May 28th DOH review Child Health

165. The mother of a 3-year-old is concerned because her child still is insisting on a bottle at nap time and at bedtime. Which is the most appropriate suggestion to the mother? 1. Allow the bottle if it contains juice. 2. Allow the bottle if it contains water. 3. Do not allow the child to have the bottle. 4. Allow the bottle during naps but not at bedtime

165. Answer: 2 Rationale: A toddler should never be allowed to fall asleep with a bottle containing milk, juice, soda pop, sweetened water, or any other sweet liquid because of the risk of nursing (bottle-mouth) caries. If a bottle is allowed at nap time or bedtime, it should contain only water.

166. The nurse is preparing to care for a 5-year-old who has been placed in traction following a fracture of the femur. The nurse plans care, knowing that which is the most appropriate activity for this child? 1. A radio 2. A sports video 3. Large picture books 4. Crayons and a coloring book

166. Answer: 4 Rationale: In the preschooler, play is simple and imaginative and includes activities such as crayons and coloring books, puppets, felt and magnetic boards, and Play-Doh. A radio or a sports video is most appropriate for the adolescent. Large picture books are most appropriate for the infant.

167. The mother of a 3-year-old asks a clinic nurse about appropriate and safe toys for the child. The nurse should tell the mother that the most appropriate toy for a 3-year-old is which? 1. A wagon 2. A golf set 3. A farm set 4. A jack set with marbles

167. Answer: 1 Rationale: Toys for the toddler must be strong, safe, and too large to swallow or place in the ear or nose. Toddlers need supervision at all times. Push-pull toys, large balls, large crayons, large trucks, and dolls are some of the appropriate toys. A farm set, a golf set, and jacks with marbles may contain items that the child could swallow.

APGAR SCORING

: 0 - 3 - Severely Distress - CPR, PALS : 4 - 7 - Moderately Distress - suction, O2 : 8 - 10 - Healthy

Oligohydramnios

< 300ml - The child can swallow but the child cannot urinate - The child may have KIDNEY PROBLEMS

Hydramnios / Polyhydramnios

> 2000ml - The child cannot swallow but the child can urinate - The child may have Esophageal Atresia / Tracheoesophageal Fistula

Tracheoesophageal Fistula (TEF)

Congenital defect resulting in a connection between the esophagus and trachea

(Guthrie test)

PKU screening - the child should have begun ingesting milk before the test.

Phenylketonuria

Phenylalanine must be converted to Tyrosine and Melanin • Phenylalanine Hydroxylase (converting enzyme) - Phenylalanine NOT converted because there is NO converting enzyme - Phenylalanine will stay to blood (phenylalanemia) - Kidney will detect phenylalanemia and converted into ketones (musty odor urine)

Normal Amniotic Fluid:

- 800ml - 1200ml

Hirschsprung Disease

- Aganglionic Megacolon - No ganglion cells in the large intestine - Aganglionic = No peristalsis (area)

Autosomal Recessive Disorders

- Both parents are free from disorder - Unaffected - Sex is unimportant (equal chances for male and female) - 50% chances (carrier) - 25% chances (healthy) - 25% chances (disorder)

Sickle Cell

- Changes in hemoglobin from normal shape to CRESCENT shape o Hemoglobin decreases their normal functions o Decreases oxygenation, nutrition, hemolysis

Esophageal Atresia (EA)

- Closure of the esophagus

Signs and symptoms: (3) C's

- Coughing - Choking - Cyanosis - Drooling of saliva - Abdominal distension

Celiac Disease / Gluten Sensitive Enteropathy

- Having immunologic response to food with gluten

Galactosemia

- Lacking of enzyme galactose 1 phosphate uridyl transferase (GALT) - Galactose cannot be converted into glucose

CYSTIC FIBROSIS (Respiratory Mx)

