Diabetes
Three “Ps” of diabetes
Polyphagia, Polyuria, Polydipsia
Hypopituitarism management
Growth hormone injections
pressure to radial head and supinating and flexing forearm
relocation of Nurse Maid elbow/ Radial head subluxation
Sac-like protrusion on Lumbar spine
Myelomeningocele
A document showing a patients wishes regarding recitation
DNR, POST, MOLST
The rejection of bone marrow
Graft-versus-host disease
Bulging fontanelles Early or late sign of ICP
Early
most common seizure in children with eye or eyes & head turn away from the side of focus
Partial simple
Child in triage S&S of Meningitis what is nurses first priority?
Droplet isolation
Hyperleukocytosis
WBC>100,000/mm3
Infant Fluid Imbalance affects this electrolyte
Sodium with risk of seizure
Most common time for infant to experience constipation
changing type of feeding--breastfeeding to formula
Diet for Acute Glomerulonephritis
low sodium, low protein
Bed Wetting a sign of
Hyperglycemia
Manifestations of sleepiness, myxedematous skin, periorbital edema
hypothyroidism
Management of Heat Exhaustion
place in cool environment, rest, ORS (if oriented) vs IVF d/t vomiting
Myelomeningocele interventions
Prone in incubator, Moist sterile dressing, Diapering contraindicated, measure head circumference daily
What is priority for management of a Hospice patient
comfort & pain management
Confirms diagnosis of ALL
Blast cells in bone marrow
complication with Dilated pupils
ICP and brain herniation
Interventions for EEG
quiet during procedure, no caffeine 1 hour before
Sign of severe dehydration in a infant
tenting turgor, sunken Fontenelle
Diabetes Insipidus urine results
low specific gravity < 1.005
What is Hourly urine output formula
1-2 ml/kg
Risk if swallow battery or magnet
necrosis
Interventions to prevent a UTI
avoid holding, no tight pants/diapers, wipe front to back, good fluid intake, good toileting
Assessment of BG over 3 months
HgA1C
Priority for a infant born with a goiter
Airway
Do not place this on ice
Traumatically amputated limb
percentage of Cerebral Palsy with normal IQ
50% to 60%
Team approach for those with a ´Life limiting illness
Hospice
Manifestations include petechiae, bruising, hematemesis, hematuria, bleeding gums, tarry stool
Thrombocytopenia
Why can infants head circumference increase with ICP
Open fontanels – allow for expansion
How long to keep respiratory isolation with Bacterial meningitis
For 24 hrs post start of abx
How to show support and relieve anxiety of a parent with a ill child
Provide emotional support, educate on plan of care
SIADH
High urine Specific gravity, Hyponatremia
hy children more at risk for electrolyte imbalance
Greater Body surface area, •Higher metabolic rate, •Immature kidneys
What foods to avoid with Diarrhea
BRAT diet (bananas, rice, applesauce, toast)
How to collect specimen if suspect systemic infection from urologic source
straight cath
A quick source of sugar
15g carbohydrates
Caused by a cortisol deficiency
Acute Adrenocortical insufficiency
How to explain a cast to a young child
use a doll or stuffed animal
Cause of Spina Bifida
lack of Folic Acid
Cold extremities and change in skin color called
´Mottling of skin
Positive diagnosis of Hodgkin Disease
+ Reed Sternberg cells
scale to assess neuro status
Glasgow coma scale
diagnosis includes elevated AST/ALT, ammonia, prolonged coags & recently received aspirin
Reye’s Syndrome
Urine output/hour for child 48 lbs (round to whole number)
22mL--44mL/hour
Addison disease
Hypoglycemia, Hyponatremia, Hyperkalemia
ways to assess edema
daily weights, Lower extremity pitting edema, abd girth measurement for ascites
This can be a cause if failure to pass meconium w/in 24-48 hours
Hirschsprung disease
Manifestations include Oliguria, periorbital edema, HTN, Hematuria, Proteinuria
Acute Glomerulonephritis
Sweating, shaky a sign of
Hypoglycemia
Manifestations of urine retention and hyponatremia
SIADH
What to assess with a fracture
Pain, pulse, pallor, Paresthesia, Paralysis
Manifestations include Gower sign
Duchenne Muscular Dystrophy
A common side effect of morphine that could cause urinary retention
constipation
Manifestations include headache, increased head circumference, and vomiting upon waking
Brain Tumor
Obtundation
arousable with stimulation
post op Venticuloperitoneal shunt surgery position
lay on unoperated side
How should a nursing student relieve anxiety prior to the final exam?
