Peds Capstone Review
What are interventions for treatment of GABHS?
Therapeutic procedure of Tonsillectomy Post-Op Tonsillectomy Place in side-lying position or abdomen Elevate HOB when child fully awake Assess for bleeding (i.e. frequent swallowing, clearing throat, restlessness, bright red emesis, tachycardia, pallor) Monitor for difficulty breathing Admin analgesics Provide ice collar & offer ice chips or sips of water Clear liquid diet after return of gag reflex and avoid use red-colored liquids, citrus juice, & milk-based foods initially
Identify five (5) nursing actions for a client who is in a hip spica cast.
-Assess and monitor neurovascular status -Apply ice for the first 24 to 48 hrs. to prevent swelling -Turn the client frequently while supporting all extremities and joints -Assess for increased warmth or hot spots on the cast surface, which could indicate infection -Assess general skin condition and the area around the cast edges.
Describe nursing care for a client with osteomyelitis
-Assist with diagnosis and joint biopsy -Give IV/oral antibiotics as prescribed-proper positioning -Give analgesics as prescribed. -Asses home care needs. -Educate client on length of treatment, long term antibiotic therapy, avoidance of bearing weight, diversional activities, and proper nutrition.
A nurse is discharging a client home with the diagnosis of rheumatic fever. What education should be provided to the caregivers of a child who is being discharged following this diagnosis?
-Children who have rheumatic fever might take salicylates *(aspirin)* to control the inflammatory process that occurs in the joints. -abx, -bed rest, -educate pt on need for prophylactic abx prior to any procedure/surgery -standard isolation precautions
What is the expected growth mile markers for a 6-month infant?
-Doubled birth weight -Starting to sit up alone -Sleeping 6 to 8 hours a night -Start eating solid foods -able to roll from back to front -holds bottle -starts to have stranger anxiety -16 lb avg -grow 1 in. per month w/in 6 months
A nurse is caring for a client with glomerulonephritis. What interventions regarding nutritional intake and restrictions should be taken?
-Encourage adequate nutritional intake. -Possible restriction of sodium and fluid. -Restrict foods high in potassium during periods of oliguria. -Provide small, frequent meals of favorite foods due to a decrease in appetite. -Refer the child for dietary consultation if indicated. -Avoid added salt and salty foods such as chips. -Monitor daily weights; weigh the child on the same scale with the same amount of clothing daily.
A nurse is assessing for strabismus in a pediatric client. Identify three (3) clinical findings noted with strabismus.
-Eyes that appear crossed or an eye that seems to wander -Uncoordinated eye movements -Asymmetric corneal light reflex misaligned eyes, inward deviation of eye frowning or squinting difficulty seeing print clearly one eye closed to enable better vision head tilted to one side headache, dizziness diplopia photophobia crossed eyes.
A child had tympanoplasty tubes placed and the nurse is completing discharge teaching for the family. List three (3) important points to include in the teaching.
-Insert ear plugs into the canals when the child bathes -Low the nose forcibly during a cold -Administer the prescribed antibiotic while the tubes are in place -Disregard any drainage from the ear after 1 week
What are teaching points to discuss with the caregiver(s) and child about treatment of GABHS?
-Instruct to contact provider if difficulty breathing, lack of oral intake, increase pain, or infection present -Admin pain medication PRN -Encourage intake of fluid & advance diet as tolerated (i.e. No spicy foods, or hard, sharp foods) -Limit strenuous activity & physical play with no swimming for 2 weeks
The nurse is educating an adolescent about the use of albuterol/Ventolin for asthma. What information should the nurse include in this teaching?
-It is used for acute exacerbations -Prevention of exercised-induced asthma -take this medication 15 min before exercising -Monitor for tremors & tachycardia when taking medication -Administer prior to exercise or activity -Administer bronchodilator before anti-inflammatory medication, if prescribed
Identify three (3) points that the nurse should educate the parents on regarding measures to prevent SIDS.
-Lie infants on their backs to sleep. -Make sure there are no blankets or other items in the crib. -Provide a firm mattress. -To keep your baby warm, try a sleep sack or other sleep clothing that doesn't require additional covers.
A child has been admitted to the emergency department with a closed head injury. What medications should the nurse anticipate the provider to prescribe and why?
