Peds test 3
1. What is a priority nursing diagnosis for an infant with a cleft palate? A: Acute pain B: Risk for aspiration C: Ineffective breathing pattern D: Risk for infection
Answer: B, risk for aspiration. Infants are at a higher risk for aspiration during feedings because of the opening of the palate into the nasal cavity. A cleft palate does not cause pain. Infant breathing pattern is not affected by cleft palate. Though risk for infection may be a concern, it is not the priority diagnosis.
A 12 year old male comes in with slipped capital femoral epiphysis. What statement made by the parents indicate understanding of the education provided by the nurse? "We will start our family on a healthy diet and exercise program when he is healed" "If he complains of knee or groin pain, this is normal and will go away on its own" "There is not usually pain associated with this, so it is difficult to identify" "He will be able to walk normally immediately after surgery"
"We will start our family on a healthy diet and exercise program when he is healed" Rationale: Obesity is a high risk factor for SCFE; exercise and diet limits obesity
SCIDS is often known as ______
"bubble boy disease"
how long does the treatment for Legg Calve Perthes take?
*compliance for best recovery - we want the patient to rest and do non-weight bearing activities 2-4 years before they recover, specific recovery is related to their response to treatment
treatment of SCID
- Bone marrow transplant -IVIG - Stem Cell Transplant - sterile environment to prevent infection
What causes endocarditis
- Staph aureus - bacteremia in children with acquired or congenital anomalies of the heart of great vessels - rheumatic heart disease or recent heart surgery -increased use of indwelling central lines
Goals of treatment for CHF
- administer Digoxin to help improve contractility -remove accumulated fluid and sodium with diuretics -decrease cardiac demand by providing thermal environments, treating infections, reducing the effort of breathing -provide a restful atmosphere (decrease stimuli) -feed child at sign of hunger - monitor temp regularly to prevent hypo and hyperthermia
why does the insulin amount vary greatly for teens?
- the carbs they have consumed - the exercise they are doing -their growth and development stage
earliest manifestation of Graves disease
exophthalmos
DI education for families
-monitor input and output -monitor for s/s of dehydration (dry mucous membranes) -replace the missing hormone of the ADH with vasopressin injections -educate teachers to allow unrestricted bathroom access
A type of juvenile idiopathic arthritis affects more than five joints within the first six months A. Systemic arthritis B. Polyarthritis C. Enthesitis D. Systemic lupus erythematosus
B. Polyarthritis Rationale: A characteristic of polyarthritis is that multiple joints are affected within a short time frame.
pyloric stenosis nursing diagnoses
failure to thrive electrolyte imbalance dehydration risk for aspiration, vomiting, jaundice
What teaching should be provided to parents of a child in the ER with infant intussusception (SELECT ALL THAT APPLY): A. Model the defect using latex glove and pushing finger into itself B. This is a result of poor parental care C. Continue to monitor the infant's stools after going home D. This condition is usually treated using a procedure called hydrostatic reduction, or even surgery
A. Model the defect using latex glove and pushing finger into itself C. Continue to monitor the infant's stools after going home D. This condition is usually treated using a procedure called hydrostatic reduction, or even surgery Rationale: Infant intussusception is not preventable, so the parent is not at fault for its occurrence. Blaming the parent is not therapeutic. The other options are appropriate teaching points the nurse can provide to the infant's parents.
The nurse assesses a patient with watery, grassy green foul-smelling diarrhea. Which of the following conditions would the nurse suspect? A) Botulism B) Biliary Atresia C) Rotovirus D) Meckel Diverticulum
C) Rotovirus
What clinical manifestations should the nurse watch for that would indicate infant intussusception? A. Palpable, sausage-shaped mass in RUQ, but an empty RLQ B. Palpable, sausage-shaped mass in LUQ, but an empty LLQ C. No abdominal pain D. Excessive laughing
A. Palpable, sausage-shaped mass in RUQ, but an empty RLQ Rationale: Infant is likely to have a palpable, sausage-shaped mass in RUQ, but an empty RLQ. Infant will be in a lot of pain so would not be laughing. Baby may cry excessively.
you are caring for an infant in a post-surgical unit. What pain scale would be most accurate for assessing pain? A. FACES B. FLACC C. CRIES D. OPS E. NUMERIC
C. CRIES
how often should the pins of the halo vest be cleaned?
