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65 Cards in this Set

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1. List the priority interventions for a client with a diagnosis of dehydration.
1. List the priority interventions for a client with a diagnosis of dehydration.

- Administer IV fluids, usually D5NS and electrolytes. No antiemetics. Take daily weights and I&O
- Obtain daily weights, at the same time every day
- Avoid taking rectal temperature
- Assess and monitor I&O (urine and stool)
- Initiate IV fluids as ordered
- Administer antibiotic as ordered. Metronidazole (Flagyl) is used for the child who is symptomatic of C. Diff
- Oral rehydration therapy (ORT) guidelines
- Administer IV fluids as prescribed; usually D5NS.
- Fluid replacement takes place rapidly for isotonic and hypotonic
dehydration but should take 24 to 48 hr for hypertonic dehydration to
prevent cerebral edema.
- Antiemetics are not recommended because vomiting usually resolves
with treatment of dehydration.
- Determine the cause of diarrhea. Antibiotics are usually reserved for
children who are immunocompromised.
- Starting replacement with an oral replacement solution (ORS) of
75 to 90 mEq of Na+/L at 40 to 50 mL/kg over 4 hr.
Determining further rehydration after initial replacement. Maintenance
therapy should limit ORS to 150 mL/kg/day.
Giving ORS of 40 to 60 mEq of Na+/L for children with diarrhea but no
significant dehydration.
Giving water, breast milk, or lactose-free formula if supplementary fluid is
needed.
Advancing infants and older children to their regular diet while on
maintenance ORT.
Replacing each diarrheal stool with 10mL/kg of ORS for ongoing diarrhea.
Inform or have parent inform school or day care center of the child’s infection/
infestation. The child should stay home during the incubation period.
Teach the family to use commercially prepared ORS when the child experiences
diarrhea. Foods and fluids to avoid include:
Fruit juices, carbonated sodas, and gelatin, which are all high in
carbohydrates, low in electrolyte content, and have a high osmolality.
Caffeine, due to its mild diuretic effect.
Chicken or beef broth, which has too much sodium and not enough
carbohydrates.
Bananas, rice, applesauce, and toast (BRAT diet). This diet carries low
nutritional value, high carbohydrate content, and low electrolytes.
Teach the parent/caregiver to administer medications as prescribed.
Pyrantel pamoate (Antiminth) and mebendazole (Vermox) are the
medications of choice. Both are administered in a single dose that may need
to be repeated in 2 weeks.
All members of the family should be treated.
Instruct the family about home treatment for Enterobius vermicularis.
Wash bed linens and underwear in hot water and dry in a hot clothes dryer
daily for several days.
- Cleanse toys and child care areas thoroughly to prevent further spread or reinfestation.
- Keep toys separate and avoid shaking linen to prevent spread of disease.
- Teach the family how to avoid the spread of infectious diseases.
- Avoid undercooked or under-refrigerated food.
- Promote and instruct on proper handwashing.
- Clip nails and discourage nail biting and thumb sucking.
Clean toilet area.
- Leads to electrolyte imbalance
What is Dehydration?
What is Dehydration?

- Amount of water leaving the body is greater than amount of water entering the body
2. What are the signs of dehydration in a child?
2. What are the signs of dehydration in a child?

- Dry, pale skin.
- Cool lips,
- dry mucous membranes,
- poor skin turgor,
- decreased urine output,
- concentrated urine,
- thirst,
- rapid pulse,
- sunken fontanels and
- decreased B/P
- Increased Specific gravity
3. List the nursing interventions for an infant following surgery for a cleft palate.
3. List the nursing interventions for an infant following surgery for a cleft palate.

