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Children's Health > EXAM #4 > Flashcards

EXAM #4 Flashcards

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1
Q

What is the patho/etiology of Attention deficit hyperactivity disorder?

A

Unknown cause but we think dopamine and norepinephrine are involved

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2
Q

What clinical manifestations are seen in ADHD?

A

-Inattention
-Hyperactivity
-Impulsivity

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3
Q

What screenings are performed to dx ADHD?

A

-Medical and developmental hx
-Physical exam
-Vision and hearing
-Neuro evaluation
-Behavioral checklist
-Presentation that meets the criteria within the last 6 months

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4
Q

What medication is used for ADHD?

A

Psychostimulants methylphenidate, dextroamphetamine, amphetamine, lisdexamfetamine
-Based on symptoms not weight

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5
Q

What should be monitored when a child is on medication for ADHD?

A

The appetite. Assess weight and nutrition

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6
Q

What behavioral therapies will a child with ADHD have?

A

-Parenting skills: prevention of undesired behaviors
-Counseling
-Peer groups
-Family therapy
-Rewards

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7
Q

What is included in environmental manipulation for children with ADHD?

A

-Limit stimulation
-Testing
-Organization
-Redirection

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8
Q

What is the patho for Autism?

A

Continuum of disorders involving limitations in social relatedness, verbal & nonverbal communication, & range of interest & behaviors

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9
Q

What clinical manifestations are seen in children with Autism?

A

-Impairment in social reciprocity
-Inability to maintain eye contact
-Impaired communication
-Restrictive or repetitive behaviors, interest or activities

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10
Q

How is Autism diagnosed?

A

First signs program around 18 to 3 months

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11
Q

How is autism managed?

A

-Early interventions
-Be aware of child’s physical boundaries & reluctance to by others
-Routine very important

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12
Q

What is considered maltreatment of children?

A

Abuse and neglect of a child less than 18 years of age by anyone
-Physical, sexual, emotional

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13
Q

What are possible signs and symptoms of abuse or neglect?

A

-Suspicious injuries
-Scared of caregivers
-Fearful of going home
-Acting out
-CNS injury
-Prolonged or recurrent illness that cannot be explained
-Poor relationships
-Sexual knowledge
-Running away
-Decline in school
-Suicide
-Depression
-Hostility
-Poor hygiene
-Hunger

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14
Q

What are nursing intereventions used for maltreatment of children?

A

-Identify risk factors
-Teach parents appropriate ways to disipline the child (take away privileges, time out, praise for good behaviors)
-Teach about use of alcohol and drugs during pregnancy
-Educate children about the body and personal boundaires
-Report suspected abuse or follow agency guidelines

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15
Q

What is the patho/etiology for down syndrome?

A

Chromosomal abnormality: Trisomy 21

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16
Q

What clinical manifestations are seen with Down syndrome?

A

-Poor muscle tone
-Slanting eyes
-Hyper flexibility of the joints
-Flat bridge of the nose
-Short neck with extra folds of skin
-Small stature
-Low-set ears
-Simian crease
-Protruding tongue

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17
Q

How is down syndrome diagnosed?

A

Chromosomal blood test

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18
Q

Management of down syndrome:

A

-Assist new parents with information and resources
-Early intervention

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19
Q

What is the patho/etiology of Type 1 Diabetes?

A

-Not preventable
-Autoimmune disease that causes distruction of the pancreatic cells that produce insulin

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20
Q

What clinical manifestations are seen with T1DM?

A

-Polyuria
-Polydipsia
-Polyphagia
-Weight loss

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21
Q

How is T1DM diagnosed?

A

-Random glucose levels (>200mg/dL)
-Elevated HgBA1c every 3 months (>7)
-Increased ketones and urine glucose

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22
Q

What are s/s of hypoglycemia?

A

-Irritable
-Nervous
-Difficulty concentrating
-Shaky feelings
-Hunger
-Pallor
-Sweating
-HA
-Tachycardia
-Shallow respirations

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23
Q

What are s/s of hyperglycemia?

A

-Lethargic
-Confusion
-Double vision
-Thirst
-Weakness
-Flushed dry skin
-Deep rapid Kussmaul respirations
-Fruity acetone breath (from ketones)
-Parethesia

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24
Q

What is included in medical management for T1DM?

A

-Monitor BS and A1C
-Nutrition
-Insulin therapy
-Monitoring for complications and ketones

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25
Q

Ketones in the urine indicate…

A

insulin deficiency

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26
Q

What type of insulin is Humalog/Novolog? When is it used best?

A

Rapid acting (10 to 15 min)
-Immediately before meals or after
-Picky eaters or toddlers who do not eat the same amount each time

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27
Q

What type of insulin is Regular insulin?

