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Anxiety Medication Categories and Names

Antianxiety Agent: Buspirone

Selective Serotonin Reuptake Inhibitors: Fluoxetine, Paroxetine, Sertraline

Tricyclic Antidepressants: Amitriptyline, Desipramine, Imipramine, Nortriptyline

Medications used to treat anxiety, other than the antianxiety agent buspirone include; tricyclic antidepressants and selective serotonin reuptake inhibitors.

Depression Medications Categories and Names

Atypical Antidepressant: Trazodone

Tricyclic Antidepressants: Amitriptyline, Desipramine, Imipramine, Nortriptyline

Selective Serotonin Reuptake Inhibitors: Fluoxetine, Paroxetine, Sertraline

Antimanic Agent: Lithium

Atypical antidepressants are used for depression.

ADHD Medication Categories and Names

Psychostimulants: Methylphenidate, Dextroamphetamine, Lisdexamfetamine, Pemoline, Long-acting Methylphenidate, Long acting Dextroamphetamine

Nonstimulant norepinephrine reuptake inhibitor: Atomoxetine

Alpha-Agonist Antihypertensive Agents: Clonidine, Guanfacine

Nonstimulant norepinephrine reuptake inhibitors are used for ADHD.

Child Maltreatment

Child maltreatment includes physical abuse, sexual abuse, emotional abuse, and neglect. Child maltreatment may result in significant physical injury, poor physical health, and, in some cases, impaired brain development.

Common Medical Treatments for Cancer

Blood product transfusion

Leukapheresis

Hematopoietic Stem Cell Transplantation

Supplemental Oxygen

Biopsy

Splenectomy

Surgical Removal of Tumor

Radiation

Main Causes of Iron-Deficiency Anemia

usually due to malabsorption, hemorrhage, or diet.

What is Anemia?

Anemia is a condition in which the level of RBCs is lower than the age-appropriate normal value. Anemia may develop as a result of decreased production of RBCs or loss and destruction of RBCs. The loss of production can be related to lack of dietary intake of the nutrients needed to produce the cells, alterations in the cell structure, or malfunctioning tissues (e.g., bone marrow).

Therapeutic Management of Iron-Deficiency Anemia

Iron supplements are usually provided in the form of ferrous sulfate or ferrous fumarate and are available over the counter. The recommended dose is 4 to 6 mg of elemental iron daily. In more severe cases, blood transfusions may be indicated. Transfusion of PRBCs is reserved for uncompensated anemia. When PRBC administration is warranted, follow specific blood bank guidelines for administration. Monitor subsequent laboratory results for improvement.

Sickle Cell Disease Patho

SCD is a group of inherited hemoglobinopathies in which the RBCs do not carry the normal adult hemoglobin, but instead carry a less effective type.

results in an elongated RBC with a shortened lifespan. The elongated cell is more rigid than a normal cell and becomes sickled in shape Significant anemia may occur when the RBCs sickle. Sickling may be triggered by any stress or traumatic event, such as infection, fever, dehydration, physical exertion, excessive cold exposure, or hypoxia. As the cells sickle, the blood becomes more viscous because the sickled cells clump together and prevent normal blood flow to the tissues of that area.

What is the main symptom with sickle cell crisis

Pain crisis results as circulation is decreased to the area. Pain can occur in any part of the body but is most common in the joints. Pain causes increased metabolic need by resulting in tachycardia and sometimes tachypnea, which leads to further sickling.

Therapeutic Management of Sickle Cell Disease

The therapeutic management of children with SCA focuses on preventing vaso-occlusive episodes and infection as well as other complications. Functional asplenia (decrease in the ability of the spleen to function appropriately) places the child at significant risk for serious infection with Streptococcus pneumoniae or other encapsulated organisms. Prophylactic antibiotics in the young child and appropriate immunization in all children with SCA can reduce the risk of serious infection.

