NURSING MISCPeds Final Study Guide.
Peds Final Study Guide:
Chapter 27
Esophageal atresia (pg. 729): keywords: hydramnios, vomiting at birth, aspiration risk, surgical fix
needed, cyanotic, choking.
Associated with (polyhydramnios) Hydraminos in utero. failure of the esophagus to connect to the
stomach, excessive mucous secretions and drooling, periodic cyanotic episodes and choking, abdominal
distention after birth, and immediate regurgitation after birth. After birth the infant will cough, become
cyanotic, and have obvious difficulty breathing as fluid is aspirated from collecting in the blind pouch at
the end of the esophagus. Failure of the esophagus to connect to the stomach, excessive mucous
secretions and drooling, periodic cyanotic episodes and choking, abdominal distention after birth, and
immediate regurgitation after birth. These are potentially serious disorders because, during a feeding,
milk can fill the blind pouch of the upper esophagus, then overflow into the trachea, or a fistula can
allow milk to enter the trachea from the esophagus, resulting in aspiration. The ultimate prognosis for
children with this disorder depends on the extent of the repair necessary, the condition of the child at the
time of surgery, and the presence or absence of other congenital anomalies. NOTE: Causes
hydraminos.
Increased Cranial Pressure: keywords: caused by hydrocephalus, craniosynostosis
Signs that a child is developing increased intracranial pressure are: increased temp, decreased pulse (HR)
and decreased Respiratory rate (RR) with widening pressure pulse or increased BP (systolic).
Related QSEN question:
The primary healthcare provider for Maia’s baby asks the nurse to observe him for signs that he is
developing increased intracranial pressure while he waits for surgery. What vital sign changes
should most prompt the nurse to report the findings to the primary care provider?
A. Decreased temperature and increased blood pressure
B. Increased respirations and decreased pulse rate
C. Increased temperature and decreased pulse rate
D. Decreased blood pressure and increased temperature
ANSWER: C. The nurse should report changes in vital signs. Changes in vital signs with increased
cranial pressure are easy to remember because they move in opposite directions: Temperature and
blood pressure increase, and pulse and respiratory rate decrease.
Meningomyelocele: keywords: neural tube defect, spina-bifida cystica, surgical intervention needed,
diminished motor function, associated with talipes (club foot), developmental dysplasia of hip and 90%
have hydrocephalus.
In a meningomyelocele, not just the meninges protrude through the vertebrae, but the spinal cord usually
ends at the point of protrusion. Motor and sensory function will be decreased or absent beyond this point.
The child will have partial or complete paralysis, partial or complete lack of sensation of the lower
extremities, as well as loss of bowel and bladder control.
Related ATI question:
,NURSING MISCPeds Final Study Guide.
A nurse is caring for an infant who has a myelomeningocele. Which of the following actions should the
nurse include in the preoperative plan of care?
A. Assist the mother with cuddling the infant - could cause rupture of the sac
B. Assess the infant's temperature rectally - could cause irritation or rectal prolapse
C. Place the infant in a supine position - could cause pressure on sac and possible rupture
D. Apply a sterile, moist dressing on the sac - CORRECT.
Hip Dysplasia: keywords: congenital birth defect, spica cast, Pavlik harness (up to 6 mos old)
All infants should be screened for DDH from birth and up until 3 months of age by performing the
Ortolani & Barlow maneuver. Ortolani (abduction) and Barlow (adduction). Trendelenburg sign in
preschoolers as they walk; downward displacement of hip.
Related ATI question:
A nurse is assessing a pre-school age child for developmental dysplasia of the hip. Which of the
following assessments should the nurse include?
A. Barlow Test - assesses developmental dysplasia of the hip for infants.
B. Trendelenburg sign - CORRECT. The preschooler bears weight on the affected leg while holding
onto something for balance. The examiner observes from behind for abnormal downward tilting of
the pelvis of the unaffected side.
C. Manipulation of foot and ankle - assessment for clubfoot
D. Ortolani test - assesses developmental dysplasia of the hip for infants.
Related QSEN question:
A nurse is caring for a toddler who is diagnosed with hip dysplasia and has been placed in a hip spica
cast. The child's mother asks the nurse why a Pavlik harness is not being used. Which of the following
response should the nurse make?