A

Short acting (30 min)

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28
Q

What type of insulin is NPH insulin? When is it best taken?

A

Intermediate acting (2-4 hrs)
-Varies
-Taken in the morning but does not take effect until the afternoon

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29
Q

What type of insulin is Lantus? How long does it last? Can it be mixed?

A

Long acting (1-2hrs)
-Lasts 24 hours with steady levels
-CANNOT be mixed

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30
Q

Education for T1DM:

A

-How to count carbs
-Exercise monitor sugar before and after
-Ketone monitoring (glucose over 240 and/or child lost weight)
-Monitor blood sugar up to 6 times per day
-Follow up Q3 months
-DKA
-How to administer insulin
-Nutrition
-Sick day rules

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31
Q

What is the patho/etiology of hypothyroidism?

A

Thyroid insufficiency
-Too little thyroid hormone is produced or released

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32
Q

Clinical manifestation of hypothyroidism in an infant?

A

-Prolonged jaundice
-Poor feeder
-Constipation
-Cool/mottled skin
-Hypotonia
-Sleepiness
-Larger fontanelles
-Decreased crying
-Large thick tongue

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33
Q

Clinical manifestation of hypothyroidism in a child?

A

-Short stature
-Delays in developmental milestones
-Weight gain
-Hypotonia
-Puffy facial features
-Mental retardation
-Protruding abdomen
-Sparse, coarse, dry or brittle hair

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34
Q

How is hypothyroidism diagnosed?

A

Newborn screening: TSH levels high and low T4

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35
Q

What medication is used to treat hypothyroidism?

A

Levothyroxine

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36
Q

What education/discharge instructions should the nurse provide for hypothyroidism?

A

-Treatment plan
-Medication administration
-Milestones/development
-Labs for T4 and TSH serum levels Q 4-6mths

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37
Q

What is the patho/etiology of Type 2 diabetes?

A

The body’s resistance to recognize and use insulin

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38
Q

What are the clinical manifestations of T2DM?

A

-May have no signs
-Obesity
-Fatigue
-Frequent infections
-3 Ps

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39
Q

How is type 2 diabetes diagnosed? (risk factors)

A

-Overweight >85th percentile
+ 2 of the following risk factors
-Family Hx (1st or 2nd degree relative)
-Native American, AA, Latino, Asian, Pacific islander
-Insulin resistance (acanthosis nigricans) a dark pigment on the neck, armpits, or arms, HTN, dyslipidemia, PCOS, small for gestational age
-Maternal hx of diabetes or gestational

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40
Q

How can T2DM be prevented?

A

Healthy Lifestyle (diet, activity, healthy weight)

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41
Q

Nursing care for T2DM:

A

-Educate on management (monitoring, lifestyle, meds, A1C
-Monitor for complications (-opathys) (DKA)
-Comprehensive care with dietician, school staff, and endocrinologist

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42
Q

What medications are used for T2DM?

A

-Insulin (rapid, short, intermediate, long)
-Metformin

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43
Q

What is the patho/etiology of diabetic ketoacidosis?

A

-Hyperglycemia, ketosis, and acidosis resulting from severly deficient insulin
-Abnormal breakdown of carbs, proteins, and fats leading to high blood sugar

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44
Q

What are the clinical manifestations of DKA?

A

-Fatigue
-Malaise
-N/V
-3 Ps
-Weight loss
-Fever
-Kussmaul respirations
-Acetone odor of breath
-Tachy

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45
Q

How is DKA diagnosed?

A

-Blood glucose greater than 250 mg/dL
-Ketonuria
-Sodium bicarb less than 18 mEq/L
-pH less than 7.34 acidosis

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46
Q

How can DKA be prevented?

A

Consistent monitoring and control of blood sugars
& preventing infection

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47
Q

Nursing interventions for DKA:

A

-Restore fluid volume with Isotonic fluids
-Prevention of lipolysis
-Electrolyte replacement especially K
-Respiratory & neuro assessment
-hourly monitoring of glucose
-K every 2 to 4 hours

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48
Q

What is the patho/etiology of precocious puberty?

A

-Overactivity of the pituitary gland
-Caused by CNS abnormalities, lesions/tumors, or brain injury
-Earlier than 8 YOA

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49
Q

What are clinical manifestations of precocious puberty in boys?

A

-Facial hair
-Penile growth
-Increased masculinity
-Testicular enlargement
-Voice changes
-Axillary & public hair
-Body odor
-Acne
-Emotional lability
-Mood swings
-Growth spurts in height

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50
Q

What are clinical manifestations of precocious puberty in girls?

