exam 2

Question 1

• Diagnosis:
o streptococcus triggers autoimmune response that damages connective tissue (heart, joints, CNS, skin).
o Erythema marginatum (rash on chest, abdomen, butt, and proximal limbs), throat culture (GABHS),
o ECG/ECHO, chorea

Answer 1

rheumatic fever

Question 2

• Treatment:
o Antibiotics and aspirin are prescribed, Tepid baths or cool compresses may be provided, IVF are monitored carefully,
o Quiet activities to prevent child from overtaxing the heart
• why we worry about it: Rheumatic heart disease (RHD) – damage to valves

Answer 2

Rheumatic fever

Question 3

o clinical manifestations: strawberry tongue,
 acute: Conjunctival hyperemia, Unresponsive to antibiotics and antipyretics
 sub-acute: The skin on the lips, hands, and feet peels off, Increased risk of coronary artery aneurysms
 third phase (6-8 weeks): Child gradually progresses with a decrease of inflammation, Resume normal energy, appetite and temperament
o management/interventions:
o monitor temp every 4 hours, aspirin therapy/assess for bleeding, monitor conjunctiva, oral mucosa, and skin every 8 hours for increasing edema,
o spreading of red rash and peeling of skin, assess for dehydration/malnutrition, auscultate heart every 4 hours for abnormal sound/rhythm, IVIG in 1st 10 days

Answer 3

Kawasaki

Question 4

poor feeding, tachypnea, tachycardia, failure to thrive, poor weight gain, activity intolerance, developmental delays, positive prenatal history, positive family history of cardiac disorders

Answer 4

s/s of heart defects

Question 5

• Management/interventions
o Manage stress
o Hydration, oxygen, pain management, bed rest, blood transfusions in early treatments
• Etiology
o Hereditary disorder affecting formation of hemoglobin (Hgb S replaces normal Hgb)
o Recessive trait, affecting African Americans

Answer 5

sickle cell

Question 6

•	Pathophys
o	Increase in abnormal WBC and decreased normal WBC
•	clinical manifestations
o	bone pain
o	easily bruised
o	tired
•	treatment/interventions
o	blood cell count, BMA, early diagnosis improves outcomes, antibiotics, blood replacement, chemo and radiation
o	high risk for infection

Answer 6

leukemia

Question 7

• clinical manifestations
o Nontender, firm, enlarged lymph nodes usually in the cervical and supraclavicular area
o Occasionally, the mediastinal lymph nodes are involved, resulting in respiratory distress from pressure against the trachea
o Fever, night sweats, and weight loss.
o Possible genetic factor
• treatment/interventions
o Combination of three to five antineoplastic agents
o Multiple drugs used to help prevent resistance
o Side effects of antineoplastic drugs include…??
o Possibly low-dose radiation

Answer 7

Hodgkin

Question 8

• Pathophys
o Decrease in number of RBC and/or hemoglobin concentration below normal
o Decreased oxygen carrying capacity of blood
• Etiology
o RBC and Gcb depletion
• Assessments
o CBC: decreased RBC and Hgb and Hematocrit
• Treatments/interventions
o Treat underlying cause: transfusion after hemorrhage if needed and nutritional intervention for deficiency anemias
o Supportive care: IV fluids to replaced intravascular volume, oxygen and bedrest
o Prevent infections
o Decrease oxygen demands
o Takes VS with activity and rest

Answer 8

anemia

Question 9

• Interventions
o Document body part where seizure began and specific movements
o EEG
• diagnosis of epilepsy
o 2 or more unprovoked seizures
• Assessments
o Control frequency and severity
o Position child on side, clear the airway and assess airway patency
o Check neurologic function
o Implement seizure precautions (padded rails, suction)

Answer 9

seizures

Question 10

•	teaching interventions
o	infection: greatest risk 1-2 months after surgery
•	s/s of malfunction
o	kinking and plugging
o	medical emergency
o	increased ICP
o	worsening neurologic status
o	altered LOC

Answer 10

VP shunts

Question 11

•	clinical manifestations
o	Headache
o	Vomiting, with or without nausea
o	Seizures
o	Diplopia, blurred vision
o	Irritability, poor feeding
o	High-pitched cry, difficult to soothe
o	Fontanels: tense, bulging
o	Cranial sutures: separated
o	Eyes: setting-sun sign
o	Scalp veins: distended

Answer 11

increased intracranial pressure

Question 12

•	Diagnosis
o	ABC FIRST
o	Vitals
o	Neuroligic exam – CT, MRI, behavioral assessments, lab
•	Assessments
o	Neuro check every 2 hours
	If loss of consciousness, hospitalize until stable
	LOC check

