peds exam three
CNS tumors signs and symptoms
depends on location of tumor infants hard to detect increased ICP symptoms increased head circumference headache when walking and vomiting unrelated to feeding words different walking with unsteady gait
Down syndrome nursing care management
diagnosis, prevention of physical problems, prenatal diagnosis and genetic counseling
hyperkalemia treatment
dialysis potassium wasting diuretics IV sodium bicarb, IV insulin with glucose, calcium gluconate
PKU treatment
diet low in phenylalanine for life avoid high protein foods and aspartame pregnant females must follow diet to prevent damage to fetus
hypopituitarism patho
diminished of deficient secretion of pituitary hormones
Hodgkins lymphoma def
disorder of lymphoid system male > females mostly adolescents 15-19 years
mucous membrane moderate dehydration
dry
mucous membrane severe dehydration
dry
eyes fluid deficit
dry, sunken
which signs of hypokalemia would the nurse monitor in the postoperative surgical client with a NG tube attached to continuous low suction?
dysrhythmias, muscle weakness
management of DM
eating enough glucose and administering enough insulin important to balance nutrition, mediations, and exercise
anemia def
education in RBCs mass per volume and/or hemoglobin concentration compared to normal values for age and gender
pre-cardiac Cath and pre-op care
education, mark peripheral pulses in legs/feet, activity level after cath or surgery, allergies, explain to them that the injection of the medicine may make them feel warm, ensure that the patient has been NPO, administer sedatives as ordered, tour of the ICU (if necessary)
klinefelter syndrome nursing intervetions
educational support, speech therapy, emotional support
the school nurse is caring for a child with hemophilia who fell on his arm during recess. what supportive measures would the nurse implement first?
elevate the arm above the level of the heart
BUN fluid deficit
elevated
anaphylaxsis
exposure to an antigen rapid generalized histamine release vasodilation bronchoconstriction increased capillary permeability
sodium
extracellular body fluid osmolality normal 135-145 mmol/L blood pressure regulation maintenance of fluid volume
side effects of chemo
extravasation, alopecia, GI issues (nausea, vomiting, constipation, diarrhea, mucosal ulceration), GU issues (hemorrhagic cystitis), neuropathy
signs of congenital heart disease
feeding problems (poor weight gain) cyanosis frequent URi respiratory distress exercise intolerance murmurs diaphoresis discrepancy in BP and pulses clubbing developmental delays
pediatric hematology differences
fetal hemoglobin has a high affinity for oxygen higher level of erythropoietin at birth- stimulates RBC production platelets counts lower at birth- vit K given
maintaining fluid balance conditions with increased requirements
fever, tachypnea, radiant warme vomiting and diarrhea, DI, acidosis shock, burns, post-op bowel surgery
addisons disease treatment
replace cortisol and aldosterone may be able to do oral hydrocortisone and lots of salt may need higher doses during stressful times patient and family education
congenital adrenal hyperplasia treatment
replace deficient hormones female surgical repair may need aldosterone replacement dietary supplementation with salt
hemophilia treatment
replace missing clotting factor DDAVP NSAIDs used only with caution avoid ASA recognize bleeding episodes early avoid contact sport, wear proper equipment
heart transplant def
replacement of diseased heart with a healthy one donated by organ donors or parents of critically ill children
the nurse is caring fora. client after abdominal surgery and encourages the client to engage in deep-breathing exercises and turn from side to side. which compilation is the nurse trying to prevent?
respiratory acidosis
vegetarian diets at risk for
rickets, vitamin b12, folate deficiency
cyanotic decreased pulmonary blood flow def
right to left shunting of blood desaturated blood mixes with oxygenated blood and is delivered systemically
type two diabetes mellitus patho and treatment
same as adults decreasing weight increasing physical activity try to manage without medications can use oral hypoglycemic agents and insulin
respiratory acidosis brain
sedatives, head injury
preschool view of death
see death as departure or type of sleep temporary and reversible
addisons disease diagnosis
serum cortisol level low electrolyte imbalances: low sodium, high potassium fasting hypoglycemia low blood pressure ACTH stimulation test
consolidation therapy ALL
several months eradicates residual leukemia cells and prevents further cloning
turner syndrome syndrome
short stature, webbing of the neck, low hair line, drooping eye lids infertility, thyroid, bone, kidney and heart abnormalities lymphedema hypertension obesity diabetes typical intelligence
which developmental assessment would the nurse make about a child with tetralogy of fallout that just began walking unsupported at age 3.5 years?
should have started to walk about two years earlier
congenital hypothyroidism untreated symptoms
thick, protruding tongue hypotonia bradycardia larger posterior fontanel prolonged neonatal jaundice difficulty feeding hypothermia
acanthosis nigricans
thickening and darkening of skin in type II diabetes
fluid balance internal mechanisms
thirst antidiuretic hormone aldosterone renin-angiotensin system
hypernatriemia signs and symptoms
thirst low urine output decreased level of conciousness seizures if rapid onset or severe
immune thrombocytopenia characteristics
thrombocytopenia, platelet count <20,000, normal bone marrow
non-hogdkins diagnosis
tissue biopsy burritos lymphoma may be preceded by EBV
risk of radiation for CNS tumor in young children
tissue necrosis, subsequent malignancies, endocrine dysfunction, behavioral or intellectual deficits
cyanotic mixed blood flow CHD
transposition of great arteries total anomalous pulmonary venous return truncus arteriosus hypo plastic left heart syndrome
sickling triggers
trauma fever infection dehydration stress hypoxia vasoconstriction anything that increases the body's need for oxygen or alters the transport of oxygen
septic shock family support
trauma sudden illness or deterioration education
precocious puberty treatment
treat the underlying cause 50% of cases stop on own can be treated with injections or implantation of device of luteinizing hormone releasing hormone psychological support
what is the primary therapy for secondary hypertension in children?