Patients with sickle cell disease are at an increased risk of infection and sickle cell crisis can be deadly. Monitor the patient's pain

Nursing Assessment Idiopathic Thrombocytopenia Purpura

Monitor platelet levels

Elicit the child's health history (usually a previously healthy child who recently has developed increased bruising, epistaxis, or bleeding of the gums). Note history of blood in the stool. Note risk factors such as recent viral illness, recent MMR immunization, or ingestion of medications that can cause thrombocytopenia. Inspect for petechiae, purpura, and bruising, which may progress rapidly within the first 24 to 48 hours of the illness. Document the size and location of each lesion. Inspect the lips and buccal mucosa for petechiae. The remainder of the physical examination is usually within normal limits. Usual laboratory findings include an extremely low platelet count (less than 50,000), normal WBC count and differential, and normal hemoglobin and hematocrit unless hemorrhage has occurred (this is rare). Bone marrow aspiration may be performed to rule out leukemia.

Nursing Management Idiopathic Thrombocytopenia Purpura

Many children require no medical treatment except observation and reevaluation of laboratory values. Educate the family about avoiding aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and antihistamines because these medications may precipitate the development of anemia in these children. The use of acetaminophen for pain control is more appropriate when necessary. Teach the family to prevent trauma by avoiding activities that may cause injury, such as contact sports. Instead, encourage activities, such as swimming, that provide physical activity with less risk of trauma. Explain to parents the signs and symptoms of serious bleeding and whom to call if it is suspected.

After a patient with idiopathic thrombocytopenia purpura has surgery, monitor closely for bleeding.

Physical Exam for Brain Tumor

Brain tumors are the most common form of solid tumor and the second most common type of cancer in children. Observe for strabismus or nystagmus, "sunsetting" eyes, head tilt, alterations in coordination, gait disturbance, or alterations in sensation. Note alteration in gag reflex, cranial nerve palsy, lethargy, or irritability. Note the child's posture. Check pupillary reaction, noting size, equality, reaction to light, and accommodation. Measure blood pressure, which may decrease with increasing intracranial pressure. In the infant, palpate the anterior fontanel for bulging. Assess deep tendon reflexes, noting hyperreflexia. Fixed and dilated pupils is not a good sign at all.

Nursing ssessment of Leukemias

Bone marrow biopsy

Explore the health history for common signs and symptoms, which may include recent weight loss, fever, drenching night sweats, anorexia, malaise, fatigue, or pruritus. Elicit the health history, determining risk factors such as prior Epstein-Barr virus infection, family history of Hodgkin disease, genetic immune disorder, or HIV infection. Evaluate respiratory status, as the presence of a mediastinal mass may compromise respiration. Palpate for enlarged lymph nodes; they may feel rubbery and tend to occur in clusters (most common sites are cervical and supraclavicular). Palpate the abdomen for hepatomegaly or splenomegaly, which may be present with advanced disease. The chest radiograph may reveal a mediastinal mass. The complete blood count may be normal or reflect anemia. Tissue sampling will reveal Reed-Sternberg cells.

Nursing Assessment Lymphomas

Explore the health history for common signs and symptoms, including recurrent infections, fever, or fatigue. Explore the medical history for risk factors, such as Hispanic race, previous chemotherapy, and genetic abnormalities such as Down syndrome, Fanconi anemia, neurofibromatosis, Wiskott-Aldrich syndrome, and Diamond-Blackfan anemia. Perform a thorough physical examination. Note skin pallor and salmon-colored or blue-gray papular lesions. Palpate the skin for subcutaneous rubbery nodules. Palpate for lymphadenopathy. Note headache, visual disturbance, or signs of increased intracranial pressure, such as vomiting, which may indicate CNS involvement. Upon diagnosis of AML, the child's WBC count is typically extremely elevated.

Nursing Assessment Wilms Tumor

Wilms tumor is the most common renal tumor, the second most common abdominal solid tumor in children, and most commonly occurs between the ages of 2 and 5 years. The etiology is unknown Measure blood pressure; hypertension occurs in 25% of children with Wilms tumor the abdomen for asymmetry or a visible mass. Observe for associated anomalies as noted above. Auscultate the lungs for adventitious breath sounds associated with tumor metastasis. Palpate for lymphadenopathy.

