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Peds Test 4
Stack #106302
| Question | Answer |
|---|---|
| What are the major complications that can occur in the post transplant phase of hematopoietic stem cell transplantation | infection,bleeding,anemia, also, graft-versus-host disease |
| Name clinical manifestations of Thasselemia regarding the blood, heart, and skeleton | RBC changes (hypochromic and microlytic changes; folic acid deficiency; frequent epistaxis),Skeletal changes (osteoporosis; delayed growth;susceptibility to pathologic fx; facial deformities),Heart (Chronic CHF; myocardial fibrosis; murmurs) |
| Name clinical manifestations of Thasselemia regarding the liver, spleen, endocrine system, and skin | Liver/gallbladder (hepatomegaly; hepatic insufficiency),Spleen (splenomegaly),Endocrine (delayed sexual maturation; fibrotic pancreas, resulting in diabetes mellitus),Skin (darkening of skin) |
| Nursing Management of Hemophilia includes: | teach parents to supervise children closely when learning to walk, etc. |
| Nursing Management of Hemophilia includes: | control any superficial bleeding by applying pressure for at least 15 minutes |
| Nursing Management of Hemophilia includes: | immobilize and elevate affected area and apply ice packs to promote vasoconstriction |
| Nursing Management of Hemophilia includes: | orient the child to room and keep it free of hazards as much as possible when |
| Nursing Management of Hemophilia includes: | once bleeding is controlled range of motion exercises are performed to strengthen muscles and prevent flexion contractures |
| Nursing Management of Hemophilia includes: | as ordered, medicate for pain/avoid rectal temperatures/use finger sticks to obtain blood samples |
| Nursing Management of Hemophilia includes: | check blood pressure by cuff as INFREQUENTLY as possible/do not give aspirin or drugs that alter bleeding time |
| Nursing Management of Hemophilia includes: | avoid IM or sub-Q injections as much as possible/use only paper or silk tape |
| Nursing Management of Hemophilia includes: | perform mouth care q3hours, as indicated with a glycerin swab |
| Nursing Management of Hemophilia includes: | avoid all venipunctures, except to administer factor replacement therapy |
| Nursing management of DIC: | carefully assess for petechiae, ecchymoses, and oozing every 1 to 2 hours,check dependant areas, blood will pool there, IV site should be assessed for oozing every 15 minutes, examine stool and monitor urine for presence of blood, measure blood loss |
| Nursing management of DIC: | assess extremities for capillary refill, warmth, and pulses;frequently assess vital signs; measure I & O;BUN and creatinine to assessrenal function;institute bleeding precautions;monitor prescribed therapy(transfusion, anticoagulant) |
| Nursing management of DIC: | monitor oxygen saturation and ABG's;maintain patency of airway and ensurecorrect endotracheal tube position;reposition gently;tube feedings or TPN as needed;assess family coping strategies, provide support |
| Teaching for Idiopathic Thrombocytopenic Purpura: | use acetaminophen, avoid aspirin or drugs that influence bleeding time;avoid contact sports & activities that increase risk of injury;S&S of bleeding (petechia&purpura/nosebleeds/oozing at IV sites/GI bleeding)& of intracranial bleeding ~vomiting/seizures |
| What are the best interventions to prevent oppurtunistic infections in a child with HIV? | frequent hand hygiene and limit exposure to individuals with URT infections. (and other infections) |
| What should you teach a child about avoiding triggers for systemic lupus erythematous? | avoid sun exposure and stressors. Alcohol/smoking/drugs also pose a risk due to the potential to stimulate flares. Avoid birth control pills that contain the hormone estrogen b/c estrogen may exacerbate symptoms. Discuss alternate birth control methods |
| What are the clinical manifestations of graft versus host disease? | after 100 days of transplant the skin manifest a pruritic and macular-papular rash that begins on extremities and progressess to the trunk.GI effects are N&V, anorexia, diarrhea, cramping and abdominal pain. |
| which children are more at risk for latex allergies? | myelodysplasia and congenital urinary tract anomalies, children withspina bifida, bladder extrophy, repeated surgeries |
| What are the signs and symptoms of anaphylaxis shock? | itching;localized or generalized hives on the hands and feet or mucosea,soft tissue swelling, cough, dyspnea, pallor, sweating, tachycardia and severereactions may lead to respiratory distress and death. |
