Pediatric part 3
Comorbidities of Scoliosis
-Impaired gait -Frequent respiratory infections
Enuresis
-Inability to control bladder after five years of age -2x a week for three months -Diurnal vs Nocturnal or mixed -Primary vs secondary (they were once completely potty trained and now they arent)
Comorbidities of CP
-Learning disabilities -Seizure disorders -Vision and hearing problems -Gastroesophageal reflux -Aspiration -Chronic Respiratory infections -Poor dental health -Constipation -Failure to thrive -Contractures -Chronic pain
Risk Factors for CP
-Low birth weight -Premature birth -Mulitple birth -Assisted repro -Infections during pregnancy -Jaundice -Medical conditions of the mother
Presentation of Spina Bifida
-Lower limb paralysis and sensory loss -Bowel and bladder dysfunction -Joint deformities -Hydrocephalus
Treatment for Nephrotic Syndrome
-Medications -Corticosteroids -Diuretics -Antihypertensives -Lipid-lowering drugs -Nursing care -Daily Wts -Strict I&Os -Frequent urine dipsticks -Complications -Infection -Thrombosis -Pulmonary edema
PROV
-Mnemonic for Tetralogy of Fallot -Pulmonic stenosis -Right Ventricular Hypertrophy -Overriding aorta -Ventricular Septal Defect
Cause of spina bifida
-Multifactorial -Lack of folic acid in mother's diet
Aortic stenosis
-Narrowing at aortic valve -Decreased cardiac output -Left ventricular hypertrophy -Pulmonary congestion -Symptoms -Murmur -Weak pulses -Hypotension -Tachycardia -Poor feeding
Pulmonic Stenosis
-Narrowing at pulmonary valve -Right ventricular hypertrophy -Systemic congestion -Symptoms -Murmur -Cyanosis when severe -Poor feeding -Edema -HF
Coarctation of the Aorta
-Narrowing of the descending aorta (after subclavian artery) -Increased blood flow to upper body -Decreased blood flow to lower body -Symptoms -Upper extremities: High BP & bounding pulses -Lower extremities: low BP & weak or absent pulses -Older kids: dizziness & epistaxis
Long term care of spina bifida patients
-Neurogenic bladder (intermittent cath, oxybutynin chloride) -Bowel control (toileting schedule, fiber and laxatives) -MSK problems (paralysis, surgery, braces, maximize mobility)
Atrioventricular Canal Defect
-Opening connecting all four chambers -Blood shunts left to right -Most common heart defect in Down Syndrome -Symptoms -Cyanosis -Tachypnea -Difficulty feeding -Loud systolic murmur -Moderate to severe HF
Post-op care of Scoliosis surgery
-PCA pump -Logrolling -Skin/wound care -Complications- bleeding, spinal cord damage -PT
Mixed Heart Defects
-PDA, ASD, Foramen ovale -Blood must mix to oxygenate
Management of measles
-No pregnant staff members -Supportive care -Antipyretics -Vitamin A -Monitor for complications
Treatment for CP
-PT, OT, SLT -Goals: max mobility, communication, and independence -Common medications -Valium -Baclofen -Botox -Anti-seizure meds -Laxatives
Presentation of Chickenpox
-Fever -Malaise -Pruritic rash ( 3 stages pustule, vesicle, crust) -Irritability -Insomnia
Mild Scoliosis
10-25*
When do we vaccinate for chickenpox?
