Peds final

Tretalogy of Fallot

4 defects- Vsd, pulmonary stenosis, overriding aorta and hypertrophy.

aplastic crisis

A condition in which the body stops producing red blood cells; typically caused by infection. tx-rbc transfusions

congenital adrenal hyperplasia

A form of intersexualism in which a genetic female has internal female sexual structures but masculinized external genitals. An ambiguous genitalia. Salt wasting can lead to seizures.

Osgood-Schlatter disease.

An active 13-year-old boy has anterior knee pain. he major component of treatment for Osgood-Schlatter disease is activity restriction for 6 weeks or more

The nurse is caring for a child with a diagnosis of hemophilia, and hemarthrosis is suspected because the child is complaining of pain in the joints. Which measure should the nurse expect to be prescribed for the child?

Application of a bivalved cast for joint immobilization In an acute period, immobilization of the joint would be prescribed. Range-of-motion exercise during the acute period can increase the bleeding and would be avoided at this time. Heat will increase blood flow to the area, so it would promote increased bleeding to the area. Nonsteroidal anti-inflammatory drugs (NSAIDs) can prolong bleeding time and would not be prescribed for the child.

Oral iron is prescribed for a child with iron deficiency anemia. The nurse provides instructions to the mother regarding the administration of the iron. The nurse should instruct the mother to administer the medication in which way?

Between meals

The nurse is caring for a client diagnosed with a hydrocephalus. Which should the nurse anticipate as being the cause of this disorder?

Closure of cranial sutures The closure of cranial sutures during childhood prevents expansion of the cranial vault when hydrocephalus occurs in the adult. This leads to increased neurological changes with lesser degrees of hydrocephalus compared with hydrocephalus during early childhood. The other structures identified in the remaining options are associated with cerebrospinal fluid formation and circulation but are not responsible for hydrocephalus.

A 12-year-old child with newly diagnosed thalassemia is brought to the clinic exhibiting delayed sexual maturation, fatigue, anorexia, pallor, and complaints of headache. The child seems listless and small for age and has frontal bossing. What should the nurse expect to note on review of the results of the laboratory tests?

Deficient production of functional hemoglobin Rationale: Defective hemoglobin is produced as a result of genetically deficient beta-polypeptide. This hemoglobin is unstable, disintegrates, and damages the erythrocytes. Rapid destruction of the red cells stimulates rapid production of immature red cells, and the net gain is less than optimally functioning red cells. Iron from the red blood cell destruction is stored in the tissues, causing multiple problems. In thalassemia, immature erythrocytes proliferate, not mature ones. This is a progressive anemia. The nurse also would note microcytosis and hypochromia.

Hypopituitarism

GH deficiency. Causing poor growth and short stature or hypoglycemia. Causes: Brain tumor, brain injury, surgery. TX: SQ injections replacement therapy/

lysosomal disorders

Heritable lysosomal storage diseases Caused by defects in genes encoding one or more of the lysosomal enzymes. Harmful accumulation of polysaccharides or lipids

Tinea corporis (ringworm)

I. Pathophysiology A.Fungal Infection 2. Exposure to infected animals or people tx- lotrimin

The nurse is preparing a plan of care for a child with sickle cell crisis who will be admitted to the nursing unit. The nurse should include which intervention as a priority in the plan of care for the child?

Initiate an intravenous (IV) line for the administration of fluids. The priorities in management of sickle cell crisis are hydration therapy and pain relief. To achieve this, the child is given IV fluids to promote hydration and reverse the agglutination of sickled cells in small blood vessels. Opioid analgesics may be given to relieve the pain that accompanies the crisis. Genetic counseling is recommended but not during the acute phase of illness. Red blood cell transfusion may be done in selected circumstances such as aplastic crisis or when the episode is refractive to other therapy. Oxygen would be administered according to individual need, but the client would not require intubation and mechanical ventilation.

pituitary gland

It is the master gland. Under the influence of the hypothalamus, the pituitary regulates growth and controls other endocrine glands. GH, ACTH,TSH, ovaries and testes.

