Docsity
Docsity

Prepare for your exams
Prepare for your exams

Study with the several resources on Docsity


Earn points to download
Earn points to download

Earn points by helping other students or get them with a premium plan


Guidelines and tips
Guidelines and tips

Nur 254 Pediatric Exam 4 Galen College of Nursing Maternal and Pediatrics (Galen College, Exams of Nursing

Nur 254 Pediatric Exam 4 Galen College of Nursing Maternal and Pediatrics (Galen College of Nursing)

Typology: Exams

2023/2024

Available from 02/12/2025

lenah-smith
lenah-smith 🇺🇸

632 documents

1 / 12

Toggle sidebar

This page cannot be seen from the preview

Don't miss anything!

bg1
Nur 254 Pediatric Exam 4 Galen College of
Nursing
Maternal and Pediatrics (Galen College of
Nursing)
pf3
pf4
pf5
pf8
pf9
pfa

Partial preview of the text

Download Nur 254 Pediatric Exam 4 Galen College of Nursing Maternal and Pediatrics (Galen College and more Exams Nursing in PDF only on Docsity!

Nur 254 Pediatric Exam 4 Galen College of

Nursing

Maternal and Pediatrics (Galen College of

Nursing)

Child Caring Exam #4 Study Guide Unit 9: Oncology, Hematology, Grief, and Loss

  • Nursing management o Communication ▪ Appropriate responses following death of a child (therapeutic communication) - Stay with the family - Accept the family’s grief reactions and avoid judgmental statements - Avoid “rationalizing” (She isn’t suffering anymore) - Avoid artificial consolation (“I know how you feel”) - Do everything possible to ensure comfort - Express personal feelings of loss or frustration (you can cry!) - Allow family to stay with child as long as needed - Refer to the dead child by name o Recognizing signs/symptoms ▪ Impending death (everything slows down) - Loss of sensation and movement in lower extremities – progresses towards upper body - Sensation of heat, although body is cold - Loss of senses (photosensitivity, tactile sense decreases) - Confusion, loss of consciousness, slurred speech - Muscle weakness - Loss of bowel and bladder control - Decreased appetite and thirst - Difficulty swallowing - Change in respiratory pattern (Cheyne-Stokes respirations) - Weak, slow pulse - Decreased BP o Creating care plans ▪ Leukemia= (involves blood cells and bone marrow) too much WBC Not enough RBC for clotting - Acute lymphocytic leukemia (ALL) ▪ Most common (2-5year old)
  • Acute myelogenous leukemia (AML) ▪ Higher rate in infants - S/S: generally, there are few “dramatic” signs and symptoms ▪ Diagnosis can occur when a cold fails to go away ▪ Weight loss, petechia, bruising, complaints of bone or joint pain, fatigue, anemia, unsteady gait, thrombocytopenia ▪ Immature “baby” WBCLabs: low H&H and low Platelets - Neutropenic precautions and bleeding precautions ▪ Private room ▪ All visitors wear a mask – NO sick visitors ▪ Hand hygiene ▪ WE are a threat to the child, not the other way around ▪ No fresh flowers ▪ Thoroughly cooked foods - Treatment= radiation & chemo ▪ Induction phase ▪ Low level chemo for 4-5 weeks ▪ Intensification phase ▪ “pulses” of chemo over 6 months ▪ Maintenance therapy ▪ Combined drugs to keep in remission for 2-3 years ▪ Bone marrow transplant

▪ Have some understanding of death ▪ see death as temporary or reversible ▪ Magical thinking ▪ May feel guilt or shame ▪ Greatest fear is separation from parents ▪ May inappropriately giggleNursing interventions- same nurse sch; sch play time

