NURSING 2244C CH 19 PEDIATRIC PROBLEMS

NURSING 2244C CH 19 PEDIATRIC PROBLEMS 1. A 3-month-old infant arrives at the health center for a scheduled well-child visit. The parents ask the nurse why the infant extends the arms and legs in response to a loud sound. Which response by the nurse is best? 1 Inform the parents that this is a normal reflex that generally . disappears by 4 to 6 months of age. 2 Tell the parents that if the behavior does not change by 6 . months, the infant will need further evaluation. 3 Remind the parents that this is a normal response that . indicates the infant's hearing is intact. 4 Reassure the parents that the behavior is normal and not an . indicator of any problem such as cerebral palsy. Rationale: The infant's behavior is consistent with the Moro and startle reflexes. The Moro reflex usually disappears by 6 months of age. The startle reflex usually disappears by 4 months of age. A hearing test is not based on response to loud sounds alone. Although it is true that further evaluation may be needed if the reflexes do not disappear, there is no need for the nurse to discuss this with the parents at this time. The infant's behavior is not consistent with cerebral palsy. 2. Which pediatric pain patient should be assigned to a newly graduated RN? 1 An adolescent who has sickle cell disease and was recently . weaned from morphine delivered via a patient-controlled analgesia device to an oral analgesic; he has been continually asking for an increased dose 2 A child who needs premedication before reduction of a . fracture; the child has been crying and is resistant to any touch to the arm or other procedures 3 A child who is receiving palliative end-of-life care; the . child is receiving opioids around the clock to relieve suffering, but there is a progressive decrease in alertness and responsiveness 4 A child who has chronic pain and whose medication and . nonpharmacologic regimen has recently been changed; the mother is anxious to see if the new regimen is successful Rationale: The set of circumstances is least complicated for the child with the fracture, and this would be the best patient for a new and relatively inexperienced nurse. The child is likely to have a good response to pain medication, and with gentle encouragement and pain management, the anxiety will resolve. The other three children have more complex social and psychological issues related to pain management. 3. The nurse caring for a 3-year-old child plans to assess the child's pain using the Wong- Baker FACES® Pain Rating Scale. Which accompanying assessment question would be the most useful? 1 "If number 0 (smiling face) were no pain and number 10 . (crying face) were a big pain, what number would your pain