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68WM6 Peds 2
Pediatrics 2 68WM6
| Question | Answer |
|---|---|
| What things should be in a physical assessment of cardiac function? | Auscultation, inspection, palpation for PMI, capillary refill, percussion |
| List 3 things you would do to help prepare a child for a cardiac catheterization. | Describe the procedure to the parents and the child on their level, Obtain baseline O2, Describe expected length of catheter based on child’s height and post procedure care (sedation,iv,npo) |
| What are the most important nursing responsibilities after a child returns from a cardiac catheterization? | Check pulses (equality/symmetry), Check temp & color, Monitor VS q 15 min (BP for hypotension), Assess drsg for evidence of bleeding or hematoma |
| Your patient just returned from cardiac catheterization. While assessing her, you note bleeding from the cath site. What should you do immediately? | Apply pressure direct & continuous 2.5cm above the percutaneous skin site. |
| What are 5 factors (maternal) that may cause congentital heart disease? | Diabetes Mellitus, PKU (poorly controlled), Alcohol consumption, Exposure to environmental toxins, Infections |
| You are taking care of a 2 day old infant. During your assessment, you note additional heart sounds, a discrepancy between the apical and radial pulses and blood pressure and dyspnea. What are these signs and symptoms of? | CHF |
| You are giving Digoxin to a 2 year old child. What do you need to do prior to administering the medication? | Take apical pulse for one full minute. |
| Your patient is having a “blue spell.” What do you do? | Calm the infant, Place child in knee chest position, Give blow by o2 100%, Call for help, IV fluids/morphine as ordered |
| Name 3 types of congenital defects that increase pulmonary blood flow. | Atrial septal defect (ASD), Ventricular septal defect (VSD), Patent ductus Arteriosis (PDA) |
| What are the clinical manifestations of Ventricular Septal Defect? | CHF s/s, Tachycardia, Sweating, Gallop, Tachypnea, Dyspnea, Weight Gain, Neck vein distention, Edema (pg 907) |
| How is Ventricular Septal Defect (VSD) treated? | Surgical (palliative or complete repair), Non surgical (device closure with cardiac cath) |
| What is a Patent Ductus Arteriosis (PDA)? | Failure of the fetal ductus arteriosis to close with inthe first weeks of life which allows blood to flow from aorta to pulmonary artery causing left to right shunt. |
| What is a typically the first sign of Patent Ductus Arteriosis? | Machine like murmur. |
| What do you need to observe for with a post anastomosis from Coarctation of the Aorta? | Post op hypertension > 160mm Hg treated with IV sodium nitroprusside or PO amrinone (pg 900) |
| What defects are present in Tetralogy of Fallot? | Ventricular Septal Defect, Pulmonic Stenosis, Overriding Aorta, Hypoxia, Anoxia |
| Explain hypoplastic left heart syndrome. | Underdevelopment of the left ventricle and aortic atresia. Most blood from the left atrium flows across the patent foramen ovale to the right atrium to the right ventricle and out the pulmonary artery to the descending aorta receiving blood from the PDA. |
| Heart disease is classified into what 2 categories? | congenital, acquired |
| Your 3 month old pt has dyspnea, retractions, nasal flaring, wheezing, gruntin, and occasional cyanosis. Which group of manifestations of congestive heart failure is she categorized in? | Pulmonary congestion: 3 types of manifestations (Impaired myocardial function, Pulmonary congestion, Systemic venous congestion) |
| How do you decrease cardiac demands on a 5 year old with congestive heart failure? | Limit physical activity (bedrest), Preserve body temp, Tx infections, Decrease effort of breathing (ie; semi-fowlers), Meds to sedate if irritable |
| List 3 common nursing diagnoses for a pt in CHF: | decrease cardiac output, ineffective breathing pattern, fluid volume excess |
| You administered digoxin to you 8 month old pt 1 hour ago. Your pt is now experiencing signs of digoxin toxicity. What s/s would you expect to see? | GI-nausea, vomiting, anorexia, Cardiac-bradycardia, dysrhythmias |
| What should be included in the teaching for an 8 month old patien with Hx of CHF who is pending discharge? | digoxin q 12, 1 hr before or 2 hr after meals, Calendar to keep track of dose d. Refill as needed, Slowly direct med to side/back of mouth, Don't mix with fluid/food, Brush teeth & drink water, If >4 hrs hold & Vomit don't repeat |
| When is bacterial endocarditis most likely to occur? | After an infection |
| A 15 yo has a Hx of bacterial endocarditis. He is scheduled to have his wisdom teeth removed. What does he need to do prior to the procedure? | Take abx |
