Exam 2 3490
Cleft Lip and Palate
- Bonding issues: call social work • Affects Speech (speech therapy), swallowing, dental, and hearing - Can have a cleft lip, a cleft palate, or both (more complex surgically). Many specialists are involved in surgery. Can have a double or single cleft It can also be the hard palate, the soft palate, or both. They'll go home first and then come in for a surgical procedure - What if it can't have surgery for 2 weeks? - The child is not to have anything PO.
Which should the nurse include in the plan of care to decrease symptoms of gastroesophageal reflux (GER) in a 2-month-old? Select all that apply.
- Encourage the parents to hold the infant in an upright position for 30 minutes following a feeding - Suggest that the parents burp the infant after every 1-2 ounces consumed.
Congenital heart defects (CHDs) are classified by which of the following? Select all that apply
Defects with increased pulmonary blood flow Defects with decreased pulmonary blood flow Mixed defects Obstructive defects
A nurse taking a health history of a newborn notes that there is a maternal history of polyhydramnios. What GI condition might this history precipitate?
Esophageal atresia (EA)
A nursing action that promotes ideal nutrition in an infant with congestive heart failure (CHF) is:
Feeding formula that is supplemented with additional calories.
The nurse is doing an examination on an infant with a diagnosis of developmental dysplasia of the hip (DDH). Which finding would be an indication of this diagnosis?
Gluteal fold higher on one side than the other
The nurse is conducting a physical examination of an infant with suspected pyloric stenosis. Which finding indicates pyloric stenosis?
Hard, moveable "olive-like mass" in the upper right quadrant
The nurse is performing echocardiography on a newborn who is suspected of having a congenital heart defect. The child's mother is concerned about the safety of using this on a newborn and wants to know how this technology works. The nurse assures her that this technology is very safe and may be repeated frequently without added risk. What should the nurse mention in explaining how this diagnostic test works?
High-frequency sound waves are directed toward the heart
The nurse is checking a newborn for the presence of Ortolani maneuver and Barlow sign. For which health problem are these assessments used?
Hip Dysplasia
The nurse is teaching about congenital clubfoot in infants, the nurse evaluates the teaching as successful when the parent states that clubfoot is best treated when?
Immediately after diagnosis
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.
The most common problem of children born with myelomeningocele is:
Neurogenic bladder.
A nurse is assessing a child after an open reduction of a fractured femur. Which assessment findings would indicate that the child is experiencing compartment syndrome? Select all that apply.
Pain not relieved by pain medication Prolonged capillary-refill time with paresthesia Skin appears tense. Explanation: The major serious complication post-fracture reduction is compartment syndrome. A prolonged capillary-refill time with loss of paresthesia, pain not relieved by medication, and skin that appears tense are signs of compartment syndrome. Pink, warm extremity; pain relieved by medication; and a present dorsalis pedis pulse would all be normal findings post-fracture reduction.
When educating the family of an ill infant with a large, symptomatic ventricular septic defect (VSD), which of the following would be included in the education if the doctor is planning on performing palliative care until the infant is healthier?
Palliative pulmonary artery banding should help the infant grow. Explanation: Palliative pulmonary artery banding should help the infant grow enough so that the large VSD can be repaired. The pulmonary artery banding will help, but the defect will still need to be fixed. Most infants will need surgery for a large, symptomatic VSD. The medication indomethacin is used for a PDA.
The nurse is caring for a 9-month-old with cryptorchidism noted on the medical record. In which manner will the nurse assess this condition?
Palpate the scrotum for the testes.
A major clinical manifestation of rheumatic fever is:
Polyarthritis
The nurse is caring for a 5-month-old boy with an undescended left testis. What would the nurse identify as indicative of true cryptorchidism?
Testis cannot be "milked" down inguinal canal
A 6-month-old who has episodes of cyanosis after crying could have the congenital heart defect (CHD) of decreased pulmonary blood flow called
Tetralogy of Fallot (TOF).
The parent of an infant diagnosed with clubfoot asks the nurse about the casting treatment regimen. The nurse determines that further instruction is not needed when the parent states
The cast will be changed in 2 weeks
A parent asks if her newborn's undescended testicles will need surgery to repair. What is the best response by the nurse?
There is a chance the testicles will descend on their own.
What occurs in the gastrointestinal system of the child with Hirschsprung disease?
There is a partial or complete mechanical obstruction in the intestine.
In which situation is there the greatest risk that a newborn infant will have a congenital heart defect (CHD)?
Trisomy 21 detected on amniocentesis
The nurse knows that which of the following causes the symptoms seen in testicular torsion?
Twisting of the spermatic cord interrupts the blood supply.
A baby with developmental dysplasia of the hip is placed in a Pavlik harness. The harness positions the hip in which position?
a flexed, abducted position to press the femur head against the acetabulum
Which of the following nursing diagnoses would best apply to a child with rheumatic fever?
Activity intolerance related to the inability of the heart to sustain the extra workload Explanation: Children with rheumatic fever need to reduce activity to relieve stress during the illness.
José is a 4-year-old child scheduled for a cardiac catheterization. Preoperative teaching should be:
Adapted to his level of development so that he can understand.
Which should be included in the plan of care for a 14-month-old whose cleft palate was repaired 12 hours ago? Select all that apply.
Allow the infant to have familiar items of comfort such as a favorite stuffed animal and a "sippy" cup. Administer pain medication on a regular schedule, as opposed to an as-needed schedule.
Which problem-based nursing care plan will the nurse indicate as a priority for the child following cardiac surgery for tetralogy of Fallot?
Altered cardiopulmonary tissue perfusion risk
Congenital myelomeningocele is commonly associated with which condition?
hydrocephalus
An infant has been born and diagnosed with a meningocele. Which action will the nurse incorporate into each contact with this infant?
inspection of the cystic sac on the child's back for leakage.
A nurse is assessing the skin of a 12-year-old with suspected right ventricular heart failure. Where should the nurse expect to note edema in this child?
lower extremities
A nurse is preparing a plan of care for an infant who has undergone surgery to repair a myelomeningocele. The nurse would include placing the infant in which positions postoperatively? Select all that apply..
right side lying left side lying prone
The nurse is caring for an 8-month-old infant with a suspected congenital heart defect. The nurse examines the child and documents which expected finding?
softening of the nail beds
A nursing student is caring for a newborn with a defect in the neural arch where the posterior laminae of the vertebrae have failed to close. The nurse knows that this infant is suffering from which disorder?
spina bifida
A pregnant client tells her nurse that a friend of hers recently gave birth to an infant who was found to have congenital heart disease. She asks the nurse whether there is anything she can do to reduce the risk of this type of condition occurring in her baby. Which of the following should the nurse mention to this patient?
"Make sure you are fully immunized." Explanation: The cause of congenital heart disease often cannot be documented, although it is associated with familial patterns of inheritance and possibly triggers such as rubella (German measles) and varicella (chickenpox) infection during pregnancy. Women need to enter pregnancy fully immunized to help prevent infection during pregnancy. Encouraging the child to eat a low-sodium diet and exercise as he grows up will help prevent acquired heart disease, not congenital heart disease
The nurse is caring for a 6-year-old boy with myelomeningocele. The nurse is teaching the mother how to promote appropriate bowel elimination and avoid constipation. Which response from the mother indicates a need for further teaching?
"My son's activity is too limited to stimulate his bowels."
The nurse is caring for the parents of a newborn who has an undescended testicle. Which comment by the parents indicates understanding of the condition?
"Our son's condition may resolve on its own." Normally both testes will descend prior to birth. In the event this does not happen the child will be observed for the first 6 months of life. If the testicle descends without intervention further treatment will not be needed. Surgical intervention is not needed until after 6 months if the testicle has not descended
The nurse is caring for a newborn with a cleft lip and palate. The mother states, "I will not be able to breastfeed my baby." Select the nurse's best response.
"Sometimes breastfeeding is still an option for babies with a cleft lip and palate. Would you like more information?" Rationale: Some mothers can breastfeed their infants who have a cleft lip and palate. The breast can help fill in the cleft and help the infant create suction.
The nurse is caring for an 8-week-old infant being evaluated for pyloric stenosis. Which statement by the parent would be typical for a child with this diagnosis?
"The baby is always hungry after vomiting so I refeed." Rationale: Infants with pyloric stenosis are always hungry and often appear malnourished.
The nurse is caring for an infant girl with a suspected cardiovascular disorder. Which statement by the mother would warrant further investigation?
"The baby seems more comfortable over my shoulder." The nurse should be alert to statements indicating that the baby seems to be more comfortable when she is sitting up or over her mother's shoulder than when she is lying flat.
A nurse is caring for a child with spina bifida. The child's mother asks the nurse what she did to cause the birth defect. Which statement would be the nurse's best response?
"The cause is unknown and there are many environmental factors that may contribute to it."
The nurse is taking a health history of a toddler with a suspected congenital heart defect. Which response by the mother could indicate that the child is experiencing hypercyanotic spells?
"He likes to stop and squat wherever he walks." The walking toddler may squat periodically to relieve a hypercyanotic spell. This position serves to improve pulmonary blood flow by increasing systemic vascular resistance.
A nurse is taking the history of a 4-year-old boy who will undergo a cardiac catheterization. Which of the following statements by his mother may necessitate rescheduling of the procedure?
"He seems listless and slightly warm." Explanation: Fever and other signs and symptoms of infection may necessitate rescheduling the procedure. Although information about allergies is important, not all contrast media contain iodine as a base. The nurse should address the child's fears in a developmentally appropriate way, but fear of the procedure does not warrant rescheduling. Not using any medication would not be a reason for rescheduling the procedure.
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 discharging a baby with clubfoot who has had a cast applied. The nurse should provide additional teaching to the parents if they state:
"I should use a pillow to elevate my child's foot as he sleeps." Rationale: Elevating the extremities at different points during the day is helpful to prevent edema, but pillows should not be used in the crib because they increase the risk of sudden infant death syndrome (SIDS). A change in the color of the toes is a sign of impaired circulation and requires medical evaluation. Children typically need a series of 5-10 casts to correct the deformity. Infants with club feet still need frequent holding like any other newborn.
The mother of an infant tells the nurse during a routine visit to the clinic that she often notices a bulging mass in the lower abdominal and groin area when her baby cries. She asks the nurse if this is normal. How should the nurse respond?
"I understand your concern. I will be sure to document this in your child's medical record and report this information to your child's physician immediately." The nurse should tell the mother that her baby may have an inguinal hernia if she sees a bulging mass in the lower abdominal and groin area when her baby cries. An inguinal hernia is a kind of hernia that occurs when tissue or part of an organ, usually the intestines, protrudes through a weakened area in the abdominal muscles. The inguinal canal, which runs from the abdomen to the scrotum in boys and the labia in girls, is where inguinal hernias usually happen. Inguinal hernias can cause pain and a bulge in the groin. A hernia is a medical emergency that requires immediate medical attention. The nurse should tell the mother to keep an eye on her infant and take note of when the bulge appears, such as when the baby cries or coughs.
The nurse is giving discharge instructions to the parent of a 1-month-old infant with a tracheoesophageal fistula and a gastrostomy tube (GT). The nurse knows the mother understands the discharge teaching when she states:
"I will clean the area around the GT with soap and water every day." Rationale: The area around the GT should be cleaned with soap and water to prevent an infection.
A 13-month-old is being discharged following the repair of his epispadias. Which of he following statements made by the parents indicate that they understand the discharge teaching?
"If a mucous plug forms in the urinary drainage tube, we will irrigate it gently to prevent a blockage."
A 10-week-old infant has not resolved a small ventricular septal defect. She is prescribed digoxin. The father asks how the medication helps the child? The nurse is correct to state which?
"It will help prevent fluid from accumulating in the lungs."
The parents of a 5-year-old child with a cardiovascular disorder tell the nurse they don't understand why their child isn't gaining weight, "We make sure our child has 3 very nutritious meals every day." How should the nurse respond?
"It's great you are providing nutritious meals, but smaller frequent meals will tire your child less and promote weight gain."
