child health test 3

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Renal System Assessment

-Physical examination- palpating the bladder -History taking- UTI'S, calculi, stasis, retention, pregnancy, STD, bladder cancer medications that can impact function- antibiotics, anticholinergics, antispasmodics surgeries, pattern of elimination, hygiene

The nurse is developing a plan of care for a child who is undergoing chemotherapy treatment. Which of the following nursing interventions would NOT be included the plan of care?

Assess rectal temperature Q 4 hours

Renal Development and Function in Infancy

Glomerular filtration and absorption low in infancy until age 1-2 Newborn is unable to concentrate urine effectively Newborn unable to reabsorb sodium and water Newborn produces very dilute urine

Which of the following clinical manifestations are associated with acute glomerulonephritis? Select all that apply.

Hematuria Decreased urine output Hypertension Fatigue

chemo therapy drugs and be administered

IV or PO

petaling a cast

If the edging is rough and rubbing on the skin, put material over it

nursing care managment for CL/CP

Noisy feeders burp after every ounce, or at least 2-3 times during the feeding some liqueid may enter nasal cavity during feeding- dont be alarmed

Positive Trendelenburg Sign

Pelvis sags on nonaffected side affected hip can not bear weight Superior Gluteal Nerve Injury

The nurse is developing a plan of care for a child who has been diagnosed with nephrotic syndrome. Which of the following interventions should be included in the plan of care? Select all that apply.

Restrict client's fluid intake Administer corticosteroids Limit client's sodium intake

The nurse is administering intravenous chemotherapy to a child who has been diagnosed with cancer. The nurse notices that the child has begun to show symptoms of a possible reaction to the chemotherapy drug. What should the nurse do first?

Stop the chemotherapy infusion

Which of the following is the most common cause of acute glomerulonephritis in children?

Streptococcus

Myleosuppression

Suppression of bone marrow function, which can result in dangerously reduced numbers of red blood cells, white blood cells, and platelets

what causes CO2 to increas with metabolic alkalosis partially compensated

The lungs decrease the respiratory rate, increasing CO2

The parents of a newborn diagnosed with cleft palate ask the nurse when their child's palate will be repaired. What is the best response by the nurse?

The palate is typically repaired when the baby is at least 6 months old.

therpaeutic managment for DDH

VARIES with age of child and degree of dysplasia

Which of the following clinical manifestations are associated with nephrotic syndrome? Select all that apply.

Weight gain Correct answer: Proteinuria Correct answer: Lethargy

The nurse is preparing to admit a child who has been diagnosed with dehydration. Which of the following assessment findings should the nurse anticipate? Select all that apply.

Weight loss Correct answer: Decreased urine output Poor skin turgor

sequential compression device

a plastic, air filled sleeve that is placed around the leg and inflates and deflates regularly to help improve circulation, reduce fluid build up, and prevent blood clots

Tracheoesophageal fistula is best described by which of the following statements?

A passageway joining the trachea and esophagus present at birth.

three degrees of DDH

Acetabular dysplasia Subluxation Dislocation

Which form of leukemia is most common in children?

Acute lymphoblastic leukemia

The nurse is caring for a child after the surgical correction of scoliosis. Which of the following nursing interventions should be included in the plan of care?

Administer pain medication Perform neurovascular assessment Assist client with ambulation

Which of the following interventions should be included in the plan of care for a 12 month old whose cleft palate was repaired 12 hours ago?

Administer pain medication on a regular schedule, as opposed to an as-needed schedule

The nurse is caring for a child who is severely dehydrated and has begun to exhibit clinical manifestations of shock. Which of the following nursing interventions should the nurse implement? Select all that apply.

Administer supplemental oxygen Assess for changes in LOC Administer intravenous fluids

t Question 8 is unpinned. Click to pin. Question at position 8 Esophageal atresia is best described by which of the following statements?

An incomplete passageway from the mouth to the stomach present at birth.

superficial first degree burns

epidermis red, dry blanches with pressure painful heal in 4-5 days with no scarring

partial thickness 2nd degree burns

epidermis and dermis red, moist, swollen blisters, blanches with pressure takes about 2 weeks to heal with minimal to no scarring painful

full thickness 3rd and 4th degree burns

epidermis, dermis, hypodermis, tendons, nerves, muscles black, charred, non blanching, edema, possible bone exposed no pain skin grafting necessary, extensive scars, contractures and limited function may occur

how often should immobile client be repositioned

every 2 hours

clean intermittent catherization with NTD

every four hours during the day and once at night

polyhydramnios

excessive amniotic fluid

patho of cleft palate

failed fusion of the hard and soft palates may involve soft palate, hard palate, or both

neurogenic bladder

failure of the bladder to store urine or empty itself of urine

patho of Cleft lip

failure of the maxillary processes to fuse with the nasal elevations, with or without CP is the most common birth defect in the US, can occur unilaterally (one side) or bilaterally (both)

neural tube defect

failure of the neural to close

It is likely that a child with ewing sarcoma will need to have the affected extremity amputated.

false

Neuroblastoma is a type of brain tumor.

