Unit 5

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The nurse is caring for a 4-year-old with oral vesicles and ulcers from herpangina. The child refuses fluids due to the pain and the mother is concerned about his hydration status. Which of the suggestions would be most appropriate?

""Offer 'magic mouthwash' followed by a popsicle."

The nurse is speaking with the parents of a child who has a cast. The parents state that the child reports itching in the area of the cast. What is the best response by the nurse?

"Blowing cool air with a fan or hair dryer may relieve the feeling."

The nurse is teaching the mother of an infant with a temporary ileostomy about stoma care. What is the most important instruction to emphasize to the mother to avoid an emergency situation?

"Call the doctor immediately if the stoma is not pink/red and moist."

The nurse is teaching a client about peptic ulcers. The client understands the provided education when stating which of the following?

"Hemorrhage and gastritis are the most common complications."

The nurse has performed client education for a 15-year-old boy with Crohn disease and his parents regarding the cobblestone lesions in his small intestine. Which comment by the family indicates learning has occurred?

"I have to be careful because I am prone to not absorbing nutrients."

A nurse caring for an infant born with a cleft palate notices that the parents rarely interact with their child. The nurse overhears the mother telling her spouse that she "feels like crying" every time she looks at their infant. What would be the best response from the nurse?

"I sense you could use more information on caring for a cleft palate. Would you be interested in meeting with other parents who have dealt with this?"

The nurse is caring for an infant recently diagnosed with oral candidiasis (thrush) who has been prescribed nystatin. Which statement by the infant's mother would suggest a need for further education?

"I will add the nystatin to her bottle four times per day."

A client has a plaster cast applied to the left leg. Which comment by the client following the procedure should the nurse address first?

"My toes are stiff."

The student nurse is preparing a presentation on celiac disease. What information should be included? Select all apply.

"Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders." "The only treatment for celiac disease is a strict gluten-free diet." "Gluten is found in most wheat products, rye, barley and possibly oats."

The nurse is speaking with a parent of a child diagnosed with scoliosis. The parent states, "I hate to think about my child having to wear a huge brace to treat this disorder. My best friend growing up had to wear one and she hated it." What is the best response by the nurse

"The newer type of braces fit under the arms and are made to fit under clothing. They aren't nearly as big as they used to be."

The nurse is assessing a client with a musculoskeletal system condition. Which statement indicates to the nurse that the client is experiencing bone pain?

"The pain feels deep in my legs and keeps me awake at night."

The nurse has been teaching the parents of a child diagnosed with osteogenesis imperfecta about the use of bisphosphonates for this condition. What statement by a parent indicates a need for further education?

"This medication will cure my child of this disorder."

flaccid

(adj.) limp, not firm; lacking vigor or effectiveness

Management of GERD

- Lifestyle modification (maintain ideal body weight, eat smaller meals, no eating 3 hrs before sleep, stay upright after meals, elevated HOB, no smoking) - Nutritional therapy (no acidic food, peppermint, fatty foods, coffee, fruits, chocolate, alcohol)

Flat Foot (Pes Planus)

- has no arch and may cause pain and swelling of the foot surface. - medial border becomes convex - sole touches floor cannot join the army*

rhematoid arthritis

-autoimmune disorder -person's immune system attacks their joints that causes massive deformation

Bone healing stages

1. Hematoma Formation 2. Fibrocartilaginous Callus Formation 3. Bony Callus Formation 4. Remodeling Phase

Treatment of GERD

1. Lifestyle modifications 2. drug therapy 3. Surgical intervention

Pharmacologic therapy for osteoporosis?

1. calcium and vitamin D 2. calcitonin

Normal BMI (body mass index)

18.5-24.9

When is myelination complete?

2 years of age it is complete

Duchenne muscular dystrophy

3-7 years of age most common walking ability is lost at 9-12 years

How long does a patient taking bisphosphonates needto stay upright after administration?