  • School age (6- 12 )= Death is perm ▪ Curious and fearful ▪ Child may feel responsible for occurrence - Adolescents (12- 18 )= Death is perm ▪ Funerals are barbaric and not needed ▪ Have a more mature understanding but are the least likely to accept death ▪ When their own death: body image issues ▪ Feel alone and alienated ▪ Respect privacy and allow to express emotions ▪ Allow for some control and independence ▪ Appreciate peer supportRetinoblastoma
  • Caused by a mutation in a gene (can be sporadic or inherited)
  • Average diagnosis: 2 years old
  • Manifestations ▪ Cat’s eye reflex- whitish pupil “glow ” (Normal: red pupil reflex when taking photos) ▪ Strabismus (cross-eyed)- late sign ▪ Heterochromia (different colored eyes)
  • Care after an enucleation (removal of the eye) ▪ Surgically implanted sphere will help keep facial symmetry, the socket is covered in mucosal lining, fitting for a prosthesis in 3 - 4 weeks ▪ Important to help both parents and child cope ▪ Face will be edematous and bruised ▪ Wound is generally clean with little to no draining ▪ If an antibiotic ointment is prescribed: thin line on the surface tissues of socket ▪ Dressing: eye patch that is changed daily – once socket has healed, no patch is necessary ▪ Prosthesis is cleaned by placing in hot water and allowing to soak ▪ Red flag : bright red drainage on pressure patch ▪ Medication administration
  • Iron supplements- ferrous sulfate PO; Iron Dextran IV ▪ Use a straw (it stains teeth) ▪ On an empty stomach ; No milk; take 1 hour before meds & food ▪ Add Vitamin C – helps with absorption ▪ Calcium inhibits absorption – do not eat at the same time as iron ▪ Normal Side effects : Black/green tarry stools, possible constipation ▪ Foods w/iron = Red, organ meats, green leafy vegetables , kale, liver, shellfish, fortified dry cereal ▪ Causes = excessive cow milk consumption over 24oz a day o Knowing if teaching is effective/ineffective

Osteosarcoma: bone tumor arising from the osseous tissue/

  • most common bone cancer found in children
  • Most commonly found in the metaphyseal regions of long bones (femur)
  • Peak age of dx: 15 ; range 13-16 years old
  • S/S : bone pain, swelling, fractures limp, limited ROM may have a palpable mass, extremity may feel warm
  • Often mistaken for growing pains/ extremity injury
  • TX goal: SAVE the limb ▪ Ewing Sarcoma : arises from the bone marrow
  • Age of dx= 10-20; younger than 30
  • S/S= bone pain, swelling, fractures
  • Originates in the shaft of long bones ( femur, trunk, Sacrum ) ▪ Iron-deficiency anemia
  • Causes- premature, bariatric, excessive cows milk over 24oz a day
  • Iron-rich foods : kale, liver, shellfish, organ meats, egg yolk, whole wheat, leafy greens, dried fruit, legumes (fish, poultry and meats have most)
  • Possible need for supplements
  • No cow’s milk until 12 months old ▪ Neuroblastoma- Spinal cord & adrenal glands (hat of kidney)
  • Primary site: ABDOMENcrosses the midline
  • “silent” tumor with a poor prognosis
  • Firm, irregular, Bilateral non-tender mass
  • Clinical manifestation : urinary catecholamines, frequency
  • Palliative care o Appropriate nursing actions ▪ Caring for a patient with Wilm’s tumor aka Nephroblastoma (kidney tumor)
  • Kidney tumor
  • Peak occurrence between ages 2 and 3 years old
  • Manifestations ▪ Painless, One-sided firm mass in the abdomen (Deep flank) ▪ Weight loss, fever, anemia, possible HTN, urinary retention, hematuria, fever fatigue
  • DO NOT PALPATE ABDOMEN – could cause rupture
  • Nursing action - SIGN on bed: “do not palpate abdomen” o Recognizing signs/symptoms
  • Hemophilia A= clotting factor VIII/8 missing
  • Cause: by X linked recessive gene ( mom passes down to son)
  • S/S : Prolonged bleeding, hemorrhage, bruising, hemarthrosis, spontaneous hematuria, epistasis, joints stiff
  • TX: prevent bleeding, replace clotting factor (VIII), regular exercise and PT, control bleeding, corticosteroids, NSAIDS (use carefully), DDAVP (desmopressin)
  • Restrictive play, no contact sports (jogging, swimming)
  • RICE : rest, ice, compression, elevation
  • Nursing consideration : NO IM injections; only subQ (smallest needle; 5 mins pressure after inject)
  • Teaching : med alert bracelet; protective gear, no contact sports; no OTC aspirin
  • (Hemophilia B= factor IX/9 missing)

