Download Final Exam Review

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Final Exam Review
Patty Severt, MSN, RN
ADHD
Lead
GU
Cancer
Heme
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ADHD
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ADHD
What
areas of the child’s life are
affected by ADHD?
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Every aspect of the child’s life:
social, home, and school
School is the most problematic
area.

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What other issues do children with
ADHD experience?
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Low

self-esteem
Lack of friends
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How is it treated?
What
side effects of the
medications are the most
troubling?
What
are some ways to
counteract those?
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Environmental changes, Behavioral
therapy, medications, elimination
diet
 Most troubling side-effects of meds:
Nervousness
Decreased
appetite
Sleeplessness
Counteract
side-effects:

Give early in day to decrease insomnia

Give at meal times to decrease anorexia
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What causes ADHD?
Is
it a legit physical impairment
or is it a behavioral/parenting
issue?
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Deficit of catecholamines

dopamine & norepinephrine
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Lead Poisoning
 What
is the body system that
receives the most impact from lead
poisoning?
Are
these effects reversible?
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Neurologic
 They
are not reversible!
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Where is lead stored in the body?
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Bones!
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Why is lead poisoning dangerous
for children?
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children
more at risk d/t
increased absorption and
retainment in proportion to body
wt
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What are the risk factors for lead
poisoning?
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Living in poverty
House before 1978
African-American
Diet-iron, zinc, calcium, Vitamin C, fat
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What are the ages considered most
susceptible to lead poisoning?
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Less than 6 years old
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What is the key nutrient needed to
fend off lead poisoning or to help
once it has been dx?
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Iron
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What are the sources that could
lead to lead poisoning in kids?
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 Ceramic glazes

 Lead-based paint
 Lead soldering of cans

Sealant
 Drinking water systems
 Eye cosmetics from other
countries
 Litargirio (lead monoxide)
powder used as deodorant
in Hispanics
Mexican pottery
 Folk remedies
Topical agents
 Alternative meds
 Chinese & Middle Eastern
herbs for teething, colic,
and GI d/o

 Toys and crayons made
in China
 Soil
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What is the blood lead level (BLL)
that requires chelation therapy?
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BLL of 45 mcg/dl
 What
BLL is considered lead
poisoning?
BLL > 5 mcg/dl
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What are the treatment measures
for low levels of lead?
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Nutrition
Education

Possible change of environment
Clean-up of environment by
professionals

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Why does anemia accompany lead
poisoning?
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Lead interferes with heme
synthesis
Iron can help counteract the
absorption of lead.

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The best intervention for high level
lead poisoning is:
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Promote excretion of lead from the
body.
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Genitourinary
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Genitourinary System
When
should toilet training
begin?
What
are some do’s and
don’t’s with toilet training?
What
processes should be in
place before toilet training
can be successful?
+ “Training” should begin when child shows
physical and psychosocial signs of readiness
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Readiness signs:
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Able to stand and walk well

Able to pull pants up and down
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
Do’s and Don’ts:
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Don’t rush the process
Able to recognize the need to potty and
then wait until able to get to bathroom
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Don’t humiliate or punish the child
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Able to sit on potty without support
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Praise the child’s successes

Able to remain dry for at least 2 - several
hours

Make the switch from diapers to cotton
underwear a “special moment”
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Receptive language skills (able to follow
simple commands)

*They may prefer their own chair vs the
large toilet

Expressive language skills (able to
communicate need to use potty)
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Desire to please, based on positive
relationship with caregivers

Toddlers have little control over
anything in their lives….except for
eating and eliminating. They will
exercise this control!

Desire for independence and control of
bowel and bladder function
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Best method to assess fluid status
in a child?
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Weigh the child daily!
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Urinary Tract Infections
What
causes UTI’s?
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Urinary Stasis
Bacterial infection (usually E.Coli)
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What are the symptoms based on
child’s age? How does an infant
present?
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 Infants and Young
Children
 Typically nonspecific
 Fever
 Irritability,
 Malaise,
 N/V, anorexia,
feeding problems,
 Diarrhea
 Older
children
 specific symptoms
are more common
 Dysuria
 Frequency,
urgency, burning,
 Pain in back
 Daytime or
bedtime wetting
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What is the best method to obtain
a urine culture on a child?
Infant?
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Clean-catch in a child;
Catheterization in an infant
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Enuresis
What
is enuresis?
What
causes it?
What
is the pathophysiology
behind enuresis?
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Repeated involuntary urination
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Usually nocturnal; rarely diurnal
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Theory: Bladder capacity insufficient to hold
urine produced during the night
 Kawauchi et al., 2003
 ADH - insufficient
 Genetics – structural abnormalities
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Child must be at least 5 years of age
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Child must experience at least 2x/week for 3
months
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Name the treatment methods for
enuresis.
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1st step - R/O organic causes (UTI,
diabetes)

