Peds Exam 3
tx for arthritis...
- Nonsteroidal anti-inflammatory meds - PT and OT - Instruct parents on ways to decrease pain while or maintaining mobility for the child w/juvenile idiopathic arthritis
what is the diet modification for DM type 1?
-Carbohydrate counting --> flexibility when planning meals -A high fiber diet --> controls blood glucose
tx for seizure activity...
-Ensure airway patency -Have suction and O2 ready -Time the seizure activity -Ensure child's safety and comfort - If vomiting occurs turn child to one side -Do not restrain!!! NOTHING in child's mouth -Stay w/child until fully recovers
nursing care for viral meningitis...
-Treat s/s -Keep environment quiet and dark to decrease stimuli and meningeal irritation - Encourage PO fluids -NO antibiotics needed!!!
what does TDAP stand for and when is it given?
-tetanus, diphtheria, tetanus, acellular pertussis -between 11-12 years
An infant of a mother infected with human immunodeficiency virus (HIV) is seen in the clinic each month and is being monitored for symptoms indicative of HIV infection. With knowledge of the most common opportunistic infection of children infected with HIV, the nurse assesses the infant for which sign? 1. Cough 2. Liver failure 3. Watery stool 4. Nuchal rigidity
1. Cough
dx of DM type 1...
1. Presence of classic s/s 2. Hemoglobin A1C > 6.5% and one of the following... -Fasting plasma glucose > 126 w/no food for at least 8 hours -2-hour plasma glucose > 200 during oral glucose tolerance test -Random plasma glucose concentration > 200
When does the anterior fontanelle usually close?
18 months
how is the HPV vax given?
2 dose series w/6-12 months between vax and MUST repeat dose if administered too soon
When does the posterior fontanelle usually close?
2 months
The nurse creates a plan of care for a child at risk for tonic-clonic seizures. In the plan of care, the nurse identifies seizure precautions and documents that which item(s) need to be placed at the child's bedside? 1. Emergency cart 2. Tracheotomy set 3. Padded tongue blade 4. Suctioning equipment and oxygen
4. Suctioning equipment and oxygen
what ages do febrile seizures occr?
6 months-5 years
when is the peak onset of DM type 1?
7-15 years old
how long are IV antibiotics given for meningitis?
7-21 days
describe a complex febrile seizure...
> 15 min and may recur w/in same day
what is reye syndrome associated with?
ASA use and viral illness
why are babies prone to hemorrhage if shaken/force is applied?
Brain need 10x more O2!!! b/c infant brain is highly vascular
manifestations of a TBI...
Bruise/bump on head Bruising over temporal area/around eyes H/A Bleeding from ears, nose Laceration Seizures Vomiting Irritability and agitation LOC Decorticate or decerebrate
tx of hydrocephalus
Bypass the blockage and drain the fluid from ventricles where it can be reabsorbed
disorientation exits --> child may be alert but responds inappropriately to ?s
Confusion
deficiency of insulin secretion dur to pancreatic B-cell damage
DM type 1
consequence of insulin resistance that occurs at the level of skeletal muscle, liver, and adipose tissue w/different degrees of B-cell impairment
DM type 2
gradual onset w/out ketosis
DM type 2
what is the gold standard dx for a seizure?
EEG
measures electric potentials of individual's muscles
Electromyogram (EMG)
manifestations in children/teens w/meningitis...
Fever H/A rigid neck
assessment of increased ICP
GCS look @ infant fontanels measure head circumference complete neuro exam
neonatal meningitis causes
Group B strep E.coli
early signs of increased ICP
H/A visual disturbance N/V pupils unequal and slow in infants= increased head circumference and bulging fontanels
s/s of shunt malformation or infx...
H/A (progressive or worsening) Drowsiness/inappropriate sleepiness during day Irritability N/V Personality changes/changes in school performance Fever Redness/swelling along shunt tract
what is the primary concern of a Near-Drowning/Submersion injury? and why?
Hypoxia/asphyxiation b/c Brain cells sustain irreversible damage after 4-6 minutes of submersion
dx for neuro disorders
LP CT MRI EMG EEG
Corticosteroids may be used during exacerbations= short term in low doses but NOT...
