Exam 2 Flashcards

Question

Endocarditis assessment

Answer 1

- malaise - fever - **new murmur or change in murmur: hallmark sign** - myalgias - arthralgias - weight loss - splenomegaly - hemorrhages under fingernails - petechiae Neonates: - tachycardia - feeding problems - respiratory distress - heart failure - septicemia

Answer 2

left to right shunt = pulmonary congestion - PFO - ASD - VSD tachypnea, dyspnea, pulmonary edema, pulmonary hypertension - pulmonary HTN in children presents as: -- tachycardia -- tachypnea -- S3 and S4 sounds -- dyspnea -- diaphoresis -- easily fatigued -- difficulty eating -- enlarged spleen/enlarged liver

Answer 3

Glomerulonephritis, inflammation of the glomeruli of the kidney, is most common in children between the ages of 5 and 10 years. The child typically has a history of a recent streptococcal respiratory infection (within 7 to 14 days). Symptoms are as described with this client. Kidney agenesis (absence of kidneys) and polycystic kidneys (formation of large, fluid-filled cysts in the place of normal kidney tissue) are serious congenital conditions that would likely be discovered either in utero or shortly after birth, not conditions that would appear acutely in an 8-year-old child.

Answer 4

ventricular septal defect - Abnormal opening between left and right ventricles - 2 types (membranous and muscular) Heard best in left lower sternal border Symptoms: Increased blood pressure Low Sp02 *Confusion and irritability are signs of low 02

Answer 5

- inflammation of the vermiform appendix (blind sac at end of cecum) - cause is obstruction of the lumen of the appendix, by hardened fecal material - often after a viral infection, swollen lymphoid tissue can obstruct appendix - pinworms can also obstruct - most common cause of emergency surgery in childhood Symptoms: - umbilical pain - nausea - RLQ pain (McBurney point) - vomiting - fever - physical exam findings: -- dunphy's sign: sharp pain in RLQ with cough; pain caused by peritoneal irritation -- rebound tenderness: pain is greater when deep palpation is quickly released than during palpation; indicates peritoneal irritation Labs: - elevated WBC - CRP > 8mg/L - UA Assess: - mcburney's point - iliopsoas test - obturator test

Answer 6

- a fever is a medical emergency - CVA - call with s/s of infection

Answer 7

Congenital Aganglionic Megacolon - caused by lack of ganglionic cells in segments of the colon, resulting in decreased mobility and mechanical obstruction Hirschsprung’s Disease is a congenital condition where parts of the colon are missing nerve cells (ganglion cells), leading to a lack of peristalsis (the normal wave-like movement of the intestines). This can cause stool to build up behind the affected section of the colon, leading to bowel obstruction.

Answer 8

no contact sports!! online: To protect a single kidney, focus on a healthy lifestyle, including a balanced diet, regular exercise, staying hydrated, managing blood pressure and blood sugar, and avoiding smoking and excessive alcohol consumption.

Answer 9

online: Keep your baby upright during the feeding and for 20–30 minutes after to limit nasal regurgitation. If milk leaks out of your baby's nose, wipe it away with a clean cloth. You do not need to use a suction bulb. Though babies with a cleft palate can't breastfeed, moms can feed them breast milk in the bottle.

Answer 10

ultimately, myocardial dysfunction - reduced cardiac output can lead to reduced baroreceptor stimulation: activation of SNS -- increased HR -- increased cardiac contractility -- vasoconstriction -- these three lead to myocardial toxicity, leading to myocardial dysfunction - reduced cardiac output can lead to reduced renal perfusion: activation of RAAS -- vasoconstriction -- sodium and water retention -- these two lead to myocardial apoptosis/fibrosis, leading to myocardial dysfunction

Answer 11

The tape test uses transparent tape placed in the perianal area overnight to detect the presence of ova and/or parasites, which will be visible under a microscope. The test should be performed on three consecutive nights and the tape should be removed before the child uses the toilet to defecate.

Answer 12

"An echocardiogram uses ultrasound to see the structures of the heart and visualize patterns of blood flow."

Answer 13

Decreased pulmonary blood flow: - tetralogy of fallot - tricuspid atresia Mixed blood flow: - transposition of great arteries - total anomalous pulmonary venous return - truncus arteriosus - hypoplastic left heart syndrome

Answer 14

Mixed blood flow, cyanotic defect - underdevelopment of the left side of the heart - inability to supply oxygen needs of the body Etiology: - unknown - poor prognosis - PDA is necessary to sustain life - symptoms may be mild until ductus arteriosus closes at 2 weeks causing marked cyanosis and decreased cardiac output

Answer 15

The characteristic appearance of stools for a child with intussusception is "currant-jelly"-like stool. This is from the blood and mucus that is present in the stools of children with this condition.

Answer 16

can fix itself sometimes Nursing care: - stabilize - IVF - NGT - educate Therapeutic procedures: air enema Complications: reoccurring intussusception; needs surgery

Answer 17

Ongoing monitoring. similar to ekg but worn longer (up to 48 hours) diagnose arrhytmias

Answer 18

IV fluids, strict I & O and NPO for surgery The infant is displaying signs of pyloric stenosis and dehydration and should be prepared for surgery. NPO will prevent forceful vomiting and is required pre-operatively to decrease risk of aspiration. IV fluids will replace fluids lost from vomiting. Intake and output should be monitored to assess fluid volume status.

