week 10

Question 1

Nasopharyngitis (common cold)

Answer 1

-Caused by numerous viruses such as , RSV, rhinovirus, adenovirus, influenza, and parainfluenza viruses.

-Clinical manifestations
Stuffy, runny nose.
Scratchy, tickly throat.
Sneezing.
Watering eyes.
Low-grade fever.
Sore throat.
Mild hacking cough.
Achy muscles and bones.

-Therapeutic management and nursing care
Treated at home
Promoting comfort
Teach families signs of complications

Question 2

Respiratory syncytial virus (RSV)

Answer 2

-Most common cause of bronchiolitis in infants and toddlers
-If a child is at high risk for serious lung infections, they will need treatment once a month during RSV season – Nov to April
-Spread by touching, living on hard objects for more than 6 hours
-Treatment is mainly to relieve symptoms
-Antibiotics have no effect on viruses, Palivizumab vaccine to prevent RSV from becoming serious

Question 3

Influenza

Answer 3

-Caused by orthomyxoviruses
Types A, B, and C
-Clinical manifestations
fever* or feeling feverish/chills.
cough.
sore throat.
runny or stuffy nose.
muscle or body aches.
headaches.
fatigue (tiredness)
Therapeutic management/Nursing care

-rest
fluids, like water, meds
medication to reduce any fever or aches
Prevention
Yearly vaccination

Question 4

Types of flu vaccines for children*

Answer 4

-During the current flu season, CDC recommends annual influenza vaccination during the flu season for everyone 6 months and older with any licensed, age-appropriate flu vaccine.

-Injectable influenza vaccines (IIV4)are given as an injection (with a needle) and are approved for use in as young people 6 months and older. (Indications vary by vaccine.)

-Live attenuated influenza vaccine (LAIV4)is given as a nasal spray and is approved for use in non-pregnant, healthy people 2 through 49 years old.

Question 5

Emergency Warning Signs of Flu *

Answer 5

People experiencing these warning signs in children should obtain medical care right away.

-Fast breathing or trouble breathing
-Bluish lips or face NOT EXTREMETIES
-Ribs pulling in with each breath
-Chest pain
-Severe muscle pain (child refuses to walk)
-Dehydration (no urine for 8 hours, dry mouth, no tears when crying)
-Not alert or interacting when awake
Seizures
-Fever above 104°F
-In children less than 12 weeks, any fever
-Fever or cough that improve but then return or worsen
-Worsening of chronic medical conditions

Question 6

Acute Otitis Media (AOM)*

Answer 6

-Inflammation or infection located in the middle ear. Otitis media can occur as a result of a cold, sore throat, or respiratory infection.

-Etiology/pathophysiology: happen when bacteria or virus infect and trap fluid behind the eardrum, causing pain and swelling/bulging of the eardrum.

-Therapeutic management:
Pharmacological: Antibiotics, pain-relieving medications

-Surgical: Placement of ear tubes ( Ear tubes are tiny, hollow cylinders that are surgically insertedinto the eardrum to enable drainage of the middle ear, allows air to flow into the middle ear and prevents the buildup of fluids behind the eardrum.

-Prevention:
Pneumococcal 13-valent conjugate vaccine

Question 7

Risk factors for AOM

Answer 7

-exposure to secondhand tobacco smoke
-preschool or daycare attendance
-bottle feeding
-pacifier use
-allergies
-esophageal reflux
-siblings with recurrent ear infections
-congenital or acquired autoimmune disease
-chromosomal abnormalities
-craniofacial abnormalities (such as cleft lip palate or down syndrome) which may involve oral-palate and Eustachian tube defects that can interfere with normal tube ventilation
-lower socioeconomic status
AOM risk may be related to unhealthy diets, poor housing conditions, and limited access to medical care

Question 7

Risk factors for AOM

Answer 7

-exposure to secondhand tobacco smoke
-preschool or daycare attendance
-bottle feeding
-pacifier use
-allergies
-esophageal reflux
-siblings with recurrent ear infections
-congenital or acquired autoimmune disease
-chromosomal abnormalities
-craniofacial abnormalities (such as cleft lip palate or down syndrome) which may involve oral-palate and Eustachian tube defects that can interfere with normal tube ventilation
-lower socioeconomic status
AOM risk may be related to unhealthy diets, poor housing conditions, and limited access to medical care

Question 8

Otitis Media: Nursing Care*

Answer 8

-Nursing care
Relieving pain
Facilitating drainage when possible
Preventing complications or recurrence
Educating the family in care of the child such as:

-Positioning. Have the child sit up, raise head on pillows, or lie on unaffected ear. *
Heat application. Apply heating pad or a warm hot water bottle.
Healthy diet/fluid intake
Hygiene( hand washing)
Monitoring hearing loss.- don’t want to excrabate this

Question 9

Bronchitis

Answer 9

-Inflammation of the breathing tubes that causes increased mucus production and narrowing the airway

-Caused by:
Viral infection
Bacterial infection
Physical or chemical agents that are breathed in such as dusts, allergens, and strong fumes, including those from chemical cleaning compounds or tobacco smoke.
Acute bronchitis may come after a common cold or other viral infections in the upper respiratory tract.. Pneumonia is a complication that can follow bronchitis.

-Clinical manifestations:
Cough.
Production of mucus (sputum), which can be clear, white, yellowish-gray or green in color — rarely, it may be streaked with blood.
Fatigue.
Shortness of breath.
Slight fever and chills.

Question 10

Bronchitis: Nursing Care *

Answer 10

Avoiding exposure to secondhand smoke
Cough medicine
Humidifying the air
Increased fluid intake
Pain relievers and fever reducers, such as acetaminophen (Tylenol)
Quitting smoking

Avoid antihistamines because they dry up the secretions and can make the cough worse. (also makes it hard to breathe) *

Question 11

Asthma

Answer 11

Chronic inflammatory disorder of airways in which the airways narrow and swell and may produce extra mucus(Bronchial hyperresponsiveness) . This can make breathing difficult and trigger coughing, a whistling sound (wheezing) when you breathe out and shortness of breath.

Question 12

Triggers for asthmatic exacerbations:

Answer 12

-Infections like colds and flu.
-Allergies – such as to pollen, dust mites, animal fur or feathers.
-Exercise and weather.
-Smoke, fumes and pollution.
-Medicines – particularly anti-inflammatory -painkillers like ibuprofen and aspirin.
-Emotions, including stress, or laughter.

Question 13

Clinical manifestations of asthma

Answer 13

-Shortness of breath.
-Chest tightness or pain.
-Wheezing when exhaling, which is a common sign of asthma in children.
-Trouble sleeping caused by shortness of breath, coughing or wheezing.
-Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu.

Question 14

Medication Therapy for Asthma

Answer 14

-Generally, there are 4 groups of medication:
1. Bronchodilators
2. Anti-Inflammatories (Steroidal)
3. Leukotriene modifiers
4. Cromolyn sodium

-Long-term control medications (controllers or preventer medication) such as, Singulair, Flovent, Advair, Pulmicort, Symbicort and QVAR.

-Quick-relief medications (reliever medications) such as Albuterol and Ipratropium bromide.

-Metered-dose inhaler (MDI)
-Corticosteroids
-Cromolyn sodium
-Albuterol, levalbuterol, terbutaline
-Long-term bronchodilators
-Theophylline: Monitor serum levels
-Leukotriene modifiers

Question 15

Asthma Nursing Care

Answer 15

-Providing acute asthma care
-Long-term asthma care
-Avoiding allergens
-Relieving bronchospasm
-Teaching how to administer medications -Supporting the child or adolescent and family

Question 16

How to use your puffer with a spacer

Answer 16

1. Shake the inhaler well before use (3-4 shakes)
2. Remove the cap from your inhaler, and from your spacer, if it has one
3. Put the inhaler into the spacer
4. Breathe out, away from the spacer
5. Bring the spacer to your mouth, put the mouthpiece between your teeth and close your lips around it
6. Press the top of your inhaler once
7. Breathe invery slowlyuntil you have taken a full breath. If you hear a whistle sound, you are breathing in too fast.
8. Hold your breath for about ten seconds, then breathe out.
9. If you need to take more than one puff at a time, wait a minimum of 30 seconds between puffs and be sure to shake the puffer (as in step 1) before each puff. Only put one puff of medication into the spacer at a time.

