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6TH SEMESTER > PEDI EXAM 5!!!!!!!!! > Flashcards

PEDI EXAM 5!!!!!!!!! Flashcards

1
Q

Coping mechanisms by parents

A

Irritability
Crying
Hostility toward staff
Withdrawal

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2
Q

What cognitive and/or behavioral skills does the child/family have to help them deal with the situation

A

Coping mechanisms by child

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3
Q

Defense mechanisms

A 
regression
denial
repression
postponement
bargaining
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4
Q

involuntary forgetting

A

repression

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5
Q

what to do when family exhibits anger

A

listen

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6
Q

Parental Needs

A 
Information
Proximity
Reestablishment of parental control
Participation in the child’s care
Confidence in the treatment plan and caregivers
Psychologic support
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7
Q

Presenting bad news to families

A

preparation

conversation

follow-up

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8
Q

Respectful and clear communication

Plan what you will say –(tone, words, time, & place)

A

preparation

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9
Q

Indicate that the news is not good

Show concern- empathy-respect-listen – do not give false hope

Allow families time – news is difficult to absorb and process

Assess for understanding

A

conversation

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10
Q

Arrange for further discussions

A

follow-up

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11
Q

Parental reactions

A 
Shock and disbelief
Anger and guilt
Deprivation and loss
Anticipatory Waiting
Readjustment or Mourning
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12
Q

Sibling Reactions Depend on

A

Age

Developmental level

Perception and severity of illness

Prior experience and coping

Knowledge and understanding of illness

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13
Q

Strategies for siblings

A

honesty

reassurance

allow questions and discussion of feelings

encourage visits

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14
Q

stress reduction: the 4 Rs

A

recreation

rest

relationships

routines

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15
Q

: toys, games, activities, physical activity

A

recreation

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16
Q

calm, quiet; bedtime rituals

A

rest

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17
Q

family members, siblings, peers, support groups

A

relationships

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18
Q

follow normal routine, provide transition objects, provide consistent caregivers

A

routines

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19
Q

Minimizing Stressors

A

maximize control

therapeutic play

therapeutic recreation

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20
Q

infants are in the cognitive stage sensorimotor so they see death as?

A

separation and abandonment

senses disruption in home, emotions of caregivers, and altered routines

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21
Q

toddlers are in the cognitive stage preoperational so they see death as?

A

no understanding of true concept of death

aware someone is missing–separation anxiety

unable to distinguish death from temporary separation or abandonment

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22
Q

preschoolers are in preoperational so they see death as

A

temporary and the dead person will return

confuses death with being away or asleep

death is seen as punishment

magical thinking

death of animals and plants

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23
Q

school-age child is in concrete operations so how do they see death?

A

understand the difference between temporary separation and death

knows that death occurs in others, but begins to recognize that he/she will also die

may have guilt or assume blame for the death

may not realize that death can occur at any age

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24
Q

by 6 years, recognizes that death is

A

permanent

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25
Q

by 9-10 years

A

understanding of death is same as adult

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26
Q

adolescents are at formal operations and what about death?

A

intellectually capable of understanding death

since of invincibility

recognize the effects of death on others

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27
Q

Factors Affecting a Child’s Response to Loss

A

Cultural traditions and practices
Religion and spirituality
Social support systems

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28
Q

interventions for all children

A

Provide opportunities for play, drawing, without reinforcing death themes

Listen to children

Provide support, materials to children who want to leave a legacy

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29
Q

interventions for adolescents

A

Remember outbursts of anger are common; provide support despite behaviors

Provide activities to help adolescents channel feelings

Promote friendships with other adolescents

Provide as much independence and control as possible

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30
Q

Withdrawing or Withholding Treatment

A

Decision is extremely difficult

Some parents feel the decision to discontinue treatment is a form of abandonment

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31
Q

Parents or nurses may feel that aggressive therapies

A

extend child’s suffering

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32
Q

Aggressive comfort measures, including ______ ________, should be provided to the child

A

pain medication

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33
Q

Refusal of treatment may be based on ?

A

religious beliefs or desire to provide peaceful death

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34
Q

may cause emotional and financial stress to parents

A

Technical interventions

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35
Q

if decision can’t be made with refusal of treatment

A

Consultation with hospital ethics committee

Court interventions may be used

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36
Q

an approach to improve QOL

A

Palliative care

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37
Q

care focusing on ensuring comfort

A

Hospice care

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38
Q

end of life decisions

A

palliative care

hospice care

DNR

tissue and organ donation

autopsy

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39
Q

Informing Parents of a Child’s Prognosis or Death

A 
Privacy
Body language
Social support
Response to emotions
Timing
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40
Q

cardiac system and dying

A

decreased cardiac output and peripheral circulation.

