Pediatrics

Therapeutic management of Idiopathic thrombocytopenic purpura

-IVIG's-Steroids-Anti-D antibody

2 forms of Idiopathic thrombocytopenic purpura

-acute--self limiting (usually following a viral illness) -chronic (lasting longer than 12 months)

Labs in the diagnosis of sickle cell

-decreased hgb -increased WBC, bilirubin, and increased reticulocytes

Topical treatment scabies

5% permethrin to ENTIRE body (neck to toes) for 8 - 12 hrs Repeat in one week

The parent of a toddler newly diagnosed with CP asked the nurse what caused it the nurse should answer with which of the following a. most cases are caused by unknown prenatal factors b. it is commonly caused by perinatal factors c. the exact cause is not known d. the exact cause is known in every instance

A

acute chest syndrome

A symptom associated with sickle cell anemia where sickle cells get trapped in the lung and cause infection

which applies to CP select all that apply a. it is the most common chronic disorder of childhood b. hyeprbilirubinemia increases the risk of CP c. it is a progressive chronic disorder d. most children do not experience any learning disabilities e. there is a familial tendency seen in children with CP

A,B

A child with sickle cell anemia has been admitted to the unit. After assessing the child, the nurse notes the the child is having a vasoocclusive crisis. Which of the following signs and symptoms can occur from a vasoocclusive crisis? Select all that apply. a. Pain B. Swelling of hands and feet C. Stroke D. Painful Joints

A,B,C,D

Which muscle is contraindicated for the administration of immunizations in infants and young children? a. Deltoid b. Dorsogluteal c. Ventrogluteal d. Anterolateral thigh

ANS: B The dorsogluteal site is avoided in children because of the location of nerves and veins. The deltoid is recommended for 12 months and older. Ventrogluteal and anterolateral thigh sites can safely be used for the administration of vaccines to infants.

The nurse is concerned with the prevention of communicable disease. Primary prevention results from which of the following? a. Hand washing b. Strict isolation c. Immunizations d. Early diagnosis

ANS: C Primary prevention rests almost exclusively with immunizations. Hand washing and isolation are control measures to prevent the spread of disease. Early diagnosis assists in instituting appropriate therapy when available and in preventing spread to others.

Complication of sickle cell

Acute Chest Syndrome

SELECT ALL THAT APPLY.Which statements by the mother of a toddler would lead the nurse to suspect that the child has iron-deficiency anemia? A."He drinks over 3 cups of milk per day." B."I can't keep enough apple juice in the house; he must drink over 10 ounces per day." C."He refuses to eat more than 2 different kinds of vegetables." D."He doesn't like meat, but he will eat small amounts of it." E."He sleeps 12 hours every night and take a 2-hour nap."

Answer: A, B. Toddlers should have between 2 and 3 cups of milk per day and 8 ounces of juice per day. If they have more than that, then they are probably not eating enough other foods, including iron-rich foods that have the needed nutrients.

What causes iron deficiency anemia at 12-36 months age?

At 12 to 36 months, due to ingestion of large amounts of cow's milk and diet

A child with cerebral palsy has been fitted for braces and is beginning physical therapy to assist with ambulation the parents ask why he needs the braces when he was calling without any assistive devices select the nurses best response a. the CP has progressed and he now needs more assistance to ambulate b. as your child grows different muscle groups may need more assistance c. most children with CP need braces to help with ambulation d. we have found that when children with CPUs braces they are less likely to fall

B

A trio child with CP is admitted for dehydration following an episode of diarrhea the nurses assessment follows awake hale then ChildLine in bed multiple contractors drooling coughing spells noted wooden parent feeds temperature 97.8 pulse 75 respiratory rate 25 weight 7.2 kg no diarrhea stool for 48 hours which nursing diagnosis is most important a. potential for skin breakdown lying in one position b. alterations in nutrition less than body requirements c. potential for impaired social support mother sole caretaker d. alteration in elimination diarrhea

B

The nurse should suspect brainstem damage in a child when which of the following clinical manifestations is present? a) Intermittent decorticate posturing b) Bilateral dilated, nonreactive pupils c) Acetone odor of the breath d) Deep and rapid breathing pattern

B

which med is used for the treatment of spasticity in CP A. decadron B. baclofen C. coltaren D. tegretol

