PEDS EXAM 2

Anencephaly

- Failure of neural tube to close at cranial end. - Function brainstem, but large portions of the skull and brain are missing. - Fatal; no treatment available (majority are stillborn or die within a couple hours of birth). - Prenatal counseling is imperative to make informed decisions regarding the pregnancy. dead

Compartment Syndrome

- Fascia are tight, non-stretching bands that divide the muscle groups of the body. - Swelling and pressure inside one of the muscle group sections (compartments) can impair tissue circulation and cause necrosis. - Casting can also cause compartment syndrome due to edema inside an immovable cast. - Manifestations: pallor, pain, paresthesia (tingling), paralysis, and pulselessness. - Medical emergency; must relieve pressure in the compartments (through cast removal or fasciotomy) to prevent tissue ischemia, necrosis, and permanent damage.

CHF (congestive heart failure) signs and symptoms

- Fatigue and weakness - Ankle swelling (edema) - Clubbing of the digits - Syncope (fainting) - Angina - Breathing difficulties - Increased urination at night

UTI Risk Factors

- Female= wiping back-to-front (E. coli enters sterile urethra): teach proper hygiene! - Uncircumcised males - not retracting foreskin to clean smegma: teach proper hygiene! - Stasis: incomplete bladder emptying - Chronic constipation (decreased peristaltic activity) is related to UTI: gather an elimination history - Sex in adolescents promotes "milking" of bacteria from perineum and vagina

Influenza A and B

- Flu, most prevalent during fall and winter - Severe illness and worsens some chronic medical conditions - Symptoms include fatigue, nasal congestion, a cough, headaches, a sore throat, body aches, chills, a fever - Vomiting and diarrhea are more common symptoms in children - *Antivirals; immunization

Hydrocele

- Fluid accumulation in the scrotal sac. - Typically, noncommunicating and self-limiting; resolves by 1 year of age. - Transillumination of the scrotum to confirm fluid collection. - If persists beyond 12 to 18 months, likely noncommunicating and require surgical repair.

Pediatric versus Adult Neuromuscular System

- Fully formed at birth, but immature. - Gross and fine motor development over first 2 years of life. - Developmental (primitive) reflexes present at birth + replaced by protective reflexes over first year of life.

Resp Infection Clinical Manifestations

- Generalized signs and symptoms and local manifestations different in young children - Fever, Anorexia, vomiting, diarrhea, abdominal pain, Cough, sore throat, nasal blockage, or discharge

Kawasaki Disease: Acute Phase

- High fever - Eyes red without drainage (conjunctivitis) - Inflammation oral mucosa and pharynx, strawberry tongue - Rash macular or papular - Edema hands & feet - Irritability

Neonates HR + BP

- High heart rates and low blood pressures at birth. - Heart rate decreases and blood pressure increases with age. - 0-3 months HR + BP= 100-150 + 75/50 - 1-3 years= 70-110 + 95/65

Developmental Dysplasia of the Hip (DDH)

- Inadequate coverage of socket of the hip joint or dislocation of the ball from the socket. - Most often diagnosed during newborn examination, but may not be noticed until walking. - Manifestations: limited hip abduction, differing leg lengths, uneven thigh skin folds, palpable and audible click as femoral head moves (Ortolani/Barlow test), and limping gait. - Monitor skin for breakdown with cast or brace.

Neural Tube Defects (NTD)

- Includes brain + spinal cord. - Congenital disorders that occur during development of the neural tube - Risk factors: in utero exposure to certain medications, folate deficiency, maternal diabetes, maternal obesity, hyperthermia during early conception, and genetic factors. - Most common defects: spina bifida, encephalocele, and anencephaly. - Diagnosed through prenatal ultrasound and maternal alpha-fetoprotein tests.

Skin Traction

- Indirect pulling on the skin that puts traction on muscle and bone - Bryant, Buck, Russel

Infective Endocarditis

- Infection + inflammation of endocardium (inner lining of heart), causing dysfxn of valves - Caused by bacterial pathogens• - Osler nodes and Janeway lesions may be seen - Administer antibiotics, manage CO and CHF - Prophylactic antibiotics before procedures and surgeries in the future Symptoms: valvular dysfunction, may affect organ systems, chest pain, CHF, clubbing, meningitis, low back pain, arthralgia, arthritis

Acute Poststreptococcal Glomerulonephritis (APSGN)

- Inflammation and impairment of the glomeruli not caused by direct infection of the kidneys. - Caused by streptococcus (post-streptococcal). - Latency period 1-to-2 weeks after streptococcal pharyngitis - Symptoms include gross hematuria (cloudy, dark tea-colored urine), periorbital edema, anorexia, proteinuria, and hypertension. - Therapeutic interventions to maintain blood pressure and normal fluid volume status (antihypertensives, diuretics

Streptococcal Pharyngitis

- "Strep throat" (bacterial) - Pharyngitis, headache, fever and abdominal pain - Risk for serious sequelae, Acute rheumatic fever, Acute glomerulonephritis - Antibiotics (cillin; mycin)

Bacterial Epiglottitis

- Serious obstructive, inflammatory process - Potential for complete respiratory obstruction/failure - medical emergency! (Go to the ER!) - Prevention: Hib vaccine - Predictive signs◦ Absence of cough, drooling, and agitation

Fetal Circulation

- Site for blood oxygenation= placenta - Lungs nonfunctional - Umbilical vein carries oxygenated blood to body

Encephalocele

- Skull fails to fuse during 3rd or 4th week of gestation. - Brain and cranial membranes protrude along midline - Most common location is the base of the skull. - Prognosis depends on size and location of protrusion. - May also have other craniofacial abnormalities. - Treat with surgical repair. look like you got two heads, not dead

Heart Failure

- Structural or functional impairment of ventricles. - Ventricular dysfunction, volume overload, or pressure overload - Volume overload can be cardiac or noncardiac. - Pressure overload typically from obstruction. - Monitor mental status, pulmonary function, and kidney function.

skeletal traction

- Surgically placed pins through bone to apply pull - Skeletal cervical, Halo, 90-90.

Impaired Myocardial Function Leads to

- Tachycardia - Gallop rhythm - Diaphoresis - Poor perfusion - Restlessness - Fatigue

Pulmonary Congestion Signs

- Tachypnea - Dyspnea - Accessory muscle use - Nasal flaring - Grunting - Exercise intolerance - Orthopnea

Growth of bone

- 300 bones at birth that ossify to form 206 bones. - Sutures and fontanelles in the skull of infants. - Growth plates until early 20s. - Flat feet until 6 years old. - Pigeon-toed gait until 8 years old. - "Knock-knees" until 7 years old.

Blount Disease

- AKA tibia vara or bowed legs. - Disorder of the tibial growth plate that causes inward turning of the lower legs, which worsens with time. - Suspected if leg alignment is not straightened by 3 - Leg length discrepancy and knee pain also present. - Treat with bracing if younger than 4 years old. - Surgical treatment if persists despite bracing. - Increased susceptibility for compartment syndrome and deep vein thrombosis postoperatively. - Provide psychosocial support (e.g., for adolescent body image concerns).

Patent Ductus Arteriosus

- Abnormal Channel between pulmonary artery and aorta - Blood that should exit the heart via the aorta is circulated back to the lung via the PDA

Hemolytic Uremic Syndrome (HUS)

- Acute renal disease= thrombocytopenia, hemolytic anemia, and acute kidney injury. - Main cause of acute kidney injury in early childhood. - Usually preceded by diarrhea, Mainly caused E. coli - Most common in preschool and school-aged children. - Presents with subtle onset with vomiting, abdominal pain, anorexia, and ascites. - Toxins enter the bloodstream and destroy red blood cells, breakdown of red blood cells clog the kidneys

RSV/Bronchiolitis

- Acute viral infection—Respiratory Syncytial Virus (RSV) - Typically affects infants - Symptoms= rhinorrhea, intermittent fever, pharyngitis, coughing, sneezing, wheezing, possible ear or eye infection, + refusal to nurse or bottle feed - If severe*, tachypnea (greater than 70/min), listlessness, apneic spells, poor air exchange, poor breath sounds, cyanosis

Acute Spasmodic Laryngitis

- Also called spasmodic croup, midnight croup - Paroxysmal attacks of laryngeal obstruction - Occurs chiefly at night, sudden; transient - Unknown cause; maybe viral (self-limiting) - Barking cough, afebrile, mild resp. distress - Home treatment: cool mist vaporizer; cool night air

Cardiac Medications: Inotropes

- Alters force or strength of heart muscle contractions to improve cardiac output. - Used for heart failure management.

