Ped 2 Notes

when does birth weight triple?

12 months

Types of diarrhea?

- Acute - Chronic - Chronic nonspecific diarrhea (CNSD)

The nurse is preparing to admit a 7-year-old child with an upper motor neuron syndrome. What clinical manifestations of an upper motor neuron syndrome should the nurse expect to observe? (Select all that apply.)

- Babinski reflex present - No wasting of muscle mass - Hyperreflexia with tendon reflexes exaggerated

7 yr old psychosocial development that requires further evaluation

- Child complains daily about going to school

Autoimmune hypoparathyroidism

- Deficient production of PTH

Management for constipation?

- Depends on cause and duration of symptoms - Increase fiber and fluids - habit training - dietary history "self-perpetuating" problem

MMR first dose, parent statement understanding

- I can give my child acetaminophen for discomfort associated with the immunization

The nurse is caring for a child with celiac disease. The nurse understands that what may precipitate a celiac crisis? (Select all that apply.)

- Infections - Electrolyte Depletions - Emotional Disturbance

Types of Cerebral Palsy

- Monoplegia - Hemiplegia - Diplegia - Quadriplegia

What signs and symptoms are indicative of a urinary tract disorder in the infancy period (124 months)? (Select all that apply.)

- Pallor - Poor feeding - Excessive thirst - Frequent urination

Scabies Treatment:

- Permethrin 5% (Elimite) cream - 10% crotamiton cream or lotion or oral ivermectin.

The nurse is conducting preoperative teaching to parents and their child about an external fixation device. What should the nurse include in the teaching session? (Select all that apply.)

- Pin care - Crutch walking - Modifications in activity - Observing pin sites for infection

UTI urinary tract infection symptoms for child (2 to 14 year olds)

- Poor appetite - vomiting - growth failure - excessive thirst - incontinence - frequent and painful urination - hematuria - abdominal or back pain - edema.

6 yr old assessment that requires further assessment

- Pubic hair

Management for celiac disease

- Remove gluten from diet - dietary referral

S/s of Cellulitis

- Swelling - Redness - Warm to touch - Pain - Itching - Fever - Malaise - Headache (systemic effects)

Parents of a child who will need hemodialysis ask the nurse, What are the advantages of a fistula over a graft or external access device for hemodialysis? What response should the nurse give? (Select all that apply.)

- There are fewer complications with a fistula. - There is less restriction of activity with a fistula. - It produces dilation and thickening of the superficial vessels.

IQ for a person with cerebral palsy

- Wide variation, difficult to assess - 50% to 60% of CP patients have normal IQ

What can GERD cause

- failure to thrive - aspiration - dysphagia

Signs and symptoms of upper tract UTI

- fever - chills - flank pain

Infectious Causes of Diarrhea?

- rotavirus - shigella - salmonella - e. coli

Medications for uncomplicated cystitis

- short-term course of antibiotics

Skeletal system

-Bone demineralization -Negative calcium balance

Nursing Considerations for Scoliosis

-Concerns of body image -Concerns of prolonged treatment of condition -Preoperative/Postoperative care -Support of adolescent development -Family issues

Iridocyclitis/uveitis

-Inflammation of iris and ciliary body, seen in 8-20% of cases -Extraarticular complication -Requires treatment by ophthalmologist -Can lead to permanent vision loss if not aggressively treated

Management of necrotizing enterocolitis (nec)

-breast milk -probiotics -decompress via NGT -antibiotics, -fluid/electrolyte replacement -Infection control

How often is Hirschsprung Disease diagnosed among people?

1 in 5000 birth; 4 times more common in males

The nurse is preparing to admit a child to the hospital with a diagnosis of minimal change nephrotic syndrome. The nurse understands that the peak age at onset for this disease is what?

2 to 3years

An injury to which part of the brain will cause a coma?

Brainstem

Coping with Stress in Death

Burnout: state of physical, emotional, and mental exhaustion Self-awareness: deliberate choice to be involved Knowledge and Practice: therapeutic intervention Support systems Other strategies: Box 19.18

A child is having tests done to determine parathyroid function. The clinic nurse knows that the parathyroid hormone (PTH) regulates the homeostasis of what in the serum?

Calcium

Complications for fractures

Circulatory impairment and nerve compression syndromes, compartment syndromes; Growth plate (physeal) damage, nonunion, infection, kidney stones, & pulmonary emboli

Most common birth defects

Cleft lip & Palate

What is a major goal for the therapeutic management of juvenile idiopathic arthritis (JIA)?

Control pain and preserve joint function.

Treatment for Folate Deficiency

Correctly prepare folate rich foods, intake of folate-enriched foods and/or 1 mg of folate daily.

When are Hernias dangerous?

Danger if it causes ischemia, poor circulation = incarceration

What chemotherapeutic agent is classified as an antitumor antibiotic?

Daunorubicin (Cerubidine)

Immobilization causes what effect on metabolism?

Decreased metabolic rate

Which best describes a full-thickness (third-degree) burn?

Destruction of all layers of skin evident with extension into subcutaneous tissue

T/F: Constipation is a disease

F: its a symptom

What immunization is recommended for all newborns?

Hepatitis B vaccine

Sickle Cell Anemia (SCA) Hemoglobinopathies

Hgb A is partially or completely replaced by abnormal sickle Hgb S. Autosomal recessive: Both parents with SC trait25% child with SCD

What condition is an acquired hemorrhagic disorder that is characterized by excessive destruction of platelets?

Idiopathic thrombocytopenic purpura

What pathologic process is believed to be responsible for the development of postinfectious glomerulonephritis?

Immune complex formation and glomerular deposition

A child has been admitted with status epilepticus. An emergency medication has been ordered. What medication should the nurse expect to be prescribed?

Lorazepam (Ativan)

What is the initial clinical manifestation of generalized seizures?

Loss of consciousness

Neurosensory System for Immobilization

Loss of innervation: -If nerve tissue is damaged by pressure -If circulation to nerve tissue is interrupted -Effects of improper positioning -Range of motion. - Sensory and perceptual deprivation

Intussusception is common in what demographic

More common in boys, and children under age 2

What nursing intervention is most appropriate when caring for the child with osteomyelitis?

Move and turn the child carefully and gently to minimize pain.

Neuropathic bladder disorders are common among children with which disorder?

Myelomeningocele

For case management to be most effective, who should be recognized as the most appropriate case manager?

Nurse

What test is never performed on a child who is awake?

Oculovestibular response

A child with hemophilia A will have which abnormal laboratory result?

PTT (partial thromboplastin time)

The parents of a child with spastic cerebral palsy (CP) state that their child seems to have significant pain. In addition to systemic pharmacologic management, the nurse includes which teaching?

Positions to reduce spasticity

A child has a nasogastric (NG) tube after surgery for Hirschsprung disease. What is the purpose of the NG tube?

Prevent abdominal distention.

What needs to be included as essential teaching for adolescents with systemic lupus erythematosus (SLE)?

Protection from sun and fluorescent lights to minimize rash

A child experiences frostbite of the fingers after prolonged exposure to the cold. Which intervention should the nurse implement first?

Rapid rewarming of the fingers by placing in warm water

What finding is characteristic of fractures in children?

Rapidity of healing is inversely related to the childs age.

The nurse is caring for an adolescent who has just started dialysis. The child always seems angry, hostile, or depressed. The nurse should recognize that this is most likely related to what underlying cause?

Resentment of the control and enforced dependence imposed by dialysis

What is associated with aspirin use and influenza?

Reye's Syndrome

What condition is the most common cause of acute renal failure in children?

Severe dehydration

A 2-year-old child starts to have a tonic-clonic seizure. The childs jaws are clamped. What is the most important nursing action at this time?

Stay with the child and observe his respiratory status.

What is an important nursing consideration when caring for a child with juvenile idiopathic arthritis (JIA)?

Teach the child and family correct administration of medications.

What is the purpose in using cimetidine (Tagamet) for gastroesophageal reflux?

The medication reduces gastric acid secretion.

Head injury

Trauma to the scalp, skull or brain, resulting in injury

A 5-year-old child is being prepared for surgery to remove a brain tumor. Preparation for surgery should be based on which information?

Usually the postoperative dressing covers the entire scalp.

Amelia

absence of entire extremity

infant GERD teaching

add rice ceral to baby feeding

Primary hyperparathyroidism

adenoma of the gland

A child is admitted with extensive burns. The nurse notes that there are burns on the childs lips and singed nasal hairs. The nurse should suspect that the child has a(n):

inhalation injury.

Medication treatment for complicated UTI

long-term treatment

Nursing Interventions of Encephalitis

•Patent airway, administer medications; control fever; and monitor neurologic status and vital signs. Provide emotional support to the child and family

Hemimelia

partial absence of extremity

TSH for?

thyroid gland

Meningitis Nursing Interventions and Patient Teaching

•Rest should be promoted in the initial phase of the disease and environmental stimuli kept to a minimum. •Observe vital signs, LOC, I&O, and neurologic signs.

Treatment for Hypopituitarism (growth hormone deficiency)

• Biosynthetic growth hormone (injections) • Other hormone replacements as needed like thyroid extract, cortisone, testosterone or estrogens and progesterone

Quick Facts Diabetes Mellitus (DM)

• Characterized by a total or partial deficiency of the hormone insulin • The most common endocrine disorder of childhood • Peak incidence in early adolescence - 3 types: 1, 2, and Maturity-onset diabetes of the young (MODY)

Precocious Puberty

• Defined as sexual development before age 9 in boys or before age 8 in girls • Occurs more frequently in girls

The nurse is discussing with a child and family the various sites used for insulin injections. What site usually has the fastest rate of absorption?

Abdomen

What type of seizure may be difficult to detect?

Absence

What is a condition that can result if hypersecretion of growth hormone (GH) occurs after epiphyseal closure?

Acromegaly

A 6-year-old child is admitted for revision of a ventriculoperitoneal shunt for noncommunicating hydrocephalus. What sign or symptom does the child have that indicates a revision is necessary?

Alteration in level of consciousness

Etiology / Patho of Spina Bifida (myelomeningocele)

•Congenital defects of neural tube closure

Diaper Dermatitis

◦ Acute inflammatory ◦ Compound presentation—yeast infection

Causes of Chronic Renal Failure (CRF)

◻ Congenital renal and urinary tract malformations ◻ VUR associated with recurrent UTIs ◻ Chronic pyelonephritis ◻ Chronic glomerulonephritis

Prognosis of Guillain-Barre Syndrome

✔The disease is self limiting ✔Recovery is a slow process, however the prognosis is good ✔Remyelization occurs in reverse (from upper body to lower). ✔Disease progression is NOT dependent on the causative organism ✔May require mechanical ventilation as result of possible paralysis of intercostal muscles

Severe Head Injury

⮚Loss of consciousness of more than ten minutes ⮚Amnesia for more than 24 hours preinjury ⮚Glasgow Coma Scale (GSC): < 8 ⮚Coma

Postoperative nursing care for hydrocephalus

⮚Positioning ⮚Assessing vital signs ⮚Providing incision care ⮚Monitoring for signs of shunt malfunction ⮚Increased intracranial pressure ⮚Infection

Preoperative nursing care for hydrocephalus

⮚Positioning ⮚Providing skin care ⮚Meeting nutritional needs ⮚Providing emotional support

Things you would find in a UA (urine alaysis) or Urine Culture that indicate urinary tract infection UTI

Leukocytosis Positive findings for bacteria in urine culture WBCs and RBCs

Three main types of meningitis

(1) bacterial, or pyogenic, caused by pus-forming bacteria, especially meningococci and pneumococci, (2) viral, or aseptic, caused by a wide variety of viral agents, and (3) tuberculous, caused by the tuberculin bacillus.

Clinical Manifestations of Seizure Disorders

(depend on the brain region): Alterations in LOC Involuntary movements Changes in perception, behaviors, sensations, and posture

Medications for IBD

- 5-ACAs for inflammation - steroids; (immunomodulators (6-MP) for those who are steroid resistant or steroid dependent) - antibiotics - biologic therapies

Post op care for cleft palate and cleft lip regarding specialized bottles or specialized feeders

- ABCs - wound care - monitor for bleeding - clear liquid, then other liquid then soft diet

Vaso-occlusive (VOC) thrombotic Sickle Cell Crisis

- AKA painful event/ painful episode - Most common type of crisis—very painful - Stasis of blood with clumping of cells in microcirculation → ischemia → infarction - Signs—fever, pain, tissue engorgement

Nursing considerations for Wilms' Tumor (Nephroblastoma)

- AVOID PALPATION OF THE ABDOMEN IN CHILD WITH WILM'S TUMOR and mobilize the child carefully - it is important to keep encapsulated tumor intact. Rupture of the tumor can cause the cancer cells to spread

What findings should the nurse expect to observe in a 7-month-old infant with Werdnig-Hoffman disease? (Select all that apply.)

- Absent deep tendon reflexes - Abnormal tongue movements - Failure to thrive

What are characteristics of diabetic ketoacidosis? (Select all that apply.)

- Acidosis - Dehydration - Electrolyte imbalance

Disseminated Intravascular Coagulation

- Acquired pathological process in which the clotting system is abnormally activated, resulting in widespread clot formation in the small vessels throughout the body. - A disorder of coagulation that occurs as a complication of numerous pathologic processes + Hypoxia, Acidosis, Shock, Endothelial damage (burns) + Severe systemic disease (sepsis, severe viral infection, necrotizing enterocolitis, congenital heart disease) The hallmark of the disease are bleeding and clotting, which occurs simultaneously + Coagulation process is abnormally stimulated + Excessive amounts of thrombin are generated + Fibrinolytic mechanisms are activated and cause extensive destruction of clotting factors

Alpha-thalassemia

- Alpha chains affected - Occurs in Chinese, Thai, African, and Mediterranean people

What is irritable bowel syndrome (IBS)?

- Alternating diarrhea and constipation; Bloating, abd distention, abd pain

Thalassemia Pathophysiology

- Anemia results from defective synthesis of Hgb, structurally impaired RBCs, and shortened life of RBCs - Chronic hypoxia + Headache, irritability, precordial and bone pain, exercise intolerance, anorexia, epistaxis - Detected in infancy or toddlerhood + Pallor, FTT, hepatosplenomegaly, severe anemia (Hgb <6)

The nurse is planning to admit a 10-year-old child with syndrome of inappropriate antidiuretic hormone (SIADH). What clinical manifestations should the nurse expect to observe in this child? (Select all that apply.)

- Anorexia - Irritability - Stomach cramps

Treatment for Tinea

- Antifungal - May last 6-8 weeks

The nurse is caring for a 14-year-old child with systemic lupus erythematous (SLE). What clinical manifestations should the nurse expect to observe? (Select all that apply.)

- Arthralgia - Abdominal pain - Glomerulonephritis

Legg-Calve-Perthese Disease:

- Avascular necrosis of femoral head, self-limiting and idiopathic, occurs in children age 3-12 (most common in males 4-8) - Limp on affected side, hip pain, limited ROM - After resolution, femoral head could be normal or severely altered - Surgery may be required

Medical management of nephrotic syndrome (nephrosis)

- Bedrest and a low-sodium diet (to prevent edema) - Steroids: Prednisone 2mg/kg divided into BID doses - Immunosuppressant therapy (cytoxan) - Diuretics (prevent fluid retention)

Secondary hyperparathyroidism

- Chronic renal disease - congenital anomalies of the urinary tract

The nurse is teaching parents of a child with gastroesophageal reflux (GER) disease foods that can exacerbate acid reflux. What foods should be included in the teaching session? (Select all that apply.)

- Citrus - Spicy Foods - Peppermine

Fractures

- Common injury in children - Rare in infants, except with MVC - Distal forearm fracture is the most common fracture in children - School-age—bicycles, skateboards/scooters, sports injuries

What is Hirschsprung Disease?

- Congenital disorder that causes obstruction due to inadequate motility in parts of the intestine.

What are the 2 major forms of inflammatory bowel disease (IBD)?

- Crohn's Disease (CD) and Ulcerative Colitis (UC)

Diabetes Insipidus VS SIADH

- Diabetes Insipidus: High urinary output, low levels of adh, hypernatremia, dehydration, lose too much fluid - SIADH: Low urinary output, high levels of ADH, hyponatremia, over hydrated, retain too much fluid - Both will present excessive thirst

Developmental Dysplasia of the hip (DDH)

- Diagnosis: Ortolani and Barlow tests, older children may limp, X-rays. - Therapeutic management: Pavlik harness vs casting. - Nursing mgmt.: Skin assessment, education, promote normal G&D

acromegaly quick facts

- Dx's is based on pts hx and clinical manifestations as well as a CT - MRI (r/o tumor) - Cranial x-ray evaluation - A complete ophthalmic exam including visual fields - Blood test confirm the elevated levels of GH and plasma insulin-like growth factor-1 (IGF-1) - Endocrine studies to rule out excess of other hormones, specifically thyroid, cortisol and sex hormones

S/s of Von Willebrand Disease

- Easy bruising - epistaxis - gingival bleeding - excessive bleeding with laceration or surgeries and menorrhagia.

Parent and Sibling need for education and support through the caregiving process

- Educational needs - Emotional support - Religious and spiritual support - Sibling support - Caregiver support

Clinical manifestations of Wilms' Tumor (Nephroblastoma)

- Enlarging, asymptomatic, and firm abdominal masses - Abdominal pain, hematuria, fever, hypertension, weight loss, and fatigue

Lead blood level

- Ensure the child's dietary intake of calcium and iron is adequate

3 Categories of Glasgow Coma Scale

- Eye Opening - Verbal Response - Motor Response

The nurse is preparing to admit a 6-year-old child with irritable bowel syndrome (IBS). What clinical manifestations should the nurse expect to observe? (Select all that apply.)

- Flatulence - Constipation - Feeling of incomplete evacuation of the bowel

Treatment for Diabetes Insipidus

- Fluid management - DDAVP (oral desmopressin acetate) - Nephrogenic DI-thiazide diuretic (decreases Na reabsorption) - prostaglandin inhibitors (decreases water excretion) - do not restrict fluids, may lead to worsening hypernatremia - Monitor electrolytes (Na and K)

What dietary instructions should the nurse give to parents of a child undergoing chronic hemodialysis? (Select all that apply.)

- Fluid restriction - Sodium restriction - Potassium restriction

Early signs of increased intracranial pressure

- Headache - Visual disturbances, diplopia - N & V - Dizziness or vertigo - Slight change in vital signs - Pupils not as reactive or equal - Sunsetting eyes (sclera visible above iris), cranial nerve VI palsy - Seizures - Slight change in LOC - restlessness - infant has above signs plus: - irritability - Bulging Fontanel - Wide sutures, increased head circumference - dilated scalp veins - high-pitched, catlike cry

3 types of dialysis

- Hemodialysis - Peritoneal dialysis - Hemofiltration

Diagnostic Evaluation for Thalassemia

- Hemoglobin electrophoresis - RBC changes often seen by 6 weeks of age - Child presents with severe anemia, FTT

The nurse is teaching the family with a child with cerebral palsy (CP) strategies to prevent constipation. What should the nurse include in the teaching session? (Select all that apply.)

- Increase fluid intake. - Increase fiber in the diet. - Administer stool softeners daily as prescribed.

Diagnostics for Cushing's Disease

- Increased 24 hour urinary clearance of free cortisol and 17- hydroxycorticosteroid (17-OHCs) - elevated salivary cortisol level - hyperglycemia - serum electrolytes - adrenal suppression test - elevated HgbA1c - CT & MRI to detect tumors in adrenal and pituitary glands - X-rays—evaluate for osteoporosis and skull films to look for enlargement of sella turcica.

possible causes of Hypopituitarism (growth hormone deficiency)

- Infarction/disease/tumor of the pituitary gland or hypothalamus - Brain tumor/trauma - Chemotherapy - Familial short stature - Growth Delays/Down Syndrome - Hypothyroidism - Turner syndrome - Renal failure - Cushing syndrome - Inborn error of metabolism - Severe cardiac, pulmonary or GI issue

What is Inflammatory bowel disease (IBD)?

- Inflammation due to autoimmune, bacteria, virus, or genetic defect

Etiology/Pathophysiology of Acute Glomerulonephritis

- Inflammation of glomeruli of the kidney - commonly a post infection (streptococcal)

The nurse is preparing to admit a 9-year-old child with syndrome of inappropriate antidiuretic hormone (SIADH). What interventions should the nurse include in the childs care plan? (Select all that apply.)

- Initiate seizure precautions. - Weigh daily at the same time each day. - Measure intake and output hourly.

The nurse is planning to admit a 12-year-old with Graves disease (GD). What clinical manifestations should the nurse expect to observe in this child? (Select all that apply.)

- Insomnia - Irritability - Hyperactivity

Therapeutic Management of Type 1 Diabetes Mellitus

- Insulin therapy - Glucose monitoring—goal range: 80 to 120 mg/dl - Lab measurement of hemoglobin A1c - Urine testing for ketones - Nutrition (Well balanced diet, Calories should be calculated to fit activity pattern of the child, timing of insulin administered should correspond to the timing of food consumption) - Exercise (exercise is generally encouraged, avoid exercised area for injections; avoid exercise with severe hyperglycemia >240 mg/dl, which may lead to ketoacid production) - Management of Hypoglycemia/Diabetic Ketoacidosis

Care and comfort measures for Atopic Dermatitis (Eczema)

- Keep nails short, gloves/socks at bedtime - Cool (not warm) compresses Cotton or soft, cool, synthetic clothes, avoid wool, avoid overdressing - Hypoallergenic laundry soap, no fabric softener, no perfumes, oils, scented products - Double rinse laundry - Room humidifier may help if very dry skin - Teach signs of secondary infection - Decrease exposure to allergens-dust, mold, animals, smoke - Hypoallergenic diet - Encourage therapeutic baths and sedating antihistamine before bed to aid sleep - Teach topical steroid precautions

Labs for precocious puberty

- LH - FSH - Testosterone - Estradiol - GnRH (gonadotropin-releasing hormone) - Radiologic imaging of brain (r/o brain tumor) as well as bone age

The nurse is preparing to admit a 5-year-old with spina bifida cystica that was below the second lumbar vertebra. What clinical manifestations of spina bifida cystica below the second lumbar vertebra should the nurse expect to observe? (Select all that apply.)

- Lack of bowel control - Flaccid, partial paralysis of lower extremities - Overflow incontinence with constant dribbling of urine

The nurse is preparing to assist with a growth hormone provocative test for a child with short stature. The nurse recognizes that which pharmacologics should be used to provoke the release of growth hormone (GH)? (Select all that apply.)

- Larodopa (levodopa) - Clonidine (Catapres) - Propranolol (Inderal)

Specific signs for Viral meningitis

- Lesser severity of symptoms - Fever - Lethargy - Irritability - Malaise - Maculopapular Rash

Splenic Sequestration Sickle Cell Crisis

- Life threatening—death can occur within hours - Blood pools in the spleen - Signs - Profound anemia - Hypovolemia - Shock

The nurse is caring for a child with an anterior pituitary tumor. What hormones are secreted by the anterior pituitary? (Select all that apply.)

- Luteinizing hormone - Thyroid-stimulating hormone - Adrenocorticotrophic hormone

s/s of HIV and AIDS

- Lymphadenopathy, hepatosplenomegaly, oral candidiasis, chronic or recurrent diarrhea, failure to thrive, recurrent bacterial infections, parotitis, lymphoid interstitial pneumonitis (LIP), early onset of progressive neurological deterioration. - CNS abnormalities- neuropsychological deficits and developmental disabilities; deficits in motor skills, communication and behavior functioning, expressive language- use of language may be affected. - HIV-infected children often do not grow normally; they may be proportionally smaller in both length and weight for age

Hyperthyroidism Therapy

- Methimazole - propylthiouracil (PTU)- treatment for 2 years or longer - propranolol - radiation (radioactive iodine) - surgery (thyroidectomy)

Nursing interventions and teaching for nephrotic syndrome (nephrosis)

- Monitor I&O, body weight, and abdominal girth. - Encourage protein intake. - Instruct parents in testing urine for albumin - Administration of medications - Monitor for side effects of steroids

The nurse is caring for a child immobilized because of Russel traction. What interventions should the nurse implement to prevent renal calculi? (Select all that apply.)

- Monitor output. - Ensure adequate fluids. - Encourage the patient to drink cranberry juice.

Rhabdomyosarcoma

- Most common soft tissue sarcoma in children -rhabdo- striated muscle -Myo-muscle + Can occur in many sites, most often occurs in head and neck, especially the orbit Symptoms are usually vague and common to childhood maladies like earache + Two-thirds of cases occur in children under age 10 Treatment: surgery, chemotherapy, radiation Survival rate 70% if found early, but long-term survival is poor when relapse occurs

Idiopathic Scoliosis

- Most common spinal deformity - May be congenital or develop during childhood. - Generally becomes noticeable after preadolescent growth spurt - ill fitting cloths

Early Side effects of radiotherapy

- N & V - Anorexia - mucosal ulceration - diarrhea - alopecia - dry or moist desquamation -Mucositis - parotitis - sore throat - loss of taste - xerostomia (dry mouth) - rarely cystitis - myelosuppresion

Other Tumors

- Nervous system tumors, including brain tumors and neuroblastoma - Bone tumors, including osteosarcoma and Ewing sarcoma - Wilms tumor - Rhabdomyosarcoma - Retinoblastoma - Germ cell (2% of childhood tumors) and liver (1%)

Is there a cure for IBD?

- No

Infant home safety

- No pillows in crib - Rear-facing car seat until age 2 - Safety gate on stair case - Water heater temp at 49*C or 120* F

UTI urinary tract infection symptoms for infants (1 to 24 months)

- Poor feeding - vomiting - failure to gain weight - frequent urination - screaming on urination - FOUL SMELLING URINE - FEVER - PERSISTENT DIAPER RASH - seizures - dehydration - enlarged bladder

Nursing care for cleft palate and cleft lip

- Position upright to prevent aspiration and frequent burping. - High calories - weekly weight check - specialized bottle/feeder - lactation consult

Nursing considerations for cryptorchidism

- Postoperative care, infection prevention, pain control, and activity restrictions - Parental counseling about the future fertility of the child

Nursing Interventions and Patient teaching for Wilms' Tumor (Nephroblastoma)

- Prepare child and family for surgery. - Provide postoperative care. - Provide discharge planning.

Treatment for sports injuries

- Rest, Ice, Compression, Elevation (RICE)

Prognosis

- Retarded growth - Delayed or absent secondary sex characteristics - Expect to live well into adulthood with proper clinical management

Management for Appendicitis?

- Surgery - Antibiotics - IV fluids - Pain meds with caution - antipyretics - antiemetics

Medical Management of Wilms' Tumor (Nephroblastoma)

- Surgical resection as soon as possible; radiation and/or chemotherapy

The nurse is preparing to admit a 5-year-old child with hepatitis A. What clinical features of hepatitis A should the nurse recognize? (Select all that apply.)

- The onset is rapid. - Fever occurs early. - Nausea and vomiting are common.

The nurse is planning to admit a 14-year-old adolescent with Cushing syndrome. What clinical manifestations should the nurse expect to observe in this child? (Select all that apply.)

- Truncal obesity - Petechial hemorrhage - Facial plethora

What can IBD cause?

- Ulcerations - Bleeding - Intestinal Edema

What are some of the associated disabilities seen with cerebral palsy? (Select all that apply.)

