Chapter 13: Health Problems of Toddlers and Preschoolers Flashcards
Based on the nurse’s knowledge of wounds and wound healing, what are factors that can delay or cause dysfunctional wound healing? Select all that apply.
a. Overweight
b. Hypoxemia
c. Hypervolemia
d. Prolonged infection
e. Corticosteroid therapy
a. Overweight
e. Corticosteroid therapy
Poor nutrition without proper protein and calorie intake affects healing more than being overweight itself. Corticosteroid therapy or other immunocompromising therapy prevents macrophages from migrating to the site of injury, thus suppressing epithelialization. Hypovolemia, not hypervolemia, inhibits wound healing d/t low circulating blood volume and oxygenation of tissues. Hypoxemia makes tissues more susceptible to infection d/t insufficient oxygenation. Prolonged infection affects the healing process and causes increased scarring.
The nurse is caring for the 12-year-old who sustained major burns when putting charcoal lighter on a campfire. The nurse observes that the child is “very brave” and appears to accept pain with little or no response. What is the most appropriate nursing action related to this?
a. Request a psychological consultation
b. Ask the child why the child does not have pain
c. Praise the child for the ability to withstand pain
d. Encourage continued bravery as a coping strategy
a. Request a psychological consultation
A psychological consultation will assist the child in verbalizing fears. This age group is very concerned with physical appearance. The psychologist can help integrate the issues the child is facing. It is likely that the child is having pain but not acknowledging the pain. Speaking with a psychologist might assist the child in relaying his or her fears and pain. If the child is feeling pain, the nurse should not praise the child for hiding the pain. The nurse should encourage the child to speak up during painful episodes so that the pain can be managed appropriately. Bravery may not be an effective coping strategy if the child is in severe pain.
During the rehabilitative phase of care, pressure dressings are primarily applied to the burned areas to
a. Relieve pain
b. Decrease blood supply to scar
c. Limit motion during the healing process
d. Encourage healing through scar formation
b. Decrease blood supply to scar
Uniform pressure to the scar decreases the blood supply. The use of pressure garments serves to decrease the blood supply to the hypertrophic tissue. This is done to prevent scarring and contractures. The goal of the pressure dressing is to improve the appearance of scars by decreasing the blood supply to the area. Motion is encouraged because it prevents contractures. Movement should take place to the point of pain, but no further. The goal of the pressure dressing is to minimize the development of scar tissue.
The school nurse is seeing a child who brought poison ivy to school in a leaf collection. The child says that only hands touched it. The most appropriate nursing action is to
a. Apply burow solution compresses immediately
b. Soak hands in warm water
c. Rinse hands in cold, running water
d. Scrub hands thoroughly with antibacterial soap
c. Rinse hands in cold, running water
Washing the child’s hands in cold running water is the recommended first action. Once contact has been made, it is desirable to flush the skin with cold running water within 15 minutes of exposure to neutralize the effect. Applying Burrow solution is effective for soothing the skin lesions once the dermatitis has begun. Antibacterial soap is not recommended as it removes protective skin oils, and may allow spread of contact.
A child is brought into the hospital following a fire at his home. The child appears to be sleeping on the stretcher bed. No observable burn injuries are noted based on preliminary surveys. However, the nurse would place a priority observation on the possibility of the child having?
a. Inhalation injury
b. Thermal burns
c. Decreased metabolism leading to hypovolemic shock
d. Chemical burns
a. Inhalation injury
Inhalation injury in the form of carbon monoxide poisoning or smoke inhalation should be considered in this situation. It is critical for the nurse to make these observations in order to prevent further complications. Thermal and chemical burns would cause evident tissue destruction which would be found on preliminary survey. In burn states, increased metabolism would occur.
What is the most important nursing consideration in the management of cellulitis?
a. Application of Burow solution compresses
b. Administration of oral or parenteral antibiotics
c. Topical application of an antibiotic
d. Incision and drainage of severe lesions
b. Administration of oral or parenteral antibiotics
Oral or parenteral antibiotics are indicated depending on the extent of the cellulitis. Warm water compresses may be indicated for limited cellulitis. Antibiotics need to be administered systemically (orally or parenterally), not topically. If incision and drainage are implemented, there is a risk of spreading infection or making the lesion worse.
A child is being treated for burns in the ER. The parents have provided information relative to the origin of the burn event but the patterns of injury are not consistent with their description. The nurse would suspect that
a. The parents are too upset to provide information at this time, so additional questions can be answered later
b. The child may have not told the parents the truth about the event
c. There may be a potential for abuse and as such requires follow up
d. There is no real concern as the burn injuries are minimal and non life threatening
c. There may be a potential for abuse and as such requires follow up
Anytime burn pattern injuries do not correlate with the provided information of the event, there is a potential for suspecting abuse. As such the nurse should be cognizant of this fact and follow up accordingly. Being upset would be a reasonable parent response but the physical evidence should coincide with the provided description. Suspecting that the child (victim) is not telling the truth would not be a concern unless additional evidence would be presented that would support that conclusion. Even if the burn injuries are not considered to be life-threatening, health care providers take the issue of suspected abuse very seriously and it must be reported and followed through as part of professional practice guidelines.