VP shunt (ventriculoperitoneal) post-op spina bifida teaching
A cerebral shunt that drains excess cerebrospinal fluid (CSF) when there is an obstruction in the normal outflow or there is a decreased absorption of the fluid. Some kids will need a VP shunt after SPINA BIFIDA surgery for a short period and some kids will need it for years. Because this involves the spinal column there is a risk of developing hydrocephalus The shunt is placed underneath the skull against the brain and it has a tube that drains the fluid out to the peritoneal cavity. It helps keep the pressure down after surgery Otherwise, the brain will herniate and the child will be brain-dead.
For what clinical manifestation should a nurse be alert when suspecting a diagnosis of esophageal atresia?
A nasogastric tube fails to pass at birth. Atresia is suspected when a nasogastric tube fails to pass 10 to 11 cm beyond the gum line. Abdominal radiographs will confirm the diagnosis. Prenatal radiographs do not provide a definitive diagnosis. The defect is not externally visible. Bronchoscopy and endoscopy can be used to identify this defect. Infants with esophageal atresia may have been born prematurely and with a low birth weight, but neither is suggestive of the presence of an esophageal atresia.
The nurse is conducting a physical examination of an 18-month-old with suspected intussusception. Which finding would the nurse identify as the hallmark of this condition?
A sausage-shaped mass in the upper mid-abdomen
Which diagnostic measure is most accurate in detecting neural tube defects?
A significant level of alpha-fetoprotein present in amniotic fluid
The nurse is reviewing the medical record of the antepartum client with an abnormal alpha-fetoprotein test. The mother is distraught and states, "How bad can it be?" The nurse is correct to describe which?
A type of spina bifida
The nurse is caring for a school-age girl who has had a cardiac catheterization. The child tells the nurse that her bandage is "too wet." The nurse finds the bandage and bed soaked with blood. The most appropriate initial nursing action is to:
Apply direct pressure above the catheterization site. If bleeding occurs, direct continuous pressure is applied 2.5 cm (1 inch) above the percutaneous skin site to localize pressure over the vessel puncture. Notifying the physician and applying a new bandage with more pressure can be done after pressure is applied. The nurse can have someone else notify the physician while the pressure is being maintained. The Trendelenburg position would not be helpful; it would increase the drainage from the lower extremities.
The nurse is caring for a 10-year-old boy following a cardiac catheterization. Four hours after the procedure, the nurse notes some minor bleeding at the site. Which action would be most appropriate?
Apply pressure 1 inch above the site. Explanation: If bleeding occurs after a cardiac catheterization, apply pressure 1 inch above the site to create pressure over the vessel, thereby reducing the blood flow to the area. The nurse should first apply pressure and then notify the physician if this measure is ineffective or if the bleeding increases. The child should maintain the leg in a straight position for about 4 to 8 hours. However, this would not address the bleeding assessed at the site. Changing the dressing would not be effective.
In caring for the child with rheumatic fever which medication would the nurse likely administer?
Aspirin Explanation: Salicylates are administered in the form of aspirin to reduce fever and to relieve joint inflammation and pain in the child with rheumatic fever. Although salicylates as a general rule are not given to children, they continue to be the treatment of choice for rheumatic fever. Tylenol is not effective for the inflammation.
General Principles of Nursing Care - GI kids.
Assess abdominal girth- before and after each feed Assess bowel sounds Q 4 quadrants Begin oral feeding with frequent, small feedings of clear liquids - advance diet as tolerated - Pain - Rebound tenderness (appendix) - Stool pattern (intussusception: jelly/currant-like mucous bloody stool) - Assess for nausea/vomiting - Daily weights - I&O's for all post-surgical patients and Before going to Ct with contrast Abdominal girth measure before and after feeding - if distended don't feed. If hypoactive bowel sounds: - worsening condition. After surgery: - NPO, getting food through TPN and lipids, - IV hydration. Resuming feeding: - slowly with clears then advancing,
The nurse is assessing an infant and notes brachial pulses of 2+ and femoral pulses of 1+. Which action will the nurse perform first?
Assess blood pressure in all extremities.
Nursing interventions for the child after a cardiac catheterization include which of the following? Select all that apply.
Assess the affected extremity for temperature and color. Maintain a patent peripheral intravenous catheter until discharge.
The nurse is caring for a child diagnosed with hydrocephalus following ventriculoperitoneal shunt placement. The child is currently on a ventilator. Which nursing action is a priority?
Assess the client's respiratory status The nurse would place priority on monitoring the client's respiratory status since the client is on a ventilator and at risk for intracranial pressure. The nurse would educate the family on the shunt, monitor for infection, and measure head circumference; however, these actions are not a priority over ensuring the client maintains an airway.
The nurse is caring for a child admitted to the hospital for a cardiac catheterization. Upon return from the cardiac catheterization, which nursing action is priority?
Assess the dressing at the insertion site. The child returning from a cardiac catheterization is at risk for hemorrhage from the insertion site. The nurse will assess the dressing at the insertion site immediately upon the child's return from the procedure. Palpating pulses, maintaining IV patency, and applying a blood pressure monitor would be done after first assessing the child for bleeding. Although assessing pulses will provide the nurse with information about the circulatory status of the extremities, weak pulse strength is a later sign of hemorrhage than visually assessing the insertion site.
What is the nurse's first action when planning to teach the parents of an infant with a congenital heart defect (CHD)?
Assess the parents' anxiety level and readiness to learn.
Coarctation of the aorta demonstrates few symptoms in newborns. What is an important assessment to make on all newborns to help reveal this condition?
Assessing for the presence of femoral pulses
A nurse is caring for a 4-year-old child who has undergone surgery to repair a hernia. Which of the following is a priority nursing intervention for this patient?
Assisting with early ambulation to facilitate peristalsis
Why will it be necessary for the nurse to be very supportive of parents' attempts to feed the infant with recently repaired myelomeningocele?
Assuming the usual feeding position will be difficult.
A 5-year-old is being prepared for diagnostic cardiac catheterization, in which the catheter will be inserted in the right femoral vein. Which of the following interventions should the nurse take to prevent infection?
Avoid drawing a blood specimen from the right femoral vein before the procedure Explanation: Because the vessel site chosen for catheterization must not be infected at the time of catheterization (or obscured by a hematoma), never draw blood specimens from the projected catheterization entry site before the procedure (generally a femoral vein). The other interventions listed are performed for reasons other than prevention of infection. Children scheduled for the procedure are usually kept NPO for 2 to 4 hours beforehand to reduce the danger of vomiting and aspiration during the procedure. Be certain to record pedal pulses for a baseline assessment. The site for catheter insertion is locally anesthetized with EMLA cream or intradermal lidocaine.
Latex allergy is suspected in a child with spina bifida. Appropriate nursing interventions include:
Avoid using any latex product.
Cardiac catheterization - Nursing Considerations and care
Before Procedure: - Vital signs, H&H, cap refill & pedal/popliteal pulses - Age-appropriate explanation/teaching to prepare the child. After Procedure: - Monitor for arrhythmia, bleeding, and/or hematoma at site and infection, Vital signs, lower extremity perfusion (cap refill of the toenails, temp/color & pulses of lower extremities). - Child must keep the leg straight for several hours. - Bed rest 4-6 hours - Activity is limited for 24 hours - A younger child might get some mild sedation to stay in bed. - School-aged kids will be able to follow instructions. - Maintain pressure dressing and watch for bleeding at the site (look under child- blood may pool and run under child) - I&O's: contrast medium used/ may cause diuresis.
Which of the following would be included in the care of an infant with heart failure?
Begin formulas with increased calories. Explanation: Infants with heart failure need increased calories for growth. The infants are typically given smaller, more frequent feedings to decrease the amount given and to help conserve energy for feeding. They often are given a higher-calorie formula. The infant should be placed in an upright position or in a car seat to increase oxygenation. The infant should not have any pressure on the diaphragm while in this position. Vomiting is a sign of digoxin toxicity and this should be considered before administering.
A nurse is conducting a postoperative assessment on an infant who has just had a ventriculoperitoneal shunt placed for hydrocephalus. Which assessment finding would indicate a malfunction in the shunt?
Bulging Fontaneles
A common, serious complication of rheumatic fever is:
Cardiac valve damage.
Infants with congenital heart disease should not be allowed to become dehydrated because this makes them prone to
Cerebrovascular accident. Explanation: Children who have polycythemia from cardiovascular disease can develop thrombi if they become dehydrated.
Cleft Lip and Palate - feeding
Challenging to feed bilateral cleft lip babies. Babies with this condition have trouble suctioning during feeding because air leaks out through the cleft Special bottle with flat/long nipples and longer upper part of bottle. - Feed slowly - Small frequent meals - Monitor for chocking/aspiration • Mom can pump milk for the baby - no breastfeeding. • Baby might need OG tube or NG tube feeds. - Have a lactation consultant come in to facilitate breastfeeding - cleft babies won't easily learn without help.
A child is born with clubfoot (congenital talipes equinovarus). The child later receives a cast on the affected leg to correct the problem. Which measure should the nurse mention to the mother to ensure good circulation in the affected leg?
Check the infant's toes for coldness or blueness.
A 6-year-old girl had a cardiac catheterization at 9 a.m. At 11 a.m. the nurse notes hypotension as compared to baseline. Based on this assessment finding, which of the following would the nurse do first?
Check the insertion site. Hypotension may signify hemorrhage due to perforation of the heart muscle or bleeding from the insertion site. Rechecking the blood pressure every 15 minutes is done during the first hour and then every 30 minutes for the next hour. Rechecking the blood pressure would be appropriate after the nurse checks the insertion site and determines that bleeding is not present. Pain or fever would be more likely with infection or thrombus formation. Pallor, diminished temperature, and altered capillary refill time in the affected extremity could signal compromised neurovascular status.
The parent of a 3-week-old baby states that the infant was recast this morning for clubfoot and has been crying for the past hour. Which intervention should the nurse suggest the parent do first?
Check the neuro-circulatory status of the foot
The nurse is collecting data on a child being evaluated for rheumatic fever. The caregiver reports that over the past several weeks she has noticed that the child seems to have a lack of coordination. In addition, she reports the child has had facial grimaces and repetitive involuntary movements. The signs the caregiver reports indicate the child has which of the following?
Chorea Explanation: Chorea is a disorder characterized by emotional instability, purposeless movements, and muscular weakness. The onset of chorea is gradual, with increasing incoordination, facial grimaces, and repetitive involuntary movements.
The nurse is caring for a newborn male with hypospadias. His parents ask if circumcision is an option. Which is the nurse's best response?
Circumcision is an option, but it cannot be done at this time. It is usually recommended that circumcision be delayed in the child with hypospadias because the foreskin may beneeded for repair of the defect.
The nurse is caring for an infant whose cleft lip was repaired. Important aspects of this infant's postoperative care include:
Cleansing of the suture line, supine and side-lying positions, and arm restraints. The suture line should be cleansed gently after feeding. The child should be positioned on the back or side or in an infant seat. Elbows are restrained to prevent the child from accessing the operative site. Postural drainage is not indicated. This would increase the pressure on the operative site when the child is placed in different positions. Mouth irrigations would not be indicated.
A murmur is auscutated in
Coarctation of the Aorta (systolic murmur) Ventricular Septal Defect Rheumatic Fever
Cohortation of the Aorta
Coarctation of the aorta (COA) One of the tale signs: - blood pressure is lower in the legs, may hear a murmur with coarctation. May be symptomatic: cyanosis, and tachypnea. Give Prostaglandins to keep the PDA open for better perfusion. Follow up with cardiology - Aorta narrows, usually near the ductus, obstructing blood flow - Common defect - Four-extremity blood pressures - Blood pressure is higher in the arms than legs. - Weak femoral or pedal pulses. Repair: - Dilate with a balloon angioplasty or surgical repair via bypass graft Prognosis: - Persistent hypertension is common - and requires lifelong follow-ups - Restenosis can occur.
When caring for a child who has just had a cardiac catheterization, which of the following would indicate a sign of hypotension?
