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72 Cards in this Set

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BILATERAL CLEFT LIP:

What Interventions would be appropriate for the PARENTS?
[McKinney p 1106]

Emotional Support [Parents]:
[]Encourage dicussion of feelings
[]Encourage Support Groups
[]Express acceptance of baby/encourage bonding.

Refer to reconstructive Drs.
[Repair done @ 3-6 mos old
& then @ 4-5 years]
[]Show Before & After Pictures of Repair
CLEFT LIP REPAIR:

What would POSTOPERATIVE CARE involve?
Assess for Color
Assess Swallowing
[Freq. Swallowing = bleeding]

Do NOT place prone.

Place on SIDE allows drainage
[for Palate repair]

Use Elbow restraints
aka "No-No's:
Tongue depressors taped on the front & back of elbow to restrict bending & prohibit infant to scratch surgical site. Remove for 10-15 mins q2h for ROM.

Diet: Clear liquids to formula.
Any injury or surgery on mouth will always involve risk for airway obstruction.
TEF:

What MATERNAL DIAGNOSIS is related to TEF in the baby?
POLYHYDRAMNIOS:

Excessive amount of amniotic fluid during pregnancy.
TEF = TracheoEsophageal Fistula:

a congenital malformation in which the esophagus terminates prior to reaching the stomach.

Condition Fatal without early Dx & Tx.
GER: (GE Reflux)

What would Discharge Teaching for infant with GER include?
McKinney pg 1119+
Teach parents about:

Medication:
[]Antacids: Sx releif.
[]H2-rcpt Antagonist
decrease acid secretion:
cimetidine, ranitidine
[]Mucosal barrier protectant:
sucralfate
[]Proton pump inbitors supress gastric acid secretion:
omeprazole
[]prokinetic agent speeds Gastric emptying:
metoclopramide

Diet:
[]Small, freq. feedings of predigested formula:
Nutramigen or Pregestimil
[]Feed in upright position.
[]Adequate burping.

Position for sleeping:
[*]HOB 30-45 degrees
[]Under 12 mos: Suppine

Surgery:
[]Fundoplication involves a wrap to stomach fundus, tightens LES, prevents reflux.
GE Reflux:
Condition which results from a weak LES resulting in regurgitation of gastric juice into the esophagus.

Amost All Infants with GER will present symptoms around 6 weeks old.

Hallmark S/Sx: Vomiting or spitting up after meal, hiccupping, and recurrent Otitis media r/t pooled secretions in nasopharynx during sleep.

Other S/Sx possible:
Wt Loss, FTT, irritability, discomfort, and AB pain.

Severe GER S/Sx:
Possible Hematemesis or melena & anemia.

Stomach Lavage (washing) via NG Tube is used to evacuate blood & clots in episodes of Upper GI bleeding.
CELIAC DISEASE DIET:

What would be the Priority Nursing DIAGNOSIS?
McKinney pg 1147

Imbalanced Nutrition Less than Body Requirements r/t malabsorption.
Celiac Disease is aka:
Gluten Enteropathy or
Tropical Sprue.

Pts with Celiac disease can NOT eat foods containing Gluten because they can NOT break it down.

Gluten is the protein of certain GRAINs. (Wheat, Barley, Rye, & Oat).

Foods containing Gluten:
pasta
baked products
breakfast cereals

Substitute these foods with:
Corn
Rice
Millet
& take vitamin supplements, especially FOLATE, and Vit A, D, E, & K.
HIRSCHSPRUNG's DISEASE:

What would you expect to find on ASSESSMENT?
McKinney pg 1142+

Abdominal Distention

Relief upon DRE:
[Digital Rectal Exam]

Loose Stools

Vomits Bile/Fecal material

Hx: No Meconium
[1st stool of NB]
Hirschsprung's disease results from absence of nerves in the colon.
OMPHALOCELE:

What is it?
McKinney p 1116

Large herniation of GUT into UMBILICAL CORD.

Viscera are outside the abdominal cavity but inside translucent sac, covered with peritoneum & amniotic membrane.

Associated with Beckwith's Syndrome (hypoglycemia, macrosomia, macroglossia).

Complications include:
Sepsis & intestinal obstruction.
INTUSSUSCEPTION:

1.) What are the symptoms?

2.) What would the nurse watch for after administration of a Barium Enema?
McKinney p 1140

1.) Classic Symptom:
"Currant Jelly" Stool
[Bloody mucus stool]

as well as a Sausage shaped AB mass.