Restrict
Wake
PM fluids
child to void
Bladder
capacity training
Self-hypnosis
Electrical
devices-alarms, watches
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What causes acute
glomerulonephritis?
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Nephrogenetic strain of group A
Strep (recent strep throat)
Or
pneumococcal
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What are the symptoms of
glomerulonephritis?
 What
does the urine look like?
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How is glomerulonephritis
treated?
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Abrupt flank or mid-abdominal
pain, fever, irritability + edema
Dark-colored
urine
Tea or cola colored
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Antibiotics
Possible
steroids, diuretics, and
anti-hypertensives
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Nephrotic syndrome aka
Nephrosis – What causes it?
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Something that causes damage to
the glomerular membrane

an immune result
Possible
URI prior
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What are the key manifestations of
nephrosis?
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Massive proteinuria

Edema

Hypoalbumunemia

Hyperlipidemia
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What does the urine look like in
nephrotic syndrome?
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
Frothy, foamy (d/t proteins)
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Concentrated
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How is nephrosis treated?
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Steroids
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What are side effects of steroids?
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
Moon face

Increased appetite
 Weight

gain
Blurred vision
Increased growth of body/facial
hair (hirsutism)

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Cancer
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Radiation therapy – What are the
educational topics to include?
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 DO
NOT REMOVE MARKINGS!
 No lotions on skin
 Shield other organs
 Sedation or distraction
 No concerns with radioactivity after treatment
 Explain side effects to patient & family
 Fertility affected in males & females
 This should be explained to patient, if mature
enough, and families.
 Males should be given the opportunity to use
sperm banking for the future. Usually around
age 14 the males are considered mature
enough for this option.
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What is the greatest risk while on
chemotherapy?
What
is the best method for
prevention of this?
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Infection!
Handwashing!
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Absolute Neutrophil Count (ANC)
What
does this determine?
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Risk of infection.
Physicians
want cancer patients to
be above 1,000 mm.
Above
500 – preventative measures
for infection include standard
precautions: hand-washing, gloves
Less
than 500 mm is increased risk of
infection.
Must
place patients on protective
isolation.
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What is protective isolation?
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Isolation to protect the patient!
Positive
pressure isolation
rooms are used.
Rooms
have pressure that
pushes out the outside air and its
contents=cleaner environment
for the patient.
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Bone marrow aspiration helps dx
cancer. Where is this obtained
from?
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Posterior
iliac crest
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How should you answer questions
that your cancer patient asks you?
For example, if a teen asked if he
was going to die, what would you
say?
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Be honest!
Sometimes
patients with cancer
die.
Review
all the treatment methods
that are available.
Reassure
that everyone involved
in their care will be doing their
best to help them get better.
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What effects does cancer have on
the patient’s family?
How would you know if CA was
effecting the pt’s sibling?
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Siblings may act out!

Encourage parents/families to spend special one-on-one
time with the other children. You often have to give them
permission to step away from the bedside of the sick child.
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Why is a lumbar puncture (LP)
done? (3 reasons.)
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CSF
inspection.
Intrathecal
Measure
chemotherapy.
intracranial pressure.
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Leukemia
What
do parents often deal with
upon this type of dx?
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Guilt!
Symptoms
are often so vague or
mimic so many other diseases or
illness.
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Retinoblastoma
What
are the symptoms of
retinoblastoma?
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Leukocoria
Strabismus
Esotropia
Conjunctivitis w/o exudate
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Wilms Tumor
What
should the nurse make sure
to avoid during assessment?
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Palpation!
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Heme
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What is hemophilia A?
What are the signs and sx?
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– classic hemophilia deficiency in factor VIII
Symptoms
Mild
to severe bleeding from
injuries
Hemarthrosis (early signs are
reluctance to move a joint)
Echymosis
Potential airway problems
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Hemophilia A Precautions
 What
precautions should be
taken for a procedure in which
bleeding is expected?
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Factor VIII – Cryoprecipitate prior
to the procedure
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Iron-deficient Anemia – What
should also be taken with an iron
supplement to enhance the
absorbtion?
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Vitamin C!
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Foods with iron content to suggest
to parents:
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
Leafy greens

Meats, esp. red meats

Beans, lentils

Fe fortified cereals

Citrus fruits
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What is a vaso-occlusive sickle cell
crisis and how is it treated?
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Pain crisis!
 Vaso-occlusive
- blockage of blood vessel
 usually – back, abdomen, chest, joints
 Must be treated with opioids and usually a PCA
pump
 Also hydration and oxygenation
 Sickling
triggered by fever, hypoxia, stress (physical
or emotional)
 Precipitating
factors-increased blood viscosity (fever
or low fluid intake)


-hypoxia, or low oxygen tension (high altitudes,
poorly pressurized planes, hypoventilation,
vasoconstriction from cold, emotional stress)
- infection, trauma (increased for oxygen)