Long term should be avoided due to s/e and adverse effects on growth
what occurs during prolonged seizure activity?
Neurons damaged and cerebral hypoxia
rare autosomal-recessive disorder where body cannot metabolize essential amino acid phenylalanine which accumulates in blood after infant starts feeding
Phenylketonuria (PKU)
meds for seizure disorders...
Phenytoin (Dilantin) Carbamazepine (Tegretol) Valproic acid (Depakene) Diazepam (Valium) Lorazepam (Ativan) Phenobarbital Gabapentin (Neurontin) Topiramate (Topamax) Levetiracetam (Keppra)
types of child abuse..
Physical abuse Physical neglect Emotional abuse Emotional neglect Verbal abuse Sexual abuse
manifestations of DM type 1...
Polyuria Polydipsia Polyphagia Unexplained fatigue or lethargy, H/A, stomachaches
what do you do when increased ICP is suspected?
Quick intervention and tx NEEDED to prevent permanent damage!!!
late signs of increased ICP
Significant LOC decrease Increased systolic BP and pulse pressure Bradycardia Irregular RR Fixed, dilated pupils decorticate or decerebrate
manifestations of arthritis...
Single/multiple joints involved Stiffness Swelling Loss of motion in affected joints Swollen joints à warm to touch "Morning stiffness"
what are the adolescent vaccines given?
TDAP meningococcal HPV flu
when HIV is transmitted via perinatal transmission what is the tx?
ZCV/AZT during pregnancy and delivery --> baby treated for 6 weeks o If baby did not receive ZDV during pregnancy à watched for 18 months before disease identified o ELISA test performed after maternal antibodies have disappeared
The nurse is caring for a child diagnosed with erythemia infectiosum (fifth disease). Which clinical manifestation should the nurse expect to note in the child? a. an intense fiery red edematous rash on the cheeks b. pinkish rose maculopapular rash on the face, neck, and scalp c. reddish and pinpoint petechiae spots found on the soft palate d. small bluish white spots with a red base found on the buccal mucosa
a. an intense fiery red edematous rash on the cheeks
The home care nurse provides instructions regarding basic infx control to the parent of an infant with HIV infection. Which statement if made by the patient indicates the need for further instruction? a. i will clean up any spills from the diaper with diluted alcohol b. i will wash baby bottles, nipples, and pacifiers in the dishwasher c. i will be sure to prepare foods that are high in calories and high in protein d. i will be sure to wash my hand carefully before and after caring for my infant
a. i will clean up any spills from the diaper with diluted alcohol
The nurse notes documentation that a child is exhibiting an inability to flex the leg when the thigh is flexed anteriorly at the hip. Which condition does the nurse suspect? a. meningitis b. spinal cord injury c. intracranial bleeding d. decreased cerebral blood flow
a. meningitis
Which home care instructions should the nurse provide to the parents of a child with AIDS (Select all that apply)? a. monitor the childs weight b. frequent hand washing is important c. the child should avoid exposure to other illnesses d. the childs immunization schedule will need revision e. clean up body fluid spills with bleach solution f. fever, malaise, fatigue, weight loss, vomiting, and diarrhea are expected to occur and do not require special intervention
a. monitor the childs weight b. frequent hand washing is important c. the child should avoid exposure to other illnesses e. clean up body fluid spills with bleach solution
The nurse is creating a plan of care for a child who is at risk for seizures. Which interventions apply if the child has a seizure? Select all that apply a. time the seizure b. restrain the child c. stay with the child d. place the child in a prone position e. move furniture away from the child f. insert a padded tongue blade in the child's mouth
a. time the seizure c. stay with the child e. move furniture away from the child
what is the major cause of injury/death for adolescents?
accidents
tx of s/s of viral meningitis...
acetaminophen/ibuprofen (> 6 months) to help decrease fever, H/A, muscle/joint pain
common when kids miss school, visit PCP often, receive referrals to neurologists
acute and chronic H/A
When is the initial HPV vax given?
age 9-14 years
an abnormal or altered reaction an antigen
allergy
when is the flu vax given?
annually
No definitive tests and s/s should be present > 6 weeks for...
arthritis
NEVER give a child w/PKU...
artificial sweetener NutraSweet (aspartame) --> contains phenylalanine!!!