- Visual impairment - Hearing impairment - Speech difficulties - Intellectual impairment

Discussing Death with Children

- be honest and accurate

Labs for hypoparathyroidism

- decreased serum calcium levels - increased serum phosphorus - low PTH with idiopathic hypoparathyroidism and high PTH in pseudohypoparathyroidism - kidney function tests - bone radiographs (may demonstrate increased bone density and suppressed growth). - End organ responsiveness is tested by the administration of PTH with measurement of urinary cyclic adenosine monophosphate.

signs and symptoms of GERD

- heartburn - spitting up - ab pain - dysphagia

findings of measles

- koplik spots - fever - malaise - conjunctivitis - other cold manifestations

Diagnostics for Appendicitis?

- labs - Urinary Analysis - H&P (including pain: "McBurney point") - Ultrasound - CT

lab values for acute lymphocytic leukemia

- low platelet - low rbc - high WBC - low hct

Lower tract UTI involves what?

- lower urinary tract - bladder - urethra

signs and symptoms of hypertrophic pyloric stenosis (HPS)?

- olive-like mass in upper abd - vomiting

Treatment for Addison disease

- replace deficient hormones - hydrocortisone (glucocorticoid) - fludrocortisone (mineralcorticoid).

Bone Tumor Treatment

- surgical resection - amputation - chemotherapy - radiation

Nursing management for GI Disorders

- teach care givers to monitor for dehydration - count wet and soiled diapers - vomiting is not a contraindication to ORT (unless severe)

Medications for UTI

- trimethoprim-sulfamethoxazole (TMP-SMX) - Sulfa - Amoxicillin - Cephalexin - Gentamicin

Cardiovascular system

-Orthostatic intolerance -Increased workload of the heart -Thrombus formation

Possible issues with pica?

-Possible psychologic or nutritional factors -Possible development of abd pain and other GI symptoms depending on what they ate.

Cancer Etiology

-Result of multiple genetic events, but not necessarily hereditary -Chromosome abnormalities are important in development of various types of cancer; such as Down Syndrome and leukemia -Children with immunodeficiencies, those artificially suppressed following transplant procedures, and kids treated for a primary malignancy, are all at higher risk

Food to avoid for ppl with celiac disease

-barley - oat - rye - wheat

Management of cleft lip & palate

-surgery - speech therapy (2-3 months old for CL, 6-12 months old for CP) - emotional support

Therapeutic management for juvenile idiopathic arthritis (JIA)

-treated with NSAIDs, Corticosteroids, Cytotoxic agents and disease-modifying antirheumatic drugs (DMARDs) -Weekly, low-dose methotrexate therapy is usually the first DMARD used. -Families often concerned regarding potential adverse effects from methotrexate therapy such as bone marrow suppression, liver disease, and teratogenic effects. -When methotrexate therapy is not successful, biologic DMARDs such as etanercept, infliximab, and adalimumab are used to reduce the proinflammatory response that promotes arthritis. -Glucocorticoids may be used but will not cure arthritis. Effects of long-term steroid use is not desirable. "burst and taper" or alternate-day schedule used to reduce side effects.

What specific gravity of the urine is desired so that hemorrhagic cystitis is prevented?

1.005

Treatment for Vitamin B12 Deficiency

100 mcg or higher of vitamin B12 parenteral therapy for 7 days; followed by injections of 400-1000 mcg of vitamin B12 every 1-2 months.

2 year old caloric needs

1000 calories per day

The clinic nurse is evaluating lab results for a child. What recorded hemoglobin (Hgb) result is considered within the normal range?

12 g/dl

The nurse should instruct parents to administer a daily proton pump inhibitor to their child with gastroesophageal reflux at which time?

30 minutes before breakfast

What is the peak incidence of gastro-esophageal reflux disease (GERD)

4 months old; usually resolves by age1 (88% of cases)

What behavior seen in children should be addressed by the nurse who is providing care to a child with a chronic illness?

A preschooler who refuses to participate in self-care

Kyphosis

Abnormally increased convex angulation in the curvature of the thoracic spine. "Postural" kyphosis common in adolescent girls attempting to hide breast development and increasing height.

The parents of an infant with cerebral palsy (CP) ask the nurse if their child will have cognitive impairment. The nurses response should be based on which knowledge?

About 45% of affected children have normal intelligence.

Acute Bacterial Meningitis

Acute bacterial meningitis is a medical emergency that requires early recognition and immediate therapy to prevent death and avoid residual disabilities. The child is isolated from other children, usually in an intensive care unit for close observation. An intravenous (IV) infusion is started to facilitate administration of antimicrobial agents, fluids, antiepileptic drugs, and blood, if needed. The child is placed in respiratory isolation.

The parent of a child hospitalized with acute glomerulonephritis asks the nurse why blood pressure readings are being taken so often. What knowledge should influence the nurses reply?

Acute hypertension is a concern that requires monitoring.

What statement is most accurate in describing tetanus?

Acute infectious disease caused by an exotoxin produced by an anaerobic spore-forming, gram- positive bacillus.

The nurse is preparing to administer a unit of packed red blood cells to a hospitalized child. What is an appropriate action that applies to administering blood?

Administer the first 50 ml of blood slowly and stay with the child.

An adolescent with long-term, complex health care needs will soon be discharged from the hospital. The nurse case manager has been assigned to the teen and family. The adolescents care involves physical therapy, occupational therapy, and speech therapy in addition to medical and nursing care. Who should be the decision maker in the adolescents care?

Adolescent and family

What statement is correct regarding sports injuries during adolescence?

Adolescents may not possess insight and judgment to recognize when a sports activity is beyond their capabilities.

Glucocorticoids, mineralocorticoids, and sex steroids are secreted by which gland?

Adrenal cortex

s/s of complex partial seizure

Age of onset: Uncommon before age 3 Frequency (per day): rarely over 1-2 times Duration: Usually >60 sec, rarely <10 sec Aura: Frequent Impaired Consciousness: Always Automatisms: Frequent Clonic Movement: Occasional Postictial Impairment: Frequent Mental Disorientation: Common

s/s of simple partial seizure

Age of onset: any Frequency (per day): variable Duration: usually <30 sec Aura: May be sole manifestation of seizure Impaired Consciousness: Never Automatisms: NO Clonic Movement: Frequent Postictial Impairment: Rare Mental Disorientation: Rare

The nurse is caring for a child admitted with acute abdominal pain and possible appendicitis. What intervention is appropriate to relieve the abdominal discomfort during the evaluation?

Allow the child to assume a position of comfort.

Immune Trombocytopenia (idiopathic Thrombocytopenic Purpura)

An acquired hemorrhagic disorder characterized by - Thrombocytopenia—excessive destruction of platelets - Purpura—discoloration caused by petechiae beneath the skin - Normal bone marrow with usual increase in large immature platelets Although cause in unknown- it is understood that ITP involves evolution of antibodies against multiple platelet antigens, leading to reduced platelet survival and impaired platelet production. The disease occurs in two forms - Acute: self limiting; occurs commonly after upper respiratory tract infections, after childhood diseases like measles, mumps, chickenpox or Human parvovirus. - Chronic: > 12 months duration

What signs or symptoms are most commonly associated with the prodromal phase of acute viral hepatitis?

Anorexia and malaise

An adolescent is scheduled for a leg amputation in 2 days for treatment of osteosarcoma. What approach should the nurse implement?

Answer questions with straightforward honesty.

The nurse is assessing the coping behaviors of the parents of a child recently diagnosed with a chronic illness. What behavior should the nurse consider an approach behavior that results in movement toward adjustment?

Anticipating future problems and seeking guidance and answers

Homeostasis in the body is maintained by what is collectively known as the neuroendocrine system. What is the name of the nervous system that is involved?

Autonomic

What is a nursing intervention to reduce the risk of increasing intracranial pressure (ICP) in an unconscious child?

Avoid activities that cause pain or crying.

management for GERD

Avoid certain foods including citrus, tomatoes, spicy or fried, peppermint

A 2-year-old child has a chronic history of constipation and is brought to the clinic for evaluation. What should the therapeutic plan initially include?

Bowel cleansing

What clinical manifestations suggest hydrocephalus in an infant?

Bulging fontanel and dilated scalp veins

Imaging for Gigantism

CT/MRI to r/o tumors

The nurse is examining 12-month-old Amy, who was brought to the clinic for persistent diaper rash. The nurse finds perianal inflammation with satellite lesions that cross the inguinal folds. This is most likely caused by:

Candida albicans.

Which nursing consideration is important when caring for a child with impetigo contagiosa?

Carefully wash hands and maintain cleanliness when caring for an infected child.

Cat Scratch

Causes painless, non pruritic erythematous papule, followed by regional lymphadenitis Self limiting (resolves in 4-6 weeks)—bacterial (bartonella henselae) Antibiotics may be used (azithromycin)

A child with leukemia is receiving intrathecal chemotherapy to prevent which condition?

Central nervous system (CNS) disease

An infant with short bowel syndrome will be on total parenteral nutrition (TPN) for an extended period of time. What should the nurse monitor the infant for?

Central venous catheter infection, electrolyte losses, and hyperglycemia

What is a physiologic effect of immobilization on children?

Circulatory stasis can lead to thrombus and embolus formation.

A young child has sustained a minor burn to the foot. Which is recommended for treatment of a minor burn?

Cleanse the wound with a mild soap and tepid water.

Human Bites

Cleansing and medical treatment when indicated (human dental plaque and gingiva harbor pathogenic organisms) wash with soap and water, pressure dressing to stop bleeding, ice, tetanus toxoid, antibiotics.

What pain management approach is most effective for a child who is having a bone marrow test?

Conscious or unconscious sedation

The nurse is assisting a child with celiac disease to select foods from a menu. What foods should the nurse suggest?

Corn on the cob with butter

What explanation provides the rationale for why iron-deficiency anemia is common during infancy?

Cows milk is a poor source of iron.

The nurse is caring for a child receiving chemotherapy for leukemia. The childs granulocyte count is 600/mm3 and platelet count is 45,000/mm3 . What oral care should the nurse recommend for this child?

Daily toothbrushing and flossing

What measure of fluid balance status is most useful in a child with acute glomerulonephritis?

Daily weight

Hydrotherapy is required to treat a child with extensive partial-thickness burn wounds. Which is the primary purpose of hydrotherapy?

Dbride the wounds.

A young child with human immunodeficiency virus (HIV) is receiving several antiretroviral drugs. What is the purpose of these drugs?

Delay disease progression.

Feelings of the nurse towards the child with life-threatening Illness

Denial Anger and depression Guilt Ambivalence

What is important to incorporate in the plan of care for a child who is experiencing a seizure?

Describe and record the seizure activity observed.

What finding is a clinical manifestation of increased intracranial pressure (ICP) in children?

Diplopia, blurred vision

What nursing intervention is especially helpful in assessing feelings of parental guilt when a disability or chronic illness is diagnosed?

Discuss the meaning of the parents religious and cultural background

A parent tells the nurse that 80% of children with the same type of leukemia as his sons have a 5-year survival. He believes that because another child on the same protocol as his son has just died, his son now has a better chance of success. What is the best response by the nurse?

Each child has an 80% likelihood of 5-year survival.

The parents of a child with sickle cell anemia (SCA) are concerned about subsequent children having the disease. What statement most accurately reflects inheritance of SCA?

Each sibling has a 25% chance of having SCA.

A child has just returned from surgery for repair of a fractured femur. The child has a long-leg cast on. The toes on the leg with the cast are edematous, but they have color, sensitivity, and movement. What action should the nurse take?

Elevate the foot and leg on pillows.

What recommendation should the nurse make to prevent urinary tract infections (UTIs) in young girls?

Ensure clear liquid intake of 2 L/day.

The nurse observes that a newborn is having problems after birth. What should indicate a tracheoesophageal fistula?

Excessive frothy saliva

The parents of a child born with ambiguous genitalia tell the nurse that family and friends are asking what caused the baby to be this way. Tests are being done to assist in gender assignment. What should the nurses intervention include?

Explain the disorder so they can explain it to others.

The nurse asks the mother of a child with a chronic illness many questions as part of the assessment. The mother answers several questions, then stops and says, I dont know why you ask me all this. Who gets to know this information? The nurse should respond in what manner?

Explain who will have access to the information.

T/F GI bleed is common in infants and children, but potentially serious

False; Uncommon

A child is receiving propylthiouracil for the treatment of hyperthyroidism (Graves disease). The parents and child should be taught to recognize and report which sign or symptom immediately?

Fever, sore throat

The parents of a child with cancer tell the nurse that a bone marrow transplant (BMT) may be necessary. What information should the nurse recognize as important when discussing this with the family?

Finding a suitable donor involves matching antigens from the human leukocyte antigen (HLA) system.

Tinea Pedis "athletes foot"

Fine vesiculopustular/scaly lesion on the soles of feet. Peeling, fissures, burning.

A child develops syndrome of inappropriate antidiuretic hormone secretion (SIADH) as a complication to meningitis. What action should be verified before implementing?

Forcing fluids

Nursing strategies to improve the growth and development of the child with human immunodeficiency virus (HIV) infection should include what?

Fortify foods with nutritional supplements to maximize quality of intake.

What should the nurse determine to be the priority intervention for a family with an infant who has a disability?

Foster feelings of competency by helping parents learn the special care needs of the infant.

A child with osteosarcoma is experiencing phantom limb pain after an amputation. What prescribed medication is effective for short-term phantom pain relief?

Gabapentin (Neurontin)

What term refers to seizures that involve both hemispheres of the brain?

Generalized

What manifestation observed by the nurse is suggestive of parental overprotection?

Gives inconsistent discipline

A child is on phenytoin (Dilantin). What should the nurse encourage?

Good dental hygiene

The clinic nurse is assessing a child with hypopituitarism. Hypopituitarism can lead to which disorder?

Growth hormone deficiency

A child is admitted for revision of a ventriculoperitoneal shunt for noncommunicating hydrocephalus. What is a common reason for elective revision of this shunt?

Growth of the child since the initial shunting

In teaching the parent of a newly diagnosed 2-year-old child with pyelonephritis related to vesicoureteral reflux (VUR), the nurse should include which information?

Have siblings examined for VUR.

What are the most common clinical manifestations of brain tumors in children?

Headaches and vomiting

A child is admitted with acute glomerulonephritis. What should the nurse expect the urinalysis during this acute phase to show?

Hematuria and proteinuria

What information should the nurse include when teaching an adolescent with Crohn disease (CD)?

How to cope with stress and adjust to chronic illness

After chemotherapy is begun for a child with acute leukemia, prophylaxis to prevent acute tumor lysis syndrome includes which therapeutic intervention?

Hydration

Exophthalmos (protruding eyeballs) may occur in children with which condition?

Hyperthyroidism

A child with a serious chronic illness will soon go home. The case manager requests that the family provide total care for the child for a couple of days while the child is still hospitalized. How should the request be viewed?

Important because it can be beneficial to the transition from hospital to home

Causes of Folate Deficiency

Inadequate diet, overcooking of vegetables with loss of folates, and malabsorption.

The nurse should expect to care for which age of child if the admitting diagnosis is retinoblastoma?

Infant or toddler

What statement is most descriptive of Meckel diverticulum?

Intestinal bleeding may be mild or profuse.

Which is usually the only symptom of pediculosis capitis (head lice)?

Itching

Viral Skin Infections

Leads to inflammation or proliferation Many communicable diseases present with characteristic rash Prevention of transmission/Isolation procedures Antiviral medications Example: Verucca (warts), Herpes simplex type 1 & 2, varicella (chicken pox)/herpes zoster (shingles), molluscum contagiosum (pox virus)

Spina Bifida Occulta

Least serious and most common type. It is usually discovered only on x-rays or scans. Most people never become aware of their condition

The nurse is assessing a child who was just admitted to the hospital for observation after a head injury. What clinical manifestation is the most essential part of the nursing assessment to detect early signs of a worsening condition?

Level of consciousness

The nurse should implement which prescribed treatment for a child with warts?

Local destruction

Nursing care for spina bifida (myelomeningocele)

Longer-term concerns ⮚Skin integrity ⮚Elimination ⮚Infection risk ⮚Mobility ⮚Injury risk ⮚Latex allergies Care of the infants and children with myelomeningocele is directed toward protecting the meningeal sac, preventing infection and skin breakdown, observing for signs of urologic and bowel complications, promoting early parent-infant interaction, and planning appropriate interventions to optimize the child's development. Associated problems include infection, impaired genitourinary and bowel function, musculoskeletal impairment, and latex allergy.

What diet is most appropriate for the child with chronic renal failure (CRF)?

Low in phosphorus

A child will start treatment for central precocious puberty. What synthetic hormone will be injected?

Luteinizing hormonereleasing hormone

Urinary tract anomalies are frequently associated with what irregularities in fetal development?

Malformed or low-set ears

A child is admitted in acute renal failure (ARF). Therapeutic management to rapidly provoke a flow of urine includes the administration of what medication?

Mannitol (Osmitrol) or furosemide (Lasix) (or both)

Chemotherapeutic agents are classified according to what feature?

Mechanism of action

In teaching parents how to minimize or prevent bleeding episodes when the child is myelosuppressed, the nurse includes what information?

Meticulous mouth care is essential to avoid mucositis.

A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by which dietary intervention?

Milk and peanut butter on bread

A mother states that she brought her child to the clinic because the 3-year-old girl was not keeping up with her siblings. During physical assessment, the nurse notes that the child has pale skin and conjunctiva and has muscle weakness. The hemoglobin on admission is 6.4 g/dl. After notifying the practitioner of the results, what nursing priority intervention should occur next?

Minimize energy expenditure to decrease cardiac workload.

Medical Management / Nursing Interventions for Guillain-Barre syndrome

Monitor respiratory status closely! •Adrenocortical steroids •Plasmapheresis (removal of pathologic components from the blood) •IV immunoglobulin •Mechanical ventilation •Gastrostomy tube •Meticulous skin care •Passive Range-of-motion (ROM) exercises

A 14-year-old girl is in the intensive care unit after a spinal cord injury 2 days ago. What nursing intervention is a priority for this child?

Monitoring and maintaining systemic blood pressure

One pediatric oncologic emergency is acute tumor lysis syndrome. Symptoms that this may be occurring include what?

Muscle cramps and tetany

An 8-year-old child is hospitalized with infectious polyneuritis (Guillain-Barr syndrome [GBS]). When explaining this disease process to the parents, what should the nurse consider?

Muscle strength slowly returns, and most children recover.

What GI disorder is an acute inflammatory bowel, seen in pretern and high-risk infants?

Necrotizing Enterocolitis (NEC)

Does Lower tract UTI have signs or symptoms?

No

What is a common clinical manifestation of Hodgkin disease?

Nontender enlargement of lymph nodes

After surgery yesterday for gastroesophageal reflux, the nurse finds that the infant has somehow removed the nasogastric (NG) tube. What nursing action is most appropriate to perform at this time?

Notify the practitioner

Biologic dressings are applied to a child with partial-thickness burns of both legs. Which nursing intervention should be implemented?

Observing wounds for signs of infection

What is Appendecitis?

Obstruction causing inflammation and ischemia which can lead to rupture of appendix which can then lead to peritonitis

A child is being admitted to the hospital with acute gastroenteritis. The health care provider prescribes an antiemetic. What antiemetic does the nurse anticipate being prescribed?

Ondansetron (Zofran)

What is the onset of necrotizing enterocolitis (nec)

Onset is 4-10 days after initial feeding, usually detected in 1st 10 days.

The nurse is taking care of a 7-year-old child with herpes simplex virus (type 1 or 2). Which prescribed medication should the nurse expect to be included in the treatment plan?

Oral antiviral agent

What condition can result from the bone demineralization associated with immobility?

Osteoporosis

Peripheral precocious puberty (PPP) differs from central precocious puberty (CPP) in which manner?

PPP may be viewed as a variation in sexual development.

Whats the Etiology/Pathophysiology of Nephrotic Syndrome (Nephrosis)

PROTEINURIA resulting from GLOMERULAR DAMAGE that renders the glomerulus permeable to protein.

What statement is characteristic of type 1 diabetes mellitus?

Peak age incidence is 10 to 15 years.

Therapeutic management of a 6-year-old child with hereditary spherocytosis (HS) should include which therapeutic intervention?

Perform a splenectomy.

The majority of children in the United States with human immunodeficiency virus (HIV) infection acquired the disease by which means?

Perinatally from their mothers

The nurse is caring for a child with severe head trauma after a car accident. What is an ominous sign that often precedes death?

Periodic or irregular breathing

What finding by the nurse is most characteristic of chronic sorrow?

Periods of intensified sorrow at certain landmarks of the childs development

What is the antiepileptic medication that requires monitoring of vitamin D and folic acid?

Phenobarbital (Luminal)

Total-body irradiation is indicated for what reason?

Preparation for bone marrow transplant

Ethical Considerations of death

Principle of "double effect" (box 19.12) This principle acknowledges that when there is an attempt to relieve extreme pain with high medication doses, it is possible that death will be hastened. Addiction is not a concern in these instances, and there is NO MAXIMUM DOSAGE Terminally ill pediatric patients may require large opioid doses for pain relief Nonpharmacological interventions: Music therapy, distraction, guided imagery

What measure is important in managing hypercalcemia in a child who is immobilized?

Provide adequate hydration.

The nurse is caring for a hospitalized adolescent whose femur was fractured 18 hours ago. The adolescent suddenly develops chest pain and dyspnea. The nurse should suspect what complication

Pulmonary embolism

The nurse is caring for a neonate with a suspected tracheoesophageal fistula. What should nursing care include?

Raise the patients head and give nothing by mouth.

What is a major goal of therapy for children with cerebral palsy (CP)?

Recognize the disorder early and promote optimum development

One of the major differences in clinical presentation between Crohn disease (CD) and ulcerative colitis (UC) is that UC is more likely to cause which clinical manifestation?

Rectal bleeding

A child with extensive burns requires dbridement. The nurse should anticipate which priority goal related to this procedure?

Reduce pain.

Long-term goals for a pt with IBS

Regular bowel habits and relief of symptoms

A young child with leukemia has anorexia and severe stomatitis. What approach should the nurse suggest that the parents try?

Relax any eating pressures.

A child with hypopituitarism is being started on growth hormone (GH) therapy. Nursing considerations should be based on which knowledge?

Replacement therapy requires daily subcutaneous injections.

The nurse has been assigned as a home health nurse for a child who is technology dependent. The nurse recognizes that the familys background differs widely from the nurses own. The nurse believes some of their lifestyle choices are less than ideal. What nursing intervention is most appropriate to institute?

Respect the differences.

Tinea Corporis

Ring like plaques with pale centers with scaly, red margins. Found on trunk, face, and extremities

The nurse is caring for a child with meningitis. What acute complications of meningitis should the nurse continuously assess the child for? (Select all that apply.)

Seizures Cerebral edema Cognitive impairments

What condition is an inherited immunodeficiency disorder characterized by absence of both humoral and cell-mediated immunity?

Severe combined immunodeficiency syndrome (SCIDS)

The nurse is discussing long-term care with the parents of a child who has a ventriculoperitoneal shunt. What issues should be addressed?

Shunt malfunction or infection requires immediate treatment.

A child steps on a nail and sustains a puncture wound of the foot. Which is the most appropriate method for cleansing this wound?

Soak foot in warm water and soap.

What most accurately describes bowel function in children born with a myelomeningocele?

Some degree of fecal continence can usually be achieved.

A child, age 3 years, has cerebral palsy (CP) and is hospitalized for orthopedic surgery. His mother says he has difficulty swallowing and cannot hold a utensil to feed himself. He is slightly underweight for his height. What is the most appropriate nursing action related to feeding this child?

Stabilize his jaw with caregivers hand (either from a front or side position) to facilitate swallowing.

A 10-year-old boy on a bicycle has been hit by a car in front of a school. The school nurse immediately assesses airway, breathing, and circulation. What should be the next nursing action?

Stabilize the childs neck and spine.

A 10-year-old child, without a history of previous seizures, experiences a tonic-clonic seizure at school that lasts more than 5 minutes. Breathing is not impaired. Some postictal confusion occurs. What is the most appropriate initial action by the school nurse?

Stay with child and have someone else call emergency medical services (EMS).

An infant with short bowel syndrome is receiving total parenteral nutrition (TPN). The practitioner has added continuous enteral feedings through a gastrostomy tube. The nurse recognizes this as important for which reason?

Stimulate adaptation of the small intestine

A young adolescent experiences infrequent migraine episodes. What pharmacologic intervention is most likely to be prescribed?

Sumatriptan

Management of Hernia

Surgery if it does not resolve on its own.

What side effect commonly occurs with corticosteroid (prednisone) therapy?

Susceptibility to infection

A 12-year-old child with Guillain-Barr syndrome (GBS) is admitted to the pediatric intensive care unit. She tells you that yesterday her legs were weak and that this morning she was unable to walk. After the nurse determines the current level of paralysis, which should the next priority assessment be?

Swallowing ability

The nurse is teaching parents of toddlers about animal safety. Which should be included in the teaching session?

Teach your toddler not to disturb an animal that is eating.

Therapeutic Management

Team approach, bracing , exercise, possible surgery

Clinical manifestations of cryptorchidism

Testes are not palpable or easily guided into the scrotum

An adolescent whose leg was crushed when she fell off a horse is admitted to the emergency department. She has completed the tetanus immunization series, receiving the last tetanus toxoid booster 8 years ago. What care is necessary for therapeutic management of this adolescent to prevent tetanus?

Tetanus toxoid booster is needed because of the type of injury.

A 16-year-old boy with a chronic illness has recently become rebellious and is taking risks such as missing doses of his medication. What should the nurse explain to his parents?

That this is a normal part of adolescence

A parent of a child with major burns asks the nurse why a high-calorie and high-protein diet is prescribed. Which response should the nurse make?

The diet will avoid protein breakdown.

Hypoparathyroidism Nursing Alert

The earliest indication of hypoparathyroidism may be anxiety and mental depression, followed by paresthesia and evidence of heightened neuromuscular excitability, such as: - Chvostek Sign- Facial muscle spasm elicited by tapping the facial nerve in the region of the parotid gland - Trousseu Sign- Carpal spasm elicited by pressure applied to nerves of the upper arm - Tetany- Carpopedal spasm (sharp flexion of wrist and ankle joints), muscle twitching, cramps, seizures, and stridor

The nurse is evaluating the laboratory results of a stool sample. What is a normal finding?

The laboratory reports a negative guaiac.

A toddlers mother calls the nurse because she thinks her son has swallowed a button type of battery. He has no signs of respiratory distress. The nurses response should be based on which premise?

The location needs to be confirmed by radiographic examination

The nurse is preparing a school-age child for computed tomography (CT) scan to assess cerebral function. The nurse should include what statement in preparing the child?

The scan will not hurt.

Melena, the passage of black, tarry stools, suggests bleeding from which source?

The upper gastrointestinal (GI) tract

The nurse is caring for a 5-year-old child with impetigo contagiosa. The parents ask the nurse what will happen to their childs skin after the infection has subsided and healed. Which answer should the nurse give?

There will be no scarring.

Brain coverings (meninges)

Three membranes: dura mater, arachnoid, pia mater

A goiter is an enlargement or hypertrophy of which gland?

Thyroid

What is the rationale for orthopedic surgery for a child with cerebral palsy?

To improve function

The clinic nurse is assessing infant reflexes. What assessment indicates a persistence of primitive reflexes?

Tonic neck reflex at 8 months of age

Identification and treatment of cryptorchid testes should be done by age 2 years. What is an important consideration?

Treatment is necessary to maintain the ability to be fertile when older.

T/F Lumbar puncture is contraindicated in child with ICP (risk of brain herniation)

True

T/F Neonates with limb deficiency should be assessed for associated cardiovascular, CNS, renal, and digestive abnormalities

True

T/F Prosthetics fitted as early as possible, surgical intervention as needed

True

T/F Unintentional injury is the number one health risk for children and leading cause of death in children >1 year.