false

primary purposes of traction

fatigue the involved muscle and reduce muscle spasms so bone can be realigned position the distal and proximal bone ends in desired realignment to promote proper healing immobilize the fracture site until realignment has been achieved and sufficient healing has taken place to permit casting or splinting

social isolation with nephrotic sydrome

fatigue, lack of energy, causing them to not have normal activity level, immunosupression due to use of corticosteroids long term, change in appearance due to large amount or edema

neural tube

fetal structure from which the brain and spinal cord form

how to restore and maintain fluid volume with burns

fluid administration monitor urinary output daily weighs monitor electrolyte levels

nursing managment for acute post-strep glomerulonephritis

fluid restrictions low sodium low potassium diet administer meds- diuretic, antihypertensives, antibiotics (persistent) daily weights strict I&O

nursing care managment for child with nephrotic syndrome

fluid restrictions due to edema low sodium diet administer meds- prednison (COrticosteroid), albumin because its decreased, diuretics to pull out extra fluid , strict I&O, daily weight, management of edema

therpeutic managment for burns

fluid resuscitation wound care prevention of infection restoration of function

albumin has an osmotic force as sodium where albumin goes water follows,

fluid shifts when the protein shifts, with third spacing occurring resulting in hypovolemia

Prevention of neural tube defects

folic acid for women of child bearing age

for fluid calculation it is 100 ml/kg

for the first 10 kg of body weight

fo fluid calculation it is 20 ml/kg

for the rest of the weight

for fluid calculation it is 50 ml/kg

for the second kg of body weight

third spacing allows the child to have

generalized edema, noticeable all over body

etiology of cancer

genetics chromosomal abnormlities immunodeficiency environmental radiation maternal smoking prolonged exposure to sun

Pathophysiology of acute post-strep glomerulonephritis

glomeruli has become inflamed with filtering capability impaired accumulation of na and other waste products in the blood may be primary or secondary to a systemic disorder most common cases are post infectious range from minimal to severe

Nephrotic sydrom patho

glomeruli membrane becomes permeable to proteins, albumin spills into urine (proteinuria), serum albumin decreases, fluid shifts to interstatial fluid,

therapeutic managment of diabetes

glucose control preventing complications promoting normal growith and development promote positive adjustment to disease and self managment

in partial compenstion the CO2 and HCO3 will always

go in the same direction

Which of the following are common side effects of cancer treatment?

hair loss anorexia stomatitis constipation

after cast application

handle wet casts with palms of hands only to prevent indentations of cast which can create pressure areas petal the casT routine skin assessment do not get wel keep elevated 5 P'S

Positioning for shock

head flat, legs elevated, promoting return of blood back to the heart

clinical manifestations of acute post-strep glomerulonephritis

hematuria- tea or cola colored urine (blood) proteinuria decreased urinary output irritability, fatigue, lethargy hypertension headache loss of appetite pale edema- begins periorbital, more noticeable in the morning, transitions to lower extremeties including genetalia, more noticeable in evening

type of diet for immobilization

high protein, adequate fiber, vitamin and mineral supplements

Iv sites must be assessed

hourly for signs of infiltration

lack of insulin leads to

hyperglycemia

what cuses respiratory alkalosis

hyperventiltion increased respirtions blowing off CO2 at faster rate than breathing in

what causes respiratory acidosis

hypoventilation- decreased respirations retaining CO2

Which of the following types of shock is most common in children?

hypovolemic

type of shock most common in children

hypovolemic shock

most common type of scoliosis in adolescents

idiopathic

what will lumbar puncture determine

if there is metastasis of the tumor

due to a large amount of the infants body being water

if they become dehydrated they are going to lose weight

healthy funcitonal glomeruli is

impermeable to protein, particularly albumin

Vasopressors

improve cardiac output

fluid and electrolyte imbalances are much more common

in children than adults and occur more frequently and rapidly

family should be prepared that hair may fall out

in clumps patchy baldness

with shock dopamine will

increase cardiac output, and improve renal function

phases of chemotherapy treatment for leukemia in the correct order.

induction consolidation maintenance CNS prophylaxis

chemo IV agents have to be watched closely for

infiltration

CL/CP therapeutic management

initial correction/repair may happen in first year of life treatment to fully repair may continue into adulthood focus on surgically repairing the defect, prevention of complications, promoting normal growth

irreversible shock

irreversible damage to vital organs, weak thready pulse, anuria, hypotension, lethargy, periodic breathing or apnea, obtuned, stupor, or coma

by the time a diagnosis is made for neuroblastoma

it has metastasized, prognosis is poor

In which of the following organs is wilm's tumor located?

kidney

Which organ compensates to regain homeostasis when a client is experiencing respiratory acidosis or alkalosis?

kidneys

fluid for burns in first 24 hours

lactated ringers

minimal change nephrotic syndrome clinical manifestations

large protenuria, hypoalbumenia, generalized edema, significant weight gain, dark frothy urine, dcreased urinary output, pale, irritable, fatigue, lethargic, poor appetite

scoliosis

lateral curvature of the spine greater than 10 degrees congenital, neuromuscular, idiopathic most commonly identified during preadolescence growth spurt early detection, referral, and treatment is important

