Exam 4 Blueprint Flashcards
(264 cards)
1
Q
What is a macule?
A
circular, flat discoloration < 1 cm
2
Q
What is a papule?
A
superficial, solid, elevated <0.5 cm
3
Q
What is a plaque/annular?
A
ring-like with central clearing
4
Q
What is a vesicle?
A
circular collection of free fluid < 1 cm
5
Q
Wha is a pustule?
A
vesicle containing pus
6
Q
Why are children at risk for skin injuries?
A
due to their developmental immaturity, they suffer accidental minor injuries frequently
7
Q
Approximately one in ____ children experience child abuse or neglect
A
4
8
Q
What is a non accidental injury to a child
A
done with harm intent ; child abuse
9
Q
What are the types of injuries?
A
abrasions, lacerations, bites, bruises, burns
10
Q
Where are common sites of bruises (these are caused by normal play)
A
-forehead
-eyebrows
-elbows
-shins
-knees
11
Q
Questionable sites for bruises in children include places such as ?
A
-thighs
-calves
-neck
-back
-tops of shoulders
-etc
12
Q
Risk factors for child abuse include
A
-poverty
-prematurity
-chronic illness
-intellectual ability
-parent w/abuse history
-unrelated partner
-alcohol/substance abuse
-extreme stressors
13
Q
Why are premature infants, children with intellectual ability, and children with chronic diseases at higher risk of maltreatment?
A
it is harder to care for them
14
Q
If a child comes into the ED with injuries in uncommon locations (such as backside) and has multiple in places other than the legs, the nurse should be suspicious of
A
child abuse
15
Q
Bruises in an infant <9 months should raise suspicion to?
A
child abuse
16
Q
What should the nurse observe for if she is working in the ED and suspects child abuse?
A
-frequent visits / delay in seeking care
- inconsistent stories
-unusual caregiver-child interaction
17
Q
Physical cues of abuse include?
A
-suspicious location
-injuries in various stages of healing
-fear of parents
-lack of emotional responses
18
Q
Infant <6 months sun safety rules
A
-keep out of direct sunlight
-use minimal sunscreen
19
Q
What extra clothing can a child wear to increase sun safety
A
-hats
-sun shirts
20
Q
Sun exposure time should be limited between what hours
A
10am - 4 pm
21
Q
Why should sunscreen be broad spectrum
A
-screens out other UVA and UVB rays
22
Q
Requirements for choosing a good sunscreen:
A
-fragrance and oxybenzone free
-spf 15 or higher
23
Q
What can be applied to nose, cheeks, ears, and shoulder areas to provide extra sun protection
A
zinc oxide products
24
Q
Sunscreen should be applied 30 minutes before activity, and reapplied how often?
A
-q 80-90 min if in water
-at LEAST q 2 hours
25
What is the primary burn assessment the nurse should perform when a child comes to the ED?
1. assess if airway is patent
2.determine if airway injury is present
3.evaluate child's skin color, respiratory effort, pulse ox, ABG, carboxyhemoglobin levels, and breath sounds
4.determine pulse strength, perfusion status, and HR
5.note any edema
26
IF a client experiences an electrical burn, what do they require?
an EKG
27
S/s of airway injury from burn or inhalation include?
-burns to face/lips
-nose hairs singed
-black sputum
-stridor, hoarseness, wheezing
28
The secondary assessment a nurse should perform upon child admission to the ED with burns is?
1. determine burn depth
2. estimate burn extend by calculating BSA affected
3. inspect child for other traumatic injuries (I.E spinal cord injury)
29
Describe a first degree burn:
damage to epidermis
30
Appearance of first-degree burn:
-pink to red in color
-no blisters
-blanches
31
Describe a second degree Superficial Partial Thickness burn
-damage to the entire epidermis
-dermal elements remain intact
32
Appearance of a second degree Superficial Partial Thickness burn
-moist, red, painful
-blisters
-mild to moderate edema
-blanches
-no eschar
33
Describe a second degree Deep Partial Thickness burn
-damage to the entire epidermis and some parts of the dermis
-sweat glands and hair follicles remain intact
34
Describe the appearance of a second degree Deep Partial Thickness burn
-mottled, red to white
-blisters
-moderate edema
-blanches
35
Describe a third degree burn
-damage to the entire epidermis and dermis
-possible damage to subcutaneous tissue
-nerve endings, hair follicles, and sweat glands are destroyed
36
What is the appearance of a third degree burn?