A

-Breast development
-Onset of menarche
-Ovary enlargement
-Cyst on ovaries
-Axillary & public hair
-Body odor
-Acne
-Emotional lability
-Mood swings
-Growth spurts in height

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51
Q

How is precocious puberty dx?

A

-Blood tests of sex hormones (LH, FSH, testosterone & estrodiol)
-CT or MRI

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52
Q

Nursing care for precocious puberty:

A

-Prevent early exposure to hormones
-Growth charts
-Blood tests
-Collaborative care with endocrinologist

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53
Q

Medical care for Precocious puberty:

A

-CNS tumor removal

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54
Q

What medication is given for precocious puberty?

A

-Gonadotropin-releasing hormone (GnRH) agonist
-Injection daily or every 3/4 weeks, every 3 mths
-Histrelin or Supprelin LA-permanent implant that released inhibitior for a year

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55
Q

What education/discharge instructions are given for precocious puberty?

A

-Psychosocial, body image
-Follow chronological age not developmental age

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56
Q

What is the patho/etiology of acne?

A

Caused by propionibacterium acnes
-Onset of adrenal androgenic hormones

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57
Q

What are the Clinical manifestations of acne?

A

-Increased sebum production
-Inflammation with papules, pustules or nodules

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58
Q

How is acne dx?

A

Skin assessment and history

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59
Q

How can we prevent acne?

A

-Avoid oil based products
-Do not touch, pick or rub acne
-Stress management

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60
Q

What education should be provided for acne?

A

-Clean gently without using oil based products
-Take medication at night
-Side effects
-Birthcontrol

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61
Q

What classes of medication is used for acne?

A

-Antimicrobials
-Retinoids
-Hormones

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62
Q

What is the patho/etiology of atopic dermatitis/eczema?

A

Associated with allergies and asthma

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63
Q

IS atopic dermatitis contagious?

A

No

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64
Q

What are the clinical manifestations of atopic dermatitis/eczema?

A

-Crusty lesion that may weep
-Red, raised, rash that is pruritic that may cause pain

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65
Q

How is atopic dermatitis/eczema dx?

A

H&P, blood test

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66
Q

Nursing care for atopic dermatitis/eczema:

A

-Monitor rash
-Warm water baths
-Avoid excessive scrubbing
-Moisturize immediatley after bathing

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67
Q

Education/discharge instructions for atopic dermatitis/eczema:

A

-Itch avoidance
-Keep nails short
-S/s of infections
-Dress in light,soft non-irritating clothing
-Identify and remove potential irritants

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68
Q

What is the patho/etiology of impetigo contagiosa?

A

-Bacterial infection caused by Staph aureus around the nose or mouth
-Not usually painful
-Highly contagious

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69
Q

What are the clinical manifestations of Impetigo?

A

-Vesicle or pustule with edema and erythema
-Lestions will then erupt leaving sticky, honey-colored exudate than turn to crust
-Itching

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70
Q

How is impetigo dx?

A

Assessment of the skin

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71
Q

How can impetigo be prevented?

A

-Good hand washing
-Keep child home for 24 hours AFTER the start of antibiotics
-Change pillow case nightly

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72
Q

What medication is used for impetigo?

A

Topical antibiotics or oral for widespread infection
-apply with a cotton tip swab

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73
Q

What is the patho/etiology of cutaneous candidiasis?

A

-Fungal infection caused by Candida albicans
-Occurs in infants and children who use corticosteroid inhalers

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74
Q

What are the clinical manifestations of oral cutaneous candidiasis?

A

Whitish gray plaques that can no be removed on the tongue or oral mucosa

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75
Q

What are the clinical manifestations of skin cutaneous candidiasis?

A

Fine, red, or pink papules with scalloped borders

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76
Q

How is cutaneous candidiasis dx?

A

-Hx
-Visualization of the lesions
-Fungal culture

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77
Q

How can cutaneous candidiasis be prevented?

A

-Clean nipples from the bottles with soap and water
-Keep diaper area dry and use barrier creams
-Rinse mouth out after corticosteroid inhalers

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78
Q

What medications are used for cutaneous candidiasis?

A

Nystatin, Clotrimazole, Miconazole

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79
Q

Nursing intervetions for cutaneous candidiasis:

A

-Apply oral medication to the inside of both cheeck with a cotton tip applicator
-Medication education

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80
Q

What is Tinea capitus?

A

Scaly pruritic patches on the scalp. May have hair loss

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81
Q

What is Tinea Corporis?

A

Round oval lesion with a maculopapular border with central clearing ringworm

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82
Q

What is Tinea Cruris?

A

Red, scaly skin that involves the inner thighs, inguinal creases, or perineal area ‘jock itch’

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83
Q

What is Tinea Pedis?