Children with spina bifida are at high risk for

latex allergies due to repeated exposure during procedures, have a latex environment, educate parents about nonmedical objects that contain latex (pacifiers, pool toys) also urinary tract infections

bone marrow biopsy is related to what cancer

leukemia

effects of immobilization

loss of muscle strength, edurance, and muscle mass loss of joint mobility- joint stiffness and contractures demineralization of the bone- osteoporosis dependent edema DVT Pneumonia constipation- fecal impaction less mobility hypercalemia due to immobility do absorping calcium and releasing into bloodstream rean calculi- deue to hypercalcemia due to immobility skin break delayed growth and development

Hypoalbuminemia

low albumin levels in the blood

Which of the following diagnostic tests is used to determine if cancer has metastasized to the central nervous system?

lumbar puncture

The most common complication of osteosarcoma is metastasis to which of the following organs?

lungs

Which organ compensates to regain homeostasis when a client is experiencing metabolic acidosis or alkalosis?

lungs

organ most sensitive to shock

lungs

EA/TEF therapeuticc management

maintain patent airway prevent aspiration immediately NPO IV fluids position to facilitate drainage of secretions Suction to clear airway Surgical correction

primary responsibility of the kidneys

maintain the composition and volume of the body fluids in equilibrium

nursing care management for DDH

maintenance of the pavlik harness or cast promote growth and dvelopment educate parents about pavlik harness and other devices post surgical procedure- same as care of any in a cast

most common consequences of GI dysfunction

malabsorption poor growth fluid and electrolyte disturbance malnutrition

with traction nurses does not

manipulate traction

nursing care focus with immobilization

maximize physical mobility promote adequate nutrition promote effective elimination promote skin integrity maximize self care promote development prevent injury provide support and eucation to the child and family assess skin for redness or breakdown perform ROM exercises keep dkin clean and dry encourage fluid intake monitor intake and output encourage courghing deep breathing use of incentive spirometer apply sequential compression devices monitor peripheral pulses and skin temp monitor breath sounds monitor for sings of pulmonary embolism monitor calcium levels provide nutritional support

major complications of leukemia

metastasis to blood, blone, CNS, spleen, liver hepatosplenomegaly alterations in growth and development infection hemorrhage

to prevent gingival bleeding oral muccositis stomatitis

meticulus mouth care soft bristle toothbrush bland moist soft diet frequent mouth rinses

with scoliosis curves less than 25 degress are considered

mild and if non progressive then treatment not required

when removing an old dressing for burns

moisten it

with diet and exercise in diabetes

monitor carbohydrates intake consistent food intake regular physical activities

post operative care of NTD

monitor vital signs pain management observe for s/s of infection prone positon, some allow side lying monitor for increased ICP

osteosarcoma

most common bone cancer in children most common sites are long bones

minimal change nephrotic syndrome

most common in children non identifiable cause

fractures in children

most common in forearm and wrist since periosteum is ticker and more elastic bones are more flexible causing them to yield to the force encountered with trauma, plastic/bowing deformity, buckle, and greenstick fractures heal quicker, result in less disability and deformity than adults the younger the child, the quicker the healing process in children younger than 2 should be further investigated

acute post-strep glomerulonephritis

most common type in children typically often group A beta hemolytic strep most common in early school age children and uncommon younger than 2 almostall do recover completely without any complications

patho of hypertrophic pyloric stenosis

muscle of the pyloric sphincter becomes thickened resulting in narrowing of pyloric canal results in compensatory dilation, hypertrophy, and hyper peristalsis of the stomach not congenital, develops in first few weeks of life etiolgoy unknown

fluid administration rate ml/hr

must be included in input/output

therapeutic managment for neuroblastoma

must be surgically removed chemo, radiation

esophageal stricture

narrowing of the esophagus, poor feeding, choking, dysphagia, drooling, regurgitations of undigested food

barlow maneuver

newborn hip evaluation - adduction of hip - evaluates for congenital dislocation, causes the hip to dislocate, downward motion

pain control with burns

non traumatic ongoing and prior to dressing change or debridement nonpharmacologic along with pharmacologic

spina bifida occulta

not externally visible no protrusion of the spinal cord of meninges benign, asymptomatic, no neurogical signs Lumbosacral area may be noticeable dimpling, abnormal patches of hair, or discoloration of skin skin at the site of defect

treatment options for scoliosis

observation with regular clinical evaluation and x rays orthotic intervention (bracing) surgical correction

post op care cleft palate

observe for signs of airway obstruction, hemmorrhage, laryngeal spasm assess vital signs and O2 sats monitor for potential airway compromise clear liquids for 24 hours followed by clear liquid diet for 2 weeks soft diet may be encouraged for 6 weeks open cups for liquids avoid spoons, straws, hard tipped sippy cups elbow restraints pain managment

nursing care managment for fractures

obtain health history cold therapy to reduce swelling in first 48 hours elevated injured extremity assess 5 p's- pain, pallor, parethesia, paralysis, pulses pain management provide family education

ewing sarcoma pathophysiology

occurs in bone or soft tissue surrounding the bone most common site are pelvis, legs, arms most common sits of metastasis lungs, bone, bone marrow

signs and symtoms of neuroblastoma

often parents first to notice a swollen and asymmetric abdomen

The parents of a child who is receiving radiation therapy ask the nurse if they can wash off the purple markings on the child's skin when they give him a bath. What is the best response by the nurse?

