VN 34 Test 11 Peds

Question 1

1. Rheumatic fever manifestations and nursing actions pp slide 5

Answer 1

Manifestations (pp slide 5):
 Carditis polyarthritis & chorea (emotional instability, purposeless movements & muscular weakness)
Nursing Actions (pp slide 5)
 Conversing energy
 Reducing pain
 Providing diversional activities & sensory stimulation
 Preventing injury

Question 2

1. Rheumatic fever cause & diagnostics pp slide 5

Answer 2

Cause:
 Group A strep
Diagnostics:
 Elevated ESR (less than or equal to 10mm/hr)
 Elevated WBC (4,500- 11,000)
 +Group A strep

Question 3

2. Iron supplements for toddlers client education (pp slide 10):

Answer 3

 Advise patient/parent to take liquid forms of iron via a straw, rinse mouth w/water & dilute w/juice to avoid staining
 Provide iron rich foods (take w/vitamin c for better absorption, strawberries)
 Inform parent that iron salts change stool to dark green or black
 Take between meals & not w/milk
 Lock solution up! (iron solution)

Question 4

3. Iron deficiency anemia Actions (pp slide 10, pg.778):

Answer 4

 Administer IM or IV iron when oral iron is poorly absorbed
 Z-track for parenteral injections (don’t massage)
 7-10mg of iron in diet for good health

Question 5

4. Thalassemia client education/nursing care pp slide 8

Answer 5

 Diet: avoid foods high in iron (red meats, poultry, lentils/beans, egg yoks, spinach, dried fruit, peanut butter)
 Child & family support important
 Assist w/RBC transfusions & iron- chelating therapy: deferoxamine

Question 6

4. Thalassemia manifestations pp slide 8

Answer 6

 Pallor
 Irritability
 Bone pain & fractures
 Anemia
 Fatigue
 Failure to thrive
 Lethargy
 Enlargement of spleen
 Skin bronze color or jaundiced

Question 7

5. Hemophilia Nursing Actions/Client education (pp slide 13):

Answer 7

 SubQ injections when possible, w/the smallest needle, apply pressure & monitor for excessive bleeding
 Monitor urine & stool for blood
 No ASA or NSAIDS
 Elevate & apply ice to affected joints during bleeding
 Immobilize & apply elastic wrap to reduce bleeding
 Avoid activities that include high contact/ensure safety

Question 8

5. Hemophilia Manifestations & priority pp slide 13

Answer 8

Manifestations (pp slide 13):
 Bruising
 Bleeding
 Pain

Priority:
 Focused on stopping the bleeding, decreasing pain, increasing mobility & preventing injury

Question 9

6. Manifestations of CHF in infants (pp slide 3):

Answer 9

(Hard to detect)
 Tires easily, tachycardic
 Rapid respirations w/expiratory grunt
 Flaring of nares
 Sternal retractions
 May refuse bottle after 1-2oz
 Periorbital edema, rapid weight gain

Question 10

6. Manifestations of CHF of older child (pp slide 3):

Answer 10

 Failure to gain weight
 Abdominal pain, nausea
 Restlessness, irritability, pale,
 Tachycardia, tachypnea, dyspnea
 Vomiting, weakness, fatigue
 Coughing, edema, enlargement of liver & heart

Question 11

6. CHF actions/concerns pp slide 4

Answer 11

 Small frequent feedings
 Administer medications: digoxin, furosemide, ACE
 Decreasing workload of the heart
 Elevate HOB
 Allow for maximum chest expansion w/loose clothing

Question 12

7. Digoxin Kill hurt know (pg.772 & pharm notes)

Answer 12

 USE: HF, AFIB, Aflutter
 Antidote: Immune fab, digiband
 Check apical pulse for a minute, hold med if less than 90-110 for infants & 70-85 for older children
 Digoxin Therapeutic Range: 0.8- 2 (if greater than 2 toxicity)
 Digoxin Toxicity: anorexia, N/V, irregular pulse, or bradycardia
 Contraindication: St. Johns worth
 Risk of toxicity for clients on loop/thiazide diuretics (because it decreases potassium)

Question 13

8. Furosemide therapeutic response:

Answer 13

 Eliminates excess fluids
 Most powerful diuretic
 Hypokalemia (low/slow, brady cardia, fatigue, muscle twitching)
 Increase potassium rich foods (bananas, strawberries, dark leafy veggies, raisins)
 Toxicity sx: Tinnitus, dizziness, hearing changes (monitor sx)
 Hyperglycemia
 Monitor daily weights, I & O’s
 Photosensitivity

Question 14

9. Kawasaki disease manifestations(pp slide 6):

Answer 14

(An acute, febrile disease. Serious complication for MI if aneurysm is formed)

Manifestations
 Red eyes w/out draining
 Red chapped lips
 Enlarged lymph nodes
 Pale skin indicates O2 deprivations
 Strawberry tongue

Question 15

9. Kawasaki Client education pp slide 6

Answer 15

No live vaccines for 6 mos
 Advise parents to keep cardiac evals
 Teach to monitor for o2 deprivation, inconsolable crying, abdominal pain, restlessness
 Aspirin is use to control inflammation & fever often for months

Question 16

10. Sickle cell anemia Nursing actions (pp slide 12):

Answer 16

 Relieving pain
 Increasing fluid intake
 Improving physical mobility (mild activity is encouraged)
 Conserving energy to maintain o2 levels (avoid strenuous activity following crisis)
 Avoid infections, adequate hydration & maintaining skin integrity

Question 17

10. Sickle cell Manifestations & complications pp slide 11 & 12

Answer 17

Manifestations (pp slide 12):
 Pain
 Fever
 Elevated WBC

Complications (pp slide 11):
 Impaired circulation resulting in tissue damage & infarction:(PRIORITY COMPLICATION!)
-sudden onset of headache
-paralysis of an arm/leg

Question 18

11. Leukemia client education related to vaccines (pp slide 16):

Answer 18

(Most common form of leukemia is acute)
 No live vaccines (MMR, Rotavirus, varicella)

Question 19

12. Leukemia client education pp slide 16

Answer 19

 No live vaccines
 Work w/child to help promote normal growth & development & improve body image
 Encourage caregivers to verbalize feelings & help them to increase their coping abilities

Question 20

12. Leukemia Neutropenic precautions/priority

Answer 20

 Preventing infection (strict handwashing)
 Preventing injury
 Relieving pain & reducing fatigue
 No fresh flowers, no fresh fruits, no salad bars, bottled water only

Question 21

12. Leukemia Manifestations

Answer 21

 Low-grade fever
 Lymph nodes may be enlarged & bruising is a constant problem
 Low platelets, elevated WBC
 Fatigue & pallor
 Bone & joint pain
 Petechiae, purpura (rash of purple spots), bleeding

Question 22

Digitalization (pg. 772)

Answer 22

The use of large doses of digoxin at the beginning of therapy to build up blood levels of the drug to a therapeutic level