Pediatric Remediation

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Remediation for ATI assessment in pediatrics

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Pediatric Remediation
A nurse is assessing pain in a toddler. What are findings in this age group that indicate
pain?
Loud cry or screaming
Verbal expressions of pain
Thrashing of extremities
Attempt to push away or avoid stimulus
Noncooperation
Clinging to significant person
Behaviors occur in anticipation of painful stimulus
What are the daily protein needs of the average preschooler?
Preschoolers need 13 to 19 g/day of protein
A nurse is providing discharge education to the parents of a child with cerebral palsy.
What information regarding skin care should the nurse provide?
A child with CP has a need for skin care. A nurse should teach parents to assess the child
with CP on the integrity of the skin especially under splints and braces, if applicable.
How to turn child with CP to keep pressure off of boney prominences. Also, how to keep
skin clean and dry.
A nurse is providing discharge education to the parents of a child prescribed phenytoin
(Dilantin) for a seizure disorder. What information regarding adverse effects should the
nurse provide?
Dilantin comes with several adverse effects that the parents should be aware of. The
following are adverse effects that the parents of a child taking Dilantin should note:
CN effects( nystagmus, sedation, ataxia, double vision,cognttive impairment) ; Gingival
hyperplasia; Skin rash; Cardiovascular effects(dysrhythmias, hypotension); Endocrine
and other effects( coarsening of facial features, hirsutism, and interference with vitamin
D metabolism); and Interference with vitamin K dependent clotting factors causing
bleeding I newborns.
A nurse is caring for a client following a pylorotomy for the treatment of pyloric
stenosis. What post-operative care will be required?
Post-op care for patient who has had pylorotomy will include the following:
Obtain routine postoperative vital signs.
Administer antiemetic for vomiting.
Provide IV fluids.
Monitor daily weights and I&O.
Administer analgesics for pain.

Assess for signs of infection.
Start clear liquids 4 to 6 hr after surgery. Advance to breast milk or formula as tolerated.
Document tolerance to feedings.
A nurse is preparing to administer ear drops to a 2 year old child. How should the client
be positioned and how should the nurse position the ear?
Use medical aseptic technique when
administering medication.
Have client sit upright or maintain side‐lying position.
Straighten ear canal by pulling auricle upward and outward for adults, or down and
back
for children. Hold dropper 1 cm above ear canal, instill medication, and then gently
apply pressure with finger to tragus of the ear.
A nurse is caring for a 12-year-old anorexia nervosa. What are common laboratory and
diagnostic testing results commonly associated with anorexia nervosa?
Laboratory and diagnostic tests
Common laboratory abnormalities associated with anorexia include:
Hypokalemia, especially for those who have bulimia nervosa
There is a direct loss of potassium due to purging (vomiting).
Dehydration stimulates increased aldosterone production, which leads to sodium and
water retention and potassium excretion.
Anemia and leukopenia with lymphocytosis
Possible impaired liver function, evidenced by increased enzyme levels
Possible elevated cholesterol
Abnormal thyroid function tests
Elevated carotene levels, which cause skin to appear yellow
Decreased bone density (possible osteoporosis)
Abnormal blood glucose level
ECG changes
Electrolyte imbalances associated with bulimia nervosa are common and may depend on
the client’s method of purging (laxatives, diuretics, vomiting). Laboratory abnormalities
include:
Hypokalemia
Hyponatremia
Hypochloremia
Discuss care of the client following a cleft lip and palate repair.
Postoperative:
Cleft lip and cleft palate repair