-Mannitol to treat cerebral edema -Antibiotics: Use r/t CSF leakage, laceration, or penetration injuries -Analgesics: Used of HA/pain management -Corticosteroids: Used to decrease cerebral edema -Antiepileptics: Used to prevent/treat seizures
meningitis care
-implement droplet precautions right away -maintain for at least 24 hours following initiation of abx -keep pt npo if there is a decreased LOC (r/f aspiration) -dark quiet environment (photophobia) -admx medications (abx, corticosteroids) -mx for signs of increased ICP -Position the client without a pillow, and slightly elevate the head of the bed. The client can also be positioned side-lying to reduce neck discomfort. -keep room cool -Presence of petechial or purpuric-type rash requires immediate medical attention
A nurse is caring for a child with Hirschsprung disease. What are manifestations of this disease in an older child?
-failure to thrive -abdominal distention -visible peristalsis -palpable fecal mass -constipation-foul-smelling -ribbonlike stool
What are manifestations of a urinary tract infection (UTI) in infants?
-increase in irritability -screaming with urination -poor feeding, vomiting, or failure to gain weight -increase in thirst-frequent urination -straining with urination -foul-smelling urine -fever -diaper rash -dehydration -seizure -pallor
Explain how methylphenidate hydrochloride works in children who have Attention Deficit Hyperactivity Disorder (ADHD)
Methylphenidate inhibits the reuptake of dopamine and norepinephrine, increased dopaminergic and noradrenergic activity in the prefrontal cortex may explain its efficacy in ADHD
What does FLACC stand for? How old does a child need to be to use the FLACC Scale for pain? What is the form of evaluation when using the FLACC Scale?
FLACC (Face, Legs, Activity, Cry, & Consolability). Used to evaluate child from 2 months to 7 y/o. Evaluates pain by assessing the child's behavior.
A pediatric client is complaining of a sore throat and general weakness. The provider diagnoses the client with Group A B-hemolytic streptococci (GABHS). Identify three (3) manifestations of GABHS?
Mouth odor/breathing Snoring & nasal qualities in voice Fever Also include Tonsil inflammation with redness & edema
What are two (2) ways in which a parent can handle temper tantrums of toddlers?
(1) Providing consistent, age-appropriate expectations helps them work through their frustration (2) Additionally, temper tantrums should be ignored after ascertaining the child is safe.
What are three (3) points the nurse should educate the parents of an epileptic client on regarding seizure medications?
1) a complication of seizure medications are CNS effects such as hyperactivity and irritability 2) seizure medications will control the seizures not cure the disorder 3) medications should be taken same time every day. 4) most common side effect of seizure medications is feeling sleepy (drowsiness, irritability, nausea, rash, and clumsiness) 5) Be aware of medication and food interaction Blood tests, urinalysis, and liver function tests will need to be performed at regular intervals to determine effect on organ function, 6) Medication should be administered at the same time every day
What are three (3) measures the nurse will inform the mother about to address the infestation of pediculosis capitis?
1) teach about medications (1% permethrin shampoo, Spinosad 0.9% topical suspension). Both medicines kill only live lice, not the eggs, so they should be reapplied in 7-10 days to kill newly hatched lice 2) wash clothing and bedding in hot water with detergent and bag items that can't be laundered into tightly sealed bags for 14 days 3) boil combs, brushes and hair accessories for 10 min or soak in lice-killing products for 1 hr 4) Before applying the over-the-counter lotions, do not use conditioner on the hair, as this will coat the hair and protect the lice from the medicine. Also, do not wash the hair for 1-2 days after treatment.
What is a Wilm's tumor and what are manifestations of this type of cancer?
a Wilm's tumor or nephroblastoma (kidney cancer) is a malignancy that occurs in the kidneys or abdomen. Manifestations -firm, nontender abdominal swelling or mass -fatigue, malaise, weight loss -fever -hematuria -hypertension -avoid abdominal palpation or manipulation
A nurse is caring for a client newly prescribed cefazolin who has hereditary glomerulopathy. What are three (3) adverse effects of this class of medication? Is the administration of cefazolin safe for this client?
cefazolin: antibiotic used to treat a wide variety of bacterial infections Three adverse side effects: -Loss of appetite -Hyper/hypoglycemia -Anorexia *Not safe for this client, contraindicated in:* -Renal failure, renal impairment -Cephalosporin hypersensitivity, penicillin hypersensitivity -pregnancy, breast feeding
A nurse is caring for a client who will be vaccinated. By what route should the Hepatitis B vaccine be given?
intramuscular.
Identify two (2) adverse effects of methylphenidate hydrochloride (Ritalin) in the school aged child.
Insomnia Loss of appetite or anorexia Nervousness abdominal pain weight loss during prolonged therapy tachycardia
What is a Patent Ductus Arteriosus? Identify two (2) clinical manifestations of patent ductus arteriosus (PDA).
