Flashcards in FINAL EXAM Deck (57):
What is the most common cause of acute renal failure in children?
Hemolytic uremic syndrome (HUS)
What are the symptoms of UTI in an infant?
Fever over 100.4ºF without a known focus for infants and young children 2-24 months of age suggests a UTI (this is the most common cause of fever in infants).Irritability, dysuria as evidence by crying when voiding, change in urine odor or color, poor weight gain, feeding difficulties, suprapubic tenderness.
What will be found in a urinalysis in a child with acute glomerulonephritis?
Glomerulonephritis is a problem with tiny filtering units in the kidneys called glomeruli become inflamed and the kidneys stop working properly. Microscopic (small) or macroscopic (large) amounts of hematuria with RBC casts. High serum potassium, low serum bicarbonate levels.
Why does the child with acute glomerulonephritis develop edema?
Sodium and water are retained – causing edema
What is the most common cause of acute renal failure in children?
Hemolytic uremic syndrome (HUS)
What are the primary clinical manifestations of acute renal failure?
Electrolyte abnormalities – potassium elevated, sodium decreased
Fluid volume shifts – edema
Increased BUN and serum CRE levels
Acid-imbalances – unable to excrete hydrogen ions and ammonia through the kidney, metabolic acidosis develops
HUS is characterized by abdominal pain, fever, vomiting, bloody diarrhea
What diagnostic finding is present when a child has primary nephrotic syndrome?
Urinalysis demonstrates protein (+3 to +4), urine appears dark and frothy, microscopic hematuria
Serum cholesterol, triglycerides, hematocrit, and hemoglobin values are elevated
Serum albumin is markedly decreased
At what age is hypospadias corrected?
6-12 months old
What dietary modification is appropriate for a child with chronic renal failure?
Diet supplements, administration of Growth Hormone, small frequent meals – but with food the child likes
Reduction in sodium and fluid intake, phosphorus is restricted to manage bone disease
Possible decrease in serum potassium levels if the kidneys can
How is acid-base balance regulated in children?
Chemical and cellular buffers
Respiratory control of carbon dioxide
Renal regulation of bicarbonate and secretion of hydrogen ions
The amount of fluid ingested during the day should equal the amount of fluid that is lost through sensible (urination) and insensible (respiratory tract and skin).
What are normal potassium, sodium and calcium levels?
Why are infants at greater risk for dehydration than older children?
Severe gastroenteritis is the most common cause of hospitalization in infants – intestinal infection (N/V/D, cramps, fever) results in dehydration
They are at greater risk because they have a higher ECF than older children, which makes them more susceptible to rapid fluid depletion.
difference between hyper-hypo-isotremic dehydration.
Hypernatremic – sodium concentration is above that of normal body fluids
Hyponatremic – sodium concentration is below that of normal body fluids
Isonatremic – sodium concentration is practically identical to that of body fluids and is the most common form
Know the criteria used for diagnostic evaluation of dehydration.
History of acute or chronic fluid loss
Serum electrolyte values (determine moderate to severe dehydration)
Know symptoms of dehydration
Hypernatremic = fever, diarrhea, high sodium intake, DI (diabetes Insipidus)
Hyponatremic = fever, vomiting, diarrhea, increased water intake without electrolytes, burns, CF
Fewer wet diapers than usual
No tears when crying, inside of mouth is dry and sticky
Irritability; high-pitched cry
Difficulty in awakening
Increased respiratory rate or difficulty breathing
Sunken soft spot, sunken eyes
Abnormal skin color, temperature, or dryness
Why would antidiarrheal medications NOT be used in an infant who is diagnosed with diarrhea caused by a pathogen?
Potential for toxicity
Binding nature of the products
Have not been found to shorten the course of diarrhea
Might increase fluid and electrolyte loss interfering with the body’s attempt to rid itself of the organism.
Therapeutic management of a child with acute diarrhea and dehydration usually begins with what type of therapy?