Cellular Immunity vs. Humoral Immunity

humoral immunity (immunity mediated by antibodies secreted by B cells),

cellular immunity (cell-mediated immunity controlled by T cells, this is the immunity that mothers pass down to infants), present and functional at birth

10 Warning Signs of Primary Immunodeficiency

• Four or more new episodes of acute otitis media in one year

• Two or more episodes of severe sinusitis in one year

• Treatment with antibiotics for two months or longer with little effect

• Two or more episodes of pneumonia in one year

• Failure to thrive in the infant

• Recurrent deep skin or organ abscesses

• Persistent oral thrush or skin candidiasis after one year of age

• History of infections requiring IV antibiotics to clear

• Two or more serious infections such as sepsis

• Family history of primary immunodeficiency

What to watch for with IV Immunoglobulin?

Watch for dehydration & infection, and assess therapeutic effects to make sure it is working.

Ensure that the child is well hydrated before the infusion to decrease the risk for rate-related reactions and aseptic meningitis after the infusion.

Premedication for IVIG

Premedication with diphenhydramine or acetaminophen may be indicated in children who have never received IVIG, have not had an infusion in more than 8 weeks, have had a recent bacterial infection, have a history of serious infusion-related adverse reactions, or are diagnosed with agammaglobulinemia or hypogammaglobulinemia

Assessment for IVIG

Assess vital signs and check for adverse reactions every 15 minutes for the first hour, then every 30 minutes throughout the remainder of the infusion (the frequency of assessments may vary according to institutional protocol). IVIG is a plasma product, so observe closely for signs of anaphylaxis such as headache, facial flushing, urticaria, dyspnea, shortness of breath, wheezing, chest pain, fever, chills, nausea, vomiting, increased anxiety, or hypotension.

What is the key with HIV Therapeutic Management?

Medication compliance, stop the spread by having a low viral load

Systemic Lupus Erthematosus- What to know?

Avoid Heat

Watch Temp

Butterfly rash

SLE Labs

Laboratory findings may include decreased hemoglobin and hematocrit, decreased platelet count, and low WBC count. Complement levels, C3 and C4, will also be decreased.

Though not specific to SLE, the antinuclear antibody (ANA) is usually positive in children with SLE.

Nursing Assessment for Juvenile Idiopathic Arthritis

Manage pain. Keep low stress environment and good diet.

Nursing Management Myasthenia Gravis

The goals of nursing management include prevention of respiratory problems and providing adequate nutrition.

Prevention of infection

Food Allergies: What to know

Try one food at a time

Inspect the skin for color, rash, hives, or edema. Auscultate the heart and lungs to determine heart rate and to assess for wheezing.

The child who has been prescribed an EpiPen should carry the pen with him or her at all times. Since these reactions can be so sudden (unknown ingestion of allergen) and severe, it is helpful for the family to have a written emergency plan in case of a reaction. Keep an Epi Pen and Benadryl with you at all times

Allergies with cross-reactivity with latex

Determine whether the child has ever had allergic symptoms after eating foods with a known cross-reactivity to latex, such as pear, peach, passion fruit, plum, pineapple, kiwi, fig, grape, cherry, melon, nectarine, papaya, apple, apricot, banana, chestnut, carrot, celery, avocado, tomato, or potato

Endocrine Disorder: Important to focus on

Growth and Health History

GH Comes From

Pituitary

Delayed Growth-

Dwarfism

Physical Exam for GH Abnormalities

Use growth chart

What to know about Diabetes Insipidus

Polyuria and Polydipsia, Increase their water intake, and Allow access to bathroom frequently

Promote Hydration: The goal of treatment is to achieve hourly urine output of 1 to 2 mL/kg and urine-specific gravity of at least 1.010.

Assess neurologic status, noting lethargy, behavioral changes, headache, altered level of consciousness, seizure, or coma. Neurologic signs develop as the sodium level decreases.

Management of Congential Hypothyroidism

To prevent intellectual disability and restore normal growth and motor development, thyroid hormone replacement with sodium L-thyroxine (Synthroid, synthetic thyroxine, or Levothroid) is given. The recommended starting dosage is 10 to 15 μg/kg/day

The overall goal of nursing management of the infant or child with congenital hypothyroidism is to establish a normal growth pattern without complications such as intellectual disability or failure to thrive. Individualize the nursing care plan based on the infant's responses to the illness. Allow them a good environment to thrive.

Medication for Congential Adrenal Hyperplasia

glucocorticoid- hydrocortisone and mineralcorticoid fludrocortisone (Florinef) of life.

