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178 Cards in this Set

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Before administering DPAT what should in the child's history should the nurse assess for?
History of reactions, seizures, neurologic symptoms after previous vaccie or systematic allergic reactions
Before administering MMR what should the nurse assess for in the child's history
History of anaphylactic reaction to eggs or neomycin
What type of injection invalidates the Mantoux test?
Subcutaneous rather than intradermal injection
What is not a contraindication for immunization?
The common cold
Following immunization what teaching should he nurse provideto the parents regarding DTAP and IPV?
1. Irritability, fever < 102, redness, and soreness at injection site for 2-3 days are normal side effects of DTAP and IPV
When should a parent of a recently immunized child call the MD?
If the child has seizures, high fever, or high pitched crying occurs
What can a parent due to decrease soreness in an infant after vaccination?
Place a warm washcloth on the thigh injection site and bicycling the legs with each diaper change
How often and how much acetiminophen (tylenol) should be administered following a immunization?
Administer oraly 4-6 hours (10-15 mg/kg)
What should a nurse teach a pregnant mother about German Measles?
Chidlren with German measles pose a serious threat to their unborn siblings and the consequences of being exposed to German Measles
How much urinary output should an infant or child have?
1-2 ml/kg/hr
What should a parent be taught about ipecac and induced vomiting?
The ipecac is no longer recommended and induced vomiting can cause more damage than good
How should milk be stored?
In an opaque container
How should vegetables be cooked to preserve potency?
In small amounts of liquid
What should parents be taught regarding hot and cold water?
That lead is absorbed more on an empty stomach
Hot water absorbs lead more quickly so use cold water for drinking, cooking, and when making infant formula
List two contraindications to live virus immunization
Immunocompromised child or a child in a household with an immunocomprimised individual
List three classic signs of mealses
1.Photophobia
2. Confluent rash that begins on the face and spreads downward
3. Koplik spots on the bucal mucosa
List the signs and symptoms of iron deficiency
Anemia; pale conjuctiva, pale skin color, atrophy of papillae on tongue, brittle, rigid or spoon shaed nails, thyroid edema
Identify food sources wih vitamin A
Liver, sweet potatoes, carrots, spinach, peaches, apricots
What disease occurs with vitamin c deficiency?
Scurvy
What measurements reflect present nutritional status?
Weight, skinfold thickness, and arm circumference
List the signs and symtoms of dehydration in an infant
Poor skin turgor, absence of tears, dry mucous membranes, weight loss, depressed fontanel, and decreased urinary output
List the laboratory findings that can be expected in a dehydrated child?
loss of bicarbonate/decreased serum pH, loss of sodium, loss of potassium, elevated Hct, and elevated BUN
How should the burns in children be assessed?
By using the Lund-Browder chart which takes into account the changing proportions of the child's body
How can the nurse best evaluate the adequacy of fluid replacement in children?
By monitoring the urine output
How should a parent be instructed to childproof a house?
Lock all cabinets, safely store all toxic household items in locked cabinets, and to examine the house from the child's point of view
What interventions should the nurse perform first when caring for a child who has ingested poison?
Assessment of the child's respiratory, cardiac, and neurologic status
What early signs should the nurse asssess for if lead poisoning is suspected?
Anemia, acute cramping, abdominal pain, vomiting, constipation, anorexia, headache, lethargy, hyperactivity, aggression, impulsiveness, decreased interest in play, irritability, short attention span
What should be used to provide supplemental oxygen to an infant?
Oxygen Hood
Nursing interventions for a child using tent oxygen?
It provides mist and oxygen; Monitor the child's temp, Keep edges tucked in, keep child dry
Wha type of oxygen does Nasal Prongs provide?
Low to moderte concentrations of oxygen
What percentage of caloric intake does a child need for normal growth and development?
150%
How should the nurse assess a child with epiglottitis?
The nurse should not examine the throat of a child with epiglotitis
Do not put a tongue blade or any object into the throat for risk of obstructing the airway completely
Signs and symptoms of epiglotitis?