| 1) Name the most common manifestations of Systemic Lupus Erythematosus | fatigue, arthritis, skin rash (butterfly rash) |
| Type 1 allergic reaction | localized or systemic reactions (anaphylaxis): hypotension, wheezing, gastrointestinal or uterine spasm, stridor, urticaria (hay fever) |
| Type 2 allergic reaction | tissue specific reactions: variable, may include dsypnea or fever (ABO incompatibility) |
| Type 3 allergic reaction | Immune- complex reactions: Urticaria, fever, joint pain (serum sickness) |
| Type 4 allergic reaction | Delayed reactions: Variable, may include fever, erythema, itching (Contact dermatitis, graft-versus-host disease) |
| List the most important interventions to protect an immunosupressed child from infections: | Frequent and proper hand hygiene,Limiting exposure to other individuals with infections, Encourage proper immunizations with special attention to live vaccines, Parent/family teaching r/t reducing risk of infection |
| When teaching families about safe food preparation for an immunosuppressed individual, the nurse should include: | Frequent & proper hand hygiene,Promote use of separate cutting board used only for meats,Encourage washing &peeling or all fruits/vegetables,Discourage use of sponge for cleaning,Discourage eating raw foods/undercooked foods,promote use of bleach solution |
| Since platelet levels and clotting factors are lower in newborns than in adults, what is given prophylacticly at birth? | Vit K injection |
| What are general characteristic signs of a bleeding disorder? | tendency toward easy bruising, nosebleeds, pallor, frequent infections, and lethargy |
| Describe the teaching aimed at the family for the child with anemia | screening for the disorder and educating parents and child about causes of iron deficiency, dietary management, and importance of complying with medication regimen |
| What vitamin enhances the absorption of iron? | Vitamin C |
| How is folic acid important in iron digestion? | Folic acid helps convert ron from ferritin to hemoglobin |
| What are good iron sources? | meats, fish, poultry, vegetables, dried fruits, legumes, enriched grain products, whole grain cereals, iron fortified dry cereals. |
| How is liquid ferrous sulfate prepared and administered? | Dilute well in water (avoid milk and fruit juice unless manufacture states those fluids are o.k. for mixing) give through a straw to prevent staining/mask taste, rinse mouth with clear water immediately. |
| If both parents have the sickle cell trait, the child has a ________% chance of having the disease? | 25 |
| What are some precipitating factors that contribute to a sickle cell crisis? | fever, dehydration, altitude, extremities in temperature, vomiting, emotional distress, fatigue, alcohol consumption, pregnancy, increased hemoglobin levels,excessive exercise or physical activity. |
| What are typical symptoms of a sickle cell crisis? | acute painful episodes typically in the back, abdomen, chest and joints, also chest tightness and shortness of breath |
| Describe the nursing management for sickle cell crisis | hydration, oxygenation, pain managment, bed rest, prevention of infection,emotional support for family, adequate nutrition |
| Name Signs and Symptoms of Transposition of the Great Arteries (TGA) | Cyanosis (soon after birth), progressing to Hypoxia & acidosis.Cyanosis that does not improve with O2. Tachypnea present withoutretractions, Systolic Murmur is present, The infant will take a long time to feed, Growth Failure by 2 wks of age is evident |
| Things to Know before administering Digoxin | Take pulse,if bradycardic (<60-100 bpm for infants,<60 for adolescents or below number designated MD)don't give, call the MD, Administer the med same time each day, Don't repeat the dose if the child vomits (unless directed otherwise by the MD) |
| What interactions should you be concerned about regarding Digoxin? | Don't give the child otc meds without MD approval.Don't give herbal preps such as ginseng, ma haung, or ephedra. (DIGTOXICITY)Remember about the interaction between Dig and AntiBx: Tetracyline, Erythromycin, Clarithromycin, Beta-lactams |
| Name some NORMAL side effects of Immunosuppresive agents that will usually be taken after a heart transplant: | (i.e. these are not signs to call a doctor, these are signs to say hey your OK)hair growth, gum hyperplasia, weight gain, moon face, acne, rashes, osteoporosis |
| What are signs of a Acute Rejection of a Transplanted heart? | low grad efever, increasing resting heart rate, fatigue, abdominal pain, nausea,vomiting, decreasing exercise tolerance.------chest pain is usually not experienced. |