B used to treat spasticity in CP it is a centrally acting muscle relaxant

Impetigo treatment

Bactroban Topical Antibiotics: ◦Mupirocin, retapamulin x 5-7 days Oral Abx: ◦Erythromycin or Dicloxacillin

A child with spastic CP had an intrathecal dose of baclofen in the early afternoon what is the expected result 3 1/2 hours post does it suggest the child would benefit from a baclofen pump a. the ability to self feed b. the ability to walk with little assistance c. decreased spasticity d. increased spasticity

C

A mother states that she brought her child to the clinic because the 3-year-old girl was not keeping up with her siblings. During physical assessment, the nurse notes that the child has pale skin and conjunctiva and has muscle weakness. The hemoglobin on admission is 6.4 g/dl. After notifying the practitioner of the results, the nurse's priority intervention is to: a. reduce environmental stimulation to prevent seizures. b. have the laboratory repeat the analysis with a new specimen. c. minimize energy expenditure to decrease cardiac workload. d. administer intravenous fluids to correct the dehydration.

C

The nurse prepares to administer Baclofen into a child with CP who just had her hamstring surgically released the child's parents ask with the medication is for select the nurses best response a. It is a medication that will help decrease the pain from her surgery b. it is a medication that will prevent her from having seizures c. it is a medication that will help control her spasms d. it is a medication that will help with bladder control

C

The parent of a young child with CP brings the child to the clinic for a check up which parent statement indicates an understanding of the child's long-term needs a. my child would need all of my attention for the next 10 years b. once in school my child will catch up and be like the other children c. my child will grow up and need to learn to do things independently d. I'm the one who knows the most about my child and can do the most for my child

C

The parent of an infant with CP asked the nurse if infant will be mentally retarded which is the nurses best response a. Children with CP have some amount of mental retardation b. approximately 20% of children with CP have normal intelligence c. many children with CP have normal intelligence d. mental retardation is expected of motor and sensory deficits are severe

C

The parents of a child with meningitis and multiple seizures ask if the child life we develop CP select the nurses best response a. when your child is stable she will undergo CT and MRI the physicians will be able to let you know if she has CP b. most children do not develop CP at this late age c. your child will be closely monitored after discharge in the developmental specialist will be able to make the diagnosis d. most children who have had complications following meningitis develop some amount of CP

C

a nurse notes that a 4yo child with CP has a weight at the 30th percentile and a height at the 60th percentile. what is the most important information for the nurse to provide this childs family a. the child should eat fewer calories per day b. the childs height and weight are within the normal range c. the child needs to increase his number of calories d. the child is small for a 4 yo and will never be avg

C

In a child with sickle cell anemia (SCA), adequate hydration is essential to minimize sickling and delay the vasooclusion and hypoxia-ischemia cycle. The nurse teaches the parents to: a. encourage drinking. b. keep accurate records of output. c. check for moist mucous membranes. d. monitor the concentration of the child's urine.

C Children with SCA have impaired kidney function and cannot concentrate urine. Parents are taught signs of dehydration and ways to minimize loss of fluid to the environment. Encouraging drinking is not specific enough for parents. The nurse should give the parents and child a target fluid amount for each 24-hour period. Accurate monitoring of output may not reflect the child's fluid needs. Without the ability to concentrate urine, the child needs additional intake to compensate. Dilute urine and specific gravity are not valid signs of hydration status in children with SCA.

The clinical manifestations of sickle cell anemia (SCA) are primarily the result of which of the following? a. Decreased blood viscosity b. Deficiency in coagulation c. Increased red blood cell (RBC) destruction d. Greater affinity for oxygen

C The clinical features of SCA are primarily the result of increased RBC destruction and obstruction caused by the sickle-shaped RBCs. When the sickle cells change shape, they increase the viscosity in the area where they are involved in the microcirculation. SCA does not have a coagulation deficit. Sickled red cells have decreased oxygen-carrying capacity and transform into the sickle shape in conditions of low oxygen tension.

Which of the following is an important nursing consideration when a child is hospitalized for chelation therapy to treat iron poisoning? a. Maintain bed rest. b. Maintain isolation precautions. c. Keep accurate record of intake and output. d. Institute measures to prevent skeletal fracture.