PDA is a heart problem that affects some babies soon after birth. In this condition, the normal fetal circulation conduit between the pulmonary artery and the pulmonary aorta fails to close leading to *increase in pulmonary bloodflow* Manifestations: -murmur, wide pulse pressure, bounding pulses, heart failure, possibly asymptomatic tachypnea, working hard to breathe, or shortness of breath. Premature infants may need increased oxygen or help breathing from a ventilator. -Poor feeding and poor weight gain. -Tiring easily. -Sweating with exertion, such as while feeding.
What are defined gross motor skills for a 4-year-old client who is a preschooler?
Skips and hops on one foot Throws a ball overhead Catches a ball reliably
Name two (2) manifestations of infective endocarditis in children.
The signs of IE are like the signs of flu. This can make it hard to know if your child has IE. a slight fever of 37.5°C (99.5) to 38.5°C (101.3) that you cannot explain and that lasts for 5 to 7 days sweating loss of appetite pain in the muscles and joints, such as the knees, shoulders, or knuckles loss of weight a skin rash headaches a general feeling of weakness
What is a myringotomy? How is this procedure performed and what post-operative care should the nurse provide?
placement of tympanoplasty tubes are indicated for a child who has multiple episodes of otitis media. It may be performed by laser treatment. A small incision is made in the tympanic membrane, and tiny plastic or metal tubes are placed into the eardrum to equalize pressure and minimize effusion. Post-operative care -Limit the child's activities for a few days following surgery. -Instruct the parents to notify the provider when tubes come out. -Inform the client/parents about comfort measures. -Encourage the parents to feed the child in an upright position when bottle or breastfeeding. -If drainage is present, clean the external ear with sterile cotton swabs. Apply antibiotic ointment. -Teach the parent to avoid exposure of child to risk factors if possible (secondhand smoke, exposure to infections). -Stress the importance of medical care at initial signs and symptoms of infections (change in behavior, tugging on ear) -Encourage parents to keep immunizations up to date.
cleft palate post op care
post surgery: -avoid having baby suck on nipple or pacifier -place baby laterally or on stomach to help prevent aspiration and facilitate drainage -apply restraints to prevent baby from disturbing operative site -Keep the infant pain-free to decrease crying and stress on repair -Feed w/ cups, Avoid sucking on nipple or pacifier -monitor I/O's daily -Change position frequently to facilitate breathing & place on abdomen in immediate post-op period -Maintain IV fluids until infant able to eat & drink
Identify two (2) initial clinical manifestations of RSV.
-fever, -cough, -dyspnea, -hoarseness, -restlessness
Identify three (3) clinical manifestations of hydrocephalus in an infant.
-high pitched cry -bulging fontanels and widening cranial suture lines -increased head circumference -vomiting -"setting sun" sign
The nurse is caring for a child with epiglottitis. List three (3) nursing interventions the nurse will be expected to carry out.
protect airway: don't put anything in mouth, no throat culture, no tongue blade administer IV fluids, humidified oxygen and antibiotics, prepare for intubation continuous pulse oximetry
A pediatric client was diagnosed with Reye Syndrome. Which of the following statements by the parent indicate understanding of this diagnosis? (select all that apply) -"Reye Syndrome typically follows a viral illness." -"There is no association between using aspirin for fevers and development of Reye Syndrome." -"My son's liver function may return to full function." -"His symptoms of irritability, confusion, and lethargy are expected with this diagnosis." -"There is no known treatment for Reye Syndrome and its symptoms."
"Reye Syndrome typically follows a viral illness." "My son's liver function may return to full function." "His symptoms of irritability, confusion, and lethargy are expected with this diagnosis."
What are the common causes of iron deficiency anemia and which children are at risk?
*causes include:* -Inadequate dietary supply of iron (excessive intake of cow's milk in toddlers) -Blood loss during menstruation (adolescent females) -Rapid growth during puberty (adolescent males) -Malabsorption disorders -Blood loss -Premature birth resulting in decreased iron stores *Children at risk include* -Adolescents (due to poor diet, rapid growth, menses, strenuous activities, and obesity) -Premature babies -Toddlers who drink more than 24oz of milk/day -Common Causes: Usually results from inadequate dietary supply *Risk Factors:* -Premature birth -Excessive intake of cow's milk in toddlers -Malabsorption disorder due to prolong diarrhea -Poor dietary intake of iron -Increased iron requirement due to blood loss -Chronic disorder (i.e. folate deficiency, sickle cell anemia, hemophilia)
What symptoms would the nurse expect to find if a child were having an acute hemolytic reaction during a blood transfusion?
