Peds unit 2 (cardio,hematology,cancer, communicable diseases)
Anemia
A reduction in the number of RBCs, the quantity of hemoglobin, and the volume of packed red cells to below-normal levels Can be caused by loss or destruction of existing RBCs, or by impaired or decreased rates of red cell production Can also be a clinical manifestation of an underlying disorder
A child is admitted for an allergenic bone marrow transplant. The nurse is aware that the donor marrow is coming from which source?
A sibling
Nursing planning for immunizations
Advocate for Inform if possible side effects Provide written and verbal information Obtain consent
What should you do for a child with von Willebrand disease who has a nose bleed?
Apply pressure to the nose for at least 10 minutes
Rheumatic fever
Carditis caused by group A beta-hemolytic strep
Describe ITP
Causes excessive destruction of platelets Children will have normal bone marrow Petechiae are common
Pertussis
Causes nasal discharge and fever Causes Wheezy breathing and occasional vomiting Symptoms commonly worse at night Droplet precautions Bacterial infection, use antibiotics Hallmark symptom is a long whooping sounding cough Transmission by respiratory droplets/direct contact with secretions Treated with antibiotics, steroids, and supportive care Infectious period 6weeks or longer Incubation period 7-10 days
Which are the common causes of acquired aplastic anemia?
Certain anticonvulsant medications Certain chemotherapeutic agents Idiopathic causes
The parents of an 18 month old bring him to the emergency department with the complaint that the toddler scratches his bottom. What should the nurse recommend?
Check his stool for worms Perform the tape test tonight
What should the nurse tell the parent of a child who has neuroblastoma?
Chemotherapy and radiation may be necessary for treatment Your child will need a bone marrow biopsy Your child we need surgery for resection of the tumor
Exposure to which illness should be a cause to discontinue therapy and substitute dipyridamole (persantine) in a child receiving aspirin therapy for KD?
Chickenpox or influenza
Severe anemia leads to
Chronic hypoxia
The nurse informs the parent of a child with beta thalassemia (Cooley anemia) is at risk for
Chronic hypoxia and iron overload
Most prevalent infections in middle childhood
Ectoparasites (lice) Foodborne illnesses Upper respiratory infections Pharyngitis (strep)
A three month old has been diagnosed with a VSD. The flow of blood through the heart is...
Left to right
PDA causes what type of shunt
Left to right
During a well- child check up for an infant with TOF, the child develops severe respiratory distress and becomes cyanotic. The nurses first action should be to.
Hold the child in the knee-chest position to decrease venous blood return
A child has aortic stenosis. Which manifestation does the nurse assess for? Aortic aneurysm Left ventricular failure Right ventricular atrophy Tricuspid regurgitation
Left ventricular failure
The following can be manifestation of leukemia in a child?
Leg pain Fever Bruising Enlarged lymph nodes
In fetal circulation, Oxygenated blood is diverted away from these
Lungs Liver
A nurse is caring for a five-year-old with sickle cell vaso-occlusive crisis. She should question the following orders.
Meperidine (Demerol) 25 mg IV q4 hours PRN pain Restrict oral fluids Apply oxygen per nasal cannula to keep oxygen saturations above 94%
Three types of oncologic emergencies
Metabolic Hematologic Space occupying lesions
Thalassemia major (Cooley anemia)
Most severe form Pallor Fatigue Weakness Poor feeding Failure to thrive Delayed growth and development
Impact of a chronic condition on a child/adolescent
Physical development Achieving developmental milestones Psychological development The earlier we intervene, the better the outcome
School-age child is diagnosed with hemarthrosis after tripping and falling. Which diagnostic testing is a priority for this child?
Plasma factor activity
The nurse is instructing the parent of a child with HIV about immunizations. What should the nurse tell the parent
Pneumococcal and influenza vaccines are recommended Meningitis immunization can be administered on the regular schedule Hepatitis B vaccine is administered according to the immunization schedule Varicella vaccine is avoided in the child who is HIV infected, not in other family members.
Which of the following is the most common opportunistic infection in children infected with HIV
Pneumocystic pneumonia
Hypoxic spells in the infant with the HD can cause
Polycythemia Blood clots CVA Developmental delays Brain damage
Which finding might delay a cardiac catheterization procedure on a one year old?
Severe diaper rash
Most prevalent infections in adolescence
Sexually transmitted infections Mononucleosis
A nurse is caring for a 15-year-old. He's just been diagnosed with non-Hodgkin lymphoma. The following should be included in teaching the parents about this lymphoma.
The malignancy originates in the lymphoid system Mediastinal involvement is typical The disease is diffuse, rather than nodular Treatment includes chemotherapy and radiation
Hair loss usually begins
Within 10 days of induction of chemo
Radiation therapy
use of ionizing radiation to break apart bonds within a cell causing cell damage and death External beam therapy accounts for the majority of treatments in children Used for local and regional control of cancer, often in combination with surgery and chemotherapy Problems: radiation beams cannot distinguish between malignant cells and healthy cells It Is harsh on the skin
Lymphomas
The third most common type of childhood cancer -Hodgkin lymphoma -Non-Hodgkin lymphoma
VSD
There is an increase in pulmonary blood flow as a result of the blood shunting from the left to the right ventricle
Caring for terminally ill or dying child
Tissue/organ donation Autopsy Post Mortem care
The nurse is caring for a child with sickle cell disease, who is scheduled to have a splenectomy. The nurse should tell the parents the reason for the splenectomy is
To prevent splenic sequestration
When working with terminally ill children, the nurse knows that in which age group perceptions of death are intertwined with fantasy?
Toddlers
Tetanus
Transmission via wounds in the skin Systemic manifestations: neck or jaw stiffness, facial spasms, prolonged muscle contraction Treatment: tetanus IG, Respiratory monitoring and ventilation Nursing: wound care, monitor respiratory status, hydration
Rocky mountain spotted fever
Transmitted by infected tick May be mild (malaise, fever) to severe(encephalitis, shock) Maculopapular rash (extremities, then trunk) Treatment: doxycycline Nursing: prevent tick bites , standard precautions, administer antibiotics, monitor for worsening symptoms
The parents of a five-year-old child with ALL are told their child is in remission and they want to stop chemotherapy. Which response by the nurse is most appropriate? A yes, we usually stop chemotherapy as soon as remission is achieved B there is no scientific evidence that favors continuing or stopping treatment C if treatment is discontinued, most children have a relapse within a short time D of course, the decision about treatment is entirely up to you as parents
If treatment is discontinued, most children have a relapse within a short time
Nursing diagnosis of child with cancer
Imbalanced nutrition, less than body requirements, especially after starting chemo Risk for infection Risk for injury Activity intolerance Pain Disturbed sleep pattern Anxiety
Why are children at risk for communicable diseases?
Immature immune system Limited prior exposure Poor hygiene behaviors Poor health and immunodeficiency Passively acquire antibodies from mother, so protection is limited and fades after birth Immunizations have not been received, so protection is incomplete
Children are at an increased risk for communicable disease, because
Immature immune system Limited prior exposure Poor hygiene behaviors Poor health in immunodeficiency increase risk Passively acquire antibodies from mother -Protection is limited -Protection face after birth Have not received immunizations, yet, so protection is incomplete
Fever with neutropenia needs
Immediate attention
A child's complaint of headache associated with n/v necessitates
Immediate evaluation by a medical professional
Anergy
Immune system so deficient that it cannot mount a reaction to the TST
The nurse is caring for a child with KD. A student nurse who is on the unit asks if there are medications to treat this disease. The nurse's response to the student nurse is.
Immunoglobulin G and aspirin
The nurse is caring for a child with a diagnosis of ALL who is receiving chemotherapy the nurse notes that the child platelet count is 20,000/ mm3. based on this laboratory finding what information should the nurse provide to the child and parents
A soft toothbrush should be used for mouth care
A nurse is assessing an infant who has coarctation of the aorta. Which of the following findings should the nurse expect? Select all that apply. A weak femoral pulses B cool skin of lower extremities C severe cyanosis D clubbing of the fingers E low blood pressure
A,B,E
A nurse is providing teaching about epistaxis to the parent of school age child. Which actions to be taken should the nurse include with managing an episode of epistaxis? Select all that apply. A press the nares together for at least 10 minutes B breathe through the nose until bleeding stops C pack cotton or tissue into the naris that is bleeding D apply warm cloth across the bridge of the nose E insert petroleum into the naris after the bleeding stops
A,C
A nurse is caring for a child of a suspected of having rheumatic fever. Which findings should the nurse expect? Select all that apply A erythema marginatum B continuous joint pain of the digits C tender, subcutaneous nodules D decreased erythrocyte sedimentation rate E elevated C-reactive protein
A,E
Classifications of leukemia
ALL acute lymphoblastic leukemia is the most common at 78% incidence but slightly over 85% will survive at least five years past their diagnosis AML acute myeloid leukemia, 15% to 20% incidence, but 60% of patients under 15 years old have a five-year survival rate CML has a 5% incidence CLL almost never affects children
Goal of pediatric rehabilitation
Improving the lives of children with disabilities by relearning previous skills and abilities and returning to the community
Right sided heart failure presents
In the body
Left sided heart failure presents
In the lungs
What is CHF cause in children?
Increase fluid volume Increase in Cardiac demand Increase in cardiac pulmonary pressure decreasing myocardial contractility
Hypercyanotic spell (TET spell)
Increased R-L shunting
Retinoblastoma
Intraocular malignancy of the retina Treatment: almost always radiation , sometimes chemotherapy, but it's often ineffective Removal of the eye, if other treatments fail Examination is done under anesthesia using an ophthalmoscope It's evidenced by leukocoria (white pupillary reflex) On the Reese Ellsworth, group staging classification of retinoblastoma, the higher the stage, the less favorable the outcome
What should be done to protect the central nervous system from the invasion of malignant cells in a child, newly diagnosed with leukemia
Intrathecal chemotherapy
The nurse should expect to administer this to a child with ITP in a platelet count of 5000/mm3
Intravenous immunoglobulin Prednisolone
An 18 month old with a myelomeningocele is undergoing a cardiac catheterization. The mother expresses concern about the use of dye in the procedure. The child does not have any allergies. In addition to concern for an iodine allergy, what other allergy should the nurse bring to the attention of the catheterization staff?
Latex
Child has restrictive cardiomyopathy. What information given to the parents by the nurse is correct? A caused by toxic agents B least common form C most common form D often of familial disorder
Least common form
Sibling response to the chronically ill child
Left out forgotten, neglected Changes in day-to-day family routine (having to adapt to the ill child) Jealousy, resentment, anger Regression May fear becoming ill themselves Encourage them to visit Referre to child life therapy to lower anxiety and fear
Hypoplastic left heart
Left side of heart not developed Decreased systemic blood flow Treatment is staged surgery First at 24 hours Second at 3 to 6 months Third at a year Used to be a little defect, but children can survive this The first surgery is the most dangerous because they are so small
The blood flow through the heart with an ASD is
Left to right
The pediatric nurse, working in an acute inpatient unit, understands that a DNR order includes which measure? A administering radiation therapy in an attempt to eradicate the disease B administering antibiotic therapy as scheduled by the physician C administering no life-saving measures in the event of a respiratory arrest D administering feeding via an orogastric tube for artificial nutrition
Administering no life-saving measures in the event of a respiratory arrest
Strategies for increasing the rate of immunization compliance
Administration of immunizations at healthcare visits, hospitalizations, and schools -Vaccines can be administered when children have a mild illness -Gift combinations of vaccines at the same visit Provide parents with information -VIS required for each vaccination -must document that it was given Legal issues -Informed consent must be obtained before immunization administration -A record of the administration should be given to the patient's parent (form 121)
Start antibiotics
After culture is collected, but before results are in
The nurse is caring for a child who has undergone a cardiac catheterization. During recovery, the nurse notices the dressing is saturated with bright red blood. The nurses first action is to...