C The iron chelates are excreted though the kidneys. Adequate hydration is essential. Periodic measurement of renal function is done. Bed rest is not necessary. Often the chelation therapy is done on an outpatient basis. The chelation therapy is not infectious or dangerous. Isolation is not indicated. Skeletal weakness does not result from high levels lead.

A school-age child is admitted in vaso-occlusive sickle cell crisis. The child's care should include which of the following? A) Correction of acidosis B) Adequate hydration, pain management C) Pain management, administration of heparin D) Adequate oxygenation, replacement of factor VIII

Correct Answer: B Rationale: The management of crises includes adequate hydration, minimizing energy expenditures, pain management, electrolyte replacement, and blood component therapy if indicated

Which of the following statements best describes iron deficiency anemia in infants? a. It is caused by depression of the hematopoietic system. b. It is easily diagnosed because of infant's emaciated appearance. c. It results from a decreased intake of milk and the premature addition of solid foods. d. Clinical manifestations are related to a reduction in the amount of oxygen available to tissues.

D In iron deficiency anemia the child's clinical appearance is a result of the anemia, not the underlying cause. Usually the hematopoietic system is not depressed. The bone marrow produces red cells that are smaller and contain less hemoglobin than normal red cells. Children who are iron deficient from drinking excessive quantities of milk are usually pale and overweight. They are receiving sufficient calories, but are deficient in essential nutrients. The clinical manifestations result from decreased intake of iron-fortified solid foods and an excessive intake of milk.

Ringworm

Dermatophytoses: ◦fungal infections of skin, hair and nails Tinea cruris: ◦Inner thighs / inguinal area (jock itch) Tinea pedis: ◦feet (athlete's feet) Tinea corporis: ◦body Tinea capitis / Trichophyton tonsurans: ◦scalp

Lymphatic cancer, biopsy reveals Reed- Stemberg cells (mature B cells)

Hodgkin's Disease

RESEMBLES ABUSE AND THIS MUST BE RULED OUT PLATELET TRANSFUSION NOT RECOMMENDED. THEY HAVE NORMAL LEVELS

ITP

management: supportive (bleeding precautions, prednisone, IVIG, possible splenectomy--risk outweigh benefits), avoid contact sports, no NSAIDs

ITP

An acquired hemorrhagic disorder

Idiopathic Thrombocytopenic Purpura

Nursing consideration Impetigo

If lesions do not improve within 24 hrs, call MD Observe other family members for break outs

Highly contagious, superficial infection caused by Strep, Staph or both

Impetigo

◦May treat with Burow's solution to remove crusts prior to treatment with antibiotics

Impetigo

What causes iron deficiency anemia in teens?

In adolescents, due to rapid growth and poor eating habits

What causes iron deficiency anemia in infants?

In premature infants, due to low fetal supply

Nursing management of sickle cell anemia

Monitor the child's growth and watch for failure to thrive Carefully do a multisystem assessment Assess and treat pain Observe for the presence of inflammation or possible infection Carefully monitor for signs of shock Promote growth and development -hydration -minimize energy expenditure

60% of cases, malignant tumor of lymphreticular system, worse prognosis, more aggressive, more responsive

Non-hodgkin lymphomas

Intense nocturnal perianal pruritis, irritability, restlessness, enuresis Vaginal/vulvar pruritis, vaginal discharge

Pin worms

the appearance of multiple purple discolorations on the skin caused by bleeding underneath the skin

Purpura

Skin: ◦Red-ringed raised patch of vesicles ◦Itching, pain, scaling ◦Expanding red ring with central clearing

Ringworm

How can you diagnose pin worms?

Tape test (overnight or 3-5 day am collection)

ITP characteristics

Thrombocytopenia (excessive destruction of platelets) Purpura (discoloration caused by petechiae beneath the skin, with no other signs of bleeding) NORMAL bone marrow

Ischemia and pain caused by sickle-shaped red blood cells that obstruct blood flow to a portion of the body.

Vaso-occlusive crisis

visual disturbance, hematuria, painful swelling extremities, fever, tachy, PAIN

Vaso-occlusive crisis

What does impetigo look like?

