NURSING 3081 peds capstone Questions and Answers solutions | Download To Score A

NURSING 3081 peds capstone Questions and Answers solutions A pediatric client is complaining of a sore throat and general weakness. The provider diagnoses the client with Group A B-hemolytic stre ptococci (GABHS). Identify three (3) manifestations of GABHS? What are interventions and teaching points to discuss with the caregiver(s) and child about treatment of GABHS? Manifestations 1) Mouth odor/breathing 2) Snoring & nasal qualities in voice 3) Fever • Also include Tonsil inflammation with redness & edema Interventions/Teaching • Therapeutic procedure of Tonsillectomy • Post-Op Tonsillectomy o Place in side-lying position or abdomen o Elevate HOB when child fully awake o Assess for bleeding (i.e. frequent swallowing, clearing throat, restlessness, bright red emesis, tachycardia, pallor) o Monitor for difficulty breathing o Admin analgesics o Provide ice collar & offer ice chips or sips of water o Clear liquid diet after return of gag reflex and avoid use red-colored liquids, citrus juice, & milk-based foods initially • Teaching o Instruct to contact provider if difficulty breathing, lack of oral intake, increase pain, or infection present o Admin pain medication PRN o Encourage intake of fluid & advance diet as tolerated (i.e. No spicy foods, or hard, sharp foods) o Limit strenuous activity & physical play with no swimming for 2 weeks A child has been admitted to the emergency department with a closed head injury. Identify the lab and diagnostic tests that will be ordered. List at least five (5) interventions the nurse will provide to the client? What medications should the nurse anticipate the provider to prescribe and why? Lab/Diagnostic Tests • ABGs, & CBC with differential • Cervical spine XR, CT/MRI of head/neck, & ICP measurement Interventions 1) Maintain patent airway 2) Keep HOB elevated to 30 degrees 3) Avoid extreme flexion, extension, or rotation of head & maintain in midline neutral position 4) Keep body in alignment 5) Implement seizure precautions & provide calm, restful environment Medications • Corticosteroids: Used to decrease cerebral edema • Mannitol: Osmotic diuretic to treat cerebral edema • Antiepileptics: Used to prevent/treat seizures • Antibiotics: Use r/t CSF leakage, laceration, or penetration injuries • Analgesics: Used of HA/pain management A nurse is discharging a client home with the diagnosis of rheumatic fever. What education should be provided to the caregivers of a child who is being discharged following this diagnosis? Promote rest during the acute phase & encourage well-balanced meals. Also provide information and reassurance r/t the development of chorea and its self- limiting nature. A nurse is caring for a client who will be vaccinated. By what route should the Hepatitis B vaccine be given? Route that Hepatitis B vaccine is admin is intramuscular. A nurse is preparing to administer the MMR immunization to a client. What are two (2) contraindications for this vaccine? 1) Pregnancy 2) Allergy to gelatin & neomycin • Also Hx of thrombocytopenia or thrombocytopenic purpura; Immunosuppression; or Recent transfusion of blood products/immunoglobulin What does FLACC stand for? How old does a child need to be to use the FLACC Scale for pain? What is the form of evaluation when using the FLACC Scale? FLACC (Face, Legs, Activity, Cry, & Consolability). Used to evaluate child from 2 months to 7 y/o. Evaluates pain by assessing the child’s behavior. What are the common causes of iron deficiency anemia and which children are at risk? Common Causes: Usually results from inadequate dietary supply Risk Factors: • Premature birth • Excessive intake of cow’s milk in toddlers • Malabsorption disorder due to prolong diarrhea • Poor dietary intake of iron • Increased iron requirement due to blood loss • Chronic disorder (i.e. folate deficiency, sickle cell anemia, hemophilia) What antipyretic drugs can safely be administered to a child who is febrile? Aspirin can be safely administered during febrile stage Identify two (2) adverse effects of methylphenidate hydrochloride (Ritalin) in the school aged child. 1) Insomnia 2) Loss of appetite or anorexia When feeding a client who has Gastroesophageal Reflux (GER), in which position should the client be placed in and why? Position with head elevated at 30 degrees for 1hr after meals to prevent nausea from occurring. Identify nursing actions in the immediate post-operative period of a client who had a cleft palate repair. • Change position frequently to facilitate breathing & place on abdomen in immediate post-op period • Maintain IV fluids until infant able to eat & drink • Monitor packing for bleeding (usually removed in 2-3 days) • Avoid placing objects in infant’s mouth in post-op • Elbow restraints may be needed to used to prevent injuring repair Identify three (3) clinical manifestations of hydrocephalus in an infant. 