The nurse is caring for a child who was burned in a house fire. The nurse develops a plan of care for monitoring the child during the treatment for burn shock. The nurse identifies which assessment as providing the most accurate guide to determine the adequacy of fluid resuscitation?

Level of consciousness

Prostaglandin E1 is prescribed for a child with transposition of the great arteries. The mother of the child is a registered nurse and asks the nurse why the child needs the medication. What is the most appropriate response to the mother about the action of the medication?

Maintains adequate cardiac output

A child undergoes surgical removal of a brain tumor. During the postoperative period, the nurse notes that the child is restless, the pulse rate is elevated, and the blood pressure has decreased significantly from the baseline value. The nurse suspects that the child is in shock. Which is the most appropriate nursing action?

Notify the primary health care provider (PHCP). In the event of shock, the PHCP is notified immediately before the nurse changes the child's position or increases intravenous fluids. After craniotomy, a child is never placed in the supine or Trendelenburg's position because it increases intracranial pressure (ICP) and the risk of bleeding. The head of the bed should be elevated. Increasing intravenous fluids can cause an increase in ICP.

iron-deficiency anemia manifestations

Pale, tired, irritable Tachycardia, muscle weakness, systolic heart murmur Growth retardation, mentally delayed Deformed nail beds

The nurse analyzes the laboratory results of a child with hemophilia. The nurse understands that which result will most likely be abnormal in this child?

Partial thromboplastin time

A 12-year-old girl is admitted to the hospital with suspected appendicitis. What nursing interventions should be implemented preoperatively?

Placing the adolescent in a fetal position, side-lying with legs drawn up to chest

The emergency department nurse is caring for a child with suspected epiglottitis and has ensured that the child has a patent airway. Which action is the next priority in the care of this child?

Prepare the child for a chest radiograph.

The nurse is assisting the pediatrician in performing an assessment on a newborn suspected of having imperforate anus. Which finding would be noted in this disorder?

Presence of an anal membrane

A child is brought to the emergency department after being accidentally struck in the lower back region with a baseball bat. When gathering assessment data, the nurse discovers that the child has hemophilia. The nurse should immediately assess for which data?

Presence of hematuria

Tx for metabolic disorders

Prevent progression if possible Alter nutrition Large doses vitamins Removal of toxic substances (eg. Dialysis) Drug therapy

thyroid gland

Produces hormones that regulate metabolism, body heat, and bone growth. Produces Thyroxin, T3 AND T4.

The clinic nurse is obtaining data about a child with a diagnosis of lactose intolerance. Which data should the nurse expect to obtain on assessment?

Reports of frothy stools and diarrhea

A child in whom sickle cell anemia is suspected is seen in a clinic, and laboratory studies are performed. The nurse checks the laboratory results, knowing that which value would be increased in this disease?

Reticulocyte count Rationale: Sickle cell anemia is a group of diseases termed hemoglobinopathies, in which hemoglobin A is partly or completely replaced by abnormal sickle hemoglobin S. It is caused by the inheritance of a gene for a structurally abnormal portion of the hemoglobin chain. Hemoglobin S is sensitive to changes in the oxygen content of the red blood cell. Insufficient oxygen causes the cells to assume a sickle shape, and the cells become rigid and clumped together, obstructing capillary blood flow. A diagnosis is established on the basis of a complete blood count, examination for sickled red blood cells in the peripheral smear, and hemoglobin electrophoresis. Laboratory studies will show decreased hemoglobin level and hematocrit, a decreased platelet count, an increased reticulocyte count, and the presence of nucleated red blood cells. Reticulocyte counts are increased in children with sickle cell disease because the life span of their sickled red blood cells is shortened.

The nurse is caring for a newborn infant after surgical intervention for imperforate anus. The nurse should place the infant in which position in the postoperative period?

