CMS Exam Review
Sickle cell anemia
- Autosomal recessive - genetic testing
- How can we find sickle cell anemia → how is it tested
- Newborn metabolic screening
- Genetic counseling
- Risk factors: AA, mediterranean, darker hispanics from south america
- Primary symptoms of sickle cell disease
- Pain
- RBC change into a crescent shape → become vaso occlusive in the capillary
- Biggest concerns in terms of problems d/t occlusive
- Tissue hypoxemia
- Dehydration → increases sickling
- Stroke → up to 10% of kids can have one
- Apply warm compress to the affected areas & initiate bed rest
- Drink 8 glasses of fluid daily
- Wear surgical mask to school
- Immunizations: pneumococcal conjugate (PCV13)
Care for a child who has pertussis / whooping cough
- Droplet precaution / protected environment
- Report diagnosis to the public health department
- Prevention: immunizations (DTAP)
- Need to hospitalize them
- Cyanotic lips
- Feeding through ng tube → aspiration risk
- Make sure they have airway management
- High pitch inhalation sound
- Treatment: antibiotic, suctioning and O2 therapy, high fowler's position
- Why do they not have oxygen on?
- They cant breathe it in anyway to the lungs
- May use c-pap: May need to intubate if too occluded / cpap doesn't work
How do we plan for care with autism
- Might not want to be touched
- Don't want to be overstimulated
- Repetitive things → things that spin, things that light up
- Keep staff visits with the child brief
Indications of child abuse
- Gravitate towards strangers
, - Spiral fractures → different stages of healing
- Psycho Emotionally: won't let the child speak for themselves
- Child is very trusting of others, Acting it out on others
- Mother is hesitant to comfort her 6 month old infant
- Bruising around the wrists
- Denies discomfort during assessment of injuries
- Symmetric burns of the lower extremities
What is the appropriate developmental response to death
- 4 year old - thought he could still talk to his dad
- Does Not fully understand concept of death
- 8 year old was angry with father for leaving -- didn't want to talk to them
- More concrete understanding of death
- 15 year old would completely understand
- Child feels responsible for the siblings death
Lasix / Furosemide
- Priority: sunken fontanels
Contraindications to MMR vaccine
- Allergy to neomycin
Difference lidocaine and lidocaine prilocaine cream
- EMLA cream
- Lidocaine is used for cardiac dysrh
- Apply cream 1 hour before IV catheter procedure
Vital signs
- HR: 98 - 140
- RR: 22 - 37
- BP: 18 - - 63
- Abnormal: 118/74
How position child for lumbar puncture
- Apply EMLA cream 1 hr before the lumbar puncture
- Empty bladder
- After procedure pt must lay flat in order to monitor for any CSF leaks
- On their side with the head flexed forward and knees flexed to the abdomen, back arched
- Lateral
Cardiac catheterization
- Before Procedure: pt needs to be NPO 6-8 hrs prior, assess for allergies to iodine or
shellfish….can be allergic to the contrast dye used in the procedure, assess kidney function
(Creatine and BUN levels)
- After Procedure: inspect insertion site for bleeding, the distal pulse, cap.refill and temp.
Increase pt fluid intake to help flush out the contrast dye, position pt in supine position
- Keep legs straight for 8 hours following procedure
Pavlik harness
- Type of brace used in babies that have developmental dysplasia of the hip, helps keep the
Sickle cell anemia
- Autosomal recessive - genetic testing
- How can we find sickle cell anemia → how is it tested
- Newborn metabolic screening
- Genetic counseling
- Risk factors: AA, mediterranean, darker hispanics from south america
- Primary symptoms of sickle cell disease
- Pain
- RBC change into a crescent shape → become vaso occlusive in the capillary
- Biggest concerns in terms of problems d/t occlusive
- Tissue hypoxemia
- Dehydration → increases sickling
- Stroke → up to 10% of kids can have one
- Apply warm compress to the affected areas & initiate bed rest
- Drink 8 glasses of fluid daily
- Wear surgical mask to school
- Immunizations: pneumococcal conjugate (PCV13)
Care for a child who has pertussis / whooping cough
- Droplet precaution / protected environment
- Report diagnosis to the public health department
- Prevention: immunizations (DTAP)
- Need to hospitalize them
- Cyanotic lips
- Feeding through ng tube → aspiration risk
- Make sure they have airway management
- High pitch inhalation sound
- Treatment: antibiotic, suctioning and O2 therapy, high fowler's position
- Why do they not have oxygen on?
- They cant breathe it in anyway to the lungs
- May use c-pap: May need to intubate if too occluded / cpap doesn't work
How do we plan for care with autism
- Might not want to be touched
- Don't want to be overstimulated
- Repetitive things → things that spin, things that light up
- Keep staff visits with the child brief
Indications of child abuse
- Gravitate towards strangers
, - Spiral fractures → different stages of healing
- Psycho Emotionally: won't let the child speak for themselves
- Child is very trusting of others, Acting it out on others
- Mother is hesitant to comfort her 6 month old infant
- Bruising around the wrists
- Denies discomfort during assessment of injuries
- Symmetric burns of the lower extremities
What is the appropriate developmental response to death
- 4 year old - thought he could still talk to his dad
- Does Not fully understand concept of death
- 8 year old was angry with father for leaving -- didn't want to talk to them
- More concrete understanding of death
- 15 year old would completely understand
- Child feels responsible for the siblings death
Lasix / Furosemide
- Priority: sunken fontanels
Contraindications to MMR vaccine
- Allergy to neomycin
Difference lidocaine and lidocaine prilocaine cream
- EMLA cream
- Lidocaine is used for cardiac dysrh
- Apply cream 1 hour before IV catheter procedure
Vital signs
- HR: 98 - 140
- RR: 22 - 37
- BP: 18 - - 63
- Abnormal: 118/74
How position child for lumbar puncture
- Apply EMLA cream 1 hr before the lumbar puncture
- Empty bladder
- After procedure pt must lay flat in order to monitor for any CSF leaks
- On their side with the head flexed forward and knees flexed to the abdomen, back arched
- Lateral
Cardiac catheterization
- Before Procedure: pt needs to be NPO 6-8 hrs prior, assess for allergies to iodine or
shellfish….can be allergic to the contrast dye used in the procedure, assess kidney function
(Creatine and BUN levels)
- After Procedure: inspect insertion site for bleeding, the distal pulse, cap.refill and temp.
Increase pt fluid intake to help flush out the contrast dye, position pt in supine position
- Keep legs straight for 8 hours following procedure
Pavlik harness
- Type of brace used in babies that have developmental dysplasia of the hip, helps keep the
