NUR 224 Unit 3 Exam - Past Paper PDF

Normal growth and development, parenting styles, infant reflexes, immunizations, genetics, pediculosis (lice), MEDS Wilm's tumor Patho: renal tumor, fast growing, unilateral, often late dx with large tumor and metastasis Assessment: palpable mass\*\* (do not palpate abdomen or mass), pain, hypert...

Normal growth and development, parenting styles, infant reflexes, immunizations, genetics, pediculosis (lice), MEDS Wilm's tumor Patho: renal tumor, fast growing, unilateral, often late dx with large tumor and metastasis Assessment: palpable mass\*\* (do not palpate abdomen or mass), pain, hypertension/crackles Tx: surgical removal of kidney, radiation or chemo depending on stage Intervention: medical home, supportive care Cryptorchidism Patho: undescended testicles, infertility, inc risk of testicular cancer Assessment: palpate as part of newborn assessment, undescended testicle at 12 months TX: orchiopexy to release the spermatic cord Intervention: consults, teaching phimosis/paraphimosis Patho : phimosis = foreskin cannot be retracted, normal for newborn, gradual change Paraphimosis = EMERGENCY (necrosis), swelling, color changes, dysuria, pain, incarceration of the glands if untreated Tx: steroid cream, circumcision, incision to release incarceration Intervention: hygiene (do not forcefully retract foreskin in newborns , freq diaper change, when older clean the gland once a week, dry area and replace foreskin menstrual cycle Ovarian Follicular phase -- begins with 1 day ends with mature ovum at day 14 Ovulatory Phase -- mature ovum released Luteal phase -- corpus luteum maintains hormone level Endometrial Proliferative phase -- new endometrial epithelium proliferates Secretory phase -- thickness 5-6 mm, ready for implantation Ischemic and menstrual phase -- necrosis, about 5 days, 40ml blood loss Amenorrhea (absence of menses) Primary (never had a period) - Turners' syndrome - Low body weight - Stress - Hormonal imbalance Secondary (had a period but went away for some reason) - Low body weight - Stress - Hormonal imbalance - Polycystic ovarian syndrome (PCOS) - High androgen levels abnormal bleeding - Types = spontaneous abortion, lesions, drug induced - TX - Progestin -- estrogen combination oral combination - Preg test - Ultrasound - Surgery - iron Mittelschmerz (middle pain): most common cause of cyclic pain Primary dysmenorrhea (period pain) - Endometriosis - Tissue outside the uterus that resembles endometrial tissue - Assessment - Asymptomatic - Dysmenorrhea - Infertility - Dyspareunia - TX - Meds - Surgery - Intervention urinary tract infection Patho: common, urine would be cloudy, hazy, or thick with noticeable strands of mucus and pus, bad smell, untreated can lead to pyelonephritis Risk factors: alkaline urine, urine retention, dehydration Assessment: infants -- fever, jaundice, vomiting, failure to thrive, irritability Children -- fever and vomiting, dysuria, freq, hesitancy, urgency, pain DX: urinalysis -- positive for blood, nitrites, leukocytes, esterase, white blood cell, bacteria/ urine culture will be positive for infecting organism TX: antibiotics (IV/PO), antipyretics, fluids Intervention: superficial heat for flank/abdominal pain Hirschsprung disease (congenital aganglionic megacolon) Patho: lack of motility in the intestine Risk factors: family hx, down syndrome Assessment: failure to pass meconium in first 24 hours, abdominal distention DX: biopsy TX: surgical removal of impaired bowel (multiple), temporary ostomy (while healing) Intervention: ostomy care and enterocolitis Clef lip Patho: congenital, dx prenatal Assessment: inspect for incomplete lip/palate, gagging, choking, and regurgitation of milk TX: specialized team Intervention: feeding support, consults Anomalies: heart defects, ear malformations, skeletal deformities, genitourinary abnormalities Complications: feeding difficulties, altered dentition, delayed or altered speech development, otitis media pyloric stenosis Patho: