peds exam 1

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The nurse meets to discuss the denial of the child's diagnosis. During the conversation, the mother finally breaks down crying and tells the nurse, "I just can't believe what I have been thinking. My child is going to die, and it is all my husband's fault! I should never have married him. No one in my family has ever had this disease. My husband is adopted and his parents do not know anything about his biological background. His biological parents must have had this nasty disease and now he has passed it on to my baby. I am such a terrible wife and mother for having these thoughts, but I just can't bear to watch my precious baby suffer." What response reflects that the nurse values the principle of beneficence?

"I know this has to be a very scary and difficult time for you. What can I do to help you?"

Which statement by the parents indicates a correct understanding of a proper nutritional protocol of a client with CF? (Select all that apply. One, some, or all options may be correct.)

-Her diet should include more calories than an unaffected child. -Client should take vitamin A, D, E, and K supplementation along with her diet. -Her diet should consist of high fat, high protein, and unrestricted fats.

acute spasmodic laryngitis

-self-limiting illness that can result from allergens -characterized by paroxysmal attacks of laryngeal obstruction that occur mainly at night

What actions should the nurse educator take to address this? (Select all that apply. One, some, or all options may be correct.)

1. Aerosolized medications should be adminstered before CPT. 2. Instruct the parents to perform chest physiotherapy (CPT) either 2 hours before meals or 2 hours after meals. 3. Encourage "blowing" activities, such as bubbles or pinwheels.

infant normal rr rate

30-60

newborn normal rr rate

30-60 bpm

flutter valve

A one-way valve that allows air to leave the chest cavity but not return; formed by taping three sides of an occlusive dressing to the chest wall, leaving the fourth side open as a valve.

Peds Assessment Triangle

Apperance 1. Awake? 2. Aware? 3. Upright? Work of Breathing 1. Retractions? 2. Noises? Circulation 1. Skin = flushed?

The CNS refers the parents to the local chapter of the Cystic Fibrosis Foundation (CFF). Which rationale best supports this referral?

Community resources often provide support groups for parents of children with CF.

Which instruction should the nurse educator give the client's parents concerning the use of pancreatic enzymes as an oral prescription? (Select all that apply. One, some, or all options may be correct.)

Ensure that enzymes are administered within 30 minutes of consuming meals and snacks

pharyngitis assessment

Fever **Sore throat **Redness or swelling of pharynx and tonsils White/yellow exudate (pus) Enlarged cervical lymph nodes Fine rash over torso Headache Abdominal pain

nasopharyngitis assessment

Fever Sneezing, runny or stuffy nose Aches/discomfort Poor PO intake Post-nasal drip may cause sore/red throat, cough, vomiting, or diarrhea

Anticholinergics

Ipratropium bromide (atrovent) MDI or nebulizer Reduce bronchospasm SE: drying secretions, tachycardia

What information will the nurse include when teaching about the sweat test?

It is a simple and reliable test that measures the chloride in sweat.

The parents have been at the client's bedside since she was admitted to the hospital. The father asks to speak to the nurse outside in the hall. He tells the nurse that the mother is telling everyone that the client is going to be fine and that there has just been a mistake and everything will be all right. What action should the nurse take first?

Make arrangements to meet privately at the first opportunity.

Leukotrienes

Montelukast, zileuton Oral (capsule, chew tab, powder) Reduce chronic inflammation that leads to hyperreactivity

The nurses recognize that energy needs are increased as a result of malabsorption of nutrients and that extra effort is needed for respirations and frequent pulmonary infections. The nurse teaches the client's parents about pancreatic replacement enzymes. Which of the following statements by the parents would indicate a correct understanding of the teaching?

Pancreatic enzymes are needed to digest fats and proteins.

pancreatic issues with CF

Pancreatic obstruction from mucus eventually causes pancreatic fibrosis Decreased enzymes released to break down fats, proteins and nutrients Malnutrition, with potential effects on growth Fatty, frothy, foul smelling stools

Which action indicates to the nurse educator that the parents need more instruction about the respiratory care of the child with CF complications?

Placing the client in a prone position when she is having a dyspneic episode.

what are the causes of rr infections

Shorter straighter airway structures Narrower diameter of airway structures Immune system not fully developed Exploring the world with hands and mouth

The nurse is a preceptor for a student nurse from the local community college. The student nurse asks the preceptor, "I keep hearing about standards of care. What are standards of care?" Which is the best explanation for the nurse to provide to the student?

Standards of care are published statements that describe the level of care that the client can expect from nurses.

Which statement should the nurse record as the expected outcome for this nursing problem?

The client will be able to remove mucus from the airway by coughing.

While discussing pancreatic enzymes, the CNS explains that the dosage of the pancreatic enzyme is adjusted according to stool formation, which indicates how well client is digesting her food. Which adjustment would the nurse anticipate will be required, if client has constipation?