Unit 10: Neurosensory

  • Nursing management o Patient care ▪ Interventions - Caring for a patient with increased ICP o Causes- trauma, hemorrhages, meningitis, Hydrocephalus o S/S = bulging fontanelles @rest , separated suture lines, irritability, drowsiness, lethargy, shrill cry, increased head circumference (larger than chest), distended scalp veins, headache, forceful vomiting, sunset eyes o Infants S/S - bulging fontanelle @ rest; increased head circumference, skull plates pushed apart, irritability, o Late signs - seizures, shrill cry o Nursing interventions : HOB 15 to 30 degrees – l ow semi fowler’ s; DO NOT LAY FLAT, NOT TOo HIGH; Cluster care with a quiet and dimly lit room; low stimuli; No airway suctioning – unless absolutely necessary; Crying increases ICP; try to avoid baby crying, Strict I & O; mannitol ▪ VS ( BP/HR); Pupils - Sluggish constriction= barbituates,optic nerve injury, brain stem lesions - Fixed and dilated= - Pin point pupils- high o Only motor function – to painful stimuli o Medication: Mannitol

▪ Monitor for at least 6-8 hours after injury ▪ Support family ▪ PREVENTION o Management- monitor 6-8hrs, #1 100% oxygenation , Prevention o Teaching prevention = Supervision around any water

o Knowing when to intervene if a dangerous action is being performed ▪ Caring for a patient with spina bifida (nuero tube defect ) close week 3

  • Assess the back area
  • S/S = small tuft of hair; back dimple
  • Dx: amniocentesis
  • Differentiate between types o Meningocele : CSF and meninges have sac o Spina Bifida Occulta : no external defect o Myelomeningocele : mega sac protrusion- CSF, meninges, and nerves ( spinal involvement) has sac ▪ Functioning stops wherever the spinal cord is involved ▪ Needs to have c -section o Anencephaly : absence of both cerebral hemispheres= BABY will die
  • Meningocele & Myelomeningocele= Maintain sac integrity! Until surg o No diaper ( under them) o Keep prone o Keep sac sterile and moist (saline)
  • Prevention while PG = Folate acid B9 (400mcg); avoid antiseizure meds o Recognizing signs/symptoms ▪ Cerebral palsy (most common type spastic)= nuchal cord (
  • Cause – birth asphyxia , prenatal brain abnormalities; Usually caused by a birth injury
  • SS -Abnormal muscle tone and coordination (reflexes), impaired motor skills and contractures, difficulty with speech and voluntary movement, rigid muscle and muscle spasms, stiff rigid posture, arching back , pushing way, floppy tone , feeding dificulties o Prolonged Milestones: unable to sit unsupported 8m; no smile 3m , feeding difficult ( thrust , chocking) + Babinski
  • Treatment – PT,OT, surg, Rx; Baclofen (muscle spasm)
  • Prevention - Magnesium sulfate
  • Dx- MRI ▪ ASD (autism spectrum disorder) - unknown cause
  • 2 domains- social interaction awkwardness, repeated behavior and severely restricted and actions
  • Usually Dx: 3 years old
  • Early red flags : no smiling 3m, no eye contact, no babbling@12m, no words@16m, o Failure to interact socially, communicate appropriately, inability to maintain eye contact
  • interventions : Provide decreased stimulation; routine
  • Management- routine , behavior modification, positive reinforcement, increased social awareness of other , decrease stimulation
  • With families: emphasize the positivity! ▪ ADHD
  • Etiology: unknown
  • S/S - Inattention, hyperactivity, impulsiveness (safety) , distractibility, fidgeting, easily distracted, talk excessively; Signs seen IN 2 SETTING
  • Usually the teacher notices first*
  • Enforce safety r/t impulsivity; Behavior therapy, needs routine, frequent breaks
  • Dif types = Aspergers, Retts
  • Medication : stimulants Ritalin; side effects- appetite suppression, nervousness, insomnia, Hypertension ▪ Down’s syndrome ( trisomy 21)
  • Amniocentesis – Dx during PG
  • S/S - slanted eyes, short stare, wide neck, hypotonic( low muscle), depressed nasal bridge, short stubby digits, hyper reflexive, protruding tongue, ear low set,
  • Comorbidities: heart defects, suspectable to respiratory probs, hypothyroidism ,
  • No cure – focused on management of complications
  • “Work with them” – where are they cognitively?
  • Manifestations: low birth weight, short stature, depressed nasal bridge, short and stubby digits, hypotonicity, hyper flexibility , protruding tongue, upward slanted eyes ▪ Reye’s Syndrome RARE; Emergency
  • S/S= cerebral edema leads to seizure & liver damage, fever, profuse effortless, vomit, lethargy , to delirium
  • Following viral infection ( flu and varicella)
  • Aggressive and early treatment (similar to increased ICP)
  • DX: liver biopsy (post lay on right side) AST, ALT
  • NO ASPIRIN FOR KIDS!!!!
  • Nursing intervention: monitor ICP; HOB 30 or higher; mannitol, seizure precaution, Vik K ▪ Head trauma Posturing
  • Decorticate : (towards core) rigid flexion with arms held tightly to body, legs extended and rotated in ward
  • Decerebrate: (away from the body) rigid extension and pronation of arms and legs o Nursing interventions to perform based on patient’s current health state ▪ Based on assessment findings, what should the nurse do?
  • Pay attention to labs and assessment findings
  • Education o What to include in teaching ▪ Submersion injuries
  • An infant can drown in ANY amount of water
  • Priority: restore tissue perfusion – apply oxygen – prevent further injury