30 minutes

Obesity BMI

30 or greater

Peak of GERD in infants?

4 months

new borns respiratory rate

40-60

Mild to moderate dehydration requires?

50-100 mL/kg of ORS over 4 hours

How many ml do you flush a feeding tube with?

60 mL Toomey syringe

infants are how much water

75%

Calcium level

8.8-10.4

Periosteum

A dense fibrous membrane covering the surface of bones (except at their extremities) and serving as an attachment for tendons and muscles.

creptius

A grating or grinding sensation caused by fractured bone ends or joints rubbing together

A patient is scheduled for a Billroth I procedure for ulcer management. What does the nurse understand will occur when this procedure is performed?

A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum.

joint

A place in the body where two bones come together

contracture

Abnormal shortening of a muscle

Why do we not GERD to become chronic in infants?

Acidic irritation Chronic ear infections Asthma Resp issues

Sucralfate (Carafate)

Adheres to injured gastric ulcers upon contact with gastric acids; protective action for up to 6 hour, has no systemic effects. Used for gastric and duodenal ulcers and GERD. Administer on an empty stomach at least one hour before meals and do not administer within 30 minutes of antacids.

Risk factors for osteoarthritis?

Aging Obesity Genetics Joint injury female gender

Juvenile Idiopathic Arthritis

An autoimmune disorder 2- 4 years of age. More common in girls

Toddler 2-4 years causes of constipation?

Anal fissures withholding toilet refusal short-segment Hirschsprung disease Neurologic disorders Meningomyelocele tumors tethered cord

Scopolamine (Transderm Scop)

Anticholinergic prevent post-op nausea & and vomiting Side effects: visual impairment, confusion, pharyngitis

A client has undergone arthroscopy. After the procedure, the site where the arthroscope was inserted is covered with a bulky dressing. The client's entire leg is also elevated without flexing the knee. What is the appropriate nursing intervention required in caring for a client who has undergone arthroscopy?

Apply a cold pack at the insertion site.

The nurse is preparing a client for a surgical procedure that will allow visualization of the extent of joint damage of the knee for a client with rheumatoid arthritis and also obtain a sample of synovial fluid. What procedure will the nurse prepare the client for?

Arthroscopy

Clavicle fractures are more common in?

Babies

The nurse is caring for a pediatric client with idiopathic celiac disease. Which meal will the nurse select for this client?

Baked salmon, potato slices, vanilla ice cream, and apple juice

A client has been diagnosed with chronic gastritis. The nurse knows that which of the following symptoms are indicative of gastritis? Select all that apply.

Belching Early satiety Sour taste in the mouth

A patient has stepped in a hole in the yard, causing an ankle injury. The ankle is edematous and painful to palpation. How long should the nurse inform the patient that the acute inflammatory stage will last?

Between 24 and 48 hours

A client with peptic ulcer disease has a blood pressure of 88/40 mm Hg, dizziness, and nausea. Which complication will the nurse suspect is occurring with this client?

Bleeding from the ulcer

osteoclast

Bone-destroying cells

Bryant traction

Both lower extremities flexed 90 degree at hips; rarely used because extreme elevation of lower extremities causes decreased peripheral circulation

What food can the nurse suggest to the client at risk for osteoporosis?

Broccoli

Always look at what lab value for bones?

Calcium levels

The nurse caring for children with neuromuscular disorders knows that which is the most common movement disorder of childhood?

Cerebral palsy

The nurse is administering an enteral feeding to a child with a gastrostomy tube (G-tube). Which action will the nurse take when administering a prescribed feeding through the client's G-tube?

Check for gastric residual before starting feeding.

Structural Anomalies of the GI Tract

Cleft Lip and palate Pyloric stenosis Hernias prevent injury to suture line promote adequate nutrition encourage infant-parent bonding provide emotional support

Which type of fracture produces several bone fragments?