A child has been stung by a bee and the parents call the walk in clinic asking for instructions on what to do as they make their way to the clinic. The nurse responds by stating?
a. Tell the parents to remove all the child’s clothing and apply warm water to the affected area
b. Remove the stinger from the site
c. Encourage the child to take slow deep breaths to minimize associated anxiety that has occurred d/t the event
d. Have the parents offer the child water
b. Remove the stinger from the site
First action is to remove the stinger, then cleanse the area with soap and water and apply a cool compress. There is no need to remove the child’s clothing or provide fluid hydration. There is no indication that the child is experiencing any evidence of anxiety provided by the parent’s communication.
Which statement by the student nurse indicates that additional instruction is needed regarding topical agents being used to treat burns?
a. They eliminate bacterial growth but do not remove the bacteria from the skin
b. They are not considered to be toxic substances
c. They are associated with electrolyte derangement of surrounding tissues
d. They are able to penetrate through eschar levels to reach the wound
c. They are associated with electrolyte derangement of surrounding tissues
Topical agents used in the treatment of burns should provide minimal electrolyte derangement. The other options stated are all consistent with the expected actions of topical agents used in the treatment of burns.
A parent calls the health clinic stating that her child was just exposed to poison ivy and asks what she should do to prevent further complications?
a. Have the parents contact the Health Department so they will be aware of a possible outbreak of this event
b. Quarantine the child until the rash disappears as the child is considered to be contagious
c. Was the exposed area of contact with cold water to neutralize effects of the oil exposure
d. Suggest to the parent that a tetanus booster is necessary to prevent further complications from this puncture exposure
c. Was the exposed area of contact with cold water to neutralize effects of the oil exposure
Best practice if this is a recent exposure is to wash the affected area with cold running water to minimize the effects by neutralizing the oil and possible bonding to skin areas. The Health Department does not have to be contacted as this is not considered to be a public health issue. The child does not have to be quarantined as poison ivy can only be spread by direct contact of oils associated with the plant. Tetanus booster is not required as this is associated with contact and not puncture.
Which statement is correct about young children who report sexual abuse by one of their parents?
a. They may exhibit various behavioral manifestations
b. In most cases, the child has fabricated the story
c. Their stories are not believed unless other evidence is apparent
d. They should be able to retell the story the same way to another person
a. They may exhibit various behavioral manifestations
There is no diagnostic profile of the child who is being sexually abused. Many different behavioral manifestations may be exhibited, from outward sexual behaviors with others to withdrawal and introversion. It is never appropriate to assume that a child has fabricated the story of sexual abuse. Adults are reluctant to believe children, and sexual abuse often goes unreported. Physical examination is normal in approximately 80% of abused children. The child will usually try to protect their parents and may accept responsibility for the act.
A child is brought to the ED after falling down the basement stairs. On assessment, what findings may cause the nurse to suspect child abuse? Select all that apply.
a. The child’s bruises are located only on the right arm and leg
b. The child is brought to the ED by an unrelated adult
c. The child has a history of a broken arm last year from falling off a swing
d. The child’s caregiver is anxious that the child get immediate medical attention
e. The child has red, green, and yellow bruises on more than one plane of the body
b. The child is brought to the ED by an unrelated adult
e. The child has red, green, and yellow bruises on more than one plane of the body
A child brought to a health care provider for a trauma or suspicious injury by an unrelated adult or if the primary care provider is totally unavailable is a warning sign of abuse. Varying degrees of healing of bruises in more than one plane of the body is a warning of abuse. Falling down stairs can be an unintentional injury. A child with an isolated documented injury is not a warning sign of abuse. Multiple fractures of differing ages are a warning sign of abuse. An anxious caregiver is a normal response for an injured child. A delay in seeking care is a warning sign of abuse.
Enteral feedings are ordered for a young child with burns covering 40% of the total body surface area. The nurse should know that
a. Oral feedings are contraindicated
b. Enteral feedings must be stopped during painful procedures
c. Paralytic ileus precludes use of enteral feedings
d. The feedings will be high in carbohydrate and low in protein
c. Paralytic ileus precludes use of enteral feedings
Enteral feedings can begin when the paralytic ileus resolves. Oral feedings are not contraindicated. Oral feedings are encouraged. Most children with burns are unable to consume sufficient calories by mouth, but every possible effort is made to encourage oral feeding. Enteral feedings can continue during procedures. A high-protein, high-calorie diet is recommended to compensate for the increased basal metabolic rate that occurs after a burn injury.
