Exam 3 6500 PEDS

A child with leukemia received chemotherapy about 10 days ago. She presents today with a temperature of 100.4°F, an absolute neutrophil count of 500, and mild bleeding of the gums. What is the priority nursing intervention? 1. Administer IV antibiotics as ordered. 2. Provide vigorous oral care frequently with a firm toothbrush 3.Monitor pulse and BP changes 4. Admin packed RBC transfusion

1

An 11-year-old boy has come to the school nurse more than 15 times for somatic complaints during the first quarter of school year and has subsequently left school after each visit. Which action by the school nurse would be most appropriate? 1. Contact the child's parents to discuss the situation 2. Talk to the student's teacher 3.Make an announced home visit on a day the child is not in school 4.Keep a log of the child's attendance and continue to monitor the situation

1

Sam, age 11, has a diagnosis of rheumatic fever and has missed school for a week. What is the most likely cause of this problem? 1. previous streptococcal throat infection 2. hx of open heart surgery at 5 yo 3. playing too much soccer and not getting enough rest 4. exposure to a sibling with pneumonia

1

The nurse is caring for a 5-year-old child with a congenital heart anomaly causing chronic cyanosis. When performing the history and physical examination, what is the nurse least likely to assess? 1. obesity from overeating 2. clubbing of the nail beds 3. squatting during play activities 4. exercise intolerance

1

The nurse is caring for a child who has been pronounced brain dead. The family has made the decision to donate the child's organs. Ventilator support continues while waiting for organ procurement. The child's aunt asks the nurse, "Why is the ventilator still on?" Which response by the nurse would be most appropriate? 1. The ventilator is supplying oxygen to the organs that will be donated soon; it is not to preserve life. 2. The ventilator is keeping the child alive until it is time to procure the organs for donation 3. The ventilator is in place to make the child comfortable until the organ donation team is ready 5. The ventilator is supplying the brain with O2 so the nerve cells will survive

1

A child with heart failure is receiving digoxin therapy and will be discharged home on that therapy. After teaching the parents about the drug, the nurse determines that the teaching was successful when the parents identify which of the following as a sign of digoxin toxicity? SATA 1. Vomiting 2. Anorexia 3. Constipation 4. Increased HR

1 2

Which of the following are disorders with decreased pulmonary blood flow? 1. Tetralogy of Fallot 2. Tricuspid atresia 3. ASD (atrial septal defect) 4. VSD (Ventricular septal defect) 5. PDA (Patent ductus arteriosus)

1 2

The nurse is providing care to a child who has undergone a cardiac catheterization and is being discharged. Which of the following would the nurse include in the teaching plan for the parents? SATA 1. Inspecting the cath site daily for the first week. 2. Using a sponge bath or shower for the first 2 days. 3. Reporting an increase in numbness in the affected extremity. 4. Avoid pain relievers such as acetaminophen and Ibuprofen

1 2 3

Nonaccidental head trauma can lead to which of the following signs and symptoms? SATA 1. Failure to thrive 2. vomiting 3. irritability 4. fatigue 5. sunken to fontanel

1 2 3 4

Which of the following are associated with child abuse? Select all that apply 1. children do not want to admit that their parent/relative hurt them 2. abuse and neglect are more prevalent among the poor 3. hx of child abuse is associated with development of depression 4. a risk factor for being an abuser is extreme stress 5. The largest percentage of those affected are b/t 5 & 7 yrs old

1 2 3 4

Which of the following are defects of Tetralogy of Fallot? 1. pulmonary stenosis 2. VSD (ventricular septal defect) 3. overriding aorta 4. right ventricular hypertrophy 5. ASD

1 2 3 4

Which of the following should be included in a parent teaching for a child with congenital heart disease? 1. weigh child once a week 2. allow activity as tolerated 3. allow frequent rest periods 4. avoid frequent handwashing 5.notify PCP if fever

1 2 3 5

Which of the following might be signs of pediatric heart disease? 1. poor feeding 2. failure to thrive 3. sweating during feeding in infancy 4. excess wt gain 5. cyanosis 6. fatigue

1 2 3 5 6

When caring for a 8 YO child experiencing grief from a sibling's death, which of the following would be appropriate responses. SATA 1. Would you like some crayons and paper? 2. I know your brother has died. How are you feeling? 3. I know you are sad, but your brother is in a better place, free from suffering. 4. Your brother has gone away. I know you must be scared. 5. You should know that this did not happen bc of anything you did. 6. Are you thinking about hurting yourself? 7. It's fine if you don't want to talk about this for a while.