• Airway management
• Pain control
• Position in infant seat – upright position
• Elbow restraints
• Wound care as ordered by MD (Keep clean)
• Monitor site for signs of infection
• Minimizing crying (stress on repair)
• Assess ability to suck/eat
• Feeding techniques
• I&O and daily weight
• Observe family interaction with the child/Coping
• Done around 1 year of age after teeth have erupted and before the child is talking to promote better speech outcomes
• Prone in immediate post-op period
• IV fluids till child can eat
• Monitor packing; removed in 2-3 days
• Position upright to facilitate breathing
• No forks, straws, pacifier, tongue depressor
• Discharge home on soft diet
• Monitor post-op protective device
• Position upright (car seat position), back, or side immediately after surgery (maintain integrity of repair)
• Elbow restraints, jacket restraint (prevent rolling over)
• Periodically remove restraints
• Clean incision site, antibiotic ointment
• Suction with bulb syringe only to prevent respiratory complications
• Avoid injury to palate with syringes, straws, cups etc.
- Place infant on stomach (prone), IV fluids until able to eat and drink, monitor packing, facilitate breathing with upright position, NPO to disturb sutures, soft diet and elbow restraints
What is cleft lip/palate?
What is cleft lip/palate?

• Failure of the lip and/or palate to grow together (between 7-12 weeks gestation)
• Normally occurs together, but an occur alone
• Unilateral on the left side more common
• Most often in boys
• Cleft palate alone more common in girls
• 1.5 in 1000 births/About 4200 babies in US each year
• Often occurring with nasal deformity, dental disorders
• Hereditary factors, ↑risk if family members have defect
• Environmental, i.e., lack of folic acid during pregnancy
• Teratogens, maternal smoking
• Compication: AOM, Speech delay, aspiration
4. What is Hirschsprung’s disease?
4. What is Hirschsprung’s disease?

• Structural anomaly of GI tract caused by lack of ganglionic cells in the segments of the colon, causing mechanical obstruction
• Stool accumulates (lack of peristalsis)
• Usually diagnosis as infant
• Can be acute or chronic
• More common in boys
5. What are the signs and symptoms of Hirschsprung’s disease?
5. What are the signs and symptoms of Hirschsprung’s disease?

- Newborn – no meconium, distended abdomen, FTT
- Child – Constipation
- failure to pass meconium, poor feeding, vomiting bile, abdominal distention, FTT, fever, visible peristalsis, backed up for all ages
• Newborn-Failure to pass meconium, refusal to eat, vomits bile, distention
• Infant-Failure to thrive, constipation, distention, episodes of vomiting and diarrhea, fever, explosive diarrhea
• Older child-Constipation, abdominal distention, visible peristalsis, ribbon-like stool, obvious fecal mass, malnourished appearance.
What is the treatment for Hirschsprung’s Disease? (Megacolon)
What is the treatment for Hirschsprung’s Disease? (Megacolon)

• - Two-stage procedure
– Placement of colostomy to relieve the obstruction and allow megacolon to regain it’s tone
• At 6-15 mos. (18-20lbs)
– Pull-through procedure (resects to ganglionic segment/Closing colostomy
6. How is diarrhea defined?
6. How is diarrhea defined?

- mild to severe, acute or chronic and by its consistency
- Consistency of stool
7. List some nursing interventions for the client with bulimia.
7. List some nursing interventions for the client with bulimia.

- Correct the malnutrition, psychosocial counseling, TPN, IV fluids, electrolytes and cardiac meds. Evaluate eating habits, reestablish a normal eating pattern, family counseling and careful monitoring of purging
- Watching after they eat
- Keep them from binging
- Admission to a highly structured inpatient unit providing a therapeutic milieu in order to interrupt the binge-purge cycle and prevent the disordered eating behaviors
- Careful monitoring of food intake, exercise patterns, and the attempt to purge after eating
8. What pediatric age group is most at risk for accidental poisoning?
8. What pediatric age group is most at risk for accidental poisoning?
- Children less than 6 years old
9. What is tracheoesophageal atresia?
9. What is tracheoesophageal atresia?