Comminuted

Myelomeningocele (spina bifida)

Congenital disorder where the spinal cord does not close before birth

Tendon

Connects muscle to bone

Anorexia

Defined as a lack of appetite A common symptom of many physical conditions Side effects of certain drugs Emotional issues The aim of nutrition therapy is to stimulate the appetite maintain adequate nutritional intake

The younger they are of children they are prone to ?

Dehydration

Acute Gastrointestinal Disorders

Dehydration Vomiting Diarrhea Oral candidiasis and oral lesions Hypertrophic pyloric stenosis Necrotizing enterocolitis Intussusception, malrotation and volvulus Appendicitis

pectus excavatum (funnel chest)

Depression of the sternum

What would be signs or symptoms of intolerance to TPN?

Diarrhea, high glucose levels

plaster cast

Do not get wet

cast

Do not stick foreign objects into a cast

A preschooler has celiac disease. The parent is preparing a gluten-free diet. The nurse knows that the parent understands the diet when the parent prepares which breakfast foods?

Eggs and orange juice

Clavicle fracture what are we not going to do?

Elevate above arm for 6 weeks!!

Epiphysis

End of a long bone

Which intervention would the nurse implement with the client in skeletal traction? Select all that apply.

Ensure the pins or wires are covered with caps. Position trapeze within the client's reach. Instruct the client on isometric exercises for immobilized extremity.

How often do you check residuals?

Every 4 hours

The nurse is caring for a child with diarrhea related to infectiousenteritis. The nurse accurately informs the parents that most cases ofdiarrhea are bacterial in nature and therapeutic management is usuallysupportive in nature?

False

Sliding esophageal hernia

GERD management

Steroids cause what in the GI?

GI bleeding

Simethicone

Gas-X relief of bloating

Halo traction

Halo type bar that encircles the head screws are inserted into the outer table of the skull. The halo is attached to bed or rods that is secured to a rest

A neonatal nurse teaches students how to recognize gastrointestinal disorders in infants. The nurse tells the students that failure of the newborn to pass meconium in the first 24 hours after birth may indicate what disease?

Hirschsprung disease

Any age constipation

Hypothyroidism withholding medication side-effects Previous anorectal sx Rapid change to sedentary state Dehydration

ICES

Ice, Compression, Elevation, Support

The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of gastroesophageal reflux?

In this disorder the sphincter that leads into the stomach is relaxed.

A nurse understands the influence of hormones on bone maintenance. Therefore, the nurse knows that a patient on long-term cortisol may experience:

Increased bone resorption.

Guarding

Involuntary muscle contractions (spasms) of the abdominal wall in an effort to protect an inflamed abdomen; a sign of peritonitis.

Which term refers to mature compact bone structures that form concentric rings of bone matrix?

Lamellae

insensible water loss

Loss of fluid from the body by evaporation, such as that which normally occurs during respiration.

LES

Lower esophageal sphincter

Newborn/infant causes of constipation?

Meconium plug Hirschsprung disease Cystic fibrous Congenital anorectal malformations hypothyroidism diabetes renal tubular acidosis withholding dietary changes

The nurse teaches the client which intervention to avoid hip dislocation after replacement surgery?

Never cross the affected leg when seated

Can you admister medication with tube feeding?

No

The nurse is auscultating the bowel sounds of a 4-year-old child anddocuments hypoactive bowel sounds. What might this finding indicate?

Obstruction

Proton Pump Inhibitors

Omeprazole Antacids H2 receptors antagonist Small frequent feedings Rice cereal for thicken Positional changes

What type of infection can we see on a x-ray?

Osteomyelitis

Which of the following is the most common and most fatal primary malignant bone tumor?

Osteosarcoma

Osteo in a child?