A

Red, scaly, pruritic skin that may develop weeping.
-Involves webbed area of the toe and feet, ‘athlete’s foot’

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84
Q

How are the Tinea infections dx?

A

Visual inspection using a Wood’s lamp (will be gold-yellowish color)

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85
Q

How can the Tinea infections be prevented?

A

-Check family pets
-Good handwashing
-Bathe after sports
-Do Not share towel, combs, hats or helmets

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86
Q

What medication is used for the Tinea infections?

A

Antifungals that must be taken at least 6 weeks

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87
Q

Nursing interventions for the Tinea infections:

A

-Whole family must be treated
-Complete meds
-Wear lightweight dry socks
-Clean/disinfect
-Shower/bathe

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88
Q

What is patho/etiology for contact dermatitis?

A

Occurs when allergen or irritant is encountered
-Diaper area, playing outside, jewelry, plants

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89
Q

What are clinical manifestations of contact dermatitis?

A

-Irritated, inflamed, pruritic rash
-Vesticles and bull
-Vesicles may weep serous fluid

90
Q

How is contact dermatitis dx?

A

-Hx and phyical
-Biopsy of vesicles
-Rule out impetigo and varicella

91
Q

How can contact dermatitis be prevented?

A

-Wear pants and long sleeves
-Avoid known allergens
-Wash well

92
Q

What medications are used for contact dermatitis?

A

Antipuritic, oral, or topical steroids

93
Q

Nursing interventions for contact dermatitis:

A

Cool baths and frequent diaper changes for infants

94
Q

What is the patho/etiology of pediculosis capitis?

A

-Scalp, body, pubic
-Lice pierce the skin and suck the blood

95
Q

What are the clinical manifestations for pediculosis capitis?

A

-lice near the nape of the neck and ears
-Louse eggs
-Pearlescent teardrop in shape
-Florescent blue under a Wood’s lamp

96
Q

What medication is used to treat pediculosis capitis?

A

-Permethrin 1%

97
Q

Patient education for pediculosis capitis:

A

-Wash hair according to shampoo instructions
-Olive oil
-Clean all hats, helmets and toys
-Wash everything is boiling water
-Stay home until lice-free
-Recheck in 7 to10 days
-If item cannot be washed, bag it and leave it for 14 days

98
Q

What does a mosquito bite look like?

A

-Red, edematous papule
-Pruritic
-Burning pain

99
Q

What does a spider bite look like?

A

-Red, edematous papule, wheal or pustule often solitary
-Pruritc
-Mild to severe pain
-Local necrosis

100
Q

What does a tick bite look like?

A

-Small redish area that may be raised
-Sometimes pruritic

101
Q

What does a bee, wasp sting look like?

A

-Red edematous papule
-Pain
-Allergic reaction: hives, flushing, angioedema or wheezing

102
Q

How bug bites be prevented?

A

-Wear light-colored clothing with minimal scents
-Cover skin
-Use bug repellant
-Do not play in dead foliage or live, blooming foliage
-Playing in the woods is okay but check for ticks

103
Q

What type of medication is used for bites and stings?

A

Allergy meds

104
Q

Nursing interventions for bites and stings:

A

-Clean with soap and water
-monitor for secondary signs of infection

105
Q

Patient education for bites and stings:

A

-Remove stingers
-Use repellants
-Remove ticks and save them

106
Q

What are clinical manifestations of dog bites?

A

-Scratches and abrasions
-Deep lacerations or punctures
-Crushing tissue and bone injury including never/tissue/muscle and bone

107
Q

What are clinical manifestations of cat bites?

A

-Scratches and abrasions
-Puncture like bites
-Complications such as cat scratch disease, osteomyelitis, and septic arthritis

108
Q

Medical management for animal bites:

A

Antibiotics and suture larger wounds

109
Q

Nursing interventions for animal bites:

A

-Hx
-Clean with soap and water
-Topical antibiotics and clean dressing
-Tetanus booster

110
Q

What are clinical manifestations of human bites?

A

-Teeth marks without penetration
-Cutting or piercing of the skin
-Brusing, swelling tenderness
-Erthema, pain, or fever

111
Q

Nursing interventions for human bites:

A

-Hx
-Irrigate wound
-Topical antibiotics
-Dress wound
-Elevate extremity
-Monitor for infection

112
Q

Patient education for human bites:

A

Notify family about the risk for blood-borne diseases
-Wound care
-Signs of infections
-Take antibiotics as directed

113
Q

What is the patho/etiology of cat scratch disease?

A

-From cat scratch or bite. When the saliva penetrates the human skin
-Lasts 6-12 weeks

114
Q

What are the clinical manifestations of cat scratch disease?