- A fistula that connects the trachea and esophagus. atresia is the pouch where the esophagus closes off and does not go to the stomach.
• - Esophageal Atresia: Prior to 1939 (first repair) condition was fatal.
• Esophagus ends in a blind pouch.
• Infant has a lot of mucous at birth.
• The rationale for giving sterile water for the first feed.
- Tracheo-esophageal Fistula (TEF): Tracheoesophageal fistula is an abnormal connection in one or more places between the esophagus and the trachea. Normally, the esophagus and the trachea are two separate tubes that are not connected.
- 85 to 90% of defects
- Failure of the esophagus
to recanalize between
4th and 6th week of
development.
- Diagnosis that the esophagus is interrupted is confirmed by the inability to insert a nasogastric suction tube into the stomach.
What are the signs and symptoms E.A and TEF?
What are the signs and symptoms E.A and TEF?

• Excessive drooling / frothy mucus
• Inability to pass NG tube
• High risk for aspiration of HCL from stomach causing a chemical pneumonia.
• Hx of polyhydramnios during pregnancy (95%)
• Coughing, gagging, cyanosis, and choking with attempted feeding
• Difficulty breathing
• Very round, full abdomen
10. What is an ASO titer?
10. What is an ASO titer?

- Antistreptolysin O Titer. Blood test to measure antibodies against streptolysin O (strep throat)
- Test for exposure to strep antibodies
- Strepococcal causes AGN
11. What are the nursing interventions for a client who has attempted suicide?
11. What are the nursing interventions for a client who has attempted suicide?

- Major nursing goal is prevention
12. List some signs that a client might be at risk for suicide.
12. List some signs that a client might be at risk for suicide.

- Hx of previous attempted suicide
- Friend committed or attempted suicide
- School problems or changes in grades
- Pregnancy
- Drug use or abuse
- Problems with a romantic relationship
- Minority sexual practice
- Loneliness, withdrawal
- Feelings of anxiety
- History of chronic family problems
- Chronic Illness
- Physical, emotional, or sexual abuse
- History of suicide in a family member
- History of depression
- Chronic low self-esteem
- Change in behavior
- Change in weight
- Giving away special possessions
- Access to firearms and ammunition
13. How is lead poisoning treated?
13. How is lead poisoning treated?

- Chelation therapy (EDTA)
- Chelation therapy using calcium EDTA (calcium disodium versenate) NO IPECAC
What are S/S of Plumbism (Lead poisoning)?
What are S/S of Plumbism (Lead poisoning)?

• Low: easily distracted, impulsivity, hyperactivity, impaired hearing, mild intell. difficulty
• High: mental retardation, blindness, paralysis, coma, seizures, death
• Other: renal impairment, impaired calcium function, anemia
14. List some disorders that cause mental retardation in pediatric clients.
14. List some disorders that cause mental retardation in pediatric clients.

- FAS, Trisomy 21, Fragile X syndrome
- Fetal Alcohol Syndrome (FAS) – Small head, Low nasal bridge, Epicanthal folds, Small eye openings, Flat midface, short nose, thin upper lip, smooth philtrum, upturned nose
• - One of the leading causes of mental retardation
• Alcohol- related neurodevelopment disorder (ARND)
• Alcohol in the mother’s blood freely crosses the placenta.
• Can cause birth defects
- Trisomy 21 (Down syndrome)
- Fragile X Syndrome. (fragile x syndrome is a change in genetic code of a single gene on the X chromosome, this defect inhibits the body's ability to produce a protein called FMRP.
• Fragile X Syndrome is genetic, sex-linked abnormality of the X chromosome.
• The condition is often associated with other conditions such as ADHD, anxiety, and autism
• Leading cause of inherited mental impairment
Early interventions with speech and occupational therapy
– S/S: Male children have a large head and chin and a long face.
– Their eyes are wide set.
– There is a noted speech delay, heart murmur. Lower IQ
– Attention deficits and hyperactivity
– Autistic behaviors and characteristics
– Large forehead and/or ears with a prominent jaw
– Flat feet
– Mental impairment, ranging from learning disabilities to mental retardation
– Large testicles (macro-orchidism)
– Hyperextensible joints, especially fingers
– Seizures (epilepsy affects approximately 25% of people with Fragile X)
– Large size for age
High anxiety with unstable moods
15. What are the signs and symptoms of cocaine use?
15. What are the signs and symptoms of cocaine use?

