lOMoARcPSD|62239921
1
CMS Review Topics
o Monitoring for postoperative complications
o Monitor for signs of infection
o encourage mobilization as soon as possible
o medicate for pain as needed
o watch for compartment syndrome
o compartment syndrome has increased pain, paresthesia (pins and needles), or
numbness, pulselessness distal to fracture, inability to move digits, warm digits with skin
taut and tight, shiny, pallor
o Identifying priority child to assess
o Prioritize systemic before local (life before Limb)
o prioritize acute before chronic
o prioritize actual problems before potential future problems
o listen carefully to clients and own assume
o recognize and respond to trends versus transient findings
o recognize indications of medical emergencies and complications versus expected
findings
o Consider Maslow’s hierarchy of human needs
o ABCDE- airway, breathing, circulation, disability, exposure
o look for safety risk
o least restrictive and least invasive interventions should be utilized as much as possible
o Manifestations of nephrotic syndrome and lab findings
o Hypoalbuminemia reduced serum protein and albumin
o Hyperlipidemia elevated serum lipids
o Hemoconcentration elevated hemoglobin, hematocrit, and platelets
o Possible hyponatremia reduced sodium level
o Glomerular filtration rate is normal or high
o Tonic clonic seizures
o Onset is without warning
o Three parts: Tonic, clonic, and postictal
o Hold head in lap if the client is on the floor
o Turn the client to the side to decrease the risk of aspiration.
o Loosen restrictive clothing
o Document onset and duration of seizure and client findings/observations prior to during
and following the seizure
o Seizures – postictal period
o Following a seizure, maintain the child in a side-lying position to prevent aspiration and
to facilitate drainage of oral secretions
o Check position of tongue
o Perform neurologic checks
o Maintain seizure precautions
o Try to determine the possible trigger, such as fatigue or stress
, lOMoARcPSD|62239921
2
o Child with heart failure
o Heart failure occurs when the heart is unable to pump adequate blood to meet the
metabolic and physical demands of the body
o Impaired myocardial function: sweating, tachycardia, fatigue, pallor, cool extremities
with weak pulses, hypotension, gallop rhythm, cardiomegaly PRIORITY FINDINGS
o Pulmonary congestion: Tachypnea, dyspnea, Retractions, nasal flaring, grunting,
wheezing, cyanosis cough, orthopnea (discomfort when breathing while laying flat),
exercise intolerance
o Systemic venous congestion: hepatomegaly, peripheral edema, ascites, neck vein
distention, periorbital edema, weight gain
o The metabolic rate is high because of poor cardiac function. Nurse should provide small,
frequent meals to conserve energy- a feeding schedule should not be less than every 3
hours as this does not allow sufficient time for rest. Restrict play activities to bed to
minimize energy expenditure. Weigh Daily and Maintain semi-fowlers position when in
bed
o Manifestations of Kawasaki Disease
o Acute phase: High fever unresponsive to antipyretics(fever reducing drug) and
antibiotics lasting 5 days to 2 weeks, irritability, red eyes without drainage, bright red,
chapped lips, strawberry tongue, red oral mucous membranes, swelling of hands and
feet with red palms and soles, non-blistering rash, bilateral joint pain, enlarged lymph
nodes (cervical nodes on one side that are non tender), desquamation of the perineum,
cervical lymphadenopathy, myocarditis, decreased left ventricular function, pericardial
effusion, mitral regurgitation
o Subacute phase: resolution of fever and gradual subsiding of other manifestations,
irritability, peeling skin around the nails and on the palms and soles, temporary arthritis
o The nurse should expect the child to be tachycardic with gallop rhythm. Long term
effects include coronary artery aneurysms and myocardial infarctions
o Blood Transfusion Reactions
o Laryngeal edema is an indication of allergic reaction to a blood transfusion
o Flank pain is caused by the breakdown of RBCs and is an indication of a hemolytic
reaction to a blood transfusion
o Distended neck veins are an indication of circulatory overload, which is a complication
of blood transfusion
o Muscle weakness is an indication of electrolyte disturbances, which is a complication of
blood transfusion
o Manifestations of Intussusception
o Sudden episodic abdominal pain, screaming with drawing knees to chest during
episodes of pain, sausage-shaped abdominal mass, stools mixed with blood and mucus
that resemble the consistency of red currant jelly, vomiting, fever, tender, distended
abdomen
o Detected by ultrasound
o Nursing care: stabilize the child prior to the procedure. IV fluids. NG tube.
