Test #7 Flashcards

Question

What are some assessments for Scoliosis?

Answer 1

Unequal shoulder heights Scapulae prominences Waist angles Rib prominences Chest Asymmetry Leg Length Discrepancy

Answer 2

Discuss bracing & exercise Assess body image & maintain brace use Less than 25 degrees it will be watched More than 25 degrees it will go to a brace - Goal is to prevent further curvature Tight fitting shirt under their brace to prevent breakdown (NOT an option) PRE-OP CARE (P.1355) Explain to child and parents what to expect Tour ICU Teach ROM exercises POST-OP CARE VS, Neuro status Fluid balance Pain Control NG Tube Advance Diet Chest Tube S/S of infection Logrolling Preventing constipation Discharge teaching, Community resources & encourage to be as active as possible Alternative - Chiropractics for initial treatment

Answer 3

Brace should be comfortable Skin care Wear fitted t-shirt beneath brace Check brace daily for rough edges

Answer 4

Asymmetry of hip folds Limited abduction (Found early) Allis Sign Barlow Maneuver Ortolanie Maneuver (move and you will feel a click)

Answer 5

Pavlik harness (P.1362 50-10) - For less than 6 months most common Monitor for skin breakdown, know how to secure in carseat Keep top of femur where it should be Hip Spica Cast Prevent complications or injury Parent education & support

Answer 6

-Persistent hip pain that worsens with movement. It may initially come and go and be felt in other areas such as the groin, thigh, or knee. Patients typically limp or have limited ROM.

Answer 7

Hip or knee soreness or stiffness Painful limp, quadriceps muscle atrophy

Answer 8

Monitor non-weight bearing hip abduction, Bed Rest Abduction brace may be used if bed rest isn't workng, Looks like A Assess ROM, pain & neurovascular status Toronto brace - Feet are externally rotated Educate brace

Answer 9

Anti-Inflammatory meds, non-weight bearing and ROM exercises, bedrest If it doesn’t get better in 7-10 days use: Petrie Cast or abduction braces (Toronto brace)

Answer 10

- Stress on the proximal femur at the time when the epiphyseal plate is just about to close – during adolescence. It is more common in obese or overweight boys. - It is believe to be a combination of stress along with hormonal changes. Typically starts out only affecting one side but is seen bilaterally in 25% of the cases.

Answer 11

Adolescent growth spurt, obesity Pain in groin, thigh or knee & limping Worsens with any activity Loss of Hip Motion

Answer 12

Bed rest to prevent further damage Maintain non-weight bearing, NO ROM! Post op care-PT, Crutches, walking Address obesity if present, refer to dietician Provide emotional support Home care Teaching

Answer 13

X-Ray w/pt in frog-leg position

Answer 14

Appears between 3 & 7 Waddling, wide based gait The child will have to use the “Gower maneuver” to rise from the floor (described as putting hands on the knees and moving the hands up the legs until standing erect). Ability to walk is lost between 9 & 12 Death is caused by cardiomyopathy and resp complications Such as: Heart Failure/Sudden Cardia Arrest

Answer 15

Progressive symmetrical muscle wasting Muscle weakness without loss of sensation Gower maneuver

Answer 16

Focus on issues with immobility Preventing contractures Preventing skin breakdown Prevent respiratory infections Monitor skin Help client maintain independence & self care Ensure good nutrition Increased fiber and decreased calories Assess mobility & safety Provide emotional support Facilitate collaboration Complimentary Care How to turn, reposition, Do PROM, massage & when to call PCP

Answer 17

- JA is the leading cause of childhood disability and blindness. It is an autoimmune inflammatory disease with no known cause. - It affects the synovial joints – movable joints that contain synovial fluid

Answer 18

Child must be less than 16 Have swelling in at least 1 joint for more than 6 weeks that is not the result of trauma

Answer 19

Medications Corticosteroids NSAIDS DMARDs (Disease modifying antirheumatic drugs Methotrexate Prevent injuries and identify exacerbations Encourage stretching 10 min prior to activity Especially in am before getting out of bed Teach family about disease and proper care Eye Exams Diet Collaborate with physical & occupational therapist Provide age-appropriate activities Include the child in decision making Proper nutrition Increased fiber, protein, calcium & fluids Monitor for chronic & acute uveitis (Intraocular inflammation)

Answer 20

- MC Cancerous tumor affecting skeleton of children - Usually follows injury to affected bone during rapid growth - Prognosis good if caught early