Yellow crusting around mouth, honey crusted looking scab

Nursing considerations Idiopathic thrombocytopenic purpura

avoid contact sports for a few weeks after occurrence until platelet levels are increased

Impetigo

bacterial inflammatory skin disease characterized by vesicles, pustules, and crusted-over lesions

If in sickle cell crisis

bed rest, hydration (IV), replace electrolytes, oxygen, pain management, antibiotics & blood transfusion

Platelet count in Idiopathic thrombocytopenic purpura

less than 20,200/mm

spleen sequestration crisis

life threatening, death can occur in hours, blood pools in spleen,

Pin Worm Treatment

mebendazole is the drug of choice Good hand washing Keep fingernails clean/short Wash toilet seat Treat all family members

Iron administration (iron deficiency anemia)

o1 hour before or 2 hours after milk or antacid oGI side effects common at first oStraw to prevent tooth staining- rinse mouth with water oTarry, dark stools (can be green)—constipation sometimes oZ-track for deep IM injections

What should you give antifungal with?

◦Give with fatty foods (whole milk/peanut butter) to enhance absorption

What is important to monitor during ringworm treatment with antifungal?

◦Monitor renal & liver function ongoing treatment

When can child return to school with impetigo?

◦Okay to return to daycare / school after 24-48 hrs abx

The nurse is developing a plan of care for a child recently diagnosed with CP what should be the nurses priority goal a. Ensure the ingestion of sufficient calories for growth b. decrease intracranial pressure c. teach appropriate parenting strategies for a special needs child d. ensure that the child reaches full potential

D

The parent of an infant asked the nurse what to watch for to determine if the infant has CP which is the nurses best response a. if the infant cannot sit up without support before eight months b. if the infant demonstrates tongue thrust before four months c. if the infant has poor head control after two months d. if the infant has clenched fist after three months

D

the nurse is teaching the parents of a 17mo dx with cerebral palsy how to prevent the scissoring position. what is the most appropriate instruction by the nurse a. keep the child in leg braces 23 hours a day b. let the child lay down as much as possible c. try to keep the child as quiet as possible d. straddle the child on your hip when being carried

D

which statemetn by the parent of a child with cerebral palsy, would indicate that a nurses teaching has been successful a. my childs muscles will get stronger over time b. my childs condition will get progressively worse c. my child will have low intelligence d. my child will need continual therapy to maintain functioning

D

Signs of spleen sequestration

-hypovolemia, hypotension, shock

Diet high in iron

-red meat- green leafy vegetables -legumes-peanut butter -eggs -tofu -vitamin c helps increase the absorption of iron

The parents of a 12 month old with CP asked the nurse if they should teach their child sign language because he has not begun to vocalize the nurse bases the response and the knowledge that sign language a. may be a very beneficial way to help children with CP communicate b. may cause confusion and further delay vocalization c. is difficult to learn for most children with CP d. is beneficial to learn but it would be best to wait until the child is older

A

The parents of a child with CP are learning how to feed their child and avoid aspiration the nurse would question which of the following when reviewing the teaching plan a. place the food on the tip of the tongue b. place the child in an upright position during feedings c. feed the child soft and blended foods d. feed the child slowly

A

Which of the following explains why iron deficiency anemia is common during infancy? a. Cow's milk is a poor source of iron. b. Iron cannot be stored during fetal development. c. Fetal iron stores are depleted by 1 month of age. d. Dietary iron cannot be started until 12 months of age.

A

Meperidine (Demerol) is not recommended for children in sickle cell crisis because it: A) May induce seizures. B) Is easily addictive. C) Is not adequate for pain relief. D) Is given by intramuscular injection

A Rationale: A metabolite of meperidine, normeperidine, is a central nervous system stimulant that produces anxiety, tremors, myoclonus, and generalized seizures when it accumulates with repetitive dosing. Patients with sickle cell disease are particularly at risk for normeperidine-induced seizures

A school-age child is admitted in vasoocclusive sickle cell crisis (pain episode). The child's care should include which of the following? a. Hydration, pain management b. Oxygenation, factor VIII replacement c. Electrolyte replacement, administration of heparin d. Correction of alkalosis and reduction of energy expenditure

A The management of crises includes adequate hydration, pain management, minimization of energy expenditures, electrolyte replacement, and blood component therapy if indicated. Factor VIII is not indicated in the treatment of vasoocclusive sickle cell crisis. Oxygen may prevent further sickling, but it is not effective in reversing sickling because it cannot reach the clogged blood vessels. Also, prolonged oxygen can reduce bone marrow activity. Heparin is not indicated in the treatment of vasoocclusive sickle cell crisis. Electrolyte replacement should accompany hydration. The acidosis will be corrected as the crisis is treated. Energy expenditure should be minimized to improve oxygen utilization. Acidosis, not alkalosis, results from hypoxia, which also promotes sickling.