A

-3-10 days
-Papule/vesicle
-Tender lymphadenopathy (head, neck, and or upper limbs)
-HA
-General malaise and low-grade fever

115
Q

How is cat scratch disease dx?

A

H&P with lab work (biopsy of lymph node)

116
Q

Nursing interventions for cat scratch disease:

A

-Wound care
-Assess lymph nodes & complications like hepatomegaly
-Hand hygiene

117
Q

What are thermal burn types?

A

-Flame: fire
-Flash: Explosions
-Scald: Hot liquid or steam
-Contact: touching a hot object

118
Q

What is a radiation burn?

A

Sunburn, radiation therapy, radioactive material

119
Q

What is a chemical burn?

A

Corrosive chemical (lye, ammonia, sulfuric acid)

120
Q

What is an electrical burn?

A

Electricity (chewing, touching power lines, inserting something into an outlet

121
Q

What is a superficial burn?

A

-Erthema and pain for 2-3 days
-Intact epidermis without blisters
-Peeling of skin
-Heals without scarring

122
Q

What is a superficial partial burn?

A

-Erthema and blister formation that may weep
-Bleeds easily and is very painful
-Damage to epidermis and the outer portion of the dermis
-Heals within 3 weeks
-Scarring will occur

123
Q

What is a deep partial burn?

A

-White or pale color to injured tissue
-Huge blisters
-Extremely painful
-Heals in 3-9 weeks
-scarring will occur
-Excision and grafting occur

124
Q

What is a full thickness burn?

A

-Destroys dermis and epidermis
-Eschar is visible
-May damage nerves, bone and muscle

125
Q

How is the size/extend of a burn measured?

A

Rule of nines: adolescents
Lund & Browder chart: pedi

126
Q

What are the 3 phases of burns?

A

-Burn shock/resusciatative: 1st 24-48 hours after injury, characterized by shock
-Recovery/wound healing: Close the wound as quickly as possible
-Rehabilitative: Prevent scar contractures. Enable child to reenter their social environment

127
Q

What is included in a burn assessment?

A

-Hx
-Remove clothing, jewelry
-Cover with blankets
-Assess depth, surface area and severity

128
Q

Children with about what percent of TBSA will need fluid resuscitation?

A

10%

129
Q

Chilren who are 15%< of TBSA are at risk for…

A

hypovolemic shock and cellular shock

130
Q

What is the urine output goal during the resuscitation phase?

A

0.5 to 1ml/kg/hr

131
Q

How often should dressing changes occur fro burns?

A

Once or twice daily

132
Q

Pain mangement for burns:

A

Central lines
-Pain meds 20 to 30 minutes before dressing changes
-Diversion activities
-Child can participate

133
Q

Circulation mangement for burns:

A

-Assess circulation to extremeties
-Decompression
-Fasciotomy & escharotomy
-Balanced diet and biweekly weigh ins
-TPN for those who cannot handle oral nutrition

134
Q

Pruritis management in burns:

A

Cool the burn scar

135
Q

What nursing interventions occur during the rehabilitation phase?

A

-Positioning and splinting
-Start active ROM
-Regular massages
-Pressure garments

136
Q

What is the patho/etiology of inhalation burns:

A

Burns of the airway
-Causes the lungs to fill up with fluid, causing sudden acute pulmonary edema

137
Q

What are the clinical manifestations of inhalation injuries

A

-Singed eyebrows, nasal hairs
-Stridor
-Hoarseness
-Burns around the nose or the mouth
-Edematous lips
-Hypoxemia
-HX

138
Q

How are inhalation injuries dx?

A

-H&P
-Symptoms of sudden acute pulmonary edema
-Sleep obstructive apnea
-Dyspneaworsens when lying down
-Weezing & gasping for air

139
Q

Medication management for inhalation injuries:

A

Early intubation and ventilation

140
Q

Nursing interventions for inhalation injuries:

A

-Assess respiratory function
-Minimize development of pneumonia
-Frequent turning
-Chest physiotherapy

141
Q

Clinical manifestations of chemical burns:

A

Mimick skin conditions (dermatitis)

142
Q

Nursing management for chemical burns:

A

Priority: Remove the chemical by diluting or brush off
Do NOT use another chemical
-Monitor for renal failure
-Watch blood pressure

143
Q

What is the 6 Cs for burns?

A

Used for minor burns
-Clothing: remove any clothing that is hot or has chemicals
-Cooling: Use cool saline soaked gauze. NO ice
-Cleaning: Wash with mild soap and water
-Chemoprophylaxis: Bacitracin & Tetanus booster
-Covering: Cover with nonadherent gauze
-Comfort: Give acetaminophen or ibuprofen to decrease pain

144
Q

What is the patho/etiology of Phenylketonuria (PKU)?

