peds exam 4

treatment of sickle cell crisis

"Hop" to it: Hydration Oxygen (prevents additional sickling) Pain relief

treatment of leukemia

(1) induction, which achieves a complete remission or clinical disappearance of leukemic cells (2) intensification, or consolidation, therapy, which further decreases the total tumor burden, (3) maintenance, which consists of further chemotherapy to ensure the disease stays in remission.

how to calculate ANC

(segs + bands) x WBC

Cushing triad - what is it a sign of?

*3 primary signs that often indicate an increase in ICP - increased systolic BP - decreased pulse (low CO) - decreased respiration

Right sided heart failure symptoms

*BODY:* -->Fatigue -->Ascites -->Increased Peripheral Venous Pressure -->JVD -->Edema -->Weight Gain -->GI Upset

hypo plastic left heart syndrome

*DECREASED blood flow to the lungs and body

Left sided heart failure symptoms

*LUNGS* -->Paroxysmal Nocturnal Dyspnea (Asleep and Woken Up Because Pt Feels Like they're Suffocating) -->Restlessness -->Confusion -->Cough -->Crackles -->Fatigue -->Cyanosis -->Wheeze -->Tachypnea/tachycardia

shock symptoms

*opposite of ICP - decreased BP - increased pulse - increased respiration

sickle cell anemia complications

- infections - stroke - URIs - leg ulcers - splenomegaly

brain tumors s/s

-headache (morning vomiting) -seizures and convulsions -abnormal growth -vision changes -changes in behavior -abnormal head position

guidelines for treating hyper cyanotic spells (TET spells)

-knee chest position -100% oxygen by face mask -give morphine -begin iv fluid replacement

s&S of testicular cancer

-lump or enlargement in either testicle -feeling of heaviness in the scrotum -dull ache in the abdomen or groin -sudden collection of fluid in the scrotum -pain or discomfort in testicle or scrotum

clinical manifestations Hodgkins lymphoma

-painless enlargement of lymph nodes -low grade fever, anorexia, nausea, night sweats, coughing

defects with tetralogy of fallout

-pulmonic stenosis -overriding aorta -ventricular septal defect -right ventricular hypertrophy

sickle cell anemia interventions

-supportive care -pain relief -hydration

digoxin -use -administration -toxicity side effect

-use: contractility of the heart -administration:assess apical HR for 1 min before administration -toxicity:bradycardia 0.5-2

age requirement for TDAP vaccine

11-12 years

Menigiococcal vaccines

11-12 years also protects with other vaccines

HPV vaccine

11-12yrs -to protect individuals against 9 types of HPV

peak onset of testicular torsion

13 -surgical emergency to prevent necrosis

sickle cell anemia prevention of crisis

PREVENT -trauma -infection -stress -dehydration -hypoxia

if a child has received chemotherapy, when should the child receive vaccines?

6 months after chemotherapy has stopped

what increases a child's risk for developing Hodgkin lymphoma?

AIDS

cyanotic

Decreased pulmonary blood flow Mixed blood flow -tetralogy of fallot, tricuspid atresia

what abnormality puts a child more at risk for developing leukemia?

Down syndrome

components of HEADSS assessment

Home Education Activity Drugs Sexual activity/identity Suicide/depression

neutropenic precautions

Isolation procedures to protect an immunocompromised patient from infections

A child is admitted to the hospital with a febrile seizure. What action should the nurse take? Keep the child supine. Place the child in isolation. Keep the room temperature low and bedclothes to a minimum. Place a padded tongue blade at the bedside.

Keep the room temperature low and bedclothes to a minimum.

Kawasaki manifestations

Manifestations: high fever, strawberry tongue, edema, extreme irritability, arthritis, coronary complications

Which action should the nurse include in the plan of care for a child with leukemia who has an absolute neutrophil count of 400/mm3 (0.4 X 109/L)? Restrict staff and visitors with active infections. Place the child in strict isolation. Consult with the primary care provider to administer an antiemetic. Increase the child's oral fluid intake.

Restrict staff and visitors with active infections.

interventions for blood transfusion reaction

Stop infusion Change tubing start IV of 0,9% sodium chloride. Keep tubing, bags to send back to lab

Kawasaki treatment

Treatment: high dose aspirin to help with clotting, steroids, IVIG

What helps absorb iron?

Vitamin C

thrombocytopenia

a condition in which there is an abnormally small number of platelets circulating in the blood, difficulty clotting

neutropenia

a decreased number of neutrophils

Reye's syndrome

a disorder defined as metabolic encephalopathy -fever, impaired consciousness and disorders liver function -cerebral edema with increased ICP

sickle cell anemia

a genetic disorder that causes abnormal hemoglobin, resulting in some red blood cells assuming an abnormal sickle shape

The nurse is providing postoperative care for an infant who had a ventriculoperitoneal shunt placed to correct hydrocephalus. Which clinical finding warrants immediate intervention? abdominal distension lethargy facial edema headache

abdominal distension

Kawasaki disease

acute systemic vasculitis -inflammation of arteries

what factor is appropriate to consider when administering iron?