Cold clammy skin and increased heart rate Explanation: Cold, clammy skin, increased heart rate, and dizziness are signs of hypotension that may be a complication after a cardiac catheterization. Decreased heart rate, syncope, and tachypnea would also be very concerning, but not necessarily a sign of hypotension.
A nurse admits an infant with a possible diagnosis of congestive heart failure. Which of the following signs and symptoms would the infant most likely be exhibiting?
Feeding problems Explanation: The indications of CHF vary in children of different ages. Signs in the infant may be hard to detect because they are subtle, but in infants, feeding problems are often seen. In infants and older children, tachycardia is one of the first signs of CHF. The heart beats faster in an attempt to increase blood flow. Failure to gain weight, weakness, and an enlarged liver and heart are other possible indicators of CHF but are not as common as tachycardia and may take longer to develop
After assessing a child, the nurse suspects coarctation of the aorta based on which of the following?
Femoral pulse weaker than brachial pulse Explanation: A femoral pulse that is weak or absent in comparison to the brachial pulse is associated with coarctation of the aorta. A bounding pulse is characteristic of patent ductus arteriosus or aortic regurgitation. A narrow or thread pulse is associated with heart failure or severe aortic stenosis. Hepatomegaly is a sign of right-sided heart failure
Nurses must be alert for increased fluid requirements when a child has:
Fever Fever leads to great insensible fluid loss in young children because of increased body surface area relative to fluid volume.
Gastroschisis - Abdominal Wall Defect
Gastroschisis: Abdominal organs herniate through the abdominal wall Same as omphalocele BUT NOT covered with peritoneal membrane (no peritoneal sac) Allow contents to go in by gravity if can't put them back inside during surgery, keep it open, and allow it to go back in by gravity. Possibility of colostomy bags - might not require them for life. Preoperative care - preventing hypothermia - maintaining perfusion to abdominal contents - protecting exposed contents from trauma and infection, - preventing intestinal distention - maintaining fluid and electrolyte balance Postoperative care parent-newborn interaction
A school nurse is caring for a child with a severe sore throat and fever. Which of the following would be the best recommendation by the nurse to the parent?
Have the child be seen by the primary care provider. Explanation: Children with sore throats and fevers should be seen by their primary care provider to rule out strep throat. This is extremely important due to the fact they may contract an acquired heart disease called rheumatic fever. Taking acetaminophen, resting, and drinking fluids are all good recommendations, but the best recommendation is to see the provider. Going to the emergency room is not necessary at this time.
The parents of a boy diagnosed with Hirschsprung disease are anxious and fearful of the upcoming surgery. The mother states, "I'm worried about having to care for our son's ostomy." Which intervention would be most helpful for the parents?
Having a wound, ostomy, and continence nurse meet with them
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
Which problem is most often associated with myelomeningocele?
Hydrocephalus
Hydrocephalus
Hydrocephalus The body's response to an imbalance between the production and absorption of CSF Can develop as a complication illness/trauma & commonly associated with myelomeningocele Can be communicating/non-communicating
Pyloric stenosis
Hypertrophic obstruction of the pyloric sphincter Pyloric stenosis often gets misdiagnosed - thinking it's a formula intolerance or reflux (up to 50% of kids have reflux ) Boys more than girls (4:1 ratio) Inability to move food from stomach to duodenum Vomiting and dehydration Not noticeable right away after birth, then a few weeks after going home, the baby starts to spit up a lot at first - then vomiting, non-bilous PROJECTILE VOMITING up to 3 feet from the child's mouth due to pressure - can palpate an olive-shaped mass. Needs ambulatory surgery. After surgery, start feeding slowly. Diagnosed through scans. There could be some vitamin deficiencies, malnutrition, ... Easy fix - No long-term complications. Dx. through scans - can see peristaltic waves in skinny kids. Delays in growth, nutrition deficiencies...
The nurse is providing discharge teaching to the parents of an infant with an umbilical hernia. Which should be included in the plan of care?
If the hernia appears to be more swollen or tender, seek medical care immediately. Rationale: If the hernia appears larger, swollen, or tender, the intestine may be trapped, which is a surgical emergency.
The nurse is caring for a 3-month-old being evaluated for possible Hirschsprung disease. His parents call the nurse and show her his diaper containing a large amount of mucus and bloody diarrhea. The nurse notes that the infant is irritable and his abdomen appears very distended. Which should be the nurse's next action?
Immediately obtain all signs and a quick head-to-toe assessment.
The nurse is caring for the newborn with bilateral clubfoot. What nursing diagnoses would the nurse address? Select all that apply.
Impaired physical mobility Risk for impaired skin integrity Impaired parenting Explanation: Nursing diagnoses that may apply to the newborn with bilateral clubfoot are impaired physical mobility, risk for impaired skin integrity, impaired parenting, and ineffective health maintenance.
A nurse is reviewing blood work on a patient with a cyanotic heart defect. Which of the following results would most likely be seen in a patient experiencing polycythemia?
Increased RBC Explanation: Polycythemia can occur in patients with a cyanotic heart defect. The body tries to compensate for having low oxygen levels and produces more red blood cells (RBCs). This would cause an increased result on the lab tests. This problem does not affect the white blood cells (WBCs).
The nurse is caring for a child with rheumatic fever who has polyarthritis. Which lab result would the nurse most anticipate with this child's diagnosis and symptoms?
Increased erythrocyte sedimentation rate (ESR)
An 8-month-old has a ventricular septal defect. Which nursing diagnosis below would best apply?
Ineffective tissue perfusion related to the inefficiency of the heart as a pump Explanation: A ventriculoseptal defect permits blood to flow across a septum, creating an ineffective pump.
A 9-month-old girl is brought to the emergency room with what appears to be bouts of intense abdominal pain 15 minutes apart in which she draws up her legs and cries, often accompanied by vomiting. In between the bouts, the child recovers and appears to be without symptoms. Blood is found in the stool. What condition should the nurse suspect in this case?
Intussusception
An infant with poor feeding is suspected of having a congenital heart defect. The parents are asking why a chest x-ray is necessary for their infant. What is the best response from the nurse?
It will determine if the heart is enlarged.
A nurse reads the medical history of a client who is scheduled for a hernia repair that is termed "reducible." What best describes this type of hernia?
Its contents can be easily manipulated back into the peritoneal cavity.
After teaching a group of students about acute rheumatic fever, the instructor determines that the teaching was successful when the students identify which assessment finding?
Jerky movements of the face and upper extremities Sydenham chorea is a movement disorder of the face and upper extremities associated with acute rheumatic fever.
Which postoperative intervention should be questioned for a child after a cardiac catheterization?
Keep the affected leg flexed and elevated. The child should be positioned with the affected leg straight for 4 to 6 hours after the procedure. IV fluid administration continues until the child is taking and retaining adequate amounts of oral fluids. The insertion site dressing should be observed frequently for bleeding. The nurse should also look under the child to check for pooled blood. Peripheral perfusion is monitored after catheterization. Distal pulses should be palpable, although they may be weaker than in the contralateral extremity.
The nurse will teach parents of children with myelomeningocele to maintain an environment free of what element?
Latex Up to 73% of children with repeated surgeries for spina bifida are sensitive to latex.
When preparing a school-age child and the family for heart surgery, the nurse should consider:
Letting child hear the sounds of an electrocardiograph monitor.
The nurse is assessing a newborn and suspects developmental dysplasia of the hip (DDH). For which sign is the nurse prioritizing this potential diagnosis?
Limited abduction of the affected hip
The nurse is preparing a teaching plan for the parents of a child who has been diagnosed with a congenital heart defect. What would the nurse be least likely to include?
Maintenance of strict bed rest
The nurse is conducting a physical examination of a 7-year-old girl prior to a cardiac catheterization. The nurse knows to pay particular attention to assessing the child's pedal pulses. How can the nurse best facilitate their assessment after the procedure?
Mark the child's pedal pulses with an indelible marker, then document Explanation: The nurse should pay particular attention to assessing the child's peripheral pulses, including pedal pulses. Using an indelible pen, the nurse should mark the location of the child's pedal pulses as well as document the location and quality in the child's medical records.
The nurse is caring for a newborn with esophageal atresia. When reviewing the mother's history, which would the nurse expect to find?
Maternal polyhydramnios (too much amnionic fluid). Rationale: Maternal polyhydramnios is present because the infant cannot swallow and absorb the amniotic fluid in utero.
Which nursing intervention is most appropriate when caring for an infant with a myelomeningocele in the preoperative stage?
Measuring head circumference every shift to identify developing hydrocephalus
An infant with pyloric stenosis experiences excessive vomiting that can result in:
Metabolic alkalosis Infants with excessive vomiting are prone to metabolic alkalosis from the loss of hydrogen ions. Chloride ions and sodium are lost with vomiting.
Club foot
More common in boys Involves 3 areas of deformity: - midfoot is directed downwards - hindfoot turns inwards - forefoot curls towards the heel - Can occur from abnormal intrauterine positioning/ twins/multiples First Line of Care: - Serial Casting: every 1 to 2 weeks for 8 to 12 months - Parents MUST be compliant. - Keep cast dry - Teach the signs and symptoms of compartment syndrome - Assess pulses, color, edema, sensation, capillary refill after casting.
Cleft Lip and Palate- causes
Most common congenital anomaly in the U.S. No known cause - common in Asians and Caucasians. Familial trends, believed polygenic multifactorial genetic/ environment, lack of folate. Folic acid prevents cleft lip/palate and spina bifida Happens between the 5th and 6th week of gestation. Maxillary processes fail to fuse
The nurse is reviewing the medical record of a child with a cleft lip and palate. When reviewing the child's history, what would the nurse identify as a risk factor for this condition?
Mother age 42 with pregnancy
A 3-year-old child with Hirschsprung's disease is hospitalized for surgery. A temporary colostomy will be necessary. The nurse should recognize that preparing this child psychologically is:
Necessary because it will be an adjustment.
Spina Bifida
Neural Tube Defects - The higher in the spine, the greater the neuro dysfunction - The lower in the spine- the greater the GI/GU dysfunction Anencephaly: - no brain development above stem (organ donation?) Encephalocele: (higher) - a sac-like protrusion or projection of the brain and the membranes that cover it through an opening in the skull. Spina bifida: (lower) - a sac-like protrusion or projection of meningeal-covered tissue through a defect in the vertebrae - Surgery improves the quality of life and prevents hind After surgery - concerned about meningitis and excess cerebral spinal fluid (hydrocephalus) and require a VP Shunt. Types of Spina Bifida: 1. Meningocele: contains nerve roots 2. Myelodysplasia: (aka myelomeningocele): contains nerve roots and spinal cord (most complicated)
A 3-month-old girl is found to have an umbilical hernia at a well visit. On examination, the nurse discovers that the fascial ring through which the intestine protrudes is about 1 cm in diameter. Which of the following should she mention to the girl's father as the likely intervention required to correct this condition?
No intervention is needed, as the opening will most likely close spontaneously
A nurse suspects a child is experiencing cardiac tamponade after heart surgery. What would be the priority nursing intervention?
Notify the doctor immediately.
The nurse is caring for a boy with probable intussusception. He had diarrhea before admission but, while waiting for the administration of air pressure to reduce the intussusception, he passed a normal brown stool. The most appropriate nursing action is to:
Notify the practitioner. Passage of a normal brown stool indicates that the intussusception has reduced itself. This is immediately reported to the practitioner, who may choose to alter the diagnostic/therapeutic plan of care.
The nurse is caring for a 6-year-old with a congenital heart defect. To best relieve a hypercyanotic spell, what action would be the priority?
Place the child in a knee-to-chest position. The priority nursing action is to place the infant or child in a knee-to-chest position. Once the child has been placed in this position, the nurse should provide supplemental oxygen or administer medication as ordered. A calm, comforting approach should be used but is not the priority action. Once a child is placed in the knee-to-chest position, supplemental oxygen will be provided as ordered. Once a child is placed in the knee-to-chest position, medications will be given as ordered.
An infant with Tetralogy of Fallot becomes cyanotic. Which nursing intervention would be the first priority?