1-2 times per day
The best outcome for a child with SCIDS includes 3 of the following interventions:
1. Timely diagnosis (within the first 3 months) 2. HLA matched donor transplant especially with an identical twin 3. Prevention infections 4. HLA matched donor Transplant from a sibling or unrelated donor
An infant is admitted to the hospital for hypertrophic pyloric stenosis. As a nurse on the floor, what are the points of care you need to consider? SELECT ALL THAT APPLY. A. Record strict intake and output B. Monitor nutritional status C. Place patient on cardiac monitoring D. Prepare patient for possible surgery E. Make patient NPO immediately upon admission
A. Record strict intake and output B. Monitor nutritional status D. Prepare patient for possible surgery Rationale: This condition does not require cardiac monitoring. NPO status only needs to be implemented at midnight the night before the surgical procedure.
• A child with a history of chronic infections comes into the clinic. Which of the following would be the most common diagnostic finding if the child has HIV/AIDS ? 1. Karposi's Sarcoma 2. Pneumocystis carinii pneumonia 3. Diarrhea 4. Headaches
2. Pneumocystis carinii pneumonia
Asymmetry of the ribs and flanks is noted when the child bends forward at the waist. This test is called________.
Adams forward bend test.
The nurse is educating parents on appropriate food choices for their 6 year old child with constipation. Which of these foods would be the best choice? A. Apples, yogurt, sandwiches on whole grain bread B. Grilled cheese and tomato soup C. Pizza and salad D. Spaghetti and meatballs
A. Apples, yogurt, sandwiches on whole grain bread
A 2-month old boy is brought to the hospital because he is projectile vomiting after every feeding, is having less frequent bowel movements, and is irritable. What does the ED nurse suspect? A. Hypertrophic pyloric stenosis B. Cleft palate C. Celiac disease D. Constipation
A. Hypertrophic pyloric stenosis Rationale: These clinical manifestations are cardinal signs of an obstructive disease
What is hirschsprungs
A congenital abscense of ganglion cells in rectum and colon where stool cannot effectively more through the colon "mega colon"
What is considered the Gold Standard for correcting spine curvature in scoliosis? A) Bracing B) Spinal Fusion C) Incision and Draining D) ROM Exercises
A) Bracing
My child is experiencing profuse watery diarrhea and vomiting. Which action should the nurse instruct the parent to take? a. Include high fiber foods to help with inflammation of the bowel b. Eat a diet low in calories and proteins c. Consult your healthcare provider immediately because these indicate a celiac crisis d. Continue to monitor your child's stool as this an expected finding of celiac disease
Answer C: These are symptoms of a celiac crisis and the child should consult a HCP immediately. A is not correct because high fiber foods worsen inflammation of the bowel. B is not correct because a celiac diet should be high in calories and proteins. D. This is an expected finding of a crisis but not an expected symptom of celiac disease
2. What are potential clinical manifestations of a hepatitis infection in a child? Select all that apply: A: Clay-colored stools B: Nausea and vomiting C: Dark urine D: Jaundice E: Itching
Answer: A, C, D, E. Clay-colored stools, dark urine, jaundice, and itching are all clinical manifestations of hepatitis infections. Nausea and vomiting is not a clinical manifestation.
A nurse is caring for a 2-year-old child with cirrhosis of the liver. Upon assessment, she discovers bright red blood in recent vomit. What treatment does the nurse anticipate? A. Dietary sodium restriction B. Emergency intubation C. IV fluids/blood transfusion with possible gastric lavage D. Vitamin supplements to prevent anemia
Answer: C Rationale: Esophageal/gastric varices is a life-threatening complication of cirrhosis. Treatment includes fluid replacement and/or blood transfusion as appropriate, and gastric lavage to manage hemorrhage. Dietary sodium restriction is a teaching point for management of cirrhosis but is not appropriate in an emergency situation. The patient may need vitamin supplements as part of routine treatment but this does not address the life-threatening complication. Intubation is not indicated in this case.