12-15 months and 4-6 years
Severe Scoliosis
>45*
Tetralogy of Fallot
-Four separate heart defects (Pylmonic stenosis, Right Ventricular Hypertrophy, Overriding aorta, Ventricular Septal Defect) -Symptoms -Progressive cyanosis & hypoxia -Tet spell -Squatting position
Treatment for enuresis
-Frequent toileting during the day -No caffeine or sugary drinks past 4pm -Voiding immediately before bed -Bed alarms -Medications -Desmopressin acetate -Oxybutynin -Should be child led -Not a sign of misbehavior
Complications of Mumps
-Hearing loss -Orchitis -Sterility
Pediatric signs of meningitis
-High pitched cry -Poor feeding -Lethargy -Budging fonteles -Nonblanching
Precautions for Mumps
Droplet
Rubeola
Measles
Complications of Measles
Pneumonia Encephalitis Blindness Hearing loss Learning difficulties
Types of CP
Spastic Dyskinetic Ataxic Mixed type
Spastic CP
Stiff muscles
Dyskinetic CP
Uncontrolled movements
Pertussis
Whooping Cough
Measles precautions
airborn
Atrial Septal Defect (ASD)
-Hole in septum between atria -Blood shunts left to right -Often asymptomatic -At risk for: atrial dysrhythmias, emboli, stroke -Childhood symptoms: murmur, Dyspnea, frequent chest infections -Adult symptoms: SOB, heart palpitations
Ventricular Septal Defects (VSD)
-Hole in the septum between ventricles -Blood shunts from left to right -Symptoms(based on size) -Asymptomatic at birth -Sweating with feeds -Tachypnea -Failure to thrive -Loud systolic murmur -Hypertrophy of Right side -HF is common
Types of spina bifida
-Anencephaly -Spina bifida occulta -Meningocele -Myelomeningocele
Obstructive Heart Defects
-Blood flow is obstructed due to narrowing -Increased pressure in the area of the heart just before the stenosis -Decreased pressure in the are of the heart after the stenosis
Treatment of Scoliosis
-Brace worn 23hrs/day -monitor skin under brace for moderate cases -Brace worn 23hrs/day -monitor skin under brace for moderate cases -Surgery is severe is severe
Presentation of Whooping Cough
-Catarrhal stage- upper resp. infection -Fever -Runny nose -Mild cough -Paroxysmal stage -Cough progresses -Short rapid coughs followed by high pitched whoop sound -Worse at night -May cause vomiting, fractured ribs -Lats 4-6 weeks
CHDs that cause obstruction to blood flow
-Coarctation of the aorta -Aortic stenosis -Pulmonic stenosis
Nephrotic Syndrome
-Damaged glomeruli- More permeable to protein -Excessive proteinuria -Hypoalbuminemia -Edema&hypovolemia -Hyperlipidemia
Assessment of Nephrotic Syndrome
-Edema worse in the morning (periorbital at first, labial/scrotal, peripheral, ascites) -Weight gain from fluid -Abnormal BP ( Hyper usually, hypo if septic) -Decreased UOP (frothy urine from protein) -Sings of infection (fever, lethargy, tachycardia, >CRT, abdominal pain, resp distress)
Patent Ductus Arteriosus (PDA)
-Failure of the DA to close in the first weeks of life -Blood flows back into the lungs -Symptoms -Machine-like murmur -Tachypnea -Resp Infection -Feeding difficulty -Failure to thrive -HF is rare in kids
Treatment for mixed heart defects
-Prostaglandin E1 given IV within first 48hrs to keep PDA open -Multiple surgeries -Nursing care -Decrease cardiac workload -Promote rest -Monitor feeding -Manage pain -Monitor for infection, hemorrhage, stroke, pneumothorax
Transposition of the great arteries (TOGA)
-Pulmonary artery and Aorta swap places -Creates two separate systems -Oxygenated blood circulates to the heart -Deoxygenated blood circulates to the body -Symptoms (present within first hour of birth unless a large opening is present then it will take one month) : -Cyanosis, poor feeding, HF
Common causes of Enuresis
-Slow development -Anxiety/stress -Genetics/family history -Overactive bladder -Idiopathic
Causes of Enuresis to rule out
-Spina bifida -Diabetes mellitus -Diabetes insipidus -UTI -Constipation
Treatment of Pediatric meningitis
-Start IV antibiotics when suspecting meningitis -IV antibiotics/antifungals for 10-14 days -Droplet precautions
Treatment for Mumps
-Supportive care -Saltwater gargles -Warm/cool compress -Soft bland diet
Tricuspid Atresia Treatment
-Surgery (Modified Fontan procedure) -Post-op care (pain management, monitor for complications)
Pre&Post op care of spina bifida patients
-Surgery within 24-72 hours -COver sack with a sterile, moist dressing -A prone position with hips flexed -Monitor for hypothermia -No rectal temp -Intermittent cath -Latex free environment
Tetralogy of Fallot Management
-Surgery within the first year of life -Tet Spells -Keep child calm -Knee to chest position -Oxygen -Morphine IV
CHDs that cause obstruction to mixed-blood flow
-Transposition of great arteries -Truncus arteriosus -Hypoplastic Left Heart
Treatment for Obstructive Heart Defects
-Treatment for Obstructive Heart Defects Prostaglandin E1 given IV to keep DA open -Cardiac cath and surgery -Nursing post-op care -Decrease cardiac workload -Promote rest -Monitor feeding -Manage pain -Monitor for hemorrhage, stroke, pneumothorax
Diagnostics for Nephrotic Syndrome
-Urine dipstick proteinuria 2+ -Hyperalbuminemia -Hyperlipidemia -Kidney biopsy sometimes
Poor balance and cordination
-Usually presents during the first year of life -Abnormal movements (involuntary, persistent tongue thrust, writhing, jerking) -Abnormal posturing (Contractures, scissoring of legs, frog legs) -Abnormal muscle tone ( flopping, rigid, persistent fisting of hands) -Abnormal reflexes (primitive reflexes >6 mo, hyperreflexia)
Hypoplastic Left Heart
-Variety of structural abnormalities -Small left ventricle -Fatal in the first month without intervention -Symptoms -Cyanosis -Tachypnea/dyspnea -Poor feeding -HF -Severe when PDA closes
Patent Truncus Arteriosus
-Very uncommon -Lack of separate pulmonary artery and aorta -Circulating blood is mixed -Symptoms -Cyanosis -Tachypnea/dyspnea -Poor feeding -Activity intolerance -HF
Assessment of Enuresis
-Voiding history -Toilet training history -Daily routine (hydration, meals, school routine) -Look for the possible cause
Treatment of heart defects with increased pulmonary blood flow
-Watchful waiting (VSD,PDA) -Cardiac cath (ASD, CSD) -Surgery (AVCD) -Medications (PDA-NSAIDs)
When is the MMR given?