| List 4 objectives of nursing care for a child with rheumatic fever. | encourage compliance with drug regimens, facilitate recovery from illness, provide emotional support, prevent disease. |
| What is chorea and what does the nurse need to do for the child? | Manifestation of rheumatic fever, Involuntary movements suddenly that is transitory and usually disappears, weakness |
| Explain the AAP guidelines for treating children with high cholesterol. | 2 step dietary approach that restricts the intake of cholesterol and fat, 7% of calories = saturated fat, 200mg/day of cholesterol intake |
| Your pt is taking Cholestyramine (Questran). What side effects do you need to monitor the pt for? | Constipation, abdominal pn, GI bloat, flatulence, nausea |
| What are signs and symptoms of cardimyopathy? | S/S CHF, Tachycardia, Dyspnea, Hepatosplenomegaly, Fatigue, Poor growth, Dysrhythmias |
| What is the difference between dilated, hypertrophic and restrictive cardiomyopathy? | Dilated ventricular dilation with decreased contractility leading to s/s CHF, Hypertrophic increased size of heart muscle w/o increase in cavity size (left ventricle), Restriction to ventricular filling due to endocardial or myocardial dz |
| True or False - Essential hypertension is primarily caused by vascular dz | False |
| What is the difference btwn significant and severe hypertension? | Significant hypertension persistently btwn 95th and 99th. Severe hypertension - persistently > 99% for age/sex/ht |
| 7 y/o male whose BP is 145/92. He denies having a headache, blurred vision and has not had visual changes. His other vitals are within normal limits and he has no significant FHx or personal Hx of hypertension. What causes hypertension? | Large for his age, family Hx of hypertension, Wrong Cuff Size |
| 5 clinical manifestations of Kawasaki's dz? | fever > 5 days, Bilateral conjunctival infection w/ exudate, changes in oral mucous membranes (Strawberry Tongue), Changes in extremities, Polmorphous rash, Cervical lympodenopathy (1 node > 1.5cm) |
| Your pt has polymorphous rash and is c/o itching and burning skin. What can you do to promote comfort w/ this pt. | Cool cloths, unscented lotions, soft loose clothing |
| Describe risks, pathophysiology, manifestations, diagnosis and treatment of leukemia. | Unrestricted proliferation of immature WBCs, S/S- amenia, infection, bleeding, DX- Peripheral blood smear with immature cells;bone marrow aspiration; lumbar puncture, TX-Induction tx, cns prophylactic tx;intensification tx;maintenance tx |
| Describe the pathophysiology, manifestations, Tx and nursing care for Hodgkins dz. | Lymph node involement (staging 1-4), S/S Painless enlarged lymph glands, low temp, anorexia, nauses, wt loss, night sweats, pruritis, Tx - Radiation & Chemotherapy (nurse preps) |
| What are 2 types of leukocytes? | Granular & Non-granular |
| What is the primary function of the spleen? | Bring blood into contact w/ lymphocytes |
| True or False - Anemia is the most common hematologic disorder of infancy. | True |
| Name 4 s/s of exertion that you would expect to see in an anemic child. | Lack of energy, Easily fatigued, Pallor, Decreased hemoglobin & hematocrit |
| Why are children btwn the age of 12 & 36 months at risk for iron deficiency anemia? | Due to cows milk being a major food staple, Iron deficiency decreased with initiation of WIC |
| You are caring for a child being discharged with a prescription for oral iron. What teaching should you provide to the parents regaurding the iron? | Give in 2 divided doses btwn meals, Citrus fruit or juice taken with meds aid in absorption |
| Explain how a child inherits sickle cell anemia. | It is an autosomal recessive disorder-when both parents have sickle cell trait there is a 25% chance each pregnancy will produce offspring with sickle cell anemia. |
| What are four types of sickle cell crises? | Aplastic Crisis, Vasocclusive Crisis, Splenic Sequestration, Hyperhemolytic |
| What are s/s of Aplastic Crisis? | Bone marror stops producing RBCs |
| What are s/s of Vasocclusive Crisis? | Painful, characterized by distal eschemia and pn. |
| What are s/s of Splenic Sequestration? | Pooling of large amounts of blood in the liver and spleen. |
| What are s/s of Hyperhemolytic? | An accelerated rate of RBC destruction characterized by anemia, jaundice, and reticulocytosis. |
| Acute chest syndrome is a serious complication of sickle cell anemia. What are the signs and symptoms? | Chest pn, Fever, Cough, Tachypnea, Wheezing Hypoxia |
| Why do kids with sickle cell dz need to stay well hydrated? | To prevent sickling and to delay the stasis-thrombosis-ischemia cycle in a crisis. |
| List three things that you can do to support a child with sickle cell during a crisis: | Rest to minimize energy expenditure and O2 use, Hydration through oral & IV therapy, Electrolyte replacement, Analgesics, Blood replacement |