True

What form of diabetes is characterized by destruction of pancreatic beta cells, resulting in insulin deficiency?

Type 1 diabetes

What description identifies the pathophysiology of leukemia?

Unrestricted proliferation of immature white blood cells (WBCs)

The nurse is teaching a client to prevent future urinary tract infections (UTIs). What factor is most important to emphasize as the potential cause?

Urinary stasis

Nursing care of the child with myelosuppression from leukemia or chemotherapeutic agents should include which therapeutic intervention?

Use good hand-washing technique

The nurse is teaching nursing students about childhood skin lesions. Which is an elevated, circumscribed skin lesion that is less than 1 cm in diameter and filled with serous fluid?

Vesicle

A child with hypoparathyroidism is receiving vitamin D therapy. The parents should be advised to watch for which signs or symptoms of vitamin D toxicity?

Weakness and lassitude

The nurse knows that parents need further teaching with regard to the treatment of congenital clubfoot when they state what?

Were happy this is the only cast our baby will need.

When does Chronic Renal Failure (CRF) begin?

When diseased kidneys cannot maintain normal chemical structure of body

A child, age 10 years, has a neuroblastoma and is in the hospital for additional chemotherapy treatments. What laboratory values are most likely this childs?

White blood cell count, 3,000/mm3; hemoglobin, 11.5 g/dl

Unexpected Childhood death

With sudden unexpected death, family is deprived of the advantages of anticipatory grief. Interventions with survivors after sudden childhood death (Box 19.16) Active withdrawal of life supporting intervention, such as ventilator or bypass machine leads to ethical issues. Community-based follow-up

What statement is descriptive of most cases of hemophilia?

X-linked recessive inherited disorder in which a blood clotting factor is deficient

The nurse is talking to the parent of a child with special needs. The parent has expressed worry about how to support the siblings at home. What suggestion is appropriate for the nurse to give to the parent?

You should help the siblings see the similarities and differences between themselves and your child with special needs

The nurse is teaching a child with a cast about cast removal. What should the nurse teach the child about cast removal?

You will feel a tickly sensation as the cast is removed.

What are supportive interventions that can assist a preschooler with a chronic illness to meet developmental milestones? (Select all that apply.)

a. Encourage socialization. b. Encourage mastery of self-help skills. c. Provide devices that make tasks easier. d. Clarify that the cause of the childs illness is not his or her fault.

What activity should the school nurse recommend for a child with hemophilia A?(Select all that apply.)

a. Golf d. Jogging e. Swimming

What are signs and symptoms of anemia? (Select all that apply.)

a. Pallor b. Fatigue e. Muscle weakness

The nurse is caring for a 14-year-old child with disseminated intravascular coagulation (DIC). What clinical manifestations should the nurse expect to observe? (Select all that apply.)

a. Petechiae d. Bleeding from openings in the skin e. Hypotension f. Purpura

The nurse is preparing to admit a 10-year-old child with absence seizures. What clinical features of absence seizures should the nurse recognize? (Select all that apply.)

a. There is no aura. d. There is a brief loss of consciousness. e. There is an occasional clonic movement.

A child on chemotherapy has developed rectal ulcers. What interventions should the nurse teach to the child and parents to relieve the discomfort of rectal ulcers? (Select all that apply.)

a. Warm sitz baths b. Use of stool softeners c. Record bowel movements e. Occlusive ointment applied to the area

treatment for pinworms

albendazole today and again in 2 weeks

what med can you give to children with rheumatic fever

aspirin

Causes of Chronic Adrenal Insufficiency (Addison's Disease)

autoimmune, infection, metabolic disease or metastatic disease.

The clinic nurse is evaluating causes for iron deficiency due to impaired iron absorption. What should the nurse recognize as causes for iron deficiency due to impaired iron absorption? (Select all that apply.)

b. Chronic diarrhea c. Lactose intolerance e. Inflammatory bowel disease

What effects of an altered pituitary secretion in a child with meningitis indicates syndrome of inappropriate antidiuretic hormone (SIADH)? (Select all that apply.)

b. Serum sodium is decreased c. Urinary output is decreased d. Evidence of overhydration e. Urine specific gravity is increased

The nurse is teaching parents of a child being discharged from the hospital after a splenectomy about the risk of infection. What should the nurse include in the teaching session? (Select all that apply.)

c. The child should receive prophylactic penicillin for certain procedures. d. Have the child immunized with the Haemophilus influenzae type b vaccination. e. Notify the health care provider if your child develops a fever of 38.5 C (101.3 F).

Tinea capitis (ringworm), frequently found in schoolchildren, is caused by a(n):

fungus.

Causes for Vitamin B12 Deficiency

gastric mucosa fails to secrete sufficient intrinsic factor, which is essential for absorption of B12 or body is deprived of B12. The erythrocytes are usually immature and because of extremely fragile cell membrane, are rapidly destroyed during circulation.

purpose of antistreptolysin O (ASO) titer

indicates taht the child has had a recent strep infection

how can you administer iron tablets to a 10 year old kid

iron tablet with orange juice

Metatarsus Adductus

most common congenital foot deformity. "kidney shaped" as a result of abnormal positioning in utero usually corrects itself spontaneously in first 4 years of life

In intussusception the bowel telescopes into itself causing?

obstruction and edema which then causes more obstruction an ischemia + pouring of mucus into intestine

Herpes zoster is caused by the varicella virus and has an affinity for:

posterior root ganglia and posterior horn of the spinal cord.

Nursing actions for intussusception

prepare for barium enema

Nursing care of the infant with atopic dermatitis focuses on:

preventing infection.

Rocky Mountain spotted fever is caused by the bite of a:

tick

Hypothyroidism

• Active thyroid hormone is decreased • Delayed growth and intellectual disability may develop • Congenital or acquired

SIADH (syndrome of inappropriate antidiuretic hormone)

• Excessive ADH; Failure of normal feedback mechanism • Increased water reabsorption, increase intravascular volume and decrease urine output.

Negative Feedback System

• Hormone secretion regulation occurs through negative feedback mechanism- it maintains an optimum internal body environment. • Negative feedback occurs when an endocrine gland receives a message that the target cell have received an adequate amount of hormone. In response, further secretion is inhibited.

Hypopituitarism (growth hormone deficiency)

• Inhibits somatic growth • Decreased activity of pituitary gland • Primary site of dysfunction appears to be in the hypothalamus

Nursing considerations for growth hormone replacement

• Nurse is key in helping to establish diagnosis (Serial height/weight records) • Family members support needs • Child's body image concerns • Preparing child for daily injections • Injections given at bedtime for best results • Treatment very expensive ($20,000 to $30,000 per year)

Iron Deficiency Anemia Pathophysiology

• One molecule of hemoglobin consists of protein (globin) combined with four molecules of pigmented compound (heme). Each molecule of heme contains one atom of iron. When iron stores are deficient, the production of hemoglobin is reduced.

Clinical Manifestations / Assessment for Guillain-Barre Syndrome (Polyneuritis)

•Symptoms are progressive •Paralysis usually starts in the lower extremities and moves upward to upper extremities and facial muscles; possible respiratory paralysis (!) •Self-limiting disease, may stop at any point •Respiratory failure if intercostal muscles are affected •May have difficulty swallowing, breathing, and speaking •Respiratory acidosis •Cardiac dysrhythmias •Elevated protein in CSF

s/s of hydrocephalus

•widening and bulging of the fontanels •separation of the cranial sutures •dilation of scalp veins •thin and shiny scalp •rapidly increasing head circumference

History of skin

◦ Allergy profile ◦ Contact/environment/ingestion exposure ◦ Timing of appearance

Seborrheic Dermatitis

◦ Chronic recurrent inflammatory process ◦ Not associated with positive family history

Manifestations of Pediculosis Capitis (Head Lice)

◦ Pruritus ◦ Small gray specs on hair that crawl fast ◦ Nits visible, firmly attached, look like dandruff

Diagnostic Procedure for head injury

⬤Blood testing ⮚Include drug testing ⬤Lumbar puncture or tap ⬤Electroencephalogram (EEG) ⬤Auditory and visual evoked potential tests ⬤CT and MRI ⬤Nuclear brain scan

Mild Head Injury

⮚No or brief loss of consciousness ⮚Headache, memory loss, unsteady, tired ⮚GSC 13 and higher

Signs and symptoms for Chronic Adrenal Insufficiency (Addison's Disease)

- weakness - fatigue - lethargy - emotional liability - anorexia - salt craving poor weight gain or loss - hyperpigmentation - generalized bronzing of skin - abd pain - Nausea - Vomit - Diarrhea - Hypoglycemia

Renal system

-Alteration of gravitational force -Difficulty voiding in supine position -Urinary stasis/retention -Impaired ureteral peristalsis -Hypercalcemia (renal calculi)

After the acute stage and during the healing process, the primary complication from burn injury is:

infection

Candidiasis

inflamed areas with white exudate, peeling and easy bruising (oral or vaginal form most common)

Nursing Care Management

psychological support, preventing complications related to pancytopenia, monitor for side effects of medications and manage appropriately- site injection pain (apply anesthetic cream), N/V, alopecia, mucosal ulceration, etc (with chemo drugs).

Skeletal limb deficiency

range from minor to serious

What is gastro-esophageal reflux disease (GERD)?

"Transfer of gastric contents to esophagus"

Von Willebrand Disease

- A hereditary bleeding disorder involving deficiency of von Willebrand factor (a plasma protein and the carrier for factor VIII) - Von Willebrand factor needed for platelet adhesion (the bleeding time will be prolonged because platelets will fail to adhere to the walls of ruptured vessels to form platelet plug). - Transmitted as autosomal dominant trait - Occurs in both males and females

The nurse is preparing to admit a 6-month-old child with gastroesophageal reflux disease. What clinical manifestations should the nurse expect to observe? (Select all that apply.)

- A spitting up - Failure to thrive - Excessive crying - Respiratory Problems

Leukemia: ALL vs AML

- ALL is most common form of childhood cancer (ALL=acute lymphoblastic leukemia) - Approx. 4900 new cases annually in the United States - Peak onset between 2 and 5 years old, more boys than girls - Survivability: survival rates for children with ALL approach 90% in major research centers. - See table 29.3 (pg 1086) for factors affecting prognosis - AML (acute myeloid leukemia) accounts for 20% of all cases of childhood leukemia, approx. 730 new cases in US annually - Similar rates for males and females; higher rates in first year of life - 5-year survival rate 68% under age 15, and 57% for adolescents 15-19 years of age

Henoch-schonlein purpura

- Allergic vasculitis; Inflammation of small vessels - Occurs in ages 6 months to 16 years (ages 2-11, Caucasian and boys more often) - Etiology is unknown, but the disease often follows an upper respiratory infection, an allergy o drug sensitivity. - A generalized vasculitis of dermal capillaries (to a lesser extent small arterioles and veins), causing extravasation of rbcs, which produces the petechial skin lesions. characterized by: - Non thrombocytopenic purpura, arthritis, nephritis and abdominal pain

Prognosis of Sickle Cell Anemia

- Allogenic HSCT offers a curative approach for some children with SCD - Umbilical cord blood transplantation, Haploidentical transplants (half matched donor), Nonmyeloablative conditioning regimens, Sibling donor protocols - Gene Therapy is Evolving - Supportive care/prevent sickling episodes - Frequent bacterial infections may occur due to immunocompromise (bacterial infection is leading cause of death in young children with sickle cell disease (greatest risk for children under 5) - Strokes in 5% to 10% of children with disease + Result in neurodevelopmental delay, mental retardation

Level of Consciousness (LOC)

- Altered LOC= Neurologic Dysfunction - Asses: alertness and cognitive power Level of consciousness is the most important indicator of neurologic health. Various levels include full consciousness, confusion, disorientation, lethargy, obtundation, stupor, coma, and persistent vegetative state. An altered state of consciousness may be the outcome of several processes that affect the central nervous system (CNS).

The nurse is admitting a 9-year-old child with hemolytic uremic syndrome. What clinical manifestations should the nurse expect to observe? (Select all that apply.)

- Anorexia - Hypertension - Purpura

Precipitating Factors of sickle cell crisis

- Anything that increases the body's need for oxygen or alters transport of oxygen - Trauma - Infection, fever - Physical and emotional stress - Increased blood viscosity due to dehydration - Hypoxia + from high altitude, poorly pressurized airplanes, hypoventilation, vasoconstriction due to hypothermia

Lymphoma (soft tissue tumor)

- Arises from Lymphoid & Hemopoietic Systems: + Hodgkin disease peaks 15-19 y/o, extremely rare before 5 years of age, 29 cases per 1 million children + Non-Hodgkin lymphoma (NHL), 10 cases per 1 million children under age 20

Therapeutic management for GI Disorders.

- Assess F&E imbalance - rehydration - maintenance fluid therapy -reintroduction of usual diet - ORT (oral rehydration therapy) - ORS (oral rehydration solutions)

Postoperative nursing care management for amputation

- Assessment - Compression bandage "figure eight" - Positioning/pain mgmt. - Support of child and family - Planning for rehab/follow-up/home care

Dyskinetic (nonspastic, extrapyramidal)

- Athetoid - Dystonic

Manifestations of Hemophilia A

- Bleeding tendencies range from mild to severe - Symptoms may not occur until 6 months of age +Mobility leads to injuries from falls and accidents - Hemarthrosis + Bleeding into joint spaces of knee, ankle, elbow, leading to impaired mobility - Ecchymosis/Epistaxis - Bleeding after procedures

Therapeutic Management for Thalassemia

- Blood transfusion to maintain normal Hgb levels - Side effect—hemosiderosis (iron overload) - Treat chelating drugs such as - Binds excess iron for excretion by kidney - IV or SQ over 8 to10 hr multiple times/wk. - May be given at home with IV pump per parents - New oral chelation drugs—deferasirox - Worldwide use - Also give oral vitamin C to facilitate binding of iron

Therapeutic Management for Aplastic Anemia

- Bone marrow transplant - Stem cell transplant (HSCT) - Immunosuppressive therapy

Clinical Manifestations of Increased Intracranial Pressure (ICP) Late signs in infants and children

- Bradycardia - Decreased motor response to command - Decreased sensory response to painful stimuli - Alterations in pupil size and reactivity - Extension or flexion posturing - Cheyne-Stroke Respirations - Papilledema - Decreased Consciousness - Coma

CNS TUMORS

- Brain tumors and neuroblastoma are derived from neural tissue - Account for approximately 25% of childhood cancers - Tumors are difficult to treat, with poor survival rates

HIV and AIDS

- CDC estimates that less than 200 infants with HIV infection are born annually in United states - Of the children diagnosed with AIDS, the majority were African Americans, followed by Hispanic and Caucasians. - The majority of these children acquired the disease perinatally from their mothers. - The rate of mother-to-child transmission of HIV continues to decrease due to prenatal screening, elective cesarean, use to antiretroviral treatment of HIV-infected mothers and infants and avoidance of breastfeeding for HIV-infected mothers and their newborns. • Transmission rates for untreated women in USA and Europe is 12% to 30%→ transmission rates for women who received preinatal/preventative care is 1%-2% (C-section, antiretroviral drugs, avoidance of breastfeeding) • Adolescents are fastest-growing group for newly affected persons, maybe due to increased participation in high-risk behaviors such as unprotected sexual contact and IV drug use (4% of current aids population)

The nurse is preparing to admit a 10-year-old child with Duchenne muscular dystrophy. What clinical features of Duchenne muscular dystrophy should the nurse recognize? (Select all that apply.)

- Calf muscle hypertrophy - Progressive muscular weakness, wasting, and contractures - Loss of independent ambulation by 9 to 12 years of age - Slowly progressive, generalized weakness during adolescence

Hemophilia A diagnostics

- Can be diagnosed through amniocentesis - Genetic testing of family members to identify carriers - Diagnosis on basis of history, labs, and exam +Labs—low levels of factor VIII or IX, prolonged PTT + Normal—platelet count, PT, and fibrinogen

Retinoblastoma Diagnostic Evaluation

- Cat's eye reflex—most common sign - Strabismus—second most common sign - Red, painful eye, often with glaucoma - Blindness—late sign

What are some signs of Endocrine disorders

- Changes in: Growth rate, cognitive development, sexual development, and metabolic regulations likes fluids, electrolytes, and glucose.

Cancer in Children

- Childhood cancer is the leading cause of death from disease in children younger than age 15 - Males have higher overall incidence, Caucasian children have an overall higher incidence vs African American children. - Fast Rate of Cell Growth in Children - Can Lead to Proliferation of Cancerous Cells

Who are most susceptible of ingestion of Foreign Substances?

- Children under age 4 - check stool if object is not removed - Possible Surgery

Diagnostic for IBD

- Colonoscopy/Endoscopy - U/S - CT - labs: CBC+ESR or CRP, H&P

What functional goal should the nurse expect for a child who has a C7 spinal cord injury?(Select all that apply.)

- Complete independence within limitations of a wheelchair - Can roll over in bed, sit up in bed, and eat independently - Requires some assistance in transfer and lower extremity dressing

The nurse is preparing to admit a 2-year-old child with spina bifida occulta. What clinical manifestations of spina bifida occulta should the nurse expect to observe? (Select all that apply.)

- Dark tufts of hair - Skin depression or dimple - Port-wine angiomatous nevi - Soft, subcutaneous lipomas

Labs for Hypothyroidism

- Decreased T4 - Normal T3 - Elevated TSH

Metabolism and Physiologic effects of Immobilization

- Decreased metabolic rate - Anema, delayed wound healing

Lab Findings for Von Willebrand Disease

- Decreased von willebrand factor levels - decreased platelet agglutination - prolonged bleeding time, - PTT maybe normal or prolonged

Quick facts of Chronic Adrenal Insufficiency (Addison's Disease)

- Deficiency of glucocorticoids (cortisone), mineralcorticoids (aldosterone) and adrenal androgens. - Lack of body's ability to handle stress - Rare in children( when it occurs, usually result of neoplasm or lesion of adrenal glands or idiopathic cause) - Symptoms appear gradually after 90% of adrenal tissue is nonfunctional

The school nurse recognizes that the adverse effects of performance-enhancing substances can include what? (Select all that apply.)

- Depression - Aggressiveness - Changes in libido

The nurse is teaching the family of a child with type 1 diabetes about insulin. What should the nurse include in the teaching session? (Select all that apply.)

- Diabetic supplies should not be left in a hot environment. - After it has been opened, insulin is good for up to 28 to 30 days. - Insulin bottles that have been opened should be stored at room temperature or refrigerated.

Potential causes for precocious puberty

- Disorder of the gonads, adrenal glands, or hypothalamic-pituitary-gonadal axis - No causative factor in 80% to 90% of girls and 50% boys

Signs and Symptoms for hypoparathyroidism

- Dry - scaly skin with eruptions - Brittle hair - thin nails with transverse grooves - Tetany - paresthesia - tingling - laryngeal stridor, and/or spasms - Headache - seizures - emotional lability - depression - confusion -memory loss - Positive Chvostek and/or Trousseau sign

Managing Hemarthrosis for Hemophilia A

- Elevate and immobilize the joint - Ice and Analgesics as needed - ROM after bleeding stops to prevent contractures - PT - Avoid obesity to prevent joint stress

A child has had a short-arm synthetic cast applied. What should the nurse teach to the child and parents about cast care? (Select all that apply.)

- Elevate the arm when resting. - Observe the fingers for any evidence of discoloration. - Do not allow the child to put anything inside the cast. - Examine the skin at the cast edges for any breakdown.

Rebound hyperglycemia (Somogyi effect)

- Elevated BG levels at bedtime and a drop at 2 am with rebound rise following; The treatment for this phenomenon is decreasing the nocturnal insulin dose to prevent the 2 AM hypoglycemia - The rebound rise in the blood glucose level is a result of counterregulatory hormone (epinephrine, GH and corticosteroid), which are stimulated by hypoglycemia.

signs and symptoms of SIADH (syndrome of inappropriate antidiuretic hormone)

- Elevated bp - distended jugular veins - crackles in lungs - weight gain without edema - fluid and electrolyte imbalance - concentrated urine with decrease UO. - High urine osmolality - low serum osmolality - low serum sodium - decreased BUN

Labs for Hyperparathyroidism

- Elevated calcium - decreased phosphorus levels - renal function tests - imaging ultrasound to locate adenoma -ECG - radiographic bone surveys.

Iron deficiency Anemia

- Excessive milk intake (Lack of iron-fortified cereals/iron rich solid foods in diet) - Rapid growth periods - Vegetarian diet (also greater risk of vitamin D, vitamin B12 and folate deficiency) - Malabsorption disorders - Adolescents are at risk due to rapid growth rate, menses, poor eating habits, obesity and strenuous activities.

Signs and symptoms of Cushing's Disease

- Excessive weight gain - linear growth retardation - hypertension - mental and behavioral problems. - "Cusingoid Appearance"= Moon Face, chubby cheeks, double chin, fat pads over shoulders and back- buffalo hump.

What to monitor for a pt with Hirschsprung disease?

- F&E imbalance - Perforation

What to look for in pt vomiting.

- F&E imbalance - dehydration - malnutrition - aspiration

Diagnostic evaluation of Hypopituitarism (growth hormone deficiency)

- Family history - Growth patterns and health history - Definitive diagnosis based on radioimmunoassay of plasma GH levels - Hand x-rays to evaluate growth potential vs. ossification - Endocrine studies to detect deficiencies

What signs and symptoms are indicative of a urinary tract disorder in the childhood period (2 to 14 years)? (Select all that apply.)

- Fatigue - Growth failure - Blood in the urine

What are signs and symptoms of a possible kidney transplant rejection in a child? (Select all that apply.)

- Fever - Diminished urinary output - Swelling and tenderness of graft area

The nurse is preparing to admit a 10-year-old child with appendicitis. What clinical manifestations should the nurse expect to observe? (Select all that apply.)

- Fever - Vomiting - Tachycardia

Treatment for SIADH (syndrome of inappropriate antidiuretic hormone)

- Fluid management - meds - treat underlying reason - Fluids are restricted to prevent further dilution of the blood - Meds include diuretics, demeclocycline to block action of ADH at the renal collecting tubules, and hypertonic saline IV fluids.

What is celiac disease?

- Gluten allergy causing damage in villi of small intestine it causes malabsorption - a toxic substance called gliadin accumulates - auto-immune disorder

HIV AIDS Management

- Goals are slow the growth of virus, prevent and treat opportunistic infections, provide nutritional support and symptomatic treatment - Laboratory markers (CD4+ lymphocyte count and viral load) assist in monitoring both disease progression and response to therapy - Monitory for side effects and medication adherence (especially with children) - PCP prevention: all infants should be given prophylactic therapy (trimethoprim- sulfamethoxazole is the agent of choice) - Administration of IVIG to prevent recurrent or serious bacterial infections - Immunizations for pneumococcal and influenza vaccine - Varicella and MMR if not severely immunocompromised - Antibody production to vaccine maybe poor so immediate prophylaxis after exposure to several vaccine-preventable diseases (e.g., measles and varicella)

Hodgkin vs Non-Hodgkin

- Hodgkin lymphoma is considered one of the most treatable cancers, with an overall survival rate as high as 95% percent, but depends on histology & staging. Survival rates for patients with non-Hodgkin lymphoma tend to be lower. - The two forms of lymphoma are marked by a painless swelling of the lymph nodes. Hodgkin lymphomas are more likely to arise in the upper portion of the body (the neck, underarms, or chest). - Non-Hodgkin lymphoma can arise in lymph nodes throughout the body, but can also arise in normal organs. Patients with either type can have symptoms such as weight loss, fevers, and night sweats

The nurse is caring for a child with acute renal failure. What laboratory findings should the nurse expect to find? (Select all that apply.)

- Hyponatremia - Hyperkalemia - Elevated blood urea nitrogen level

The school nurse is teaching a group of adolescents about avoiding contaminated water during a mission trip. What should the nurse include in the teaching? (Select all that apply.)

- Ice - Meats - Raw Vegetables - Unpeeled Fruits

4 yr old preschooler toys

- Imitative activity you can give a plastic stethoscope

Nursing interventions for Head trauma

- Immobilize and Stabilize the Spine! - Monitor: Respiratory status and patent airway Neurological status and vital signs Signs of increased ICP, Decreased LOC Pain and restlessness - Check ears and nose for bleeding and discharge - Apply dry sterile dressing if the discharge is present - Maintain HOB elevation and neutral head position - Assess reflexes, motor and sensory function - Initiate seizure precautions - Do NOT attempt nasal suctioning (!) - Monitor for signs of infection - Prevent complications of immobility

s/s Henoch-schonlein purpura

- Inflammation and hemorrhage may also occur in the GI tract, synovium, glomeruli and CNS. • Symmetric purpura starts from lower extremities and extend to upper extremities • Marked edema of scalp, eyelids, lips, ears and dorsal surface of hands and feet • Pain and swelling in joints • GI symptoms- pain, nausea, vomiting; the stools contain gross or occult blood and mucus • Renal involvement in 50% of children- nephritis- blood, casts and protein in urine- chronic renal disease

Thalassemias

- Inherited blood disorders of hemoglobin synthesis - Mild to Severe Anemia - Beta thalassemia is an autosomal recessive disorder, so if both parents carry the abnormal gene, with each pregnancy there is a 25% chance of passing the disorder on to the child.

The nurse is assisting with application of a synthetic cast on a child with a fractured humerus. What are the advantages of a synthetic cast over a plaster of Paris cast? (Select all that apply.)

- Less bulky - Drying time is faster - Permits regular clothing to be worn - Can be cleaned with small amount of soap and water

The nurse is teaching parents about high-fiber foods that can prevent constipation. What foods should the nurse include in the teaching? (Select all that apply.)

- Lima Beans - Baked Beans - Raisin Bran Cereal

The nurse is preparing to admit a 5-year-old child with a lower motor neuron syndrome. What clinical manifestations of a lower motor neuron syndrome should the nurse expect to observe? (Select all that apply.)

- Loss of hair - Skin and tissue changes - Marked atrophy of atonic muscle

Medical treatment for cryptorchidism

- MONITOR FOR THE FIRST 12 MONTHS of life for spontaneous descent - AFTER 1 YEAR OF LIFE SURGICAL or medical CORRECTION - (Orchiopexy or Human gonadotropin)

Interventions for short-bowel syndrome

- Maintain nutrition via PN (parenteral nutrition), NG, or gastrostomy tube - monitor growth and development - intestinal transplant for those dependent on long-term PN or have suffered complications such as *fulminant sepsis or severe PN cholestasis*

What is Short-bowel syndrome ("short gut")

- Malabsorption disorder due to decreased mucosal surface area

What is Esophageal Atresia and Tracheoesophageal Fistula?

- Malformation, failure of esophagus to develop; failure of trachea and esophagus to separate

Etiology / Pathophysiology of Wilms' Tumor (Nephroblastoma)

- Malignant tumor of the kidney; uni/bi lateral

Non-Hodgkin lymphoma

- Malignant tumors of lymphoreticular system - Treatment: chemotherapy and irradiation - Approximately 800 new diagnoses of NHL each year in the United States - Clinical appearance + Disease usually diffuse rather than nodular + Cell type is evenly split between + B-cell and T-cell lineages Dissemination occurs earlier, more often, and more rapidly

Cancer Holistic Care

- Manage Effects Due to Treatment ---Chemotherapy effects- myelosuppression (decrease in platelets, rbc & wbc-risk of bleeding); alopecia (new hair maybe different in color and texture); Radiation S/E: fatigue - Prevent Complications Due to Treatment - Reduce Fear through Education Cancer, treatment, treatment effects Coping skills - Support Child Siblings Family - Pain Control

Therapeutic Management for chronic renal failure (CRF)

- Manage diet - hypertension - recurrent infections - seizures

What functional goal should the nurse expect for a child who has a T1 to T10 spinal cord injury?(Select all that apply.)