A mother brings her 2 week old infant to a clinic for a phenylketonuria rescreening blood test. The test indicates a serum phenylalanine level of 1 mg/dl (60.5 mcmol/L). The nurse reviews this result and makes which interpretation? a. it is positive b. it is negative c. it is inconclusive d. it requires screening at age 6 weeks
b. it is negative
An infant with a diagnosis of hydrocephalus is scheduled for surgery. Which is the priority nursing intervention in the preoperative period? a. test the urine for protein b. reposition the infant frequently c. provide a stimulating environment d. assess BP every 15 min
b. reposition the infant frequently
The clinic as instructing the parent of a child with HIV infection regarding immunizations. The nurse should provide which instructions to the parent? a. the hep B vaccine will not be given to the child b. the inactivated influenza vax will be given yearly c. the varicella vax will be given before 6 months d. a western blot test needs to be performed and the results evaluated before immunizations
b. the inactivated influenza vax will be given yearly
what are the 2 types of meningitis?
bacterial and viral
when is the first dose of the meningococcal vax given?
between 11-12 years
dx for DM type 2...
blood glucose > 200 w/out fasting fast glucose > 126
neck flexion causes adduction and flexion movements of the L extremities
brudzinski's sign
when do primitive reflexes disappear? but why may they reappear?
by 5 months reappear w/a neuro disease
The parents of a child recently diagnosed w/cerebral palsy ask the nurse about the limitations of the disorder. The nurse responds by explaining that the limitations occur as a result of which pathophys process? a. in infectious disease of the CNS b. an inflammation of the brain as a result of a viral illness c. a chronic disability characterized by impaired muscle movement and posture d. a congenital condition that results in moderate to severe intellectual disabilities
c. a chronic disability characterized by impaired muscle movement and posture
A child has fluid volume deficit. The nurse performs an assessment and determines that the child is improving and the deficit is resolving if which finding is noted? a. the child has no tears b. urine SPG is 1.035 c. cap refill is < 2 sec d. UOP is < 1 ml/kg/hr
c. cap refill is < 2 sec
An LP is performed on a child suspected to have bacterial meningitis, and CSF is obtained for analysis. The nurse reviews the results of the CSF analysis and determines that which results would verify the diagnosis? a. clear CSF= decreased pressure, elevated protein level b. clear CSF= elevated protein, decreased glucose levels c. cloudy CSF= elevated protein, decreased glucose levels d. cloudy CSF= decreased protein, decreased glucose levels
c. cloudy CSF= elevated protein, decreased glucose levels
A mother of a 6-year-old child with type 1 diabetes mellitus calls the clinic nurse and tells the nurse that the child has been sick. The mother reports that she checked the child's urine and it showed positive ketones. Which of the following would the nurse instruct the mother to do? a. hold the next dose of insulin b. come to the clinic immediately c. encourage the child to drink liquids d. administer an additional dose of regular insulin
c. encourage the child to drink liquids
The nurse should implement which interventions for a child older than 2 years w/ type 1 DM who has a blood glucose level of 60 mg/dl. Select all that apply a. administer regular insulin b. encourage the child to ambulate c. give the child a tsp of honey d. provide electrolyte replacement therapy IV e. wait 30 min and confirm the blood glucose reading f. prep to administer glucagon subQ if unconsciousness occurs
c. give the child a tsp of honey f. prep to administer glucagon subQ if unconsciousness occurs
The nurse is assessing a child admitted with a diagnosis of rheumatic fever. Which significant question should the nurse ask the child's parent during the assessment? a. has you child had difficulty urinating? b. has your child been exposed to anyone with chickenpox? c. has any family member had a sore throat within the past few weeks? d. has any family member had a GI disorder in the past few weeks?
c. has any family member had a sore throat within the past few weeks?
