Maternal Child Exam 3 Review PDF

lOMoARcPSD|15450111 Exam 3 Maternal Child - Exam 3 review Maternal-Child Nursing (Rasmussen University) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Craig Cman ([email protected]) lOMoARcPSD|15450111 Maternal Child Exam 3 Review Points 1....

lOMoARcPSD|15450111 Exam 3 Maternal Child - Exam 3 review Maternal-Child Nursing (Rasmussen University) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Craig Cman ([email protected]) lOMoARcPSD|15450111 Maternal Child Exam 3 Review Points 1. 12-year-old with pyelonephritis signs and symptoms. (3 check all that apply) Enuresis, malodor, dysuria with frequency, urgency and discomfort, fever/chills (especially when related to pyelonephritis) abdominal pain, flank pain, malaise, vomiting and diarrhea. 2. Nursing interventions of seizure precautions for child (3 check all that apply). Airway patency, ensure nothing is placed in the child's mouth during seizure, watch for loose teeth that may be aspirated or knocked out, suction if needed after the seizure, monitor oxygenation saturation should be at 95% or greater. For safety raise and pad side rails when the child is in bed or crib. During administration of medications give Iv medications slowly during a seizure to reduce risks of side effects. 3. 9-year-old with fractured distal radius plan of care (3 check all that apply). Provide emotional support and review management plan, principles of bone healing, how to perform a neurovascular assessment, cast care, teach family about adaptations to home environment. Teach the family about nutrition and safe transfer. 4. Education presentation to prevent skin cancer topic to include (4 check all that apply). Apply sunscreen, reduce length of time in the sun, avoid tanning beds and 2 or more severe sunburns in a row increase skin cancer risk 5. Toddler with Kawaski Disease, findings with physical assessment (3 check all that apply). Rash, conjunctivitis with exudate, cervical lymphadenopathy greater than 1.5mm in diameter, irritation and inflammation of the mouth with erythema “strawberry tongue” and cracking lips, erythema and edema of hands and feet with eventual peeling of the skin. 6. Signs of sexual abuse in preadolescent client that parent should be educated about (4 check all that apply). Quieter, more distant, cries for no reason, start to have accidents and wets bed at night, can be aggressive and angry for no obvious reason, says there tummy or head hurts, starts having nightmares, is clingy, isn’t plating with others, having trouble sleeping, showing problematic sexual behavior, doing worse in school, swelling and redness in genital area, pain with urination, bruising on butt and thighs, UTIs, STD symptoms 7. School-aged child diagnosed with obesity. Patient education to achieve proper BMI (3 check all that apply). Make a detailed log about food they eat the time and circumstances, always eating in one place (Kitchen table) slowing the process of eating by counting mouthfuls and putting the fork down between bites, encourage exercise as well. 8. 38 weeks pregnant having an NST what would RN observe for (3 check all that apply). Baby's movement, heartbeat and contractions. You will note changes in Downloaded by Craig Cman ([email protected]) lOMoARcPSD|15450111 heart rhythm if the baby goes from resting to moving or during contractions if you are in labor. 9. School-aged child with open reduction for fractured femur, assessment findings of developing infection (3 check all that apply). Assess the wound, monitor, intervene to prevent infection, manage pain through positioning and medications as ordered. 10. Adolescent female after sexual assault. PTSD signs and symptoms (4 check all that apply). Re-experiencing the traumatic event, avoiding reminders of the trauma, startling easily, having negative thoughts and beliefs. Body aches, fatigue, flashbacks, insomnia, headaches, nightmares. 11. School-aged child developing pneumonia signs and symptoms (3 check all that apply). Cough that produces mucus, rapid breathing, cough pain, vomiting or diarrhea, loss of appetite, fatigue, fever. 12. Instructing adolescent about sexual activity includes (3 check all that apply). 13. School-aged child with leg cast. Nurse to include for patient education (4 check all that apply). When the cast is applied it will feel warm, tell them to report pain that is severe or not relieved 1 hour after the administration of pain medication, perform neurovascular checks, give instructions for proper use of crutches, don’t place anything inside of cast, notify provider if there are any hot or soft spots on cast, report any foul smells 14. Preschool age health screening and questions about secondary health promotion activities (3 check all that apply). vision , hearing screens and vaccines. 15. Meter-dosed inhaler for asthma and patient education (3 check all that apply). Remove cap from inhaler, shake 5-6 times, attach spacer, hold inhaler with the mouthpiece at the bottom, hold the inhaler with the thumb near the mouthpiece and the index and middle fingers at the top, Open mouth method (hold 3-4 cm away from mouth) or closed mouth method (place inhaler between lips and form a seal) take a deep breath and exhale, tilt head slightly back and press inhaler, begin a slow, deep breath that lasts for 3-5 seconds. Hold breath for 5-10 seconds. Wait 1 minute between puffs. Take the inhaler out of the mouth and slowly exhale through your nose and resume normal breathing. Rinse out mouth after use and clean after every use 16. Parent education for 6-year-old of iron-deficiency anemia (3 check all that apply). Expect stools to turn a tarry green color when taking iron supplements, brush teeth after oral dose to prevent teeth staining. Dietary sources- dried beans and lentils, peanut butter, green leafy vegetables, iron-fortified breads and flour, poultry, and red meat 17. PPE while inserting urinary catheter for +HIV and TB child (4 check all that apply) N95 mask, sterile gloves, gown, and eye goggles Downloaded by Craig Cman ([email protected]) lOMoARcPSD|15450111 18. 