Final

Question 1

MUSCULOSKELETAL: bone fractures

Answer 1

s/s: Pain and joint tenderness, Pulselessness and Paresthesia distal to fracture, Pallor, Paralysis
tx: cast, surgery for open reduction of fracture; realign and immobiize fractured extremity by traction, ilizarov external fixator

Question 2

*MUSCULOSKELETAL: developmental hip dysplasia/ dislocated hip

Answer 2

s/s: asymmetry of gluteal folds, ortolani’s click [hip click], limited hip abduction, shortened femur, trendelenburg sign [pelvis falls instead of rises w/ stepping of the affected leg/ hip], wide waddling gait
tx: relocate femoral head in acetabulum [may wait and watch w/ NB-6 m.o.], bryant’s traction; pavlik harness [keep child strapped as much as possible; assess for ability to kick, swollen feet]

Question 3

MUSCULOSKELETAL: bryant’s traction

Answer 3

traction will help position the top of the femur into the hip socket correctly
modified extension traction w/ body as counterweight
risks: circulatory insufficiency
NI: neurovascular assessment, ensure safety

Question 4

MUSCULOSKELETAL: osteomyelitis

Answer 4

bacterial infection [often staph. aureus] of the bone and soft tissue surrounding the bone, often affected the long bone metaphysis

tx: antibiotics X 4-6 w
- goal is to prevent bone destruction

Question 5

MUSCULOSKELETAL: osteogenesis imperfecta

Answer 5

characterized by the formation of pathologic fractures resulting from connective tissue and bone defects
- there’s normal Ca and P levels but low collagen formation
risk factors: simple walking > fractures
s/s: multiple fractures, blue sclera, thin soft skin w/ easy bruising, inc’d joint flexibility, short stature, adol. [hypoplastic bluish-grey teeth, conductive hearing loss]
tx: calcitonin to promote healing and biphosphonates to increase bone mass

Question 6

*MUSCULOSKELETAL: scoliosis

Answer 6

lateral curvature of spine usually associated

tx: goal is to prevent further curvature or help correct severe curvature
- bracing for curvatures of 20-50 degrees usually worn for 16-23 h/day
- - NI: risk for impaired skin integrity, body image disturbance, ineffective health maintenance
- surgery for curvatures of > 45 degrees
- - NI: pain, risk for injury r/t surgical intervention, altered breathing patterns, impaired skin integrity, altered bowel elimination [place on regime], altered urinary elimination

Question 7

*MUSCULOSKELETAL: duchenne muscular dystrophy

Answer 7

common type of inherited muscular dystrophy
s/s: late accomplishment of gross motor milestones, increasing muscle weakness [including resp. muscles], gower’s sign [using legs to push self up from a sitting to a standing position], waddling gait, difficulty climbing, hypertrophied calf “muscles” [fatty and connective tissues], scoliosis and lordosis, contractures
tx: GOAL IS TO MAXIMIZE BREATHING AND MOVEMENT AS LONG AS POSSIBLE; bracing, orthotics, splints, wheelchair; incentive spirometry; low kcal, high fiber, high fluid, high protein diet

Question 8

MUSCULOSKELETAL: juvenile arthritis [JA]

Answer 8

autoimmune disease of connective tissue characterized by chronic inflammation of the synovia and possible joint destruction
- episodes recur w/ remissions and exacerbations for a few months up to a life-time
s/s: inflammation around joints; stiffness, pain, guarding at affected joint
tx: reduce stress, climate aggravators; low does corticosteroids or NSAID’s, ROM [delay and prevent damage]; warm compress; splints; preventative eye care, surgery

Question 9

MUSCULOSKELETAL: skull fractures

Answer 9

types:

• linear: str8 line fracture [dura not involved]
• depressed: bone pressing downward
• basilar: fracture at base of skull
• • s/s: battle sign [bleeding behind the ear], racoon eyes, rhinorrhea, otorrhea [careful that drainage is not ICF]
• communicated: fragmentation of bone into many pieces or a multiple fracture line
  tx: AVOID ACTIVITIES THAT WILL INCREASE ICP [constipation, suctioning, lying supine. hyperextension or flexion of the neck, stimulating env’t.], frequent neuro. exam.’s

Question 10

MUSCULOSKELETAL: concussion

Answer 10

a transient or reversible neurologic dysfunction w/ instantaneous loss of AWARENESS and RESPONSIVENESS
- there does not have to be a loss of consciousness
s/s: hematomas, cushing’s triad [bradyc., HTN, resp. depression], anisocoria [unequal pupil sizes], abnormal posturinng, SIADH
tx: AVOID ACTIVITIES THAT WILL INCREASE ICP [constipation, suctioning, lying supine. hyperextension or flexion of the neck, stimulating env’t.], frequent neuro. exam.’s

Question 11

MUSCULOSKELETAL: intracranial hemorrhage

Answer 11

types:

• epidural hematoma
• • occurs b/w the skull and the dura w/ brain herniation and compression of the brain stem; life-threatening
• subdural hematoma
• • occurs b/w the dura and arachnoid dura
• • s/s: H/A, confusion, seizures, coma
    tx: AVOID ACTIVITIES THAT WILL INCREASE ICP [constipation, suctioning, lying supine. hyperextension or flexion of the neck, stimulating env’t.], frequent neuro. exam.’s