Bronchitis

- Associated with an upper respiratory infection, usually viral, and inflammation of the trachea, bronchi, and bronchioles - Self-limiting and requires symptomatic relief - Persistent dry, hacking cough as a result of inflammation; chest pain; thick sputum; may vomit thick mucus - Resolves in 5-to-10 days

Congenital Heart Defects: Increased Pulmonary Blood Flow (L to R shunting)

- Atrial Septal Defect - Ventricular Septal Defect - Patent Ductus Arteriosus - Atrioventricular Canal

Neuromuscular Assessment

- Cranial nerve assessments - Posture and muscle movements - Muscle tone= Hypotonia or hypertonia, Active and passive range of motion, + Grade on 5-point scale - Tendon reflexes:o Biceps, triceps, brachioradialis, patellar, and Achilles - Developmental reflexes

Spinal Cord Injury

- Damage to the spinal cord resulting in loss of physical and/or sensory function. - Spines are more mobile and elastic, so spinal cord injury without bony abnormality is more common in children. - Manifestations vary based on the level and type of injury.

Congestive Heart Failure Priority Nursing Diagnoses

- Decreased cardiac output - Decreased tissue perfusion - Activity intolerance

PEDS Respiratory Anatomy

- Diameter of airways plays significant role in respiratory illnesses - Distance between structures is shorter, allowing organisms to rapidly move down - Short Eustachian tubes= More ear infections

Drugs that Improve Cardiac Function

- Digoxin - Angiotensin-converting enzyme (ACE) inhibitors (Capoten,Vasotec)

Osteogenesis Imperfecta (OI)

- Genetic collagen disorder resulting in fragile bones. - Type I is the most common and mildest form. - Other manifestations: frequent fractures, blue sclera, hearing loss, short stature, and muscle weakness. - Treatment is palliative and focuses on strengthening muscles and preventing fractures; may require mobility aids. - Avoid automatic blood pressure cuffs - GH and bisphosphonates for bone growth.

Cystic Fibrosis

- Genetic disorder, person can asymptomatically carry the gene - Abnormalities in body's salt, water, + mucus cells - Thick, sticky mucus builds up in lungs, sinuses, liver, pancreas, intestines, and reproductive organs - Manifestations: fatty stool, failure to thrive, tachypnea, wheezing, retractions, recurrent pneumonia Treat and manage the affected systems: Pancreatic enzyme replacement, Percussion and drainage of lungs, Mucolytics (thin mucous), + Diet: high protein, high calorie, high fat

Cast Care

- Handle a wet cast with open palms. - Elevate the cast above the level of the heart and ice to prevent swelling. - Assess for signs of infection (i.e., foul odor, drainage, fever, warmth, and redness). - Assess for skin breakdown and pressure points. - Keep the cast clean and dry. - Never put anything inside the cast. - Prepare patients and caregivers before cast removal.

Systemic Venous Congestion Signs

- Hepatomegaly - Edema - Weight gain - Distended neck veins (only in older children)

Pediatric GU differences

- Larger kidneys in relation to abdomen - Urethral opening close to rectum - Shorter urethras - All nephrons present at birth but immature - Reduced (GFR) - Unable to concentrate urine - Less urine output per day but more voids

Post-Catheterization Care

- Leg straight 4-6 hours - Vital signs - particularly assessment of heart rate and rhythm - Assess pressure dressing - Assess extremity color and pedal pulse - Attention to fluid intake

Autonomic Dysreflexia (Hyperreflexia)

- Life-threatening emergency in patients with spinal cord injury above T6 history, causes a hypertensive emergency - Symptoms= Increased BP, severe pounding headache, sweating, respiratory distress, + nasal congestion

Spinal Muscular Atrophy

- Loss of motor function throughout all muscles of the body due to mutation in the survival motor neuron. - Degeneration of the motor neurons in the anterior horn cells of the spinal cord. - Progressive, symmetrical weakness and atrophy of the proximal muscles leading to premature death.

Tuberculosis (TB)

- Lung infection with acid-fast bacilli - Spreads by airborne droplets - Manifestations: Persistent cough, Night sweats, Fevers - Diagnostic testing= Tuberculin skin testing - Long-term antibiotic treatment

Heart Failure Interventions

- Maintain oxygenation and cardiac output. - Monitor fluid balance and weight. - Administer medications like Cardiac glycoside, ACE inhibitors, Beta Blockers, + Loop diuretics

Strains and Sprains

- Manifestations—pain, swelling, difficulty moving the area or bearing weight. - RICE technique and NSAIDs for treatment: - Rest: avoid weight bearing for 48 to 72 hours. - Ice: apply ice for 10 to 20 minutes three times daily. - Compression: wrap in elastic bandage to reduce swelling. - Elevation: elevate above the level of the heart. - Immobilization for 10 to 14 days if severe.

Cardiac Catheterization Interventions

- Measure oxygen saturations and pressures in chambers and great arteries - Evaluate cardiac output - Visualize defects and blood flow patterns - Evaluate cardiac conduction - Some corrective procedures performed

Spina Bifida

- Most common neural tube defect, failure for neural tube to fuse in the lower spinal area. - Manifestations: open vertebral arches, sac protruding from spinal area, and paralysis below the level of defect. - Require ongoing support for ventilation, oxygenation, thermoregulation, fluid management, and infection prevention. - Treat with surgical intervention to close the defect 24 to 36 hours after birth. - Likely to have neurological impairment below the lesion; may have neurogenic bladder and/or bowel.

Rheumatic Fever

- Most significant complication= cardiac valve damage (rheumatic heart disease), Autoimmune - Relationship between strep infection and subsequent development of RF (2-6 wks) - Prevented by administering antibiotics for streptococcal pharyngitis. - Major manifestations: heart involvement, joint involvement, non-pruritic rash, SQ nodules, chorea - Minor manifestations: fever, arthralgia - Antistreptolysin O titers - indicate a prior strep infection

Kawasaki Disease: Cardiac Manifestations

- Myocarditis with EKG changes - Decreased left ventricular Fn - Congestive Heart Failure

Coarctation of the Aorta

- Narrowing of aorta results in increased pressure proximal to the defect and decreased pressure distal to obstruction

Botulism (Big Kev)

- Neuroparalytic illness caused by toxins from Clostridium botulinum bacteria. - Symmetric descending flaccid paralysis of muscles under autonomic and voluntary control. - Manifestations: poor feeding, diminished suckling, drooling, weak cry, floppy appearance of neck, constipation, hypoxia, and tachypnea. - Treat with supportive care and botulism immune globulin (if severe) - Delay immunization for 6 months after administration - Rash is most common side effect.

Oxygenation

- Newborns are obligatory nose breathers, Mouth breathing begins at 4 months of age. - Use nasal cannula due to nose breathing. - Monitor O2 sat. while on supplemental oxygen. - Position child to increase oxygenation.

Renal Failure

- Temp or permanent damage to the kidneys that results in loss of normal kidney function. - acute or chronic.

Congenital Heart Defects: Decreased Pulmonary Blood Flow (R to L shunting)

- Tetralogy of Fallot - Pulmonic Stenosis - Pulmonary Atresia - Tricuspid Atresia

Tonsillitis

- Tonsils become inflamed/reddened - Acute tonsillitis can become chronic - Report of sore throat/difficulty swallowing - History of otitis media w/hearing difficulties

Congenital Heart Defects: Mixed Defects

- Transposition of the Great Arteries - Truncus Arteriosus - Double Outlet Right Ventricle

Pediatric Manifestations of UTI

- Urinary frequency, retention, urgency - Fever in some cases - Odiferous (foul-smelling) urine - Blood or blood-tinged urine - Sometimes no symptoms except generalized sepsis - Sometimes no symptoms, or nonspecific symptoms, like fatigue or anorexia (low or no appetite)

Cardiac Medications: Indomethacin

- Used to close PDA - Inhibits prostaglandin, which allows smooth muscle contraction to close openings.

Rickets

- Young bone fails to calcify due to vitamin D deficiency. - Usually occurs in children with dark skin and limited exposure to sunlight who are exclusively breastfed and do not receive vitamin D supplementation. - Treat w vitamin D supplementation + correction of any skeletal deformities. Avoid magnesium products. - Foods with vitamin D include fortified dairy, eggs, fatty fishes, sardines, and chicken livers. - Sunlight increases vitamin D absorption.

Tetralogy of Fallot (TOF)

4 defects: Ventricular septal defect, Pulmonic stenosis, Overriding aorta, Right ventricular hypertrophy Blood flows out of heart into rest of body

The nurse is providing education to parents of a child with a blood pressure in the 90th percentile. What would be included in the intervention strategies? A. The nurse would review the child's 24-hour diet recall. B. The child should not be allowed to participate in sports. C. Blood pressures should be measured daily. D. Beta blocker education should be given to the parents.

A: The nurse would review the child's 24-hour diet recall. With a child in the 90th percentile for blood pressure, diet and physical activity should be the main focus. Blood pressures should be measured, but daily measurement is not necessary.