thickening of the pyloric outlet, obstruction Assessment: non-bilious vomiting (projectile), dehydration/lethargy Tx: surgical repair -\> pyloromyotomy Intervention: nutrition and hydration Intussusception Patho: Invagination of the bowels, obstruction Assessment: can be asymptomatic, sausage -- shaped mass in upper mid -- abdomen, sudden crampy abd pain, severe abd pain, N/V/D, currant jelly stools, gross blood, hemoccult -- positive stool, lethargy Tx: barium enema (tx and dx), surgical reduction, surgical resection (necrosis) Glomerulonephritis Patho: immune process damage to kidneys, poststreptococcal acute glomerulonephritis, follows URI, skin, or other infection, more common in males Assessment: inc blood pressure, mild edema, cardiopulmonary congestions(inc work of breathing, cough), crackles, proteinuria, hematuria, tea colored, cola colored, or dirty green urine Tx: antibiotics, supportive care (manage HTN), fluid and sodium restrictions, manage mild edema Intervention: monitor BP, daily weight, strict I&O, no strenuous activity until proteinuria and hematuria resolve, avoid NSAIDS Appendicitis + McBurney's point McBurney's point -- rebound pain/tenderness right lower quadrant at McBurney's point Patho: acute inflammation of the appendix, EMERGENCY Assessment: vague pain to RLQ pain in a few hours, N+V, small volume, freq, soft stools (like diarrhea) fever Dx: CT scan, inc WBC, inc CRP TX: Laparoscopic appendectomy, Open laparotomy for lavage if perforated, Antibiotics Intervention: pain management IVF maintenance by weight Calculating the daily fluid requirements for a child (for 24 hours): 100 mL/kg of body weight for the first 10 kg 50 mL/kg of body weight for the next 10 kg 20 mL/kg of body weight for the remainder of body weight in kilograms dehydration in children Oral rehydration solution (ORS) - Sodium chloride - Glucose - Standard ORS include Pedialyte - Mild to moderate dehydration requires 50 to 100 ml/kg ORS over 4 hours Mild dehydration: Fluid loss of 3--5% of body weight. Moderate dehydration: Fluid loss of 6--9% of body weight. Severe dehydration: Fluid loss of 10% or more of body weight, which is a medical emergency. Assessment: dry mucous membrane, sunken eyes, sunken fontanelles, skin tenting, slow cap refill time \>2 seconds, tachycardia, hypotension, fever, dark urine, tachypnea sickle cell crisis Patho: autosomal recessive abnormal RBC production Assessment: crisis -- SOB, activity intolerance (hypoxia), pain, acute chest syndrome (chest pain/tightness, fever, SOB/cough) DX: cord blood/newborn screening, genetic testing, sickle turbidity test, hemoglobin electrophoresis Precipitating factor for crisis: trauma, fever, physical and emotional stress, inc blood viscosity, hypoxia Tx: tx infection, prophylactic antibiotics, hydration, bed rest, transfusion, pain meds, superficial heat, oxygen congenital cardiac defects and complications Atrial septal defect (ASD) Patho: hole between atrium Complications: pulmonary hypertension, heart failure, arrhythmias, thromboembolic disorders Assessment: poor feeding/ growth, murmur Dx: echo Tx: small -\> spontaneous closure by 18 months If not by 3 years -\> surgical correction Ventricular septal defect (VSD) Patho: hole between the ventricles Complications: pulmonary hypertension, right sided heart failure, valve damage, endocarditis Assessment: poor feeding/growth, murmurs, activity intolerance Dx: echo Tx: small = spontaneous closure \< 2 years If not by 3 years then surgical correction Oral hygiene Patent ductus arteriosus (PDA) Patho: failed to close ductus arteriosus by 15 hours post birth Assessment: tachycardia/tachypnea, bounding peripheral pulses, widened pulse pressures(low diastolic) Complication: right sided heart failure, respiratory complications, poor growth/development Tx: cath (coil), meds (prostaglandin inhibitor) Tetralogy of Fallot: four defects PROV P (pulmonary stenosis) R(right ventricular hypertrophy) O(overriding aorta), V (ventricular septal defect) Assessment: cyanosis (abrupt of gradual) worse with feeding, crying, stress, hypercyanotic spells, posturing (squatting , fetal positioning) , clubbing, inc wob, SOB, s/s of heart failure Dx: within first weeks of life, echo, cardiac cath Tx: surgical correction Interventions: limit stressors pulmonary stenosis Patho: narrowing of path from right ventricle to the lungs, inc pressure on the right side of the heart, right ventricle hypertrophy Assessment: mild -\>asymptomatic, severe -\> cyanosis (abrupt of gradual) worse with feeding, crying, stress, hypercyanotic spells, posturing (squatting , fetal positioning) , clubbing, inc wob, SOB, s/s of heart failure Dx: echo Tx: cardiac cath, surgical repair (valve replacement) Coarctation of aorta Patho: linked with closure of ductus arteriosus, narrowed aorta Assessment: inc bp in upper body (bounding pulse), dec bp in lower body (weak pulses), rib notching, irritability, epistaxis, headache, older child(leg pain with activity, dizziness, fainting) Tx: ballon angioplasty/stent placement, surgical repair Complications: left -sided heart failure, aortic aneurysm, aortic rupture, CVA (stroke) Intervention: measure Bp in all four extremities, activity restrictions (lifting), life long follow up hypoplastic left heart syndrome Patho: left side of heart fails to develop normally assessment: can be born circulatory collapse, when PDA closes rapid decompensation Dx: echo Tx: assisted ventilation, multiple surgery, heart transplant Transposition of the great vessel Patho: Right ventricle connects to aorta left ventricle connects to pulmonary artery Assessment: Cyanosis worsens when the PDA closes Tx : Surgical correction Kawasaki disease Patho: acute systemic vasculitis (6 month -- 5 years) Assessment: high fever for 5 days, chills, headache, malaise, extreme irritation, distinctive rashes (strawberry tongue, palmar erythema), desquamation (peeling) of perineum, fingers and toes, vomiting, diarrhea, abdominal and joint pain Tx: Iv immunoglobulin and aspirin, med for inflammation, ice chips/petroleum jelly (mouth care) Complications: coronary artery aneurysm, cardiomyopathy Interventions: avoid live vaccines for 11 months after IVIG Meningitis Bacterial meningitis -- requires rapid assessment and tx Patho: usually caused by streptococcus pneumoniae or haemophiles influenzae Assessment: high fever, severe headache, stiff neck, N+V, sensitivity to light, confusion or altered mental status Dx: a lumbar puncture (spinal tap) to analyze cerebrospinal fluid (CSF). The presence of bacteria, elevated white blood cell counts, and specific protein levels indicate bacterial meningitis. Tx: Iv antibiotics, corticosteroids, controlling seizures, reducing ICP, maintaining cerebral perfusion, HIB vaccine hydrocephalus Patho: imbalance in the production and absorption of CSF, congenital or acquired Assessment: ICP, inc head size, bulging fontanelle, sunset eyes, loss of developmental milestones, changes in personality in older children, brisk reflexes (lower extremities) Dx: CT/MRI Clinical manifestations: Infants -\> large head size, bulging fontanels, downwards -- deviated eyes, low muscle tone Toddlers and older -\> headache, vision problem, developmental delays or poor school performance, changes in personality Tx: reduce pressure with shunts Reye syndrome Patho: brain swelling, liver failure, caused by aspirin use in young children or viral infections such as varicella or influenza Assessment: seizures, tachypnea, severe and continual vomiting, change in mental status, lethargy, irritation, confusion, hyperreflexia, jaundice Dx: liver enzymes and ammonia level, hypoglycemia, CT, MRI Tx: controlling intracranial pressure, managing fluid and electrolyte balance, and addressing any metabolic issues pediatric injuries shaken baby syndrome Patho: Abusive head trauma from maltreatment concussion Patho: Direct/Indirect Impact to Head or Neck, Coup-Contrecoup Injury, Requires close monitoring Assessment: Headache, Sleep