A 14 year old girl with a broken arm has on a cast and comes into the Emergency Room with complaints; the nurse suspects that the patient might have component syndrome. Select the symptoms from the list below A. Numbness and tingling feeling in the hand with the cast B. Capillary refill greater than 3 seconds C. Itching in the arm below the cast D. A red rash on the hand E. Severe pain not relieved by analgesics
Answers: A, B, E. Rationale: Signs and symptoms of compartment syndrome are the 6 P's: pain, pulselessness, pallor, paresthesia, paralysis, and pressure (pg. 951 in textbook)
The parents of a four year old with recently diagnosed septic arthritis are asking you, their nurse, how their child developed this condition. How do you respond? A. Your child was born with this condition; his recent infection just brought the genetic mutation to the surface. B. The trauma to your child's hip introduced bacteria into his joint, causing an infection. C. The cause of this condition is idiopathic, meaning we don't know how this happens. D. Your child is going to be fine, this disease appears and resolves spontaneously.
B. The trauma to your child's hip introduced bacteria into his joint, causing an infection. Answer: B. Septic arthritis results from trauma-introduced infection in a joint or blood-borne infection that has moved to the joints. The condition is not genetic or idiopathic and requires antibiotic treatment and pain management for proper care and recovery.
1. Following a visit with the primary care provider, a mother brings her 3-week old infant to the hospital. The physician suspects biliary atresia. The nurse knows to look for what clinical manifestations related to this disease. A. Erythema, butterfly rash, pain in joints B. Constipation, sunken fontanels, neurobehavioral changes C. Jaundice, splenomegaly, stools look like white-putty D. Black tarry stools, loss of appetite, weight loss
C. Jaundice, splenomegaly, stools look like white-putty Rationale: Biliary Atresia is a congenital malformation within pregnancy that leads to eventual obstruction or attack by the immune system, which causes a child's bile ducts to improperly form and result in obstruction. The liver is unable to remove bilirubin, which causes it to back up in the blood and cause jaundice. Other clinical manifestations include dark urine, grayish pale stools, and slow weight gain and growth.
Which of the following would be a priority nursing care management strategy of a child with short bowel syndrome? a) Monitor urine output b) Withhold gluten c) Prepare for pyloromyotomy d) Administration and monitoring nutritional therapy
Correct answer: D. Administration and monitoring nutritional therapy are priority nursing management strategies for short gut syndrome. Monitoring urine output may be important, but it is not priority for this condition. Gluten intolerance is not related to short gut. A pyloromyotomy is a procedure related to pyloric sphincter.
When planning care for a child with idiopathic juvenile arthritis, a nursing student requires further teaching when he/she plans to perform which action first? A. Provide nonpharmacologic pain management B. Administer ordered NSAIDs C. Administer ordered DMARDs D. Administer ordered opioids
D. Administer ordered opioids Rationale: Opioids are beneficial for severe pain but also come with a host of complications. It is best practice to try nonpharmacologic treatments first and then move on to mild pain relievers before jumping straight to opioids.
What finding is most likely to be present in a newborn suspected of having Hirschsprung's disease? A. Normal bowel movements B. Projectile vomiting C. Regurgitation of feeding D. Foul-smelling ribbon-like stools
D. Foul-smelling ribbon-like stools Hirschsprung's Disease is a congenital abnormality that occurs as a result of an absence of ganglion cells in the rectum and other areas of the affected intestine. Chronic constipation may begin in the first month of life and result in pellet-like or ribbon-like stools that are foul-smelling is a clinical manifestation of this disorder. Options 1, 2, 3 are not associated specifically with this disorder.
what is the major source for postpartum hemorrhage is?
uterine atony, when the uterus does not contract back to its normal size.