12-15 months and 4-6 years
Moderate Scoliosis
26-45*
When should a child stop nighttime bedwetting?
6-8
How long is Mumps contagious for?
9 days after the swelling begain
Tricuspid Atresia
=Lack of tricuspid valve =ASD, VSD or PDA allows for blood to flow =Symptoms -Cyanosis -Tacycardia/dyspnea -HF
A nurse is giving vaccinations to a 12-month old child. The child requires an MMR vaccine. Which of the following needle lengths should the nurse choose for a child this age? A) 5/8 inch B) 1 1/4 inch C) 1 inch D) 1 ½ inch
A A) 5/8 inch The MMR (measles, mumps, rubella) vaccine is given as a subcutaneous injection, preferably into the fatty tissue over the anterolateral thigh muscle. In order to inject the vaccine into the subcutaneous tissue and not the underlying muscle, a shorter needle should be used. 5/8 inch is the recommended length. B) 1 1/4 inch C) 1 inch D) 1 ½ inch
The nurse caring for a newborn diagnosed with transposition of the great vessels knows that which of the following interventions is a priority? A) Administer IV prostaglandin E1 B) Record intake and output C) Administer IV furosemide D) Daily weights at the same time
A A) Administer IV prostaglandin E1 It is essential that the ductus arteriosus be kept open to allow blood to mix. If the ductus arteriosus closes there will be no communication between oxygenated blood and deoxygenated blood resulting in extreme hypoxia. B) Record intake and output Prostaglandin E1 should be given top priority because it is essential that the ductus arteriosus be kept open to allow blood to mix. If the ductus arteriosus closes there will be no communication between oxygenated blood and deoxygenated blood resulting in extreme hypoxia. C) Administer IV furosemide D) Daily weights at the same time
The nurse caring for an infant diagnosed with coarctation of the aorta knows to expect which of the following on assessment. A) Bounding pulses in the upper extremities and weak or absent pulses in the lower extremities B) Bounding pulses in the lower extremities and weak or absent pulses in the upper extremities C) Bounding peripheral pulses and weak or absent central pulses D) Bounding central pulses and weak or absent peripheral pulses
A A) Bounding pulses in the upper extremities and weak or absent pulses in the lower extremities B) Bounding pulses in the lower extremities and weak or absent pulses in the upper extremities C) Bounding peripheral pulses and weak or absent central pulses D) Bounding central pulses and weak or absent peripheral pulses The narrowing in the aorta occurs in the descending aorta after the subclavian artery. This results in increased pressure in the upper extremities and decreased pressure in the lower extremities which causes weak or absent femoral pulses.
Upon performing an initial exam after the birth of an infant, the provider hears a murmur when auscultating the baby's heart. The provider suspects that the baby has an atrial septal defect. Which of the following tests would be performed to diagnose this condition? A) Echocardiogram B) Nuclear imaging C) Chemical stress test D) Isotope test
A A) Echocardiogram An atrial septal defect (ASD) occurs as a hole in the septum between the atria of the heart. An ASD can cause blood to flow between the two chambers and can decrease oxygenation in the baby's blood. The condition is most commonly diagnosed by an echocardiogram, which is performed as an ultrasound of the heart to check pumping strength, heart valves and visualize the two chambers. B) Nuclear imaging This uses radioactive materials that are not necessary to diagnose an ASD. C) Chemical stress test This test also uses a radionuclide to track circulation, plus a medication that speeds up the heart as if it were under stress. This would not be administered to an infant to diagnose an ASD. D) Isotope test An isotope is a radionuclide and is not used to diagnose an ASD.