| Who is at most risk of devoloping Thalassemia? | Mediterrain descent |
| What is Cooley's Anemia? | Thalassemia Major |
| What is Fanconi Syndrome? | A rare hereditary disorder characterized by pancytopenia, hypoplasia of the bone marrow and patchy brown discoloration of the skin. |
| What factors contribute to the development of acquired aplastic anemia? | Idiopathic - 70% |
| The less Factor VIII found in the blood, the (more/less) severe the dz. | More SEVERE |
| List the common s/s of hemophilia: | Prolonged bleeding from anywhere on the body, Hemorrhage from trauma, Excessive bruising, SQ & IM hemorrhages, Hemarthrosis, Hematomas, Hematuria |
| What things can you teach a child and family w/ hemophilia to prevent bleediing? | s/s of internal bleeding, headache, slurred speech, loss of consciousness, black tarry stools |
| What is Idiopathic Thrombocytopenic Purpura (ITP)? | An acquired hemorraghic disorder characterized by thrombocytopenia, pupura and normal bone marrow w/ normal or increased number of immature platelets and eosinophils. |
| True or False: ITP is self-limiting | True |
| How is ITP treated medically? | Supportive care of of symptoms |
| What is the most common form of childhood cancer? | Leukemia |
| What type of diet should a child with leukemia be placed on? | High protein, high calorie |
| True of or false: Hodgkin's dz is twice as common in females as in males? | False |
| List 4 common manifestations of Hodgkin dz: | Painless enlargement of lymph nodes, Non-productive Cough, Unexplained abd pn, Low-grade fever, Anorexia, Nausea/Vomiting, Night sweats, Pruritis |
| What are s/s of Stage I Hodgkin's dz? | Restricted to a single group or localized in a group of lymph nodes |
| What are s/s of Stage II Hodgkin's dz? | Two or more lymph nodes in the same area or same side of diaphragm are affected |
| What are s/s of Stage III Hodgkin's dz? | Involves lymph nodes on both sides of the diaphragm; involves adjacent organs or spleen |
| What are s/s of Stage IV Hodgkin's dz? | Diffuse dz; least favorable prognosis |
| True or False: An infant produces copious amounts of saliva in the first few montshs of life? | False |
| Explain why infants and children are more prone to dehydration? | Greater fluid intake and output relative to size than adults, Adjust less promptly to these alterations |
| Describe Isotonic dehydration: | primary form found in children; occurs when there is a balance in electrolyte and water deficits |
| Describe Hypotonic dehydration: | Occurs when the electrolyte deficit exceeds the water deficit |
| Describe Hypertonic dehydration: | Results from water loss in excess of electrolyte loss. This type is the most dangerous |
| Name 3 things essential to nursing care of a child w/ dehydration | Strict I&Os, VS, Daily weights |
| What is the difference btwn acute and chronic diarrhea? | Acute: Sudden increase in frequency and change in consistency, Chronic: Increase in stool frequency and increase in water content, with a duration of greater than 14 days. |
| What is the most common cause of serious gasteroenteritis among children; and is a source of nosocomial infections? | Rotovirus |
| What things should a child undergoing fluid therapy avoid? | Anti-emetics w/ IV fluids, Caffeine, Elevated sodium, Elevated carbohydrates, Brat diet |
| What is ORT and what is it used for? | Oral rehydration therapy and its the best intervention for diarrhea |
| What are the types of constipation? | Constipation: alteration in frequency, consitency, or ease of passing stools, Obstipation: when there is long intervals btwn stools, Encopresis: constipation with fecal soiling |
| How long before the newborn passes a first meconium stool? | Normally, within 24 to 36 hours after birth |
| A mother has three month old infant who has frequent bouts of constipation. She asks the nurse, what she can do to help relive the problem. What is your best response? | Increase cereal, vegetables, and fuit in diet. Increase FIBER! |
| What is Hirschsprung's dz? | mechanical obstruction caused by inadequate motility of part of the intestine |
| List 5 common manifestations of Hirschsprung's dz in infancy: | Failure to pass meconium w/in 48 hours, Refusing to feed, Bilious vomiting, Abd distention, Failure to thrive |
| List 2 common antiemetic drugs commonly prescribed for children: | Zofran & Tigon |
| Your 2 y/o pt was admitted for severe vomiting. What is the best position to place this child in to prevent aspiration? | Semi-fowlers |
| Which infants and children are especially prone to reflux | Premature infants, Infants w/ bronchopulmonary dysplasia, Children w/ tracheosophageal or esophageal atresia |
| List 5 s/s of GER in children: | Heartburn, Abd pn, Non-cardiac chest pn Chronic cough, Dysphagia |
