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NSG 207 EXAM III 2025 VERIFIED PEDS
QUESTIONS AND ANSWERS GRADED A+
When informed consent must be obtained
before any invasive procedure
The most common cause of intestinal obstruction
intussusception
Why do children <2 require special evaluation for intracranial regulation
they are unable to respond to directions
Age range for intussusception
5 months to 3 years
how neuro information of infants is obtained
through observation of spontaneous and elicited reflex responses
what informed consent should obtain
sufficient information to make an informed health care decision, expected outcome, potential risks, benefits, and alternatives
2 conditions to obtain valid consent
person must be capable of giving consent (age of majority and considered competent). person must receive the information necessary to make an intelligent decision. person must act voluntarily
intussusception
intestinal obstruction. unknown etiology. occurs when a proximal segment of the bowel invaginates into the distal segment. pulls the mesentery with it more common in males than females. potentially life threatening
what the reflexes are replaced by as an infant matures
purposeful movement
how many times consent must be obtained
for each invasive procedure - one universal consent is not sufficient
what intussusception results in
venous and lymphatic obstruction. ischemia. blood and mucous leak into the intestine
classic symptoms of intussusception
currant jelly-like stools
what parents or legal guardians have full responsibility for
the care of their minor children. they are required to give informed consent
clinical manifestations of intisussecption
sudden acute abdominal pain. child screaming and drawing the knees toward the chest. child appearing comfortable during intervals between episodes of pain. vomiting (bilious). lethargy. passage of red, currant jelly-like stools (stool mixed with blood and mucous). tender, distended abdomen. palpable sausage-shaped mass in the upper right quadrant. empty lower right quadrant (Dance sign). eventual fever, prostration, and other signs of peritonitis
anatomy and physiology differences in neurological assessment of children with intracranial abnormalities
head size, cranial bones, fontanels, suture lines
eligibility for giving informed consent for married parents
usually only 1 needs to give consent
therapeutic management of intussusception
radiologist-guided pneumoenema (air enema) with or without water-soluble contrast. ultrasound- guided hydrostatic (saline) enema. surgery if these are unsuccessful
what the neurological assessment consists of
baseline neurologic information, observation, health history, developmental milestones, physical assessment (fontanels for infant), family history
eligibility for giving informed consent for divorced parents
consent needs to come from the parent who has legal custody
advantage of ultrasound-guided hydrostatic (saline) enema
no ionizing radiation is needed
the earliest indicator of IICP
LOC - deterioration or improvement
nursing assessment for intracranial regulation
vital signs, skin, eye, motor function, posturing, reflexes
recurrence of intussusception
what surgery for intussusception involves
manually reducing the invagination. resection of any nonviable intestine
may cause an increase or decrease in temperature
hypothalamic involvement
child maltreatment
a broad term that includes intentional physical abuse or neglect, emotional abuse or neglect, and sexual abuse of children
pre-procedural care management for intussusception
NPO status, routine lab testing (CBC, UA), signed parental consent, pre-anesthetic sedation
what the skin is examined for in pediatrics
signs of trauma
estimated children who were victims of child maltreatment by CPS in 2010
794,
pre-procedural care management of intussusception for the child with signs of electrolyte imbalance, hemorrhage, or peritonitis
replacement IV fluids, blood transfusion, NGT placement and attachment to suction
what the eyes are checked for in intracranial regulation
if the pupils are "fixed and dilated"
specific reflexes to check for intracranial regulation
Moro and Tonic neck
CPS
child protective services
what the nurse is to monitor before intussusception surgery/procedure
all stools
percentage of physical abuse of confirmed child maltreatment cases
17.6%
nephrotic syndrome
a glomerular disease whose clinical state is characterized by massive proteinuria, hypoalbuminemia, hyperlipidemia (not fully understood), edema
causes of altered levels of consciousness
trauma, infection, poisoning, VP shunt malfunction, seizures, tumors
clinical manifestations of altered levels of consciousness
restlessness, fussy, pupil changes, irritability, posturing, increased ICP
percentage of psychological maltreatment / emotional abuse of confirmed child maltreatment cases
8.1%
types of nephrotic syndrome
primary, secondary, and congenital
primary types of nephrotic syndrome
idiopathic nephrosis, childhood nephrosis, minimal-change nephrotic syndrome (MCNS)
early signs of increased ICP in infants
tense, bulging fontanel. separated cranial sutures. macewen (cracked-pot) sign. irritability and restlessness. drowsiness. increased sleeping. high-pitched cry. increased fronto-occipital circumference. distended scalp veins. poor feeding. crying when disturbed. setting-sun sign
the most common form of child maltreatment
child neglect
neglect
the failure of a parent/guardian to provide for the child's basic needs and adequate level of care
MCNS
minimal change nephrotic syndrome
the early signs of increased ICP in infants to focus on