- chills, - fever, - hypotension, - uncontrollable bleeding, - increased heart rate, - constricting chest pain, - lumbar region pain, flank pain - hemoglobinuria - hyperbilirubinemia
A child has been admitted to the emergency department with a closed head injury. Identify the lab and diagnostic tests that will be ordered.
-ABGs, -blood alcohol and toxicology screening, -CBC with differential -liver function tests; -cervical spine x-rays to rule out cervical spine injury, -CT and/or MRI of head and/or neck might be performed with and without contrast if indicated -measurement of ICP
A nurse is providing education to an adolescent client with diabetes and his parents regarding 'Sick Day Rules' while sick. What information should the nurse provide?
-Monitor blood glucose and urinary ketones every 3 hr -Continue insulin and/or oral antidiabetic agents (dosages may vary) -Encourage sugar-free, non-caffeinated liquids to prevent dehydration -Meet carbohydrate needs by eating soft food, if possible -Rest -Call provider if: blood glucose is >240 mg/dL, positive ketones in urine, disorientation/confusion occurs, rapid breathing, vomiting more than once, liquids cannot be tolerated
When feeding a client who has Gastroesophageal Reflux (GERD), in which position should the client be placed in and why?
-Position with head elevated at 30 degrees for 1hr after meals to prevent nausea from occurring. *Interventions depend on the severity of the symptoms* -Offer small, frequent meals -Thicken infants formula with 1 tsp to 1 tbsp rice cereal per 1 oz. formula -Avoid foods that cause reflux (caffeine, citrus, peppermint, spicy or fried foods) -Assist with weight control -Position the child with the head elevated after meals -Position prone with extreme caution; supine is still the recommended position
Identify four (4) points to discuss with parents of a preschooler regarding nutrition to ensure a balanced and healthy diet.
-Preschoolers consume approximately half the amount of energy that adults do (1,800 kcal). -Finicky eating can remain a behavior in preschoolers, but often by 5 years of age they become more willing to sample different foods. -Preschoolers need 13 to 19 g/day (0.45 to 0.67 oz/day) of protein in addition to adequate intake of calcium, iron, folate, and vitamins A and C. -Saturated fats should be less than 10% of preschoolers' total caloric intake, and total fat over several days should be 20% to 30% of total caloric intake. -Fresh fruit will help them form better choices
Identify three (3) contraindications associated with antidiabetic agents
-Renal disease or renal dysfunction or kidney disease -Liver or hepatic disease -Alcoholism -metabolic acidosis, -Hypoglycemia -Cross allergy if patient allergic to sulfonamide antibiotics -sulfa allergy -Class III or IV heart failure
What are three (3) manifestations of osteomyelitis?
-appearing ill -irritability -fever -tachycardia -edema -pain -not wanting to use affected extremity -site of infection tender/bone pain worse with movement
A nurse is caring for a child with a closed head injury. What clinical manifestations would suggest deterioration in this client's condition?
-changes in vital signs -altered mental status -increased intracranial pressure -alterations of pupillary response -posturing -bradycardia -decreased motor response -decreased sensory response -Cheyne-Stokes respirations -coma
The nurse is caring for a child with epiglottitis. What are three (3) expected findings during the assessment of this client?
-drooling, -difficulty/painful swallowing -high fever -inspiratory stridor
A nurse is caring for a child who has had surgery for hypospadias. Which of the following nursing interventions would be contraindicated?
Hypospadias is when the urethral opening is located below the glans penis, behind the glans penis, or on the ventral surface of the penile shaft. -Intake and output - monitor I & O -Limit activity - Limit activity as prescribed -Provide wound care - provide wound and/or dressing care *Contraindicated interventions:* -Tub bath - do not provide tub baths for at least 1 week
A nurse is preparing to administer the MMR immunization to a client. What are two (2) contraindications for this vaccine?
Pregnancy Allergy to gelatin & neomycin Also Hx of thrombocytopenia or thrombocytopenic purpura; Immunosuppression; or Recent transfusion of blood products/immunoglobulin
Identify 3 points to discuss with new mothers who are breastfeeding their newborn
Wash her hands before to prevent infection Feed 8-12 times in 24 hrs fo at least 15-20 minutes Caffeine free non alch fluids to drink during and get comfortable Let-down reflex= stimulation of maternal nipple releases oxytocin that causes the let-down of milk🡪 this will cause uterine contractions Show proper latch position🡪 full mouth over the areola not just nipple Positions= football, cradle or modified cradle, across lap and side lying Have the newborn get best nutrition by emptying the breast When the newborn has latched on and is sucking effectively, his chin, cheeks, and tip of the nose all touch the breast;