Sore throat, dysphagia, muffled voice, drooling, child assuming upright sitting position (tripod) with chin and tongue protruding
What can be done to prevent epiglotitis?
Hib vaccine
What usually causes broncholitis?
RSV (respiratory syncytical virus)
High risk category for RSV
young infants
Nursing Interventions for child with RSV
1. Isolate child/ Contact isolation b/c readily transmitted by close contact with hospital personnel, families, and other children
2. Assign nurses to the care of an RSV client to a nurse that does not care for other children
3. Airway secretions should be cleared by using a bulb syringe
4. Ribavirin aerosol may be prescribed
What should be administered to provide passive immunity to high risk children?
Palivizumab (Synagis)
What classifies as a high risk child?
Child less than 2 years of age with a history of prematurity, lung disease, or congenital heart disease
Signs and symptoms of Otitis Media
1. Upper respiratory symtpoms
2. Fever, pain, may pull at ear
3. discharge from ear if drum is ruptured
Nursing interventions for a child with Otitis Media
1. Reduce body temp via tempid bath, and tylenol
2. Position child on affected side
3. Give warm compress on affected ear for comfort
4. Monitor for hearing loss
What should a nurse assess for prior to a child having a tonsillectomy?
1. PT and PTT
2. More important a history of prolonged or excessive bleeding
3. A history of bleeding disorders in the family
Homecare of a child with a tonsillectomy?
1. Encourage warm saline gargles
2. Provide ice chips
3. Manage fever with tylenol
Signs of post operative bleeding in a child with a tonsillectomy?
1. Frequent swallowing
2. Vomiting Fresh blood
3. Clearing of throat
Teaching regarding foods for a child post tonsillectomy
Soft foods, no fluids that are red, do not use straws
What can be used for pain and vasocontrictyion of a child post tonsillectomy?
Ice Colar
What the highest risk periods for hemorrhage regarding a post tonsillectomy of a child?
1. First 24 hours
2. 5-10 days after surgery
What are the purpose of bronchodilators?
To reverse Bronchospasms
What are the physical assessment findings of a child with asthma?
Expiratory wheezing, rales, tight coughs, signs of altered blood gases
What nutritional support should be provided for a child with cystic fibrosis?
Pancreatic enzyme replacement, fat soluble vitamins, and a moderate-low carbohydrate, high protein, moderate-to high fat diet
List seven signs of respiratory distress in a pediatric client
1.Restlessness
2.Tachycardia
3. Tachypnea
4. Diaphoresis
5. Flaring nostrils
6. Retractions
7. Grunting
Why are IV fluids important for a child with an increased respiratory rate?
Because the child is at risk for dehydration and acid base balance
Children with chronic otitis media are at risk for developing what problem
Hearing Loss
What is common in children with a CHD?
Polycethemia, so require hydration to prevent thrombus formation
What may be required to conserve an infants energy with CHD?
Tube feedings, but need to still satisfy sucking needs
What are the basic differences between cyantotic and acyantoic defects?
Acyanotic- has abnormal circulation but all blood entering the systemic circulation is oxygenated
-CHF is more associated with
Cyanotic- has abnormal circulation with unoxygenated blood entering the systemic circulation
Why is CHF the most common complication of CHD?
Because it reflectes the workload of the heart caused by shunts or obstructions.
Objective in treating CHF is to reduce the workload of the heart and increase cardiac output
What are the therapeutic blood levels of digoxin?
0.8-2.0 ng/ml
Teaching strategies of at home adminstration of Digoxin?
1. Do not skip or make up for missed doses
2. Give 1 hour before or 2 hours after meals
3. Do not mix with forumla or food
What is an early sign of digoxin toxicity?
Vomiting, spit up is commonly overlooked in infants
Other GI sxs of Digoxin Toxcity
-anorexia, diarrhea, and abdominal pain
Neurological signs of Digoxin toxicity
Fatigue, Muscle weakness, and drowsiness
What can increase digoxin toxicity?
Hypokalemia
Why is Penicillin G given in patients with CHD?
