Primary goal of tx for child w/ nephrotic syndrome is...
BONUS: Is fluid restriction warranted?
Reduce excretion of urinary PROTEIN and maintain protein-free urine.
Incorrectly mixed formula can cause an infant to develop electrolyte and nutrition imbalances.
Congenital heart disease (areas of turbulent blood flow) provide an optimal environment for bacterial growth. Therefore, a child with CHD is at increased risk for bacterial endocarditis, an infxn of the heart valves and lining. Therefore, what's an important topic the nurse should talk to the client about?
Prophylactic antibiotics before dental work and invasive procedures.
These children can receive all childhood immunizations.
Nurse may use the performance improvement process to determine the underlying causes and contributing factors r/t sentinel events by:
1. randomly observing client care w/o advance warning
2. evaluating a single incident that resulted in an unanticipated outcome
3. requesting that a document expert in the field perform a review
4. conducting root cause anaylis
4. Root cause analysis is used to gather info about facts that contribute to a problem (root causes)
Expert consultation doesn't necessarily reveal site-specific underlying causes and contributing factors in an individual health care facility
What is an important adverse effect of vincristine (Oncovin) (used in chemo)-- that parents have to report promptly
- Neurotoxicity -- blindness << MUST REPORT
- Other a/e: peripheral neuropathy
When should a girl get a Pap smear
When a girl is either sexually active or reaches 18 years of age
Preschoolers and surgery. Ways to decrease anxiety
- 1. Preop teaching right before surgery, since they have a limited concept of time. Delay between teaching and surgery might heighten anxiety
- 2. Have child act out the surgicalexerience using dolls and medical equipment
- 3. Do not use words with dual or negative meaning to a young child such as "put to sleep"
When should child receive first immunizations for MMR and varicella?
Age 12 months
Immunizations required for a child 2 months of age
HIB, HepB, PCV, IPV, DtaP
Early sign of hemarthrosis
This condition doesn't affect pulses and bleeding into joints can be observed directly
How to differentiate the s/s of viral and bacterial mengitis?
Viral: fever, nuchal rigidity, irritability, photophobia
Bacterial: petechial and purpuric rash
Walking with crutches. After advancing both crutches to the length of one step, move the bad or good leg forrward next?
Move the bad leg forward
*good guys finish last
To help the Down syndrome toddler cope with painful procedures, nurse should
Hold, rock, give child a security object
Infant younger than 1, what is the best location to evaluate presence of pulse?
- Since child of this age has very short and often fat neck, so carotid artery is inaccessible.
- Radial artery not the best place b/c cardiac output is low, even with a heart beat
Fantasy play is usually seen in which age group/
Preschool age (3-5 y.o)
When does a first tooth usually erupt? The last?
How many deciduous teeth by age 5?
- First: 6 months.
- Last: 30 months
- Decidous teeth by age 5: 20 teeth
Most infants can sit up without support by which age?
Infant can move from a prone to sitting position and pull himself up to a standing position by which age?
What is cystic fibrosis
It is an inhertied disorder of the exocrine glands that affects multiple organ systems, causing such condition as chronic pulmonary disease, pancreatic deficiency, sweat gland dysfunction, malabsorption, and liver obstruction
The child with cystic fibrosis is at risk for frequent respiratory infections secondary to increased viscosity of mucus gland secretions. To help revent resp infxn, caregivers must do what severl times daily to loosen and drain secretions/
What is the use of sodium bicarbonate?
For a child with hyperkalemia. Administering sodium bicarbonate would promote movement of potassium into the intracellular spaces
Interventions for severely low sodium
- Fluid and sodium replacement RAPIDLY!
- Institute seizure precautions
A toddler's increasing autonomy is commonly expressed by
What is rheumatic fever?
Is it transmittable from one child to another?
An inflammatry dz sometimes occuring if group A beta-hemolytic streptococcal infxn is inadequately treated
S/S: fever, joint inflammation, nonpruritic rash. Strep throat usually precede rheumatic fever
No, rheumatif fever can't be transmitted from one to another
When can a child feed himself with a spoon?
By 17 months
A child can play patty-cake at what age?
Thumbsucking at 12....
Is important to the baby. Many fetuses begin sucking on their fingers in utero, and as infants, refuse a pacifier as a substitute.
If persists after age 4, then is a problem
Heart failure may cause a (what kind of heart rhythm) in a child?
i.e: bounding peripheral pulses, gallop heart rhythm, widened pulse pressure, bradycardia
GALLOP HEART RHYTHM
*Horse on a child's chest indicates heart failure
Most oral pediatric meds are administered
ON AN EMPTY STOMACH.
B/c most child's meals usually contain milk or milk products, they can affect gastric pH and alter drug absorption, meds are NOT even administered 1/2 hour after meal
What are some examples of therapeutic play?
Energy release, dramatic play, and creative play.
They are used to help understand a child's feelings
Which age group is associated with each of the following play:
1. associative play
2. parallel play
3. cooperative play
- 1. Preschoolers -- engaged in a similar activity but there is little organization
- 2. Toddlers
- 3. School-age
What's the most important teaching plan in a child with acute poststretococcal glomerulonephritis.
Blood pressure monitoring since this dz may cause severe, life-threatening htn.
This takes priority over infxn control
Sickle cell anemia
Adolescents are most at risk for what complication?
Children younger than age 2?