Answer 21

Hx of injury & hx of discomfort Palpation at site, tenderness, swelling, warmth, erythema Limp

Answer 22

Administer chemotherapy P. 1268 Box 48-1 Sugery – limb sparing versus amputation Manage Pain Support & Refer client & family Radiation – Only as palliative tx, doesn’t treat

Answer 23

- Human Immunodeficiency Virus - Acquired Immunodeficiency Syndrome - HIV is viewed as a chronic condition with ongoing challenges - AIDS is the most advanced manifestation of the HIV infection - Viral infection infects CD4 lymphocytes

Answer 24

Category N - Not symptomatic - Stage 1: No signs or symptoms considered to be the result of HIV infection are present, or the child has only one of the conditions listed in the mildly symptomatic section. Category A - Mildy symptomatic - Stage 2 Two or more of the following conditions are present, but the child has none of the conditions listed in the moderately or severely symptomatic sections. »»Lymphadenopathy »»Hepatomegaly »»Splenomegaly »»Recurrent upper respiratory infections, sinusitis, or otitis media »»Dermatitis »»Parotitis Category B - Moderately symptomatic - Stage 3 ›› Children with the following conditions are considered moderately symptomatic. »»Anemia »»Bacterial meningitis, pneumonia, or sepsis (single episode) »»Oropharyngeal candidiasis »»Cardiomyopathy »»Cytomegalovirus infection, with onset before 1 month of age »»Recurrent or chronic diarrhea »»Hepatitis »»Herpes simplex virus (HSV), stomatitis, bronchitis, pneumonitis, or esophagitis »»Herpes zoster »»Nephropathy »»Leiomyosarcoma »»Lymphoid interstitial pneumonia (LIP) or pulmonary lymphoid hyperplasia complex »»Persistent fever (lasting more than 1 month) »»Toxoplasmosis before 1 month of age »»Disseminated varicella Category C - Severely symptomatic - Stage 4 Children with the following conditions are considered severely symptomatic. »»Multiple serious bacterial infections (meningitis, bone or joint, abscesses of internal organ or body cavity, septicemia, pneumonia) »»Esophageal or pulmonary candidiasis, (bronchi, trachea, lungs) »»Cytomegalovirus disease (greater than 1 month of age with site other than liver, spleen, or lymph nodes) »»HSV stomatitis, bronchitis, pneumonitis, or esophagitis lasting longer than 1 month »»Kaposi’s sarcoma »»Brain or Burkitt’s lymphoma »»Disseminated or extrapulmonary mycobacterium tuberculosis »»Encephalopathy with developmental delays »»Disseminated coccidioidomycosis »»Extrapulmonary cryptococcosis »»Cryptosporidiosis or isosporiasis with diarrhea longer than 1 month »»Disseminated histoplasmosis »»Pneumocystis carinii pneumonia »»Multifocal leukoencephalopathy »»Salmonella septicemia »»Toxoplasmosis of the brain »»Wasting syndrome

Answer 25

Blood, tissue, mom to infant Infants During pregnancy Labor Birth After birth if breastfed Adolescents Sexual contact IV drug use Both contaminated blood exposure

Answer 26

Frequently Present, Highly Indicative Signs * Repeated or persistent respiratory tract infection * Repeated or persistent otitis media or sinusitis * Severe bacterial infections * Opportunistic infections, such as Pneumocystis jiroveci (PCP) or cryptosporidiosis * Poor response to appropriate therapy Frequently Present, Somewhat Suggestive Signs * Skin lesions * Failure to thrive or grow * Chronic diarrhea * Thrush * Hepatosplenomegaly * Anemia, thrombocytopenia, neutropenia * Small or absent lymph nodes, tonsils, and adenoids **BIG signs in infants: Persistent Failure to thrive, thrush, cradle **

Answer 27

Identifying, treating and educating HIV-positive pregnant women is a must ELISA or western blot (mom can refuse to test self and baby) Enzyme Link Immunosuppressive Not accurate for + or - dx in infants younger than 18 months Passive maternal antibodies until around 18 months Virologic testing at: Immediately following birth in known exposure risk 14-21 days 1-2 months 4-6 months 12-18 months to confirm 2+ on two separate occasions gives + dx 2 - on two separate occasions taken at 1 month and older in non-breastfed infants gives - dx CD4+ counts & HIV RNA assays assess: (P.629 & 1049 Medications) Infected children's immune status Response to therapy Risk for disease progression Need for PCP prophylaxis after age 1 Measured at dx and every 3-4 months after Stable adolescents may be done less frequently