To prevent recurrence of Rheumatic Fever
Pen G is release very slowly over several weeks giving sustained levels of concentration
List four Defects associated with tetralogy of Fallot
VSD, overriding aorta, pulmonary stenosis, righ ventricular hypertrophy
List the common signs of cardiac problems in an infant
Poor feeding, poor weight gain, respiratory distress and infections, edema, cyanosis
Describe the nursing interventions to reduce the workload of the heart
Give small frequent feedings or gavage feedings. Plan frequent rest periods. Maintain a neutral environment.
What position would best relieve the child experiencing a tet spell
Knee chest position or squatting
List five risks in cardiac catheterization
Arrhythmia, bleeding, perforation, phlebitis, and obstruction of the arterial entry site
What cardiac complications are associated with rheumatic fever
Aortac valve stenosis and mitral valve stenosis
What medications are use to treat rhematic fever
Penicillin, erythromycin and aspirin
What is the nursing goal of a child with Down Syndrome?
To help the child reach his or her optimal level of functioning
How should an infant/child with cerebral palsy be fed?
With the cild in an upright position and support to the lower jaw
Signs of ICP vs Shock
Shock= increased pulse, decreased blood pressure
ICP= decreased pulse, increased blood pressure
Pumping of a shunt
Should only be done with specifically prescribed
B/C the shunt is made of delicate valves and the pumping changes the pressures within he ventricles
What is the most common cause of increased seizure activity?
Medication Noncompliance
What should be monnitored in patients with Menningitis?
Hydration status and IV theraphy
B/C there may be inappropriate ADH secretions causing fluid retention (Cerebral Edema) and dilutional hyponatremia
What is the most common presenting symptom of brain tumors?
Headache on awakening
What position is most postoperative clients with infratentorial tumors ?
To lie flat or turn to either side
If it is a large tumor the child should not be turned to the operative side
What actions can increase ICP?
Suctioning, coughing, strainin, and turning
What are the physical features of a child with Down Syndrome?
Simian creases in palms, hypotonia, protruding tongue, and upward-outward slant of eyes
Describe scissoring
A common characteristic of spastic cerebral palsy of infants legs are extended and crossed over each other, feet are plantar flexed
What are the two nursing priorities for a newborn with myelomenigngocele?
Prevention of infection of the sac and monitoring for hydrocephalus
Which includes measure head circumference, check fontannel, assess neurologic functioning
List the signs and symptoms of increased ICP in older children
Irritability, change in LOC, motor dysfuntion, headache, vomiting, unequal pupil response and seizures
What teaching should parents of a newly shunted child recieve?
1. Signs of increased ICP
2. Understanding that shunt should not be pumped and that the child will need revisions with growth
3. Guidance concerning growth and development
State the three main goals in providing nursing care for a child experiencing a seizure?
1. maintain patent airway
2. Protect from injury
3. Observe carefully
What are the side of effects of Dilantin?
Gingival hyperplasia, dermatitis, ataxia, GI distress
Decribde the signs nd symptoms of a child with meningitis?
Fever, irritability, vomiting, neck stiffness, opisthotonos, positive Kernig signs, positive Brudzinski sign
Infant may not show all classic symtpoms even though very ill
What antibiotics are usually prescribed for bacterial meningitis?
Ampicillin, penicillin, chloramphenicol
How is a child usually positioned after brain tumor surgery?
Flat or on either side
Describe the function of an osmotic diuretic
Remove water from the CNS to reduce cerebral edema
Describe the mechanism of inheritance of Duchenne muscular dystrophy
Inherited as an X-linked recessive trait
What is the Gower's Signs?
Is an indicator of muscular dystrophy; to stand the child has to "walk" hands up legs
What is the first sign of renal failure
Decreased urinary output
When and why is surgical correction hypospadias?
Usually done before preschool years
to allow for the achievement of sexual identity to avoid castratio, anxiety, and to facilitate toilet training
Compare the signs and symptoms of Acute glomeruloephritis with those of nephosis
AGN
1. Edema=mild, usually around eyes
2. BP elevated
3. Dark, tea colored (hematuria)
4. Slight or moderate proteinuria
Nephrosis
1.severe generalized edema
2.Normal BP
3. Dark, frothy yellow urine
4. Massive proteinuria
What antecedent even ccurs with AGN?