Question 12

CV: fetal circulation

Answer 12

goal of fetal circulation is to perfuse the fetus w/ highest amount of O2 possible
- placenta works as the lungs; lungs are fluid-filled w/ pulmonary vessels vasoconstricted causing an inc’d pulmonary vascular resistance
blood flows via ductus venosus, foramen ovale, ductus arteriosus
- these shunts close w/i 24-48 h’s p/ birth
upon birth lungs inflate reducing pulmonary resistance > pulmonary artery pressure drops > increasing blood flow to lungs > R-side pressure drops and L-side increases > change in pressures closes foramen ovale, ductus arteriosus > lack of blood flow results in ductus venosus closure

Question 13

*CV: care for a child undergoing cardiac catheterization

Answer 13

pre-procedure 
- obtain an accurate weight [determines hydration status]
- assess of skin 
- assess and mark pedal pulses 
- O2 sat.
- vital signs [to compare a/ and p/]
- voiding [ensures contrast can get excreted]
-sedation
post-procedure
- assess site/ dressing 
- assess pulses in lower extremities
- lay supine and flat [~4-6 h]
- vital signs [q15m x3, q30m X3]
- monitor catheterization site
- fluid status
- immobolize extremity [may > bleeding 
- home care [area cannot become saturated]

Question 14

*CV: congestive heart failure [CHF]

Answer 14

s/s: tachyc., diaphoresis, low urine output, fatigue [from inc’d metabolic needs], restlessness [from dec’d O2], anorexia, poor peripheral circulation, cardiomegaly [b/c of inc’d work], inc’d volume, gallop rhythm, resp. distress, intolerance, anasarca
goals of tx: improve cardiac contractility [digoxin; 0.8-2 ng/mL], preserve energy and decrease metabolic demands, decrease IV fluid volume [diuretics]
NI: strict I/O, daily weights, inc’d HOB [promote diaphragmatic excursion and lung expansion], hi kcal diet, cluster nursing care, decrease risk of infection, monitor electrolytes [Na [decreases fluid overload], K [decreases risk of arrhythmias]; teach parents how to perform CPR and to assess pulses [if child is on digoxin] and provide use and s.e. of digoxin and diuretics

Question 15

CV: classification of congenital heart disease

Answer 15

acyanotic
- inc’d pulmonary blood flow
– atrial septal defect, ventricular septal defect, PDA, AV canal
- obstruction to blood flow from ventricles
– coarctation of aorta, aortic stenosis, pulmonic stenosis
cyanotic
- dec’d plmonary blood flow
– tetralogy of fallot, tricuspid atresia
- mixed blood flow
– transposition of great arteries, total anomalous pulmonary venous connection, truncus arteriosus, hypoplactic L-heart syndrome

Question 16

CV: atrial septal defect [ASD]

Answer 16

opening b/w the wall that divides the R and L atrium causes shunting of blood from LA [higher pressure] to RA [lower] causing mixing of deO and O blood
risks: inc’d volume > inc’d workload
tx: may resolve spontaneously [w/i 18 m], surgery [patch]
NI: vitals [esp. pulse ox.], monitor for sx.’s of CHF, strict I&O, daaily weights, hi kcal diet, cluster care, allow for extended rest periods, HOB elevated; post-op. [activity restrictions, incision site care, place on reverse isolation, manage pain, educate for follow-up care]

Question 17

CV: ventricular septal defect

Answer 17

opening b/w the R and L ventricles causing shunting of blood from LV [higher pressure] to RV [lower] causing mixing of deO and O blood
risks: dec’d volume going to body
tx: may resolve spontaneously [w/i 3 y]
NI: vitals [esp. pulse ox.], monitor for sx.’s of CHF, strict I&O, daily weights, hi kcal diet, cluster care, allow for extended rest periods, HOB elevated; post-op. [activity restrictions, incision site care, place on reverse isolation, manage pain, educate for follow-up care]

Question 18

CV: atrioventricular canal septal defect [AVSD]

Answer 18

endocardial cushions fail to develop [needed to separate the mitral and tricuspid valves] causing a central hole
tx: septal and valve repair
NI: vitals [esp. pulse ox.], monitor for sx.’s of CHF, strict I&O, daily weights, hi kcal diet, cluster care, allow for extended rest periods, HOB elevated; post-op. [activity restrictions, incision site care, place on reverse isolation, manage pain, educate for follow-up care]

Question 19

*CV: patent ductus arteriosus [PDA]

Answer 19

communication b/w the pulmonary artery and aorta [which should’ve closed during the 1st days of life] causing deO blood in the pulmonary artery to enter the aorta and out into the system w/o becoming oxygenated]
s/s: symptomatic; bounding pulses, machinery-like systolic murmur
tx: indomethcin IV w/i 1st 2 weeks of life [inhibits prostaglandin (present in vitro) to encourage closure; s.e.: masks s/s infection, edema, thickens blood]
- if DA needs to remain open, administer prostaglandin [s.e.: apnea [ventilator use], flushing, hTN, bradyc., bleeding]
NI: vitals [esp. pulse ox.], monitor for sx.’s of CHF, strict I&O, daily weights, hi kcal diet, cluster care, allow for extended rest periods, HOB elevated