1) High-pitched cry 2) Bulging fontanenls & widening cranial suture lines 3) Increased head circumference The nurse is education an adolescent about the use of Ventolin for asthma. What information should the nurse include in this teaching? • Monitor for tremors & tachycardia when taking medication • Administer prior to exercise or activity • Administer bronchodilator before anti-inflammatory medication, if prescribed What are manifestations of a urinary tract infection (UTI) in infants? • Increase in irritability • Screaming with urination • Poor feeding, vomiting, or failure to gain weight • Increase in thirst • Frequent & straining with urination • Foul-smelling urine • Fever • Diaper rash • Dehydration • Seizure • Pallor A nurse is caring for a client with meningitis. Identify four (4) priority interventions for the client who has meningitis. 1) Presence of petechial or purpuric-type rash requires immediate medical attention 2) Isolate as soon as meningitis is suspected & maintain droplet precautions 3) Initiate seizure precautions & decrease environmental stimuli 4) Maintain NPO status if decrease LOC present 1. Identify four (4) points to discuss with parents of a preschooler regarding nutrition to ensure a balanced and healthy diet. • Preschoolers consume approximately half the amount of energy that adults do (1,800 kcal). • Finicky eating can remain a behavior in preschoolers, but often by 5 years of age they become more willing to sample different foods. • Preschoolers need 13 to 19 g/day (0.45 to 0.67 oz/day) of protein in addition to adequate intake of calcium, iron, folate, and vitamins A and C. • Saturated fats should be less than 10% of preschoolers’ total caloric intake, and total fat over several days should be 20% to 30% of total caloric intake. 2. A nurse is caring for a client with glomerulonephritis. What interventions regarding nutritional intake and restrictions should be taken? • Monitor I&O • Monitor daily weights; weigh the child on the same scale with the same amount of clothing daily. • Encourage adequate nutritional intake o Possible restriction of sodium and fluid o Restrict foods high in potassium during periods of oliguria o Provide small, frequent meals of favorite foods due to a decrease in appetite o Avoid added salt and salty foods such as chips • Manage fluid restrictions as prescribed. o Fluids can be restricted during periods of edema and hypertension 3. A nurse is preparing to administer amoxicillin to a pediatric client. Ordered is 40 mg/kg/day to be given in divided doses every 12 hours. The client weighs 48 pounds. How many milligrams will be administered per dose? Round your answer to the nearest whole number. 436 mg Identify three (3) clinical manifestations of hydrocephalus in an infant. 4) High-pitched cry 5) Bulging fontanenls & widening cranial suture lines 6) Increased head circumference 4. A nurse is caring for a child with a closed head injury. What clinical manifestations would suggest deterioration in this client's condition? alterations in pupillary response, posturing (flexion and extension), bradycardia, decreased motor response, decreased response to painful stimuli, Cheyne­Stokes respirations, optic disc swelling, decreased consciousness, com 5. A nurse is caring for a client with meningitis. Identify four (4) priority interventions for the client who has meningitis. 5) Presence of petechial or purpuric-type rash requires immediate medical attention 6) Isolate as soon as meningitis is suspected & maintain droplet precautions 7) Initiate seizure precautions & decrease environmental stimuli 8) Maintain NPO status if decrease LOC present 6. The nurse is educating an adolescent about the use of albuterol for asthma. What information should the nurse include in this teaching? It is used for acute exacerbations, and Prevention of exercised­induced asthma 7. What is a Patent Ductus Arteriosus? Identify two (2) clinical manifestations of patent ductus arteriosus (PDA). • A heart murmur may be the only sign. Some othere signs are Fast breathing, working hard to breathe, or shortness of breath. Premature infants may need increased oxygen or help breathing from a ventilator. • Poor feeding and poor weight gain. • Tiring easily. • Sweating with exertion, such as while feeding. 8. Name two (2) manifestations of infective endocarditis in children. The signs of IE are like the signs of flu. This can make it hard to know if your child has IE. • a slight fever of 37.5°C to 38.5°C that you cannot explain and that lasts for 5 to 7 days • sweating • loss of appetite • pain in the muscles and joints, such as the knees, shoulders, or knuckles • loss of weight • a skin rash • headaches • a general feeling of weakness 9. A nurse is providing education to an adolescent client with diabetes and his parents regarding 'Sick Day Rules' while sick. What information should the nurse provide? • Monitor blood glucose and urinary ketone levels Every 3 hr. • Continue to take insulin or oral antidiabetic agents. However, dosages can differ. • Encourage sugar­free, noncaffeinated liquids to prevent dehydration. • Meet carbohydrate needs by eating soft foods if possible. If not, consume liquids that are equal to the usual carbohydrate content. • Rest. Call the provider for the following. • Blood glucose greater than 240 mg/dL • Positive ketones in the urine • Disorientation or confusion occurs • Rapid breathing is experienced • Vomiting occurs more than once Show Less