| What signs present in a child with a congenital heart defect indicate a need for immediate medical intervention: | Exercise induced dizziness & Syncope |
| What are nursing interventions for cardiac catheterization | Monitor VS during, After apply direct pressure for 15min, Put pressure dressing over the site for 6hrs, Maintain bed rest for 6hrs with effort to keep leg straight, Avoid elevating HOB b/c flexion of the hips isn't permitted, Activity limited for 24hrs |
| What are the clinical manifestations of congestive heart failure in an infant? | Normally develops subtly. The infant may tire easily during feedings,weight loss or lack of normal weight gain, diaphoresis, irritability, and frequent infections may be evident. |
| What are the clinical manifestations of congestive heart failure in older children? | May have exercise intolerance, dyspnea, abdominal pain or distention, andperipheral edema. As the disease progresses symptoms such as tachypnea, tachycardia, pallor or cyanosis, nasal flaring, retractions, cough,crackles may occur. |
| What is nursing management of Rheumatic fever? | During AI phase, take temp q4h, Maintain bed rest while monitoring for carditis, if carditis develops maintain bed rest for at least 4wks, Auscultate heart sounds, Watch for changes in skin/joints/behavior, Throat culture family members, admin meds |
| Clinical Therapy and nursing interventions for shock | Obtain lab tests(H&H, ABGs, electrolytes, glucose, osmolality, BUN, andurinalysis),Establish airway/give O2,Establish IV sites,Ringer's lactatepreferred for initial resuscitation. 20mL/Kg given rapidly over 5 min. |
| If initial intervention for shock does not improve conditons, what additional interventions are implemented? | Repeated 20mL/Kg given rapidly over 5 min if the child's condition doesn'timprove.If the child's condition still doesn't improve, blood or albumin given. |
| Compare and contrast the clinical manifestations of inceased pulmonary blood flow and decreased pulmonary blood flow. | Increased:tachypnea, tachycardia, murmur, CHF, poor weight gain, diaphoresis,periorbital edema, frequent respiratory infections. Decreased: cyanosis, hypercyanotic episodes, poor weight gain, polycythemia. |
| A non-Hodgkin’s lymphoma pt develops high uric acid levels, potassium is elevated and calcium is low, and EKG changes are noted. You suspect Tumor lysis syndrome. What treatments are indicated? | Vigorous hydration with 2-4 times maintenance fluid.Correction of electrolyte imbalances.Administration of allopurinol or urate oxidase(rasburicase) to reduce conversion of metabolic by products to uric acid. |
| Chemotherapy is organized into four phases; Induction, Consolidation, Delayedintensification, Maintenance of remission. At what stage\time interval does the CNS prophylaxsis begin? And what additional drug is given prophylaxis intrathecal ________. | 3-4 weeks when remission has occurred; methotrexate |
| what are the cardinal signs of bone marrow failure in ALL ANLL pts? | petechiae, frank bleeding, and lethargy, malaise, anorexia and large joint or bone pain |
| What are the S & S that leukemia has infiltrated the CNS by means of lymphoid system? | Child may exhibit signs such as headache, vomiting, papilledema, and sixth cranial nerve palsy (no movement in the eye) |
| What are the sites of lymphoid system infiltration by leukemia? | testicles, spinal cord, and bown marrow are most common ( the testicular cells cause a mass the enlarges the testicles painlessly |
| When a child is considered neutropenic, what treatment is necessary? | A broad-spectrum antibiotic will be given; granulocyte colony-stimulating factor may also be given. Take the child's temperature, isolate the child from others with infection, and perform serum lab studies as ordered. (ch.23, p.867) |
| What are some concerns of thrombocytopenia, which can sometimes result from cancer treatments? | Protect child from bruises,be alert for signs of bleeding (petechiae/nosebleeds/bleeding gums/dark colored or bloody stools/presence of blood in urine or vomit)Minimize needlesticks and other intrusive procedures; Report bleeding episodes to MD |
| What are some concerns of thrombocytopenia, which can sometimes result from cancer treatments (cont.)? | Child should avoid contact sports/rough activities, & that any health care provider (dentist) should know about the condition; Infusions to increase platelets are sometimes administered. Encourage child to eat iron rich foods; give supplements if needed |