Unit 11/12 Endocrine

  • Education o What to include in teaching ▪ Caring for a child with DM 1 while sick - Some hyperglycemia and ketones in urine when sick is expected - Insulin needs will more than likely change – DOCTOR changes the orders - Encourage hydration ▪ Caring for a child with precocious puberty - School age 10- - Age 8 in females, 9 in males – is the child mature enough to handle this? - S/S- pubic, axillary hair, voice beHavior changes, acne, breast development manarche, hip spread, penile enlargement in males - TX: birth control and hormone suppression – luteinizing hormone injections (suppress estrogen , Testosterone) or NOTHING - Teach = Treat the child by their age, not their appearance, dress their age, friend their age - Keep them with peers in the same age group ▪ Clinical manifestations of DM Diabetes Mellitus - Type 1 : not producing or not enough insulin o Cause : Autoimmune disease o Require insulin replacement for life - Type 2: body doesn’t use insulin properly o Cause : Diet o Teach – diet and exercise - 3 P’s : polyuria, polydipsia, polyphagia - Hypoglycemia: Glucose under 70 irritability, nervousness, shaky, hungry, pallor, sweating, tachycardia, shallow breathing (may appear ‘drunk’) o Causes - exercise, insulin peak times o S/S - cool, clammy, anxious, trebling, headache newborn- tremor, jittery, high pitch cry o Teach - awake and hypoglycemia episode give food PO = juice, cracker, low fat milk (no high fat) ▪ If not alert ( only response to pain)- inject D50 and reassess in 15mins ▪ Rotate location every 2-3 weeks ▪ Carry simple carb snack