A

Autosomal recessive gene
-Inherited error in metabolism lacks an enzyme
-No prevention

145
Q

What are the s/s of PKU?

A

No symptoms at birth
-Developmental delays
-Intelectual disabilities
-Seizures

146
Q

How is PKU dx?

A

Metabolic newborn screening

147
Q

How is PKU treated?

A

-Phenylalanine-free diet (eliminate proteins)
-No milk for formula
-No meat, dairy, nuts, eggs, dry beans or aspartame
-In moderation: cereal, fruits, veggies

148
Q

What is the pato/etiology of anemia?

A

Decreased circulating RBCs decrease the oxygen-carrying capacity of the blood

149
Q

What are the clinical manifestations of anemia?

A

-Fatigue
-SOB
-Lethargy
-Tachycardia
-Pale skin
-Irritability
-Dizziness

150
Q

How is anemia dx?

A

-H&P
-CBC
-Reticulocyte count (shows how fast the body is making RBCs)

151
Q

Nursing care for anemia:

A

-Responsible for blood transfusions
-Diet or supplements

152
Q

Education/discharge instructions for anemia:

A

-Education on s/s of anemia
-Administration of iron
-Quiet play, frequent rest periods

153
Q

What is the patho/etiology of iron deficiency anemia?

A

-Decreased iron supply
-Increased iron demands
-Blood loss

154
Q

What are the clinical manifestations of iron deficiency anemia?

A

-Irritability
-Fatigue
-Delayed motor development
-Tachycardia
-Shortness of breath
-Pale skin/conjunctival pallor

155
Q

Management requirements for iron deficiency anemia:

A

-Iron-rich foods
-Iron supplementation (no milk)
-Lab work Q 3mths

156
Q

Education for iron deficiency anemia: Infant and feedings

A

-Breast milk or iron-fortified formula until 12 months of age
-Iron-fortified cereal from 6-12 months of age
-No cow’s milk before 12 months.
-After 12 months, limit cow’s milk
-Give supplements inbetween meals
-May stain teeth

157
Q

What is the patho/etiology of sickle cell anemia?

A

Autosomal recessive
C or S-shaped RBC’s

158
Q

What are the clinical manifestations of sickle cell anemia?

A

-Pain
-Weakness
-Pallor
-Fatigue
-Tissue hypoxia due to obstruction

159
Q

How is sickle cell anemia dx?

A

-In utero - chorionic villus biopsy
-Newborn screening
-H & P
-Hemoglobin electrophoresis

160
Q

Nursing interventions for sickle cell anemia: Think HOP

A

Hydration, oxygentation & pain control (PCA pump)
-Respiratory status

161
Q

Education for sickle cell anemia:

A

-Chronic illness (get vaccines)
-S/S of sickle cell crisis
-Prevention of complications
-Adequate hydration

162
Q

What are some Precipitating Factors for sickle cell anemia?

A

Anything that increases the body’s need for oxygen or alters the transport of oxygen
Trauma
Infection, fever
Physical and emotional stress
Dehydration
Hypoxia
Altitude

163
Q

What is a Vaso-occlusive thrombotic crisis?

A

-Pain crisis
-Ischemia causing mild to severe pain
-Stasis of blood leads to ischemia & then infarction
-Signs: Fever, pain, tissue engorgement

164
Q

What is an Aplastic crisis crisis?

A

-Diminished production and increased destruction of RBCs (usually after removing spleen)
-Viral infection
-Signs: paleness, lethargy, headache, fever, anemia, fainting, recent illness

165
Q

What is a Splenic sequestration crisis?

A

-Intrasplenic pooling of large amounts of blood
-5 mo-2yrs
-Life-threatening: death can occur within hours
-Signs: profound anemia, hypovolemia, and shock

166
Q

What is an Acute chest syndrome crisis?

A

-Lower level of oxygen in the blood
-Similar to pneumonia with the presence of new pulmonary Infiltrates
-Signs: chest pain, tachypnea, fever, wheezing, cough, hypoxia

167
Q

What is the patho/etiology of hemophilia?

A

The coagulation process cannot be completed, so bleeding is prolonged
Type 1: deficiency of factor VIII

168
Q

What are the clinical manifestations of hemophilia?

A

-Brusing
-Excessive bleeding
-Swelling and stiffness of the joints with pain

169
Q

How is hemophilia dx?

A

-PT/PTT
-Direct assay of plasma factor activity level for hemophilia A and B

170
Q

How is hemophilia managed?