Question 17

General guidelines for Nursing care/respiratory conditions

Answer 17

-Easing respiratory effort
-Promoting rest
-Promoting comfort
-Reducing the spread of infection
-Reducing temperature
-Promoting hydration
-Providing nutrition
-Encouraging family support and home care

Question 18

Emergency warning signs for respiratory complications **

Answer 18

Parents should be instructed to notify their primary health care provider if any of the following are noted:

-If child is less than 3 months of age:
-Is having trouble breathing,
-Is not eating or is vomiting, or
-Has a fever (temperature of 38.5°C or higher)

In children of all ages:

-Is breathing rapidly or seems to be working hard to breathe
-Has blue lips
-Is coughing so bad that they are choking or vomiting
-Wakes in the morning with one or both eyes stuck shut with dried yellow pus
-Is much sleepier than usual, doesn’t want to feed or play, or is very fussy and cannot be comforted
-Has thick or coloured (yellow, green) discharge from the nose for more than 10 to 14 days.

Question 19

Pediatric Gastrointestinal Differences

Answer 19

-Mouth is highly vascular
-Lower esophageal sphincter muscle tone not fully developed until 1 month of age
-Stomach capacity increases with age
-Intestinal growth spurts between 1 and 3 years and between 15 and 16 years of age

Question 20

Pediatric Gastrointestinal Differences

Answer 20

-Children are less able than adults to receive and transform the nutrients given to them as they are born with immature
digestive systems.
-Digestive enzymes are not as plentiful and efficient.
-Their digestive capacity may be weakened and impaired due to an early exposure to poor dietary choices and environmental stressors.
-The ingestion of incompletely chewed foods places a stress on a child’s digestive and immune systems

Question 21

Dehydration*

Answer 21

Types of dehydration

Isotonic- Water and salt are lost in equal amounts.
Hypotonic- Electrolyte deficit exceeds water deficit. (when u have more h20)
Hypertonic- Water loss exceeds water deficit. (when u lose too much h20)

Symptoms: dark-colored urine, decreased urination, headaches, fatigue, dry skin, decreased skin turgor. *

-Therapeutic management
Oral fluid therapy , parenteral fluid therapy (oral rehydration solution)
Treat the underlying cause of fluid loss

Question 22

Vomiting

Answer 22

-Often accompanied by nausea

Therapeutic management
-Detect and treat cause
-Prevent complications(dehydration)
-Provide fluids
-Antiemetic in some cases

Question 23

Diarrhea

Answer 23

-loose, watery and possibly more-frequent bowel movements.

-Acute diarrhea is a leading cause of illness in children under 5 years of age.

-Acute infectious diarrhea (infectious gastroenteritis)

-Chronic diarrhea is defined as an increase in stool frequency and increased water content for a duration of more than 14 days
-Therapeutic management
-Assess fluid and electrolytes, rehydrate, maintain fluid therapy, and reintroduction of an adequate diet

Question 24

Cleft Lip or Cleft Palate

Answer 24

-Facial malformations that occur during embryonic development

-May appear separately or together

-Therapeutic management
Surgical correction of cleft lip
Surgical correction of cleft palate

-Prognosis
-Nursing care
Feeding
Pre-operative care
Post-operative care
Long-term care

Question 25

Breast-feeding- with cleft lip

Answer 25

-During breast-feeding, the soft breast tissue often will fill the opening in the lip and/or gum line. This seals off the mouth and lets your baby create enough suction.
-Sometimes it helps to hold a finger across the cleft while your baby feeds.
-Swallowing noises and normal weight gain are signs that breast-feeding is going well.
-If your baby is “noisy” with feeding, making clicking or kissing noises, they may not have enough suction.

Question 26

bottle feeding- cleft lip

Answer 26

-If you bottle-feed your baby, feeding may work better using special bottles or nipples with a wider base.
-When starting a feeding, hold your baby in a slightly upright position.
-Touch the baby’s lower lip with the nipple.
-When the baby latches on, direct the nipple slightly downwards.
-Try to keep the nipple in the center of the baby’s mouth. Do not let it slip up into the cleft.

Question 27

Juvenile (Type 1) Diabetes

Answer 27

-Autoimmune condition, pancreas cannot produce any insulin
-Exact cause unknown
-If untreated/undetected can lead to ketoacidosis
-Diagnosis: high blood sugar level symptoms & fasting blood sugar reading of at least 7.0mmol/L or 11mmol/L at any time of day

Question 28

Juvenile (Type 1) Diabetes- Management

Answer 28

Diet & Exercise
Insulin injections
Monitoring
-hypoglycemia is top emergency bc of brain damage * go back to slide and look at picture

Question 29

Cerebral Palsy (CP) *

Answer 29

-A group of disorders of movement, muscle tone and posture associated with activity limitations and attributed to nonprogressive, permanent injury or malformation of the developing fetal, infant or young child’s brain