ou should not wash off the markings, they are needed for the radiation therapy

nursing managment for burns

oxygenation and ventilation restoring and maintaing fluid volume airway edema may be delayed prevent hypothermia cleanse the burn

lab values with metabolic alkalosis partially compensated

pH 7.45 HCO3 increased CO2 increased

lab values for partially compensated metabolic acidosis

pH decreased HCO3 decreased CO2 decreased

respirtory acidosis partilly compensated

pH decresed CO2 increased HCO3 increased

respiratory alkalosis partially compensated

pH incresed CO2 decreased HCO3 decreased

signs and symptoms of osteosarcoma

pain limp limited movement of affected extremity swelling or tenderness at the site of the tumor

postoperative care for scoliosis

pain management neurological assessment of extremitites log roll assessment of skin and sskin care encourage early ambulation

Post op nursing care management for EA/TEF

pain managmenet administer total parenteral nutrition resume oral feedings in aproximately 1 week closely observe the initial attempt at oral feeding

signs and symptoms of cancer in children

pain, swelling at location of tumor pallor unusual bleeding excessive bleeding fatigue or malaise excessive, rapid weight loss abdominal mass swollen lymph nodes recurring fever, frequent infections LOC/ behavior changes visual disturbances bone fractures

clinical manifestations for hypertrophic pyloric stenosis

palpable olive shapped mass in RUQ nonbilious projectile vomiting after feeding hungry and irritable visible gastric peristalsis resembling waves if not diagnosed early can lead to dehydration, metabolic alkalosis and failure to thrive

with wilm's tumor do not

palpate the abdomen because it is very soft and can very easily start to seed leading to metastasis

nursing care managment for external fixations

partial weight bearing allowed full weight bearing not allowed until complete healing has occcurred assess and maintain skin integrity assess for s/s of infection provide pin care prevent injury 5 P's elevate extremityh provide education to child and family

Which of the following devices would be used to treat developmental dysplasia of the hip?

pavlik harness

with limb salvage procedure provide education about

phantom limb pain stump care crutch walking prosthetics

what to do for nose bleed

pinch nose and tilt head forward

congential nephrotic syndrome

present at birth, hereditary

nursing care management of NTD

prevent infection- assess and maintain intactness of sac, prevent trauma, apply sterile, moist dressing, prone position Assess LOC and degree of neurologic involvement Promote urinary elimination- neurogenic bladder, clean intermittent catherization, teaching self cauterization bowel elimination- panned or timed enemas promote adequate nutrition

with pyloric stenosis the thickened muscle around the pylorus

prevents food ffrom entering the small intestine

lymphoblastic

primarily effect lymphoid cells, normally grow into lymphocytes

myelogenous

primarily effect myloid cells, normally grow into RBC's, granulocytes, and monocytes, platelets

chronic leukemia

progression is slow, cells retain some of normal function

radiation therapy management

protect skin from sunlight and sudden changes in temp wear loose fitting clothing over sight use extremity as tolerated

post op care for cleft lip

protect the operative site, avoid prone positon supervise child to ensure suture line is not damaged, may apply elbow restraints infant may return to breast or bottle feeding may require syringe feeding initially pain managment proper cleaning fo suture line monitor for infection and bleeding

most common type of EA and TEF in children

proximal esophagus ends in a blind pouch distal end forms a fistula with a trachea

therapeutic management for hypertrophic pyloric stenosis

pyloromyotomy (laparoscopic) Pre op: fluid and electrolyte therapy fluid replacement may delay surgery continuous vomiting may need to decompress stomach with NG

acute leukemia

rapidly progressing, cells are without normal function

goal of radiation therapy

reduce the size of tumor

therpeutic managment of fractures

reestablish alighment and length of one retain alignment and length of bone (immobilization) resotre function of the injured extremity prevent further injury

NURSING CARE MANAGMENT FOR DIABETES

regulating glucose- blood glucose monitoring, carb counting, food intake, activity level, insulin administrations monitor for s/s of hyperglycemia hypoglycemia Educate the family

what does reduction mean with fractures

relignment for proper healing

goal of cancer surgery

remove all traces of tumor

Wilm's tumor

renal tumor unilateral, only one kidney grows rapidly, large at time of diagnosis

children in indoor fire or chemical fire have a greater risk for

respiratory failure

A nurse in the emergency department is caring for a 12-year-old child who is a victim of a house fire. The child has sustained deep partial-thickness and full-thickness burns to his arms, chest, and face. Which of the following is the priority assessment for this child?

respiratory status

clinical signs of hypovolemic shock

respiratory- normal to increased heart rate- tachycardia breath sounds- normal pulse pressure- narrow peripheral pulse weak urine output- decreased, irritable early capillary refill delayed <2 seconds pale cool skin

pre op nursing care managment of hypertrophic pyloric stenosis

restore fluid and electrolyte balance NPO monitor iv fluids strict I&O document frequency and description of vomit assess vital signs look for signs and symptoms of dehydration maintain/monitor NG tube assess and record NG drainage offer family support

scald burns

result of contact with hot liquids

hypovolemic shock

result of exvessive blood loss or fluid loss

how are corticosteroids helpful with nephrotic syndrome

reversing the permeability of the glomeruli, will no longer allow protein in

meningocele

sac contains meninges and CSF, spinal cord is normal, little to no neurological deficits

myelomeningocele

sac contains meninges, CSF, and nerves most severe form of NTD spinal cord often ends at the point of the defect, absent motor or sensory function beyond that point paralysis, orthopedic deformities, bowel and bladder incontinence associated with hydrocephalus

where are scoliosis screening often done

school

secondary nephrotic sydrome

secondary to another disease process

family teaching for EA/TEF

semi upright position small, frequent feedings observe for adequate swallowing TEACH S/S of respiratory distress safeguard against swallowing foreign object

external fixation

series of pins and wires surgically inserted into bone then attached to an external frame