A. "The Pavlik harness is used for child with scoliosis, not hip dysplasia"
B. "The Pavlik harness is used for school-age children" - used for infants.
C. "The Pavlik harness cannot be used for your child because her condition is too severe"
D. "The Pavlik harness is used for infants less than 6 months of age" - CORRECT.
Pierre Robin-Syndrome: keywords: triad symptoms of small jaw, cleft palate, glossoptosis (large
downward placed tongue)
Monitor infants for possible airway obstruction (as a result of their small jaw, their tongue tends to drop
backward and obstruct their airway). Suctioning to remove secretions may be necessary. A side-lying
rather than a supine sleeping position is recommended for all newborns and infants (until they can roll
over) to avoid obstruction.
Related QSEN question:
Parents are taught to place their infants on their backs to sleep to prevent sudden infant death syndrome
(SIDS). Which disorder would require the infant to be placed on the side to sleep to avoid airway
obstruction?
A. Thyroglossal cyst
B. Pierre Robin syndrome
, NURSING MISCPeds Final Study Guide.
C. Preoperative cleft lip
D. Repaired cleft lip
ANSWER: B. Rationale: Infants with Pierre Robin syndrome may have complete airway obstruction if the
large tongue falls back over the airway; thus, side-lying positioning is recommended.
Omphalocele: keywords: warm sterile bowel bag, surgically fixed, umbilicus sac.
A protrusion (herniation) of abdominal contents through the abdominal wall at the point of the junction
of the umbilical cord and abdomen. The herniated organs involved are usually the intestines, but they
may include the stomach and liver. The organs are usually covered and contained by a thin transparent
layer of amnion and chorion with the umbilical cord protruding from the exposed sac. This condition
occurs because, at approximately weeks 6 to 8 of intrauterine life, the fetal abdominal contents, which
grow faster than the fetal abdomen, are pushed out from the abdomen into the base of the umbilical cord.
At 7 to 10 weeks, when the fetal abdomen has enlarged sufficiently, the intestine normally returns to the
abdomen.
Hydrocephalus: keywords: obstruction of CSF system, downward eyes appearance, large head, measure
circumference of head to find early, sunsetting eyes, ventriculoperitoneal shunt.
The treatment for hydrocephalus depends on its cause and extent. If it is caused by overproduction of
fluid, acetazolamide (Diamox), a diuretic, may be prescribed to promote the excretion of this excess fluid.
Destruction of a portion of the choroid plexus may be attempted by ventricular endoscopy; if a tumor in
that area is responsible for the overproduction of fluid, removal of the tumor should provide a solution.
Hydrocephalus is usually caused by obstruction, however, so the treatment for children that do not have
other neural tube involvement (such as a meningomyelocele) usually involves laser surgery to reopen the
route of flow or bypassing the point of obstruction by shunting the fluid to another point of absorption. As
more and more obstructions in the third or fourth ventricles are relieved by endoscopy, the next
generation of children with isolated hydrocephalus may not need artificial shunting.
A shunting procedure involves threading a thin polyethylene catheter under the skin from the ventricles
to the peritoneum (a ventriculoperitoneal shunt). Fluid drains by this route into the peritoneum, where it
is absorbed across the peritoneal membrane into the body circulation. The shunt usually has to be
replaced as the child grows or it will become too short. As another complication, it could become
enclosed in a fold of peritoneum and become obstructed or it could become infected.
Nutrition and parent–child bonding are two major concerns for the infant with hydrocephalus.
Cleft Lip: keywords: feeding issues, diagnosed in utero, lip formation problems, Parental bonding with
baby concerns.
Nothing hard or sharp must come in contact with a recent cleft suture line. Observe infants after palate
repair carefully, therefore, to be certain they do not put toys with sharp edges into their mouths. It’s also
good practice to not allow them to use a straw to drink or hold a toothbrush to clean their teeth so they
don’t brush the suture line accidentally. Keep elbow restraints in place as necessary so they do not put
their fingers in their mouth and poke or pull at the sutures. Sutures on the lip or palate feel extremely odd,
so most children not only run their tongue over their sutures but also don’t respond to advice not to do
this. Because this often occurs when children have nothing to think about, help the parents provide
diversional activities such as reading or singing to keep the child’s attention off the suture line.
If parents will be continuing to give an analgesic such as acetaminophen (Tylenol) or ibuprofen (Advil)
after they return home, be certain they are aware of the correct dosage and time schedule for
administration of the liquid forms. They must also continue to keep the suture line protected until healing
is complete.
