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Pedi NLN Final exam
Activity level for child who has congenital heart disease - answer -Excessive fatigue, especially during feeding. Inability to tolerate exercise. They become short of breath more quickly compared to their peers and need to rest more often. Shortness of breath can occur even with minimal exertion, such as climbing stairs or taking a walk if the heart failure is severe. These children will often lack energy when compared to their friends, although this may be harder to determine because all children have different levels of energy. In children with heart failure, passing out during exercise may be very serious and needs to be evaluated immediately. Acute epiglottitis assessment - answer -It occurs usually in children aged 2-6 yr, with a peak incidence at 3 yr. Clinically, there is an abrupt onset of high fever, sore throat, dysphagia, stridor, and drooling. Speech may be muffled or lost and there
is an absence of spontaneous cough. Typically, the child looks ill and may prefer to sit leaning forwards, mouth open, and with tongue and jaw protruding in order to open the airway. In contrast to viral croup, the signs of respiratory obstruction in epiglottitis are unlikely to be relieved by administration of nebulized epinephrine. The disease can be rapidly progressive with the use of the accessory muscles, cyanosis, and alteration in conscious level indicating severe respiratory compromise. 4 Ds of epiglottitis - answer -Dysphonia Dysphagia Drooling Distress respiratory Administration of oral medication in a 3-year-old - answer - Usually helps to have a parent or someone else available Letting child handle the equipment helps reduce some fear Explain why the medication will help Let child hold the medicine cup if he can cooperate Don't rush the child. Administration of Virazole - answer -An antiviral for hospitalized infants and young children with severe lower respiratory tract infections due to Respiratory Syncytial Virus (RSV). Infants and young children: Inhalant delivered via mist Adverse effect of Azmacort - answer -Corticosteroid inhaler to prevent asthma attacks Call your doctor at once if you have a serious side effect such as:
- problems with your vision;
- enlarged breasts in men; or
- mild skin rash Adverse effect of Proventil - answer -Stop using albuterol and call your doctor at once if you have a serious side effect such as:
- new bronchospasm or worsening of your asthma symptoms;
- pounding heartbeats or fluttering in your chest;
- chest pain, tremor, nervousness;
- seizure (convulsions);
- low potassium (confusion, uneven heart rate , extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling);
- dangerously high blood pressure (severe headache, blurred vision , buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats); or
- severe skin reaction -- fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling. Less serious side effects of albuterol may include:
- dizziness, spinning sensation;
- headache;
- sleep problems (insomnia);
- muscle cramps;
- dry mouth and throat;
- unusual taste in your mouth; or
- nausea Alternate feeding for infant who is lactose intolerant - answer - Soy-based formulas:
- These formulas are made using soy proteins. They do not contain lactose. The American Academy of Pediatrics
recommends soy formulas for parents who do not want their child to eat animal protein, and for infants with galactosemia or congenital lactase deficiency.
- Soy-based formulas have not been proven to help with milk allergies or colic. Babies who are allergic to cows' milk may also be allergic to soy milk. Analysis of vomiting in an infant who is receiving digoxin and Lasix - answer -Vomiting is usually a sign of digoxin toxicity; infant's digoxin levels should be checked for toxicity; Lasix causes increased diuresis and the child's lytes should be checked for any imbalance. Appropriate blood sugar level in 10-year-old - answer -Blood sugar levels fluctuate greatly depending on activity and diet during the course of a day, but the normal range for blood sugar in children is 70 to 150 mg/dL. (varies slightly from lab to lab) Appropriate, toys for a 4-month-old - answer -Rattles, objects to grasp Assessing for CHF in child who has congenital heart disease - answer -FACES acronym F - fatigue A - limitation of activity C - chest congestion/cough E - edema S - shortness of breath Assess for tachycardia, nocturia, chest pain, weight changes Assess for skin changes: cool, damp, diaphoretic, absent hair growth and a brown or brawny skin discoloration on lower extremities
risk of developing diabetes-related heart, kidney and eye disease or nerve damage.