Which of the following is a major complication of dehydration?

shock

decompensated shock

signs more obvious, tachypnea, oliguria, cool clammy extremities, poor capillary refill, decreased bp, pronounced tachycardia, change in LOC (drowsiness, confusion)

nursing care managment for child with club foot

skin assessment circulatory assessment teach parents to observe the skin and look for problems with circulation teah parents the importance of complying with treatment plan encourage parents to facilitate normal growth and development as best as possible and within the limitations

fluid edema in chldren can lead to

skin break down if the child is not active

After cast removal

skin will be covered with dead skin cells and oily secretions soak in warm water, may take several days avoid scrubbing or pulling off deak skin decreased muscle mass expected resume routine activity to regain strength and normal appearance

POST op care for pyloromyotomy

small frequent feedings of water and pedialyte 4-6 hours after surgery can then start formula feeding about 24 hours post op normal schedule should resume about 48 hours post op some vomiting due to edema may occur

the primary osmotic force that controls fluid movement in our body

sodium

tracheomalacia

softening/ weakening of the trachea, barking cough, stridor, wheezing, recurrent respiratory tract infections, cyanosis, apnea

In cancer WBC'S are suppressed

specifically neutrophils, which are most abundant type, major fighters

long term problems from CL/CP

speech impairment requirng speech therapy, usually with cleft palate additional surgeeries recurrent otitis media secondary to CP dental anomalies- missing teeth, misaligned teeth

most common type of NTD

spina bifida

newborns to 6 months DDH

splinting with hips flexed and abducted (pavlik harness) training the hip until condition is corrected Pavlik harness worn continuously for about 3 months

with EA/TEF the oral feedings begin with

sterile water or pedialyte followed by small, frequent, feedings of formula/ breastmilk

how to cleanse burns

stop the burning process, remove charred clothing, rinse with cool water, do not break blisters, debridement, dressing change

neutropenic precautions

strict handwashing no live flowers or fresh fruit/vegetables client must wear mask when outside of room

pre op nursing care management for EA/TEF

suction the child's airway elevate HOB at least 30 degress respiratory assessment airway managment Fluid and electrolyte management

signs of pulmonary embolism

sudden dyspnea, chest pain, respiratory distress

The mother of a 2-year-old child calls the pediatric clinic and tells the nurse that the child accidently touched the mother's curling iron this morning. The mother describes the child's burn as red, dry, and painful. Which type of burn has this child most likely sustained?

superficial

The nurse is caring for a 4 month old who just had a cleft lip repair. In which position should the child be placed?

supine

curves greater than 45 degrees typically require

surgery

therpeutic managment for cancer

surgery chemo radiation bone marrow transplant (hematopoietic stem cell transplant)

if the curve does not respond to bracing

surgery is needed

6-24 months treatment options for DDH

surgical closed reduction spica cast for 12 weeks

therapeutic of neural tube defect

surgical closure soone after birth within 24-72 hours, much sooner if sac is leaking CSF or danger of sac rupturing Goal- prevent infection and minimize further loss of function

older than 2 treatment options for DDH

surgical open reduction casting rehabilitation measures

open reduction

surgical opening in the skin

therapeutic managment of wilm's

surgical removal of tumor and affected kidney chemo and radiation

treatment of osteosarcoma

surgical removal- radical amputation (affected removed), limb salvage procedure (remove only affected portion) replace with prosthetic chemo

with EA/TEF the chid can not

swallow the amniotic fluid like nnormally leading to the mother having polydraminos

The nurse is caring for a child who has been diagnosed with metabolic acidosis. Which of the following assessment findings should the nurse anticipate?

tachypnea

The nurse is caring for pediatric client whose lab values indicate respiratory alkalosis. Which of the following is the most likely cause of this imbalance?

tachypnea

The nurse is caring for a child who has been diagnosed with ewing sarcoma of the left leg. Which of the following assessment findings should the nurse anticipate? Select all that apply.

tenderness pain swelling

we describe the type of dehydration based on

the amount of sodium that is in the plasma

decreased level of protein in the blood hypoproteinemia

the body increases the production of lipids and proteins this leads to increased level of cholesterol (hyperlipidemia)

when the child goes into remission

the bone marrow biopsy will usually show less than 2% blasts

since extremity is not being used in cast

the bones are immobile and are not absorbing calcium propery so it is being released in bloodstream, causing hypercalcemia leading to kidney stones

