final exam Flashcards
Malabsorption d/t decreased mucosal area?
SBS
Barrel chest indicates?
Severe obstructive lung disease (CF, asthma)
When does heart begin to form in utero?
4th week
Initial management after delivery of infant with omphalocele?
InspectionIf bowel covering is intact, a nonadherent dressing is placed over the defect. If exposed, the contents are covered with a bowel bag or moist dressings and plastic drape to prevent excessive fluid loss, drying, and temp instability.IVF and ABXgastric bowel decompression - with silastic double-lumen cath (NG-OG)
Diaphragmatic differences in infants under 5 years of age?
Diaphragmatic abdominal breathing
When is heart completely formed in utero?
8th week
Most common cause of intestinal obstruction in children b/w ages 3 months and 3 years?
Intussusception
When are respirations (ventilations) best to assess and best determined in a child/infant?
While sleeping or quietly awake
Fetal circulation
Brain-needs highest O2 concentrationLungs - nonfunctionalLiver - partially functional*Fetus needs < blood in liver/lungs
The DX of HPS is PRIMARILY based on?
H&P - PRIMARY -projectile vomiting, olive shaped massU/S - 2nd choiceUpper GI radiography - 3rd choice
When should an infant be able to hold their head up?
4-5 mo
Most common manifestation of GER during infancy?
Passive regurgitation or emesis
Tachypnea often occurs with?
AnxietyElevated tempSevere anemiaMetabolic acidosisMAY be assoc. w/resp alkalosis d/t psychoneurosis and w/CNS disturbances.
Occurs when the abd contents herniate through the umbilical ring, usually with an intact sac?
Omphalocele
Hyperpnea is assoc. with?
FeverSevere anemiaRespiratory alkalosis assoc. w/psychosisCNS disturbancesResp acidosis that accompanies DKA/diarrhea
Leading cause of death in children under the age of 15?
CA
Most common site of intussusception?
Ileocecal valve (ileocolic)
Head bobbing in a sleeping or exhausted infant is a sign of ?
Dyspnea
When does GER most frequently occur?
After meals and at night
COMMON causes of stridor?
CroupEpiglottitisFBTracheitis
Clinical manifestations of Intussusception?
Sudden acute abd painchild screaming and drawing knees to chestchild appearing normal & comfortable b/w episodesvomitinglethargypassage of red, currant jelly-like stoolsTender distended abdpalpable sausage shaped mass in RUQEmpty RLQeventual s/s of peritonitis (fever, prostration, etc)
Grunting in older children is frequently a sign of?
Pain, suggesting pneumonia or pleural involvement.
SBS prognosis?
Improved with advances in PN and enteral nutrition.Intact Ileocecal valve improves prognosis
GRUNTING from an infant or newborn is a characteristic sign of?
Respiratory distress
An infant with SBS will be discharged home on TPN and gastrostomy feedings. Nursing care should include which of the following?
A. Prepare family for impending death.
B. Teach family how to calculate caloric needs.
C. Ensure that family can identify signs of central venous catheter infections.
D. Secure TPN and gastrostomy tubing under diaper to lessen risk of dislodgment.
C. RATIONALE: During TPN therapy care must be taken to minimize the risk of complications related to the central venous access device, such as catheter infections, occlusions, or accidental removal. This is an important part of family teaching. The prognosis for patients with SBS depends in part on the length of residual small intestine. It has improved with advances in TPN. Although parents need to be taught about nutritional needs, the caloric needs and prescribed TPN and rate are the responsibility of the health care team. The tubes should not be placed under the diapers because of the risk of infection. p. 1328
What causes wheezing in infants?
Increased airway resistance and a compliant chest wall.Inflammatory mediators (histamines, leukotrienes, interleukins)
An infant who was born yesterday is scheduled for surgery tomorrow. Which of the following interventions in the pre-op period will be the most helpful in assessing post-op pain in this neonate?A. Assess neonate’s behavior. B. Interview mother about neonate’s behavior. C. Ask mother what measures comfort neonate. D. Assess neonate’s response after inducing pain.
A. A pre-op assessment of the infant’s behavior is essential. This provides a baseline against which to measure post-op behavior. Changes may indicate pain or unstable condition. The mother will not have had an opportunity to learn the infant’s response to pain and comfort measures.
Older children often have wheezing because of?
A LRI as a result of inflammation, bronchospasm, and secretions
Why is Necrotizing Enterocolitis so serious?
Because it occurs in infants, who cannot describe their pain level – so it can be missed or overlooked
Criteria for the presence of clubbing?
Angle > 160 degrees and decided curvature of the nail
Pre-op care for infant with HPS undergoing a pyloromyotomy?
Decompression with NGHydration and Lyte balanceNPOIVF of glucose and Lytes
- Of the following resp system structures, the one that does not distribute air is the:a. bronchialb. alveolusc. bronchusd. trachea
B
DX of Hirschspung Disease?
Neonate: Clinical signs or failure to pass meconiumInfants & children: H&PRectal BX confirms DXBarium enema
- The general shape of the chest at birth is:a. relatively roundb. flattened from side to sidec. flattened from front to backd. the same shape as an adult’s
A
Mr. and Mrs. Wilson have a newborn with ambiguous genitalia. Tests are being done to assist in gender assignment. The parents tell the nurse that family and friends are asking what caused the baby to be this way. The nurse’s intervention should include which of the following?A. Explain the disorder so they can explain it to others. B. Help parents understand that this is a minor problem. C. Encourage parents not to worry while the tests are being done. D. Suggest that parents avoid family and friends until the gender is assigned.
A.Although ambiguous genitalia may appear as one entity, there are many causes. It is essential that the parents understand the complex issues that are involved in gender assignment as they work with the multidisciplinary team. Depending on the etiology, this can be a life-long problem. Gender assignment should be a slow, deliberative process. Telling the parents not to worry negates their concern about their child. Suggesting that parents avoid family and friends until the gender is assigned is not realistic.
- The infant relies primarily on:a. mouth breathingb. intercostal muscles for breathingc. diaphragmatic abdominal breathingd. all of the above
C
Biliary Atresia Management?
Nutritional support Kasai procedureliver transplant
- Because of the position of the diaphragm in the newborn:a. there is additional abd dist from gas and fluid in the stomach.b. the diaphragm does not contract as forcefully as that of an older infant or child.c. diaphragmatic fatigue is uncommond. lung volume is increased
B
HPS has GREATEST risk of recurrence in which individual?
First-born boy of a mother who was affected.
- Which of the following is true in regard to the anatomy of an infant’s nasopharyngeal area?a. the glottis is deeping in infants than older childrenb. the laryngeal reflexes are weaker in infants than older childrenc. the epiglottis is longer and projects more posteriorly in infants than adults.d. the infant and youg child are both less susceptible than adults to edema formation in the nasopharyngeal region.
