Pediatric Exam 3
The charge nurse is planning staffing on a pediatric unit. Which client will the charge nurse assign to the registered nurse? the 6-year-old client admitted yesterday for oral rehydration following a mild gastrointestinal disorder the 1-year-old client with a respiratory disorder prescribed oxygen therapy the 8-year-old client recovering from an appendectomy who is ambulating the 12-year-old client with a urinary tract infection taking oral antibiotics
the 1-year-old client with a respiratory disorder prescribed oxygen therapy
A child is to receive an oral corticosteroid as part of the treatment regimen for leukemia. After teaching the child and family about this drug, the nurse determines the need for additional teaching when they state: "We should administer the drug on an empty stomach." "We will need to gradually decrease the dosage." "He might develop a rounded face from this drug." "We should check our son's urine for glucose."
"We should administer the drug on an empty stomach."
Suggestions to promote coping in children
- Breathing techniques (blowing bubbles) - Distraction - Imagery - Music - Teaching
A nurse is providing care for a child with disseminated intravascular coagulation (DIC). What would alert the nurse to possible neurologic compromise? - Petechiae - Widely fluctuating blood pressure - Hematuria - Equal pupillary response
- Widely fluctuating blood pressure
NHL diagnosis
-Node biopsy -Chest radiograph -Bone marrow aspiration -CT Scan
Wilms tumor staging
1. limited to kidney + completely resectable. renal capsule intact 2. tumor extends locally but can still be excised 3. residual tumor remains in abdomen, tumor outside kidney, not fully removable 4. metastasis to lung, liver, distant lymph 5. bilateral kidney involvement
Separation anxiety stages
3 stages: 1. protest: -kicking/screaming when parents leave 2. despair: -the child will settle in and not throw a fit when the parents leave. no crying. -s/s of depression -bonding issues 3. denial/ displacement/detachment: -Care less about the parents and more about the nurses and doctors -bonding issues -this is a prolonged effect of despair
In caring for a child diagnosed with Hodgkin's disease, which oncologic emergency should the nurse be most concerned about? 1. Hyperleukocytosis 2.Spinal cord compression 3.Superior vena cava syndrome 4.Disseminated intavascular coagulation
3. Superior vena cava syndrome
Main location of neuroblastomas
Adrenal gland
Brain tumor complications
Blocked CSF Compression of brain IICP
Clinical manifestations of neuroblastomas
Bowel or bladder dysfunction Neurologic symptoms Bone pain Anorexia Neck or facial edema Bruising or edema above eyes Cough Lymphadenopathy Nontender mass Hepatomegaly/splenomegaly
Second most common type of childhood cancer
Brain and CNS tumors
Neuroblastoma diagnosis
CT or MRI to determine tumor site 24 hour urine collection for elevated homovanillic acid and vanillylmandelic acid
Brain tumor dx
CT scan MRI or PET Lumbar puncture
Hodgkin's Lymphoma affected lymph nodes
Cervical, axillary and inguinal
What lymph nodes are impacted with non-hodgkin lymphoma
Deep lymph nodes are affected
The nurse is monitoring a child with a brain tumor for complications associated with increased intracranial pressure. Which finding, if noted by the nurse, would indicate the presence of diabetes insipidus?
Diabetes insipidus (DI) can occur in a child with increased intracranial pressure. Weight gain, hypertension, and a urine specific gravity greater than 1.030 are indications of the syndrome of inappropriate antidiuretic hormone secretion, not DI. A high urine output would be indicative of DI.
Spiritual interventions for preschoolers
Do not underestimate comprehension Concrete explanations Advance preparation Use pictures, models, actual equipment
NHL clinical manifestations
Dyspnea, cough, facial edema, mediastinal mass, lymphadenopathy, abdominal mass
The nurse is caring for a 13-year-old who is hospitalized for management of his recently diagnosed diabetes. The child has been withdrawn, and when asked she reports she is "just tired of being sick". What action by the nurse will be of the greatest benefit to helping the child with this concern? Encourage the child to participate in planning her daily care. Encourage the child to call her friends on the phone. Ask one of the parents to stay with her at all times. Provide books and magazines of interest to her.