Answer 19

positive nitrites positive leukocytes: need rapid raise, can be there without a bacterial infection (hematuria can be seen with other disease processes)

Answer 20

- **glomerular inflammation and sodium retention:** -- In nephritic syndrome, the inflammatory damage to the glomeruli causes reduced glomerular filtration rate (GFR) and impaired kidney function. The kidneys sense a decrease in renal perfusion, leading to activation of the RAAS system. This results in sodium and water retention, which increases blood volume. The retained fluid leads to increased blood pressure (hypertension). - **vasoconstriction and fluid retention:** -- The inflammatory process also promotes vasoconstriction (narrowing of the blood vessels), which increases systemic vascular resistance. This contributes to an increase in blood pressure. In addition, the kidneys may have reduced ability to excrete sodium and water, further contributing to fluid overload and increasing blood pressure. - **increased permeability to smaller molecules:** -- While nephritic syndrome does have proteinuria (like nephrotic syndrome), the level of protein leakage is usually lower, and the more significant issue is the glomerular inflammation that leads to impaired filtration. This leads to retention of both sodium and fluid, which can raise blood pressure.

Answer 21

Intravenous infusion of Factor VIII -Hemophilia A occurs when a genetic sequence prevents the formation of Factor VIII, which is necessary for clotting. -The nurses's first priority in a bleeding situation is to stop the bleeding. This necessitates administering an intravenous infusion of the missing clotting factor. The extremity will be elevated and immobilized to prevent further injury.

Answer 22

AKA mucocutaneous lymph node syndrome - an infectious or possibly toxic trigger that initiates an immune response that effects medium size arteries: coronary arteries - inflammatory process that causes thickening and scarring of vascular walls

Answer 23

- **forceful vomiting**

Answer 24

online - sudden, severe pain - pain spreads - fever and chills - weakness and malaise - swollen abdomen - urinary symptoms - bowel paralysis is a medical emergency

Answer 25

Why: Feeding a baby with a cleft palate can be tiring because it often requires more effort to suck and swallow. Rest periods during the feedings allow the baby to recover from fatigue, reducing the risk of them becoming overly tired, which can interfere with proper feeding and increase the chance of aspiration.

Answer 26

Acute stage: 10-14 days - fever (>5 days) - bilateral non-purulent conjunctivitis - strawberry tongue - swelling of hands and feet; erythema of palms and soles - generalized erythematous rash - enlarged cervical lymph nodes - tachycardia - irritability Subacute stage: 15-25 days - fever gone - anorexia - irritable - desquamation of fingers and tones - arthritis and arthralgia symptoms - cardiovascular symptoms (CHF, dysrhythmias, coronary aneurysms) Convalescent stage: 26 days til ESR returns to normal and symptoms disappear - deep beau lines on nails - all symptoms disappear unless irreversible complications

Answer 27

Goal is to prevent coronary artery complications - IVIG (IV immune globulin) and anti-pyretic therapy - aspirin therapy: 10-15mg/kg/dose qh4 (max 3.6g/day) - corticosteroids can be prescribed ** not live vaccines for at least 11 months after IVIG

Answer 28

Online: Ibuprofen use later in pregnancy might also cause premature closure of the ductus arteriosus (an opening between the two major blood vessels leading from the heart). - If the ductus arteriosus closes before it should, it can cause high blood pressure in the fetal lungs (pulmonary hypertension)

Answer 29

- enuresis - perianal itching - restlessness - disturbed sleep transmission: fecal-oral

Answer 30

patent ductus arteriosus - Failure for the DA to close after the first weeks of life - Machine like murmur

Answer 31

- penicillin to treat any remaining group A strep - ASA or naproxen to reduce inflammation, relieve pain, and minimize joint swelling - corticosteroids if patient has carditis or if anti-inflammatory agents are non-responsive - **strict bedrest for 5 weeks until ESR returns to normal to reduce cardiac demands** - **bedrest, sodium restriction, ACE inhibitors, digoxin, and diuretics to treat heart failure**

Answer 32

Common findings on physical assessment for a child with nephrotic syndrome include weight gain, periorbital and facial edema, generalized edema, decreased urinary output, dark, frothy urine, and normal or slightly decreased blood pressure.