The parents of a 6-year-old are seeking treatment for the child's cardiac condition. The child will need surgery to correct coarctation of the aorta. During the history and physical, the parents tell the nurse that the child was adopted from another country last year. The parents are planning to sign informed consent for the procedure. Which of the following responses from the nurse is most appropriate? A) I will get the paperwork for you to sign as the parent B) I'm sorry, I must have the parent or legal guardian sign the consent form C) I will need a copy of your legal adoption paperwork before we can sign this consent D) You do not have authority to sign paperwork until the child has been legally adopted
A A) I will get the paperwork for you to sign as the parent A child who must undergo a surgical procedure must have a consent form signed by a parent or legal guardian before starting the surgery. Because the child is 6 years old in this case, the parents must sign the consent, since the child is not developmentally mature enough to understand the process. Although the parents adopted the child from another country, they are considered the parents and/or legal guardians if they legally adopted. They can sign the consent for the child. B) I'm sorry, I must have the parent or legal guardian sign the consent form The adoptive parents are legally the child's parents. C) I will need a copy of your legal adoption paperwork before we can sign this consent Adoptive parents are treated the same as biological parents. Adoption paperwork is not required in order to sign a consent. D) You do not have authority to sign paperwork
The nurse caring for an infant who is prescribed digitalis knows to monitor which of the following electrolytes when administering this medication? A) Potassium B) Sodium C) Calcium D) Magnesium
A A) Potassium Increased potassium levels will decrease the effectiveness of digoxin. B) Sodium Increased potassium levels will decrease the effectiveness of digoxin. C) Calcium Increased potassium levels will decrease the effectiveness of digoxin. D) Magnesium Increased potassium levels will decrease the effectiveness of digoxin.
The nurse is caring for an 8-year-old is diagnosed with mumps and experiencing orchitis. The nurse knows that which of the following interventions would be most helpful in providing relief from this common complication of mumps? A) Provide a warm compress and support with tight-fitting underpants B) Provide a soft, bland diet to minimize pain with eating C) Dim the lights and keep the eyes clean D) Keep the room cool and encourage the child to wear loose fitting clothing
A A) Provide a warm compress and support with tight-fitting underpants Orchitis is an inflammation of the testicles. Warm compresses and support with tight-fitting underpants may help with the discomfort associated with orchitis. B) Provide a soft, bland diet to minimize pain with eating C) Dim the lights and keep the eyes clean D) Keep the room cool and encourage the child to wear loose fitting clothing
A baby is born at full term and is taken to the NICU for further observation for potential cardiac issues. After diagnostic testing, the provider determines that the infant has tetralogy of Fallot. The four components of this condition include a ventricular septal defect (VSD), overriding aorta, right ventricular hypertrophy, and which of the following? A) Pulmonary stenosis B) Atrial septal defect (ASD) C) Patent foramen ovale (PFO) D) Patent ductus arteriosus
A A) Pulmonary stenosis Tetralogy of Fallot is a serious cardiac condition that develops before birth. It consists of four conditions that affect the heart; when combined, these abnormalities cause decreased oxygenation and poor blood flow and the condition must be surgically corrected. Tetralogy of Fallot consists of a VSD, overriding aorta, ventricular hypertrophy, and pulmonary stenosis. B) Atrial septal defect (ASD) C) Patent foramen ovale (PFO) D) Patent ductus arteriosus
A nurse is caring for a child who has been diagnosed with measles. The nurse must wear a N95 respirator when caring for a child and the parents ask the nurse why the mask is necessary. Which of the following statements by the nurse is accurate? A) This mask filters out a certain size of particles that can be transmitted through the air and breathed in B) I must wear this until she is no longer contagious, which is usually after 48 hours C) This is a mask that keeps the virus from entering oral mucous membranes and transmitting the disease D) I'm wearing this mask to protect your daughter from my own germs, not because she is contagious
A A) This mask filters out a certain size of particles that can be transmitted through the air and breathed in Measles is a very contagious viral illness that is spread through aerosolized droplets. The nurse must utilize airborne precautions and wear a filtered mask around the client. The N95 respirator is able to filter a certain size of particles that could be breathed in through droplets that enter the air, such as after the client sneezes or coughs. B) I must wear this until she is no longer contagious, which is usually after 48 hours The respirator must be worn for a minimum of four days after the client's rash disappears. C) This is a mask that keeps the virus from entering oral mucous membranes and transmitting the disease It could also enter through the nose D) I'm wearing this mask to protect your daughter from my own germs, not because she is contagious Measles does not cause lowered immunity
The nurse knows that in which of the following clinical scenarios would a lumbar puncture be contraindicated? Select all that apply. A) A neonate with bulging fontanelles B) A 9-year-old with sluggish pupils C) A 6-year-old with meningeal signs D) A 10-year-old with a temperature of 104.5 F E) A neonate who is lethargic with poor feeding