treatment of underlying cause
pituitary hyperfunction treatment
treatment related to cause growth cannot be reversed may need pituitary hormone replacements after surgery
which clinical signs of hydration would the nurse assess in a toddler experiencing a sickle cell crisis?
turgor of tissue, texture of mucous membranes
clinical manifestations of iron deficiency anemia
underweight or overweight infants (due to excess milk ingestion) pale poor muscle development prone to infection edema decreased growth irritability tachycardia fatigue glossitis angular stomatitis concave or spoon finger nails (koilonychia) impaired neurocognitive dysfunction
maintenance therapy ALL
2-5 years chemotherapy maintains the remission phase
irreversible septic shock
-irreversible -significant damage to vital organs -cardiac arrest
induction therapy ALL
4-5 weeks corticosteroids to maintain high levels chemotherapy family support achieves a complete remission
diabetes complications
DKA, coma, death, heart and blood vessel disease, neuropathy, kidney damage, retinopathy, foot injuries, pregnancy complications
pituitary hyperfunction diagnosis
IGF-1 increase GH test increased MRI
prevention of acute tumor lysis syndrome
IV hydration, urinary alkalization, allopurinol (decreases uric acid formation), monitor I&O, monitor serum electrolytes, treatment: supportive care send every urine to lab exchange transfusion may be necessary for child with high tumor burden
severe dehydration treatment
IV hydration: LR and Ns 20 mL/kg bolus bolus then maintenance IVF
cancer diagnostic test
LP (for leukemia, brain tumors, mets) bone marrow aspiration, tumor biopsy CT, MRI, PET
long-acting (insulin glargine)insulin
Lantus reaches blood in 6-14 hours no peak lasts 20-24 hours
CNS tumor diagnosis
MRI, CT, tissue biopsy
rapid acting insulin
Novolog, humalog reaches blood in 15 min peaks in 30-90 min lasts up to 5 hours
labs to monitor in chemo
WBC (lowered) platelets (low) hemoglobin (low)
creatinine fluid excess
WNL
which assessment finding in a laboring client indicates respiratory alkalosis?
a tingling sensation in the hands
neuroblastoma diagnosis
abdominal ultrasound CT scan MRI CT chest (to look for mets) CBC kidney function UA
partial precocious puberty causes
abnormal levels of estrogen or testosterone
acute tumor lysis syndrome signs and symptoms
anorexia, vomiting, weakness, lethargy, edema hyperphosphatemia, hypocalcemia, hyperuricemia, hyperkalemia acute kidney injury form hyperuricemia, seizures, arrhythmia
ARF treatment
antibiotics (penicillin) pain control anti-inflammatory medications evaluate heart damage
respiratory acidosis causes
anything that interferes with the ability of the lungs to excrete CO2
a four year old with sickle cell crisis is complaining of pain his right wrist. what is the best action?
apply a warm blanket to his right wrist
what would the nurse recognize as an early clinical sign of compensated shock in a child?
apprehension, irritability, normal blood pressure, narrowing pulse pressure, thirst, pallor, and decreased urinary output
precocious puberty parent education
appropriate dress and modesty safety appropriate activities for childs age sexual interest is NOT advanced beyond the childs age
Ewing sarcoma def
arises in the marrow spaces of bone, "soft tissue", originates fro the shaft of the long bones, and trunk bones most often affecting the pelvis, femur, tibia, fibula, humorous, ulna, vertebrae, scapula, ribs, skull
post cardiac cath care
arrhythmias? child will need to remain in bed with affected leg straight for 4-6hours check color, temperature, and dorsals pedis and posterior tibialis assess for bleeding- if bleeding occurs, don gloves and place pressure approx one inch above insertion site
respiratory acidosis lungs
aspiration, atelectasis, BPD, CF
acyanotic increased pulmonary blood flow CHD
atrial septal defect ventricular septal defect patent ductus arteriosus artioventricular canal
infective endocarditis def
bacterial infection of the valves and inner lining of the heart sequelae of bacterial infection common with prior heart defect
SCA treatment
bed rest, hydration, electrolyte replacement, analgesia, blood transfusion, exchange transfusion, antibiotics, prevention infection (vaccinations, PVK)
Kawasaki disease convalescent phase
begins around day 25 and lasts until about day 40 lab values have not returned to normal 6-8 weeks from onset
leukemia relapse
can mutate re-induction start cycle again- use corticosteroid and combination chemo not previously used remission may be achieved after a relapse each relapse indicates an increasingly poor prognosis stem cell transplant
mixed disorders def
complex cardiac anomalies not classified by other areas
DKA def
complication of DM, child usually presents with DKA when first diagnosed MEDICAL EMERGECENCY insulin in absent
which clinical indicator would the nurse expect a client with hyperkalemia to exhibit?