o Ventricular Septal Defect
, lOMoARcPSD|62239921
3
o A hole in the septum between the right and left ventricle that results in increased
pulmonary blood flow (left to right shunt)
o Loud, harsh murmur auscultated at the left sternal border
o Heart failure
o Many close spontaneously
o Neutropenic precautions
o Restrict visitors
o Prohibit visitors with an infection
o Restrict live plants
o Restrict fresh fruit/vegetables
o Avoid contaminating client's own bacterial flora (avoid rectal temps/limit IM injections)
o Peritoneal dialysis
o Assess dry weight (obtained when dialysate is drained)
o Determine client’s ability to perform self-peritoneal dialysis and follow sterile technique
o Warm dialysate prior to instilling
o Instruct client about possibly feeling fullness when dialysate is instilling
o Monitor clear (clear, light yellow is expected) and amount of outflow (expected to equal
or exceed amount of inflow)
o Pain management and school age children
o To assess pain depends on age of child and what is appropriate
o Can treat with nonopioid or opioid pain relievers such as morphine
o Lab values - disseminated intravascular coagulation
o Low platelet count, elevated d-dimer
o Hemolytic uremic syndrome – lab values
o HUS is defined by three features: hemolytic anemia, thrombocytopenia, and acute
renal failure.
o Urinalysis may reveal presence of blood, Protein, post, and or casts
o Elevated bun and creatinine
o Moderate to severe anemia with the presence of burr cells, schistocytes, spherocytes or
helmet cells
o Increase reticulocyte count
o Increased bilirubin and lactic dehydrogenases (LDH) levels
o negative Coombs test except in cases of streptococcus pneumoniae infection
o Leukocytosis with left shift
o Hyponatremia, hyperkalemia, hyperphosphatemia, metabolic acidosis
o Teaching should include proper hand washing, after using the bathroom before eating
and after petting farm animals. encourage the use of swim diapers for children who are
not potty trained, teach parents to thoroughly cook all meats to a core temperature of
155 degrees or until the meat is grey or brown. ensure that drinking water and water
used for recreation or treated appropriately. Avoid unpasteurized dairy products in fruit
juices including cider
o Lab test for confirming rheumatic fever
o throat culture for GABHS
1
CMS Review Topics
o Monitoring for postoperative complications
o Monitor for signs of infection
o encourage mobilization as soon as possible
o medicate for pain as needed
o watch for compartment syndrome
o compartment syndrome has increased pain, paresthesia (pins and needles), or
numbness, pulselessness distal to fracture, inability to move digits, warm digits with skin
taut and tight, shiny, pallor
o Identifying priority child to assess
o Prioritize systemic before local (life before Limb)
o prioritize acute before chronic
o prioritize actual problems before potential future problems
o listen carefully to clients and own assume
o recognize and respond to trends versus transient findings
o recognize indications of medical emergencies and complications versus expected
findings
o Consider Maslow’s hierarchy of human needs
o ABCDE- airway, breathing, circulation, disability, exposure
o look for safety risk
o least restrictive and least invasive interventions should be utilized as much as possible
o Manifestations of nephrotic syndrome and lab findings
o Hypoalbuminemia reduced serum protein and albumin
o Hyperlipidemia elevated serum lipids
o Hemoconcentration elevated hemoglobin, hematocrit, and platelets
o Possible hyponatremia reduced sodium level
o Glomerular filtration rate is normal or high
o Tonic clonic seizures
o Onset is without warning
o Three parts: Tonic, clonic, and postictal
o Hold head in lap if the client is on the floor
o Turn the client to the side to decrease the risk of aspiration.
