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

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” WBC ▪ Labs: 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 giggle ▪ Nursing 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 support ▪ Retinoblastoma
• 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: ABDOMEN – crosses 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