1 2 3 6 7

A nurse is reading a journal article about congenital heart defects. Which of the following would the nurse expect to be discussed in the article related to defects associated with increased pulmonary blood flow? SATA 1. Patent ductus arteriosus 2. Ventricular septal defect 3. Tricuspid atresia 4. Tetralogy of Fallot (ToF) 5. Atrial Septal Defect (ASD)

1 2 5

A nurse is talking with a child who is dying and his parents. Which of the following would be most effective in promoting appropriate communication? SATA 1. Maintain eye contact with the child and family. 2. Use medical terminology to emphasize the seriousness 3. Allow time for questions from the parents and the child. 4. Encourage the use of play for the child to express his feelings. 5. Distract the family from sharing their stories and sadness

1 3 4

After teaching a group of nursing students about the core principles of palliative care, the instructor determines that the teaching was successful when the students identify which of the following as a core principle? SATA 1. Respect for the child's preferences and choices 2. Provision of episodic care 3. Acknowledgement of caregiver concerns 4. Development of supportive systems for policy making 5. Implementing the use of discipline-specific resources

1 3 4

After the cath Trina is brought back to the PICU and you assist getting her into bed. Identify nursing interventions that should be implemented immediately following the procedure. A. Direct P should be placed on the site of insertion of the cath and guide wires B. Assess the area proximal to the incision C. Apply a P dressing over the cath site for several hours D. Elevate the HOB until comfort has been achieved E. Place the child on bedrest for 6 hrs following the procedure F. Encourage fluid intake

1. Bed rest and proper fluid intake 2. P above insertion site, not directly on site, want to be able to see 3. See P dressing regularly 4. Check distal areas to incision 5. Lay flat after surgery, not up

Normal Hgb (adolescent)

11.1-15.7 g/DL

Normal P or BP

120/80

Normal platelet count

150,000-400,000 cells/mm3

How can nonaccidental head trauma differ from other forms of child abuse? 1. cases of nonaccidental head trauma include children who are usually older than other children who are victims of abuse 2. In shaken baby, there is frequently no intent to harm the baby 3. S/S of nonaccidental head trauma usually occur immediately 4. nonaccidental head trauma recovery is usually faster than other types of abuse

2

The nurse is caring for a terminally ill child who is preparing to return home and attend school half-days. The patient is excited about returning to school and seeing friends. Which of the following nursing interventions is the most beneficial for this patient? 1. Ask the pt if attending school is a wise decision 2. Prepare the patient for the questions and reactions of friends, teachers, and other students. 3. Inform the pt of the many dangers that school can pose at this time 4. Tell the pt you are happy for them

2

The nurse is providing palliative care to a 5-year-old child. When developing the child's plan of care, the nurse understands that a child of this age views death as which of the following? 1. Separation 2. Temporary state 3. Irreversible 4. Permanent

2

Which of the following would be expected with an infant with a large unrepaired VSD? SATA 1. Cyanosis 2. Poor wt gain 3. BP higher in UE (20 mmHg) than LE 4. Systolic murmur heard @ left sternal border 5. PA band procedure scheduled 6. Order for SBE prophylaxis 7. Risk for HF

2 3 4 5 6 7

A group of nursing students is reviewing information about child abuse and neglect and the effects on children. The students demonstrate understanding of the information when they identify which of the following as accurate? Select all that apply. 1. Most abused children exhibit signs that are readily apparent 2.The effects of abuse are manifested in multiple ways 3.Abused children might experience a fear of failure but are motivated to achieve 4. Evidence of abuse is often clear cut 5.Vulnerability to abuse depends on the child's age and sex