confusion, weakness, dysrhythmias
hypercalcemia signs and symptoms
consitpation, nausea, vomiting, fatigue, renal calculi, cardiac arrhythmias
turners syndrome treatment
estrogen replacement therapy at adolescence
pituitary hyperfunction patho
excessive secretion of pituitary hormones (prolactin, ACTH, growth hormone) often due to pituitary adenoma can grow 7-8 feet tall acromegaly if continues after growth plates close diagnosis often delayed
creatinine fluid deficit
elevated
retinoblastoma treatment
enucleation, radiation, cryotherapy, chemo, prosthesis, protective eye wear
non-hogdkin lymphoma risk factors
epstein-barr virus, inherited or acquired immunodeficiency, DNA repair syndromes (ataxia-telangiectasia), previous cancer
edema causes
inflammation right sided heart failure increased albumin secretion nephrotic syndrome burns
acute rheumatic fever disease
inflammatory disease that affects heart, joints, CNS, and subcutaneous tissues
addisons disease patho
insufficient cortisol and aldosterone production from adrenal glands
hypotonic IV fluids
lower osmolarity than blood 0.45 NaCl (1/2 NS) 0.2% NaCl
Hodgkins lymphoma diagnosis
lymph node biopsy (+ reed Sternberg cells) cest xray ct scan mri CBC
bp in mild dehydration
normal
adolescent view on death
searching for meaning
osteogenic sarcoma treatment
surgery- amputation, limb salvage procedures chemotherapy- given preoperatively and post op
heart transplant treatment
surgical replacement of heart encourage nutrition assess for organ rejection medications to prevent rejection and infection
skin turgor fluid deficit
tenting, poor
hyponatremia causes
water intoxication diluted formula or milk excessive ADH congestive heart failure replacing lost fluids with water excessive sweating (CF) diuretics
ARF diagnosis
ASO titer, ESR, CRP, Echo, ECG
cardiovascular assessments and tests
HR, RR, BP, color, WOB, S1 and S2, adventitious cardiac sounds (murmurs), pulses, CR, EKG, CXR, echo, TEE, cardiac MRI, cardiac Cath, angiography labs: CRP, ESR, blood cultures, ASO titer
fontanel fluid excess
full/bulging
insulin drip monitoring
hourly blood glucose checks do not want glucose to drop more than 100 in one hour to avoid cerebral edema
short acting (regular) insulin
humulin R, novolin R reaches blood within 30 min peaks in 2-4 hours lasts 4-8 hours
full precocious puberty causes
hypothalamic gonadotropic releasing hormone
respiratory problems cyanosis
improves with crying
HSP etiology
unknown, follows URI
types of non-hodgkins lymphoma
lymphoblastic burkitt non-burkitt large cell
carbohydrates
main source of energy 100% becomes sugar in blood peak in on hour and out of blood in two hours very important in managing diabetes
acyanotic obstructive defects def
mechanical obstruction of the heart can be in valves or vessels
hypercalcemia treatment
medications (lasix, glucocorticoids) underlying cause, encourage mobility
non-hodgkins other involvement
metastasis to bone marrow or CNS= s/s of leukemia compression of intestinal or airway obstruction cranial nere palsies, spinal paralysis
mild dehydration treatment
oral hydration supportive treatment of cause
moderate dehydration treatment
oral or iv hydration
what would be included in nursing care of an infant with heart failure?
organize activities to allow for uninterrupted sleep
fluid balance moverment mechanisms
osmotic pressure diffusion active transport
immune thrombocytopenia presentation
1-4 weeks after viral illness, peak incidence 1-6 years old
wilm's tumor (nephroblastoma) def
malignant tumor that rises from the kidney swelling or mass in abdomen DO NOT PALPATE ABDOMEN- encapsulated tumor rapid growing one sides firm, contender, deep
precocious puberty patho
manifestations of sexual development before 9 for boys and 8 for girls
quality of pulses severe dehydration
markedly decreased
risk factors for congenital heart disease
maternal rubella during pregnancy maternal alcoholism/drug use maternal age over 40 years family history of congenital heart defects
cardiac problems chest x-ray (cardiac silhouette)
may have abnormal cardiac shape or position, cardiomegaly
cardiac problems ekg
may have abnormal rhythm
leukemia diagnostic tests
CBC with peripheral smear (pancytopenia- anemia, thrombocytopenia, neutropenia) bone marrow aspiration LP to rule out CNS involvement
cancer labs
CBC, CMP, LFTS, coagulation studies, UA, ANC
post cardiac op complications
CHF, dysrhythmias, decreased cardiac output syndrome, decreased peripheral perfusion, pulmonary changes, neurological changes, postperiacardiotomy syndrome
early signs of childhood cancer
Continued, unexplained weight loss Headaches, often with early morning vomiting Increased swelling or persistent pain in bones, joints, back or legs Lump or mass especially in abdomen, neck, chest, pelvis or armpits Development of excessive bruising, bleeding, or rash Constant infections A whitish color behind the pupils Nausea which persists or vomiting without nausea Constant tiredness or noticeable paleness Eye or vision changes which occur suddenly or persist Recurrent or persistent fevers of unknown origin
hypovolemic shock treatment
IV fluid resucitation normal saline lactated ringers to counteracts acidosis- 20mL/kg PRRBs inotropic IV drips
routes of chemotherapy
IV push IVPB intrathecal IM PO
cardiac medications
IVIG, digoxin, ACE inhibitors, ASA, NSAIDS, lasix, spironolactone, antibiotics
cardiac problems chest auscultation