- check several times a day -- upon waking, before and after meals, before bed or if you experience any symptoms of low or high blood sugar such as the shakes, sweats, irritability or confusion.
- Wash your hands with soap and water.
- Insert a test strip into the monitor
- Alcohol swab finger and rub to bring blood to surface
- Prick finger with lancet
- Squeeze blood onto test strip
- Journal results
- Take action...med, Care for poison ivy exposure - answer -Wash hands and clothing that may have oils on it. Poison ivy treatments are usually limited to self-care methods, and the rash typically goes away on its own within two or three weeks. If the rash is widespread or results in a large number of blisters, your doctor may prescribe an oral corticosteroid, such as prednisone, for poison ivy treatment. If a bacterial infection has developed at the rash site, your doctor will likely give you a prescription for an oral antibiotic. To help control the itching: Apply an over-the-counter corticosteroid cream for the first few days.
- Apply calamine lotion.
- Take oral antihistamines, such as diphenhydramine (Benadryl, others), which may also help you sleep better.
- Soak in a cool-water bath containing an oatmeal-based bath product (Aveeno).
- Place cool, wet compresses on the affected area for 15 to 30 minutes several times/day. Care of 8-week-old who has diarrhea - answer -** Very susceptible to complications from dehydration and hypovolemia** Care of a hip spica cast when wet - answer -Protect while drying, change position Q2H to increase drying, try not to touch with fingertips as it will leave the impression while drying Care of child diagnosed with Duchenne's muscular dystrophy
- answer -Supportive care. Focus on promoting independence and mobility and providing psychosocial support that helps the child and family deal with this progressive, incapacitating disease. Monitor cardiac and respiratory functioning frequently Assess urinary function Measure strength and ROM Assess mobility via ambulation or assisted device Perform periodic development and nutritional assessments Provide braces, splints, and assistive devices as needed Psychosocial support to child and family Care of child who has glomerulonephritis - answer -Protect kidneys by preventing secondary infection: Antibiotics if positive for strep Child will voluntarily restrict activity Avoid nephrotoxic drugs (especially aminoglycosides) Maintain fluid balance: Monitor I & Os Maintain diet and fluid restrictions
nonjudgmental. Interview parent and child separately if possible. Obtain details from each person and compare. Observe behavior of child and parents behavior. Assess childs general appearance and behavior - is demeanor very different from parets description of child. Be aware of shaken baby s/s and cultural practices such as cupping or coining. Use figures and diagrams to document. Take photographs as directed to document location, nature and extent of injuries. Compensatory- behavior in child with Tetralogy of Fallot - answer -Child may squat assuming a knee-chest position to reduce systemic blood return to the heart. Contraindication for DTaP - answer -Contraindication for DTaP
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
- Encephalopathy (e.g., coma, decreased level of consciousness, prolonged seizures) not attributable to another identifiable cause within 7 days of administration of previous dose of DTP or DTaP
- Progressive neurologic disorder, including infantile spasms, uncontrolled epilepsy, progressive encephalopathy; defer DTaP until neurologic status clarified and stablized.
