Pediatric Test 3 Blueprint

1. Hodgkin's disease (Ch. 27 Pg. 650, 651; Saunders 372-373)

● Description: a type of lymphoma, a malignancy of the lymph nodes that
originates in a single lymph node or a single chain of nodes.
○ Predictably metastasizes to non nodal or extralymphatic sites, especially
the spleen, liver, bone marrow, lungs and mediastinum.
○ Characterized by the presence of Reed-Sternberg cells in the lymph
nodes.
○ Peak in mid-adolescence.
○ Possible causes include viral infections and previous exposure to
alkylating chemical agents.
○ Primary treatment modalities are radiation and chemotherapy, each may
be used alone or in combination, depending on clinical staging of the
disease.
● Painless enlargement
● Enlarged, firm, nontender, movable nodes in the supraclavicular area; in children
the sentinel node located near the left clavicle may be first enlarged node.
● Nonproductive cough as a result of lymphadenopathy.
● Abdominal pain as a result of enlarged retroperitoneal nodes.
● Interventions:
1. For early stages without mediastinal node involvement, the treatment of
choice is usually extensive external radiation of the involved lymph node
regions
2. With more extensive disease; radiation in combo with multiagent chemo
is used.
3. Monitor for drug induced pancytopenia and an abnormal depression of all
cellular components of the blood; which will increase the risk for infection,
bleeding and anemia.
4. Protect the child from Infection
5. Provide a safe, hazard free environment
6. Monitor for adverse effects related to chemo or radiation.
a. Common effect is malaise
b. Pt does NOT become radioactive during or after therapy
7. Monitor for nausea and Vomiting administer antiemetics as prescribed.
8. After lymphangiogram, the skin and urine may take on a bluish color
9. Child and parent should be prepared to handle the impact on self image
10. Skin must be protected against exposure to sunlight and irritation
a. Sun block agent containing para-aminobenzoic acid (PABA)
i. Prevents burning
11. Nothing should be applied to the treatment area without the
recommendation of the pcp
● Stage 1: 1 tumor present
● Stage 2: 2 tumors present above or below the diaphragm
● Stage 3: 3 or more tumors present above and below the diaphragm
● Stage 4: Tumors present all over the place.

2. Blood transfusions and reactions 643, 650

○ Safety tip:
■ Blood transfusion reaction occurs, stop the infusion, keep the vein open
with normal saline solution, and notify the charge nurse. Take the
patient's vital signs and observe closely.
○ Registered nurse should positively identify donor and recipient blood types and
groups on labels and the patient's chart together with another licensed
professional.
○ Medications are NEVER added to blood.
○ Administered slowly
○ Iv site is frequently checked for infiltration
○ Pt. observed for signs of transfusion reaction (chills, itching, rash, fever,
headache, and pain)
○ If reaction occurs: tubing should be clamped off immediately, line kept open with
normal saline solution, and nurse in charge is notified.
○ Circulatory overload is always a danger with children.
■ Dyspnea, precordial pain, rales, cyanosis, dry cough, and distended neck
veins indicate circulatory overload.
■ Apprehension can also be a warning signal of air emboli or electrolyte
disturbance.
○ Blood bag and tubing are saved and returned to the blood bank
○ Most transfusion reactions occur within the first 10 minutes of administration.
■ Diphenhydramine (benadryl) may be ordered for allergic reactions.
■ Medication may be ordered for wheezing
■ Oxygen may be necessary to relieve dyspnea and cyanosis.
■ To prevent cardiac dysrhythmias a blood warmer must warm blood
transfusions that are administered through central lines.
3. Peripheral neuropathy of the bowel with chemotherapy 649
○Peripheral neuropathy may be signaled by severe constipation caused by
decreased nerve sensations to the bowel.
4. Recombinant antihemophilic factor 646
○ Used for the treatment of hemophilia patients
○The development of recombinant antihemophilic factor, a synthetic product, has
eliminated the need for repeated blood transfusions and its accompanying
dangers (such as human immunodeficiency virus [HIV] and hepatitis infection).