- Management: o *Decrease accumulation / deposit of mucus in the lungs = CPT o **Forced expiratory technique (huffing) o Aerosolized Antibiotic / Bronchodilators = Prescribed o Oxygen (during acute phase) - nasal cannula o Lung transplantation (Positioning / Percussion / Vibration) - During morning o Flutter mucus clearance device o Hand held percussor o Vest (oscillating) o Exercise program

CYSTIC FIBROSIS ; Integumentary Mx

- Management: o Avoid exposure to hot weather (summer) = Perspirations o Skin care

Cystic Fibrosis

- Mucovisidosis (mucus with increase viscosity) - Multisystem (affected) 1. Respiratory o Increase in mucus = Lungs o Can lead to Bacterial Infection o Atelectasis / Hypoxemia / Emphysema

Management: of EA and TEF

- NPO - Upright position Preventing Aspiration - Temporary Gastrostomy - Nutrition / Feeding - Correction of Fluid and Electrolytes / Weight - Surgical Management: Anastomosis and Removal of fistulas

PROCESS OF HEAT LOSS b. Convection

- shielding the newborn from aircon / fan / air

Atresia? Fistula? Stenosis?

1. CLosure 2. Connection 3. Narrowing

Phenylalanine Normal:

1.2 to 3.4 mg/dl (blood)

157. A 4-year-old child diagnosed with leukemia is hospitalized for chemotherapy. The child is fearful of the hospitalization. Which nursing intervention should be implemented to alleviate the child's fears? 1. Encourage the child's parents to stay with the child. 2. Encourage play with other children of the same age. 3. Advise the family to visit only during the scheduled visiting hours. 4. Provide a private room, allowing the child to bring favorite toys from home.

157. Answer: 1 Rationale: Although the preschooler already may be spending some time away from parents at a day care center or preschool, illness adds a stressor that makes separation more difficult. The child may ask repeatedly when parents will be coming for a visit or may constantly want to call the parents. Options 3 and 4 increase stress related to separation anxiety. Option 2 is unrelated to the subject of the question and, in addition, may not be appropriate for a child who may be immunocompromised and at risk for infection.

158. A 16-year-old client is admitted to the hospital for acute appendicitis and an appendectomy is performed. Which nursing intervention is most appropriate to facilitate normal growth and development postoperatively? 1. Encourage the client to rest and read. 2. Encourage the parents to room in with the client. 3. Allow the family to bring in the client's favorite computer games. 4. Allow the client to interact with others in his or her same age group.

158. Answer: 4 Rationale: Adolescents often are not sure whether they want their parents with them when they are hospitalized. Because of the importance of their peer group, separation from friends is a source of anxiety. Ideally, the members of the peer group will support their ill friend. Options 1, 2, and 3 isolate the client from the peer group.

159. Which car safety device should be used for a child who is 8 years old and 4 feet tall? 1. Seat belt 2. Booster seat 3. Rear-facing convertible seat 4. Front-facing convertible seat

159. Answer: 2 Rationale: All children whose weight or height is above the forward-facing limit for their car safety seat should use a belt-positioning booster seat until the vehicle seat belt fits properly, typically when they have reached 4 feet, 9 inches in height (145 cm) and are between 8 and 12 years of age. Infants should ride in a car in a semireclined, rear-facing position in an infant-only seat or a convertible seat until they weigh at least 20 pounds (9 kg) and are at least 1 year of age. The transition point for switching to the forward-facing position is defined by the manufacturer of the convertible car safety seat but is generally at a body weight of 9 kilograms (20 pounds) and 1 year of age.

160. The nurse assesses the vital signs of a 12-month-old infant with a respiratory infection and notes that the respiratory rate is 35 breaths per minute. On the basis of this finding, which action is most appropriate? 1. Administer oxygen. 2. Document the findings. 3. Notify the pediatrician. 4. Reassess the respiratory rate in 15 minutes.

160. Answer: 2 Rationale: The normal respiratory rate in a 12-month-old infant is 20 to 40 breaths per minute. The normal apical heart rate is 90 to 130 beats per minute, and the average blood pressure is 90/56 mm Hg. The nurse would document the findings.

