NURS 2050 Exam 2 (Pedi) Questions With Complete Solutions

NURS 2050 Exam 2 (Pedi) Questions With Complete
Solutions

Assessment of the Pediatric Nervous System
• Children younger than 2 years require special evaluation
because they are unable to respond to directions designed to
elicit specific neurologic responses

• Most information about infants and small children is gained
through observation of spontaneous and elicited reflex responses

• Red flags include delay or deviation from expected milestones
and persistence or reappearance of reflexes that normally
disappear

A & P Differences between the Child and Adult
• Normal infant HC = 34-35cm, by 1 year = 47cm

• At birth, brain wt. is 2/3 of an adult. By age 6, the brain weighs
approximately 90% of adult brain

• In the 1st yr., the neurons become completely myelinated &
primitive motor reflexes are replaced by purposeful movement

• The infant has open fontanels; posterior closes by 3 months;
the anterior fontanel should close between 12-18 months

• Infants have a proportionately large heavy head compared to
adults

anemias in children

,•Decreased production of RBC’s
– Iron deficiency anemia---already discussed in G & D
– Aplastic anemia
•Increased Destruction of RBC’s (hemolysis)
– Sickle Cell Anemia
– Thalassemia
• Blood loss
– Hemophilia

Acquired Heart Diseases
Infective Endocarditis

Rheumatic Fever

Kawasaki Disease

• Coarctation of the Aorta
CYANOTIC DEFECT

congenital cardiac condition characterized by a narrowing of the
aorta

"crimp in a hose"

•Narrowing of a major vessel interfering with the ability of the
blood to flow freely through the vessel.

•Resulting in blood flow to the lungs is affected -> increased
pressure backing up toward the heart -> increased workload on
heart.

,-risk for aneurysm formation
Assessment: Questions to ask r/t CHD
• Ask about mother’s health history (Dilantin, ETOH, DM,
Lupus, Exposure to infections)
• Family history
• Ask about symptoms that may indicate cardiac issue
 Tires easily? Less active?
 Sweaty?
---Infants becoming sweaty with feeding
 Urine output? Less wetness of diapers?
 Breathing differently?
 Any complaints of pain?
 Legs, chest


Kidneys
Remove liquid waste from the blood in the form of urine

Keep a stable balance of salts and other substances in the blood.
Helps maintain blood pressure

Produce erythropoietinhormone that aids the formation of RBCs
Disorders of the Kidneys
-Subject to many of the same types of disorders that affect other
body structures
-developmental defects
-Infections
-Altered immune responses
-Neoplasms
Renal System Assessment

, -Physical examination
---inspection of genitalia
---palpation (CVA tenderness)
*** tap the back with the hand cupped over location of the
kidney
***would cause great discomfort in a kidney infection
-History taking
---previous UTI, calculi, retention
---medications
---patterns of elimination (how often? color? odor?)
-Observation of symptoms
-Laboratory, radiologic, or other evaluation methods
Normal Characteristics of Urine
Kidney reaches near-adult function at 6-12 months
Bladder capacity in ounces: AGE + 2
Make sure child urinates at least Q 4 hrs during your shift!!!
pH 5 to 9 & Clear SG 1.001 to 1.035
***specific gravity is very important
NONE OF THE FOLLOWING in the urine :
 Glucose  RBCs  Ketones Casts  HGB  Nitrites
WBCs
***urinalysis
Minimum Urine Output
Infants: 1-2 ml/kg/hour
***much less able to concentrate urine therefore more output
Children 1-12 years: 1 ml/kg/hour
Adolescents > 12 years: 0.5 ml/kg/hour
Diagnostic Studies
Dipstick
***can be done at bedside
***requires maintenance and observation