Nursing Care Exam 3 Study Guide

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Questions and Answers

Which type of seizure is characterized by the rhythmic alternating contraction and relaxation of muscle groups?

Focal seizure without impaired awareness (correct)

Febrile seizure

Tonic-clonic seizure

Absence seizure

What is a common initial manifestation of a complex focal seizure?

Uncontrollable shaking

A cry or scream

Intense fear or anxiety (correct)

Sudden muscle rigidity

Which of the following statements about febrile seizures is TRUE?

They only occur in children over 5 years old.

Treatment is always required during the seizure.

They are caused by CNS infections.

They can occur in children with no prior seizure activity. (correct)

What defines status epilepticus?

Continuous seizure activity without recovery for greater than 30 minutes Signup and view all the answers

Which factor is NOT considered a risk factor for febrile seizures?

Recent head injury Signup and view all the answers

What is a key nursing intervention for a child who is immobilized?

Use of pressure reduction mattresses Signup and view all the answers

Which statement is true regarding fractures in children?

Growth plates in children absorb shock effectively. Signup and view all the answers

What is a common cause of toddler's fractures?

Trivial trauma Signup and view all the answers

Which assessment tool is used to assess the risk of pressure sores?

Braden scale Signup and view all the answers

Why might stress fractures in children require an MRI for diagnosis?

They are typically not visible on plain films. Signup and view all the answers

What should be considered when assessing a child for potential child abuse related to fractures?

Injuries must align with the child's reported history. Signup and view all the answers

What is an important factor regarding the healing of fractures in children?

Children only complain of pain when something is wrong. Signup and view all the answers

What is a recommended approach for allowing autonomy in immobilized children?

Provide wheelchair access and let them make choices. Signup and view all the answers

Which symptom is typically seen in infants with increased intracranial pressure (ICP)?

Bulging fontanelles Signup and view all the answers

What is the most common cause of hydrocephalus?

Impaired absorption of CSF Signup and view all the answers

Which of the following is considered a late manifestation of increased intracranial pressure?

Bradycardia Signup and view all the answers

What nursing care is essential in management of increased ICP?

Keep the head and neck at neutral Signup and view all the answers

Which clinical manifestation may indicate a child is experiencing hydrocephalus?

Tense, bulging anterior fontanelle Signup and view all the answers

What is a possible complication following a ventriculoperitoneal shunt placement?

Obstruction of the shunt Signup and view all the answers

What is the primary genetic inheritance pattern for Duchenne Muscular Dystrophy (DMD)?

X-linked recessive inheritance Signup and view all the answers

Which symptom is an early manifestation of increased ICP?

Fatigue Signup and view all the answers

What is the primary infection associated with osteomyelitis in children?

Bacterial infection Signup and view all the answers

What protein is associated with Duchenne Muscular Dystrophy, crucial for muscle fiber strength?

Dystrophin Signup and view all the answers

Which of the following best describes Cushing's triad?

Hypertension, bradycardia, irregular respiration Signup and view all the answers

At what age does the onset of symptoms typically occur for children with Duchenne Muscular Dystrophy?

3-5 years of age Signup and view all the answers

What is a characteristic cry of infants with increased ICP?

High-pitched catlike cry Signup and view all the answers

What is one of the first clinical signs of Duchenne Muscular Dystrophy?

Difficulty in running Signup and view all the answers

Which of the following is a potential complication associated with Duchenne Muscular Dystrophy?

Joint contractures Signup and view all the answers

Which intervention is NOT used for Duchenne Muscular Dystrophy?

Gene therapy to replace dystrophin Signup and view all the answers

What diagnostic method is commonly used to assist in diagnosing Duchenne Muscular Dystrophy?

Serum levels of dystrophin Signup and view all the answers

What is most commonly used as a symptomatic treatment to help maintain muscle strength in DMD?

Glucocorticoids Signup and view all the answers

What is the most common sign of nephroblastoma (Wilm's tumor)?

Firm, non-tender abdominal mass Signup and view all the answers

What diagnostic tool is considered the gold standard for identifying brain tumors?

MRI Signup and view all the answers

Which of the following is NOT a common symptom of increased intracranial pressure (ICP) related to brain tumors?

Abdominal pain Signup and view all the answers

What nursing consideration is critical when managing a patient with nephroblastoma?

Document strict intake and output Signup and view all the answers

Which treatment modalities are typically employed for brain tumors?

Surgery, radiation, and/or chemotherapy Signup and view all the answers

What is a significant complication of chemotherapy that impairs the body's ability to fight infections?

Myelosuppression Signup and view all the answers

Which phenomenon involves the rapid release of intracellular contents in patients with large tumor burdens?

Tumor lysis syndrome Signup and view all the answers

In which condition would you expect a peripheral white blood cell count greater than 100,000?

Hyperleukocytosis Signup and view all the answers

What is a common early manifestation of leukemia in children?

Anorexia Signup and view all the answers

What diagnostic procedure is used to determine CNS involvement in leukemia?

Lumbar puncture Signup and view all the answers

Which treatment options are commonly used for managing leukemia?

Chemotherapy, radiation, and bone marrow transplant Signup and view all the answers

Which condition is characterized by excessive microthrombi due to overwhelming infection?

DIC Signup and view all the answers

What is one of the late manifestations of leukemia?

Shortness of breath Signup and view all the answers

Which syndrome is caused by compression of the superior vena cava due to space-occupying lesions?

Superior vena cava syndrome Signup and view all the answers

Which type of leukemia is most common in pediatric patients?

Acute lymphoblastic leukemia (ALL) Signup and view all the answers

Study Notes

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.

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Description

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.