Beta-hemlytic streptococcal infection
Compare the dietary interventions for AGN an nephrosis
AGN- low sodium diet with no added salt
Nephrosis- High protein, low salt diet
What is the physiologic reason for the lab finding of hypoproteinemia in nephrosis?
B/c the glomeruli are permeable to serum proteins
Describe safe monitoring of prednisone administration an withdrawal
-Long term prednisone should be given every other day
-Signs of edema, moo changes, and GI distress should be noted and reported
-The drug should be tapered not discontinued suddenly
Acute Glomerulonephritis (AGN)
Immune complex response to an antecedent beta-hemolytic strep infection
Antigen-antibody complexes become trappe in the membrane of the glomeruli causing inflammation and decreased glomerular filtration
Nephrotic Syndrome
The basement membrane of the glomeruli becomes permeable to plasma proteins; most often idiopathic in nature
What interventions can be taught to prevent urinary tract infections in children?
Avoid bubble baths, void frequently, drink adequate fluids, especially acidic fluids such as apple or cranberry juice and clean genital area from front to back
Describe the pathophysiology of vesicoureteral reflux
A malfunction of the valves at the end of the ureters allowing urine to reflux out of the bladder into the ureters and possible into the kidney
What are the priorities for a client with a Wilms tumor?
Protect the child from injury to the encapsulated tumor
Prepare the family and child for surgery
What are the typical and family reactions to a child with an obvious malformation
Guilt, disappoinment, grief, sense of loss, and anger
When is closure of the Cleft and of the palate defect done?
Closure of the cleft when infant weighs 10 pounds and Hgb is >10g
Palae closure usually done before 1y/o to minimize speech impairment
Why does a client with a cleft lip/palate and pyloric stenosis have the dx of "Altered Nutrition less tha body requirements"
Lip/palate= decreased ability to suck
Pyloric stenosis= frequent vomiting
What are key problems for children with GI disorders?
nutritional, fluid, and eletrolyte imbalances
Congenital Agranglionic Megacolon AKA? and pathophysiology
Hirschsprung disease
Congential absence of autonomic para sympathetic ganglion cells in a distal portion of the colon and rectum
Where should the temp be taken in children with Congenital Megacolon
Axillary
What are the physical features of a child with Down Syndrome?
Simian creases in palms, hypotonia, protruding tongue, and upward-outward slant of eyes
Describe scissoring
A common characteristic of spastic cerebral palsy of infants legs are extended and crossed over each other, feet are plantar flexed
What are the two nursing priorities for a newborn with myelomenigngocele?
Prevention of infection of the sac and monitoring for hydrocephalus
Which includes measure head circumference, check fontannel, assess neurologic functioning
List the signs and symptoms of increased ICP in older children
Irritability, change in LOC, motor dysfuntion, headache, vomiting, unequal pupil response and seizures
What teaching should parents of a newly shunted child recieve?
1. Signs of increased ICP
2. Understanding that shunt should not be pumped and that the child will need revisions with growth
3. Guidance concerning growth and development
State the three main goals in providing nursing care for a child experiencing a seizure?
1. maintain patent airway
2. Protect from injury
3. Observe carefully
What are the side of effects of Dilantin?
Gingival hyperplasia, dermatitis, ataxia, GI distress
Decribde the signs nd symptoms of a child with meningitis?
Fever, irritability, vomiting, neck stiffness, opisthotonos, positive Kernig signs, positive Brudzinski sign
Infant may not show all classic symtpoms even though very ill
What antibiotics are usually prescribed for bacterial meningitis?
Ampicillin, penicillin, chloramphenicol
How is a child usually positioned after brain tumor surgery?
Flat or on either side
What are the physical features of a child with Down Syndrome?
Simian creases in palms, hypotonia, protruding tongue, and upward-outward slant of eyes
Describe scissoring
A common characteristic of spastic cerebral palsy of infants legs are extended and crossed over each other, feet are plantar flexed
What are the two nursing priorities for a newborn with myelomenigngocele?
