Peds: Chapter 28
The health care provider prescribes ceftazidime (Fortaz) 75 mg per intravenous piggy back (IVPB) every 8 hours for a child with cystic fibrosis. The pharmacy sends the medication to the unit in a 100-ml bag with directions to run the medication over 30 minutes. What milliliters per hour will the nurse set the intravenous pump to run the medication over 30 minutes? Fill in the blank and record your answer in a whole number.
200
The nurse is calculating the amount of expected urinary output for a 24-hour period on a child with bacterial pneumonia who weighs 22 lb. The nurse recognizes the formula to be used is 1 ml/kg/hr. What is the expected 24-hour urinary output for this child in milliliters? Record your answer below in a whole number.
240
A school-age child has asthma. The nurse should teach the child that if a peak expiratory flow rate is in the yellow zone, this means that the asthma control is what?
50% to 79% of a personal best and needs an increase in the usual therapy.
A child with cystic fibrosis (CF) receives aerosolized bronchodilator medication. When should this medication be administered?
Before chest physiotherapy. Rationale: Bronchodilators should be given before CPT to open bronchi and make expectoration easier.
The mother of a 20-month-old boy tells the nurse that he has a barking cough at night. His temperature is 37° C (98.6° F). The nurse suspects mild croup and should recommend which intervention?
Provide fluids that the child likes and use comfort measures. Rationale: In mild croup, therapeutic interventions include adequate hydration (as long as the child can easily drink) and comfort measures to minimize distress.
The nurse is assessing a child with croup in the emergency department. The child has a sore throat and is drooling. Examining the child's throat using a tongue depressor might precipitate what condition?
Complete obstruction. Rationale: If a child has acute epiglottitis, examination of the throat may cause complete obstruction and should be performed only when immediate intubation can take place.
The nurse is preparing to admit a 3-year-old child with acute spasmodic laryngitis. What clinical features of hepatitis B should the nurse recognize?
Croupy cough Tendency to recur Occurs sudden, often at night
In providing nourishment for a child with cystic fibrosis (CF), what factors should the nurse keep in mind?
Diet should be high in calories,proteins, and unrestricted fats. Rationale: Children with CF require a well-balanced, high-protein, high-caloric diet, with unrestricted fat (because of the impaired intestinal absorption).
Decongestant nose drops are recommended for a 10-month-old infant with an upper respiratory tract infection. Instructions for nose drops should include?
Do not use for more than 3 days. Rationale: Vasoconstrictive nose drops such as Neo-Synephrine should not be used for more than 3 days to avoid rebound congestion.
A 3-year-old is brought to the emergency department with symptoms of stridor, fever, restlessness, and drooling. No coughing is observed. Based on these findings, the nurse should be prepared to assist with what action?
Emergency intubation Rationale: Three clinical observations that are predictive of epiglottitis are absence of spontaneous cough, presence of drooling, and agitation. Nasotracheal intubation or tracheostomy is usually considered for a child with epiglottitis with severe respiratory distress.
A school-age child with cystic fibrosis takes four enzyme capsules with meals. The child is having four or five bowel movements per day. The nurse's action in regard to the pancreatic enzymes is based on the knowledge that the dosage is what?
Needs to be increased to decrease the number of bowel movements per day
A 4-year-old girl is brought to the emergency department. She has a "froglike" croaking sound on inspiration, is agitated, and is drooling. She insists on sitting upright. The nurse should intervene in which manner?
Notify the physician immediately and be prepared to assist with a tracheostomy or intubation. Rationale: This child is exhibiting signs of respiratory distress and possible epiglottitis. Epiglottitis is always a medical emergency requiring antibiotics and airway support for treatment. Sitting up is the position that facilitates breathing in respiratory disease.
One of the goals for children with asthma is to maintain the child's normal functioning. What principle of treatment helps to accomplish this goal?
Reduce underlying inflammation. Rationale: Children with asthma are often excluded from exercise. This practice interferes with peer interaction and physical health. Most children with asthma can participate provided their asthma is under control. Inflammation is the underlying cause of the symptoms of asthma.
A 3-month-old infant is admitted to the pediatric unit for treatment of bronchiolitis. The infant's vital signs are T, 101.6° F; P, 106 beats/min apical; and R, 70 breaths/min. The infant is irritable and fussy and coughs frequently. IV fluids are given via a peripheral venipuncture. Fluids by mouth were initially contraindicated for what reason?
Tachypnea Rationale: Fluids by mouth may be contraindicated because of tachypnea, weakness, and fatigue. Therefore, IV fluids are preferred until the acute stage of bronchiolitis has passed.
A child with asthma is having pulmonary function tests. What rationale explains the purpose of the peak expiratory flow rate?
To assess the severity of asthma. Rationale: Peak expiratory flow rate monitoring is used to monitor the child's current pulmonary function. It can be used to manage exacerbations and for daily long-term management.
When caring for a child after a tonsillectomy, what intervention should the nurse do?
Watch for continuous swallowing. Rationale: Continuous swallowing, especially while sleeping, is an early sign of bleeding. The child swallows the blood that is trickling from the operative site.
Pancreatic enzymes are administered to the child with cystic fibrosis. What nursing consideration should be included in the plan of care?
Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.
A child is in the hospital for cystic fibrosis. What health care provider's prescription should the nurse clarify before implementing?
Pancreatic enzymes every 6 hours Rationale: The principal treatment for pancreatic insufficiency that occurs in cystic fibrosis is replacement of pancreatic enzymes, which are administered with meals and snacks to ensure that digestive enzymes are mixed with food in the duodenum. The enzymes should not be given every 6 hours, so this should be clarified before implementing this prescription.