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41
Q

respiratory system and dying

A

impaired cardiac function leads to pulmonary congestion

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42
Q

neurologic system and dying

A

agitation or restlessness

withdrawal

increased drowsiness

confusion

unconscious

speak of visions

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43
Q

considered the last of the senses to go

A

hearing

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44
Q

musculoskeletal system and dying

A

muscle weakness and fatigue

unable to reposition self and toilet self.

difficulty swallowing occurs

may be unable to cough effectively and clear airway secretions

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45
Q

renal system and dying

A

decreased urine production

parenteral fluids may cause increased edema

sphincters relax and incontinence can occur.

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46
Q

GI system and dying

A

decreased oral fluid intake and anorexia are common

sphincters relax and bowel incontinence can occur

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47
Q

airway clearance nursing management

A

elevate HOB (conscious child)

side lying position (unconscious child)

suction throat

maintain oxygen

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48
Q

skin and hygiene care nursing management

A

bathe freq. and change linens

frequent oral care for dry mouth

apply lotions

apply moisture barrier for incontinence

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49
Q

elimination and nursing management

A

encourage fiber

stool softness

call light

bedpan, urinal, or commode chair is within access

absorbent pads under child

perform catheterization if necessary

maintain a clean odor-free room

50
Q

nutrition and nursing

A

administer antiemetics

encourage liquid foods as tolerated

provide child’s favorite foods

encourage family participation at mealtime

51
Q

fatigue/sleep and nursing management

A

prioritize activities of daily living to reduce unnecessary activities.

plan rest periods and social interactions to maximize the child’s energy for visitors

reduce sleep disruptions

52
Q

physical mobility and nursing management

A

reposition child

support with pillows

use pressure-relieving surfaces

assist them to chair if able

53
Q

sensory and nursing management

A

reduce frequency of monitoring the child’s BP and HR

ask alert child about room lighting preference

reduce noise

decrease excessive stimulation

54
Q

how much time to say goodbye

A

as long as they need

55
Q

Provide Mementos such as:

A

save clothing and personal items

collect footprints, locks of hair

preserve the last clothes worn in a sealed bag to retain child’s scent

56
Q

Require care at a developmentally appropriate level

Need reassurance they did not cause the death, that death is not a punishment for their wrongdoing

A

siblings

57
Q

Nurses Who Work with Dying Children May Feel:

A

Helpless

That they failed the dying child

Sad

Grief

Compassion fatigue

58
Q

medical condition expected to last at least 3 months

A

chronic conditions

59
Q

chronic conditions require adaptations to ____

A

ADLs

60
Q

many children with chronic conditions:

A

require special healthcare needs (CAHCN)

have a disability or handicap

are considered medically fragile

61
Q

reaction to initial diagnosis

A

relief

distress

anger

62
Q

grief response includes:

A

loss of family routines and goals

sibling loss of normal childhood

loss of expectations for normal development and life expectancy

loss of the child’s normal childhood

63
Q

negative sibling reactions

A

jealously, anger, worry, resentment

fear for own health

behavioral problems

64
Q

positive responses from siblings

A

responsibility

independence

maturity

sensitivity

65
Q

normally regulates cellular growth and development.

A

proto-oncogene

66
Q

When altered by a virus or other external cause, it can change to an _____, which allows unregulated genetic activity and tumor growth.

A

oncogene

67
Q

regulate the effects of oncogenes to decrease wildly proliferating cellular growth.

A

Tumor-suppressor genes

68
Q

Chemotherapy drugs either act at

A

specific parts of the cell cycle or are nonspecific for action (act throughout all cell phases).

69
Q

protect from what with thrombocytopenia

A

bruising

bleeding

hemorrhage

70
Q

watch for sx of _____ with thrombocytopenia

A

petechiae

71
Q

minimize what with thrombocytopenia

A

invasive therapy

72
Q

when ANC

A

500

73
Q

nursing action with neutropenia

A

monitor child’s temp

isolate from others with infection

perform serum lab studies and cultures PRIOR TO INITIATION OF ANTIBIOTIC THERAPY

74
Q

Do not apply skin products to area prior to treatment

No vigorous massage or scrubbing to affected area

Areas of treatment will be very sensitive to light. Apply sunscreen to areas prior to sun exposure