Question 20

*CV: coarctation of the aorta

Answer 20

narrowing in the aortic arch resulting in L-ventricular overload
risks: L-sided CHF, aneuryms [b/c of Hi pressure against narrowing]
s/s: may present w/ other heart deformities; murmurs, change in BP, irritability, tachypnea, poor feedings > no weight gain
tx: PDA [administer prostaglandin] NEEDED UNTIL REPAIR CAN BE MADE; surgery, resection angioplasty
NI: CHECK BP/ PULSE IN ALL 4 EXTREMITIES [BP inc’d in areas a/ narrowing/ and vice versa]
NI: vitals [esp. pulse ox.], monitor for sx.’s of CHF, strict I&O, daily weights, hi kcal diet, cluster care, allow for extended rest periods, HOB elevated; post-op. [activity restrictions, incision site care, place on reverse isolation, manage pain, educate for follow-up care]

Question 21

CV: aortic valve stenosis

Answer 21

obstruction of blood flow from the L-ventricle to aorta > blood back flow into lungs
risks: L-sided HF, delayed development [from dec’d blood getting to brain], bacterial endocarditis [w/ valve replacement]
s/s: angina, dizziness, poor feeding
tx: balloon angioplasty, aortic valve replacement
NI: stress follow-up care for life p/ valve replacement
NI: vitals [esp. pulse ox.], monitor for sx.’s of CHF, strict I&O, daily weights, hi kcal diet, cluster care, allow for extended rest periods, HOB elevated; post-op. [activity restrictions, incision site care, place on reverse isolation, manage pain, educate for follow-up care]

Question 22

CV: pulmonary valve stenosis

Answer 22

obstruction of blood flow from the R-ventricle to the pulmonary artery > blood back flow into system
risks: R-sided heart failure
s/s: lethargic,
tx: PDA or ASD needed until repair can be made; balloon angioplsty, pulmonic valve replacement
NI: vitals [esp. pulse ox.], monitor for sx.’s of CHF, strict I&O, daily weights, hi kcal diet, cluster care, allow for extended rest periods, HOB elevated; post-op. [activity restrictions, incision site care, place on reverse isolation, manage pain, educate for follow-up care]

Question 23

CV: tetralogy of fallot [TOF]

Answer 23

involves 4 defects: RV hypertrophy [inc’d work from pushing blood via stenosed p. valve], overriding aorta [valve present in both ventricular chambers when it should only be in the L-chamber], VSD, pulmonary valve stenosis
s/s: cyanosis [d/o amount of pulmonary stenosis], tet spells
tx: PDA [give prostaglandin] NEEDED UNTIL REPAIR CAN BE MADE; blalock-taussing shunt [anastomosis R-subclavian to pulm. artery to increases pulmonary circulation], cardio-pulmonary bypass
NI: vitals [esp. pulse ox.], monitor for sx.’s of CHF, strict I&O, daily weights, hi kcal diet, cluster care, allow for extended rest periods, HOB elevated; post-op. [activity restrictions, incision site care, place on reverse isolation, manage pain, educate for follow-up care]

Question 24

*CV: tet spells

Answer 24

inc’d constriction of the R ventricular outflow > sudden dec’d oxygenation in the child > cyanosis
may be precipitated by crying, feeding, procedures
s/s: do not occur until p/ the closure of the DA
NI: help child bend knees to chest to increase venous return to the heart [improves oxygenation]; be aware of hypoxia-inducing experiences; O2 therapy may help slightly but not to the full affect until defects are fixed

Question 25

CV: tricuspid atresia

Answer 25

no communication [no tricuspid valve] b/w the RA and RV > mixing of deO and O blood risks: hypoplastic RV, under-developed pulm. artery [since no blood flow is going via RV] tx: PDA or foramen ovale needed until repair can be made NI: vitals [esp. pulse ox.], monitor for sx.'s of CHF, strict I&O, daily weights, hi kcal diet, cluster care, allow for extended rest periods, HOB elevated; post-op. [activity restrictions, incision site care, place on reverse isolation, manage pain, educate for follow-up care]

Question 26

CV: pulmonary valve atresia

Answer 26

no communication b/w RV and PA > blood cannot leave the RV - usually presents w/ a VSD and/or ASD [creating mixing of blood so that child. can get some O into system] tx: PDA needed until repair can be made NI: vitals [esp. pulse ox.], monitor for sx.'s of CHF, strict I&O, daily weights, hi kcal diet, cluster care, allow for extended rest periods, HOB elevated; post-op. [activity restrictions, incision site care, place on reverse isolation, manage pain, educate for follow-up care]

Question 27

CV: transposition of the great vessels

Answer 27

position of the aorta and pulmonary artery are switched creating 2 separate circulations [R-side pumps to system, L-side pumps to lungs] tx: PDA, VSD, etc. needed until repair can be made; atrial septotomy NI: vitals [esp. pulse ox.], monitor for sx.'s of CHF, strict I&O, daily weights, hi kcal diet, cluster care, allow for extended rest periods, HOB elevated; post-op. [activity restrictions, incision site care, place on reverse isolation, manage pain, educate for follow-up care]