Answer 33

mitral valve is most infected, followed by aortic

Answer 34

the upturned cardiac apex (toe of boot) and concave pulmonary artery segment (heel of boot) look like a boot silhouette what causes the above: - right ventricular hypertrophy: RV becomes enlarged and hypertrophied due to increased workload from pulmonary stenosis - upturned cardiac apex: hypertrophy causes apex to point upwards - concave pulmonary artery segment: pulmonary stenosis leads to reduced pulmonary artery segment

Answer 35

- predominantly between the ages of 2-7 - males more than females - may be a metabolic, physiochemical, biochemical, or immune mediated disturbance that causes the basement membrane of the glomeruli to become permeable to protein - one of 4 types of renal lesions characterized by: hypoalbuminemia, edema, proteinuria BP usually normal Types: - primary or MCNS (minimal change nephrotic syndrome) - most common - systemic: lupus erythematous, cancer, heavy metal poisoning, hepatitis

Answer 36

**1-2ml/kg/hour**

Answer 37

online: To effectively educate parents about colostomy care, nurses should focus on practical skills like pouching, skin care, and dietary guidelines, while also emphasizing when to contact a surgeon for concerns like persistent diarrhea, bleeding, or skin irritation

Answer 38

- narrowing of aortic valve which interferes with flow of blood out of left ventricle to aorta - causes left ventricle wall to thicken as result of pressure to pump blood through aortic valve etiology: - congenital birth defect - rheumatic fever - worsens as heart grows

Answer 39

- may be a metabolic, physiochemical, biochemical, or immune mediated disturbance that causes the basement membrane of the glomeruli to become permeable to protein

Answer 40

- edema - anorexia - abdominal pain - fatigue - **BP normal or slightly decreased** - susceptible to infection - **hyperalbuminurea** (high in urine) - **hypoalbuminemia** (low in blood) - **hypovolemia** nephrOtic = prOtein loss = in urine

Answer 41

- if PDA closes: infant will progressively deteriorate with worsening cyanosis, decreased cardiac output, and eventual cardiac collapse - echo will visualize the defect online: common nursing measures focus on maintaining a balance between systemic and pulmonary blood flow, ensuring adequate cardiac output and oxygen saturation, and providing supportive care before and after surgeries, including the Norwood, Glenn, and Fontan procedures

Answer 42

**acyanotic** **is under left to right shunt** Abnormal opening between the R and L atrium (is an opening in the atrial septum; what separates the two artia) - allows blood to flow directly from LA to RA leading to increased blood volume in right side of heart; extra blood can be pumped to lungs - leads to increased pressure in lung and strain on heart overtime - murmur commonly heard along upper left sternal border (typically systolic) - Incompetent foramen ovale is the most common defect -- Three types of abnormalities cause incorrect development of atrial septum

Answer 43

- Proteinuria: mild to moderate - Hematuria: present (tea colored) - Edema: mild to moderate - HTN: common - urine output: decreased - common causes: PSGN, IgA nephropathy - treatment: antibiotics, diuretics, anti-HTNs, immunosuppressants

Answer 44

The nurse should withhold the digoxin dose for heart rate of 60/min or below in an adult, 70/min or below in a child, and 90/min or below in an infant.

Answer 45

online: Following a head injury, seek immediate medical attention if you experience repeated vomiting, a worsening headache, loss of consciousness, seizures, unequal pupil size, slurred speech, or unusual behavior.

Answer 46

Why: Positioning the bottle at a 180-degree angle (parallel to the floor) helps control the flow of milk and reduces the risk of milk flowing too quickly or too slowly, which can be difficult for an infant with a cleft palate to manage. Holding the bottle this way also helps prevent aspiration because the milk doesn't flow directly into the baby’s mouth without control.

Answer 47

- may be asymptomatic - mild stenosis - signs of heart failure - loud murmur - angina and dyspnea - increased risk for bacterial endocarditis

Answer 48

- acute crisis: narcotics/opioids IV, codeine PO - a parenteral NSAID (ketorlac, toradol) - mild analgesic: PO NSAID - IV methylprednisone: -- decreases duration of severe pain in children -- decreases inflammatory response

Answer 49

online: After a renal biopsy, common nursing considerations include monitoring vital signs, urine output, and the biopsy site for bleeding or infection, while also educating the patient about activity restrictions and when to seek medical attention.

Answer 50

- typically when child falls below the 5th percentile for child's age

Answer 51

- Abdominal circumference is a key indicator of internal changes, especially in infants who have undergone surgery. An increase in the abdominal girth could indicate the development of complications like **intestinal obstruction, bowel perforation, or infection.** - After a colostomy, the infant is recovering from major surgery, and the nurse must monitor the infant for signs of complications, such as **ileus (a temporary paralysis of the bowel), bowel distention, or sepsis.** - **A 3 cm increase in abdominal circumference over a 2-hour period** is a significant and concerning finding because: -- **Bowel Obstruction**: In the case of Hirschsprung’s disease, the absence of nerve cells in the colon can lead to bowel obstruction, where stool cannot pass properly. This can cause distention of the abdomen as gas and stool accumulate behind the blockage. -- **Ileus**: After surgery, it’s normal for the intestines to take some time to "wake up" and resume normal function. However, a significant increase in abdominal girth might indicate that the bowel is not functioning properly (ileus) or has become obstructed. -- **Perforation or Sepsis**: Another concern is that a rapid increase in abdominal size could signal a bowel perforation (a hole in the intestines), which allows air and waste to leak into the abdominal cavity. This is a medical emergency and can lead to peritonitis (infection of the abdominal cavity) and sepsis.