PICC line and 6- 8 weeks of antibiotics Fever, vancomycin

Five P's

Pain, pallor, pulse, parathesia, paralysis

S/s to report with a cast or splint

Pain, swelling

Geomycin

Peak & troff

Famotidine

Pepcid GERD Side effects: headache, constipation, diarrhea Prolonged QT intervals

Promethazine

Phenergan Motion sickness Side effects: Seizures, bradycardia, tachycardia, thrombocytopenia

What goes with calcium?

Phosphorus

In caring for an infant diagnosed with pyloric stenosis the nurse would anticipate which intervention?

Prepare the infant for surgery.

compartment syndrome

Pressure builds up usually after surgery

Vitamin B is a what?

Protein

Gathering information about infant vomiting?

Questions to ask include Could you wipe the vomitus off the child with a rag? Did the vomiting require a change of clothes? How big a circle did it make? Did it happen after every feeding? Did it look like what was eaten, or was it curdled? What color was it? Did it appear to be projected away from the child?

Which nursing intervention is essential in caring for a client with compartment syndrome?

Removing all external sources of pressure, such as clothing and jewelry

Lactobillus acidophilus

Restores normal bowel flora gave for: diarrhea Side effects: gas, hypersensitivity of lactulose products

Treatment of fractures in children

Retention and reduction methods.

bariatric procedures

Roux-en-Y gastric bypass (RYGB) Gastric banding Sleeve gastrectomy

A client arrives in the emergency department with a suspected bone fracture of the right arm. How does the nurse expect the client to describe the pain?

Sharp and piercing

CPK

Skeletal muscle and muscle injury. It increases.

A client sustains an injury to the ligaments surrounding a joint. What will the nurse identify this injury as?

Sprain

A client with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. The wound appearance has not improved. What action would the nurse anticipate to promote healing?

Surgical debridement

The nurse is working with a 6-year-old child recently diagnosed with Legg-Calvé-Perthes disease. The child's parents tells the nurse they understand exercise is important for their child but are not sure which activities are appropriate. Which activity will the nurse recommend for this client?

Swimming

joint capsule

The fibrous sac that encloses a joint.

Remodeling

The process of resorption and formation of bone

The nurse is preparing a client to have his cast cut off after having it for 6 weeks to treat a fractured tibia. What should the nurse inform the client prior to the cast being removed?

The skin may be covered with a yellowish crust that will shed in a few days.

Which condition causes a fat embolism?

Total hip arthroplasty

The nurse working in the emergency room knows that trauma orunintentional injury is a leading cause of childhood morbidity andmortality in the United States?

True

The nurse is talking with a pregnant client about cleft lips and palates. The client has asked if these can be tested for. What information should be included in the nurse's response? Select all that apply.

Ultrasounds can be used to assess for these conditions. Most cleft lips and palates are found at delivery.

cystic fibrosis

Usually have a peg tube gastrostomy or jejunostomy.

A nurse is providing care for a client recovering from gastric bypass surgery. During assessment, the client exhibits pallor, perspiration, palpitations, headache, and feelings of warmth, dizziness, and drowsiness. The client reports eating 90 minutes ago. What will the nurse suspect?

Vasomotor symptoms associated with dumping syndrome

What testing are we going to do for injury in a child?

X-rays.

Encopresis

a childhood disorder characterized by repeated defecating in inappropriate places, such as one's clothing

spina bifida

a congenital defect that occurs during early pregnancy when the spinal canal fails to close completely around the spinal cord to protect it

traction

a pull to the arm or leg muscles to bring a bone back into place when it is dislocated or fractured

hammer toe

a toe that is curled due to a bend in the middle joint of the toe

developmental dysplasia of the hip

abnormal development of the hip joint found that is congenital Sx: fat rolls asymmetrical, abnormal leg length, AROM limited Tx: Cast, surgery, PT Tests: US (ultrasonogram), x-ray of hips, AROM testing of hips