- Temperature of ≥ 105 ° F (≥40.5° C or higher) within 48 hours after vaccination with a previous dose of DTP or DTaP
- Collapse or shock-like state (i.e., hypotonic hyporesponsive episode) within 48 hours after receiving a previous dose of DTP/DTaP
- Seizure ≤ 3 days after receiving a previous dose of DTP/DTaP
- Persistent, inconsolable crying lasting ≥ 3 hours within 48 hours after receiving a previous dose of DTP/DTaP
- GBS <6 weeks after a previous dose of tetanus toxoid- containing vaccine
- History of arthus-type hypersensitivity reactions after a previous dose of tetanus or diphtheria-toxoid containing vaccines (including MCV4); defer vaccination until at least 10 years have elapsed since the last tetanus toxoid-containing vaccine
- Moderate or severe acute illness with or without fever Contraindication of a varicella immunization - answer -Severe allergic reaction, known severe immunodeficiency, pregnancy Croup manifestation requiring immediate action - answer -- Acute Epiglottitis (absence of spontaneous cough and drooling and agitation are the cardinal signs) -Increasing or persistent breathing difficulty, fatigue, bluish coloration of the skin, or dehydration indicates the need for medical attention or hospitalization Developmental task in adolescence - answer -Erikson: Identity vs. role confusion -Peer groups are most important -Behavior defined by group members Diet assessment for a 6-month-old - answer -Introduce new foods by 4-6 mo; 1 new food every few days to check for allergic reactions; no cow's milk or honey or eggs Diet for child diagnosed with renal failure - answer -Are at risk for malnutrition. Diet is tailored to meet individual needs for calories, carbs, fats, amino acids or protein hydrolysates. Depending on degree of renal failure sodium, potassium and phosphorous may be restricted.
Early manifestations of a brain tumor - answer -Symptoms may be subtle and only gradually become worse. Or they may occur very quickly. Headaches are probably the most common symptom. Patterns that may occur with brain tumors include:
- Headaches that get worse when waking up in the morning, and then go away within a few hours
- Headaches that get worse with coughing or exercise, or with a change in body position
- Headaches that occur while sleeping and with at least one other symptom (such as vomiting or confusion) Expected outcome of digoxin therapy in CHF - answer -The child's cardiac output will be sufficient to meet the body's metabolic needs as indicated by increased energy, adequate feeding intake and decreased edema. Expected outcome of therapy for glomerulonephritis - answer -Patient's BP will remain within normal limits; decrease any edema; consume adequate calories; show understanding of dx and tx to best of ability Expected outcome treatment for dehydration in infants - answer -Back to baseline; normal F&E balance no s/s of hypovolemia Feeding a child who has cerebral palsy - answer -Extra teaching and time for each feeding; possible G/J tube due to inability to swallow or lack of gag reflex Glomerulonephritis assessment - answer -Hematuria, proteinuria, increased creatinine, BUN, WBCs in urine, CT scan of kidneys, biopsy of kidneys to test
Growth and development of a 3-month-old - answer -Respond to noises; follow people or objects with eyes; smiles; cooing; reaching for objects Home care for child who has a PICC catheter - answer - Weekly dressing changes; flush lines at recommended intervals; do not let child touch the line Immunization contraindicated for immunosuppressed child - answer -Live vaccines: Varicella and MMR; liquid Polio Incorrect procedure for administering IM to a 6year-old - answer -Correct procedure - Injections sites: Deltoid muscle
- Ventrogluteal site
- Dorsogluteal site-not recommended for <3 years
- Vastus lateralis muscle Needle length - 7/8" - 1 1/4" Gauge - 22-25 G Needle - 90 degree angle Indication of problem with ambulation in post-cardiac surgery - answer -Fatigue is normal - rest before and after Problems - post surgery
- Fever of 101 °F or above
- Sweating or chills
- Any redness, swelling or drainage from your incisions
- Shortness of breath
- Any pain unrelieved by pain medication
- Persistent coughing
- Stomach contractions. You may notice wave-like contractions (peristalsis) that ripple across your baby's upper abdomen soon after feeding but before vomiting. This is caused by stomach muscles trying to force food through the narrowed pylorus.
- Dehydration. Your baby may cry without tears or become lethargic. You may find yourself changing fewer wet diapers or diapers that aren't as wet as you expect.
- Changes in bowel movements. Since pyloric stenosis prevents food from reaching the intestines, babies with this condition may be constipated.