Side-lying with the legs flexed

ACTH (adrenocorticotropic hormone)

Stimulates adrenal cortex to release glucocorticoids (cortisol)

pyloric stenosis tx

Surgery (pyloromyotomy)

compartment syndrome

Swelling in a confined space that produces dangerous pressure; may cut off blood flow or damage sensitive tissue. Serious emergency. -elevate leg above child's heart -loosen or split cast -call physician

An emergency department nurse is caring for a conscious child who was brought to the emergency department after the ingestion of half a bottle of acetylsalicylic acid (aspirin). The nurse anticipates that which will be the initialtreatment?

The administration of an emetic.

A child with croup is being discharged from the hospital. The nurse provides instructions to the mother and advises the mother to bring the child to the emergency department if which occurs?

The child develops stridor. The mother should be instructed to bring the child to the emergency department if the child develops stridor at rest, cyanosis, severe agitation or fatigue, or moderate to severe retractions or is unable to take oral fluids.

Hypothyroidism S/S

Under-active thyroid gland (t4). Babies- large tongue and fontanel tired, Iodine deficiency Cold intolerant obese Tx-levothyroxine (synthroid)

precocious puberty

a condition in which puberty begins before the age of 7- 8 in girls and 9 in boys.

The appropriate position following surgical intervention for an imperforate anus

a side-lying position with the legs flexed or a prone position to keep the hips elevated.

VSD (ventricular septal defect)

a small/large opening between the ventricles. Can fell a thrill. Common in Down syndrome.

hyperthyroidism/ grave's disease

abnormally high secretion of thyroid hormones. Expothalmos (bulging eyes). Weight loss. Heat intolerance. Anxiety s/s. Thyroid storm. Temp can get high. tx: Antithyroid drugs and radioactive iodine PO- 10yrs or older.

Phenylketonuria (PKU)

an inherited disorder of protein metabolism in which the absence of an enzyme leads to a toxic buildup of phenylalanine (amino acid) , causing intellectual disability.

diabetes insipidus

antidiuretic hormone is not secreted adequately, or the kidney is resistant to its effect. Large amount of urine that looks like water.

Chelation therapy is begun on a child with -thalassemia major. The purpose of this therapy is to: a. treat the disease. b. eliminate excess iron. c. decrease risk of hypoxia. d. manage nausea and vomiting.

b. drug deferoxamine drug is continued when iron levels are back to normal.

splenic sequestration sickle cell crisis

blood pooling in the spleen, causing splenic enlargement life threatening- shock 6months-4years tx-blood transfusions spelenectomy in severe cases

aplastic anemia

characterized by an absence of all formed blood elements caused by the failure of blood cell production in the bone marrow. petechiae, pallor etc

Common foods that are especially well tolerated during diarrhea

complex carbohydrates (rice, wheat, potatoes, cereals), yogurt containing live cultures, cooked vegetables, and lean meats.

Decerebrate posturing

extensor posturing arms are stiffly extended and held

A child who has a history of cleft palate should be routinely checked for

hearing loss

Newborn metabolic problems signs

hypotonia, lethargy, dysmorphic features § Feeding intolerance/poor suck, weight loss, electrolyte issues, resp distress, V & D, seizures

risk for tumor lysis syndrome (TLS).

kidney failure, the tumor's intracellular contents are dumped into the child's extracellular fluid as the tumor cells are lysed in response to chemotherapy. Because of the large volume of these cells, their intracellular electrolytes overload the kidneys and, if not monitored, can cause kidney failure.

Hypotonia

loss of muscular tone or a diminished resistance to passive stretching

coarctation of the aorta

narrowing of the descending portion of the aorta, resulting in a limited flow of blood to the lower part of the body. Bp higher in upper extremities.

Infants younger than 12 months need

need iron-fortified formula or breast milk.