A

-Prompt treatment
-Patient safety, prevention of complications
-Factor Replacement

171
Q

Education for hemophilia:

A

-Administration of factor via IV
-Prevent bleeding
-Monitor patient for s/s of a cerebral bleed
-Close supervision and a safe environment
-Superficial bleeding: apply pressure for at least 15 minutes +RICE
-If significant bleeding occurs, transfuse for factor replacement
-Avoid contact sports

172
Q

What is the patho/etiology of neutropenia?

A

Absolute neutrophil count
< 1,000/L in infants
<1,500/L for those older than 1 yr

173
Q

What are the clinical manifestations of neutropenia?

A

-Fever
-Lymphadenopathy
-Pallor
-Bruising
-Petechiae
-Organomeagaly

174
Q

How is neutropenia dx?

A

-H & P
-CBC with diff
-Peripheral smear
-Possible bone marrow aspiration

175
Q

What precautions are neutropenia patients under?

A

Neutropenic

176
Q

Nursing care for neutropenia:

A

-Monitoring for infection
-Evaluating ANC
-Administration of antibiotics

177
Q

Medical care for neutropenia:

A

-Colony-stimulating factors
-Bone marrow transplant

178
Q

Education/discharge instructions for neutropenia:

A

-Handwashing
-Monitor temperature, not rectally
-Oral hygiene using soft toothbrush

179
Q

Pretransfusion, Starting the transfusion, During, After blood transfusions:

A

-Pretransfusion
Get vitals, verify orders, call for blood, must hang within 30 minutes, can only hang for 4 hours, follow facility policy for checking blood
-Starting the transfusion
Get vitals, start the infusion, and monitor in the room for 15 minutes for adverse reaction
-During
Monitor vitals signs for adverse reaction, DO NOT add anything to the blood
-After
Save the bag for an hour, complete paperwork

180
Q

What should the nurse do when there is a transfusion reaction?

A

-Stop the transfusion
-Monitor vital signs
-Call the MD

181
Q

Cancer is caused by one or a combination of what 3 factors?

A

-External or environmental stimuli
-Viruses that can alter the immune system and allow cancer growth
-Chromosomal and gene abnormalities

182
Q

What are some consequences of cancer treatments?

A

-High-tone hearing loss may be a side effect of cisplatin
-Loss of speech
-Impairment of depth perception
-Increased response time
-Lung problems caused by scarring of lung tissue or reduction in lung elasticity
-Shortness of breath
-Reduced exercise capacity
-Kidney problems: Bleeding, Damage to tubules, Protein wasting
-Musculoskeletal defects involving bones or soft tissue and teeth
-Functional and/or mobility deficits may persist if amputation is performed
-Hormonal abnormalities

183
Q

What is the Etiology/patho of acute lymphocytic leukemia?

A

-Affects mostly immature, undifferentiated cells
-Leukemia is an overproduction of WBCs

184
Q

What are the clinical manifestations of ALL?

A

-Vague feelings resembling the flu
-Abnormal blood counts
-Anemia
-Easy bruising
-Petechia
-Fever
-Infection
-“Blueberry muffin” lesions
-Signs & labs consistent with DIC

185
Q

How is ALL dx?

A

Bone marrow aspiration

186
Q

Education for ALL:

A

-infection s/s
-Monitor for brusing if counts are low

187
Q

Treatment phases for ALL:

A

1: Remission-induction: reduce tumor to undetectable size
Multiple Chemo drugs for 4 weeks
CNS prophylaxis
Outpatient once stable
2: Consolidation: destroy any residual leukemic cells
Chemotherapy administered in high doses
Not hospitalized
Radiation may be required
3: Maintenance: control leukemia
Can last for 2–3 years after diagnosis
Usually carried out in an outpatient setting

188
Q

What is the patho/etiology of neuroblastoma?

A

-Tumor of nerve tissue that forms the sympathetic nervous system
-Most commonly develops in the abdomen

189
Q

What are the clinical manifestations of neuroblastoma?

A

-Palpation of mass
-Crosses the midline
-Edema in lower extremities if severe

190
Q

How are neuroblastomas dx?

A

-CT/MRI
-Biopsy of tumor
-Bone marrow aspiration
-Lab studies

191
Q

How are neuroblastomas tx?

A

-Comfort and pain control
-Surgical resection is performed initially
-In advanced cases, chemo is initiated
-Radiation

192
Q

What is the patho/etiology of Wilm’s tumor?

A

Originates in one or both kidneys

193
Q

What are the clinical manifestations of Wilm’s tumor?

A

-Palpable mass
-Does not cross the midline
-Painless
-Hematuria hypertension occurs infrequently

194
Q

How is a Wilm’s tumor dx?