  • 10 ‘ no treatment
  • if 25-45 brace
  • 45’ surgery o Log roll, pain meds, early ambulation
  • Teach braces prevent further curvature S shape in lower back (observe from side) ▪ Kyphosis: upper back hump (observe from side) o Priority ▪ Who to see first?
  • Pay attention! ▪ Knowing when to intervene if a dangerous action is being performed
  • Cast care (plaster and fiberglass) o Keep clean & dry; (bag in shower); above heart 1st^ 48hrs o Don’t stick anything inside cast o Don’t touch plaster cast with fingertips while drying or put weight – will create pressure points o Petaling= Smooth edges to prevent irritation o If itchy= Low cool air from blow dryer is okay – NOT hot o Elevate for blood return o Report hot spots and unrelieved pain immediately o Regular skin checks o Spica cast- infant can put min weight ; DO NOT STAND IN; ▪ Interventions to perform based on condition
  • Fracture o #1 immobilize first o Biggest concern is circulatory ▪ REMEMBER the 6 P’s ▪ Complications- fat embolism and osteomyelitis o Open fracture = Priority Infection o Spiral fracture = Priority (maybe abuse) o Crush fracture = monitor for fat emboli o Patient care ▪ Assessment
  • Recognizing abnormalities when patient has a cast o Compartment syndrome ▪ 1 st^ sign = Relentless and worsening pain (unrelieved with pain meds; Increase with passive movements) ▪ Hot spots on cast= infection ▪ Treatment= loosen cast; fasciotomy ▪ Tell HCP!!!!!
  • Education o Knowing if teaching is effective/ineffective ▪ Juvenile idiopathic arthritis (autoimmune)
  • Unknown cause; no cure
  • S/S=Morning stiffness – nighttime brace/splinting can help; worse pain in AM; fever, skin rash o Concern - Contracture
  • Need to encourage movement
  • Medications: NSAIDs, antirheumatics, steroids
  • Treatment- PT, nighttime splinting, exercise (heat therapy), isometric exercise
  • TX goals : control pain, preserve ROM and functioning, promote normal growth
  • Educate - low impact exercise (swim, yoga, stationary bicycle) ▪ Care of child with developmental hip dysplasia
  • Positive Trendelenburg sign =
  • Pavlik harness- for nonmobile patient o Treatment: developmental hip dysplasia

Lordosis:

o Must wear 24/7; DO NOT REMOVE, unless Dr. says o Follow up every 2 weeks for readjustment o Will wear for 6 - 12 weeks o If the harness doesn’t work or child is older/mobile – spica cast= FOR MOBILE PATIENTS

Unit 11/12 Integumentary

  • Nursing Management o Priority ▪ Caring for a patient following a dog bite - Let dog sniff child before petting - Cleanse with soap and water - Cover the wound; pressure dressing - Go get treatment: antibiotics, rabies and tetanus shots
  • Education o Medication administration ▪ Eczema aka atopic Dermatitis - Genetic component - S/S - itchy red scaly skin, pruritis, pain , tenderness, (burning, prickling, crawling) - Hydrate the skin, relieve itching, reduce flare-ups or inflammation, prevent and control secondary infections o If rash- touch it - Avoid: irritants or allergens; avoid wool, fabric softener, baby powder, long fingernails, stress - Humid climates, stay hydrated, skin moisturized, don’t scratch (keep nails short) - Intervention : tepid bath 5 - 10mins (pat dry) put THIN LAYER topical 3 mins after bath; cut nails short, Aveno ( hydration), colloidal oatmeal bath - Complication- MRSA - Meds: Antihistamines, topical steroids, antibiotics, mild sedatives - Labs - CBS, ESR (up) o What to include in teaching ▪ Pediculosis capitis (lice) - S/S= child scratches scalp, head, neck, shoulders - Prevention : stop the spread and reinfestation (no sharing hats, combs, scarfs) o Everyone needs to be treated - Isolate and CLEAN CLEAN CLEAN - Keep home from school - Nits/Eggs attach to hair shaft - Education: Wash laundry in hot cycle; seal other larger items in sealable plastic for min 2 week then wash; vacuum furniture and carpets - Medication - Permethrin 1% NIX (shampoo) ▪ Phenylketonuria (PKU) - DIET -cereal, fruits and veggies= - Avoid : Protein and iron (NO meat, NO eggs, NO peanut butter) - In older children- Can cause eczema, photosensitivity, ADHD, Schizoid behavior disorder o Knowing if teaching is effective/ineffective ▪ Animal bite prevention ▪ Highest incident in boys 5- ▪ 1 st^ treatment- mild soap and water & bandage then go to hospital - Leave pets alone when: eating, sick, sleeping - Avoid strange or nervous animals - Get pets vaccinated - Make sure animals are aware of your presence - If threatening animal approaches remain motionless - Allow animals to smell you