C
The nurse is caring for a neonate born with an omphalocele. Initial mgmt after delivery includes:A. Beginning breast-feeding B. Supine positioning with nasogastric feedings C. Covering the omphalocele with saline-soaked gauze and plastic drape D. Using radiant warmer to dry sac and maintain neutral thermal environment
C.The sac is covered to prevent drying and excessive fluid loss from the neonate. The child will not be fed. With the abdominal contents outside of the infant, the stomach is decompressed and the infant is maintained with parenteral nutrition.
- List four anatomic factors that significantly affect the development of respiratory disorders in infants.
Fewer # of alveoliSmaller size of alveoliMore shallow air sacksDecreased surface area for gas exchange
Biliary atresia is not seen in the _________ or _______ or _________ infant.
fetusstillbornnewborn
- The condition that is most likely to reduce the # of alveoli in the newborn is:a. maternal heroin useb. increased prolactinc. hyperthyroidismd. kyphoscoliosis
D
Primary source of nutrition in children with SBS?
PN
- As a child grows, chest wall comopliance:a. increasesb. decreases
B
Which of the following is an important nursing consideration in the care of a child with celiac dz?A. Refer to a nutritionist for detailed dietary instructions and education. B. Help child and family understand that diet restrictions are usually only temporary. C. Teach proper hand washing and Standard Precautions to prevent disease transmission. D. Suggest ways to cope more effectively with stress to minimize symptoms.
A: RATIONALE: The main consideration is helping the child adhere to dietary management. Considerable time is spent in explaining to the child and parents the disease process, the specific role of gluten in aggravating the condition, and those foods that must be restricted. Referral to a nutritionist would help in this process. The most severe symptoms usually occur in early childhood and adult life. Dietary avoidance of gluten should be lifelong. Celiac disease is not transmissible. Celiac disease is not stress related. pp. 1326, 1327
- As the child grows, elastic recoil of the lungs:a. increasesb. decreases
A
Nursing Care for SBS?
NUTRITIONAL THERAPYPrevent complications r/t central venous device
- Relaxation of the bronchial smooth muscles occurs in response to:a. parasympathetic stimulationb. inhalation of irritating substancesc. sympathetic stimulationd. histamine release
C
Which of the following is the earliest clinical manifestation of biliary atresia?A. Jaundice B. Vomiting C. Hepatomegaly D. Absence of stooling
A.Jaundice is the earliest and most striking manifestation of biliary atresia. It is first observed in the sclera, may be present at birth, but is usually not apparent until ages 2-3 wks. Vomiting is not associated with biliary atresia. Hepatomegaly and abdominal distention are common but occur later. Stools are large and lighter in color than expected because of the lack of bile.
- Room air (ambient air) consists of:a. 7% O2b. 21% O2c. 50% O2d. 79% O2
B
True or False:HPS is a congenital disorder.
FALSEIt is NOT a cong disorder
- A child with anemia tends to be fatigued and breathe more rapidly, b/c the majority of O2 is carried through blood as:a. a solute dissolved in the plasma and the H2O of the RBCsb. bicarbonate and hydrogen ionsc. carbonic acidd. oxyhemoglobin
D
Passage of red, currant jelly-like stools occurs with?
Intussusception
- In a child, cough may be absent in the early stages of:a. CFb. measlesc. pneumoniad. croup
C
Constipation has recently become a problem for a school-age girl. She is healthy except for seasonal allergies, which are now being successfully treated with antihistamines. In this situation, the constipation is most likely caused by which of the following?A. Diet B. Puberty C. Allergies D. Antihistamines
D. Constipation may be associated with drugs such as antihistamines, antacids, diuretics, opioids, antiepileptics, and iron. Because this is the only known change in her habits, the addition of antihistamines is the most likely cause of the constipation. A: With a change in bowel habits, the presence and role of any recently prescribed medications should be assessed. B: With a change in bowel habits, the presence and role of any recently prescribed medications should be assessed. C: With a change in bowel habits, the presence and role of any recently prescribed medications should be assessed. p. 1303
A sign of dyspnea in the infant who is sleeping or exhausted?
Head bobbing
Which of the following reflexes appear at about 7 to 9 months of age?A. Moro B. Parachute C. Neck righting D. Labyrinth righting
B: The parachute reflex appears at 7 to 9 months of age and persists indefinitely. The Moro reflex is one of the primitive reflexes present at birth. Neck righting appears at 3 months of age and persists until 24 to 36 months. Labyrinth righting appears at 2 months and is strongest at 10 months.
Respirations are too deep?
Hyperpnea
Dx of Intussusception?
Frequently made on subjective data alone.Definitive DX-Barium enema (MUST do abd XR 1st)Rectal exam - reveals mucus
Respirations are too shallow?
Hypopnea
Clinical manifestations of Hirschspung Disease during childhood?
ConstipationRibbonlike, foul-smelling stoolsAbd distentionvisible peristalsiseasily palpable fecal massUndernourished, anemic in appearance
May be a complaint of older children; may be caused by disease of any of the chest structures?
Chest pain
The RN should assess a child DX with HPS for which of the following?? A. Respiratory alkalosis B. Respiratory acidosis C. Metabolic alkalosis D. Metabolic acidosis
C. Metabolic alkalosis
May be referred to the base of the neck posteriorly and anteriorly or to the abdomen?
Diaphragmatic pleural irritation
Pica refers to which of the following? A. Overeating of nonnutritive food substances B. Refusal to eat proper amts of food despite its availability C. Obsessive ingestion of unusual foods that persists over time D. Compulsive and excessive ingestion of both food and nonfood substances
D. Pica is the compulsive and excessive ingestion of both food and nonfood substances. Food picas include the excessive eating of ordinary foods or unprepared food substances, such as coffee grounds or uncooked cereals. Nonfood picas include the ingestion of substances such as clay, soil, stones, laundry starch, paint chips, ice, hair, paper, rubber, and feces. A: Pica also includes the eating of nonfood substances. B: Eating, not refusing to ingest, is the issue in pica. C: Nonfood substances are also involved. p. 1298
Significant finding in an infant; helps reduce resistance and maintain airway patency?
Nasal flaring
Transfer of gastric contents into the esophagus?
Gastroesophageal reflux (GER)
Proliferation of tissue at the terminal phalanges; associated with chronic hypoxia; does NOT reflect disease progression?
Clubbing
Acute inflammatory disease of the bowel with increased incidence in preterm and other high-risk infants.
Necrotizing Enterocolitis (NEC)
Frequently associated with hypertrophied adenoidal tissue, choanal obstruction, polysps, or foreign body in the nasal passages?
Noisy breathing
Pica refers to which of the following?
A. Overeating of nonnutritive food substances
B. Refusal to eat proper amounts of food despite its availability
C. Obsessive ingestion of unusual foods that persists over time
D. Compulsive and excessive ingestion of both food and nonfood substances
Biliary atresia
Usually localized over the affected area and aggravated by respiratory movement?