A&B A) A neonate with bulging fontanelles Lumbar punctures are contraindicated when there are specific signs of increased intracranial pressure. Bulging fontanelles and sluggish pupils are signs of increased intracranial pressure (ICP) in infants. B) A 9-year-old with sluggish pupils C) A 6-year-old with meningeal signs D) A 10-year-old with a temperature of 104.5 F E) A neonate who is lethargic with poor feeding
The nurse providing care to a 16-year-old client diagnosed with severe scoliosis that had a spinal fusion, knows that which of the following symptoms are signs of a complication associated with this procedure? Select all that apply. A) Lower extremity paralysis B) Bladder incontinence C) Headaches D) Photophobia E) Lower back pain
A&B A) Lower extremity paralysis Neurological and spinal cord injury are possible complications of spinal fusion surgery, therefore, it is important to assess for signs of paralysis, changes to mobility and sensation, and bowel and bladder dysfunction. B) Bladder incontinence C) Headaches The most common complications associated with these surgeries are spinal cord injury, blood loss, infection, ileus, and atelectasis. A headache is not a likely symptom of these complications. D) Photophobia E) Lower back pain
The nurse providing care to an infant diagnosed with aortic stenosis knows to expect which of the following symptoms? Select all that apply. A) Faint pulses B) Hypotension C) Exercise intolerance D) Poor feeding E) Hypertension
A,B&D A) Faint pulses The stricture in the aorta causes decreased cardiac output which causes faint pulses and hypotension. B) Hypotension The stricture in the aorta causes decreased cardiac output which causes faint pulses and hypotension. C) Exercise intolerance The client is an infant. Exercise intolerance would be an expected symptom in a child with aortic stenosis but not an infant. D) Poor feeding The stricture in the aorta causes decreased cardiac output. The decrease in cardiac output results in decreased energy making it difficult for infants to feed. E) Hypertension The stricture in the aorta causes decreased cardiac output which causes hypotension, not hypertension.
A newborn is in the OR for surgery to correct a VSD. There is confusion about the extent of the defect on the echocardiogram, so the nurse calls a time out. Surgery can continue when which of the following happens? Select all that apply. A)The surgeon verifies the correct procedure B) The surgeon verifies the correct surgical site C) The nurse re-establishes a sterile field D) The surgical team identifies the client through two sources of identification E) Another echocardiogram is ordered
A,B&D A) The surgeon verifies the correct procedure B) The surgeon verifies the correct surgical site C) The nurse re-establishes a sterile field Calling a time-out does not break the sterile field, so another sterile field would not need to be established. D) The surgical team identifies the client through two sources of identification E) Another echocardiogram is ordered An echocardiogram does not need to be repeated if the other steps to ensure the right procedure on the right client are followed.
The nurse caring for a newborn diagnosed with a ventricular septal defect knows that which of the following are common symptoms of heart failure in infants? Select all that apply A) Sweating B) Gallop rhythm C) Periorbital edema D) Weight gain E) Arthralgia
A,B,C&D A) Sweating Ventricular septal defects cause an increase in pulmonary blood flow which can cause heart failure as the right side of the heart is overworked. Sweating in an infant is a sign of impaired myocardial function. B) Gallop rhythm Ventricular septal defects cause an increase in pulmonary blood flow which can cause heart failure as the right side of the heart is overworked. A gallop rhythm is a sign of impaired myocardial function. C) Gallop rhythm Ventricular septal defects cause an increase in pulmonary blood flow which can cause heart failure as the right side of the heart is overworked. A gallop rhythm is a sign of impaired myocardial function. D) Weight gain Ventricular septal defects cause an increase in pulmonary blood flow which can cause heart failure as the right side of the heart is overworked. Weight gain is a sign of systemic venous congestion. E) Arthralgia
The parents of a 13-month-old diagnosed with spastic cerebral palsy have asked the nurse how this happened. The nurse explains that which of the following are possible causes of cerebral palsy? Select all that apply. A) Bacterial meningitis B) Traumatic brain injury C) Intracranial hemorrhage D) Respiratory syncytial virus E) Hypoglycemia
A,B,C&E A) Bacterial meningitis This can damage the brain which could cause cerebral palsy. B) Traumatic brain injury This can damage the brain which could cause cerebral palsy. C) Intracranial hemorrhage This can damage the brain which could cause cerebral palsy. D) Respiratory syncytial virus Respiratory syncytial virus is a common respiratory infection and is unlikely to cause damage to the brain. E) Hypoglycemia This can damage the brain which could cause cerebral palsy.
The nurse caring for a client diagnosed with hypoplastic left heart syndrome knows that which of the following are signs of heart failure? Select all that apply. A) Gallop rhythm B) Prolonged capillary refill C) Grunting D) Hypertension E) Periorbital edema
A,B,C&E A) Gallop rhythm In heart failure, there is often an increased amount of blood in the ventricles which causes a gallop rhythm. B) Prolonged capillary refill Clients with heart failure are unable to pump adequate amounts of blood into the systemic circulation causing poor perfusion and symptoms like delayed capillary refill (>2 seconds). C) Grunting In heart failure it is common for the lungs to become congested causing signs of respiratory distress like grunting, tachypnea, and hypoxia. D) Hypertension Clients with heart failure will have decreased cardiac output resulting in hypotension, not hypertension. E) Periorbital edema Heart failure cause systemic venous congestion which causes edema.