Question 28

CV: truncus arteriosus

Answer 28

one major artery leaving the R and L ventricles > mixing of blood risks: CHF of both sides, pulmonary vascular disease tx: separation of the pulmonary artery from the aorta NI: vitals [esp. pulse ox.], monitor for sx.'s of CHF, strict I&O, daily weights, hi kcal diet, cluster care, allow for extended rest periods, HOB elevated; post-op. [activity restrictions, incision site care, place on reverse isolation, manage pain, educate for follow-up care]

Question 29

CV: hypoplastic L-heart syndrome

Answer 29

mitral and aortic valve are not properly formed, ascending aorta is underdeveloped, ASD s/s: pale, poor perfusion, tachyc., tachyp., metabolic acidosis, poor feeding NI: vitals [esp. pulse ox.], monitor for sx.'s of CHF, strict I&O, daily weights, hi kcal diet, cluster care, allow for extended rest periods, HOB elevated; post-op. [activity restrictions, incision site care, place on reverse isolation, manage pain, educate for follow-up care]

Question 30

CV: bacterial endocarditis

Answer 30

infection of the inner lining of the heart or valves risk factors: CHD, valvular disease/ repairs causes: dental work, non-sterile/ indwelling catheterization s/s: low-grade fever, maliase, wt. loss, H/A, myalgia, splenomegaly, osler nodes [lesions of fingers/ toes], janeway spots [hardened lesions on hands/ feet], mucosal petechiae dx: CBC, cardiogram tx: antibiotics NI: prophylactic antibiotics for certain procedures

Question 31

*CV: rheumatic fever

Answer 31

a systemic disease caused by post [2-3 w]-group A strep. infection that affects the brain, heart [> weakened contractility], all bony joints s/s: major [carditis, polyarthiritis, chorea (rapid, jerky movements), erythema marginatum (reddened rashes), subq. nodules], minor [low-grade fever, arthralgia, epitaxis] dx: CBC, ESR [for inflammation], EKG tx: med.'s [anti-inflammatory, antibiotics], supportive therapy [bed rest, pain relief] NI: monitor cardiac status, prevention and prophylactic measures

Question 32

*CV: kawasaki disease

Answer 32

self-limiting autoimmune disorder where edema and inflammation > vaculitis of the vessels > impairment > aneurysms risks: acquired heart disease, thrombocytosis s/s: acute [abrupt Hi fever, bulbar conjunctivitis w/o drainage, pharyngeal mucosal inflammation, strawberry tongue, edema of hands/ feet, erythema of palms/ soles, myocarditis, cervical lympadenopathy], subacute [continued vessel damage, thrombocytosis, periungual desquamation], convalescent [no sx.'s except coronary complications] tx: manage sx.'s, med.'s [IVIG, aspirin NI: monitor cardiac status, steroids monitor for sx.'s of reye's w/ aspirin use in young child., teach parent CR, delay IV immunoglobulins [MMR, varicella]

Question 33

INTEGUMENTARY: impetigo contagiosa

Answer 33

highly contagious [not communicable p/ 48 h on antibiotics] bacterial invasion via skin breakdown or carried in nares or opening in the skin and passed onto skin [usually oon face, neck, limbs] - incubation time is about 2-5 d risk factors: immuncompromised pt.'s causes: group A strep./ staph. aureus risks: MRSA [rule out] > necrotizing fascitis, glomerular nephritis s/s: discrete/ grouped vesicles or pustules on an erythematous base > golden, honey colored crusted lesions NI: hand-wash; mupirocin [bactroban] to lesions

Question 34

INTEGUMENTARY: cellultis

Answer 34

acute inflammation involves 3 layers of skin causes: GABHS, s. aureus risk factors: trauma, impetigo, otitis media, sinusitis risks: severe cases > osteomyelitis; infection of the face > meningitis; periorbital cellulitis > optic nerve infection > blindness s/s: erythema, pain, edema, warmth at site; malaise; lymphadenopathy tx: PO [mild]/ IV [systemic; esp. if the infection reaches face] antibiotics NI: warm compresses [for pain and draw pus out], elevate affected limb, pain relief

Question 35

INTEGUMENTARY: tinea corporis [ring-worm]

Answer 35

a fungal infection causes: trichophyton, microsporum s/s: round/ oval scaling patches w/ central clearing and well demarcated raised borders involving the trunk, hands or face tx: topical antifungal; PO [for severe cases] NI: can return to school p/ tx has begun

Question 36

*INTEGUMENTARY: tinea capitis

Answer 36

involves the hair shaft > loss of hair s/s: red, scaly lesion dx: organism fluorescent under wood lamp exam. tx: PO griseofulvin, selenium shampoo [reduces contagiousness] NI: wash sheets/ clothes in hot water

Question 37

*INTEGUMENTARY: atopic dermatitis [eczema]

