FINAL! - Test 3 Flashcards

Question

Isotonic (isonatremic)

Answer 1

- most common inadequate intake - primary form of dehydration occurring in children. - occurs in conditions in which electrolyte and water deficits are present in approximately balanced proportions. - Shock is the greatest threat to life in isotonic dehydration, and the child with isotonic dehydration displays symptoms characteristic of hypovolemic shock. - Plasma sodium remains within normal limits, between 130 and 150 mEq/ L.

Answer 2

1. Restoration and maintenance of intravascular volume and systemic perfusion - Initial therapy focuses of treating or preventing shock - Mild dehyration may be treated with oral fluid replacement - For moderate to severe shock must have vascular access 2. Replacement of fluid and electrolytes -Fluid replacement with isotonic fluids =NS or LR usually first choice =May require colloids if intravascular dehydration not responsive to fluid bolus 3. Provision of maintenance fluid 4. Supportive care -Monitor respirations =May be inadequate if child is tachypneic or acidotic -Monitor electrolytes, glucose, urine output - Weight -Vital signs - If the child's condition is deteriorating early vital sign changes will be heart rate and respirations. -Blood pressure is usually the last vital sign to change as child's condition worsens. -Also assess: color, perfusion, activity, responsiveness, feeding behavior

Answer 3

- of major importance is recognition of ambiguous genitalia and diagnostic confirmation in newborns - cortisol and aldosterone replacement are the treatments - during stressful situations cortisol disagree must be tripled to accommodate the body's increased need for glucocorticoids. failure to meet this requirement will precipitate an acute crisis. overdose appears as cushingoid signs - sudden termination sof ht drug because of inadequate supplies, places the child in danger of an acute adrenal crisis. teach parents to always have a spare supply of medication. - undesirable side effects of cortisone include gastric irrigation, increased excitably and sleeplessness, weight gain, occasionally behavioral changes. - infants are especially prone to dehydration and salt-losing crises, parent need to be aware of signs of dehydration.

Answer 4

100 ml for each of the first 10kg = up to 1000 ml 50ml for each kg 11-20 = up to 500 ml 20 ml for each additional kg

Answer 5

ph: 7.35 - 7.45 pCO2: 35 - 45mmHg HCO3: 22 - 26 mEq/L

Answer 6

- palliative care for children is the active total care of the child's body, mind, and spirit and involves giving support to the family. - it begins when illness is diagnosed and continues regardless of whether or not a child receives treatment directed at the disease. - health providers must evaluate and alleviate the child's physical, psychological, and social distress - effective palliative care requires a broad multidisciplinary approach that includes the family and makes use of available community resources; it can be successfully implemented even if resources are limited. - it can be provided in tertiary care facilities, in community health center, and even in children's homes

Answer 7

palliative care interventions

Answer 8

- No effective treatment has been established - Primary goal is to maintain function in unaffected muscles as long as possible - Keep the child as active as possible - Range of motion, bracing, performance of activities of daily living, surgical release of contractures as needed - Genetic counseling for the family

Answer 9

- normalization and promotion of self-care activities that empower the child and family to achieve maximum potential. - Live longest, most healthiest life possible

Answer 10

1. To establish locomotion, communication, and self-help skills 2. To gain optimal appearance and integration of motor functions 3. To correct associated defects as early and effectively as possible 4. To provide educational opportunities adapted to the child's needs and capabilities 5. To promote socialization experiences with other affected and unaffected children

Answer 11

1. Pain: Severe pain that is not relieved by analgesics or elevation of the limb, movement that increases pain 2. Pulselessness: Inability to palpate a pulse distal to the fracture or compartment 3. Pallor: Pale appearing skin, poor perfusion, capillary refill greater than 3 seconds 4. Paresthesia: Tingling or burning sensations 5. Paralysis: Inability to move extremity or digits 6. Pressure: Involved limb or digits may feel tense and warm; skin is tight, shiny; pressure within the compartment is elevated

Answer 12

The nursing care objectives in either situation are to (1) reassure the child and family throughout every phase of treatment, (2) orient the child to the surroundings, (3) provide a safe environment, and (4) encourage independence.