VSD is
ventricular septal defect when there is an abnormal opening between the right & left ventricles
Which statement by the student nurse shows effective learning when teaching another student about Crohn disease? A. "Growth failure and delayed sexual maturation is a serious complication commonly seen with Crohn disease." B. "With proper medical treatment, lifestyle changes, and diet, a child can be cured of IBD by the time they reach sexual maturity." C. "Total parenteral nutrition is the primary therapy for Crohn disease." D. "Avoiding specific foods such as garlic and shellfish will decrease the severity of your symptoms."
Explanation: A ) correct. B ) Though medical treatment, lifestyle changes, and nutrition can reduce symptoms and obtain long term remission, there is no known cure to IBD. C) Total parenteral nutrition may promote short term remission, but an elemental diet is a safe and potentially effective primary therapy for patients with Crohn disease. D) There is insufficient evidence that supports avoiding specific food influences the severity of the disease
Mothers should avoid breastfeeding if their infant has GER/GERD. True or False
False; Breastfeeding may continue. However, parents should avoid feeding the child spicy foods or foods that they find aggravate symptoms in general and avoid caffeine, chocolate, tobacco smoke, and alcohol when breastfeeding.
G- T- P- A- L- G- P-
G- number of pregnancies T- number of term pregnancies greater than 37 weeks P-# preterm pregnancies 20-37 weeks A- # of abortions- before 20 weeks L-# of living children G-# of times she's been pregnancy P- # of pregnancies that lasted past 20 weeks
Where is the most common site for fracture in a child?
Growth plate/ epiphyseal plate
acute systemic vasculitis of an unknown cause
Kawasaki Disease
When caring for a patient with acute appendicitis. What are the appropriate nursing interventions? Select all that apply. A. Deep Palpation B. Document time of symptom onset C. IV fluids D. Prepare patient and family for surgery E. Warm Compress to the RLQ
Rational: B C and D are correct. IV fluids for rehydration r/t vomiting, deep palpation could cause a rupture, onset of symptoms is important to know because rupture can occur 24-72 hrs after onset. A warm compress is not recommended because it could cause the appendix to rupture.
Why do we use traction?
Resist response of the muscle, immobilization, alignment, prevent contracture
What indicates bleeding in a child that is post-tonsillectomy and indicates a medical emergency?
SWALLOWING A LOT =BLEEDING
shunting of VSD
Shunting will occur from high to low pressure. Right side is low pressure. Left side is high pressure. Once you shunt blood into the low pressure area (the R side) then where does the blood go now? Back to the lungs, so you now have an increased pulmonary blood flow.
how do you prevent rheumatic fever?
proper antibiotic treatment for strep; if a child has had one strep infection, they are more likely to get another (Penicillin is usually antibiotic of choice)
celiac crisis s/s
acute, severe episodes of profuse watery diarrhea and vomiting may be precipitated by: - infections - prolonged fluid and electrolyte depletion -emotional disturbances
endocarditis and dental procedures
approach with caution and provide prophylactic antibiotics before going to the dentist to decrease infection
kids with hyperthyroidism have what common characteristics:
are intolerant to heat, are restless, exhausted
animism
ascribing lifelike qualities in inanimate objects (may be why a preschool child fears an object)
1. What position should you hold an infant with GER/GERD after feeding? a. supine b. prone c. RT side lying d. LT side lying
b. prone The prone position aids in reducing frequent regurgitation. The supine position is recommended for infant sleeping. Parents should not place infants on their sides as an alternative to fully supine sleeping. (pg 707—10th edition)
late decals
bad for baby bc lack of perfusion
when do children with SCID usually present the disease?
before 3 months of age
abnormal post-procedure findings for cardiac cath
bleeding and tachypnea
if a kid with diabetes is exercising a lot what do we want to educate pt to do?
they are burning more calories, so eat more carbs so glucose won't bottom out
when does parent have to tell the school nurse that a child has HIV?
they don't have to, but they might want to if they are concerned for that child due to being exposed to illness due to being immunocompromised
an infection of the inner lining of the heart, generally involving the valves
endocarditis
Toddles unique characteristics:
give them choices this or that, now or later - don't give yes or no questions keep the same or close to the same ritual that is at home may have an imaginary friend
moderate variability
good sign for oxygenation of baby
Adams test
have the patient bend over and touch their toes to assess for scoliosis
treatment for Kawasaki Disease
high dose IVIG, aspirin to decrease inflammation, and anticogulates to help decrease bleeding
what is a good indicator of bleeding after a cardiac cath?