-red to tan, black, brown, or waxy white color
-dry, leathery appearance
-no blanching
37
Describe a fourth degree burn
-damage to all layers of the skin that extends to muscle, fascia, and bone
38
Describe the appearance of a fourth degree burn
-color variable
-dull and dry
-charring
-possible visible ligaments, bone, and tendons
39
What type of burn is painful, heals in 3-5 days, and has no scarring
first
40
What type of burn is painful, heals in < 21 days. Has variable amts of scarring, is sensitive to temperature changes/air/light touch
superficial partial thickness burn (2nd)
41
What type of burn is painful, is sentive to temp changes/light touch, and scarring is likely
deep partial thickness burn (2nd)
42
What stage of burn has pain that begins as burn heals, scarring is present, and a skin graft is needed
full thickness burn (3rd)
43
what stage of burn has no pain, scarring is present, skin graft is needed, amputation is possible
deep-full thickness (4th)
44
How many minutes before dressing changes or procedures should we administer pain medications to clients with burns
45 minutes
45
What combination of pharmacologic pain management is used when treating burns
-opioids: morphine and fentanyl
-sedative: midazolam
46
Nonpharmacologic pain measures should be used in clients with burns. Examples of these include
-music, distraction
47
Fluid resuscitation for 2nd and 3rd degree burns are based on
TBSA (Lund and Browder formula)
48
What solution is used for fluid replacement for burns in the first 24 hours
LR
49
24-48 hours after a burn, when capillary permeability improves, what is added to IV fluids to help resuscitation
colloids such as albumin and FFP (fresh frozen plasma)
50
Adequacy of fluid replacement when treating burns is determined by
evaluating urine output
51
A urine output of ___ should be maintained when treating burns
1-2 ml/kg/hr
52
What should be monitored when administering fluid resuscitation to clients with burns
DW, fluid and electrolyte imbalances, I and O's
53
Nursing considerations for wound care
-maintain standard precautions/ PPE
-clean with mild soap and water
-assist with debridement and hydrotherapy
54
Should nurses pop blisters while performing wound care?
no, leave blisters intact
55
Loose skin from burns should be removed with
sterile scissors
56
How to prevent infection when caring for burns?
-use aseptic technique
-use Pt-designated equipment such as BP cuffs and thermometers
57
If a tetanus vaccine is > 5 years old or if status is unknown, what should happen if they have a burn
administer one to prevent infection
58
Why should flowers/plants be avoided in clients with burns
avoids exposures to pseudomonas to prevent infection
59
Complications of burns include:
-carbon monoxide injury
-hypovolemic/septic shock
-wound infections
-inhalation injury
60
What is a skin abrasion
superficial rub or wearing off of the skin usually due to friction; mainly limited to the epidermis
61
What is a laceration
injury that penetrates skin and soft tissue
62
What is atopic dermatitis (eczema)
inflammation/rash/itching caused by antigen response to environmental factors, temp changes, sweating
63
common sites of atopic dermatitis/eczema include
wrists, antecubital of arm, popliteal space
64
What does atopic dermatitis/eczema cause?
elevated IgE levels
65
What medications are used to treat atopic dermatitis/eczema
-topical corticosteroids
-immune modulators - tacrolimus
66
Nursing considerations for tacrolimus include
- used in children > 2
- must avoid direct sunlight
-can cause itching, flu-like symptoms ,and HA
67
We should educate parents that children with atopic dermatitis should avoid soaps containing
perfumes, dyes, or fragrances
68
How to promote moisture in children with atopic dermatitis?