what causes partially compensated metabolic alkalosis

the child is vomitting, decreases the acid, increasing the base

hypotonic dehydration

the child lost more salt than water, sodium level is decreased

hypertonic dehydration

the child lost more water than salt, the sodium level is increased

what causes HCO3 to decrese with respiratory alkalosis partially compensated

the kidneys excrete it, to bring the level down

what causes HCO3 to increase

the kidneys work to compensate, kidneys will retain it

Isotonic dehydration

the loss of salt and water is equal, they have a normal sodium level

what causes co2 to decrease with partially compensated metabolic acidosis

the lungs compensate by increases respirations to help decrease CO2

the younger the child

the more immature their kidney function is

the type of dehydration determines

the type of fluid that would be used to get back to normal levels

we can not vasodilator the vessels if

there is no volume to circulate

if the client platelets drop below a certain number

there is usually a standing order

due to the large amount of water than children have in their body

they are going to have more of an imbalance

children have underdeveloped kidney function

they are unable to effectively concentrate or dilute urine necessary, inefficient in excreting waste

children have increased fluid requirements

they excrete more urine and require more fluids

with isolated cleft lip managment

they have difficulty getting an adequate seal have special nipples with wide base, breastfeeding less difficult, squeeze cheeks together during feedings

diagnositic procedures for acute post-strep glomerulonephritis

throat culture- determines child has active strep infection urinalysis BUN, creatinine- degree of renal impairment antistreptolysine tider

never apply ice

to a burn

lower extremity cast

to immobilize ankle or knee

graft vs host disease

when a recipient's immune system is destroyed and receives a new one, the donor's mature T cells attack and reject the recipient's healthy tissue

SURGICAL correction of CL typically happens

when child is around 2-3 months old

compartment syndrome

when swelling starts to develop around tissues of affected fracture site, and then it starts to impede circulation acting as a turniquet, a medical emergency

diagnostic evaluation for scoliosis

when viewed from behind child may exhibit asymmetry of shoulder, height, scapular, or flank shap, or hip height To exam, child should bend forward at the waist with trunk parallel to the floor, arms hanging freely X-ray

closed reduction

without opening the skin

diagnostic evaluation of fractures

x rays- used to diagnose, taken after reduction and during healing process to confirm satisfactory progress

The mother of an infant who is scheduled to undergo surgical correction of hypertrophic pyloric stenosis asks the nurse how her infant will be fed after surgery. What is the best response by the nurse?

"Your baby will be fed by mouth from a bottle or breast just as he normally would."

The nurse is caring for pediatric client whose lab values indicate respiratory acidosis. Which of the following is the most likely cause of this imbalance?

Decreased respiratory rate

normal urinalysis findings

PH- 5-9 Specific gravity- 1.001- 1.035 protein <20 no glucuose, ketones, Hgb, WBC, RBC yellow, amber, clear, odorless,

post op nursing care management of hypertrophic pyloric stenosis

assess for vomiting administer and monitor IV fluids pain management monitor I&O assess vital signs supervise feedings

nursing care management for wills tumor

assess remaining kidney assess side affects of radiation or chemo provide education for no contact sports, UTI prevention, report signs of GU issues

nursing management for a dehydrated child

assessment, get history, vital signs, weight, capillary refill, intake/output strict, encourage oral fluid intake, iv fluids, preparing the child and parents

surgial correction of CP typically happens

at 6-9 months of age early repair may restrict skeletal growth of childs midface delaying the repair after first words can lead to significant speech problems

for cancer how long should one wait for live vaccine

at least 3 months after completion

diagnosis of EA/TEF

attempt to insert an NG and when you try it doesnt go anywhere Xrays bronchoscopy polyhydraminos

type 1 diabetes

autoimmune response damages cells of pancreas

priority after discharge for cancer

avoid crowded areas limit exposure to friends practice good hand washing

neurological problems from chemo

constipation- stool softners, mild laxatives, physical activity weakness numbness changes in gait changes in fine motor jaw pain

children recieivng cancer treatment should avoid

contact sports

therapeutic management of clubfoot

correction of deformity maintenance of the correction until normal alignment is regained follow up observation to prevent recurrence

teaching of food restrictions with EA/TEF

cut solid food into small pieces teach child to chew food thoroughly give frequent sips of liquid avoid food such as whole hotdogs or large pieces of meat that may become lodged in the esophagus

An adolescent who is undergoing radiation therapy for ewing sarcoma of the leg asks the nurse if it is okay for her to suntan. What is the best response by the nurse?

"It is best that you not suntan while you are receiving radiation therapy."

The nurse is preparing a 4-year-old child who sustained partial-thickness burns to his lower arm and hand for discharge. Which of the following statements made by the child's parents indicate the nurse's discharge teaching has been effective?

"We will apply a thin layer of antibiotic ointment to the burns when we change the dressing."

how long should child be monitored after chemo when assessing for anaphylaxis

1 hour

expected urinary output for child

1 ml/kg/hr

normal specific gravity

1.005-1.030

When are boys screened for scoliosis?

13-14 years 1x

when are girls screened for scoliosis

10 and 12

maintenance fluid calculation formula

100ml(first 10kg) + 50ml(second 10kg) + 20ml(rest of kg) divided by 24

normal HCO3

22-26 Base

How many ml/hr of continuous intravenous fluid should the nurse expect to administer to a child who weighs 5.6 kg?