Peds Final Study Guide:
Chapter 27
Esophageal atresia (pg. 729): keywords: hydramnios, vomiting at birth, aspiration risk, surgical fix
needed, cyanotic, choking.
Associated with (polyhydramnios) Hydraminos in utero. failure of the esophagus to connect to the
stomach, excessive mucous secretions and drooling, periodic cyanotic episodes and choking, abdominal
distention after birth, and immediate regurgitation after birth. After birth the infant will cough, become
cyanotic, and have obvious difficulty breathing as fluid is aspirated from collecting in the blind pouch at
the end of the esophagus. Failure of the esophagus to connect to the stomach, excessive mucous
secretions and drooling, periodic cyanotic episodes and choking, abdominal distention after birth, and
immediate regurgitation after birth. These are potentially serious disorders because, during a feeding,
milk can fill the blind pouch of the upper esophagus, then overflow into the trachea, or a fistula can
allow milk to enter the trachea from the esophagus, resulting in aspiration. The ultimate prognosis for
children with this disorder depends on the extent of the repair necessary, the condition of the child at the
time of surgery, and the presence or absence of other congenital anomalies. NOTE: Causes
hydraminos.
Increased Cranial Pressure: keywords: caused by hydrocephalus, craniosynostosis
Signs that a child is developing increased intracranial pressure are: increased temp, decreased pulse (HR)
and decreased Respiratory rate (RR) with widening pressure pulse or increased BP (systolic).
Related QSEN question:
The primary healthcare provider for Maia’s baby asks the nurse to observe him for signs that he is
developing increased intracranial pressure while he waits for surgery. What vital sign changes
should most prompt the nurse to report the findings to the primary care provider?
A. Decreased temperature and increased blood pressure
B. Increased respirations and decreased pulse rate
C. Increased temperature and decreased pulse rate
D. Decreased blood pressure and increased temperature
ANSWER: C. The nurse should report changes in vital signs. Changes in vital signs with increased
cranial pressure are easy to remember because they move in opposite directions: Temperature and
blood pressure increase, and pulse and respiratory rate decrease.
Meningomyelocele: keywords: neural tube defect, spina-bifida cystica, surgical intervention needed,
diminished motor function, associated with talipes (club foot), developmental dysplasia of hip and 90%
have hydrocephalus.
In a meningomyelocele, not just the meninges protrude through the vertebrae, but the spinal cord usually
ends at the point of protrusion. Motor and sensory function will be decreased or absent beyond this point.
The child will have partial or complete paralysis, partial or complete lack of sensation of the lower
extremities, as well as loss of bowel and bladder control.
Related ATI question:
,NURSING MISCPeds Final Study Guide.
A nurse is caring for an infant who has a myelomeningocele. Which of the following actions should the
nurse include in the preoperative plan of care?
A. Assist the mother with cuddling the infant - could cause rupture of the sac
B. Assess the infant's temperature rectally - could cause irritation or rectal prolapse
C. Place the infant in a supine position - could cause pressure on sac and possible rupture
D. Apply a sterile, moist dressing on the sac - CORRECT.
Hip Dysplasia: keywords: congenital birth defect, spica cast, Pavlik harness (up to 6 mos old)
All infants should be screened for DDH from birth and up until 3 months of age by performing the
Ortolani & Barlow maneuver. Ortolani (abduction) and Barlow (adduction). Trendelenburg sign in
preschoolers as they walk; downward displacement of hip.
Related ATI question:
A nurse is assessing a pre-school age child for developmental dysplasia of the hip. Which of the
following assessments should the nurse include?
A. Barlow Test - assesses developmental dysplasia of the hip for infants.
B. Trendelenburg sign - CORRECT. The preschooler bears weight on the affected leg while holding
onto something for balance. The examiner observes from behind for abnormal downward tilting of
the pelvis of the unaffected side.
C. Manipulation of foot and ankle - assessment for clubfoot
D. Ortolani test - assesses developmental dysplasia of the hip for infants.
Related QSEN question:
A nurse is caring for a toddler who is diagnosed with hip dysplasia and has been placed in a hip spica
cast. The child's mother asks the nurse why a Pavlik harness is not being used. Which of the following
response should the nurse make?