-pat skin dry and leave moist while applying moisturizers multiple times daily
69
Should children with atopic dermatitis bath in warm or hot water
2 x a day in warm water / avoid hot
70
What type of clothes should children with atopic dermatitis wear?
-100% cotton clothing AND bed linens
-avoid synthetics and wool
-keep fingernails short
71
What drugs may be given at bedtime for children with atopic dermatitis
antihistamines
72
What is diaper dermatitis
inflammatory reaction caused from urine, feces, harsh soaps, wipes
73
T or F: diaper dermatitis can be either non-candida or candida
yes
74
Non-candida diaper dermatitis assessment finding s
red, shiny, NOT IN CREASES OR FOLDS
-occurs on buttocks, thighs, abdomen and waist
75
Candida diaper dermatitis assessment findings
deep red lesions, scaly with satellite lesions (outside of diaper area)
-OCCURS IN CREASES OR FOLDS
76
Children with candida diaper dermatitis may also have
thrush of the mouth
77
Does candida dermatitis improve with standard diaper cream
no
78
tx for non-candida diaper dermatitis
-topical A,D, and E or zinc oxide
79
Tx for candida diaper dermatitis
nystatin or miconazole anti fungal cream
80
Diaper dermatitis management include
-change diaper s frequently
-avoid rubber pants, harsh soaps, and baby wipes with fragrance or preservatives
81
Why should nurses obtain the date of LMP for females with acne during their history assessment
acne is worse 2-7 days prior to start of menses
82
During the history and physical assessment for acne vulgaris, the nurse should ask
-onset of lesions
-medications that exacerbate
-note oily skin/hair
-hx of endocrine disorder
83
We should educate clients with acne to avoid
oil - based cosmetics and hair products, headbands, helmets/ hats
84
We should educate our patients with acne to do what to manage their symptoms
-clean skin with mild soap and water BID
-shampoo hair regularly
-avoid picking/squeezing
-eat a balanced diet
85
How does tretinion work to treat acne
interrupts abnormal keratinization
86
How does benzoyl peroxide, an OTC medication help manage acne
-inhibits growth of P. acnes
87
What topical antibacterial medication can be given to reduce acne
clindamycin
88
What oral antibiotics can be given to treat acne
-tetracycline and erythromycin
89
What teratogenic medication can be given for severe cases of acne
isotretinoin
90
How can oral contraceptives be used to help reduce acne
decreases endogenous androgen production
91
what is rubeola (measles)
a highly contagious viral respiratory illness spread via droplets
92
Assessment findings of measles includes
-Fever, Koplik spots, cough, nasal inflammation, malaise, conjunctivitis
93
How does maculopapular rash spread with rubeola
starts on face --> neck --> trunk > arms > legs > feet
94
Patients with rubeola need to be placed on what type of precautions
airborne
95
Nursing management of Rubeola / measles includes
-supportive care
-antipyretics
-bedrest, fluids, humidification
96
If a client is 6 months - 2 years old and is hospitalized or immunocompromised with rubeola, what is the treatment
Vitamin A
97
Complications of rubeola / measles includes
diarrhea, OM, PNA, encephalitis
98
Rubeola is communicable _______ days before rash appears and until ______ after the rash disappears
3-5 ; 4-6 days
99
Physical findings of pertussis include?
-acute respiratory disorder
-paroxysmal cough
-whooping cough
-copious nasal / oral secretions
100
Patients with pertussis need to be placed in
droplet/standard precautions
101
therapeutic management of pertussis
-high humidity environment
-observing airway for obstruction
-push fluids
-abx compliance
102
What is the medication treatment for pertussis?
-Macrolides "mycins"
-erythromycins, azithromycins
103
If a client is < 1 month of age, pertussis must be treated with
azithromycin
104
Pertussis can be prevented with what vaccine? When is it given?