Answer 52

- urethral opening on top of penile shaft - mild to severe: severe associated with exstrophy of the bladder - male infant should not be circumcised until corrective surgery is done

Answer 53

Body weight is the most reliable indicator of fluid loss (Note: this is a very testable concept!!!) in infants and children. It can more accurately reflect the amount of fluid loss than other indicators of dehydration. **Although skin integrity can be impaired as a result of dehydration, it is usually a late sign and does not directly reflect the amount of fluid loss. A sunken anterior fontanelle (the posterior one should be closed for this 6 month-old infant) is also a sign of dehydration but is not as reliable as a loss of weight and does not adequately measure the amount of fluid loss. Tachypnea can occur with dehydration but is not a direct indicator of fluid loss.

Answer 54

Newborn: - failure to pass meconium within 24-48 hours after birth - bilious emesis - abdominal distention - refusing to eat Infants: - FTT - constipation - vomiting - diarrhea Children: - undernourished - abdominal distention - visible peristalsis - palpable fecal mass - **foul smelling, ribbon-like stool** - constipation

Answer 55

Why: Infants with cleft palates are at higher risk for aspiration because the gap in the palate can interfere with the proper closure of the oral cavity, making it easier for milk to enter the airway. Monitoring swallowing helps ensure the baby is safely swallowing milk and not aspirating it into the lungs, which could lead to choking or respiratory issues.

Answer 56

Right to left shunt = hypoxemia (this flow bypasses the lungs) - Eisenmenger syndrome - pulmonary atresia - TOF - transposition of the great arteries Result -> Hypoxemia, cyanosis Polycythemia -> increase in viscosity of blood emboli

Answer 57

**acyanotic** L to R shunt - failure of ductus arteriosus to close after the first weeks of life - left to right shunt - higher pressure aorta to lower pressure pulmonary artery - alteration in blood flow: -- increase workload on left side of heart -- increase pulmonary vascular congestion and resistance -- potential increase in right ventricular pressure and hypertrophy

Answer 58

Hematuria Blood in the urine (hematuria) is the cardinal sign of acute glomerulonephritis. Urine in nephrotic syndrome is dark and frothy, but generally not bloody. Edema, decreased urine output (oliguria), and massive proteinuria are common to both disorders and reflect impaired renal function.

Answer 59

- daily hydroxyurea - oxygen PRN - oral penicillin prophylaxis - hydration - blood transfusions - electrolyte replacement - analgesics - antibiotics - avoid the cold (sickles)

Answer 60

- Proteinuria: Massive > 3.5g/day - Hematuria: usually, absent - Edema: significant - HTN: rare - Urine output: normal or decreased - Common causes: minimal change disease, FSGS, membranous nephropathy - Treatment: steroids, diuretics, ACE inhibitors

Answer 61

Nephritic syndrome, on the other hand, is typically characterized by hematuria (blood in the urine), proteinuria, hypertension, and azotemia (elevated blood urea nitrogen and creatinine levels). - The glomeruli are damaged by an inflammatory process, often due to an infection or autoimmune response, which leads to the formation of immune complexes that obstruct the glomerular filtration barrier and cause inflammation.

Answer 62

Exstrophy of the bladder is a congenital defect in which the bladder is exposed on the outside of the infant's abdomen. It must be corrected from surgery. In order to protect the bladder, the priority is to keep the bladder moist and protected from pathogens with a sterile plastic bag. Petroleum jelly gauze should not be used because this type of dressing can dry out, adhere to the mucosa, and damage the delicate tissue when removed. The infant should be sponge-bathed rather than immersed in a tub bath to prevent injury to the bladder, which should not be washed with soap and water. Although the infant's diaper should be changed frequently to avoid contamination of the bladder with fecal material, this is not the priority intervention.

Answer 63

kidney disorders characterized by injury to the glomerulus; both primary and secondary diseases result in glomerular injury types: - systemic/infectious: caused glomerular inflammation - acute: sudden inflammatory process of glomerular - acute post-streptococcal glomerulonephritis (APGSN); most common in peds

Answer 64

- sodium and fluid restriction for treatment of s/s of fluid retention - bed rest recommended until signs of glomerular inflammation and circulatory congestion subside - long term monitoring online: Treatment for Post-Streptococcal Glomerulonephritis (PSGN) focuses on managing symptoms and preventing complications, often including antibiotics to eradicate any remaining streptococcal bacteria, and medications to control blood pressure and swelling. nursing interventions: - physical examinations - assess weight daily b/c fluid elimination -- need to watch because of excess fluid volume - monitor fluid intake and output every 4 hours -- watch for altered urinary elimination - assess vital signs: monitor BP and PR ever hour to assess HTN -- also temp b/c hyperthermia r/t ineffectiveness of thermoregulation secondary to infection - assess breath sounds and pattern - monitor imbalanced nutrition less than body requirements r/t decreased appetite, N/V

