Case study mod 6

Question 1

How does the nurse describe the pathophysiology of ITP to Dillon’s parents?

Answer 1

Autoimmune destruction of platelets, low platelet count

Question 2

2. What clinical manifestations are associated with ITP?

Answer 2

Petichiae, nosebleeds, gum bleeding, easy bruising

Question 3

4. The provider orders anti-D antibody. The nurse knows that this medication will stop Dillon’s nosebleed immediately.

Answer 3

False

Question 4

5. The most common viral infections associated with acute ITP are:

Answer 4

Upper respiratory diseases, MMR

Question 5

6. ITP can become a chronic condition. What is the best therapy for long-term remission of chronic ITP?

Answer 5

Splenectomy at age 5+

Question 6

2. What is aplastic anemia?

Answer 6

Depression of RBC, WBC, Platelets

Question 7

3. What findings confirm a diagnosis of aplastic anemia?

Answer 7

Bone marrow cellularity: 25% or under, that means 75%+ fat in marrow

Question 8

3. What is the most frequent type of internal bleeding associated with hemophilia?

Answer 8

Hemoarthrosis

Question 9

4. What are some potential management strategies for hemophilia?

Answer 9

FFP, factor replacement therapy, DDAVP, exercise

Question 10

3. List the vital sign changes that are associated with brainstem injury following acute head trauma:

Answer 10

Temp, RR, BP fluctuations, wide pulse pressures

Question 11

4. In contrast, what is a key clinical manifestation of IICP in an infant?

Answer 11

Fontanelle bulging

Question 12

6. You note that Tommy appears to have a runny nose. He has no other respiratory symptoms and is not febrile. What is an important nursing consideration?

Answer 12

Glucose test to see if CSF

Question 13

1. Marshall is a 9-month-old admitted to the pediatric unit for Haemophilus influenzae meningitis. Marshall has not been vaccinated. What clinical findings are expected in an infant with meningitis?

Answer 13

Fever, vomiting, inconsolable, high pitched cry, bulging firm fontanelles

Question 14

4. Could this case of meningitis have been prevented? How?

Answer 14

Hib vaccine

Question 15

1. Callie is a 5-year-old who presents to the clinic because of a palpable painless mass on the left side of her abdomen. Her mother found the mass while bathing her. Why is the diagnosis most likely Wilms tumor rather than neuroblastoma?

Answer 15

Wilms doesn’t cross midline, and it is more common in older toddlers

Question 16

2. Where is Wilms tumor located?

Answer 16

On one of the kidneys

Question 17

5. What is the prognosis associated with Wilms tumor?

Answer 17

Very good prognosis- tumor is encapsulated

Question 18

1. Kimberly, a 2-year-old, is brought to the emergency room for evaluation because of having a headache and vomiting after waking up for the past week. Kimberly is admitted to the hospital and after magnetic resonance imaging (MRI) with contrast is performed, she is diagnosed with a brain tumor. Discuss why the most common presenting symptoms of a brain tumor are headache and vomiting.

Answer 18

Increased pressure from dural stretching, brainstem compression

Question 19

2. The treatment of choice is total removal of the tumor surgically. Discuss some preoperative teaching that should be given to the family.

Answer 19

Symptoms might be worse after surgery due to inflammation

Question 20

1. You arrive home from a long day at clinical and begin scrolling through your social media account. You come across a photo of a friend’s infant, and notice something strange – a whitish “glow” in the infant’s left pupil. You are concerned that the infant may have a retinoblastoma. What is the medical term for this manifestation?

Answer 20

Leukochoria, cat’s eye

Question 21

2. What is the next most common sign that may indicate the presence of a retinoblastoma?

Answer 21

Strabismus

Question 22

4. What is a late sign of retinoblastoma?

Answer 22

Blindness

Question 23

5. When blindness is present, what procedure may be performed?

Answer 23

Enucleation: removal of affected eye