Apply direct pressure 1 inch above the puncture site
Herpes viruses
CMV EBV HSV-1 (fever blister) HSV-2 (genital) HHV7 VZV (chicken pox or shingles)
In which CHD will with the nurse need to take upper and lower extremity BPs?
COA
The school nurse has been following a child who comes to the office frequently for vague complaints of dizziness and headache. Today she is brought in after fainting in the cafeteria following a nosebleed. Her BP is 122/85, and her radial pulses are bounding the nurse suspect she has.
COA
Fanconi anemia
Café au lait spots and other pigmentation abnormalities Short stature Anomalies of the hands and forearms Microcephaly Other anomalies-Reno, broad, nasal base, small eyes and jaw, epicanthal folds Only left to their 30s
Why do I need a Tdap immunization?
Can protect children in your care Contains protection against tetanus, diphtheria and pertussis Single dose is recommended for adults and adolescents
My child with cardiomyopathy is prescribed a beta blocker. Which drug is the nurse teach the parents about? Carvedilol Flecainide Quinidine Verapamil
Carvedilol
Acyanotic Defects
Cause left to right shunting
Rheumatic fever
Caused by a group A beta-hemolytic strep Can develop cardiomyopathy if allowed to continue S/s : usually 20 days after a URI Diagnosis : JONES CRITERIA Major : carditis, polyarthritis, Chorea, SQ nodules, erythema marginatum Minor: polyarthralgia, fever, previous history Acute: elevated ESR, C-reactive, protein, leukocytosis, and prolonged PR interval(too long for conduction to move through the myocardium) Treatment : Inotropes, diuretics, vasodilators, steroids
Ductus arteriosus
Communication between the aorta and the pulmonary artery
S/s of child cancers
Compression infiltration or obstruction caused by tumor (bone pain, abdominal pain, mediastinal mass) Changes in blood cell production, such as decreased, hemoglobin, hematocrit, white blood cell count or platelets Metabolic, electrolyte, hormonal, or immunologic alterations, caused by tumor, metabolism, or cell death (increased frequency of infections, hypercalcemia)
Different types of chemotherapy agents are used because
Each drug works in a different stage of cellular development or destruction
Manifestations of ITP
Ecchymoses Petechiae Purpura Bleeding from gums Possibly intracranial bleeding -Check LOC, Neuro(AAO), pupils, gait, motor responses
Barriers to immunization compliance
Economic factors (expensive/not covered by insurance) Limited access to healthcare (rural) Lack of convenient primary care (working parents/kids in school) Parental knowledge deficit (don't understand benefits/have heard false information) Religious/cultural prohibitions
Nurses' response to death of a child
Feel sense of loss, grief Deeper loss the longer the nurse has cared for the child Feelings of helplessness Distance self from family Reluctant to form close connection with other children in unit Reaction may be more intense if nurse has own children
The nurse is caring for a child who is receiving a transfusion of PRBCs. The nurse is aware that if a child has a hemolytic reaction to the blood, the signs and symptoms will include.
Fever Oliguria Hypotension
Hand foot and mouth
Fever vascular rash on buccal mucosa and tongue Papillar rash on the hands and feet, which can become vesicular Patho: spread by respiratory droplets, fecal - oral, or from mother to infant during peripartal period Assess for group B coxsackievirus, active virus can cause serious disseminated disease in a newborn which can ultimately be fatal
Clinical manifestations of Wilms tumor
Firm, nontender, painless mass in the abdomen Hematuria Hypertension (because it's affecting the kidney) DO NOT PALPATE THE ABDOMEN
Care of a chronically ill child
Focus on the child developmental age versus chronological age Assist child/family to return to normal pattern of living Determine how child is/was Cared for at home prior to Promote child's maximum level of growth and development Assess family response to child illness Involve Family in care Encourage self-care
Which measures should the nurse implement to help with the nausea and vomiting caused by chemotherapy
Give an anti-emetic 30 minutes prior to the start of therapy Continue the anti-emetic as ordered until 24 hours after the therapy is complete Remove food that has a lot of odor
A student nurse is teaching the mother of an infant ways to prevent iron deficiency anemia. Which instruction causes the registered nurse to intervene and correct the teaching?
Give your child whole milk instead of low fat milk
induction phase of cancer treatment
Goal is to achieve remission (lasts about one month) Drugs: L-asparaginase, vinchristine, and a steroid, (dexamethasone). for high-risk children fourth drug (daunorbucin) Intensive therapy is given to kill enough cancerous cells to induce a remission
A preschooler presents to the emergency department with the following signs and symptoms: bilateral leg purpura, eyelid edema, edema and arthralgia of the left knee, mild bloody diarrhea What is the most likely diagnosis?
HSP
A nurse is reviewing a chart on a child who has sickle cell disease and notes the diagnosis dactylitis. what does a nurse understand about this condition?
Hand foot syndrome
Avoid using the following terminologies for chronic conditions
Handicapped Compromised Impaired Technology dependent
Prevention of the spread of infectious disease
Handwashing Standard precautions Avoid exposure to infected individuals Promote immunizations Decrease/eliminate pathogens
What is the best method to prevent the spread of infection to an immuno suppressed child?
Have people wash their hands prior to contact with the child
An adolescent has been diagnosed with hyper lipidemia on a screening laboratory test. Which of the following with the nurse recommend to decrease is hyper lipidemia?
Heart healthy diet Lifestyle modifications
Dilated cardiomyopathy
Heart muscle is stretched out because blood is pooling, typically in one of the ventricles. The dilation of that chamber prevents the heart from squeezing properly.
A nurse is teaching parents of a child who has an atrial septal defect ASD about the possible treatment options. Which treatment option does the nurse not include in the teaching session? A heart transplant B spontaneous closure C surgical repair D use of a closure device
Heart transplant
Thalassemia intermedia
Hematologic abnormalities Hyperbilirubinemia Splenomegaly Hepatomegaly Delayed growth in sexual maturation Abnormal facial appearance
Frequent transfusion to treat sickle cell anemia can lead to
Hemosiderosis (iron in the tissues) -Treat with iron chelation therapy — parenterally-deferoxamine — oral-deferasirox or deferiprone — used alone or in combination — + vitamin C to promote iron Excretion
Child's lab value shows red blood cells that are small, dense , and round with a hemoglobin value of 8.5 g/dL. Based on these laboratory findings which disease process does nurse suspect?
Hereditary spherocytosis
Contraindications to vaccine administration
History of anaphylactic reaction to the vaccine or one of its components Moderate to severe acute illness on the day of For specific vaccines, pregnancy or allergy to some components (example: allergy to eggs, no flu vaccine)
A nurse sees in a child's chart that laboratory studies were positive for reed Sternberg cells. Which disease process does a nurse associate with this finding?
Hodgkin disease
TET spell
Hypercyanotic episode (An acute severe cyanosis spell)
Oncologic emergencies
Hyperleukocytosis Tumor lysis syndrome Septic shock DIC Typhlitis (bacterial infection in the cecum) Spinal cord compression SIADH Superior vena cava syndrome Anaphylaxis
A child diagnosed with CHF is receiving maintenance doses of digoxin and furosemide. She is rubbing her eyes when she is looking at the lights in the room, and her HR is 70 BPM. The nurse expect which laboratory finding?
Hypokalemia
Congenital heart disorders that decrease systemic blood flow
Hypoplastic left heart Total anomalous pulmonary venous return Coarctation of the aorta
A heart transplant may be indicated for a child with severe heart failure, and
Hypoplastic left heart syndrome
The Norwood procedure is used to correct
Hypoplastic left heart syndrome
Family discharge teaching has been effective in the parent of a toddler diagnosed with KD states
I know she will be irritable for 2 months after her symptoms started
The pregnant mother of a child diagnosed with fifth disease is crying and says "I'm afraid. Will my unborn baby die? I have a plan cesarean section next week ". What is a therapeutic response?
I understand you are afraid. Can we talk about your concerns?
Which statement by the mother of a child with RF ensures she has good understanding of the care of her child?
I will give him his oral anti-inflammatory medication for pain and inflammation I will take my child every month to the healthcare provider's office for his penicillin shot
Which statement by parent of an infant with CHF, who is being sent home digoxin indicates the need for further education?
I will mix the digoxin in some formula to make it taste better
The nurse is discharging a child.who has just received chemotherapy for neuroblastoma. If the parent says this, they need further teaching.
I will take a rectal temperature daily and report a temperature greater than 101°F immediately to the healthcare provider
A child is returned to the pediatric intensive care unit following a brain tumor resection. Which nursing assessment takes priority? A intracranial pressure B skin integrity C pain and discomfort D mobility
ICP
Which statement by the mother of a child with RF shows an understanding of prevention for her other children?
If their culture is positive for group A streptococcus, I will give them their antibiotic
Treatment of osteogenic sarcoma
Limb salvage Amputation Chemotherapy
How do we manage CHF?
Limited fluid intake Promote energy conservation Positioning Give meds on time
A Family Practice nurse is teaching a student about different types of vaccines. Which information about vaccines this correct? A attenuated vaccines are used only in adults B inactivated vaccines prevent disease reactivation C live virus vaccines need occasional boosters D toxoid vaccine contain highly potent viruses
Live virus vaccines need occasional boosters
What is true about Cyanotic heart defects?
Long-term low oxygenation results in polycythemia They cause an increased risk of thrombi and stroke
Babies and immune compromised people may have
Low WBC count with infection
Neutropenia
Low absolute blood cell count < 1000 in infants two weeks to one year of age Or <1500 in children, older than one year of age Severe ANC=<500 or 500-1000 when chemo is being administered
Causes of iron deficiency anemia
Low amount in diet Malabsorption G.I. bleeding, menses, or injury Rapid growth
German measles (rubella)
Low-grade fever, malaise, tiredness Red pinpoint rash, starts on face spreads downward Rash last 3 to 5 days Isolate for 7 days after the onset Blueberry muffin baby due to purpura 50% develop muscle and joint pain Infection during pregnancy can cause, severe birth defects, miscarriages, and stillbirths
Pathophysiology of CNS tumors
Low-grade tumors are slow-growing, contain a few mitotic cells, and show no evidence of necrosis or vascular proliferation Although they are less malignant than high-grade tumors, their progress may go undetected for sometime, causing major damage to adjacent tissue High-grade tumors are rapidly growing, contain multiple mitotic cells, and show evidence of necrosis and endothelial and vascular proliferation
Magic medicine for mucositis
Maalox, Viscous Xylocaine, & Benadryl Mixed together and painted in the mouth with a swab
S/S of patent ductus arteriosus
Machine-like murmur
Expected behavior of a preschool aged child is to relate fears to
Magical thinking
Do you maintain professional effectiveness, a nurse, caring for dying children should
Maintain contact with a Family after their loss Develop a professional support system Take time off work
A child is admitted with neutropenia. Which nursing action takes priority?