| What is the Nissen fundoplication? | The most common procedure for surgically correcting GER in children. It involves passing the gastric fundus behind the esophagus so that it encircles the distal esophagus |
| What foods should an adolescent w/ a HX of GER avoid? | Caffeine, chocolate, spicy foods (these weaken the lower esophageal sphincter) |
| True or false: There is an association btwn being overweight and GER | True |
| You are caring for a 7 y/o male who c/o RLQ abd pn, rebound tenderness, and vomiting. What are these s/s of? | Appendicitis (although rebound tenderness is an unreliable sign) |
| What are primary postoperative goals for a child who is 3 hours post-appendectomy? | Pain Control, Express feelings, Prevent postop infection |
| What is Meckel's diverticulum? | A remnant of the fetal ophalomesenteric duct that connects the yolk sac w/ the primitive mid-gut during fetal life. |
| Where is Meckel's diverticulum more common in? | Males (Twice as common) |
| List 3 common clinical manifestations of Crohn's dz: | Diarrhea, Pain, Anorexia |
| What type of diet is recommended for a child w/ Crohn's dz? | High-protein & high calorie |
| What is a primary ulcer? | Ulcers that occur in the absence of predisposing factors and are chronic |
| What is a secondary ulcer? | Ulcers that are due to stress of another underlying dz |
| What causes peptic ulcer dz? | Exact cause is unknown. Bacterial infection such as h. pylori may contribute to ulcer formation as well as environmental and genetic factors |
| What is the most reliable procedure to diagose PUD? | Endoscopic biopsy to determine the presence of h. pylori |
| What are esophageal atresia & tracheoesophageal fistula though to be a result of? | Failed separation of esophagus and trachea by a septum that forms during 4th week of gestation |
| What is the acronym VATER? | V-Verterbral A-Anorectal T-Tracheo E-Esophageal R-Renal Abnormalities |
| What is the acronym VACTERL? | V-Verterbral A-Anorectal C-Cardiovascular T-Tracheo E-Esophageal R-Renal L-Limb Abnormalities |
| What are the three "C's" of Tracheoesophageal Fistulas (TEF)? | Coughing Choking Cyanosis |
| True or False: Esophageal Astesia can be managed at home w/ frequent small feedings of thickened formula? | False |
| You are caring for a 2 week old pt with TEF/EA. She is pending d/c. What things do you need to teach the parents? | Educate and practice care of gastrostomy |
| True or False: An incarcerated hernia can be put back in place by applying gentle pressure to the affected area. | False |
| What is the strangulated hernia, and when is it most likely to occur? | Blood supply to herniated organ is impaired and occurs before 6 months of life. |
| Pyloric stenosis is a congenital anomaly. In what infants is it more common? | First-born Males |
| List 5 common nursing interventions for a child that is post-pylormyotomy | Monitor IV Fluids, VS, I&Os, Observe & Control Pain, NG tube maintained - start with clears/glucose/electrolytes |
| Explain intussusception and the results if not treated: | Occurs when a proximal section of the bowel telescopes into a more distal segment, pulling mesentery with it (impeding arterial blood flow). If untreated, can result in necrotic bowel and eventually death |
| What are currant jelly stools? | Stools mixed with blood and mucus. |
| What is celiac dz? | A dz of the proximal small intestine that is characterized by abnormal mucosa & permanent intolerance to gluten. Tx AVOID Gluten in diet. |
| What is the role of the kidneys? | Maintain homeostasis, Produce substances that stimulate RBC formation in bone marrow, Produce renin to regulate BP |
| Why are children more susceptible to dehydration and overhydration than adults? | They adjust less promptly to fluid alterations |
| True or False: Genitals of preterm females appear underdeveloped | True |
| What is Phimosis? | Narrowing or stenosis of the preputial opening of foreskin |
| What is the purpose of urodynamics and the process as if you were explaining it to a 5 y/o child? | To assess problems with voiding |
| Why are UTIs more common in girls than in boys? | Shorter urethra |
| You are caring for an infant whose mother states she has a UTI. What manifestations would you expect to see? | Poor feeding, Vomiting, Failure to gain weight, Increased respiratory rate, Respiratory distress |
| What criteria may require urodynamic testing treatment? | More than three UTIs in one year |
| What nursing education can you provide a 7 y/o child on preventing UTIs? | s/s of UTI: poor appetite, vomiting, increased thirst, painful urination, Increase fluids, water, Girls should wipe from front to back (meatus to anus) |
| What is polycystic kidney dz? | Cyst on the kidney |
| What type of problems is the child with a urinary stone prone to? | Infection, Damage, Obstruction, Body image disturbance |
| Your male preschool pt is scheduled for GU surgery. What impact might you expect the surgery to have on this child? | Increased anxiety |