Place the infant in the knee-chest position. Explanation: Placing the infant in the knee-chest position is the first priority when caring for an infant with tetralogy of Fallot. Starting IV fluids and preparing the child for surgery would not be necessary since it is known that the infant has a cyanotic birth defect. Raising the head of the bed would not be a priority since the infant needs to be placed in the knee-chest position.
A nurse is caring for a newborn client who is diagnosed with myelomeningocele. Which nursing intervention would protect the newborn from injury?
Place the newborn in a prone or lateral position.
A child with pulmonary atresia exhibits cyanosis with feeding. On reviewing this child's laboratory values, the nurse is not surprised to notice which abnormality?
Polycythemia
Hypoxic spells in the infant with a congenital heart defect (CHD) can cause which of the following?
Polycythemia Blood clots Cerebrovascular accident Developmental delay Brain damage
Which physiological changes occur as a result of hypoxemia in congestive heart failure (CHF)?
Polycythemia and clubbing.
An infant with congenital heart disease is not growing and developing adequately. The nurse will institute what feeding strategy?
Raise the caloric density of the feeding beyond 20 calories per ounce Increasing the caloric density of the feeding allows the infant to ingest more calories without increased volume and in a shorter period. This conserves energy. Calories per ounce can be increased by adding supplements to pumped breast milk. Using a commercial formula could be necessary if a special formula is needed. However, breast milk is usually the infant's best source of nutrition. Feeding the infant every 2 hours and increasing the length of the feeding beyond 30 minutes will fatigue the child and allow for little rest between feedings.
A 3-month-old boy is found to have undescended testes. The parents are concerned. What should the nurse anticipate as the next step for this client?
Reassess the client's testes at 6 months of age.
Cleft Lip and Palate - Post-Op
Reconstructive surgical repair • Fisher repair • Millard rotation-advancement technique After surgery - NPO feeding until healed After feeding: - milk or formula could leave residue behind - rinse suture lines after feeding with sterile water. - Put elbow immobilizers on to avoid touching the face. If the baby goes home after surgery: - any high temperature - instruct parent not to give Tylenol - bleeding, or drainage at the site, irritability - call the doctor immediately. - Child should lie supine when not eating/drinking to lower the risk of damaging sutures Teeth: - Pulling the palate close surgically may cause the teeth to not have enough space - need a dental appointment - May need to get some teeth pulled. - No pacifier and no feeding after surgery to Keep pressure off the sutures until they get the ok from the doctor - Advise parents that the child may have speech delays, swallowing, dental issues. • Pain management - FLACC scale and medicate. • Risk for delayed growth and development r/t nutritional intake
Which action by the school nurse is important in the prevention of rheumatic fever?
Refer children with sore throats for throat cultures.
The leading cause of death after heart transplantation is:
Rejection
During the first few days after surgery for cleft lip, which intervention should the nurse do?
Remove restraints periodically to cuddle infant. The nurse should remove restraints periodically, while supervising the infant, to allow him or her to exercise arms and to provide cuddling and tactile stimulation. The infant should not be left in the crib, but should be removed for appropriate holding and stimulation. Analgesia and sedation are administered for pain. Heavy sedation is not indicated. The child should not be placed in the prone position.
Seventy-two hours after cardiac surgery, a young child has a temperature of 37.7 C (101 F). The nurse should:
Report findings to physician. In the first 24 to 48 hours after surgery, the body temperature may increase to 37.7 C (100 F) as part of the inflammatory response to tissue trauma. If the temperature is higher or an elevated temperature continues after this period, it is most likely a sign of an infection and immediate investigation is indicated. Blankets should be removed from the child to keep the temperature from increasing.
A neonatal nurse examines an infant born with a congenital diaphragmatic hernia (CDH). The nurse is prepared for what condition associated with CDH that generally occurs at birth or within the first few hours of life?
Respiratory distress
A 10-year-old child is recovering from a severe sore throat. The parent states that the child complains of chest pain. The nurse observes that the child has swollen joints, nodules on the fingers, and a rash on the chest. The likely cause is _________________________.
Rheumatic Fever (RF).
Which nursing diagnosis is most relevant in the first 12 hours of life for a neonate born with a myelomeningocele?
Risk of infection
Ventricular Septal defect - what do you see/hear in a child? Plus nursing considerations
Signs & Symptoms - Whooshing or murmur in 3rd or 4th intercostal space. Systolic murmur. - CHF and Fluid excess - Poor feeding and appetite - Inability to gain weight - Frequent illness - Tachycardia - Tachypnea - Cyanosis on fingernails and toenails ****Most cases will resolve without surgery by age 1****.
After the birth of an infant with clubfoot, what should the nursery nurse do when instructing the parents? select all that apply
Speak in simple language about the defect Present the infant as precious, emphasize well-formed parts of the body Be prepared to answer questions multiple times
The nurse is discussing types of treatment used when working with children who have orthopedic disorders. Which form of treatment covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open?
Spica cast.
The nurse is assessing the neonate shown. From the assessment, the nurse notes that there is paralysis of the lower extremities. For which condition does the nurse anticipate performing care?
Spina bifida with myelomeningocele
The nurse is caring for a 4-month-old who has just had an isolated cleft lip repaired. Select the best position for the child in the immediate postoperative period.
Supine Rationale: The supine position is preferred because there is a decreased risk of the infant rubbing the suture line.
Therapeutic management of most children with Hirschsprung's disease is primarily:
Surgical removal of the affected section of the bowel. Most children with Hirschsprung's disease require surgical rather than medical management. Surgery is done to remove the aganglionic portion of the bowel, relieve obstruction, and restore normal bowel motility and function of the internal anal sphincter. Preoperative management may include enemas and low-fiber, high-calorie, high-protein diet until the child is physically ready for surgery. The colostomy that is created in Hirschsprung's disease is usually temporary.
When caring for a child with a congenital heart defect, which assessment finding may be a sign the child is experiencing heart failure?
Tachycardia
At 3 years of age, a child has a cardiac catheterization. After the procedure, which interventions would be most important?
Taking pedal pulses for the first 4 hours
At 3 years of age, a child has a cardiac catheterization. After the procedure, which of the following interventions would be most important?
Taking pedal pulses for the first 4 hours Explanation: Insertion of a catheter into the femoral vein can cause vessel spasms, interfering with blood circulation in the leg. Assessing pedal pulses ensures circulation is adequate.
What is the most important information to be included in the discharge planning for an infant with gastroesophageal reflux?
Teach the parents how to do infant cardiopulmonary resuscitation (CPR).
The nurse is providing education to the parents of a female toddler with hydrocephalus who has just had a shunt placed. Which statement is the best to make during a teaching session?
Tell me your concerns about your child's shunt. Always start by assessing the family's knowledge. Ask them what they feel they need to know. Knowing when to call the doctor and how to raise the child's head is important, but they might not be listening if they have another question on their minds.
A nurse is conducting discharge teaching to parents about the care of their infant after cardiac surgery. The nurse instructs the parents to notify the physician if what conditions occur (Select all that apply)?
Temperature above 37.7° C (100° F) New, frequent coughing. Turning blue or bluer than normal The parents should be instructed to notify the physician after their infant's cardiac surgery for a temperature above 37.7° C (100° F); new, frequent coughing; and any episodes of the infant turning blue or bluer than normal. A respiratory rate of 36 at rest for an infant is within normal expectations, and it is expected that the appetite will increase slowly.
The nurse in the neonatal intensive care unit is caring for an infant with myelomeningocele scheduled for surgical repair in the morning. Which early signs of infection should the nurse monitor in this infant? Select all that apply
Temperature instability Irritability Lethargy The nurse should observe an infant with unrepaired myelomeningocele for early signs of infection, such as temperature instability (axillary), irritability, and lethargy. Bradycardia and hypertension are not early signs of infection in infants.
A newborn has been diagnosed with a congenital heart disease. Which of the following congenital heart diseases is associated with cyanosis?
Tetralogy of Fallot Explanation: Tetralogy of Fallot is associated with cyanosis. The defects include ventricular septal defect (VSD), right ventricular hypertrophy, right outflow obstruction, and overriding aorta. Coarctation of the aorta, pulmonary stenosis, and aortic stenosis are NOT cyanotic heart diseases and are NOT associated with cyanosis.
Which assessment indicates that the parent of a 7-year-old is following the prescribed treatment for congestive heart failure (CHF)?
The 50th percentile height and weight for age show good growth and development, indicating good nutrition and perfusion.
A nurse is providing education to a family about cardiac catheterization. Which of the following would be included in the education?
The catheter will be placed in the femoral artery. Explanation: The femoral artery is the correct placement of the cardiac catheter. The child will need to lie still for several hours after the procedure. The procedure is usually postponed if the child has a fever.
Parents of a 3-year-old child with congenital heart disease are afraid to let their child play with other children because of possible overexertion. The nurse's reply should be based on knowing that:
The child needs opportunities to play with peers.
When a child is scheduled for cardiac catheterization, an important health teaching point for parents is that
The child will return with a bulky pressure dressing over the catheter insertion area. Explanation: Cardiac catheterization is typically performed with the child awake but using conscious sedation. A dressing will be placed on the catheter insertion site.
The child has returned to the nurse's unit following a cardiac catheterization. The insertion site is located at the right groin. Peripheral pulses were easily palpated in bilateral lower extremities prior to the procedure. Which finding should be reported to the child's physician? Select all that apply
The child's right foot is cool with a pulse assessed only with the use of a Doppler The child has a temperature of 102.4° F (39.1° C) The child is reporting nausea.
A nurse explains to the family of an infant with an inguinal hernia that the surgeon will attempt manual reduction prior to surgical repair. Which statement describes this technique?
The client is sedated and the incarcerated contents of the hernia are manipulated back into the peritoneal cavity
After cardiac catheterization, the nurse monitors the child's fluid balance closely based on the understanding of which of the following?
The contrast material used has a diuretic effect. Explanation: The contrast material has a diuretic effect so the nurse assesses the child closely for signs and symptoms of dehydration and hypovolemia. Although blood loss can occur, this is not the reason for monitoring the child's fluid balance. Catheter insertion into the heart does not initiate a diuretic response. Typically, food and fluid is withheld for 4 to 6 hours before the procedure.
A nursing instructor is preparing a discussion which will illustrate the different forms of spina bifida. The instructor determines the session is successful after the students correctly choose which form as being spina bifida with myelomeningocele?
The spinal cord, meninges, and nerve roots protrude out the lower back.
The community health nurse is preparing a presentation that will illustrate the various forms of spina bifida for a health fair. Which explanation should the nurse use to explain spina bifida with meningocele?
The spinal meninges protrude through the bony defect and form a cystic sac.
The nurse is caring for an infant newly diagnosed with Hirschsprung disease. What does the nurse understand about this infant's condition?
There is a lack of peristalsis in the large intestine and an accumulation of bowel contents, leading to abdominal distention. Rationale: In Hirschsprung disease, a portion of the large intestine has an area lacking in ganglion cells. This results in a lack of peristalsis as well as an accumulation of bowel contents and abdominal distention.
A 4-month-old infant has gastroesophageal reflux disease (GERD) but is thriving without other complications. What should the nurse suggest to minimize reflux?
Thicken formula with rice cereal. Giving small frequent feedings of formula combined with 1 teaspoon to 1 tablespoon of rice cereal per ounce of formula has been recommended. Milk-thickening agents have been shown to decrease the number of episodes of vomiting and increase the caloric density of the formula. This may benefit infants who are underweight as a result of GERD. Continuous nasogastric feedings are for infants with severe reflux and failure to thrive. Smaller, more frequent feedings are recommended for reflux.
A child with a congenital heart defect is getting an echocardiogram. How would the nurse describe this test to the parent?
This is a test that will check how blood is flowing through the heart.
A parent asks why their infant with a cyanotic heart defect turns blue. What is the best response by the nurse?
This is due to a decreased amount of oxygen to the peripheral tissue. Explanation: Cyanosis associated with certain congenital heart defects is due to the body naturally compensating and decreasing the amount of oxygen to the peripheral tissue. This keeps the oxygen in the vital organs to sustain life. The lack of oxygen is not in the brain; it is in the systemic flow of the body. Cyanosis is a common finding with these types of heart defects and in general, does not usually need immediate surgery or is a sign of heart failure
A parent is told their infant has a heart defect with a left to right shunt. What is the best way for the nurse to explain this type of shunting to the parent?