The nurse is reviewing the health history and physical examination of a child diagnosed with heart failure. What would the nurse expect to find? Select all that apply. A. Tiring easily when eating B. Shortness of breath when playing C. Crackles on lung auscultation D. Bradycardia E. Hypertension

A: Tiring easily when eating B: Shortness of breath when playing C: Crackles on lung auscultation tachycardia and hypotension are also symptoms

The nurse is caring for a child diagnosed with a urinary tract infection. The caregiver asks the nurse why it is so important for the child to have so much fluid. What is the most important reason the child needs increased fluids? A. To dilute the urine and flush the bladder B. To fill the bladder so a specimen can be obtained C. To prevent the child from developing a fever D. To decrease the pain of urination

A: To dilute the urine and flush the bladder

A child is having their urine checked for complaints of polyuria. When analyzing the results, what would positive glucose indicate? A. This may indicate a urinary tract infection. B. This determines the presence of sugar in the urine. C. This indicates renal disease. D. This determines the presence of bacteria in the urine.

B: This determines the presence of sugar in the urine. Positive glucose determines the presence of sugar in the urine. This could signify diabetes and needs to be evaluated immediately. Positive leukocytes may indicate a urinary tract infection.

In developing a plan of care for the child diagnosed with rheumatic fever, the nursing intervention that takes highest priority for this child is to: A. position the child to relieve joint pain. B. monitor the C-reactive protein and ESR levels. C. provide age-appropriate diversional activities. D. promote rest periods and bed rest

D: promote rest periods and bed rest Bed rest if best for preventing long term complications such as residual heart disease, so this is highest priority

CN XI (accessory)

Ability to perform coordinated movements of neck and shoulders

CN II (optic)

Ability to regard a person's face, maintain eye contact, reach for an object, and pupillary response

CN VIII (vestibulocochlear)

Ability to startle to loud noises and turn to a familiar voice

Acute Renal Failure

Abrupt onset and is potentially reversible.

The nurse is caring for a child with Kawasaki disease in the acute phase. Which of the following clinical manifestations would the nurse expect to observe? Select all that apply. A) Osler nodes B) Cervical lymphadenopathy C) Strawberry tongue• D) Chorea E) Erythematous palms F) Polyarthritis

B,C,E (Cervical lymphadenopathy, strawberry tongue, and erythematous palms)

Syndactyly

Digits are fused and fail to separate (often involves nerves and muscles).

The nurse is collecting data on a 5-year-old child admitted with the diagnosis of congestive heart failure. Which clinical manifestation observed during the physical assessment would be consistent with this diagnosis? A. Jerking movements of the arms and legs B. Scissoring of the legs with toes pointed down C. Failure to gain weight D. Spooning of the finger nails

C. Failure to gain weight In infants and older children, one of the first signs of CHF is tachycardia. Other signs of CHF often seen in the older child include failure to gain weight, weakness, fatigue, restlessness, irritability, and a pale, mottled, or cyanotic color.

When assessing a child for the probable cause of acute bronchiolitis, the nurse focuses on which factor? A. Bacterial infections B. Environmental allergies C. Prenatal complications D. Viral infections

D. Viral infections

Improve Tissue Oxygenation

Humidified oxygen supplementation via Oxygen hood or nasal canula

Spinal Cord Injury Treatments

Immobilization to prevent further injury. - Prevent emergent complications: Autonomic dysreflexia, Neurogenic shock, + Surgical decompression if required. - Manage spasticity with physical therapy, stretching, splinting, and medications.

Which medication is used to close a patent ductus arteriosus (PDA)?

Indomethacin

Bacterial Pneumonia

Infection or inflammation in lower airways May also be viral; community or hosp. acquired. Symptoms= High fever, Cough, white sputum, tachypnea, and nasal flaring, Chest pain, dullness with percussion, Rhonchi, fine crackles, Pallor progressing to cyanosis, Irritability, restlessness, lethargy, Abdominal pain, diarrhea, lack of appetite, and vomiting

Sprain

Injury to a ligament.

Heart Shunt

Irregular patterns of blood flow in your heart. After birth, these shunts should be closed in order to establish the normal adult blood flow, and if not heart shunt disorders develop.

Respiratory Infections in PEDS Timing

Most common during winter and spring

CN III (oculomotor)

Move a brightly colored toy through the visual fields to assess tracking, corneal light reflex, and pupillary response

PEDS RR

Newborn= 30-60 1yr= 25-40 3yr= 20-30 10yr= 16-20

CN IX (glossopharyngeal)

Observe strength and quality of cry, ability to suck and swallow, and gag reflex

Atrial Septal Defect: Left-to-right shunt

Oxygenated blood that returns from the lungs to the left atrium flows through the defect back to the right atrium and then back to the lungs

Chronic Renal Failure

Progresses slowly over at least three months and can lead to permanent renal failure.

Scoliosis

Progressive lateral curvature of the spine with rotation of the vertebrae, S-shaped appearance of spine. - 80% are idiopathic and occur in adolescents. - Manifestations: truncal asymmetry, uneven shoulders, raised hips, and rib hump. - Routine screenings by school nurses (e.g., Adam's forward-bending test or scoliometer). - Bracing prevents further curving and must be worn 23 hours per day and be properly fitted; avoid skin breakdown. - Surgical interventions: spinal fusion, activity limitations postoperatively, and frequent neurovascular assessments.

Signs of MI in PEDS

Rare to see chest pain, Abdominal pain, Vomiting, Restlessness, Pallor, Shock, + Inconsolable crying

CN I (olfactory)

Reaction to noxious odor

Strain

Stretched or torn muscle or tendon.

CN IV (trochlear)

Symmetric eye movements and corneal light reflex

CN XII (hypoglossal)

Symmetrical movements of tongue

Kawasaki Disease

Systemic vascular disease that causes inflammation of multiple small blood vessels including the coronary arteries.

Life Threatening Cardiac Arrhythmias

Warning Signs: - family history of unexpected, unexplained sudden death under age 40 years - fainting or seizure during exercise, excitement, or startle - consistent or unusual chest pain and/or shortness of breath during exercise

Infants younger than 3 months

have protection due to maternal antibodies

Toddler and preschool-ages Infection rate

high rate of viral infections; the incidence of these infections decreases by age 5.

Gower Sign

indicates generalized muscle weakness in children

At 3-to-6 months

infection rate increases

Cystitis

inflammation of the bladder

pyelonephritis

inflammation of the renal pelvis and the kidney

Osteomyelitis

- Inflammation of the bone secondary to bacterial infection. - Staph aureus is the most common bacterial cause. - Manifestations: fever, malaise, fatigue, chills, bone pain, difficulty bearing weight, and swelling, redness, and warmth of the extremity. - Treat w antibiotics; get blood cultures before starting.

Ventricular Septal Defect

- Influence of high pressures in the left ventricle on the degree of left-to-right shunting - CHF common - Episodes of pneumonia

Duchenne and Becker Muscular Dystrophy

- Inherited diseases characterized by muscle wasting and progressive muscle weakness due to muscle fiber degeneration. - Fatal - Manifestations: generalized muscle weakness, toe walking, failure to meet developmental motor milestones, Gower sign, and lordotic posture.

Enuresis

- Involuntary discharge of urine, past the age of toilet training - Diurnal (daytime) versus nocturnal (bed wetting) - More frequently in boys than in girls - Assess for asymptomatic UTI - Runs in fams, suggests the disorder may be inherited

Nephrotic Syndrome Interventions

- Provide rest. - Monitor I&O + daily weights; weigh the child on the same scale with the same amount of clothing - Monitor edema and measure abdominal girth daily. - Monitor for skin breakdown

The nurse is caring for a school-age child recovering from an open reduction for a fractured femur. Which assessment findings indicate that the child is developing an infection? Select all that apply. A. Lethargy B. Increased pulse rate C. Reduced pulse in the ankle D. Cyanosis of the casted foot E. Increased body temperature

A. Lethargy B. Increased pulse rate E. Increased body temperature

Bladder Exstrophy

- Bladder extrudes through lower abdominal wall. - Displaced umbilicus and separates rectus muscles. - May have other GU malformations. - Cover exposed bladder with plastic wrap or sterile plastic bag to keep moist. - Keep in supine position and change soiled diapers immediately. - Use protective cream barriers to prevent skin breakdown. - Surgical intervention 48-to-72 hours after birth. - Treat bladder spasms with antispasmodics. - May require urinary diversion devices if surgery not effective to establish continence.

Legg-Calvé-Perthes Disease (LCP)

- Blood supply to the femoral head is disrupted, causing necrosis and bone cell death. - Manifests with a limp; may or may not have pain. - Treatment goals: relieve pain, protect femoral head shape, and restore hip movement.

