Exam 4 Flashcards by Cassada Gillis

What are the 4 defects in Tetralogy of Fallot?

1.Pulmonary stenosis 2.Ventricular septal defect 3.Right ventricular hypertrophy 4. overriding aorta

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What is the most common clinical manifestation of coarctation of aorta?

The BP in the arms is 20mm Hg higher than that of the legs

hypertension upper extremities

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Why would iron deficiency anemia not be diagnosed earlier than approx. 6 months of age?

When the maternal stores of iron become depleted

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What medication(s) is/are given to treat iron-deficiency anemia?

Fer-in-sol (ferrous sulfate)

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What causes the pain of sickle cell anemia?

The clumping of sickled cells; destructed blood flow to the area

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What measures can be taken to reduce the risk of sickle cell crisis?

Maintaining adequate hydration to prevent further sickling, administering analgesics as ordered.

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What lab test is abnormal for the child with hemophilia?

PT , PTT

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What is the most effective therapy for maintaining remission of acute lymphatic leukemia?

Daily doses of (6-mp) 6-meracaptopurine, weekly doses of methotrexate, and monthly doses of prednisone and vincristine for 2-3 years long term chemotherapy

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The severity of infant respiratory distress syndrome is most influenced by what factor?

deficiency of surfactant gestational age-the younger the age, the less surfactant

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Know the expected oxygen levels for an oxygen tent? (remember low levels of oxygen can cause restlessness)

high cool mist humidity with low concentration oxygen (30%) by mist tent increase oxygenation

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Why is the child with laryngotracheobronchitis kept NPO?

Because the typically rapid respiration predispose to aspiration

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What is the danger associated with acute epiglottitis?

epiglottal spasm, and stopped breathing airway obstruction

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what preventative measures are there for pneumonia during childhood?

get pneumonia vaccine

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In what position should the child NOT be put in to help reduce the risk of SIDS?

prone position

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How should the nurse interact with parents of an infant who has just died of SIDS? What feelings should the nurse help allay?

Offer to stay with the family, or allow them private if they wish. pack the baby’s belongings and give them to the family on their departure. Ensure that the parents’ last moments with their infant are quiet and as meaningful as possible support them and not feel guilty

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What is the mainstay of therapy for the child with cystic fibrosis?

pulmonary therapy and chest physiotherapy

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What is the underlying pathophysiology of cystic fibrosis?

excessive thick mucus that obstructs the lungs and the GI system pulmonary failure

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What is the best time to administer pancreatic enzymes for the child with cystic fibrosis?

before meals and snacks

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What implement should be avoided immediately following repair of a cleft lip and palate?

DON’T use spoons , forks, and straws

USE cup feeding dropper and syringe

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What is an appropriate nursing diagnosis for the parents of an infant born with a clef lip and palate?

risk for impaired attatchment

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What are the long-term complications of cleft lip and palate?

speech impairment and middle ear infections and faulty dentition

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How does the nurse measure output for an infant with dehydration?

Weigh wet diapers. By subtracting the weight (in grams) of a dry diaper from the weight of the wet diaper, you will be able to calculate the actual fluid content of the diaper

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A child has been rehydrated after a bout of diarrhea. what foods would be nonirritating to the bowel and appropriate to feed this child?

Bananas, rice, applesauce, vegetable juice, crackers, pretzels and toast (BRAT diet modified)

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How is gastroesophageal reflux (GER) treated within the first week of life?

small frequent meals, head elevated at least 30degrees , thicken with cereal

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What are the expected assessment findings of the child with hypertrophic pyloric stenosis?

PROJECTILE VOMITING, weight loss, palpable olive shape mass at the midline.

What is the hallmark sign of intussuseption?

currant jelly stools (feces that is mixed with blood and mucus from the intestinal mucosa)

What is the pathophysiology of Hirschsprung's disease?

Absence of innervation to a segment of the bowel. the lower portion of the sigmoid colon just above the anus is affected (megacolon)

What are the treatments for acute glomerulonephritis

bed rest and adequate nutrition. A diet of restricted fluids, sodium, potassium and phosphate

What are the priority nursing Dx for a 4 year old with nephrosis?

IDK

Why is it critical to place a newborn baby on oral thyroid replacement therapy if he has hypothyroidism?

To avoid permanent cognitive (the process of knowing) impairment

A Pavlik harness for dev. hip dysplasia holds the femurs in what position?

abduction

A teenager in a body cast for Tx of scoliosis would have what nursing Dx as a priority?

Disturbed body image r/t body's appearance, anything to improve appearance

How often are the casts changed for a newborn with talipes (clubfoot)?

weekly

Know the description of Gower's sign in a child with Duchenne's muscular dystrophy.