- May be braced for standing - Able to drive automobile with hand controls - Can manage adapted public transportation

Amputation

- May be congenital absence, traumatic loss, surgically required because of a condition (like cancer)

4 common types of cerebral infections

- Meningitis - Encephalitis - Guillain Barre Syndrome - Reye's Syndrome

What dietary instructions should the nurse give to parents of a child in the oliguria phase of acute glomerulonephritis with edema and hypertension? (Select all that apply.)

- Moderate sodium restriction - Limit foods high in potassium

The nurse is planning to admit an 8-year-old child with hypoparathyroidism. What clinical manifestations should the nurse expect to observe in this child? (Select all that apply.)

- Muscle cramps - Positive Chvostek sign - Laryngeal spasms

What is short-bowel syndrome caused by?

- Necrotizing Enterocolitis - volvulus - trauma - gastroschisis

Nursing care management in traction

- Never released by the nurse unless emergency or under direct supervision of the provider - Pin site care - PAIN management - Support to patient - Education and discharge planning with family

Diagnosis of Sickle Cell

- Newborn screening done in all 50 states (Universal Screening) - Genetic testing to identify carriers and children who have disease - Sickle-turbidity test (Sickledex)- heel stick, determine results in 3 minutes. - Hgb electrophoresis to Diagnose trait versus disease

What dietary instructions should the nurse give to parents of a child with minimal change nephrotic syndrome with massive edema? (Select all that apply.)

- No salt added at the table - Restriction of foods high in sodium

Bacterial Infections of the Skin

- Normal skin flora (Staphylococci or Streptococci grows and invades) - Role of Immunodeficiency (AIDS, Leukemia, Lymphoma) - Careful handwashing can prevent spread (decline in rates of MRSA since 2007). Hand hygiene is the most important function for all health care providers in preventing the spread of infection - Identify etiologic agent or agents Prompt treatment with effective therapies - Issues with development of different strains that are resistant to antibiotic therapies

Glomerular Membrane

- Normally impermeable to large proteins - Becomes permeable to proteins, especially albumin - Albumin lost in urine (hyperalbuminuria) - Serum albumin decreases (hypoalbuminemia) - Fluid shifts from plasma to interstitial spaces ■ Hypovolemia■ Ascites

Family education for Cancer

- Nurses have a significant supportive role and are instrumental to building trust - Nurses must stay well-informed themselves and help families navigate their "new normal" - Nurses must teach about medication schedules, observing for side effects and toxicities, caring for special devices such as CVCs (central venous catheters) - Stress the importance of families disclosing use of complementary and alternative medicine (CAM)

HIV AIDS NURSING CARE

- Nutritional management - Nurse should educate the community about HIV prevention practices (safe sex, appropriate storage - of needles and syringes, drug use) - HIV counseling and screening for high risk adolescents - Pain Management (EMLA or LMX, acetaminophen, NSAIDs, Muscle relaxants and opioids) - Psychological support To Reduce Opportunistic Infections - Good hand washing - Avoid raw and undercooked food (salmonella) - Avoid drinking or swimming in lake or river water or being in contact with young farm animals (Cryptosporidium) - Risk of playing with pets (Toxoplasma and Bartonella for cats, salmonella for reptiles

Failure To Thrive Interventions

- Observe parents actions when feeding kid - Maintaining a detailed record of food and fluid intake

Manifestations of Sickle Cell Anemia

- Obstruction caused by sickled RBC - Vascular Inflammation - Increased RBC destruction - vaso-occlusion may occur leading to cell death or local hypoxia

Beta-Thalassemia

- Occurs in Greeks, Italians, and Syrians - Beta is most common and has four forms - Four types + Thalassemia minor—asymptomatic silent carrier + Thalassemia trait—mild microcytic anemia + Thalassemia intermediate—moderate to severe anemia + splenomegaly + Thalassemia major "Cooley anemia"—severe anemia requiring transfusions to survive

Objective assessment for acromegaly

- On going assessment of BONE ENLARGEMENT an JOINT INVOLVEMENT evidenced by gait changes and inability to perform other activities - Pain med doses should be evaluated - Changes in vital signs that may lead to onset of early CHF

Onset, Peak Time, and Duration for Intermediate-acting (NPH, Novolin N)

- Onset: 2-6 hours - Peak Time: 4-14 hours - Duration: 14-20 hours

Onset, Peak Time, and Duration for Short-Acting (regular) Insulin

- Onset: 30 minutes - Peak Time: 2-4 hours - Duration: 4-8 hours

Onset, Peak Time, and Duration for Long Acting (Lantus)

- Onset: 6-14 hours - Peak Time: 10-16 hours (no peak or very small peak) - Duration: 20-24 hours

The nurse is preparing to admit a 7-year-old child with type 2 diabetes. What clinical features of type 2 diabetes should the nurse recognize? (Select all that apply.)

- Oral agents are effective - Ketoacidosis is infrequent - Diet only is often effective

Diagnostics for Gigantism

- Oral glucose challenge test (GH concentrations should fall during GTT for a normal individual but not for a person with gigantism) - elevated GH levels (>10ng/ml) and elevated IGF-1.

Amputations

- Orthotics: fabrication and fitting of braces - Prosthetics: fabrication and fitting of artificial limbs - Developments in these fields have led to lighter and better fitting appliances, resulting in greater patient compliance - Nursing considerations include skin assessments, meticulous skin care, assessing for SAFETY (including fall risk)

Bone Tumors

- Osteosarcoma and Ewing's sarcoma: Osteosarcoma and Ewing sarcoma are the primary bone tumors that occur most often in young people. Highest incidence occur during accelerated growth rate of adolescence.

Childhood Cancer Survivor

- Overall 5-year survival rate is 80% - Treatment, as well as the disease, may affect psychosocial, cognitive, emotional, and physical development - Almost every antineoplastic agent (especially irradiation)is responsible for some adverse effect.

signs and symptoms of acromegaly

- Overgrowth of the head, lips, nose, tongue, jaw and paranasal and mastoid sinuses - Separation and malocclusion of the teeth in the enlarged jaw - Disproportion of the face to the cerebral division of the skull - Increased facial hair; thickened, deeply creased skin - The hands and feet become enlarged as well as the: Heart, Liver, Spleen - Muscle weakens usually develops. - Joint hypertrophy and becomes painful and stiff - Males become impotent - Females develop a deepened voice, increase in facial hair and amenorrhea.

Manifestations for fractures

- Pain, swelling, diminished function; possibly bruising muscle rigidity, crepitus

The nurse is preparing to admit a 3-year-old child with intussusception. What clinical manifestations should the nurse expect to observe? (Select all that apply.)

- Passage of red, currant jellylike stools - Tender, distended abdomen - Sudden acute abdominal pain

s/s of Immune Thrombocytopenia (Idiopathic Thrombocytopenic Purpura)

- Petechiae - bruising - bleeding from mucous membranes - prolonged bleeding from abrasions - Symptomatic bleeding does not usually occur until platelet count is lower than 20,000/mmɜ

S/S Disseminated Intravascular Coagulation

- Petechiae - purpura - bleeding from opening of skin - GI bleeding - hypotension - organ dysfunction from infarction and ischemia

Etiologies of Cushing Syndrome

- Pituitary -> excess ACTH - Adrenal -> hypersecretion of glucocorticoids - Ectopic -> extrapituitary neoplasm - Iatrogenic- administration of excessive steroids - Food dependent -inappropriate adrenal response to secretion of polypeptide

The nurse is planning to admit a 14-year-old adolescent with hyperparathyroidism. What clinical manifestations should the nurse expect to observe in this patient? (Select all that apply.)

- Polyuria - Vague bone pain - Paresthesia in extremities

UTI urinary tract infection symptoms for neonate (birth to 1 month)

- Poor feeding - vomiting - failure to gain weight - frequent urination - screaming on urination - POOR STREAM - JAUNDICE - seizures - dehydration - enlarged bladder.

Cancer Nursing Care

- Prepare the patient for procedures (psychological support) + EMLA and LMX4 cream as topical anesthetics/lidocaine as intradermal anesthetic - Pain management + Oral or IV dosing preferred + Appropriate dosage based on body weight + Titrated to increase analgesia and minimize side effects - Health Promotion + Dental Care: proper oral hygiene, use of fluoride, regular dental exam and cleaning + Immunizations: No live vaccines during chemotherapy, inactive vaccines can be given but the response will be suboptimum, so delaying vaccinations is recommended; children vaccinated 2 weeks before or during chemotherapy should be considered unimmunized and should be revaccinated or receive a live vaccine 6 months after chemotherapy has stopped

Treatment for Von Willebrand Disease

- Pressure to nose for nosebleeds/Ice to nose - DDAVP (before surgery, during menses or bleeding episodes) - Infusion of von willebrand protein concentrate - Children with VWD have normal life expectancy if well managed

Interventions for Hemophilia A

- Prevent Bleeding: safe environment, avoid injury, early dental care, shave with electric razor, soft tooth brush. - Teach family the signs of cerebral bleeding (headaches, slurred speech and loss of consciousness) and gastrointestinal bleed (black tarry stools)

Management of Esophageal Atresia and Tracheoesophageal Fistula?

- Prevent aspiration and pneumonia - Surgery - NPO - Suction - Upright position.

Treatment goals for septic arthritis

- Prevent destruction of joint cartilage, and secondary bone infection - Maintain circulation - Eradicate infection

Sickle Cell Anemia Therapeutic Management

- Prevent sickling: Maintain hemodilution. - Multiple transfusions carries the risk of transmission of viral infection, hyperviscosity, transfusion reaction, alloimmunization, hemosiderosis and transfusion-related acute lung injury Fe overload: - SQ deferoxamine (Desferol) chelation (30-40 mg/kg over 8-10 hours, 5-6 nights per week); give with vitamin C to promote iron excretion (Parenteral Chelator) Annual TCD ‒ Transcranial Doppler Ultrasound screen for CVA risk in 2-16 y/0 children. ‒ Transfusion given Q 4-5 wks to Hgb S level to < 30% (prevent repeat CVA) ‒ Hydroxyurea (Mylocel): only FDA-approved drug to Hgb F & painful episodes & acute chest syndrome. ‒ Oral penicillin prophylaxis by 2 months of age (to reduce change of sepsis) ‒ Short-term O2 to prevent hypoxia ( fatal systemic sickling) (Long-term O2 may depress bone marrow more anemia). ‒ Hematopoietic stem cell transplant (HSCT) is the only potential cure (high risk of neurologic complications)

Etiology of Aplastic Anemia

- Primary (congenital)- Fanconi syndrome - Secondary (acquired)-infection, irradiation, immune disorders, certain drugs (chemo, anticonvulsants, antibiotics), toxic chemicals, leukemia/lymphoma.

Principle Feature of Acute Renal Failure (ARF)

- Principle feature oliguria - Associated with azotemia, metabolic acidosis, and electrolyte disturbances

Pseudohypoparathyroidism

- Production of PTH is increased, but end organs are unresponsive to the hormone - Thought to be inherited as X-linked dominant trait with variable expressivity

Insulin Waning

- Progressive rise in BG levels from bedtime to morning; it is treated by increasing the nocturnal insulin dosage

Nursing interventions and patient teaching for acute glomerulonephritis

- Promote rest and adequate nutrition and prevent and detect complications

What is Hypertrophic Pyloric Stenosis (HPS)?

- Pyloric sphincter becomes thick causing narrowing and obstruction

Lab Iron Deficiency Anemia

- RBC maybe normal, borderline or moderately reduced, low HgB, RBC are small (microcytic), so MCV is decreased (mean corpuscular volume=average size of RBC). - Reticulocyte count is usually normal or slightly reduced (due to decreased stores of iron). If there is a severe anemia then reticulocyte count might be elevated by 3-4%. - Total Iron Binding Capacity will be elevated. - A guaiac test (stool occult blood)

The nurse is caring for a child with a urinary tract infection who is on trimethoprimsulfamethoxazole (Bactrim). What side effects of this medication should the nurse teach to the parents and the child? (Select all that apply.)

- Rash - Urticaria - Photosensitivity

The nurse is preparing to admit a 7-year-old child with hepatitis B. What clinical features of hepatitis B should the nurse recognize? (Select all that apply.)

- Rash is common - Jaundice is present -The mode of transmission is principally by the parenteral route

Purposes for a child in traction

- Realign bone fragments/provide immobilization - Provide rest for an extremity and reduce muscle spasms - Prevent or improve contractures and joint deformities

Dawn Phenomenon

- Relatively normal BG until about 3 am, when the level begins to rise, avoid carbohydrates at bedtime, switch insulin type and dose

What does the Upper tract UTI involve?

- Renal parenchyma - Pelvis - Ureters

Management for Hemophilia A

- Replacement of deficient clotting factors - DDAVP(vasopressin) - Pressure and Ice - Transfusions (following major hemorrhage) - Corticosteroids for hematuria, hemarthrosis and chronic synovitis - Avoid Aspirin and NSAIDS (inhibit platelet function) - Amicar to prevent clot destruction- use is limited to mouth trauma or surgery, with a dose of factor VIII first. - Regular program of exercise and physical therapy- strengthens muscles around joints and maybe decrease the number of spontaneous bleeding episodes. - Prompt treatment at home with factor VIII (during bleeding episodes)

Retinoblastoma

- Retinoblastoma +Retinal malignancy, can be present at birth + White pupil, changes in red reflex 60% of cases are unilateral and nonhereditary

Cancer Diagnostics

- Review of symptoms, physical exam, complete history - Labs: CBC, chemistries, others specific to cancer type, UA - Biopsy or other diagnostic procedures (Lumbar puncture, Bone Marrow Aspiration and biopsy) - Imaging studies (X-ray, CT, MRI, PET, MIBG scan) + (Metaidobenzylguanidine Scan- to diagnose neuroblastoma and soft tissue tumors)

Special Decisions at the time of dying and death

- Right to Die/DNAR - Viewing the body - Organ/tissue donation - Sibling attendance at funeral services: Offer, but DO NOT FORCE

Ewing Sarcoma

- Second most common malignant bone tumor in children and adolescents - Prognosis best if no metastasis at time of diagnosis; distal lesions have best potential for cure - Arises in the marrow, especially in Femur, tibia, ulna, humerus Vertebrae, pelvis, scapula, ribs, skull

What to expect in Hypertrophic Pyloric Stenosis?

- Seen 1st few weeks of life -> projectile vomiting after feeding -> F&E imbalance, fussy, failure to thrive risk, dehydration

Sickle Cell Crisis Acute Chest Syndrome

- Similar to pneumonia - Vasoocclusion or infection results in sickling in the lungs - Chest pain, fever, cough, tachypnea, wheezing, and hypoxia - Repeated episodes may lead to pulmonary hypertension

Child in traction

- Skin: Buck's & Russell's - Skeletal: Steinmann pin or Kirschner wire used; 90-90 or balanced suspension traction -Manual: (used during closed reduction)

The nurse is caring for a 14-year-old child with juvenile idiopathic arthritis (JIA). What clinical manifestations should the nurse expect to observe? (Select all that apply.)

- Soft tissue contractures - Swelling in multiple joints - Morning stiffness of the joints - Loss of motion in the affected joints

The nurse is preparing to admit a 6-year-old child with celiac disease. What clinical manifestations should the nurse expect to observe? (Select all that apply.)

- Steatorrhea - Malnutrition - Foul-smelling stools

Diagnostics for GI Disorders

- Stool Exam - Ova/Parasites - Guaiac Test - H-pylori Test - Radiography - Exams with Contrast - Biopsy - Endoscopy

HIV AND AIDS ETIOLOGY

- Strains: HIV-1 is more common in US and HIV-2 is more common in Africa - Horizontal Transmission: Intimate sexual contact or parenteral exposure to blood or body fluids. - Vertical (perinatal) Transmission: Mother passes to an infant - Transfusion of infected blood or blood products has accounted for 3% to 6% pediatric cases (before 1985) - Sexual contact and unsafe sexual practices may lead to it; sexual abuse may lead to it - Circumcision reduces heterosexually acquired HIV in adolescent boys and men

therapeutic Managment Henoch-schonlein purpura

- Supportive Management ; Analgesics and NSAIDS for edema, rash, malaise and arthralgia (occasionally mild sedation) - Corticosteroids for more severe symptoms (edema, arthralgia, and colicky abdominal pain) - Nephropathy monitoring - Some children may feel better within a month whereas other may take 2 to 3 years; rarely death may occur from GI complications, acute renal failure or CNS involvement.

Cancer Treatment Modalities

- Surgery: conservative, most effective when tumor is localized and encapsulated - Chemotherapy: primary form of treatment or adjunct with other therapies; many are vesicants that can cause severe tissue damage. Therefore, not all nurses can administer chemotherapy! It is only administered by nurses with experience handling and administering these medications. ***Must be given via free flowing IV and stopped immediately for extravasation or if s/s of anaphylaxis occur...especially when giving L-asparginase, bleomycin, cisplatin, and etoposide (VP-16)*** - Radiation therapy: causes both lethal and sublethal damage to cells - Radiation is used in conjunction with chemotherapy or surgery, can be palliative (shrinks tumor size to lessen symptoms) or curative - GI tract, skin, head, urinary bladder, and bone marrow most adversely affected - Bone marrow transplantation is used for malignancies unlikely to be cured by other means. + Large dose of chemotherapy/radiation is given first to get rid of cancer cells; once body is free from cancer cells, the stem cells are given to hopefully start producing normal blood cells + HLA (human leukocyte antigens: A, B, C, D, DR and DQ) are matched to prcompatibility and prevent serious graft-versus-host-disease (GVHDedict ).

Hypothyroidism Therapy

- Synthroid - Pediatric - endocrinologist - periodic T4 and TSH testing - bone age - intellectual levels - growth patterns (trial to wean off the medicine at 3 years of age)

Diagnostics / Labs for Hyperthyroidism

- TSH - T3 (triiodothyronine) - T4 levels - thyroid scan - thyroid antibodies - T3 and T4 are elevated and TSH is decreased.

Clinical Manifestations of Increased Intracranial Pressure (ICP) for Infants

- Tense, bulging fontanel - Separated Cranial Sutures - Macewen (cracked-pot) sign - Irritability and restlessness - Drowsiness - Increased Sleeping - High-pitched cry - Increased frontooccipital circumference - Distended scalp veins - Poor feeding - Crying when disturbed - Setting-sun sign

Osteosarcoma

- The most frequent malignant bone tumor type in children - Most primary tumor sites are in the metaphysis of long bones, especially legs - More than 50% occur in distal femur - Other sites—humerus, tibia, pelvis, jaw, phalanges

Therapeutic Management for Anemia

- Transfusion after hemorrhage prn - Nutritional intervention

Most common pathologic cause for Acute Renal Failure

- Transient renal failure resulting from severe dehydration

Treatment for Gigantism

- Transsphenoidal surgery for pituitary adenomas - radiation treatment - drugs (suppress growth hormone secretion/block growth hormone)

Complications of cancer therapy

- Tumor Lysis Syndrome: most common with ALL or Burkitt lymphoma, but also common in malignancies with large tumor burdens, those very sensitive to chemotherapy, or that have a rapid proliferative rate +*caused by rapid release of intracellular contents during the lysis of malignant cells, which results in serious metabolic abnormalities* + Clinical s/s: flank pain, lethargy, nausea and vomiting, muscle cramps, pruritus, tetany, and seizures. + Treatment: involves frequent urine pH and blood chemistry monitoring, strict I & O, aggressive IV fluids, medication to treat high uric acid (allopurinol, rasburicase), treat specific metabolic abnormality and exchange transfusion - Hyperleukocytosis: WBC count greater than 100,000/mm3, can lead to capillary obstruction, microinfarction and organ dysfunction - Others: Superior Vena Cava Syndrome, Spinal cord compression and Disseminated Intravascular Coagulation.

The nurse is preparing a community outreach program for adolescents about the characteristic differences between type 1 and type 2 diabetes mellitus (DM). What concepts should the nurse include? (Select all that apply.)

- Type 1 DM has an abrupt onset - Type 1 DM occurs primarily in whites - Type 2 DM always requires insulin therapy - Type 2 DM occurs in people who are overweight

Iron Deficiency Anemia Manifestations

- Underweight infants/sometimes overweight due to excessive milk ingestion 'milk baby' - Pale skin/Pallor - Poor muscle development - Edema/Retarded growth - Decreased serum concentration of proteins albumin, gamma globulin and increased transferrin/TIBC - Irritability - Tachycardia - Fatigue - Glossitis - Angular Stomatitis - Koiloncyhia - Impairedneurocognitivefunction (e.g. attention span, memory, alertness, learning, and behavioral problems). - Systolic Heart murmur

What clinical syndrome is associated with Chronic Renal Failure (CRF)

- Uremia

How do you obtain urine sample?

- Urine bag collection - Catheterization - Suprapubic aspiration

Iron Deficiency Anemia Prevention

- Use of only breast milk or iron fortified formula for first the first 12 months (no cow's milk)/ Delayed introduction of cow's milk in diets - Introduction of iron-fortified cereal/ Iron supplementation. - Weaning from bottle by 1 year of age - Limiting cow's milk to 16 to 24 oz per day (encouraging more solids and iron rich foods)

Nursing interventions for a child in a cast

- Used for immobilization to promote healing and ensure proper alignment - Nursing responsibilities during application and removal? Consider developmental age of child! - During healing: 1. Assess 2. Support skin and circulation 3. Support family and ADL's

Treatment for Pediculosis Capitis (Head Lice)

- Wash all linens - Pyrethrins 1% cream rinse (Nix) Piperonyl butoxide shampoo (RID) - Malathion 0.5% (prescription drug) if other two are not effective - Comb out nits with fine tooth comb daily for 7-10 days, then repeat shampoo treatment - Do not share combs, hair ornaments, hats, caps, scarves, coats and other items or near the hair.

Nursing care management for hyperparathyroidism

- Watch for symptoms of hyperparathyroidism - enforce adequate hydration to prevent renal calculi - acidic juices to maintain low urinary PH to promote calcium absorption - brace for osteodystrophy (renal rickets) - physical therapy as needed - vital sign abnormalities - low-phosphate foods particularly dairy products.

What interventions can you teach to a person with GERD?

- Weight Control - Small frequent meals - Upright position - Medications - Nissen Fundoplication

The nurse is preparing to admit a 2-month-old child with hypertrophic pyloric stenosis. What clinical manifestations should the nurse expect to observe? (Select all that apply.)

- Weight loss - Projectile Vomiting - The infant is hungry after vomiting

Diagnostic Evaluation of HIV AIDS

- Western Blot Immunoassay and HIV enzyme-linked immunosorbent assay (ELISA) testing- for children 18 months of age or older (maternal antibody may persist in infant for 18 months) - HIV DNA, RNA PCR or HIV culture allows for more definitive diagnosis in young infants 1 6 months of age. - Positive results on two separate tests performed on separate blood specimens are required for diagnosis of HIV infection. - Severity of infection may also be determine by clinical signs and symptoms and CD4 counts.

The nurse is preparing to admit a 7-year-old child with ataxic cerebral palsy. What clinical manifestations of ataxic cerebral palsy should the nurse expect to observe? (Select all that apply.)

- Wide-based gait - Rapid, repetitive movements performed poorly - Disintegration of movements of the upper extremities when the child reaches for objects

Etiology of Hemophilia A

- X-linked recessive trait (union of unaffected male with trait- carrier female) - Males are affected - Females may be carriers - Degree of bleeding depends on amount of clotting factor and severity of a given injury - Up to one third of cases have no known family history + In these cases disease is caused by a new gene mutation

In teaching a 16-year-old adolescent who was recently diagnosed with systemic lupus erythematosus (SLE), what statements should the nurse include? (Select all that apply.)

- You should use a moisturizer with a sun protection factor (SPF) of 30. - You should avoid pregnancy because this can cause a flare-up. - You may need to modify your daily recreational activities.

signs and symptom of celiac disease

- ab pain - ab distention - failure to thrive - diarrhea - fatigue

management of Intussusception

- air enema - IV fluids - NG tube - antibiotics - surgery - NPO

Lower GI bleed can come from?

- anal fissure - IBD - intussusception - anal fissure, colonic polyps, enteric infections

Causes of Diarrhea?

- bacteria - viruses - parasites -IBD - Food sensitivities

Causes of Vomiting

- bacteria - viruses - GI obstruction - Food intolerances

tracheomalacia manifestation for tracheoesophageal fistula repair

- barking cough - stridor - wheezing cyanosis - apnea Infants who have tracheomalacia have a weakened trachea, which leads to collapse

What is pica?

- compulsive and excessive ingestion of both food and nonfood substances

Most common Upper GI bleed is from?

- esophagus - peptic inflammation - ulceration - esophagitis caused by GER, gastritis, bleeding disorders

Urinary tract infection uti nonspecific symptoms for children under 2 years old

- fever - irritability - lethargy - poor feeding - vomiting - diarrhea

Specific Signs of bacterial Meningitis

- fever - lethargy - vomiting - headache - nuchal rigidity

Interventions for IBS that are not very effective

- fiber supplements - lactose-free diets - probiotics

Who usually gets Hypertrophic Pyloric Stenosis?

- first born child, boys are 4-6x more likely

urinary tract infection UTI specific symptoms for older children

- frequency and painful urination - small amount of urine - no or low grade fever.

Things you should not see in Urine (urinalysis)

- glucose - ketones - WBCs - RBCs - Casts - Nitrates

Subjective assessment for acromegaly

- headaches or visual disturbances - Muscle weakness - Encourage pts to verbalize emotional response to sexual problems

Central precocious puberty

- hypothalamus is prematurely activated to secrete gonadotropin-releasing hormone, and it is considered idiopathic. - Premature thelarche (breast development), premature menarche, premature adrenarche (pubic and axillary sexual hair), advanced bone age- unusually tall for age but growth ceases prematurely due to early closure of epiphyseal plates

lab values for nephrotic syndrome

- increased platelet - low sodium - normal or increased hemoglobin - high cholesterol

Acute Renal failure (ARF)

- kidneys suddenly unable to regulate the volume and composition of urine

Young children's response to head injury is different from the response of older children and adults because:

- larger head size - expandable skull - larger blood volume to the brain - small subdural spaces - thinner, softer brain tissue.

Therapeutic Management for hypoparathyroidism

- maintain normal serum calcium and phosphate levels - tetany is corrected by IV and oral administration of calcium gluconate with vitamin D therapy - after initial treatment frequent monitoring of Ca, Mg, Phos, - renal function tests - BP and serum vitamin D levels.

Prognosis for Hemophilia A

- mild to moderate hemophilic lives a near normal live - Gene therapy is evolving

signs and symptons of IBD

- mild to severe depending to case - bloody diarrhea - abd pain - failure to thrive - anemia

Anemia

- most common hematologic disorder for kids - The cause of anemia are inadequate production of RBCs or RBC components, increased destruction of RBCs and excessive loss of RBCs through hemorrhage. - Decreased oxygen carrying capacity of the blood - When anemia develops slowly, child adapts

Signs and symptoms of hypoglycemia

- nervousness - pallor - tremors - palpitations - sweating - hunger - weakness - dizziness - headache - drowsiness - irritability - loss of coordination - seizures and coma

Signs and Symptoms of Esophageal Atresia and Tracheoesophageal Fistula?