This type of shunting causes an increase of blood to the lungs.
For what reason might a newborn infant with a cardiac defect, such as coarctation of the aorta, that results in a right-to-left shunt receive prostaglandin E1?
To improve oxygenation Prostaglandin E1 is given to infants with a right-to-left shunt to keep the ductus arteriosus patent. This will improve oxygenation and increase pulmonary blood flow.
The nurse is preparing to admit a newborn with myelomeningocele to the neonatal intensive care nursery. Which describes this newborn's defect?
Visible defect with an external saclike protrusion containing meninges, spinal fluid, and nerves A myelomeningocele is a visible defect with an external saclike protrusion, containing meninges, spinal fluid, and nerves. Rachischisis is a fissure in the spinal column that leaves the meninges and the spinal cord exposed. Encephalocele is a herniation of the brain and meninges through a defect in the skull, producing a fluid-filled sac. Meningocele is a hernial protrusion of a saclike cyst of meninges with spinal fluid, but no neural elements.
The nurse is caring for an infant with suspected pyloric stenosis. Which clinical manifestation would indicate pyloric stenosis?
Visible peristalsis and weight loss Visible gastric peristaltic waves that move from left to right across the epigastrium are observed in pyloric stenosis, as is weight loss. Abdominal rigidity and pain on palpation, and rounded abdomen, and hypoactive bowel sounds, are usually not present. The upper abdomen is distended, not the lower abdomen.
A child is allowed full activity following the repair of a clubfoot. Which activity would be most helpful for this child?
Walking
Which intervention should be included in the plan of care for an infant with the nursing diagnosis of Excess Fluid Volume related to congestive heart failure?
Weigh the infant every day on the same scale at the same time.
Which should the nurse include in the teaching plan for a child who had surgery to correct bilateral clubfeet and had the casts removed? select all that apply.
Your child will need to wear a brace on the feet 23 hours a day for at least 2 months. Your child should see an orthopedic surgeon regularly until the age of 18 Your child may have a recurrence of clubfoot in a year or more. Most children treated for clubfeet develop feet that appear and function normally
Nurses will need to teach the parents of the infant being treated for Hirschsprung disease (aganglionic megacolon) to:
care for a temporary colostomy
The nurse has developed a nursing plan for the care of a 6-year-old girl with congenital hydrocephalus whose shunt has become infected. The most important discharge teaching point for this family is:
ensuring the parents know how to properly give antibiotics. Educating parents on how to properly give antibiotics would be the priority intervention because the child's shunt has become infected. Maintaining cerebral perfusion is important for a child with hydrocephalus, but the priority intervention for the parents at this time is regarding the infection.
The nurse in a pediatric cardiovascular clinic is talking with the father of a 5-year-old child who underwent cardiac surgery for a heart defect at the age of 3. The father reports that the child has been having increased shortness of breath, tires easily after playing, and has been gaining weight. The nurse is aware that the child is most likely demonstrating symptoms of which acquired cardiovascular disorder?
heart failure
While assessing an infant, the nurse suspects developmental dysplasia of the hip (DDH) based on which findings? Select all that apply.
prominence of the trochanter on the right asymmetry of gluteal skin folds right knee lower than the left in the supine position
A 3-year-old is scheduled for a surgery to correct undescended testes. An important postoperative consideration the nurse would want to prepare the parents for is:
some discomfort at the surgery site. After they are returned to the scrotum, testes may be sutured there to prevent them from returning to the abdominal cavity. This produces a "tugging" or painful sensation.
When assessing a newborn, the nurse observes dimpling and thickening of the newborn's skin over the lumbar spine and the presence of a tuft of hair. On further examination, the nurse notices no motor or sensory deficits in the newborn. The nurse interprets these findings as indicating which of the following?
spina bifida occulta
The nurse identifies a nursing diagnosis of Ineffective airway clearance related to inflammation and copious thick secretions. What action is the priority? a. administering oxygen as ordered. b. suctioning secretions from the airway.
suctioning secretions from the airway.
A child is diagnosed with intussusception. The nurse would prepare the child and family for which of the following?
surgery
What is an early sign of congestive heart failure that nurses should recognize?
tachypnea - Early signs of CHF: tachycardia at rest tachypnea dyspnea retractions activity intolerance
After a cardiac catheterization, the nurse monitors the child's fluid balance closely based on the understanding that:
the contrast material used has a diuretic effect.
A young child with tetralogy of Fallot may assume a posturing position as a compensatory mechanism. The position automatically assumed by the child is
the squatting position - creates centralized shunting
The mother of a neonate with clubfoot feels guilty because she believes she did something to cause the condition. The nurse should explain that the cause of clubfoot is...
unknown
The nurse is caring for a child diagnosed with rheumatic fever. The nurse would do all of the following nursing interventions. Which two interventions would be the priority for the nurse? Select all that apply.
• Carefully handle the child's knees, ankles, elbows, and wrists when moving the child. • Administer salicylates after meals or with milk Explanation: Pain control and relief are the highest priorities for a child with rheumatic fever. Position the child to relieve joint pain. Large joints, including the knees, ankles, wrists, and elbows, are usually involved. Carefully handle the joints when moving the child to help minimize pain. Salicylates are administered in the form of aspirin to reduce fever and relieve joint inflammation and pain
The nurse is assessing a child with suspected rheumatic fever. Which of the following would the nurse expect to find? Select all that apply.
• Involuntary limb movement • Macular rash on trunk • Tender swollen joints Explanation: Signs and symptoms of rheumatic fever include systolic murmur, involuntary limb movement, macular rash on the trunk, tender swollen joints, and subcutaneous nodules.
The nurse is implementing the plan of care for a child with acute rheumatic fever. Which of the following would the nurse expect to administer if ordered? Select all that apply.
• Non-steroidal anti-inflammatory drugs • Penicillin • Corticosteroids Explanation: A full 10-day course of penicillin or equivalent is used. Corticosteroids are used as part of the treatment for acute rheumatic fever. Non-steroidal anti-inflammatory drugs are used as part of the treatment for acute rheumatic fever.
The nurse is reviewing the health history and physical examination of a child diagnosed with heart failure. Which of the following would the nurse expect to find? Select all that apply.
• Shortness of breath when playing • Crackles on lung auscultation • Tiring easily when eating Explanation: Manifestations of heart failure include difficulty feeding or eating or becoming tired easily when feeding or eating, shortness of breath with exercise intolerance, crackles and wheezes on lung auscultation, tachycardia, and hypotension.
Caring for a newborn with a cleft lip and palate before surgical repair includes:
Providing satisfaction of sucking needs. Using special or modified nipples for feeding techniques helps to meet the infant's sucking needs. Gastrostomy feedings are usually not indicated. Feeding is best accomplished with the infant's head in an upright position. The child requires both nutritive and nonnutritive sucking.
The nurse is assessing the past medical history of an infant with a suspected cardiovascular disorder. Which of the following responses by the mother warrants further investigation?
"I am on a low dose of steroids" Explanation: Some medications, like corticosteroids, taken by pregnant women may be linked with the development of congenital heart defects. Reports of nausea during pregnancy and an Apgar score of eight would not trigger further questions. Febrile illness during the first trimester, not the third, may be linked to an increased risk of congenital heart defects.
The nurse is caring for a 2-year-old boy with an umbilical hernia and is teaching the mother about this condition. Which response from the mother indicates a need for further teaching?
"I can tape a quarter over the hernia to reduce it."
The nurse is preparing an adolescent for discharge after a cardiac catheterization. Which statement by the adolescent would indicate a need for further teaching?
"I have to stay on strict bed rest for 3 days." The child does not need to be on strict bed rest for 3 days. Showers are recommended; children should avoid a tub bath. The pressure dressing is removed the day after the catheterization and replaced by an adhesive bandage to keep the area clean. Strenuous activity must be avoided for several days, but the child can return to school.
The nurse is taking a health history of a 6-week-old boy with a suspected cardiovascular disorder. Which response by the mother would lead the nurse to suspect that the child is experiencing heart failure?
"He gets sweaty when he eats."
The condition in which one or both of the testes does not descend in the male infant is referred to as:
Cryptorchidism
A child is scheduled for a urea breath test. The nurse understands that this test is being performed for which reason?
Detect Helicobacter pylori
In caring for an infant diagnosed with pyloric stenosis, the nurse would anticipate that she would:
Prepare the infant for surgery.
A preschool child is scheduled for an echocardiogram. Parents ask the nurse whether they can hold the child during the procedure. The nurse should answer with which response?
"Your child must lie quietly; sometimes a mild sedative is administered before the procedure." Although an echocardiogram is noninvasive, painless, and associated with no known side effects, it can be stressful for children. The child must lie quietly in the standard echocardiographic positions; crying, nursing, being held, or sitting up often leads to diagnostic errors or omissions.
A child is having surgery for a congenital heart defect. The parent asks about their 1-year-old's growth and developmental delays and what they can expect after surgery. What is the best response by the nurse?
"After surgery, most children will catch up." Explanation: A child with a congenital heart defect who has growth and developmental delays will usually catch up after the defect is fixed. There is no way of predicting exactly what each child will do and it is not appropriate to tell a parent that these delays are permanent when that is unknown until the defect is corrected by surgery.
The nurse is caring for an 8-week-old male who has just been diagnosed with Hirschsprung disease. The parents ask what they should expect. Select the nurse's best response.
"Although your child will require surgery, there are different ways to manage the disease, depending on how much bowel is involved." Rationale: The aganglionic portion needs to be removed. Although most children have a temporary colostomy placed, many infants can bypass the colostomy and have the bowel immediately reattached.
The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with rheumatic fever. The nurses in the group make the following statements. Which statement is most accurate regarding rheumatic fever?
"Children who have this diagnosis may have had strep throat." Explanation: Rheumatic fever is precipitated by a streptococcal infection, such as strep throat, tonsillitis, scarlet fever, or pharyngitis, which may be undiagnosed or untreated. Rheumatic fever is a chronic disease of childhood, affecting the connective tissue of the heart, joints, lungs, and brain. There is no immunization to prevent rheumatic fever. The onset of rheumatic fever is often slow and subtle.
The caregiver of a 1-year-old son calls the nurse, upset that his wife has just told him that their son is being given a hormone. His wife says that the pediatrician called it human chorionic gonadotropic hormone but that is all she understood. The nurse most accurately clarifies the caregiver's question by making which statement regarding the son's treatment?
"The doctor is hoping that the hormone will cause your son's undropped testes to move into their proper place." Explanation: Shortly before or soon after birth, the male gonads (testes) descend from the abdominal cavity into their normal position in the scrotum. Occasionally one or both of the testes do not descend, which is a condition called cryptorchidism. The testes are usually normal in size; the cause for failure to descend is not clearly understood. A surgical procedure called orchiopexy is used to bring the testes down into the scrotum and anchor them there. Some physicians prefer to try medical treatment such as injections of human chorionic gonadotropic hormone before doing surgery. If this is unsuccessful in bringing down the testes, orchiopexy is performed. If both testes remain undescended, the male will be sterile. If the processus does not close, fluid from the peritoneal cavity passes through, causing hydrocele. If the hydrocele remains by the end of the first year, corrective surgery is performed.
The nurse is caring for a 5-month-old infant with a diagnosis of intussusception. The infant has periods of irritability during which the knees are brought to chest and the infant cries, alternating with periods of lethargy. Vital signs are stable and within age-appropriate limits. The physician elects to give an enema. The parents ask the purpose of the enema. Select the nurse's most appropriate response.
"The enema will help confirm the diagnosis and has a good chance of fixing the intussusception."
The nurse is providing child and family education prior to discharge following a cardiac catheterization. The nurse is teaching about the signs and symptoms of complications. Which statement by the mother indicates a need for further teaching?