- Dilated pupils, Stimulant
- dilated pupils, shaking hands, runny nose, tachycardia, weight loss, increased bp
16. What are the signs and symptoms of acetaminophen poisoning?
16. What are the signs and symptoms of acetaminophen poisoning?

• 2-4 hrs: nausea, vomiting, sweating, pallor
• 24-36hrs: Improvement
• 36-7 days: pain in upper rt. quadrant, confusion, stupor, jaundice, coagulation disturbances
• Final: death or gradual recovery
• Antidote
– Acetylcysteine (Mucomyst) orally
- Liver damage
- Initially – N/V, sweating, pallor
- Late – Jaundice, coma,
What is Nephrotic Syndrome?
What is Nephrotic Syndrome?

• A group of symptoms, not a disease.
• Glomerular capillaries are damaged from immune complex deposits, nephrotoxic antibodies, or non-immunological insults.
• These damaged capillaries permeable to serum proteins (↓serum osmotic pressure)
• Proteinuria, hypoalbuminemia, edema, hematuria
• Causes kidneys to excrete massive amounts of protein
• Lg amt of protein excreted in urine→hypoalbuminemia →edema
• 80% of cases are minimal change nephrotic syndrome (MCNS)
• Peak between ages 2 and 7
• Cause unknown
• Can be secondary or congenital (inherited)
• Dx: UA, 24-hour urine collection
• Serum chemistry
• Lipid panel (↑Chol, triglycerides)
• Albumin ↓
• ↑Hgb, Hct, platelets, Na, BUN, Creat
• Kidney biopsy (fatty deposits in tubules, glomerular sclerosis, epithelium changes)
17. What are the signs and symptoms of nephrotic syndrome?
17. What are the signs and symptoms of nephrotic syndrome?

Generalized edema, increased in scrotum and abdomen. Weight gain, pallor, fatigue, anorexia, N, V, decreased urinary output, dark and frothy urine with elevated SG. Proteinuria, hypoalbuminuria, hematuria, increased B/P and increased cholesterol and triglycerides, hyperlipidemia
• Urine output is scanty, ↑BP
• Distended abdomen
• Child doesn’t eat – uncomfortable
• Weight gain with poor appetite, nausea and vomiting
• Ascites, dependent edema
• Dark frothy urine, ↓output, ↑ SG
• Irritability, malaise, activity intol., fatigue
• Generalized edema; Dramatic weight gain
• Edema is worse in scrotum and abdomen (ascites)
• Pale, fatigue, anorexic
• Anorexia
• Edema (periorbital) is worse in morning and decreases as the day progresses
18. How is nephrotic syndrome treated?
18. How is nephrotic syndrome treated?

• Symptomatic
• Corticosteroids
• Limiting salt and fluid intake
• Diuretics
• Encourage child to eat.
• Protect against infection
• Careful skin care
1. - Goals of treatment: To decrease urinary protein loss
2. Controlling edema
– Corticosteroids up to 12 months
3. Balanced nutrition
4. Restore normal metabolic function
5. Prevent or treat any infection
What are some Nephrotic syndrome nursing interventions?
What are some Nephrotic syndrome nursing interventions?

• Diuretics (during acute phase lasix would be given after IV albumin)
• Fluid restriction if edema severe
• VS, Daily weights, Abdominal girth
• Strict intake and output
• Monitoring daily renal function labs
• Observe for fluid, electrolyte, and acid-base imbalance
• Encourage low-sodium, high-calorie, with adequate protein
• Provide good skin care/oral hygiene
• Family teaching/medication teaching
• Administer meds
19. What type of acid-base imbalance is caused by vomiting?
19. What type of acid-base imbalance is caused by vomiting?

- Metabolic Alkalosis
20. What are the signs and symptoms of possible child abuse?
20. What are the signs and symptoms of possible child abuse?