Shock & Sepsis if obstructed for 12-24 hours.

Child may be Listless.

2.) If NO Sx of shock or sepsis:
Hydrostatic Reduction by Barium enema until flow of barium into the terminal ileum is evident.

The nurse would:
[]Observe for passage of barium
[]Document stool characteristics.
Intussusception: Bowel "Telescopes" inside itself => obstruction & ischemia

ALWAYS correlate INTUSSUSCEPTION with CURRANT JELLY STOOLS on NCLEX.
NG Tube after Abdominal Surgery:

1.) Why would it be used?

2.) What purpose does it serve?
McKinney 1141

1.) Used for Suction

2.) To evacuate Bile
CROHN's DISEASE:

What are the SYMPTOMS?
McKinney pg 1135
Crohn's Disease
Symptoms:
[]Abdominal Pain
[]Diarrhea/NO BLOOD
[]Fever
[]Palpapble AB Mass
[]Anorexia/wt loss
[]Sig. growth impair
[]Perianal/anal lesion
[]Fistulas/Obstruction
Extraintestinal Sx:
[]Arthralgia & Arthritis
Crohn's disease is an inflammatory Bowel disease that can affect ANY part of the GI Tract: from the mouth to anus. It involves ALL LAYERS of the intestine.
GASTROENTERITIS:

What is the best way to prevent spreading of this?
McKinney p 1131

HANDWASHING
Gastroenteritis: Infection of the stomach & intestines d/t viruses, bacteria or parasites.
APPENDICITIS:

1.) What is the significance of SUDDEN Relief of Pain?

2.) How does HEAT affect the swollen appendix?
McKinney p 1131+

1.) Sudden pain relief indicates that the appendix has PERFORATED (ruptured).

2.) Heat INCREASEs Risk of Perforation:
NO Heat should be applied to the abdomen.
It may increase the chance of perforation secondary to vasodilation.
(McKinney pg 1132)
Appendicitis S&Sx:
[]Early Pain -
around umbilicus.
[]Pain progresses to Lower Right Quad @ McBurney's Point.
[]N/V
[]anorexia
[]diarrhea or constipation
[]Fever and chills

Dx Testing:
[]Rebound Tenderness
[]WBC 15K-20K
[]Ultrasound
[]CT scan of AB

Therapeutic Mgt:
[]Appendectomy

Pre-op care:
[]IV fluids
[]Immobilize to control pain
[]NPO
[]Antibiotics
HYPOTHYROIDISM:

Why do a mandatory screening for this condition in the Newborn?
McKinney pg 1456

Untreated Hypothyroidism leads to mental retardation.

Initial Tests should be done @ 2 to 6 days of age.
Tests done sooner than 48 hours after delivery may give a false result
(b/c of the normal rise in TSH immediately after birth).

Lifelong thyroid hormone replacement is necessary, usually levotyroxin given in a single daily oral dose that varies with body size.
SHORT ACTING INSULIN:

When is the best time to check for PEAK effectiveness of it?
2 hours after administration.
DIABETES:

What is the primary concern in concealing diabetes from school officials?
RISK FOR INJURY
If child becomes hypoglycemic and no one is aware of the child's medical condition, the child is at risk for injury resulting from lack of medical attention
HYPOGLYCEMIA:

1.) Lab results show?

2.) How would you treat the CONSCIOUS CHILD?
McKinney pg 1469

1.) BG < 70

2.) Oral admin:
15g carbohydrate
(ie: Orange Juice)
IDDM (Insulin Dependant Diabetes Melitus):

1.) What is the "HONEYMOON" Phase?

2.) What happens to insulin needs during the Honeymoon phase?
McKinney pg 1448+

1.) Early phase in which RESIDUAL ENDOGENOUS INSULIN is produced.

2.) Need for Insulin decreases because the body is producing some.
IDDM:

1.) How does it affect sports participation?

2.) How would this be handled?
McKinney pg 1471

1.) Exercise LOWERS blood glucose levels.

2.) add 15 to 30g carbohydrate snacks for each 45 to 60 minutes of exercise.
IDDM:

Review Teaching for IDDM.