A 6 year old child with HIV infection has been admitted to the hospital for pain management. The child asks the nurse if the pain will ever go away. The nurse should make which best response to the child? a. The pain will go away if you lie still and let the med work b. try not to think about it, the more you think it hurts the more it will hurt c. i know it must hurt, but if you tell me when it does i will try to make it hurt a little less d. everytime it hurts press on the call button and i will give you something to make the pain go all away
c. i know it must hurt, but if you tell me when it does i will try to make it hurt a little less
The nurse is assigned to care for an 8 year old child w/a diagnosis of a basilar skull fracture. The nurse reviews the pediatrician's prescriptions and should contact the pediatrician to question which prescription? a. obtain daily weight b. provide clear liquid intake c. nasotracheal suction as needed d. maintain a patent IV line
c. nasotracheal suction as needed
The nurse is reviewing the record of a child w/increased ICP and notes that the child has exhibited signs of decerebrate posturing. On assessment of the child, nurse expects to note which characteristics of this type of posturing? a. flaccid paralysis of all extremities b. adduction of the arms at the shoulders c. rigid extension and pronation of the arms and legs d. abnormal flexion of the U extremities and extension and adduction of the L extremities
c. rigid extension and pronation of the arms and legs
A mother of a child with mumps calls the healthcare clinic to tell the nurse that the child has been lethargic and vomiting. What instructions should the nurse give to the mother? a. to continue to monitor the child b. that lethargy and vomiting are normal with mumps c. to bring the child to the clinic to be seen by the pediatrician d. that as long as there is no fever there is nothing to be concerned about
c. to bring the child to the clinic to be seen by the pediatrician
when a child w/DM type 1 is sick what should the parents do to check for ketones?
check for urinary ketones w/EACH void!!! If ketones present --> liquids essential to help clear ketones
can be intentional or unintentional physical and mental injury, sexual abuse, as well as emotional and physical neglect of a child under the age of 18 who was under the care of an adult
child abuse
nursing care for a child abuse pt....
child has difficulty trusting --> 1 to 1 nursing care
if GCS score < 8...
child is admitted to PICU
what is the most common form of child abuse?
child neglect
infant s/s of HIV...
chronic diarrhea, failure to thrive, delayed development, frequent infxs
seizure w/alternating contraction and relaxation of muscles
clonic
what are the 2 types of seizures?
clonic tonic
child cannot be aroused --> even w/painful stimuli
coma
The nurse provides home care instructions to the parent of a child with AIDS. Which statement by the parent indicates the need for further teaching? a. I will wash my hands frequently b. I will keep my child's immunizations up to date c. I will avoid direct unprotected contact with my child's body fluids d. I can send my child to daycare if he has a fever, as long as it is a low grade fever
d. I can send my child to daycare if he has a fever, as long as it is a low grade fever
A mother arrives at the ER w/her 5 year old child and states that the child fell off a bunk bed. A head injury is suspected. The nurse checks the child's airway status and assesses the child for early and late signs of increased ICP. Which is a late sign of increased ICP? a. nausea b. irritability c. H/A d. bradycardia
d. bradycardia
A pediatrician prescribes an intravenous (IV) solution of 5% dextrose and half-normal saline (0.45%) with 40 mEq of potassium chloride for a child with hypotonic dehydration. The nurse performs which priority assessment before administering this IV prescription? a. obtains a weight b. takes the temp c. takes the BP d. checks the amount of UOP
d. checks the amount of UOP
A school-age child w/type 1 DM has soccer practice and the school nurse provides instructions regarding how to prevent hypoglycemia during practice. Which should the school nurse tell the child to do? a. eat twice the amount normally eaten at lunchtime b. take half the amount of prescribed insulin on practice days c. take the prescribed insulin at noontime rather than in the morning d. eat a small box of raisins or drink a cup of orange juice before soccer practice
d. eat a small box of raisins or drink a cup of orange juice before soccer practice
"An adolescent client with type I diabetes mellitus is admitted to the emergency department for treatment of diabetic ketoacidosis. Which assessment findings should the nurse expect to note? a. sweating and tremors b.hunger and hypertension c. cold, clammy skin and irritability d. fruity breath and decreasing level of consciousness