23.3

for fluid whar is the total ml/kg divided by

24 to get hourly weight

clinical manifestations of EA/TEF

3 C'S coughing, choking, and cyanosis forthy saliva in nose and mouth, drooling, coughing and gagging with feedings, return of formula through nose and mouth, cyanosis and apnea because of aspirations, stomach distended with air

clinical manifestations of diabetes

3 P's polyuria polydipsia polyphagia blurred vision headache weight loss

when should expect hair growth after chemo

3-6 months

when should antiemitic be administered with chemo

30 mins- 1 hour before and as scheduled for at least 24-48 hours afterward

Normal CO2

35-45 acid

How many ml/hr of continuous intravenous fluid should the nurse expect to administer to a child who weighs 19 kg?

60.4

percentage of childs body that is water

65%

Norml pH

7.35-7.45

How many ml/hr of continuous intravenous fluid should the nurse expect to administer to a child who weighs 30 kg?

70.8

percentage of infants body that is water

75%

Labs for cancer

CBC chemistry panel (kidneyk liver, acid-base, electrolytes) urinalysis lumbar puncture

Signs of infiltration

Cool to touch, redness/blanching, paleness, edema (swelling), painful

Which of the following accurately explains why infants and young children experience fluid and electrolyte imbalances more easily than adults? Select all that apply.

Infants and young children excrete more urine than adults Infants and young children have a greater need for fluid because a larger percentage of their body weight is water Infants and young children have a larger body surface area than adults

A child with partial thickness burns to both legs is admitted to the pediatric unit. Which description is most accurate for the appearance of this child's burns?

Moist, red, with blisters

with anemia in cancer treatment

RBC'S are suppressed monitor HgB Regulate activity level as neccessary transfuse packed RBC's as needed

signs of wilms tumor

abdominal mass and swelling parents typically discover

ortolani maneuver

abduct the legs to feel "clunk" of femur slipping intoacetabulum, upward motion

developmental dyssplasia of the hip

abnormal development of the hip may develop at any time during fetal life, infancy, and childhood risk factors- femal gender, family history, breech intrauterine position, high birth weight idiopathic- no neurological defects tetratologic- involves nueromuscular defects

percutaneous heelcord tenotomy

achilles tendon servered may be necessary with clubfoot may be in cast for 12 weeks

vomit is a

acid

if the pH is less than 7.35 it is

acidosis

with ewing sarcoma before surgery discourage

active play or weight beiging on affected extremity to prevent fracture at tumor site

Nurses must be trained or have experience in

administering chemo

Children in which age group are most often affected by scoliosis?

adolescent

Osteosarcoma most commonly occurs in which of the following age groups?

adolescent

Which of the following is the most common location for a neuroblastoma to form?

adrenal gland

the glomerulonephritis has most often started

after child has had previous infection and it is the bodies autoimmune response to that

if the pH is more than 7.45 it is

alkalotic

pathophysilogy of cancer

alteration in cellular regulation resulting in out of control cell growth

leukemia results in

anemia neutropenia thrombocytopenia

most useful diagnostic test for glomerulonephritis

antistreptolysine tider ASO, detects streptotoccal antibodies, elevated comfirms this

periorbital

area around the eye, more noticeable in the morning

Which type of fracture is most common in children?

arm

to avoid hemorrhage do not give in cancer treatment

aspirin gibe tylenol instead

emergency assessment of a burned child

assess airway, note if patent, maintainable or unmaintainable, evaluate skin color, respiratory effort, symmetry of breathing, determine pulse strength, perfussion status, heart rate, extent and location of edema

nursing care managment of traction

assess child and traction apparatus physcician will apply and manipulate traction skin care at pin sites, assess for s/s of infection assess for skin breakdown pain managment assess 5 P's promote growth and development

before cast application

assess for abraisions, cuts or other ckin alterations, check for items that may cause constriction or swelling

poop is a

base

neuroblastoma

begin as neuroblast in the fetus, most mature, other form into tumor

Which of the following diagnostic tests is used to determine the staging of cancer?

biopsy

definitive method for determining cancer

biopsy

carbonaceous sputum

black colored, may indicate airway injury

glucose control

blood glucose moitor hemoglboin A1C

type 2 diabetes

body reistance to insulin or inadequate insulin secretion to meet body's demands

countertraction on proximal bone fragment achieved by

body weight

signs and symptoms of leukemia

bone pain headache weight loss nausea/vomitting abdominal pian unusal bleeding/bruising pallor fatigue recurrent infection fever with unknown cause

malunion

bony break that is not aligned correctly

with scoliosis 25-45 degree

bracing may be best option

Which of the following clinical manifestations would NOT be associated with shock?

bradycardia

suspect airway injury from burn or smoke inhalation if these are present

burns around the nose, mouth, or eyes, carbonaceous (black) sputum, hoarseness or stridor

bracing does not correct current curve

but prevents progression

teaching about brace

can only be removed for bath/shower skin care

nephrotic sydrome in children can be a

chronic condition with repalpse so they may not meet developmental milestones due to being hospitalized frequently

burns in pediatrics

common but preventable young children are at highest risk most do not result in death 60-80% are scald burns

fracture complications

compartment syndrome nonunion malunion infection kidney stones pulmonary emboli

stages of hypovolemic shock

compensated, decomensated, irreversible

patho of esophageal atresia and tracheoesophageal fistula

congenital defect where the esophagus fails to develop as a continuous passage the esophagus and trachea fail to separate May occur separately or together