Make sure the treatment is working

Congenital Adrenal Hyperplasia- Crisis

Tachycardia, Dehydration, Does not look healthy

Big Education for Diabetes

Carb counts for insulin

Teach the child and family to use proper subcutaneous injection techniques to avoid injecting into muscle or vascular spaces. (abdomen, outer thighs, back of upper arms, shoulder blades, low back-just above the buttock. Teach the child and family to rotate sites to avoid adipose hypertrophy (fatty lumps that absorb insulin poorly). If the child is using an insulin pump, additional education will be needed.

Pimative Reflexes

Primitive reflexes are subcortical and involve a whole-body response. Selected primitive reflexes present at birth include Moro, root, suck, asymmetric tonic neck, plantar and palmar grasp, step, and Babinski. Except for the Babinski, which disappears around one year of age, these primitive reflexes diminish over the first few months of life, giving way to protective reflexes.

Protective Reflexes

Protective reflexes (also termed postural responses or reflexes) are gross motor responses related to maintenance of equilibrium. These responses are prerequisites for appropriate motor development and remain throughout life once they are established. The protective reflexes include the righting and parachute reactions.

3 years Gross Motor:

Climbs well

Pedals tricycle

Runs easily

Walks up and down stairs with alternating feet

Bends over easily without falling

3 Years Fine Motor:

Undresses self

Copies circle

Builds tower of 9-10 cubes

Screws and unscrews lid

Turns pages in a book

4 years Gross Motor

Thows ball overhand

Kicks ball and catches bounced ball

Hops on one foot

Stands on one foot for 5 seconds

Alternates feet going up and down steps

Moves backward and forward with agility

4 Years Fine Motor

Uses scissors

Copies capital letters

Draws circle and square

Traces cross or diamond

Draws person with 2-4 body parts

Laces Shoes

5 Years Gross Motor:

Stands on one foot for 10 seconds or longer

Swings and climbs well

May skip and do somersaults

May learn to skate or swim

5 Years Fine Motor:

Prints some letters

Dresses and undresses without assistance

Can tie shoes

Can use silverwear

Mostly cares for own toileting needs

Caring for Casts

Assess for swelling

Assess for compartment syndrome

Change positions Q2Hr

Never insert anything to the cast

Protect cast from wetness

What can Metatarsus Adductus lead to?

Can lead to hip dysplasia.

Nursing Management of Metatarsus Adductus

Range of motion of the ankle, hindfoot, and midfoot is normal. Exercising to prevent stiffening.

Watch movement

Therapeutic Management of Cerebral Palsy

The overall focus of therapeutic management will be to assist the child to gain optimal development and function within the limits of the disease. Treatment is mainly preventative, symptomatic, and supportive.

Spasticity management will be a primary concern and will be determined by clinical findings.

Children with cerebral palsy may have difficulty eating and swallowing due to poor motor control of the mouth, tongue, and throat. This may lead to poor nutrition and problems with growth. The child may require a longer time to eat because of poor motor control. Special diets, such as soft or puréed, may make swallowing easier

What causes Rickets? & Who is at risk?

Lack of vitamin D

Limited exposure to sunlight

Strict vegetarian diet or lactose intolerance (either one without milk product ingestion)

Exclusive breastfeeding by a mother who has a vitamin D deficiency

Dark-pigmented skin

Prematurity

Malabsorptive gastrointestinal disorder

Chronic renal disease

What is used to monitor Legg-Calve Perthes

X-ray

Nursing Management Legg-Calve Perthes

Explore the health history for short stature, delayed bone maturation, related trauma, or a family history of Legg-Calvé-Perthes disease. Note painless limp, which may be intermittent over a period of months. Mild hip pain may result and may be referred to the knee or the thigh. Pain may be aggravated by exercise. Observe the child walking and note Trendelenburg gait. Perform range of motion, noting internal rotation of the hip and limited abduction. Muscle spasm may result with hip extension and rotation. Hip radiographs are obtained to evaluate the extent of epiphyseal involvement. MRI or bone scan may also be used to differentiate Legg-Calvé-Perthes disease from other disorders. Ultrasound and arthrograms may also be useful.

Important keys for Scoliosis management

Compliance with brace is important and log roll with moving

Key for Epilepsy

Safety

S/S Of Hydrocephalus Shunt Infection/Malfunction

Signs and symptoms of a shunt infection include elevated vital signs, poor feeding, vomiting, decreased responsiveness, seizure activity, and signs of local inflammation along the shunt tract.