may have murmur pulmonary findings possible with longer time to diagnosis and/or more complicated cardiac presentation
school-age view of death
may personify death as devil, God, ghost, boogeyman etc preoccupation with what happens to dead body because they are so literal
congenital adrenal hyperplasia diagnostics
abnormal levels of ACTH and cortisol 17-hydroxyprogesterone on newborn screen chromosomal analysis to determine sex
Kawasaki disease acute phase signs and symptoms
abrupt onset of high fever, strawberry tongue, reddened and swollen hands, rash appears and lymph nodes enlarged leukocytes, CRP and ESR elevated RBCs decreased mitral valve murmur due to regurgitation gallop rhythm
tears fluid deficit
absent
fats
absorbs A, D, E, K little direct effect on blood sugar delays digestion so carb effect on blood sugar is delayed
immune thrombocytopenia def
acquired hemorrhagic disorder, evolution of antibodies against multiple platelet antigens
exercise in DM
activity increases insulin absorption may need snacks for PE, recess, sports
hypercyanotic spells signs and symptoms
acute arterial oxygen desaturation hypoxia greater resistance to pulmonary blood flow (right to left shunting) most common with TOF
edema treatment
address the cause careful attention to skin care careful monitoring of intake and output
treatment of DKA
admission to PICU cardiac monitor due to electrolyte distrubances IVs containing specific amount of potassium, sodium, and GLUCOSE insulin drip titrated to bring glucose down slowly monitor urine (strict I&O, check for glucose and ketones)
type two diabetes mellitus def
adult, gradual onset, insulin resistant failure to use insulin properly and insulin excreted in varying amounts dx: after 45 yrs, sometimes teens strongly linked to obesity, sedentary lifestyle, and family hx
turner syndrome patho
affects females 45X
klinefelter syndrome patho
affects males XXY
cerebral edema risk factors
age diagnosis severity
Henoch-Scholein Purpura (HSP) def
allergic vasculitis, allergic purpura inflammation of small blood vessels and manifestations observed are influenced b size and distribution of affected vessels
hemophilia diagnostics
amniocentesis, genetic testing of family to identify carriers, history, labs- deficiency of factor VII or IX, prolonged PTT, normal PT, fibrinogen and platelets
distributive shock subtypes
anaphylaxis, toxic, sepsis, neurogenic, endocrine
which clinical manifestation would the nurse expect to find in a client with hypokalemia?
anorexia, leg cramps
treatment of septic shock
antibiotics, fluid resuscitation, ventilatory support, vasopressors high morbidity and mortality even with early treatment
Kawasaki disease treatment
aspirin to decrease inflammation n(also offers anti platelet aggregation) IVIG AVOID STERIODS coronary artery bypass grafting may needed later in life
addisons disease cause
autoimmune idopathic tumor affecting adrenal gland infection of adrenal gland
mannitol side effects
dehydration, fluid and electrolyte imbalances, phlebitis at IV site
H&P leukemia
bleeding tendencies and petechiae overwhelming infection fatigue fever of unknown origin lymphadenopathy hepatospleomegaly
diagnostic testing for DM
blood glucose test random >200 fasting >125 normal blood glucose for child 60-100 hemoglobin A1C R/O alternative causes of hyperglycemia
in which way does a sequestration crisis differ from a painful episode (vasoocclusive crisis) in a child with sickle cell disease?
blood volume decreases and signs of shock appear
hypoglycemia symptoms
blurred vision, extreme tiredness and paleness, hunger, sweating, trembling, headaches, dizziness, mood swings
how does the blood flow through an anatomically correct heart?
body to RA to RV to lungs to LA to LV to body
AML leukemia risk factors
boys=girls higher rates during first year of life
precocious puberty manifestations
breast development enlargement of testes/penis pubic or underarm hair growth spurts body odor menarche acne
iron deficiency anemia prevention
breastmilk or iron-fortified formula x6 months (12 premature) iron supplementation of 1mg/kg/day iron drops to breastfed preterm infants after 2 months of age infants less than 12 months should not be given cows milk
which finding will the nurse identify in most children with symptomatic cardiac malformations?
delayed growth and development
which complication would the nurse prevent by addressing the needs of a hyperventilating client?
carbonic acid deficit
systems affected by cardiac surgery
cardiac, pulmonary, neuro, hematologic, infection risk
non-hogdkins treatment
chemo and radiation removal of tissue mass
the parent of a 10-year-old child with diabetes asks the nurse why home blood glucose monitoring is being recommended. what is the basis for the nurse's explanation?
children have a greater sense of control over the diabetes
surgical interventions for CHD
closed heart procedures open heart procedures staged procedures prepare child and family for procedures
acyanotic obstruction to blood flow from ventricles CHD
coarctation of aorta aortic stenosis pulmonic stenosis
sickle cell anemia diagnosis
cord blod in newborns/ newborn screening hemoglobin electrophoresis genetic testing/ counseling sickle-cell turbidity test
congenital adrenal hyperplasia patho
cortisol deficiency increased ACTH adrenal hyperplasia excess androgens males precocious genital development females may be born with varying degrees of ambiguous genitalia
what is an important nursing responsibility when a dysrhythmia is suspected?