A

radiation

75
Q

Caused by cancer itself or as a side effect of treatment

A

oncologic emergencies

76
Q

oncologic emergies include

A

metabolic

hematologic

space occupying

77
Q

Cell distruction releases high levels of

Uric acid
Potassium
Calcium
Phosphorus

A

tumor lysis syymphomandrome

78
Q

Tumor Lysis Syymphomandrome is which type of emergency

A

metaoblic

79
Q

what 4 things to cells destruct in Tumor Lysis Syymphomandrome

A

uric acid
potassium
calcium
phosphorus

80
Q

hyponatremia is frequently a result of Tumor Lysis Syymphomandrome, leading to:

A

metabolic acidosis

cardiac arrhythmias

renal failure

81
Q

**Tumor Lysis Syndrome is commonly noted with

A

“ALL” and non-Hodgkin Lymphoma

82
Q

type of metabolic emergency from large amount of bone destruction

A

hypercalcemia

83
Q

bone marrow suppression (hematologic emergency) cause what 2 things:

A

anemia

thrombocytopenia

84
Q

thrombocytopenia can lead to:

A

DIC

85
Q

Infiltration of Leukemic Blast Cells into brain and lung tissue is an example of what type of emergency

A

hematologic emergency

86
Q

a preschool girl may be most upset at ?

A

hair loss

87
Q

a school age child has the most difficulties with?

A

changes that interfere with the developmental task of industry

88
Q

an amputation will be a major challenge when?

A

school-age years

89
Q

teenagers are most often worried about changes such as:

A

hair loss

cushingoid features

90
Q

has a rounded face and prominent cheeks. This change in body image can be a challenge for some children.

A

cushingoid features

91
Q

which 2 questions are suggested for adolescents with cancer?

A

“during treatment there are good and bad days. what makes a good day for you? and how has being sick been for you?”

92
Q

hypnosis can manage?

A

pain and N/V during CA treatment with children from 5-18 years

93
Q

allows chemotherapeutic agents to be administered without the need for repeated “sticks” to the child.

A

A vascular access device

94
Q

when children are tested for genetic disease, the decision is made by who?

A

the parent

95
Q

non specific signs of brain tumor

A

headache

morning vomiting

somnolence

irritability

96
Q

secondary signs of brain tumor

A

disturbances of cranial nerves; other signs depend on site of tumor

97
Q

focal signs of brain tumor

A

truncal ataxia

general nystagmus

head tilting

98
Q

midline brain tumors

A

truncal ataxia

99
Q

tests for initial diagnosis of neuroblastoma

A

light microscopy or biopsy of tumor cells plus laboratory evaluation showing increased urine or serum catecholamines

100
Q

Most commonly diagnosed pediatric malignancy in children under 14 years of age

A

leukemia

101
Q

Proliferation of abnormal white blood cells in the body

A

leukemia

102
Q

stem cells in the bone marrow produce?

A

immature WBCs that cannot function properly

103
Q

the WBCs in leukemia proliferate rapidly instead of going through?

A

mitosis

104
Q

the immature WBCs in leukemia fill bone marrow and spill into circulation then replace normally functioning WBC leaving the body vulnerable to

A

infection

105
Q

the WBCs also replace RBCs in leukemia resulting in?

A

anemia and bleeding

106
Q

most common types of leukemia

A

acute lymphoblastic leukemia (ALL)

acute myleogenous leukemia (AML)

107
Q

The higher the leukocyte count at diagnosis,

A

the worse the prognosis

108
Q

Probability for long term survival for children in the low risk group is

A

90%

109
Q

Children in the higher risk groups have a

A

75%-80% cure rate

110
Q

Most common type of childhood cancer

A

ALL

111
Q

ALL peak age of onset =

A

2-3 years

112
Q

ALL is more common in

A

white boys

113
Q

From leukemias that affect myeloid cells

A

AML

114
Q

AML is most common in adolescents in children under ___ year of age.

A

2

115
Q

AML is more common in

A

females

116
Q

is the most common type of leukemia in children and the most common cancer affecting children under 5 years of age.

A

Acute lymphoblastic leukemia

117
Q

leukocytes in leukemia

A

greater than 10,000/microliter

118
Q

platelets in leukemia

A

20,000-100,000/microliter

119
Q

hemoglobin in leukemia

A

7-11

120
Q

is characterized by ptosis and swelling.

A

Rhabdomyosarcoma

121
Q

is characterized by leukokoria, a white reflection in the pupil.

A

Retinoblastoma

6TH SEMESTER (22 decks)

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