ATI NURSING CARE OT THE CHILD RETAKE 2021 STUDY GUIDE

1. Hematological Disorders: Determining Priority Client A. Acute vs. chronic, urgent vs. nonurgent, stable vs. unstable -A client who has an acute problem takes priority over a client who has a chronic problem. -A client who has an urgent need takes priority over a client who has a nonurgent need. -A client who has unstable findings take priority over a client who has stable findings. B. Sickle Cell Anemia- Vaso-occlusive crisis (painful episode) -Acute (related to dehydration and decreased oxygen) -Severe pain, usually in bones, joints, and abdomen -Swollen joints, hands, and feet -Abdominal pain -Hematuria -Obstructive jaundice -Visual disturbances -Chronic -Increase risk of respiratory infections and osteomyelitis -Retinal detachment and blindness -Systolic murmurs -Renal failure and enuresis -Liver cirrhosis; hepatomegaly -Seizures -Skeletal deformities; shoulder or hip avascular necrosis 2. Pediatric Emergencies: Planning Interventions for Lead Exposure -Nursing Actions -Provide prevention measures to families -Routine screening for lead levels at 1, 2, and 3 years of age -Provide case management for children who have elevated lead levels -Make appropriate referrals (community nurse, teacher, early intervention) 3. Acute Neurological Disorders: Findings that Indicate Bacterial Meningitis -CSF analysis indicative of meningitis -Bacterial -Cloudy color -Elevated WBC count -Elevated protein content -Decreased glucose content -Positive Gram stain -Viral -Clear color -Slightly elevated WBC count -Normal or slightly elevated protein content -Normal glucose content -Negative Gram stain 4. Cardiovascular Disorders: Planning Care for a Child Who Has Heart Failure Nursing Care: -Remain calm when providing care -Keep the child well-hydrated -Conserve the child’s energy by providing frequent rest periods; clustering care; providing small, frequent meals; bathing PRN; and keeping crying to a minimum in cyanotic children -Perform daily weight and I&O to monitor fluid and nutritional status -Monitor heart rate, blood pressure, blood electrolytes, and kidney function to assess for complications -Provide support and resources for parents to promote developmental growth in the child -Monitor family coping and provide support -Administer prescribed medications -Maintain fluid and electrolyte balance -Decrease workload of the heart -Provide adequate nutrition -Increase tissue oxygenation 5. Asthma: Evaluating Understanding of Asthma Attack Prevention -Triggers to Asthma: -Allergens -Indoor: mold, cockroach antigen, dust, dust mites -Outdoor: grasses, pollen, trees, shrubs, molds, spores, air pollution, weeds -Irritants: Tobacco smoke, wood smoke, odors, sprays -Exercise -Cold air or changes in weather or temperature -Environmental change (new home or school) -Infections/viruses (colds) -Animal hair or dander -Medications: Aspirin, NSAIDs, antibiotics, beta blockers -Strong emotions: fear, anger, laughing, crying -Conditions: Gastroesophageal reflux, tracheoesophageal fistula -Food allergies or additives (sulfites) -Endocrine factors: menses, pregnancy, thyroid disease 6. Cardiovascular Disorders: Expected Findings for an Infant who has a Ventricular Septal Defect -Ventricular septal defect (VSD): a hole in the septum between right and left ventricle that results in increased pulmonary blood flow (left-to-right shunt) -Loud, harsh murmur auscultated at the left sternal border -Heart failure -Many VSDs close spontaneously early in life 7. Health Promotion of School-Age Children (6-12 Years): Teaching About Bicycle Safety 8. Burns: Teaching About Sunburn Prevention Injury Prevention: A. Bodily harm: -Keep firearms in locked cabinets or boxes -Identify safe play areas -Teach stranger safety to children -Teach children to wear helmets and/or pads when roller skating, skateboarding, bicycling, riding scooters, skiing, and snowboarding B. Burns -Teach fire safety and potential burn hazards -Keep working smoke detectors in the home -Children should use sunscreen when outside -Teach safety precautions for children to take while cooking C. Drowning -Children should be supervised when swimming or when near a body of water -Children should be taught to swim -Check depth of water before allowing children to dive -Encourage breaks to prevent children from becoming over-tired D. Motor-vehicle injuries -Children should use an approved car restraint system until they achieve the height of 4 feet, 9 inches -Teach children appropriate seat belt use when no longer using a car restraint system or booster seat -Safest area for children is the backseat of the car -Never let children ride in the bed of a pickup truck -Reinforce safe pedestrian behaviors E. Poisoning/substance misuse -Cleaners and chemicals should be kept in locked cabinets or out of reach of younger children -Children should be taught to say “no” to substance misuse 9. Infection Control: Priority Consideration When Making Room Assignment A. Safety/Risk Reduction -Look first for a safety risk. For example, is there a finding that suggests a risk for airway obstruction, hypoxia, bleeding, infection, or injury? -Next ask, “What’s the risk to the client?” and “How significant is the risk compared to other posed risks?” -Give priority to responding to whatever finding poses the greatest (or most imminent) risk to the client’s well-being. B. Clients suspected of having or known to have a communicable disease should be placed in the appropriate form of isolation 10. Acute Neurological Disorders: Teaching About Droplet Precautions for Bacterial Meningitis -Maintain respiratory isolation for a minimum of 24 hours after initiation of antibiotic therapy 11. Cardiovascular Disorders: Clarifying a Prescription A. Question the provider if the prescription is unclear or seems inappropriate for the client’s condition. Refuse to administer medication if it seems unsafe, and notify the charge nurse or supervisor B. Hyperkalemia- result of an increased intake of potassium, movement of potassium out of the cells, or inadequate kidney excretion resulting in a blood potassium level greater than 5.0 -Expected ECG findings: premature ventricular contractions, ventricular fibrillation, peaked T waves, widened QRS .............................................................................CONTINUED