-DTaP
-2,4,6,8, 15-18 months
-booster at 11 years
105
Clinical manifestations of fever include
-sweating, weakness, lethargy, flushing, s/s of dehydration if severe
106
A fever in an infant younger than 3 months is
100.4 or higher
107
A fever in a child 3 months to 3 years is
102.2 or higher
108
An older child will have more traditional s/s of fever such as
-rash
-appearing sick
-persistent diarrhea or vomiting
-s/s of DHD
109
How often should temp be assessed if client has a fever
-assess q 4-6 hours
-30 - 60 min after administering antipyretic
- any change of condition
110
Should the nurse change the site or device used for temperature measurement for a client experiencing a fever
No ; use the same to accurately gage changes in temperature
111
When should antipyretics be administered
when child is experiencing discomfort or cannot keep up with metabolic demands of the fever
112
Nursing interventions during fever
-assess fluid intake
-encourage oral intake
-IV fluids per order
-keep linens and clothing dry
113
What two medications are given to manage fever
-tylenol 10-15 mg/kg/dose q 4-6 h
-ibuprofen 5-10 mg/kg/dose q 6-8 h
-ibuprofen only given if > 6 months
114
Physical findings of Lyme disease include
-onset of rash and erythema migrans
-fever
-HA
-joint/muscle pain that progresses to larger joints
115
How long after bite from deer tick does onset of rash and erythema migrans occur
usually 7-10 days
116
Lyme disease treatment for clients > 8 years old
-14-28 day course of Doxycycline
117
Lyme disease treatment for clients < 8 years old
-Amoxicillin to prevent teeth discoloration
118
Nursing education for preventing future tick bites includes
-wear protective clothing that fits tightly around wrists, waists, and ankles
-do a full body check after leaving area with ticks
-examine gear, clothes, and pets for ticks
-tumble dry gear on high heat for an hour
-insect repellent is temporary and may be toxic to children
119
Teaching patients how to remove a tick includes
-using fine-tipped tweezers
-protect fingers with gloves
-do not twist or jerk the tick
-clean site with some and water or alcohol
-save the tick in case child becomes sick
120
Physical cues of pediculosis captitis
-nits or lice behind ears or on nape of neck
-extreme pruritis
-small red bumps on scalp
-white specks on hair shaft
121
management of pediculosis capitis
-follow directions exactly on pediculicide
-comb out hair q 2-3 days
-soak combs and hairbrushes in treatment solution, hot water, or shampoo
122
What should we do to bed sheets or environmental items when our patient has head lice
-use hot water
-use dry cleaning
-seal in plastic bags
123
What kind of precautions are patients with head lice placed in
contact precautions
124
What are standard precautions
-applies to all patients
-hand hygiene before and after
-gloves when handling all body fluids
-masks/goggles if splashing of body fluids indicated
125
What are contact precautions?
-private room or cohort w / like conditions
-gloves and hand hygiene
-gowns donned before entering and doffed before exiting
126
What are droplet precautions
-respiratory or mucous containing pathogens from nose / mouth
-private room or cohort with like illness
-surgical mask if within 3 feet
127
what are airborne precautions
-droplets or dust in air
-negative pressure required
-masks or n95 device
-restriction of susceptible visitors or staff
128
What kind of precautions does rubeola (measles) require
airborne
129
What kind of precautions does pediculosis capitus need
contact
130
what kind of precautions does pertussis need
droplet/standard
131
History cues of immunodeficiency in pediatric patients
-four or more episodes of otitis media in 1 year
-2 or more episodes of severe sinusitis
-tx with abx for 2 months or longer with no effect
-FTT in the infant
-recurrent deep skin or organ abscesses
-persistent oral thrush or skin candidiasis
-hx of infections requiring iv abx
-two or more serious infections such as sepsis
-family hx of primary immunodeficiency
132
Lab findings for infections include CBC with differential, what does this evaluate?