Encourage the child to participate in planning her daily care.
A 5-year-old child is scheduled for hospitalization in 2 weeks. Which is the best intervention to help ease the potential stress of hospitalization in this child? Arrange for the child to tour the hospital. Have the parents explain the situation. Encourage the family and client to participate in a program to prepare for the hospitalization. Allow the child to talk to a client who recently had the same procedure.
Encourage the family and client to participate in a program to prepare for the hospitalization.
The nurse is caring for a child who had a stem cell transplant and is being monitored for engraftment. Which nursing action is priority? Monitor daily complete blood count (CBC). Encourage therapeutic play activities. Ensure neutropenic precautions are in place. Remind parents to contact the child's school.
Ensure neutropenic precautions are in place
HL risk factors
Epstein-barr virus Adolescent Males
Myeloalblative chemotherapy used in
Ewing sarcoma
ALL
Excessive proliferation of immature lymphoblasts. Abnormal cells begin to replace normal cells in the bone marrow. Affects adaptive immunity: B and T cells. NK cells.
T or F: Radiation is helpful with osteosarcoma
False.
HL staging
I: one group of lymph affected II: two or more groups of lymph on same side of diaphragm III: groups of lymph above or below diaphragm IV: metastasis A: Absence of symptoms B: Systemic symptoms
Neuroblastoma patho
In embryo, neuroblasts do not become mature nerve cells or adrenal medulla cells Immature cells populate the ganglia, adrenal medulla and other areas (typically arises in adrenal gland)
A physician specialist is on a tight time schedule and wishes to share information about a child with special needs with the child's mother, who is the only parent currently available. What will be the nurse's next action? Provide the father's phone number so the physician may speak with the father immediately after talking with the mother. Indicate to the physician when the father will be available, and make plans for the three to talk then. Find a private conference room where the two can sit down together. Soothe the child while the mother and the physician talk in another part of the child's room.
Indicate to the physician when the father will be available, and make plans for the three to talk then.
Stages of leukemia treatment
Induction: 3-4 weeks Consolidation: strengthen remission Maintenance: 2-3 years CNS prophylaxis: reduce risk of CNS disease
AML ALL diagnosis
Lab values High myeloblasts/lymphoblasts Low RBC Anemia, neutropenia, thrombocytopenia
Spiritual interventions for toddlers
Minimize separation from parents Keep security objects Simple explanations Therapeutic play Disease is not a punishment
Spiritual interventions for school age children
Provide choices Stress peer contact Emphasize normal Hospitalization is not a punishment
A child is undergoing a series of diagnostic tests for a suspected malignancy. Which diagnostic test result is only present in Hodgkin disease? T-lymphocyte surface markers Reed-Sternberg cells elevated lymphocytes megakaryocyte cells
Reed-Sternberg cells
HL diagnosis
Reed-Sternberg cells Anemia Mediastinal mass Splenomegaly/hepatomegaly Lymphadenopathy
Wilms tumor dx
Renal or abdominal ultrasound CT scan Urinalysis 24 hour urine collection
The nurse is providing home care for a 4-year-old girl with a chronic respiratory illness. What would be a case management activity? - Teaching the grandmother how to do chest physiotherapy. - Establishing eligibility for a Medicaid waiver. - Assessing the cleanliness of the home. - Scheduling intravenous and respiratory therapy services needed by the child.
Scheduling intravenous and respiratory therapy services needed by the child
When do children recognize all the components of death
School age
Wilms tumor diet
Soft, moist, bland food Use soft toothbrush
A nurse is caring for an 18-month-old girl undergoing traction therapy in a rehabilitation unit. The nurse understands that the girl is in the second phase of separation anxiety when she observes what behavior? The girl ignores her. The girl acts extremely agitated. The toddler cries inconsolably. The toddler is quiet, looks sad, and is disinterested in playing. The child exhibits signs of anger.
The toddler is quiet, looks sad, and is disinterested in playing.