2-year-old osteomyelitis primary nursing intervention.- Maintaining intravenous antibiotic therapy- Is it a serious infection that needs to be treated vigorously 19. Gravida 2 Para 1 36-week gestation prenatal visit. What lab test is ordered? Group B Strep 20. 3-month-old failure to thrive indication- Less than 5th % on growth chart, malnourished appearance, no fear of strangers, minimal smiling, decreased activity level, withdrawal behavior, developmental delays, feeding disorder, wide-eyed gaze, stiff or flaccid body 21. 4-year-old having bronchoscopy to remove a pea. Parent education to include. Child is put to sleep and then topical lidocaine spray is used to further anesthetize the child's larynx. The child will typically stay in the hospital overnight for observation. There may be airway swelling, increased secretions, infection or difficulty breathing after the foreign body is removed. Sometimes the child requires antibiotics, steroids or inhaled bronchodilators for a brief period of time 22. 4-year-old with UTI having a voiding cystourethrogram. What is patient prep? To be able to view the urinary structures and flow of urine, a contrast is given via catheter Educate the child and family about the procedure, assess for allergy to iodine or shellfish if contrast is used, child removes underwear and socks and lies on bed with legs like a frog’s, nurse will wash between the legs, place a catheter, and collect a urine sample. 23. 4-year-old child with acute lymphocytic leukemia (ALL). Reason nurse to take axillary temp rather than rectal. If a child has a low platelet count (I questioned this one because the book was vague and she said that the rectum is highly vascular and we want to reduce the risk of bleeding. 24. Signs and symptoms of pertussis. aka Whooping cough- fever, coughing bouts, nasal congestion, rapid coughing followed by high pitched inhalation with characteristic “whoop” sound, vomiting, cyanosis. 25. 5-year-old in skeletal traction. What should nurse encourage parents to do during immobilization? Ensure that the traction weight bag is hanging freely, the bag must not rest on the bed or the floor, If the rope becomes frayed replace them, The rope must be in the pulley tracks, Ensure the bandages are free from wrinkles, Tilt the bed to maintain counter traction. 26. 6-month-old with atopic dermatitis parent education. Food allergy is a major trigger for atopic dermatitis in infants (milk, eggs and peanuts are the most common). Any infant who presents with atopic dermatitis needs to have a thorough food evaluation done.Sweating, heat, tight clothing, and contact irritants, such as soap tend to increase Downloaded by Craig Cman ([email protected]) lOMoARcPSD|15450111 the pruritus associated with atopic dermatitis. Hydrating the skin by bathing or applying wet dressings (moistened with tap water or Burow’s solution) for 15-20 minutes, followed by the application of a barrier to seal the moisture is helpful. 27. 6-month-old with fever, what should nurse inquire about pertaining to fever when obtaining health history? 28. Streptococcal pharyngitis and assess for what dangerous outcome. This is an infection with group A beta-hemolytic streptococcus leads to airway inflammation. Left untreated, can lead to rheumatic fever or acute glomerulonephritis. 29. 7-year-old with Type 1 DM. One of the first symptoms parents notice when illness develops. Abrupt onset- Weight loss is the most common sign. Polydipsia, polyphagia, polyuria (bedwetting), blurred vision, mood changes, fatigue. 30. Signs and symptoms of varicella myalgia, anorexia, fever, vesicular rash on the body, and pruritis 31. Signs and symptoms of asthma: recurrent wheezing, SOB, exercise intolerance, associated allergies, cough at night, prolonged expiration 32. Child with anaphylactic shock. What MD order should nurse do first? Epi first, followed by O2, IV fluids and meds. Family and caregivers should be aware if triggers and know how to give epi, make sure there is a medical alert bracelet or card. Activate EMS, do CPR if needed, ensure airway, give epi, lay flat with feet elevated, give corticosteroids and anti-histamines, determine the cause. 33. Valproic acid for epilepsy in child. Important patient education. Take medication around the same time everyday, Take with food to avoid upset stomach. 34. Child with kidney transplant. Post-op care parent education. Sterile environment, at risk for kidney rejection. Hemodialysis may be continued until the kidney is fully functioning after recovery. They often go through a “honeymoon” phase modeling perfect behavior on belief of successful transplant. 35. Patient in labor with chronic back pain taking hydrocodone. What should nurse plan for of care of infant. 36. Child with croup and treatment and patient education. Symptoms: URI symptoms, barky cough, dyspnea Downloaded by Craig Cman ([email protected]) lOMoARcPSD|15450111 Diagnosis: clinical history and presentation, Soft Tissue imaging of the neck shows steeple sign Management: maintain airway, provide rest, position with HOB elevated, provide humidified air, corticosteroids to reduce inflammation (dexamethasone at 0.6mg/kg x 1), nebulized epinephrine for more severe cases (stridor at rest) Intubation if severe. Patient education- Prevent patient agitation (can worsen symptoms), keep patient hydrated. Use cool mist humidifer, Obtain recommended vaccinations 37. Coarctation of aorta, what assessment should a nurse do? Assess the femoral arteries together. 38. Child with superficial burns on foot. Nursing priority? Protect the airway, fluid replacement, risk for infection, pain management, debridement, exudate 39. Respiratory distress syndrome signs and symptoms in newborns. Ineffective or absent cough, nasal flaring, excessive sputum, adventitious breath sounds. 40. Child with tonic-clonic seizure. Priority nursing action? First comes the loss of consciousness followed by muscle convulsions that usually last for less than 2 mins. Protect patients from injury, do not put anything in their mouth, turn on their side, do not restrain the patient from movements. 