Maintain strict handwashing
A nurse is reviewing the lab values for a toddler. The child's hemoglobin is 7.7 g/dL. How would the nurse characterize the child's results?
Moderately anemic
For a child with thrombocytopenia, the nurse should
Monitor for manifestations of bleeding Avoid peripheral venipunctures
Disease surveillance by the CDC
Monitoring patterns of disease occurrence
What is the most effective treatment for pain in a child with sickle cell crisis?
Morphine Behavioral techniques Acetaminophen with codeine
Tumors of the central nervous system
The second most common malignancy in childhood. In the United States, approximately 2500 to 3500 children younger than 20 years of age are newly diagnosed each year. Brain tumors all the rare during the first year of life, tend to occur,, most frequently and children younger than 10 years of age Approximately 74% of all children with CNS tumors demonstrate a five-year survival rate ( with the exception of the rapidly growing diffuse intrinsic Pontine glioma DIPG, which does not have a good survival rate)
In a normal heart of a pediatric patient, what is most responsible for the pumping work of the heart?
The ventricles
Describe the action of chemotherapeutic agents used in the treatment of cancer in children
They suppress the function of normal lymphocytes in the immune system They interrupt the cell cycle, therefore causing cell death Prednisone is a natural hormone
What is a reason to perform a lumbar puncture on a child with a diagnosis of leukemia?
To assess the central nervous system for infiltration
CMV
Usually asymptomatic, almost everyone encounters it Transmission: direct contact with virus containing secretions (urine,saliva) -Transmission for adolescents is primarily sexual intercourse and saliva (kissing) Later can develop cancer - can cause female organ cancer
TOF involves which defects?
VSD Right ventricular hypertrophy PS Overriding aorta
Vaccines: basic concepts
Vaccines introduce antigens into the body Antigens trigger immune response to a foreign substance Antibodies are made by the body in response to the antigen This is a 28 day process
HSP (Henoch-Schonlein Purpura)
Vasculitis — raised purpuric lesions — joint pain — colicky, abdominal pain — G.I. bleeding — renal involvement
The parents of a child diagnosed with Kawasaki disease, asked the nurse to explain the disease and symptoms. Which response by the nurse is most appropriate? A bacterial infection after an invasive procedure B chronic viral infection of unknown origin C genetic defect, causing vessel abnormalities D vasculitis affecting all organs of the body
Vasculitis affecting all organs of the body
An 18 month old male client is brought to the clinic by his mother. His height is in the 50th percentile, and his weight is in the 80th percentile. The child is pale. The physical examination is normal, but his hematocrit level is 20%. These questions will assist the nurse in making a diagnosis.
What does your child eat every day? How much milk does your child drink per day?
What would be a therapeutic response for a mother who tells the nurse she does not want her six month old infant to have a DTaP vaccine because the infant had a localized redness the last time she received the vaccine?
Would you mind if we discussed your concerns?
Diagnostic tests for cancer
X-ray CT scan MRI PET scan Ultrasound Bone marrow aspiration
The parents of a 12 month old with HIV are concerned about his receiving routine immunizations. what will the nurse tell them about immunizations?
You are concerned about your child receiving immunizations. Let me explain why your child will not receive routine immunizations today.
What should the nurse's response be to a mother of a two month old who is going to get the polio immunization when the mother tells the nurse the older brother is immuno compromise?
Your a baby can be immunized with the polio vaccine; he will not be contagious
The parents of a three month old ask why their baby will not have an operation to correct a VSD. The nurses best response is...
Your babies defect is small, and will likely close on its own by one year of age
Hypoplastic Left Heart Syndrome
underdevelopment of the left side of the heart Decreased systemic blood flow Used to be a little defect, Critical/ life threatening 3 stage surgery - 24 hours -3-6 months -1 year Goal of surgery is to make them be able to live off their right ventricle First surgery is the most dangerous because they are so small If defect is detected in utero, they will be born at a specialty hospital
Typical signs and symptoms of Wilms tumor
weight loss, abdominal distention, and fatigue
Rhabdomyosarcoma
Most common SOFT TISSUE TUMOR in children Especially common in children under 5 Locations: muscles around eyes; (produce swelling, ptosis, visual disturbances, and eye-movement abnormalities) In neck, and less commonly in abdomen (seem to be completely asymptomatic) how long GU tract; (urinary obstruction, hematuria, dysuria, vaginal discharge and protruding vaginal mass ) And extremities treatment: surgery when possible Widefield radiation Chemotherapy Has a rapid metastasis to lungs, bones, bone marrow and distant lymph nodes
Wilms tumor
Most common type of renal, tumor and children 6% of cancers in children younger than 15 years of age Most diagnosed by 5 y/o, with average age of diagnosis at 2 - 3 Approximately 500 new cases each year Children with hypospadias (urethral opening misplacement ) or cryptorchidism (undescended testicle) have a slightly higher incidence African-American females are at highest risk
Consolidation phase of cancer treatment
Most intensive phase Last 4 to 8 months Several drugs are used in combination to prevent remaining cells from developing resistance Drugs: methotrexate and 6-Mercaptopurine, vinchristine, and prednisone Intensive therapy is given to destroy remaining cancer cells
Nonpharmacologic measures for pain
Music therapy Hand holding Imagery, hypnosis, relaxation Diversion, rest and sleep Massage, heat Breathing exercises Biofeedback
Bacterial infections
Mycobacterial infections (non-tuberculosis mycobacteria (NTM) and tuberculosis(TB) Pertussis Pneumococcal disease Staphylococcal disease Streptococcal disease - group A streptococcal infections (GAS) and Group B streptococcal infections (GBS)
Hypertrophic cardiomyopathy
Myocardium has become second Affects squeezing and/or filling Treatment : Digoxin Activity restriction Control CHF Transplant -can't correct hypertrophy once it has occurred you can only treat the symptoms
The best method to prevent a communicable disease is
Obtaining immunizations
A child with leukemia is receiving chemotherapy and is complaining of nausea. The nurse has been giving the scheduled anti-emetic. What should the nurse do when a child is nauseated
Offer cool, clear liquids
What should the nurse do for a child who has mucositis?
Offer soft foods Use a soft, disposable toothbrush for oral care Encourage gargling with warm saline mouthwash
Radiation and chemotherapy
Often curative, but can be palliative A tumor can be shrunk for comfort measures if it cannot be removed surgically
Focused health history for a child with cancer
Onset, sequence, and duration of current symptoms Whether culturally based remedies were tried first Pertinent information about each body system Child's past medical history Any history of previous malignancy Family medical history History of environmental exposures Social history Baseline physical and developmental milestones
What blood vessel is used for cardiac catheterization?
Pediatric : brachial artery to access left heart and vein to access right heart in adults, the femoral artery and vein are used
Pinworm infestation
Perianal itching with localized irritation Sleeplessness Hyperactivity Weight Loss Tooth grinding Abdominal pain Vomiting Rx: mebendazole Albendazole OTC: pyrantel pamoate Diagnosed by direct visualization of worms
How to diagnose ALL
Peripheral blood smear Lumbar puncture Bone marrow analysis
Complications from group A strep
Pharyngitis: scarlet fever Rheumatic fever (damages heart) Glomerulonephritis (damage to kidney)
Interventions for the dying child and their family
Physical comfort -Pain management -Nonpharmacologic methods Decision making Emotional comfort -Support group referral -Presence of family at time of death Preparations for death Involve whole family (siblings)
The nurse is caring for a child who is receiving extensive radiation as part of the treatment for Hodgkin disease. what intervention should be implemented?
Provide adequate rest, because the child may experience excessive malaise and lack of energy
Implementing strategies to minimize pain during administration of immunizations
Provide local anesthetic Give child as much control as possible (do you want a sticker or a sucker after?) Be honest with a child (it does hurt) Provide sucrose drink and pacifier, if appropriate Use age-appropriate distraction techniques
What nursing intervention should take place before all vaccination administrations?
Provide the vaccine information sheet hand out and answer all questions
Which heart valve prevents regurgitation of blood from the pulmonary artery into the right ventricle?
Pulmonary
Truncus arteriosus
Pulmonary artery and aorta fail to split -critical/life-threatening -Increased pulmonary blood flow -Blood completely mixed — oxygenated and deoxygenated blood in systemic circulation Treatment = surgery
Truncus arteriosus
Pulmonary artery and aorta fail to split Increased pulmonary blood flow - Critical /life-threatening -Mixed blood disorder Treatment is surgery
Total anomalous pulmonary venous return
Pulmonary veins empty into right atrium
Total anomalous pulmonary venous return
Pulmonary veins empty into right atrium Decreases systemic blood flow Critical/life-threatening Treatment:surgery
A 10 year old is undergoing a cardiac catheterization. At the end of the procedure, the nurse should first assess.
Pulses
The nurse is caring for an eight year old girl whose parents indicate she has developed spastic movements of extremities and trunk, facial grimace, and speech disturbances. They state It seems worse when she is anxious and does not occur while sleeping. The nurse questions to parents about which recent illness?
RF
Rubella (German Measles)
RNA virus Droplet and contact Low-grade fever, headache, malaise, anorexia Pink, non-confluent, maculopapular rash (tiny pink dots everywhere) Disease is usually mild, but is a major risk to the fetus if mother infected during first trimester It will run its course Nursing: isolation (especially from pregnant women ) and comfort measures
Infants and adolescents may have iron deficiency anemia because of
Rapid growth
Contributing factor to childhood cancers
Rapid, cellular growth and development
Varicella
Rash begins a small red spots that develop into itchy fluid filled. Vesicles or blisters. Rash presents as vesicles on macules or dewdrops on rose petals Usually begins on the body, face, and scalp, then spreads to the arms, legs Very itchy Most infectious 12 to 14 hours before the rash appears Cannot return to school before all lesions are crusted over Airborne and contact precautions
Rubeola (measles)
Rash starts on face Highly contagious viral illness Vaccination available 3 Cs: cough, coryza, conjunctivitis Airborne precautions Koplik spots in the mouth
Assessment parameters for infectious disease
SYMPTOMS: General questions regarding the presenting symptoms of illness (fever, rash, enlarged lymph nodes, and cough) EXPOSURE: Information regarding the child's recent illness, daycare or school exposures, environmental or animal exposures, or recent travel VACCINES: Document immunization status & history of past infections SPECIFICS: Ask specific questions about the presenting illness COMPROMISED: Determine whether the child has an impaired host defense RESISTANCE: Check if infections resolve completely between episodes
92% of childhood cancers
Sarcomas, leukemias, and lymphomas
Which hormone is partly responsible for ensuring that the ductus arteriosus closes normally?
Prostaglandin
For a child with hypoplastic left heart syndrome, which drug maybe given to allow the PDA to remain open until surgery
Prostaglandin E
Which medication should the nurse give to an infant diagnosed with transposition of the great vessels?