Answer 65

- tachycardia - pallor - brittle, spoon-shaped fingernails (koilonychia) - fatigue, irritability, muscle weakness - systolic heart murmur - cravings for non-nutritive substances (ice, dirt, paper): PICA Labs: - decreased RBC, Hgb, Hct levels (Hgb level varies with age) - microcytic-hypochromic - Reticulocytes can be decreased - total iron binding capacity (TIBC): elevated - transferrin: 10% indicate of anemia - stool analysis: guaiac test schedule universal anemia screens at 12 months of age

Answer 66

Management: - diet - medications -- H2-RAs: reduce amount of acid produced by cells in lining of stomach, block histamine receptors, reduction of gastric acid and pepsin production -- PPIs: blocks proton pumps of stomach; prevent final step of acid production - decreasing level of acid - surgery (nissen fundoplication; watch for long-term complications) Complications: - FTT - recurrent pneumonia - weight loss nursing: probably watching for improvement in symptoms, weight gain, no pneumonia *I think part of the answer is making sure they’re upright for 30 minutes after meals

Answer 67

What is Normal Saline? Normal saline (0.9% sodium chloride) is isotonic, meaning it has a similar concentration of sodium and water to that of normal blood plasma. It is used to gradually expand the extracellular fluid volume without introducing significant shifts in osmolarity. Why 0.9% NaCl? Normal saline is used because it is isotonic, which means it will not drastically alter the balance of sodium in the blood. In cases of hypertonic dehydration, the goal is to slowly rehydrate the child without making their sodium levels drop too quickly. If hypotonic fluids (like water or 0.45% saline) were used too early, they could cause the cells to absorb too much water, increasing the risk of cerebral edema.

Answer 68

This surgical procedure involves creating an opening (stoma) on the abdominal wall to divert stool into an external bag, bypassing the part of the colon affected by Hirschsprung’s disease. Babies will have a colostomy and then eventually a pull through procedure. How will you help care for a colostomy after the surgery – same typical surgical recovery principles apply. - Signs of Infection: Redness, warmth, or drainage around the surgical site. - Feeding Difficulties: The infant may refuse feedings or vomit, especially if there’s a bowel obstruction. - Abnormal Vital Signs: Elevated heart rate, fever, or low blood pressure can indicate infection or sepsis, including measuring abd circumference. - Increased Pain: The baby may show signs of discomfort or pain (e.g., crying, irritability, or stiffening of the body).

Answer 69

CVA can occur in patients with sickle cell disease when sickled red blood cells obstruct blood vessels in the brain. This situation requires immediate intervention. The condition is marked by severe headache, seizure activity, unusual behaviors, one sided weakness, slurred speech or sudden onset of stuttering, uncoordinated gait, and visual disturbances.

Answer 70

Expected findings in a child with anemia include pallor of the conjunctiva, oral mucosa, nail beds, and palmar surfaces, fatigue and lethargy, thin, spoon-shaped nails, and tachycardia. In advanced cases, a flow murmur, decreased oxygen saturation and neurologic effects, such as inability to eat sufficiently and impaired mobility.

Answer 71

- do not give IM injections online: low-impact exercises like walking, swimming, cycling, and yoga, while avoiding contact sports like football, hockey, or wrestling

Answer 72

- treat to eradicate the infecting organism - first line of therapy is usually combo of penicillin and gentamycin - IV abx should start promptly and continue 4-6 weeks - will need prophylactic abx before, during, and after dental work, GU, GYN, or GI procedures

Answer 73

fecal incontinence "when children poop in their pants" - when constipation causes impacted stool to fill colon and liquid stool leaks out symptoms: - may not notice they have pooped their pants - feces in pants - prob shit streaks is a big sign (skidmarks lol)

Answer 74

Red meats, dark meat chicken, organ meats, dried beans, green leafy vegetables, and fortified cereals are good sources of iron. Animal sources of iron contain heme iron, which is easier to absorb. Plant foods have iron that is less easily absorbed but still beneficial if they are consumed in adequate amounts. Milk does not contain sufficient iron and the calcium can inhibit absorption of iron if consumed with other foods.

Answer 75

- most common of the post-infectious renal diseases in childhood - APSGN is an immune disease that occurs after a group A beta-hemolytic streptococcal infection -- latent period - more prominent in the late summer or early fall when associated with impetigo - can't go to the heart and cause rheumatic fever

Answer 76

- use an enlarged nipple if bottle feeding - stimulate infant suck reflex while feeding - assess the infant's swallowing during feeding to prevent aspiration - maintain periodic rest periods for the infant during feedings - hold bottle at 180 degrees

Answer 77

13% weight loss A weight loss greater than 10% is a manifestation of severe dehydration in an infant. Sunken fontanelles, Tachypnea A capillary refill of 4 seconds or greater is a sign of dehydration.

Answer 78

"The surgeons will need the foreskin to repair the defect." Hypospadias is abnormal placement of the urethral meatus on the ventral side of the penis. The opening may be near the glans, on the shaft of the penis, or at the base of the penis. It is usually corrected between 6 and 12 months of age to prevent later erectile dysfunction and infertility. To repair the defect, surgery is performed to extend the urethra to the normal position in the center of the glans. Foreskin is used in the surgical procedure to . Attention is paid to both the functional and cosmetic outcome of the procedure.