41. 36 weeks gestation with placenta previa signs and symptoms. Abrupt, painless, bright red bleeding. 42. Priority nursing action for cord prolapse. Identify the changes in the fetal heart rate. Do a vaginal exam – note the feeling of a difference – something pulsing? Push the presenting part (head or butt or whatever you find UP) do not push on cord. Stay there until cesarean can be done. Now if the cord is outside of the body – then wrap in saline, but get the head off the cord. Change her position to a modified Trendelenburg – head down on bed, butt up in air. 43. Cardiac catheter and bandage is saturated. Most appropriate nursing action? Take the bandage off, assess the catheter, and put a new clean dry bandage on. 44. Child with severe dehydration from diarrhea and vomiting. What is primary nursing intervention? Encouraging fluid intake. Small full glasses, popsicles, or jello, milk or pedialyte. Also encouraging food intake- calorie counting. Measuring I and O. 45. Patient on oxytocin with contraction lasting 90 seconds every 2 minutes. What is nursing priority action for nurse to take. STOP OXYTOCIN 46. Child after cardiac surgery and has chest tubes attached to underwater seal drainage. When should nurse clamp chest tube? Tubes are clamped when the tube is disconnected. Downloaded by Craig Cman ([email protected]) lOMoARcPSD|15450111 47. 18-month-old signs and symptoms of increased intracranial pressure. Irritability, headache, or restlessness. Bulging fontanelle. High pitched cry, poor feeding. 48. Sickle-cell anemia and initial nursing intervention. Three primary needs; pain relief, adequate hydration, and oxygenation. 49. Signs and symptoms of fracture Deformity, edema, and pain. 50. Adolescent patient deliveries 9-pound infant. What is she at highest risk for? PPH 51. Adolescent male attempted suicide with medication overdose. Intervention most effective to prevent future attempts. Receive consult from mental health/ crisis center/ case worker and get counseling. 52. Signs and symptoms of dehydration of infants. Increased thirst, poor skin turgor, dry & clammy skin consistency, cool to touch, warm in hypertonic dehydration, decreased urine output, irritable & lethargic activity. Sodium serum=normal in isotonic, decreased in hypotonic, increased in hypertonic. Common causes: Profuse diarrhea, fever, emesis 53. Action of Digoxin in infant to teach parents.Digoxin is a cardiac glycoside made from digitals, acts directly on the heart to Improve myocardial contractility. (force of the contraction) which slows the heart rate. Education to parents: Always check apical pulse prior to administration pulse should be greater than 100 for an infant. Always use only a clearly marked syringe so the dose given is accurate and consistent. Do not change the amount or timing of the dose without specific instructions from your cardiologist. If you miss a single dose, give the next dose on time as prescribed. If you miss more than one dose, telephone your cardiologist for further instructions. Give digoxin 1 hour before or 2 hours after feeding to ensure complete absorption and to avoid a dose being lost if the infant spits up. If a dose is vomited, do not repeat the dose. Give the next dose at the scheduled time. If the child vomits the next dose, call your cardiologist as this could be a sign of toxicity. Keep the medication bottle away from the child. Draw up the dose away from the child and recap the bottle to prevent it from being knocked over and medicine being lost. Downloaded by Craig Cman ([email protected]) lOMoARcPSD|15450111 Call your cardiology office for a refill several days before you actually run out of medicine so there is no lapse in medication availability. Direct the parents to NOT give their child any herbal supplements or other over-thecounter medications unless directed by their provider. Many supplements interact negatively with prescribed medications or we do not completely understand the interactions. Simple over-the-counter (OTC) medications such as acetaminophen or diphenhydramine (Benadryl) are typically safe, but it may be best to clear it with the provider before giving the first time. Digoxin has a narrow therapeutic window 0.8-2mg/ml Toxicity S/S= anorexia,N/V/D, dizziness, headache, arrhythmias, bradycardia 54. Weight gain in first year of life. 3 times birth weight at 1 year. 55. Apgar scoring- Checked at 1 minute and 5 minutes after birth. Should be a score of 7-10. APGAR= activity, pulse, grimace, appearance, respirations 56. Epiphyseal lines in long bones closure in males? This happens around the age of 18-22 in males. When the epiphyseal line is present that means that growth has ended. 57. Signs and symptoms of hyperopia. (Farsightedness) Vision is blurry at close range, clear for distance/far range. S/S are headache, dizziness 58. Moro reflex. (Startle reflex) reflex stimulates the action of someone trying to ward off an attacker. Very strong for the first 8 weeks of life, fading by 4-5 months. If present at 6 months suspicion of neurologic disease may be present. 59. Health teaching for parents of immunosuppressed child. Reinforce the importance of hygiene and infection control measures.Children need to receive routine immunizations. Avoid ill persons, stay home if ill, PPE for personal cares due to exposure of fluids. Do not share cups, silverware, etc. Assess the child for fever, malaise, fatigue, weight loss, vomiting, diarrhea, altered activity level, and oral lesions; notify the pediatrician if any of these occur.. Administer antiretroviral medications and other medications to the child as prescribed. 60. Signs and symptoms of hypoglycemia in newborn blueish, jitteriness, apnea, hypothermia, poor feeding 61. Safest place for infant car seats. rear facing in the back seat. Preferably in the middle with 5 point harness. Chest clip needs to rest at the nipple or armpit level (not on the abdomen) Downloaded by Craig Cman ([email protected]) lOMoARcPSD|15450111 62. Child having myringotomy tubes. Nurse education for parents? Bath vs shower is encouraged as to not allow water to enter the ears. Showers are ok when ear plugs are worn and same with swimming. Hearing impairment is also noted so parents should notify the school of compromised hearing and the child may need to sit in front of the classroom. 