inform parents of the hereditary aspects of the disorder. WARNING: Administration of meperidine for pain is avoided because of the risk of normeperidine-induced seizures.

What is Sickle Cell Anemia?

Included four defects: VSD, Pulmonary Stenosis, Overriding Aorta, and Right Ventricular Hypertrophy (thickening of ventricle wall; prohibiting from pushing all blood out of ventricle) -Admitted to the ICU IMMEDIATELY -A characteristic murmur is present -Acute episodes or cyanosis and hypoxia (hypercyanotic episode), called blue spells or tet spells, occur when the infant's oxygen requirements exceed the blood supply, such as during periods of crying, feeding, or defecating What to do during a Blue Spell of Tetralogy of Fallot? 1.) Places the infant in a knee-chest position 2.) Administers oxygen 100% as prescribed 3.) Administers morphine sulfate as prescribed 4.) Administering fluids intravenously as prescribed Two types of Surgical Management: Palliative Shunt: -The shunt increases pulmonary blood flow and increases oxygen saturation in infants who cannot undergo primary repair -The shunt provides blood flow to the pulmonary arteries from the left or right subclavian artery Complete Repair: -Complete repair usually is performed in the first year of life -The repair requires a median sternotomy and cardiopulmonary bypass

What is Tetralogy of Fallot: (Defects with Decreased Pulmonary Blood Flow: Cyanotic)?

Purposes of Traction: -Relieve fatigue in involved muscles -Position distal and proximal bone ends -Immobilize fracture site -Prevent deformity -Immobilize healing bone and prevent further injury -Reduce muscle spasms Care management: -Maintain correct amount of weight -Ensure weights hang freely -Check all ropes for fraying and all knots for tightness; be sure that the ropes are appropriately tracking in the grooves of the pulley wheels -NEVER take them off of it before stabilization -Monitor neurovascular status -Protect the skin from breakdown -Monitor for s/s of complications of immobilization: Constipation, skin breakdown, lung congestion, renal complications, and disuse syndrome of unaffected extremities -Provide therapeutic and diversional play

What is Traction?

Is an abnormal opening between the right and left ventricles (May be more than just one) -Many VSDs close spontaneously during the first year of life in children with with small or moderate defects (May wait a year to operate if stable) -A characteristic murmur is present -S/S of HF are commonly present Management: -Closure during cardiac catheterization may be possible -Open repair may be done with cardiopulmonary bypass

What is VSD: (Defects with Increased Pulmonary Blood Flow)?

Description: 1.) The signs and symptoms of a brain tumor depend on its anatomical location and size and, to some extent, on the age of the child; a number of tests may be used in the neurological evaluation, but the most common diagnostic procedure is magnetic resonance imaging (MRI), which determines the location and extent of the tumor. 2.) Therapeutic management includes surgery, radiation, and chemotherapy; the treatment of choice is total removal of the tumor without residual neurological damage. Assessment: 1.) Headache that is worse on awakening and improves during the day Because increased ICP 2.) Vomiting that is unrelated to feeding or eating 3.) Ataxia 4.) Seizures 5.) Behavioral changes 6.) Clumsiness; awkward gait or difficulty walking 7.) Diplopia (double vision) 8.) Facial weakness WARNING: Monitor for signs of increased ICP in a child with a brain tumor and after a craniotomy. If signs of increased ICP occur, notify the PHCP immediately. Craniotomy: Preoperative interventions: -Shave the child's head as prescribed (provide a favorite cap or hat for the child); shaving the head may also be done in the surgical suite. ----Doll or teddy -Prepare the child as much as possible; tell the child that they will wake up with a large head dressing. Postoperative interventions: -Assess neurological and motor function and level of consciousness. -Monitor for colorless drainage on the dressing or from the ears or nose, which indicates cerebrospinal fluid and needs to be reported immediately; assess for the presence of glucose in the drainage (dipstick). -Monitor for signs of increased ICP -Administer analgesics as prescribed. ---CORTICOSTEROIDS -Never place the child in Trendelenburg's position because it increases intracranial pressure and the risk of hemorrhage.

What is a Brain Tumor?

Description: -A break in the continuity of the bone as a result of trauma, twisting, or bone decalcification -Break of the bone; rare in infants because they have extremely spongy bone and it takes extreme force to fracture (red flag) WARNING: Fractures in infancy are generally rare and warrant further investigation to rule out the possibility of child abuse and to identify bone structure defects. Assessment: -Pain or tenderness over the involved area -Obvious deformity -Edema -Ecchymosis -Muscle spasm -Loss of function -Crepitation Initial care of a fracture: 1.) Immobilizes the extremity 2.) Checks neurovascular status of the extremity 3.) Covers the wound with a sterile dressing (clean dressing if a sterile dressing is unavailable) 4.) Elevates the injured extremity if possible 5.) Applies cold to the area 6.) Arranges for immediate transport to the nearest emergency department

What is a Fracture?

Opening of the urinary meatus is on the under portion of the penis -May need extra foreskin when doing reconstruction so they need to avoid circumcision --Done at 6-12 months of age --Once healed from this can then look at circumcision

What is a Hypospadias?

Echocardiography involves the use of ultra-high-frequency sound waves to produce an image of the heart's structure. -A transducer placed directly on the chest wall delivers repetitive pulses of ultrasound and processes the returned signals (echoes). -It is the most frequently used test for describing cardiac anatomy and detecting cardiac dysfunction in children. -Although the test is noninvasive, painless, and associated with no known side effects, it can be stressful for children. -A full echocardiogram can take an hour, and the child must lie quietly in the standard echocardiographic positions. Therefore infants and young children may need conscious sedation or anesthesia, and older children benefit from preparation for the test. -The distraction of a video or movie is often helpful.

What is an Echocardiogram?

Assessment: -Fever: Low-grade fever that spikes in the late afternoon ---Complete all antibiotics??? -Elevated antistreptolysin O titer -Elevated erythrocyte sedimentation rate -Elevated C-reactive protein level -Aschoff bodies (lesions): Found in the heart, blood vessels, brain, and serous surfaces of the joints and pleura Interventions: -Assess vital signs -Control joint -SEIZURE PRECAUTIONS -IV antibiotics (completing and taking as prescribed) -Prevention!! -ASPIRIN THERAPY FOR COAGULATION PROPERTIES

What is the assessment and interventions for Rheumatic Fever?

a.) Monitor the child's weight. b.) Frequent hand washing is important. c.) The child needs to avoid exposure to other illnesses. e.) Clean up body fluid spills with bleach solution (10:1 ratio of water to bleach).

Which home care instructions would the nurse provide to the parent of a child with acquired immunodeficiency syndrome (AIDS)? Select all that apply a.) Monitor the child's weight. b.) Frequent hand washing is important. c.) The child needs to avoid exposure to other illnesses. d.) The child's immunization schedule will need revision. e.) Clean up body fluid spills with bleach solution (10:1 ratio of water to bleach). f.) Fever, malaise, fatigue, weight loss, vomiting and diarrhea are expected to occur and do nor require special intervention.

b.) Reduce exposure to environmental organisms. c.) Use strict aseptic technique for all procedures. d.) Ensure that anyone entering the child's room wears a mask.

Which specific nursing interventions are implemented in the care of a child with leukemia who is at risk for infection? Select all that apply. a.) Maintain the child in a semiprivate room. b.) Reduce exposure to environmental organisms. c.) Use strict aseptic technique for all procedures. d.) Ensure that anyone entering the child's room wears a mask. e.) Apply firm pressure to a needlestick area for at least 10 minutes.