Parietal pleural pain
DX of biliary atresia is confirmed by?
Exploratory lap & intraoperative cholangiogram
Frequently a sign of chest pain; suggests acute pneumonia, pleural involvement, pulmonary edema, or respiratory distress syndrome; increases end-respiratory pressure and prolongs gas exchange?
Grunting
Manifestations of Malrotation?
Bilious vomitingAbd painAbd distentionGI bleeding
Performed to assess adequacy of collateral circulation?
Allen test
Cong anomaly resulting in mechanical obstruction from inadequate motility of part of the intestine?
Hirschspung Disease (Cong Aganglionic Megacolon)
HgB saturated with O2?
Oxyhemoglobin
The nurse is assessing a 6-month-old infant who has head lag. The nurse should recognize which of the following?A. This is normal. B. Child is probably cognitively impaired. C. Developmental-neurologic evaluation is needed. D. Parent needs to work with infant to stop head lag.
C: Most infants have only slight head lag when pulled from a lying to a sitting position at 4 months of age. By 6 months head control is well established. Developmental-neurologic evaluation is indicated to determine why the child is not achieving an expected milestone. A 6-month-old infant with head lag is a sign of delay. The head lag is suggestive of a developmental delay. It does not provide information about cognitive status. As part of normal development, interventions cannot be done until a cause is identified.
A noninvasive method of continuously monitoring partial pressure of O2 in arterial blood; may also be used to measure CO2?
Transcutaneous monitoring
Which of the following is an important consideration in understanding the reactions of parents when their infant is born with physical defects?A. Grief lasts until the defects are repaired. B. Denial is a common maladaptive reaction. C. The psychologic reaction is similar to that with the death of an infant. D. Reactions of health professionals to the birth of an infant do not affect parents’ reactions.
C. Parents need to grieve for the loss of the expected child. They also must adapt to the needs of a child with physical defects and the additional demands this will place on the family. The grief usually consists of several stages, including shock, frustration, and anger. The grief response may last for years. Denial and disbelief during the shock phase are not maladaptive. They can serve to protect the parents as they begin to deal with the impact of the initial stress. Parents are sensitive and responsive to the behaviors of others. Health professionals’ interactions w/the infant and parents provide cues to the parents that can greatly influence their reaction to the infant.
HgB capable of carrying O2?
Functional HgB
According to Erikson, infancy is concerned with acquiring a sense of which of the following?A. Trust B. Industry C. Initiative D. Autonomy
A: During the first year of life, the infant focuses on the task of developing a sense of trust of self, of others, and of the world. This presents challenges for infants who are separated from parents or consistent caregivers. Industry is the focus of school-age children. Preschoolers are engaged in acquiring initiative. Autonomy is a developmental task during the toddler years.
HgB that is not saturated with O2?
Deoxyhemoglobin
NEC PATHO?
Damage to mucosal cells lining the bowel wallDiminished blood supply to mucosal cells causes their deathUnable to secrete protective, lubricating mucusThin, unprotected bowel wall is attacked by proteolytic enzymesGas-forming bacteria produce intestinal pneumatosis (presence of air in submucosal/subserosal surfaces of bowel)
Reduced blood oxygenation?
Hypoxemia
Which of the following vaccines is recommended for administration at birth?A. MMR B. Hepatitis B C. Hepatitis A D. Haemophilus influenzae type b
B: Hep B immunization is recommended early. Hep B virus infections that occur during childhood can lead to fatal consequences from cirrhosis or liver cancer during adulthood. MMR is recommended for children ages 12 to 15 months. The hep A series should begin between 12 and 23 months. Hib is administered beginning at age 2 months.
A hazard of O2 therapy; may occur in persons with chronic pulmonary disease; seldom encountered in children except those with CF?
Oxygen-induced CO2 narcosis
Abdominal pain, abdominal mass, and bloody stools are the classic triad of ________ symptoms?
Intussusception
Examples: Passy-Muir, Kistner, and Tucker; not appropriate for use in seriously ill children, children using a trach cuff, or children with copious secretions?
Speaking valves
Nursing Interventions for GER?
· Position with head elevated 30-45 º· Small, frequent feedings with adequate burping· Provide client teaching and discharge planning· Teach parents how to position and feed infant· Administration of medications
Used to help move secretions toward the head during exhalation?
Vibration
HPS may be associated with other disorders such as?
Intestinal malrotationEsophageal and duodenal atresiaAnorectal anomalies
A new type of MDI that does NOT require a spacer device?
Rotahaler or Turbuhaler
A newborn was admitted to the nursery with a complete bilateral cleft lip and palate. The physician explained the plan of therapy and its expected good results. However, the mother refuses to see or hold her baby. Initial therapeutic approach to the mother should be which of the following?A. Encourage her to express her feelings. B. Suggest holding baby but without eye contact. C. Restate what the physician has told her about plastic surgery. D. Recognize that attachment usually does not occur until after initial surgery.
A. For parents, cleft lip and cleft palate deformities are particularly disturbing. The nurse must emphasize not only the infant’s physical needs but also the parents’ emotional needs. The mother needs to be able to express her feelings before she can accept her child. As the mother expresses her feelings, the nurse’s actions should convey to the parents that the infant is a precious human being. The child’s normalcy is emphasized, and the mother is assisted in recognizing the child’s uniqueness. Although this will be addressed, it is not part of the initial therapeutic approach. Maternal-infant attachment usually is not negatively affected at this stage.
A form of CPB; provides both pulmonary and cardiac support?
ECMO
Labs associated with HPS?
Metabolic alterations d/t dehydration.Decreased Cl Increased pH & HCO3 (Metabolic alkalosis)Increased BUN
Techniques that are useful with older motivated children with kyphoscoliosis, CF, asthma, or bronchiectasis?
Breathing and postural exercises
Most serious type of intestinal obstruction? Why?
Malrotation!Because, if the intestine undergoes complete volvulus (twisting around itself), it will lead to intestinal necrosis, peritonitis, perforation, and death.
The method of O2 administration that is BEST tolerated by infants?
O2 hood
The parents of a 3-month-old girl complain to the nurse that they are exhausted because she still wakes up as often as every 1 to 2 hours during the night. When she awakens, they change her diaper, and her mother nurses her back to sleep. Which of the following should the nurse suggest to help them deal with this problem?A. Let her cry herself back to sleep. B. Put her in parents’ bed to cuddle. C. Start putting her to bed while still awake while the parent is present. D. Give her a bottle of formula instead of breast-feeding her so often at night.
C: Current research suggests that parents be present at bedtime until the child is drowsy. The child should then be allowed to fall asleep alone. This encourages self-soothing behaviors. Children who learn to fall asleep on their own have longer sustained sleep periods than those who fall asleep with parents present. Letting the child cry herself back to sleep is difficult to implement for many parents. Cobedding could be unsafe at this age. The type of feeding will not affect the child’s sleep pattern.