161. The nurse is monitoring a 3-month-old infant for signs of increased intracranial pressure. On palpation of the fontanels, the nurse notes that the anterior fontanel is soft and flat. On the basis of this finding, which nursing action is most appropriate? 1. Increase oral fluids. 2. Document the finding. 3. Notify the pediatrician. 4. Elevate the head of the bed to 90 degrees.

161. Answer: 2 Rationale: The anterior fontanel is diamond-shaped and located on the top of the head. The fontanel should be soft and flat in a normal infant, and it normally closes by 12 to 18 months of age. The nurse would document the finding because it is normal. There is no useful reason to increase oral fluids, notify the pediatrician, or elevate the head of the bed to 90 degrees.

162. The nurse is evaluating the developmental level of a 2-year-old. Which does the nurse expect to observe in this child? 1. Uses a fork to eat 2. Uses a cup to drink 3. Pours own milk into a cup 4. Uses a knife for cutting food

162. Answer: 2 Rationale: By age 2 years, the child can use a cup and spoon correctly but with some spilling. By age 3 to 4 years, the child begins to use a fork. By the end of the preschool period, the child should be able to pour milk into a cup and begin to use a knife for cutting.

163. A 2-year-old child is treated in the emergency department for a burn to the chest and abdomen. The child sustained the burn by grabbing a cup of hot coffee that was left on the kitchen counter. The nurse reviews safety principles with the parents before discharge. Which statement by the parents indicates an understanding of measures to provide safety in the home? 1. "We will be sure not to leave hot liquids unattended." 2. "I guess our children need to understand what the word hot means." 3. "We will be sure that the children stay in their rooms when we work in the kitchen." 4. "We will install a safety gate as soon as we get home so the children cannot get into the kitchen."

163. Answer: 1 Rationale: Toddlers, with their increased mobility and development of motor skills, can reach hot water or hot objects placed on counters and stoves and can reach open fires or stove burners above their eye level. The nurse should encourage parents to remain in the kitchen when preparing a meal, use the back burners on the stove, and turn pot handles inward and toward the middle of the stove. Hot liquids should never be left unattended or within the child's reach, and the toddler should always be supervised. The statements in options 2, 3, and 4 do not indicate an understanding of the principles of safety.

164. A mother arrives at a clinic with her toddler and tells the nurse that she has a difficult time getting the child to go to bed at night. What measure is most appropriate for the nurse to suggest to the mother? 1. Allow the child to set bedtime limits. 2. Allow the child to have temper tantrums. 3. Avoid letting the child nap during the day. 4. Inform child of bedtime a few minutes before it is time for bed.

164. Answer: 4 Rationale: Toddlers often resist going to bed. Bedtime protests may be reduced by establishing a consistent before-bedtime routine and enforcing consistent limits regarding the child's bedtime behavior. Informing the child of bedtime a few minutes before it is time for bed is the most appropriate option. Most toddlers take an afternoon nap and, until their second birthday, also may require a morning nap. Firm, consistent limits are needed for temper tantrums or when toddlers try stalling tactics.

169. The nurse is preparing to care for a dying client, and several family members are at the client's bedside. Which therapeutic techniques should the nurse use when communicating with the family? Select all that apply. 1. Discourage reminiscing. 2. Make the decisions for the family. 3. Encourage expression of feelings, concerns, and fears. 4. Explain everything that is happening to all family members. 5. Touch and hold the client's or family member's hand if appropriate. 6. Be honest and let the client and family know they will not be abandoned by the nurse.

169. Answer: 3, 5, 6 Rationale: The nurse must determine whether there is a spokesperson for the family and how much the client and family want to know. The nurse needs to allow the family and client the opportunity for informed choices and assist with the decision-making process if asked. The nurse should encourage expression of feelings, concerns, and fears and reminiscing. The nurse needs to be honest and let the client and family know they will not be abandoned. The nurse should touch and hold the client's or family member's hand, if appropriate.