hypotension or evidence of bleeding in the site of the cardiac cath
what are children at risk for after a cardiac cath?
hypovolemia and dehydration due to the blood loss in surgery and NPO status before the surgery
telescoping causing obstruction, one part telescopes up into another part of the intestine
intussception
what do you want the fundus to be like in assessment after birth?
midline and firm; do not want a boggy fundus- the fundus should be shrinking
S/S if dioxin overdose
n/v, anorexia, bradycardia, and dysrhythmias
pyloric stenosis
narrowing of the channel
what do you monitor before giving digoxin?
pulse
new born care
respiratory, dry baby, keep warm, thermoregulation, vitamin K injection, ointment for eyes -make sure mom and baby are bonding and have established a nourishing relationship - baby eating well - wet diapers and poops
what age group can pick where they want injections for diabetes
school age , adolescents, make sure you rotate your sites, plan a rotation schedule (can do this an entire month in advance), sites to use are abdomen and back of the arm - fatty tissue, by school age can remember where they last got stuck
what position is good for kids with CHF?
semi-fowlers position because it reduces their efforts for breathing
a teenage girl with DM 1 just had her boyfriend break up with her and is very stressed about it, what is some teaching for her and her parents?
she may need more insulin due to the stress increasing her glucose level
how do you treat HTN in teens?
treat underlying cause; weight control; DASH diet; decrease stress; stop smoking; avoid alcohol
after a cardiac catheterization, pulses distal to the site would be weaker for the first few hours. true/false
true
for kids under 5 you _______ the number of units of insulin they receive for kids over 5 you_______ the number of units of insulin they receive
under 5- round down over 5- round up
shunting of blood in TOF:
shunts right to left because of pulmonary stenosis
What type of fracture usually indicates abuse?
spiral fracture
celiac disease clinical manifestations
steatorrhea (excessively large, oily, forthy stools), very foul smelling stools, malnutrition, muscle wasting, anemia, anorexia, abdominal dissension, irritability
what kind of oxygen should a CHF patient receive?
supplemental cool humidified oxygen
s/s of rheumatic fever
tachycardia, new murmurs, swollen, hot painful jnts, chorea- irregular movements of extremities, subcutaneous nodes
prognosis of SCID
without treatment and stem cell transplants, severe infection and death by 2 yo usually results
what is the best diagnostic tool to assess a bone fracture?
x-ray
Do children still get insulin when they are sick?
yes
halo traction care
• Maintain traction; Maintain alignment (Make sure body is perfectly aligned) • Prevent skin breakdown & complications • The nurse should never release skeletal traction. • Do not lift the weights that are applying traction • Weights have to hang freely at all time • Pain meds • Pin care with hydrogen peroxide • Ensure they are doing incentive spirometer
Buckle (torus fracture)=
produced by compression of the porous bone; appears as a raised or bulging projection at the fracture site; occur in the most porous portion of the bone near the metaphysis and are more common in young children
reintroduction of diet for a child
reintroduce regular diet ASAP- as tolerated ** BRAT diet not recommended
complications of acute glomeruloneprthitis
tea-colored urine, periobrital edema that spreads, proteinurea
s/s of bone fracture
the 5 p's (pain, pallor, pulselessness, parenthesis, and paralysis) generalized swelling, deformity, diminished functional use of affected limb or digit; bruising, severe muscular rigidity; crepitus (grating sensation at fracture site)
signs and symptoms of compartment syndrome
the 6 p's • Pain: severe pain that is not relieved by analgesics or elevation of the limb, movement that increases pain • Pulselessness: inability to palpate a pulse distal to the fracture or compartment • Pallor: pale appearing skin, poor perfusion, capillary refill greater than 3 seconds • Parenthesis: tingling or burning sensations • Paralysis: inability to move extremity or digits • Pressure: involved limb or digits may feel tense and warm; skin is tight, shiny; pressure within the compartment is elevated
ritualism
the need to maintain sameness and reliability to provide comfort (toddlers need same hospital schedule)
what is the pavlik harness used for?