| Following postop of GU. What teaching would the nurse be required to provide? | No tube baths x 1 wk, Keep surgical site clean, Catheter or stoma care prn, Restrict activity (push, life, straddling) |
| True or false: Nephrosis is more common in boys than girls | True |
| What are common manifestations of nephritic syndrome in children? | Wt gain, pleural effusion, fatigue, edema, diarrhea, lethargy, ascites, anorexia, decreased urine volume, irritability, frothy urine |
| Your are caring for a 6 y/o with nephritic syndrome. What is the most important nursing invervention for the patient? | Continuous monitoring of fluid restriction excretion. STRICT I&Os! |
| What is the dz formerly known as "Bright's Disease"? | Acute glomerulonephritis |
| List three common manifestations of acute glomerulonephritis: | Edema, Anorexia, Tea/cola colored urine |
| Two-thirds of growths of Wilm's tumor are discovered before what age | 5 y/o |
| For a child with Wilm's tumor, what should be placed inside their crib as a warding for all that interact with the child? | DO NOT palpate tumor / abdomen |
| List 2 nursing Dx related to kidney removal secondary to Wilm's tumor: | Risk for fluid volume deficit, Altered family processes |
| What is the principle feature of acute renal failure (ARF)? | Oliguria |
| ARF is usually (reversible/irreversible) and mortality is peds is (high/low) | Reversible, High |
| What are the signs of hyperkalemia? | Cardiovascular changes, Prolonged QRS complexes, Depressed ST segment, High peaked T waves, Badycardia, Heart block |
| What are 2 complications that children with ARF are more prone to? | Water intoxication & Hyponatremia |
| Name three nursing considerations when caring for a child with ARF. | Strict I&Os, VS, Alert for s/s of complications |
| What is chronic renal failure? | Long standing kidney disease or anomaly |
| What is acute renal failure? | Sudden failure due to inadequate kidney perfusion or urinary obstruction |
| As chronic renal failure advances, what manifestations might a child experience? | Decreased energy, fatigue, Pallor, Increased BP, Decreased appetite, Change in urine output, Headache, Muscle crapms, Nausea |
| What is one major consequence of chronic renal failure, and what has been successful in countering this? | Growth failure, growth hormones |
| List three common nursing Dx for childrena in chronic renal failure: | Risk for injury, Fluid volume excess, Altered Nutrition |
| More than ________________ of dermatologic problems in children are forms of dermatitis. | One-half |
| It is important when interview the child and parents to ascertain what information about legions? | When the lesion/symptom first appeared |
| How are wounds classified? | Acute & Chronic |
| How are burns classified? | Minor, Moderate, or Major |
| List 2 factors that influence healing of wounds in children: | Maintain moist, crust free environment DO NOT use antiseptics |
| What is the goal of therapy for treating some skin disorders in children? | Prevent further damage Eliminate the cause Prevent complications Provide relief from discomfort |
| What should a tradition dry dressing not be used on open wounds? | It allows drying of the wound, does not prevent bacterial invation, and adheres to the dried scab |
| What do you assess for when you palpate the skin of the child with lesions? | Detect characteristics of the lesion (temp, moisture, texture, elasticity, edema) |
| How would you teach a parent to help prevent scratching in a 3 y/o with lesions? | Cool affected area and increase skin pH with cool baths or compresses Alkaline applications (baking soda) are helpful in coolin and reducing itch |
| Topical applications are applied to the skin to ____________, to prevent _____________, and facilitate _____________. | ease discomfort, further injury, healing |
| What causes impetigo? | Staphylococcus |
| A doctor has just diagnosed a 6 y/o w/ scalded skin syndrome. The parent asks you to explain what that means. What is your best response? | Bacterial infection caused by S. Aureus |
| You are caring for an 18 y/o male who has MRSA. What type of isolation is neessary for this patient | Strict isolation, aseptic techniques, standard precautions, disposable equipment |
| What are common areas for verruca to form? | Exposed areas: fingers, hands, face, soles |
| Describe the two different types of herpes: | Type I - Cold sore / fever blister Type II - Genital |
| How would you educate a child with herpes to prevent further outbreaks? | Type I can be prevented by using sunscreens and avoid corticosteroids |
| What is tinea capitis? | Lesions in scalp that may extend to hairline/neck caused by trichophyton tonsurans, microsporum audovinii, microsporum canis ("kitten/puppy dz") |