Prevention of infection of the sac and monitoring for hydrocephalus
Which includes measure head circumference, check fontannel, assess neurologic functioning
List the signs and symptoms of increased ICP in older children
Irritability, change in LOC, motor dysfuntion, headache, vomiting, unequal pupil response and seizures
What teaching should parents of a newly shunted child recieve?
1. Signs of increased ICP
2. Understanding that shunt should not be pumped and that the child will need revisions with growth
3. Guidance concerning growth and development
State the three main goals in providing nursing care for a child experiencing a seizure?
1. maintain patent airway
2. Protect from injury
3. Observe carefully
What are the side of effects of Dilantin?
Gingival hyperplasia, dermatitis, ataxia, GI distress
Decribde the signs nd symptoms of a child with meningitis?
Fever, irritability, vomiting, neck stiffness, opisthotonos, positive Kernig signs, positive Brudzinski sign
Infant may not show all classic symtpoms even though very ill
What antibiotics are usually prescribed for bacterial meningitis?
Ampicillin, penicillin, chloramphenicol
How is a child usually positioned after brain tumor surgery?
Flat or on either side
Describe the feeding techniques for a child with cleft lip or palate
Use lamb's nipple or prosthesis. Feed child upright with frequent bubbling
List the signs and symptoms of esophageal atresia with TEF
Choking, coughing, cyanosis, and excess salivation
What nursing actions are initiated for the newborn with suspected esophageal atresia with TEF
Maintain NPO immediately and suction secretions
Describe the postoperative care for an infant with pyloric stenosis
Maintain IV hydration, provide small frequent oral feedings of gluocose or electrolyte solutions or both within 4-6hrs
Gradually increase to full-stregnth formula. Position infant on right side in semi-fowler position
Describe why a barium enema is used to treat intussusception
Reduces the telescoping of the intestine through hydrostatic pressure without surgical intervention
Describe the preoperative nursing care for a child with Hirshsprung disease
Check vital signs, take temp, teach about colostomy. Observe for bowel perforation. Measure abdominal girth
What care is needed for a child with a temporary colostomy?
Family needs education about skin care, appliancees. Refer to an enterostomal
What are the signs of anorectal malformation
&who does not pass meconium within 24 hours; neconium appearing through a fistula,
Or in the urine; an unusual appearing anal dimple
What are the priorities for a child undergoaing abdominal surgery?
1. Maintain fluid balance (I&O, nasogastric sunction, and monitor electrolytes
2. Vital Signs
3. Care for drains
4. Prevent infection
5. Assess bowel function
What the Hgb norms? Ages newborn, infant, child
Newborn-14-24
Infant-10-17
Child 9.5-15.5
What are the teaching points reagarding administration of oral iron
1. Give on empty stomach
2. Give with citus juices for increased absorption
3. Use dropper or straw to avoid discoloration of the teeth
4. Teach that stools will become tary
5. Iron can be fatal in severe overdoses
6. Do not give with any dairy products
Why are clients with sickle cell anemia not given iron?
Because the anemia is not caused b iron deficiency.
Instead give folic acid because it stimulates RBC synthesis
What should be readily available when administering L-asparaginase
Have epinephrine and oxygen
What are some medications given to reduce renal damage caused by the buildup of uric acid and cellular lysis?
Aloopurinol, xanthine, oxidase inhibitor
What can be given to reduce mitosis of lymphocytes?
Prednisone in combination with antineoplastic drugs
List dietary sources of iron
Meat, green leafy vegetables, fish, liver, whole grains, legumes
What should families and clients do to avoid triggering sickling episodes?
Keep child well hydrated. Avoid known sources of infections. Avoid high altitudes. Avoid strenous exercise.
Nursing interventions and medical treatment of a child with leukemia are based on what three physiologic problems?
1. Anemia
2. Infection (neutropenia)
3. bleeding thrombocytopenia
Describe how an infant iwth Hypothyroidism would be described?