A generic term for devices that use a rapid cycling rate and deliver small tidal volumes with each cycle?
High-frequency ventilation
DX of GER?
H&PUpper GI 24 hr intraesophageal pH - GOLD STANDARD!!!Scintigraphy-detects radioactive sub feeding comp.
A method of O2 administration that is NOT usually well tolerated by children?
Oxygen mask
The nurse is caring for a boy with probable intussusception. He had diarrhea before admission, but while waiting for a barium enema, he passes a normal brown stool. The most appropriate nursing action is which of the following?A. Notify physician. B. Measure abdominal girth. C. Auscultate for bowel sounds. D. Take vital signs, including blood pressure.
A. RATIONALE: Passage of a normal brown stool indicates that the intussusception has reduced itself. This is immediately reported to the practitioner, who may choose to alter the diagnostic and therapeutic care plan. The first action would be to report the normal stool to the practitioner. p. 1325
Absence of airflow (or absence of breathing that lasts for more than 20 seconds?)
Apnea
Pyloric stenosis can best be described as which of the following?A. Dilation of pylorus B. Hypertrophy of pyloric muscle C. Hypotonicity of pyloric muscle D. Reduction of tone in the pyloric muscle
B. RATIONALE: Hypertrophic pyloric stenosis occurs when the circumferential muscle of the pyloric sphincter becomes thickened, resulting in elongation and narrowing of the pyloric channel. Dilation of pylorus, hypotonicity of pyloric muscle, and reduction of tone in the pyloric muscle are not the definition of pyloric stenosis. p. 1322
Occurs in 2 conditions: (1) when there is increased work of breathing with near-normal gas exchange function, and (2) when hypoxemia and acidosis develop secondary to CO2 retention?
Respiratory insufficiency
Leads to cirrhosis, liver failure, and eventually death if untreated?
Biliary atresia
Absence of air flow that occurs when no respiratory efforts are present?
Central apnea
This condition usually develops in the first few weeks of life, causing projectile vomiting, dehydration, metabolic alkalosis, and failure to thrive (FTT)??
Hypertrophic pyloric stenosis (HPS)
Condition in which components of central and obstructive apnea are present?
Mixed apnea
When assessing an infant, the nurse notes the infant to be hungry and irritable. The mother states the her child has been vomiting a lot which explains why the infant is dehydrated and has lost weight. The nurse should suspect?
HPS
The cessation of respiration?
Respiratory Arrest
Occurs when the intestine herniates lateral to the umbilical ring, usually to the right of the umbilicus and without a sac?
Gastroschisis
Disease involving increased resistance to airflow?
Obstructive lung disease
Biliary atresia manifestations?
Healthy @ birth JAUNDICE (after two wks needs testing!!) CLAY colored stool d/t no bile pigmentDark urineLiver is firm on palpation Enlarged liver early in the DZ
Disease involving impaired lung expansion?
Restrictive lung disease
occurs in approx. 1 in 10,000 - 15,000 live births?
Biliary atresia
May be caused by cerebral trauma, intracranial tumors, CNS infection, tetanus?
Respiratory center depression
Clinical manifestations of Hirschspung Disease during the newborn period?
Failure to pass meconium w/in 24-48 hr after birthRefusal to feedBilious vomitingAbd distention
Includes pulmonary edema, fibrosis, embolism?
Pulmonary diffusion defect
Manifestations associated with HPS in infants?
Vomiting begins at 3 wk (may start @ 1 wk to 5 wk)PROJECTILE VOMITINGVisual peristalsisMETABOLIC ALKALOSISNonbilious vomiting (early stages)Projectile and progressiveBrown in later stages if gastritis develops
Used to relieve FB obstruction in infants; involves hand placement over the spine b/w the shoulder blades?
Back blows
What is the primary TX for biliary atresia?
Kasai portoenterostomy
Involves a series of nondiaphragmatic abdominal thrusts; recommended for children over 1 y/o?
Heimlich maneuver
Projectile vomiting is associated with?
HPS
- When an infant’s digits are connected to a pulse ox, the part of the sensor that is placed on the top of the nail is called the:a. photodetectorb. microprocessorc. Light-emitting diode (LED)d. electrode
C
Nursing care for Intussusception?
NPOPain mgmt.Check for jelly like stoolIf stool is normal, Intussusception has resolved
- In children, O2-induced CO2 narcosis is encountered most frequently with:a. prematurityb. asthmac. CFd. congenital heart disease
C
The biggest single reason why children need a liver transplant is _________________
Biliary Atresia
- For a child under 5 y/o who needs intermittent delivery of an aerosolized med, the nurse should consider using a:a. hand-held NEBUb. MDI with a spacer devicec. humidified mist tent with low-flow O2d. MDI w/o a spacer device
B
GER symptoms in infants?
Spitting up, regurgitation, vomitingExcessive crying, irritability, arching of backWt. loss, FTTResp (cough, wheeze, stridor, gagging, choking)HematemesisApnea or apparent life-threatening event
- Postural drainage should be performed:a. before meals but after other respiratory therapyb. after meals but before other respiratory therapyc. before meals and before other respiratory therapyd. after meals and after other respiratory therapy
A
The nurse assesses the neonate immediately after birth. EA or TEF is suspected if which of the following is present?A. Jaundice B. Absence of sucking C. Hyperactive bowel sounds D. Excessive amount of frothy saliva in the mouth
D.Frothy saliva in the mouth and nose, drooling, choking, and coughing in a newborn are associated with esophageal atresia and TEFs. Jaundice in a neonate is indicative of a hematologic problem. Absence of sucking and hyperactive bowel sounds are not signs of esophageal atresia or TEF.
- Which of the following pts is likely to benefit from CPT that includes forced expiration combined with postural drainage?a. pts with pneumoniab. uncomplicated surgical ptsc. pts with increased sputum productiond. all of the above
C
abnormal rotation of intestine during embryonic development?
Malrotation
- Chest percussion is being performed correctly if:a. it makes a slapping soundb. it is painfulc. a soft circular mask is usedd. it is performed over the rib cage & diaphragm
C
What is the Kasai procedure?
surgery that involves dissecting the porta hepatis to promote bile drainage. A Roux-en-Y jejunal limb is then anastomosed to the porta hepatis.Highly successful if done before 8 wk of age.
- The BEST method to stimulate deep breathing in a child is to:a. have child cover mouth & suppress coughb. have child cough repeatedlyc. use games that extend expiratory time& pressured. leave some balloons at the bedside for the child to blow up
C
Olive-like mass in the upper abdomen is associated with?