Answer 37

chronic inflammatory skin disease causes: familial hx., allergic rhinitis, asthma s/s: infantile [erythematous, weeping vesicles w/ crusting esp. on face/ scalp/ extremities; accompanied by intense pruritus [monitor for 2o infection b/c of scratching], child. [dry, scaly, papular lesions, fissures and lichenification (thick, leathery skin); found on wrists, ankles, flexor aspects of antecubital/ popliteal spaces] NI: avoid skin irritants, mittens for child. to prevent scratching [benadryl to reduce itch]

Question 38

*INTEGUMENTARY: seborrheic dermatitis [cradle cap]

Answer 38

inflammatory, SCALING disorder of face and scalp caused by dysfx. of sebaceous glands [w/i the hair follicle] s/s: erythematous, greasy salmon-colored oval scaly lesions on scalp/ face tx: antiseborrheic shampoo [leave-in for 5-10 minutes] softens and loosen scales, remove scales w/ fine brush

Question 39

*INTEGUMENTARY: contact dermatitis [poison ivy]

Answer 39

cell mediated response to poisonous oil causing hypersensitivity [T-cell response] s/s: rash, pruritis, blister formation, oozing and crusting tx: steroids, benadryl [pruritis]; claritin/ zyrtec [inflammation] NI: wash exposed area but no scrubbing, wash clothes to rid oil

Question 40

INTEGUMENTARY: scabies

Answer 40

occurs from burrowing of adult female mite into epidermis - incubation form 4-6 w w/o prior exposure and 1-4 d w/ exposure s/s: linear red rash; INTENSE PRURITUS tx: permethrin, lindane [not on infants/ child. b/c of risk for neurotoxicity], antipruritics NI: treat head only in infants and child., tx for family and notification of daycare; treat clothing in hot water

Question 41

INTEGUMENTARY: pediculosis [lice]

Answer 41

tx: pedulicilicide [NIX] then COMB HAIR P/ TX TO GET RID OF NITS NI: child. can go to school p/ tx: treat family if infected; delouse home env't

Question 42

INTEGUMENTARY: rubeola [red measles, 10-day measles]

Answer 42

highly contagious viral infection transmitted via infectious droplets causes: RNA virus - incubation: 10-12 d, communicable several days a/ rash and 5 d p/ its appearance risks: desquamation, resp. complications [otitis media, bronchopneumonia] s/s: prodrome [a/ lesion appearance] Cold, hacking Cough, Conjunctivitis, photophobia, fever; confluent maculopapular rash; koplik's spots [red spot w/ white center] on buccal mucosa dx: elevated IgM antibdy titer tx: fever control [febrile seizures], acetaminophen, fluids, tepid fluids NI: protect from light, no school until p/ 5 days of rash appearance,

Question 43

INTEGUMENTARY: rubella [german measles, 3-day measles]

Answer 43

viral infection - incubation: 2-3 w, communicable: 5-7 d a/ rash to 7 d p/ rash causes: RNA virus s/s: prodrome malaise, low-grade fever; resp. tract virus; lympadenopathy; pink, maculopapular rah starting on face and spreading rapidly downward over trunk and extremities; trasient polyarthralgia/ polyarthritis [distinguishes rubella from rubeola] dx: elevated IgM antibody titer NI: PREVENT EXPOSURE TO PREG. WOMEN [may > birth defects]

Question 44

INTEGUMENTARY: mumps

Answer 44

viral infection transmitted via direct contact or droplet - incubation: 14-21 days p/ exposure, communicability: a/ and p/ swelling causes: paramyxovirus risks: meningitis, deafness sx: fever, H/A, general malaise, earache [r/t swelling] aggravated w/ chewing, parotitis tx: supportive, MMR vaccine for prevention

Question 45

INTEGUMENTARY: erythema infectiosum [fifth's diease]

Answer 45

``` MOST CONTAGIOUS A/ RASH incubation: 4-21 d causes: human parovirus risks: aplastic crisis in child. w/ SCD s/s: prodrome low-grade fever, H//A, mild URI; fiery red rash on cheeks [slap face] spreads to extremities, may return when skin is traumatized tx: comfort measures ```

Question 46

*INTEGUMENTARY: coxsackie virus [hand-foot-mouth]

Answer 46

causes: enterovirus s/s: common cold, pharyngitis, pneumonia; painful papulovesicular lesions on cheeks, gums, hands, feet NI: cool drinks, PREVENT DEHYDRATION, antipyretics

Question 47

INTEGUMENTARY: varicella zoster [chickenpox]

Answer 47

incubation: 2-3 w, communicability: Hi 1st 2 d a/ eruption until ALL LESIONS ARE CRUSTED OVER causes: resp. herpes zoster virus risks: shingles [virus remains in nerve ending], pneumonia, encephalitis s/s: mild fever, general weakness, teardrop lesion tx: benadryl, acyclovir, oatmeal baths

Question 48

*INTEGUMENTARY: scarlatina [scarlet fever]

Answer 48

infection of oropharnyx caused by group A beta-hemolytic strep - incubation: 1-3 d risks: AOM, acute glomerulonephritis, rheumatic fever s/s: predrome sore throat, chills, fever, H/A, vomiting; fine erythematous maculopapular rash w/ sandpaper quality [desquamation occurs when rash fades], beefy red tonsils/ pharynx, strawberry tongue tx: 10 days PCN, antipyretics NI: non-infectious p/ 48 h on antibiotics; gargles for comfort; throw out toothbrushes p/ infection

Question 49

NEURO: neurological assessment

Answer 49