- Parents tell different stories
- Different stages of bruising
- Physical S/S = unexplained bruises, bite marks, bald spots, cigarette burns, immersion burns, swollen areas, unexplained fractures and abrasions. Also watch for S/S of sexual, emotional abuse and neglect in ATI
– unexplained bruises (in various stages of healing)
– welts, human bite marks, bald spots
– unexplained burns, especially cigarette burns or immersion burns
– unexplained fractures, lacerations or abrasions
– swollen areas
– evidence of delayed or inappropriate treatment for injuries
– self destructive behaviors
– withdrawn and/or aggressive - behavioral extremes
– arrives at school early or stays late as if afraid to be at home
– chronic runaway (adolescent)
– complains of soreness or moves uncomfortably
– wears clothing inappropriate to weather, to cover body
– bizarre explanation of injuries
21. What diagnostic tests are used to diagnose appendicitis?
21. What diagnostic tests are used to diagnose appendicitis?

- Appendicitis may be diagnosed by ultrasound or CT scan of the abdomen
- CBC usually shows WBC count greater than 10,000/mm3 with shift to left (increased immature neutrophils referred to as bands)
22. What are the signs and symptoms of salicylate toxicity?
22. What are the signs and symptoms of salicylate toxicity?

Dizzyness and lightheadedness
- Tinnitus (ringing ears)
• Acute- nausea, vomiting, disorientation, diaphoresis, tachypnea, tinnitis, oliguria, lightheadedness, seizures
• Chronic- subtle acute sx, bleeding tendencies, dehydration, more severe seizures
What is the treatment for aspirin overdose?
What is the treatment for aspirin overdose?

• Activated charcoal
• Gastric lavage
• Sodium bicarbonate
• Oxygen and ventilation
• Vitamin K
23. List some nursing interventions for a child with nephrotic syndrome.
23. List some nursing interventions for a child with nephrotic syndrome.

- Monitor for protein in urine
- Assess respiratory system for fluid overload (crackles, dyspnea)
• Diuretics (during acute phase lasix would be given after IV albumin)
• Fluid restriction if edema severe
• VS, Daily weights, Abdominal girth
• Strict intake and output
• Monitoring daily renal function labs
• Observe for fluid, electrolyte, and acid-base imbalance
• Encourage low-sodium, high-calorie, with adequate protein
• Provide good skin care/oral hygiene
• Family teaching/medication teaching
• Administer meds
• Assess specific gravity
• Diuretics, fluid restrictions, low sodium and low protein diet, daily weights, I&O and monitor abdominal girth
24. What are the signs and symptoms of pinworm infection?
24. What are the signs and symptoms of pinworm infection?

• - Enterobiasis, or pinworm infection as it is commonly called, is an intestinal infection caused by the parasitic roundworm called Enterobius vermicularis. The most common symptom of this irritating, but not particularly dangerous, disease is itching around the anal area.
- Itching around anal area, enuresis, sleepiness, restlessness and irritability
What is SIDS?
What is SIDS?

- SIDS is the sudden, unpredictable, and undetectable death of an infant without an identified cause, even after investigation and autopsy
- It is a major cause of death in infants from 1 month to 1 year
- SIDS is not preventable, but risks may be reduced
- Education about reducing the risk of SIDS is on the rise
25. What are the risk factors for sudden infant death syndrome?
25. What are the risk factors for sudden infant death syndrome?

- Maternal health and behaviors during pregnancy.
Age less than 20 years
Alcohol, drug, and/or tobacco use
Low weight gain during pregnancy
Anemia
Placental abnormalities
Sexually transmitted disease or urinary tract infection
Twins.
Premature birth.
Small for gestational age.
Persistent apnea.
Bronchopulmonary dysplasia.
Family history of SIDS.
Environmental risk factors.
Low socioeconomic status
Crowded living conditions
Cold weather
Use of soft items in crib (e.g., stuffed animals, blankets)
Prone sleeping position
Sleeping with others
26. What can the nurse teach families to reduce the risk of SIDS?
26. What can the nurse teach families to reduce the risk of SIDS?