Wash hands, increase fluid intake, continue feedings, eat frequently, close monitoring and observation, antibiotics given if diarrhea is caused by bacteria, parasites, or fungi
What STD should the nurse suspect when the adolescent girl complains of vaginal discharge that is white and has a fishy smell?
May be asymptomatic and is not usually associated with abdominal pain, skin rashes, itching, or painful urination.
What is part of innate immunity?
Skin and intact mucous membranes
Acid secreted in sweat and by sebaceous glands
Smooth muscle contraction and ciliary actions (coughing, sneezing)
Physical and chemical membranes
What are the symptoms of Erythema Infectiosum (Fifth disease)?
Mild systemic disease
Headache, runny nose, mild fever, malaise
Intense, fiery red, edematous rash on cheeks
“Slapped cheek” appearance
Approx. 1-4 days after the facial rash appears, an erythematous, maculopapular rash appears on trunk and extremities
The disease is most contagious the week before the rash appears.
What should be included in the care of a neonate diagnosed with pertussis?
Erythromycin (-mycin) antibiotic given
Hospitalization, supportive care
Monitor airway, respiratory status
What education should be given to parents to prevent Lyme disease?
Anticipatory guidance and information about routine preventive measures to avoid insect bites
Proper use of diethltoluamide (DEET) insect repellent should be stressed
What action is taken when a child has been scratched or bitten by a rabid animal?
The bite should be cleaned with A LOT of soap and water
Human Rabies Immune Globulin (HRIG) is infiltrated locally around the wound and IM
Rabies vaccination should be given as early as possible after exposure (within 24 hrs)
Only vaccine that can be given after exposure and still work
What are the symptoms of mumps?
Fever, myalgia (muscle pain), headache, malaise
Parotid glandular swelling (in the mouth) – classic sign
What does the CDC recommend for immunizing infants who are HIV positive?
What kind of teaching is important to include for toddlers who will be taking prednisone for several months?
Alternate days of taking the medication
Increase Vitamin D and Calcium intake (take with food or milk)
Killed-virus vaccines are substituted for live-virus vaccines.
Supplementary steroids are indicated if the child gets an acute infection or surgery
Height velocity should be assessed on a regular basis
What are children most at risk for when receiving long-term systemic corticosteroid therapy?
Adrenal Insufficiency – caused by abrupt cessation without gradual increase in adrenal production, the drug is providing the steroid so the adrenal gland doesn’t anymore
What disease should be suspected when a child has a butterfly rash across his cheeks and nose?
SLE- Systemic Lupus Erthematosus
Chronic, inflammatory autoimmune disease that can affect any organ or system in the body
Why do we use several antiretroviral drugs to treat HIV?
Viral suppression caused by HIV can lead to medication resistance
What is the priority goal in planning care for an adolescent with AIDs?
Want to maximize the child and family’s quality of life
Optimal growth and development
What are causes of bilateral cleft lip? (Look at notes by Dr. Burns)
Embryonic development failures related to multiple genetic and environmental factors:
Genetic pattern and family risk
ex: Maternal smoking
What are postoperative nursing interventions for infant with surgical repair of a cleft lip?
Modifying feeding techniques as needed to allow adequate growth
o Use of special feeding techniques, obturators, and unique nipples and feeders
o Breastfeeding may be possible if child has small cleft lip
o A soft plastic bottle will prevent the child from having to suck vigorously, mom can squeeze bottle
o Longer nipple
o Feed child slowly, keep child in upright position during feedings, burp frequently
· Elbow restraints so the baby does not touch the stitches
· Infant must sleep on back (supine)
· Do not brush teeth for 1-2 weeks after surgery
What is included in nursing care for a neonate with a suspected tracheoesophageal fistula (TEF) regarding positioning and feeding?
Keep the infant supine with the head of the bed elevated
o Decreases the chance of gastric secretions entering the lungs
What maternal assessment is related to an infant’s diagnosis of TEF? Remember what we talked about in class about amniotic fluid….
A history of polyhydramnios (too much amniotic fluid) is a significant prenatal clue
What are the therapeutic management interventions for GERD?