``` glasgow coma scale LOC development - developmental age; gross/ fine motor development vital signs PERRL posturing - decorticate v decerebrate -- decor. > decer. indicates worsening of overall status reflexes kernig's sign - + indicates meningitis: severe stiffness prevent str8ning of leg when hip is flexed brudzinski's sign - + indicates meningitis; severe neck stiffness > hip and knees to flex when neck is flexed infant's fontanels - bulging indicated inc'd ICP ```

Question 50

*NEURO: types and sub-types of seizures

Answer 50

partial seizures: 1 area of cortex, manifests w/ prodromal [aura] sx.'s - simple partial: localized to 1 hemisphere, no loss of consciousness - complex partial: starts in 1 focal area > to both hemispheres, possible loss of consciousness generalize seizures: both hemispheres - tonic-clonic: violent body seizures; manifests w/ tonic [stiff] phase, clonic [jerking] phase, postictal [confusion, lethargy] phase - absent: loss of responsiveness but ability to maintain posture control and not fall and no postictal sx.'s - atonic/ akinetic: sudden brief loss of muscle tone/ posture, temp. LOC - myoclonic: sudden, brief cxn.'s of a muscle or muscle groups, can occur in combo. w/ other seizure types unclassified - status epilepticus: recurrent or continuous seizures w/o interruption; risk of anorexia > multi-organ damage - infantile spasms: associated w/ cognitive impairment

Question 51

*NEURO: febrile zeizures

Answer 51

causes no neurological damages causes: RAPID rise of temp. to > 102 oF - only 1 seizure occurs per increase in temp. occurs in child. ages 6 m to 3 y NI: FEVER MANAGMENT [tylenol], seizure management

Question 52

*NEURO: nursing care of child. w/ seizures

Answer 52

place child on their side when possible to prevent aspiration if they have excess secretions or vomit in their airway administer antiepilectic as ordered - pt.'s taking dilantin need frequent oral care have O2/ resuscitation equipment and suction at the bed side at all times have side rails raised and padded document assessment findings during seizure monitor vitals signs assess quality of resp.'s an color changes monitor LOC note time of onset of seizure and its duration note any precipitating factors - plan to avoid these triggers

Question 53

*NEURO: spina bifida I

Answer 53

a type of neural tube defect where there is a failure of total enclosure of spinal cord w/i vertebrae/ meninges risk: neurosensory/ neuromotor dysfx. s/s: d/o degree of defect and the nerves involved; hydrocephalus; arnold-chiari malformation [downward displacement of portion of brain]; meningitis; UTI's, bowel obstructions tx: preventative [FOLIC ACID], post-birth surgical repair, fetal surgery NI: prevent urinary complications, assess urological status, instruct family self-catheterization techniques; provide colon training, diet high in fiber and low in CHO, laxatives PRN; carefully monitor the skin [due to dec'd sensation] and provide frequent respositioning, PT; provide latex-free env't; educate about life-long care needs

Question 54

NEURO: hydrocephalus I

Answer 54

it is a collection of excess CSF in the brain ventricular system - a manifestation of an underlying probem [e.g. spina bifida] types: - communicating: excess production of CSF due to impaired absorption of CSF -- causes: scarring, congenital anomalies, hemorrhage - non-communicating: obstruction to flow -- causes: malformations tumors, clots, edema s/s: infant [enlarged head, thinned cranial bones, separated sutures, bulging fontanels, dilated scalp veins, cranial nerve palsy; poor feeding, vomiting; high-pitched cry], child [H/A, NV, visual changes, ataxia,behavior changes, seizures]

Question 55

NEURO: nursing care perioperatively for a pt. w/ spina bifida

Answer 55

preoperatively - check for leakage of CSF from sac, PREVENT INFECTION AND INJURY; apply moist sterile dressing to defect, avoid fecal contamination to opening; monitor s/s of infection and meningitis; thermoregulation; administer antibiotics; place child in prone position or side-lying; no rectal temp.'s; check for movement sensation of the lower extremities; initiate antibiotic tx, create latex-free env't postoperatively - prevent infection/ injury; MONITOR HC; maintain dry sterile dressing over lesion, examine dressing for CSF leakage, place child in prone or side-lying position [frequent repositioning]; no rectal temp.'s; prevent urinary complications; continue antibiotics -- complications post-op.: hydrocephalus, monitor for sx. on inc'd ICP, measure HC qshift; neurogenic bladder/ bowel; neuromuscular disorders

Question 56

*NEURO: s/s of inc'd ICP

Answer 56

infants: - irritability, high-pitched cry; poor feeding; bulging fontanels, setting-sun sign of the eyes child.: - HA, vomiting [w/ or w/o nausea]; seizures; diplopia behavioral: - irritability, drowsiness, dec'd physical activity and motor skills; complaint of fatigue; inability to follow commands, memory loss; anorexia late signs: - cushing's triad [systolic HTN w/ widening pulse pressure, bradyc. w/ full pulse, cheyne-stokes resp.']; dec'd LOC/ motor response to command/ sensory response to painful stimuli; decerebrate/ decorticate posturing; anisocoria