Answer 28

Infants born to +moms start oral ZDV therapy within 6-12 hours after birth Prevent infections Facilitate growth and development Medications as prescribed (P.629 &1049 Table 1) Antiretrovirals ZDV P. 629 in box Norvir (Look it up! Will be on test) They will only take meds until - or + dx. Then depending on viral loads. If they are above 500-600 they will not need to take medications. Pain Relief Small frequent meals, high calorie, high protein Encourage fluids Provide play time Prevention Immunizations Table P.1062 42-2 Rotavirus and Varicella maybe not given Provide Support Give references www.aidsinfo.nih.gov

Answer 29

- Genetic Disorder - Production of sickle hemoglobin (HBs), chronic hemolytic anemia, and ischemic tissue injury - RBCs become sickle shaped and rigid - Rigidness obstructs the capillary blood flow and tissue hypoxia - May result in a crisis

Answer 30

----------------------------CHARACTERISTICS Most common type of crisis and reason for hospitalization Typically produces bone or joint pain, but pain can occur anywhere Pain may come and go Frequency of pain is individualized Pain is precipitated by infection, cold, stress, acidosis, local or generalized hypoxia ----------------------------MANIFESTATIONS Mild: Joint or bone pain lasting a few hours Severe: Joint or bone pain lasting days ----------------------------TREATMENT Oral analgesics initially and, if ineffective, IV opioids (usually morphine), which may be given by either intermittent or continuous infusion Oral or IV NSAIDs Oral and IV hydration Aggressive incentive spirometry use (10 breaths every 2 hr when awake) Consistent manner to assess subjective experience of pain is essential Use of nonpharmacologic pain management strategies in addition to medications (McKinney 1247) McKinney, Emily, Susan James, Sharon Murray, Kristine Nelson, Jean Ashwill. Maternal-Child Nursing, 4th Edition. W.B. Saunders Company, 2013. VitalBook file.

Answer 31

-------------------------CHARACTERISTICS Common cause of hospitalization Sometimes confused with pneumonia Can recur ------------------------MANIFESTATIONS Chest pain, fever, cough, abdominal pain -------------------------TREATMENT IV hydration (1-1½ times maintenance), antibiotics, oxygen, RBC transfusion, analgesics

Answer 32

---------------------CHARACTERISTICS Occurs in children ages 6 mo to 4 yr Self-limiting complication ---------------------MANIFESTATION Swelling of hands or feet, pain, warmth in affected area ---------------------TREATMENT Oral analgesics, hydration (oral or IV), rest

Answer 33

-----------------------CHARACTERISTICS Occurs if penile blood flow becomes obstructed -----------------------MANIFESTATION Persistent, painful erection -----------------------TREATMENT Analgesics; hydration Avoid hot and cold packs

Answer 34

-------------------------------CHARACTERISTIC Without treatment, mortality rate of 20%; 70% of patients have a recurrence -------------------------------MANIFESTATIONS Hemiparesis or monoparesis, aphasia/dysphasia, seizures, alteration in level of consciousness, vomiting, vision changes, ataxia, headache -------------------------------TREATMENT Long-term RBC transfusion therapy or erythrocytapheresis and possibly chelation therapy May require extensive rehabilitation

Answer 35

Dehydration Hypoxia Acidosis

Answer 36

History Symptoms usually appear after 4-6 months of age Delayed growth and puberty are common Pain Fever of 101.3 or higher We need to watch CLOSELY bc it can turn bad Cough Swelling Decreased hemoglobin level Pallor Lethargy Headache

Answer 37

CBC Isoelectric focusing Hemoglobin electrophoresis (Dx tool for this disease) High performance liquid chromatography Children have elevated reticulocyte counts Prenatal Dx between 8-10 weeks using chronic villus sampling 15 weeks using amniocentesis

Answer 38

Adequate hydration and blood flow Administer O2 Blood transfusion (1 QUESTION) Administer analgesics as prescribed Opiods and NSAIDS Elevate HOB no more than 30 degrees Prevent Infection Administer abx as prescribed Prevention of crisis Education P.1248 - Home care Box ENCOURAGE FLUID INTAKE

Answer 39

Pain relief then O2 (Usually at the same time) Make sure blood is warm

Answer 40

- Lifelong hereditary blood disorder - No cure - Different types depending on the coagulation factor deficiency - X-Linked autosomal recessive disorder --Carrier females pass on the defect to affected males -Rare for females to have