■ prevention and control of hemorrhagic episodes
5. Leukemia 647-650
○ Malignant disease of the bone marrow and lymphatic system.
○ Acute lymphoid leukemia (ALL) most common type of childhood.
○ Patho:
■ Malignant disease of the blood forming organs of the body that results in
an uncontrolled growth of immature WBC’s. (blast or stem cells)
■ Cells are immature and do not function as healthy WBC to fight infection;
increased susceptibility to infection results.
■ WBC take over the centers that are designed to form RBC and anemia
results
■ When the WBC infiltrate and take over the marrow centers that form
platelets, the reduced platelet counts cause bleeding tendencies.
■ Can infiltrate the spleen, liver, and lymph glands, resulting in fibrosis and
diminished function.
○ Manifestations:
■ Common symptoms:
1. Low grade fever, pallor, bruising tendency, leg and joint pain,
listlessness, abdominal pain, and enlargement of lymph nodes.
2. Progression of the disease can cause an enlarged liver and
spleen.
a. Skin unusual lemon yellow color
3. Petechiae and purpura may be early objective signs.
4. Ulcerations develop around mucous membranes of the mouth and
anal regions and have the tendency to bleed.
○ Diagnosis:
■ A piece of bone marrow is aspirated from the sternum or more often in
children from the iliac crest.
■ X-ray films of the long bones show changes.
■ Spinal tap determines CNS involvement
■ Kidney and liver function studies are also performed because normal
functioning of these organs is absolutely necessary for chemotherapy to
be safely used in treating the disease.
○ treatment/nursing care:
■ Long term care is provided
■ Referred to a specialized center where facilities for required care are
available.
■ Chemotherapy is performed.
■ Educated family about infection prevention
■ Adequate hydration should be emphasized to minimize kidney damage
■ Active routine immunizations must be delayed while the child is receiving
immunosuppressive drugs.
■ **chickenpox is life threatening to a child who is immunosuppressed.
■ TPN may be indicted to support nutritional needs.
■ I&O is recorded and oral hygiene is provided.
■ Alopecia is a side effect of chemotherapy (offer a hat or wig)
 ○ **Nursing tip: four priority challenges in the care of leukemic children are:
■ The complications of anemia from decreased red blood cell infection.
■ Infection from neutropenia
■ Bleeding from decreased platelets
■ Fractures resulting from involvement of the bone marrow.**
6. Coarctation of the Aorta Saunders 429
○ Refers to the localized narrowing near the insertion of the ductus arteriosus.
○ Signs of HF may occur in infants
○ Signs and Symptoms of decreased cardiac output may be present
○ Children may experience headaches, dizziness, fainting and epistaxis resulting
from hypertension
○ Management of the defect may be done via balloon angioplasty in children;
restenosis can occur. Surgical intervention may be necessary.
○ Blood pressure is higher in the upper extremities than the lower. In addition,
bounding pulses in the arms, weak or absent femoral pulses and cool lower
extremities may be present.