2 5

A 5-year-old has been diagnosed with Wilms tumor. What is the priority nursing intervention for this child? 1. Educate the parents about dialysis, as the kidney will be removed 2. Measure abd girth every shift 3. Avoid palpating the child's abd 4. Monitor BUN & Cr every 4 hrs

3

A child on the pediatric unit has morning laboratory results of Hgb 10.0, Hct 30.2, WBC 24,000, and platelets 20,000. What is the priority nursing assessment? 1. Assess for pallor, fatigue, and tachycardia 2. Monitor for fever 3. Assess for bruising or bleeding 4. Determine intake and output

3

A child with cancer is receiving chemotherapy, and his mother is concerned that the nausea and vomiting associated with chemotherapy are reducing his ability to eat and gain weight appropriately. What is the most appropriate nursing action? 1. Admin an antiemetic at first hint of N 2. Offer the child's favorite foods to encourage him to eat 3. Start antiemetic drugs prior to chemo infusion 4. Maintain IV fluid infusion to avoid dehydration

3

A nurse is caring for an infant who is experiencing heart failure. Which of the following would the nurse most likely include in the infant's plan of care? SATA 1. Providing large, less frequent feedings 2. Placing the infant in prone position 3. Administering diuretic and oxygen therapy

3

The nurse is caring for a child after a cardiac catheterization. What is the nursing priority? 1. Allow early ambulation to encourage activity participation 2. Check pulses above the cath insertion site for strength and quality 3. Assess extremity distal to the insertion site for temperature and color. 4. Change the dressing to eval the site for infection

3

While interviewing an adolescent boy with depression, he reveals to the nurse that he has considered hurting himself. Which response by the nurse would be most appropriate? 1. Why would you want to hurt yourself 2. Do your parents know that you want to hurt yourself 3. Tell me exactly how you would hurt yourself 4. Have you discussed this with anyone else

3

A child is brought to the clinic for an evaluation. The nurse suspects that the child has leukemia based on assessment of which of the following? SATA 1. wt gain 2. increased platelet count 3. splenomegaly 4. lymphadenopathy 5. elevated leukocyte count

3 4 5

normal Hct (adolescent)

34-44%

A 2-day-old infant was just diagnosed with aortic stenosis. What is the most likely nursing assessment finding? 1. gallop and rales 2. BP discrepancies 3. RV hypertrophy on ECG 4. heart murmur

4

A child with leukemia has the following AM laboratory results: Hgb 8.0, Hct 24.2, WBC 8,000, platelets 150,000. What is the priority nursing assessment? 1. Monitor for fever 2. Assess for bruising and bleeding 3. Determine intake and output 4. Assess for pallor, fatigue, and tachycardia

4

Normal WBC count Adolescent?

4,000-11,000 4.8-10.8 (x10^3/mm3)

What HgB count of a cancer pt would pose a blood transfusion, EPO, assessment for O2 need? (Compensation is fairly well and O2 may not be needed)

7

Platelet Range that may pose a bleeding risk and hold meds due to platelet injections?

80-1000

Which malignancy is more aggressive? Which is more common in kids? Which is more common in adults? AML (acute myeloid leukemia) or ALL (acute lymphocytic leukemia)

AML ALL AML

Defects that INCREASE blood in the lungs

ASD (atrial septal defect) VSD (ventricular septal defect) PDA (Patent Ductus Arteriosus)

Which direction is the shunt when there is increased blood flow to the lungs? S/S? Tx? ASD vs VSD or PDA

ASD- blood flows from L to R atrium bc of hole in heart LA has lower P Tx: often surgery not needed, watch for 6 MO, yearly follow-ups, surgery wait until 2-5 yrs, usually older, w/ chest tubes after surgery, ~2+ days in hospital, minimal complications VSD- hole in heart/wall=lower P of 25 Tx: surgery wait until 2-5 yrs, quick recovery PDA- structure that goes away after birth= 115/80 to extra circulation -blood going out to body is fully oxygenated-pt not cyanotic Tx: if needed (does not close on its own 1st 6W/ped litigation) (may or may not be left open to get blood back with prostaglandin) PDA separated and closed off by cardiac Cath, clip, or cauterize vessel S/S fatigue participate in ADLs exercise intolerance