63. Fetus is breech Where best to listen to fetal heartbeat. Above the belly button 64. Cystic Fibrosis patient on pancrelipase, and patient education on when and how to take. Pancreatic enzymes (Pancrelipase) with meals and snacks, by mouth. 65. Child with heart murmur. What non-invasive test nurse to expect to do to evaluate heart structure and movement Echocardiogram. 66. Circumcision and contraindication for procedure. prematurity, anomalies of the penis, hypospadias, epispadias, concealed or buried penis, micropenis, webbed penis, and ambiguous genitalia 67. Teaching for 1-month -old with GERD.- Feed the child small frequent feedings with rice cereal mixed in to thicken it. After feeding, hold the infant upright for 30 minutes. Do not place the baby in a car seat inside the home. Avoid tight clothing and avoid smoking around the baby (nicotine worsens reflux. If breastfeeding, mothers should eliminate dairy. Medications might be prescribed- ranitidine or omeprazole. 68. Early warning signs of a child with head injury. Child won't stop crying,, complains of head and neck pain , vomits more than one time, won't awaken easily, becomes hard to comfort, isn't walking or talking normally. 69. 10-year-old, growth hormone deficiency and treatment Treatment of growth hormone deficiency involves regular injections of synthetic human growth hormone. Children receive daily injections. Treatment usually lasts several years, although results are often seen as soon as three to four months after the injections are started. 70. Lung sounds with bacterial pneumonia. Crackling or bubbling noises (rales) made by movement of fluid in the tiny air sacs of the lung. Dull thuds are heard when the chest is tapped (percussion dullness), which indicates that there is fluid in a lung or collapse of part of a lung. 71. Technique for ear drops in 4-year-old. Room temperature, Turn child’s head to one side pull pinna up and back 72. Patient teaching for self-breast exam. Visual inspection- first stand in front of the mirror and look for changes in shape, swelling, dimpling, raise hands overhead, put hands on hip and press firmly to make chest muscles flex. Use the right hand to examine the left breast and vice versa. With pads of three middle fingers, feel for lumps with a circular motion, squeeze nipple. Lie down and put your right arm above your head during examination and change sides. Call the provider if there are any abnormalities. Do the exam monthly and when not on period. Downloaded by Craig Cman ([email protected]) lOMoARcPSD|15450111 73. Most appropriate response for young a child for med administration. 74. How to minimize separation anxiety with toddler hospitalized. Allow parents to stay and be involved. Allow children to bring things from home like a stuffed animal or blanket. 75. Post tonsillectomy and hydration. Cool fluids first such as water, ice blocks, and non-acidic fruit juices (ie apple juice). Avoid red foods/liquids, spicy foods, straws, coughing and blowing nose forcefully. 76. Parent education for tetralogy of Fallot for sudden cyanosis and dyspnea. Congenital heart defect, place your baby on his or her side and pull your baby's knees up to his or her chest. This helps increase blood flow to the lungs. Call 911 77. Signs and symptoms of salt-losing form of congenital adrenal hyperplasia Ambiguous genitalia, in which the clitoris is enlarged or the genitals look more like those of a male child. Male infants have normal appearing genitals. Their body will produce an insufficient amount of cortisol. These children can have problems maintaining normal blood pressure, normal blood sugar and energy levels, and are more vulnerable to stress. An excess of the male sex hormones can result in short height and early puberty for both boys and girls. Other symptoms are appearance of pubic hair at a very early age and rapid growth during childhood, but shorter than average final height. 78. Erikson stages for infant and patient education. Trust vs mistrust: Developmental task is to form a sense of trust versus mistrust. Child learns to love and be loved. When an infant is hungry, a parent feeds and makes the infant comfortable again. When an infant is wet, a parent changes his or her diaper and the infant is dry again. When an infant is cold, a parent holds the baby closely. By these simple processes, infants learn to trust that when they have a need or are in distress, a parent will come and meet that need. If care is inconsistent, inadequate, or rejecting, infants learn mistrust; they become fearful and suspicious of people and then of the world. Like a burned child who avoids fire, emotionally burned children shun the potential pain of further emotional involvement. This can cause children to be “stuck” emotionally at this stage, although they continue to grow and develop in other ways. Provide a primary caregiver. Provide experiences that add to security. Encourage mothers to continue to breastfeed Downloaded by Craig Cman ([email protected]) lOMoARcPSD|15450111 79. Determining gravida, para Gravida- a woman who is or has been pregnant Para- the number of pregnancies that have reached viability, regardless of whether the infants were born alive A more comprehensive system for classifying pregnancy status (GTPAL or GTPALM) provides greater detail on a woman’s pregnancy history. By this system, the gravida classification remains the same, but para is broken down as follows: T: the number of full-term infants born (infants born at 37 weeks or after) P: the number of preterm infants born (infants born before 37 weeks) A: the number of spontaneous miscarriages or therapeutic abortions L: the number of living children Using this system, a woman in the first example who is pregnant and has two children at home would be gravida 3, para 2002 (GTPAL) 80. 