count the apical rate for a full minute and compare with radial rate
why LP avoided in CNS tumor
danger of possible brainstem herniation after sudden release of pressure
urine fluid deficit
dark, small amount
BUN fluid excess
decreased
skin turgor moderate dehydration
decreased
skin turgor severe dehydration
decreased
specific gravity fluid excess
decreased
weight fluid deficit
decreased
hypokalemia causes
decreased K intake (anorexia), shift from extracellular fluid to cells (alkalosis, hypothermia, hyperalimentation due to increased secretion of insulin) increased K excretion (vomiting, diarrhea, bulimia, NG suctioning, hypomagnesemia, meds: glucocorticoids, aminoglycosides, laxatives)
hyponatremia signs and symptoms
decreased LOC, headache, muscle weakness, confusion, seizures if rapid, can be fatal if severe
acquired hypothyroidism symptoms
decreased appetite thinning hair bradycardia depressed reflexes slowed growth fatigue constipation
the nurse is assessing a child with a cardiac history. the child's extremities are Coll with thready pulses, and urinary output is diminished. what do the assessment findings suggest for this child?
decreased contractility
hypocalcemia causes
decreased intake/absorption shift from Ca to an unavailable form increased Ca excretion (steatorrhea or chronic diarrhea)
hypotensive hypovolemic shock signs
decreased level of consciousness, decreased urine output, decreased blood pressure
compensated hypovolemic shock symptoms
decreased pulse strength, pale/mottled color, cool extremities increased heart rate, respiratory effort, and longer cap refill blood pressure is often normal due to compensation DECREASED BLOOD PRESSURE IS A LATE SIGN
eyes of severe dehydration
deeply sunken orbit
hypernatremia causes
dehydration diabetes insipidus (low ADH)
Hopkins lymphoma signs and symptoms
firm, non-tender lymphadenopathy- enlarged, moveable nodes, supraclavicular or cervical area fever of unknown origin night sweats anorexia weight loss
hyperglycemia symptoms
frequent bed wetting, drowsiness, frequent urge to urinate, extreme thirst, dry mouth, stomach pain
risk factors for pediatric cancer
genetic basis for some types chromosome abnormalities environmental carcinogens drug exposure as risk for cancer
hypoglycemia nursing interventions for unconscious patient
glucagon injection, 10-15 min recheck glucose consider transport to ER
skin turgor fluid excess
good turgor
a newborn whose mother has type one diabetes has been receiving a continuous infusion of fluids with glucose. which would the nurse do when there is an order to discontinue the infusion?
gradually decrease the rate
respiratory problems chest x-ray (lung fields)
ground glass appearance, pneumonia, atelectasis, pneumothorax
ARF cause
group A beta hemolytic strep
hemophilia def
group of bleeding disorders resulting from congenital deficiency, dysfunction, or absence of specific coagulation proteins or factors
leukemias def
group of malignant diseases of bone marrow, blood, and lymphatic system
SCA clinical manifestations
growth decreased chronic anemia possible delay in sexual maturation marked susceptibility to sepsis
pituitary hormones
growth hormone thyroid stimulating hormone gonadotropins (LH or FSH) corticotropin hormone
growth hormone treatment
growth hormone replacement
acute tumor lysis syndrome def
happens when a large number of cancer cells are destroyed causes rapid release of intracellular contents during the lysis of the malignant cells most common with ALL, burkitts
maintaining fluid balance conditions with decreased requirements
heart failure increased ICP renal failure
hypovolemic shock signs of improvement
heart rate decreasing to normal range capillary refill more brisk increased color and responsiveness
proteins
helps body build tissues, immunity, and wound healing some will be converted to sugar (if body needs it) stays in blood for 3 hours
iron deficiency anemia diagnostics
hemoglobin, morphologic changes in RBC, iron concentration, total binding capacity, ferritin/CRP, MVC, reticulocyte count, stool analysis
causes of hypovolemic shock
hemorrhage, plasma loss, fluid/electrolyte loss
IE treatment
high dose antibiotics for 2-8weeks
hypertonic IV fluids
higher osmolality than blood 1.5%, 3%, or 5% NaCl D5NS D5LR
nursing assessment dehydration
history, clinical observations, intake and output measurements
rapid replacement of fluid is essential in the treatment of what types of dehydration
hypotonic, isotonic
growth hormone deficiency causes
idiopathic CNS infection/disease infarction of pituitary gland tumors of pituitary or hypothalamus brain trauma chemotherapy
hypoglycemia nursing interventions for conscious patients
immediate intake of simple sugars (milk, juice, two glucose tablets) 15 min later recheck sugars <70 repeat simple sugars >80 more substantial snack honey or icing under tongue if unable to eat or drink
CHF treatment
improve cardiac function (digoxin) remove fluid (diuretics) improve oxygenation and tissue perfusion measure intake/output elevate HOB scheduled weights
congestive heart failure def
inability of the heart to pump an adequate amount of blood to meet the demands of the body symptom of an underlying defect
circulatory failure def
inadequate tissue perfusion results in ischemia and the tissue death
phenylketonuria (PKU) patho
inborn error of metabolism autosomal recessive deficiency of the liver enzyme phenylalanine hydroxylase if untreated can lead to irreversible brain damage, seizures, and death
hypocalcemia treatment
increase intake, IV Ca if severe
heart rate moderate dehydration
increased
heart rate severe dehydration