Fractures

- Broken bones; varying types of fractures. - Growth plate fractures have higher risk for deformity and impaired healing. - Manifestations: swelling, pain, obvious deformities, abnormal positioning, and inability to bear weight or move affected area. - Immobilize with splints, casts, or traction. - Infection control to prevent osteomyelitis.

Nasopharyngitis—"common cold"

- Caused by numerous viruses - Clinical manifestations= Fever, Nasal inflammation + secretions, Irritability, restlessness, Decreased appetite + fluid intake, Vomiting and diarrhea - Home management - Self-limiting virus; persists for 4-to-10 days

Guillain-Barré Syndrome

- Autoimmune response resulting in an attack on the peripheral nervous system and demyelination of the peripheral nerves. - Triggered by recent bacterial or viral infections. - Manifestations: ascending hypotonia, numbness, pain, paresthesia, decreased or absent deep tendon reflexes and weakness. - Cerebrospinal fluid has protein levels more than twice the normal value.

Allergic Rhinitis

- Caused by seasonal reaction to allergens most often in the autumn or spring - Symptoms: Watery rhinorrhea; nasal obstruction; itchiness of the nose, eyes, pharynx and conjunctiva; snoring; fatigue; malaise; headache; and poor performance in school - Management: avoid allergens; give nasal corticosteroids (first‑line medication), antihistamines, beta-adrenergic decongestants, mast cell stabilizers

Croup Syndromes

- Characterized by hoarseness, "barking" cough, inspiratory stridor, and varying degrees of respiratory distress - Affect larynx, trachea, and bronchi - Described by anatomic area primarily affected - Can be Laryngotracheobronchitis (LTB), Acute spasmodic laryngitis, or Bacterial epiglottitis

Congenital Heart Defects: Obstruction to Systemic Blood Flow (Obstructive Disorders)

- Coarctation of the Aorta - Aortic Stenosis - Mitral Stenosis - Interrupted Aortic Arch - Hypoplastic Left Heart Syndrome

Pertussis (Whooping Cough)

- Common cold manifestations: runny nose, congestion, sneezing, mild fever, mild cough - Severe coughing starts in 1-to-2 weeks! - Violent and rapid coughing fits - Loud "whooping" sound upon inspiration - Interventions: supplemental oxygen; breathing treatments; antibiotics (azithromycin, erythromycin) - Vaccine= DTaP

Slipped Capital Femoral Epiphysis (SCFE)

- Common in adolescents due to growth spurts. - Ball at the head of the femur slips off the neck of the bone at the growth plate. - Risk factors: male, fat, renal + thyroid disease, pituitary disorders, and family history. - Manifestations: hip, knee, or groin pain, limping; Symptoms worsen with activity. - Medical emergency; avoid weight-bearing after diagnosis because may worsen condition. - Treat with immediate surgical intervention to prevent avascular necrosis of the bone

Cerebral Palsy

- Complex, non progressive, and permanent disorder. - Results from improper development or insult to brain. - Can be congenital or acquired. - Manifestations (depend on type): increased or decreased muscle tone, gross and fine motor delays, feeding difficulties, seizures, and joint deformities. - Treatment: therapy, case manager, early intervention, and adaptive and assistive technology.

Pectus Excavatum

- Congenital deformity; ribs and sternum grow inward. - Severity increases during growth spurts. - Severe deformity can cause cardiovascular compromise. - Surgery to reshape sternum and relieve pressure if pulmonary or cardiovascular effects. - Straight posture and no lifting for first month postoperatively. - Metal bars placed during surgery may be removed after 2 years (when bones have healed and fused).

Management of VUR

- Continuous antibiotic prophylaxis (CAP) - Mild cases may disappear by age 5 - Surgical management: open reimplantation of the ureter(s) or endoscopic correction - Nursing intervention includes: Care of the ureteral or suprapubic catheters (stents) and urine collection bags - Measurement of urinary output from each kidney should be similar, or obstruction is suspected - Pain management - Hydration - Avoidance of constipation

Nursing Goals in Renal Failure

- Correct or eliminate any reversible causes of kidney failure. - Provide support by taking accurate measurements of intake and output, including all body fluids. - Monitor vital signs - Maintain proper electrolyte balance. - I.V. therapy: administer IV fluid slowly in dehydrated patients, and hold K+ until kidney function normalizes - P.O. fluid: limit to prevent heart failure - Chronic renal failure, restrict bananas, carrots, nuts, and milk

Cardiomyopathy

- Disease of the heart muscle resulting in muscle defects - Thin heart muscle, dilated LV, loss of squeeze, and reduced CO (dilated) - Myocarditis is most common cause of dilated cardiomyopathy (viral) - Malformation syndromes are most common cause of hypertrophic cardiomyopathy - LV and septum enlargement; rigid walls (hypertrophic) - Obstructions occur after hypertrophic cardiomyopathy - Treatment: SAME AS FOR HEART FAILURE

Testicular Torsion

- Emergency condition, Testicle rotates and twists the spermatic cord, cutting off blood supply to the scrotum. - Caused by excessive mobility of the testes, impact injury, vigorous activity, cold temp., growth spurt - Uncommon before 10 years old. - Sudden onset of severe pain and swelling. - Prompt surgical intervention

Treatment for Enuresis

- Emotional support and patient education for patient and caregivers - Reassure parents bout their child's health and counsel to eliminate guilt, shame, and punishment - Incorporate fluid restriction (especially in the evening) - Bladder exercises (Kegel exercise) - Timed voiding (interruption of sleep to void) - Enuresis alarms ("Wee Alert") - Antidiuretic hormones, Tricyclic antidepressants (imipramine), + Anticholinergics (oxybutynin)

Specific Interventions for UTIs

- Encourage children to drink enough fluid - Advise wearing loose-fitting cotton underwear, which reduces the incidence of perineal irritation - Discourage the wearing of tight-fitting jeans - Teach girls to wipe from front-to-back after toileting - Discourage holding urine for long periods of time - Remind children to void often; look for cues - the "pee dance," crossing legs, holding genital area - Discourage frequent bubble baths, hot water baths, and heavily scented laundry detergent, all of which irritate the urethra

Overuse Injuries

- Microtrauma damage to bone, muscle, or tendon from repetitive stress without time to heal. - Initially treated using RICE and NSAIDs to reduce inflammation. - May also use stretching exercises, support devices, and/or physical therapy. - Prevention is key; limit activities, take time off between activities, and prepare multisport athletes.

Congenital Clubfoot

- More common in boys + have genetic component. - Heel tilts in and down, forefoot turns in, and bottom of the foot faces inward or upward. - Shorter Achilles tendon, foot + calf on affected side. - Treatment using serial casting with long leg casts changed weekly (begin early before bones ossify). - Can also use surgical treatment or French functional physical therapy to treat. - Compliance with nonsurgical treatment is key.

Asthma

- Most common chronic condition in children - Chronic inflammation in airways - Bronchoconstriction, increased mucus production - Treatment: medications, control of triggers**, and education

Acute Laryngotracheobronchitis (LTB)

- Most common croup disorder (viral) - Low-grade fever, restlessness, hoarseness, barky cough, dyspnea, inspiratory stridor, retractions, fear and anxiety over dyspneic state - INFANTS: nasal flaring, intercostal retractions, tachypnea, and continuous stridor - May lead to respiratory distress!

Nephrotic Syndrome

- Not a disease, but a group of symptoms that - Indicates damage to the glomeruli, result in the release of too much protein from the body (albumin) into the urine - Leads to a fluid shift from the intravascular spaces to tissue (interstitial space). - Most common cause: Minimal change disease (MCD) - Symptoms= Massive proteinuria/albuminuria, Hypoalbuminemia, Hyperlipidemia, + Edema (anasarca) - History of a viral respiratory tract infection immediately preceding the onset

Urinary Tract Infections (UTIs)

- One of the most common pediatric infections - Bacteria - Cystitis or pyelonephritis - Clinical manifestations vary by age and severity of UTI. - Lab work: urine sample for culture and sensitivity. - Medications: oral antibiotic therapy (uncomplicated); IV version, long-term, if pyelonephritis (complicated). - Phenazopyridine (Pyridium*) for symptomatic management - soothing effect

Kawasaki Disease: Sub-Acute Phase (II)

- Peeling fingers and toes - Arthritis - Highest risk for aneurysms in coronary arteries and thrombosis - Irritability persists - No fever

Rheumatic Heart Disease Long term

- Prophylactic Antibiotics for any proceudre - Compliance with meds is vital

Heart Failure Manifestations

- Pulmonary venous congestion: Tachypnea, labored breathing during feeding, cough, crackles, grunting, cyanosis, diaphoresis during feeding - Systemic venous congestion: Peripheral edema, fluid retention, ascites, enlarged liver, jugular venous distension - Impaired cardiac output: Tachycardia, pallor, tiring with play, cool extremities, weak pulses, hypotension, oliguria, irritability, delayed capillary refill - Increased metabolic demand: Diaphoresis, slow weight gain, failure to thrive, weight loss