■ The systolic pressure is normally 10 to 15 mm Hg higher in the legs than
the arms
■ Systolic pressure that is lower in the legs than in the arms should be
reported
7. Death in children (Ch. Pg. 652-656)
○ Facing death: nurse must understand grieving process, cultural and personal
views and perceptions of the child facing death
■ Manifestations
1. Somatic distress such as weakness, anguish, or SOB
2. May feel detached from the world and have a sense of unreality or
disbelief
3. A sense of guilt and blame may fallow
4. Hostility is normal; may drive away those who don’t understand
that it’s normal
5. Restlessness and general irritability or inability to function may
follow
■ Nursing priorities: patient advocate, family advocate, providing support,
and facilitating the grieving process
○ Child’s Reaction to Death
■ Nurses must be honest and inform patients about upcoming procedures
and in terms child can understand
1. Child must be allowed to have much control as possible regarding
what happens to them
2. They should not be offered a choice when there is none
■ Nurses must listen to what they say to adults, their toys, and to other
children
 1. Crayons and paper are provided for self expression
■ Kids younger than 5 years mainly concerned with separation from parents
and abandonment
■ Preschoolers respond to questions about death by relying on their
experience and turn to fantasy
1. May believe death is reversible or that they are to blame
■ Children don’t develop realistic concept of death as a permanent process
until 9 or 10 years old
■ Teens face conflict between their treatment regimens and their need to
establish independence from parents and conformity with peers
1. Leads to anger and resentment
■ Nursing Tip: brothers and sisters often feel neglected and lonely. They
are frustrated because they are unable to comfort their parents and loved
ones
1. They need to be included in care plan
○ Physical Changes of Impending Death
■ Cool, mottled cyanotic skin
■ Slowing of body processes
1. Hearing is intact
■ Rales in chest
1. Pooling of increased secretions in lungs
■ Movement and neurological signs lessen
■ If thrashing or groaning, assess for pain and provide pain relief
○ Stages of Dying
■ Denial, Anger, Bargaining, Depression, Acceptance
■ It’s therapeutic for children to be in their own surroundings whenever
possible
■ Siblings involved in care, feel less neglected and the sacrifices they must
take become more meaningful
■ Discussion before deathallow then to make amends for their hostilities
toward the sick child
■ Religion and spiritual philosophy can be a source of strength and support
■ Statistics show a high correlation between the death of a child and
divorce
1. Observe for signs of tension between parents for interventions
■ Feelings left unexpressed can cause depression or physical illness
8. Death and dying of children (see topic above)
○ Increased authority in a dying child involves the charge nurse.
○ Be truthful, honest, and understanding.
9. Hypertension in children (Ch. 26 Pg. 633, 634)
○ Patho
■ Systemic hypertension increases with age and correlates with age, sex
and height throughout childhood and adolesence
 ■ Abnormal BP reading should be measured and confirmed by auscultation
on 3 different occasions before a diagnosis is made
■ Normal blood pressure: below the 90th percentile for age, height and
sex of child less than 120/80
■ Elevated BP: between 90th and 95th percentile 120/<80 or 129/<80
■ Stage 1 Hypertension: Above the 90th to 95th percentile +12 mm Hg;
130/80 to 130/89
■ Stage 2 Hypertension: Above the 95th percentile +12 mm Hg or
>140/90
■ Risk Factors
1. Heredity, obesity, stress, poor diet, exercise pattern
■ Assessment should be part of physical exam during childhood for kids
over 3 yrs
○ Treatment and Nursing Care
■ Lifestyle management
■ Counsel teens about drugs, alcohol and tobacco use and BP
■ CAFFEINE, NSAIDS, herbal and nutritional supplements and hormonal
contraceptives may be associated with the development of hypertension
■ DASH diet
1. High in fruits and veggies
2. Avoid salty foods
3. Low fat milk products
4. Grains, fish, poultry, lean red meat and low sodium products
5. Some sugar and sweets are allowed
6. Limit sedentary style to 2 hours per day
a. At least 30 to 60 minutes of activity daily exercise
■ Stage 2: includes lifestyle changes mentioned above with
antihypertensive meds like ACE inhibitors
■ Drug therapy may not be effective in teens (noncompliance)
10. Abnormal hemoglobins (Ch. 27 Pg. 641)
○ Seen in Sickle cell disease
○ Sickling (clumping) caused by decreased blood O2 levels may be triggered by
dehydration, infection, physical or emotional stress, or exposure to cold
○ RBC have changed its shape to resemble that of a sickle blade
○ Sickle cells contain an abnormal form of hemoglobin termed hemoglobin S (the
sickling type)
■ Membranes are fragile and easily destroyed
■ Crescent shape make it hard to pass through capillaries causing pileup of
cells in small vessels
■ May lead to thrombosis and cause obstruction
1. Pain in affected area
11. Pursed Lipped breathing
○ Strengthens vulnerable lungs
 ○ This type of breathing is blowing out as if blowing a kiss
○ Inhale through the nose then exhale through the mouth with lips pursed as if
whistling
○ Exhalation should be at least twice as long as inhalation
○ If it takes 3 seconds to breathe in, it should take 6 seconds to allow all the air to
escape
○ Teach not to force the air out but to let it escape naturally
12. Pulse oximetry
○ Needs to be changed q24hrs for pedi patient’s that requires a continuous pulse
oximeter.