Prostaglandin E
Closure of the ductus arteriosus
Prostaglandin inhibitor (ibuprofen) Surgery Spontaneous
A child has been diagnosed with valvular disease following RF. during patient teaching, the nurse discusses the child's long-term prophylactic therapy with antibiotics for dental procedures, surgery, and childbirth. The parents indicate they understand when they say.
She will need to take antibiotics when she has such procedures for the rest of her life
Nursing assessment of the child with cancer
Signs of bruising, bleeding, or infection Renal function (Wilms tumor, chemo) Mucosal sores in mouth Central nervous system infiltration -Decreased level of consciousness -Irritability -Vomiting -Lethargy -Headache
Habilitation
Similar to rehabilitation as it involves the same professional supervised services to the child and family The focuses on helping a child with acquired and developmental disabilities to learn new skills and first time abilities to achieve his or her maximum potential
Frequently present, somewhat Suggestive signs of HIV
Skin lesions FTT Chronic diarrhea Thrush Hepatosplenomegaly Anemia, thrombocytopenia, neutropenia
Thalassemia minor
Some asymptomatic abnormal hematologic findings
Assessment for CNS tumors
The most common complaint in children older than two years of age associated with increased ICP is headache Any headache associated with vomiting or lethargy should be a valuated immediately by physician to rule out increased ICP The head pain may be more vague and nonspecific
Medications for heart failure
Prostaglandin-keeps DA and FO open Indomethacin or ibuprofen -closes DA FO Digoxin - increases contractility/decreases workload (Inotropic) Slows HR to increase filling Furosemide/spironolactone -diuretics Spironolactone spares K Heparin/ASA -blood thinners prevent clots ACE inhibitors, beta blockers, and hydralazine decrease work load of the heart ACE drops blood pressure decreases work load Beta blockers slow and cause vasodilation Hydralazine cause vasodilation
Giardiasis
Protozoal organism that lives in freshwater streams The cyst form is infectious The cyst must be ingested ranges from asymptomatic to severe LIFE-THREATENING DIARRHEA Acute watery, foul, smelling, diarrhea with abdominal pain, particularly if they have been hiking or camping May last a few days to years Treatment: 5 to 7 day course of metronidazole or a 3 day course of nitazoxanide
The nurse is caring for a child with sickle cell disease, who is scheduled to have an exchange transfusion. What information should the nurse teach the family?
The procedure is done to prevent further sickling during a vaso-occlusive crisis
Blood volume
75ml newborn 2650ml 80lb child 4500-5700ml adult (4.5-5.7L)
Treatment for a four-year-old with HSP includes
Administer NSAIDs for pain Monitor BP Monitor for renal involvement
This intervention should be implemented after a bone marrow aspiration?
Administer analgesics as needed for pain
Which plan would be appropriate and helping to control CHF in an infant?
Feeding in semi fowler position
5% to 10% of children with sickle cell disease will experience
Strokes, which result in neurodevelopmental delay, or cognitive impairment
Where is the pain from a splenic sequestra felt
Upper left quadrant
The pediatric nurse is aware that which disease process is the most commonly inherited genetic disease worldwide?
Beta thalassemia
Absolute confirmation of cancer can only be diagnosed with
Biopsy
What is a prognostic factors for determining survival for a child newly diagnosed with ALL
The initial white blood cell count on diagnosis
Mortality and morbidity rates decrease
The longer we wait to intervene with congenital heart defects
CHDs are classified by which of the following?
Defects with increased pulmonary blood flow Defects with decreased pulmonary blood flow Mixed defects Obstructive defects
Issues associated with HIV
Adherence to medication regimen(it's expensive, hard to get and sometimes the caregivers are not responsible) Can requires primary in specialty care practices (a whole team) Family, beliefs and cultural influences must be included in care
Transposition of the great vessels
A cyanotic defect which presents within 24 hours of birth as an emergency Upper extremities have decreased O2 saturation compared with lower extremities Resulting in lack of oxygenated blood, circulating and perfusing the body and tissues Profound cyanosis with crying, tachypnea, and heart murmur may be present Signs of CHF are seen on assessment Surgical correction must be performed Prognosis is good with correction
What is the presence of bleeding feel like under the skin?
A hard raised knot
Common transmission routes for communicable diseases in children
Fecal oral Respiratory
The mother of a toddler reports that the child's father has just had an MI. Because of this information to nurse recommend the child have.
A lipid profile
Pulmonary stenosis
A narrowing of the pulmonary artery Not enough blood flow to the lungs The amount of narrowing affects the degree of signs and symptoms
Interventions for n/v
Anti-emetics (phenergan, and Thorazine) Granisetron and Zofran (>3 years) Anti-histamines : Benadryl
Complications after cardiac catheterization
Bleeding Circulation Infection
What are the clinical manifestations of non-Hodgkin lymphoma?
Depends on the anatomical site and extent of involvement
Three phases of cancer treatment
Induction Consolidation Maintenance
Management of mild to moderate aplastic anemia
Supportive therapy
Hypertension and hyperlipidemia
Treated with: Exercise Diet Medication
Fever management treatment
Administer antipyretics Remove unnecessary clothing Monitor temperature (usually axillary) Encourage extra fluids (because of insensible fluid loss) (do not encourage milk or OJ because they can cause stomach upset)
The nurse should teach the parent of a child with hemophilia to do this first of the child sustains an injury to a joint causing bleeding.
Administer factor per the home care protocol
Fever management, parent education
Administer only one antipyretic at a time (acetaminophen and ibuprofen, can be alternated every 3 hours) Use correct dosage (infant medications are more concentrated than childrens medications) Use the correct administration intervals
Parental response to developmental issues
-Children still need discipline -Behavioral expectations should be the same as a healthy child within that developmental age
Diagnostic criteria for sepsis
-Core temperature > 101°F or < 96°F -tachycardia (2 standard deviations above normal without external stimuli) -Bradycardia and children < 1 y/o (<10th percentile for age, not caused by external agents) -Mean respiratory rate more than 2 standard deviations above age norms -Leukocyte count: depressed, or elevated for age, > 10% immature, neutrophils -Infant WBC count maybe⬇️
Cancer diagnosis: reaction of the parents
-Disbelief, shock, denial, anger -Must gather resources, make treatment decisions because it is usually already a stage III or IV Diagnosis -Travel often required for treatment -Financial strain, potential job loss -Adaptation
Who is at greater risk for developing beta thalassemia
A child of Mediterranean descent
Treatment for CHF in an infant began three days ago, and has included digoxin and furosemide. The child no longer has retractions, lungs are clear, and HR is 96 BPM, while the child sleeps. The nurse is confident that the child has diuresed successfully and has good Renal perfusion when the nurse notes that the child urine output is.
1 cc/kg/hour
Measures to promote growth and development
1. Provide children with choices in their daily care as much as possible.(medicine with apple juice or grape juice., or therapy, at 10 o'clock or 2 o'clock) 2. Establish a schedule of daily activities with the child and try to stick to it as best as you can. 3 if the child is hospitalized, ensure that the schedule provides opportunities for visits from school friends and activities with other hospital as children 4 if the child requires isolation, ensure that visitors and items are screened , so that activities and schoolwork can be brought to the child's room
Educational topics for the child (and family) undergoing cancer treatment
1. Pathophysiology, (in layman's terms, so they understand what is happening in the body ) prognosis, (usually good for leukemia, it's very treatable ) and signs and symptoms of the malignancy 2. Diagnostic testing methods and procedures (labs, scans, poking, and prodding, fear of the unknown is a major cause of noncompliance) 3. Disease-specific treatment, options and outcomes, treatment-induced side effects 4. Tumor and treatment related pain management (what will Pain be treated with, this is very important to the parents) 5. Infection prevention measures (meticulous, handwashing in neutropenic precautions, reverse isolation) 6. Management of treatment side effects 7. Nutritional needs and measures.(small frequent meals, let them choose.) 8. Care of devices.(such as CVCs) 9. Promotion of growth and development. (FaceTime, zoom, video, games, coloring books.) 10. Home management of medication's, medical equipment, and assistive devices.(02 tanks, breathing treatments.) 11. Needs of child and other family members.(keep sibling routines as normal as possible.) 12. Coping techniques. 13. Management of long-term sequelae related to the child's tumor in specific therapy regimen. (amputation, long-term care)
According to the American Academy of pediatrics, at which age should an infant, have their first blood draw to test for lead level?
12 months
Diagnostic tests for CNS tumors
95% can be detected with CT scan MRI is the image of choice for a medically stable and cooperative child because of its safety and its ability to collect detailed information. It's particularly useful in diagnosing infiltrate of tumors of the brainstem. PET scan is also used to image the tumor and assess its level of activity A lumbar puncture is usually performed to obtain CSF for analysis with no signs of obstructive hydrocephalus or increased ICP are present. The fluid is tested for the presence of tumor cells, as well as for ⬇️ sugar, ⬆️ protein, and ⬆️enzymes.
The nurse is taken care of a child with sickle cell disease. The nurse is aware that these problems are associated with sickle cell disease
Aplastic crisis Vaso-occlusive crisis
A nurse is providing teaching about the management of epistaxis to an adolescent. Which position should the nurse instruct the adolescent to take when experiencing a nosebleed? A sit up and lean forward B sit up and tilt their head back C lie in a supine position D lie in a prone position
A
How many days should be between vaccinations, unless given together?
28
The most important reason healthcare providers prescribe a combination of antiretroviral drugs to children with HIV is to delay
Drug resistance
BP screenings to detect organ damage should be done routinely, beginning at what age
3 years
Pressure changes at birth cause the closure of
Ductus arteriosus Foramen ovale Ductus venosus
A 3 y/o child is admitted with a low neutrophil count 10 days after chemo for ALL. which roommate is most appropriate? A 3 y/o with bronchitis B 5 y/o with femur fracture C 4 y/o with strep D 3 y/o with history of diarrhea
5 y/o with femur fracture
Which assessments indicate that the parent of a seven year old is following the prescribed treatment for CHF?
50th percentile height and weight for age Playing basketball with other children his age
Physiological anemia
6-9 weeks after birth Resolves itself
Roseola
6th disease Transmission: possibly respiratory secretions of healthy individuals Rash first develops on the neck and chest, and then spreads to the rest of the body Spots on rash turn white, if pressed (blanchable) Spots may have a lighter color ring around them Most common in kids, 3 to 5 years of age Febrile seizures due to high fever, otherwise mild to few issues High fever for three days, then fever drops, and they develop the rosy pink rash AKA 3 day measles (once the rash shows the disease is over)
Most prevalent infections in early childhood
Upper respiratory infections Enteric infections Communicable diseases, transmitted by adults and other caregivers Soil borne diseases Foodborne illnesses
Tetralogy of Fallot (TOF)
4 defects Ventricular septal defect VSD Pulmonary stenosis Overriding aorta Secondary hypertrophy of the right ventricle, causing left or right shunting Hallmark sign is cyanosis with crying or playing, which can progress to fainting
Most prevalent infections in infancy
Upper respiratory infections Enteric infections Vaccine - preventable diseases Gastroenteritis Diseases, transmitted by fecal-oral route
Fever management OTC medications
Acetaminophen 10 to 15 mg/kg/dose every 4 to 6 hours not to exceed 5 doses in 24 hours (daily maximum for children 12 and older is 4 g) Ibuprofen 4 to 10 mg/kg/dose every 6 to 8 hours, not to exceed 40 mg/kg daily No ibuprofen for infants
Viral infections
Adenovirus infection Enterovirus infection Herpes virus infection HIV/AIDS Measles Mumps Parvovirus B19 infection Viral hepatitis
Where is the primary site of origin of the tumor and children who have neuroblastoma?