Post- OP Care After Cardiac Surgery

- Respiratory: care during suctioning, assess for decreased breath sounds, cough & deep breathe - Plan care to allow for adequate rest - Medicate for pain

Respiratory Distress

- Restlessness, Tachycardia, Tachypnea, Diaphoresis - Grunting (helps keep alveoli open) - Retractions (assist with ventilation) - Head bobbing (assists with ventilation) - Nasal flaring (increases diameter of air passages) - Hyperextension of head and neck (opens the airway)

Vesicoureteral Reflux (VUR)

- Retrograde flow (backflow) of bladder urine into one or both ureters during voiding - Increases potential for infection (UTI) - Reflux occurs because the ureters are implanted in the bladder wall at an abnormal angle

A 4-year-old child is scheduled for an echocardiogram. The nurse is explaining this procedure to the child's parents. Which information would the nurse likely include? Select all that apply. A. "This test uses sound waves to check the heart structures." B. "This test should not cause your child any pain." C. "This test exposes your child to radiation so we need to be careful." D. "This test checks the electrical conduction of your child's heart." E. "This test will require us to give your child a small amount of anesthesia."

A. "This test uses sound waves to check the heart structures." B. "This test should not cause your child any pain." An echocardiogram is a noninvasive ultrasound procedure used to assess heart wall thickness, size of heart chambers, motion of valves and septa, and relationship of great vessels to other cardiac structures.

A 3-year-old demonstrates lateral bowing of the tibia. Which signs would indicate that the boy's condition is Blount disease rather than the more typical developmental genu varum? A. A sharp, beaklike appearance to the medial aspect of the proximal tibia on x-ray B. The medial surfaces of the knees are more than 2 in apart C. The malleoli are touching D. The condition is bilateral

A. A sharp, beaklike appearance to the medial aspect of the proximal tibia on x-ray Blount disease is retardation of growth of the epiphyseal line on the medial side of the proximal tibia (inside of the knee) that results in bowed legs. Unlike the normal developmental aspect of genu varum, Blount disease is usually unilateral and is a serious disturbance in bone growth that requires treatment

How would the nurse best describe Gowers sign to the parents of a child with muscular dystrophy? A. A transfer technique B. A waddling-type gait C. The pelvis position during gait D. Muscle twitching present during a quick stretch

A. A transfer technique

The nurse is caring for a 1-day-old newborn with patent ductus arteriosus with the following vital signs: pulse 160, respirations 80, oxygen saturation 92%, retractions, and crackles noted in bilateral lungs. Which nursing actions are appropriate at this time? Select all that apply. A. Administer furosemide. B. Initiate intravenous access. C. Apply oxygen via oxyhood. D. Feed a high-calorie formula. E. Begin indomethacin infusion.

A. Administer furosemide. B. Initiate intravenous access. C. Apply oxygen via oxyhood. E. Begin indomethacin infusion.

A nurse is working with a 12-year-old girl with osteomyelitis who is recovering from surgery. What nursing interventions should be implemented? Select all that apply. A. Administration of IV antibiotics at the hospital B. Instruct the parents on how to care for an IV line at home C. Instruct the parents regarding the importance of maintaining bed rest D. Institute infection-control precautions related to drainage tubes E. Cast care of the affected limb F. Instruction to the parents regarding proper traction of the limb

A. Administration of IV antibiotics at the hospital B. Instruct the parents on how to care for an IV line at home C. Instruct the parents regarding the importance of maintaining bed rest D. Institute infection-control precautions related to drainage tubes

An infant has been born and diagnosed with a meningocele. Which action will the nurse incorporate into each contact with this infant? A. Inspection of the cystic sac on the child's back for leakage B. Auscultation for bowel sounds C. Listening for a shrill cry D. Careful supine positioning

A. Inspection of the cystic sac on the child's back for leakage Leakage from the cystic area indicates loss of cerebrospinal fluid (CSF) and risk of infection of the central nervous system.

The nurse is caring for a child diagnosed with a sprain of the lower extremity. Which health care prescription(s) would the nurse clarify with the provider before implementing? Select all that apply. A. Apply a heating pad four times daily for 20 minutes per application B. Offer aspirin (ASA) three times daily orally to the child for pain and inflammation C. Avoid bearing weight on the affected extremity for 3 to 4 days D. Compress the site using an elastic bandage to wrap the area E. Assure the parents understand when to return and to call or follow-up with concerns

A. Apply a heating pad four times daily for 20 minutes per application B. Offer aspirin (ASA) three times daily orally to the child for pain and inflammation

The nurse is creating a care plan for a child with a leg cast. What interventions would be appropriate for the nursing diagnosis of Risk for ineffective peripheral tissue perfusion related to pressure from cast? Select all that apply. A. Assess foot and toes every 4 hours for color, warmth, and presence of pedal pulses. B. Keep leg elevated by a pillow at all times. C. Remind the parents to not allow the child to put anything in the cast. D. Assess capillary refill of toes every 4 hours. E. Educate the child's parents on use of good body mechanics when repositioning the child.

A. Assess foot and toes every 4 hours for color, warmth, and presence of pedal pulses. B. Keep leg elevated by a pillow at all times. D. Assess capillary refill of toes every 4 hours.

Parents of a preschooler with cerebral palsy ask the nurse what the surgeon plans to implant in their child's body to control spasticity. What is the nurse's answer? A. Baclofen pump B. Vagal nerve stimulator C. Central venous catheter D. Botulinum toxin

A. Baclofen pump

The student nurse is preparing a presentation on bones and bone growth. What information should the student include? Select all A. Calcium and vitamin D play important roles in bone growth and bone breakdown. B. Calcitonin plays a role in remodeling of bone. C. Adipose cell formation happens in the red bone marrow. D. Periosteum is the outer covering of the bone. E. The diaphysis is the rounded end portion of the bone.

A. Calcium and vitamin D play important roles in bone growth and bone breakdown. B. Calcitonin plays a role in remodeling of bone. D. Periosteum is the outer covering of the bone.

A nurse is conducting a presentation for a community parent group about respiratory conditions in children. The nurse determines that the teaching was successful when the group identifies which of the following as one of the most common conditions seen during early childhood? A. Croup B. Bronchiolitis C. Asthma D. Pneumonia

A. Croup Croup is one of the most common acute respiratory conditions seen during early childhood (6 months to 5 years of age), with a peak in the second year of life, and the most common cause of upper airway obstruction

When caring for a child with acute bronchiolitis which nursing interventions should be included in the plan of care. Select all A. Encourage fluids B. Administer oxygen C. Place child in mist tent D. Administer antibiotics E. Follow contact precautions F. Encourage activity

A. Encourage fluids B. Administer oxygen C. Place child in mist tent E. Follow contact precautions

The nurse is assessing a child with spastic cerebral palsy. What findings would the nurse expect to assess? Select all that apply. A. Exaggerated deep tendon reflexes B. Hemiplegia C. Poor control of balance D. Hypertonicity E. Drooling F. Dysarthria

A. Exaggerated deep tendon reflexes Spastic cerebral palsy is associated with exaggerated deep tendon reflexes; poor control of posture, balance, and movement

A nurse is assessing the history of a 7-year-old boy who is suspected of having a cardiovascular disorder. Which of the following findings would tend to indicate a cardiovascular disorder in this child? Select all that apply. A. Fatigues easily after a short walk home from school B. A tendency to squat C. Periorbital edema D. A lack of perspiration E. Frequent voiding F. Bouts of hyperactivity

A. Fatigues easily after a short walk home from school B. A tendency to squat C. Periorbital edema

A child who is experiencing an exacerbation of asthma is brought to the emergency department by his parents. When reviewing the child's laboratory and diagnostic test results, which is consistent with the diagnosis? A. Hyperinflation of lungs on chest radiograph B. Increased peak expiratory flow rate C. Low arterial blood carbon dioxide level D. Decreased pulmonary function tests

A. Hyperinflation of lungs on chest radiograph

Which of the following congenital heart disorders is not considered a mixed defect? A. Hypoplastic left heart syndrome B. Transposition of the great arteries C. Truncus arteriosus D. Double-outlet right ventricle

A. Hypoplastic left heart syndrome, this is an obstructive congenital heart defect.

The nurse is conducting a routine physical examination of a newborn to screen for developmental DDH. The nurse correctly assesses the infant by placing the infant: A. In a prone position, noting asymmetry of the thigh or gluteal folds. B. With both legs extended and observes the hip and knee joint relationship. C. With both legs extended and observes the feet. D. In a supine position with both legs extended and observes the tibia/fibula