- Weight problems. Pyloric stenosis can keep a baby from gaining weight, and sometimes can cause weight loss. Manifestation of severe dehydration in infant - answer -Same as adult but sunken fontanels Manifestation of UTI in 6-vear-old - answer -Symptoms of a UTI range from slight burning with urination or unusual- smelling urine to severe pain and high fever. A child with a UTI may also have no symptoms. A UTI causes irritation of the lining of the bladder, urethra, ureters, and kidneys, just as the inside of the nose or the throat becomes irritated with a cold. In infants or children who are only a few years old, the signs of a UTI may not be clear because children that young cannot express exactly how they feel. Children may have a high fever, be irritable, or not eat. On the other hand, children may have only a low-grade fever; experience nausea, vomiting, and diarrhea; or just not seem healthy. Children who have a high fever and appear sick for more than a day without signs of a runny nose or other obvious cause for discomfort should be checked for a UTI.
Older children with UTIs may complain of pain in the middle and lower abdomen. They may urinate often. Crying or complaining that it hurts to urinate and producing only a few drops of urine at a time are other signs of a UTI. Children may leak urine into clothing or bed sheets. The urine may look cloudy or bloody. If a kidney is infected, children may complain of pain in the back or side below the ribs. Parents should talk with their health care provider if they suspect their child has a UTI. Manifestations of asthma - answer - • Shortness of breath
- Chest tightness or pain
- Trouble sleeping caused by shortness of breath, coughing or wheezing
- A whistling or wheezing sound when exhaling (wheezing is a common sign of asthma in children)
- Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu Signs that your asthma is probably worsening include:
- Asthma signs and symptoms that are more frequent and bothersome
- Increasing difficulty breathing (measurable with a peak flow meter, a device used to check how well your lungs are working)
- The need to use a quick-relief inhaler more often Manifestations of Hirschsprung's disease - answer -Most obvious sign - newborn's failure to have a bowel movement within 48 hours after birth. Other signs and symptoms in newborns may include:
- Swollen belly
- Vomiting, including vomiting a green or brown substance
- Constipation or gas, which might make a newborn fussy
abdomen, an enlarged liver with fatty infiltrates, thinning hair, loss of teeth, skin depigmentation and dermatitis. Children with kwashiorkor often develop irritability and anorexia. Manifestations of lead poisoning - answer - • Irritability
- Loss of appetite
- Weight loss
- Sluggishness and fatigue
- Abdominal pain
- Vomiting
- Constipation
- Learning difficulties Symptoms in newborns Babies who are exposed to lead before birth may experience:
- Learning difficulties
- Slowed growth Manifestations of nephrotic svndrome - answer -Swelling (edema) is the most common symptom. It may occur:
- In the face and around the eyes (facial swelling)
- In the arms and legs, especially in the feet and ankles
- In the belly area (swollen abdomen) Other symptoms include:
- Foamy appearance of the urine
- Poor appetite
- Weight gain (unintentional) from fluid retention Manifestations of tinea capitis - answer - • One or more round patches of scaly skin where the hair has broken off at or just above the scalp
- Patches that slowly expand or enlarge
- Scaly, gray or reddened areas
- Patches that have small black dots where the hair has broken off at the scalp
- Brittle or fragile hair that easily pulls out
- Tender or painful areas on the scalp Nursing action prior to inserting a Foley catheter - answer - • Female catheterization: The female urethra is short compared to the male urethra. It is located above the vagina in the pelvis. Insertion of the catheter is facilitated by having the patient lie down on his or her back with the buttocks at the edge of the examination table. Adequate exposure of the urethra is obtained by elevating and supporting the legs by stirrups or placing them in a frog-legged position. Finally, the labia are separated to expose the urethra.
- male catheterization: The male urethra is long compared to the female urethra. A catheter is placed while lying down or in the frog-legged position. If there is a foreskin, it is retracted to its maximal limit. Nursing diagnosis for child who is in a sickle cell crisis - answer -Impaired gas exchange r/t decrease in o2 carrying capacity Pain r/t vasoclusive crisis Hypoxia r/t disease process Sickle Cell Crisis - answer -the term used to describe periods when the percentage of hgb S increases resulting in the appearance of symptoms, often marked by acute pain resulting from ischemia. Nursing diagnosis of child who has enuresis - answer - Impaired urinary elimination r/t nighttime incontinence