Abdomen
When caring for a child with lymphoma, the nurse needs to be aware that
Aggressive chemotherapy with central nervous system prophylaxis will give a child a good prognosis
Medical management of sickle cell disease
Aggressive treatment of infection Possibly prophylactic with oral penicillin from age 2 months to five years Pain medications for sickle cell crisis Hydration to prevent and treat pain crisis Blood transfusion(for anemia, to prevent stroke, to treat acute chest syndrome, splenic sequestration, and other emergencies) Folic acid (to help prevent severe anemia) Bone marrow transplant
Which procedures require preventive antibiotics for children with high risk, cardiac disease
All dental procedures Invasive procedures of the respiratory tract All procedures on infective skin or musculoskeletal tissue
What defects are associated with heart failure?
All of them
Which interventions decrease cardiac demands in an infant with CHF?
Allow parents to hold and rock their child Make frequent position changes Feed the child when sucking the fists Change bed linens only when necessary Organize nursing activities
Nursing diagnosis for the chronically ill child
Altered growth and development Risk for altered family process Anxiety/fear related to test, procedure Risk for injury Diversional activity deficit Impaired social interaction Body image disturbance
Focus of pediatric rehabilitation
Ambulation and mobility Dressing and grooming Personal hygiene Bladder and bowel management(possibly retraining) Language and communication Eating Acquiring vocational skills Adaptive an assistive devices(such as a supportive seat for a child with cerebral palsy)
A 10 year old with severe factor VIII deficiency falls, injures an elbow, and is brought to the ED the nurse should prepare what
An IV infusion of factor VIII
Communicable disease
An illness passed by direct or indirect contact
The nurse is caring for a child with leukemia. The nurse should be aware that children being treated for leukemia may experience the following complications
Anemia Infection Bleeding tendencies
s/s expected in a child with rheumatic fever
Ankle and knee joint pain
Early manifestations of leukemia in a child
Anorexia Petechiae Unsteady gait
Transposition of the great arteries
Aorta comes off RV Pulmonary artery comes off LV
Transposition of the great arteries
Aorta comes off, right ventricle and pulmonary artery comes off left ventricle -incompatible with life -Maintain FO and DA with prostaglandins -Surgery
What should the nurse assess before administering digoxin?
Apical pulse rate
What question should the nurse ask when preparing to administer the varicella vaccine to an adolescent?
Are you currently taking corticosteroid medication?
Maintenance phase of cancer treatment
As long as the cancer is still in remission, this therapy can be started Lasts up to three years ANC checked Drugs: vinchristine and steroids over a brief period every 4 to 8 weeks This is the Designated period during which treatment is continue to destroy any residual cancer cells.
Nursing interventions for the child with leukemia
Assess for infection Monitor blood values I&O, nutrition Complications of chemotherapy Meticulous washing Aseptic technique for blood draws
Acute chest syndrome
Associated with sickle cell disease Similar to pneumonia VOC or infection results in the sickling in the lungs Chest pain, fever, cough, tachypnea, wheezing, and hypoxia Repeated episodes may lead to pulmonary hypertension, which damages the lungs
Types of CNS tumors
Astrocytomas account for 50% of all childhood brain tumors, however, some can be benign Medulloblastomas account for 20% of our childhood brain tumors and are the most common malignant CNS tumor (Other gliomas account for 15%, ependymomas account for 10%, and all others account for 3%) In children, 50% to 60% of brain tumors are infratentorial (located in the cerebellum, fourth ventricle, or brain stem) whereas in adults, they are primarily supratentorial (in the cerebrum) 75% or more of brain tumors in children occur in the midline (third and fourth ventricles, optic chiasm, and brain stem)
ITP idiopathic thrombocytopenia purpura
Autoimmune disorder Destruction of platelets after a viral illness 90% of pediatric resolved without treatment Followed by a pediatric hematologist
Two types of stem cell transplantation
Autologous (self) Allogenic (donor)
The nurse should teach the parent of a child who has HIV to
Avoid individuals who have colds Provide nutritional supplements Obtain yearly influenza vaccination
A nurse is caring for a two year old child who has a heart defect and is scheduled for cardiac catheterization. Which action should the nurse take? A place on NPO status for 12 hours prior to the procedure B check for iodine are shellfish allergies prior to the procedure C elevate the affected extremity following the procedure D limit fluid intake following the procedure
B
A nurse is caring for an infant whose screening test reveals a potential diagnosis of sickle cell disease. Which test should be performed to distinguish of the infant has the trait or the disease? A sickle solubility test B hemoglobin electrophoresis C complete blood count D transcranial Doppler
B
A nurse is preparing to administer iron dextran IM to school age child, who has iron deficiency anemia. Which action by the nurse is appropriate? A administer the dose in the deltoid muscle B use the Z track method when administering the dose C avoid injecting more than 2 mL with each dose D massage the injection site for one minute after administering the dose
B
A nurse is assessing an infant who has heart failure. Which of the following findings should the nurse expect? Select all that apply. A bradycardia B cool extremities C peripheral edema D increased urinary output E nasal flaring
B,C,E
Types of infectious agents, and what they are treated with
Bacteria: antibiotics Viruses: antivirals Fungus: antifungals Parasites: anti-parasitics
The nurse explains to the parents of a child undergoing an oncological work- up that the exact cause of most cancers, is unknown, but some factors are known to be involved. Which of the following is inconsistent with his understanding? A viruses B genetics C environmental exposures D bacterial infections
Bacterial infections
Nurses role in Caring for a dying child and family
Be available to assist both child and family Avoiding posing personal beliefs and expectations Provide time and attention to the dying child Recognize the need to talk about illness and death Provide adequate pain control, oral care, privacy and information about signs of imminent death After death, allow family members as much time as they desire with the child
Nursing implementation for immunizations
Be efficient, but support child Longer needle used to ensure IM administration Do not lie, the immunization will hurt Give injections in multiple extremities if needed, and document what went where Allow parent to comfort child
A toddler has been diagnosed with iron deficiency anemia, and is to start iron supplementation. What is appropriate parental teaching
Be sure to give the iron with juice You can give the iron with a straw Be sure to bring him back in one month to recheck his hemoglobin Iron can cause constipation Do not give the iron supplement with milk
Assessment for non-Hodgkin lymphoma
Because most lymphomas are generalized at the time of diagnosis, most children are diagnosed with stage III or IV disease The most common sites of nodal involvement are intra-abdominal, mediastinal, peripheral nodal, and nasopharyngeal Intussusception (telescoping of the bowel) may be caused by lymphoma. As a rule, symptoms of intussusception in children older than 5 years of age are highly suspicious for NHL
Cultural considerations and ethical issues
Beliefs about death Beliefs about post Mortem care Death of a child -emotionally charged Withdrawing or withholding treatment Parental treatment refusal DNR orders
My child is diagnosed with chronic immune thrombocytopenia. Which diagnostic platelet count supports this diagnosis?
Below 150,000
Most common clinical presentation of aplastic anemia
Bleeding secondary to thrombocytopenia
What causes CHF?
Blood backs up so the heart and vascular system can't handle the volume
A five-year-old is admitted to the hospital with complaints of leg pain and fever. On physical examination, the child is pale and has bruising over various areas of the body. The healthcare provider suspects that the child has ALL. The nurse informed the parents that the diagnosis will be confirmed by.
Bone marrow aspirate
Which test provides a definitive diagnosis of aplastic anemia
Bone marrow aspiration
Management of severe aplastic anemia
Bone marrow transplant Immunosuppressive therapy or androgen therapy if no donor available Platelets PRBCs only if hemoglobin is dangerously low Preventive antibiotic therapy Meticulous handwashing (these patients are compromised) Prevention of infection and bleeding
Assessing a child with neuroblastoma of the adrenal gland, what indicates metastasis from the primary site?
Bone pain Periorbital ecchymoses Proptosis Weight loss
A child is hospitalized with Ewing sarcoma. Which assessment finding is consistent with this diagnosis? A shortness of breath B bone pain and swelling C bloody diarrhea D ataxia and falls
Bone pain and swelling
Following the removal of a Wilms tumor, the child should stay NPO if
Bowel sounds are absent
When teaching the parents of a child diagnosed with von Willebrand's disease, which information is most appropriate for the nurse to provide?
Boys and girls are affected equally often
The pediatric nurse provides teaching to the parents of a 6 year old who is being discharged after chemotherapy. Which instruction by the nurse is the most appropriate. A do not allow your child to play with any other children for a few days B be sure to encourage your child to brush his teeth vigorously every day C if your child feels warm, be sure to take her temperature rectally D bring your child to the ED for a fever of 101.2°F.
Bring your child to the ED for a fever of 101.2°F.
A nurse is providing teaching to the caregiver of an infant who has a prescription for digoxin. Which of the following instruction should the nurse include? A do not offer your baby fluids after giving the medication B digoxin increases your baby's heart rate C give the correct dose of medication at regularly scheduled times D if your baby vomits a dose, you should repeat the dose to ensure that the correct amount is received
C
Three week old infant, residing in a homeless shelter, has a mild cough, poor appetite, low-grade fever, weight loss, and fussiness over the past two weeks. Which nursing intervention would be the highest priority? A weigh the baby to have an accurate weight using standard precautions B reassure the mother that the baby may have a cold, which can last a few weeks C immediately initiate droplet, facemask precautions and isolate the infant D take a rectal temperature while completing the assessment using standard precautions
C
5 test sepsis workup
CBC with differential Blood culture Urine culture Lumbar puncture Chest x-ray
A child born with down syndrome should be a evaluated for which associated cardiac manifestation
CHD
The nurse is caring for a nine month old, who is born with a CHD. Assessment reveals HR 160, capillary refill 4 seconds, bilateral crackles, and sweat on the scalp. These are signs of...
CHF
TB
Caused by an infection with Mycobacterium tuberculosis Spread person to person in respiratory droplets In children and adolescents most infections are asymptomatic (this type of infection is called LTBI : (latent TB infection) history of exposure is often the most vital piece of information obtained Assess for non-specific symptoms such as fever, growth delay or weight loss, persistent cough, fatigue, and night sweats (rare in children) The first obvious sign after an asymptomatic pulmonary infection may be extrapulmonary (outside the lungs) -Most commonly cervical lymphadenitis, meningitis, bone infection, and military TB
Mumps
Causes swelling and tenderness Viral illness Droplet precautions Possible male infertility Headache, earache, and aggravated by chewing Gland inflammation involvement Affects parotid salivary glands Usually self-limiting , Has to run its course
Chronic illness characteristics and goals
Characteristics : Long-term Limits ADLs May or may not be physically apparent Goals for the child: Achieve and maintain normalization (routine) Adapt environment (to fit their needs) Promote coping skills Obtain the highest level of health and function possible (early intervention on any deficit) Goals for the family : Remain intact Achieve and maintain normalization Maximus function throughout the illness Shared decision-making (sometimes a struggle between parents, if they are separated)
Physical assessment parameters for a child with cancer
Child's overall appearance Skin color Presence of ecchymoses or petechiae Nutritional status Asymmetry a facial features or extremities Lymph nodes (enlarged) Level of activity (decreased) Presence of pain, limping, or decreased range of motion (guarding) Complaint of headache
Psychological issues with death
Children do not fear death like adults do Children fear abandonment, and separation from their parents Usually aware of death Process even if they have not been told
A child has completed treatment for leukemia and comes to the clinic for a check up with the parents. The parents express to the nurse that they are glad their child has been cured of cancer and is safe from getting cancer later in life. What is the best response from the nurse?
