Most common post op complication of tonsillectomy?
hemorrhage
Risk time for hemorrhage after tonsillectomy?
10 days to 2 weeks post op
Signs and symptoms of hemorrhage after tonsillectomy?
restlessness, swallowing frequently, low BP (late sign)
How should child lay post op to prevent hemorrhage from tonsillectomy?
side lying or on abdomen
What should the child avoid after a tonsillectomy post op?
coughing or blowing nose
How should xrays be taken to see the section of the lung behind the heart (lingual)?
Laterally
Why are lateral xrays needed to view the lingual area?
a common site for pneumonia
If a child is “barking” and has hoarseness and inspiratory stridor what might they have?
croup
What does inspiratory stridor sound like?
a gasp
If stridor reduces in a child previously showing stridor, what can that mean?
blockage and imminent respiratory failure
Do not put anything in the __ of a child with acute epiglottitis.
Mouth
Acute LTB
Croup symptoms, Inflammation mucosa lining larynx & trachea causing narrowing airway-subglottic area narrowest part causes respiratory acidosis
Diagnosis of Asthma is
peak expiratory flow (PEF)
Treatment of Asthma is
beta agonists such as albuterol to relieve bronchospasms
Preventing chronic problems with Asthma treatment
anti-inflamatories such as corticosteroids
treatment for an emergency with Asthma attack
repeat dose q15min twice, on 3rd dose call ambulance
Parents need education about beta agonists, what should a nurse advise?
don’t give them around the clock, they should be prn, do not abuse
Common side effects of beta agonists
nervousness, tachycardia
What is Cystic Fibrosis?
Sludge, or increased viscosity of mucous, a build up of thick, sticky mucus in the lungs
What diet should a patient with cystic fibrosis eat?
high protein, high calorie
Signs and symptoms of Increased Intracranial pressure
High pitched cry, difficult to soothe, tense and bulging fontanels, cranial sutures separated, setting sun eyes, distended scalp veins, headache, vomiting, seizures, diplopia, irritability/restlessness, drowsiness, indifference, decrease in physical activity & motor skills, complaints of fatigue, somnolence, weight loss
Late signs of increased ICP
decreased LOC, decreased motor response to command, decreased sensory response to painful stimuli, loss of PERRLA, palliledema
Decorticate positioning
all flexed
Decorticate positioning is a dysfunction of what?
cerebral cortex
decerebrate positioning
all extended
Decerebrate positioning is a dysfunction of what?
mid brain
Cushing’s reflex
Reflex due to cerebral ischemia that causes an increase in blood pressure, decrease in pulse rate, and changes in breathing patterns.
What is Myelomeningocele?
the most common form of spina bifida in which the bones of the spine do not completely form, resulting in an incomplete spinal canal, causing the spinal cord and meninges to stick out of the childs back
What should be done for Myelomeningocele?
4×4 soaked in normal saline placed over “sac”, normal saline drip over 4×4 to prevent rupture until surgery
Main prevention for Spina Bifida (Myelomeningocele)?
Folic acid early in pregnancy
Diagnostic indication for Neuroblastoma is?
High catecholamines in 24 hour urine collection
Neuroblastoma
Malignant childhood tumor originating in cells of the nervous system.
Retinoblastoma
tumor arising from a developing retinal cell (a congenital, malignant tumor)
Leukokoria
aka cat’s eye reflex; yellowish white reflex seen in the pupil because of a Retinoblastoma tumor behind the lens
Bacterial Meningitis
Inflammation of the membranes covering the brain and spinal cord; caused by bacteria (e.g., meningococcus); symptoms include nasopharyngeal catarrh, headache, convulsions, vomiting, and stiff neck.
Definitive diagnostic test for bacterial meningitis is
Lumbar puncture with decreased glucose, increased protein, increased WBC’s
Treatment for Bacterial Meningitis
Give antibiotic immediately, do not wait for C&S
Reye’s syndrome
A brain inflammation that occurs in children following a viral infection, usually the flu or chickenpox. It is characterized by vomiting and lethargy and may lead to coma and death.
What should be monitored with Reye’s syndrome to watch for possible cerebral edema?
I&O’s
Infantile seizures are usually associated with some degree of _____.
mental retardation
There are no – __ in infantile spasms
post-ictal drowsiness
What should be done for pediatric seizures?
side lying to keep airway patent, document exact length of seizure and any precipitating factors, do not put anything in the mouth
How many concussions with in several months lead to permanent brain injury?