- newborn with frothy saliva - drooling - choking - coughing - respiratory distress - aspiration

Normal Urinalysis

- pH 5-9 - Specific Gravity 1.001-1.035 - Protein <20 mg/dl - Urobilinogen up to 1 mg/dl - Things you should not see in Urine: Glucose, Ketones, WBCs, RBCs, Casts, & Nitrites

Causes of constipation?

- pain meds - poor diet - low fiber - immobility - hirschsprung disease - hypothyroid - lead poisoning - medications

signs and symptoms of Nephrotic Syndrome (Nephrosis)

- periorbital edema - decreased urine output - abdominal distention - generalized edema - increased body weight - vomiting - anorexia - diarrhea - irritability

expected finding of glomerulonephritis

- periorbital edema - hypertension

signs and symptoms for Hirschsprung Disease?

- poor feedings - vomiting - abd distention - failure to thrive - ribbonlike and foul-smelling stool

Diagnostic Evaluation for Disseminated Intravascular Coagulation

- prolonged prothrombin - partial thromboplastin and thrombin times - depressed platelets - fragmented RBCs - depleted fibrinogen levels

Management for IBD

- promote growth and nutrition - possible surgery in UC= subtotal colectomy or ileostomy

signs and symptoms of intussusception

- red currant jelly-like stools (mucus/blood mix) - sudden abd pain - mass

Management of nephrotic syndrome (nephrosis) is aimed at what?

- reducing protein - reducing or preventing fluid retention by tissues - preventing infection and other complications

Medical Management of Acute Glomerulonephritis

- restricted fluids, sodium, potassium, phosphate - regular measurement of vital signs, body weight, and I&O - management of hypertension - antibiotic therapy

Diagnostics for Addison Disease

- serum cortisol (low cortisol level) and 17-hydroxycorticosteroid (17- OHCs) - low Na - High K - Low FBG - CT to visualized adrenals.

Late Signs of Increased intracranial pressure (ICP)

- significant decrease in LOC - Cushing triad - Increased systolic bp and widened pulse pressure - bradycardia - irregular respirations - fixed and dilated pupils

Nursing management for vomiting patients

- similar to diarrhea; possibly antiemetics, find cause and treat as able

Management for Hirschsprung disease

- surgery - fix F&E imbalance - NG tube - emotional support - post-op care

Therapeutic management for hyperparathyroidism

- surgical removal of parathyroid gland (watch for laryngeal stridor- airway obstruction) or treat underlying cause if possible.

Treatment for Cushing's Disease

- surgical removal of pituitary adenoma - irradiation of pituitary- lifelong glucocorticoid and mineralcorticoid replacement will be required after surgery (Replacement of growth hormone, ADH, TH, gonadotropins, and steroids).

Thyrotoxicosis for Hyperthyroidism

- thyroid crisis or thyroid storm- emergency state (muscle weakness, tremors, diarrhea, extreme sweating, palpitations, can progress to coma or cardiac failure)

What is the goals in medical management of UTI urinary tract infection

- treat acute infection and prevent renal complications: - uncomplicated cystitis - complicated UTI

Quick facts of Hernias

- usually asymptomatic, painless - Do not tape or strap - caution with lifting, pushing, wrestling, sports, etc

What to watch for in parathyroidectomy

- watch for complications of hypocalcemia: seizures and tetany (have calcium gluconate available at bedside)

S/s of adrenal crisis (acute adrenal insufficiency)

- weakness - fever - abd pain - hypoglycemia with seizures - hypotension - dehydration - shock - coma (Etiologic factors—hemorrhage into the gland from trauma - fulminating infections - abrupt withdrawal of exogenous cortisone - failure to increase cortisone during times of stress)

What kind of foods should a pt with celiac disease should avoid

- wheat - barley - rye - oats

Osteogenesis Imperfecta:

-A group of inherited disorders of connective tissue, characterized by excessive fragility and bone defects. Most common osteoporosis syndrome in children. -Faulty bone mineralization, abnormal bone architecture, increased susceptibility to fracture. Error in formation of type I collagen, a major structural component of bone. Patients also manifest with hyperextensibility of ligaments. -At least 11 types with Type II being most severe, children with type II are stillborn or die in early infancy. 2/3 of cases are type I. -Treatment is primarily supportive. Educate families on cautious handling, plan home care, provide genetic counseling. 50% risk of affected individual passing gene to offspring.

Septic Arthritis

-Also called suppurative, pyogenic, and purulent arthritis -Most common in hip, knee, and shoulder, usually involves only one joint -Joint is warm, tender, painful, swollen -Frequently follows traumatic injury -Fever, leukocytosis, increased sedimentation rate -Neisseria gonorrhoeae is frequent cause of septic arthritis in sexually active teens

Pharmacologic Interventions to Decrease Spasticity in CP

-Botulinum toxin type A (Botox) -Baclofen: Oral or Implanted pump for intrathecal administration -Dantrolene sodium (Dantrium) -Diazepam (Valium)

Brain Tumors

-Brain Tumors +Most common solid tumor +Cerebellum, midbrain, brainstem +Effects related to size, location, growth rate -60% are infratentorial +Occur in the posterior third of the brain +Primarily in cerebellum or brainstem -40% are supratentorial +Occur in the anterior two thirds of the brain +Mainly in the cerebrum +Treatment: surgery, chemotherapy, radiation

Types of Fracture

-Complete versus incomplete -Simple versus compound -Compound or open—fractured bone protrudes through the skin -Complicated—bone fragments have damaged other organs or tissues - Transverse - Oblique - Spiral -Comminuted—small fragments of bone are broken from the fractured shaft and lie in surrounding tissue -Greenstick—compressed side of bone bends, but tension side of bone breaks, causing incomplete fracture

Types of sports injuries

-Contusions and dislocations -Sprains and Strains -Overuse and stress fractures

Integumentary system for immobilization

-Decreased circulation and pressure leading to decreased healing capacity -Risk for ischemia and tissue damage

Gastrointestinal system

-Decreased mobility of the bowel (constipation) -Risk for aspiration

Respiratory system

-Decreased respiratory effort -Reduction in normal movement of secretions

Muscular system

-Decreased strength, endurance -Atrophy, loss of joint mobility

Spastic (pyramidal) cerebral palsy

-Di/tri/tetra (quadri) plegia -Monoplegia -Hemiplegia

Psychologic effects of immobilization

-Diminished environmental stimuli -Altered perception of self and environment -Increased feelings of frustration, helplessness, anxiety -Depression, anger, aggressive behavior -Developmental regression

Goals of therapy for a person with cerebral palsy

-Establish locomotion, communication, and self-help -Gain optimum integration of motor functions -Correct associated defects as early and effectively as possible -Provide educational opportunities -Promote socialization experiences

Neuroblastoma

-Most common malignant extracranial solid tumor of childhood. + Most common primary site is within the abdomen + Other sites—head, neck, chest, pelvis - Silent tumor = 70% Dx'd after metastasis. 1- st S/S r/t involvement in non-primary site: lymph nodes, bone marrow, skeletal system, skin, or liver. + Sympathetic nervous system + Median age of diagnosis is 19 months + Prognosis related to stage at diagnosis - Signs and symptoms depend on the location and stage of the disease - Radiologic studies, bone marrow evaluation - IVP to evaluate renal involvement - Clinical staging to establish treatment plan - Surgery to remove tumor and obtain biopsies - Radiation, chemotherapy - Bone marrow transplantation - Stem cell rescue ***In general, younger age at diagnosis equals better prognosis***

Cerebral Palsy

-Most common permanent physical disability in childhood -Characterized by early onset of impaired movement and posture -Reported incidence ranges from 1.5 to over 4 per 1000 live births (U.S.)

Diagnostic evaluation of Juvenile Idiopathic Arthritis (JIA)

-No definitive diagnostic tests (diagnosis of exclusion), no specific cure -Labs: Leukocytosis frequently present during exacerbations (flares); elevated C-reactive protein and sedimentation rate may or may not be present -Diagnosis based on criteria of American College of Rheumatology -Age of onset younger than 16 years -One or more affected joints -Duration of arthritis more than 6 weeks -Exclusion of other forms of arthritis -Goals of therapy: preserve function, prevent deformities, relieve symptoms

Motor signs of cerebral palsy

-No smiling by 3 months (also behavioral sign) -Poor head control after age 3 months -Clenched fists after age 3 months -Unable to sit without support at age 8 months -Floppy tone -Stiff or rigid limbs -Arching back/pushing away

Juvenile Idiopathic Arthritis (JIA)

-Peak ages—1 to 3 years and 8 to 10 years, female prominence of 2:1 -Autoimmune disorder characterized by chronic inflammation of synovium with joint effusion, destruction of cartilage, and ankylosis of joints as disease progresses -Stiffness/swelling/growth retardation -Loss of mobility, warm to touch, usually without erythema; symptoms increase with stressors

Nursing Care management for a person with cerebral palsy

-Reinforce therapeutic plan: surgery, medications, mobility aids, etc. -Assist in normalization -Address health maintenance needs -Family support -ADVOCATE for continued therapy of the hospitalized child with CP

Osteomyelitis

-Signs and symptoms begin abruptly; resemble symptoms of arthritis and leukemia, early x-rays may appear normal -Most frequently seen in children under age 10, usually caused by Staphylococcus aureus -Prompt, vigorous IV antibiotics for extended period (3 to 4 weeks or up to several months) -Monitor hematologic, renal, hepatic responses to treatment

Bone healing and remodeling

-Typically rapid healing in children -Neonatal period 2 to 3 weeks - Early childhood 4 weeks - Later childhood 6 to 8 weeks - Adolescence—8 to 12 weeks

signs and symptoms of childhood cancer

-Unusual mass or swelling -Unexplained paleness and loss of energy -Easy bruising -Persistent, localized pain or limping -Prolonged, unexplained fever or illness -Frequent headaches, often with vomiting -Sudden eye or vision changes -Unexplained, rapid weight loss

What does the endocrine system do?

releases hormones. These hormones affect cellular activity and have a cellular response, which has to do with the quantity and timing of the hormone

Iron deficiency Anemia

1. Give Iron supplement 1 hr before or 2 hr after milk or antacid to prevent decreased absorption 2. GI upset is common at the start of therapy. These will decrease over time. 3. If tolerated, administer iron supplements on an empty stomach (more effective) 4. Give with meals and start with reduced dose and gradually increase if GI distress occur. 5. Use a straw with liquid preparations to prevent staining of teeth. Instruct the child to brush teeth after oral dose to prevent staining of teeth. 6. Use a Z-track into deep muscle for parenteral injection. Do not massage after injection. 7. Educate the child and family to expect stools to turn a tarry green color if dose is adequate. 8. Increase fiber and fluids if constipation develops 9. Store no more than 1 month's supply in a child-proof bottle out of reach of children (to prevent overdose) 10. Inform parent that treatment will be depended on child's response to treatment. Hgb levels will be checked in a month. 11. PICA (Craving for substances that has no nutritional value like ice, clay, soil and paper).

Common Symptoms Experienced by Dying Children (Box 19.13)

1. Pain: visceral, bone, neuropathic 2. GI: anorexia, N/V/D, constipation 3. GU: UTI, urinary retention 4. Hematologic: anemia/bleeding 5. Respiratory: cough, congestion, secretions, SOB, wheezing 6. CNS: fatigue, fever/chills, sleep disturbance, restlessness/agitation, seizures 7. Integumentary: dry skin, rash, itching, pressure sores, edema 8. Emotional: fear, anxiety, depression

Care of the grieving family

1. Parental grief 2. Sibling grief 3. Mourning Shock and disbelief Expression of grief Disorganization and despair Reorganization Bereavement Programs- self help groups like compassionate friends, nurses can offer help as well.

The nurse is teaching a parent of an infant to limit the amount of formula to encourage the intake of iron- rich food. What amount should the nurse teach to the parent?

1000 ml

Calculate the absolute neutrophil count (ANC) for the following: WBC count of 5000 mm3; neutrophils (segs) of 10%; and nonsegmented neutrophils (bands) of 12%.

1100/mm3

A child with cancer being treated with chemotherapy is receiving a platelet transfusion. The nurse understands that the transfused platelets should survive the body for how many days?

1to3days

When does birth weight quadruple?

30 months

What blood glucose measurement is most likely associated with diabetic ketoacidosis?

330 mg/dl

A 3-year-old child has a femoral shaft fracture. The nurse recognizes that the approximate healing time for this child is how long?

4 weeks

The clinic nurse is evaluating lab results for a child. What recorded hematocrit (Hct) result is considered within the normal range?

40%

Daily toothbrushing and flossing can be encouraged for the child on chemotherapy when the platelet count is above which?

40,000/mm3

The nurse is preparing to admit a child to the hospital with a diagnosis of acute poststreptococcal glomerulonephritis. The nurse understands that the peak age at onset for this disease is what?

5 to 7years

Defects in Hemostasis: Hemophilia

A group of hereditary bleeding disorders that result from deficiencies of specific clotting factors Hemophilia A - Classic hemophilia - Deficiency of factor VIII - Accounts for 80% of cases of hemophilia - Occurrence—1 in 5000 males Hemophilia B - Also known as Christmas disease - Caused by deficiency of factor IX - Occurrence- 1 in 20,000-30,000 live male births - 15% of cases of hemophilia 48

The nurse is taking care of a 7-year-old child with a skin rash called a papule. Which clinical finding should the nurse expect to assess with this type of skin rash?

A lesion that is elevated, palpable, firm and circumscribed; less than 1 cm in diameter

A toddler with spastic cerebral palsy needs to be transported to the radiology department. What transportation method should the nurse use to take the toddler to the radiology department?

A wagon with pillows

Atopic Dermatitis (Eczema)

AD is chronic relapsing inflammatory skin disorder that results in itching and lesions (20% of children)

Lordosis

Accentuation of the cervical or lumbar curvature beyond physiologic limits. May be secondary complication of trauma or idiopathic. In obese children, abdominal fat alters center of gravity, causing lordosis.

The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. What effect does exercise have on a type 1 diabetic?

Additional snacks are needed before exercise

A preadolescent has maintained good glycemic control of his type 1 diabetes through the school year. During summer vacation, he has had repeated episodes of hypoglycemia. What additional teaching is needed?

Additional snacks are needed to compensate for increased activity.

s/s of absence seizure

Age of onset: Uncommon before age 3 year Frequency (per day): multiple Duration: Usually < 10 sec, rarely > 30 sec Aura: Never Impaired Consciousness: Always, brief loss of consciousness Automatisms: Frequent Clonic Movement: Occasional Postictial Impairment: Never Mental Disorientation: Unusual

What type of chemotherapeutic agent alters the function of cells by replacing a hydrogen atom of a molecule?

Alkylating agents

A young childs parents call the nurse after their child is bitten by a raccoon in the woods. The nurses recommendation should be based on what knowledge?

Antirabies prophylaxis must be initiated immediately.

In which condition are all the formed elements of the blood simultaneously depressed?

Aplastic anemia

A young girl has just injured her ankle at school. In addition to notifying the childs parents, what is the most appropriate, immediate action by the school nurse?

Apply ice.

One of the supervisors for a home health agency asks the nurse to give a family of a child with a chronic illness a survey evaluating the nurses and other service providers. How should the nurse recognize this request?

Appropriate to improve quality of care

Nursing management for fractures

Assess 5 P's, alleviate pressure on nerves, manage pain, promote nutrition and hydration, support growth and development, support family system

What is an appropriate nursing intervention when caring for a child in traction?

Assessing for tightness, weakness, or contractures in uninvolved joints and muscles

A 23-month-old child is admitted to the hospital with a diagnosis of meningitis. She is lethargic and very irritable with a temperature of 102 F. What should the nurses care plan include?

Assessing the level of consciousness (LOC) and vital signs every 2 hours

What should the nurse plan for an immobilized child in cervical traction to prevent deep vein thrombosis (DVT)?

Assist the child to dorsiflex the feet and rotate the ankles.

What is the single most prevalent cause of disability in children and responsible for the recent increase in childhood disability?

Asthma

A child with growth hormone (GH) deficiency is receiving GH therapy. When is the best time for the GH to be administered?

At bedtime

A toddler is diagnosed with chronic benign neutropenia. The parents are being taught about caring for their child. What information is important to include?

Avoid large indoor crowds and people who are ill.

What intervention should be beneficial in reducing the risk of Reye syndrome?

Avoidance of aspirin for children with varicella or those suspected of having influenza

When a child develops latex allergy, which food may also cause an allergic reaction?

Bananas

diagnostics Henoch-schonlein purpura

Based on H&P and clinical manifestations; Lab tests are performed to assess for GI and renal involvement; test for occult blood and increased levels of immunoglobulin A are frequent finding.

A school-age child with diabetes gets 30 units of NPH insulin at 0800. According to when this insulin peaks, the child should be at greatest risk for a hypoglycemic episode between when?

Bedtime and breakfast the next morning

A 20-kg (44-lb) child in ketoacidosis is admitted to the pediatric intensive care unit. What order should the nurse not implement until clarified with the physician?

Begin intravenous line with D5 0.45% normal saline with 20 mEq of potassium chloride.

Preadolescent and adolescent Atopic Dermatitis (eczema)

Begins at about 12 years of age; may continue into early adult years of indefinitely (face, sides of neck, hands, feet, face and antecubital and popliteal fossa)

A 5-year-old girl sustained a concussion when she fell out of a tree. In preparation for discharge, the nurse is discussing home care with her mother. What sign or symptom is considered a manifestation of postconcussion syndrome and does not necessitate medical attention?

Behavioral changes

The nurse observes that a seriously ill child passively accepts all painful procedures. The nurse should recognize that this is most likely an indication that the child is experiencing what emotional response?

Belief that procedures are a deserved punishment

If an intramuscular (IM) injection is administered to a child who has Reye syndrome, the nurse should monitor for what?

Bleeding

What statement best describes a subdural hematoma?

Bleeding occurs between the dura and the cerebrum

The nurse is caring for a child after a parathyroidectomy. What medication should the nurse have available if hypocalcemia occurs?

Calcium gluconate

4 yr old fine motor development

Can copy circle

The school nurse is conducting a class for school-age children on Lyme disease. Which is characteristic of Lyme disease?

Caused by a spirochete that enters the skin through a tick bite

Scabies

Caused by scabies mite (Sarcoptes Scabiei), 30-60 days between infestation and symptoms Lesions are created as the impregnated female burrows into the stratum corneum of the epidermis (never into living tissue) to deposit her eggs and feces. Inflamed, intense pruritus (from eggs, mites, and excrement), excoriation r/t to itching. Papules, burrows and vesicles are common. Distributed in intertriginous areas: interdigital surfaces, axillary-cubital area, popliteal folds, and the inguinal region. Treat all contacts - Contagious by close contact with infected person (Family and day care contacts); All bedding and clothing to be washed in hot water. Risk of impetigo, secondary to scratching

The nurse is conducting a staff in-service on appearance of childhood skin conditions. Lymphangitis (streaking) is frequently seen in which condition?

Cellulitis

A child who has just had definitive repair of a high rectal malformation is to be discharged. What should the nurse address in the discharge preparation of this family?

Changes in stooling patterns to report to the practitioner

A child with juvenile idiopathic arthritis (JIA) is started on a nonsteroidal antiinflammatory drug (NSAID). What nursing consideration should be included?

Check for abdominal pain and bloody stools.

In a child with sickle cell anemia (SCA), adequate hydration is essential to minimize sickling and delay the vasoocclusion and hypoxiaischemia cycle. What information should the nurse share with parents in a teaching plan?

Check for moist mucous membranes.

The nurse outlines short- and long-term goals for a 10-year-old child with many complex health problems. Who should agree on these goals?

Child, family, and all professionals involved

The nurse is preparing a staff education in-service session for a group of new graduate nurses who will be working in a long-term care facility for children; many of the children have cerebral palsy (CP). What statement should the nurse include in the training?

Children with spastic pyramidal CP have a positive Babinski sign and ankle clonus.

Which pt is at increased with for GERD?

Children with: - hiatal hernias - morbid obesity - neurologic impairment - premature birth

What are quick, jerky, grossly uncoordinated, irregular movements that may disappear on relaxation called?

Choreiform movements

What is the major health concern of children in the United States?

Chronic illness

An 8-year-old girl is receiving a blood transfusion when the nurse notes that she has developed precordial pain, dyspnea, distended neck veins, slight cyanosis, and a dry cough. These manifestations are most suggestive of what complication?

Circulatory overload

Leave the tourniquet in place.

Circulatory stasis can lead to thrombus and embolus formation

What statement best describes iron deficiency anemia in infants?

Clinical manifestations are related to a reduction in the amount of oxygen available to tissues

The nurse is caring for a child with tetanus during the acute phase. What should the nurse plan in the care for this child?

Clustering nursing care to limit distractions

Preschool concept of death

Concept: Can't separate physical death from living abilities Death is temporary and reversible, with literal meaning "grandma has gone to sleep" Reaction: Feelings of guilt, shame, punishment, due to their sense of self-power and omnipotence. Allow for play as a coping mechanism, may c/o stomachaches, HA's, other physical symptoms

Adolescent concept of death

Concept: Mature understanding, but tend to think they will not die. Search for spiritual meaning. Reaction: Least likely of all age-groups to accept the cessation of life, particularly their own Box 19.10: Dying child's right to refuse treatment; acceptance without judgement ***Remember, palliative care IS NOT "withdrawal of care", it is allowing a natural death (AND) when the time comes.

The nurse is teaching parents the proper use of a hipkneeanklefoot orthosis (HKAFO) for their 4-year-old child. The parents demonstrate basic essential knowledge by making what statement?

Condition of the skin in contact with the brace should be checked every 4 hours.

A school-age child has sustained a head injury and multiple fractures after being thrown from a horse. The childs level of consciousness is variable. The parents tell the nurse that they think their child is in pain because of periodic crying and restlessness. What is the most appropriate nursing action?

Consult with a practitioner about what analgesia can be safely administered.

Etiologic factors for skin lesions

Contact with: ◦ Injurious agents (infective organisms; toxic chemicals, physical trauma) ◦ Hereditary ◦ External factors such as allergens ◦ Systemic disease (varicella, lupus, etc) - Response can be variable - Age can play a role - Seasonal variation of environment can play a role - More than 1⁄2 of skin problems in children presents as dermatitis

An infant is born with a gastroschisis. Care preoperatively should include which priority intervention?

Covering the defect with a sterile bowel bag

what do you use to feed a child that had a surgical repair of a cleft palate?

Cup

The nurse is caring for a child with Meckel diverticulum. What type of stool does the nurse expect to observe?

Currant jellylike

What physiologic defect is responsible for causing anemia?

Decreased oxygen-carrying capacity of blood

The parents of a child on a ventilator tell the nurse that their insurance company wants the child to be discharged. They explain that they do not want the child home under any circumstances. What principle should the nurse consider when working with this family?

Desire to have the child home is essential to effective home care.

Intranasal administration of desmopressin acetate (DDAVP) is used to treat which condition?

Diabetes insipidus (DI)

Diagnosis for septic arthritis

Diagnosis made from blood culture, joint fluid aspirate, and x-ray

A child is receiving vincristine (Oncovin). The nurse should monitor for which side effect of this medication?

Diarrhea

What medication is classified as an antiretroviral?

Didanosine (Videx)

What immunoglobulin pattern does the nurse expect in a child recently diagnosed with Wiskott-Aldrich syndrome?

Diminished levels of IgM

Which is one of the first signs of overwhelming sepsis in a child with burn injuries?

Disorientation

For minimal change nephrotic syndrome (MCNS), prednisone is effective when what occurs?

Diuresis occurs as urinary protein excretion diminishes

The nurse is teaching the parent of a preschool child how to administer the childs insulin injection. The child will be receiving 2 units of regular insulin and 12 units of NPH insulin every morning. What should the parent be taught?

Draw the regular insulin first and then the NPH into the same syringe.

What is a common clinical manifestation of juvenile hypothyroidism?

Dry skin

When does idiopathic scoliosis become most noticeable?

During the preadolescent growth spurt

The middle school nurse is speaking to parents about prevention of injuries as a goal of the physical education program. How should the goal be achieved?

Education of adults to recognize signs that indicate a risk for injury

A child has a seizure disorder. What test should be done to gather the most specific information about the type of seizure the child is having?

Electroencephalogram (EEG)

A 7-year-old child has just had a cast applied for a fractured arm with the wrist and elbow immobilized. What information should be included in the home care instructions?

Elevate casted arm when both upright and resting.

The nurse is caring for a 10-year-old child who has an acute head injury, has a pediatric Glasgow Coma Scale score of 9, and is unconscious. What intervention should the nurse include in the childs care plan?

Elevate the head of the bed 15 to 30 degrees with the head maintained in midline.

What is an appropriate nursing intervention for a child with minimal change nephrotic syndrome (MCNS) who has scrotal edema?

Elevate the scrotum with a rolled washcloth.

The nurse is planning care for a 3-year-old boy who has Down syndrome and is on continuous oxygen. He recently began walking around furniture. He is spoon fed by his parents and eats some finger foods. What goal is the most appropriate to promote normal development?

Encourage mobility.

What intervention is most appropriate for fostering the development of a school-age child with disabilities associated with cerebral palsy?

Encourage socialization with peers.

The nurse is planning care for a child recently diagnosed with diabetes insipidus (DI). What intervention should be included?

Encourage the child to wear medical identification.

What intervention is contraindicated in a suspected case of appendicitis?

Enemas

Therapeutic Regimen for Atopic Dermatitis (Eczema)

Enhancing hydration ◦ *Tepid baths w/no soap, mild soap or oil emulsion ◦ *Apply emollient w/in 3 min; Eucerin, Cetaphil, Aquaphor Reliving pruritis ◦ Colloid baths prn 2 cups cornstarch ◦ *Antihistamines both sedating and non-sedating ◦ Topical corticosteroids- low, mod, and high potency (Anti-Inflammatory) Preventing Flare-ups ◦ Topical immunomodulator at first sign of flare-up (when skin is red and itches) ◦Tacrolimus or Pimecrolimus (increases risk of cancer for children <2 yrs, so reserved for ages 2 or more) Prevent infection ◦ Systemic antibiotics prn secondary bacterial infection

What is an important priority in dealing with the child suspected of having Wilms tumor?

Ensuring the abdomen is protected from palpation

The parents of a child born with disabilities ask the nurse for advice about discipline. The nurses response should be based on remembering that discipline is which?

Essential for the child

A 12-year-old girl is newly diagnosed with diabetes when she develops ketoacidosis. How should the nurse structure a successful education program?

Essential information is presented initially.

Poison Ivy, Oak, and Sumac

Exposure/contact to offending agent—urushiol Classic lesion presentation: ◦ Itching ◦ Localized ◦ Oozing ◦ Painful ◦ Streaked or spotty Remove offending agent ◦ Cleansing skin ◦ Prevent secondary infection

An adolescent has just been brought to the emergency department with a spinal cord injury and paralysis from a diving accident. The parents keep asking the nurse, How bad is it? The nurses response should be based on which knowledge?

Extent and severity of damage cannot be determined for several weeks or even months.

As part of the diagnostic evaluation of a child with cancer, biopsies are important for staging. What statement explains what staging means?

Extent of the disease at the time of diagnosis

The nurse is taking care of a child who had a thyroidectomy. The nurse recognizes what as a positive Chvostek sign?

Facial muscle spasm elicited by tapping the facial nerve in the region of the parotid gland

T/F Flare-ups are predictable for IBD

False; unpredictable

The nurse is preparing to admit an adolescent with bacterial meningitis. What clinical manifestations should the nurse expect to observe? (Select all that apply.)