-proportion of each of the 5 WBC types
133
Neutrophils increase in the presence of
-bacterial infections or severe stressor
134
Neutrophils decrease in the presence of
some viruses, exhausted BM (bone marrow), chemo
135
Eosinophils are associated with
antigen-antibody reactions
136
Lymphocyte numbers increase in
presence of viral infections, chronic bacterial infections, ALL
137
Lymphocytes decrease in
HIV/AIDs
138
Immunoglobulin lab cues of immunodeficiency
IgG
IgA
IgM
IgE
IgD
139
Lab cues of immunodeficiency that indicate inflammation
ESR and CRP
140
Lab cues of immunodeficiency that monitor amount of T-helper cells
CD4 Count
141
What is the Complement C3 lab cue for immunodeficiency
evaluated to determine howe well the immune system is working
142
Characteristics of IgG
-only immunoglobulin that crosses the placenta and transferred via breastmilk
-protects against viruses, bacteria, and toxins
143
Lack of IgG causes
severe immunodeficiency
144
At what age do infants produce their own IgG
6 months - 1 year of age
145
Characteristics of IgA
-first line of defense against respiratory, gi and gu pathogens
146
At what age do infants begin producing IgA
3 months of age
147
Characteristics of IgM
-presence indicates an active infection
148
Characteristics of IgE
-increases in allergic states
-increases in parasitic infections
-increases in hypersensitivity reactions
149
what immunoglobulin level is measured during allergy testing
IgE
150
Pathophysiology of Severe Combined Immune Deficiency (SCID)
-absent B and T cell function
-x - linked autosomal recessive
151
SCID is a potentially fatal disorder that requires
emergency intervention at time of diagnosis
152
History and physical cues of SCID
-hx of frequent, severe infections
-chronic diarrhea
-FTT
-persistent thrush
153
Lab cues of SCID
-very low levels of immunoglobulins IgA and IgM
154
Main treatment of SCID includes
-preventing infections
155
What can be administered to reduce the number of bacterial infections in a child
IVIG
156
What is necessary for a patient with SCID
-a bone marrow transplant with HLA matched sibling or donor
157
If a transfusion is necessary in a child with SCID, what must we take note of
-only cytomegalovirus (CMV) negative, irradiated blood or platelets can be administered
158
Diagnostic labs for children with HIV 18 months or older
+ ELISA and +Western blot
159
Lab criteria for diagnosis of HIV in infants < 18 months and born to an infected mother
+ PCR and viral culture
160
HIV in children can cause
-progressive HIV encephalopathy
161
Sx of HIV encephalopathy
-acquired microcephaly
-motor deficits
-loss of previously achieved development milestones
162
HIV affects what type of cells
CD4 (T-helper cells)
163
Pathophysiology of juvenile idiopathic arthritis
-autoimmune disease that causes the body to release inflammatory chemicals that attack synovium
-attack joints + eyes or other organs
164
The first sign of juvenile idiopathic arthritis may be?
-history of irritability or fussiness
165
Other assessment findings of JIA include
-redness, pain, swelling and stiffness with inactivity or in the AM, eye inflammation, organomegaly, poor weight gain, severe anemia
166
Lab cues of JIA include
Anemia
+ ANA in young child with pauciartiular type
Increased WBC
+RA Factor in serious cases
167
Cross reactions to latex - containing products and specific foods such as
pear, peach, passion fruit, plum, pineapple
168
Latex allergies have a response similar to food allergies. what immunolglobulin mediates this
IgE
169
Nursing care and interventions for latex allergy???????
-avoid products that contain latex ?
170
Clinical manifestations of latex allergy????