Question 57

NEURO: tx. and NI of a child w/ hydrocephalus

Answer 57

tx: - surgical shunting - direct removal of obstruction and insertion of shunt - ventriculostomy: non-shunting procedure to treat child. w/ non-communicating disorder NI: - pre-op.: neuro. assessments, assess HC and other signs of inc'd ICP; skin care and assess for breakdown; small, frequent feedings to prevent vomiting; encourage bonding - post-op.: frequent neuro. checks, monitor fluid balance; position off operative area; pain management; prevent infection [prophylactic antibiotics, monitor incision]

Question 58

*NEURO: meningitis

Answer 58

a potentially fatal infection [viral or bacterial] that begins elsewhere in the body [ears, sinuses, upper resp. tract] risks: cerebral edema, hydrocephalus, cognitive impairment, deafness blindness s/s: fever, chills; HA; changed LOC; photophobia; nuchal rigidity [child. moves entire upper body instead of just neck]; + kernig and brudzinski signs; petechial rash; septic shock; infants [poor feeding, lethargy; vomiting, opthisotonus] dx: LP, blood culture tx: antibiotics, isolation, monitor neuro. fx and s/s inc'd ICP; dec'd sensory input; fever control; seizure precautions

Question 59

*NEURO: cerebral palsy

Answer 59

nonprogressive disorders of motor fx. types: spastic, dyskinetic, ataxic risk factors: anoxia during labor s/s: lack of coordination and inc'd spasticity; abnormal motor skills [asymmetry, early handedness, feeding/ swallow problems, persistent toe-walking], altered muscle tone, PERSISTENCE OF PRIMITIVE REFLEXES, abnormalities of cognition, seizures, hearing and vision tx: PT/ OT/ ST [maintenance of ROM, fx. skills, feeding, language, communication]; orthopedic care; pain relief NI: handling/ positioning, self-care skills

Question 60

ENDOCRINE: GH deficiency

Answer 60

causes: hypopituitarism, infections, trauma, brain tumors s/s: constitutional delay [delay in growth/ sexual growth]; inc'd amount of fat on waist/ face; psychosocial implications; dec'd muscle mass; delayed skeletal maturation/ onset of puberty/ tooth development; hypoglycemia dx: GH stimulant test, karotyping tx: exogenous GH subq. shots [stopped when growth plates fuse] NI: stress imp. for follow-up appt.'s [dosages may need to change], monitor growth accurately, teach proper technique for shots, have parents call doc. if [H/A, joint pain, rapid weight gain] occur

Question 61

*ENDOCRINE: congenital hypothyroidism

Answer 61

dec'd production of T4 [thyroxine] which is essential for growth and development risks: mental retardation s/s: large-for-age; puffy face, swollen tongue; hoarse cry; poor muscle tone; cold extremities; persistent constipation; lethargy; little or no growth [despite weight gain] tx: exogenous T4 [synthroid] NI: monitor growth and development; assess for retarded physical growth and slow intellectual development; stress imp. of med.'s and to go to follow-up visits [dosages may need to be changed]; never place med. in a whole bottle in case the child doesn't finish their bottle; teach parents how to take pulse [to monitor for signs of drug overdose]

Question 62

ENDOCRINE: congenital adrenal hyperplasia

Answer 62

caused by dec'd enzyme activity required for cortisol [responsible for growth, maintains BP, protects against stress] and, less so, aldosterone [maintains BP, keeps balance b/w Na K and fluids] production in the adrenal cortex types: salt-losing, simple virilizing salt-losing form of CAH - near total deficiency of enzyme > complete inability to produce cortisol/ aldosterone - risks: hypoglycemia [b/c of x cortisol], Na and H2O loss [b/c of x aldosterone]; inc'd aldos. > masculinization s/s: males [precocious genital development], females [varying degrees of ambiguous genitalia] tx: assign sex to child. d/o gentotype; cortisone to balance high secretions of ACTH; reconstructive surgery; exogenous aldosterone; salt-retaining hormone tx. NI: teach parents s/s of dehydration and alt-losing crises, teach imp. of follow-up care

Question 63

*ENDOCRINE: phenylketonuria [PKU]

Answer 63

lack or low levels of an the enzyme phenylalanine hydroxylase (PAH)]; PAH needed to convert phenylalanine to tyrosine risks: inc'd phenyl. in blood > affects the myelinization process of the CNS > seizures, brain damage, mental retardation tx: protein restrictions NI: protein restrictions can be dec'd p/ full brain growth; levels should be measured periodically, child. of mother's w/ PKU may > congenital defects

Question 64

*ENDOCRINE: type II diabetes

Answer 64

s/s: - hypoglycemia -- trembling, diaphoresis, tachyc., pallor, clammy skin; personality change, irritability, slurred speech, dec'd LOC, seizures - hyperglycemia -- 3 P's [poly [uria, dipsia, phagia], fatigue, weight loss, blurred vision, emotional lability, HA, hunger - ketoacidosis -- s/s of hyperglycemia + abd. pain, chest pain, kussmaul resp.'s N/V, acetone breath, dehydration NI: teach that an ill child needs extra kcal to keep body from burning fats for fuel and to speed healing developmental issues: - infants: erratic eating/ sleeping patterns; very rapid growth - tot's: dec'd appetite, temper tantrum v hypoglyecemia rxn. - pre-school: peer pressure; difficult to find foods that match what siblings/ friends eat - school-aged: tests independent decision making, fear of being diff. from others - adol.'s: erratic growth, difficult glucose control, concern about body image, may challenge authority, risk-taking behaviors, substance use [> inc'd complications w/ diabetes]