170. An infant receives a diphtheria, tetanus, and acellular pertussis (DTaP) immunization at a well-baby clinic. The parent returns home and calls the clinic to report that the infant has developed swelling and redness at the site of injection. Which intervention should the nurse suggest to the parent? 1. Monitor the infant for a fever. 2. Bring the infant back to the clinic. 3. Apply a hot pack to the injection site. 4. Apply a cold pack to the injection site

170. Answer: 4 Rationale: On occasion, tenderness, redness, or swelling may occur at the site of the DTaP injection. This can be relieved with cold packs for the first 24 hours, followed by warm or cold compresses if the inflammation persists. Bringing the infant back to the clinic is unnecessary. Option 1 may be an appropriate intervention but is not specific to the subject of the question, a localized reaction at the injection site. Hot packs are not applied and can be harmful by causing burning of the skin.

171. A child is receiving a series of the hepatitis B vaccine and arrives at the clinic with his parent for the second dose. Before administering the vaccine, the nurse should ask the child and parent about a history of a severe allergy to which substance? 1. Eggs 2. Penicillin 3. Sulfonamides 4. A previous dose of hepatitis B vaccine or component

171. Answer: 4 Rationale: A contraindication to receiving the hepatitis B vaccine is a previous anaphylactic reaction to a previous dose of hepatitis B vaccine or to a component (aluminum hydroxide or yeast protein) of the vaccine. An allergy to eggs, penicillin, and sulfonamides is unrelated to the contraindication to receiving this vaccine.

172. A parent brings her 4-month-old infant to a well-baby clinic for immunizations. The child is up to date with the immunization schedule. The nurse should prepare to administer which immunizations to this infant? 1. Varicella, hepatitis B vaccine (HepB) 2. Diphtheria, tetanus, acellular pertussis (DTaP); measles, mumps, rubella (MMR); inactivated poliovirus vaccine (IPV) 3. MMR, Haemophilus influenzae type b (Hib), DTaP 4. DTaP, Hib, IPV, pneumococcal vaccine (PCV), rotavirus vaccine (RV)

172. Answer: 4 Rationale: DTaP, Hib, IPV, PCV, and RV are administered at 4 months of age. DTaP is administered at 2, 4, and 6 months of age; at 15 to 18 months of age; and at 4 to 6 years of age. Hib is administered at 2, 4, and 6 months of age and at 12 to 15 months of age. IPV is administered at 2, 4, and 6 months of age and at 4 to 6 years of age. PCV is administered at 2, 4, and 6 months of age and at 12 to 15 months of age. The first dose of MMR vaccine is administered at 12 to 15 months of age; the second dose is administered at 4 to 6 years of age (if the second dose was not given by 4 to 6 years of age, it should be given at the next visit). The first dose of HepB is administered at birth, the second dose is administered at 1 month of age, and the third dose is administered at 6 months of age. Varicella-zoster vaccine is administered at 12 to 15 months of age and again at 4 to 6 years of age.

173. The clinic nurse is assessing a child who is scheduled to receive a live virus vaccine (immunization). What are the general contraindications associated with receiving a live virus vaccine? Select all that apply. 1. The child has symptoms of a cold. 2. The child had a previous anaphylactic reaction to the vaccine. 3. The mother reports that the child is having intermittent episodes of diarrhea. 4. The mother reports that the child has not had an appetite and has been fussy. 5. The child has a disorder that caused a severely deficient immune system. 6. The mother reports that the child has recently been exposed to an infectious disease.

173. Answer: 2, 5 Rationale: The general contraindications for receiving live virus vaccines include a previous anaphylactic reaction to a vaccine or a component of a vaccine. In addition, live virus vaccines generally are not administered to individuals with a severely deficient immune system, individuals with a severe sensitivity to gelatin, or pregnant women. A vaccine is administered with caution to an individual with a moderate or severe acute illness, with or without fever. Options 1, 3, 4, and 6 are not contraindications to receiving a vaccine.