A nurse is caring for a 6-month-old recently diagnosed with cerebral palsy. The nurse knows that which of the following diagnoses are commonly associated with cerebral palsy? Select all that apply. A) Hydrocephalus B) Epilepsy C) Gastroesophageal reflux D) Hyperbilirubinemia E) Scoliosis
A,B,C&E A) Hydrocephalus Children with cerebral palsy are at increased risk of having hydrocephalus., epilepsy, gastroesophageal reflux, and scoliosis. B) Epilepsy Children with cerebral palsy are at increased risk of having hydrocephalus., epilepsy, gastroesophageal reflux, and scoliosis. C) Gastroesophageal reflux Children with cerebral palsy are at increased risk of having hydrocephalus., epilepsy, gastroesophageal reflux, and scoliosis. D) Hyperbilirubinemia Hyperbilirubinemia is not associated with cerebral palsy. Hyperbilirubinemia is associated with newborns born with ABO blood incompatibility to their mother, large for gestational age, and bruising from delivery. E) Scoliosis . Children with cerebral palsy are at increased risk of having hydrocephalus., epilepsy, gastroesophageal reflux, and scoliosis.
The nurse is caring for a 9-month-old client diagnosed with cerebral palsy. The nurse knows that which of the following are signs of abnormal tone in an infant? Select all that apply. A) Scissoring of legs B) Repeatedly arching back C) Persistent fisting of the right hand D) Rocking back and forth on hands and knees E) Difficulty feeding
A,B,C&E A) Scissoring of legs This movement is a sign that increased tone and tightness are present in an infant. B) Repeatedly arching back This movement is a sign that increased tone and tightness are present in an infant. C) Persistent fisting of the right hand This movement is a sign that increased tone and tightness are present in an infant. D) Rocking back and forth on hands and knees This movement is common in infants who are developing muscles to work towards crawling and is not a sign of increased tone and tightness. E) Difficulty feeding This is a sign that increased tone and tightness are present in an infant.
An adolescent has presented to the emergency room with meningeal symptoms and is assigned a nurse. The nurse knows to expect which of the following symptoms for this client? Select all that apply. A) Nuchal rigidity B) Positive kernig's sign C) Positive brudzinski's sign D) Vomiting E) Increased urine output
A,B,C,&D A) Nuchal rigidity Nuchal rigidity is a sign that the meninges are inflamed. B) Positive kernig's sign A positive Kernig's sign indicates that the meninges are inflamed. C) Positive brudzinski's sign A positive Brudzinski's sign indicates that the meninges are inflamed. D) Vomiting Vomiting is an indication that the meninges are inflamed. E) Increased urine output A decrease in urine output does not indicate that the meninges are inflamed.
The nurse is caring for an infant that has been diagnosed with meningitis. The infant is irritable with a high pitched cry, and the nurse notes bulging fontanels and distended scalp veins. Which of the following interventions are appropriate for this infant? Select all that apply. A) Assess consistency of poop and administer stool softener as needed B) Lay the infant down and place rolled towels to prevent rolling over C) Prop the infant upright D) Turn off the lights E) Comfort the infant by singing to them
A,C&D A) Assess consistency of poop and administer stool softener as needed Straining increases ICP, and should be prevented. B) Lay the infant down and place rolled towels to prevent rolling over Positioning an infant upright decreases ICP, but laying the infant down can increase ICP. C) Prop the infant upright Straining, head down position, and environmental stimuli all increase the ICP, so the nurse must eliminate as many potential worsening factors as possible. D) Turn off the lights Lights increase stimulation, and therefore increase the intracranial pressure of an infant. E) Comfort the infant by singing to them Singing or talking to an infant increases stimulation, which can increase ICP. The nurse must take action to decrease stimulation instead.