clubfoot

congenital deformity of the ankle and foot foot points downward and inward cause unknown bilateral in 50% of cases more common in males

nursing care management for scoliosis

consideration for growth and development- provide positive reinforcement, encourage socialization with peers, encourage self care and independence, potential social isolation, dealing with pain, body image

patho of burns

damaged vessels lead to increased permeability and vasodilation leaking of fluid from vasculature- third spacing and edema fluid loss 5-10 times greater fluid loss continues until skin is healed or grafted

a specific gravity more than 1.030 may indicate

dehydration

children are very susceptible to

dehydration and a major complication is shock

poor glucose control may lead to

delayed wound healing recurrent infections retinopathy neuropathy nephropathy cardiovasuclar disease DKA

after completion of casting with club foot

denis brown bar with ponseti shoes, paces the feet in abduction and worn for an extended period of time

deep partial thickness 2nd degree burns

dermis, epidermis, hypodermis yellow, white, waxy, leathery non blanching decreased pain, may feel pain around area take up to 8 weeks to heal with no visible scarring may require surgery or skin grafting

what can biopsy assist with

determining if malignant or benign classification or staging bone marrow location of origin

The nurse is caring for pediatric client whose lab values indicate metabolic acidosis. Which of the following is the most likely cause of this imbalance?

diarrhea

what causes metabolic acidosis partially compensated

diarrhea, pooped out all of base, leaving only acid

with Myelomeningocele

do not let the sack rupture, protect the sac

preferred first line drug for shock

dopamine

physical assessment findings for a child who is experiencing dehydration

dry mucous membranes, no tears, sunken fontanels, sluggish capillary refill, pale, lethargic, irritable, poor skin turgor, decreased urinary output, increased specific gravity, weight loss, irregular respirations

diagnostic evaluation for DDH

early treatment before 2 months old achieves greater success the longer treatment is delayed, the more severe deformity the more difficult the treatment Orolani and barlow maneuver asymmetric thigh and gluteal folds limited hip abduction shortening of leg on affected side positive trendelenburg sign

greatest weapon of cancer

early detection and treatment

facial cues while feeding signaling the need for a break with CL/CP

elevated eyebrows wrinkled forehead watery eyes

How can neural tube defects be detected prenatally?

elevated levels of alpha-fetoprotein in mothers blood and ultrasound

nonunion

total failure of healing of a fracture

complications with EA/TEF

tracheomalacia, esophageal stricture

Which of the following signs would be diagnostic of developmental dysplasia of the hip?

trendelenberg

most tumor surgeries are successful when

tumor is encapsulated/localized (confined to site of origin)

children with cleft palate standardly receive

tympanostomy tubes due to recurrent otitis media

INSULIN therapy

type 1 diabetes rapid, short, immediate, long insulin pump

oral hypoglycemic meds

type 2 used if diet and exercise are not effective type and action vary if not effective insulin will be required

feeding is much more difficult with Cleft palate

unable to achieve adequation suction, may need modified bottles or specialized feeding system, breastfeeding effective

Which of the following are clinical manifestations of leukemia? Select all that apply.

unexplained fever unusual bleeding weight loss bone pain

Which of the following assessment findings are associated with cancer?

unusual bleeding fatigue recurring fever

with nephrotic sydrome we should make sure that the child is

up and active

nursing care managment of CL/CP

upright position for feeding

spica cast

used to immobilize hip and knee

casts

used to immobilize the joints above and below the site of injury to maintain bone alignment and prevent displacement

upper extremity cast

used to immobilize wrist or elbow

prep care for scoliosis

various test including blood test, blood replacement may be needed, developmentally appropriate preparation

fluid before

vasodilators

the client must have adequate volume before we give

vasodilators

medications possibly given for shock

vasopressors, dopamine, vasodilators

major goals of treatment for shock

ventilation, replacing volume that was lost, improve pumping action of the heart

nursing interventions for shock

ventiliation, administer oxygen, administer and monitor fluids, administer medications, monitor vital signs, monitor I/O, assess LOC

spina bifida cystica

visible with an external saclike protrusion most often at lumbar or lumbosacral region

compensated shock

vital organ function maintained, early signs are subtle, apprehension, thirst, irritability, pallor, normal bp, narrowing pulse pressure, mild tachycardia, diminshed urine output

The nurse is caring for an infant who has been diagnosed with hydrocephalus. Which of the following assessment findings should the nurse anticipate?

vomiting irritability lethargy poor feeding

The nurse is caring for pediatric client whose lab values indicate metabolic alkalosis. Which of the following is the most likely cause of this imbalance?

vomitting

If the IV is infiltrated

we must remove it immediately

due to use of corticosteroids leading to immunosupression

we need to have extra infection precautions

when assessing pallor of extremity

we will look at the color of the extremity, if pale circulation is not adequate

when assess for parathesia of extremity

we will look for numbness and tingling

to determine if interventions are effective with nephrotic syndrome

we will see a decrease in weight

ponseti method

weekly manipulation and stretching of the foot with cast changes cast changes then occur every 2 weeks casting continues until maximum correctionis achieved serial casting

one of the very first signs of dehydration in children

weight loss

traction

weights applied to the distal bone fragment Produces equlibrium at the fractrue site to regain and maintain alignment


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