3-year-old with croup and stridor while asleep. Nurse intervention for this. Provide measures for a child to remain calm using distraction, toys, etc., while monitoring for respiratory changes through pulse oximetry monitoring and respiratory assessment. Laryngospasm with total occlusion of the airway can occur if a child’s gag reflex is elicited or when the child is crying. Therefore, do not elicit a gag reflex in any child with a croupy, barking cough and provide comfort to prevent crying. 81. Signs and symptoms absence seizure school-aged child. Absence seizures are one form of generalized seizures, formerly known as petit mal seizures. They occur more often in girls than boys, usually occur in school-age children between 4 and 12 years, and consist of a staring spell that lasts for a few seconds. A child might be reciting in class, for example, when he or she pauses and stares for 1 to 5 seconds and then continues the recitation as if he or she is unaware time has passed. Rhythmic blinking and twitching of the mouth or an extremity may accompany the staring. As many as 100 seizures can occur during a day. 82. Stages of Kubler-Ross grief. Denial, anger, bargaining, depression and acceptance Stage 1- denial: parents have difficulty realizing what has occurred. They ask, “how could this have happened to me?” Stage 2- anger: Parents react to the injustice of being singled out this way. They say, “It isn’t fair this is happening.” Downloaded by Craig Cman ([email protected]) lOMoARcPSD|15450111 Stage 3- bargaining: parents attempt to workout a “deal” to buy their way out of a situation. They say, “if my child gets well, i'll devote the rest of my life to doing good.” Stage 4- depression: Parents begin to face what is happening. They feel sad and unprotected. Stage 5- acceptance: Acceptance is being able to say, “Yes, this is happening, and it is all right it is happening.” With a child who has a long-term illness, parents may never reach this stage but will always remain in the chronic sorrow of the depression stage. 83. 4-month-old exposure to measles. Most appropriate parent education for vaccine. Educate parent on when the MMR vaccine can be given. 84. Acute glomerulonephritis caused by what organism. Group A beta-hemolytic streptococcal infection 85. Failure to thrive and successful outcomes. Lack of appropriate weight gain, not appropriate height increase and head circumference, irritability, easily fatigued, excessive sleepiness, lack of age appropriate social response, does not make vocal sounds, delayed motor development, learning and behavior difficulties. 86. Anterior fontanel closes when? Closes between 9 and 18 months of age 87. IV rate of Pitocin dosage calc 88. Magnesium sulfate dosage calc IV rate 89. Epiglottis and appropriate child position Epiglottitis is inflammation of the epiglottis, which is the flap of cartilage that covers the opening to the larynx to keep out food and fluid during swallowing. Although it is rare, inflammation of the epiglottis is an emergency because the swollen epiglottis cannot rise and allow the airway to open. It occurs most frequently in children from 2 to about 8 years of age. Epiglottitis can be either bacterial or viral in origin. Haemophilus influenzae type B has been replaced as the most common bacterial cause of the disorder followed by pneumococci, streptococci, or staphylococci. Echovirus and RSV also can cause the disorder. The incidence of epiglottitis has greatly decreased with the introduction of the H. influenzae type B vaccine. Children with epiglottitis should never be assessed for a gag reflex using a tongue blade because the elevated epiglottis can occlude the airway. 90. Stool specimen for ova and parasites and RN responsibility with lab sample. Make sure that the stool does not come into contact with water or urine. Place a hat in the toilet to catch the stool if it is mixed with urine discard and attempt a new sample. Downloaded by Craig Cman ([email protected]) lOMoARcPSD|15450111 91. Child with burn injury with daily debridement and parent education on purpose of treatment. Monitor for infection, continue to perform range of motion, keep extremity elevated, work with physical therapist 92. Home visit with previous history of physical neglect and observation of successful interventions. Recognize risk factors for abuse/neglect, must report, recognize indications of neglect observed in parental behavior or interaction. Know your audience, understand developmental influences on thought process that might influence group 93. Child with type 1 DM getting short- and long-term acting insulin and proper learning of self-administration. Rotate injection sites to prevent lipohypertrophy within one anatomic site four or six injections before switching to another anatomic site, inject at a 90 degree angle, when mixing a rapid or short acting insulin with a longer acting insulin draw up the short acting insulin into the syringe first and than the long acting one. 94. Discharge teaching for child and family after anaphylaxis. Medical ID band needed. Giving epinephrine injection when respiratory distress is experienced. Making family aware of triggers and allergens. 95. Routine health maintenance for toddler and how to assess growth. Weight, height, head circumference, BMI, body contour, body systems maturation (for example, decreasing RR and HR), teeth, language, emotional and cognitive development Downloaded by Craig Cman ([email protected]) lOMoARcPSD|15450111 Read Chapter 30 pg. 810-1660       “Erikson’s developmental task for the toddler period is to form a sense of autonomy or independence versus shame or doubt. Toddlers make great strides forward in development, but their physical growth slows. A critical milestone of toddler development is being able to form two-word sentences (a noun and a verb) by 2 years of age. Toddlers are capable of preoperational thought or are able to deal much more constructively with symbols than they could while infants. Important aspects of toddler care are promoting safety, toddler development, and healthy family functioning because all three of these facets help in planning nursing care that not only meets QSEN competencies but that also best meets a family’s total needs. Toddler appetites decrease from those of the infant, so children eat proportionally less than they did as infants.” (pg. 1660 key points) Downloaded by Craig Cman ([email protected]) lOMoARcPSD|15450111 96. Blood administration in pediatric patients and safe practice. Always need another nurse, ensure you are giving the right blood and type, keep checking patient information to label on blood product, administer within 30 minutes from receiving blood, baseline vitals, only give with normal saline, filter blood and special tubing for filtering, stay with patient for at least 15 minutes. 