Long term complications of pediatric meningitis
Learning disabilities Hearing loss Seizures
Precautions for chickenpox
Airborn
A nurse is educating students about a diagnosis of atrial septal defect. The nurse knows that which of the following statements is the most accurate way to describe the normal physiology and hemodynamic function of the heart? A) Cyanosis occurs when blood is shunted from the left side of the heart to the right side of the heart B) Pressure on the left side of the heart is greater than pressure on the right side of the heart C) Increased resistance in the heart causes an increase in the rate of blood flow D) Resistance in pulmonary circulation is greater than resistance in systemic circulation
B A) Cyanosis occurs when blood is shunted from the left side of the heart to the right side of the heart B) Pressure on the left side of the heart is greater than pressure on the right side of the heart C) Increased resistance in the heart causes an increase in the rate of blood flow D) Resistance in pulmonary circulation is greater than resistance in systemic circulation
A nurse is assigned to a 6-month-old diagnosed with a large ventricular septal defect and is being treated for signs of heart failure. The nurse knows to expect which of the following orders to help decrease pulmonary and systemic vascular resistance? A) Digoxin B) Captopril C) Alprostadil D) Hydromorphone
B A) Digoxin Digoxin improves the contractility of the heart and does not have an impact on vascular resistance. B) Captopril Captopril is an ACE inhibitor that causes vasodilation, which decreases pulmonary and systemic vascular restriction. C) Alprostadil Alprostadil is a medication given to keep the ductus arteriosus open when the DA must be kept open to allow blood to mix and increase oxygenation of the systemic circulation. This is important for clients with transposition of the great arteries and hypoplastic Left Heart. However, it does not impact pulmonary and systemic vascular resistance. D) Hydromorphone
A 2-week-old infant was admitted with difficulty feeding and weight loss. During the assessment, the nurse assesses absent femoral pulses and knows this is a sign of which of the following congenital heart defects? A) Tetralogy of fallot B) Coarctation of the aorta C) Ventricular septal defect D) Tricuspid atresia
B A) Tetralogy of fallot This does not cause weak or absent femoral pulses. B) Coarctation of the aorta The narrowing in the aorta occurs in the descending aorta after the subclavian artery. This results in increased pressure in the upper extremities and decreased pressure in the lower extremities which causes weak or absent femoral pulses. C) Ventricular septal defect This does not cause weak or absent femoral pulses. D) Tricuspid atresia This does not cause weak or absent femoral pulses.
You are the nurse caring for a neonate that has presented with symptoms of meningitis. As the nurse, you know that which of the following is the most common cause of meningitis in this age group? A)S. pneumoniae B) Group B streptococci C) Neisseria meningitidis D) Meningococcal meningitis
B A)S. pneumoniae B) Group B streptococci C) Neisseria meningitidis D) Meningococcal meningitis
The nursing providing care to an infant with tricuspid atresia knows that which of the following nursing interventions would be appropriate to decrease cardiac demands? Select all that apply. A) Wait until the child is very hungry and crying for a feed B) Provide smaller feedings every 3 hours C) Coordinate care to minimize disturbing the infant D) Monitor the client's temperature closely E) Keep the client in the prone position
B,C&D A) Wait until the child is very hungry and crying for a feed The stress of crying will increase the child's energy needs. B) Provide smaller feedings every 3 hours Three hours spacing between feeds is optimum because it allows for adequate rest and prevents the child from becoming so hungry that they need a larger feed which they may not have the energy to consume. C) Coordinate care to minimize disturbing the infant D) Monitor the client's temperature closely Hypothermia and hyperthermia will increase the child's need for oxygen causes an increased use of energy to regulate the temperature. E) Keep the client in the prone position The child should be allowed to stay in a position that makes them most comfortable. If they are experiencing respiratory distress the head of the bed should be elevated to a 45-degree angle.
A pediatric nurse has been assigned to care for a 3-year-old client who has pertussis. Which of the following nursing interventions are appropriate in managing this situation? Select all that apply. A) Administer antiviral medications as ordered B) Place the client in a private room C) Administer over-the-counter cough medicine to control coughing spells D) Wear a mask when working with the client E) Encourage oral fluid intake and provide intravenous fluids
B,D,E A) Administer antiviral medications as ordered Pertussis is caused by the bacteria "Bordetella pertussis". It is not a virus. B) Place the client in a private room C) Administer over-the-counter cough medicine to control coughing spells a 3-year-old child should not be given cough medicine unless ordered by the provider. D) Wear a mask when working with the client E) Encourage oral fluid intake and provide intravenous fluids Supportive management, including rest, fluids and maximizing nutrition should be employed. Oxygenation and breathing treatments can be administered if needed, as well as antibiotic medications if ordered.
Management of Chickenpox
Baths Calamine lotion Short nails Diphenhydramine Antipyretics Acyclovir
The parents of a 10-year-old have asked the nurse for more information about treatment options for their child's mild scoliosis. The nurse accurately tells them which of the following? A) Your child will need surgery to prevent respiratory problems B) Your child will need to wear a brace for a few hours a day C) If the scoliosis doesn't progress, your son won't need to wear a brace D) Your child needs to wear a brace 23 hours a day
C A) Your child will need surgery to prevent respiratory problems The surgical repair of scoliosis is only necessary if the curvature is severe (>45 degrees). B) Your child will need to wear a brace for a few hours a day If mild scoliosis doesn't progress the child will not need to wear a brace. C) If the scoliosis doesn't progress, your son won't need to wear a brace If mild scoliosis doesn't progress it will not need treatment with surgery or with braces. D) Your child needs to wear a brace 23 hours a day If mild scoliosis doesn't progress the child will not need to wear a brace.