- Reduction of risk for SIDS
Infant sleep position should be on back for sleep.
Prevent exposure to tobacco smoke.
Prevent overheating.
Use a firm, tight-fitting mattress in the infant’s crib.
Remove pillows, quilts, and sheepskins from the crib during sleep.
Ensure that the infant’s head is kept uncovered during sleep.
Allow the infant’s family an opportunity to express feelings.
Provide private time for the family to be with the infant after death.
Provide support.
Encourage using a home monitoring system for future infants.
Provide home monitoring for those at high risk, such as a remaining twin.
Educate or reinforce proper sleeping position, crib environment, smoke-free
environment, and the avoidance of overheating.
Recommend support groups.
Recommend counseling.
27. What is pyloric stenosis?
27. What is pyloric stenosis?

• - Hypertrophic pyloric stenosis
– the thickening and tightening of the pyloric sphincter, creating an obstruction
– Has a genetic component and is more common in 1st born male children
28. What are the signs and symptoms of pyloric stenosis?
28. What are the signs and symptoms of pyloric stenosis?

• Vomiting occurring 30-60 min after meal and becomes projectile
• Constant hungry
• Weight loss, signs of dehydration
• Olive-shaped mass URQ
• Observation of peristalsis when lying supine
• Treatment is surgery
29. What abdominal organs are directly affected?
29. What abdominal organs are directly affected?

- It affects the stomach and the colon
- The stomach and the duodenum
What is GERD?
What is GERD?

• Occurs when gastric contents reflux back up into the esophagus
• May lead to failure to thrive, resp. difficulties
• Caused by the relaxation of the lower esophageal sphincter
• More likely to occur in premature infants and those born with congenital defects
• After you eat, food travels from your mouth down the esophagus to your stomach. Along the way, food passes through a one-way valve called the lower esophageal sphincter (LES), the opening to your stomach. Normally the LES opens when you swallow. It allows food to enter the stomach, then closes quickly. With GERD, the LES doesn’t work normally. It allows food and stomach acid to travel back (reflux) into the esophagus.
S/S: History of premature birth, constantly spitting up
bronchopulmonary dysplasia, cerebral palsy,
tracheoesophageal or esophageal atresia
repair, cystic fibrosis
Excessive spitting up or forceful vomiting
Irritability, heartburn
Hematemesis, blood in stool
• Apnea or apparent life-threatening event
30. What are the nursing interventions for an infant with GERD?
30. What are the nursing interventions for an infant with GERD?

- Cereal in bottle, positioning upright, small frequent feedings (constantly spitting up)
- thickened formula, elevate head after feedings
- Treatment for infants/children with GERD is based on severity and includes:
Offering small frequent feedings of thickened formula.
Positioning the child with the head elevated after eating.
Placing the infant in prone position for sleep, which can prevent aspiration
of stomach contents. This is only recommended for the child with severe
GERD.
Placing the child older than 1 year in the side-lying position with the head of
the bed elevated for sleep.
31. What is acute glomerulonephritis?
31. What is acute glomerulonephritis?

• An inflammation of the glomerular capillaries, usually following a streptococcal infection. It is an immune complex disease, not an infection of the kidney.
• Most common form of nephritis in children 5-10 years old.
• Results from an immunologic reaction to infection
• Assessment: History of streptococcal infection
• Renal symptoms
• Fluid volume excess symptoms
• Risk Factors: GABHS infection
• Systemic lupus erythematosus
• Hypertension
• Metabolic disease (diabetes mellitus)
• Nephrotoxic medications
• Excessively high-protein/sodium diets
• Mainly affects children between ages 6 and 7.
• Most common noninfectious renal disease in children.
• Symptoms usually show 10 to 21 days after infection
What are the diagnostic for AGN?
What are the diagnostic for AGN?

