exam 2 Flashcards

Question

AGN and Nephrotic syndrome: teaching/clinical manifestations/nursing care

Answer 1

``` AGN CM: Edema -- periorbital Anorexia Cola-colored urine Decreased urine output Pale, irritable, lethargic HA, abdominal discomfort, dysuria Increased BP hematuria ``` management: No specific treatment Recovery often spontaneous Supportive measures Hospitalization for substantial edema, hypertension, or significant oliguria Rest as needed Thorough assessments Assess urine volume, color, character Assess child’s appearance Assess behavior Advise family against bringing in salty foods, not to consume salty foods in front of child Divide amount of fluid allowed evenly and provide throughout the day Provide it in small cups to give the illusion of increased quantity Activity planning: need for frequent rest periods Infection prevention Frequent health supervision once/if at home (weekly to monthly) Assess BP every 4-6 hours Assess body weight daily Strict I/O Consider sodium and water restriction Dialysis for severe cases Medication Therapy: Loop diuretics i.e. furosemide, Calcium channel blockers, beta blockers, ACE inhibitors, Antibiotics, anti-convulsants if seizures are present Nutrition: Sodium restriction, Restrict foods with potassium if oliguria is present, Protein restriction for severe azotemia ``` Nephrotic Weight gain Edema Diarrhea, loss of appetite, malabsorption Decreased UO Urine is dark and frothy Pallor Skin breakdown Irritable Fatigue, lethargic Weight loss is often obscured by edema Nails are white Normal or decreased BP Susceptible to infection Goals: Reduce the excretion of urinary protein Maintain protein-free urine Prevent / treat acute infection Control edema Good nutrition (including protein, restrict salt) Corticosteroid therapy Prednisone daily for six weeks, then tapered for six weeks Expect improvement 7-21 days after initiating steroids Immunosuppressant therapy Indicated with frequent relapsing or steroid-resistant nephrotic syndrome Oral alkylating agent such as cyclophosphamide Loop Diuretics: Furosemide Plasma expander like human albumin Prognosis With early detection and prompt treatment, damage to membrane is minimal and full renal function is often restored Relapse ``` ``` Daily weight I/O Urine for albumin Abdominal girth Edema Skin condition Shock and infection Skin care Infection prevention Nutrition Diversion Family Anticipatory Guidance and Support ```

Answer 2

Prevent pyelonephritis!!! Conservative, non-operative therapy is effective in most cases High incidence of spontaneous resolution over time Low-dose antibacterial therapy with frequent urine cultures Surgery may be indicated with recurrent UTI’s, intolerance to antibiotics, noncompliance with therapy, or VUR after puberty in females Follow up ultrasounds post-operatively to evaluate renal growth

Answer 3

``` Conditioning therapy Retention control training Waking schedule treatment Medication therapy (anticholinergic effect) Punishment is not treatment! Supportive therapy Child’s role Fluid restriction Behavior modification Patient education for the child and the parents ANTICIPATORY GUIDANCE Encouragement, patience and support Child’s active participation Side effects of medications Avoid diapering Positive reinforcement ```

Answer 4

SKFE Femoral head dislocates from the neck and shaft of the femur at the level of the epiphyseal plate Cause- mostly unknown!  Teen growth spurt Hormonal alterations Management Quick intervention is needed!! Screw inserted percutaneously into the femoral head Osteoarthritis may be a long term complication Legg-Calve-Perthes Avascular necrosis of the femoral head Most often children 4-8 years old, males more than females Patho Interruption of the blood supply to femoral head Swelling of soft tissue around the hip New blood vessels develop to provide the area with circulation allowing bone resorption and deposition 18-24 months for revascularization, more likely to fracture in this process. Over time the femoral head is reformed Treatment Anti-inflammatory meds Activity limitation Bracing, casting, or traction recommended Nursing implications Pain medications Education!! know how to properly place the brace and care for skin under the brace. Exercise of unaffected extremity is recommended. Treatment is based on severity of the disease. Sometimes no treatment except for avoiding contact sports. Often swimming and bicycling is recommending to help with range of motion without further damage.