The mother of your 10-year-old sickle cell patient walks up to the nurses station and tells the nurse that she thinks her son may be experiencing signs and symptoms of acute chest syndrome (ACS). Which of the following are signs of ACS? Select all that apply. a. Dyspnea, tachypnea b. Severe headache c. Severe chest, back, or abdominal pain d. Fever of 38.5 C (101.3 F) or higher e. Vomiting

A,C,D

Child is admitted to the pediatric unit with spastic CP witch with the nurse expect a child with spastic CP to demonstrate select all that apply a. increased deep tendon reflex b. decreased muscle tone c. scoliosis d. contractures e. scissoring f. good control of posture g. good fine motor skills

A,C,D,E

a nurse is teaching the parents of a child recently dx with CP about the dx. which statements, by the parents would indicate that teaching was effective. select all that apply a. we will schedule frequent rest periods throughout the day b. our child will have to spend a lot of time in the hospital c. we will have to learn to feed our son through a feeding tubed. D. our child will have to learn to read sign language in order to communicatee. E. we will have to learn exercises and positioning to prevent deformities from occuring

A,E

Nursing considerations ringworm treatment

Assess all family and household pets Give griseofulvin with fatty foods to enhance absorption of med Finish rx!

Child requires continuous follow up because of behavior suspicious of Cerebral Plasy a. one month old who demonstrates the startle reflex when allowed noises heard b. six-month-old who always reaches for toys with the right hand c. 14th-month-old who has not begun to walk d. two-year-old who is not yet achieved bladder control during waking hours

B

An infant age 4 months comes to the clinic for a well-infant check-up. Immunizations she should receive are DTaP (diphtheria, tetanus, acellular pertussis) and IPV (inactivated poliovirus vaccine). She is recovering from a cold but is otherwise healthy and afebrile. Her older sister has cancer and is receiving chemotherapy. Nursing considerations include which of the following? a. DTaP and IPV can be safely given. b. DTaP and IPV are contraindicated because she has a cold. c. IPV is contraindicated because her sister is immunocompromised. d. DTaP and IPV are contraindicated because her sister is immunocompromised.

ANS: A These immunizations can be given safely. Serious illness is a contraindication. A mild illness with or without fever is not a contraindication. These are not live vaccines so they do not pose a risk to her sister.

The therapeutic management of children with sickle cell disease consists primarily of which of the following? A. Oxygen therapy B. Prevention and treatment of pain C. Adequate hydration D. Frequent blood transfusions

B

the nurse is teaching the mother of a child with cerebal palsy about the condition. which observation would indicate that the mother needs further instruction a. the mother gvies the child assistive devices for eating b. the mother feeds the child because he is unable to eat without making a mess c. the mother provides adequate time for the child to finish eating d. the mother provides finger foods

B

The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction. The nurse should explain that narcotic analgesics: A) Are often ordered but not usually needed. B) Rarely cause addiction because they are medically indicated. C) Are given as a last resort because of the threat of addiction. D) Are used only if other measures, such as ice packs, are ineffective

B Rationale: The pain of sickle cell anemia is best treated by a multidisciplinary approach. Mild to moderate pain can be controlled by ibuprofen and acetaminophen. When narcotics are indicated, they are titrated to effect and are given around the clock. Patient-controlled analgesia reinforces the patient's role and responsibility in managing the pain and provides flexibility in dealing with pain. Few, if any, patients who receive opioids for severe pain become behaviorally addicted to the drug

A child suspected of having sickle cell disease is seen in a clinic, and laboratory studies are performed. A nurse checks the lab results, knowing that which of the following would be increased in this disease? A.Platelet count B.Hematocrit level C.Reticulocyte count D.Hemoglobin level

Answer: C A diagnosis is established based on a complete blood count, examination for sickled red blood cells in the peripheral smear, and hemoglobin electrophoresis. Laboratory studies will show decreased hemoglobin and hematocrit levels and a decreased platelet count, and increased reticulocyte count, and the presence of nucleated red blood cells. Increased reticulocyte counts occur in children with sickle cell disease because the life span of their sickled red blood cells is shortened.