Answer 13

Nurses have a major role in minimizing the effects of temporary loss of vision. They need to talk to the child about everything that is occurring, emphasizing aspects of procedures that are felt or heard. They should always identify themselves as soon as they enter the room and before they approach the child. Encourage the parents to room with their child and participate in the care. Familiar objects, such as a teddy bear or doll, should be brought from home to help lessen the strangeness of the hospital. As soon as the child is able to be out of bed, orient the child to the immediate surroundings. If the child is able to see on admission, this opportunity is taken to point out significant aspects of the room. Encourage the child to practice ambulating with the eyes closed to

Answer 14

Stephenson slides - Concerns of body image - Concerns of social isolation - Concerns of prolonged treatment of condition - Preoperative care - Postoperative care - Family issues - In adolescents, this period is the one in which their identity, both physical and psychological, is formed. The identification of scoliosis as a “deformity,” in combination with unattractive braces and a significant surgical procedure, can have a negative effect on the already fragile adolescent body image. - Nursing care of the adolescent who is facing scoliosis surgery, potential social isolation, pain, and uncertainty, not to mention misunderstood emotions and body image issues, must be evaluated from the adolescent's perspective to be successful in meeting the individual's needs. - When a child or adolescent first faces the prospect of a prolonged period in a brace or other device, the therapy program and the nature of the device must be explained thoroughly to both the child and the parents so they will understand the anticipated results, how the appliance corrects the defect, the freedoms and constraints imposed by the device, and what they can do to help achieve the desired goal. - Management involves the skills and services of a team of specialists, including the orthopedist, physical therapist, orthotist (a specialist in fitting orthopedic braces), nurse, social worker, and sometimes a thoracic or pulmonary specialist.

Answer 15

- Infection prevention - Avoid using latex as infants w/ myelomeningocele have a high risk of developing latex allergy - Daily head circumference measurements ( high risk for hydrocephalus) - Cover with sterile gauze or tegaderm

Answer 16

- Harness should not be removed until provider says its ok - 23hrs a day and then off for an hour to bath - Parents should not adjust harness - Parents should assess child's skin at least 2-3 times daily for red areafs or skin irritation in skin folds under the straps - Gently massage healthy skin under the straps once a day to stimulate circulation - Always place diaper under straps - Encourage parents to hold the infant with harness and continue care and nurturing activities

Answer 17

- Infection prevention

Answer 18

Thyroid-stimulating hormone(TSH) deficiency

Answer 19

Generalized slowing down of everything) - Decelerated growth - Myxedematous skin changes (dry skin, puffiness around the eys, sparse hair) - Constipation - Lethargy and mental decline

Answer 20

- bone bends causing an incomplete fracture | - kids are more prone bc there bones are soft

Answer 21

- Importance of dental hygiene - Parents may need assistance and advice with medication administration through a gastrostomy tube to prevent clogging. - Manual jaw control - Car restraints especially designated for children with poor head and neck control are available and should be used.*

Answer 22

- Jaundice (starts earlier and last longer) - dark urine - clay colored stools - Abdominal distention, - Failure to Thrive - Pruritus

Answer 23

Congenital absence or obstruction of bile duct causing - impaired drainage of bile - Progressive inflammation and cirrhosis of liver

Answer 24

- Maintain fluid and electrolyte balance - Support nutrition - Promote Growth and Development - Protect from infection - Psychosocial support

Answer 25

- Diet: moderate sodium restriction and fluid restriction | - Potassium restriction during oliguria

Answer 26

- leukocytosis | - elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).

Answer 27

1) Reducing excretion of urinary protein 2) Reducing fluid retention 3) Preventing infection 4) Minimizing complications related to therapies 5) Relapses & Complications

Answer 28

Massive proteinuria, hypoalbuminemia, hyperlipidemia and edema

Answer 29

- Nurses should instruct parents to observe for signs and symptoms suggestive of UTI. - These are not always obvious, particularly in an infant, young child, or developmentally delayed child. - A high fever without obvious cause should be a signal to check the urine. - Report a careful history regarding voiding habits, stooling pattern, feeding tolerance, and episodes of unexplained irritability may assist in detecting less obvious cases of UTI.