Answer 5

Clinical manifestations Swelling, bruising or redness, pain or tenderness Diminished functional use of affected part Muscular rigidity Crepitus Vascular injury Complications Circulatory impairment, nerve compression syndromes Physeal damage Nonunion, Malunion Infection, Pulmonary emboli 1. Observe nerve/circulation status closely 2. Reposition every 2 hours 3. Support wet cast with pillow & palm hand 4. Elevate extremity 5. Petal rough cast edges 6. No objects under cast 7. R.O.M. to extremity distal to cast 8. Restrict strenuous activity 9. Report foul odor, observe drainage 10. Clean soiled areas 11. Prepare for cast removal 12. Provide positive diversion and therapeutic play

Answer 6

Pain Medications for inflammation Maintain joint range of motion without tension on the joints Splits or orthotics can be used, monitor skin for breakdown Psychosocial needs School Adequate sleep to minimize fussiness and non-compliance Support groups maintain weight

Answer 7

assessment Trendelenburg Gait Trunk shifts over affected joint Ortolani Maneuver Abduct hips , listen and feel for a clunk Barlow Maneuver Adduct hips and feel for the femoral head slipping out ``` treatment Early detection is important! Pavlik Harness Keeps knees flexed and hips abducted to allow hips to grow normally Cares Do not adjust straps, only remove as directed Sleep on back Long socks and shirt under harness Call doctor with complications ```

Answer 8

Starts as soon after birth as possible Bracing, casting, or surgical release of soft tissue Once casted, skin assessment is important. Show parents how to assess temperature and cap refill of extremities when home as this will be an outpatient procedure if the child has no other problems. There will be pressure on the skin to move the foot into placement! Bones should be set before they start walking

Answer 9

cause Diagnosed 3-4 months of age Individuals of African, Mediterranean, Middle Easter, and Indian decent Recessive genes for sickle cell are passed on from both parents who have the gene or trait Stress on the body can cause sickling: trauma, infection, fever, acidosis, dehydration, physical exertion, excessive cold exposure, or hypoxia. Blood gets viscous and starts to clump in small capillaries preventing normal blood flow. ``` manifestation Pain and clumping most often occurs in the joints, but can be anywhere in the body. Clumping in the lung capillaries leads to acute chest. This is a medical emergency. This leads to decreased gas exchange, producing hypoxia, which leads to further sickling. retinopathy/blindness avascular necoris splenomegaly hematuria ab pain dactylics osteomyelitis priapism anemia CHF ``` treatment aggressive hydration. They will get 2x maintenance fluids IV for the first few days. Once they start to have a decrease in pain we can change them to IV+PO. Narcotics- ED protocol and then PCA+basal rate IV fluids Antibiotics if febrile Hgb F decreased hgb- shorter cell life

Answer 10

RBCs and Hgb are lower than normal ``` Causes Decreased production or RBCs Lack of dietary intake of nutrients needed to produce the cells Alterations in the cell structure Malfunctioning tissues (bone marrow) Toxin exposure (lead poisoning) Blood loss Genetic and cellulation development disorders ``` ``` iron deficiency anemia Lack of iron to produce hemoglobin Peak prevalence in children 6-24 months and puberty Causes Cow’s milk consumption 50% of iron in maternal milk is absorbed 10% of iron in cow’s milk is absorbed Assessment Health history Milk consumption Lack of supplementation Diet Chronic or acute blood loss Exam Fatigue, lethargy, pallor Safety Risk for changes in neuro function Unsteady gait related to dizziness Dietary interventions Infants fed only iron fortified formula Breast fed infants to start on supplementation at 4-5 months Limit milk to 24oz per day Education on iron rich foods Picky eaters Supplementation Proper iron fortified diet Oral or IV supplement Blood transfusions Oral care Stool softeners ```