A. In a prone position, noting asymmetry of the thigh or gluteal folds.

A child with a suspected airway obstruction is brought to the emergency room. He produces a harsh, strident sound on inspiration (stridor). Where is the obstruction likely to be located, based on this information? A. In the larynx B. Lower trachea C. Bronchioles D. Pharynx

A. In the larynx

The nurse is caring for a child who has been admitted with a possible diagnosis of tuberculosis. Which laboratory/diagnostic tools would most likely be used to help diagnose this child? A. Purified protein derivative test B. Sweat sodium chloride test C. Blood culture and sensitivity D. Pulmonary functions test

A. Purified protein derivative test Purified protein derivative tests are used to detect TB. Sweat sodium chloride tests= cystic fibrosis. Blood culture and sensitivity= causative agent Pulmonary function= asthma

A child has been admitted to the inpatient unit to rule out acute Kawasaki disease. A series of laboratory tests have been ordered. Which findings are consistent with this disease? Select all that apply. A. Reduced hemoglobin levels B. Reduced white blood cell count C. Elevated erythrocyte sedimentation rate (ESR) D. Negative C reactive protein levels E. Reduced platelet levels

A. Reduced hemoglobin levels C. Elevated erythrocyte sedimentation rate (ESR)

A child is admitted to the inpatient unit with Guillain-Barré syndrome. Which assessment should the nurse perform first? A. Respiratory assessment B. Neurological assessment C. Motor assessment D. Nutritional assessment

A. Respiratory assessment The nurse should assess respiratory status first. Guillain-Barré can lead to respiratory failure and decreased oxygenation

The nurse is caring for a 7-year-old with Guillain-Barré syndrome (GBS). Which of the following would be the most effective intervention to monitor for respiratory deterioration? A. Serial measurement of tidal volume B. Pulse oximetry C. Ineffective cough D. Diminished breath sounds

A. Serial measurement of tidal volume

The nurse is assessing the neuromusculoskeletal system of a newborn. What is an abnormal assessment finding? A. Sluggish deep tendon reflexes B. Full range of motion in extremities C. Absence of hypotonia D. Lack of purposeful muscular control

A. Sluggish deep tendon reflexes Deep tendon reflexes are present at birth and are initially brisk in the newborn and progress to average over the first few months.

The nurse is providing care to a child with a congenital heart defect. Which of the following would lead the nurse to suspect that the child is developing heart failure? Select all that apply. A. Tachycardia B. Sacral edema C. Bradypnea D. Inability to sweat E. Splenomegaly

A. Tachycardia B. Sacral edema Signs of heart failure include tachycardia, edema such as in the sacral area, tachypnea, and hepatomegaly. In addition, diaphoresis, fatigue and exercise intolerance

The nurse is assisting in the development of a plan of care for a child with asthma. In planning care, many goals would be appropriate for this child and/or family caregiver. Which two goals would be the highest priority for this child or family? A. The child will maintain a clear airway. B. The child will have adequate fluid intake. C. The child and family will connect with families living with the same diagnosis. D. The child and family will improve knowledge and understanding of varied pharmacologic options. E. The child will maintain adequate pain control.

A. The child will maintain a clear airway. B. The child will have adequate fluid intake. Treatment and management of asthma centers around avoiding triggers and controlling inflammatory episodes. Keeping the airway open is always the priority (ABCs). The next physiologic need is adequate fluid intake. These are priorities over psychosocial considerations such as connecting with other families. Pain is not normally an issue.

When caring for children with respiratory issues in relationship to the anatomy and physiology of the child's respiratory system, it is important to recognize which of the following? A. The diameter of the child's trachea is about the size of the child's little finger. B. As soon as the child is born, respiratory passages needed during fetal life close. C. Full development of the lungs and respiratory organs involved does not occur until the child is an adolescent. D. The newborn uses the thoracic muscles to breathe, and as they grow they begin using the abdominal muscles to breathe.

A. The diameter of the child's trachea is about the size of the child's little finger. This small diameter makes it extremely important to be aware that something can easily lodge in this small passageway and obstruct the child's airway.

A parent calls the "on call" line stating that her infant has had a bark-like cough for the past three nights. The parent states no fever or cold symptoms. Which suggestions may save a trip to the emergency department? Select all that apply. A. Use a cool mist humidifier in the infant's room. B. Take the infant into a steamy bathroom. C. Provide the infant cold oral fluids. D. Use the coolness of the night air. E. Assess throat for throat obstruction.

A. Use a cool mist humidifier in the infant's room. B. Take the infant into a steamy bathroom. D. Use the coolness of the night air.

The nurse is caring for a 2-year-old diagnosed with bacterial pneumonia. The child has been placed in a mist tent. In caring for the child, it is important for the nurse to: A. monitor the child regularly for signs of cyanosis. B. avoid contact with the mist if the nurse is a sexually active female of childbearing age. C. use contact transmission precautions. D. check for hyperthermia related to enclosure in the tent.

A. monitor the child regularly for signs of cyanosis.

A 5-year-old girl who was already admitted to the hospital for an unrelated condition suddenly becomes irritable, restless and anxious. These may be early signs of respiratory distress in a child if accompanied by: A. tachypnea. B. retractions. C. cyanosis. D. clubbing of fingers

A. tachypnea. Restlessness, irritability, and anxiety result from difficulty in securing adequate oxygen. These might be very early signs of respiratory distress, especially if accompanied by tachypnea (an increased respiratory rate).

The nurse is caring for a 12-year-old girl with nephrotic syndrome. The girl confides that she feels like a "freak" compared to her peers because of her weight, edema, and moon face. Which response by the nurse would be most appropriate? A. "Let's put you in touch with some other girls who are also having the same body changes." B. "Luckily, this is just a temporary, unfortunate part of your condition; you need to accept it." C. "Your real friends do not care about your appearance and just want you to get well." D. "You are beautiful in your own way; what matters is what is on the inside."

A: "Let's put you in touch with some other girls who are also having the same body changes."

An 8-year-old boy and his father visit the pediatrician's office with reports of a sudden onset of abdominal pain and reddish-brown urine. A urinalysis shows 4+ protein. On taking the boy's health history, the nurse learns that he had strep throat a little over a week ago. Which condition should the nurse suspect? A. Acute glomerulonephritis B. Kidney agenesis C. Polycystic kidney D. Nephrosis

A: Acute glomerulonephritis Glomerulonephritis, inflammation of the glomeruli of the kidney, is most common in children between the ages of 5 and 10 years. The child typically has a history of a recent streptococcal respiratory infection (within 7 to 14 days).

A 10-year-old girl is experiencing acute renal failure due to dehydration. The nurse is preparing to administer IV fluid. Which of the following interventions should the nurse take in caring for this child? A. Administer the IV fluid slowly B. Make sure the IV fluid contains potassium C. Increase oral intake of fluid D. Provide a diet high in protein and sodium

A: Administer the IV fluid slowly If the child is dehydrated (as with diarrhea or hemorrhage), IV fluid is needed to replace plasma volume. Administer such fluid slowly, however, to avoid heart failure as extra fluid cannot be removed by the nonfunctioning kidneys.

After teaching a group of students about medications commonly used for neuromuscular disorders, the nursing instructor determines that the teaching was successful when the students identify which agent as a centrally acting skeletal muscle relaxant? A. Baclofen B. Prednisone C. Lorazepam D. Botulin toxin

A: Baclofen Baclofen is a centrally acting skeletal muscle relaxant used to treat painful spasms and decrease spasticity in children with motor neuron lesions

The nurse is teaching the parent of a child with chronic renal failure on high-potassium foods that should be restricted. Which foods will the nurse include in this teaching? Select all that apply. A. Bananas, carrots, nuts, and milk B. Peaches, broccoli, and red meat C. Oranges, potatoes, wheat, and bran D. Spinach, chicken, fish, and green beans

A: Bananas, carrots, nuts, and milk

The nurse is caring for a child diagnosed with rheumatic fever. When addressing the child's pain, the nurse should perform which intervention(s)? Select all that apply. A. Carefully handle the child's knees, ankles, elbows and wrists when moving the child. B. Administer salicylates after meals or with milk. C. Teach the child how to use a patient-controlled analgesia system. D. Administer intravenous morphine as prescribed. E. Prioritize nonpharmacologic interventions over pharmacologic interventions.

A: Carefully handle the child's knees, ankles, elbows and wrists when moving the child. B: Administer salicylates after meals or with milk. Pain control + relief are the highest priorities rheumatic fever. Position child to relieve joint pain in Large joints Carefully handle the joints when moving the child to help minimize pain. Salicylates are administered in the form of aspirin to reduce fever + joint inflammation + pain .They are also used as a heart protective.