Children surviving one cancer are at a higher risk for a second cancer
Cancer evaluation process involves
Clinical assessment Laboratory and radiologic tests Biopsy of tissue or fluid for pathologic confirmation
The parent of a teen diagnosed with Hodgkin disease ask what the child's prognosis will be with treatment. What should the nurse say?
Clinical staging of Hodgkin disease will determine the treatment; long-term survival for all stages of Hodgkin disease is excellent
Nurses role in home care of the child with cancer
Conduct ongoing assessment of the families ability to care for the child in the home (not everybody is capable of caring for a child with a chronic condition) Provide needed healthcare interventions Coordinate delivery of homecare services by other members of the team Collaborate with interdisciplinary treatment team members to ensure child's developmental support Establish a trusting relationship with the child by communicating honestly, and answering questions directly Provide age-appropriate explanations for daily routines and procedures Encourage the child verbalize fears and concerns regarding disease and treatment Advocate for the patient participating and drug trials or research studies Serve as an additional source of information and support for the family as needed
Manifestations of neuropathy
Constipation Foot drop Jaw pain
Which precautions would be the priority intervention for a child suspected of having varicella?
Contact and droplet precautions
Education begins at diagnosis and
Continues through the treatment phase, it's maintained in the post-survival years, and/or there is support upon the patient's death, if the child dies
A nurse is caring for a child hospitalized with possible KD. What nursing action is most important for this child? Continuous cardiac monitoring Frequent blood pressures Total bed rest until corrected Treatment of hypertension
Continuous cardiac monitoring
What is the goal when diagnosed with CHF?
Control fluid and maintain oxygenation
Diagnosis of sickle cell
Cord blood in newborns Newborn screening done in all 50 states Genetic testing to identify carriers and children, who have disease Sickle turbidity test -Quick screening purposes and children older than six months
Which are the most serious complications for a child with KD?
Coronary thrombosis Coronary stenosis Coronary artery aneurysm
TET spell or hypercyanotic episode caused by
Crying BM feeding
Therapeutic management of HIV
Currently no cure for pediatric HIV disease(may not die of it, but they will die with it) Disease prevention of great importance, immunization against common childhood illnesses is recommended Early recognition and improved medical care have changed HIV disease from a rapidly fatal to a chronic but terminal, disease of childhood Children, diagnosed with AIDS in early infancy are more likely to die at an earlier age Pain management is a serious concern for AIDS patients and pain is often under treated in pediatrics
Tet spells
Cyanotic events that worsen with crying and excitement
A nurse is providing teaching to the parent of a child who has a new prescription for liquid oral iron supplements. Which statement by the parent indicates an understanding of the teaching? A I should take my child to the emergency department if his stools become dark B my child should avoid eating citrus fruits while taking the supplements C I should give the iron with milk to help prevent upset stomach D my child to take the supplement through a straw
D
A nurse is providing community education about preventing mosquito borne diseases in children. What is an appropriate instruction for the nurse to provide?
DEET-containing repellent can be sprayed on the clothes
Cardiomyopathy
Damaged heart muscle resulting in decrease in pumping ability Can be dilated, hypertrophic, or restrictive
Cardiomyopathy
Damaged heart muscle resulting in decrease in pumping ability Usually secondary to another disease process
Cardiomyopathy
Damaged heart muscle resulting in decreased pumping ability
Cancer diagnosis: reaction of the child
Depends on the child's age Infants and toddlers: limited understanding Preschooler: may believe they caused the illness School-age: improved understanding, they like to talk about it Adolescent: they like to talk with other adolescents
Four year old's sibling has died. Even though she was told her sibling is dead. The child keeps asking when she will come back. The pediatric nurse knows this is an example of.
Developmental approach to death
Which cardiac murmurs are usually pathologic?
Diastolic and continuous type
Nursing responsibilities pertaining to children with iron deficiency anemia
Dietary counseling Instructions on administration of supplement Stressing Importance of follow up labs studies Monitoring growth and development for appropriate milestones
Signs of impending death
Difficulty swallowing Cheyne stokes respirations
Three types of cardiomyopathy
Dilated Hypertrophic Restrictive
Modes of transmission
Direct: physical contact between a source of infection, and a new host Indirect: pathogens survive outside humans before causing infection
The parent of a four year old brings the child to the clinic and tells the nurse that the child's abdomen is distended After a complete examination, a diagnosis of Wilms tumor is suspected. What is most important when doing a physical examination of this child.
Do not palpate the abdomen
When blood backs up the result will be
Either pulmonary edema Or Peripheral edema with Ascites
School-age children with cancer often have a body image disturbance related to their hair loss, moon face, and their debilitation. what interventions are most appropriate
Encouraged them to wear a wig similar to their own hairstyle Help them find a special friend who understands what they are experiencing
Nursing interventions for heart failure
Energy conservation -Quiet play -Small frequent feeding -Cluster care Positioning - Fowlers (at least 30°) Decrease work load -Allow 30 minutes for feeding then NG tube Watch for ⬆️ respiratory rate ⬆️ heart rate ⬇️ O2 sats nutritional support -Formula more concentrated with less water Control fluids -Ice chips or 1️⃣ popsicle to help control fluid volume
A nurse suspects an infant of having advanced heart failure. Which clinical manifestation of heart failure did the nurse assess to reach this conclusion? Enlarged liver Feeding problems Poor growth Sweating excessively
Enlarged liver
Manifestations of rhabdomyosarcoma of the nasopharynx include
Enlarged neck lymph nodes Pain Epistaxis
A teen is seen in the clinic for possible diagnosis of Hodgkin disease. The nurse is aware that which symptom should make the healthcare provider suspect Hodgkin disease?
Enlarged, painless, and movable lymph nodes in the cervical area
Which medication is most important to have available in all clinics and offices of immunizations are administered?
Epinephrine 1:1000 injection (EpiPen)
Immunization assessment
Examine record (up-to-date?) Consult catch-up schedule of child is behind Make full use of opportunities to vaccinate -Minor illness or fever is not a contraindication to vaccination Ask about past reactions to vaccines, pregnancy, and allergy to vaccine components (allergy to Eggs, neomycin, gelatin)
Effects of hospitalization on a toddler
Experiences separation anxiety Displays intense emotions Exhibit regressive behavior's
3 populations primarily affected by HIV in pediatrics
Exposed in utero to an infected mother Those who received blood transfusion Adolescents who are infected because of sexual activity
Triggers for varicella reactivation
Exposure to a stressor (even good stress) Excessive sunlight Extreme cold Labor Loss of a job or a loved one Chemotherapy Other forms of immune suppression
A child with hemophilia A fell and injured a knee while playing outside. The knee is swollen and painful. What should be done to stop the bleeding?
Extremity should be immobilized Extremity should be elevated Factor VIII should be administered
After death care
Family -Spend as much time as desired with child -Prepare for possible bleeding of sites or urine/bowel evacuation -foot/handprints, lock of hair -Bathe the child -Clergy Siblings -May want to be present
Before pediatric cardiac catheterization
Family visit Comfort item (toy) V/S, O2 sat Void Allergies Neurovascular assessment
S/s heart failure (early)
Fatigue Weight loss or gain Diaphoresis Irritability Dyspnea/crackles/productive cough/respiratory infections Pallor/mottling Abdominal pain/distention Peripheral edema
Nursing action for most ideal nutrition in an infant with CHF is
Feeding formula that is supplemented with additional calories
Why are steroids used in cancer treatment?
For Immunosuppression so the chemo will work Toslow cell division To help prevent allergic reaction To Decrease inflammation
What serves as the septal opening between the Atria of the fetal heart?
Foramen ovale
These bypass the lungs in fetal circulation
Foramen ovale ductus arteriosus
The #1 problem in people with sickle cell disease
Frequent bacterial infections may occur due to immunocompromise
Acquired immunity
From vaccination and actually having a disease
Strep A
GAS Transmission: contact with respiratory secretions - direct contact Manifestations: pharyngeal(sore throat, fever) Skin manifestations : impetigo(honey, colored lesions) Treatment: antibiotics (penicillin for 10 days) Uncomplicated impetigo treated topically Nursing: usually cared for at home with fever management, warm fluids(to soothe a sore throat)
Weight gain or loss because of heart failure
Gain because of fluid and interstitial spaces Loss because of not eating or too much energy expenditure
Kawasaki disease
Generalized vasculitis: coronary artery abnormalities, leading to MI (damages vascular space, and coronary arteries develop aneurysms Predominantly Asian S/s Fever> 5 days & At least 4 of the following: Conjunctivitis Oral mucosal changes Extremity changes Erythematous rash (first occurs on hands and feet then spreads) Lymph node swelling Diagnosis: heart Cath,echocardiogram Treatment: ASA and IVIG Long-term aspirin, Plavix, heparin
Hodgkin lymphoma
Generally fairly localized and can be treated as a solid tumor Assessment : Painless, progressive lymph node enlargement, with 2/3 of the cases involving a site above the diaphragm, and 1/3 of the cases involving a site below the diaphragm Cervical or supraclavicular lymphadenopathy, 60% to 90% Painless, firm nodes that are movable in surrounding tissue Hepatomegaly, splenomegaly, or both Anorexia Malaise Lethargy Drenching night sweats Fever of 100.4° or higher occurring for at least 3 consecutive days. It disseminates, and may involve any organ in the body, but particularly involves the spleen, liver, bone, lungs, and bone marrow Rare before the age of 10 5% happened between the ages of 10 and 15 and 15% between the ages of 15 and 19
Chronic illness
Individuals are perceived as being sick, and not in a state of wellness, but they can recover Example: cancer
Chronic condition
Individuals do not have an illness from which they can recover and should not be treated as such Example: cystic fibrosis
concept of death
Infant -No concept of death -May sense caregivers are tense -May sense routines are altered Toddler -Unable to distinguish fact from fantasy -No understanding of true concept of death -Senses separation -Equates death to separation or abandonment Preschoolers -Believe death is temporary -Believe dead person can come back to life" magical thinking" -Believes bad thoughts cause death -Has beginning concept of death (death of plants, animals, etc.) School-age children -More realistic understanding of death -By 8 to 10 years know death is permanent and irreversible -know people die from external and internal causes -Believe death is universal -May have exaggerative concerns about death Adolescent -Capable of understanding death -Understand the connection between illness and death -May feel invincible -Understands that death impacts other people deeply
Which client could require feeding by gavage?