-Most common permanent physical disability in childhood
-A significant number of children with CP will also have epilepsy
-non-progessive and early onset

Question 30

Prenatal brain abnormalities- CP

Answer 30

-Gross abnormalities of the brain
-Vascular occlusion
-Laminar degeneration
-Effects of low birth weight
-Anoxia
-Hypoxic infarction or hemorrhage

Question 31

Cerebral Palsy (CP)
six attributes that require investigation

Answer 31

-Early handedness in a child under 12 months
-Stiffness or tightness in the legs between 6 and 12 months
-Persistent fisting of the hands in children over 4 months
-Persistent head-lag in a child over 4 months
-Inability to sit without support in child over 9 months
-Any asymmetry in posture or movement.

Question 32

Cerebral Palsy (CP)- management

Answer 32

-Rehabilitation
Physical, occupational & speech-language therapy
-Pharmacological
To treat pain related to spasms and seizures
Botulinum toxin A injections (BoNT-A) iseffective for reducing over-activity in muscles in children with cerebral palsy. This results in a reduction in muscle strength and muscle tone with small, short-lived gains in aspects of gait and function
-Neurosurgical
-Orthopedic
-Dental hygiene
-Neuromuscular electrical stimulation (NMES)

Question 33

Duchenne Muscular Dystrophy (DMD) *

Answer 33

-Also called pseudohypertrophic muscular dystrophy
-Most severe and most common of muscular dystrophy in childhood
X-linked inheritance pattern; one third are fresh mutations
Incidence: 1 in 3600 male births

picture: Gower sign
** progressive main difference btwn CP and DMD
Remember the sign for this condition * grower sign **
Mainly in men bc of XY- must require one gene that has one disease –genetic counselling is a must ** bc its an X link
Women can be a carrier

Question 34

Duchenne Muscular Dystrophy

Answer 34

-Early onset, usually between 2 and 5 years of age
Progressive muscular weakness, wasting, and contractures
-Calf muscle hypertrophy in most patients
-Loss of independent ambulation by 12 years of age
-Slowly progressive, generalized weakness during teenage years
-Relentless progression until death from respiratory or cardiac failure

-Waddling gait
-Lordosis
-Frequent falls
-Gower sign (child turning onto side or abdomen, flexing knees to assume a kneeling position, then with knees extended gradually pushing torso to an upright position by “walking” the hands up the legs)
-Enlarged muscles (especially thighs and upper arms); feel unusually firm or woody on palpation

Question 35

Duchenne Muscular Dystrophy Later stages:

Answer 35

-profound muscular atrophy
-Cognitive impairment
Mild (about 20 IQ points below normal)
IQ <70 present in 25 to 30% of patients

-Complications:
Contracture deformities of hips, knees, and ankles
Scoliosis- compenstation
Risk of fractures
Respiratory and cardiac compromise
Obesity

Cognitive and eye impairment- bc of ocular muscle- becomes weak=
Respiratory and cardiac problem – diagraph muscle- if it becomes weak, lung expansion gets affected
Cardiac leads u to the ICU- in advance stage HF- doesn’t have the ability to contract

Question 36

Duchenne Muscular Dystrophy nursing care

Answer 36

Nursing care
-Help child and family cope with chronic, progressive, incapacitating disease
-Design program to foster independence and activity for as long as possible
-Teach child self-help skills
-Appropriate health care assistance as child’s needs intensify (e.g., home health, skilled nursing facility, respite care for family)
-Often live into adulthood

Question 37

Congenital Heart Disease (CHD)

Answer 37

-Incidence: 12 per 1000 live births
-CHD is a major cause of death in the first year of life (after prematurity).
-Critical congenital heart disease (CCHD) is more severe and usually requires intervention early in life
-The most common anomaly is ventricular septal defect (VSD).

Question 38

Congenital Heart Disease - cyanotic *

Answer 38

-decrease pulmonary blood flow –> tetralogy of fallot tricuspid atresia

-mixed blood flow -transposition of great arteries. total anomalous pulmonary venous return
-truncus arteriosus
-hypoplastic left heart syndrome

Question 39

Congenital Heart Disease -acyanotic

Answer 39

-increase pulmonary blood flow- atrial septal defect. ventricular septal defect. patent ductus arteriosus. atrioventricular canal defect

-obstruction to blood flow from ventricles. contraction of aorta. aortic stenosis. pulmonic stenosis

Question 40

Defects With Increased Pulmonary Blood Flow

Answer 40

-Common in:
Atrial septal defect (ASD)
Ventricular septal defect (VSD)
Patent ductus arteriosus (PDA)

-Abnormal connection between two sides of heart
-Increased blood volume on right side of heart
-Increased pulmonary blood flow
-Decreased systemic blood flow

In a healthy heart, the wall that separates the right and left chambers (the septum) prevents non-oxygenated blood from mixing with oxygenated blood. A septal defect allows blood to flow back and forth between the right and left sides of the heart.