| What things need to be stressed to a parent of a child diagnosed with tinea capitis? | Spread from person to person, animal to person, personal items to person |
| How is pediculosis capitis transmitted? | Head lice and transmitted person-to-person or on personal items |
| List common manifestations of pediculosis capitis? | Nits observable on hair shaft, occipital area, behind ears, at the nape of neck, eyebrows or lashes |
| You are caring for a 4 y/o with eyebrow and eyelash pediculosis. How would you advise the parents to get rid of the nits? | Use a fine-tooth comb for removal after a thick coat of vaseline |
| What are scabies, and how do they differ from pediculosis capitis? | An endemic infestation caused by the scabies mite, sacroptes scabiei which affect intertriginous areas - interdigital, axillary-cubital, popliteal, inguinal |
| What is Stage I of Lyme dz? | The tick bite at the time of inoculation, followed by 3 to 31 days with erythema migrans at the site. |
| What is Stage II of Lyme dz? | The most serious stay of the dz, characterized by systemic involvement of the neurologic, cardiac and musculoskeletal systems. |
| What is Stage III of Lyme dz? | Includes musculoskeletal pn that involves tendons, bursae, muscles, and synovia. Other problems include deafness and chronic encephalopathy. |
| What information would your teach the parents to prevent or limit their child's exposure to ticks? | Avoid tick infested areas, Wear light colored clothing, Tuck pants into socks, Wear long-sleeved shirt tucked into pants |
| What are common s/s of impetigo? | Red, inflamed, moist, partially denuded, marginated areas where exposed skin surfaces rub together |
| True or False: Seborrheic dermatitis may involve the eyelids and external ear canal. | True |
| How is diaper dermatitis treated? | Zinc oxide |
| Describe a inflamed lesion. | Inflammatory process of acne |
| Describe a open comedone lesion. | The surface is darkened by melanin |
| Describe a closed comedone lesion. | Pulg of keratin, sebum, and bacteria |
| What good habits should you stress when teaching a 14 y/o child about acne? | Basic skin care, use of meds, avoid aggravating the skin, avoice mechanical irritation |
| Why are parents cautioned against heating formula or baby food in the microwave? | Hot spots |
| What is the difference between a 1st degree burn and a 2nd degree burn? | 1st degree - Minor...redness...superficial 2nd degree - full thickness injury and involves the entire epidermis, dermis, and extends to subq tissue |
| Why are small children more susceptible to burns than adults? | Small BSA, infants have thin skin and leads to deeper injury. |
| You are caring for a 5 y/o burn pt admitted 30 hours ago. The child starts wheezing, increasing secretions, has wet rales, and is becoming hoarse. What type of injury would you suspect this child has? | Inhalation Burns |
| List 3 complications of burns. | Infection, Fluid Imbalance, Impaired Circulation |
| Why is fluid replacement therapy done on a child with major burns? | Compensate for water & sodium loss, Reestablish sodium blance, Restore circulating volume, Improve renal function, Provide adequate perfusion, Correct acidosis |
| What solutions are used during the initial phase of therapy for burns? | Cystalloid Solutions |
| What solutions are used after the initial 24 hours to help maintain plasma volume for burns. | Colloid Solutions |
| List 3 types of biologic skin coverings used after debridement: | Allograft (homograft), Xenograft, Synthetic skin covering |
| What is the primary emphasis of nursing care on a burn pt in the acute phase? | Tx of burn shock and management of pulmonary status |
| What complications are you watching for in the acute phase for burns? | Loss of circulation, Alteration in electrolyte imbalance, Changes in respiratory function, Hypothermia, Edema |
| What nursing interventions can be done for a child who has been burned to prevent contractures? | Proper body alignment, Positioning, Splinting involved extremity in extension, Physical therapy, Encourage spontaneous moevement |
| What preventative teaching can the nurse provide to families regarding burn injuries? | Keep hot liquids out of reach, Safety plugs in electrical outlets, Decrease water heater temp to max 120 degrees, Caution with microwave, Teach fire safety to older kids |
| State 5 physical and behavioral indicators that should arouse suspicion of child abuse | Absent from school, Begs or steals, Substanance abuse, Vandalism, Sexual Misconduct, physical indicators (bruises, welts, burns, fractures, bite marks) |
| What are the different types of neglect? | Physical & Emotional neglect, Emotional abuse |
| What is the role of the nurse regarding child abuse? | Report suspected child abuse to appropriate authorities |
| What are some signs of physical neglect? | Not clean, tired, no energy, lack of food, absent from school |