2
Signs and symptoms of cerebral palsy
poor head control after 3 months, unable to sit without support at age 8 months, clenched fists after age 3 mths
ADHD medications
dexedrine, adderall, ritalin
Side effects of ADHD medications
insomnia, anorexia, weight loss, hypertension, may suppress growth over long term
5 p’s of fracture
pain, pulse, pallor, paresthesia, paralysis distal to point of fracture
How do you handle a fresh cast?
with palms of hands, not fingertips
Osteomyelitis treatment
begin IV antibiotics before C&S is done
Osteomyelitis
infection of bone and bone marrow causing inflammation
Osteomyelitis diet
protein – milkshake
Developmental dysplasia of the hip
A genetic condition in which the head of the femur dislocates from the acetabulum of the pelvis.
The limb on the affected side of DDH is _.
shortened
What two tests will be positive with DDH?
Ortolani test and Barlow test
Ortolani test
-hip abduction w/a resulting clunk as the head relocates into the joint
Barlow test
Detection of unstable hip by adduction and extension of hip. The “feel” of dislocation is felt as femur leaves acetabulum
Signs of DDH
restricted abduction of hip on affected side, shortened limb, unequal gluteal folds when infant prone, positive ortolani and barlow
What can juvenile Rheumatoid arthritis lead to?
iridocyclitis and uveitis (blindness)
Juvenile Rheumatoid arthritis
an autoimmune disorder that affects children aged 16 or less with symptoms that include stiffness, pin, joint swelling, skin rash, fever, slowed growth, and fatigue
iridocyclitis
inflammation of the iris and ciliary body of the eye
uveitis
inflammation of the uvea of the eye
What is the best therapy for JRA?
moist heat, warm baths
Osteogenic sarcoma
occurs most often in femur, tibia, humerus during growth spurt of teen-age males and may metastasize to lungs
What should a nurse prepare for with a patient with osteogenic sarcoma?
possible amputation and phantom limb pain
If a child is exhibiting incontinence with frequency & foul-smelling urine, they should be evaluated for
UTI
Nephrotic syndrome definition
condition in which very high levels of protein are lost in the urine and abnormally low levels of protein are present in the blood
Nephrotic syndrome includes:
proteinuria, hypoalbumenia, hyperlipidemia, edema, massive urinary protein loss
How is Nephrotic syndrome diagnosed?
urine test shows 3+ protein
Treatment for neprhotic syndrome?
low salt diet, fluid restriction, prednisone is drug of choice
Wilm’s tumor
malignant kidney tumor found most often in children
Do not __ the abdoment with Wilm’s tumor.
palpate
Wilm’s tumor post op instructions should include?
no contact sports
Signs of smoke inhalation
trunk circumferential burns, edema of face and neck, singed hair, soot in mouth, hoarseness
Fluid therapy for burns
1/2 in first 8 hours, 1/4 in second 8 hours, 1/4 in third 8 hours
Urinary output should be
1-2 ml/kg/hr
VS Newborn
Temp: 37.5
PR: 80-180
RR: 30-35
BP: 65-80/40-50
uTeaching parents about immunizations, the nurse explains the child will need which of the following immunizations at 2 months of age? Select all that apply
1.DTaP
2.IPV
3.MMR
4.Hep A
5.Hep B
6.Influenza
7.Rotavirus
8.Hib
9.PCV (pneumococcal vaccine)
1
2
5
7
8
9
At what ages do children receive the MMR vaccine?
- 6 months and 12 months
- 12 months and 4 years
- 36 months and 48 months
- 9 months and 8 years
2
Rationale: CDC recommends all children get two doses of MMR (measles-mumps-rubella) vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age.
•A nurse is performing a developmental screening on an 18 month old. Which of the following skills should the toddler be able to perform? (Select all that apply.)
1.Build a tower with six blocks
1.Throw a ball overhand
1.Walk up and down stairs
1.Draw circles
1.Use a spoon without rotation
2
5
remaining skills are for a toddler b/w ages 2-3
Ms. Aloha is worried about her 4-year-old who is waking with night terrors. What advice should the nurse give this mother? Select all that apply.
1.Let the child choose their own bedtime
2.Use a night-light in the room.
3.Provide the child with a favorite toy.
4.Reassure the child and provide comfort, but avoid allowing the child to sleep with their parents.