Tricuspid Atresia

Absence of tricuspid valve and hypoplastic RV; requires both ASD and VSD for viability. aka missing tricuspid valve, holey VSD or RA causes mixing of blood or mixing lesion

Who is responsible for mandated report? Is there penalty for reporting? Is there penalty for not reporting? Who's job is it to investigate reporting the situation?

Anyone-see something, say something No Yes CPS (despite how overworked child protective services is)

A mother calls the office about her son, a 15 YO complaining of pain in his legs that is dull, aching and constant at night. Choose the best RN response. A. This sounds like bone cancer, I will schedule an appt for an exam. B. What activities is he involved in? C. Thhis sounds like growing pain D. Is there any family hx of cancer?

B

Parents are suspected of abusing their child. What should be done first? A. Report to supervisor B. Complete assessment C. Call Dept of Child Service D. Document "bruise appears to be possibly due to abuse."

B Note: deferring to someone else is not really an answer, never assume, document after asking open-ended Qs

A 4 YO is being seen in a mental health clinic after suffering physical abuse. Which type of therapy will be most helpful in developing a trusting relationship, as well as determining the pts current emotional state? A. Behavioral therapy B. Play therapy C. Coginitive therapy D. Family therapy

B Note: develops trusting relationship of emotional state. Child is 4 (toddler stage)

Which of the following is a true statement regarding child maltreatment? A. RNs must report abuse if they see their neighbor spank their child B. RNs must report suspected neglect C. RNs only have to report abuse if 2 parents stories are conflicting D. RNs will be held accountable if suspected abuse is not found, after reported

B Note: reasons why, not responsible for suspecting, utilize resources (food banks, clothing, shelters, community public services)

Interviewing/Assessment of suspicion of child neglect/abuse

Bruising healing at different stages Finger marks- not made by falling Hit by something Scratches/bruises all up and down legs Linear back marks and child is quiet/withdrawn Belt marks Mongolian marks-congenital birth marks, hyperpigmented, no blanching, black/blue marks Open ended Qs Tell me more about bruises I see? (Do stories match marks on body?) I would like for you step out of the room and I will have you return shortly. (unless child safety compromised) Documentation Typical bruising on child at shins Document bruising/marks

A 5 YR is dx'd w/ a malignancy, is receiving chemo, and has WBC of 2,000, platelet of 400,000, HgB 11 gm/dL. Which of the following is the priority care? A. Assess airway B. Provide developmentally appropriate toys C. Private room D. Monitor for bleeding, bruising

C Note: low WBC= risk for infection, put in isolation

A 9 MO is noted to have the following (see picture). Choose the best nursing action. A. Report findings to DCFS B. Document findings C. Ask the parent if the infant has been ill recently D. Recommend parent counseling

C Note: start with open-ended Qs picture looks like bruising/petechiae=purpura bleeding disorders-get HSPs, APCs

9 YO Trina is scheduled for a cardiac cath to evaluate the status of her cardiac disorder. A sedative has been administered 30 minutes ago. Prioritize the nursing interventions in terms of their importance beginning with the highest priority, then put them in order. A. Ask the child to void and document the results. B. Support the family members who are anxious about the procedure. C. Monitor for respiratory depression. D. Assess the child's baseline cardiac status E. Answer any Qs the child my have before the cath

C D A E B

What test is done to find intravenous hemorrhage or subdural hematoma?

CT

s/s of TOF (Tetralogy of Fallot)

Decreased pulmonary flow HF Hypoxemia Polycythemia Clubbing Paroxysmal hyper cyanotic spells

What test would be done for a pediatric pt with tonic-clonic or absent seizures?

