VN 34 test 14

Question 1

1. Hirschsprung Disease: client education and manifestations (ch.38 pp slide 9)

Answer 1

Manifestations:
 Newborn fails to have a stool in the 1st 24hrs, bile stained emesis & generalized abdominal distention
 Gastroenteritis w/diarrheal stools, ulceration of the colon & severe constipation w/ribbonlike or hard pellet stools in older child

Client Education:
 Tx involves 2 step surgery
 Client will have a temporary ostomy

Question 2

2. Intussusception: manifestations (ch.38 pp slide 10)

Answer 2

 Stools will have blood & mucus in them
-client might exhibit anorexia.

Question 3

3. Appendicitis: manifestations (ch.38 pp slide 11)

Answer 3

 Older Child: pain & tenderness in the RLQ of the abdomen, N/V, fever & constipation
 Young Child: difficulty localizing the pain, may act restless & irritable & may have a slight fever, flushed face & rapid pulse
 WBC is slightly elevated, decreased bowel sounds, tachycardia

Question 4

4. Lead poisoning: chronic manifestations (ch.38 pp slide 15)

Answer 4

 Irritability, hyperactivity, aggression, impulsiveness, or disinterest in play
 Learning difficulties & distractibility (long term)

Question 5

4. Lead poisoning:acute manifestations (ch.38 pp slide 15)

Answer 5

 Convulsions
 Constipation
 Coma & death
 Anorexia
 Mental retardation
 Paralysis
 Blindness
 Decreased urinary output (if kidneys involved)

Question 6

5. Type 1 diabetes: client education (ch.31 pp slide 18)

Answer 6

 Administer insulin SubQ
 Avoid injecting in area that will be exercised soon after
 Increase fluids during illness
 Obtain yearly flu vaccine
 Observe for ketoacidosis manifestations: change in LOC & test urine for ketones

Question 7

6. Priority care with pediatric respiratory disorders (ch.36 pp slide 18)

Answer 7

 Excellent hand washing!

Question 8

7. Manifestations for epiglottitis, foreign body aspiration, laryngotracheobronchitis (ch.36 pp slide 9 &13)

Answer 8

 LTB: often viral
 Foreign body aspiration: tachypnea, irritability
 Epiglottis: drooling & dysphagia (can be caused by Hib encourage vaccinations)

Question 9

8. RSV nursing considerations (ch.36 pp slide 11)

Answer 9

 Place in private room on contact & droplet precautions & treated w/high humidity by mist tent, rest & increased fluids
 Ribavirin (antiviral) may be used

Question 10

9. Montelukast K,H,K

Answer 10

 Give in the evening/bedtime
 Used in children as young as 12mos of age
 Not rescue med, works in the 1st 24hrs
 Monitor for behavior changes (can cause depression, suicidal ideation)
 Establish baseline LFTS & observe for GI sx’s (can cause liver damage)

Question 11

9. Albuterol K,H,K

Answer 11

 Rescue med
 Hold w/dominant hand, tilt head back, hold in for 10 seconds
 If additional puffs are needed wait 20-30 secs in between
 Don’t share medication
 Monitor for hyperglycemia in clients w/diabetes

Question 12

10. Asthma (acute) manifestations (ch.36 pp slide 15)

Answer 12

 Episodic in mild asthma (2-3x/week), throughout the day in severe persistent asthama
 Dyspnea
 Expiratory wheeze
 Cough
 Limitations w/activity
 Diagnostic evaluation: peak flow

Question 13

11. Asthma (acute) nursing actions (ch.36 pp slide 15)

Answer 13

 Drug therapy to prevent/relieve bronchospasm (albuterol, montelukast)

Question 14

12. Cystic Fibrosis client education/nursing management (ch.36 pp slide 18)

Answer 14

 Diet high in protein & carbs, salts & fats are allowed
 Chest physiotherapy, administer antibiotics & inhalation therapy
 Excellent hand washing
 Avoid places w/high risk of infection

Question 15

13. Cystic Fibrosis pancreatic enzymes K,H,K (ch.36 pp slide 18)

Answer 15

 Given with each meal & snack to help digest the fat in their foods

Question 16

14. Cystic fibrosis diagnostic tests (ch.36 pp slide 17)

Answer 16

 Sweat chloride test (shows elevated sodium chloride levels in the sweat)
 Principal diagnostic test used to confirm CF.

Question 17

15. Croup Manifestations (ch.36 pp slide 9)

Answer 17

 Hoarseness, “barking cough”
 Inspiratory stridor & varying degrees of respiratory distress including retractions , fever, irritability
 Described by anatomic area primarily affected:
-Epiglottitis
-laryngitis
-laryngotracheobronchitis (LTB)
-tracheitis

Question 18

15. Croup nursing actions (ch.36 pp slide 9)

Answer 18

 Assess for need of immediate medical attention when:
-increased stridor (child might lean forward & breath w/tongue out)
-increased restlessness
-increased heart rate & respiratory rate

Question 19

16. Celiac and diet (ch.38 pp slide 5)

Answer 19

 Education of gluten products: barley, rye, oats, wheat

Question 20

17. Pyloric stenosis and manifestations (ch.38 pp slide 8)

Answer 20

 The vomiting increases in frequency & force, becoming projectile.
 Child is irritable, loses weight rapidly, muscle waste & becomes dehydrated
 Might be constantly hungry

Question 21

18. Hypoglycemia manifestations (ch.31 pp slide 18)

Answer 21

 Headache
 Shallow breathing
 Tremors
 Sweating
 Tachycardia
 Lightheaded

Question 22

18. hypoglycemia nursing actions/client education (ch.31 pp slide 18)

Answer 22

 Check glucose Q3hrs during illness
 Observe for hypoglycemia & treat 15-20g fast acting carbs