administer with ascorbic acid

sickle cell anemia inheritance

autosomal recessive, primarily in African Americans

what is the leading cause of death in children with sickle cell anemia?

bacterial infection

coarctation treatment

balloon dialation

stenosis treatment

balloon dilation

A toddler with a ventricular septal defect is receiving digoxin to treat heart failure. Which assessment finding should be the nurse's priority concern? bradycardia tachycardia hypertension hyperactivity

bradycardia

signs of puberty in boys and girls

breast development in girls growth of pubic hair in boys

signs and symptoms of ICP

bulging fontanel, irritability and restlessness, headache, N/V, drowsiness, distended scalp veins, poor feeding, seizures

A 4-year-old child with anemia is receiving oral iron supplements. What dietary recommendation would the nurse provide to this family? A.Administer the iron with a dairy product. B.Administer the iron with apple juice. C.Administer the iron with orange juice. D,Administer the iron prior to breakfast

c

Retinoblastoma s/s

cats eye reflex strabismis red painful eye blindness

which is the most common brain tumor occurring in childhood?

cerebellar astrocytoma

Henoch-Schonlein Purpura

common acquired disorder known as allergic vasculitis characterized by a - nonthrombocytopenic purport, arthritis, nephritis and abdominal pain -supportive care with NSAIDS, corticosteroids, and antihypertensives

anemia

decrease in number of RBC and or hemoglobin and decrease in oxygen carrying capacity of blood

pancytopenia

deficiency of all types of blood cells -aplastic anemia -tx bone marrow transplant

Leukemia S/S

early- low grade fever - pallor -Vomiting -anorexia Late- pain -hematuria -ulceration in mouth -enlarged testicles -signs of ICP

interventions to keep ICP controlled

elevating HOB 30 degrees, monitoring temp,

most common method of suicide attempt in adolescents

firearms, pills

VP shunt

for hydrocephelus -prevent ICP by draining extra fluid

cardiac output calculation

heart rate x stroke volume

transfusion reactions

hemolytic, febrile, allergic, air emboli, hypothermia, electrolyte disturbances

atrial septal defect blood flow pattern

hole in atrium -blood leaks into right atrium

impetigo

honey crusted lesions

manifestations of anemia

increased HR, cyanosis, growth retardation, CNS issues

CSF results in bacterial meningitis

increased WBC, decrease glucose, increased protien, cloudy

Erkison stages 1-5

infant: trust vs mistrust toddler: autonomy vs shame and doubt preschool: initiative vs guilt school age: industry vs inferiority adolescent: Identity vs role confusion

A nurse is assessing an infant for signs of increased intracranial pressure (ICP). What is the earliest sign of increased ICP in an infant? vomiting papilledema vital sign changes irritability

irritability

which position would the nurse caring for a young child with tetralogy of fallot observe in an attempt to compensate for the congenital heart defect

knee-chest

what is the most common form of childhood cancer?

leukemia

for which body system does the malignancy in Hodgkin disease originate?

lymphatic

Wilms tumor (nephroblastoma)

malignant tumor of the kidney occurring in childhood -3x more likely in African American children -2-3 yrs -males

Which toxic adverse reaction should the nurse monitor in a toddler taking digoxin? weight gain tachycardia nausea and vomiting seizures

nausea and vomiting

Care of an unconscious child

observation, ensure patent airway, breathing and circulation, stabilization of the spine, treating shock, reducing ICP, thermoregulation, pain assessment, skin protection

ventriclar septal defect blood flow pattern

opening between left and right ventricles -oxygenated and deoxygenated blood mixes

causes of primary amenorrhea

pregnancy, polycystic ovarian syndrome, hypothalamic, exercise

acyanotic

pulmonary blood flow increased obstruction to blood flow from ventricles

bulimia nervosa

repeated epidoses of binge eating followed by inappropriate compensatory behaviors -assess potassium

When teaching the parents of a child diagnosed with tetralogy of Fallot about the cardiac defects involved with this condition, which defects should the nurse describe? Select all that apply. right ventricular hypertrophy aortic valve stenosis ventricular septal defect overriding aorta atrial septal defect pulmonary stenosis

right ventricular hypertrophy ventricular septal defect overriding aorta pulmonary stenosis

glasgow coma scale

score of 8=intubate

non Hodgkins lymphoma clinical manifestations

similar to Hodgkin's • course of symptoms variable • may have metastases to bones, CNS, liver, prior to diagnosis

anorexia nervosa

social, psychological, behavioral, cultural and physiologic components characterized by distorted body image

causes of secondary amenorrhea

stress, chronic illness, polycystic ovary, anorexia, phenothiazines, heroin

seizure precaution set up

suction, oxygen, pulse ox, record time started -do not put anything in mouth - do not restrain

Wilms tumor interventions

surgical excision, chemotherapy, radiation -do not palpate abdomen

causes and interventions for iron deficient anemia

too much milk can cause decreased iron -increase iron rich foods

what does iron do to teeth in a person with anemia?

weakens in

main signs and symptoms of cancer in children

weight loss, headaches, swelling and pain, lumps, bruising, infections, white behind pupils, nausea, tiredness, vision changes, severe

when to transfuse blood?

when H&H below 8 and 28