EEG

ICP s/s

Early signs: slight change LOC headache N V visual disturbances (diplopia) seizures Late signs: significant decrease in LOC bradycardia decreased motor and sensory responses alterations in pupil size and reactivity posturing, Cheyne-Stokes respirations coma death

Define neglect

Failure to provide a child with appropriate food, clothing, shelter, medical care, and schooling

NAME THE MALIGNANCY: node is large, fixed on the neck not mobile squishy hard & in one place

Hodgkins Lymphoma

CHF management

Lifestyle: decrease salt intake, exercise, no alcohol/tobacco ACE inhibitor + BB Diuretics if fluid overloaded ICD if EF falls below 35

Normal RBC count M vs F? Adolescent

Male: 4.7-6.1 Female: 4.2-5.4 4.2-5.4 (x10^3/mm3)

Normal Hgb values >18 YR

Men: 14-17.4 Women: 12-16

School Age Blood Counts - If LOW? S/S? WBC 4.8-10.8 (actual # of WBCs in V of blood) RBC 4.2-5.4 HgB 11/1-15.7 (protein that transports O2 made up by heme) Hct 34-44 (# & V of RBCs) Platelet 150-450 REVIEW: -MCV (mean corpuscular volume)-avg size of RBC -MCH (mean corpuscular hemoglobin)- O2 carrying capacity of HgB in RBCs -MCHC (mean corpuscular hemoglobin concentration)- conc of HgB inside RBC -MPV (mean platelet V)- size of platelets -RDW (red cell distribution)- width of RBC

Neutropenia-infections fighting cells Anemia-O2 carrying cells Thrombocytopenia-clotting cells S/S: fever/infection fatigue increased RR/HR bleeding

Childhood Cancer vs Adult Cancer: Most common sites in adults? Environmental factors adults? Detection adults? Responses to tx adults?

ORGANS breast lung prostate bowel bladder strongly influences very early detection possible less responsive

Parent comes into hospital stating child has been sick every month and presented with fever. Could this be malignancy?

Possibly or may have underdeveloped immune system. If it is lasting more than several days with S/S of bruising, pale, low WBC count, anorexia, then that is more concerning.

Develop a nursing care plan for an adolescent with cancer who is undergoing radiation and chemotherapy and experiencing a significant number of adverse effects from his treatment.

Refer to Nursing Care Plan 24.1. Focus on the nursing dx for pain, risk for infection, impaired oral mucous membranes, nausea, imbalanced nutrition, impaired skin integrity, activity intolerance, and disturbed body image. The plan should be individualized depending on the adolescents particular response to therapy. Integrate concepts related to communicating with adolescents from Ch 3 & 7 as appropriate. Risk for Infection due to inadequate secondary defenses Outcomes for Immune status Client will remain free from symptoms of infection during contact with health care providers Client will state symptoms of infection before initiating a health-care related procedure Client will demonstrate appropriate care of infection-prone sites within 48 hours of infection Client will maintain white blood cell count and differential within normal limits within 48 hours of treatment initiation Client will demonstrate appropriate hygienic measures such as hand washing, oral care, and perineal care within 24 hours of initiation Nursing Interventions Infection Control Infection Protection Nursing Interventions & Rationales Assess temperature for neutropenic clients; report a single temperature of greater than 100.5 degree F. Rationale: The immunocompromised host may present with a very different clinical picture when compared to an immunocompromised host. The progress of infection may be more rapid, and the infection may quickly become life-threatening; repeat temperature measurement if significant changes occur and report temperature changes from baseline. Oral, rectal, tympanic, temporal artery, or axillary thermometers may be used to assess temperature in adults and infants Rationale: The use of axillary in addition to oral, tympanic, and temporal artery temperature measurement is supported. Rectal and oral temperature measurements are more accurate than other methods of temperature measurement, such as temporal or axillary measurement. Note and report laboratory values (e.g. white blood cell count and differential, serum protein, serum albumin, and cultures Rationale: While white blood cell count may be in the normal range, an increased number of immature bands may be present. A neutropenic client with a fever represents an absolute medical emergency. Ensure the client's appropriate hygienic care with handwashing, bathing, oral care, and hair, nail, and perineal care performed by either the nurse or the client. Daily showers or baths can help to reduce the number of bacteria on the client's skin. The oral cavity is a common site for infection. Follow meticulous hand hygiene when working with children. Rationale: Keep nails short; prohibit false finger-nails and limit wearing jewelry as it interferes with effective hand hygiene. Parents recognize the importance of hand hygiene but in a study only 67% would definitely remind health care workers of it importance. Recommend responsible use of antibiotics; use antibiotics sparingly. Monitor recurrent antibiotic use in children. Rationale: Use and misuse of antibiotics diminishes their therapeutic benefit and facilitates the development of multidrug resistant organisms (MDROs) and C. difficile-associated disease, and increase of health-care costs. Antibiotic stewardship is essential in reducing current and future resistance in bacteria. Home care Adapt the above interventions for home care as needed. Review standards for surveillance of infections in home care Maintain infection-prevention policies Refer for nutritional evaluation; implement dietary changes to support recovery and maintain health. Client/Family Teaching & Discharge Planning Teach client risk factors contributing to surgical wound infection. Teach the client and family the importance of hand hygiene in preventing postoperative infections.