Answer 79

- fluid and electrolyte replacement - TPN - low fiber, high protein, high calorie diet - enemas - surgical management - temporary ostomy - pull-through procedure nursing: - developmentally prepare the child for surgery - IVF - bowel prep: pre-op - post-op care/colostomy care - nutritional education and supplements goal is to preserve as much of bowel as possible, maintain child's nutritional status, growth, development, stimulate intestinal adaptation with TPN, minimize complications r/t disease process

Answer 80

Application of pressure to the nares will help stop bleeding (applying pressure for like 5-10 minutes). Ice will reduce bleeding and swelling at the injury site. Positioning should be upright with the head tilted slightly forward to prevent aspiration. The patient should not be supine. Forcefully blowing the nose will not stop the bleeding. The patient should be instructed to breathe through the mouth until the bleeding stops.

Answer 81

- usually occurs with potty training -- if learning or withholding, it builds up and body turns off signal, so keep eating and continue to impact feces - need retraining of bowel to not hold feces

Answer 82

To calculate the adequate urinary output for a child, first convert the child's weight to kg: 33 lbs divided by 2.2 = 15 kg. Then, multiply the weight in kg by the number of hours in the shift = 15x 12 = 180. If 1-2 mL/kg is adequate, the range is 180 - 360 mL for this child. Now compare the child's output (120 mL) to the bottom number (180); the child's output is not adequate and should be reported to the provider.

Answer 83

Bell peppers are a rich source of Vitamin C, which facilitates absorption of iron. Calcium inhibits the absorption of iron; one of the leading causes of iron deficiency anemia in children is over-reliance on cow's milk in the diet. This is common in older infants and toddlers when fetal iron stores are depleted. Tannins in tea inhibit the absorption of iron. Additionally, tea contains caffeine which is not appropriate for toddlers. Dried beans are high in phytates, which inhibit the absorption of iron and zinc.

Answer 84

Identifies heart structure Identifies the pattern of movement -allows visualization of blood flow movement -allows visualization of heart movement | Cardiac structures and heart movement

Answer 85

The walking toddler may squat periodically to relieve a hypercyanotic spell. This position serves to improve pulmonary blood flow by increasing systemic vascular resistance.

Answer 86

Ferrous sulfate elixir can stain the teeth and gums. Rinsing with plain water can help prevent this. Ferrous sulfate is poorly absorbed if given with foods, drinks, or supplements containing calcium. Ferrous sulfate is absorbed better when given on an empty stomach. It is not usually advised to give with meals.

Answer 87

- prevention is key -- routine vaccinations -- oral penicillin prophylaxis -- daily hydroxyurea -- oxygen PRN if hypoxic -- avoid aspirin - prevent the sickling that is responsible for pathologic sequalae - manage medical emergencies of SCD - provide rest - hydration: oral and IV - electrolyte replacement - blood transfusions: provides hydration, decreases sickle cells, reduces blood viscosity -- hemaphresis: blood replacement with patient's own blood - analgesics (opioids best) - antibiotics

Answer 88

- emptying bladder every 6-8 hours - proper education on hygiene, wiping properly - if a child has a history of recurrent UTIs: repeat UA and UCX 7 days after treatment

Answer 89

Bedrest is standard care for children who have had a renal biopsy. It is thought that bedrest, preferably with supine positioning, decreases the risk of bleeding. A pressure dressing is usually in place to prevent bleeding at the biopsy site, and the complete blood count is assessed 6 hours post-operatively and the next day to ensure that the hemoglobin and hematocrit are stable and do not indicate blood loss. The patient should be NPO prior to the procedure and usually follows a clear liquid diet in the immediate post-op period.

Answer 90

"I will place the liquid in the front of the mouth right near the gum line." Liquid iron supplements usually have an unpleasant flavor and infants or young children frequently try to spit them out. Therefore, the parent should take the dropper or syringe and aim for the side of the child's mouth, further back. The medication can be dispensed in small squirts, and may be mixed with a small amount of sweet liquid, such as orange juice. It is important to shake the bottle to ensure that the supplement is equally distributed. Accurate measurement of the dose is important to avoid iron toxicity which can be lethal for small children. Milk and other foods that interfere with iron absorption should be offered at least two hours before or after administration of the iron supplement.

Answer 91

highly contagious so treat whole household - pyrantel pamoate: common first line - mebendazole - albendazole - meds typically given as single dose then followed by second two weeks later to ensure any newly hatches are killed improve hygiene practices: - handwashing - keep fingernails short and clean - launder in hot water - clean surfaces - avoid scratching

Answer 92

Coarctation of the Aorta

Answer 93

It is an inflammatory disease that occurs as a reaction to Group A beta-hemolytic strep infection of throat - acute phase - rheumatic heart disease - secondary prevention? -- after acute phase, child on long-term prophylactic abx -- treatment continues for 5 years or until 21 (whichever is longer) - prophylactic abx for all dental work and other invasive procedures to prevent endocarditis 2-6 weeks of a strep infection expected findings: - irritable - CNS involvement - Hx of URi - fever - cardiac symptoms - subcutaneous nodules over bony prominence - larger joints - pink, macular rash