Disturbances, Dizziness, Temporary Speech and Mental Processing Issues (should resolve 1 to 4 weeks) Dx: CT or MRI Tx: rest, NSAIDS contusion/laceration Patho: Ruptured Blood Vessels and Hemorrhaging, Potential for Permanent Disability, Contusions are common in Temporal/Frontal Lobes Assessment: Possible Loss of Consciousness, Vomiting, Seizures Neuroimaging Findings: Lesions, Edema, Fractures Dx: CT or MRI Tx: manage intracranial pressure, external bleeding control hematoma: epidural and subdural Patho: Accumulation of Blood in Brain-Skull Space Assessment: Altered Consciousness, Headache, Paralysis, gradual cognitive impairment Dx: CT or MRI Tx: surgical drainage Pediatric Glascow Coma Scale three-part assessment: eye opening, verbal response, and motor response. Numeric values of 1 through 5 are assigned to the levels of response in each category. The sum of these numeric values provides an objective measure of the patient's level of consciousness (LOC). A person with an unaltered LOC would score the highest, 15. It is an Objective measure of child's LOC by assigning numerical values to the presence of developmentally appropriate clues (eye-opening, verbal response, and motor response) Down syndrome Patho: trisomy 21 Assessment: of intellectual disability, characteristic facial features (e.g., slanted eyes and depressed nasal bridge), and other health problems, such as cardiac defects, visual and hearing impairments, intestinal malformations, and an increased susceptibility to infection Dx: genetic testing Tx: echo, sleep apnea testing, thyroid hormone level, vision and hearing screening, cervical radiograph to assess for atlantoaxial instability, ultrasound for gastrointestinal malformations tonsillectomy Patho: inflamed/infected tonsils, usually bacteria (GAS) Complications: infection can extend and cause a peritonsillar abscess Risk factors: ages 5 to 15 years, winter and early spring Dx: GAS swab Tx: bacterial -- antibiotics, viral -- self-limiting, tonsillectomy Tonsillectomy -- side lying or prone, watch for continuous swallowing a sign of bleeding, maintaining fluid volume (discourage coughing, avoid citrus, brown or red fluids), relieve pain with ice collar and analgesics Croup Patho: upper and middle airway swelling -\> restricted airflow, can be spasmodic (allergen), virus (viral), or bacterial, short and self-limiting, usually non emergent, usually manifest at night barky cough Assessment: 1 -2 days of nasal congestion and discharge (coryza), day 3 fever and barky cough and hoarseness, swelling in airway and prolonged inspiratory phase, can lead to respiratory distress, anxious or agitated Dx: parental interview for s/s, screening for respiratory illness and fever in viral croup (inflammation, fever, does not repeat) , absence of fever and recurrent episodes in spasmodic croup (edema and occurs at night, re-occurs), XRAY, and WBC Tx: nebulized, oral or injectable steroids, severe -\> mech vent, hot steam from shower or cold outside air can relax airway, corticosteroids, dexamethasone Epiglottitis Patho: serious obstructive, inflammatory process (EMERGENCY), ages 2 to 8 years Assessment: similar to croup, severe respiratory distress, tripod (orthopnea) position, **drooling, absence of spontaneous cough, agitation,** sore throat, pain with swallowing (early sign), retractions, inspiratory stridor, mild hypoxia, and distress Tx: NO THROAT EXAMINATION UNLESS INTUBATING, prevention (HIB vaccine), give O2 (100%), may need trach, no supine position Bronchiolitis Patho: inflammation at the end of the bronchioles, excessive mucus production, edema, alveoli collapse, usually caused by RSV (droplet) , \ diminished or absent breath sounds (respiratory collapse) cystic fibrosis Patho: anomaly in the proteins (genetics), mucus is syrupy and thick, affects sodium dec levels in the blood - 75% will not have it, 50% will be carrier, 25% will have CF, 25% will not be carrier or have CF - Testing done with blood or saliva for carrier gene, during preg -\> metabolic