Signs and symptoms of shunt malfunction include vomiting, drowsiness, and headache. Signs and symptoms of increased ICP, can also be indicative of shunt complications.

Diagnosis for Craniosynostosis

X-ray

What is craniosynostosis

sutures of skull fuse prematurely and are not properly fused, skull deformity is evident

Bacterial Meningitis Treatment

Administer prescribed antibiotics as soon as possible after obtaining cultures (Culture is done with a lumbar puncture for diagnosis)

Precautions for Meningitis

Initiate appropriate isolation precautions. In addition to standard precautions, infants and children diagnosed with bacterial meningitis will be placed on droplet isolation until 24 hours of antibiotics have been received to help prevent transmission to others.

Assessment for Head Trauma

includes LOC, pupillary response, and any seizure activity. Fixed and dilated pupils, fixed and constricted pupils, or sluggish pupillary reaction to light will warrant prompt intervention.

Look for retinal hemorrhage, blown pupils

Medication Classes for Neurological Disorders

Antibiotics

Anticonvulsants

Benzodiazepines (Diazepam or Lorazepam)

Analgesics

Osmotic Diuretics (Mannitol)

Corticosteroids (Dexamethasone)

Gender for Turner Sundrome

Women

Gender for Fragile X

Male or Female

Klinefleter Syndrome Gender and who is it passed down by?

Male- Low testosterone

Passed down from mother

How does klinefleter affect the male?

Parents may be upset that their son will not be able to reproduce, so explain that many alternatives for reproduction are available and technology is advancing in the field of infertility.

How does turner syndrome affect the female?

Explain that intellectual disability is unlikely, but some learning disabilities may be present

Parents may be upset that their daughter will not be able to reproduce, so explain that many alternatives for reproduction, such as in vitro fertilization and adoption, are available. Providing resources for the family is an important nursing function

Neruofibromatosis what is it?

Tumors on nerves with complains of pain

Inborn errors of metabolism nursing management

Ensure that the diet prescribed for the infant or child is followed

Supplementation with specific vitamins may also be important in the treatment of these disorders. Strict adherence to the diet is necessary and will require close supervision by registered dietitians, physicians, and nurses and the cooperation of both the parent and child.

Physcial Exam of Child- What to do?

Inspect and observe how they play

Fine motor skill of 4 year old (powerpoint note)

Buttoning a shirt would be an appropriate way to evaluate fine motor skills of a 4-year-old.

Gross motor skill of 6 year old (powerpoint note)

Walking in a straight line would be a gross motor skill of a 6-year-old.

Fine Motor skill of 5 year old (powerpoint note)

Tying shoe laces would be a fine motor skill of a 5-year-old

Expected skill of 3 year old (powerpoint note)

walking upstairs using alternate feet would be expected of a 3-year-old.

What is Metatarsus adductus (powerpoint note)

Metatarsus adductus is a congenital anomaly of the musculoskeletal system that involves a deviation of the forefoot caused by positioning in utero. Treatment depends on the degree of flexibility and only stretching is required if the foot is flexible to neutral manipulation. If the forefoot is rigid and is not flexible to neutral manipulation, serial casting would be required. A hip spica cast, pillow under the knees and a splint or brace at night are not treatment options for this condition.

Assessment for hip dysplasia (powerpoint note)

Assessment techniques for developmental dysplasia of the hip include; assessing for asymmetry of thigh and gluteal folds; assessing for unequal knee height related to femur shortening; noting pelvis/hip drops when leg is raised; feeling for a "clunk" when adduction and depression of femur dislocates hip (Barlow test); assessing for "clunk" when the dislocated hip is abducted and relocated (Ortolani sign)

Hallmark sign of duchenne muscular dystrophy

A hallmark finding of Duchenne muscular dystrophy is the presence of the Gowers sign: the child cannot rise from the floor in standard fashion because of increasing weakness

Nursing Care Cerebal Palsy (powerpoint note)

Children with cerebral palsy may have difficulty eating and swallowing due to poor motor control of the mouth, tongue, and throat. When planning nutritional care for the child the nurse should first determine the child's ability to eat and swallow. If poor motor control is noted, the child can receive a special diet and enough time that is appropriate for eating. A dietician can be beconsulted to ensure adequate nutrition is provided.