HPS
- To avoid barotrauma when using the bag-valve-mask device, the nurse shoulda. use the type without a reservoirb. use the type with a pop-off valvec. use a low O2 concentrationd. hyperextend the infant’s neck
B
Therapeutic management of most children with Hirschsprung dz is primarily which of the following?A. Daily enemas B. Low-fiber diet C. Permanent colostomy D. Removal of affected piece of bowel
D. Most children with Hirschsprung disease require surgical rather than medical management. Surgery is done to remove the aganglionic portion of the bowel, relieve obstruction, and restore normal bowel motility and function of the internal anal sphincter. A: Preoperative management may include enemas and low-fiber, high-calorie, high-protein diet, until the child is physically ready for surgery. B: Preoperative management may include enemas and low-fiber, high-calorie, high-protein diet, until the child is physically ready for surgery. C: The colostomy that is created in Hirschsprung disease is usually temporary. p. 1306
- The MOST severe complication that can occur during intubation is:a. infectionb. sore throatc. laryngeal stenosisd. hypoxia
D
The parent of a 10-week-old infant tells the nurse, “She cries sometimes when nothing is wrong—for example, when she is dry and has recently been fed.” The most appropriate nursing intervention is which of the following?A. Reassure parent that nothing is wrong. B. Explain how to better interpret infant cues. C. Evaluate for failure of parent to bond with infant. D. Reassure parent that periods of “unexplained fussiness” are normal.
D: A crying infant can be a source of great distress for parents. There is great variability in the amount of crying that can be expected from an infant. Parents should be reassured that some crying without apparent cause is normal. Persistent and inconsolable crying may need further attention. Reassuring the parent that nothing is wrong negates the parent’s concern about the child. The parent is responding to cues from the infant by feeding and changing diapers. There is no evidence that an attachment issue exists. The parent is seeking information about how to care for the infant.
- Of the following vacuum pressures, the MOST acceptable pressure to use to suction the trach of a child is:a. 30 mm hgb. 50 mm hgc. 70 mm hgd. 120 mm hg
C
Associated with trisomies 13, 18m and 221 (down syndrome), and with advanced maternal age (>30 years)?
Omphalocele
- For a trach dressing, it would be INCORRECT to use:a. DuoDERM CGFb. Allevyn dressingc. a wet 4X4 gauze pad cut into the needed shape.d. Hollister Restore
C
Clinical manifestations of Intussusception?
Sudden acute abd painchild screaming and drawing knees to chestchild appearing normal & comfortable b/w episodesvomitinglethargypassage of red, currant jelly-like stoolsTender distended abdpalpable sausage shaped mass in RUQEmpty RLQeventual s/s of peritonitis (fever, prostration, etc)
- After the initial post-op change, the trach tube is usually changed:a. Weekly by the surgeonb. Weekly by the nurse or familyc. Monthly by the surgeond. Monthly by the nurse or family
B
Initial Management of Gastroschisis involves?
Covering exposed bowel with transparent bowel bag or loose, moist dressings.IVF and ABXLARGE amt of IVFsSURGICAL REPAIR!!
- A trach with a speaking valve:a. decreases secretionsb. decreases child’s sense of taste and smellc. limits gas exchanged. has no effect on the ability to swallow
A
A PPI is ordered for an infant with GER. The nurse should include in the drug teaching that:A. drug should be given 30 min before bedtime. B. three times a day dosing has maximum effect. C. drug can be stopped once sxs have resolved. D. several days may pass before full effect
D. RATIONALE: PPIs require several days to achieve the max effect. A: Optimum admin time is 30 min before breakfast. This allows for peak plasma levels at mealtime. B: Once daily dosing is usually recommended. C: Continued admin is necessary to maintain effect. p. 1309
- Of the following strategies, the one that is LEAST likely to decrease the O2 demand of the child with respiratory distress is:a. maintain child’s body temp WNLb. place child in supine positionc. control paind. maintain a warm room temp
B
Management of Intussusception?
Radiologist guided air enema with or w/o water soluble contrast or U/S-guided hydrostatic (saline) enema.IVF, NG decompression, & ABX before hydrostatic reduction.Surgery if procedures are not successfulRecurrence is RARE
- Cardiac arrest in the pediatric population is MOST often a result of:a. atherosclerosisb. congenital heart diseasec. prolonged hypoxiad. undiagnosed cardiac conditions
C
Complications after Kasai procedure?
ascending cholangitiscirrhosisportal HTNGI bleeding
- The nurse should place the bag-valve-mask over both the mouth & nose for individuals whose age is:a. birth to 1 yrb. 1 to 3 yrsc. birth to 3 yrsd. birth to 2 yrs
A
3 MAJOR signs of entercolitis that MUST be reported STAT?
Explosive watery diarrheaFeverSevere Lethargy
- The brachial pulse is the preferred site to use to assess circulation in the:a. infantb. school-aged childc. adolescentd. adult
A
NEC is most common in?
Premies
- In a child who is conscious & choking, the RN should attempt to relieve the obstruction if the child:a. is making soundsb. has an effective coughc. has stridord. all of the above
C
Occurs when the proximal segment of the bowel telescopes into a more distal segment?
Intussusception
Increases CO and HR by blocking vagal stimulation in the heart?
Atropine
Main cause of death in children with SBS?
INFECTION
The first choice for V-Tach that is refractory to defibrillation is ?
Amiodarone
In terms of fine motor development, what should the infant of 7 months be able to do?A. Transfer objects from one hand to the other B. Use thumb and index finger in crude pincer grasp C. Hold crayon and make a mark on paper D. Release cubes into a cup
A: The ability to transfer objects from one hand to another occurs about age 7 months. The infant can use one hand for grasping and hold a cube in the other at the same time. A crude pincer grasp develops by ages 8 to 9 months. The ability to hold a crayon and mark on a piece of paper develops between ages 12 and 15 months. Infants can release a cube into a cup at ages 9 to 12 months.
Used for hypermagnesemia; needed for normal cardiac contractility?
Calcium chloride
DX evaluation of biliary atresia is based on?
HXphysical findingsLabs
Causes vasoconstriction and increases CO?
Dopamine
GER symptoms in Children
Heartburnabd painnoncardiac chest painchronic coughdysphagianocturnal asthmarecurrent pneumonia
Used for ventricular dysrhythmias?
Lidocaine
Management of Intussusception?
Radiologist guided air enema with or w/o water soluble contrast or U/S-guided hydrostatic (saline) enema.IVF, NG decompression, & ABX before hydrostatic reduction.Surgery if procedures are not successfulRecurrence is RARE
Acts on alpha and beta receptors, causing contraction, especially at the site of the heart, vascular, and other smooth muscle?
Epinephrine
Two common forms of cong abd wall defects?
Gastroschisis and omphalocele
Administered rapidly; causes a temporary block through the AV node?
Adenosine
When are feedings begun and how are they initiated for an infant after a pyloromyotomy (surgery for HPS)?
4 to 6 hrs post-op - start w/small, frequent feedings of glucose, water, or Lyte soln.If clear liquids are retained - formula is started 24 hrs after surgery.