"The feeling of the heart skipping a beat is common." Explanation: Reports of heart "fluttering" or "skipping a beat" should be reported to the doctor as this can be a sign of a complication. This statement is appropriate because tub baths should be avoided for about 3 days. This statement is appropriate because strenuous activity is limited to about 3 days. Changes in skin color or difficulty breathing indicate potential complications that need to be reported
The parents of a newborn diagnosed with a cleft lip and palate ask the nurse when their child's lip and palate will most likely be repaired. Select the nurse's best response.
"The lip is repaired in the first few weeks of life, but the palate is not usually repaired until the child is 18 months old."
The parents of a 2-year-old toddler newly diagnosed with tricuspid atresia ask the nurse, "I do not understand why our toddler's fingertips are spread out and rounder than normal fingertips?" Which response by the nurse is best?
"The low blood oxygen levels from the heart defect cause the lack of oxygen to the fingers, causing these changes."
A 6-week-old male is scheduled for hypospadias and chordee repair. The parent tells the nurse, "I understand why the hypospadias repair is necessary, but do they have to fix the chordee as well?" What is the nurse's best response?
"The repair is done to optimize his sexual function when he is older."
What is the most appropriate nursing response to the father of a newborn infant with myelomeningocele who asks about the cause of this condition?
"There may be no definitive cause identified." The etiology of most neural tube defects is unknown in most cases. There may be a genetic predisposition or a viral origin, and the disorder has been linked to maternal folic acid deficiency; however, the actual cause has not been determined. There is no evidence that children who have parents with spinal problems are at greater risk for neural tube defects. p1581
The nurse provides education to the parent of an infant being treated for hydrocephalus with a ventriculoperitoneal (VP) shunt. Which statement by the parent indicates the need for further instruction?
"This shunt is the only surgery my baby will need."
A nurse is teaching the parents of a child diagnosed with rheumatic fever about prescribed drug therapy. Which statement would indicate to the nurse that additional teaching is needed?
"We can stop the penicillin when her symptoms disappear." Explanation: For a child with rheumatic fever, drug therapy must be given for the full 10 to 14 days to ensure complete eradication of the infection. The drug must not be stopped when the signs and symptoms disappear. To prevent recurrent attacks, prophylactic antibiotic therapy is prescribed for at least 5 years or until the child is 18 years old. Additional prophylactic therapy should be instituted when dental or tonsillar surgery is planned.
The nurse is caring for a 7-year-old who is being discharged following surgery with a Gore® Helex device to repair an atrial septal defect. The parents of the child demonstrate understanding of the procedure with which statements? Select all that apply.
"We will be sure to not allow our child to ride a bicycle for at least 2 weeks." "We will be sure to monitor our child for any signs of infection and notify the doctor if we notice any." "We know how important our child's medications are so we will write out a schedule to be sure medications are taken as prescribed."
After teaching the parents of an infant with clubfoot requiring the application of a plaster cast and how to care for the cast, which of the following statements would indicate that the parents have understood the teaching?
"We will check the color and temperature of the toes of the casted leg frequently."
The nurse is talking to a parent of an infant with heart failure about feeding the infant. Which statement about feeding the child is correct?
"You may need to increase the caloric density of your infant's formula."
The nurse is caring for a pediatric client diagnosed with tetralogy of Fallot. After speaking with the physician, the parents stated to the nurse, "The doctor said something about our child having too many red blood cells. We don't understand how that could happen?" What is the best response by the nurse?
"Your child's body is trying to compensate for the low blood oxygen levels from the heart defect by making more red blood cells, but this makes the heart actually work harder."
The nurse receives a call from the mother of a 6-month-old who describes her child as alternately sleepy and fussy. She states that her infant vomited once this morning and had two episodes of diarrhea. The last episode contained mucus and a small amount of blood. She asks the nurse what she should do. Select the nurse's best response.
"Your infant will need to have some tests in the emergency room to determine if anything serious is going on." Rationale: The infant is displaying signs of intussusception. This is an emergency that needs to be evaluated to prevent is- chemia and perforation.
Rheumatic Fever
- Inflammatory disorder of the connective tissue Cause: - Group A beta-hemolytic streptococci (some parents will get antibiotics for one child and split the prescription for both kids) Clinical manifestations Rash (very common), carditis (infection of the heart, joint inflammation, neuro-facial grimacing- affecting the brain). Dx. by a positive throat culture & 2 or + of these symptoms: - Heart - Joints - Brain - Skin Rheumatic Fever: Treatment - Antibiotics (Penicillin) to eradicate strep infection. - Aspirin to treat carditis and inflammation. - Steroids - Long-term antibiotic prophylaxis - Most children recover fully Rheumatic Fever: Nursing Management - Prevention (throat cultures, completion of antibiotics) - Monitor temperature. - Bed rest. - Administer medications. - Home teaching
Cyanosis related to congenital heart
- Pulse oximetry" amount of oxygen available for tissue delivery. (Cyanosis is seen when O2 sat drops to less than 79% in a neonate; O2 should be above 94%) - Normal vs hypoxic levels - Response to chronic hypoxia: polycythemia. (the body responds to hypoxia by having the bone marrow produce more red blood cells, which increases the body's hemoglobin level) TGA- Transposition of the great arteries - everything is Transposed (switched places) Main sign: As soon as the baby is born, it becomes cyanotic, is given O2, and does not improve. Manifestations: - Cyanosis - Tachypnea (labored) - CHF - Poor Feeding - Cold extremities - Low O2 ****If no surgical repair within the first week of life, usually the child does not survive****. - The prognosis depends on if the child goes into CHF...some may be ok. - Children with TGA may need pacemakers because arrhythmias can be a complication. - Parallel circulation - life-threatening at birth - Mixing can occur via PDA, Patent foramen ovale (PFO), ASD, or VSD Correction - Give IV Prostaglandin E1 to keep/maintain PDA open. - Balloon atrial septostomy to enlarge PFO (creates ASD) Surgical repair within the first week of life Prostaglandins
The nurse is caring for a newborn following delivery who has been diagnosed with gastroschisis. Which actions by the nurse indicated knowledge of appropriate care for this disorder?
- The nurse assesses the color of the newborns abdominal organs - The nurse places the newborn in a radiant warmer to maintain the newborn's temperature - The nurse closely monitors the hydration status of the newborn for signs of dehydration
The nurse is conducting discharge teaching about signs and symptoms of heart failure to parents of an infant with a repaired tetralogy of Fallot. Which signs and symptoms should the nurse include? Select all that apply.
Decreased urinary output Sweating (inappropriate) Fatigue The signs and symptoms of heart failure include decreased urinary output, sweating, and fatigue. Other signs include pale, cool extremities, not warm and flushed, and weight gain, not weight loss.
Which plan would be appropriate in helping to control congestive heart failure (CHF) in an infant?
Feeding in semi-Fowler position The infant has a great deal of difficulty feeding with CHF, so even getting the maintenance fluids is a challenge. The infant is fed in the more upright position so fluid in the lungs can go to the base of the lungs, allowing better expansion.
The nurse is assessing a 6-week-old at a pediatrician's appointment. What objective data gathered by the nurse indicates a diagnosis of possible developmental dysplasia of the hip? Select all that apply
Apparent shortening of the femur Limited abduction of the affected hip Asymmetry of the gluteal skin folds
Immediately after birth, the nurse is caring for a newborn with a myelomeningocele. What intervention should the nurse provide to prevent drying out of the sac to avoid damage?
Apply a sterile dressing moistened in a warm, sterile saline solution.
The nurse is explaining the possible side effects of corticosteroids to the caregiver of a child diagnosed with rheumatic fever. The caregiver comments, "I don't understand what hirsutism means." The nurse would be correct in explaining that hirsutism is which of the following?
Abnormal hair growth Explanation: The child whose pain is not controlled with salicylates is given corticosteroids. Side effects such as hirsutism (abnormal hair growth) and "moon face" may be noted. Facial grimaces and repetitive involuntary movements are symptoms of chorea.
A 6-year-old child with hydrocephalus had a ventriculoperitoneal (VP) shunt placed 6 weeks ago and now has experienced a seizure, vomiting, and loss of appetite. Which intervention will target the child's priority need?
Administer intravenous antibiotics as prescribed. The major complications associated with shunts are infection and malfunction. When a shunt malfunctions the child experiences vomiting, drowsiness, and headache. When infection has occurred the child experiences increased vital signs, poor feeding, vomiting, decreased responsiveness, seizure activity, and signs of local inflammation along the shunt tract. When an infection occurs the priority of care is to treat the infection with IV antibiotics. The seizures and the poor eating will resolve once the infection is cleared. The parents can be taught about seizure precautions and the bed can be padded but these are not the priority of care.
The nurse is caring for a newborn who has just been diagnosed with tracheo-esophageal fistula and is scheduled for surgery. What should the nurse expect to do in the pre-operative period?
Administer intravenous fluids and antibiotics. Rationale: Intravenous fluids are administered to prevent dehydration because the infant is NPO. Intravenous antibiotics are administered to prevent pneumonia because aspiration of secretions is likely.
To prevent infective endocarditis in the child with an artificial heart valve, the nurse teaches parents to:
Administer prophylactic antibiotics before dental work. Dental procedures may allow organisms to enter the child's bloodstream and grow on the artificial valve. This makes excellent oral hygiene also important. Unexplained fevers should be discussed with the child's healthcare provider and not automatically treated at home. Raw fruits and vegetables and household pets are not a particular threat to this child.
An important nursing consideration when suctioning a young child who has had heart surgery is to:
Administer supplemental oxygen before and after suctioning.
The nurse is admitting a child with rheumatic fever. Which therapeutic management should the nurse expect to implement?
Administering penicillin The goal of medical management is the eradication of the hemolytic streptococci. Penicillin is the drug of choice. Salicylates can be used to control the inflammatory process, especially in the joints, and reduce the fever and discomfort. Bed rest is recommended for the acute febrile stage, but it does not need to be strict. The chorea is transient and will resolve without treatment.
The nurse is preparing to care for an infant returning from pyloromyotomy surgery. Which prescribed orders should the nurse anticipate implementing? Select all that apply.
Administration of analgesics for pain Intravenous (IV) fluids continued until tolerating fluids by mouth Clear liquids as the first feeding Feedings are usually instituted soon after a pyloromyotomy surgery, beginning with clear liquids and advancing to formula or breast milk as tolerated. IV fluids are administered until the infant is taking and retaining adequate amounts by mouth. Appropriate analgesics should be given around the clock because pain is continuous. Ice should not be applied to the incisional area as it vasoconstricts and would reduce circulation to the incisional area and impair healing.
Gastroesophageal Reflux (GERD)
Affects 50% of all children Lower esophageal sphincter relaxes Allows passive regurgitation of stomach contents into esophagus May also enter the airway causing Risk of aspiration Cells in the esophagus exposed to stomach cells (through acid) can cause cancer over time Tums and overtime proton pump inhibitor If severe, may see esophagitis, poor waking, cough (may turn respiratory), and delays in growth due to not keeping food down. They may grow out of it. Serious manifestation of GERD-affects 1 in 300 infants Gastroesophageal Reflux Disease: Poor weight gain Esophagitis Persistent respiratory symptoms due to cough Requires treatment Treated the same way as an adult - can see poor weight gain, esophagitis may look like respiratory symptoms with cough. Manage with meds but as the child grows they usually grow out of it IMPORTANT: Protect the esophagus
What is the appropriate priority nursing action for the infant with a CHD who has an increased respiratory rate, is sweating, and is not feeding well?
Alert the physician These are signs of early congestive heart failure, and the physician should be notified. Although rechecking blood pressure may be indicated, it is not the priority action. Withholding the infant's feeding is an incomplete response to the problem. Increasing oxygen may alleviate symptoms; however, medications such as digoxin and furosemide are necessary to improve heart function and fluid retention. Notifying the physician is the priority nursing action.
When assessing a child for possible congenital heart defects (CHDs), where should the nurse measure blood pressure?