Answer 94

infants: diapers and feces can get in easily; any hx of structual issue younger kids: potty training, wiping improperly adolescents: sexual activity, bubble baths, bath bombs

Answer 95

- most common cause of intestinal obstruction in children 3mo-3 years -- more common in boys than girls - cause unknown - is telescoping or invagination of one portion of intestine into another

Answer 96

- increased BP and bounding pulses in arms - weak or absent femoral pulses - cool lower extremities - increased deterioration of symptoms: severe acidotic and hypotensive older children: dizziness, faintness, headaches, epistaxis (increased BP)

Answer 97

child showing signs and symptoms of decreased pulmonary blood flow and possible hypercyanotic (tet) spell, which includes a toddler with tetralogy of Fallot squatting. - Squatting increases systemic vascular resistance and forces blood to flow through the narrow pulmonary valve to improve oxygenation. - It is the child's natural response during a "tet spell" to reverse abnormal shunting of blood.

Answer 98

no. very rare Epispadias is a very rare birth defect affecting the urethra, occurring in about 1 in 117,000 newborn boys and 1 in 484,000 newborn girls.

Answer 99

serves purpose of bypassing the lungs in utero

Answer 100

online: Vesicoureteral reflux (VUR) management aims to prevent kidney infections and scarring, and can involve non-surgical approaches like antibiotic therapy and minimally invasive procedures like endoscopic injection, or surgical options like ureteral reimplantation.

Answer 101

- peaks between 2-5 years old; 5-10% involve both kidneys and can be simultaneous or one after another - **hematuria** - fatigue and malaise - **HTN** - weight loss - **fever** - abdominal swelling or mass -- firm -- nontender -- confined to one side **DO NOT PALPATE THE ABDOMEN!!!!!** - high risk of rupture and metastasis Treatment: - surgery 24-48 hours of admission - tumor, affected kidney, and adjacent adrenal gland are removed - keep encapsulated tumor intact - other kidney inspected carefully and biopsied later - B/L kidneys: chemo or radiotherapy -- agents: actinomycin D -- cyclophosphamide can be added for unfavorable histologic characteristics or advanced in disease progress of tumor - possible partial nephrectomy on one side and total nephrectomy on other side; depends on stage/spread

Answer 102

Diagnosis: based on subjective findings, ultrasound, enema Symptoms: - abdominal pain - loud crying - bilious vomitus - **abdominal mass: palpable sausage shaped mass in RUQ** - **jelly-like bloody stools**

Answer 103

Why: Infants with a cleft palate often struggle to create enough suction to draw milk from a standard bottle nipple because of the gap in their palate. The enlarged nipple helps the baby get enough milk by providing a more controlled flow, making it easier for the baby to feed without having to generate as much suction. The nipple will have to help fill in the opening so that the infant can get a good seal to be able to feed.

Answer 104

- congenital defect - bladder is open and exposed to the outside of the abdomen - highest priority is skin disruption related to the exposed bladder mucosa

Answer 105

- immune disease that occurs after a group A beta-hemolytic streptococcal infection - pathophysiology unknown - immune complexes are deposited in the basement membrane: -- glomeruli become edematous and infiltrated with polymorphonuclear leukocytes, which occlude the capillary lumen -- there is a decrease in plasma filtration -> causes water and sodium retention -> leads to edema -- fluid retention is not the complete cause of HTN

Answer 106

When hypertonic dehydration is severe, the osmolarity in the blood is high, and the cells may have lost water to try to balance this high osmotic pressure. If you correct the dehydration too quickly, there’s a risk of causing cerebral edema (swelling of the brain). This happens because the sudden influx of water into the bloodstream could cause water to shift back into the cells too quickly, particularly in the brain, where cells are sensitive to osmotic changes. Fluid Replacement Rate: The body needs time to adjust to the new balance of fluids and electrolytes. A rapid correction could lead to serious complications. Generally, the goal is to replace the fluid over 48 hours or longer, depending on the severity.

Answer 107

pulmonary congestion

Answer 108

Tenderness at McBurney's point is characteristic of appendicitis. The nurse should give SBAR to the provider and recommend surgical consultation.

Answer 109

A vaso-occlusive crisis occurs when sickle-shaped cells are clumped together in a joint or organ. This causes severe pain and hypoxia to the tissues. The management for a vaso-occlusive crisis is to : provide adequate pain relief, oxygen to correct the hypoxemia, and increased IV fluids to thin out viscosity and allow the cells to flow in the vascular system.

Answer 110

DDAVP (desmopressin) is a synthetic version of vasopressin. It acts as as an antidiuretic hormone and controls bleeding. It is given to clients with hemophilia prior to minor surgical procedures.

Answer 111

- asymptomatic - CHF symptoms - machinery like murmur "humming top" - widened pulse pressure - bounding pulse

Answer 112

- abnormal opening between L and R ventricles (L/R shunt) - 50% close spontaneously clinical manifestations and complications: - CHF, murmur, bacterial endocarditis, eisenmenger syndrome

Answer 113

The patient with hemophilia is susceptible to bleeding in the brain after a head injury. Signs and symptoms of this include severe headache, alteration in level of consciousness, vomiting, and seizures. There may be visual changes as well.