Fever Chills Headache Drowsiness

Postmortem Care

Final moments are extremely stressful Varied emotions from joy and relief initially if the child was suffering, to occasional angry outbursts. Nurse must expect this and be supportive. Offer for parents to hold and participate in bathing and dressing if they desire, allow for good-byes Escort family to exit, provide needed paperwork, make community referrals as needed, follow-up call

The nurse is taking care of a 2-year-old child with a macule skin lesion. Which clinical finding should the nurse expect to assess with this type of lesion?

Flat, brown mole less than 1 cm in diameter

Postoperative positioning for a child who has had a medulloblastoma brain tumor (infratentorial) removed should be which?

Flat, on either side with pillows behind the back

A recommendation to prevent neural tube defects (NTDs) is the supplementation of what?

Folic acid for all women of childbearing age

What is a priority of care when a child has an external ventricular drain (EVD)?

Frequent assessment of amount and color of drainage

What therapeutic intervention is most appropriate for a child with b-thalassemia major?

Frequent blood transfusions

What clinical manifestation is considered a cardinal sign of diabetes mellitus?

Frequent urination

A neonate is born with mild clubfeet. When the parents ask the nurse how this will be corrected, what should the nurse explain?

Frequent, serial casting is tried first.

A child has an absolute neutrophil count (ANC) of 500/mm . The nurse should expect to be administering which prescribed treatment?

G-CSF (Neupogen) daily

The nurse is caring for a child with myasthenia gravis (MG). What health care prescription should the nurse verify before administering?

Garamycin (gentamicin)

What should preoperative care of a newborn with an anorectal malformation include?

Gastrointestinal decompression

Parents of a newborn with ambiguous genitalia want to know how long they will have to wait to know whether they have a boy or a girl. The nurse answers the parents based on what knowledge?

Gender assignment involves collaboration between the parents and a multidisciplinary team.

A school-age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time. What is the most appropriate nursing action to prevent or minimize these reactions with subsequent treatments?

Give an antiemetic before chemotherapy begins.

Which is an effective strategy to reduce the stress of burn dressing procedures?

Give child as many choices as possible.

What nursing intervention is most appropriate in promoting normalization in a school-age child with a chronic illness?

Give the child as much control as possible.

Families progress through various stages of reactions when a child is diagnosed with a chronic illness or disability. After the shock phase, a period of adjustment usually follows. This is often characterized by what response?

Guilt and anger

The nurse is preparing a child for possible alopecia from chemotherapy. What information should the nurse include?

Hair may have a slightly different color or texture when it regrows.

A child with hemophilia A is scheduled for surgery. What precautions should the nurse institute with this child?

Handle the child gently when transferring to a cart.

An 8-year-old child is hit by a motor vehicle in the school parking lot. The school nurse notes that the child is responding to verbal stimulation but is not moving his extremities when requested. What is the first action the nurse should take?

Have someone notify the emergency medical services (EMS) system.

s/s of brain tumor

Headache - recurrent and progressive - frontal or occipital area - dull and throbbing and worse when rising Vomiting Neuromuscular Changes - clumsiness - loss of balance - poor fine motor skills - weakness -postivie babinski - spasticity - paralysis Behavior Changes - Irritability - Decreased Appetite - Failure to thrive - Fatigue - Lethargy - Coma - Bizzare Behavior Cranial Nerve Neuropathy Decreased Pulse Increased BP

A child with sickle cell disease is in a vasoocclusive crisis. What nonpharmacologic pain intervention should the nurse plan?

Heat to the affected area

The potential effects of chronic illness or disability on a childs development vary at different ages. What developmental alteration is a threat to a toddlers normal development?

Hindered mobility

A 3-day-old infant presents with abdominal distention, is vomiting, and has not passed any meconium stools. What disease should the nurse suspect?

Hirschsprung disease

A toddler sustains a minor burn on the hand from hot coffee. Which is the first action the nurse should recommend in treating this burn?

Hold burned area under cool running water.

The nurse is preparing to administer a prescribed dose of desmopressin acetate (DDAVP) intramuscularly (IM) to a child with diabetes insipidus. What action should the nurse take before drawing the medication into a syringe?

Hold the medication under warm water for 10 to 15 minutes and then shake vigorously.

Palliative care delivery

Hospital, home, hospice Hospice care specializes in the care of dying patients by combining the hospice philosophy with the principles of palliative care. "Hospice philosophy regards dying as a natural process and views the care of dying patients as including management of the physical, psychological, social, and spiritual needs of the patient and family." ***25% of children enrolled in outpatient hospice care still die in an acute care setting*** Parents who actively participate in their child's care report better bereavement outcomes; including less anxiety, stress and depression

Spastic cerebral palsy (CP) is characterized by which clinical manifestations?

Hypertonicity; poor control of posture, balance, and coordinated motion

The nurse is conducting discharge teaching with the parent of a 7-year-old child with minimal change nephrotic syndrome (MCNS). What statement by the parent indicates a correct understanding of the teaching?

I should not add additional salt to any of my childs meals.

The nurse is teaching the parents of a 3-year-old child who has been diagnosed with tonic-clonic seizures. What statement by the parent should indicate a correct understanding of the teaching?

I should place a pillow under my childs head during a seizure.

The nurse is teaching the parent of a 4-year-old child with a cast on the arm about care at home. What statement by the parent indicates a correct understanding of the teaching?

I will use an ice pack to relieve the itching.

An adolescent comes to the school nurse after experiencing shin splints during a track meet. What reassurance should the nurse offer?

Ice, rest, and nonsteroidal antiinflammatory drugs (NSAIDs) usually relieve pain.

Fungal Skin Infections

Identified dermatophytosis "Tinea" Can present in various locations of the body—can be localized and/or systemic Prevention of transmission: can be person to person or animal to person. Hygiene procedures (do not share bedding, grooming items, towels, caps or anything else that comes in close contact with infected area)

Preventing Hereditary Atopy

Identify families and children at risk ◦ Family history ◦ Increased IgE levels ◦ Infant with dry, flaky skin Prenatal Precautions (last trimester) ◦ Avoid any known food allergies ◦ Avoid dairy, peanuts, eggs, ◦ Avoid other hyper-allergenic foods (soy, shellfish) Postnatal Precautions - Breast milk or casein-whey hydrolysate formula for 6mo - No solid food for 6 mo - No cow or soy milk for 12 mos - No eggs, fish, corn, citrus, peanuts, nuts, or chocolate for 18mo - Do not add a new food more frequently than 1 every 5 days

The nurse is teaching a class on preventing diaper rash in newborns to a group of new parents. Which statement made by a parent indicates a correct understanding of the teaching?

If my infants buttocks become slightly red, I will expose the skin to air.

Spina Bifida Myelomeningocele

If the spinal cord is enclosed in the cyst the condition is called myelomeningocele. This is the most serious type of spina bifida.

For children who do not have a matched sibling bone marrow donor, the therapeutic management of aplastic anemia includes what intervention?

Immunosuppressive therapy

After spinal fusion surgery the nurse should check for signs of what?

Impaired color, sensitivity, and movement to the lower extremities

Spina Bifida Meningocele

In the next most serious type, meningocele the coverings of the spinal cord (meninges) pass back through the opening in the spine to form a cyst-like swelling

A child with severe anemia requires a unit of red blood cells (RBCs). The nurse explains to the child that the transfusion is necessary for which reason?

Increase her energy so she will not be so tired.

Which explains physiologically the edema formation that occurs with burns?

Increased capillary permeability

What statement best describes b-thalassemia major (Cooley anemia)?

Increased incidence occurs in families of Mediterranean extraction.

Nutritional management of the child with Crohn disease includes a diet that has which component?

Increased protein

The clinical manifestations of sickle cell anemia (SCA) are primarily the result of which physiologic alteration?

Increased red blood cell (RBC) destruction

During a well-child visit, the mother tells the nurse that her 4-month-old infant is constipated, is less active than usual, and has a weak-sounding cry. The nurse suspects botulism and questions the mother about the childs diet. What factor should support this diagnosis?

Infant cereal with honey

A 4-month-old with significant head lag meets the criteria for floppy infant syndrome. A diagnosis of progressive infantile spinal muscular atrophy (Werdnig-Hoffmann disease) is made. What should be included in the nursing care for this child?

Infant stimulation program

Age related rashes

Infants: birthmarks Early Childhood: atopic dermatitis School-Age children: tinea / ringworm Adolescents: acne

Cellulitis

Infection of the skin and subcutaneous tissue with intense redness, swelling and firm infiltration. Lymphangitis "streaking" frequently seen Involvement of regional lymph nodes common; may progress to abscess Staph/Strep usual causes (sometimes Haemophilus influenzae) Organism enters through break in skin: abrasion, bite, trauma Most commonly seen in extremities, bucal, periorbital areas

Iron overload is a side effect of chronic transfusion therapy. What treatment assists in minimizing this complication?

Infusion of deferoxamine

Care for the child with acute idiopathic thrombocytopenic purpura (ITP) includes which therapeutic intervention?

Intravenous administration of anti-D antibody

The nurse stops to assist an adolescent who has experienced severe trauma when hit by a motorcycle. The emergency medical system (EMS) has been activated. The first person who provided assistance applied a tourniquet to the childs leg because of arterial bleeding. What should the nurse do related to the tourniquet?

Leave the tourniquet in place.

The nurse is caring for an infant who had surgical repair of a tracheoesophageal fistula 24 hours ago. Gastrostomy feedings have not been started. What do nursing actions related to the gastrostomy tube include?

Leave the tube open to gravity drainage.

After a tonic-clonic seizure, what symptoms should the nurse expect the child to experience?

Lethargy and confusion

The nurse is teaching infant care to parents with an infant who has been diagnosed with osteogenesis imperfecta (OI). What should the nurse include in the teaching session?

Lift the infant by the buttocks, not the ankles, when changing diapers.

The nurse has been visiting an adolescent with recently acquired tetraplegia. The teens mother tells the nurse, Im sick of providing all the care while my husband does whatever he wants to, whenever he wants to do it. What reaction should be the nurses initial response?

Listen and reflect the mothers feelings.

What therapeutic intervention provides the best chance of survival for a child with cirrhosis?

Liver transplantation

What should the nurse consider when providing support to a family whose infant has just been diagnosed with biliary atresia?

Liver transplantation may be needed eventually.

The thyroid-stimulating hormone (TSH) increases secretion in response to which hormone?

Low levels of circulating thyroid hormone

How do you diagnose Meningitis

Lumbar puncture

Aseptic Meningitis

Many different viruses cause aseptic meningitis. The onset may be abrupt or gradual. The initial manifestations are headache, fever, photophobia, and nuchal rigidity. Diagnosis is based on clinical features and cerebral spinal fluid findings. Treatment is primarily symptomatic.

What procedure is most appropriate for assessment of an abdominal circumference related to a bowel obstruction?

Marking the point of measurement with a pen

What do the clinical manifestations of minimal change nephrotic syndrome include?

Massive proteinuria, hypoalbuminemia, and edema

What immunization should not be given to a child receiving chemotherapy for cancer?

Measles, mumps, rubella (MMR)

Essential postoperative nursing management of a child after removal of a brain tumor includes which nursing care?

Measuring all fluid intake and output

What pain medication is contraindicated in children with sickle cell disease (SCD)?

Meperidine (Demerol)

A child with pyloric stenosis is having excessive vomiting. The nurse should assess for what potential complication?

Metabolic alkalosis

Gingivitis is a common problem in children with cerebral palsy (CP). What preventive measure should be included in the plan of care?

Meticulous dental hygiene

Lyme Disease

Most common tick borne disorder seen in United States Caused by Spirocete Borrelia burgdorferi Three stages ◦ Early localized disease—classic Bull's eye lesion, 3-10 days ◦ Early disseminated disease—constitutional symptoms, 3-10 weeks ◦ Third stage—systemic involvement of multi systems, 2-12 months No definitive test in early stages for diagnosis (antibodies not detectable early). Early treatment—doxycycline (age>8) or amoxicillin (age<8), 14-21 days Prevent complications from progression

What is appropriate mouth care for a toddler with mucosal ulceration related to chemotherapy?

Mouthwashes with plain saline

What nursing consideration is most important when caring for a child with end-stage renal disease (ESRD)?

Multiple stresses are placed on children with ESRD and their families because childrens lives are maintained by drugs and artificial means.

The nurse should suspect a child has cerebral palsy (CP) if the parent says what?

My 4-month-old doesnt lift his head when on his tummy.

What refers to a hernial protrusion of a saclike cyst of meninges, spinal fluid, and a portion of the spinal cord with its nerves through a defect in the vertebral column?

Myelomeningocele

To help an adolescent deal with diabetes, the nurse needs to consider which characteristic of adolescence?

Need to be perfect and similar to peers

What is the most common cause of cerebral palsy (CP)?

Neonatal encephalopathy

The nurse is doing a neurologic assessment on a 2-month-old infant after a car accident. Moro, tonic neck, and withdrawal reflexes are present. How should the nurse interpret these findings?

Neurologic health

The nurse is closely monitoring a child who is unconscious after a fall and notices that the child suddenly has a fixed and dilated pupil. How should the nurse interpret this?

Neurosurgical emergency

An adolescent with a spinal cord injury is admitted to a rehabilitation center. Her parents describe her as being angry, hostile, and uncooperative. The nurse should recognize that this is suggestive of which psychosocial state?

Normal response to her situation that can be redirected in a healthy way

A 5-year-old child is admitted to the hospital in a sickle cell crisis. The child has been alert and oriented but in severe pain. The nurse notes that the child is complaining of a headache and is having unilateral hemiplegia. What action should the nurse implement?

Notify the health care provider.

A child with sickle cell anemia (SCA) develops severe chest and back pain, fever, a cough, and dyspnea. What should be the first action by the nurse?

Notify the practitioner because chest syndrome is suspected.

A 4-year-old child is placed in Buck extension traction for Legg-Calv-Perthes disease. He is crying with pain as the nurse assesses the skin of his right foot and sees that it is pale with an absence of pulse. What should the nurse do first?

Notify the practitioner of the changes noted.

A child with acute glomerulonephritis is in the playroom and experiences blurred vision and a headache. What action should the nurse take?

Obtain the childs blood pressure and notify the health care provider

What term is used to describe a childs level of consciousness when the child is arousable with stimulation?

Obtundation

When does cryptorchidism occur?

Occurs when ONE OR BOTH TESTES FAIL TO DESCEND through the inguinal canal and INTO THE SCROTAL SAC

Shaken baby syndrome

Often referred to as the "triad": (1)damage to the brain, evidenced by severe brain swelling and/or diffuse traumatic axonal injury (2) bleeding under the membranes which cover the brain (subdural and/or subarachnoid hematomas) (3) bleeding in the layers of the retina (retinal hemorrhage)

A woman who is 6 weeks pregnant tells the nurse that she is worried that, even though she is taking folic acid supplements, the baby might have spina bifida because of a family history. The nurses response should be based on what?

Open neural tube defects (NTDs) result in elevated concentrations of a-fetoprotein in amniotic fluid.

The nurse notes that the parents of a critically ill child spend a large amount of time talking with the parents of another child who is also seriously ill. They talk with these parents more than with the nurses. How should the nurse interpret this situation?

Parent-to-parent support is valuable.

What is a major premise of family-centered care?

Parents are the experts in caring for their child.

The nurse uses the five Ps to assess ischemia in a child with a fracture. What finding is considered a late and ominous sign?

Paresthesia

Why is breast milk considered a great management therapy for necrotizing enterocolitis (nec)

Passive immunity (IgA), macrophages and lysozymes Human milk may have a protective effect

The nurse is caring for a child with hemophilia A. The childs activity is as tolerated. What activity is contraindicated for this child?

Passive range of motion exercises

What is the narrowing of preputial opening of foreskin called?

Phimosis

Care at the time of death

Physical changes: lack of energy, appetite decreases, less responsive, final stages of breathing slow and shallow, irregular Cheyne-Stokes breathing, urine decreases or stops, skin may be pale, grayish-blue in color, and may be cool to touch. (Box 19.14) Emotional changes: "angels" "not afraid" Death vigils: family and friends gather @ bedside Legacy building: hand molds, footprints Spiritual, religious, cultural, or family rituals

Tinea Cruris "jock itch"

Pink papules and scales on inner thigh, groin, and scrotum. Pruritus is present

The most important nursing intervention when caring for an infant with myelomeningocele in the preoperative stage is which?

Place the infant on the side to decrease pressure on the spinal sac.

A feeding technique the nurse can teach to parents of a child with cerebral palsy to improve use of the lips and the tongue to facilitate speech is which?

Placing food at the side of the tongue

Diagnostic Evaluation for Immune Thormbocytopenia (Idiopathic Thrombocytopenic Purpura)

Platelet count less than 20,000 mmɜ; several tests are conducted to rule out other disorders related to thrombocytopenia such as lupus, lymphoma, leukemia

The nurse is caring for a school-age child with severe anemia and activity intolerance. What diversional activity should the nurse plan for this child?

Playing board or card games

A school-age child with celiac disease asks for guidance about snacks that will not exacerbate the disease. What snack should the nurse suggest?

Popcorn

What is a high-fiber food that the nurse should recommend for a child with chronic constipation?

Popcorn

A 17-year-old patient is returning to the surgical unit after Luque instrumentation for scoliosis repair. In addition to the usual postoperative care, what additional intervention will be needed?

Position changes are made by log rolling.

An infant has been diagnosed with bladder obstruction. What do symptoms of this disorder include?

Posturination dribbling

The nurse is teaching the girls varsity sports teams about the female athlete triad. What is essential information to include?

Pregnancy can occur in the absence of menstruation.

In anticipation of the admission of a child with hereditary spherocytosis (HS) who is experiencing an aplastic crisis, what action should the nurse plan?

Prepare for a transfusion of packed red blood cells.

A feeling of guilt that the child caused the disability or illness is especially common in which age group?

Preschooler

Inspection of Skin

Presence of lesions Presenting symptoms: ◦ Pruritus ◦ Pain or tenderness ◦ Anesthesia or hyperesthesia or hypoesthesia or paresthesia can occur

Management of pain and suffering

Presence of unrelieved pain and other distressful symptoms are unfortunately common among terminally ill children In fact... Studies show children continue to be under-medicated for pain Nurses need to practice holistic, family-centered care and incorporate pharmacologic and non- pharmacologic interventions for symptom management Carefully consider the route of administration LEAST TRAUMATIC Pain control in the terminal stages should be given the HIGHEST PRIORITY!!

Surgery is performed on a child to correct cryptorchidism. The parents understand the reason for the surgery if they tell the nurse this was done to do what?

Prevent damage to the undescended testicle.

What condition precipitates polycythemia?

Prolonged tissue hypoxia

What rationale explains why prolonged use of oxygen should be discouraged in a child with anemia?

Prolonged use of oxygen can decrease erythropoiesis.

What cerebrospinal fluid (CSF) analysis should the nurse expect with viral meningitis? (Select all that apply.)

Protein count is normal. Gram stain findings are negative. White blood cell (WBC) count is slightly elevated.

What is a hernia?

Protrusion of an organ through an abnormal opening: inguinal (80% of childhood hernias), umbilical, femoral (<1%)

A goal for children with spina bifida is to reduce the chance of allergy development. What is a priority nursing intervention?

Provide a latex-free environment.

Nitrous oxide is being administered to a child with extensive burn injuries. Which is the purpose of this medication?

Provide anesthesia.

The nurse is teaching the family of a child, age 8 years, with moderate hemophilia about home care. What should the nurse tell the family to do to minimize joint injury?

Provide intravenous (IV) infusion of factor VIII concentrates.

Fentanyl and midazolam (Versed) are given before dbridement of a childs burn wounds. Which is the rationale for administration of these medications?

Provide pain relief.

What statement related to clinical trials developed for pediatric cancers is most accurate?

Provide the best available therapy compared with an expected improvement

The nurse is taking care of a child with scabies. Which primary clinical manifestation should the nurse expect to assess with this disease?

Pruritus

The nurse is caring for a 4-year-old child with cerebral palsy (CP). The child, developmentally, is at an infant stage. Appropriate developmental stimulation for this child should be what?

Putting a colorful mobile with music on the bed

Prolonged steroid therapy has caused a child to have Cushing syndrome. To lessen the cushingoid effects, the steroid should be administered at which time?

QOD in the AM

An 8-year-old girl with moderate cerebral palsy (CP) recently began joining a regular classroom for part of the day. Her mother asks the school nurse about joining the after-school Girl Scout troop. The nurses response should be based on which knowledge?

Recreational activities often provide children with CP with opportunities for socialization and recreation.

What laboratory finding, in conjunction with the presenting symptoms, indicates minimal change nephrotic syndrome?

Reduced serum albumin

The nurse notes that a child has lost 3.6 kg (8 lb) after 4 days of hospitalization for acute glomerulonephritis. What is the most likely cause of this weight loss?

Reduction of edema

An adolescent girl is cooking on a gas stove when her bathrobe catches fire. Her father smothers the flames with a rug and calls an ambulance. She has sustained major burns over much of her body. Which is important in her immediate care?

Remove her burned clothing and jewelry.

Parents tell the nurse that their child keeps scratching the areas where he has poison ivy. The nurses response should be based on which knowledge?

Scratching the lesions may cause them to become secondarily infected.

Congenital adrenal hyperplasia (CAH) is suspected in a newborn because of ambiguous genitalia. The parents are appropriately upset and concerned about their childs gender. In teaching the parents about CAH, what should the nurse explain?

Sexual assignment should wait until genetic sex is determined.

A nurse is teaching a parent of an infant about treatment of seborrhea dermatitis (cradle cap). Which should the nurse include in the instructions?

Shampoo every day with an antiseborrheic shampoo.

What condition occurs when the normal adult hemoglobin is partly or completely replaced by abnormal hemoglobin?

Sickle cell anemia

Skin Objective Findings

Size and Morphology - Erythema - Ecchymosis - Petechiae - primary or secondary lesion Distribution Pattern - Bilateral or Unilateral - Localized or Systemic Configuration and arrangement - ex: discrete, clustered, diffuse, or confluent Diagnostic Tesitng - Biopsy or scraping - Microscopic analysis - Blood work-CBC, specific testing and/or autoimmune testing - Use of wood light examination - allergy skin test

A child is upset because, when the cast is removed from her leg, the skin surface is caked with desquamated skin and sebaceous secretions. What technique should the nurse suggest to remove this material?

Soak in a bathtub.

Cerebral Edema

Some degree of cerebral edema is expected after craniocerebral trauma. Cerebral edema peaks at 24 to 72 hr after injury and may account for changes in a child's neurologic status. Cerebral edema associated with traumatic brain injury may be a result of two different mechanisms, cytotoxic edema or vasogenic edema.

What type of cerebral palsy (CP) is the most common type?

Spastic

What test is used to screen for carbohydrate malabsorption?

Stool pH

The nurse is administering an intravenous chemotherapeutic agent to a child with leukemia. The child suddenly begins to wheeze and have severe urticaria. What nursing action is most appropriate to initiate?

Stop the drug infusion immediately.

Cellulitis is often caused by:

Streptococcus or Staphylococcus organisms.

An adolescent with irritable bowel syndrome comes to see the school nurse. What information should the nurse share with the adolescent?

Stress management may be helpful.

What term is used when a patient remains in a deep sleep, responsive only to vigorous and repeated stimulation?

Stupor

A father calls the clinic nurse because his 2-year-old child was bitten by a black widow spider. The nurse should advise which to the father?

Take child to emergency department.

The nurse is caring for an immobilized preschool child. What intervention is helpful during this period of immobilization?

Take the child for a walk by wagon outside the room.

Which prescribed treatment should the nurse plan to implement for a child with psoriasis?

Tar and exposure to sunlight and ultraviolet light

What statement best describes Hirschsprung disease?

The colon has an aganglionic segment.

The parents of a newborn with an umbilical hernia ask about treatment options. The nurses response should be based on which knowledge?

The defect usually resolves spontaneously by 3 to 5 years of age.

A health care provider prescribes feedings of 1 to 2 oz Pedialyte every 3 hours and to advance to 1/2 strength Similac with iron as tolerated postoperatively for an infant who had a pyloromyotomy. The nurse should decide to advance the feeding if which occurs?

The infant is taking the Pedialyte without vomiting or distention.

What statement applies to the current focus of the dietary management of children with diabetes?

The intake ensures day-to-day consistency in total calories, protein, carbohydrates, and moderate fat while allowing for a wide variety of foods.

The mother of a child with cognitive impairment calls the nurse because her son has been gagging and drooling all morning. The nurse suspects foreign body ingestion. What physiologic occurrence is most likely responsible for the presenting signs?

The object may be lodged in the esophagus.

The nurse is teaching the family of an infant with cerebral palsy how to administer a diazepam (Valium) pill by gastrostomy tube. What should the nurse include in the teaching session?

The pill should be crushed and mixed with a small amount of water.

A parent of a hospitalized child on chemotherapy asks the nurse if a sibling of the hospitalized child should receive the varicella vaccination. The nurse should give which response?

The sibling can get a varicella vaccination.

A mother tells the clinic nurse that she often puts honey on her infants pacifier to soothe the infant. What response should the nurse make to the mother?

There is still a risk for infant botulism from honey.

A 5-year-old child will be starting kindergarten next month. She has cerebral palsy, and it has been determined that she needs to be in a special education classroom. Her parents are tearful when telling the nurse about this and state that they did not realize her disability was so severe. What is the best interpretation of this situation?

This is a normal anticipated time of parental stress.

A 14-year-old is admitted to the emergency department with a fracture of the right humerus epiphyseal plate through the joint surface. What information does the nurse know regarding this type of fracture?

This type of fracture requires different management to prevent bone growth complications.

The regulation of red blood cell (RBC) production is thought to be controlled by which physiologic factor?

Tissue hypoxia

Management for Disseminated Intravascular Coagulation

Treat the underlying cause, platelets/IV fluids or FFP maybe needed to replace lost plasma components; ill newborn infants may require exchange transfusion with fresh blood 60

T/F for Short-bowl syndrome you need to minimize complications like infection, occlusion, and dislogement

True

T/F: The majority of children with acute febrile encephalopathy have either bacterial meningitis or viral meningitis as the underlying cause.

True

Infantile atopic dermatitis (eczema)

Typically begins by 2-6 months; generally undergoes spontaneous remission at 3 years of age (generalized- face, scalp, neck, extensor surface of extremities)

Childhood Atopic Dermatitis (eczema)

Typically begins by age 2-3 years; 90% of children has manifestations by 5 years (flexural areas, antecubital and popliteal fossa, neck, wrists, ankles, feet)

A preadolescent has been diagnosed with scoliosis. The planned therapy is the use of a thoracolumbosacral orthotic. The preadolescent asks how long she will have to wear the brace. What is the appropriate response by the nurse?

Until your vertebral column has reached skeletal maturity.

The mother of a 1-month-old infant tells the nurse she worries that her baby will get meningitis like the childs younger brother had when he was an infant. The nurse should base a response on which information?

Vaccinations to prevent pneumococcal and Haemophilus influenzae type B meningitis are available.

An infant had a gastrostomy tube placed for feedings after a Nissen fundoplication and bolus feedings are initiated. Between feedings while the tube is clamped, the infant becomes irritable, and there is evidence of cramping. What action should the nurse implement?

Vent the gastrostomy tube.

The nurse should expect to assess which causative agent in a child with warts?

Virus

A lumbar puncture (LP) is being done on an infant with suspected meningitis. The nurse expects which results for the cerebrospinal fluid that can confirm the diagnosis of meningitis?