Scoliosis

abnormal lateral curvature of the spine

plantar fasciitis

an inflammation of the plantar fascia on the sole of the foot

corn on foot

area of hyperkeratosis (overgrowth of a horny layer of epidermis) produced by internal pressure (the underlying bone is prominent because of a congenital or acquired abnormality, commonly arthritis) or external pressure (ill-fitting shoes).

callus

area of thick hard skin

Osteoclastomas

benign for long periods but may invade local tissue and cause destruction

Adolescent constipation

body issues; dieting, laxatives, IBS-C, anorexia, pregnancy

Osteoblasts

bone forming cells

Tibia Vara

bowing of the legs

osteogensis imperfecta

brittle bone disease shock & denial - family

What is a contusion?

bruise

protuberant

bulging

hallux valgus

bunion

callus

cartilaginous/fibrous tissue at fracture site

CSM

circulation, sensation, movement

atlectasis

collapsed lung after sx

Osteoid osteoma

common tumor in children & young adults

cortical bone

compact bone

spinal muscle atrophy

condition of progressive degeneration of anterior horn cell.

Metatarsal adductus

congenital curving inward of the feet

avascular necrosis

death of tissue due to insufficient blood supply

A child is scheduled for a urea breath test. The nurse understands that this test is being performed for which reason?

detect Helicobacter pylori

A child with cerebral palsy is referred for physical therapy. When describing the rationale for this therapy, the nurse would emphasize what as the primary goal?

development of gross motor movement

constipation

difficulty in passing stools

dysphagia

difficulty swallowing

effusion

excess fluid in joint

Halo traction

external fixation device

Polydactyly

extra digits

steatorrhea

fat in the feces

russell traction

femur or lower leg

The nurse is caring for a 12-year-old child with Crohn disease. What assessment finding will the nurse report to the health care provider when caring for the child?

fever

fascia

fibrous membrane of connective tissue supporting and separating muscles and body organs

bursa

fluid-filled sac that allows for easy movement of one part of a joint over another

osteogenesis

formation of bone

Diarthrosis

freely movable joint

Osteon

functional unit of compact bone

GERD

gastroesophageal reflux disease

Overweight BMI

greater than 25

Torticollis

head tilt due to shortening or spasm of one sternomastoid muscle

muscular dystrophy (MD)

hereditary condition causing progressive degeneration of skeletal muscles

Hirschsprung disease

hereditary defect causing absence of enteric nervous system

Meningocele

herniation of the meninges less serious than spina bifida

Manifestations of GERD

hiccups Vomit after meals Ear infections

kyphosis

hunchback

buck traction

immobilizes hip/femur fractues supine position with foot of bed raised

Synarthrosis

immovable joint

Alkaline phosphate

increases in bone diseases, tumors, sarcomas.

Osteomyelitis

infection of the bone

Osteoarthritis

inflammation of the bone and joint

Diverticulitis

inflammation of the diverticula

Morton's Neuroma

inflammation of the nerve typically between the 3rd and 4th metatarsals

The parent reports that the health care provider said that the infant had a hernia but cannot remember which type. When recalling what the health care provider said, the parent said that a surgeon will repair it soon and there is no problem with the testes. Which hernia type is anticipated?

inguinal hernia

sprain

injury to a ligament

strain

injury to muscle or tendon

congenital curved foot

inversion of the heel

Fasciculation

involuntary twitch of muscle fibers

S/S of dehydration in children

irritable/lethargy - cool skin - eyes sunken-no tears - poor skin turgor, dry mucous membranes, depressed fontanel - decreased U/O - urine SG >1.030 - delayed cap refill - weight loss

Icteric

jaundice

atonic

lacking normal muscle tone

cancellous bone

latticelike bone structure; trabecular bone

trabeculae

latticework of osseous tissue that makes up the structure of spongy or cancellous bone

The difference between a ligament and a tendon?

ligament- bone to bone tendon- muscle to bone

Osteocytes

mature bone cells

Lamellae

mature compact bone structures that form concentric rings of bone matrix; lamellar bone

external fixation devices

medical devices used to stabilize fractures without penetrating the skin (casts, for example)