171
Symptoms of allergic reactions include
-hives
-flushing
-angioedema
-mouth/throat itching
-swelling of throat/pharnyx/uvula
-runny nose
-gi distress
172
What allergic reaction symptoms may indicate the airway is compromised
-wheezing
173
Physical cues of anaphylaxis reactions
-swelling of mucosal tissue, lips
-respiratory compromise
-reduced BP or associated s/s of end organ dysfunction
174
Management of allergies
-administration of histamine blockers
-If anaphylaxis: epipen should be carried at all times
-written emergency plan for child's allergy
-dietary consult ot assist family with reading foods labels and recognizing hidden sources of allergens
175
Nursing assessment for allergic and anaphylactic reactions
-ABC's
-VS ; auscultate heart and lungs
-assess oropharynx
-assess skin
-note length of time between exposure and reactions
176
What causes allergic and anaphylaxis reactions
-food or environmental allergens initiate IgE mediated antibodies to form --> mediators and cytokines released
177
What is amblyopia? aka lazy eye
poor visual acuity in one eye ; can lead to blindness if not corrected ; can be caused by strabismus
178
all preschoolers should be screened for visual acuity by age
3
179
the only sign of amblyopia in preverbal child may be
asymmetry of cornea light reflex
180
Therapeutic management of amblyopia includes:
-wearing patch or administering atropine drops to STRONGER eye
181
What are the types of hearing loss
conductive and sensorineural
182
Conductive hearing loss means
transmission of sound through middle ear is disrupted
183
Causes of conductive hearing loss include
-frequent otitis media with effusion (fluid in middle of ear)
-ruptured tympanic membranes
184
Sensorineural hearing loss means
caused by damage to hair cells in the cochlea
185
What are causes of sensorineural hearing loss
-ototoxic meds, meningitis, rubella, excessive noise
186
Pathophysiology of infantile glaucoma
obstruction of aqueous humor flow, causing high intraocular pressure; vision loss occurs from retinal scarring and optic nerve damage
187
Assessment findings of infantile glaucoma
spasmodic winking, corneal clouding, enlarged eyeball, excessive tearing, red reflex appears gray or green
188
Management of infantile glaucoma
-3-4 surgeries (surgical management) is first line treatment
189
Congenital cataracts pathophysiology
opacity of the optic lens preventing light from entering the eye
-leading cause of visual impairment and blindness
190
Assessment findings of congenital cataracts
cloudy cornea, absent red reflex
191
Tx for congenital cataracts
-best outcomes when surgically removed by 3 months of age
-can begin surgery as young as two weeks
192
Nursing care of children with visual impairment
-use child's name to get attention
-tell child you are there before touching them
-encourage independency while maintaining safety
-name and describe people/objects to make child more aware of what is happening
-discuss upcoming activities
-use simple and specific directions
-use parts of child's body as reference
-encourage exploration of objects through touch
193
What is acute otitis media?
infection of middle ear structures
Bacterial: strep
Viral: RSV , influenza
194
s/s of acute otitis media
fever, ear pulling, irritability, poor feeding, lymphadenopathy
195
what does the tympanic membrane look like with acute otitis media
dull, red, bulging, deceased or no movement
196
management of acute otitis media
-Amoxicillin/Augmentin or azithromycin: PO
-Ceftriaxone: IM x 1 dose
-Tylenol / ibuprofen: manage ear pain and fever
-Benzocain: ear drops for pain if TM intact
197
If > 3 years old, to assess TM or administering ear drops we pull the pinna
up and back
198
if < 3 years old, to assess TM or administering ear drops we pull the pinna
down and back
199
What is otitis media with effusion
collection of fluid in the middle ear with NO infection
-related to allergies or Ig adenoids
200
S/s of otitis media with effusion
feeling of fullness, transient hearing loss possible
201
What does the tympanic membrane look like with otitis media with effusion
dull, orange discoloration, air bubbles, decreased movement
202
Tx of otitis media with effusion
-resolves on own
- if > 3 months no resolution, refer to ENT and assess for hearing or speech loss
203
What is myringotomy and tympanovstomy
-small incision in TM and placement of PE tubes that can be indicated for a child with recurrent OM
204
Is post op pain common after PE tube placement
no
205
is PE tube placement usually done outpatient or inpatient
outpatient under general anesthesia
206
What is recommended while swimming after ear tube placement
ear plugs
-if water enters ear allow it to drain out
207
Patient education after PE tube placement
-notify provider if drainage occurs
-ear drop administration