The nurse explains to the parents of a 1-year-old child admitted to the hospital in a sickle cell crisis that the local tissue damage the child has on admission is caused by which of the following? A. Autoimmune reaction complicated by hypoxia B. Lack of oxygen in the red blood cells C. Obstruction to circulation D. Elevated serum bilirubin concentration

Answer: C Characteristic sickle cells tend to cause "log jams" in capillaries. This results in poor circulation to local tissues, leading to ischemia and necrosis. The basic defect in sickle cell disease is an abnormality in the structure of RBCs. The erythrocytes are sickle-shaped, rough in texture, and rigid. Sickle cell disease is an inherited disease, not an autoimmune reaction. Elevated serum bilirubin concentrations are associated with jaundice, not sickle cell disease.

Which of the following would the nurse identify as the priority nursing diagnosis during a toddler's vasoocclusive sickle cell crisis?A.Ineffective coping related to the presence of a life-threatening disease B.Decreased cardiac output related to abnormal hemoglobin formation C.Pain related to tissue anoxia D.Excess fluid volume related to infection

Answer: C For the child in a sickle cell crisis, pain is the priority nursing diagnosis because the sickled cells clump and obstruct the blood vessels, leading to occlusive and subsequent tissue ischemia. Although ineffective coping may be important, it is not the priority. Decreased cardiac output is not a problem with this type of vasoocclusive crisis. Typically, a sickle cell crisis can be precipitated by a fluid volume deficit or dehydration.

A clinic nurse instructs the mother of a child with sickle cell disease about the precipitating factors related to pain crisis. Which of the following, if identified by the mother as a precipitating factor, indicates the need for further instructions? A.Infection B.Trauma C.Fluid overload D.Stress

Answer: C Pain crisis may be precipitated by infection, dehydration, hypoxia, trauma, or physical or emotional stress. The mother of a child with sickle cell disease should encourage fluid intake of 1 ½ to 2 times the daily requirement to prevent dehydration.

A 10-year-old child has just received his first immunization of influenza vaccine. His lips begin to swell, and he states, "It feels like my throat is closing shut and my chest is tight when I breathe." The nurse recognizes these as signs of which of the following? A) A common systemic allergic reaction to immunization B) A local allergic reaction to the influenza vaccine injection C) A life-threatening reaction to the influenza vaccine D) An anxiety reaction due to receiving an injection

Answer: C This child's reaction describes angioedema, laryngeal edema, and respiratory distress, indicating impending anaphylactic shock. All other answer choices are possible reactions to immunizations, but are non-life-threatening.

The mothers asks the nurse why her child's hemoglobin was normal at birth but now the child has S hemoglobin. Which of the following responses by the nurse is most appropriate? A."The placenta bars passage of the hemoglobin S from the mother to the fetus." B."The red bone marrow does not begin to produce hemoglobin S until several months after birth." C."Antibodies transmitted from you to the fetus provide the newborn with temporary immunity." D."The newborn has a high concentration of fetal hemoglobin in the blood for some time after birth."

Answer: D Sickle cell disease is an inherited disease that is present at birth. However, 60% to 80% of a newborns hemoglobin is fetal hemoglobin, which has a structure different from that of hemoglobin S or hemoglobin A. Sickle cell symptoms usually occur about 4 months after birth, when hemoglobin S begins to replace the fetal hemoglobin. The gene for sickle cell disease is transmitted at the time of conception, not passed through the placenta. Some hemoglobin S is produced by the fetus near term. The fetus produces all its own hemoglobin from the earliest production in the first trimester. Passive immunity conferred by maternal antibodies is not related to sickle cell disease, but this transmission of antibodies is important to protect the infant from various infections during early infancy.