A child is diagnosed with Kawasaki disease and is in the acute phase of the disorder. What would the nurse expect the physician to prescribe? Select all that apply. A. Intravenous immunoglobulin B. Ibuprofen C. Acetaminophen D. Aspirin E. Alprostadil

A: Intravenous immunoglobulin C: Acetaminophen D: Aspirin

An infant with poor feeding is suspected of having a congenital heart defect. The parents are asking why a chest x-ray is necessary in their infant. What is the best response from the nurse? A. It will determine if the heart is enlarged. B. It will determine disturbances in heart conduction. C. It will show if blood is being shunted. D. This image will clarify the structures within the heart.

A: It will determine if the heart is enlarged. Chest x-rays are performed to see if the heart is enlarged. This will determine if the heart muscle is increasing in size. Disturbances in heart conduction are detected by an EKG. Visualizing where blood is being shunted is through the echocardiogram. The image used to clarify the structures of the heart is the MRI.

At a well-child visit, a urine specimen is obtained from a child for testing. The nurse is reviewing the results which reveal positive leukocytes. The nurse interprets this as indicating which of the following? A. Possible urinary tract infection B. Diabetes C. Renal disease D. Bleeding

A: Possible urinary tract infection

A voiding cystourethrogram (VCUG) is prescribed for a child. What education should be provided to the parents? A. The VCUG will rule out vesicoureteral reflux. B. The VCUG will detect if the infection is gone. C. The VCUG will rule out kidney stones. D. The VCUG will prevent further complications of the urinary tract infection (UTI).

A: The VCUG will rule out vesicoureteral reflux.

The nurse is working with a child with altered genitourinary status. The child demonstrates excess fluid volume. Which of the following would the nurse most likely do? A. Weigh the child 2 times a day on the same scale. B. Hold all medication until the fluid retention improves. C. Avoid administering IV fluids. D. Measure the amount of nitrates present in the urine.

A: Weigh the child 2 times a day on the same scale.

An infant is born with congenital clubfoot and the nurse tells the mother that serial casting should be started soon after birth. The mother asks why treatment must start so early? Which response, if made by the nurse, would best explain the need for early treatment?A. "That's how it's always done." B. "Early treatment allows the bone to be reformed before it hardens." C. "It's okay to wait if you think that would be best." D. "Early treatment allows for the extensive surgical interventions that are required later in life."

B. "Early treatment allows the bone to be reformed before it hardens."

The nurse is conducting a wellness examination of a 6-month-old child. The mother points out some dimpling and skin discoloration in the child's lumbosacral area. How should the nurse respond? A. "This could be an indicator of spina bifida; we need to evaluate this further." B. "This can be considered a normal variant with no indication of a problem; however, the doctor will want to take a closer look." C. "Dimpling, skin discoloration, and abnormal patches of hair are often indicators of spina bifida occulta." D. "This is often an indicator of spina bifida occulta as opposed to spina bifida cystica."

B. "This can be considered a normal variant with no indication of a problem; however, the doctor will want to take a closer look." Dimpling and skin discoloration in the child's lumbosacral area can be an indication of spina bifida occulta, but best to respond that the dimpling and discoloration is possibly a normal variation

The nurse is reinforcing teaching with the family caregivers of a child diagnosed with tuberculosis who is being treated with the drug rifampin. Which statement made by the caregivers indicates an understanding of this medication? A. "My son will have to take this medication the rest of his life." B. "While she is taking this medication, I won't worry if her tears look orange." C. "This medication may cause slight bleeding when she urinates." D. "He will not be able to attend school for the first few months that he is on this medication."

B. "While she is taking this medication, I won't worry if her tears look orange." Rifampin is tolerated well by children, but causes body fluids such as urine, sweat, tears, and feces to turn orange-red. Drug therapy is continued for 9 to 18 months

The nurse is assessing an infant at a well-check visit. The infant's mother states that she is worried about her child's feet because they are so flat and wide. What the appropriate response by the nurse? A. "You don't need to worry about your child's feet. They will change as your child grows." B. "Your child's feet are normal for an infant. A child's longitudinal arch will not develop until the child is walking for several months." C. "Flat feet are normal in infants. Their longitudinal arch doesn't appear until they are 3 to 5 years old." D. "When your child starts walking, encourage walking on the heels. This will help to develop the arch more so your child doesn't have a problem with flat feet as an adult."

B. "Your child's feet are normal for an infant. A child's longitudinal arch will not develop until the child is walking for several months."

Which assessment findings should the nurse expect to see in the infant diagnosed with pulmonary stenosis and heart failure? Select all that apply. A. Crackles (rales) B. Cyanosis C. Left ventricular hypertrophy D. Murmur E. Right ventricular hypertrophy

B. Cyanosis D. Murmur E. Right ventricular hypertrophy Patients with pulmonary stenosis have a narrowing in their pulmonary arteries, causing a decrease in blood flow to the lungs, which can cause cyanosis and the inability of the right ventricle to empty, leading to right ventricular hypertrophy.

A nurse is caring for an infant with spinal muscle atrophy (SMA) type 1 What will the nurse note when assessing the child? A. Spastic upper and lower extremities B. Narrow chest and protuberant abdomen C. Enlarged head with low-set ears D. Lusty cry with voracious appetite

B. Narrow chest and protuberant abdomen

Which nursing intervention is the priority for the immobilized child in an acute care setting? A. Ambulate the child up and down the hall twice a day. B. Offer age-appropriate toys and diversional activities. C. Take the child to the playroom at least once a day. D. Encourage active and passive range of motion exercises once a day.

B. Offer age-appropriate toys and diversional activities.

The nurse is caring for a child with history of asthma who presents to the emergency department with wheezing, tachypnea, and dyspnea. What will the nurse do first? A. Ask what may have triggered the attack. B. Place the child in high-Fowler's position. C. Assess the child's pulse oximetry reading. D. Apply oxygen via nasal cannula at 2 liters.

B. Place the child in high-Fowler's position.

The nurse is teaching a 14-year-old child on the proper use of a metered-dose inhaler to control symptoms of asthma. Which teaching points should the nurse include in these instructions? Select all that apply. A. Take two puffs at a time. B. Shake the canister before using. C. Wait 5 minutes between puffs. D. Hold the breath for 5 to 10 seconds. E. Activate the inhaler while taking a deep breath.

B. Shake the canister before using. D. Hold the breath for 5 to 10 seconds. E. Activate the inhaler while taking a deep breath.

The nurse is assessing a child with suspected rheumatic fever. What assessment findings are consistent with the disease process? Select all that apply. A. Diastolic murmur B. Involuntary limb movement C. Macular rash on trunk D. Tender swollen joints E. Nonpalpable subcutaneous nodules

B: Involuntary limb movement C: Macular rash on trunk D: Tender swollen joints palpable subcutaneous nodules + systolic murmur are other symptoms

The nurse is assessing a child with suspected infective endocarditis. Which assessment finding would the nurse interpret as a sign of extracardiac emboli? A. Pruritus B. Roth spots C. Delayed capillary refill D. Erythema marginatum

B: Roth spots

The nurse receives the shift report of multiple pediatric clients. Which pediatric client will the nurse see first? A. an infant whose parents report difficulty feeding with a temperature of 100.1°F (38°C) B. a toddler with tetralogy of Fallot squatting quietly in the corner of the room C. a child with history of hypertension and a current blood pressure of 130/90 mm Hg D. an adolescent with coarctation of the aorta with reports of coughing and coryza

B: a toddler with tetralogy of Fallot squatting quietly in the corner of the room

When changing diapers, caregivers should lift children with osteogenesis imperfecta

By the hips, the bones fracture very easily in children with osteogenesis imperfecta. Caregivers should handle children gently and avoid pulling on extremities.

A nurse is teaching the parents of a child who has been diagnosed with spina bifida. Which statement by the nurse would be the most accurate description of spina bifida? A. "It has little influence on the intellectual and perceptual abilities of the child." B. "It's a simple neurologic defect that's completely corrected surgically within 1 to 2 days after birth." C. "Its presence indicates that many areas of the central nervous system (CNS) may not develop or function adequately." D. "It's a complex neurologic disability that involves a collaborative health team effort for the entire first year of life."

C. "Its presence indicates that many areas of the central nervous system (CNS) may not develop or function adequately." When a spinal cord lesion exists at birth, it commonly leads to altered development or function of other areas of the CNS. Spina bifida is a complex neurologic defect that heavily impacts the physical, cognitive, and psychosocial development of the child and involves collaborative, lifelong management due to the chronicity and multiplicity of the problems involved.

The nurse has been teaching the parents of a child diagnosed with osteogenesis imperfecta about the use of bisphosphonates for this condition. What statement by a parent indicates a need for further education? A. "This medication will help to increase bone mineral density." B. "My child's risk for fractures will hopefully be decreased as by taking this medication." C. "This medication will cure my child of this disorder." D. "This medication doesn't prevent fractures from happening."