to help maintain the hip joint by dynamic splinting for hip dysplasia
primary goal of treatment for nephrotic syndrome
treat underlying cause to reduce exertion of urinary protein
lactose intolerance can develop when celiac disease is untreated T/F
true
erikson's developmental stages
trust vs mistrust autonomy vs shame industry vs inferiotriy identity vs role confusion
how can you decrease edema postpartum
use a cold compress
Bend fracture
where bone just bends (doesn't break)
risk factors of slipped capital femoral epiphysis
• Develops shortly before or during accelerated growth and onset of puberty- suspected with clinical signs and c/o pain (hip and knee) • Seen more often in boys • • obese children • More common in AA and Hispanics • pubertal hormone changes • endocrine disorders
when does lactation first occur
48 hours- 5 days after birth
homecare fo legg calve perthes
- Activities they enjoy doing that do not involve much movement - Providing low-impact exercise and sports to prevent sedentary lifestyle - More supervision needed to stay in brace - Provide reasonable choices
complications of chrons disease
- Severe growth restrictions - Under weight - Social isolation - Delayed sexual maturation - Alteration in body composition - development of colorectal cancer later - bleeding
post-op after scoliosis surgery
- Use barrel/log roll to turn patient - Get Hemoglobin and hematocrit checks - Neuro checks every 2 hours b/c could cause neurologic or spinal cord injury - Bowel checks are essential - Antibiotics to prevent osteomyelitis - manage pain -
nursing education for when to contact doctor after birth if:
- high fever - change in lochia - evidence of mastitis - evidence of UTI - mood changes/ signs of postpartum depression -severe pelvic pain -boggy uterus
nursing actions for acute glomeruloneprthitis
- measure I's and Os to monitor edema through measuring abdominal girth - monitor BP for hypertension -low-sodium & low-moderate protein diet
family education about diarrhea care:
- small frequent oral rehydration (40-50 mL/kg every 4 hours) - avoid carbonate drinks, fruit juice, and chicken broth - use skin barrier to ensure they don't get raw - monitor for diaper amount per day to monitor for dehydration
pavlic harness care
- the harness is worn continuous for about 6-12 weeks (parents should be educated to not adjust or remove the harness without the provider's permission) - parents are instructed to hold the infant while in the harness and continue to nurture - SKIN CARE is of most importance for the infant harness- assess for redness, and massage areas of skin and place the diaper under the straps
What is correct teaching on how to perform oral rehydration therapy with a toddler? -Allow the child to drink 8oz of juice at a time to maintain hydration -Assist the child with taking small sips of water every ten minutes. -Encourage the child to drink a bottle of gatorade every hour. -Teach the child to drink soda whenever they feel like it to promote hydration.
-Assist the child with taking small sips of water every ten minutes. Rationale: For rehydration, water is the only appropriate choice for rehydration. It should be taken in small sips and not large amounts.
initial rehydration
20-30 ml/kg bolus
maintenance fluid formula
4-2-1 4 ml for first 10 kg 2 ml for second 10 kg 1 ml for remaining kg
Passage of a normal brown stool usually indicates that the intussusception has reduced itself. This is immediately reported to the HCP who may decide to alter the care plan.
:)
An infant comes into the ER screaming and drawing her knees up to chest. Infant presents with a temperature of 38.5 C, redcurrant-jelly-like stools, and vomiting. The physician says she will need surgery. What postop care should the nurse provide (SELECT ALL THAT APPLY)? A. Assess vital signs B. Monitor sutures and dressing C. Auscultate for return of bowel sounds D. Start tube feedings
A. Assess vital signs B. Monitor sutures and dressing C. Auscultate for return of bowel sounds Rationale: Nurse should monitor vital signs, monitor intact sutures and dressing, and monitor for return of bowel sounds postoperatively. Tube feedings should not be started without a physician order.
