Nursing Care Exam 3 Study Guide

Exam 3 Study Guide

• Exam 3 consists of 40 questions.
• The exam covers content from week 8-10.
• There will be 4 math questions.
• There are 6-10 questions from each module.
• Exam format includes multiple choice and select-all-that-apply questions.
• A calculator is allowed (not a phone), and scrap paper is permitted.
• Study content includes pathophysiology, clinical manifestations, nursing assessment, interventions, education, and management.

Week 8: Musculoskeletal Impact of Immobility in Children

• Loss of innervation:
  • Sensory and perceptual deprivation
  • Decreased exposure to normal play opportunities
  • Impaired growth and development

Nursing Care of the Immobilized Child

• Physical assessment:
  • Repositioning/position changes
  • Pressure reduction mattresses
  • ROM exercises
  • Braden scale
• Encourage activity and mobility devices:
  • Allow autonomy when possible

Fractures & Complications

• Toddler's fracture:
  • 9-36 months
  • Trivial trauma
  • Spiral fx of the tibia
  • Stress fractures (repetitive sports activities)
  • MRI may be needed for diagnosis (not always visible on plain X-rays)
• Child abuse: Ensure the history matches the injury! Look for multiple fractures that might not be obvious.
• Muscle strains/sprains:
  • Salter 1 injuries - Bones do not grow if an epiphyseal plate is fractured while it is open.
  • Doctors may still cast even if injury is not confirmed.

Fractures in Children

• Growth plate: Absorbs shock.
• Periosteum: Thicker and stronger in children.
• Bones: More likely to bend, buckle, or break in younger children.
• Children: Only complain when something is wrong.
• Clinical manifestations:
  • Generalized swelling/edema
  • Pain or tenderness
  • Decreased use of affected area
  • Ecchymosis (bruising)
  • Warmth or redness
• Diagnostic Evaluation:
  • X-rays
  • etc..

Nursing Care Management- Child with Emergent Fracture

• Stabilize the injured site.
• Cover open wounds with sterile dressing.
• Apply manual traction if circulatory compromise is present.
• RICE protocol

Complications of Fractures

• Pain: Assess for severe pain.
• Pulse: Assess distal to fracture site.
• **Pallor:**Assess for decreased blood flow.
• Paresthesia: Assess for sensation distal to fracture site.
• Paralysis: Assess movement distal to fracture site.

Cast Care in Children

• Clubfoot (congenital talipes equinovarus)

Legg-Calvé-Perthes Disease

• Disruption of blood flow to the femoral head.
• Manifestations: painless limp, hip pain/ stiffness, decreased hip ROM.

Scoliosis

• Complex spinal deformity in three planes.
• Classification based on age of onset (infantile, juvenile, adolescent).
• Screening guidelines are often controversial; however, screenings should be recommended in ages 10-12 in girls, and 12-13 in boys.
• Signs & symptoms: asymmetry of shoulder height, scapular shape and hip height.

Developmental Dysplasia of the Hip (DDH)-

• Hip instability after birth due to abnormal development of the femur head and acetabulum.
• Clinical signs: asymmetric skin folds, Galeazzi's sign, limited hip abduction, Symmetry of gluteal and thigh folds (infant)
• Diagnostic tests: ultrasound (in infants), X-ray (>4 months).
• Treatment: Pavlik harness, traction, surgical closed reduction

Increased Intracranial Pressure (ICP)

• Excessive pressure on the rigid cranial vault.
• Etiology: Conditions that increase tissue or fluid volume in the skull
• Manifestations (early): Irritability, fatigue, personality changes. In infants/young children: tense, bulging, anterior fontanelle, high pitched cry, increased head circumference, "setting sun" sign.
• Manifestations (late): Bradycardia, decreased motor and sensory response, alterations in pupil size, and reactivity

Hydrocephalus

• Increased amount of CSF. Caused by impaired absorption of CSF, excessive production, or obstructed circulation.
• Manifestations: Bulging fontanelles in newborns and infants, increased head circumference, sunset eyes, irritability.

