Flashcards in Final Exam Deck (163)
Injection administered in doses of 0.5 to 1.0 mg
N/v associated with leukemia is treated with
serotonin-receptor antagonists (end in “etron”) and are often combined with dexamethasone. Administer antiemetic before chemo-therapy begins. Also, by preventing nausea and vomiting it also prevents the anorexia that is associated with leukemia.
Therapeutic management for hemophilia
DDAVP (mild hemophilia); corticosteroids; effective exercise and physical therapy programs, treatment without delay
During admission for hemophilia patients, what should you ask/do?
ask children if internal bleeding is suspected as they can usually identify where the site is located; look for signs of cerebral bleeding (headache, slurred speech, loss of consciousness) and GI bleeding (black, tarry stool); encourage exercises to strengthen muscles and joints to allow for age appropriate activity, environment needs to be a safe as possible, adjust oral hygiene practices such as using water irrigating devices and soft or sponge tipped tooth brushes, use of SQ injections instead of IM, never use aspirin, elevate joint if hemarthrosis is evidenced, improve diet r/t weight impacting joint complications, support family
What is the activity plan for anemic patients?
reduce activity levels and promote bed rest r/t fatigue that is experienced by these clients; promote minimal activity levels
Iron supplement administration and teaching
in infants: use of iron fortified cereal/formula, if dietary additions of iron-rich foods can’t treat turn to iron supplements for 3 mos (ferrous iron is more readily absorbed and raises Hgb), give with vitamin C to increase absorption, given in 2 divided doses between meals, teach parents tarry green stools are a sign of adequate iron levels being reached, vomiting or diarrhea could occur and if they do administer with meals, don’t administer with milk
parenteral form of iron therapy, given in Z-track method, DO NOT massage the site, use IV route to avoid multiple injections
Introduce iron fortified cereals by how many months?
Introduce iron supplements by how many months if LGA or preterm?
Hemoglobin levels are?
below 10-11 is low
Occurs when normal hemoglobin is replaced with abnormal sickle hemoglobin that interferes with function; this causes abnormal adhesion, entanglement, and enmeshing of rigid sickle-shaped cells that cause inflammation that blocks circulation leading to a vascoocclusive crisis which results in local hypoxia, tissue death and infarction
Sickle cell anemia
What are the manifestations of sickle cell?
growth retardation, chronic anemia, delayed maturation, susceptibility to sepsis, pain in areas of involvement during crisis
___________ and _______ _________ are important in a vasoocclusive crisis r/t improving circulation, replacing electrolytes and controlling pain
Hydration and pain control
Defect in which there is a narrow aorta
Coarctation of the aorta
Defect in which there is an opening between the right and left ventricles
Ventricular septal defect
Defect in which there is an opening between the atria that allows blood from higher pressure (left side) to flow into lower pressure (right side)
Atrial septal defect
4 defects: pulmonary stenosis, overriding aorta, VSD, right ventricular hypertrophy
Tetralogy of Fallot
Teaching for cardiac cath in school age children/adolescents
benefit from a description of the cath lab and a chronologic explanation of the procedure, emphasizing what they will see, hear, and feel; encourage them to bring headphones and music
Nursing action if cardiac cath site is bleeding
if bleeding occurs direct pressure is applied 1 inch above site to localize pressure over the puncture
Assess B/P as hypotension could indicate hemorrhaging
What are priority nursing interventions for postop cardiac cath?
maintain straight extremity for 4-6 hours after venous cath and 6-8 hours after arterial cath, younger children can be held in parent’s laps, diet can be resumed when tolerated, start with clear fluids and advance as allowed, encourage to void to clear the contrast, keep site clear from infection and complications (use plastic film over site if child wears diapers), continue to monitor for bleeding
What is family centered care teaching for cardiac cath?
remove pressure dressing the day after cath, cover site with bandage for several days, keep site clean and dry, avoid tubs, shower instead, observe site for any signs of infections (notify provider if present), avoid strenuous activity for several days, they may attend school, resume regular diet, use acetaminophen or ibuprofen, adherence promotion
What is important to remember about pulses in Lanoxin/Digoxin administration?
don’t give if in older kids the heart rate is below 70 and in younger children below 90, don’t administer if signs of toxicity are present (nausea/vomiting, anorexia, bradycardia, dysrhythmias), do not give twice if missed dose
What is the initial cause of rheumatic fever?
Group A beta-hemolytic stretpococcal pharyngitis
For a child with CHF, decrease cardiac demands by:
minimize metabolic, provide neutral thermal environment to minimize cold stress, treat any existing infections, reduce effort of breathing (semi-fowlers), use medications to sedate child, provide for rest and decrease environmental stimuli
What are sx of CHF?
tachy, sweating, decreased urinary output, fatigue, weakness, restlessness, anorexia, pale, cool extremities, decreased b/p, weak peripheral pulses, tachypnea, dyspnea, retractions, flaring, cough, weight gain, edema, ascites, neck vein distention
What is nursing care for hypercyanotic spells?
put in knee-chest position, 100% oxygen by blow-by, give morphine, begin IV fluid replacement, repeat morphine administration
Reassure parents that this won’t cause lack of oxygen to the brain, treat any sx of dehydration, and prevent resp infection
What is teaching for cast care?
elevate the cast on pillows or other support for the first day to promote venous return, don’t poke anything in the cast to prevent any further injuries and irritations, prevent further swelling to reduce chance of compartment syndrome from developing (assess for 6 P’s: pain, pulselessness, pallor, paresthesia, paralysis, pressure; can result in tissue death, requires emergency treatment: fasciotomy)
What is the most important nursing interventions for traction?
Preventing skin breakdown and constipation
skin traction on the lower leg and a padded sling under the knee, realignment of the lower extremity and immobilizes the hip and knee in a flexed position, can’t move to prevent damage to the common peroneal nerve—reduces tension on the hip, used in fractured femurs, hip/knee contractures, and disease of the hip/knee, child cannot be let out of traction—suspension of the knee, angle between the thigh and the bed is 20 degrees, ALWAYS slight flexion of both the hip and the knee, patient can move SLIGHTLY in the bed, check for skin breakdown