PRIORITIES IN NEWBORN (A - W - A - I) Airway-

A. Airway 1. Bulb Syringe o Newborn are obligatory nasal breathers o Mouth 1st

168. Which interventions are appropriate for the care of an infant? Select all that apply. 1. Provide swaddling. 2. Talk in a loud voice. 3. Provide the infant with a bottle of juice at nap time. 4. Hang mobiles with black and white contrast designs. 5. Caress the infant while bathing or during diaper changes. 6. Allow the infant to cry for at least 10 minutes before responding

Answer: 1, 4, 5 Rationale: Holding, caressing, and swaddling provide warmth and tactile stimulation for the infant. To provide auditory stimulation, the nurse should talk to the infant in a soft voice and should instruct the mother to do so also. Additional interventions include playing a music box, radio, or television, or having a ticking clock or metronome nearby. Hanging a bright shiny object in midline within 20 to 25 cm of the infant's face and hanging mobiles with contrasting colors, such as black and white, provide visual stimulation.

Kawasaki Disease

Autoimmunity - Immunoglobulin Strawberry tongue - High Fever Complication: Aneurysm in Children / MI in Children

How to use a bulb syringe?

How to use the bulb syringe? (in order) a. Position: Side lying b. Compress the bulb c. Decompress the bulb (mouth) d. Compress the bulb e. Decompress the bulb (nose)

Pyloric Stenosis

Hypertrophy of the muscle surrounding the pyloric sphincter

Intussusception

Invagination of one intestine to another

TOF squatting

Knee Chest Position / Squatting Position

Intussusception Mx

Management: o Barium enema o Pneumatic insufflation o Surgery: ***** Anastomosis

Acrocyanosis i.e usually reason for a APGar of 9

Temporary cyanotic condition, usually in newborns resulting in a bluish color around the lips, hands and fingernails, feet and toenails. May last for a few hours and disappear with warming.

sickle cell crisis

Worsening of Symptoms o *Vaso-occlusion = pain (head, chest, body, PRIAPISM) § Priapism - painful erection (muscle relaxant, aspiration of blood) § MOST painful crisis o Sequestration - pooling of blood (splenomegaly) o Aplastic crisis - decrease production RBC and other blood components o Hyperhemolytic - increase destruction if RBC

CELIAC DISEASE SIGNS AND SYMPTOMS

o Manifestations between 1 - 5 years old o Abdominal distention o Steatorrhea - Fatty stool o Vitamin A-D-E-K deficiency o Malnutrition

Galactosemia Management

o NO milk including breast milk o Lactose free / Galactose free formula o Special formula: Nutramigen

PKU signs and symptoms

o Nausea and vomiting o Seizures o Eczema o Blond hair o Blue eyes o Hyperactive behavior o Hypertonia

The APGAR scoring system is useful in determining:

activity, pulse, grimace, appearance, respiration

intussusception s/s

o Pain - drawing up of legs & crying o Sausage shaped mass (URQ) o Vomiting - with bile o Currant jelly stool - Mucoid stool o Abdominal distention

Tetralogy of Fallot Cyanotic Defect - Right to Left Shunting *HYPERCYANOTIC spell - "Blue Baby" What are the four distinct heart defects?

congenital malformation involving four distinct heart defects (4) Defects P - R - O - V 1. Pulmonary Stenosis (2) 2. Right Ventricular hypertrophy (4) 3. Overriding of Aorta (3) 4. VSD (1)

PRIORITIES IN NEWBORN (A - W - A - I) 2. WARMING

o Preventing Cold stress / Hypothermia o Swaddling § *Effective for addicted newborn (irritability) o Source of heat: § Brown fats o Newborn are NOT capable of shivering

pyloric stenosis s/s

o Projectile vomiting immediately after feeding (sour, no bile) - Across the room o Olive shaped mass o DHN

PROCESS OF HEAT LOSS c. Evaporation

drying the newborn / wrapping the newborn (bonnet)