What statements would indicate further teaching is necessary?
(review IDDM teaching)
Outcome Evaluations:
DIABETIC KETOACIDOSIS:

What Lab Values would indicate this condition in a child?
McKinney pg 1469

Blood Glucose > 300

Urinary Ketones (+)

Serum pH < 7.25

Serum Ketones (+)
CELLULITIS:

How is it Managed?
McKinney pg 1367

Nurse administers an initial IM or IV dose of antibiotic
[IE: ceftriaxone]

Followed up at home with a 10-day course of Oral antibiotics:
Cephalosporin,
cloxacillin, or
dicloxacillin.

Warm compresses are applied to the affected area.

If child's joints or face is involved or if child presents acute fever, hospitalization and IV antibiotic therapy are required.
Incision and drainage of the affected area may also be necessary.
CELLULITIS is a bacterial infection of the subcutaneous tissue and the dermis, usually associated with a break in the skin.

s/sx:
affected area is red, hot, tender, and indurated.
H. influenza agent may cause a purplish tinge.
Lymphangitis seen with red "streaking" of surrounding area.
fever, malaise, & headaches are common sx in children.
THRUSH:

How should medication be administered?
Medication:
Mycostatin

Administer:
Use GLOVED Finger
Rub medication around gums & mouth.
PEDICULOSIS: (Lice)

Serious potential side effect of Anti-Lice product?
McKinney pg 1374

*****Prescription lindane (Kwell) can be NEUROTOXIC if absorbed through the skin.*****

Recently approved pesticide for Tx of Lice:
malathion (Ovid) requires prolonged contact (8 - 10 hrs). Caution: Ovid is FLAMMABLE. Do Not use Hairdryer or allow child near flames or heater while being treated.

Other treatments are safe & effective because they do not stay on the hair after treatment (must repeat treatment in 1 to 2 weeks):
RID
Triple X
R&C
Pronto
ATOPIC DERMATITIS: (Eczema)

Most serious complication?
McKinney pg 1377

Infection r/t itch-scratch-itch cycle & a higher than normal colonization of Staph aureus in pts with this disorder. Impetigo & viral infection occur freq. in these kids.
ATOPIC DERMATITIS: (Eczema) is an allergic skin condition.
BURN INJURY CLASSIFICATION:
McKinney pg 1391

SUPERFICIAL
[1st Degree]

PARTIAL THICKNESS
[2nd Degree]

FULL THICKNESS
[3rd Degree]
No Pain b/c nerves have been destroyed.
BURN PAIN:

Drug of CHOICE:
IV administration of MORPHINE
BURN SHOCK:

1.) When does it STOP?

2.) What physiological mechanism occurs to stop burn shock?
McKinney pg 1398+
BURNS:

What is the best way to monitor adequate PERFUSION in burn patients?
McKinney pg 1398?
ACUTE GLOMERULONEPHRITIS:

What does the presence of CASTs in the URINE indicate?
McKinney pg 1171+

Casts in the urine indicate that glomerule injury is occurring.
PRIMARY NEPHROTIC SYNDROME:

What is the DIAGNOSTIC FINDING in this condition?
McKinney pg 1175+

Proteinuria (3+)


[2 weeks negitive protein in urine indicates the condition is in Remission]
NO ADDED SALT DIET:

What is it?
REGULAR DIET
NO ADDED SALT
AVOID HIGH SODIUM PRODUCTS
Diet for Primary Nephrotic Syndrome & HTN
EDEMA:

Appropriate Interventions for EDEMATOUS CHILD?
Maintain Skin Integrity & monitor I&O and weigh daily:
Good skin care (dry & clean)
Turn & reposition q 2 hours
HYPOSPADIAS:

When should it be corrected?
McKinney pg 1170

Between 6 to 12 months of age. (Before the age of toilet training).

Infants should NOT be circumcised because the foreskin may be used in surgical reconstruction.
Hypospadias: Ventral
[Bottom side] placement of urethral opening on penis.


Epispadias: Dorsal (Top side) placement of urethral opening on penis.
UTIs (Urinary Tract Infections):

Symptoms?
Cystitis
LOW GRADE FEVER = KIDNEY Infection

Look up in text
VESICOURETERAL REFLUX:

What would the TEACHING plan include?
Good dipaer care etc

look up in text
CRYPTORCHIDISM:

How to examine the infant for this condition?
McKinney pg 1170

WARM ROOM
WARM HANDS

Calm infant
Milk testis downward from groin & document distal point.
Cryptorchidism: Undescended Testes.

