Exam (elaborations) Med Surg (NUR201) (Med Surg (NUR201)) MED SURG 2 EXAM LATEST 2021/2022

Exam 2 review Pediatric Pg 1319-What is osteosarcoma in children? Bone cancer A type of bone cancer in children which malignant cells produce immature bone and is most often seen in teenage boys. Assessment findings in adolescents include changes in gait, swelling of the extremity, loss of sensation in an extremity, and tenderness in the limb Book says-surgery and Chemotherapy, surgical biopsy followed by either limb salvage or amputation. Chemo is a vital role in treatment of osteo sarcoma. Antineoplastic drugs may be administered singly or in combination and may be employed both before and after sx resection of the tumor. Pg 1309-What kind of cancer affects the blood in children? Leukemia – Childhood leukemia is a type of cancer that starts in the blood-forming cells of the bone marrow. Children usually need chemotherapy as a medical treatment for a Leukemia diagnosis. It is important to give these children an antiemetic 30 minutes before the chemo infusion to help prevent nausea and vomiting. • Some children also need a bone marrow transplant.- Autologous bone marrow transplant is when people donate their own bone marrow. "Auto" means self. Allogeneic bone marrow is obtained from a sibling and is transfused to the sibling in need. A nurse caring for a child scheduled to begin radiation therapy should educate the parents not to wash off the radiation marks drawn on the skin Pg 1314-How common are tumors of the central nervous system in children? Most common solid tumors in children Tumors of the CNS are the most common solid tumors in children and account for 25% of all childhood cancers, with an annual incidence of 5 per 100,000 children younger than 20-years-old. Pg 1314-Symptoms are directly related to part of the brain that is being affected and the age of the child..s/s- headache on wakening in the morning,n/v. tumors in cerebellum s/s- nystagmus, ataxia, dysarthria, dysmetria. Supratentorial s/s-seizures, personality or behavioral changes, visual disturbances, and hemiparesis. Tumors involving the structures of mid brain, including the hypothalamus and pituitary gland may cause endocrinopathies such as diabetes insipidus. Delayed or precocious puberty, growth failure. Pg 1315- Treatment- total removal of the tumor w/out residual neurologic damage. Pts w most complete tumor removal have the greatest chance of survival. Radiotherapy is used to shrink the size of tumor before surgery. Chemo may be used in combo w sx, and or radiation or alone. Child with cancer- When do we start teaching the parents about the importance of vaccines?-during pregnancy What would you teach the parents about vaccines? That they do not cause autism What are the 4 main reasons for refusal to vaccinate? Autism, religious, What immunizations should the child with cancer NOT receive? live vaccines (if they have cancer), Live vaccines (if on steroids)- MMR, VARICELLA The child receiving chemotherapy for cancer should not be given live, attenuated vaccines. Inactivated vaccines can be given to immunosuppressed children. Siblings and family member can receive the live measles, mumps, and rubella vaccine and the varicella vaccine without risk to the child who is immunocompromised. How do we educate parents about making sure their child gets immunized? What they protect from, what the benefits are, what could happen if they do not get them. Education should be provided to parents to vaccinate their children as soon as the child is born. Most infants will get their first Hep B vaccine before discharge. Evidence-based research does not show any correlation to immunizations and autism. Four main reasons parents not vaccinating their children: 1. religious reasons 2. personal beliefs or philosophical reasons 3. safety concerns 4. a desire for more information from healthcare providers. American Academy of Pediatrics has a form for parental refusal to vaccinate: Chp 39 pg 1067 Family centered care of the child during illness and hospitalization What kind of things make a child more vulnerable to stress when entering the hospital? Chronic illness or disability that requires frequent hospitalization Difficult temperament Male gender Age – 5 months to 6 years Cognitive impairment Why is skin care so important in the hospitalized child and how can we prevent this from happening? Make sure they are dry, change position q2, maintain adequate nutrition Good nutrition Draw sheet to minimize sheer Skin moisturizer Under pads or diapers to keep linen dry Turn child at least every 2 hours Use pressure reduction surfaces and equipment Children have bony prominences as well as adults and critically ill or immobile children can get pressure ulcers, just like adults. Pediatric variations of nursing interventions ▪ How do we ensure cooperation from the child when doing an admission