A three year old child is admitted to the emergency department. His parents tell you he fell in the street a week ago and now he won't let them touch his knee, which is red and swollen. The child also has a history of osteomyelitis. What nursing interventions should the nurse anticipate? (Select all that apply). A. Administering ordered pain medications B. Obtaining a blood culture sample C. Assessing pain level with the numerical scale D. Massaging the swollen joint E. Moving to the operating room for emergency surgery
Answer: A, B. These symptoms and history point to a diagnosis of septic arthritis, so the nurse should anticipate administering appropriate pain medications to provide comfort and reduce fever and obtaining a blood sample to culture for the bacteria causing the infection. The numerical scale is inappropriate for a child this age. Massaging the swollen joint will only cause further discomfort for the patient. Emergency surgery is only indicated for hip involvement, where decreased perfusion to the head of the femur is a high priority risk.
Nursing care of the child with gastrointestinal reflux is aimed at: A. Identifying children with suggestive symptoms B. Instituting fluid replacement even if the child has no respiratory complications to help with symptoms C. Helping parents with home care feeding and positioning D. Introducing solid foods before the age of six months to help with gastric pH E. Caring for the child undergoing surgical intervention
Answer: A, C, E Rationale: No therapy is needed if the child is thriving and has no respiratory complications. It is recommended for parents not to introduce solid foods until six months.
A 10 year old boy was placed in a halo vest for cervical traction. The parents are wondering how to care for him upon discharge. Select all the methods from below that are appropriate (Select all that apply) A. The parent can loosen the vest if the child complains B. Clean pins with soap and water C. Monitor for signs of swelling and redness at pin insertion sites D. Apply lotion and ointment to pin sites to reduce rubbing.
Answer: B, C. Rationale: Any adjustments to the vest must be made by medical staff. Do not use any ointments or antiseptics at the pin site, only clean with soap and water. Call the doctor if any reddened areas are discovered.
guillain barre syndrome
Ascending paralysis often first manifesting as falling down or clumsiness in walking with progressive motor weakness, areflexia, high protein in CSF
In an infant with a tracheoesophageal fistula, which should the nurse assess for? Select all that apply. A) Fever B) Choking C) Cyanosis D) Diarrhea E) Coughing
B) Choking C) Cyanosis E) Coughing Rationale: Clinical manifestations of a tracheoesophageal fistula are on page 726. They include coughing, choking, and cyanosis.
An adolescent patient recently diagnosed with Systemic Lupus erythematosus comes into the physician's office. She is complaining of increased joint pain. As the nurse, you would expect the doctor to prescribe what medication for this acute exacerbation? A. Acetaminophen (Tylenol) B. Corticosteroids (Prednisone) C. Furosemide (Lasix) D. Hydrochlorothiazide (Microzide)
B. Corticosteroids (Prednisone) Rationale: Corticosteroids are used in acute episodes of inflammation in patient's with SLE to decrease inflammation and relieve pain.
You are caring for a 7yo with a broken leg. How can you reduce the stressors of hospitalization, such as loss of control? A. offer yes or no options when providing care & interventions B. Do not allow child to use the restroom w/o a nurse present C. Offer choices such as fruit juice or apple juice with medications D. Do not allow friends to visit to prevent overstimulation
C. Offer choices such as fruit juice or apple juice with medications
You are caring for a 3yo who is hospitalized with pneumonia. What can you do to reduce stressors such as loss of control? A. not work greatly b/c the child is 3 & won't become stressed B. Make sure the parents leave the room during any procedures C. plan care around home routine as much as possible D. feed him every 3 hour to make sure he doesn't get hungry
C. plan care around home routine as much as possible
how do you prevent slipped capital femoral epiphysis
Could possibly be prevented by dietary changes and exercise to reduce weight to reduce obesity
Parent of a child newly diagnosed with juvenile idiopathic arthritis asks the nurse "Why is this happening to my child?" What is an inappropriate response? A. Something in the environment led to its development B. Your child was not vaccinated C. Something in your family history caused it D. Your child was vaccinated E. The etiology is unknown
D. Your child was vaccinated Rationale: Juvenile idiopathic arthritis has no direct cause. However, it is linked to environmental factors, genetic factors, and forgoing vaccination as certain diseases can lead to the exacerbation of juvenile idiopathic arthritis.