d. fruity breath and decreasing level of consciousness
The nurse is planning care for a child with acute bacterial meningitis. Based on the mode of transmission of the infx, which precautionary intervention should be included in the plan of care? a. maintain enteric precautions b. maintain neutropenic precautions c. no precautions are required as long as antibiotics have been started d. maintain resp isolation precautions for at least 24 hours after the initiation of antibiotics
d. maintain resp isolation precautions for at least 24 hours after the initiation of antibiotics
The mother with HIV infection brings her 10 month old infant to the clinic for a routine checkup. The pediatrician has documented that the infant is asymptomatic for HIV infection. After the checkup the mother tells the nurse that she is so pleased that the infant will not get HIV infection. The nurse should make which appropriate response to the mother? a. i am so pleased also that everything has turned out fine b. Because symptoms have not developed it is unlikely that your infant will develop HIV infection c. everything looks great, but be sure to return with your infant next month for the scheduled visit d. most children infected with HIV develop symptoms within the first 9 months of life and some become symptomatic sometime before they are 3 years old
d. most children infected with HIV develop symptoms within the first 9 months of life and some become symptomatic sometime before they are 3 years old
A child with type 1 DM is brought to the ED by the mother, who states that the child has been complaining of abdominal pain and has been lethargic. Diabetic ketoacidosis is diagnosed. Anticipating the plan of care, the nurse prepares to administer which type of IV infusion? a. potassium infusion b. NPH insulin infusion c. 5% dextrose infusion d. normal saline infusion
d. normal saline infusion
A pediatrician prescribes laboratory studies for an infant of a woman positive for human immunodeficiency virus (HIV). The nurse anticipates that which laboratory study will be prescribed for the infant? a. chest x-ray b. western blot c. CD4 cell count d. p24 antigen assay
d. p24 antigen assay
A child is diagnosed with Reye's syndrome. The nurse creates a nursing care plan for the child and should include which intervention in the plan? a. assessing hearing loss b. monitoring UOP c. changing body position every 2 hours d. providing a quiet atmosphere w/dimmed lighting
d. providing a quiet atmosphere w/dimmed lighting
The nurse has just administered ibuprofen to a child w/a temp of 102 F. The nurse should also take which action? a. withhold oral fluids for 8 hours b. sponge the child w/cold water c. plan to administer salicylate in 4 hours d. remove excess clothing and blankets from the child
d. remove excess clothing and blankets from the child
The nurse caring for a child diagnosed with rubeola (measles) notes the pediatrician has documented the presence of Koplik's spots. On the basis of the documentation which observation is expected? a. pinpoint petechiae noted on both legs b. whitish vesicles located across the chest c. petechiae spots that are reddish and pinpoint on the soft palate d. small blue-whitish spots with a red base found on the buccal mucosa
d. small blue-whitish spots with a red base found on the buccal mucosa
The nurse provides home care instructions to the parents of a child hospitalized with pertussis who is in the convalescent stage and is being prepared for discharge. Which statement by a parent indicates a need for further instructions? a. we need to encourage our child to drink fluids b. coughing spells may be triggered by dust or smoke c. vomiting may occur when our child has coughing episodes d. we need to maintain droplet precautions and a quiet environment for at least 2 weeks
d. we need to maintain droplet precautions and a quiet environment for at least 2 weeks
extensor posturing
decerebrate
flexor posturing
decorticate
what is contained in the complete neuro exam?
description of behavior, VS, PERRLA (nystagmus, strabismus), motor function, reflexes, look at posturing
complex febrile seizures lead to greater risk for developing...
epilepsy
what are the 3 categories of the GCS?
eye response, verbal response, motor response
manifestations in infants/young w/meningitis...
fever bulging fontanels irritability
s/s of juvenile idiopathic arthritis
fever rash lymphadenopathy splenomegaly hepatomegaly
child is fully awake and alert --> orientated and exhibits age-appropriate behavior
full consciousness
5 states of LOC...
full consciousness confusion obtunded stupor coma
if a child has s/s of low blood sugar what do you give them? and if they are unconscious what do you give?