Laboratory studies are performed for a child suspected of having iron deficiency anemia. The nurse reviews the laboratory results, knowing that which of the following results would indicate this type of anemia? A.An elevated hemoglobin level B.A decreased reticulocyte count C.An elevated RBC count D.Red blood cells that are microcytic and hypochromic

Answer: D The results of a CBC in children with iron deficiency anemia will show decreased hemoglobin levels and microcytic and hypochromic red blood cells. The red blood cell count is decreased. The reticulocyte count is usually normal or slightly elevated.

Which of the following is a condition in which the normal adult hemoglobin is partly or completely replaced by abnormal hemoglobin? a. Aplastic anemia b. Sickle cell anemia c. Thalassemia major d. Iron deficiency anemia

B Sickle cell anemia is one of a group of diseases collectively called hemoglobinopathies, in which normal adult hemoglobin is replaced by abnormal hemoglobin. Aplastic anemia is a lack of cellular elements being produced. Thalassemia major refers to a variety of inherited disorders characterized by deficiencies in production of certain globulin chains. Iron deficiency anemia affects red cell size and depth of color but does not involve abnormal hemoglobin.

A child with sickle cell anemia (SCA) develops severe chest and back pain, fever, a cough, and dyspnea. The first action by the nurse is to: a. administer 100% oxygen to relieve hypoxia. b. notify practitioner, since chest syndrome is suspected. c. infuse intravenous antibiotics as soon as cultures are obtained. d. give ordered pain medication to relieve symptoms of pain episode.

B These are the symptoms of chest syndrome, which is a medical emergency. Notifying the practitioner is the priority action. Oxygen may be indicated; however, it does not reverse the sickling that has occurred. Antibiotics are not indicated initially. Pain medications may be required, but evaluation by the practitioner is the priority.

Which child is at increased risk for Cerebral Palsy a. infant born at 34 weeks with an Apgar score of six at five minutes b. 17 day old infant with group B streptococcus meningitis c. 24 month old child who is experienced a febrile seizure d. five-year-old with a closed head injury after falling off a bike

B (any infection of the CNS system increases risk)

The parents of a child with sickle cell anemia are distraught at the newly discovered diagnosis following a severe, painful sickle cell crisis. They state: "Well neither of us have this disease so we don't think that you are right about this disease being passed along genetically". What should the RN respond with? A. You are right, I am incorrect. The disorder is not genetic. B. Actually, you might be mistaken because this disorder is autosomal dominant, meaning one of you passed the trait along to your child. C. Sickle cell anemia is an autosomal recessive trait, which means that both of you are carriers of the trait, so you do not personally have the disease, just the sickle cell trait, but you have the chance of passing sickle cell disease on to your children. D. Um, you have a good point... Let me grab your doctor.

C

The parents of a child with sickle cell anemia (SCA) are concerned about subsequent children having the disease. The nurse should know that: a. SCA is not inherited. b. all siblings will have SCA. c. each sibling has a 25% chance of having SCA. d. there is a 50% chance of siblings having SCA.

C SCA is inherited as an autosomal recessive disorder. In this inheritance pattern, each child born to these parents has a 25% chance of having the disorder, a 25% chance of having neither SCA nor the trait, and a 50% chance of being heterozygous for SCA (sickle cell trait). SCA is an inherited hemoglobinopathy.

Which of the following should the nurse include when teaching the mother of a 9-month-old infant about administering liquid iron preparations? a. Give with meals. b. Stop immediately if nausea and vomiting occur. c. Adequate dosage will turn the stools a tarry green color. d. Allow preparation to mix with saliva and bathe the teeth before swallowing.

C The nurse should prepare the mother for the anticipated change in the child's stools. If the iron dose is adequate, the stools will become a tarry green color. A lack of color change may indicate insufficient iron. The iron should be given in two divided doses between meals when the presence of free hydrochloric acid is greatest. Iron is absorbed best in an acidic environment. Vomiting and diarrhea may occur with iron administration. If these occur, the iron should be given with meals, and the dosage reduced and gradually increased as the child develops tolerance. Liquid preparations of iron stain the teeth; they should be administered through a straw and the mouth rinsed after administration.

Which of the following describes the pathologic changes of sickle cell anemia? A) Sickle-shaped cells carry excess oxygen. B) Sickle-shaped cells decrease blood viscosity. C) Increased red blood cell destruction occurs. D) Decreased red blood cell destruction occurs.