-tubes fall out spontaneously after 8-18 months
208
S/s of hearing loss in infants
-does not startle to loud noises
-wakes only to touch
-does not turn to sound by 4 months of age
-no babbling at 6 months
-no speech development
209
S/s of hearing loss in young child
-communicates needs through gestures
-does not speak by 2 years
-prefers solitary play
-does not respond to telephone or door bell ringing
210
S/s of hearing loss in older child:
-often asks for statements to be repeated
-is inattentive or daydreams
-performs poorly in school
-gives inappropriate answers to questions if not facing speaker
211
Pathophysiology of ALL
overproduction of immature lymphoblast cells that infiltrate organs and tissues
212
History cues of ALL
-reports of leg pain
-reports of decreased activity level
-recurrent infections
-persistent fevers
213
Physical cues of ALL
elevated temp (leukopenia)
pallor in color (anemia)
petechiae, purpura, brusies (thrombocytopenia)
enlarged lymph nodes
hepatomegaly, splenomegaly
214
Lab cues of ALL
-depleted CBC (WBC may be low, elevated, or high)
-Blood smear for lymphoblasts
-bone marrow aspirate (BMA) for lymphoid cells
215
Pathophysiology of lymphoma
malignancy of the lymph system
216
History cues of lymphoma
-adolescent age
-family hx
-reports of night sweats
-weight loss
-hx of frequent infections
217
Physical sx of lymphoma
-painless enlarged supraclavicular or cervical lymph nodes
218
the two classifications of lymphoma and their sx
Class A: asymptomatic
Class B: fever, night sweats, > 10 % weight loss, cough, SOB, abdominal discomfort, enlarged liver or spleen, pruritis
219
Lab cues for lymphoma
Lymph node biopsy + for reed Sternberg cells
220
Pre - op care for brain tumors
-monitor for increased ICP
-steroids to decrease swelling
-pre-op teaching /emotional support
221
Post-op management of brain tumor
-monitor for Increased ICP and manage
-frequent VS, pupil checks, and LOC
-monitor I and O's
-JP drain monitoring and care
222
How should patients be positioned post operatively of brain tumor removal
-keep head midline
-position on unaffected side at level ordered by provider
223
Hyperthermia following brain tumor surgery is treated with
antipyretics
224
Headache following brain tumor surgery is treated with
analgesics
225
Pathophysiology of Wilm's tumor (nephroblastoma)
solid tumor that commonly occurs in the abdomen (mainly kidneys)
226
Assessment/physical cues of nephroblastoma
swollen, asymmetric abdomen, hematuria, HTN, firm nontender abdominal mass
227
s/s indicative that Wilm's tumor has metastasized to lungs
cough/SOB/chest pain
228
Diagnostics for film's tumor
Abdomen: US, CT, MRI, chest X-ray
UA: gross or microscopic care
24 hr urine
229
If the 24 H urine protein is negative for homovanillic acid and vanillamandelic acid, this means?
the patient has a wilms tumor
230
Biggest nursing consideration for Wilm's tumor
do NOT palpate the abdomen
-place signs outside door and above the bed
231
What is the most common site for bone marrow aspirate? What about in infants?
-iliac crest
-tibia can be used for infants
232
Describe the procedure for Bone Marrow Aspiration?
topical anesthetic may be applied over biopsy area 45 min - 1 h prior (fetanyl) ; conscious sedation used (propofol, versed/midazolam)
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Post-procedure actions for BMA
-apply pressure to site for 5-10 min
-apply pressure dressing
-assess VS frequently
-monitor for bleeding and infection
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Neutropenic precautions
-meticulous hand hygiene
-VS q 4 h
-assess for s/s of infection q 8h
-avoid rectal temps, enemas, suppositories, urinary catheters, and invasive procedures
-restrict visitors
-mask on child when outside room
-soft toothbrush
-private room
-prophylactic ABX
-monitor ANC
-no raw fruits / veggies
-no raw plants
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What does chemotherapy do?
target different phase of the cell cycle and affects rapidly growing cells
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Common adverse effects of cancer
-mucosal ulceration
-skin breakdown
-neuropathy
-pain
-NV/ Loss of appetite
-hemorrhage cystitis
-cardiomyopathy (late)
-cognitive defects
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What is the biggest side effect of chemo
myelosuppression
-anemia, thrombocytopenia, neutropenia
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Long term complications of chemotherapy
altered G&D, CV/respiratory changes, reproductive dysfunction, vision/hearing changes, tooth loss, and secondary cances
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What is radiation therapy for cancer
-high energy radiation to kill cancer cells
-may also destroy any rapidly dividing cells in proximity to the irradiated area.