Used to buffer the pH?
Sodium bicarbonate
Clinical manifestations of Hirschspung Disease during the Infancy period?
FTTConstipationAbd distentionEpisodes of diarrhea and vomitingSigns of entercolitis
The Heimlich maneuver is recommended for children over the age of:a. 4 yrsb. 3 yrsc. 2 yrsd. 1 yr
D
Sara, age 4 months, was born at 35 weeks of gestation. She seems to be developing normally, but her parents are concerned because she is a “more difficult” baby than their other child, who was full term. The nurse should explain that:A. infants tend to become more difficult over time. B. Infants become less difficult if they are kept on scheduled feedings and structured routines. C. Sara’s behavior is suggestive of failure to completely bond with her parents. D. Sara’s difficult temperament is the result of painful experiences in the neonatal period.
B: Children perceived as difficult may respond better to scheduled feedings and structured caregiving routines than to demand feedings and frequent changes in routines. Infant temperament has a strong biologic component. Together with interactions with the environment, primarily the family, the biologic component contributes to the infant’s unique temperament. Sara’s temperament has been created by both biologic and environmental factors. The nurse should provide guidance in parenting techniques that are best suited to Sara’s temperament.
Incidence of HPS?
First born childrenBoys 5 times > girlsMore Caucasians than African American’sFull-term infants more than premiesSiblings and offspring of affected persons.
Passage of red, currant jelly-like stools occurs with?
Intussusception
The causative agent of acute epiglottitis is?
bacterial, usually H. influenzae
3 MAJOR signs of entercolitis that MUST be reported STAT?
Explosive watery diarrheaFeverSevere Lethargy
The primary management goal of epiglottitis is to?
stabilize the airway by intubation or tracheostomy.
Malformations associated with biliary atresia?
PolyspleniaIntestinal atresiaMalrotation of the intestine
The presence of daily symptoms or nighttime symptoms, more than once per week, but not nightly, places a child over 5 years of age in which category of asthma?
Moderate persistent asthma
Which of the following is a major long-term problem for a child with cleft lip and palate?A. Faulty dentition B. Nutritional deficits C. Aspiration pneumonia D. Abnormally small maxilla
A. A comprehensive team approach is used for children with cleft lip and palate. Extensive orthodontics and prosthodontics are usually required to correct the malposition of the teeth and other bony structures. The child can be adequately nourished before and after surgical repair takes place. Aspiration is a possibility before repair of the cleft palate, but it is not a long-term problem. The nonunion of the maxilla usually requires surgery and possible bone grafts to close.
Bill needs instructions about using a metered-dose inhaler (MDI). The nurse should explain that the MDI is used to: A. improve circulation. B. distribute med directly to airways. C. assess severity of breathing difficulty. D. distribute med systemically w/o the need for inj.
B
The clinic is loaning a federally approved car seat to a 10-pound (4.5 kg) infant’s family. The nurse should explain that the safest place to put the car seat is in the:A. back seat facing forward. B. Middle of the back seat facing rearward. C. front seat with airbags on passenger side. D. front seat if there is no air bag on the passenger side.
B: The rear-facing car seat provides the best protection for an infant’s disproportionately heavy head and weak neck. The middle of the back seat is the safest position for the child. The infant must be rear facing to protect the head and neck in the event of an accident. Severe injuries and deaths in children have occurred from air bags deploying on impact in the front passenger seat.
Instructions for using the MDI include:
A. breathe medication in slowly.
B. avoid breathing too deeply.
C. hold inhaler at about a 45-degree angle to the mouth.
D. breathe in through nose and out through mouth.
Instructions for using the MDI include:
breathe medication in slowly.
avoid breathing too deeply.
hold inhaler at about a 45-degree angle to the mouth.
breathe in through nose and out through mouth.
A
A slow, deep inspiration held for 5 to 10 seconds will allow the medication to reach the narrow, deep airways.
Rapid inspirations cause the medication to move through the unobstructed bronchioles to patent airways, where they are less needed.
The inhaler should be held upright with the mouthpiece in the mouth.
The nurse is guiding parents in selecting a daycare facility for their child. Which of the following is especially important to consider when making the selection?A. Health practices of facility B. Structured learning environment C. Socioeconomic status of children D. Cultural similarities of children
A: Health practices should be most important. With the need for diaper changes and assistance with feeding, young children are at increased risk when hand washing and other hygienic measures are not consistently used. A structured learning environment is not the highest priority for this age child. Socioeconomic status of the children should have little effect on the choice of facility. Cultural similarities may be important to some families, but the facility’s health care practices are more important.
Bill’s father asks the nurse if his son can still participate in sports. The nurse’s response should be based on an understanding that:
A. exercise should be encouraged.
B. avoid breathing too deeply.
C. organized sports are too strenuous for children with asthma.
D. quiet activities such as reading are best for children with asthma.
A
It has been found that moderate or even strenuous exercise is advantageous for children with asthma, provided the asthma is under control.
Restrictions on exercise are invoked only when the child’s condition makes it necessary.
Prophylactic TX with β-adrenergics or cromolyn before exercise will usually permit full participation in strenuous exercise.
What information should the nurse give a mother regarding the introduction of solid foods during infancy?A. Fruits and vegetables should be introduced into the diet first. B. Foods should be introduced one at a time, at intervals of 5 to 7 days. C. Solid foods can be mixed in a bottle to make the transition easier for the infant. D. Solid foods should not be introduced until 8 to 10 months when the extrusion reflex begins to disappear.
B: One food item is introduced at intervals of 5 to 7 days to allow the identification of food allergies. Iron-fortified cereal should be the first solid food introduced into the infant’s diet.3. Mixing solid foods in a bottle has no effect on the transition to solid food.4. Solid foods can be introduced earlier than 8 to 10 months. The extrusion reflex usually disappears by age 6 months.
What is the most prevalent etiologic agent causing bronchiolitis in young infants?
RSV
Rationale: RSV is responsible for at least 50% of children admitted for bronchiolitis.
Pre-op care for infant with HPS undergoing a pyloromyotomy?
Decompression with NGNPOIVF of glucose and Lytes (NaCl & K)Strict I&Os and urine spec gravityVS, Daily Wt., assess skin & mucous membranes
________________________is a croup syndrome with paroxysmal attacks of laryngeal obstruction that occur chiefly at night; it is usually caused by a viral agent.
Acute spasmodic laryngitis
The nurse is assessing a 6-month-old healthy infant who weighed 3.2 kg at birth. The nurse should expect the infant to now weigh approximately how many kilograms?A. 5.2 B. 6.3 C. 8.7 D. 9.6
B: Birth wt doubles at about ages 5-6 mo. At 6 mo, a child who weighed 3.2 kg at birth would weigh approx 6.3 kg. The infant would have gone from the 50th percentile at birth to below the 5th percentile; 5.2 kg is too little. The infant would have tripled the birth wt by 6 mo; 8.7 kg to 9.6 kg is too much. The infant would have tripled the birth weight by 6 mo; 8.7 - 9.6 kg is too much.