C. "This medication will cure my child of this disorder." Bisphosphonates are used in the palliative, not curative, treatment of osteogenesis imperfecta. The medication increases bone mineral density, therefore reducing the risk of the child developing fractures

The nurse is assessing a toddler. The mother states that he constantly is tripping over his own feet. What is the best response by the nurse? A. "At this age, your child is still learning how to control all of the muscles in the legs. As your child grows older, this clumsiness will get better." B. "Tripping over feet is a symptom of a severe bone disorder, metatarsus adductus. We will need to refer you to an orthopedic surgeon." C. "We will have your child stand on a copier and make a print of the feet. It will show us if the feet are turning in. If they are, your child may need some stretching exercises for the feet." D. "Turning in of feet or toeing in, is common at this age. As your child keeps walking, it will correct on its own."

C. "We will have your child stand on a copier and make a print of the feet. It will show us if the feet are turning in. If they are, your child may need some stretching exercises for the feet."

Which piece of equipment is most helpful in determining airway obstruction in the client with asthma? A. A nebulizer B. An inhaler C. A peak flow meter D. An incentive spirometer

C. A peak flow meter The peak flow meter provides the most reliable early sign of an asthma episode. Most episodes begin gradually, and a drop in peak flow can alert the client to begin medications before symptoms actually are noticeable

The nurse caring for an infant with myelomeningocele before surgical intervention will prioritize care in what way? A. Keep the mass uncovered and dry B. Prevent cold stress using an Isolette and blankets C. Cover the sac with a saline-moistened dressing D. Change position from side to side hourly

C. Cover the sac with a saline-moistened dressing Protection of exposed neural tissue is of high priority. Keeping the cystic mass moist prevents damage to neural elements from drying.

A 3-year-old child is admitted to the hospital with osteomyelitis of the right femur. The nurse would expect to start an IV and antibiotic after blood is drawn for which lab test? A. Hemoglobin and hematocrit B. White blood cell count C. Culture D. Platelets

C. Culture Only the culture will indicate which antibiotic is the correct medication to give for the infection.

In the emergency room, the nurse is assessing a toddler who is currently being treated for a radius fracture and has a history of multiple fractures. The assessment reveals short stature, blue sclera, and no bruising or swelling at the fracture site. The nurse suspects: A. Child abuse. B. Attention deficit/hyperactivity disorder. C. Osteogenesis imperfecta. D. Lack of parental supervision.

C. Osteogenesis imperfecta.

A nurse assesses a client who is complaining of calf pain, has a temperature of 101°F (38.3°C) and reports that his leg is very sore. X-rays do not reveal any abnormalities but the client's white count is 21,000 cells and his erythrocyte sedimentation rate is elevated. What problem do these symptoms suggest? A. Muscular dystrophy B. Legg-Calves-Perth disease C. Osteomyelitis D. Compartment syndrome

C. Osteomyelitis Osteomyelitis is a bone infection usually caused by Staphylococcus aureus, causes leg pain and fever

What will be the nurse's next action after noting dimpling and a tuft of hair located in the lumbosacral area of the preschool child during examination? A. Snip the tuft of hair off close to the skin for hygienic reasons B. Move on to other assessments without calling attention to the difference C. Record and refer the finding for follow-up to the pediatrician D. Inspect for precocious hair growth in the genital and underarm areas

C. Record and refer the finding for follow-up to the pediatrician Dimpling and hair growth may signal spina bifida occulta, which usually is benign. However, some complications can be associated, and further investigation is warranted to prevent possible damage to the spinal cord.

The nurse is assessing an infant with suspected hemolytic uremic syndrome. Which characteristics of this condition should the nurse expect to assess or glean from chart review? A. Hemolytic anemia, acute renal failure, and hypotension B. Dirty green colored urine, elevated erythrocyte sedimentation, and depressed serum complement level C. Hemolytic anemia, thrombocytopenia, and acute renal failure D. Thrombocytopenia, hemolytic anemia, and nocturia several times each night

C: Hemolytic anemia, thrombocytopenia, and acute renal failure

The nurse is caring for a female preschool-aged patient with a urinary tract infection. What measures should the nurse teach the mother to prevent future infections? A. Suggest the child drink less fluid daily to concentrate urine. B. Encourage the child to be more active to increase urine output. C. Teach the child to wipe the perineum front to back after voiding. D. Teach the child to take frequent tub baths to clean the perineal area

C: Teach the child to wipe the perineum front to back after voiding.

The nurse is performing a well-child assessment on a 2-week-old infant. The nurse asks why her baby only breathes out of his nose and does not seem to mouth breathe. What information can the nurse provide to the mother? A. "Babies breathe from both their nose and mouth around 2 or 3 weeks of age." B. "Breathing from the nose only will be noted in newborns for about the first 6 weeks of life." C. "Your baby is breathing normally for his age." D. "Babies are nose breathers for about the first 4 weeks of life."

D. "Babies are nose breathers for about the first 4 weeks of life."

A child with a history of T3 spinal cord injury presents to the emergency department with headache, facial flushing, and cardiac dysrhythmias. Which of the following conditions would the nurses suspect? A. Poikilothermia B. Spinal shock C. Spasticity D. Autonomic dysreflexia

D. Autonomic dysreflexia Headache, facial flushing, and cardiac dysrhythmias are all symptoms of autonomic dysreflexia, a condition that can develop after spinal cord injury Autonomic dysreflexia can be caused by a full bladder, constipation, pain, skin issues, tight clothing, menstrual cramps, abdominal conditions, or cuts and bruises.

A child with a newly diagnosed ulnar fracture has a short-arm cast applied. Which of the following symptoms would be most concerning for the nurse? A. Swelling B. Mild pain C. Itching D. Uncontrolled, severe pain

D. Uncontrolled, severe pain Uncontrolled pain is the first sign of compartment syndrome. The nurse should assess the neurovascular status of the extremity and intervene immediately to prevent tissue necrosis and permanent damage.

The nurse has received morning report on a group of pediatric clients. Which pediatric client will the nurse see first? A. an infant with rhinorrhea, coughing, and oxygen saturation of 92% B. a toddler with a temperature of 100.1°F (38°C), and a harsh, barking cough C. a preschool child with crackles in the right lower lobe and chest pain D. a school-age child with dysphagia, drooling, and a hoarse voice

D. a school-age child with dysphagia, drooling, and a hoarse voice The child with signs and symptoms of epiglottitis should be seen first because epiglottitis is an emergency that can quickly cause airway obstruction.

The nurse is administering digoxin as ordered and the child vomits the dose. What should the nurse do next? A. Contact the physician. B. Offer a snack and administer another dose. C. Immediately administer another dose. D. Administer next dose as ordered in 12 hours.

D: Administer next dose as ordered in 12 hours. Digoxin should be administered at regular intervals, every 12 hours, 1 hour before or 2 hours after feeding. If the child vomits digoxin, the nurse should not give a second dose and should wait until the next scheduled dose. It is not necessary to contact the physician.

When assessing a infant born at 32 weeks' gestation, which finding would lead the nurse to suspect to suspect that the newborn has a patent ductus arteriosus (PDA)? A. Weak, thready pulse B. Decreased pulse rate C. High diastolic arterial pressure D. Continuous murmur on auscultation

D: Continuous murmur on auscultation

A nurse is performing an assessment on a child. What would be indicative of a potential for a urinary tract infection? A. Washing the genital area with water daily B. Not using cleansing towelettes routinely C. Not using soap when cleaning the urethral area D. Holding urine while at school

D: Holding urine while at school UTIs are often caused by children who do not urinate frequently at school. It is important for a child to avoid using towelettes and soap in the genital area because this can increase the chance of a UTI.

Polydactyly

Extra digits on the hands and/or feet.

CN VII (facial)

Facial symmetry during crying (motor) and response to salt solution on tongue (sensory)

Is the following statement true or false? Children with cerebral palsy are physically and intellectually disabled.

False Children w palsy experience motor delays + physical disabilities, they often do not have intellectual disabilities.

Is the following statement true or false? The risk for coronary aneurysms ends when children enter the subacute stage of Kawasaki disease.

False, the risk for coronary aneurysms is highest when children enter the subacute stage of Kawasaki disease.

Cardiac Medications: Prostaglandin E

Relaxes smooth muscle to prevent patent ductus arteriosus (PDA) closure.

Acute Respiratory Distress Syndrome (ARDS)

Respiratory failure: Acute, diffuse, and inflammatory lung injury - Allows fluid to leak into the lungs - Hypoxemia and noncompliant lungs - Supportive care in ICU= Intubation, oxygen, Positive pressure mechanical ventilation - Antibiotics, diuretics, and vasodilators

CN V (trigeminal)

Response to light touch on face