assessment? Have mom hold the child, let her be involved as much as possible ▪ Ensure the child is as comfortable as possible to get an accurate assessment. ▪ For younger children, especially 24 months or younger, it is appropriate to perform the assessment when they are sitting in their parent’s lap. Pg 1099-What do you assess when you look at an IV site? Redness, swelling, infiltration, pain How do we know if it is infiltrated? Swelling, cold skin, pain What do you do if it is infiltrated? Stop iv, elevate site, notify MD IV site assessment Swelling Redness Pain Streaks from the site Blood or leakage on the dressing Stop the infusion Elevate extremity Notify physician Remove IV and start a new one unless told otherwise What is the proper daily care for a gastrostomy tube in a patient? Gastrostomy tube care Cleanse around the tube at least once a day with soap and water. Refrain from the urge to turn the button, tube or peg and do not use hydrogen peroxide to cleanse the site Granulation tissue is normal after a certain amount of time, do not try to remove this. Allow the tube to lay flat on the abdomen and secure it with a commercial device. What are some ways to administer oxygen to an infant and which one is best tolerated? Infants can receive oxygen via: Oxyhood is best tolerated Nasal cannula on blender Nasal continuous positive pressure flow Ventilator Oxygen via nasal cannula Oxygen delivered straight from the wall and flow meter without a blender will only deliver the percent of oxygen you see listed here. ▪ What are the steps of catheterization in an infant? ▪ Catheterization is a sterile procedure ▪ When performing urinary catheterization for an infant, the nurse will distract the child to help them relax. Make sure you have help to hold the infant still or use a restraint device. ▪ Lidocaine jelly is used ,if ordered, to anesthetize the area before insertion of the catheter. ▪ Use comfort measures through touch and voice, both during and after the procedure, to help reduce the child's distress. Pacifiers would be appropriate with parental permission. ▪ Do not advance a catheter too far into the bladder. This can cause knotting of the catheter; especially when using a feeling tube instead of a catheter because the feeding tubes are much softer and longer. ▪ Explaining the procedure to the parents helps to lessen their fear and anxiety. Demonstrating on a model is one way to explain what will be done. Reassure the parents for a female infant this does not affect their virginity. Pg 1103-What is recorded as intake and output for the pediatric patient? Intake and output…what do I count? Anything taken by mouth Anything taken by IV For strict I & O’s you may even record flushes and medications. Output Urine Stool Vomitus Fistula drainage Nasogastric suctioning Sweat Drainage from wounds Weighing diapers, chux, bedlinen are all ways to find out output. Pg 1290-What is human immunodeficiency virus (HIV) and how would a child contract this disease? Children can get HIV through rape, other sexual abuse, or the virus can be transmitted across the placenta during pregnancy, exposure to the HIV mother during labor and delivery and through the breast milk. Candida esophagitis is an opportunistic infection for a child diagnosed with HIV that can inhibit their dietary intake as it can cause painful swallowing, nausea, vomiting etc. When a child is born from a mother who is born from a mother who is HIV + the child has to take anti virals for 4-6 weeks and will be tested till about 18 mo for the final pos or neg results of child Pg 1275-What is sickle cell disease and how is it diagnosed and treated? One of the most common genetic diseases worldwide. Affects mostly African American, Hispanic, Italians, Greek, Iranians, turks. In African Americans the incidence of sickle cell trait is about 8% it is 40% in west Africans. If both parents have the sickle cell trait, there is a 25% chance in each pregnancy that the baby will have sickle cell ▪ Sickle cell anemia is an inherited red blood cell disorder in which there are not enough healthy red blood cells to carry oxygen throughout your body. ▪ Priority nursing diagnosis for a patient experiencing a vaso-occlusive crisis is Acute Pain as vascular inflammation from sickle cell disease is very painful. ▪ Priority nursing action for a patient experiencing a vaso-occlusive is initiate intravenous access to rehydrate followed by treating any pain. Oxygen may be given but is proven to have little effect. Pg 1271-What is anemia and what are the symptoms you might see? Lack of energy, easy fatigue, pallor Severe hemolytic anemia and chronic hypoxia, conjunctival icterus, jaundice of the skin, and frontal and maxillary bossing are signs and symptoms of β-thalassemia major. Administer iron dextran using Z-track method via injection into a large muscle mass to a child with iron-deficiency anemia