_________________is an acute viral infection that occurs primarily in the winter and spring. The symptoms begin with rhinorrhea and fever, often spreading to a lower respiratory tract infection.
Bronchiolitis
Which of the following behaviors indicates that an infant has developed object permanence?A. Secures objects by pulling on a string B. Actively searches for a hidden object C. Recognizes familiar face, such as mother D. Recognizes familiar object, such as bottle
B: During the first 6 months of life, infants believe that objects exist only as long as they can see them. When infants search for an object that is out of sight, this signals the attainment of object permanence, whereby an infant knows an object exists even when it is not visible. The ability to understand cause and effect is part of secondary schema development, which is a later developmental task. B/w ages 8-12 weeks, infants begin to respond differentially to the mother. They cry, smile, vocalize, and show distinct preference for the mother. This preference is one of the stages that influences the attachment process but is too early for object permanence. Recognizing familiar objects is an important transition for the infant, but it does not signal object permanence.
How is the diagnosis of RSV established?
ELISA of nasal secretions
Rationale: Either the rapid immunofluorescent antibody (IFA) or the ELISA technique for RSV detection can be used.
These techniques are rapid and have sensitivities and specificities of about 90%
Labs associated with HPS?
Metabolic alterations d/t dehydration.Decreased Cl Increased pH & HCO3 (Metabollic alkalosis)Increased BUN
Repeated episodes of bronchiolitis not associated with RSV in young children require follow-up testing for which disorders?
Asthma, cystic fibrosis.
Rationale: Because of the nature of asthma and CF, the airways are more reactive and/or mucus production is increased, causing a perfect medium for bacterial growth. Children with asthma/CF are more likely to display repeated sxs of bronchiolitis before the dx of a chronic disorder.
A mother tells the nurse that she is discontinuing breast-feeding her 5-month-old infant. The nurse should recommend that the infant be given:A. skim milk. B. whole cow’s milk. C. commercial formula without iron. D. Commercial iron-fortified formula.
D: For children younger than 1 year, the American Academy of Pediatrics recommends the use of breast milk. If breast-feeding has been discontinued, then iron-fortified commercial formula should be used. Cow’s milk should not be used in children younger than 12 months. Maternal iron stores are almost depleted by this age; the iron-fortified formula will help prevent the development of iron-deficiency anemia.
What type of isolation measures are indicated for health personnel when caring for a child with RSV?
Good hand-washing; use of gowns and gloves to prevent cross contamination.
Rationale: RSV is highly virulent, and health care personnel should take precautions to avoid spreading the virus to uninfected hospital personnel, visitors, and patients in the hospital.
Distended abdomen, Gastric residuals, Blood in stools are highly indicative of?
NEC
Discuss the guidelines for use of ribavirin aerosol therapy.
It is used for infants at high risk because of other abnormalities, especially chronic lung disorders and immunodeficiency; infants less than 6 months old; and severely ill infants.
Special precautions such as mask and goggles are required for caregivers; no pregnant personnel should be involved.
Rationale: Because of the potential toxic effects of the drug to health care workers and the unclear evidence of the drug’s benefit, the American Academy of Pediatrics recommends the preceding criteria for use of ribavirin.
Nutritional management for infants with biliary atresia?
Medium chain triglycerides and essential fatty acids.Vitamins - A, D, E, KmultivitaminMinerals - iron, zinc, seleniumContinuous gastrostomy feedings or TPN
What disease is inherited as an autosomal recessive gene; requiring inheritance of the defective gene from both parents?
CF
Prognosis of HPS?
Excellentmortality rate is LOW15% will have GER
Can fertility therapy contribute to the newborn developing CF?
NO
Primary source of nutrition in children with SBS?
PN
What is the significance of sodium and chloride in diagnosing CF?
A clinical feature of CF is a striking elevation of sweat electrolytes. Although sodium and chloride are affected, the defect appears to be primarily a result of abnormal chloride movements.
Incidence of intussusception?
More common in:maleschildren with cystic fibrosis
What are the effects of increased viscosity of mucous gland secretions on each of the following?
A. Bronchi
B. Small intestine
C. Pancreatic ducts
D. Bile ducts
A. Chronic pneumonia and emphysema
B. Meconium ileus
C. Malabsorption syndrome
D. Portal hypertension
Increased mucous gland secretion and mucus viscosity result in mechanical obstruction, which leads to chronic complications of the bronchi, small intestine, pancreatic ducts, and bile ducts.
These complications are outlined in Fig. 32-14.
Complication after surgery for malrotation?
Short bowel syndrome (SBS)
David is the 3-year-old son of parents who are 38 and 40 y/o. They have been married for 15 years and underwent fertility therapy to have a child. David has a HX of frequent colds increasing in severity during the past year. He also has been losing wt although he eats well. David has been having large loose bowel movements during the past year. David is admitted to the pediatric unit for a workup for CF.
List seven nursing diagnoses appropriate for David.
Ineffective Airway Clearance r/t secretion of thick, tenacious mucus
Ineffective Breathing Pattern r/t mechanical airway obstruction
Altered Nutrition, Less Than Body Requirements, r/t inability to digest nutrients
High Risk for Infection r/t impaired body defenses
Activity Intolerance r/t imbalance between oxygen supply and demand
Altered Growth and Development r/t chronic illness
Altered Family Processes r/t child with chronic illness
Diarrhea Incidence
Lisa is 7 y/o & has CF. She lives w/both parents & a 4 y/o sister who also has CF.
Lisa’s mother tearfully tells the RN that she is pregnant & worried that this child will also have CF. The nurse should understand that:
A. CF is usually not inherited.
B. CF can be diagnosed prenatally.
C. there is a 50% chance this child will be affected.
D. there is a 100% chance this child will be affected if it is a female.
B
Rationale:
CF is inherited as an autosomal recessive trait; the affected child inherits the defective gene from both parents.
Genetic discoveries have allowed for better screening techniques, and prenatal testing continues to be studied.
The autosomal recessive defective gene is inherited from both parents with an overall incidence of 1:4 (25% chance a child will be affected).
The autosomal recessive defective gene is inherited from both parents with an overall incidence of 1:4 (25% chance a child will be affected). The defective gene is not sex linked; therefore CF can occur in any sex.
Abd pain or cramping manifested by loud cryinng and drawing legs up to the abd?
COLIC
Lisa tells the RN that she would like to play soccer like her friends. The RN’s recommendation should be based on knowledge that physical exercise is:
A. important because it encourages effective breathing.
B. important because it stimulates underactive sweat glands.
C. contraindicated because it causes coughing.
D. contraindicated because it causes forced expiration.
A
Physical exercise is an important adjunct to daily chest physical therapy to maintain pulmonary hygiene. It stimulates mucus secretion and provides a sense of well-being and increased self-esteem in the child.