Answer 114

tape test: clear tape pressed to anal area to collect eggs which are examined under a microscope - can also do visual inspection and microscopic exam of stool

Answer 115

occurs when the loss of water exceeds the loss of electrolytes, leading to an imbalance where the extracellular fluid has a higher concentration of solutes (like sodium) than normal. This results in a higher osmolarity in the blood, causing fluid to shift from the intracellular space to the extracellular space in an attempt to balance the osmotic pressure. Cause: This can happen due to excessive fluid loss (through vomiting, diarrhea, or inadequate fluid intake) or due to high intake of salt or other solutes without enough water.

Answer 116

Reveals size and contour of the heart Visualizes characteristics of Pulmonary Vascular markings

Answer 117

Massive Proteinuria is characteristic of nephrotic syndrome. This is typically accompanied by increased BUN and Creatinine, decreased serum albumin, and hyperlipidemia.

Answer 118

- growth failure - inadequate growth from an inability to obtain or use calories required for growth - typically when child falls below 5th percentile for child's age greater risk with illnesses and diseases: - chemo and cancer - HIV - CF - SCD - low birth weight - GI malabsorption - nephrosis

Answer 119

Clinical Manifestations: - Cyanosis, - Clubbing - Systolic Murmur - Delayed growth and development - **Hypoxia -> “tet” Spells, Squatting** Risks: - Emboli - Brain Abscess - Seizures - LOC - Sudden Death

Answer 120

Physical assessment: - active bleeding - hematomas/bruising - hemarthrosis - headache - prolonged bleeding at umbilical cord stump or circumcision site - less severe: increase bruising following immunizations; lack of symptoms until trauma or surgical procedure Nursing Hospital Management: - avoid IM injections -> administer subQ - avoid unnecessary skin punctures - venipunctures are preferred over heel sticks - monitor urine, stool, and NG output for blood - DO NOT administer ASA - acetaminophen is acceptable

Answer 121

- failure of tricuspid valve to develop - defect prevents blood from entering the right ventricle from the right atrium Assessment: - postnatal cyanosis - tachycardia and dyspnea - heart murmur - echo: enlarged right atrium and decreased pulmonary blood flow

Answer 122

from ATI: A weakening at the vesicoureteral (urethral-bladder) junction allows urine to backflow when the bladder contracts during urination. - abnormal retrograde flow of bladder urine into the ureteres - causes frequent UTIs in infants and children - kidney scarring and kidney failure can occur Primary: defect at ureterovesical junction Secondary: blockage

Answer 123

increase pulmonary flow (think left to right shunt causing pulmonary congestion) - ASD - VSD - PDA (Patent Ductus Arteriosus) - AVC (atrioventricular canal defect)

Answer 124

- pain - fatigue - jaundice - hand and foot swelling and joint pain (dactylitis) - skin rash - SOB - priapism Sever complications: - vaso-occlusive crisis: painful episode; ischemia causes mild to severe pain and can last minutes to days - splenic sequestration: pooling of large amount of blood in spleen; can lead to shock - hyper hemolytic crisis - aplastic crisis - acute chest syndrome: presence of new pulmonary infiltrate -- S/S: chest pain, fever, tachypnea, cough, hypoxia, wheezing -- leading cause of death in SCD -- **a temperature is a medical emergency** - CVA - infection

Answer 125

This type of shunting causes an increase of blood to the lungs.

Answer 126

closes with the clamping of the cord In a few days to weeks; become ligamentum venosum Now with blood flowing to liver – able to process nutrients and metabolize (such as bilirubin to help resolve newborn jaundice) – takes about 3 to 5 days for liver to mature

Answer 127

Cyanotic Defects (Decrease Pulmonary blood flow) Four Main Defects - Pulmonary Stenosis - Ventricular Septal Defect - Overriding Aorta - Right Ventricular Hypertrophy - these defects collectively lead to mixing of oxygenated and deoxygenated blood: -- cyanosis -- varying degrees of oxygen saturation in the blood Most common type of Cyanotic Defect When the RV contracts there is resistance of blood r/t to pulmonary stenosis. The blood is shunted across the VSD into the aorta and LV giving persistent arterial unsaturation and cyanosis Surgical repair to correct anatomical abnormalities and improve blood flow and oxygenation

Answer 128

is a bacterial infection of the inner lining of the heart and the valves that can enter the bloodstream - **the hallmark sign is a NEW murmur** - **need 3 or more blood cultures in a 24 hours period for a confirmatory diagnosis, each from separate venipuncture site identifies the causative agent** - labs: CBC, UA, Blood culture (positive for diagnosis), ESR risks: - congenital or acquired disease - indwelling catheter

Answer 129

hypertrophic pyloric stenosis (HPS) - circumferential muscle of pyloric sphincter becomes thickened - elongation and narrowing of pyloric channel - outlet obstruction, dilation, hypertrophy - hyperperistalsis of the stomach noticed in 2-5 weeks of life