WBCs; glucose

What major complication is associated with a child with chronic renal failure?

Water and sodium retention

What strategies should the nurse implement to increase nutritional intake for the child receiving chemotherapy? (Select all that apply.)

a. Allow the child any food tolerated. b. Fortify foods with nutritious supplements. c. Allow the child to be involved in food selection.

The nurse is caring for a 12-year-old child with b-thalassemia. What clinical manifestations should the nurse expect to observe? (Select all that apply.)

a. Anorexia b. Unexplained fever c. Enlarged spleen or liver d. Bronzed, freckled complexion

The nurse should teach the family that which residual disabilities can occur for a child being treated for a brain tumor? (Select all that apply.)

a. Ataxia c. Dysphagia d. Sensory deficits e. Crania nerve palsies

The nurse is caring for a child with increased intracranial pressure (ICP). What interventions should the nurse plan for this child? (Select all that apply.)

a. Avoid jarring the bed. d. Administer prescribed stool softeners. e. Administer a prescribed antiemetic for nausea.

The nurse is administering a unit of blood to a child. What are signs and symptoms of a transfusion reaction? (Select all that apply.)

a. Chills b. Shaking c. Flank pain e. Sudden severe headache

What are favorable prognostic criteria for acute lymphoblastic leukemia? (Select all that apply.)

b. CALLA positive c. Early preB cell d. 2 to 10 years of age

The nurse is caring for a child with an epidural hematoma. The nurse should assess for what signs that can indicate Cushing triad? (Select all that apply.)

c. Bradycardia d. Systemic hypertension e. Respiratory depression

The nurse is teaching the parents of a child with a seizure disorder about the triggers that can cause a seizure. What should the nurse include in the teaching session? (Select all that apply.)

c. Emotional stress d. Flickering lights e. Hyperventilation

The nurse is preparing to admit a 7-year-old child with complex partial seizures. What clinical features of complex partial seizures should the nurse recognize? (Select all that apply.)

c. Mental disorientation is common. d. There is frequently a postictal state. e. There is usually an impaired consciousness.

intervention for acute glomerulonephritis

check bp every 4 hrs for hypertension

expected lab vaule for tetralogy fallot

increased RBC like 6.8 million/uL

findings for ventricular septal defect

murmur at the left sternal border

how long can a peripherally inserted central catherter (PICC) last on a person

several weeks with proper care

The most immediate threat to life in children with thermal injuries is:

shock.

Cause of necrotizing enterocolitis (nec)

unknown cause; ischemia, bacterial proliferation, immature GI defense

Diagnostics for fractures

x-ray

Clubfoot

§congenital deformity of ankle and foot, may occur in isolation, or with other syndromes such as spina bifida 1:1000 live births, boys affected 4x as often, 50% of cases are bilateral

Pheochromocytoma

• Adrenal tumor that secretes catecholamines • May occur around adrenal medulla, along the paraganglia of the aorta, or the thoracolumbar sympathetic chain • Children often have bilateral, multiple, benign tumors • Increased production of catecholamines(norepinephrine, epinephrine); may mimic other disorders • Do not palpate tumor (releases catecholamines) • Surgical removal of tumor(s); may require bilateral adrenalectomy and lifelong glucocorticoid and mineralocorticoid therapy

Cushing's Disease

• Adrenocortical Hyperfunction Disorder • Excessive levels of Glucocorticoid in blood stream • May be caused by excessive or prolonged steroid therapy • Increased cortisol secretion alters metabolism

Aplastic Anemia

• All formed elements of the blood (rbc, wbc, platelets) are simultaneously depressed—"pancytopenia" • The peripheral blood smear demonstrates cytopenia, including at least two of the triad that consists of leukopenia, thrombocytopenia and profound anemia. • Hypoplastic anemia—profound depression of RBCs but normal WBCs and platelets

Diagnostic Evaluation of Diabetes Mellitus

• An 8- hour fasting blood glucose level of 126 mg/dl or more • A random blood glucose value of 200 mg/dl or more, accompanied by classic sign of diabetes • Oral glucose tolerance test (OGTT) finding of 200 mg/dl or more in 2 hour sample. • Hemoglobin A1C of 6.5% or more

Pathophysiology of Diabetes Mellitus: Ketoacidosis

• Body breaks down fat for energy; Fat breaks down in fatty acids, and glycerol in fat cells is converted by liver to ketone bodies • Excess ketones are eliminated in urine (ketonuria) or by the lungs (acetone breath) • Ketones in blood (ketonemia) are strong acids that lower serum pH and produces ketoacidosis • The respiratory system attempts to eliminate the excess carbon dioxide by increased depth and rate of respirations- Kussmaul respirations. Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Diabetes Insipidus

• Central Neurogenic (ADH deficiency) and nephrogenic diabetes insipidus (renal tubule unresponsive to ADH) • ADH binds to the collecting duct of the kidney and promotes reabsorption of water back in circulation • First sign is often enuresis • Loss of water, polyuria, body unable to conserve water, polydipsia, hypernatremia, dilute urine, dehydration. • In infant, you may see vomiting, polyuria, poor skin turgor, irritability. • Seizure may occur due to extreme electrolyte imbalance • Urine osmolality and urine specific gravity is decreased, serum sodium is elevated • MRI to detect pituitary tumor • Fluid deprivation test

Diabetic Ketoacidosis

• Diabetic ketoacidosis if not managed properly can lead to dehydration, electrolyte imbalance, acidosis, coma and death • Treatment for DKA includes fluid therapy, insulin therapy and electrolyte replacement (especially potassium) • Additional treatments involve careful vital signs monitoring, cardiac monitor, blood tests, oxygen, gastric suction (to prevent aspiration for unconscious child), antibiotics for infection/fever and foley catheter if needed.

Acromegaly Consequences

• Excessive secretion of GH by a pituitary adenoma causes most cases of acromegaly. Acromegaly can develop slowly, with patients being diagnosed as much as 10 years after their first symptom appears. • Increased tendency towards hyperglycemia and diabetes mellitus (DM) • Left untreated patients have a higher mortality rate due to potential cardiovascular, metabolic and pulmonary complications. • If a tumor is present pressure on the optic nerve may cause partial or complete blindness, severe headaches may occur

Gigantism

• Gigantism occur in patients who have excessive growth hormone in childhood (before epiphyseal growth plates fuse) • Excessive action of insulin like growth factor (IGF-1) • Gigantism is a serious condition that is nearly always caused by an adenoma, a tumor of the pituitary gland.

Clinical Manifestations of Anemia

• Hemodilution • Decreased peripheral resistance Increased cardiac circulation and turbulence - May have murmur - May lead to cardiac failure - Cyanosis/Pallor - Growth retardation - Central nervous system manifestations

Kussmaul Respirations

• Hyperventilation characteristic of metabolic acidosis resulting from the respiratory system's attempt to eliminate excess CO2 by increased depth and rate

Clinical Manifestations of Diabetes

• Imitates- influenza, gastroenteritis, appendicitis • Type 2 Diabetes Mellitus-overweight, fatigue, frequent infections • Type 1 Diabetes Mellitus S/S: - enuresis - irritability - unusual fatigue - abdominal discomfort - weight loss - thirst - nausea - dehydration - malnutrition - lack of appetite - dry skin - blurred vision - sores that are hard to heal - hyperglycemia - diabetic ketosis (ketones in blood and urine) - dehydration - diabetic ketoacidosis. • Hyperglycemia, polyuria, polydipsia and polyphagia with both type 1 and 2

Long-Term Complications of diabetes mellitus

• Microvascular complications, especially nephropathy, retinopathy and neuropathy (develops during the first 30 years of diabetes) • With poor diabetic control, vascular changes can appear as early as 2.5 years to 3 years after diagnosis; however with good to excellent control, changes can be postponed to 20 or more years. • Macrovascular disease develops after 25 years of diabetes and creates the predominant problems in patients with type 2 DM • Children with type 1 diabetes: Cardiovascular disease (hypertension, stroke, myocardial infarction), altered thyroid function, limited mobility in small joints of the hand (due to glycosylation).

Disorders of Parathyroid Function

• Parathyroid glands secrete parathormone (PTH) • Function of PTH—maintain serum calcium by- (Increase PTH= Increase Serum Ca; Decrease PTH= Decrease serum Ca) - Increasing the release of calcium and phosphate from bone demineralization - Increasing absorption of calcium and excretion of phosphate by the kidneys - Promoting calcium absorption in the GI tract

Pituitary Gland

• Pea-sized • Most powerful aka "master gland" • Works closely with hypothalamus • 2 segment : anterior (adenohypophysis) and posterior (neurohypophysis)

Treatment for Diabetic Ketoacidosis

• Replacement of deficits over 36-48 hours • Cautious fluid management to reduce risk of cerebral edema (0.9% Saline Solution) • Continuous IV regular insulin at a dosage of 0.1 units/kg/hr (blood glucose should decrease by 50-100 mg/dl/hr; when BG falls to 250-300 mg/dl, dextrose is added to IV solution, to maintain BG levels between 120-240 mg/dl) • Monitor serum potassium level carefully; As soon as the child has established renal function (voiding at least 25 ml/hr) and insulin is given, vigorous potassium replacement is implemented. • Cardiac monitor is used as a guide to therapy (widening of Q-T interval and the appearance of U wave followed by flattened T wave indicate hypokalemia; an elevated and spreading T wave and shortening of the Q-T interval indicate hyperkalemia) • Sodium Bicarbonate is used conservatively; for PH less than 7.0 (risk of cerebral edema)

Hypoglycemia

• The most common cause of hypoglycemia are burst of physical activity without additional food, or delayed, omitted or incompletely consumed meals. • Other causes: Error in insulin administration, Gastroenteritis

Hyperthyroidism

• Thyroid hormone level is increased • Mostly due to graves disease (autoimmune; immunoglobulins produced by B lymphocytes stimulate oversecretion of thyroid hormone).

Acromegaly Treatment

• Treatment depends on the cause of excessive growth and may involve surgical removal of a tumor or pituitary gland (hypophysectomy), radiation therapy, or radioactive implants. • Drugs that suppress GH may be used in conjunction with transsphenoid surgery TSS (to remove pituitary adenoma) and external radiation (XRT). • The child may need lifelong pituitary hormone replacement following surgery (thyroid, cortisol and sex hormones)

Clinical Manifestations of Encephalitis

•Malaise, fever, headache, dizziness, nuchal rigidity, nausea, vomiting, ataxia, tremors, seizures, and coma; may proceed to death

Treatment for Impetigo Contagiosa

◦ Contact isolation ◦ Leave open to air, Gently wash lesions 3 X per day with warm soapy washcloth. Always use separate towels/linens ◦ Topical or Oral Antibiotics (mupirocin or triple antibiotic; penicillin for severe or extensive lesions; vancomycin for MRSA)

Antifungal medications for fungal infections

◦ Oral griseofulvin or terbinafine ◦ Oral ketoconazole ◦ 2% ketoconazole shampoo or 1% selenium sulfide shampoo ◦ Miconazole, clotrimazole topical ◦ Nystatin

Normal Characteristics of Urine

◻ Clear urine ◻ Newborn production about 1 to 2 ml/kg/hr ◻ Child production about 1 ml/kg/hr

Nursing Care management for status epilepticus

⬤Airway ⬤Seizure precautions, prevent injury ⬤Long-term care and support to child and family ⬤Education and anticipatory guidance ⬤Medication compliance and administration ⬤Prevention of triggers ⬤Nutritional support (vitamin D and folic acid) ⬤School plans to ensure safety and medication Establishing a diagnosis is critical for establishing a prognosis and planning the proper treatment. The process of diagnosis in a child suspected of having epilepsy includes (1) determining whether epilepsy or seizures exist and not an alternative diagnosis and (2) defining the underlying cause, if possible. The goals of treatment of seizure disorders are to control the seizures or to reduce their frequency and severity, discover and correct the cause when possible, and help the child live as normal a life as possible.

Types of Closed head injuries

⬤Concussion ⬤Contusion and laceration ⬤Fractures ⬤Epidural hematoma ⬤Subdural hematoma ⬤Other hemorrhagic lesions ⮚Subarachnoid ⮚Cerebral edema ⮚Post Traumatic syndrome Head injury is a pathologic process involving the scalp, skull, meninges, or brain as a result of mechanical force. The most common head injury is concussion, which is defined as an alteration in mental status with or without loss of consciousness. Fractures resulting from head injuries may be classified as linear, comminuted, depressed, open, basilar, and growing fractures. Primary head injury involves features that occur at the time of trauma, including fractured skull, contusions, intracranial hematoma, and diffuse injury. Secondary complications include hypoxic brain damage, increased ICP, infection, cerebral edema, and posttraumatic syndromes.

Moderate Head Injury

⮚5-10 minutes loss of consciousness ⮚Headache, nausea ⮚Glasgow Coma Scale (GSC): 9-12

Cerebral Blood Flow

⮚Autoregulation ⮚Oxygen ⮚Blood-brain barrier

Hemodialysis

◻ Requires creation of a vascular access and special dialysis equipment ◻ Best suited for children who can be brought to facility 3 times per week for 4 to 6 hours ◻ Achieves rapid correction of fluid and electrolyte abnormalities

Hypospadias

◻ Urethral opening is located below the glans penis or anywhere along the underside of the penile shaft ◻ Requires surgical correction ◻ Nursing assessment of every male newborn

Continuous Venovenous Hemofiltration

◻ Uses technique for ultrafiltration of blood continuously at a very slow rate ◻ Works with the fluid overload in postoperative period ◻ Successful alternative for critically ill children who might not survive rapid volume changes of hemodialysis and/or PD

Things to look for in Chronic Renal Failure (CRF)

◻ Water and sodium (Na) retention ◻ Hyperkalemia ◻ Calcium and Phosphorus disturbances ◻ Acidosis ◻ Anemia

Effects of Spina Bifida (Myelomeningocele)

✔Lower extremity weakness ✔Neurogenic bladder and bowel ✔Ambulation difficulties ✔Hydrocephalus

Neurological Assessment

❖LOC ❖Posture ❖Motor and Sensory responses ❖Reflex activity ❖Cranial Nerves ❖Vital Signs ❖Skin ❖Eyes (pupils)

Behavioral Signs of Cerebral Palsy

- Excessive Irritability - No smiling by age 3 months - Feeding difficulties like persistent tongue thrusting or frequent gagging or choking with feeds

treatment for adrenal crisis

- Fluid resuscitation - IV glucose - IV hydrocortisone

What signs and symptoms are indicative of a urinary tract disorder in the neonatal period (birth to 1 month)? (Select all that apply.)

- Frequent urination - Poor urinary stream - Failure to gain weight

Hodgkin Disease

- Lymphatic cancer, biopsy reveals Reed-Sternberg cells - Mostly affects adolescent boys - Treatment: surgery, chemotherapy, radiation - Neoplastic disease originating in lymphoid system - Often metastasizes to spleen, liver, bone marrow, lungs, and other tissues

Cause of cleft lip & palate

failure of maxillary process to fuse with nasal elevations

liquid medication administration for infants

give meds at the side of the infants mouth

Iron Deficiency Anema

- Anemia caused by an inadequate supply or loss of iron is the most prevalent nutritional disorder worldwide and the most preventable mineral disturbance. - Maternally derived iron stores are adequate for the first 5 to 6 months in full-term infant but only for 2-3 months for premature infants or infants of multiple births.

Sickle Cell Crisis: Therapeutic Management

- Bed rest. - Hydration IV, PO & Electrolytes replacement. - O2 administration (only for hypoxia) - Analgesics for severe vaso-occlusive pain. - Blood replacement for anemia & sickled blood viscosity (exchange transfusion-erythrocytapheresis) - Antibiotics for infection. The nurse should instruct the parent to seek medical attention immediately when the child has fever of 101.3 degree F (38.5 degree C), an increase in spleen size occurs or severe pallor occurs

A child is hospitalized in acute renal failure and has a serum potassium greater than 7 mEq/L. What temporary measures that will produce a rapid but transient effect to reduce the potassium should the nurse expect to be prescribed? (Select all that apply.)

- Calcium gluconate - Sodium bicarbonate - Glucose 50% and insulin

The nurse is caring for a child with a urinary tract infection who is on intravenous gentamicin (Garamycin). What interventions should the nurse plan for this child with regard to this medication? (Select all that apply.)

- Encourage fluids. - Monitor urinary output. - Monitor serum peak and trough levels.

Pituitary Hyperfunction

- Excess GH before closure of the epiphyseal shafts results in overgrowth of long bones - Reach heights of 8 feet or more - Vertical growth and increased muscle - Weight is generally in proportion to height - Proportional enlargement of head circumference - Excess GH after epiphyseal closure is called ACROMEGALY

Prognosis for Hypopituitarism (growth hormone deficiency)

- GH replacement successful in 80% of affected children; Growth rate of 3.5 to 4 cm/yr before treatment and increase to 8 to 9 cm/yr after treatment - Response varies based on age, length of treatment, frequency of doses, dosage, weight, and GH receptor amount. - Growth rates of less than 1 inch/year and a bone age of more than 14 years in girls and more than 16 years in boys are often used as criteria to stop GH therapy.

Clinical Manifestations of Increased Intracranial Pressure (ICP) for children

- Headache - Nausea - Forceful vomit - Diplopia, blurred visoin - Seizures - Indifference, drowsiness - Decline in school performance - Diminished physical activity and motor performance - increased sleeping - inability to follow simple commands - lethargy

The nurse is teaching a parent of a 6-month-old infant with gastroesophageal reflux (GER) before discharge. What instructions should the nurse include? (Select all that apply.)

- Hold the infant in the prone position after a feeding. - Prescribed cimetidine (Tagamet) should be given 30 minutes before feedings.

Urinary tract infection (UTI) quick facts

- Infection may affect the upper urinary tract or the lower urinary tract, or both. - It is primarily caused by bacteria. - Common and potentially serious problem in children - CHILDREN UNDER 2 YEARS old have NONSPECIFIC SYMPTOMS: fever, irritability, lethargy, poor feeding, vomiting, diarrhea - Manifestations in OLDER CHILDREN are more specific: frequency and painful urination, small amount of urine, no or low grade fever.

Managing Cancer Treatment Side Effects

- Infection: look for source of infection. Bactrim prophylaxis during treatment of cancer to prevent pneumocystis pneumonia, colony stimulating factors - Hemorrhage: Infection increases chances of bleeding- use aseptic techniques during skin punctures. - Anemia: Drug-induced myelosuppression may lead to anemia - Nausea and Vomiting: antiemetic 30mins-1hr before chemo starts and regular administration at least until 24 hours after chemotherapy - Altered Nutrition: individualized nutritional plan - Mucosal Ulceration: bland, soft diet, toothette, meticulous mouth care to prevent gingival bleeding - Neurologic Problems: constipation: stool softeners and laxatives; foot drop, numbness/weakness in extremities; jaw pain: analgesics, use a straw; somnolence: seek medical evaluation - Hemorrhagic Cystitis: IV fluids before, during and after the drug to ensure adequate hydration - Alopecia: hair can be cut short, disposable surgical cap during hair loss, hair regrows in 3-6 months, hair texture might be different - Steroid Effects: weight gain, moon face, red cheeks, supraclavicular fat pads, protuberant abdomen, fluid retention, body image issues and mood changes

Nursing Management for Sickle Cell

- Monitor child's growth—watch for failure to thrive - Minimize tissue deoxygenation (rest breaks during physical activity, avoid high altitudes, avoid infection, avoid contact sports that can lead to injury/bleeding). - Assess and Maintain HYDRATION (oral or other as needed) - Assess and treat pain (tylenol, ibuprofen, opioids)- avoid Demerol - Carefully monitor for signs of shock - Position of comfort/Range of motion exercises - Warm compresses/Rest and gentle massage

Thalassemia Nursing Management

- Observe for complications of transfusion - Emotional support to family - Encourage genetic counseling - Parent and patient teaching for self-care

Onset, Peak Time, and Duration for Rapid Acting Insulin Therapy

- Onset: 15 minutes - Peak Time: 30-90 minutes - Duration: 5 hours

The nurse is preparing to admit a 7-year-old child with Crohn disease. What clinical manifestations should the nurse expect to observe? (Select all that apply.)

- Pain is common. - Weight loss is severe. - Diarrhea is moderate to severe.

Nursing care managment for immobilized child

- Physical assessment (include Braden Q scale) - Prevention of injury and complications - Ecourage activity and use of devices: - orthotics and prosthetics - Crutches, cane, and wheelchairs - Pressure reduction mattresses, position changes, ROM exercises - Child-life specialists, visitors, school activities - Child participates in self-care whenever possible - Support of family

Brain Tumor Diagnostics

- Presenting clinical signs - Neurologic evaluation - MRI, CT, EEG, LP - Histologic diagnosis via surgery

treatment for cellulitis

- Rest - Immobilize - Elevate extremity - Warm Compress - Antibiotics, PO, IV, IM

Thalassemias

- Splenectomy- for splenomegaly. - Three adverse affects that can affect survival are hepatomegaly, iron overload, and portal fibrosis. - Hematopoietic stem cell transplant-for children younger than 16, who undergo allogenic HSCT have high rate of complication free survival, approximately 80-97% of these children are cured. There are many other kind of transplants that have proven successful.

Clinical manifestations of acute glomerulonephritis

- Sudden onset of HEMATURIA, PROTEINURIA, AND ORLIGURIA - Urine may be cloudy, smoky brown, or tea-colored - Edema, abdominal pain, pallor, low-grade fever, anorexia, vomiting, and headache

Signs and Symptoms of Gigantism

- Tall stature - obesity - headaches - visual changes - hypopituitary - exaggerated growth of hands and feet - thick fingers and toes - coarse facial features - jaw protrusion - hyperhidrosis - osteoarthritis - peripheral neuropathy - cardiovascular disease - benign tumors - other endocrine disorders

Leukemia

- The term leukemia refers to cancers of the white blood cells (also called leukocytes or WBCs). When a child has leukemia, large numbers of abnormal white blood cells are produced in the bone marrow. These abnormal white cells crowd the bone marrow and flood the bloodstream, but they cannot perform their proper role of protecting the body against disease, because they are defective. + Nonfunctioning WBC + Diagnosis confirmation with bone marrow aspiration Cellular destruction takes place by infiltration (of the nonfunctional leukemic cells, "blasts") and subsequent competition for metabolic elements. This infiltration results in 3 major manifestations: 1. Anemia from decreased erythrocytes 2. Infection from neutropenia 3. Bleeding from decreased platelet production

The clinic nurse is assessing a child with central precocious puberty. What conditions can cause central precocious puberty? (Select all that apply.)

- Trauma - Neoplasms - Radiotherapy

RetinoBlastoma Treatment

- Treatment: removal of eye, chemotherapy, radiation, attempt to preserve vision in good eye or least affected eye if bilateral

Epiphyseal Injuries

- Weakest point of long bones is the cartilage growth plate (epiphyseal plate) - Frequent site of damage during trauma §May affect future bone growth - Treatment may include open reduction and internal fixation (ORIF) to prevent growth disturbances

A mother calls the emergency department nurse because her child was stung by a scorpion. The nurse should recommend:

keeping the child quiet and coming to the emergency department.

Management for hypertrophic pyloric stenosis (HPS)?

- surgery-pyloromyotomy - F&E replacement - NG-tube - NPO pre-op - clears post-op - I&O

Risk factor and prevention Cancer

-Not lifestyle related like in adults -Exposure to ionizing radiation, carcinogenic drugs, immunosuppressive therapy, infections such as Epstein Barr virus and HPV, race, and genetic conditions all increase risk of cancer in children -No generally recognized preventive measures for childhood cancer -The only prevention is really to prevent adult types of cancer from developing (limit exposure to smoke/sun, pap smears, testicular and breast exams)

Nursing Interventions for juvenile idiopathic arthritis (JIA)

-PT/OT, nutrition and exercise, pain mgmt. -Promote strength -Sleep and rest -Encourage ADL's -Emotional support of child and family

Five Ps for the assessment of Fractures

-Pain and point of tenderness -Pulse—distal to the fracture site -Pallor -Paresthesia—sensation distal to the fracture site -Paralysis—movement distal to the fracture site

Expected Findings of Sickle Cell Anemia

. Exercise intolerance/shortness of breath/fatigue . Pain . Anorexia . Jaundiced sclera/generalized jaundice . Gallstones . Delayed sexual maturation and decreased fertility . Retardation of growth in both height and weight (when child reaches adulthood, full sexual development and adult height are usually achieved). . Pallor and pale mucous membranes . Chronic leg ulcers

A child has been seizure free for 2 years. A father asks the nurse how much longer the child will need to take the antiseizure medications. How should the nurse respond?

A step-wise approach will be used to reduce the dosage gradually.

Seizure Disorders Patho

A sudden, excessive, disorderly discharge of abnormal electrical impulses by the brain's neurons causing a temporary alteration in CNS function Seizures are caused by excessive and disorderly neuronal discharges in the brain. The manifestation of seizures depends on the region of the brain in which they originate and may include unconsciousness or altered consciousness; involuntary movements; and changes in perception, behaviors, sensations, and posture. Regardless of the etiologic factor or type of seizure, the basic mechanism is the same. Abnormal electrical discharges (1) may arise from central areas in the brain that affect consciousness, (2) may be restricted to one area of the cerebral cortex, producing manifestations characteristic of that particular anatomic focus, or (3) may begin in a localized area of the cortex and spread to other portions of the brain; if sufficiently extensive, this produces generalized seizure activity. Partial seizures are categorized as simple (meaning without associated impairment of consciousness) or complex (with impaired consciousness); both types may become generalized. Partial seizures may arise from any area of the cerebral cortex, but the frontal, temporal, and parietal lobes are most often affected and are characterized by localized motor symptoms; somatosensory, psychic, or autonomic symptoms; or a combination of these. Partial seizures exhibit manifestations related to where they occur in the brain. A clear description of the seizure (ictal state) by an eyewitness is a valuable aid in localizing the brain area involved. In addition to the initial event, the circumstances that precipitated the episode are important to note. The postictal state (the period after a seizure) may be varied. The child may be drowsy, be uncoordinated, have transient aphasia or confusion, and display some sensory or motor impairment. Weakness, hypotonia, or inactivity of a body part may indicate an epileptogenic focus in the corresponding contralateral cortical region. Generalized seizures are categorized as tonic-clonic, absence, myoclonic, and West syndrome (infantile spasms). Loss of consciousness and impairment of motor function occur from the outset of generalized seizures. The generalized tonic-clonic seizure, formerly known as grand mal, is the most dramatic of all seizure manifestations of childhood. The seizure usually occurs without warning and consists of two distinct phases, tonic and clonic. Absence seizures, formerly called petit mal or lapses, are generalized seizures. They have a sudden onset and are characterized by a brief loss of consciousness, a blank stare, and automatisms

What term is used to describe an abnormally increased convex angulation in the curvature of the thoracic spine?

Kyphosis

What chemotherapeutic agent can cause an anaphylactic reaction?

L-Asparaginase (Elspar)

A childs parents ask the nurse many questions about their childs illness and its management. The nurse does not know enough to answer all the questions. What nursing action is most appropriate at this time?

Tell them, I dont know, but I will find out.

The nurse is preparing to admit a 4-year-old child with chronic benign neutropenia. What clinical features of chronic benign neutropenia should the nurse recognize? (Select all that apply.)

a. Gingivitis is present. b. Anemia is not present. c. Monocytosis is present.

What are supportive interventions that can assist a toddler with a chronic illness to meet developmental milestones? (Select all that apply.)

a. Give choices. b. Provide sensory experiences. e. Encourage independence in as many areas as possible.