Nursing Management Scoliosis (powerpoint note)

The nurse should provide more teaching about exercises to strengthen back muscles that may prevent muscle atrophy from prolonged bracing and maintain spine flexibility. Modern braces display an improved appearance, with no visible neckpiece, and can be worn under clothes. The brace must be worn 23 hours per day to prevent curve progression. Encourage the teen to shower during the one hour per day that the brace is off and to ensure that the skin is clean and dry before putting the brace back on. Wearing a cotton T-shirt under the brace may decrease some of the discomfort associated with brace wear.

What is microcephaly? (powerpoint note)

Microcephaly is a condition where a baby's head is much smaller than expected. During pregnancy, a baby's head grows because the baby's brain grows. Microcephaly can occur because a baby's brain has not developed properly during pregnancy or has stopped growing after birth, which results in a smaller head size.

What is Craniosynostosis? (powerpoint note)

Craniosynostosis is a birth defect in which the bones in a baby's skull join together too early. This happens before the baby's brain is fully formed. As the baby's brain grows, the skull can become more misshapen. The spaces between a typical baby's skull bones are filled with flexible material and called sutures.

decorticate vs decerebrate posturing (powerpoint note)

While decorticate posturing is still an ominous sign of severe brain damage, decerebrate posturing is usually indicative of more severe damage at the rubrospinal tract, and hence, the red nucleus is also involved, indicating a lesion lower in the brainstem.

It is important to distinguish between decorticate and decerebrate posturing. An easy way to remember the differences is to picture the anatomy of the brain. The cerebral cortex lies above the cerebellum, so when a patient's arms flexed up toward the face , he is pointing to his "core" (de-cor-ticate)Brudzinski sign is tested by the child lying supine with the neck flexed. A positive sign occurs if resistance or pain is met. The child may also passively flex hip and knees in reaction, indicating meningeal irritation . A positive report of pain along the vertebral column and/or inability to extend knee is a positive sign and indicates irritation of meninges.

Medications for Seizures (powerpoint note)

Benzodiazepines are minor sedatives that prevent or stop seizures by slowing down the CNS, making abnormal electrical activity unlikely.

Analgesics block pain impulses in response to inhibition of prostaglandin synthesis.

Osmotic diuretics increase plasma osmolality, therefore inducing diffusion back into plasma and extravascular space to reduce intracranial pressure.

Corticosteroids suppress inflammation and normal immune response to reduce cerebral edema.

Neurofibromatoses (powerpoint note)

Neurofibromatoses are neurocutaneous genetic disorders of the nervous system that primarily affect the development and growth of neural cell tissues. Neurofibromatosis 1 causes tumors to grow on nerves and produce other abnormalities such as skin changes and bone deformities. On assessment the nurse may find café-aulait spots (light-brown macules), which are the hallmark of neurofibromatosis. They are present all over the body, particularly the trunk and extremities, while usually sparing the face. Pigmented nevi, axillary freckling, and slow-growing cutaneous, subcutaneous, or dermal neurofibromas, which are benign tumors, are other signs of neurofibromatosis. There is no cure for neurofibromatosis. Therapeutic management is aimed at controlling symptoms and managing complications. A biopsy is not necessary.

Inborn Errors of Metabolism (powerpoint note)

Inborn errors of metabolism are a group of hereditary disorders. They are caused by gene mutations that result in abnormalities in the synthesis or catabolism of proteins, carbohydrates, or fats. The body cannot convert food into energy as it normally would.

What to remember with eating disorders? (powerpoint note)

Refeeding syndrome (cardiovascular, hematologic, and neurologic complications) may occur in the severely malnourished adolescent with anorexia if rapid nutritional replacement is given. Therefore, slow refeeding is essential to avoid complications. Consult the nutritionist for assistance with calculating caloric needs and determining an appropriate diet. Aim for a weight gain goal of 0.5 to 2 lb per week. The adolescent should be assessed for the need for medical intervention for concomitant depression or anxiety (some anorexics also require psychotropic medications). Vital signs should be assessed frequently for orthostatic hypotension, irregular and decreased pulse, or hypothermia.