• - Urinalysis: proteinuria, hematuria, red cells and casts, specific gravity > 1.025
• ↑BUN, ↑ Creat., ↓Creatinine clearance
• Throat culture
• Antistreptolysin-O (ASO) titer
• Electrolytes: hyperkalemia, hypermagnesemia, hyponatremia
• ↑ sed. rate; ↑ WBC
• Antihyaluronidase, antideoxyribonuclease B, ans streptozyme antibodies
• ↓Serum complement (C3)
• Chest x-ray to r/o pulmonary complications
Pulmonary edema
Cardiac enlargement
Pleural effusions
• X-rays of kidney, bladder to r/o structural abnormalities (atrophy)
32. What are the signs and symptoms of AGN?
32. What are the signs and symptoms of AGN?

• Recent streptococcal infection
• ↓ urinary output
• Smoky/tea-colored urine
• proteinuria (3+ or 4+)
• SOB
• Orthopnea
• Rales
• Periorbital/facial edema
• Hypertension
• Child appears ill, lethargic, irritable, pale
• Hematuria (Smokey urine)
• Puffy eyes; ↓ urinary output
• ↑ BP; ↓ glomerular filtration rate
• + throat cx for GABHS
• Enlarged kidneys
• ↑ BUN, Creat
• + RBC’s in urine; ↑ urine WBC’s
• Abnormal protein, ↑ ASO titer
• Fluid retention
33. How does AGN differ from nephrotic syndrome?
33. How does AGN differ from nephrotic syndrome?

- AGN = Strep (ASO), proteinuria, hematuria, periorbital edema and HTN
NS = massive proteinuria, hypoalbuminuria, hematuria, generalized edema, hyperlipidemia
34. What signs and symptoms would alert you that a client’s acute glomerulonephritis is improving?
34. What signs and symptoms would alert you that a client’s acute glomerulonephritis is improving?

- Increased urine output
35. What should be eliminated from the diet of a child with acute glomerulonephritis?
35. What should be eliminated from the diet of a child with acute glomerulonephritis?

- Sodium and Protein
- Encourage lowering sodium intake and avoid foods high in sodium
- and foods high in potassium
36. What is hypospadias?
36. What is hypospadias?

- The urethral meatus is located on the ventral (underside) surface of the penis.
What is a UTI?
What is a UTI?

• - Refers to an infection in any portion of the lower urinary tract. (cystitis, urethritis)
• Upper UTI (pyelonephritis)
• Most commonly caused by E. coli. Also caused by Proteus, Pseudomonas, Klebsiella, and Staph. aureus
• - Risk factors: Certain urinary conditions
• Urinary reflux
• Increased sexual activity
• Sexual abuse
• Short urethra/proximity to rectum
• Synthetic, tight underwear
• Hot tubs, bubble baths
• Adolescent hormonal influences within vaginal flora
• Chronic disease (diabetes, CP)
• Interventions: Encourage frequent voiding and complete emptying of the bladder
• Small frequent meals
• Teaching: Medications, diagnostic tests, signs and symptoms
• Preventing poss. recurrence
• Wipe front to back
• Retract and clean foreskin on males
• Keep underwear dry
• Maintain adequate hydration
• Avoid bubble baths
37. What are the signs and symptoms of a child with a urinary tract infection?
37. What are the signs and symptoms of a child with a urinary tract infection?

• Fever > 103°F
• Frequency, urgency, nocturia
• Dysuria, bladder cramping/spasms
• Perineal itching, redness
• Warm sensation during urination
• Urethral discharge
• Cloudy-foul-smelling urine
• Hematuria
• Lower back, abdominal discomfort
• Nausea, vomiting , diarrhea
38. What are the S/S of an infant with UTI?
38. What are the S/S of an infant with UTI?

• Fever of unknown origin
• Irritability/fussiness
• Poor feeding
39. What is Meckel’s diverticulum?
39. What is Meckel’s diverticulum?

• A Meckel's diverticulum is a pouch on the wall of the lower part of the small bowel that is present at birth (congenital). The diverticulum may contain tissue from the stomach or pancreas.
• The remnant of a fetal duct
• May be up to 4 in. and found in the small intestine
• More common in boys
• Most sx occur < 2yrs age, but can occur up to 10 yrs
40. What are the signs and symptoms of Meckel’s diverticulum?
40. What are the signs and symptoms of Meckel’s diverticulum?