Answer 30

- Following surgery, patients are monitored in an acute care setting - log rolled when changing position to prevent damage to the fusion and instrumentation. - In some cases, an immobilization brace or cast is used postoperatively depending on the type of surgical intervention. - Skin care is important, and pressure-relieving mattresses or beds may be needed to prevent pressure wounds

Answer 31

- Child doesn't smile - Weak head control - Persistent Moro Reflex (startle reflex) - Gags or chokes while eating - Kids not meeting developmental milestones

Answer 32

- Serum potassium concentrations in excess of 7 mEq/ L is a medical emergency : - Meticulous attention to fluid intake and output - Monitoring fluid balance and vital signs continuously - Maintain an optimal thermal environment - Reduction of body temperature - electrolyte balance maintained

Answer 33

1. Initial impact Initial impact usually occurs at the time of the child's initial diagnosis. In some situations where diagnosis is delay, parents may reach this point when they begin to recognize symptoms of illness. Other parents may reach this point when they begin to recognize the potential seriousness or difficulty of the illness. During this time period, parents must give up their preexisting view of the child and previously learned parenting behaviors, and begin developing strategies for dealing with the child,s health. 2. Increase in physical symptoms Any time the child's physical symptoms change, the family's equilibrium may be disrupted. This disruption is particularly likely when the child,s symptoms worsen, but it may also occur if the child's symptoms improve.

Answer 34

- weight loss - elevated pulse - tachypnea - irritable - dry mucous membranes - decreased tears - sunken anterior fontanel - slow cap refill

Answer 35

- maintain NPO - administer IV fluids and electrolytes as prescribed to preven dehydration - monitor for changes in level of pain - monitor for signs of rupture appendix and peritonitis - administer antibiotic as prescribed - monitor bowel sounds - avoid laxative or enemas.

Answer 36

- monitor the skin for signs of infection - the preferred position is side-lying prone position with the hope elevated - keep the anal surgical incision clean and dry - maintain IV fluids unti gi motility returens - provide care for colostomy if present - a new colostomy stoma may be red and edematous, but should decrease with time - instruct parents ot performa anal dilation is prescribed to achieve and maintain bowel patency

Answer 37

for babies and young children, caregivers must monitor and intervene when food has been lacking for long periods. Hirschfeld, a pediatrician, and other health providers have been spreading information for years about how to prevent complications like seizures — caregivers should make sure the babies and children take in breast milk, formula or other glucose-containing liquids, by intravenous means if necessary, according to the advice.

Answer 38

extreme sleepiness irritable mood poor appetite

Answer 39

``` low blood sugar (hypoglycemia) high levels of ammonia in the blood breathing problems seizures coma, sometimes leading to death ```

Answer 40

If treated quickly and appropriately, these symptoms can be reversed. However, if a child has too many metabolic crises, they could develop brain damage. This brain damage can result in learning problems or intellectual disabilities. Therefore, it is important that infants and children with CPT1A arctic variant receive prompt treatment if they exhibit symptoms of metabolic crisis. Treatment should help to avoid potential long-term effects on development.

Answer 41

- low potassium | - metabolic alkalosis

Answer 42

- The WBC count becomes elevated | - Elevated C-reactive protein (CRP)

Answer 43

Greater loss of Na+ than water causing hypotonic serum Fluid shifts from intravascular to interstitial space causing signs of severe dehydration May cause shock Serum Na+ <130 Causes: vomiting, diarrhea, inappropriate fluid administration

Answer 44

Therapeutic Management The goals of fracture management are: • To regain alignment and length of the bony fragments (reduction) • To retain alignment and length (immobilization) • To restore function to the injured parts • To prevent further injury and deformity The majority of children's fractures heal well, and nonunion is rare. Fractures are splinted or casted to immobilize and protect the injured extremity. Children with displaced fractures may have immediate surgical reduction and fixation (internal or external) rather than being immobilized by traction ( Fig. 29-4 ). This practice is more common and holds true for all types of fractures, including femur fractures, although there is variation based on provider preference and institutional practice. Some conditions require immediate medical attention, including open fractures, compartment syndrome, fractures associated with vascular or nerve injury, and joint dislocations that are unresponsive to reduction maneuvers.