A. "The Pavlik harness is used for child with scoliosis, not hip dysplasia"
B. "The Pavlik harness is used for school-age children" - used for infants.
C. "The Pavlik harness cannot be used for your child because her condition is too severe"
D. "The Pavlik harness is used for infants less than 6 months of age" - CORRECT.
Pierre Robin-Syndrome: keywords: triad symptoms of small jaw, cleft palate, glossoptosis (large
downward placed tongue)
Monitor infants for possible airway obstruction (as a result of their small jaw, their tongue tends to drop
backward and obstruct their airway). Suctioning to remove secretions may be necessary. A side-lying
rather than a supine sleeping position is recommended for all newborns and infants (until they can roll
over) to avoid obstruction.
Related QSEN question:
Parents are taught to place their infants on their backs to sleep to prevent sudden infant death syndrome
(SIDS). Which disorder would require the infant to be placed on the side to sleep to avoid airway
obstruction?
A. Thyroglossal cyst
B. Pierre Robin syndrome
, NURSING MISCPeds Final Study Guide.
C. Preoperative cleft lip
D. Repaired cleft lip
ANSWER: B. Rationale: Infants with Pierre Robin syndrome may have complete airway obstruction if the
large tongue falls back over the airway; thus, side-lying positioning is recommended.
Omphalocele: keywords: warm sterile bowel bag, surgically fixed, umbilicus sac.
A protrusion (herniation) of abdominal contents through the abdominal wall at the point of the junction
of the umbilical cord and abdomen. The herniated organs involved are usually the intestines, but they
may include the stomach and liver. The organs are usually covered and contained by a thin transparent
layer of amnion and chorion with the umbilical cord protruding from the exposed sac. This condition
occurs because, at approximately weeks 6 to 8 of intrauterine life, the fetal abdominal contents, which
grow faster than the fetal abdomen, are pushed out from the abdomen into the base of the umbilical cord.
At 7 to 10 weeks, when the fetal abdomen has enlarged sufficiently, the intestine normally returns to the
abdomen.
Hydrocephalus: keywords: obstruction of CSF system, downward eyes appearance, large head, measure
circumference of head to find early, sunsetting eyes, ventriculoperitoneal shunt.
The treatment for hydrocephalus depends on its cause and extent. If it is caused by overproduction of
fluid, acetazolamide (Diamox), a diuretic, may be prescribed to promote the excretion of this excess fluid.
Destruction of a portion of the choroid plexus may be attempted by ventricular endoscopy; if a tumor in
that area is responsible for the overproduction of fluid, removal of the tumor should provide a solution.
Hydrocephalus is usually caused by obstruction, however, so the treatment for children that do not have
other neural tube involvement (such as a meningomyelocele) usually involves laser surgery to reopen the
route of flow or bypassing the point of obstruction by shunting the fluid to another point of absorption. As
more and more obstructions in the third or fourth ventricles are relieved by endoscopy, the next
generation of children with isolated hydrocephalus may not need artificial shunting.
A shunting procedure involves threading a thin polyethylene catheter under the skin from the ventricles
to the peritoneum (a ventriculoperitoneal shunt). Fluid drains by this route into the peritoneum, where it
is absorbed across the peritoneal membrane into the body circulation. The shunt usually has to be
replaced as the child grows or it will become too short. As another complication, it could become
enclosed in a fold of peritoneum and become obstructed or it could become infected.
Nutrition and parent–child bonding are two major concerns for the infant with hydrocephalus.
Cleft Lip: keywords: feeding issues, diagnosed in utero, lip formation problems, Parental bonding with
baby concerns.
Nothing hard or sharp must come in contact with a recent cleft suture line. Observe infants after palate
repair carefully, therefore, to be certain they do not put toys with sharp edges into their mouths. It’s also
good practice to not allow them to use a straw to drink or hold a toothbrush to clean their teeth so they
don’t brush the suture line accidentally. Keep elbow restraints in place as necessary so they do not put
their fingers in their mouth and poke or pull at the sutures. Sutures on the lip or palate feel extremely odd,
so most children not only run their tongue over their sutures but also don’t respond to advice not to do
this. Because this often occurs when children have nothing to think about, help the parents provide
diversional activities such as reading or singing to keep the child’s attention off the suture line.
If parents will be continuing to give an analgesic such as acetaminophen (Tylenol) or ibuprofen (Advil)
after they return home, be certain they are aware of the correct dosage and time schedule for
administration of the liquid forms. They must also continue to keep the suture line protected until healing
is complete.