97. Parent education with Legg-Calve Perthes disease. Activity restriction, limited weight bearing, physical therapy, NSAIDs, surgery 98. Preschool-age with meningitis and priority goal of care. Implement droplet precautions during the first 24 hours of antibiotic therapy. 99. Sickle cell anemia, safety precautions that RN should emphasize. Reinforce the importance of hand hygiene to prevent infection. 100. Evaluating outcomes of family caring for adolescent after spinal cord injury and family transitioning in healthy manner. “The second recovery phase is the time for parents and children to begin thinking about what this degree of disability will mean to them as a family and to face what adjustments they will need to make. Children and parents typically react to the initial diagnosis with grief. They may still be in denial or shock when the second phase begins. With no sudden miracle cure in sight, they may begin to move through stages of anger, bargaining, depression, and then acceptance (the injury happened; we must go on from this point). They need assistance and support to work through all of these feeling, however. Both the parents and the child may need counseling to reach acceptance (Fig. 49.13).” (pg. 1407) 101. How to test for drug use in pregnancy Maternal or Fetal Blood Blood, Maternal Urine, Meconium, Maternal or Neonatal Hair, Placenta, Umbilical Cord. “A wide range of tissues can be tested for drug use, including maternal blood, urine, and hair; neonatal meconium, urine, and hair; and placenta and umbilical cord tissues. Testing methods range from simple spectrophotometry and clinical chemistry to sophisticated analytical HPLC or mass spectrometry techniques.” Price, H. R., Collier, A. C., & Wright, T. E. (2018). Screening Pregnant Women and Their Neonates for Illicit Drug Use: Consideration of the Integrated Technical, Medical, Ethical, Legal, and Social Issues. Frontiers in pharmacology, 9, 961. https://doi.org/10.3389/fphar.2018.00961 102. 8-month-old with spastic Cerebral Palsy signs and symptomsshaking limbs, trouble controllig movement, trouble hearing ro seeing, difficulty with eating, difficulty speaking, difficulty swallowing, drooling, difficulty reaching milestones Downloaded by Craig Cman ([email protected]) lOMoARcPSD|15450111 “Spasticity is excessive tone in the voluntary muscles that results from loss of upper motor neurons. A child with spastic CP has hypertonic muscles, abnormal clonus, exaggeration of deep tendon reflexes, abnormal reflexes such as a positive Babinski reflex, and continuation of neonatal reflexes, such as the tonic neck reflex, well past the age at which these usually disappear. If infants with CP are held in a ventral suspension position, they arch their backs and extend their arms and legs abnormally. They fail to demonstrate a parachute reflex if lowered suddenly and tend to assume a “scissors gait” because tight adductor thigh muscles cause their legs to cross when held upright. This involvement may be so severe that it leads to a subluxated hip. By school age, tightening of the heel cord can become so severe that children walk on their toes, unable to stretch their heel to touch the ground (Fig. 49.7).” “... leg involvement may be detected most easily by examining the child’s shoes as, because the child does not put the heel all the way down on the involved side, one shoe heel will be much more worn than the other. On physical examination, it may be difficult to abduct the involved hip fully, extend the knee, or dorsiflex the foot.” (pg. 1388) 103. 18-month-old with bronchiolitis and discharge teaching. “Bronchiolitis is inflammation and edema of the fine bronchioles and small bronchi, usually due to a viral illness. The most common cause of bronchiolitis is the RSV…” (pg. 1113) “Understanding signs that could indicate worsening illness, such as respiratory distress and dehydration are critical during care. Additionally, caregivers need to understand that the symptoms of bronchiolitis can continue for an extended period of time, although worsening symptoms (such as recurrence of fever after the first few days of illness) should be brought to medical attention to evaluate for secondary infection. Caregivers should understand that medications, such as antibiotics, have no role in treatment of viral illnesses.” (pg. 1113) Understanding signs of respiratory distress and dehydration are important. Symptoms can continue for an extended period of time. Caregivers should understand that medications such as antibiotics have no role in treatment of viral illnesses. 