Good and quiet baby
Phenylketonuria
An autosomal recessive disorder in which the body cannot metabolize the essential amino acid Phenylalanine
Leads to mental retardation if left untreated, Often these kids have blue eyes and blond hair due to lack of melanin
What food should PKU clients avoid?
NutraSweet(aspartame) b/c contains phenylalanine
What are the nursing considerations for a school age child?
1. Maintenance of contact with peers important
2.Explanation and participation important
3. Privacy and Modesty
When does adult-like thinking begin?
15 years old
Nursing implications for adlescents?
1. Share room with another adolescent when possible
2. Parents rooming is discouraged
3. Some questions should be asked without the parents present
What should teaching focus on whith adolescents?
Focus on the here and now "How will this affect me today?"
What are the age group concepts of bodily injury?
1.Infant
2. Toddlers
3. Preschool
4. School Age
5. Adolescents
1. 6 months > can remember pain
2. Afraid of intusive behaviors
3. Afraid of body mutilation
4. Loss of control over their body
5. Major concern in change of body image
How is congenital hypothyroidism diagnosed?
Newborn screening revealing a low T4 and a high TSH
What are the symtpoms of congenital hypothyroidism in early infancy?
Large, protruding tongue, coarse hair, lethargy, sleepiness, and constipation
What are the outcomes of untreated congenital hypothyroidism?
Mental retardation and growth failure
What are themetabolic effects of PKU?
CNS damage, mental retardation, and decreased melanin
What two Formular are prescribed for infants with PKU?
Lofenalac and Phenex-I
List foods high in phenylalanine?
Meat, milk, dairy products, eggs
What are the three classic signs of diabetes?
Polydipsia, polyphagia, and polyuria
Differentiate the signs of hypoglycemia and hyperglycemia?
Hypoglycemia-tremors, sweating, headache, hunger nausea, lethargy, confusion, tingling around mouth
Hyperglycemia-polydipsia, polyuria, polyphagia, blurred vision, weakness, weight loss, syncope
Describe the nursing care of a child with ketoacidosis?
Administer regular insulin IV in normal saline, monitor blood gas values,and maintain strick I&O
Describe developmental factors that would impact the school age child with diabetes
Need to be like peers, assuming responsibility for own care, modification of diet, snacks and exercise in school
What is the relationship between hypoglycemia and exercise?
During excercise insulin uptake is increased and the risk for hypoglycemia occurs
What is the purpose of a brace in child with scoliosis?
It is there to stop or slow the progression it does not cure it.
List normal findings in a neurovascular assessment
Warm extremity, brisk capillary refill, free movement, normal sensation of the affected extremity and equal pulses
What is compartment syndrome?
Damage to nerves and vasculature of an extremity due to compression
What are the signs and symptoms of compartment syndrome?
Abnormal neurovascular assessment; cold extremity; severe pain; inability to move the extremity; and poor capillary refill
Why are fractures of the epiphyseal plate a special concern?
B/c it may affect the growth of the limb
How is skeletal traction applied?
It is maintained by pins or wires applied to the distal fragment of the fracture
What discharge instructions should be included concerning a child with a spica cast?
Check child's ciculation; keep cast dry; do not place anything under cast; prevent cast soilage during toileting; do not turn child using an abductor bar
What are the signs and symptoms of congenital dislocated hip infants?
Unequal skin folds of the buttocks, ortolani sign, limited abduction of the affected hip, unequal leg lengths
Ortolani Signs= a click heard in a test for a congenital dislocated hip. It is noted in infancy when the hip slips into or out of the socket
How would the nurse conduct a scoliosis screening?
Ask the child to bend forward from the hips with arms hanging free.
Examine the child for a curve in the spine, a rib hump, and hip asymetry
What instructions should a child with scoliosis recieve about the Milwaukee brace?
Wear the brace 23 hours a day; Wear a tshirt under the brace; check skin for irritation; perform back and abdominal exercises and modify clothing
The child should be encouraged to maintain normal activities as able
What care is indicated for a child with juvenile rheumatoid arthritis?
Prescribe exercise to maintain mobility; splinting of affected joints; teaching about medication management