• Abdominal pain, bloody stools w/o pain
• Bright red mucus in infant stools
• Treatment: Surgery to remove the diverticulum is recommended if bleeding develops. In these rare cases, the segment of small intestine that contains the diverticulum is surgically removed. The ends of the intestine are sewn back together.
41. What is intussusception?
41. What is intussusception?

• The telescoping of the intestine over itself. Usu. in infants and small children up to age 3, most common between 5-9 mos.
• More common in boys and children with cystic fibrosis
42. What are the signs and symptoms of intussusception?
42. What are the signs and symptoms of intussusception?

• Sudden onset severe abdominal pain
• Inconsolable crying
• Draw knees up
• Currant jelly-like stool (late sign)
• Non-bilious vomiting
• Palpable, sausage-shaped mass in abdomen/distention
• Severe acute abdominal pain
43. How is intussusception treated?
43. How is intussusception treated?

barium enema and surgery
44. What is the purpose of total parenteral nutrition?
44. What is the purpose of total parenteral nutrition?

- promote growth and sustain life when GI function is impaired
- Provides nutrients and calories
- Gives bowels a rest
45. When can emetics be used for the treatment of poisoning?
45. When can emetics be used for the treatment of poisoning?

- Aspirin OD
- Supplemental Iron OD
46. What is autism?
46. What is autism?

• - Autism is a complex developmental disability that typically appears during the first 3 years of life and is a result of a neurological disorder that affects the normal functioning of the brain, impacting development in the areas of social interaction and communication skills.
• 1 of every 166 births
• 1-1.5 million Americans have autism
• Fastest growing developmental disability
• Males 4x more likely to have autism than females
• A complex bio-neurological developmental disorder of the brain
• Onset < 3yrs age
• Broad range of severity
• Diagnosed 4x more often in boys
• Assessment: Hx pregnancy, birth history
• Sleep hx and patterns/difficulties
• Hx allergies
• Hx digestive difficulties
• Hx self-mutilation
• Assess cognitive development pattern
• Assess communication
• Goal: to allow the child the highest level of independence within the constraints of the disorder through treatment and education.
• The is no one symptom or behavior that identifies autistic children
• Provide stable environment
• Positive reinforcement
• Helmets
• Provide safety
• Modify behaviors/Socialization
• Alternative play activities
• One-on-one interactions/Communication
• Role modeling
• Prevent injury
• Growth and development
47. What are the signs and symptoms of autism?
47. What are the signs and symptoms of autism?

• Talking at others rather than to or with them
• Giving manic monologues
• Being very resistant to change
• Obsessive attachments to objects
• Pointing or gestures instead of words
• Repetitious speech
• Preferring to be alone
• Throwing tantrums
• Diff. communicating or socializing with others
• Not wanting affection, hugs, cuddling
• Little or no eye contact
• Developmental delays in gross/fine motor skills
• Unresponsive to verbal cues
• Unresponsive to normal teaching
What findings in infant with esophageal atresia and TEF? (Select all that apply)
What findings in infant with esophageal atresia and TEF? (Select all that apply)

- Abdominal distention
- Drooling
- Hear fluid in lungs
- maybe: cyanosis, aspiration
- (NO: hands and feet blue, and having to do with VS)
Goal for teen with eating disorder? (short term)
Goal for teen with eating disorder? (short term)

- Balanced nutrition
- Eating right
What are the S/S of AGN? (Select all that apply)
What are the S/S of AGN? (Select all that apply)

- Anorexia
- Pallor
- Lethargy
Highest risk for suicide?
Highest risk for suicide?

- Always when guns are involved
Complications of AGN?
Complications of AGN?

- Hypertension (HTN)
Suicide, Depression – Nursing interventions? (Select all that apply)
Suicide, Depression – Nursing interventions? (Select all that apply)

- Talking one on one (therapeutic communication)
- Remove dangerous objects
- Ask what they are thinking
- Make sure they are actually taking meds