Correct Answer: C) Rationale: The clinical features of sickle cell anemia are primarily the result of increased red blood cell destruction and obstruction caused by the sickle-shaped red blood cells.

The nurse evaluates teaching the parents of a child newly diagnosed with CP as a successful when the parents state that CP is which of the following a. inability to speak and uncontrolled drooling b. involuntary movements of lower extremity's only c. involuntary movements of upper extremity's only d. an increase in muscle tone and deep tendon reflex is

D

The nurse is caring for a child with CP whose weight is in the 5th percentile and has been hospitalized for aspiration ammonia his parents are anxious and state that they do not want a G-tube placed what should be the nurses best response a. a G tube will help your son gain weight and reduce his risk for future hospitalizations due to pneumonia b. g-tubes are very easy to care for and will make feeding times easier for your family c. are you concerned that you will not be able to care for his G-tubed. d. tell me what your thoughts are about G-tubes

D

The nurse is caring for a two month old infant who is at risk for CP. due to extreme low birth weight and prematurity his parents ask why a speech therapist is involved in his care. select the nurses best response a. your child is likely to have speech problems because of his early birth. involving the speech therapist now will ensure vocalization at a developmentally appropriate age b. the speech therapist will help with tongue and jaw movements to assist with Banbling c. many members of the healthcare team are involved in your child's care so that will know if there are any unmet needs d. the speech therapist will help with tongue and jaw movements to assist with feeding

D

Which of the following clinical manifestations should the nurse expect when a child with sickle cell anemia experiences an acute vaso-occlusive crisis? A) Circulatory collapse B) Cardiomegaly, systolic murmurs C) Hepatomegaly, intrahepatic cholestasis D) Painful swelling of hands and feet, painful joints

D Rationale: A vaso-occlusive crisis is characterized by severe pain in the area of involvement. If in the extremities, painful swelling of the hands and feet is seen; if in the abdomen, severe pain resembles that of acute surgical abdomen; and if in the head, stroke and visual disturbances occur.

Which of the following is an acquired hemorrhagic disorder that is characterized by excessive destruction of platelets? A) Aplastic anemia B) Thalassemia major C) Disseminated intravascular coagulation (DIC) D) Idiopathic thrombocytopenic purpura (ITP)

D Rationale: Idiopathic thrombocytopenic purpura (ITP) is an acquired hemorrhagic disorder characterized by an excessive destruction of platelets, discolorations caused by petechiae beneath the skin, and a normal bone marrow.

Superficial infections that live on the skin Also known as dermatophytoses Transmission from person to person or from infected animal to human Examples ◦Tinea capitis ◦Tinea corporis ◦Tinea pedis ◦Candidiasis (oral, diaper, vaginal)

Fungal Infecions

Ringworm diagnosis

If unsure: ◦Fungal culture of scalp lesion: ◦long time to grow.. ◦Potassium hydroxide (KOH) wet mount: ◦reveals rows and chains of spores w/I hair shaft

Hair: ◦Broken hairs>black dotted stubbed appearance ◦May have associated seborrhea ◦Kerion- large purulent boggy mass with drainage

Ringworm

Severely pruritic rash that worsens at night Lesions: ◦Palms of hands, webs of finger, intergluteal folds, or around axillae, wrists, elbows, inner thighs Lesions may be difficult to see d/t itching

Scabies

Diagnosis of scabies

Scrapings from a burrow under microscope Or hx and look at rash pattern

Presence of Hbg S, vaso-occlusion and hemolysis, autosomal recessive disorder, most common hereditary disorder in US.- only known cure= hematopoietic cell translation-hemoglobin in RBC are sickle shape

Sickle Cell Anemia

Treatment of ringworm skin

Skin: ◦Topical cream (clotrimazole) x 4 weeks \ ◦Can take months to treat/clear

Scabies

contagious skin disease transmitted by the itch mite, commonly through sexual contact

Treatment Ringworm Hair/nails

◦Oral anti-fungal agent: ◦Griseofulvin: ◦Resistance is high; 6-8 wks tx is necessary ◦Selenium sulfide shampoo 2-3x/week

Treatment scabies

◦Topical treatment: Permethrin 5% or lindane ◦Oral treatment: Ivermectin if body weight is more than 15 kg