PROCESS OF HEAT LOSS d. Radiation

keep away the windows, walls, ceilings

Sweat Test ... Cystic Fibrosis

measurement of the amount of salt (sodium chloride) in sweat. o **Pilocarpine Iontoporesis / Quantitative Sweat Chloride Test o Sweat (75mg) if the CL is > 69 meq/L = (+) Cystic Fibrosis

Galactosemia complication

o *Cataract

CYSTIC FIBROSIS : (GI S&S)

o *Meconium ileus - tenacious meconium (1st sign) o Intestinal obstruction o Abdominal distention o Abdominal pain o Malnutrition / Steatorrhea / Vitamin A-D-E-K o Bruising and Bleeding, Hypoalbuminemia = Edema o **Risk to have DM

Hirschsprung Disease Mx

o *Temporary Colostomy - Evacuation of stool o Correct the Fluid, Electrolytes and Weight / Nutrition o Biopsy is done to check for Aganglionic area o Surgical management: Pull through

CYSTIC FIBROSIS ; Integumentary S & S

o Abnormal release of NA and CL into skin = Salty o **Pilocarpine Iontoporesis / Quantitative Sweat Chloride Test o Sweat (75mg) if the CL is > 69 meq/L = (+) Cystic Fibrosis

Hirschsprung Disease S & s

o Chronic constipation (delayed meconium) o *Ribbon like stool (flat stool) o Abdominal distention

Management: Pyloric Stenosis

o Correction of Electrolyte imbalance, Dehydration, Nutrition, Weight o Pyloromyotomy / Fredet Ramsteat Procedure

Priorities in Newborn. Airway - How to use a French Catheter?

o Deeper suctioning o Respiratory distress, MAS o Mouth 1st o Intermittent o Circular o Upon removal o Gentle and quick o Time: 5 - 10 secs max 15 sec for Oro/Nasopharyngeal § *10 secs maximum for Tracheostomy suctioning

Galactosemia S & S

o Diarrhea and Vomiting o Lethargy o Jaundice o Hypotonia

CYSTIC FIBROSIS : Gastrointestinal Mx

o Diet: High protein and High calorie o Give Vitamin A-D-E-K supplements o **Pancreatic enzyme (Cotazym / Pancreatin) = WITH FOODS / MEALS o Colostomy may be considered!

CYSTIC FIBROSIS: Reproductive S & S

o Female - Delayed (growth, development, puberty) o Male - Sterility (problems in spermatogenesis)

CYSTIC FIBROSIS: Reproductive Mx

o Genetic counselling

Management of Celiac Disease

o Gluten free food (for life) o Vitamin supplements o Not allowed: B - R - O - W (Barley, Rye, Oat, Wheat) Ex: Birthday Party: Commercially prepared ice cream, pudding, cake, bread rolls, cookies, crackers, pasta, macaroni, preserves, beers.

sickle cell management

o Goal: Prevent the cell from SICKLING o *Hydration (IV, Oral) o Avoid activities with high O2 demand (contact sports, avoid places with high altitude) o Position: extended (comfortable) o Pain medication: Analgesic (Acetaminophen, Opioids) o Diet: High protein, Calorie, Folic acid

sickle cell- Signs and symptoms:

o Jaundice / Yellow sclera - Increase Bilirubin (destruction) o Pain (severe pain different body parts) o Vomiting o Enlarged spleen

PKU management

o Low phenylalanine diet o Low protein and dairy (including fish) o *Special formula = Lofenalac o Complication: Mental Retardation

PROCESS OF HEAT LOSS a. CONDUCTION

use padding on the surface (weighing scale)

Heat loss / Hypothermia S& S

§ Increase RR § Bradycardia § Hypoglycemia § Acidosis • *Using radiant warmer / Heat lamp / Kangaroo Care (KC)

CELIAC DISEASE ; FOOD Allowed:

§ Rice cake, cassava cake, beef, pork, fish and eggs, vegies, rice, *corn

complications of prolonged suctioning

• Hypoxia • Laryngospasm • Bradycardia - vagal nerve stimulation