Question 65

CANCER: leukemias

Answer 65

a broad group of malignant diseases of bone marrow and lymphatic system where an unrestricted proliferaton of immature WBCs in the blood-forming tissues of the body crowd our other blood elements w/ resultant anemia risks: infection [neutropenia], hemorrhage [dec'd plt production], poor growth, CNS/ bone/ testicular involvement; acute forms can > dec'd leukocyte count; anemia; spleen, liver, and lymph glands show infiltration/ fibrosis

Question 66

*CANCER: s/s of bone marrow infiltration

Answer 66

anemia - manifests as pallor, lethargy, dyspnea, inc'd incidence of murmurs dec'd plt's - manifests as bleeding, petechiae, purpura neutropenia - manifests as fevers, infections bone pain - manifests as limp, dec'd walking, irritability

Question 67

CANCER: nervous system tumors

Answer 67

most common childhood solid tumors s/s: behavior changes; inc'd HC, bulging fontanel, dilated scalp veins; HA, projectile vomiting; pupil, EOM, visual disturbances; motor/ coordination changes; seizures; papilledema; dec'd HR/ RR, wide pulse pressure, temp. instability NI: monitor for inc'd ICP; developmentally appropriate peri-op. preparation and care; post-op. [minimize activities that increase ICP, perform wound care; neuro/ VS checks; position off surgery site]

Question 68

CANCER: bone tumors

Answer 68

types: - oSteoSarcoma -- most common; found in Shaft of long bones -- tx may include amputation w/ prosthetic replacement - ewing sarcoma -- arises in marrow and mid-shaft of long bones - usually able to preserve affected limb s/s: limp, changed gait, weakness of extremity NI: pre-op. [address concerns about loss of limb]; manage complications of radiation/ chemo.

Question 69

CANCER: wilm's tumor

Answer 69

a nephroblastoma that originates from immature renoblast cells; associated w/ other syndromes s/s: unilateral abd. mass [DO NOT PALPATE]; lethargy; weight loss; fever; organ compression; HTN tx: nephrectomy and adrenalectomy, removal of other involved organs NI: pre-op. [monitor BP, prepare pt. and family for op., MINIMIZE ABD. PALPATION], post-op. [monitor bowel sounds/ urine output; assess s/s of intestinal obstruction; prevent infection; prevent post-op. pulm. complications]

Question 70

*CANCER: retinoblastoma

Answer 70

congenital malignancy s/s: cat's eye reflex/ leukokoria [common], strabismus [common]; red, painful eye often w/ glaucoma; blindness [late] risk: osteogenic sarcoma NI: educate family on: care fro surgical site/ prosthesis, protective eye gear

Question 71

ABUSE: shaken baby syndrome

Answer 71

it is the repetitive violent shaking of an infant while being held by trunk s/s: manifests as brain injury from cerebral hemorrhage/ cerebral edema [irritability, lethargy, vomiting, seizures, apnea, coma, retinal hemorrhages, rib fractures, hematoma] NI: recognition of suspicious injuries; obtain supporting evidence while finging alternative diagnosis; report suspected abuse [MANDATED]; remain objective when interacting w/ family and when documenting; advocate for the child

Question 72

DYING/ DEATH: nursing care for the dying child

Answer 72

assessment - physical signs of approaching death: inc'd sleep, dec'd appetite/ need for fluids; loss of tactile sensation/ ovement; loss of bowel/ bladder control; confusion; dysphagia; cheyne-stokes resp.'s - emotional issues: recall of family events, desire to communicate, reasssure others, visions, withdrawal/ need for closeness physical needs - sx./ pain control; mouth/ skin care; positioning; hygiene; D/C unnecessary procedures

Question 73

CANCER: side effect of cancer tx.'s

Answer 73

``` infection/ nutropenia hemorrhage anemia NV altered nutrition mucosal ulceration neuro. alterations - somnolence hemorrhagic cystitis alopecia steroid effects [e.g moon face, mood swings] ```

Question 74

MENTAL: autism spectrum disorders

Answer 74

developmental disorder of brain fx. characterized by deficits in intelligence and behavior s/s: IMPAIRED ABILITY FOR SOCIAL INTERACTIONS/ VERBAL COMMUNICATION tx: multidisciplinary support

Question 75

MENTAL: attention deficit hyperactivity disorder [ADHD]

Answer 75

developmentally inappropriate degrees of inattention, impulsiveness and hyperactivity s/s: dx when 6 sx.'s of either [inattention OR hyperactivity/ impulsivity AND onset a/ 7 y, impairment in +2 settings, impairment in social, academic, occupational fx., no other pervasive disorder tx: behavior therapy, biofeedback, structure, med.'s [psychostimulants, ritalin]