increased
specific gravity fluid deficit
increased
weight fluid excess
increased
compensated septic shock symptoms
increased HR, RR, temp, brisk cap refill, increased cardiac output, perfusion appears adequate decreased mental status: irritable, lack of interaction with parent decreased systemic venous resistance- pooling in extremities
mannitol indicatins
increased ICP, oliguric renal failure, edema, intraocular pressure
hypercalcemia causes
increased calcium intake or absorption (milk and antacids or TPN) shift from bones to extracellular fluid (hyperparathyroidism, immobilization, leukemia) decreased calcium excretion (thiazide diuretics)
hypocalcemia signs and symptoms
increased muscular excitability, twitching, cramping, spasms, tingling in mouth or fingers
hyper cyanotic spells def
increased oxygen demand with limited or reduced pulmonary blood flow
hyperkalemia causes
increased potassium intake decreased potassium excretion watch for false positives with heel stick labs shift from intracellular to extracellular fluid metabolic acidosis caused by diarrhea or diabetes mellitus
which symptoms would the nurse expect in a 3-year-old child with mild iron-deficiency anemia and fatigue
increased pulse rate
Down syndrome prognosis
increased risk for health conditions- cardiac, oncology, musculoskeletal visual, endocrine
mannitol actions
inhibits reabsorption of water and electrolytes in the nephron which decreases osmotic pressure
diabetes education should include
insulin administration nutriton illness exercise blood glucose monitoring signs and symptoms of hypoglycemia and hyperglycemia treatment coping and support
potassium
intracellular normal levels 3.5-5.0 mmol/L enzyme performance contractility of muscles
hypernatremia treatment
isotonic fluids
hyponatremia treatment
isotonic or hypertonic fluids (caution)
type one diabetes mellitus def
juvenile, sudden on-set, insulin dependent, destruction of pancreatic beta cells= insulin deficiency dx: 4-6 yrs and 10-14 yrs immune-mediated or idiopathic
klinfelter syndrome diagnosis
karyotype analysis, low testosterone levels
turners syndrome diagnosis
karyotype analysis, presence of signs and symptoms, often delayed until adolescence
DKA signs and symptoms
ketonuria, fruity breath, ketoacidosis, history of weight loss, younger children often diagnosed earlier, confusion, changes in LOC, cerebral edema, hyperglycemia, dehydration, metabolic acidosis, kussmaul breathing, fluctuating potassium levels, polyuria, polydipsia, polyphasic
respiratory acidosis compensation
kidneys excrete H+ and retain bicarb
stem cell transplant
kill original bone marrow transplant with donor marrow at risk for GVHD at risk for infection may cause change of blood type
reed-stern berg cells
large, abnormal lymphocytes that may contain more than one nucleus found in Hodgkin lymphoma
hypothyroidism treatment
levothyroxine for life dose adjusted as child grows check apical pulse and blood pressure prior to administration
infant and toddler view of death
likely no concept egocentrism and inability fact and fantasy
prevention of childhood obesity
limit consumption of sugar-sweetened beverages consume recommended quantities of fruits and vegetables limit screen time to no more than 2 hours per day remove television and computer screens from primary sleeping areas eat breakfast daily limiting eating at restaurants have frequent family meals in which parents and youth eat together limit portion sizes
hypotensive septic shock signs
longer cap refill progressive mental status changes extremities mottled and cool decreased HR, BP, and UOP may have fever start of multiple organ failure
SCA nursing care
minimizing tissue oxygenation (take frequent breaks during physical activity, avoid contact sports, avoid low oxygen environments, avoid sources of infection) promote hydration promote supportive therapies given ordered medications to treat treat infection control pain `
eye fluid excess
moist
growth hormone nursing care
monitor and plot growth on chart teach how to give injections reassure/counsel age-appropriate activities
nursing implications for congential heart defects
monitor feeds, assessment changes, HR, BP, spO2, pain, signs and symptoms daily or BID weights strict I&O cluster cares medications LOTS of family and patient education
post cardiac op care
monitor vital signs and arterial/venous pressures intra-arterial monitoring of BP intra-cardiac monitoring respiratory needs rest, comfort, pain management fluid management STRICT I&O progression of activity chest tubes
non-hodgkin lymphoma def
more common than Hodgkin 15-19 years old less predictable than Hodgkin
osteogenic sarcoma def
most common bone cancer peak-10 to 25 years tumors ion long bones, especially lower extremities
trisomy 21 (Down syndrome) patho
most common chromosomal abnormality a generalized syndrome
acute lymphoblastic leukemia (ALL) risk factors
most common form of childhood cancer boys more than girls whites more than African americans peak age 2-3 years
growth hormone replacement (somatotropin) nursing considerations
most effective with PM dosing can cause Legg-Calve-Perthes stop course of treatment when acceptable height/closure of epiphyseal plates
PKU symptoms
mousy or musty body odor irritability vomiting hypertonia eczema-like rash seizures intellectual disability
Kawasaki disease def
mucocutaneous lymph node syndrome usually <5 years old acte systemic vasculitis, aneurysms and clot formation
hyperkalemia signs and symptoms
muscular dysfunction manage underlying condition
respiratory acidosis muscles
muscular dystrophy, pneumothorax
hypokalemia signs and symptoms