5.Give Benadryl 30 minutes prior to sleep
6.Wake 15 minutes before the usual time of the terror
2
3
4
6
Night terrors typically occur between midnight and 2 am during the deepest stage of sleep. Usually you cannot wake the child.
A child with sickle cell anemia will is experience what s/s during a vaso-occlusive crisis?
-SOB
-Fatigue
-Pallor
-Jaundice
-Hands and feet cool to touch
-HA
-dizzy
-Pain
Tell whether the following lab values will be increased or decreased in the child w/ sickle cell anemia.
- hemoglobin
- WBC count
- Billirubin
- Reticulocyte
- decreased
- elevated
- elevated
- elevated
What are precipitating factors associated w/ vaso-occlusive crisis?
-cold
-dehydration
-fever
-infection
-hypoxia
-high altitude
What nursing interventions should be done for child with vaso-occlusive crisis?
-warm compress
-opioids for pain management
-blood products
-promote rest, hydration and nutrition
What is acute chest syndrome?
a vaso-occlusive crisis of the pulmonary vasculature commonly seen in patients with sickle cell anemia
How is acute chest syndrome diagnosed?
via chest Xray
will see pulmonary infiltrates
A child who has sickle cell anemia is in the ED w/ complaint of chest/back pain and a cough. The child has a fever, tachypnea, and decreased O2 sats.
The nurse suspects the child is experiencing acute chest syndrome.
As the nurse, what would you do to treat this patient?
Aggressive focus on oxygenation, adequate analgesia, frequent transfusions to correct anemia & improve oxygenation
What 3 things need to be done by the nurse prior to cardiac catheterization? SATA
A. check for allergy to shellfish and iodine
B. Ensure NPO for 12 hours prior to procedure
C. Locate/mark dorsalis pedis & posterial tibial pulse on both extremities
D. get informed consent
E. Give water
A.
C.
need to be NPO 2-6 hours prior
How long should the affected extremity be maintained in a straight position for after cardiac catheterization and why?
4-8 hr to prevent bleeding
The nurse understands proper medication administration of Digoxin by doing what prior to administration?
-taking the pulse and holding administration if PR is <90/min in infant and <70/min in children
Why would you give water following administration of digoxin to a child?
to prevent tooth decay.
What are the s/s of digoxin toxicity?
decreased HR
decreased appetite
N/V
What is the therapeutic serum digoxin level?
0.8-2 mcg/L
Baby Johnson is having a Tet Spell. Which of the following are appropriate interventions? Select all that apply.
1.Knee chest or squatting position
2.Call a code
3.Oxygen administration
4.Fluids
5.Morphine (IV or Sub Q)
6.Propranolol
1, 3, 5, 6
What is patent ductus arteriosus?
Patent ductus arteriosus is failure of the ductus arteriosus to close.
What is coarctation of the aorta?
narrowing of the aorta
What is a manifestation of coarctation of the aorta?
thigh pressure will be higher than the arm
What is the correct order of interventions for burns?
ABC
What is a full thickness burn?
third degree burn involving entire epidermis and dermis, nerve endings, hair follicles destroyed
what is treatment for a 1st degree burn?
cleanse with mild soap, and use antibiotic ointment
What is treatment for 2nd degree burns?
non adherent hydrocolloid analgesia
What two pain meds would you not give to a child w/ increased ICP? why?
morphine and fentanyl; they increase ICP
What should the level of the HOB be for a patient with increased ICP?
semi fowlers – 30 degrees
The nurse is assessing a child who reports a severe HA and a stiff neck. The assessment reveals + Kernig’s and Brudzinski’s signs and + nuchal rigidity. Which action is the priority?
a)Administer antibiotics
b)Implement droplet isolation precautions
c)Initiate IV access
Decrease bright lights.
B.
to prevent spread to others
A child presents with purple rash, petechia/purpura. What would you do first?
A. isolate child
B. initiate droplet precautions
C. spinal tap
D. MRI
A.
A nurse is planning care for a child diagnosed with bacterial meningitis. Which actions will be included in a plan of care? (Select all that apply)
a. Monitor for bradycardia.
b. Provide an emesis basin at the bedside.
c. Administer anti-pyretic medication as prescribed.
d. Perform a skin assessment.
e. Keep the head of the bed flat.
B
C
D
Besides increased intracranial pressure, another complication of meningococcal meningitis is:
A.Diabetes insipidus.
B.Diabetes mellitus.
C.Syndrome of inappropriate antidiuretic hormone (SIADH).