Answer 41

History Family Client Monitor for bleeding

Answer 42

Often dx after circumcision May be delayed until the toddler years PT PTT Bleeding time Fibrinogen level Platelet count Quantitative immunoelectrophoretic assay Factor VIII and IX assays

Answer 43

Individual Depends on severity of illness Goal is to prevent excessive bleeding May require transfusions Factor replacement therapy Factor 8 & 9 replaced into blood Prophylactic therapy Avoid activities that induce bleeding No contact sports Protect joints Bleeding is treated with RICE Treat the area that is bleeding, pressure on wound, RICE, watch for level of consciousness if hit head Make sure when we pull out/put in IV or foley on these kids be aware of excessive bleeding and monitor. NO ASPIRIN!!! If you walk in a room and your client is bleeding PUT ON GLOVES then Apply pressure!!

Answer 44

-Acquired bleeding disorder characterized by : Thrombocytopenia Purpuric Rash Normal Bone Marrow Absence of signs of other identifiable causes of thrombocytopenia Acute or Chronic Better in 6 months ACUTE; Lasts longer than 6 months CHRONIC MC acquired bleeding disorders in children

Answer 45

Sudden onset of bruising and petechiae Bleeding involving mucous Child is otherwise in good health

Answer 46

History Family (Gumline bleeding) Medications CBC Platelet count might be low but everything else is normal Physical Examination Had a febrile illness in the last month May do bone marrow aspiration to rule out oncology issues

Answer 47

Priority is to prevent rare but lefe-threatening bleeding events Restore platelet count to above 20,000/mm3 Treatment includes oral steroids and IVIG Steroids may be 2-4 weeks IVIG daily for 1-2 days May need a splenectomy Can cure children with chronic ITP (P.1257)

Answer 48

- Anemia = Decreased iron in the blood - Food high in iron - Green leafy, raisins - Bone marrow ceases production of the cells it normally manufactures - Everything is low! - Results in peripheral pancytopenia - Everything is low, RBC, hemoglobin, hematocrit, Etc! - All formed elements of the blood are simutaneaously depressed - Can be congenital or acquired - Most cases in children are idiopathic - without an identifiable cause

Answer 49

Petechiae Ecchymosis Pallor Epistaxis Fatigue Tachycardia Anorexia Infection

Answer 50

May be suspected from: History CBC Bone marrow aspiration ONLY if necessary MC known in posterior illiac crest - Can be done in tibia Procedure doesn't hurt but aftermath DOES! Pain meds after procedure and heat/cold on it! Watch for infection! Confirmed by biopsy

Answer 51

If acquired - discontinue exposure to causitive agent Treatment is otherwise based on symptoms Bone marrow or allogeneic hematopoietic stem cell transplantation remains the treatment of choice for children with severe aplastic anemia, with a suitable donor. Orange Juice helps absorbs iron

Answer 52

- Group of malignancies that affect the bone marrow and lymphatic system - Causes bone marrow dysfunction that leads to anemaia and neutropenia - Abnormal uncontrolled proliferation of WBCs - Most common form of cancer in children under 15 - ALL - Acute Lymphoblastic Leukemia - Most Common - Remission with a 5 year disease free survival rate of 85% - More common in boys - ANLL - Acure Nonlymphocytic Leukemia

Answer 53

Cause is unknown Genetic factors appear to play a signifigant role May present with : Fever Pallor Excessive bruising Bone or joint pain Lymphadenopathy Malaise Hepotosplenomegaly Abnormal WBC Mild to profound anemia and thrombocytopenia EARLY : Low Grade Temp Pallor Chills petechiae Increased Bruising Abnormal Bleeding Abd, leg and/or joint pain Headache Constipation Vomiting Unsteady Gait LATE Hematuria Ulcerations in the mouth Enlarged kidney's and/or testicles Signs of Increased ICP

Answer 54

Strongly suspected from history and clinical presentation Initial CBC Confirmatory test is bone marrow aspiration and/or biopsy BONE MARROW ASPIRATION (1 QUESTION) May need to do lumbar puncture Looks for blast cells in spinal fluid Flow cytometry

Answer 55

Chemotherapy/radiation combination: Ease adverse effects Increase fluids to flush kidney’s Help adjust to body image changes Encourage family to use support group Prevent Infections Monitor skin for bruising and breakdown Pain Relief High protein, high calorie, bland diet

Test #7 Flashcards

(79 cards)