The oncology nurse is alert for clients displaying signs and symptoms of disseminated intravascular coagulation (DIC). Which symptom would alert the nurse to this emergency condition? - platelet count 10,000/mm3 (10 ×109/L) - increased antithrombin III levels - uncontrolled bleeding - decreased D-dimer assay
Uncontrolled bleeding
Cause of brain cancer
Unknown
Therapeutic holding
Use of a secure, comfortable, temporary holding position that provides close physical contact with the parent or caregiver for 30 minutes or less
medically fragile child
a child whose condition is considered medically complex
Which intervention is most important in assuring a child's cooperation and reducing his or her fear during an emergency room visit? offering the child a popsicle for being good having the parent stay with the child allowing the child to draw and color while in the emergency room providing distractions for the child during all procedures
having the parent stay with the child
Lymphoma
malignant tumor of lymph nodes and lymph tissue
Therapeutic play
play techniques are used to understand the child's thoughts and feelings and to promote communication
The nurse is caring for a hospitalized toddler who is prescribed bedrest. Which item(s) would the nurse recognize as appropriate for the toddler? Select all that apply. fine-print books or magazines to read stacking blocks or small boxes nursery rhymes or sing-along songs on tape boxes to put toys in and/or take out toys coins, small tokens, or marbles to organize and sort jigsaw puzzle with pieces 1/2 in (1.25 cm) or smaller
stacking blocks or small boxes nursery rhymes or sing-along songs on tape boxes to put toys in and/or take out toys
A few days after discharge, the parent of an 8-year-old calls the pediatric clinic, expressing concern about the child's behavior now that she is home. The child has been treating her siblings badly and using inappropriate language. Which suggestion should the nurse prioritize to this caregiver as an appropriate way to handle this situation? "Respond to her behavior in a firm, loving, consistent way." "Children often feel guilty for the attention they've taken away from their siblings and act out as a way of earning the attention." "Coming home is a difficult adjustment. Warn your daughter that you expect her to begin to behave better over the next few weeks." "Tell her you don't like her behavior and have her stay in her room until she can be nicer to her siblings."
"Respond to her behavior in a firm, loving, consistent way."
What is more common in children: AML or ALL
ALL
What has a worse prognosis: AML or ALL
AML. AML impacts the innate immunity leaving a person more susceptible to invasion of pathogens.
The nurse is caring for a school-aged child with a terminal diagnosis. The parents and health care provider have discussed the child's condition and agreed that resuscitation efforts will be withheld when the child experiences cardiopulmonary arrest. What notation will be made in the chart by the provider? NCC (no chest compressions) resuscitation efforts per parents wishes AND (allow natural death) withhold comfort measures withhold comfort measures
AND (allow natural death)
A 15-year-old boy asks numerous questions about recovery from anesthesia and typical behaviors of someone awakening from sedation. The nurse interprets the concern of this teen to be: - adequacy of postsurgical pain control. - anxiety related to the surgical procedure itself. - about his ability to control his own behavior. - about a change in body image.
About his ability to control his own behavior
Spiritual interventions for adolescents
Allow adolescent to be an integral part of decision making Allow many choices Be honest Stress contact with peers
Non-Hodgkin lymphoma
Cancer of the lymphatic tissues other than Hodgkin lymphoma Mutations of B and T lymphocytes that proliferate rapidly
Retinoblastoma
Cancer or embrotic retinal cells that spread to other parts of the eye Pupil looks white/pink when light is shined on it (cat's eye reflex)
Lymphoma treatment
Chemo Radiation HSCT
The nurse is caring for an 18-month-old client with suspected iron-deficiency anemia. The nurse will expect to prepare the client for which laboratory tests first? iron and thrombocyte levels complete blood count and iron level hemoglobin and white blood cell levels ferritin and glycosylated hemoglobin levels
Complete blood count and iron levels
NHL risk factors
Congenital immune deficiency Viral exposure Males
AML
Excessive proliferation of immature myeloblasts. Affects innate immunity: granulocytes and monocytes
AML clinical manifestations
Fever, infection, weakness, fatigue, bleeding, gingival hyperplasia, hepatomegaly, splenomegaly, skin pallor, anemia, neutropenia
HL clinical manifestations
Fever, night sweats, weight loss, anorexia, fatigue, pruritus, lymphadenopathy
A child with hemophilia A is scheduled for surgery. Which precautions would the nurse institute with this client? - Caution the child not to brush the teeth before surgery. - Do not allow a dressing to be applied postoperatively. - Handle the child gently when transferring to a stretcher. - Mark the client's chart to receive no analgesia.