A 3-month-old is awaiting surgery to repair a truncus arteriosus. The nurse educating the parents on managing symptoms at home includes which of the following in the teaching? Select all that apply. A) "Administer prophylactic antibiotics daily" B) "Provide chest physiotherapy twice a day" C) "Weight your child daily on the same scale" D) "Limit feeding to 30 minutes to avoid over-tiring" E) "Restrict feedings to only 3 times a day to avoid fluid overload"
C&D A) "Administer prophylactic antibiotics daily" Prophylactic antibiotics are not indicated prior to surgical repair of the heart defect. B) "Provide chest physiotherapy twice a day" Chest physiotherapy is not indicated prior to surgical repair of the heart defect. C) "Weight your child daily on the same scale" Weighing the child daily is an important intervention to monitor for weight gain which may be a sign of fluid accumulation. D) "Limit feeding to 30 minutes to avoid over-tiring" Feeding for longer than 30 minutes can exhaust the child as they are likely to have activity intolerance. E) "Restrict feedings to only 3 times a day to avoid fluid overload" Feeding less frequently is likely to upset the child which would cause an increase in cardiac demands. Additionally, fluid restriction is rarely necessary in infants with heart failure because of their difficulties with feeding.
Varicella
Chicken pox
The nurse caring for a child diagnosed with coarctation of the aorta is demonstrating signs of respiratory distress. The nurse suspects this is a sign of which of the following? A) Aspiration pneumonia B) Digoxin toxicity C) Systemic congestion D) Pulmonary congestion
D A) Aspiration pneumonia A child with coarctation of the aorta is likely to experience respiratory distress because the decreased cardiac output causes pulmonary congestion. B) Digoxin toxicity Signs of digoxin toxicity in children are nausea, vomiting, anorexia, bradycardia and dysrhythmias. It would not cause respiratory distress. C) Systemic congestion A child with coarctation of the aorta is likely to experience respiratory distress because the decreased cardiac output causes pulmonary congestion. D) Pulmonary congestion A child with coarctation of the aorta is likely to experience respiratory distress because the decreased cardiac output causes pulmonary congestion.
The nurse caring for a child with nephrotic syndrome knows that which of the following medications are considered first line therapy for this diagnosis? A) Statins B) Diuretics C) ACE inhibitors D) Corticosteroids
D A) Statins Simvastatin may be used to help treat hyperlipidemia in children with nephrotic syndrome, but are not considered first line therapy. B) Diuretics Diuretics are commonly used to help manage edema in nephrotic syndrome but are not considered first line therapy. C) ACE inhibitors ACE inhibitors may be used to help treat hypertension in children with the nephrotic syndrome but are not considered first line therapy. D) Corticosteroids They are the first line of therapy for managing the inflammation associated with nephrotic syndrome.
Presentation of Mumps
Fever Malaise Headache Earache Jaw pain Swollen salivary glands
Presentation of Measles
Fever of 104 Malaise Loss of appetite Coryza Cough Conjunctivitis Koplik spots Rash
Precautions for Whooping Cough
Droplet
Treatment for Whooping Cough
Humidified O2 Positioning Antibiotics Patient education about the length of illness
Effects of CP
Movement Coordination Posturing
Complications of Chickenpox
Pneumonia Encephalitis Cellulitis
Ataxic CP
Poor balance and cordination
Heart Defects of Decreased Pulmonary Blood Flow
Pulmonary blood flow is obstructed Increased to normal heart pressures Blood shunts from right to left Deoxygenated blood is circulated Causes cyanosis Tetralogy of Fallot & Tricuspid Atresia
How long is chickenpox contagious?
Until all the spots have crusted over
there is a small gap in the spine, but no opening or sac on the back. The spinal cord and the nerves usually are normal. Many times, Spina Bifida Occulta is not discovered until late childhood or adulthood. This type of spina bifida usually does not cause any disabilities.
a protrusion of the meninges through a gap in the spine due to a congenital defect.
Myelomeningocele
is a severe form of spina bifida in which the spinal cord and nerves develop outside of the body and are contained in a fluid-filled sac that is visible outside of the back area.
Anencephaly
is the absence of a major portion of the brain, skull, and scalp that occurs during embryonic development
Spina bifida occulta
there is a small gap in the spine, but no opening or sac on the back. The spinal cord and the nerves usually are normal. Many times, Spina Bifida Occulta is not discovered until late childhood or adulthood. This type of spina bifida usually does not cause any disabilities.