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Adverse affects of radiation
-similar to chemotherapy
-irritation/ burns to site
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Long term complications of radiation therapy
-similar to chemotherapy
-pulmonary fibrosis, osteoporosis, development of secondary cancer at / near the site
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Assessment findings of iron deficiency anemia
-pallor in skin, MM, conjunctiva
-SOB
-dizziness
-weakness
-fatigue
-irritability
-spooning of nails (concave shape)
-splenomegaly
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Diagnostic labs for iron deficiency anemia
-low RBC, hgb and hematocrit, MCV, MCH, ferritin decreased
-RDW (red blood cell distribution) increased
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Tx of iron deficiency anemia
-Fe fortified formula
-4-5 months breast fed infants need Fe+ fortified cereal or Fe gets
-encourage breastfeeding mothers to increase Fe + in their diet
-Limit cow's milk in children > 1 to 24 oz/day
-SW referral for resources such as WIC
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Side effects of Fe+ supplements
-metallic taste in mouth
-nausea
-upset stomach
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Client education for Fe+ supplements
-place behind teeth to avoid stains
-cause constipation - increase fluids and may need stool softeners
-cause dark, green stools - this is normal
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Foods high in iron include:
-meat
-tuna
-salmon
-eggs
-tofu
-enriched grains
-dried beans and peas
-dried fruits
-leafy green vegetables
-Fe fortified cereals
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Physical findings of hemophilia
-swollen or stiff joints
-multiple bruises
-hematuria
-bleeding gums
-bloody sputum or emesis
-black tarry stools
-chest or abdominal pain (internal bleeding)
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Lab cues for hemophilia
-PTT prolonged, normal PT and platelets
-low Hgb and Hct
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Treatment of bleeding episodes for hemophilia
Factor VIII administration (slow IV push)
-acute and prophylactic regimens
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Nursing actions for hemophilia bleeding
-med administration first
-apply direct pressure to external bleeding
-apply ice or cold compress to joint
-elevate extremity
-desmopressin for mild cases
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What is a vaso-occlusive crisis?
-when the circulation of blood vessels is obstructed by sickled RBC's causing ischemia and infarction
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Assessment findings of vaso occlusive anemia
-joint pain, increased HR/RR,
-Acute Chest Syndrome, Splenic Sequestration Crisis
-Dactylitis
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What does Splenic Sequestration crisis cause
big drops in blood volume
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What is dactylitis
symmetric swelling of hands and feet
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Labs or vaso-occlusive crisis:
-low Hgb
-Increased platelets, sedimentation rate, LFT, bilirubin, reticulocyte count
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Management of vaso-occlusive crisis
-pain control (NSAIDs, opioids)
-Hydration (double maintenance fluid)
-150 ml/kg/day
-Hypoxia (O2 if < 92%)
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Risk factors for lead poisoning
-old home (paint/pipes/soils)
-toys
-developmental delays, learning deficits, behavioral problems
-malnutrition
-PICA
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Physical cues for lead poisoning
-irritability
-abdominal pain/cramping
-Low IQ/delayed growth and development
-poor appetite
-vomiting
-ataxia
-hematuria
-new onset of seizures
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Lab cues for lead poisoning
< 5 mcg: repeat in 6-12 months if high risk
5-14 mcg: repeat test in 1-3 months, educate parents to decrease exposure
15-44 mcg: confirm with repeat test in 1-4 wks, educate parents to decrease lead exposure, repot to local health authorities
>45 mcg: begin chelation therapy
>69 mcg: hospitalized child
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When is chelation therapy given?
when blood lead levels are >45
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How does chelation therapy work?
-removes lead from soft tissue and bone then excreted via kidneys
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What medications are given during chelation therapy
-PO or IV - succimer/Dimercaprol/Adetate calcium disodium
264
Nursing considerations for Chelation therapy
-ensure adequate fluid intake and monitor I&Os