The child lies on the side and flexes the knees (or gets on all fours), then extends the knees and uses the hands to "walk up" the thighs

KNow the classical signs of meningeal irritation

positive Kernig's sign (resistance to knee extension in the supine position with the hips and knees flexed against the torso) and a positive Brudinski's sign (flexion of the knees and hips when the neck is flexed rapidly onto the chest ** and photophobia**

How long must a child with meningitis be on antibiotic therapy before they can come out of isolation?

at least 24 hrs after initiating antibiotics

What are the priority interventions for a 4 year old child with cerebral palsy

impaired physical mobility, r/t neuromuscular impairment

What is the nursing intervention for caring for the lesion of the newborn with myleomeningocele? (spina bifida)

1. position child on abdomen 2. cover sac with sterile, saline-soaked gauze 3. protect sac from contact with feces and urine

What additional congenital malformation is expected in 80% of infants with a myelomeningocele?

hydrocephalus

in lead poisoning, when lead levels exceed the amt that can be absorbed by bones, what condition results?

anemia

What is the Tx for the scaly patches on the top of an infant with cradle cap?

applying mineral oil to soften the affected areas and help loosen crusts, followed by shampooing with a mild, tear-free shampoo and thoughly rinsing

What are the precautions an adolescent female on Accutane must take

contraceptive methods during Tx and for 1 month after Tx

For how long must the baby take nystatin when he/she has trust

full 7 day course

What are early signs of varicella?

low grade fever, anorexia, malaise-24hrs

When is the child no longer contagious after having varicella

10-21 days

How should zinc oxide used to treat diaper rash be removed

use mineral oil

How should a child be positioned after myringotomy

laying on the affected side

What are the s/s of otitis media?

pulling, tugging or rubbing the affected ear of rolling the head from side to side

What actions of the child might cause him to become cyanotic with a ventricular septal defect

crying vigorosly

What are the priority skills for a 5year old who is cognitively impaired to master?

IDK

KNow the 4 levels of cognitive impairment and the IQ associated with each

1. mild (educatable cognitive impaired) IQ of 50 or 55 to approx. 70; 2. moderate (trainable cognitive impaired) IQ of 35 or 40 to 50-55; 3. severe IQ of 20-25 or 25-35 or 40; 4. profound IQ below 25

What is the major criterion for Dx a child as cognitively impaired

IDK

What are the priority nursing interventions to support the family of a cognitively impaired child ? promoting optimal dev. and providing the family with support , education and referrals

IDK

What is the etiology/pathophysiology of Down syndrome?

Extra chromosomes on the twenty-first pair, hence the term trisomy 21

What other defects often occur in children with Down syndrome?

small, ronded skull with a flat occiput; upward slanting eyes with epicanthal folds; broad, flat nose; protruding tongue; short, thick neck; hypotonic extremities; mottled skin; low set ears; and a simian crease on the palmar side of the hands

What assessment findings are found in a child with Down syndrome?

Strengths in viual processing over auditory, weaknesses in grammar and language, delays in motor dev.

What is the broader term for child abuse and neglect

child maltreatment

What observations might make the nurse suspect child abuse if the child has a fracture

inconsistent with the parent of caretaker's explanation of how the injury was incurred

A child from southeast Asia with enuresis has several areas of small burns that are healing. how should the nurse inquire about the burns?

ask question to the child and parent(s) separately, regarding the burns

When communicating with parents suspected of child abuse, how should the nurse interact with them?

To maintain a nonjudgmental attitude towards to parent to caregivers

When is it necessary for the nurse to report child abuse?

during the child's health care visits, when you observe behaviors that indicate a lack of understanding of the child's care or when assessing the support systems available to the family in stress

How should the nurse suggest the parents help the child who is demonstrating school avoidance?

be firm in the morning if the child is refusing to go to school

When counseling the parents of the child with ADHD, the nurse recognizes that it is important to do what?

It is important to allay any inappropriate feelings of guilt or responsibility the parents might have

Know how to counsel the parent of a child who is taking Ritalin. What are the expected effects? When should it be given, etc.

Insomnia, decrease in appetite, abd pain, dazed of withdrawn behavior, worsening of behaviors as medication wears off, and the dev. of tics in the morning

How frequently should the child taking medication for ADHD be evaluated for side effects?

every 6 months

What are some of the causes of depression in children? Or what increases the risk of depression in children?

Demonstrate sad facial expressions, irritability, crying easily, accidents proneness, social withdrawal, eating and sleeping disturbances

In a team approach, what is the nurse's responsibility when a depressed child is admitted to the hospital?

IDk

Suicide is which leading cause of death for 15-19 year olds on the US

third leading cause

To prevent suicide, the school nurse knows that it is imperative to report any _____?

IDK

What question is it important to ask a depressed adolescent when doing the initial assessment (think suicide prevention)

be direct by asking about thoughts of death or suicide, when the thoughts occur, how long these thoughts lasted and whether the pt has a plan

What is the usual attempted suicide method for females? for males?

Females: medication ingested or carbon monoxide poisioning males: hanging, firearms, or wrist slashing

When a depressed teen who has attempted suicide is placed on antidepressants, of what danger should the parents be warned?

could have higher risk of suicide bc their energy increases

For how long before a suicide attempt would symptoms such as depression, loneliness, and sleep disturbances most likely be present?

1 month before suicide or attempt

Recurrent abd pain is most often seen in school-age or adolescent children. for what problems does the nurse assess closely?

consider organic causes- such as infections of the urinary tract, the GI tract and the reproductive tract

What associated symptoms does the nurse expect with recurrent abd pain?

afebrile, occasional vomiting and constipation. Episodic periumbilical or epigastric pain that is unrelated to eating, defecation or exercise