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