| Because receiving radiation effects the skin, it is important to: | Examine the skin daily during hospitalization or weekly when making homevisits. Leave the marks on the skin that outline the radiation target area.Avoid the use of lotions, powders, and soaps on the target skin area. (ch.23,p.867) |
| Some common side effects of chemotherapy are: | bone marrow suppression, nausea and vomiting, anorexia and weight loss, mouth sores, constipation, pain. (ch.23, p.868) |
| Clinical manifestations of cancer are: | pain, cachexia, anemia, frequent infection, bruising, bleeding disorders, weight loss, fatigue, changes in mental health/neurological status, and a palpable mass. (ch.23, p.845-846, 858) |
| What is cachexia? | a syndrome characterized by anorexia, weight loss, anemia, asthenia (weakness), and early satiety (feeling of being full). (ch.23, p.845) |
| What is a child that has undergone a splenectomy at increased risk for? | Risk of infection |
| Why might a child with Thalassemia be given an infusion of deferoxamine? | Deferoxamine is an iron-chelating drug. A common symptom of thalassemia is hemochromatosis (excessive absorption/accumulation of iron in the body) |
| How is deferoxamine administered? | 30-40mg/kg/day over 8-12 hours for 5 days via pump, Sub Q (fatty areas of body) or IV |
| What are complications/side effects associated with deferoxamine? | Hearing loss, renal calcium loss, blurred vision (report immediately), decreased visual acuity, night blindness, reddish colored urine. |
| What clotting factor is deficient in Hemophilia A? | Factor VIII, this is the most common type of hemophila, it affects males while women are carriers (x linked). |
| What factor is deficient in Hemophilia B? | Factor IX. Also known as Christmas disease. Also X linked. |
| What factor is deficient in Hemophila C? | Factor XI. Least severe type, occurs equally in males and females. |
| What is teh prupose of transfusing whole blood? | To replace blood volume, generally given in hemorrhagic emergencies. |
| What is the purpose of transfusing packed RBCs? | To increase oxygen-carrying capacity in anemia and some leukemias |
| What is the purpose of transfusing FFP? | To expand blood volume. |
| What is the purpose of transfusing cryoprecipitate? | To replace factor VIII, XIII, von Willebrand's factor, and fibrinogen. |
| What is the purpose of transfusing albumin? | To expand blood volume, usually during shock/trauma. |
| Why should you never administer cold blood to a sickle cell patient? | Cold may increase sickling; use a blood warming coil to bring blood to room temperature |
| Why should you never use cold nor hot compresses for pain management in a child with sickle cell? | Ischemic tissue is fragile and has reduced sensation, increasing the risk of burn injury. Cold compresses promote sickling. |
| What is the most common medication given for idopathic thrombocytopenic purpura? | Corticosteroids (prednisone or methylprednisolone) for several days up 3 weeks. Platelet counts show improvement within 3-10 days. Iv immunoglobulin and anti-D immunogloblulin are sometimes given alternatively and show improvement in 24-48hrs |
| What teaching can you give parents regarding cancer prevention among children? | Increase consumption of fruit and vegetables, use sunscreen, disourage smoking/environmental smoke around children, and have the home tested for radon. |
| What medications might you anticipate administering to a client to cope with the side effects of cancer treatment? | Broad-spectrum antibiotics and possibly G-CSF for clients that have become neutropenic; zofran/antiemetics for N&V; iron supplements/blood transfusions for anemia; platelet transfusions for thrombocytopenia; stool softeners/laxatives for constipation |
| What types of pain meds are administered to children experiencing pain r/t chemotherapy? | acetaminophen (be careful, can mask fever/infection), morphine, steroids, NSAIDs, antidepressants |
| What are the H&H values that indicate polycythemia? | Hemoglobin >20, Hematocrit >55-60 |
| How does a child respond to severe hypoxemia? | Bradycardia |
| What are the 4 defects of Tetralogy of Fallot? | Pulmonic stenosis, right ventricularhypertrophy, ventricular septal defect, overriding of aorta |
| What med do you administer for life-threatening cyanosis of ductus arteriosus closure in newborns? | PGE1 (Prostaglandin E1) to reopen ductus arteriosus &improve pulmonary/systemic blood flow. |
Created by:
shanebarnes1978
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