“When there’s a hole in the heart, either at the atrial or ventricular level, the heart just can’t work efficiently,”. The lungs end up getting too much oxygen-rich blood. This makes both the heart and lungs work harder. The surgical treatment for atrial septal defect (ASDs) and ventricular septal defect (VSDs) is open-heart surgery.

Question 41

Defects With Decreased Pulmonary Blood Flow

Answer 41

-Most common: tetralogy of Fallot and tricuspid atresa

-Pressure on right side increases, greater than left-sided pressure which result in desaturated blood in left side of heart and in systemic circulation

-Tetralogy of Fallot includes four defects:
Narrowing of the lung valve (pulmonary valve stenosis).
A hole between the bottom heart chambers (ventricular septal defect).
Shifting of the body’s main artery (aorta).
Thickening of the right lower heart chamber (right ventricular hypertrophy).

Question 42

Tetralogy of Fallot

Answer 42

1. pulmonary stenosis
2. right ventricular hypertrophy
3. overriding aorta
4. ventricular septal defect

Question 43

Nursing Care of Child and Family

Answer 43

-Helping the family adjust to the disorder.
-Educating the family about the disorder.
-Helping the family manage the illness at home.
-Preparing the child and family for invasive procedures.
-Providing postoperative care:
-Observing vital signs
-Maintaining respiratory status
monitoring fluids
-providing rest and progressive activity
-providing comfort and emotional support

Question 44

Plan for discharge and home care

Answer 44

-fainting, or heart palpitations, and feeding problems or reduced appetiteChildren need at least 3 or 4 more weeks at home and recovery may take 6 to 8 weeks.
-child should not do any activity that could result in a fall or a blow to the chest.
-keep the child from crying for too long for the first 3 to 4 weeks.
-Do not pull or lift the child by the arms or from their armpit area.
-Limit feeding time to around 30 minutes, add extra calories to formula if it is necessary. **
-Check the wound for signs of infection, such as redness, swelling, tenderness, warmth, or drainage.
-Call the doctor if the child has fever, nausea, or vomiting, chest pain, redness, swelling, or drainage from the wound, Difficulty breathing or shortness of breath, Puffy eyes or face, bluish or grayish skin, dizziness

Question 45

Preoperative preparation for children

Answer 45

-The child and family receive an adequate explanation of procedure using an interpreter if required.
-The child is fasted as indicated according to fasting guidelines.
-The child has their identification bracelet on that has been checked by the nurse.
-Conduct a pre-operative pain assessment is completed.
-Ordered blood tests are taken by appropriate staff members in advance of being taken to theatre.
-Clear oral fluids are given, and additional fluids may be required as per the pre-operative plan or the condition specific guideline.
-Inpatients have a soapy shower or wash and wear clean pajamas or gown to the operating room.
-The parent or legal guardian has signed consent (anaesthetic and surgical) in the ward or is available to do so pre-operatively.
-The family understand the estimated timeframe of the procedure and are kept informed about any delays.

Question 46

Postoperative Care for children

Answer 46

-Promotes oral fluids and then light diet as tolerated, unless otherwise stated in post-operative notes.
-Ensures the child has passed urine post anaesthetic.
-Administers intravenous fluids as prescribed and titrated to oral fluid intake.
-Assesses and documents hydration and fluid balance hourly until intravenous fluids are discontinued.
-Measures drain output and records on the Fluid -Balance Chart.
-Administers antibiotics as prescribed.
-Observes vital signs and for signs of infection.
-Involves the family in the child’s care as negotiated and appropriate
-Offer and facilitate the parent/caregiver to take breaks
-Encourages the family to have their own books and toys with them

Question 47

Sickle cell disease (SCD)

Answer 47

-Sickle cell disease (SCD) is a group of inherited red blood cell disorders
In SCD, the hemoglobin is abnormal causing the red blood cells to become hard and sticky and appear crescent or sickle-shaped
Etiology:
Caused by inheriting of the sickle cell gene.
A child has to inherit a copy of the sickle cell gene from both their parents.
Common types of SCD:

-Sickle or crescent cells die early causing a constant reduction in the number of red blood cells.