screening - Affects white Americans the most Assessment: newborn not passing meconium stool, chronic lack of oxygen, chronic cough and obstructive emphysema, chronic constipation, steatorrhea and abdominal discomfort, low BMI, growth restriction, delayed puberty, inc salt content in sweat and tears Dx: chest Xray, sweat chloride test, sputum culture, PFT, stool analysis Intervention: nutritional panel. CBC, genetic testing Tx: no cure, humidified oxygen, chest PT, bronchodilators, mucolytics, and vest that shake chest, antibiotics, cystic fibrosis transmembrane conductance regulators (CFTR) meds, sodium chloride supplements, high protein diet, pancreatic enzyme and vitamins, prevent constipation, megestrol acetate or enteral feeding, routine sputum sample collections, PFT q3 months, blood test, radiography spina bifida Patho: neural tube defect, prenatal dx (inc AFP), ultrasound/MRI, often occurs with hydrocephalus - Occulta (mild) -- tuft of hair - Meningocele (severe) -- protruding pocket of CSF - Myelomeningocele (most severe) -- protruding pocket of CSF with nerves Plagiocephaly Patho: flat head Scoliosis Patho: lateral curvature of the spine \> 10 degrees, congenital or acquired, idiopathic, neuromuscular Clinical presentation: sideways spinal curve \>25 degrees, uneven hips/shoulder, raised hip, asymmetrical rib cage, body lean Dx: xray, ct, mri, physical exam Tx: exercise to strengthen the back, braces (18 hours a day), surgery (spinal fusion) Intervention: check skin, wear cotton under the brace, neurovascular checks, log roll technique to avoid flexion, pain, risk for bleeding / infection, ambulation juvenile idiopathic arthritis Patho: autoimmune disorder that targets the joints, chronic with flare ups Assessment: pain, redness, warmth, stiffness (after inactivity/sleep), swelling, hx of fevers, salmon color rash, painful, swollen joints, fever, eye discomfort, inflammation, joint stiffness Dx: no screening, dx based on s/s, CT, MRI, ultrasound on joints, CBC, antibody testing, inflammatory markers Tx: NSAIDS, corticosteroids, antirheumatic drugs, immunosuppressants Intervention: range of motion, pain management, skin integrity, warm bath Fractures Complete fracture -- two separate pieces of bone Incomplete fracture -- partially broken bone Plastic deformation -- bent bone no fracture Buckle (torus) -- excessive pressure causes a bulge in bone instead of break Greenstick -- bone bends, causing splintering with fully breaking Simple (closed) -- bone does not puncture skin Compound (open) -- bone puncture skin Complicated -- broken bone splinter damage tissue or blood vessels Comminuted -- breaks at least 2 pieces, damage tissues or blood vessels Fracture lines -- transverse (visibly broken in straight line), oblique (diagonally across the bone), spiral fracture line (spiral fashion) Risk factor: weak bones, poor nutrition, obesity, sports and accidents, elbows and wrist Clinical presentation: pain swelling, discoloration, ecchymosis, limping, limiting use, deformity Dx: Xray, MRI, labs for bone deficiencies, CT scan Tx: reduction, immobilization, cast and splints, boots, surgical intervention Complication: impaired circulation/nerve compression, compartment syndrome (excessive swelling, inc pressure and circulation disruption, tingling, pain), physeal involvement (disrupted bone growth) , infection, pulmonary emboli Burns - Full thickness burns are life threatening - Lab testing - Electrolytes and CBC - Culture of wound drainage - Nutritional indices - Pulmonary status - Scanning for inhalation injury - Electrocardiographic monitoring for electrical injury - Tx - Wet dressing - Occlusive dressing - Emollient lotions and creams (fentanyl, morphine, silver sulfadiazine) - Therapeutic bathing - Skin biopsy - Tx for minor burns - Assess tetanus hx - Mild analgesics - Antipyretics - Tx for major burns - Airway, fluid replacement, high protein diet - Topical antibiotics, vitamin A and C - Morphine sulfate - Antimicrobial dressings - Debridement - Hydrotherapy - transfusion - Risk - Fluid loss, heat loss, infection, scarring (loss of function) - Dx: lund-bowder chart or rule of nines Sun burn Patho: exposure at 10 am to 4 pm, usually epidermal burn, use sunscreen/sun block Clinical Presentation: redness, pain, swelling, blisters, peeling, fever and chills, dehydration Tx: NSAIDS Intervention: cool compress, cool bathing, aloe vera gel, loose clothing, don't pick Common Rashes Tinea means fungal Diaper dermatitis -- a form of contact dermatitis - Change diapers freq, change stool soiled diapers quickly, avoid rubber pants, gently wash area with soft cloth, avoid hard soaps, baby wipes with no fragrance - If rash occurred, allow infant to go diaper less for a period of time per day - Blow dry the diaper rash area with dryer set on warm for 3 -- 5 minutes Diaper candidiasis (fungal) -- s/s satellite lesions Contact dermatitis - Response to allergen on skin (poison ivy for ex) - Allergy to nickel or cobalt in clothing, hardware or dyes - Complications - Secondary bacterial skin infection - Lichenification or hyperpigmentation - Clinical manifestation - Redness, pruritus, swelling, vesicle, and oozing - Dx - Allergy patch test - Tx - Avoid trigger - Oatmeal bath or cool wet compress - Corticosteroids, antihistamines, antibiotics Atopic dermatitis Patho: pruritic eczema that begins in infancy, itch rash cycle, hereditary, worse in fall and winter due to dry air Clinical presentation: pruritus, skin flaking, and inflammation Tx: topical steroids like clobetasol, tacrolimus ointment (steroid free), antihistamine oral OTC, dilute bleach bath Seborrhea and psoriasis Urticaria -- hives - Type 1 hypersensitivity, vasodilation, inc vascular permeability, erythema and wheals - Assess airways and breathing - Begins rapidly in a few days and may take 6 to 8 weeks to resolve - Tx -- antihistamines or steroids, remove trigger diabetes mellitus (Type 1) Patho: autoimmune disorder resulting from damage and destruction of the beta cells in pancreas, peak onset is childhood, insufficient insulin secretion Clinical presentation: polyuria, polydipsia, polyphagia, and weight loss, vomiting, lethargy, dehydration and acid Diabetic Ketoacidosis (DKA) -- Emergency - Ketones released, ketonuria or by the lung's acetone breath - s/s -anorexia, N+V - Altered mental status and lethargy - Dec skin turgor (dehydration) , abdominal pain - Kussmaul respirations and air hunger - Fruity or acetone breath odor - Tachycardia -\> coma and death Tx: insulin, fluids and electrolytes (especially potassium) otitis media Patho: inflammation/infect in the middle ear, fluid accumulation Screening: otoscopic examination Risk factors: exposure to smoke, allergies, daycare attendance, respiratory infection, immunocompromised, pacifier use, missing vaccines Clinical manifestations: inflammation and pain in ear, dx with physical exam Tx: meds, myringotomy with tympanoplasty palliative care - It focuses on providing relief from the symptoms, pain, and stress of the illness, regardless of the child's age or stage of the illness. - DNR autism spectrum disorder Patho: Autism spectrum disorder (ASD) is a neurodevelopmental disorder presenting in the first three years of life. Assessment: M-CHAT-R: For toddlers aged 16--30 months, STAT, PEDS-R, ARI: Evaluate behaviors and developmental delays Risk factors: Genetic predisposition, maternal age, family history, and prenatal exposures (e.g., valproate use). Environmental contributors like pollutants and pregnancy complications. Clinical Manifestation: Poor eye contact, lack of empathy, challenges with nonverbal cues, Fixations, sensitivity to routines, and self-harm tendencies, Anxiety, ADHD, seizures, GI problems, and sleep disturbances Tx: Applied behavioral analysis, Speech, occupational, and social skills training, Risperidone and Aripiprazole Interventions: Low stimulation (dim lighting, quiet spaces), structured routines, Address elopement risks (alarms, wearable tracking devices)