Handle the child gently when transferring to a stretcher.
ALL clinical manifestations
Hepatomegaly, splenomegaly, weight loss, muscle wasting, headache, vomiting, bone pain, lymphadenopathy, anemia, neutropenia, thrombocytopenia
Neuroblastoma
Highly malignant tumor of the sympathetic nervous system
____ is the most developmentally appropriate environment for children with special health care needs and those who are technology dependent
Home
Developmental level issues
Infant: Consistency. Aware of absence. Separation anxiety. Toddler: Altered routine and rituals. fearful of strangers Preschooler: May feel as if being punished School age: altered family role. fear of death Adolescence: struggle for independence. fear or injury. separation can lead to depression.
Reed-Sternberg cells
Large, transformed B cells with one or two nuclei Hodgkin's lymphoma
Bone cancer spreads to
Lungs
Hodgkin lymphoma
Malignant B lympocytes grow in lymph tissue starting in one area and include "Reed-Sternberg Cells"
Astrocytoma
Malignant tumor of astrocytes (glial brain cells) Responsive to chemo
Rhabdomyosarcoma
Malignant tumor of striated muscle Pain/swelling in the area of origin
Wilms tumor
Malignant tumor of the kidney occurring in childhood
Leukemia nursing interventions
Manage chemo Reducing pain Infection control Neuro checks (ALL) Education
Most common type of childhood brain tumor
Medulloblastoma Cerebellum
The nurse is caring for a child with disseminated intravascular coagulation (DIC). The nurse notices signs of neurologic deficit. Which nursing action is appropriate? Continue to monitor neurologic signs. Evaluate respiratory status. Notify the physician. Inspect for signs of bleeding.
Notify the physician
The nurse is monitoring a child for bleeding after surgery for removal of a brain tumor. The nurse checks the head dressing for the presence of blood and notes a colorless drainage on the back of the dressing. Which action should the nurse perform immediately? 1.Notify the surgeon. 2.Reinforce the dressing. 3.Document the findings and continue to monitor. 4.Circle the area of drainage and continue to monitor.
Notify the surgeon
Ewing sarcoma
Occurs most often in the pelvis, chest wall, or middle of bones
In caring for a child with sickle cell disease, the highest priority goal is:
The child's fluid intake will improve
The nurse is providing care to a child and is to collect a 24-hour urine specimen for catecholamines. The nurse integrates knowledge of this testing as indicative of: neuroblastoma. leukemia. osteosarcoma. Hodgkin disease.
Neuroblastoma
The child has been diagnosed with leukemia. Rank the following medications used to treat leukemia in order based on the stage of treatment. 1oral steroids and vincristine through an intravenous line 2chemotherapy through an intrathecal catheter 3low doses of 6-mercaptopurine and methotrexate 4high-dose methotrexate and 6-mercaptopurine
Oral steroids and vincristine through an intravenous line High-dose methotrexate and 6-mercaptopurine Low doses of 6-mercaptopurine and methotrexate Chemotherapy through an intrathecal catheter Explanation:During induction, the child receives oral steroids and IV vincristine. During consolidation, the child receives high doses of methotrexate and 6-mercaptopurine. During maintenance, the child receives low doses of methotrexate and 6-mercaptopurine. During central nervous system prophylaxis, the child receives intrathecal chemotherapy.
The registered nurse is creating a care plan for a hospitalized child. She has identified anxiety related to hospitalization as a nursing diagnosis. Which interventions would be most appropriate to include? Select all that apply. Orient the child and family to the unit and room. Explain all events, treatments and procedures to the child and family. Assess for signs and symptoms of anxiety and fear. Encourage the patents to inform the child when they are leaving and when they will be back. Place the child in a private room.
Orient the child and family to the unit and room. Explain all events, treatments and procedures to the child and family. Assess for signs and symptoms of anxiety and fear. Encourage the patents to inform the child when they are leaving and when they will be back.