Based on severity of symptoms and includes dietary alterations, positional changes, medications and surgery
o Diet – small, frequent feedings with frequent burping. Thickened feedings (rice cereal), concentrated high calorie formulas, NG-tube feedings. Caffeinated, carbonated, acidic, spicy, and fatty foods should be eliminated
o Positioning – Prone positioning (on belly) more effectively reduces reflux (when baby is awake), but baby should still sleep supine (on back) to avoid SIDS
- Antacids – symptom relief
-PPI, H2-receptor antagonists – decreases acid secretions
- Prokinetic agents – accelerates gastric emptying and improves esophageal and intestinal peristalsis (muscle movement)
- Antidopaminergic agents – facilitates/helps gastric emptying
What electrolyte imbalance is the child with lactose intolerance most at risk for?
How do we tell the difference between gastroenteritis and appendicitis?
Gastroenteritis – infection caused by a group of viruses, bacteria, and parasites. Ingestion of contaminated food or water and person-to-person contamination
o V/D, abdominal pain, fever, tenesmus (cramping rectal pain)
o Diagnosis made when a stool culture finds a pathogen
· Appendicitis – inflammation and infection of the appendix. Lymphoid swelling related to viral infection, impacted fecal matter, foreign bodies, and parasites
o RLQ pain, N/V/D, anorexia, constipation, fever, chills
o Rebound tenderness, ultrasound will show enlarged appendix
What is the number one cause of obstructive GI disorder in newborns – when we would first suspect a problem?
Hypertrophic Pyloric Stenosis – progressive projectile vomiting in a previously healthy infant
What would stool look like with an intussusception?
Bloody mucus stool and diarrhea “jellylike”
What type of signs/symptoms would lead a nurse to suspect that failure to thrive is associated with celiac disease?
Profuse watery diarrhea, growth failure (child is usually below the 25th percentile)
· Abdominal distention, vomiting, anemia, irritability, anorexia, muscle wasting, edema, folate deficiency
· Symptoms are not seen until 3-6 months after the introduction of grains to the diet, usually at age 9-12 months
Probable signs of pregnancy
HCP can see, but observation could be a result of other conditions
Goodell sign (softening of the cervix; 2nd month)
Chadwick sign (bluish coloration of the mucous membranes of the cervix, vagina, and vulva (6th week)
Hegar sign: softening and thinning of the lower uterine segment; 6th week
Positive pregnancy test
Ballottment: rebounding of the fetus against the examiner’s fingers on palpation
Braxton Hicks Contractions
latent phase of labor contractions
Contractions every 15-30 minutes, lasting 15-30 seconds
Contractions every 5-7 minutes, lasting 30-40 seconds
Active phase labor contractions
Contractions every 3-5 minutes, lasting 40-60 seconds
Transitional phase of labor contractions
Contractions every 2-3 minutes, lasting 60-90 seconds
Second stage of labor
Complete dilation until delivery of baby
Uterine contractions: every 2-3 minutes lasting 60-75 seconds of strong intensity
Increase in bloody show
Mom feels urge to bear down – pushing begins
Epidural will prolong this phase
VEAL CHOP CALL
flow of heat from body to air (room temp)
Nurse’s Role: Increase room temperature
loss from body to cooler surface not in direct contact (crib by window – open doors)
Nurse’s Role: Keep crib away from open windows/doors
increases need for oxygen – increases respiratory rate and if lasts too long – metabolic and respiratory acidosis)
May cause water intoxication
Cannot give if hypertensive or history of cardiac disease
Check blood pressure and hold if >140/90!!!
Prostaglandin F2 (Hemabate)
Cannot give if asthmatic!
May cause diarrhea, nausea, vomiting
Magnesium Sulfate Toxic Levels
Loss of deep tendon reflexes
Respiratory rate less than 10-12/min
Altered level of consciousness
Complaints of being too warm
Antidote to Mag Sulfate
Calcium Gluconate (keep at bedside)
Neonatal implications of mag sulfate
Lethargy, Hypotonia, Respiratory depression