Seizures

• Cushing's triad
• Post-op care: Monitor for signs of increased ICP
• VP shunts (ventriculoperitoneal shunt)
• Spinal cord compression

Spina Bifida

• Insufficient folic acid intake.
• Failure of osseous spine to close.
• Types: occulta, cystica (meningocele, myelomeningocele)

Epilepsy vs Febrile Seizures

• Epilepsy: 2+ unprovoked seizures at least 24 hours apart; OR one unprovoked seizure and high probability of further seizures in the next 10 years.
• Febrile seizures: seizure associated with a febrile illness in a child >1 month of age who has no prior history of seizure activity.

Meningitis

• Acute infection of meninges or CSF. Bacterial or viral
• Manifestations: fever, chills, headache, vomiting, and alterations in sensorium.

Head Trauma

• PATHOPHYSIOLOGY: intracranial contents (brain, blood, CSF) are damaged due to force.
• Clinical manifestations: depend on the area injured.
• Commonly caused by falls, being struck by something, or a motor vehicle accident.

Skull Fracture

• result from direct blow to the skull
• Common in children under 2 years old.
• Types: linear, depressed, diastatic, and basilar (Battle's sign & Raccoon eyes).

Cerebral Palsy

• Nonprogressive neuromuscular disorder of varying degrees.
• Usually caused by unknown prenatal factors.

Muscular Dystrophy

• Group of inherited disorders with progressive degeneration of symmetric skeletal muscle groups causing progressive weakness and wasting.
• Types include Duchenne, Becker, Myotonic, etc.
• Onset of disease, pace of progression and muscle group affected depend on type.
• Genetic/X-linked inheritance, mutation in gene that codes for dystrophin.

Childhood/Postnatal Risk Factors

• Associated disabilities: altered learning, reasoning, wide range of intelligence, behavioral problems, sensory impairment, speech and language disorders, bowel/bladder problems, dental concerns, and skin breakdown

Oncology & Hematology

• Complications of oncologic therapy/treatment: infection, tumor lysis syndrome, hyperleukocytosis, superior vena cava syndrome, spinal cord compression.

Leukemia

• Unrestricted proliferation of immature white blood cells in blood forming tissues
• Acute lymphoblastic leukemia (ALL), and acute myelogenous leukemia (AML)
• Clinical manifestations: anorexia, irritability, lethargy, chronic infections, fever, shortness of breath, bleeding, pallor, petechiae, bone pain, limp.

Lymphoma

• Cancer of lymphoid tissue.
• Hodgkin's lymphoma: develops in single lymph node (often cervical or supraclavicular) and contains Reed-Sternberg cells.
• Non-Hodgkin's lymphoma: variable presentation, and often spreads widely.

Osteosarcoma

• Cancer of bone tissue that starts in immature bone cells.
• Typically occurs in the ends of long bones during growth spurts.
• Manifestations: pain localized, mass, limping.

Neuroblastoma

• Cancer of the developing cells of the sympathetic nervous system.
• Most tumors in the abdomen (from adrenal gland).
• Can spread.

Hemophilia

• Inherited bleeding disorders caused by a deficiency of specific coagulation factors.
• Types: A (Factor VIII deficiency), B (Factor IX deficiency).
• X-linked inheritance pattern.

Anemia

• Reduction of red blood cell (RBC) volume and/or hemoglobin concentration to levels below normal.
• Types, causes, clinical manifestations, diagnostic procedures,
• Basic causes: excessive red blood cell loss, increased destruction of RBCs, impaired or decreased rate of RBC production.

Normal Hemoglobin Values (by age).

• Values for infants, children, and adolescents are listed
• Importance of monitoring through appropriate screening.

Prepare for Exam 3 with this study guide covering the topics from weeks 8-10, including musculoskeletal impact of immobility in children and nursing assessments. Brush up on critical nursing interventions, clinical manifestations, and management strategies needed for caring for immobilized children. Ensure you're ready for various formats of questions, including multiple choice and select-all-that-apply.