o Loosen restrictive clothing
o Document onset and duration of seizure and client findings/observations prior to during
and following the seizure
o Seizures – postictal period
o Following a seizure, maintain the child in a side-lying position to prevent aspiration and
to facilitate drainage of oral secretions
o Check position of tongue
o Perform neurologic checks
o Maintain seizure precautions
o Try to determine the possible trigger, such as fatigue or stress
, lOMoARcPSD|62239921
2
o Child with heart failure
o Heart failure occurs when the heart is unable to pump adequate blood to meet the
metabolic and physical demands of the body
o Impaired myocardial function: sweating, tachycardia, fatigue, pallor, cool extremities
with weak pulses, hypotension, gallop rhythm, cardiomegaly PRIORITY FINDINGS
o Pulmonary congestion: Tachypnea, dyspnea, Retractions, nasal flaring, grunting,
wheezing, cyanosis cough, orthopnea (discomfort when breathing while laying flat),
exercise intolerance
o Systemic venous congestion: hepatomegaly, peripheral edema, ascites, neck vein
distention, periorbital edema, weight gain
o The metabolic rate is high because of poor cardiac function. Nurse should provide small,
frequent meals to conserve energy- a feeding schedule should not be less than every 3
hours as this does not allow sufficient time for rest. Restrict play activities to bed to
minimize energy expenditure. Weigh Daily and Maintain semi-fowlers position when in
bed
o Manifestations of Kawasaki Disease
o Acute phase: High fever unresponsive to antipyretics(fever reducing drug) and
antibiotics lasting 5 days to 2 weeks, irritability, red eyes without drainage, bright red,
chapped lips, strawberry tongue, red oral mucous membranes, swelling of hands and
feet with red palms and soles, non-blistering rash, bilateral joint pain, enlarged lymph
nodes (cervical nodes on one side that are non tender), desquamation of the perineum,
cervical lymphadenopathy, myocarditis, decreased left ventricular function, pericardial
effusion, mitral regurgitation
o Subacute phase: resolution of fever and gradual subsiding of other manifestations,
irritability, peeling skin around the nails and on the palms and soles, temporary arthritis
o The nurse should expect the child to be tachycardic with gallop rhythm. Long term
effects include coronary artery aneurysms and myocardial infarctions
o Blood Transfusion Reactions
o Laryngeal edema is an indication of allergic reaction to a blood transfusion
o Flank pain is caused by the breakdown of RBCs and is an indication of a hemolytic
reaction to a blood transfusion
o Distended neck veins are an indication of circulatory overload, which is a complication
of blood transfusion
o Muscle weakness is an indication of electrolyte disturbances, which is a complication of
blood transfusion
o Manifestations of Intussusception
o Sudden episodic abdominal pain, screaming with drawing knees to chest during
episodes of pain, sausage-shaped abdominal mass, stools mixed with blood and mucus
that resemble the consistency of red currant jelly, vomiting, fever, tender, distended
abdomen
o Detected by ultrasound
o Nursing care: stabilize the child prior to the procedure. IV fluids. NG tube.
o Ventricular Septal Defect
, lOMoARcPSD|62239921
3
o A hole in the septum between the right and left ventricle that results in increased
pulmonary blood flow (left to right shunt)
o Loud, harsh murmur auscultated at the left sternal border
o Heart failure
o Many close spontaneously
o Neutropenic precautions
o Restrict visitors
o Prohibit visitors with an infection
o Restrict live plants
o Restrict fresh fruit/vegetables
o Avoid contaminating client's own bacterial flora (avoid rectal temps/limit IM injections)
o Peritoneal dialysis
o Assess dry weight (obtained when dialysate is drained)
o Determine client’s ability to perform self-peritoneal dialysis and follow sterile technique
o Warm dialysate prior to instilling
o Instruct client about possibly feeling fullness when dialysate is instilling
o Monitor clear (clear, light yellow is expected) and amount of outflow (expected to equal
or exceed amount of inflow)
o Pain management and school age children
o To assess pain depends on age of child and what is appropriate
o Can treat with nonopioid or opioid pain relievers such as morphine
o Lab values - disseminated intravascular coagulation
o Low platelet count, elevated d-dimer
o Hemolytic uremic syndrome – lab values
o HUS is defined by three features: hemolytic anemia, thrombocytopenia, and acute
renal failure.
o Urinalysis may reveal presence of blood, Protein, post, and or casts
o Elevated bun and creatinine
o Moderate to severe anemia with the presence of burr cells, schistocytes, spherocytes or
helmet cells
o Increase reticulocyte count
o Increased bilirubin and lactic dehydrogenases (LDH) levels
o negative Coombs test except in cases of streptococcus pneumoniae infection
o Leukocytosis with left shift
o Hyponatremia, hyperkalemia, hyperphosphatemia, metabolic acidosis
o Teaching should include proper hand washing, after using the bathroom before eating
and after petting farm animals. encourage the use of swim diapers for children who are
not potty trained, teach parents to thoroughly cook all meats to a core temperature of
155 degrees or until the meat is grey or brown. ensure that drinking water and water
used for recreation or treated appropriately. Avoid unpasteurized dairy products in fruit
juices including cider
o Lab test for confirming rheumatic fever
o throat culture for GABHS