NAME THE MALIGNANCY: Whitish glow from shining light (want red reflex) Damage to vessels, heart from chest wall SE: allopecia, N, V, irritable Offer Zofran (Adansotran)- Antiemetic Monitor damage to heart -Echo, BNP, CXR Nursing Strategies -dx/tx plans/education -pain management -opioids with cancer stage (EOL/End-Stgae esp w/ most pain, try others prior, lower dose than adults but same tx)

Retinoblastoma

Blood flow of the heart in order

SVA/IVA RA Tricuspid Valve RV Pulmonary Valve Pulmonary Artery Lungs Pulmonary Veins LA Bicuspid/Mitral Valve LV Aortic Valve Aorta Body

What if parent does not have transportation for reporting?

Still report Can assist with social work and community services (ie, unable to afford meds)

Childhood Cancer vs Adult Cancer: Most common sites in kids? Environmental factors kids? Detection kids? Responses to tx kids?

TISSUES blood lymph brain bone kidney muscle minimal usually accidental or incidental very responsive

CHF S/S

Tachypnea tachycardia difficulty feeding cyanosis grunting wheezing edema around face, eyes of infants weight gain diaphoresis especially in the head hepatomegaly

Develop a discharge teaching plan for a child who has just completed the induction phase of chemotherapy for acute lymphocytic leukemia

Teaching plan will vary depending upon meds prescribed following induction. Teaching should focus on px of infection, promoting growth, and promoting a normal life (quality of life).

A 17-year-old girl has recently been diagnosed with osteosarcoma. She is worried about how treatment will affect her plans for college, marriage, and children. How will you respond to her concerns?

The response will vary depending upon the treatment planned (amputation vs limb sparing procedure). Allow the teen to verbalize her concerns and respond with honest answers related to the effects of radiation and chemo. Following treatment, she should be able to attend college and get married. Assuming that chemo doesn't impair reproductive capability, she should still be able to bear a child even with amputation/limb sparing.

CYANOTIC heart defects that DECREASE pulmonary flow

ToF Tricupid Atresia

NAME THE TUMOR: abdominal mass that affects kidney/abdomen good expected outcome once identified DO NOT continue to palpate (can cause spread) do not be afraid of opioids (same tx as adults, different dosing)

Wilm's tumor

Congenital Defects: VSD (ventricular septal defect)

a hole in the ventricular septum that causes blood to mix between the RV and LV

Congenital Defects: ASD (Atrial septal defect)

an opening in the septum separating the atria

CHF (congestive heart failure) etiologies

arrhythmias pulm embolism HTN valvular heart disease myocarditis unstable angina renal failure severe anemia

What would you notice if there is an increase amt of blood in the lungs?