Adolescents or adults: sickling of RBCs leads to increased blood viscosity and impaired circulation. Diminished peripheral circulation makes them susceptible to chronic leg ulcers
Younger than 2: swelling of hands and feet commonly occurs during a vaso-occlusive crisis
What is the purpose of Hib vaccine?
protects against serious bacterial infxn, such as mengitis and bacterial pneumonia
When given vastus lateralis IM injection, where should the nurse give the injection?
In the center of the upper quadrant.
10 year old came with suspected inhalation anthrax. What should nurse do first?
- Nurse should also obtain blood cultures and immediately start an IV abx therapy
- Immediate abx administration has been found to lower mortality rates from inhalation anthrax
N95 and negative pressure isolation is not necessary
S/S of coarctation of aorta
Peripheral hypoperfusion: weak femoral pulse and bounding radial pulse
Playing with medical equipment before examination begins is age appropriate for school-age?
NO. This is characteristic of younger children
Restrict large amount of proteins (meats) for chronic renal failure?
Infant is dying. 68beats/min, RR 18, 92% O2 RA. Parents require opioid analgesics. Nurse's response to parents' request should be based on the fact that:
Providing an analgesics duriing the last days and hours is an ethically appropriate nursing action
Nurse's action shold be based on the fact that all clients, regardless of age, have the right to die with dignity and to be free of pain.
When should an uncuffed endotracheal tube be used?
When cricoid cartilage in the toddler is the narrowest part of the larynx and provides a natural seal. This aspect keeps the ET in place w/o requiring cuff
T or F: It's not necessary to explain to the infant (24 hr after surgery to repair a fractured tibia) what the nurse is going to do before she does it.
T or F: Same patient -- be sure the infant gets at least 14 hrs of sleep each night.
F: Although infant may not understand each event, it's better for the nurse to provide an explanation rather than leave the infant fearful of what might happen.
F: Not necessary. Pain, comfort level, and general anxiety may prevent him from receiving much sleep in the acute care setting.
At what age should screening for scoliosis begin?
At age 8 and performed yearly thereafter
What is a Russell traction?
Skin traction applied to lower extremity with the extremity suspended above the bed an a sling placed under the knee
What are some appropriate toys for 3 y.o?
Color, draw, and put together puzzles.
What test is appropriate to diagnose amblyopia ("lazy eye")?
Snellen's test: assess visual acuity and child w/ amblyopia will have decreased visual acuity in the affected eye.
Provides privacy to infants in her care is an example of concept of infant's right to privacy
Providing privacy DOES NOT REPRESENT individualizaiton of nursing care.
Chronic sinusitis and URI, result from allergies. Immunoglobulin assay is ordered. Which would nurse expect to find? (Which Ig)
: found in saliva and tears
as well as intestinal and bronchial secretions
IgD is not that important.
- IgG elevates in presence of viral and bacterial infxn
- IgM: 1st antibody activiated after an antigen enters the body, and is especially effective against graM-neg organism
Child with Down syndrome. Which physiological aspect would put a child at increased risk of infnx?
Muscular hypotonicity of chest muscles leads to diminished resp expansion and pooling of secretions, and an underdeveloped nasal bone impairs mucous drainage.
Down syndrome isn't associated w/ muscle spasticity or increased mucus viscosity.
To decrease likelihood of bradyarrhythmias in children during endotracheal intubation, succinylcholine (Anectine) is used with which agent?
What finding should nurse expect when child ingested toilet bowl cleaner?
Caustic poison such as lye may develop edema, ulcers of the lips, mouth, pain in the mouth and throat, excessive salivation, dysphagia, and brns of the mouth, lips, esophagus, and stomach.
s/s severe form of West Nile virus
- Change in mental status
- Muscle weakness
- Headache and neck stiffness
2 y.o child came in w/ fever, seizures, and vomitting. When changing gown, nurse noted petechiae across child's chest, abdomen, and back. What should the nurse suspect and what is the first thing nurse should do?
Meningitis. Check child's neurological status
Brain injury is more severe in children because of cerebral hyperemia. What is it?
Excess blood in the brain -- causes an initial increase in intracranial pressure.
Increased carbohydrate need is most likely the cause of Imbalanced nutrition: less than body requirements because
healing and repair of tissue requires more carbs.
Also, causes are decreased appetite, increased protein catabolism, and decreased digestive enzymes
What is Reye's syndrome. What dzs usually precede the syndrome?
- 1. Acute encephalopathy and fatty infiltration of the internal organs.
- 2. Usually follows acute viral infxn, (i.e: influenza B, chickenpox, enteroviruses, Epstein-Barr virus. Also has been associated in children with administration of aspirin and other salicylates
What activity should 2 year old be able to do?
1. build tower of 8 cubes
2. point out a picture
3. wash and dry his hands
4. remove a garment
- 1. 2 1/2 y.o
- 2. 2 1/2 y.o
- 3. 3y.o
Primary care nursing is when a nurse care for the same child from admission to discharge
The associate nurse is assigned to the child care assignement when the primary nurse has a day off or during the evening and night shifts
What health history would alert a nurse that her patient is at high risk for severe asthma exacerbation?
History of steroid-dependent asthma.
Late sign of dehydration in a 2 year old
Decreased BP -- b/c compensatory mechanisms in children are able to sustain BP in the low-normal range for some time.