the BRAT diet is recommend to prevent diarrhea T/F
False; the BRAT diet is contraindicated for children because it has little nutritional value
treatment guillan barre
Maintain patent airway, monitor vitals and neuro signs, ensure proper body alignment and positioning, provide physical therapy For full recovery it may take up to 2 years after diagnosis Pain management is essential
immediate sprain care
RICE Rest, ice, compression, and elevation within the first 6-12 hours for the first 12-24 hours
emergency with guillain barre
Temporary paralyzed chest= can't breathe
risks for n/v
dehydration malnutrition
treatment options for scoliosis
Treatment options (three O's)- Observation, orthosis (braces), operative intervention.
Cerebral palsy and cognition
a. Approximately 30-50% of individuals with CP have significant cognitive impairments and an even higher percentage have mild cognitive and learning deficits
why are anti-diarrheal medications contraindicated in children
due to the fact that we want the toxin to get out of the babies system; if the bacterial or other GI infection has been ceased, all of the toxin will not be evacuated
s/s of respiratory distress
a. Tachypnea (>80 to 120 breaths/min) initially b. Dyspnea c. Pronounced intercostal or substernal retractions d. Fine inspiratory crackles e. Audible expiratory grunt f. Flaring of the external nares g. Cyanosis or pallor e. prolonged expiratory phase f. Altered mental status
3. What should the nurse include in her immediate plan of care if infant malrotation is suspected? Select all that apply a. prepare IV fluid b. Prepare Iv antibiotics c. Put the patient on NPO d. Nothing, this is a normal finding e. Keep the baby from turning over
a. prepare IV fluid b. Prepare Iv antibiotics c. Put the patient on NPO
sickle cell pain intervention
apply heat to jones to promote vasodilation to allow passage of sickle RBCs
What is a common way to detect VSDs?
auscultate the heart and listen for a murmur
complete break
bone completely broken off; may be held together with periosteal hinge; divides the bone fragments. These fragments often remain attacked by a periosteal hinge, which can aid or hinder reduction
nursing diagnosis for pyloric stenosis
failure to thrive • Fluid Volume Deficit R/T vomiting • Imbalanced Nutrition: Less Than Body Requirements R/T absorption disorder • Electrolyte Imbalance • Decreased Tissue Perfusion R/T hypovolemia
greenstick or incomplete fracture
fracture on one side that doesn't go through; occurs when a bone in angulated beyond the limits of bending. The compressed side bends, and the tension side fails, causing an incomplete fracture similar to the break observed when a green stick is broken
hemophilia pain intervention
ice to painful joints
why is chicken broth not recommended for diarrhea?
it contains excess sodium
when a person has diarrhea what is their ABGs
metabolic acidosis because, lose base for our butt
When a person vomits what is their ABGs
metabolic alkalosis because barf is acid
Nephroblastoma nursing consideration
never palpate the abdomen cause could bust the tumor open and spread cancer throughout the body, so Never palpate abdomen sign should be above the bed
cerebral palsy goal
optimize abilities within confines to dysfunction
What is the best rehydration approach for mild dehydration?
pedialyte or enfalyte
s/s of intussception
• Sudden onset crampy abdominal pain • Child screaming and drawing knees onto the chest • Currant-jelly stools (with gross/occult blood) • Sausage-shaped mass • Emesis • Lethargy/ vomiting • Edema, venous obstruction → ischemia, mucus into bowel lumen • Passage of red, currant jelly-like stools (stool mixed with blood and mucus)
Hirchsprungs s/s
• Vary due to: Age at diagnosis, length of affected bowel, presence of complications • No meconium in 1st 24-48 hours • Distended abdomen • Vomiting • Signs of enterocolitis (inflammation) • Chronic constipation • Foul-smelling stool • Older Infant/Child • Symptoms more chronic • Constipation, since birth • Abdominal distention • Ribbon-like, foul-smelling stools • History of delayed meconium • History of FTT