104. Preparing CT-scan with preschool age child. “Consideration should be given to the number of diagnostic or therapeutic procedures and the time frame in which they are performed. Some children may have less anxiety if diagnostic tests are scheduled over several days to preserve the child’s coping ability. Conversely, some older children (and parents) do better if they can complete all necessary tests in 1 day to reduce the anxiety produced by the anticipation of more testing still to come.” (pg. 1022) “As a general guide, before a procedure, a child needs a detailed description of what to expect, such as “I’ll clean your finger. You will feel a small pinprick” as well as an explanation of: Downloaded by Craig Cman ([email protected]) lOMoARcPSD|15450111 Why the procedure is being performed (e.g., “Your doctor needs to look at your blood to see why you’re so sick”) Where the procedure will be done (e.g., the X-ray department, a treatment room) Any unusual sensations to be expected during the procedure (e.g., “The alcohol I use to clean your skin will feel cold”) Any pain involved (e.g., “The needle will sting, although I’ll put some cream on first to dull the feeling”) Any equipment that will be unfamiliar such as a magnetic resonance imaging machine The approximate length of time the procedure will take Any special care after the procedure (e.g., “You will need to lie quietly for 15 minutes afterward”)” (pg 1023) “If possible, introduce any equipment that will be used in procedures such as a nasogastric tube in a play session with a doll so the child can handle the new object and see that the doll is not injured or minds having the tube inserted.” “Try to associate any new equipment with things that they are already familiar, such as comparing a magnetic resonance imaging to a giant cell phone camera.” (pg. 1025) “plan for introducing therapeutic play techniques that would be helpful in relieving stress caused by the procedure.” Assess fear and pain, assess stress and introduce patient to new people and equipment, communicate according to developmental stage/age, determine last time child ate/drank (in case sedatives need to be used), explain procedure simply (avoid word test as children view it as pass/fail, avoid medical jargon, use words child is familiar with, such as camera), allow children to ask questions and foster curiosity, let them explore as this will ease anxiety and fear, assess parents understanding of procedure pg. 1032 105. Preschool age child aware of impending death and expected behavior of child. Pg. 1591 “Preschoolers cannot always differentiate what is real from what is make-believe play. This is a normal part of development and extends to abstract concepts such as illness and death. They envision death as temporary and therefore may not have the same fears adults may have about death.” Separation anxiety can complicate their response to death, their main concern may be separation from parents. Constant reassurance and having a caregiver present can help reduce these fears. Downloaded by Craig Cman ([email protected]) lOMoARcPSD|15450111 106. Newborn with patent ductus arteriosus signs and symptoms. Poor eating, which leads to poor growth, Sweating with crying or eating, Persistent fast breathing or breathlessness, Easy tiring, Rapid heart rate “Because left-side heart pressure is stronger than right-side pressure, blood then circulates through the ductus arteriosus from the left to right or from the aorta to the pulmonary artery, thus creating ineffective pump action in the heart. Struggling to breathe and circulate blood, the infant is forced to use available serum glucose quickly and so may become hypoglycemic” (pg. 673) “Be certain to monitor the rate of fluid administration conscientiously in high-risk newborns because a high fluid intake can lead to fluid overload, resulting in a patent ductus arteriosus or heart failure.” (pg. 676) 107. Chronic ill adolescent and how to prevent patient feeling lonely. “Achieving a sense of identity may be difficult for adolescents who have a chronic illness or other challenges.” “Helping these adolescents realize that even completely well people must compromise life decisions for other reasons such as lack of money, lack of qualifications, or other personal responsibilities helps them feel they are not so different from others. The fact an adult is willing to make a time commitment to discuss their future with them can be enough to give these adolescents the self-esteem they need to alter aspirations and plans and find a future role consistent with their capabilities.” (pg. 910) 108. Prenatal testing and when to do 1 hour glucose tolerance test. - 24 and 28 weeks of pregnancy High risk mothers and pregnancies (BMI over 30, glycosuria, previous unexplained fetal loss, family history of diabetes, previously large gestational babies or gestational diabetes) will need to have one at the end of the first trimester (12 weeks) (pg. 250) 109. Preemie infant with feeding tube in mouth rather than nose and parent education to explain this. “Whether enteral catheters should be passed through the nares or the mouth is controversial. Because newborns are obligate nasal breathers, passing a catheter through the nose may obstruct their breathing space, and repeated insertion of a nasal gastric tube can cause inflammation and obstruction of the nose; thus, most tubes are inserted orally in small infants (Vermilyea & Goh, 2015).’ (pg. 1043 “Although a sucking reflex is present earlier, the ability to coordinate sucking and swallowing is inconsistent until approximately 34 weeks of gestation. A gag reflex is not intact until 32 weeks of gestation. Downloaded by Craig Cman ([email protected]) lOMoARcPSD|15450111 Observe preterm infants closely after oral or gavage feeding to be certain their filled stomach is not causing respiratory distress. Offering a pacifier during gavage feeding can help strengthen the sucking reflex, better prepare an infant for bottle feeding or breastfeeding, and provide oral satisfaction. Gavage feedings may be given intermittently every few hours or continuously via tubes passed into the stomach or intestine through the mouth or nose. This can be helpful for infants on ventilators or those who cannot tolerate intermittent feedings because of the volume. If feedings are given intermittently, stomach contents may be aspirated, measured, and replaced before each feeding.” (pg.688) “Encourage the mother to come to the nursery and hold the infant before and after gavage feedings and to breastfeed or bottle feed as soon as the baby is ready for this. By feeding her infant or expressing milk for feedings, the mother is directly participating in care and learning the first steps of her new role.” (pg. 689) 110. 