The parent of a child with cystic fibrosis (CF) calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parent to bring the child to the clinic because these signs and symptoms are suggestive of what condition?
Pneumothorax Rationale: Usually the signs of pneumothorax are nonspecific. Tachypnea, tachycardia, dyspnea, pallor, and cyanosis are significant signs and symptoms and are indicative of respiratory distress caused by pneumothorax.
A child has a chronic cough and diffuse wheezing during the expiratory phase of respiration. This suggests what condition?
Asthma. Rationale: Asthma may have these chronic signs and symptoms.
What tests aid in the diagnosis of cystic fibrosis (CF)?
Sweat test, stool for fat, chest radiograohy. Rationale: A sweat test result of greater than 60 mEq/L is diagnostic of CF, a high level of fecal fat is a gastrointestinal manifestation of CF, and a chest radiograph showing patchy atelectasis and obstructive emphysema indicates CF.
It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent which condition?
Acute rheumatic fever. Rationale: Group A hemolytic streptococcal infection is a brief illness with varying symptoms. It is essential that pharyngitis caused by this organism be treated with appropriate antibiotics to avoid the sequelae of acute rheumatic fever and acute glomerulonephritis.
What condition is the leading cause of chronic illness in children?
Asthma. Rationale: Asthma is the most common chronic disease of childhood, the primary cause of school absences, and the third leading cause of hospitalization in children younger than the age of 15 years.
What consideration is most important in managing tuberculosis (TB) in children?
Chemotherapy. Rationale: Drug therapy for TB includes isoniazid, rifampin, and pyrazinamide daily for 2 months and isoniazid and rifampin given two or three times a week by direct observation therapy for the remaining 4 months. Chemotherapy is the most important intervention for TB.
The nurse is preparing a staff education program about pediatric asthma. What concepts should the nurse include when discussing the asthma severity classification system?
Children with mild persistent asthma have signs or symptoms more than two times per week. Children with moderate persistent asthma have some limitations with normal activity. Children with severe persistent asthma have frequent nighttime signs or symptoms.
A child with cystic fibrosis is receiving recombinant human deoxyribonuclease (DNase). What statement about DNase is true?
May cause voice alterations. Rationale: One of the only adverse effects of DNase is voice alterations and laryngitis.
Cystic fibrosis (CF) may affect single or multiple systems of the body. What is the primary factor responsible for possible multiple clinical manifestations in CF?
Mechanical obstruction caused by increased viscosity of mucous gland secretions. Rationale: The mucous glands produce a thick mucoprotein that accumulates and results in dilation. Small passages in organs such as the pancreas and bronchioles become obstructed as secretions form concretions in the glands and ducts.
What is the earliest recognizable clinical manifestation of cystic fibrosis?
Meconium ileus. Rationale: The earliest clinical manifestation of CF is a meconium ileus, which is found in about 10% of children with CF. Clinical manifestations include abdominal distention, vomiting, failure to pass stools, and rapid development of dehydration. History of malabsorption is a later sign that manifests as failure to thrive. Foul-smelling stools and recurrent respiratory infections are later manifestations of CF.
A 6-year-old child is in the hospital for status asthmaticus. Nursing care during this acute period includes which prescribed interventions?
Methylprednisolone (Solumedrol) IV every 12 hours, continuous pulse oximetry, albuterol nebulizer treatments every 4 hours and prn
The nurse is caring for a child with carbon monoxide (CO) poisoning associated with smoke inhalation. What intervention is essential in this child's care?
Monitor arterial blood gases. Rationale: Arterial blood gases are the best way to monitor CO poisoning. Pulse oximetry is contraindicated in the case of CO poisoning because the PaO2 may be normal. One hundred percent oxygen should be given as quickly as possible, not only if respiratory distress or other symptoms develop.
The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. What nursing action should be included in the care of the child?
Monitor pulse oximetry. Rationale: Careful monitoring of oxygenation and cardiopulmonary status is an important evaluation tool in the care of the child with ARDS.
What drug is usually given first in the emergency treatment of an acute, severe asthma episode in a young child?
Short-acting b2-agonists Rationale: Short-acting b2-agonists are the first treatment in an acute asthma exacerbation.
The parent of an infant with nasopharyngitis should be instructed to notify the health professional if the infant shows signs or symptoms of which condition?
Shows signs of an earache. Rationale: If an infant with nasopharyngitis shows signs of an earache, it may indicate respiratory complications and possibly secondary bacterial infection. The health professional should be contacted to evaluate the infant.
Children who are taking long-term inhaled steroids should be assessed frequently for what potential complication?
Slowed growth. Rationale: The growth of children on long-term inhaled steroids should be assessed frequently to evaluate systemic effects of these drugs.
What statement is the most descriptive of asthma?
There is heightened airway reactivity. Rationale: In asthma, spasm of the smooth muscle of the bronchi and bronchioles causes constriction, producing impaired respiratory function. Atopy, or development of an immunoglobulin E (IgE)-mediated response, is inherited but is not the only cause of asthma. Asthma is characterized by increased resistance in the airway. Asthma has multiple causes, including allergens, irritants, exercise, cold air, infections, medications, medical conditions, and endocrine factors.
Why are cool-mist vaporizers rather than steam vaporizers recommended in the home treatment of respiratory infections?
They are safer. Rationale: Cool-mist vaporizers are safer than steam vaporizers, and little evidence exists to show any advantages to steam.