A 3-year-old child is seen in the health care clinic, and a diagnosis of encopresis is made. The nurse expects to provide teaching about which client problem?

odor Encopresis is the repeated voluntary or involuntary passage of feces of normal or near-normal consistency in places not appropriate for that purpose according to the individual's own sociocultural setting. Signs include evidence of soiled clothing, scratching or rubbing the anal area because of irritation, fecal odor without apparent awareness by the child, and social withdrawal.

Galactosemia

recessive genetic disorder; characterized by body's inability to tolerate galactose. Avoid galactose.

Tet spells

results from a transient increase in resistance to blood flow to the lungs with increased preferential flow of desaturated blood to the body. Tet spells are characterized by a sudden, marked increase in cyanosis followed by syncope, and may result in hypoxic brain injury and death. Older children will often squat during a tet spell, which increases systemic vascular resistance and allows for a temporary reversal of the shunt.

Dactylitis

swelling of the fingers and/or toes in 6months to 4 years.

The nurse is collecting data on a 12-month-old child with iron deficiency anemia. Which finding should the nurse expect to note in this child?

tachycardia

Periosteum of children

thicker and stronger than adults, likely to get more displaced - fractures

Buck's extension

traction is a type of skin traction in which the legs are in an extended position. It is used primarily for short-term immobilization, such as in preoperative management of a child with a dislocated hip.

Leukocytes

white blood cells

Addison syndrome

↓cortisol/↓aldosterone → low stress response, hypoglycemia, low bp, hyperpigmentation, weight loss; Can lead to kidney failure or shock.

A mother brings her 5-week-old infant to the health care clinic and tells the nurse that the child has been vomiting after meals. The mother reports that the vomiting is becoming more frequent and forceful. The nurse suspects pyloric stenosis and asks the mother which assessment question to elicit data specific to this condition?

"Does the vomit contain sour, undigested food without bile, and is the infant constipated?" Vomiting undigested food that is not bile stained and constipation are classic symptoms of pyloric stenosis. Stools that are ribbon-like and a child who is eating poorly are signs of congenital megacolon (Hirschsprung's disease). An infant who suddenly becomes pale, cries out, and draws the legs up to the chest is demonstrating physical signs of intussusception. Crying during the evening hours, appearing to be in pain, eating well, and gaining weight are clinical manifestations of colic.

intussusception, and the mother of the child asks the student nurse to describe the disorder. Which statement by the student nurse indicates correct understanding of this disorder?

"It is a condition in which a proximal segment of the bowel prolapses into a distal segment of the bowel."

Glycosurea

- Sugar in the Urine - You need a lot of water to get rid of it - You are often dehydrated

DKA lab findings

- pH ↓ 7.2 - BS ↑ 250 - Ketosis, Ketonuria - ↑ BUN, Creatinine, Osmolarity (FVD) - ↓ Bicarb levels -High CO2

Decorticate posturing

-"flexor posturing" or "mummy baby" (think Egyptian mummy preservation) -adduction of arms (arms fold to chest); flexion of elbows and wrists

The nurse is preparing to perform an assessment on a child being admitted to the hospital with a diagnosis of sickle cell crisis, vaso-occlusive crisis. Which findings should the nurse expect to note on assessment of the child? Select all that apply. 1. Pallor 2.Fever 3.Joint swelling 4.Blurred vision 5.Abdominal pain

1,2,3,5. Sickle cell crises are acute exacerbations of the disease. Vaso-occlusive crisis is caused by stasis of blood with clumping of cells in the microcirculation, ischemia, and infarction. Manifestations include pallor; fever; painful swelling of hands, feet, and joints; and abdominal pain. Blurred vision is not a manifestation of vaso-occlusive crisis.

Tx of DKA

1. Restore volume : NS 20cc/kg 0.9% saline (NS) (2 large bore IVS) then antibiotics if its caused by infection. 2. Correct hyperglycemia, acidios, and ketones: IV regular insulin. Maintain BS 150-250 3. Correct electrolytes: K+ correction