○ ATI book: move probe q 4 to 8 hrs or per facility policy to prevent necrosis in
infants who have disrupted skin integrity or poor perfusion
13. Endotracheal suctioning
○ 80 to 120 mm Hg
○ 10 to 15 sec
○ Suction as needed (ATI)
14. Beta A hemolytic strep (Ch. 25 Pg. 596)
○ Strep throat (acute pharyngitis)
○ Occurs in about 37% of cases.
○ Symptoms:
■ Fever
■ Malise
■ Dysphagia
■ Anorexia
○ Determined by throat culture
■ If positive, antimicrobial therapy such as penicillin is administered orally
for 10 days.
1. Erythromycin may be prescribed if the child is allergic to penicillin
2. Acetaminophen may b taken to relieve soreness of the throat
○ Compliance is the main problem (nurses educate to parents the need for the
child to finish all of the medications.)
○ Child is no longer considered infectious to others after drug therapy has begun
and fever has decreased.
15. Laryngeotrachealbronchitis (Pg. 598)
○ Hot showers help the patient breath.
○ Viral condition
○ Manifestations
■ Edema
■ Destruction of cilia
 1. Exudate resulting in respiratory obstruction
■ Mild upper respiratory infection proceeds
■ Barking or brassy cough
■ Stridor develops and classic symptoms of respiratory distress may follow
○ Treatment and nursing care
■ The infant may prefer to be held upright or sit up in bed
■ Increase humidity levels
1. Humidifier
2. Take into bathroom where the hot water is turned on in the shower
to increase humidity
■ Opiates are contraindicated; depressed respirations
■ Sedatives are also contraindicated; increases restlessness
16. RSV (Pg. 599, 600)
○ Contact precautions!
○ Leading cause of bronchiolitis
○ Most common cause of viral pneumonia
○ Airways are so small and prone to obstruction by the thick mucus produced.
○ Transmission:
■ Spread by direct contact with respiratory secretions, usually by
contaminated hands to the mucous membranes (eyes, mouth, and nose)
■ Incubation period is 2-8 days
○ Diagnosis:
■ Exam of the nasopharyngeal washings for RSV antigens
○ Preventions:
■ Monoclonal antibody, palivizumab given monthly via IM
○ treatment/nursing plan:
■ Infection prevention and control techniques
■ Frequent hand washing is essential
1. Liquid soap dispensers available, organism survives on bar soap.
○ Support of the infant and family:
■ Effective communication skills.
■ Adults with virus can shed it 1 week after infection
■ Familiarized with the mist tent and encouraged to participate in feedings.
○ Symptomatic care:
■ Reporting tachypnea and tachycardia is essential because it can indicate
hypoxemia.
■ Auscultate breath sounds and report wheezing, ralse, or rhonchi
■ Quiet chest may be at risk for respiratory arrest.
■ Signs of respiratory distress should be assessed and reported
■ O2 monitored
■ Suctioning of mucus
 ■ **inhaled bronchodilators or steroids are not helpful in relation to RSV
infections.**
17. Asthma
○ Prophylactic(Preventative) medication is taken
○ Recurrent and reversible obstruction of the airways in which bronchospasm,
mucosal edema, and secretion of and plugging by mucus contribute to significant
narrowing of the airways and subsequently impaired gas exchange.