| What are some signs of physical abuse? | Bruises, welts, burns, fractures, bite marks, innocently self-reports abuse |
| What are some signs of Sexual abuse? | Torn, strained, bloody clothing, withdrawn personality |
| What are some signs of Emotional neglect? | Appearance less obvious for maltreatment, Behavior best indicator, Parent rejects/belittles child |
| What is Munchusen Syndrome by Proxy (MSP)? | Illness that one person fabricates or induces in another person |
| Abusive parents who report that they were abused as a child are _________ likely to injure their own child. | MORE |
| Identify four nursing goals associated with child abuse or maltreatment: | Maintain high level of suspicion, Document factually/objectively, Be suspicious of delays in seeking medical care, Be suspicious of children who are upset about being discharged |
| Why should a nurse examine personal feelings related to the abuser and the victim in a domestic abuse situation? | To maintain non-judgemental attitude |
| List four common s/s of anorexia: | Severe wt loss, Altered metabolic activity (amenorrhea), Bradycardia, Hypotension, Low temp |
| What are the three major foundations of treating a child with anorexia? | Reinstitution of normal nutrition or reversal of malnutrtion, Resolution of disturbed patterns of family interaction, Individual pyschotherapy |
| A reasonable goal for an anorexic is to reach an eventual intake of _________ to _________ kCal per day, and a weight gain of ______ to ______ pounds per week, based on their age, height, and ________ weight. | 2000 to 3000 kCal 0.5 to 2 lbs PREMORBID |
| True or False; Some bulimics are of normal weight or more often slightly above normal weight. | True |
| Name three nursing considerations when caring for a child with bulimia: | Cariac monitoring, Structured environment to decrease binging behaviors, Relaxation techniques |
| What is the difference in usual aspects of behavior and a child with ADHD? | Lies in the quality of motor activity and developmentally appropriate inattention, impulsivity, and hyperactivity. |
| Medications are often used to treat a child with ADHD. What is most commonly prescribed? | CNS stimulants & Tricyclic Antidepressants |
| Drug abuse, misuse, and addition are ___________ behaviors. Drug tolerance and physical dependence are ____________ responsed to the pharmacologic characteristics of the drug. | Voluntary...Involuntary |
| What are two CNS stimulants? | Amphetamines and Cocaine |
| What are becoming a gateway drug for young children and preteens? | Inhalants |
| What are most treatment programs based on? | 12-step |
| 12-step Tx programs are for? | Family & Child |
| What are characteristics of the most successful drug rehab programs? | Promote parenting skils, social skills, academic achievement, and skills to resist peer pressure |
| What are some traumatic events that lead to temporary states of depression? | Hopitalization & Loss of a parent |
| List 8 characteristics of children with depression: | Dependent & clinging, Agressive & disruptive, Sense of hopelessness & guilt, Constipation, Non-specific complaints, Changes in appetite (wt loss or gain), Alterations in sleep, Sadness |
| What is para-suicide? | Ranging from gestures to serious attempts |
| What is suicidal ideation? | Preoccupation with thoughts of suicide (TAKE SERIOUSLY) |
| Whats the difference between suicide and suicide attempt? | Suicides result in death. Attempts are deliberate act of self-injury with the intent of the injuries to result in death |
| List 5 family factors which contribute to a child committing suicide: | Parental loss, Family disruption, Family Hx of suicide & depression, Child abuse, Unavailable parents |
| List 8 warning signs of suicide: | s/s of depression, preoccupation w/ death themes, give away prized possessions, talks of desire to die, "worthless" self, loss of energy, exhaustion, changes in sleep |
| Whare are routine questions nurses should ask when assessing for suicidal ideation or intent? | Have you ever been so unhappy that you felt like being dead? Have you developed a plan to hurt yourself? |
| What is a safe contract? | A written agreement made by the client to initiate a safe behavior when they feel they may hurt themselves |
| List three early signs of inborn error of metabolism seen in newborns: | Lethargy, Failure to thrive, Vomiting |
| When should you advise parents to give growth hormone injections? | At Night |
| Diabetes Insipidus occurs as a result of hyposecretion of ________ ________ or __________ which produces a state of uncontrolled diuresis. | Antidiuretic hormone, vasopressin |
| What is the first sign of diabetes insipidus usually seen in children? | Enuresis (urine incontinence) |