Colic etiology?
• Rapid feeding • Overeating • Swallowing excessive air • Improper feeding technique (esp in positioning and burping) • Emotional stress or tension b/w parent & child
Lisas father calls the clinic and tells the RN that Lisa must be very sick. Her sx’s include tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The RN should recognize that this is:
A. suggestive of pneumothorax.
B. suggestive of bronchospasms.
C. terminal stage of the disease.
D. normal progression of the disease.
A
Pneumothorax is often caused by rupture of sub-pleural blebs through the visceral pleura and usually causes nonspecific sxs, which include tachypnea, tachycardia, dyspnea, pallor, and cyanosis.
Other potential causes of colic?
Smoking strained parent-infant interaction lactase deficiency difficult infant temperament CNS immaturity
Symptoms of bronchospasm usually include?
dyspnea, wheezing, and pallor
How much crying is considered colic in healthy baby?
>3 hours/day >3 days/week
Supplementation of vitamins A, D, E, & K are important for people with CF because:
A. pancreatic enzymes are administered with meals.
B. children with CF cannot receive a well-balanced diet.
C. uptake of fat-soluble vitamins is decreased in CF.
D. excretion of water-soluble vitamins is increased in CF.
C
The uptake of fat-soluble vitamins is decreased because of pancreatic insufficiency.
When does colic usually onset, how long might it persist?
Onset after 2-4 weeks30% might persist until 4 months
Ms. Drew is admitted to the hospital to prevent the spread of mono. Which of the following precautions should be taken by the nurses caring for her?
A. Respiratory isolation
B. Enteric isolation
C. Strict isolation
D. Good hand-washing techniques only
D
What is the MOST LIKELY cause of colic?
GI related etiology:
Lactose intolerance
Intolerance to proteins in mom’s diet (eg cow’s milk)
Tommy is 5 years old and is hospitalized for a tonsillectomy and adenoidectomy.
In completing a nursing care plan for Tommy, which of the following interventions would be inappropriate to include?
A. Applying an ice collar
B. Administering acetaminophen elixir
C. Offering cool liquids as tolerated
D. Suctioning the posterior pharynx
D
Suction equipment should be available in the event a hemorrhage occurs. However, the posterior pharynx should NOT be suctioned due to the potential trauma to the operative site.
An ice collar may provide relief of pain from the soreness in the throat after surgery (although many children find it bothersome and prefer not to have it).
Most children experience moderate pain after a tonsillectomy and should receive pain medication for at least the first 24 hours.
When the child is alert with no signs of hemorrhage, cool water and crushed ice are given, progressing to clear liquids as tolerated (avoiding fluids with a red or brown color to distinguish fresh or old blood in emesis from the ingested liquid).
If colic approaching 4 months, what disease might be considered?
GERD
Nursing considerations r/t the admin of O2 in an infant include which of the following?
A. Discontinue during feedings so child can be held.
B. Assess infant to determine how much oxygen should be given.
C. Ensure uninterrupted delivery of the appropriate oxygen concentration.
D. Direct oxygen flow so that it blows directly into the infant’s face in a hood.
C
What are 5 management strategies for parents of infant with colic?
1) Parent reassurance - self-limting, no long term sequelae, nobody’s fault
2) Keep a diary
3) Relief and support
4) Regular schedule and routine
5) **DIET change in MOM (avoid diary, green veggies)
The RN is teaching a mother how to perform CPT and postural drainage on her 3 y/o child, who has CF. To perform percussion, the RN should instruct her to:
A. strike the chest wall with a flat-hand position.
B. percuss before and after positioning for postural drainage.
C. percuss over the entire trunk anteriorly and posteriorly.
D. cover the skin with a shirt or gown before percussing.
D
The child should wear a light shirt to protect the skin from the percussion.
The hand is cupped when the child’s chest wall is struck.
Percussion is done after the position change.
There are identified positions and sequence for postural drainage.
What are 3 nonpharm measures for colic?
1) Rocking, music, patting, car, burping
2) Check bottle nipple; feed baby more upright
3) If formula fed, switch formulas
Which of the following situations places infants at risk for developing vitamin D–deficiency rickets?
A. Exclusively formula fed
B. Exposure to daily sunlight
C. Mothers who are lacto-ovovegetarians
D. Families using yogurt as primary source of milk
D
Yogurt does not contain adequate amounts of vitamins A and D.
What is a pharmacological measure for colic that is SAFE?
Simethicone (Ovol)
0.25-0.5ml drops with meals
but no proven efficacy
Deficiency of which of the following vitamins correlates with increased morbidity and mortality in children with measles and increased complications from diarrhea and infections?
A. Vitamin A
B. Vitamin C
C. Niacin
D. Folic acid
A
Vitamin A deficiency contributes to increased morbidity in measles, diarrhea, and infections. The American Academy of Pediatrics recommends supplementation be considered in children with measles and related disorders.
What pharm measure for colic might be effective but has safety concerns?
Antispasmodics
dicyclomine (Bentyl)
Which of the following foods should the nurse recommend as a good source of potassium for a child receiving diuretics?
A. Grains
B. Grains and legumes
C. Dairy products
D. Dark green vegetables
B
One combination of foods that provides the appropriate amounts of essential amino acids is grains (cereal, rice, pasta) and legumes (beans, peas, lentils, peanuts).
What are 2 safety concerns with antispasmodics, therefore should not be recommended?
Seizures
apnea
Although infants may be allergic to a variety of foods, the most common allergens are:
A. fruit, eggs, and rice.
B. fruit, vegetables, and wheat.
C. Eggs, cow’s milk, and peanuts.
D. cow’s milk and green vegetables.
C
Milk products, eggs, and peanuts are three of the most common food allergens. Ingestion of these products can cause sensitization and, with subsequent exposure, an allergic reaction.
What is the recommendation for probiotics for treatment of colic?
Insufficient evidence to recommend for or against
Parent guidelines for relieving colic in an infant include which of the following?
A. Avoid using a pacifier.
B. Avoid touching abdomen.
C. Change infant’s position frequently.
D. Place infant where family cannot hear the crying.
C
Changing the infant’s position frequently may be beneficial. The parent can walk holding the child face down and with the child’s abdomen across the parent’s arm. The parent’s hand can support the child’s abdomen, applying gentle pressure.
What is the problem with gripe water?
Has alcohol, Effect is likely to sedate infant
A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because it:
A. liquefies secretions.
B. improves oxygenation.
C. promotes less labored ventilation.
D. Soothes inflamed mucous membranes.
D
Warm or cold mist is useful to soothe the inflamed mucous membranes. Humidification is most useful when hoarseness or laryngeal involvement occurs.
Normal saline nose drops should be used to liquefy secretions. The mist particles do not penetrate in sufficient amounts to accomplish this.