All four extremities When a CHD is suspected, the blood pressure should be measured in all four extremities while the child is quiet. Discrepancies between the upper and lower extremities may indicate cardiac disease. Blood pressure measurements for the upper and lower extremities are compared during an assessment for CHDs. Blood pressure measurements when the child is crying are likely to be elevated; thus the readings will be inaccurate.
Which interventions decrease cardiac demands in an infant with congestive heart failure (CHF)? SATA
Allow parents to hold and rock their child Make frequent position changes Feed the child when sucking the fists Change bed linens only when necessary Organize nursing activities
An 8-year-old girl presents with drooling and a complaint of painful swallowing. She has a high fever and is lethargic. On examination, the nurse sees that her palatine tonsils are bright red and swollen. The girl's mother says that she has never had these symptoms before. A throat culture indicates a streptococcus infection. What is the course of treatment that the nurse would expect in this situation?
Antipyretic, analgesic, and antibiotic.
A child is diagnosed with intussusception. The nurse anticipates that what action would be attempted first to reduce this condition?
Barium enema
Which health care provider assessment technique does the nurse anticipate being used to determine developmental dysplasia of the hip (DDH) on a newborn?
Barlow sign and Ortolani click
Developmental dysplasia of the hip and Compartment syndrome
Conditions that include hip instability, dislocation, subluxation, and dysplasia Genetic/maternal factors - Twins, improper positioning, or congenital. - Put them on their belly and look at their gluteal fold - Barlow and Ortolani test (legs) Clinical manifestations - click, pop, rub, grind with Barlow/Ortolani - a click may indicate a problem Treatment Early treatment: - use of Plavik Harness - less than 3 months of age may help (take off bath time then put it back on) - Cat scans before determining treatment - Impaired skin integrity if too tight- put finger beneath it Clothing with harness: - Clothing goes over it (NCLEX) never put clothing under it! Surgery with a closed reduction with a spica cast( if the harness does not work): - immobility, impaired skin integrity, the cast must remain dry, nothing under it. - will need special car seats for the child to go in the car Assess for compartment syndrome: 1. Pain: may involve the entire leg & foot. 2. Pallor (pale skin tone) 3. Paresthesia (numbness): may involve the entire leg & foot. 4. Pulselessness (faint pulse) 5. Paralysis (weakness with movements). May see some edema, as long as pulses are strong, good capillary refill, just elevate the extremity - skin is warm (good)
Hypospadias and Epispadias
Congenital anomalies involving the abnormal location of the urethral meatus IMPORTANT TO RUN ADDITIONAL GENETIC TESTS - **seen in clubfoot and cleft lip. Hypospadias: - the meatal opening can be located anywhere along the ventral (FRONT) surface of the penile shaft Epispadias: - the meatal opening is located on the dorsal (BACK) surface of the penile shaft Postpone circumcision/Surgery - MAY USE NERVE BLOCK FOR SURGERY INSTEAD OF GENERAL ANESTHESIA. Post-operative nursing care May do scans before the procedure- circumcision will have to be postponed to the day of surgery because the foreskin will be used to help with repair. May use nerve blocks instead of general anesthesia. Post-care: - Must void before discharge - May need a urethral stent to maintain patency of the canal. - May see blood-tinged urine for up to several days due to the stent. - Bright red blood/Frank blood: call the provider right away. - Explain to parents the difference between blood-tinged to frank urine. Surgical site: - frequent diaper changes, no pressure on the penis when holding the baby, not putting them on the hip - put another arm under their knees.
Hirschsprung disease (Congenital Aganglionic Megacolon)
Congenital anomaly; genetic basis (RET protooncogene) Part of the large intestine lacks parasympathetic innervation- the absence of ganglion cells Usually in the recto-sigmoid region of the colon Results in Inadequate motility Obstruction of the intestine Clinical manifestations: - must pass meconium - if not within the first 12 to 24 hours, must check for Hischsprung disease. - warning sign in child -Constipation - main sign!!! - bilious vomit (due to no meconium) if continues to feed. immediate surgery! - There is no nerve to create peristalsis - surgery to remove the affected area and then reattach it. - as it will never work. May need colostomy - dark/dusty: report it. Check skin breakdown and stoma necrosis. A biopsy would show no ganglion cells. - Risk? - Parent teaching?
The nurse is caring for a 9-month-old who was born with a congenital heart defect (CHD). Assessment reveals an HR of 160, capillary refill of 4 seconds, bilateral crackles, and sweat on the scalp. These are signs of _______________________.
Congestive Heart Failure (CHF).
Which clinical manifestations would the nurse expect to see as shock progresses in a child and becomes decompensated shock? Select all that apply.
Cool extremities and decreased skin turgor Confusion and somnolence Tachypnea and Poor capillary refill time
What is used to treat moderate-to-severe inflammatory bowel disease?
Corticosteroids such as prednisone and prednisolone are used in short bursts to suppress the inflammatory response in inflammatory bowel disease. Antacids and antidiarrheals are not drugs of choice to treat the inflammatory process of inflammatory bowel disease. Antibiotics may be used as adjunctive therapy to treat complications.
The nurse is caring for an infant with myelomeningocele scheduled for surgical closure in the morning. Which interventions should the nurse plan for the care of the myelomeningocele sac?
Covered with a sterile, moist, non-adherent dressing
The parents of a newborn are struggling with the news that their infant has spina bifida. Which technique should the nurse prioritize teaching to the parents that will help increase the infant's comfort and development?
Cuddle the baby in a chest-to-chest position.
The nurse is providing care to a child with an intussusception. The child has a bowel movement and the nurse inspects the stool. The nurse would most likely document the stool's appearance as having what quality?
Currant jelly-like
The nurse is assessing a child with spina bifida occulta. During the assessment, the parents say, "It's going to be so difficult taking care of our child. He'll never be able to walk." The nurse identifies which nursing diagnosis as the priority?
Deficient knowledge related to diagnosis and condition Explanation: The parents' statement indicates a lack of understanding about the condition. Spina bifida is a term that is often used to refer to all neural tube disorders that affect the spinal cord. This can be confusing and a cause of concern for parents. There are well-defined degrees of spinal cord involvement, and it is important for healthcare professionals to use the correct terminology. Spina bifida occulta is a defect of the vertebral bodies without protrusion of the spinal cord or meninges. This defect is not visible externally and in most cases has no adverse affects. In most cases, spina bifida occulta is benign and asymptomatic and produces no neurologic signs; it may be considered a normal variant. Mobility typically is not impaired with spina bifida occulta. The child is at no greater risk for injury as any other child. The parents demonstrate a lack of knowledge, not problems with coping.
What is an expected assessment finding in a child with coarctation of the aorta?
Disparity in blood pressure between the upper and lower extremities
Orchiopexy - undescendent testicle surgery
Done before the child is 1 year of age The longer they remain up in the abdomen they are exposed to high temperatures - the risk of infertility and cancer due to high heat Quick outpatient procedure- same day/ in and out. In the diaper area, more challenging to heal can increase the risk of bacterial growth and infection Frequent diaper changes, open diaper on top to let air in, keep the site dry and clean Hold the child carefully, do not put pressure on the surgical incision. Teach signs and symptoms of infection: - sudden fever call right away. Pain Management: - Tylenol and Motrin - When picking them up, hold their legs together, don't hold them by the hip area.
Early and Late Signs of Congestive Heart Failure
Early Signs of CHF: Infants - First sign: Tiring during feeding - Weight loss (or lack of weight gain) - Diaphoresis - sweating - Frequent infections Early Signs of CHF: Children - Exercise intolerance. - Dyspnea - Abdominal pain - Peripheral edema Late Signs of CHF - Respiratory symptoms - Tachypnea, Tachycardia - Nasal flaring - Grunting - Retractions - Cough - Crackles - Generalized fluid overload - Cardiomegaly - trying to enhance perfusion
The nurse is caring for a child admitted with gastroesophageal reflux (GERD). Which clinical manifestation would likely be seen in this child?
Effortless vomiting just after the child has eaten
The nurse will apply which type of restraint for the infant recovering from cleft lip repair?
Elbow
The nurse is caring for a neonate with a suspected tracheoesophageal fistula. Nursing care should include:
Elevating the head but giving nothing by mouth. When a newborn is suspected of having a tracheoesophageal fistula, the most desirable position is supine with the head elevated on an inclined plane of at least 30 degrees. Any source of aspiration must be removed at once; oral feedings are withheld. Feedings of fluids should not be given to infants suspected of having tracheoesophageal fistulas. The oral pharynx should be kept clear of secretion by oral suctioning. This is to avoid the cyanosis that is usually the result of laryngospasm caused by the overflow of saliva into the larynx.
The parents of an infant born with clubfoot express feelings of guilt and anxiety about their child's condition. What is the nurse's most appropriate intervention?
Encourage discussion of their feelings
A newborn was admitted to the nursery with a complete bilateral cleft lip and palate. The physician explained the plan of therapy and its expected good results. However, the mother refuses to see or hold her baby. The initial therapeutic approach to the mother should be to:
Encourage her to express her feelings. For parents, cleft lip and cleft palate deformities are particularly disturbing. The nurse must place emphasis not only on the infant's physical needs but also on the parent's emotional needs. The mother needs to be able to express her feelings before the acceptance of her child can occur. Although discussing plastic surgery will be addressed, it is not part of the initial therapeutic approach. As the mother expresses her feelings, the nurse's actions should convey to the parents that the infant is a precious human being. The child's normalcy is emphasized, and the mother is assisted in recognizing the child's uniqueness. A focus on abnormal maternal-infant attachment would be inappropriate at this time.
A school nurse is trying to prevent post-streptococcal glomerulonephritis in children. What would be the best way to prevent this?
Encourage the child to take all the antibiotics if diagnosed with strep throat.
A mother who intended to breastfeed has given birth to an infant with a cleft palate. Nursing interventions should include. Select all that apply:
Encouraging and helping the mother to breastfeed. Recommending the use of a breast pump to maintain lactation until the infant can suck.
The labor and delivery nurse is caring for a mother who has demonstrated polyhydramnios upon delivery. The newborn displays copious, frothy bubbles of mucus in the mouth and nose, as well as drooling. The nurse is concerned that the infant has what disorder?
Esophageal atresia Explanation: Esophageal atresia refers to a congenitally interrupted esophagus where the proximal and distal ends do not communicate; the upper esophageal segment ends in a blind pouch and the lower segment ends a variable distance above the diaphragm. Polyhydramnios is often the first sign of esophageal atresia because the fetus cannot swallow and absorb amniotic fluid in utero, leading to accumulation. Oomphalacele and gastroschisis are congenital anomalies of the anterior abdominal wall. Hiatal hernia involves a weakened diaphragm.
The nurse is collecting data on a 5-year-old child admitted with the diagnosis of congestive heart failure. Which of the following clinical manifestations would likely have been noted in the child with this diagnosis?
Failure to gain weight Explanation: In infants and older children, one of the first signs of CHF is tachycardia. Other signs of CHF often seen in older children include failure to gain weight, weakness, fatigue, restlessness, irritability, and a pale, mottled, or cyanotic color. Rapid respirations or tachypnea, dyspnea, and coughing with bloody sputum also are seen. Edema and enlargement of the liver and heart may be present. Jerking movements indicate seizure activity. Scissoring of the legs is seen in cerebral palsy, and clubbing of the fingers is seen in cystic fibrosis.
Parent teaching Congestive Heart Failure
Nutritional intake - Growth is critical. - They tire very quickly when breastfeeding. - Poor intake affects their growth. - May be given OG or NG tube feeds and be kept on TPN/lipids/IV nutrition if the child will be going into surgery and start feeds later on. Psychosocial: - burden on families: - emotional, financial, access to care, multiple surgeries... - immunosuppression: careful with daycare - kids are in and out of the hospital, going into surgery - keep distance from other children - get them vaccinated as per the CDC vaccination schedule - recommend Synagis (RSV) vaccine. - Administer medications - Teach parents about the meds and times - make sure they know which med is and the time to give meds. - watch the parent draw it into the syringe because if they mix the meds up the child can die. - Promote rest, nutrition, and growth. - Maintain metabolic demands and oxygenation. - Provide emotional support. Provide Education Regarding Home Care - may need NG tube feeding, may have a nurse come to the house for it, may require frequent small feedings instead due to fatigue and to meet the metabolic demands of the body. Prevent infectious diseases - Handwashing - Minimize exposure. - RSV Prophylaxis - Synagis When to notify the physician - Something off, call right away, not acting like themselves, not feeding, any deviation - the child may be going into CHF. - Fever - Poor feeding - Vomiting - Diarrhea
The nurse is caring for a 5-year-old child with a congenital heart anomaly causing chronic cyanosis. When performing the history and physical examination, what is the nurse least likely to assess?