The nurse is preparing to admit a 5-year-old with an epidural hemorrhage. What clinical manifestations should the nurse expect to observe? (Select all that apply.)

a. Headache b. Vomiting c. Irritability

The nurse is preparing to admit a 6-month-old infant with increased intracranial pressure (ICP). What clinical manifestations should the nurse expect to observe in this infant? (Select all that apply.)

a. High-pitched cry b. Poor feeding c. Setting-sun sign e. Distended scalp veins

The nurse is preparing to admit a neonate with bacterial meningitis. What clinical manifestations should the nurse expect to observe? (Select all that apply.)

a. Jaundice b. Cyanosis c. Poor tone e. Poor sucking ability

The nurse is teaching coping strategies to parents of a child with a chronic illness. What coping strategies should the nurse include? (Select all that apply.)

a. Listen to the child. b. Accept the childs illness. c. Establish a support system. d. Learn to care for the childs illness one day at a time.

The nurse is preparing to admit an adolescent with encephalitis. What clinical manifestations should the nurse expect to observe? (Select all that apply.)

a. Malaise b. Apathy d. Hypoactivity

The nurse is assessing coping behaviors of a family with a child with a chronic illness. What indicates approach coping behaviors? (Select all that apply.)

a. Plans realistically for the future b. Verbalizes possible loss of the child d. Realistically perceives the childs condition

The parents of a 2-year-old boy who had a repair of exstrophy of the bladder at birth ask when they can begin toilet training their son. The nurse replies based on what knowledge?

Additional surgery may be necessary to achieve continence.

What information should the nurse include when teaching the mother of a 9-month-old infant about administering liquid iron preparations?

Adequate dosage will turn the stools a tarry green color.

What functional ability should the nurse expect in a child with a spinal cord lesion at C7?

Almost complete independence within limitations of wheelchair

The nurse at a summer camp recognizes the signs of heatstroke in an adolescent girl. Her temperature is 40 C (104 F). She is slightly confused but able to drink water. Nursing care while waiting for transport to the hospital should include what intervention?

Apply towels wet with cool water.

A 6-month-old infant with Hirschsprung disease is scheduled for a temporary colostomy. What should postoperative teaching to the parents include?

Assessing bowel function

The clinic nurse is evaluating causes for iron deficiency caused by inadequate supply of iron. What should the nurse recognize as causes for iron deficiency caused by an inadequate iron supply? (Select all that apply.)

a. Prematurity c. Excessive milk intake d. Severe iron deficiency in the mother

A nurse is evaluating the effectiveness of teaching regarding care of a child with minimal change nephrotic syndrome (MCNS) that is in remission after administration of prednisone. The nurse realizes further teaching is required if the parents state what?

We understand our child will not be able to attend school, so we will arrange for home schooling.

What clinical manifestation occurs with hypoglycemia?

Weakness and dizziness

The school nurse practitioner is consulted by a fifth-grade teacher about a student who has become increasingly inattentive and hyperactive in the classroom. The nurse notes that the childs weight has changed from the 50th percentile to the 30th percentile. The nurse is concerned about possible hyperthyroidism. What additional sign or symptom should the nurse anticipate?

Blurred vision and loss of acuity

The nurse is preparing a community outreach program about the prevention of iron-deficiency anemia in infants. What statement should the nurse include in the program?

Breast milk or iron-fortified formula should be used for the first 12 months.

A child has been diagnosed with a Wilms tumor. What should preoperative nursing care include?

Careful bathing and handling

Parents bring a 7-year-old child to the clinic for evaluation of an injured wrist after a bicycle accident. The parents and child are upset, and the child will not allow an examination of the injured arm. What priority nursing intervention should occur at this time?

Calmly ask the child to point to where the pain is worst and to wiggle fingers.

The school nurse is informed that a child with human immunodeficiency virus (HIV) infection will be attending school soon. What is an important nursing intervention to include in the plan of care?

Carefully follow universal precautions.

The nurse is collecting a 24-hour urine sample on a child with suspected diagnosis of neuroblastoma. What finding in the urine is expected with neuroblastomas?

Catecholamines

The nurse is caring for a school-age child with a tinea capitis (ringworm) infection. The nurse should expect that therapeutic management for this child includes:

administering oral griseofulvin.

What is the recommended drink for athletes during practice and competition?

Cold water for gastrointestinal tract rapid absorption

What can help cure ulcerative Colitis?

Colectomy

What clinical manifestation should be the most suggestive of acute appendicitis?

Colicky, cramping, abdominal pain around the umbilicus

Assessment of Hematologic Function

Complete blood count with differential • History and assessment findings • Child's energy and activity level • Growth patterns

School-age concept of death

Concept: By age 7 most understand that death is universal, irreversible, and nonfunctional Reaction: Fear expectation more than its realization. Fear of the unknown greater than that of the known. Encourage verbalization of feelings, allow control where possible and appropriate, provide outlets for aggression (related to anger and fear) through play *anticipatory preparation is both necessary and effective*

Impetigo Contagiosa

Contagious bacterial infection - staph, group-A strep, S Aureus Common sites, face, mouth, neck, hands Lesions begin as small red macules, then becomes vesicular that rupture easy and release serous fluid Leaving Honey crusted lesion with ulcerative base; Pruritis common Seen spread in schools via athletic mats and team contact

The nurse is preparing to care for a newborn with an omphalocele. The nurse should understand that care of the infant should include what intervention?

Covering the intact bowel with a nonadherent dressing to prevent injury

What name is given to inflammation of the bladder?

Cystitis

Parents ask for help for their other children to cope with the changes in the family resulting from the special needs of their sibling. What strategy does the nurse recommend?

Invite the siblings to attend meetings to develop plans for the child with special needs.

Iron Deficiency Anemia Management

Iron supplements, Iron fortified formula, dietary counseling for high iron foods, limit amount of formula (no more than 1 L/day) to encourage iron-rich solid food intake; Transfusions for severe anemia.

The nurse is caring for a family whose infant was just born with anencephaly. What is the most important nursing intervention?

Help the family cope with the birth of an infant with a fatal defect.

Head Injury: Hematomas

Hemorrhage may occur in the scalp, epidural, subdural, intracerebral or intraventricular areas ✔Epidural hematoma- arterial bleeding between dura mater and the skull ✔Subdural hematoma- venous bleeding between dura mater and arachnoid. Slow formation. Epidural (extradural) hematoma is a hemorrhage into the space between the dura and the skull. As the hematoma enlarges, the dura is stripped from the skull; this accumulation of blood results in a mass effect on the brain, forcing the underlying brain contents downward and inward as it expands. A subdural hemorrhage is bleeding between the dura and the arachnoid membrane, which overlies the brain and the subarachnoid space. The hemorrhage may be from two sources (1) tearing of the veins that bridge the subdural space and (2) hemorrhage from the cortex of the brain caused by direct brain trauma. Subdural hematomas are much more common than epidural hematomas and occur most often in infancy, with a peak incidence between 0 to 4 months of age.

A school-age child is admitted in vasoocclusive sickle cell crisis (pain episode). The childs care should include which therapeutic interventions?

Hydration and pain management

The nurse is caring for an adolescent with anorexia nervosa. What pituitary dysfunction should the nurse assess for in the adolescent?

Hypopituitarism

The nurse is assisting with a growth hormone stimulation test for a child with short stature. What should the nurse monitor closely on this child during the test?

Hypotension

An 18-month-old child is brought to the emergency department after being found unconscious in the family pool. What does the nurse identify as the primary problem in drowning incidents?

Hypoxia

The nurse is teaching the parents of a 1-month-old infant with developmental dysplasia of the hip about preventing skin breakdown under the Pavlik harness. What statement by the parent would indicate a correct understanding of the teaching?

I should gently massage the skin under the straps once a day to stimulate circulation.

Pediculosis Capitis (Head Lice)

Infestation of the hair and scalp with lice Very common, especially in school age Most commonly found in occipital area Transmitted by direct contact Adult louse lives only 48 hours without human host; female louse has life span of 30 days Females lay eggs (nits) at base of hair shaft Nits hatch in 7 to 10 days Priority is preventing spread and recurrence

Contact Dermatitis

Inflammatory reaction—irritant and sensitizing agent Limit exposure to offending agent Medication symptom relief and to reduce inflammation

When taking the history of a child hospitalized with Reye syndrome, the nurse should not be surprised if a week ago the child had recovered from what?

Influenza

What is the primary method of treating osteomyelitis?

Intravenous antibiotic therapy

An adolescent will receive a bone marrow transplant (BMT). The nurse should explain that the bone marrow will be administered by which method?

Intravenous infusion

What GI disorder is the most common cause of intestinal obstruction in children 3 mos. to 6 years

Intussusception

What term describes invagination of one segment of bowel within another?

Intussusception

A pregnant woman asks about prenatal diagnosis of hydrocephalus. The nurses response should be based on which knowledge?

It can be diagnosed with fetal ultrasonography.

What statement is descriptive of a concussion?

It is a transient and reversible neuronal dysfunction.

What statement is true concerning osteogenesis imperfecta (OI)?

It is an inherited disorder.

What statement best describes Duchenne (pseudohypertrophic) muscular dystrophy (DMD)?

It is characterized by presence of Gower sign, a waddling gait, and lordosis.

What statement is an advantage of peritoneal dialysis compared with hemodialysis?

It is easy to learn and safe to perform.

A 3-year-old child with Hirschsprung disease is hospitalized for surgery. A temporary colostomy will be necessary. How should the nurse prepare this child?

It is essential because it will be an adjustment.

The nurse is teaching an adolescent about giving insulin injections. The adolescent asks if the disposable needles and syringes can be used more than once. The nurses response should be based on which knowledge?

It is suitable for up to 3 days if stored in the refrigerator.

What statement is descriptive of renal transplantation in children?

It is the preferred means of renal replacement therapy in children.

The nurse is planning care for a school-age child with bacterial meningitis. What intervention should be included?

Keep environmental stimuli to a minimum.

The family of a 4-month-old infant will be vacationing at the beach. Which should the nurse teach the family about exposure of the infant to the sun?

Keep the infant in total shade at all times.

What is the primary objective of care for the child with minimal change nephrotic syndrome (MCNS)?

Minimize excretion of urinary protein.

A hospitalized child with minimal change nephrotic syndrome is receiving high doses of prednisone. What nursing goal is appropriate for this child?

Minimize risk of infection.

What nursing intervention is appropriate when caring for an unconscious child?

Monitor fluid intake and output carefully to avoid fluid overload and cerebral edema.

Palliative Care Goals

Palliative care seeks to (1) relieve the physical, emotional, social, and spiritual distress produced by life-limiting conditions, (2) to assist in complex decision making, and to (3) enhance the quality of life. 1. There must be frequent, periodic, timely discussions between family and healthcare providers... THOROUGH, OPEN, & EFFECTIVE COMMUNICATION 2. Whenever possible the goals of the child should be solicited and respected 3. Goals should be frequently revisited "...specific discussions about the burden of treatment and the benefits of end-of-life care planning is often absent."

The nurse is planning care for an adolescent with acquired immunodeficiency syndrome. What is the priority nursing goal?

Prevent infection.

Pet Bites

Prevention and education about approaching animals Cleansing and medical treatment when indicated = Rabies, Tetanus & antibiotics for puncture/infected wounds.

Congenital defects of the genitourinary tract, such as hypospadias, are usually repaired as early as possible to accomplish what?

Promote development of normal body image.

The nurse is caring for a neonate born with a myelomeningocele. Surgery to repair the defect is scheduled the next day. What is the most appropriate way to position and feed this neonate?

Prone with the head turned to the side

Lyme Disease Nursing Management

Protection from exposure Use of insect repellents—use cautiously and follow directions Use of permethrin-treated clothing has been shown to be effective Removal of tick ◦ Grasp with tweezers ◦ Wash bite area—iodine scrub, rubbing alcohol, or plain soap or water

What diagnostic test allows visualization of renal parenchyma and renal pelvis without exposure to external- beam radiation or radioactive isotopes?

Renal ultrasonography

A child is admitted for minimal change nephrotic syndrome (MCNS). The nurse recognizes that the childs prognosis is related to what factor?

Response to steroid therapy

A child with acute gastrointestinal bleeding is admitted to the hospital. The nurse observes which sign or symptom as an early manifestation of shock?

Restlessness

When communicating with other professionals about a child with a chronic illness, what is important for nurses to do?

Restrict communication to clinically relevant information

What nursing care should be included for a child diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH)?

Restrict fluids.

The nurse is teaching a child experiencing severe edema associated with minimal change nephrotic syndrome about his diet. The nurse should discuss what dietary need?

Restricting fluids

The mother of an infant tells the nurse that sometimes there is a whitish glow in the pupil of his eye. The nurse should suspect which condition?

Retinoblastoma

What childhood cancer may demonstrate patterns of inheritance that suggest a familial basis?

Retinoblastoma

A child with a hip spica cast is being prepared for discharge. Recognizing that caring for a child at home is complex, the nurse should include what instructions for the parents discharge teaching?

Specially designed car restraints are necessary.

A student athlete was injured during a basketball game. The nurse observes significant swelling. The player states he thought he heard a pop, that the pain is pretty bad, and that the ankle feels as if it is coming apart. Based on this description, the nurse suspects what injury?

Sprain

what requires immediate report to the provider for acute asthma exacerbation?

Sudden decrease in wheezing

When caring for a child with probable appendicitis, the nurse should be alert to recognize which sign or symptom as a manifestation of perforation?

Sudden relief from pain

Parents are considering treatment options for their 5-year-old child with Legg-Calv-Perthes disease. Both surgical and conservative therapies are appropriate. They are able to verbalize the differences between the therapies when they make what statement?

Surgical correction requires a 3- to 4-month recovery period.

The nurse is discussing home care with a mother whose 6-year-old child has hepatitis A. What information should the nurse include?

Teach infection control measures to family members.

When is isotretinoin (Accutane) indicated for the treatment of acne during adolescence?

The acne has not responded to other treatments.

A 12-year-old child is injured in a bicycle accident. When considering the possibility of renal trauma, the nurse should consider what factor?

The amount of hematuria is not a reliable indicator of the seriousness of renal injury.

A parent of an infant with gastroesophageal reflux asks how to decrease the number and total volume of emesis. What recommendation should the nurse include in teaching this parent?

Thicken feedings and enlarge the nipple hole.

An adolescent diabetic is admitted to the emergency department for treatment of hyperglycemia and pneumonia. What are characteristics of diabetic hyperglycemia?

Thirst, being flushed, and fruity breath

A girl, age 5 1/2 years, has been sent to the school nurse for urinary incontinence three times in the past 2 days. The nurse should recommend to her parent that the first action is to have the child evaluated for what condition?

Urinary tract infection (UTI)

A parent asks the nurse what would be the first indication that acute glomerulonephritis was improving. What would be the nurses best response?

Urine output will increase.

Which is an important consideration for the nurse when changing dressings and applying topical medication to a childs abdomen and leg burns?

Wash hands and forearms before and after dressing change.

A school-age child falls on the playground and has a small laceration on the forearm. The school nurse should do which to cleanse the wound?

Wash wound gently with mild soap and water for several minutes.

An infant is born with one lower limb deficiency. When is the optimum time for the child to be fitted with a functional prosthetic device?

When the infant is developmentally ready to stand up

A toddler is admitted to the pediatric unit with presumptive bacterial meningitis. The initial orders include isolation, intravenous access, cultures, and antimicrobial agents. The nurse knows that antibiotic therapy will begin when?

When the medication is received from the pharmacy

What are supportive interventions that can assist a school-age child with a chronic illness to meet developmental milestones? (Select all that apply.)

a. Encourage socialization. c. Encourage school attendance. e. Educate teachers and classmates about the childs condition.

The nurse is talking to the parents of a child with pediculosis capitis. Which should the nurse include when explaining how to manage pediculosis capitis?

You will need to remove nits with an extra-fine tooth comb or tweezers.

The nurse is caring for a 6-year-old child with acute lymphoblastic leukemia (ALL). The parent states, My child has a low platelet count, and we are being discharged this afternoon. What do I need to do at home? What statement is most appropriate for the nurse to make?

Your child should avoid contact sports or activities that could cause bleeding.

What are supportive interventions that can assist an adolescent with a chronic illness to meet developmental milestones? (Select all that apply.)

a. Encourage activities appropriate for age. c. Provide instruction on interpersonal and coping skills. d. Emphasize good appearance and wearing of stylish clothes.

What are supportive interventions that can assist an infant with a chronic illness to meet developmental milestones? (Select all that apply.)

a. Encourage consistent caregivers. b. Encourage periodic respite from demands of care. d. Encourage parental rooming in during hospitalization.

The nurse is assessing coping behaviors of a family with a child with a chronic illness. What indicates avoidance coping behaviors? (Select all that apply.)

a. Refuses to agree to treatment b. Avoids staff, family members, or child c. Is unable to discuss possible loss of the child e. Makes no change in lifestyle to meet the needs of other family members

The nurse is precepting a new graduate nurse at an ambulatory pediatric hematology and oncology clinic. What cardinal signs of cancer in children should the nurse make the new nurse aware of? (Select all that apply.)

a. Sudden tendency to bruise easily c. Frequent headaches f. Unexplained loss of energy

acetaminophen poisoning antidode

acetylcysteine

Encephalitis

an inflammatory process of the CNS that is caused by a variety of organisms, including bacteria, spirochetes, fungi, protozoa, helminths, and viruses. Most infections are associated with viruses and may result from direct invasion of the CNS by a virus or from involvement of the CNS after viral disease.

Atopic dermatitis (eczema) in the infant is:

associated with allergy with a hereditary tendency.

teaching for mononucleosis

avoid gym class because of the potential for sustaining abdominal trauma

The nurse is caring for a child with retinoblastoma that was treated with an enucleation. What interventions should the nurse plan for care of an eye socket after enucleation? (Select all that apply.)

b. Change the eye pad daily. d. Irrigate the socket daily with a prescribed solution. e. Apply a prescribed antibiotic ointment after irrigation.

The parent of a child with a chronic illness tells the nurse, I feel so hopeless in this situation. The nurse should take which actions to foster hopefulness for the family? (Select all that apply.)

b. Convey a personal interest in the child. c. Be honest when reporting on the childs condition. e. Demonstrate competence and gentleness when delivering care.

The nurse is preparing to admit a 1-month-old infant with severe congenital neutropenia (Kostmann disease). What clinical features of severe congenital neutropenia should the nurse recognize? (Select all that apply.)

b. Neutropenia is present. c. The illness is severe.

What guidelines should the nurse follow when handling chemotherapeutic agents? (Select all that apply.)

b. Prepare medications in a safety cabinet. c. Wear gloves designed for handling chemotherapy. d. Wear face and eye protection when splashing is possible. e. Discard gloves and protective clothing in a special container.

The nurse is planning to use an interpreter with a nonEnglish-speaking family. What should the nurse plan with regard to the use of an interpreter? (Select all that apply.)

b. The nurse should speak slowly. c. Use an interpreter familiar with the familys culture. d. The nurse should speak only a few sentences at a time.

boston brace for scoliosis

brace should be worn for 23 hr per day and only removed for showering or participating in physical therapy

The nurse is caring for a child with a subdural hematoma. The nurse should assess for what signs that can indicate brainstem compression? (Select all that apply.)

c. Hemiplegia d. Hemiparesis e. Unequal pupils

The management of a child who has just been stung by a bee or wasp should include the application of:

cool compresses.

What does increased hematocrit level indicate?

dehydration

signs and symptoms of necrotizing enterocolitis (nec)

distended abd, gastric residual, blood in stool, lethargy, poor feeding, hypotension.

How do you feed a child with more than 25% of burns around their body

enteral feedings

Tinea Capitis

erythema and scaling of scalp, often in round patches

Purpose of Neurologic Examination is to:

establish an accurate, objective baseline of neurologic information. Complete neurologic examination includes level of consciousness; posture; motor, sensory, cranial nerve, and reflex testing; and vital signs.

Tretinoin (Retin-A) is a topical agent commonly used to treat acne. Nursing considerations with this drug should include:

explaining that medication should not be applied until at least 20 to 30 minutes after washing.

What kind of genetics and environmental factors cause birth defects?

exposure to teratogens, alcohol, smoking, meds, low folic acid

During the summer many children are more physically active. What changes in the management of the child with diabetes should be expected as a result of more exercise?

food intake

what to monitor after myelomeningocele repair?

hydrocephalus

common factor for hyperparathyroidism

hypercalcemia

Reye's Syndrome aka Metabolic Encephalopathy

is a disorder defined as a metabolic encephalopathy associated with other organ involvement. It is characterized by fever, profoundly impaired consciousness, and disordered hepatic function. The most important aspects of successful management of a child with RS are early diagnosis and aggressive therapy. Cerebral edema with increased ICP represents the most immediate threat to life. Recovery from RS is rapid and usually without sequelae if the diagnosis was made and therapy implemented early.

Diagnostic for GI Disorders

labs: CBC incl. ESR + LFT's, stool studies, CT, chest XRAY

Diagnostic Evaluation of Aplastic Anemia

low RBC, low wbc and low platelet; definitive diagnosis is bone marrow aspiration which show conversion of red bone marrow to yellow, fatty bone marrow.

What urine test result is considered abnormal?

pH 4.0

recommended immunizations for a kid with HIV

pneumococcal and influenza vaccines

Diagnostics for Musculoskeletal dysfunction

standing X-rays, asymmetry of shoulder or hip height, scapular or flank shape.

Treatment for Immune Thrombocytopenia (Idiopathic Thrombocytopenic Purpura)

supportive treatment; disease is self limitng - Activity restrictions while platelet count is low - Prednisone IV, IVIG (Immune Globulin), and anti-D antibody therapy - Splenectomy for patients who do not respond to therapy for 6 months to 1 year - Rituximab (off-label usage for treating ITP in children with chronic ITP)

Peritoneal Dialysis

◻ Abdominal cavity acts as semipermeable membrane for filtration ◻ Can be managed at home in some cases ◻ Warmed solution enters peritoneal cavity by gravity; remains for period of time before removal

Transplantation

◻ From living, related donor ◻ From cadaver donor ◻ Primary goal is long-term survival of grafted tissue ◻ Role of immunosuppressant therapy ◻ Rejection ◻ Prognosis

Renal Development and Function in Infancy

◻ Glomerular filtration and absorption low in infancy until age 1-2 years old ◻ Newborn is unable to concentrate urine effectively ◻ Newborn unable to reabsorb sodium and water ◻ Newborn produces very dilute urine

Complications of Acute Renal Failure (ARF)

◻ Hyperkalemia ◻ Hypertension ◻ Anemia ◻ Seizures ◻ Hypervolemia ◻ Cardiac failure with pulmonary edema

Renal Trauma

◻ Kidneys in children are more mobile than in adults, and the outer borders of kidneys of children are less well protected ◻ Injuries usually blunt trauma Falls, sports injuries, motor vehicle crashes

Therapeutic Management of Type 1 DM: Insulin Therapy

• Insulin replacement for type 1 DM • Modes of Administration: twice daily injections, multiple-dose injections or insulin infusion pump.

Therapeutic Management of Precocious Puberty

• Pediatric Endocrinologist • In 50% of cases, precocious pubertal development regress or stop advancing without any treatment. • Treatment of specific cause if known (CNS tumors?) • Monthly injections of a synthetic analog of luteinizing hormone- releasing hormone (decreases pituitary secretion of LH and FSH) • May be treated with Lupron and Histrelin • Psychologic support for child and family

Meningitis Medical Management

•Immediate IV administration of appropriate antibiotic therapy (at least 10 days) •Isolation until 24 hours after antibiotic therapy began •Antiepileptic drugs

Guillain-Barre Syndrome (Polyneuritis): Etiology / Pathophysiology

•Inflammation and demyelination of the peripheral nervous system •Possibly viral or autoimmune reaction (following viral, trauma, surgeries, viral immunizations, HIV infection) •GBS antibodies attack Schwann cells, causing demyelination •Un insulated portion of the nerve becomes inflamed and nerve conduction is interrupted, causing muscle weakness and numbness.

Clinical Manifestations of Spina Bifida (myelomeningocele)

•All motor and sensory function below the defect is usually absent.

Etio / Patho Hydrocephalus

•An excess of fluid within the cranial vault, subarachnoid space, or both; caused by an imbalance between the production and absorption of CSF within the ventricular system Hydrocephalus is a group of conditions resulting from disturbances in the dynamics of cerebral circulation and cerebrospinal fluid (CSF) caused by either (1) impaired absorption of CSF fluid (nonobstructive or communicating hydrocephalus) or (2) obstruction to the flow of CSF through the ventricular system (obstructive or noncommunicating hydrocephalus). Surgical treatment is the therapy of choice in almost all cases of hydrocephalus; however, most children require a shunt to promote CSF drainage.

Etiology/Pathophysiology of Meningitis

•An infection of the meninges; may be bacterial, viral, or fungal; bacterial is the most common typically bacterial infection, get culture and give antibiotics

Etiology / Pathophysiology of Encephalitis

•An inflammation of the CNS •mainly the brain and spinal cord

Nursing Interventions for Seizure Disorders:

•During a seizure, protect the child from injury. •Do not force an object between the teeth. •Stay with the child to provide reassurance, emotional support, and explanations. •Educate family regarding the nature of the disorder.

Clinical Manifestations of Meningitis

•Fever, vomiting, headache, irritability, photophobia, and NUCHAL RIGIDITY •Progresses to decreased level of consciousness and seizures •Positive Kernig's sign and Brudzinski's sign

Medical Management of Encephalitis

•Hospitalization for strict observation and supportive care; control fever, ensure adequate hydration and nutrition, and monitor vital signs.

Care of Unconscious Child

⬤Respiratory management ⬤Intracranial pressure monitoring ⬤Nutritional support ⬤Hydration—adjusting fluids carefully ⬤Medications ⬤Thermoregulation ⬤Elimination ⬤Stimulation and support of skin, joints, limbs ⬤Family support Nursing care of an unconscious child focuses on ensuring respiratory management; performing neurological assessment; monitoring ICP; supplying adequate nutrition and hydration; administering drug therapy as indicated; regulating temperature; promoting elimination, hygienic care, proper positioning, exercise, and stimulation; and providing family support. Respiratory effectiveness is the primary concern in the care of an unconscious child, and establishment of an adequate airway is always the first priority. Carbon dioxide has a potent vasodilating effect and will increase cerebral blood flow and intracranial pressure (ICP). Cerebral hypoxia at normal body temperature that lasts longer than 4 minutes nearly always causes irreversible brain damage.

Status Epilepticus

⬤Seizure lasting >30 minutes ⬤Nursing care management: ⮚Maintain patent airway ⮚Ensure safety ⮚Assessment, documentation ⮚Diazepam administration (buccal, nasal, rectal, IV) ⮚Support family Status epilepticus is a continuous seizure that lasts more than 30 minutes or a series of seizures from which the child does not regain a premorbid level of consciousness. The initial treatment is directed toward support and maintenance of vital functions including the ABCs (airway, breathing, and circulation) of life support, administering oxygen, and gaining IV access followed by administration of antiepileptic agents.

Brain

⮚Cerebral hemispheres ⮚Basal ganglia ⮚Brainstem

Glasgow Coma Scale

⮚Different criteria for infants and older children ⮚Decline in LOC follows a pattern of confusion, lethargy, obtundation, stupor, coma and persistent vegetative state.

Etio of Head injury

⮚Falls ⮚MVA ⮚Bicycle injury

S/s of Reye's Syndrome

⮚Fever, nausea, vomiting, mental status changes ⮚Seizures, progressive unresponsiveness ⮚Altered hepatic function