blood flows L to R increased blood to lungs not cyanotic HF Pulm congestion Increased RR (high O2 demand) Decreased tolerance for feeding NEED REST & PLAY (normal dvlpmt)

#1 killer of cancer for kids

brain tumors

CHF (congestive heart failure) definition

condition in which the heart cannot pump enough blood to the rest of the body

Chemo would ____WBC counts

decrease

What S/S may present with a child with leukemia?

easy bruising sore throat weak anemic pale anorexia (wt loss/loss of appetite) enlarged axillary nodes Note: 1st line tx=platelets or low WBC count

Palliative care for kids is more so symptom relief. Resources may be given to live best childhood life and quality of life. Is success rate high or low? CF? AML? DM? Sickle cell? HOSPICE=EOL

high yes, lifelong illness that results in death shorter than life expectancy tricky maybe yes-but high pain management issues

Green stick fracture

incomplete fracture one in which the bone is bent but only partially broken bone breaks incompletely bones not correct ie, snapping green tree limb injury at growth plates not typical w/ general play down slide and has femur fracture

Tet Spell (S/S listed in picture)

increases the P in the aorta and LV, causing less blood to move into the LV, more out of the pulmonary artery to the lungs

Cardiac Catheterization Diagnostic What does it do? Interventions? Nursing Care? Complications? Teaching? Med given during procedure? What is the pt is hemorrhagic-S/S?

msrs P, CO, O2 sats w/in chambers visualizes heart structures to determine abnormalities evaluates blood flow thru heart TGV, ASD, PDA, PAS, recurrent coarc, conduction disorders, etc pre-assessment, allergies, NPO post-procedure: vitals, pulses, dressings ( P dressing x24 hrs), fluid intake, blood glucose levels hemorrhage, fever, N, V, loss of pulse in catheterized extremity, & transient dysrhythmias low grade 10 (100-100.4-response normal until 3 days after w/ drainage) Dexmedetomidine (relaxes pt, short 1/2 life, pt must lay flat for awhile during procedure) low BP, pale, tachycardia, tachypneic

Mandated Reporting

must report when has knowledge of or observes child abuse, sexual abuse, elder abuse

Typical abusers of child abuse Types of Injuries

non-relatives close to family TBI Skull Fractures Choking Green stick fracture Shaking baby syndrome

What does palliative care focus on? When do services start? What defines a good death? Where is the disconnect

pain/comfort care Upon dx, when needed for EOL care painless, family present What family thinks and what med care team thinks

low HgB appearance aka S/S?

pale or cyanotic (lips, palms, nail beds of African American pts) fatigue (activity exercise intolerance, no e) increased RR/HR

Congenital Defects: PDA (Patent ductus arteriosus)

passageway between the aorta and the pulmonary artery remains open after birth

Ventriculoperitoneal shunting (VP shunt)

relieves ICP due to hydrocephalus by diverting (shunting) excess CSF from the ventricles into the peritoneal or thoracic cavity lifelong occassional changes throughout life (px infection/meningitis)

Congenital Defects: Tetralogy of Fallot (TOF)

set of 4 congenital heart defects occurring together Overriding Aorta VSD Pulmonary Stenosis Right Ventricular Hypertrophy

Congenital Defects: Coarctation of the Aorta (CoA)

severe congenital narrowing of the aorta

Shaking baby syndrome CT finding

subdermal hematoma swelling caused by bleeding

Neglect

the failure to provide for a child's basic needs

Simplify the following into your own words below: PS (pulmonary stenosis) VSD (ventricular septal defect) OA (overriding aorta) RVH (Rt Ventricular Hypertrophy) S/S present?

thick and narrow holey wall wrong placed big wall cyanotic, prolonged crying/irritation, knee to chest "squatting", hypoxia, damage from low O2

Why would we hear murmurs with these pts?

turbulent flow

Child Abuse: Skull fracture/ICP

unattended on beds 4W, not able to roll ICP--> nystagmus or detachment eyes bulging fontanel head circumfrence increase decreased LOC crying/fussy high-pitched cry not feeding seizures (visible or not)