muscular weakness constipation to paralytic ileum weakness to flaccid paralysis, cardiac arrhythmias polyuria due to kidney changes potassium replacement dietary changes can lead to digitalis toxicity
hypothyroidism diagnosis
newborn screening T3, T4, and TSH levels thyroid scan or ultrasound bone age x-ray
PKU diagnosis
newborn screening, must be at least 48 hours old and have ingested milk
cardiac problems response to 100% O2
no difference or minimal change
increased pulmonary blood flow acyanotic def
no mixing of desaturated blood in the systemic arterial circulation left to right shunting of blood
dehydration late signs
no tears pallor cool, pale skin severe electrolyte imbalances shock (increased HR, decreased BP) lethargy coma
HSP characteristics
nonthrombocytopenic purpura, arthritis, nephritis, abdominal pain
bp in moderate dehydration
normal
eyes of mild dehydration
normal
fontanelle mild dehydration
normal
heart rate mild dehydration
normal
quality of pulses mild dehydration
normal
skin turgor mild dehydration
normal
growth hormone deficiency symptoms
normal birth weight and length height below third percentile overweight youthful facial features delayed dentition, sexual and skeletal development undescended testes with micro penis
respiratory problems chest x-ray (cardiac silhouette)
normal cardiac profile
cardiac problems pCO2
normal or low
bp in severe dehydration
normal to reduced
quality of pulses moderate dehydration
normal to slightly decreased
cardiac problems chest x-ray (lung fields)
normal, decreased vascularity, may have pulmonary vascular congestion
intermediate acting (NPH) insulin
novolin N, humulin N reaches blood in 2-6 hours peaks in 4-14 hours lasts 14-20 hours
counting carbs
number of carbs determines how many units of insulin 10-15 g of carbs =1 U of insulin round to nearest whole number on insulin
postmortem care
nurse offered family to bathe and dress the body final separation from the body is emotional and traumatic time support, follow-up, advise on siblings
SCA patho
obstruction caused by sickled RBCS vascular inflammation increased RBC destruction
water intoxication
occurs less frequently than dehydration may occur after ingestion of large amounts of fluid decrease in serum sodium leads to CNS symptoms
nursing action dehydration
oral fluid intake, parental fluid therapy, preparing the child and parents, securing a PIV line
SCA vasocclusive criss
pain in areas of evolvement can be pain of hands, feet, joints, abdomen stroke, visual disturbances, chest resembling pneumonia, obstructive jaundice, hepatic coma, hematuria, genital pripraism
chemo nursing interventions
pain management pharm management decrease anxiety IV hydration nutriton developmental care family care
non-hogdkins symptoms
painless, swollen lymph nodes fever fatigue weight loss
urine fluid excess
pale yellow, larger amount
leukemia early signs and symptoms
pale, listless, irritable, febrile, anorexia, weight loss, petechia, bruising with no cause, continued complaints of bone and joint pain
toxic/septic shock
pathogen induced overstimulation of immune system hyperthermia, rash, hypotension, vasodilation, increased capillary permeability, multisystem failure
how do you tell the difference between Hodgkin and non-hodgkin lymphoma?
pathology
growth hormone replacement (somatotropin) indication
pediatric patients with growth failure due to inadequate secretion of endogenous GH
immune thrombocytopenia symptoms
petechaie, bruising, bleeding from mucous membranes, prolonged bleeding from abrasions
hypercyanotic spell treatment
place in knee chest position calm/comfort child 100% O2 - hypoxia will not improve with only the administration of O2, the circulatory pathway must allow blood to reenter the pulmonary circulation morphine sulfate fluid replacement if dehydrated
discharge and home care of CHD
planning begins at admission equipment needs medications nutrition activity restrictions wound care pain complications
Kawasaki subacute phase symptoms
platelet count elevates leading to change of clot formation aneurysms most dangerous phase bc of change to rupture aneurysm or MI resolution of the fever and lasts until all signs are gone
hypothyroidism nursing care
plotting growth monitor for continued signs of hypothyroidism (weight gain, sluggish, cold, hair loss) educate parents
SCA sequestrain crisis
pooling of large amounts of blood hepatomegaly, splenomegaly, circulatory collapse
precocious puberty diagnostics
presence of signs and symptoms
tears fluid excess
present
chemotherapy
primary form of treatment interferes with cells ability to grow and reproduce used alone or in combination with other treatments
which factor is likely a cause of hyponatremia?
profuse diaphoresis, rapid IV infusion of D5W
hemophilia patho
prolonged bleeding, bleeding into tissue, hemarthrosis (bleeding in joint cavities), bleed longer but not at a faster rate
which intervention would the nurse implement for a four month old infant with tetralogy of fallout and heart failure?
providing small, frequent feedings
turners syndrome nursing interventions
psychological support growth hormone education monitor height and weight speak to child according to chronological age monitor for psychological issues
myelosuppression neutropenic fever golden hour nursing actions
put on EMLA.LMX, go to ED, access port, draw labs and cultures, start antibiotics
Hodgkins lymphoma treatment
radiation, chemotherapy, can be in combination
respiratory problems chest auscultation
rales, crackles, wheezing
the school nurse is discussing prevention of AIDS with adolescents. what is appropriate to include?