Answer 11

TREAT THE BLEED Treat with RICE REST—immobilize for comfort and to prevent further bleeding ICE—apply cold to promote vasoconstriction COMPRESSION—pressure to encourage clot formation ELEVATION—elevate joint Gentle active ROM Only after bleeding stopped—within 24 to 48 hours Allow client to control own pain tolerance DO NOT do passive exercise Could stretch joint capsule Could cause bleeding with acute episode ``` Management Prevention Factor replacement NEVER THROW FACTOR AWAY! HIV Education ```

Answer 12

treat side effects of chemo labs: Labs drawn and focused on will be determined by the suspected dx, same with radiology. A common practice when cancer is suspected is a chest xray to look for mediastinal mass. If this child with a mass is sedated and they are unable to maintain their airway, we have a serious emergency!! radiology procedures: bone marrow aspirate or biopsy as well as lumbar puncture. Biopsy of the tumor: would dictate and pre-op and post-op cares for the nurse. education Scared!! Lots of teaching and hands on practice with central lines When to be alarmed Temp of 101 or greater (or climbing) Cough or rapid breathing Oozing gums, nose bleed lasting longer than 10 minutes Lethargic, fatigue Ear, head, neck ache (nuchal rigidity) Problems with central line: broken, red/sore Abdominal pain, problems eating

Answer 13

leukemia: bone pain metastasis to blood, bone, CNS, spleen, liver or more ``` retinoblastoma: Cat Eye reflex Strabismus Red, painful eye, often with glaucoma Blindness (late sign) ``` neuroblastoma: Swollen/asymmetric abdomen Bowel and bladder dysfunction Bruising of the eyes Wilm's: Swelling, mass in abdomen R/T compression: HTN, hematuria, wt loss, fever, mets to lungs

Answer 14

risk for infection | low WBC, neutrophil count

Answer 15

ANC= Bands+Segs (or Neutrophils) x WBC(10) | < 500 neutropenic

Answer 16

social isolation poor support system parental low self-esteem & less adequate maternal functioning Alcohol abuse (caregiver)—The compulsive use of alcohol that is not of a temporary nature. Drug abuse (caregiver)—The compulsive use of drugs that is not of a temporary nature. Financial problem (caregiver)–A risk factor related to the family’s inability to provide sufficient financial resources to meet minimum needs. Inadequate housing (caregiver)–A risk factor related to substandard, overcrowded, or unsafe housing conditions, including homelessness. compatibility between child & parents temperament and parents ability to deal with behavioral style

Answer 17

Child Abuse Prevention and Treatment Act (CAPTA) provides funds to states to improve CPS systems assist states with screening and investigating child abuse and neglect report child protective services (MO) department of children & families (KS)

Answer 18

When in doubt, report. Worst case scenario, it was nothing and a social worker visit the house. Best case scenario, you save lives!!!! And break cycles!!! mandatory reporter

Answer 19

Cupping, coining, Eastern medicine practices used that could appear to be abuse goal: Better circulation, helps lymphatic system

Answer 20

Infant Unconditional love and trust Ensure family is available to the child Toddler (1-3 yo.) Familiarity and routine Maximize time with parents, bring in items from home Child (3-5 yo.) Death is punishment for wrong doing, correct this misunderstanding Use precise language Help family express that they will miss the child and will continue to function when they are gone School age (5-10 yo.) Concrete understanding of death Need specific honest details Encourage to help with decisions Young adolescent (10-14 yo.) Benefits from reinforcement of self-esteem Respect privacy and need for peers Support the need for independence and decision making Older teen (14-18 yo.) Adult-like understanding Needs support through honest, detailed explanations and need to be heard!

Answer 21

Honesty with parents and child (as developmentally appropriate) Clarify and answer questions No judgment Sensitive to ethnic, spiritual, or cultural preferences assure change in focus to pain control & comfort

exam 2 Flashcards

(45 cards)