Obesity from overeating
A nurse manages the interdisciplinary care for an infant born with an omphalocele. What is an accurate description of the care for an omphalocele?
Obtain IV access to give fluid resuscitation and correct any electrolyte abnormalities.
Omphalocele -Abdominal Wall Defects
Omphalocele: - Umbilical ring defect with evisceration of abdominal contents into the external peritoneal sac Congenital malformation Intra-abdominal contents herniate through the umbilical cord Covered with peritoneal membrane Often associated with other anomalies Run genetic testing - Often associated with other defects (cardiac, etc). - Must correct cardiac issues first before being cleared for surgery. Best to c-section this baby - Protect baby Nursing Management: - Cover sac with wet sterile gauze - must keep peritoneal membrane wet. - Then they go into surgery. After surgery: - Keep baby in radiant warmer - belly bag allows baby- gravity - contents go in - when contents are back into the abdomen, surgeons can close them up - it could take up to a week. - Goal: protect the sac Feeding after surgery: Feedings start slow. Bonding is an issue - parents can't hold their babies - nurse must facilitate bonding Preoperative care - preventing hypothermia - maintaining perfusion to abdominal contents - protecting exposed contents from trauma and infection, - preventing intestinal distention - maintaining fluid and electrolyte balance Postoperative care parent-newborn interaction
Cryptorchidism
One or both testes fail to descend through the inguinal canal into the scrotum Can be partially descended if born premature Complications of uncorrected cryptorchidism: - infertility and malignancy Orchiopexy: - Importance of timing Nursing Management: - The exam is done by palpation
Interception: telescoping in. pain, jelly-like mucus stools, usually occurs after stomach flu. Parent teaching and post-op care.
One portion of the intestine prolapses and then invaginates (or, "telescopes") into itself Usually after stomach flu. A frequent cause of intestinal obstruction Most often in boys under 2 years of age. Extremely painful. Currant (mucus in diapers) jelly stool Results in: Obstructed blood flow Ischemia and necrosis Hemorrhage, perforation if untreated Tissue death necrosis is possible, with no peristalsis. Tachycardia Knees pulling up bilious vomiting. Try before surgery: - barium enema - sometimes it causes the intestines to telescope back out (but it can also go back in) child would be monitored. - If not - the child has to go into surgery (RESECTION) to: 1) remove the affected part 2) reattach the healthy part Some children may come out with a colostomy and then it can be reversed. NPO after surgery, then feedings start slowly. Colostomy care: - no difference in child vs adult (keep area clean) Post-surgery instructions: - Look at the incision site (likely laparoscopic), and signs of fever (infection).
The nurse is caring for an infant with congestive heart disease (CHD). The nurse should plan which intervention to decrease cardiac demands?
Organize nursing activities to allow for uninterrupted sleep. The infant requires rest and conservation of energy for feeding. Every effort is made to organize nursing activities to allow for uninterrupted periods of sleep. Whenever possible, parents are encouraged to stay with their infant to provide the holding, rocking, and cuddling that help children sleep more soundly. To minimize disturbing the infant, changing bed linens and complete bathing are done only when necessary. Feeding is planned to accommodate the infant's sleep and wake patterns. The child is fed at the first sign of hunger, such as when sucking on fists, rather than waiting until he or she cries for a bottle because the stress of crying exhausts the limited energy supply. Because infants with CHD tire easily and may sleep through feedings, smaller feedings every 3 hours may be helpful.
The nurse is obtaining the history of an infant with a suspected intestinal obstruction. Which response regarding newborn stool patterns would indicate a need for further evaluation for Hirschsprung disease?
Passed a meconium plug
A newborn is diagnosed with a congenital heart defect (CHD). The test results reveal that the lumen of the duct between the aorta and pulmonary artery remains open. This defect is knowns as ________________.
Patent Ductus Arteriosus (PDA).
Post-op spina bifida surgical care
Post-Op: - Neuro checks - Extremity checks - Signs and Symptoms of Increased ICP: - Check fontanelles: increased head circumference (ICP) - "Neuro cry" (high-pitched squeal - because it hurts to cry), irritability - refusing to feed/eat. - Irritability, headache - Monitor head circumference - Fever ANYTHING outside of the norm, call the doctor, even for a cold! Even not eating well for ONE DAY, call the doctor. If something is not right, call the doctor! - Shunt infections usually happen within 1-2 months after placement, check the incision site for redness, drainage, or puffiness - meningitis, bladder bowel incontinence. "Mind Crushed" Mental Status Changes ***earliest!! (restless, confused, problems performing normal movements and responding to questions) Irregular breathing (slow down of respirations and irregular...cheyne-stokes)*late Decerebrate or decorticate posturing or flaccid Decorticate (flexor posturing): brings upper extremities to the core of the body (middle)adduction and flexion of arms, leg rotated internally, feet flexed Decerebrate: (Extension posturing): extends upper extremities from the body *worst of the two (remember all the E's in decerebrate and think EXTEND arms)adduction and extension of arms with pronation, and feet flexed Cushing's Triad: LATE SIGN...herniation of the brain stem Increased systolic blood pressure (widening pulse pressure: increase in SBP and decrease in DBP), decreased heart rate, and abnormal breathing Increased SBP (due to body trying to get more blood to the brain...thinks it's helping) Reflex positive Babinski (toe fan out...abnormal) Unconscious LATE Seizures Headache Emesis (vomiting) without nausea projectile Deterioration of motor function (hemiplegia)...weakness on one side of the body
The nurse will soon receive a 4-month-old who has been diagnosed with intussusception. The infant is described as very lethargic with the following vital signs: T 101.8°F (38.7°C), HR 181, BP 68/38. The reporting nurse states the infant's abdomen is very rigid. Which is the most appropriate action for the receiving nurse?
Prepare to get the infant ready for immediate surgical correction.
The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes that a risk of cerebrovascular accidents (strokes) exists. An important objective to decrease this risk is to:
Prevent dehydration. In children with persistent hypoxia, polycythemia develops. Dehydration must be prevented in hypoxemic children because it potentiates the risk of strokes. Minimizing seizures, promoting cardiac output, and reducing energy expenditure will not reduce the risk of cerebrovascular accidents.
The nurse is preparing a nursing care plan for an infant who was born with spina bifida with myelomeningocele. Which nursing goal should the nurse prioritize for this child?
Preventing infection
The nurse is caring for a child admitted with pyloric stenosis. Which clinical manifestation would likely have been noted in the child with this diagnosis?
Projectile vomiting
The nurse is caring for a neonate born with a myelomeningocele. Surgery to repair the defect is scheduled for the next day. The most appropriate way to position and feed this neonate is to place him:
Prone, turn head to side, and nipple feed. In the prone position, feeding is a problem. The infant's head is turned to one side for feeding. If the child can nipple feed, no indication is present for tube feeding. Before surgery, the infant is kept in a prone position to minimize tension on the sac and risk of trauma.
Diaphragmatic hernia
Protrusion of an organ through the muscle wall of the cavity that normally contains it Types: Inguinal Diaphragmatic Umbilical: easy fix. - use a diaper to reduce it. May spontaneously resolve - if not, after the child is 2 - easily fixed through surgery. Hernias are more common in black babies than white ones. Diaphragmatic Hernia - AKA CDH (Congenital) Diagnosis in uterus Weakness in the opening of the diaphragm - abdominal organs go up through this opening of the diaphragm into the lungs causing Immediate Respiratory Distress Once the infant is born, crying pulls abdominal organs into the thorax, resulting in respiratory distress Will be taken right in for surgery - will be in the hospital for months for multiple surgeries - and will usually have other congenital issues too. Life-threatening problem Diagnosed in uterus - aka congenital diaphragmatic hernia (CDH). Highly specialized care - Cornell, etc. High acuity institution. The larger the hernia, the more difficult to manage it. May cause damage to the lungs, and will be intubated, sometimes into a special isolated vent. Echmo while (waiting for surgery). Echmo is a machine that helps the child oxygenate plus heart lung bypass. Echmo: LAST RESORT! Some kids are unable to come off Echmo. Bonding is an issue - parents are unable to pick them up. - Nurses to facilitate bonding. - Delays in growth.
The nurse is caring for a child who has been experiencing hypercyanotic episodes. Which treatments will be effective in managing them? Select all that apply.
Provide supplemental oxygen. Assist the child to a knee-chest position. If medications are used, morphine would be the narcotic of choice. With hyper-cyanotic episodes, intravenous fluids are increased not decreased.
Which structural defects constitute tetralogy of Fallot?
Pulmonic stenosis Ventricular septal defect Overriding aorta Right ventricular hypertrophy
A parent brings an infant in for poor feeding. Which of the following assessment data would most likely indicate a coarctation of the aorta?
Pulses are weaker in the lower extremities compared to the upper extremities Explanation: An infant with coarctation of the aorta has decreased systemic circulation causing this problem. Cyanosis would be associated with tetralogy of Fallot.
A mother is alarmed because her 6-week-old boy has begun vomiting almost immediately after every feeding. In the past week, the vomiting has grown more forceful, with the vomit projecting several feet from his mouth. He is always hungry again just after vomiting. At the physician's office, the nurse holds the child and gives him a bottle of water. While he drinks, she notes an olive-size lump in his right abdomen. Which condition should the nurse suspect in this child?
Pyloric stenosis
The nurse is caring for an infant with pyloric stenosis. The parent asks if any future children will likely have pyloric stenosis. Select the nurse's best response.
Pyloric stenosis can run in families, and it is more common in males.
Esophageal Atresia and Tracheoesophageal "TE" fistula
The esophagus and trachea do not develop as parallel tracts The esophagus ends as either: 1) a blind pouch: esophageal atresia 2) connected to the trachea by a fistula: TE fistula. - The child is to remain NPO since birth for both conditions. - At risk for aspiration pneumonia (producing saliva that can go into the lungs) - Surgery ASAP - Dx. ultrasound Pre-Op: Have suction equipment on hand Keep HOB elevated to minimize aspiration into the trachea Withhold oral fluids Monitor Vital Signs/I&O's Parental education and support Post-Op: Measure gastrostomy drainage TPN/Lipids Monitor respirations during feeds once oral feeding begins Facilitate bonding Teach parents how to care for gastrostomy tubes at home - S&S of infection at site and complications Nursing interventions: - suction equipment, head of bed elevated, NPO, Monitor vitals, IV, I&O's (due to IV lines)... After surgery: - NG tube for decompression: measure drainage - IV hydration nutrition: TPN and lipids Surgeon clears feeding: - do it SLOWLY! Monitor respirations during feeds. Stop feeds, check respiration, then feed 5cc, then stop and check. G tube: - teach parents of signs and symptoms of complications: skin check, keep skin dry...
When examining a child with congenital heart disease, an organ in the upper right quadrant of the abdomen can be palpated at 4 cm below the rib cage. Which of the following would most likely explain this assessment finding?
The liver increases in right-sided heart failure. Explanation: The liver increases in size due to right-sided heart failure. This is one of the cardinal signs of congestive heart failure. The spleen is in the upper left quadrant of the abdomen and would increase in size under certain circumstances, but this is asking for the upper right quadrant information.
A nurse is interviewing a mother who is about to deliver her baby. Which of the following responses would alert the nurse to a higher potential for a heart defect in the infant?
The mother states she has lupus. Explanation: Having lupus while pregnant could contribute to a congenital heart defect. Acetaminophen and sleeping do not affect a child developing a heart defect. The seizure medication can have an impact on the child having a heart defect, but not necessarily a history of seizures in the mother.