recreational drug users should not share needles or other equipment
congenital adrenal hyperplasia nursing considerations
referral to genetics provide support to family. help parents learn how to explain the condition teach parents medications and treatment during times of physical stress encourage use of support groups/counseling
cardiac problems respiration
relatively comfortable at rest
neuroblastoma def
silent tumor arise from adrenal gland or in the neck, chest, or spinal cord firm, non-tender mass in abdomen that crosses midline
isotonic solutions
similar osmolarity to blood 0.9% NaCl (normal saline) LR D5W
what statement best describes hypopituitarism?
skeletal proportions are normal for age
ARF symptoms
skin rash, new murmur, 2+ joints inflamed, chorea
mucous membrane mild dehydration
slightly dry
cerebral edema treatment
slow fluids, give mannitol
retinoblastoma def
sporadic or genetic intraocular tumor leukocoria, strabismus, blindess is a late sign
early signs of hemarthrosis
stiffness, tingling, or ache
growth hormone function
stimulates linear growth builds muscle mass increases bone mineralization regulates glucose secretion in the liver
growth hormone replacement (somatotropin) effects
stimulates the liver and other tissues to secrete IGF-I IGF-I stimulates that proliferation of chondrocytes (cartilage cells), resulting in bone growth
for which condition is antibiotic prophylaxis prescribed for a 2-year-old child with a cardiac malformation who is awaiting corrective surgery?
subacute bacterial endocarditis
growth hormone replacement (somatotropin) route
subq six or seven daily, weight-based injections
fontanel fluid deficit
sunken
fontanelle moderate dehydration
sunken
fontanelle severe dehydration
sunken
eyes of moderate dehydration
sunken orbits
immune thrombocytopenia treatment
supportive, activity restrictions, prednisone, IVIG, anti-d antibody, splenectomy if no response to meds and chronic
HSP treatment
supportive- NSAIDs, corticosteriods, fluid and electrolyte balance,
cancer treatments
surgery chemotherapy steroids radiation biologic therapy stem cell transplant immunotherapy
neuroblastoma treatment
surgery to remove the affected kidney or tumor chemo radiation
CNS treatment
surgery, radiation, chemotherapy
HSP clinical manifestations
systemic purpura (buttocks and lower extremities), rash, edema, arthritis, abdominal pain, nausea, renal involvement
the nurse is assessing an infant brought to the clinic with diarrhea. he is lethargic and has dry mucous membranes. what would the nurse recognize as an early sign of dehydration?
tachycardia
respiratory problems respiration
tachypnea, distress, retractions
symptoms of CHF pulmonary congestion
tachypnea, dyspnea, retractions, orthopnea, cough, wheezing, cyanosis
iron deficiency anemia education
take supplements 2-3 months after normal labs iron can turn stools tarry green or black liquid iron can stain teeth-use straw do not keep more than one month supply in home meal planning
klinefelter syndrome symptoms
taller, more female like body small penis and testes delayed or lack of puberty developmental delays shy, sensitive, docile personalities infertile
klinefelter syndrome treatment
testosterone replacement breast tissue removal
cyanotic decreased pulmonary blood flow CHD
tetralogy of fallot tricuspid atresia
a child with type 2 diabetes is scheduled for abdominal surgery. which factors are most important for the nurse to consider during the postoperative period?
the blood glucose level will increase because of the stress of the surgery, diabetic control is usually maintained with insulin after surgery
what best describes a neuroblastoma?
the diagnosis is usually made after metastasis occurs
leukemia patho
unrestricted proliferation of immature WBC not a tumor
respiratory problems pCO2
usually increase
respiratory problems ekg
usually normal
respiratory problems response to 100% O2
usually profound
myelosuppression
usually within 7-10 days after drug given Nadir: lowest blood count anemia NEUTROPENIC FEVER IS AN EMERGENCY
cerebral edema patho
vasogenic edema osmotic edema secondary to fluid therapy
CHF evaluation
vitals within normal limits weight loss intake/output activity level nutritional requirements meeting developmental milestones
obvious signs of hemarthrosis
warmth, redness, severe pain, loss of movement
addisons disease signs and symptoms
weakness, fatigue, dizziness, syncope, increased skin pigment, black freckles and hyperpigmentation, weight loss, dehydration, anorexia, hypotension, irritability, listlessness
symptoms of CHF systemic venous congestion
weight gain, hepatomegaly, peripheral edema, neck vein distention
a parent asks the nurse, "the doctor said my baby has something called pulmonic stenosis. what does that mean?" which response by the nurse is best?
what else did the doctor say?
respiratory acidosis patho
when breathing is inadequate CO2 accumulates CO2 increases pH decreases
metabolic acidosis patho
when normal metabolism is impaired, acid form pH decreases
cardiac problems cyanosis
worsens with crying
which factor would a nurse identify as precipitating hyponatremia?
wound drainage, diuretic therapy, GI suction, inappropriate ADH secretion
growth hormone deficiency diagnostics
x rays of hand or wrist evaluation bone ossification growth hormone testing
IE diagnostics
x-ray blood culture echo