give low-fat carb snack b/c it works quickly administer glucagon
Widening fontanels in infants --> compensate for accumulating CSF and help relieve pressure on developing brain of infants w/_______ --> enlarged head circumference
hydrocephalus
imbalance between CSF production and absorption resulting in enlarged ventricles and increased ICP
hydrocephalus
what is the #1 sign in a child with increased ICP?
inconsolable irritability
what abnormalities does the CSF have w/meningitis?
increased WBCs, increased protein, and decreased glucose levels
Med noncompliance is the most common cause of...
increased seizure activity
what is the Erikson's stage of development for a school-aged child?
industry
what is the primary concern of HIV?
infection
what is the most common cause of altered LOC in children?
infx of brain and meninges
Chronic inflammatory disease that begins before 16 years à causes chronic inflammation of the synovium w/joint effusion that can lead to erosion and destruction of the articular cartilage
juvenile idiopathic arthritis
inability extend the leg when the thigh is flexed anteriorly at the hip
kernig's sign
Regular insulin IV in normal saline administered when child is in...
ketoacidosis
describe a simple febrile seizure...
last few seconds-minutes --> <15 min and do NOT recur in 24 hours
IV antibiotics tx of meningitis...
o Ampicillin o Aminoglycosides o Cefotaxime o Ceftriaxone o Penicillin G o Vanco
nursing care for school-age children/adolescents in hospital...
o Need planned recreational activities to promote developmental needs o encourage visits from friends o Need to focus on schoolwork if hospitalized during school year o Confidentiality is KEY when talking w/teenagers!!!
Causes of altered LOC in children
o Trauma o Hypoxia o Poisoning o Seizures o Endocrine/metabolic disorders o Electrolyte imbalance o Brain tumor o Alcohol/substance abuse o Congenital structural deficit
describe the growth and development of school-aged child...
o Usual skills= climbs, bikes, skips, jumps rope and swings, learns to swim, dance, skate, do somersaults, good hand/eye coordination, prints/writes, can sew, draw, build models o 20/20 visual acuity o Color discrimination fully developed o Majority of permanent teeth have erupted by 10-12 years
describe the growth and development of adolescents...
o Usual skills= focuses energy and skills on interest area, good finger dexterity for writing and other intricate tasks, precise eye/hand coordination, senses based on body language, follows complicated instructions o Girls usually begin/reach puberty earlier than boys o Teen years= form identity and rebellion against family values o Concerned about change in body image
child has limited responses to environment and falls asleep unless stimulated
obtunded
leading cause of HIV in children...
perinatal transmission
if left untreated, hydrocephalus can turn into...
permanent brain damage
excess thirst
polydipsia
excess hunger w/ significant weight loss
polyphagia
excess urination
polyuria
Fractures in infants indicate...
possible abuse
an acute encephalopathy, cerebral dysfunction caused by a toxic, inflammatory, or anoxic injury that may result in permanent damage
reye syndrome
electrical disturbance w/in brain, resulting in changes of motor function, sensation, or cognitive functioning
seizure
children may regress during hospitalizations and express..
separation anxiety and fear of bodily injury
what is decorticate or decerebrate associated with?
severe brain injury
EMERGENCY!!! prolong continuous seizure activity for 30 min or more or evidence of intermittent seizure noted from clinical or EEG tracings lasting > 15 min w/out full recovery of consciousness between seizures
status epilepticus
child only responds to vigorous stimuli
stupor
seizure w/continuous muscle contraction
tonic
leading cause of HIV in teens...
unprotected sex
more common type of meningitis that is self-limiting, resolves spontaneously, and has increase in number of blood cells and protein in CSF, normal glucose
viral meningitis
care for child w/minor TBI...
wake up q2hr to check mental status o Return to ED if V, sleepiness, H/A, confusion, restlessness, personality changes, seizures, bleeding from ears/nose, inconsolable irritability occurs
common food allergies to avoid in kid < 1 year
· Cow's milk · Eggs · Peanuts · Tree nuts · Fish/shellfish · Wheat · Soy