Children with undescended testes are at increased risk for testicular cancer.
ALL: Acute Lymphoid Leukemia

1.) Treatment:

2.) Outcome:

3.) Symptoms:

4.) History:

5.) Priority Nursing Dx for newly diagnosed child:

6.) Diagnostic Tests used to Confirm ALL:
1.) Treatment
3 Phases:

Phase 1
Induction:
Chemo induced remission
[Immature Blast cells < 5%]

Phase 2
Consolidation:
Intense Therapy begins immediately after remission occurs

Phase 3 - Maintanance:
2-3yrs of Oral Chemo
to Maintain remission


2.) Outcome:

3.) Symptoms:

4.) History:

5.) Priority Nursing Dx
for newly diagnosed child:

6.) Diagnostic Tests used to Confirm ALL:
AML:

What is the STANDARD Tx?
Look up in text
WILM's TUMOR:

Nursing care PRE-OP involves?
DO NOT PALPATE THE ABDOMEN (Palpating the abdomen would risk RUPTURE of the ENCAPSULATED tumor)!
TUMOR LYSIS SYNDROME:

What are they at risk for?
Look up in book, probably related to metastasis?
HODGKIN's DISEASE:

Physical assessment findings would include?
McKinney pg 1348+
BRAIN TUMOR:

Post-operative care plan for child having Brain Tumor Surgery?
Look up in text
CHEMOTHERAPY:

Teaching for ORAL HYGIENE would include?
Use VERY SOFT TOOTHBRUSH / SWABS.
AVOID MOUTHWASH.
Who are the "EXPERTS" in regards to a child with a profound Sensory impairment?
THE CHILD's PARENTS
COMMUNICATION:

What is the most important consideration for effective communication with a child?
Look up in text
COMMUNICATION:

What is the best way to get a child to express feelings?
Look Up in text
How would you assess a crying toddler's breath sounds?
You wouldn't while the toddler was crying.

Allow parent to hold & calm the toddler.

Assess breath sounds when toddler is CALM.
What is the site of choice to assess the Pulse rate of a 1 year old child?
look up in text
NEWBORNS:

When does the Anterior Fontanel Close?
look up in text
1.) Comfort measures to use for a small child in the ER?

2.) Normal behavior for a 3 year old when parents try to leave the room?

3.) Comfort measures for outpatient surgery?
look up in text.
Abdominal breathing in a 2 year old child.

Is it Normal or abnormal?
It is NORMAL up to age 5.
Low respiratory rate:

What does it mean?
in child: low respiratory rate would be 8 to 10 bpm.

it may indicate that respiratory failure is ensuing.
Review the ABC's of CPR:

What is critical element in emergency situation?
AIRWAY
What is the best way to remove ingestion/overdose of pills taken 1 hour ago?
Lavage: Pump stomach to remove recent ingestion.
Signs that would cause suspicion of child abuse/neglect?
freq Hx of fractures
bruises in bathing suit areas
a child who does not show emotion when painful procedures are undertaken (shot or IV insertion. child will not cry because he/she has learned that crying may lead to a spanking/abuse.)
etc
What vital sign is assessed FIRST in children?
Respiratory rate (you can assess this from a distance)
What is the primary DISADVANTAGE of outpatient and day care facility Treatments?
There is no immediate backup available for emergency care. 911 must be called, which would delay BLS.
What would be developmentally appropriate interventions when working with adolescents?
ALLOW:
own clothing to be worn
availabitly of phone
choices in treatments
How would you allow a toddler to feel a sense of control?
Allow toddler to choose "flavors" for administration of anesthesia if necessary (chapstick is applied to the inside of the mask for anesthesia. the toddler can choose what flavor they would like). etc
Stages of separation?
look up in text
What ages like to keep & organize hospital momentos?
School age children
Appropriate interventions for NEONATES include?
look up in text.

Offer parents & encourage bonding
Review Standard Precautions.
look up in text
What is the body's 1st line of defense?
skin
Type of infection occurring with Immunocompromised patients?
OPPORTUNISTIC infections.
Appropriate treatment for Fever?
look up specifics in text.
Why do children require more than 1 dose of Polio Vaccine?
It is an INACTIVE Vaccine & requires boosters.
Review Standard Precautions.
look up in text
What is the body's 1st line of defense?
skin
Type of infection occurring with Immunocompromised patients?
OPPORTUNISTIC infections.
Appropriate treatment for Fever?
look up specifics in text.
Why do children require more than 1 dose of Polio Vaccine?
It is an INACTIVE Vaccine & requires boosters.