Answer 12

head injuries

Question 13

•	clinical manifestations
o	Headache, vomiting, ataxia
o	Seizures, visual disturbances, increased intracranial pressure, vomiting
o	Hydrocephalus
o	Nystagmus
o	Behavior changes, poor school performance
•	treatment/interventions
o	Surgery, radiation and chemotherapy
o	Many complications
•	Assessments
o	Monitor for neuro status changes

Answer 13

brain tumors

Question 14

• Treatment/interventions
o Treat with abx
o Treat s/s like headaches, fever, malaise

Answer 14

meningitis

Question 15

•	clinical manifestations: 
o	Shortening of femur
o	Uneven thigh and gluteal folds
o	Hip “click”
o	Limited abduction on affected side

Answer 15

dysplasia of hip

Question 16

• Diagnosis
o X-ray, MRI, CT
• nursing interventions
o check lungs for compromise
o exercise and stretching for mild scolisos
o therapeutic brace – monitor skin breakdown, must wear 23/24 hours
o spinal fusion for severe: log rolling, pain management, postop hemorrhage, assess bowel sounds, monitor for infection

Answer 16

scoliosis

Question 17

sac contains meninges and spinal fluid but no neural elemnts of neurologic deficits

Answer 17

meningocele

Question 18

neural tube fails to close, may be anywhere along spinal column, may be diagnosed prenatally or at birth – sac contains meninges, spinal fluid and nerves

Answer 18

myelomeningocele

Question 19

• Positioning
o KEEP PRONE and turn head to one side to feed
• treatment/interventions
o prevent infection – sterile moist environment and watch for skin breakdown

Answer 19

Meningocele/Myelomeningocele

Question 20

• teaching interventions (foods)
o banana, avocado, kiwi, chestnuts can have cross reactions
o increase in severity when it comes in contact with mucous membranes, wet skin, blood stream or airway

Answer 20

latex allergies

Question 21

• nursing interventions: comfortable positioning – support affected limb, pain meds, admin antibiotics, diversional activities (on strict bedrest)
• assessments: vitals

Answer 21

osteomyelitis

Question 22

• teaching interventions
o ESR lab values may be elevated
o
• Management
o Goal: control pain, preserve ROM, minimize inflammation and deformity of joints, promote normal growth/development
o Splits
o Comfort measures, dietary management (steroids, NSAIDS, methotrexate)

Answer 22

juvenile idiopathic arthritis

Question 23

• Treatment/interventions
o Goals: establish locomotion, communication, self help skills, gain optimal appearance and integration of motor function, correct associated defects, provide educational opportunities adapted to needs/capabilities, promote socialization experiences
o Long term PT
o Adaptive equipment (walkers, crutches)
o Botulinum toxin A – helps reduce spasticity in targeted muscles
• dietary needs
o spastic CP needs higher calories due to contraction of muscles

Answer 23

cerebral palsy

Question 24

• associated defects
o short head, flat forehead, short limbs, wide neck, epicanthal folds, hands short and wide simian crease, moro reflect absent
o congenital heart defects, diabetes, leukemia and hearing loss
• teaching interventions
o provide emotional support

Answer 24

downs

Question 25

• rate of healing
o Neonatal Period: 2-3 weeks
o Early Childhood: 4 weeks
o Later childhood: 6-18 weeks
o Adolescence: 8-12 weeks
• treatment/interventions
o Assess: signs of hemorrhage, LOC, neurovascular status (pulses, sensation)
o Initial intervention: Calm child and family
o Immobilize limb, cover open wounds, apply cold packs to the area
o Prepare child for X-ray, casting, surgery
o Education on casting/immobilization
 Keep elevated
 Assess fingers/toes/extremities for discoloration, sensation, movement
 Encourage light use of muscles, joint flexion and extenstion

Answer 25

fractures

Question 26

• Pathophys
o Chronic, autoimmune disease of connective tissues/blood vessels
o Inflammation in body tissues
• Treatment
o Specific medications
o Rashes, arthritis, NSAIDS, immunosuppressive agents
o Supportive care
o Goal: balance medications to avoid exacerbation and complications while preventing medication related morbidity

Answer 26

systemic lupus erythematosus

Question 27

•	Outcomes
o	Surgery
o	Chemo
o	Potential amputation
•	Interventions
o	Support family and patient
o	Honest and straightforward answers
o	Prepare for surgery
o	Education on chemotherapy
o	Discharge planning
o	Physical therapy

Answer 27

osteosarcoma

Question 28

•	Treatment/interventions
o	Radiation
o	Chemo
o	Limb salvation
o	Prep for tests, educate on chemo s/e, PT
•	Diagnosis
o	In marrow of bone

Answer 28

ewing sarcoma