Infant with CHF Infant with significant PS
LTBI
Infection in an asymptomatic person with a positive TST No clinical findings of disease Normal chest x-ray (TB carrier)
Endocarditis
Infection of heart tissue
Endocarditis
Infection of the heart tissue S/s: fever UKO Malaise Fatigue Decreased appetite Diagnosis: echocardiogram TTE 1st then TEE Valves will look fuzzy, then eventually goes down into the ventricles Debris will be seen Treatment: Antibiotics or antifungal, or anti-microbial, depending on the cause
Examples of acquired heart disease
Infective endocarditis Rheumatic fever Cardiomyopathy KD
ALL most significant indicator
Initial WBC count The higher the number, the poorer the prognosis >100,000 = hyperleukocytosis Under 2 y/o and over 10 y/o have the poorest prognosis Girls do better than boys
Only obtain temperature rectally when
Initial temp Doctor ordered Axillary temp below 96 twice
Infection control goals
Interrupt transmission (example: isolate the infected person) Eliminate the Reservoir or habitat (example: empty, standing water were mosquitoes breed to prevent WNV)
What can ECG detect?
Ischemia Injury Dysrhythmias Conduction delay
What information should the nurse provide to a parent of a child diagnosed with thalassemia major who is receiving the first chelation therapy
It Eliminates excess iron Hydration is necessary for the process to be effective
Prednisone is given to children who are being treated for leukemia. Why is this medication given as part of the treatment plan?
It destroys abnormal lymphocytes
A child diagnosed with leukemia is receiving allopurinol as part of the treatment plan. The parents ask while their child is receiving this medication. The nurse should provide the following information.
It helps reduce uric acid level caused by cell destruction
The parent of a child with hemophilia is asking the nurse what caused the hemophilia. What is the nurses best response
It is an X-linked recessive disorder
A child, who has red eyes with no discharge; red, swollen, and peeling palms and soles of the feet; dry, cracked lips; and a strawberry tongue most likely has
KD
A child who is severely symptomatic with HIV may have
Kaposi sarcoma Wasting syndrome Pulmonary candidiasis
Types of vaccines
Killed virus (inactivated, polio) Toxoid Live virus (measles, varicella) Recombinant form (DNA antigen stimulates the response into the bacteria or mammalian cell then it is purified) Conjugated form (weak antigen with strong antigen as a carrier)
Tx for TET spell or hypercyanotic episode
Knees to chest Remain calm Administer 100% O2 Morphine ( to decrease O2 consumption)
Children at risk for sepsis
LBW infants Infants with certain congenital or acquired defects Infants with respiratory distress syndrome Infants with maternal perinatal risk factors, such as maternal infection or prolonged ROM
Non-Hodgkin lymphoma
Malignant disorder of the lymphocytes that affects the sales in organs of the immune system Generally, there is rapid onset with wide spread disease noted at the time of diagnosis Peak incidence occurs at ages 7 to 11 years Incidence in boys is 3 to 4 times greater compared to girls Higher incidence has been noted in patients with HIV, EBV, and those with congenital immuno deficiency syndrome, such as Wiskott-Aldrich syndrome, Bloom syndrome, severe combined immunodeficiency syndrome Tumor burden: the number and size of tumor present determined by laboratory analysis of LDH, uric acid, and lactic acid. This is generally determined to be the most important prognostic factor at time of presentation
Osteogenic sarcoma
Malignant tumor of bone 400 new cases each year Peak incidence yes, in the second decade of life, adolescents gaining vertical height rapidly Approximately 20% have metastases at diagnosis HIGH RATE OF METASTASIS TO LUNGS
Supportive care measures for children with cancer
Managing pain, nausea, and vomiting (PCA pumps, anti-emetics before chemo & radiation therapy, then around the clock while being treated) Infection prevention (handwashing, reverse, isolation) Providing psychosocial support (for parents) Promoting growth and development (coloring books, video, games, quiet, play, and isolation room
Home care instructions to the parent of a child who is receiving chemotherapy should include information about
Manifestations of infection Bleeding precautions Hand hygiene
Military TB
Massive numbers of tubercle bacilli are released into the bloodstream and then disseminated to other organs CNS involvement Meningitis is a serious and often fatal complication seen almost exclusively in children younger than 4 years and
Characteristics of infections
Maybe localized or systemic May have rapid onset or occur longer after exposure , may lay dormant May mimic other diseases May manifest in different ways
Assessing for sepsis
Measure temperature, heart and respiratory rate Check laboratory values that denote systemic inflammatory response and sepsis Automatically Suspect any ill infant during the first 90 days of life Infant presenting with non-specific symptoms Perform the 5 tests for sepsis
The patient has pertussis. What should the nurse expect?
Runny nose Mild fever Cough with whooping sound
Mycobacterial infections
NTM species are found everywhere in nature: soil, food, water, animals NTM may also be known as atypical mycobacterial infections or mycobacterium avium complex The most common presentation in children is cervical lymphadenitis that does not respond to typical antibiotic therapy An otherwise healthy child typically presents with cervical lymph nodes that are usually firm, mobile, and nontender. history shows that the lymph node continues to enlarge overtime and the overlying skin has turned a bluish purple color TB skin test can confirm diagnosis since NTM and TB be sure many of the same antigens, but NTM induration reaction is usually less than 10 mm Chest x-ray will rule out TB if the TST is reactive Treatment: excision of the infected lymph nodes is considered curative Drug therapy: involves 2 to 3 drugs over 6 to 12 month period (like TB) Children with HIV should receive antibiotic prophylaxis for NTM
Coarctation of the aorta
Narrowing of the aorta pass the arch Decreases systemic blood flow Flushed face, Bounding hand pulses, feet will be cold and pale, blood pressure high up top, low below Treatment : surgery (balloon angioplasty) repair in the Cath Lab High blood pressure before the point of coarctation Low blood pressure beyond the point of coarctation Hypertension >=< hypotension
What is coarctation of the aorta?
Narrowing of the aorta past the arch This defect may be fixed in the Cath Lab
Siblings of Terminally ill or dying child
Need validation that they suffered a loss as well Resolve issues of guilt/blame Same emotions as parents Unresolved grief into adulthood
WBCs and their functions
Neutrophils: phagocytosis Eosinophils: allergic reaction Basophils: inflammatory reaction Monocytes (macrophages): phagocytosis, antigen processing Lymphocytes: humoral immunity B cell,cellular immunity T cell
Erythema Infectiosum (Fifth Disease)
No cure Last around 14 days Commonly happens in children ages 4 to 12 Harmful during pregnancy Flu like symptoms due to infection with parvovirus B19 Lacy rash, not itchy Characteristic slapped red cheek appearance, then red spots appear on different parts of the body
Thalassemia minima
No hematologic abnormalities
After pediatric cardiac catheterization
No lifting No tub bath Site checks Bed rest 4-6 hours Neurovascular assessment Allergies V/S, O2 sat Comfort item (toy)
Clinical manifestations of communicable diseases
Non-specific symptoms Fever (most common) Fatigue Malaise Weakness Aches Decreased appetite Nausea/vomiting/diarrhea
Treatment of ITP
Not all require treatment Steroids decrease the rate of platelet destruction Intravenous gammaglobulin slows destruction Treat infection if it is the cause of ITP Hormone therapy and teenage girls to stop menses Splenectomy if the spleen is the site of platelet destruction(more common with older children with chronic ITP)
Toxoplasmosis
Oocytes are the Highly infectious form Transmission by eating food contaminated with, or inhaling dust that contains oocytes from cat feces Causes fetal demise Usually asymptomatic Ocular toxoplasma infection can result from congenital or acquired infection. You can cause tissue necrosis in the retina, vitreotis, iridocyclitis, and Cataracts Untreated/undetected, congenital infections usually manufacturing adolescence is ocular disease(Chorioretinitis.) Treatment with pyrimethamine and sulfadiazine. They work synergistically and serve, along with leucovorin , as standard therapy. Infants with a congenital disease are treated for 12 months Teaching: Wash all fruits and vegetables Freeze all meats and cooked thoroughly before consuming Avoid steak tartar and other raw meat pates Do not allow pregnant women to empty cat litter boxes
A child is noted to have leukocoria. Which diagnostic test can a nurse facilitate based on this assessment? A lumbar puncture B ophthalmic exam C abdominal ultrasound D muscle biopsy
Ophthalmic exam
A child who is mildly symptomatic with HIV may have
Oral candidiasis Hepatomegaly Lymphadenopathy
Routes of chemotherapy administration
Oral, subcutaneous, IM, IV, or intrathecal (spinal) IV push and IV piggyback are the most common.
The patient has a rubeola. What should the nurse monitor for?
Otitis media Laryngitis
A nurse instructs the parent of a child with sickle cell disease about factors that might precipitate a pain crisis in the child. What factor would not cause a pain crisis
Overhydration
A newborn is diagnosed with a CHD. The test results revealed that the lumen of the duct between the aorta and the pulmonary artery remains open. This defect is known as what?
PDA
Indomethacin may be given to close which CHD in newborns?
PDA
While assessing a newborn with respiratory distress, the nurse auscultates a machine like heart murmur. Other findings are a wide pulse pressure, periods of apnea, increased PaCO2, and decreased PO2 the nurse suspects that the newborn has.
PDA
Congenital heart Disorders that increase pulmonary blood flow
PDA ASD VSD
What will be abnormal in a child with a diagnosis of hemophilia?
PTT
Expected symptoms of a child who has rhabdomyosarcoma of the upper arm
Pain Lymph node enlargement Palpable mass
S/S of changes in blood cell production
Pale Tired Bruises easily Possibly petechiae
Manifestations of iron deficiency anemia
Pallor Fatigue Irritability Pica
Clinical manifestations of leukemia
Pallor and fever Lethargy Anorexia Weight Loss Hemorrhage, petechiae Hepatomegaly, splenomegaly
Nursing evaluation of immunizations
Parent fully informed and consent to immunization Immunizations are appropriate for the child's age Parents are prepared to manage my reactions at home Advil can be given before and after for the first 24 hours
A child has been diagnosed with long QT syndrome. The nurse counseled the family to have genetic testing. Which family members does the nurse encourage to be tested?
Parents and all siblings
While looking through the chart of an infant with CHD of decreased pulmonary blood flow, the nurse would expect which laboratory finding?
Polycythemia
Which physiological changes occur as a result of hypoxemia in CHF?
Polycythemia and clubbing
Behaviors of children that contribute to disease transmission
Poor hygiene, leaking diapers(fecal-oral route) Poor handwashing (fecal-oral and contact route) Don't blow their nose often (nasal secretions) Daycare staff may not use proper handwashing techniques
When caring for a toddler who has Wilms tumor, what action should the nurse take?