Deep breathing, meditation
Cushing syndrome
Hyperglycemia, hypernatremia
Classic “Shocky” patient
•Cool, clammy, diaphoretic, pale
Education on Celiac Disease diet
•No gluten – Wheat, rye, barley, oats
Education of taking antibiotics
compliance, brush teeth after taking at night, can crush meds, mix with soft food
When I am sick call the MD if
Vomit, BG >240, or high ketonuria
Treatment for Thyrotoxicosis
Antithyroid drugs (PTU, methimazole), Propranolol
Uneven thigh folds
Developmental Dysplasia of the hip
Duchenne Muscular Dystrophy high risk factors
pulmonary infections, hypoxia
Med to manage Restlessness, agitation, seizures
Lorazepam
Correct position post brain surgery
do NOT lay on operative side, brain may shift
Name the Closed vault system and theory
blood, brain, CSF; Monroe-Kellie Doctrine
Preventative for Meningitis
HIB, Pneumococcal vaccine
Nursing interventions to protect a child with leukemia who is neutropenic
neutropenic isolation, hand hygiene, only well visitors, no fresh fruits/veggies
Meningitis LP results
Viral--Clear, slightly elevated WBC count, normal or slightly elevated protein, normal glucose, negative gram stain
Bacterial--Cloudy, elevated WBC, elevated protein, decreased glucose, positive gram stain
Stop the burn
Remove heat source! Run under cool water, remove clothing, remove jewelry; educate that hot liquids must not be left unattended
Causes of colic
feeding too quickly, overfeeding, swallowing excessive air, improper technique (position/burping), emotional stress, milk allergy
Manifestations include Proteinuria, Hypoalbuminemia, ascites, edema, hyponatremia, Hyperlipidemia
Nephrotic Syndrome
Diabetic ketoacidosis lab results
Low pH, ketonuria, hyperglycemia
Interventions to give DDAVP
Run under warm water for 10-15 minutes, then shake vigorously
management of Pavlik Harness
massage skin, diaper under straps, no lotions/powders, check for redness under straps
Occurs after nonspecific viral illness leading to ascending paralysis
Guillain–Barré Syndrome
Hospice interdisciplinary team members
nurse, MD, Chaplin, social worker
Caution with Wilms Tumor
Do not palpate the abdomen
Conditions that disrupt the blood brain barrier
Htn, hypercapnia, hypoxia, acidosis
Type of seizure with twitching of eyelids, lip smacking, NO incontinence
Absence
Active seizure
Time it, lay on side, administer benzodiazepine, oxygen, RRT
Hemorrhage risk
plt < 20,000mm3
what is the Parkland formula
fluid replacement in a 24 hour period post burn
nursing care of Cleft Palate
upright position, special bottle, burp frequently, non-pharmacologic interventions--swaddle, rocking
Source of Hemolytic–Uremic Syndrome
under cooked meat, unpasteurized apple juice, public pools
Interventions for diabetes and exercise
give snack 30 before, no exercise if ketonuria
Diet for Addison disease
diet high in protein and sodium
Most common cause of fracture in school age child
bikes, sports
Manifestations include poor head control and clenched fists after 3 months
Cerebral Palsy
“Death rattle”
accumulation of pulmonary & pharyngeal secretions
Why no IV with Vesicant chemotherapy
Can cause severe cellular damage if infiltration occurs
Cushings Triad
HTN, bradycardia, respiratory depression
Surgical treatment to relieve pressure post closed head injury
Burr holes
Sudden change in LOC what are expected diagnostic?
CT, labs CBC, CMP, H&H, glucose
Neutropenia
pancytopenia, low neutrophils/ ANC<500
Pain management post burn
IV or IN Fentanyl
What is McBurney's point and Rovsing sign
•RLQ pain at McBurney’s point; rebound tenderness
•Rovsing sign – tenderness in RLQ during palpation of other quadrants
Most common cause of Acute Renal Failure
severe dehydration
Presentation Diabetic ketoacidosis
decreased level of consciousness, dehydration, electrolyte imbalance, acidosis, Kussmaul breathing, ketonuria, glycosuria
manifestations Diabetes Insipidus
Polyuria, Polydipsia, Enuresis, Dilute urine, irritability; low specific gravity < 1.005—relieved with water
Management of sports injury
First 6-12 hrs; RICE
Treatment Cerebral Palsy
LE orthotics , surgery for contractures, Botox – pain w/ spasms, Tx spasticity - dantrium, baclofen, valium, antileptic
Last to fail at end of life
hearing
Receives healthy stem cells from donor
Allogeneic bone marrow transplant
coma
no motor or verbal response to pain stimuli
Goal & Treatment for seizure
control and reduce frequency; Benzodiazepine for acute 1st line; antileptics
How to explain to a 4 year old child about a procedure
doll, stuffed animal, drawing, touch & feel
Leukemia lab findings at Diagnosis
Anemia, Thrombocytopenia, hyperleukocytosis
burn degree with charring and limited movement
4th degree
currant red jelly-like stools (mix of blood & mucus), abdominal RUQ palpable sausage shaped mass
Intussusception
Chronic Renal failure manifestations
edema, HTN, hypovolemia, Hyperkalemia, Acidosis, anemia, ´Increased phosphorus
Insulin injection sites and rotation plan
arms, thighs, hips, abdomen
give 4-6 injections 2.5 cm apart in one area then move to another area
What is Adrenal Crisis & treatment
Acute cortisol deficiency due to discontinued steroids; 1st hydrocortisone-- IV fluids, K, blood products, Vasopressors, Seizure precautions
Assessment Child Abuse
Unmatched story; TEN-4 – bruising to torso, ears, and neck in children under 4; Burns with clear demarcations, circumferential, or symmetrical--if suspicious of abuse reporting is mandatory
Cerebral Palsy risk factors
spasticity, contractures, constipation, dental caries, skin breakdown, seizures, <50% abnormal IQ
non-pharmacological pain-relieving strategies
distraction, guided imagery, music
High risks while neutropenic
infection-viral, fungal, bacterial, bleeding, skin integrity
Early & Late sign of increased ICP
Early: change in level of consciousness, sleepiness, nausea, vomiting, headache
Late: HTN, Bradycardia, Respiratory Depression, Fixed, dilated pupils, Posturing-Decorticate & Decerebrate
Signs of obstruction Venticuloperitoneal shunt
Nausea, Vomiting, Headaches, Photosensitivity, photophobia
As a new nursing grad what is the most important skill to master?
time management
Nursing intervention for anemia, low H&H
blood products, oxygen, rest, IV fluid
Which degree of burn counts towards TBSA
2nd, 3rd, 4th
Controlled by a low protein diet
phenylketonuria (PKU)
UTI manifestations infant --2 yr
Lethargy, poor feed, irritable, V, D