Perform standard postoperative care, including assessment of vital signs and pain
management using an age-appropriate tool.
Keep the infant pain-free to decrease crying and stress on repair. Z Administer
analgesics as prescribed.
Assess the operative sites for signs of crusting and infection.
Avoid sucking on nipple or pacifier.
Avoid hard toys that the infant may bring to their mouth to protect the incision site.
Monitor I&O and weigh daily.
Observe the family’s interaction with the infant.
Assess family coping and support.
Cleft lip repair:
Monitor the integrity of the postoperative protective device to ensure proper
positioning.
Position the infant upright (infant car seat position), on her back, or on her side in the
immediate postoperative period to maintain the integrity of the repair.
Apply elbow restraints to keep the infant from injuring the repair site.
Restraints should be removed periodically to assess skin, allow limb movement, and
provide for comfort.
Use saline on a sterile swab to clean the incision site. Apply antibiotic ointment if
prescribed.
Gently aspirate secretions of mouth and nasopharynx to prevent respiratory
complications.
Cleft palate repair:
Change the infant’s position frequently to facilitate breathing. The infant may be placed
on the abdomen in the immediate postoperative period.
Maintain intravenous fluids until the infant is able to eat and drink.
Monitor packing, which is usually removed in 2 to 3 days.
Avoid placing objects (tongue depressor, pacifier) in the infant’s mouth after cleft
palate repair.
Elbow restraints may needed to be used to prevent the infant from injuring the repair
A nurse has obtained a blood sample from a child with hemophilia. What action should
the nurse take to prevent bleeding?
Management of bleeding in the hospital
Avoid taking temperature rectally.
Avoid unnecessary skin punctures and use surgical aseptic technique.
Apply pressure for 5 min after injections, venipuncture, or needle sticks.
Monitor urine, stool, and nasogastric fluid for occult blood.
Control localized bleeding.
Administer factor replacement.

Observe for adverse effects, which include headache, flushing, low sodium, and
alterations
in heart rate and blood pressure.
Encourage the child to rest and immobilize the affected joints.
Elevate and apply ice to the affected joints.
Explain the kinds of medications that might be prescribed to a child diagnosed with
nephrotic syndrome.
Medications

Corticosteroid – prednisone (Deltasone)
Nursing Considerations
2 mg/kg/day for 6 weeks followed by 1.5 mg/kg every other day for 6 weeks.
Monitor for adverse effects such as hirsutism, slowed linear growth, hypertension,
GI bleeding, infection, and hyperglycemia.
Administer with meals.
Client Education
Educate the client and family to avoid large crowds (to decrease the risk of infection).
Inform the client and family that using corticosteroids can increase appetite, cause
weight
gain (especially in the face), and cause mood swings.
Educate the client and the family on the medication regime.
Educate the client and the family on adverse effects and when to notify the provider.

Diuretic – furosemide (Lasix)
Eliminates excess fluid from the body
Nursing Considerations
Encourage the child to eat foods that are high in potassium.
Monitor serum electrolyte levels periodically.

25% albumin
Increases plasma volume and decreases edema
Nursing Considerations
Administer per protocol.
Monitor I&O.
Monitor for anaphylaxis.

Cyclophosphamide (Cytoxan)
Administer for children who cannot tolerate prednisone or who have repeated relapses
of MCNS.
A nurse is caring for an infant who is in need of a hyperlipidemia panel prior to surgery.
What preparation is required to have this panel drawn?
General daetary guidelines for a lipid profile for children, infants included, are a general
fast of at least 12 hours duration.

A nurse is caring for a 5-year-old child with a severe head injury. What signs of increased
intracranial pressure should the nurse anticipate?
Increased intracranial pressure (ICP)
Infants: bulging fontanel, separation of cranial sutures, irritability, increased sleeping,
high-pitched cry, poor feeding, setting-sun sign
Children: nausea, headache, vomiting, blurred vision, increased sleeping, inability to
follow simple commands, seizures
Late Signs: alterations in pupillary response, posturing (decorticate and decerebrate),
bradycardia, decreased motor response, decreased sensory response, Cheyne-Stokes
respirations, coma
Decorticate (dysfunction of the cerebral cortex) – Demonstrates the arms, wrists, and
fingers flexed and bent inward onto the chest and the legs extended and adducted.
Decerebrate (dysfunction at the midbrain) – Demonstrates a backward arching of the
head and arms with legs rigidly extended and toes pointing downward.

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