Brain tumor interventions
Preop care: ICP, stool softeners, dexamethasone Postop: VS, pupillary rxn checks, decrease environmental stimuli, mannitol Positioning: unaffected side with flat HOB. Side position, head alignment
On the first postoperative day, a 4-year-old child who was hospitalized for an emergency appendectomy has begun to cry relentlessly, will not let the nurse touch him or her, and keeps asking for the parent. The pediatric nurse is aware that this client is in which stage of separation? grief denial protest despair
Protest
The nurse is providing home care for an 8-year-old girl who is dependent on a ventilator. What is a part of case management for the child and family? - Doing the complex sterile dressing changes the child requires. - Teaching the parents how to do passive range of motion and active range of motion with their child. - Scheduling respite care of the child with a child care provider. - Problem solving with the parents and child ways to get the child's homework when she is unable to attend school.
Scheduling respite care of the child with a child care provider
Clinical manifestations of brain tumors
Strabismus Nystagmus Sunsetting eyes Head tilt Alterations in coordination Gait disturbance Alterations in sensations
Wilms tumor tx
Surgical removal Radiation or chemo
Neuroblastoma treatment
Surgical resection for localized disease Chemo for disease that has spread
Manifestations of bone cancer
Swelling in area around bones, limitations in movement Osteosarcoma: Bone pain worse at night or with activity Ewing: Intermittent pain that progressively worsens, fever
T or F: Treatment is very effective for non-hodgkin lymphoma
TRUE. If it is localized. Treatment is very effective.
The nurse is caring for a 6-year-old girl with leukemia who is having an oncologic emergency. Which signs and symptoms would indicate hyperleukocytosis?
Tachycardia and respiratory distress
Osteosarcoma
Occurs where bones are growing rapidly towards the metaphysis
Spiritual interventions for infants
Provide constant care Minimize separation Decrease parental anxiety No invasive procedures in the crib
The nurse is caring for a 9-year-old child on an inpatient pediatric unit who is admitted for an extended stay. The child continually refuses meals. What can the nurse do to help increase the child's intake? Select all that apply. Assist the child to choose foods he or she likes from the facility menu. If approved by the physician, allow the parents to bring food from home for the child. Encourage the child to eat several small meals instead of fewer larger meals. Tell the child that play time will be shortened if he or she does not eat. Ask the dietitian to visit the child to help determine foods the child prefers.
Assist the child to choose foods he or she likes from the facility menu. If approved by the physician, allow the parents to bring food from home for the child. Encourage the child to eat several small meals instead of fewer larger meals. Ask the dietitian to visit the child to help determine foods the child prefers.
What can a nurse do during an emergency admission to alleviate some of the child's and family's fears/anxieties over the situation? Select all that apply. Ask the family members health history questions while the child is being initially treated. Place an identification bracelet on the child, explaining that this will help the hospital staff know who he or she is at all times. Remain calm, explaining procedures to both the family and the client in a caring manner. Recommend that the family remain in the waiting room until the child is fully admitted and treatment completed. Undress the child for a physical examination as soon as they arrive.
Ask the family members health history questions while the child is being initially treated. Place an identification bracelet on the child, explaining that this will help the hospital staff know who he or she is at all times. Remain calm, explaining procedures to both the family and the client in a caring manner.
Clinical manifestation of wilms tumor
Observed abdominal mass Constipation Abdominal pain Vomiting, anorexia Weight loss Difficulty breathing HTN Hematuria
Anaplasia
A change in the structure of cells and in their orientation to each other
Children with special health care needs are those who have, or are at risk for
A chronic physical, developmental, behavioral, or emotional condition that requires more intensive and diverse services than do typical children
The nurse is reviewing the plan of care initiated on a hospitalized child who has been experiencing difficulty adapting to the planned long-term admission. Which intervention(s) can be of assistance to the child and family to manage this concern? Select all that apply. Arrange for the child to have friends visit. Ask the parents to bring items from home for the room. Limit visitors to reduce distractions. Talk about plans for discharge. Encourage the child's parents to assist with care.
Arrange for the child to have friends visit. Ask the parents to bring items from home for the room. Encourage the child's parents to assist with care.