A

-Lab work
-Renal or abdominal ultrasound
-CT/MRI
-CXR if metastasis is suspected

195
Q

Nursing care for Wilm’s tumor:

A

-Sign stating “No abdominal palpation” above the bed
-Intake and output of urine

196
Q

Medical care for Wilm’s tumor:

A

-Chemotherapy and post-radiation care
-Surgical removal of the mass

197
Q

What are the clinical manifestations of retinoblastoma?

A

-Strabismus, red painful eyes
Whitish glow in the pupil
-An inward or outward turning of the eye
-Visual impairment/Blindness
-Abnormal appearance of the eye

198
Q

How is a retinoblastoma dx?

A

-Examination using an ophthalmoscope
-Orbital ultrasound and CT or MRI

199
Q

How is a retinoblastoma managed?

A

Primary enucleation

200
Q

Education/discharge instructions for retinoblastoma:

A

-Discharged 3-4 days after surgery
-Teach care of eye socket
-After 3 weeks, child is fitted for a prosthetic eye

201
Q

What is the patho/etiology of osteosarcoma?

A

-A bone tumor usually occurs in the metaphysis
-More common in long bones

202
Q

What are the clinical manifestations of osteosarcoma?

A

-Swelling and pain
-Pain increases with activity
-Limp
-Dull, aching pain for several months
-Palpation reveals tenderness, swelling, warmth, and erythema

203
Q

How is osteosarcoma dx?

A

-X-ray
-Chest x-ray to check for metastasis
-MRI/Nuclear Scan
-Lab tests
-Biopsy

204
Q

How is osteosarcoma managed?

A

-Pain Management
-Promote function and mobility
-Monitor surgical site for s/s of infection
-Chemotherapy
-Surgical resection of the affected bone or limb-sparing surgery
-Quiet activities
-Body image concerns: issues of adolescents

205
Q

What is the patho/etiology of Ewing’s sarcoma?

A

-Bone and soft tissue
-Middle of bones, most often the femur, pelvis, ribs, and upper arms
-More often seen in males

206
Q

What are the clinical manifestations of Ewing’s sarcoma?

A

-Pain and swelling at the tumor site
-Systemic manifestations: fever or weight loss

207
Q

How is Ewing’s sarcoma dx?

A

-Biopsy
-CT, MRI, bone scan

208
Q

How is Ewing’s sarcoma managed?

A

-Assessment of unusual swelling
-Multiagent chemotherapy
-Radiation therapy
-Surgical resection is preferred if possible
-Quiet activities

209
Q

What is the patho/etiology of Hodgkin’s lymphoma?

A

-Cancer of the lymph system
-Painless, firm, cervical, or supraclavicular lymphadenopathy

210
Q

What are the clinical manifestations of Hodgkin’s lymphoma?

A

-Swollen, firm lymph nodes
-Anterior mediastinal mass is present
-Unexplained fever
-Weight loss
-Night sweats

211
Q

How is Hodgkin’s lymphoma dx?

A

-Biopsy of lymph node
-Reed-Sternburg Cells
-MRI, X-ray, CT scan

212
Q

How is Hodgkin’s lymphoma managed?

A

-Monitor for fever
-Manage pain
-Comfort measures
-Treatment includes radiation and/or chemotherapy
-Quiet activities

213
Q

What is the patho/etiology of Non-hodgkin’s lymphoma?

A

-Cancer of the lymph system
-Different from HL in that there is no single focal origin
-Rapid onset with widespread involvement

214
Q

What is the clinical manifestation of Non-hodgkin’s lymphoma?

A

Pain or swelling

215
Q

How is Non-hodgkin’s lymphoma dx?

A

-Tissue diagnosis and staging
-Elevated serum lactic dehydrogenase
-CT or MRI

216
Q

How is Non-hodgkin’s lymphoma managed?

A

-Assess breathing and chest pain
-Pain management
-Support family
-Aggressive, multiagent chemo as soon as possible
-Intrathecal chemo
-Monitor child for pain, fever, infection, enlarged lymph nodes
-Teach parents to monitor for difficulty breathing

217
Q

How will a toddler react to death?

A

Based on parent’s reactions
Knows something is wrong
Unable to separate fact from fantasy
Death means separation from the parent and is reversible

218
Q

How will a preschooler react to death?

A

Understands changes in their body and something is wrong but lacks vocabulary
Fear of death can be present as early as 3 years

219
Q

How will a school aged child react to death?

A

Realistic understanding but is limited by their ability to understand the concept of time
By age 8-9 years, understands death is permanent

220
Q

How will an adolescent react to death?

A

Understands at the adult level but lacks the EMOTIONAL MATURITY to face death
Believe death can be defeated

221
Q

What are the signs of impending death?

A

Decreased heart rate
Decreased appetite
Slurred speech
Lack of thirst despite a dry mouth

Children's Health (4 decks)

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