7-year-old with burn injury signs and symptoms of each degree Superficial (First degree) Damage to epidermis only, no blisters Example sunburn, moderate pain Superficial partial thickness (second degree) Damage to the superficial dermis, red color, blisters, heals with minimal scarring. Severe pain Full thickness (third degree) Damage to subcutaneous tissue, dry/leathery appearance, minimal to no pain requires skin grafting Deep Full Thickness (fourth degree) Damage extends beyond subcutaneous tissue (muscle, bone, tendon) Black color, no pain, require skin grafting See pg 1488 111. Signs and symptoms of esotropia (an eye turns inward pg. 931). Crossing of the eyes, squinting constantly, rubbing eyes. The resting position of one eye will be divergent (turned out) or convergent (turning in). One pupil may be higher Downloaded by Craig Cman ([email protected]) lOMoARcPSD|15450111 than the other. The esotropia may be monocular which the same eye deviates constantly. 112. Pain relief of primary dysmenorrhea best option- Heating pad minimizes cramping, massage lower back to relieve back pain, rhythmic rubbing of the abdomen. Medications used to treat primary dysmenorrhea NSAIDs. “If symptoms do not respond to NSAIDs, hormonal treatment, such as combined estrogen and progestin oral contraceptive pills (COCs), can be tried.” (pg. 1329) “Several nonpharmacologic solutions such as yoga and exercise may help relieve dysmenorrhea (Chien, Chang, & Liu, 2013). Decreasing sodium intake for a few days before an expected menstrual flow by omitting salty foods such as potato chips and luncheon meats may help reduce “bloated” feelings. Abdominal breathing (breathing in and out slowly, allowing the abdominal wall to rise with each inhalation) may also be helpful. Applying heat to the abdomen with a heating pad or taking a hot shower or bath may relax muscle tension and relieve pain (Navvabi Rigi, Kermansaravi, Navidian, et al., 2012). Abdominal massages (effleurage or light massage) or acupressures are still other options (Gharloghi, Torkzahrani, Akbarzadeh, et al., 2012). Adolescents who remain sexually active during their menses may discover an orgasm helps relieve pelvic engorgement and cramping. If girls are going to apply heat to their abdomen, caution them not to do this until their menstrual flow actually begins because if the pain is actually from an inflamed appendix, heat could cause rupture of the appendix and life-threatening peritonitis.” (pg. 1329) 113. Signs and symptoms of placenta abruption (abruptio placentae). “Unknown cause; associated with hypertension; placenta separates from uterus before birth of fetus” (pg. 527) Dark red bleeding and severe abdominal pain. Fetal distress, hypotension, tachycardia, pallor Sharp stabbing pain high in uterine fundus when initial separation occurs, tenderness upon palpation “Heavy bleeding usually accompanies premature separation of the placenta, although it may not be readily apparent. External bleeding will only be evident if the placenta separates first at the edges, so blood escapes freely into the uterus and then the cervix. In contrast, if the center of the placenta separates first, blood can pool under the placenta, and although bleeding is just as intense, it will be hidden from view. Whether blood is evident or not, signs of hypovolemic shock usually follow quickly. The uterus becomes tense and feels rigid to the touch. If blood infiltrates the uterine musculature, Couvelaire uterus or uteroplacental apoplexy, forming a hard, boardlike uterus occurs. As bleeding progresses, a woman’s reserve of blood fibrinogen becomes diminished as Downloaded by Craig Cman ([email protected]) lOMoARcPSD|15450111 her body attempts to accomplish effective clot formation, and DIC syndrome can occur…” (pg. 540) “Sharp abdominal pain followed by uterine tenderness; vaginal bleeding; signs of maternal hypovolemic shock, fetal distress” (pg. 527) 114. Nagel’s rule subtract 3 months from date of first day of last menstrual cycle and add 1 week 115. Peds dosage calc. 116. Toddler stage of development. Autonomy vs shame and doubt. Focusing on self control. 117. child Terminally ill child is awake at 0200 and what RN should do for 118. STI education of teenagers and why they are at greater risk. Young women’s bodies are biologically more prone to STDs.  Some young people do not get the recommended STD tests.  Many young people are hesitant to talk openly and honestly with a doctor or nurse about their sex lives.  Not having insurance or transportation can make it more difficult for young people to access STD testing.  Some young people have more than one sex partner.  Shorter urethra in females. 119. Signs and symptoms of Cushing syndrome. Weight gain and fatty tissue deposits, moon face and buffalo hump. Pink or purple stretch marks on the abdomen, thighs, breasts and arms. Fragile skin bruises easily, slow healing of cuts, insect bites and infections. 120. Preadolescent patient in a single parent family and what nurse should do to obtain consent. 121. School-aged Type 2 DM and parent education Blood sugar monitoring, insulin administration, management of hypoglycemia (4-6oz of juice/soda, 8 oz of milk) recheck in 15 minutes. 122. Legal responsibility of suspected physical child abuse. Nurses are required to report suspicion of abuse. Ex facts and circumstances that lead them to suspect a child has been abused. They do not have the burden of providing proof 123. UTI discharge teaching of child regarding medication Downloaded by Craig Cman ([email protected]) lOMoARcPSD|15450111 124. Fiberglass cast with fracture of tibia and priority nurse action following application of cast. Air dry cast for 10 to 15 minutes and can bear weight 30 minutes after. Support cast with palms of hands and not finger tips to avoid indentations. 125. What to do if suspected cord prolapse during sterile vaginal exam. Call for assistance medical emergency, elevate the fetal presenting part off the cord. Position mom knee-chest or in Trendelenburg 126. Signs and symptoms of placenta previa. Painless bright red bleeding (remember do not do a vaginal exam) Downloaded by Craig Cman ([email protected])