irritability and restlessness. high-pitched cry. poor feeding
types of child neglect
physical, emotional
labs (blood sugar, electrolytes, BUN, creatinine, toxicology, ammonia level, CBC, blood cultures), EEG, LP, CT, MRI
emotional neglect
lack of affection, attention, and emotional nurturance. failure to meet the child's needs for affection, attention, and emotional nurturance
congenital form of nephrotic syndrome
inherited as an autosomal recessive disorder
physical abuse
deliberate infliction of physical/bodily injury on a child, usually by the child's caregiver
pathophysiology of nephrotic syndrome
the cause is unknown/not completely understood. thought to be immune-mediated, metabolic, biochemical, physiochemical. a disturbance in the basement membrane of the glomeruli causes increased permeability to proteins, especially albumin, leading to hyperalbuminuria, which reduces serum albumin resulting in hypoalbuminemia, decreasing colloidal osmotic pressure in the capillaries and causing fluid to accumulate as fluid shifts from the plasma to the interstitial space and body cavities (edema and ascites). this leads to a decrease in the vascular fluid volume, leading to hypovolemia, stimulating the release of ADH, aldosterone, and RAS. there will be tubular reabsorption of sodium and water in an attempt to increase the intravascular volume. there will also be an increase in serum lipids, cholesterol, and triglycerides
lumbar puncture
a spinal needle is inserted usually between the 3rd and 4th lumbar vertebrae
universally accepted definition of what constitutes as major and minor physical abuse
does not exist
age for nephrotic syndrome
between 2-7 years old
nursing considerations for intracranial regulation
maintain airway, perform routine care, provide adequate nutrition, provide skin care, perform ROM activities, provide sensory stimulation, provide family support and education
SBS
shaken baby syndrome
common gender with nephrotic syndrome
twice as likely to be male
number of children with shaken baby syndrome / traumatic brain injury in the US
1200-1400/year
percentage of children with shaken baby syndrome / traumatic injury that die
25-30%
what there is not in nephrotic syndrome
hematuria or hypertension
acquired hydrocephalus
infection vs trauma
what happens in shaken baby syndrome / traumatic brain injury
babies have a large head-to-body ratio, weak neck muscles, and a large amount of water in the brain. violent shaking causes the brain to rotate in the skull, resulting in shearing head injury
hallmark of nephrotic syndrome
proteinuria: >3+ on urine dipstick
communicating / non-obstructive hydrocephalus
impaired absorption. congenital malformation vs acquired due to trauma, postinfectious meningitis, intraventricular hemorrhage
prevention of shaken baby syndrome / traumatic brain injury
teach caregivers about crying. techniques on how to cope with inconsolable crying. educate (National Center on Shaken Baby Syndrome, The Period of Purple Crying)
clinical manifestations of nephrotic syndrome
weight gain. facial edema/puffiness of face (especially around the eyes, apparent on arising in the morning, subsides during the day). abdominal swelling/ascites. pleural effusion. labial or scrotal swelling. edema of intestinal mucosa possibly causing diarrhea, anorexia, poor intestinal absorption. ankle or leg swelling. irritability. easily fatigued. lethargic. blood pressure normal or slightly decreased. susceptibility to infection. urine alterations (decreased volume, frothy)
noncommunicating / obstructive hydrocephalus
due to an obstruction: infection, ventricular hemorrhage, tumor, structural deformity
early signs / clinical manifestations of hydrocephalus in infants
increased head circumference, bulging fontanels, irritability or lethargy, dilated scalp veins
medication management for nephrotic syndrome
steroids (first line therapy) give over several weeks - prednisone 2 mg/kg with response seen within 14-21 days. diuretics for severe edema offer temporary relief. 25% albumin for severe edema. antibiotics for infections
general signs / clinical manifestations of hydrocephalus in infants
difficulty swallowing or feeding. cardiopulmonary depression. shrill, high-pitched cry
resists soothing in PURPLE
your baby may not stop crying no matter what you try
nursing care management for nephrotic syndrome
monitoring for fluid retention (strict I&O, daily weight, measurement of abdominal girth). assessment of skin for edema. monitoring vital signs to detect early sign of infection process. monitoring urine for protein (albumin) and specific gravity. monitoring the child for infection and prevention of infection (keep warm and dry, keep away from others who may have an infection). encourage the child to eat as loss of appetite is common; consult dietician; restricted salt diet. support the family and teach the family the signs of relapse
clinical manifestations of hydrocephalus in children
headache. irritability, lethargy. altered level of consciousness. personality changes. alterations in motor development. signs of ICP
what the neurological assessment for hydrocephalus includes
head circumference that is increasing in the growth chart
what to teach parents with nephrotic syndrome
to test the urine of albumin. how to administer medications. general care. avoiding infections. the child should attend school
pain-like face in PURPLE
a crying baby may look like they are in pain, even when they are not
AGN
acute glomerulonephritis
what to do for serial head measurements
mark the location of the tape measure
long lasting in PURPLE
crying can last as much as 5 horus a day or more