| What is important to include when teaching a 9 y/o and his parents on the administration of DDAVP? | It must thoroughly be suspended in oil prior to being drawn up and administered |
| List 5 common manifestations of SIADH: | Increase fluid volume, Low sodium levels, Anorexia & Nausea, Stomach cramps, Irritability & personality changes |
| What nursing assessments are important when caring for a child with SIADH? | Recognize the presence of SIADH, Accurately measure I&Os, Daily weights, Seizure precautions, Instruct on fluid restrictions |
| What are 5 common manifestations of hypothyroidism? | Infant sluggish, Tongue enlarged, Dry skin, Cold hands & feet, Floppy infant |
| When a child is taking synthroid, what things are important to discuss with the child and parents? | Take at same time each day (AM preferred), DO NOT change brands |
| What features are associated with a child who has Graves dz? | Enlarged throid, Exophthalmos |
| What causes a thyroid storm? | Increased levels of TH & T3, Suppression of TSH, Due to sudden release of hormones |
| How is Chvostek's sign elicited? | Tapping the facial nerve |
| What is the difference between Type I and Type II DM in children? | Type 1 - not inherited plays a role in autoimmune process, Type 2 - Strong correlation to heredity |
| Why does the classic s/s of DM occur in children? | Lack of insulin |
| What are common s/s of ketoacidosis? | Fruity (acetone breath), Keonuria, Ketonemia, Kussmaul respirations, Fluid/electrolyte imbalance |
| What is the desirable glucose level in children? | 80-120 mg/dL |
| What source of glucose should a diabetic child always carry with them? | Simple sugars & Glycagon |
| What should be included in teaching a newly-diagnosed diabetic child and her family about giving insultin injections? | Duration, onset, and peak of insulin, Basic techiniques (Inject @ 90 degrees, common subq sites, rotate sites, clear before cloudy, proper disposal) |
| Describe the following types of insulin: Regular, Lispro, NPH or Lente | Regular (short acting), Lispro (rapid acting), NPH or Lente (intermediate acting) |
| What are the s/s of German measles, three-day measles (rubella) | Mild fever & sore throat, Maculopapular rash, Enlarged glands at back of neck |
| What is the incubation period for Hepatitis A: enterovirus 72? | 15-50 days |
| List the nursing interventions for Hep B: HBV virus? | Avoid direct contact with blood, Identify high risk mothers & newborns, Educate concerning need for vaccination |
| What is another name for mononucleosis? | Kissing dz |
| What is the contagious period for measles (rebeola)? | 4 days before to 5 days after rash appears |
| Lists the s/s of mumps (parotitis)? | Fever, HA, Vvomiting, painful swollen glands (near ear/jaw line), enlarged parotid gland, may be bilateral |
| What is the cause of Polio (infantile paralysis for poliomyelitus)? | Infection w/ polio virus |
| What are some diagnostic tests for TB? | PPD, CXR, Culture of sputum |
| Describe the audible symptoms of whooping cough (pertussis)? | Noisy gasp for air that creaes "whoop" sound |
| What is the source of Lyme dz (borrelia burgdorferi)? | Deer ticks |
| What is the name of the vaccine used to prevent diphtheria (corynebacterium diphtheriae)? | DPT |
| Explain why symptoms progress more rapidly for the pediatric AIDS pt? | Due to compromised immune system? |
| When should the nurse assess immunization status of a child? | At every clinical visit |
| What is a macule? | circular red area on the skin |
| What is a papule? | Raised area on the skin |
| What is a vesicle? | Circular red area that contains fluid |
| What is a pustule? | Circular red area on skin, elevated, contains pus |
| What is a scab? | dried pustule covered with crust |
| What is pathognomonic? | Used to describe lesion or symptom that is a characteristic of specific illness |
| What is erythema? | diffused reddened area on skin |
| List the nursing interventions for smallpox (variola): | Strict isolation, Utilize negative pressure room, Restrict # of caregivers |
| List the s/s of roseola (exanthema subitum:sixth dz): herpes virus 6 HSV-6: | Persistent high (103-105) fever that drops rapidly as rash appears, Maculopapular rash - non pruritic and blanches easily, Cervick, post-auricular lymphadenopathy |
| How can a nurse can minimize the problem of an unpleasant-tasting drug? | Administering the drug through a straw, Have child hold nose, Mix with juice or fruit |
| Wounds heal faster in what kind of environment? | Moist |
| What is the most common epidermal wounds in children? | Abrasions |
| Why do antiseptics slow wound healing? | They are cytotoxic |
| What is the medical term for warts? | Verruca |
| Skin blisters and becomes raw and weeping, caused by staph is called? | Impetigo |
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rpm824
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