-Sickle or crescent cells, when they travel through small blood vessels, clump together clogging blood flow and depriving organs of blood and oxygen
-Causing severe pain associated with sickle cell crisis
-Damage nerves and organs,
-Infection, acute chest syndrome, and stroke.

The more u have a sickle type– hbs% the more ur in a severe percentage

Question 48

HbSS

Answer 48

Child inherits Hemoglobin “S” from both parents
Most common and severe type (also called sickle cell anemia)

Question 49

HbSC

Answer 49

Child inherits hemoglobin “S” from one parent and a different type of abnormal hemoglobin called “C” from the other parent.
Usually, a milder form of SCD.

Question 50

HbAS

Answer 50

Child inherits a hemoglobin “S” from one parent and a normal gene hemoglobin “A”
Show no sign of the diseases
Can pass the abnormal gene S to their children

Question 51

Symptoms and Complications

Answer 51

-Painful episodes (vaso-occlusive crisis) or sickle cell crises (early as 6 months) ***
-Hand-foot syndrome:painful swelling of the fingers and toes (also calleddactylitis) is the first sign of sickle cell anemia in some infants.
-Acute chest syndrome:due to inflammation and infection associated with blockage of small blood vessels of the lung (children < 10 years)
-Anemia due to breakdown of a few RBC (most common symptom)
-Avascular Necrosis (Death of Bone Tissue): due to blockage of blood and oxygen (limb deformity)
-Jaundice of the skin, eyes, and mouth (RBC breakdown exceeding liver capacity)

-Priapism (painful long-lasting erection of the penis) common in males
-Splenic sequestration crises (pooling): enlarged and painful spleen due to trapping of sickle cells (1-4 years)
-Infection:Risk for some bacterial infections. (children <5 are at higher risk)
Stroke
-Delayed growth
-Psychosocial issues (depression and anxiety) associated with living with chronic disease
-Others include, liver, kidney, eye, leg ulcers, —Pulmonary Hypertension

Question 52

treatment for sickle cell disease

Answer 52

1. management of vasooculsive crisis
2. management of chronic pain syndromes
3. management of the chronic hemolytic anemia
4. prevention and treatment of infections
5. management of the complications and the various organ damage syndromes associated with the disease
6. prevention of stroke
7. detection and treatment of pulmonary hypertensions

PAIN IS ALWAYS ATYPICAL in sickle cell crisis

Question 53

Preventive and Nursing Care- sickle cell

Answer 53

-Preventive and supportive care (Canadian

Pediatric Society (CPS))
-Hydroxyurea standard of care for all patients with HbSS)
-reduces risk of acute chest syndrome (ACS), vaso-occlusive episodes (VOE), transfusions, hospitalization, and mortality
-Given to children ≥9 months of age.
-Prophylactic penicillin VK or amoxicillin should be prescribed for all children with SCD from 2 months to 5 years of age.
-Immunization
-Transfusion may be required

-A sickle cell crisis can usually be managed at home.
-Acute pain crisis require hospitalization
-Utilizes pharmacological and non-pharmacological measures
-Assess pain- level, characteristics, location, and intensity
-Administer analgesics (acetaminophen, NSAID, -Fentanyl, morphine - CPS)
-Comfort measures such distractions (read a story, watch a film or play their favourite computer game)
-Hydration, prevention of infections, and early recognition of complications.
-Physiotherapy, cognitive-behavioral therapy, and support groups.
-Complementary approaches such as a warm towel or a wrapped heated pad for gently massage
-Teaching to avoiding triggers: infection, dehydration, excessive exercise or physical activity, excessive cold or heat, nutritional deficiency

Question 54

Key Nursing Care Considerations

Answer 54

-Be aware of the stigmatization encountered by individuals with SCD, and provide culturally sensitive care and advocacy, particularly for pain management.
-Conduct a timely and comprehensive pain assessment with prompt pain management.
-Understand that individuals with SCD will likely not have a “typical” pain presentation.
-Recognize that failing to believe that the individual with SCD is in pain contributes to additional suffering.
-Monitor for life-threatening and severe complications, such as acute chest syndrome and stroke.
-Assess for psychosocial complications and make appropriate referrals.
-Provide patient and family education.
-Promote patient and family self-management

Question 55

for hypercyanotic spells

Answer 55

Infant held in knee–chest position.