The pancreatic enzymes would be increased with each meal and snack.

Broselow tape

a measuring tape for infants that provides important information regarding airway equipment and medication doses based on your patient's length.

status asthmaticus

a severe, life-threatening asthma attack that is refractory to usual treatment and places the patient at risk for developing respiratory failure.

management for strep throat

amoxicillin for 10 days

most common pharyngitis bacterial

strep throat

Diagnosis of CF

sweat test of 105 mmol/L (normal is 60) also will have elevated LFTs

nursing consideration for strep throat

teach parents to look out for penicillin allergy - raises wheel like rash and itchy

flexhaler

turns dry powder into inhalant budesonide age dependent - >6

MDI - metered dose inhaler

turns med into gas ALWAYS USE WITH SPACER

nasopharyngitis management

viral illness - no antibiotics reduce transmission

If the client attends a daycare center, what should be shared with the daycare workers? (Select all that apply. One, some, or all options may be correct.)

-Proper handwashing between care of the other children -Isolate the child from any children with upper respiratory infections -Correct techniques for performing chest physiotherapy.

The nurse shares with the student nurse that the Society of Pediatric Nurses' Standards of Care includes primary, secondary, and tertiary nursing care prevention. The student nurse asks, "What type of care is given in secondary nursing care prevention?" ​​Which statement by the nurse is correct?

"It is care such as the sweat test and DNA testing that the child received." - intervention

Acetaminophen

10-15mg/kg every 4-6 hours

toddler normal rr rate

20-40

hypotension

< 70+2(age) 70 + 2(6) = 82

cystic fibrosis

A genetic disorder that occurs in people with two copies of a certain recessive allele; characterized by an excessive secretion of mucus and consequent vulnerability to infection; fatal if untreated.

where do you check pulse in children under 2? -

apical for 1 full minute

bronchiolitis

inflammation of the bronchioles

what is the max mL per injection site for infants

o.5mL

where do you check temperature in children older than 5?

oral or axillary

where do you check BP on infants

posterior tibial

child life specialists

professionals who are focused on the coping needs of pediatric patients and their families

intestinal issues with CF

prolapsed rectum

where do you check pulse on kids older than 2?

radial

pulmonary issues with CF

recurrent resp infections esp pseudomonas productive cough/dyspnea CP/wheeze chronic sinusitis infertility 95%

The mother shares with the nurse that she is thinking about separating from her husband for a little while. She states that because her child has been diagnosed with CF, she thinks she may want out of the marriage. Shortly after this conversation, the nurse walks down the hall and the father asks to speak to her in private. He tells the nurse, "I saw you speaking with my wife earlier. I think she is going to leave me, and I am so scared." Based on her previous conversation with the mother, what is the best statement by the nurse?

will sit with your child so you and your wife can talk. We have a quiet room you can use that is private and close by.

school age child normal rr rate

18-25

what is the max mL per injection site for children

1mL

croup syndrome

barking cough stridor swelling in upper airway (larynx and trachea)

where do you check BP for toddlers and kids

brachial

larynx

croup syndromes

asthma

- the most common chronic disease of childhood A chronic allergic disorder characterized by episodes of severe breathing difficulty, coughing, and wheezing.

Acute laryngotracheobronchitis

- viral - Caused by RSV, influenza A&B, M. pneumoniae - Sx: Low-grade fever, restlessness, hoarseness, barky cough, inspiratory stridor, retractions

3 main strategies with atraumatic care

1. prevent or minimize the child's separation from the family 2. promote a sense of control 3. prevent or minimize bodily injury and pain

adolescent normal rr rate

12-20

Acute Epiglottitis

Bacterial Croup syndrome Medical emergency! Age 2-5 y/o S/S: Drooling, absence of cough, agitation, retractions Tx: NOTHING in mouth!!! Not even throat culture! Intubation, racemic epi, antibiotics

atraumatic care

Care that minimizes psychologic and physical distress experienced by children and their families in the health care system

Which assessment supports the diagnosis of CF?

Weight loss and delayed growth despite a hearty appetite.

Huff cough

breathe out and cough through small valve in airway

obligatory breathers

breathing through the nose strictly

lower

bronchitis bronchiolitis pneumonia

what food do you avoid with strep throat

citris

what med is given for tonsilitis

dexamethasone for airway edema

alveolar expansion

incentive spirometry

preschooler normal rr rate

20-30

where do you check temperature in children under 5?

axillary

Which documentation further supports the diagnosis of CF? (Select all that apply. One, some, or all options may be correct.)

bulky loose stools hx of frequent rr infectons

upper

nasopharyngitis pharyngitis tonsilitis otitis media

ibuprofen

should not be given to children >6 5-10mg/kg every 6 hours for pain or fever


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