D. Clostridum difficule.
C
uThe nurse is doing triage regarding an infant with diarrhea for two days. She has slightly sunken eyes, normal anterior fontanel, no fever, fewer wet diapers, and slight tachypnea. What level of dehydration is this and what is the expected treatment?
u
1)Severe: Hospitalization, IV Fluids
2)Mild: Remain at home, breast feed only, call tomorrow
3)Severe: Hospitalization, oral rehydration fluids
4)Moderate. Remain home, continue breast feeding, supplement with oral rehydration fluids, call tomorrow with update.
4
The nurse is caring for a child with intussusception. What are the expected findings in an acute presentation? Select all that apply.
1.Sudden episodic pain
2.Screaming, knees to chest
3.Abdominal mass sausage shaped
4.Current jelly stools
5.Pencil like stools
6.Vomiting
7.Fever
8.Dehydration
All but 5
What is Pulmozyme?
medication used to treat CF by helping remove respiratory secretions
how is pulmozyme administered?
via nebulizer
What should you monitor for in pt’s taking Pulmozyme?
sputum and ability to expectorate
improvement in PFT’s
True or False:
Pulmozyme should be refrigerated and discarded if cloudy
True
Can Pulmozyme be mixed with anything?
No
What are some complications r/t CF?
-ileus
-prolapse rectum
-GERD
-Diabetes
Acute glomerulonephritis is often caused by what?
post streptococcal infection
Patient with Acute glomerulonephritis will present with what UA findings?
-proteinuria
-tea colored urine
-hematuria
uThe nurse is giving discharge instructions to a child with asthma and his parents. Which of the following should be included in the teaching? Select all that apply
1.Review all asthma meds
2.Remind parents to observe mouth for oral candidiasis d/t inhaled corticosteroids (rinse mouth after use)
3.Take prednisone with food and do not stop abruptly
4.Drink lots of fluid to promote hydration
5.Use inhaler every 2 hours while awake and before exercise
6.Develop and reinforce an Asthma action plan
7.Follow a low sodium, low carbohydrate diet
All but 5 & 7
The nurse is teaching a child with asthmas proper use of the peak flow meter. Which of the following should be included in the teaching? (Select all that apply)
A.Sit in a chair with feet on the floor.
B.Deliver a long, slow breath into the meter.
C.Perform 3 attempts.
D.Record the average of the attempts.
E.Zero the meter before each use.
C & E
A nurse is providing teaching to the mother of an infant who has a prescription for digoxin. Which of the following instructions should the nurse include?
A. “Do not offer your baby fluids after giving the medication.”
B. “Digoxin increases your baby’s heart rate.”
C. “Give the correct dose of medication at the regularly scheduled times.”
D. “If your baby vomits a dose, you should repeat the dose to ensure that he gets the correct amount.”
C
The nurse is educating a family on use of Straterra for ADHD. Which of the following should be included in the teaching?
1.Monitor the child for suicide ideation
2.Monitor for thrombocytopenia
3.Give in the am before breakfast and before bedtime
- If not achieving focus, double the dose
A.
A child has ingested grandma’s bottle of Tylenol and is brought to the Emergency Department. The nurse can expect which clinical manifestations?
1.Jaundice should appear within 12 hours.
2.Nausea usually occurs 24 hours after ingestion.
3.Pallor and sweating will appear within 2 hours of ingestion.
4.Erythema of the oral mucosa should be present with one hour.
3.
The nurse is caring for a patient with osteomyelitis. Which of the following is essential information to give to the child and family?
1.”The treatment may take several weeks to months.”
2.”You can bear weight on the leg when it feels comfortable”
3.”You need to eat a high carbohydrate diet.”
4.”You may return to school next week.”
1.
The nurse is caring for a patient with chest tube to a chest drainage system pictured. What should the nurse expect to see in the water seal chamber?
- Bubbling
- Tidaling
- Bloody drainage
- Coffee ground drainage
2.
A nurse is caring for a toddler who has spastic CP. Which of the following should the nurse expect? SATA
A. Negative babinski
B. Ankle clonus
C. exaggerated stretch reflexes
D. Uncontrollable movements of the face
E. Contractures
B.
C.
E.
The nurse is providing discharge teaching for a client who is 1 week post op cleft lip repair. For which of the following members of the interprofessional team should the nurse refer the child to?
A. OT
B. Speech
C. Respiratory
D. PT
B.