Synovium

membrane in joint that secretes lubricating fluid

cerebral palsy (CP)

most common motor disorder in childhood High in premature & low weight infants

isotonic contraction

muscles contract and shorten

Zofran (ondansetron)

nausea and vomiting side effects: constipation, anxiety, angina

Tone

normal tension in resting muscle

parathesia

numbness and tingling

Sensible water loss

occurs through urine

ingrown toenail

onychocryptosis

stoma

opening

Lactulose

osmotic laxative decreases ammonia tx: constipation Side effects: diarrhea & vomiting

Which cells are involved in bone resorption?

osteoclasts

Two things you need to monitor when patients are on imunoglobulins?

ototoxic, and renal toxic. Kill the kidneys and renal

severely obese BMI

over 40

rebound tenderness

pain that increases when pressure (as from a hand) is removed

Odynophagia

painful swallowing

The nurse caring for an 18-month-old infant with Meckel diverticulum knows that the most common clinical manifestation of this condition is:

painless rectal bleeding.

PUD

peptic ulcer disease

Reglan (metoclopramide)

prevents nausea from chemo Side effects: tardive dyskinesia, bradycardia, tachycardia, hypotension

Ossification

process of bone formation

Protonix (pantoprazole)

proton pump inhibitor Heals esophagus Side effects: prolonged use causes low magnesium, thrombocytopenia, phlebitis in IV

hiatal hernia

protrusion of a part of the stomach upward through the opening in the diaphragm

osteopenic

refers to a reduction in bone mass to below normal levels

RICE

rest, ice, compression, elevation

Clonus

rhythmic contractions of a muscle

Ligament

ropelike bundles of collagen fibrils connecting bones

Diaphysis

shaft of a long bone

A provider asks the nurse to teach a client with low back pain how to sit in order to minimize pressure on the spine. Which teaching points would the nurse include? Select all that apply.

sit in a straight back chair with armrests avoid hip extension Place feet flat on the floor sit with the buttocks tucked under.

A client has had surgical repair of a hip injury after joint manipulation was unsuccessful. After surgery, the nurse implements measures to prevent complications. Which complications is the nurse seeking to prevent? Select all that apply.

skin breakdown wound infection pneumonia

Amphiarthrosis

slightly movable joint

Urinary Stasis

stagnation of urinary flow

hiatel hernia

stomach protrudes through diaphragm

Helicobacter pylori

stomach ulcers

lordosis

swayback

trendleburg gait

the childs trunk is shifted over the affected hip during ambulation.

hypertrophy

the enlargement of an organ or tissue from the increase in size of its cells.

Resorption

the process of removing or digesting old bone tissue

regurgitation

the return of swallowed food into the mouth

The faster the metabolic rate

the younger the child

Endosteum

thin membrane that lines the medullary cavity

Fundal blication

tightening

cervical skin traction

to decompress vertebrae or for muscle spasms (whiplash, cervical spasm). Head harness or halter.

atrophy

to waste away

school age constipation

toilet or bathroom access limited or unavailable limited ability to recognize physiologic cues, preoccupation with other activities tethered cord withholding

Clawfoot

too much arch occurs due to various pathologies

Cartilage

tough, elastic connective tissue that is more rigid than ligaments but less dense than bone

spastic

uncontrolled contractions of skeletal muscles

A child weighing 10 kg is admitted with severe vomiting for the past 3 days. The nurse writes a nursing diagnosis of Risk for deficient fluid volume related to vomiting. When the nurse reassesses the child, which outcomes would indicate the effectiveness of the treatment plan? Select all that apply.

urine specific gravity of 1.008 urine output of 15 mL/hour tolerating sips of clear fluids

Pavlik Harness

used for hip dysplasia in infants Remove only to take baths

Management of Osteoarthritis

weight loss


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