Prepare the child for surgery
Goals of oral care
Preserve the integrity of the oral cavity Promote oral comfort Promptly treat any oral problems that occur
Planning an implementation for the child with cancer
Prevent infection Skin and mouth care Attention to Renal function (chemotherapy extremely toxic to the kidneys) Monitor IV site for extravasation even with a Central line Red blood cell, platelet administration Chemotherapy administration Psychosocial interventions (schoolwork, friends)
Evaluation: Expected outcomes for a child with cancer
Prevention of infection Adequate hydration Normal urine output Normal Blood values Adaptation to illness
Dying process
Privacy -Stop unnecessary testing -Encourage spending time Oral intake/care -Diminished intake is normal -Loss of ability to swallow days before death -Fluids may cause discomfort -Provide oral care -If thirsty, offer ice/water -Dry lips (use lip balm or petroleum jelly) -Include parents in providing care
Mucositis
Progressive, inflammatory, ulcerative condition of the oral and gastric mucosa due to the interruption of cell renewal process leading to Mocosal atrophy and ulceration Thrombocytopenia, or physical trauma, may lead to bleeding and further mucosal damage Neutropenia and poor dental hygiene, predispose the oral mucosa to secondary infection Orthodontics may need to be removed from the adolescent as a precaution Adequate hydration is essential to prevent drying and cracking Detailed dental history is needed Meticulous oral care, rinsing with water, no brushing
Aspirin has been ordered for the child with RF in order to:
Reduce joint inflammation
What confirm a diagnosis of Hodgkin disease in a 15-year-old?
Reed Sternberg cells in the lymph nodes
Which is appropriate family discharge teaching following a child's cardiac catheterization
Remove pressure dressing the day after the catheterization Avoid strenuous exercise for several days Resume the child's normal diet once home
The following can lead to a possible diagnosis of HIV in a child
Repeated respiratory infections Intermittent diarrhea Poor weight gain
Tricuspid artresia
Requires emergency intervention No tricuspid valve, so no blood flow through the pulmonary artery to the lungs Requires prostaglandins
Highly indicative signs of HIV
Respiratory tract infections (repeated or persistent) Otitis or sinusitis (repeated or persistent) Severe bacterial infections Opportunistic infections, such as candidiasis or thrush Poor response to appropriate therapy (immune compromised)
S/s of enteroviruses
Respiratory: cold-like symptoms, sore throat, herpangina, stomatitis, pneumonia Skin: rash Neurologic: aseptic meningitis, encephalitis Gastrointestinal: nausea, vomiting, diarrhea, abdominal pain Eye: conjunctivitis Heart: myopericarditis
What should the nurse do when preparing an infant for lumbar puncture?
Restrain the infant during the procedure to prevent movement
Bacterial endocarditis
Results from a bacterial infection Usually after dental cleaning or surgery More common in children with damaged heart valves, her heart disease Fever of unknown origin Malaise Fatigue Decreased appetite
A 10 year old child is recovering from a severe sore throat. The parent states that the child complains of chest pain. The nurse observes that the child has swollen joints, nodules on their fingers, and a rash on the chest. The likely cause is ?
Rheumatic fever
What nursing diagnosis is most important for a child with Ewing sarcoma who will be undergoing chemotherapy?
Risk for fluid volume deficit, because of possible n/v, and diarrhea
Nursing Diagnosis for immunizations
Risk for infection (if they don't get vaccines) Knowledge deficit Risk for injury Risk for impaired skin integrity (localized) Ineffective health maintenance (if they elect to not receive vaccines)
Arrhythmias
Risks: anytime the heart is manipulated -Surgery -Cath Lab Electrolyte imbalance Hemodynamic changes Nursing actions: monitor pulse, BP and LOC Bradycardia, SVT, long QT Vfib is a lethal arrhythmia where the heart is quivering, but not pumping and has to be shocked Treatment: Ablation, ICD/pacemaker, cardioversion
Most common tickborne diseases
Rocky mountain spotted fever Human monocytotropic Ehrlichiosis (HME) Lyme disease
These communicable diseases can lead to pneumonia
Rubeola Pertussis Varicella
Scarlet fever
Sore throat, flush face, pallor, moderate fever Allergy-like red rash, appears in the groin and armpits, then spreads to the neck, torso and beyond Red rash looks like a sunburn, and feels like sandpaper Keep calm, limit contact, monitor for secondary infections Rheumatic fever and carditis are complications Droplet precautions Has a strawberry like tongue and peeling skin caused by the strep bacterium Treat with antibiotics
A child with a new diagnosis of osteosarcoma may need the nurse to
Spend time with them to answer any questions
Lyme disease
Spirochete (infected when the tick draws blood) Malaise, headache, fever, joint aches Red BULLSEYE rash around bite Treatment: 14 to 28 days of antibiotics (doxycycline) Nursing: discuss prevention of tick bites and proper tick removal Treatment usually occurs at home Rest and completion of antibiotics
Arboviral infections
Spread by mosquitoes, ticks, sandflies, and other biting arthropods Can cause CNS disease, fever with rash and headache, joint pain, and occasionally hemorrhagic fever with hepatitis Birds and small mammals are the primary Reservoir Humans and domestic animals are infected incidentally when an arthropod bites an infected animal, picks up the virus and then bites a person or pet. Person-to-person transmission does not occur except through blood, transfusions, interuterine transmission, and possibly through human breastmilk
During play a toddler with a history of TOF might assume which position?
Squatting
Which isolation precaution should the nurse implement for a child who has AIDS?
Standard
What is the narrowing of a valve called?
Stenosis
What should be provided for comfort when Administering immunizations to a four month old
Sucrose solution on a pacifier
A toddler who has been hospitalized for vomiting because of gastroenteritis, is sleeping and difficult to wake up. Assessment reveals vital signs of regular HR 220 bpm, RR of 30 per minute, BP of 84/72, and capillary refill of 3 seconds. Which dysrhythmia does the nurse suspect in this child?
Supraventricular tachycardia SVT
The most common cardiac dysrhythmia in the pediatric population is
Supraventricular tachycardia SVT
The nurse is teaching the parent of a child who has a Wilms tumor. She should say the following.
Surgery is done usually within 48 hours of diagnosis Palpating the tumor could cause spread of the cancer Further treatment will start immediately after surgery
Treatment of Wilms tumor
Surgery: Nephrectomy preventing rupture of the capsule and a Sample is sent to pathology for biopsy Chemotherapy and radiation are giving based on the stage of the disease Monitor output after surgery
A nurse expects which clinical manifestation in a child diagnosed with SCID
Susceptibility to infection
Which activity should a nurse suggest for a client diagnosed with hemophilia
Swimming Golf Hiking Fishing
Rheumatic, heart disease
Systemic, inflammatory disease that occurs after group A beta hemolytic streptococcal infection Untreated, infection can cause, bacteria or fungi to travel to the lungs, brain, kidneys, or other organs, and even cause damage to the heart valves Abdominal pain, nosebleeds, chest pain with heart palpitations, and waking from sleep with the need to sit or stand will be revealed on assessment
What diagnostic tests evaluate congenital heart defects?
TEE TTE Echocardiogram Ultrasound Cardiac catheterization
TB diagnosis
TST with a wheal of 6mm to 10 mm is crucial for accurate testing ( usual minimum 8mm)
S/a heart failure (late)
Tachycardia Tachypnea Pallor/cyanosis Grunting Nasal flaring Retractions
A six month old who has episodes of cyanosis after crying could have the CHD of decreased pulmonary blood flow called
Tetralogy of fallot TOF
The nurse is caring for a child being treated for ALL laboratory results indicate that the child has a white blood cell count of 5000/mm3 with 5% polys and 3% bands. Which is an appropriate analysis.
The absolute neutrophil count is 400/mm3 and the child is neutropenic.
A nurse is caring for a child with von Willebrand disease. The nurse is aware that the following is a clinical manifestation of von Willebrand disease.
The child bruises easily Excessive menstruation The child has frequent nose bleeds
The parent of a two-year-old who is HIV+ questions the nurse about placing the child in daycare. What is the nurses best response
The child can go to daycare without restrictions and should be allowed to participate in all activities
An 18 month old is discharged from the hospital after having a febrile seizure secondary to roseola. On discharge, the mother asked the nurse if her six year old twins will get sick. What is an accurate teaching about the transmission of roseola?
The child does not need to be isolated from the other siblings
The nurse receives a call from a parent of a child with leukemia in remission. The parents as a child has been exposed to chickenpox and has never had it. What response is most appropriate for the nurse?
The child has had two varicella immunizations, but is no longer immune after chemotherapy You need to bring the child to the clinic for a varicella immunoglobulin vaccine
what needs to be included in a teaching plan for a child with sickle cell disease
The child needs to be taken to a physician when sick Emotional stress should be avoided Is important to keep the child well hydrated Is important to make sure the child gets adequate nutrition
The parent of a child diagnosed with Wilms tumor asked the nurse what the treatment plan will be. The nurse explains that the usual protocol for this condition is...
The child will go to surgery for removal of the tumor & the kidney and will then start chemo therapy
On examination, a Nurse hears a murmur at the LSB in a child with diarrhea and fever. The parent asked why the healthcare provider never mentioned the murmur. The nurse explains.
The fever increased the intensity of the murmur
The nurse is caring for a 10 year old with leukemia who is receiving chemotherapy. The child is on neutropenic precautions. Friends of the child come to the desk and ask for a vase for the flowers they have brought with them. What should the nurse say?
The flowers from your garden are beautiful, but should not be placed in the room at this time
Leukemia
The most common childhood, cancer, and accounts for approximately 1/3 of all cases diagnosed in children younger than 15 years of age Increased incident in those with chromosomal disorders, such as down syndrome High survival rate
Heart failure
Too much fluid, volume for the heart to handle Reasons for development : Increase in volume Pressure gradient Decreased contractility Increased cardiac demand
Diphtheria
Transmission: contact with nasal or eye discharge Systemic manifestations: fever, anorexia, rhinorrhea, cough, stridor Treatment: IV antibiotics, IV antitoxin Nursing: isolation, monitor for respiratory distress, administer antibiotics Skin manifestations: pale pink rash on trunk face neck and limbs
WNV
Transmitted through the bite of an infected mosquito Also transmitted through blood transfusions and organ transplantation Intrauterine transmission and transmission in human breast milk. such cases are rare and transmission in human breast milk has not been confirmed. Occurs in late spring, summer, and early fall Sudden onset of fever, headache, muscle ache, weakness Abdominal pain with nausea, vomiting, or diarrhea Some have a rash If CNS disease, present with typical signs of meningitis are encephalitis Treatment is supportive Standard precautions recommended PREVENTION IS KEY
A pediatric intensive care nurse is providing care to a patient with disseminated intravascular coagulation. Which treatment option is most appropriate for this patient?
Treat the underlying conditions
Epstein-Barr virus (EBV)
infectious mononucleosis Presents with fever and sore throat Swollen lymph glands and possible rash or jaundice Lethargy and exhaustion are common Often called kissing disease Avoid contact activities because of hepatosplenomegaly Spread through direct and indirect contact with nose and throat secretions of infected child or person They need rest Associated with malignancies: Burkett's lymphoma Nasopharyngeal cancer Hotchkin disease And some auto immune disorder such as sjorgen syndrome
Thrombocytopenia
low platelet count
pancytopenia
deficiency of all types of blood cells
aplastic anemia
failure of blood cell production in the bone marrow
Which laboratory test will be ordered to determine the presence of the human immunodeficiency virus antigen in an infant whose mother is HIV+
p24 antigen assay