○ Onset of asthma may be triggered by house dust, animal dander, wool, feathers,
pollen, mold, passive smoking, strong odors, and certain foods.
○ Diagnosis:
■ History, physical, and response to bronchodilator therapy
■ Elevated eosinophils in the blood
■ Allergy skin testing and RAST
○ Manifestations:
■ Begin slowly or abruptly
■ Obstruction is most severe during expiration because the airways
become smaller during this phase of respiration.
18. Cystic fibrosis
○ Postural drainage
○ Sweat chloride test is performed.
19. Suctioning of the infant
○ Mouth to nose
○ Airways must be cleared before feeding and before bedtime to provide restful
sleep
20. SIDS
○ Place baby on the back to sleep.
○ No pillows or blankets in the crib
○ Should be placed on a firm mattress with no loose bedding surrounding the infant
○ Use of pacifiers may be protective
○ Flexion of baby’s head must be avoided in car seats because it can cause
oxygen desaturation and hypoxia (hanging head; chin touching chest)
21. Smoke inhalation
○ No more than 6 to 72 hours can a patient inhale smoke. (pulmonary edema)
○ Bronchopneumonia after 72 hours leads to atelectasis.
○ Burned materials can be carried deep into the respiratory tract in the form of
insoluble gases and may cause chemical injury.
○ **pulse oximetry readings are of little value in carbon monoxide poisoning
because pulse oximetry does not detect COHb and readings may appear
normal**
 ○ Treatment of carbon monoxide poisoning is often symptomatic and includes
oxygen administration, careful monitoring of intake and output, and frequent
assessments of arterial blood gas reports.
○ Severe carbon monoxide: hyperbaric oxygenation may be the treatment of
choice.
○ **respiratory arrest can occur suddenly in children who have smoke inhalation
injuries. An intubation tray should be readily available.**
○ Teaching: parents should be encouraged to have working smoke and carbon
monoxide detectors in their homes and to test them at least twice a year.
22. Pulmonary edema
○ Pulmonary edema from 6 to 72 hours (3rd stage of inhalation injury)
23. Ventricular septal defect pg 625-626
○ The lungs and heart are overworked from pushing too much of the same blood
repetitively.
○ A hole is present in the lower chambers of the septal wall of the heart.
○ More severe than and an atrial septal defect because the left side pumps blood
to the rest of the body.
24. Atrial septal defect pg 625
○ A hole in the upper chambers of the septal wall of the heart.
○ Blood is pumped back and to the right side of the heart.
25. Tetralogy of fallot pg 627-628
○ Four defects of the heart
■ Stenosis or narrowing of the pulmonary artery, which increases the blood
flow to the lungs
■ Hypertrophy of the right ventricle, which enlarges because it must work
harder to pump blood through the narrow pulmonary artery
■ Dextroposition of the aorta, in which the order is displaced to the right and
blood from both ventricles enters it.
■ Ventricular septal defect
○ Cyanosis increases with age, clubbing of the fingers and toes, Feeding
problems, growth retardation, frequent respiratory infections, and severe
dyspnea on exertion.
■ The child restis in a squatting position to breathe more easily
○ Red blood cells of the body and crease to compensate for the lack of oxygen.
(polycythemia)
○ Narrowing of the pulmonary artery causes congestive heart failure as a result of
the increased muscular force necessary to propel blood through the narrowed
orifice.
○ The increased oxygen consumption and decreased energy and ability to eat
result and failure to thrive.
 ○ Tet spells (hypercyanotic) occur during the 2 years of life.
■ Spontaneous cyanosis, respiratory distress, weakness and syncope
occur.
■ They can last a few minutes to a few hours and are followed by lethargy
and sleep.
■ Knee-chest position when a tet spell occurs often the child will pause and
voluntary squat in position until the attack abates. Recovery from the tet
spell is usually rapid.
○ X-ray chest study is done and a boot shaped heart confirms the diagnosis.
○ Cerebral thrombosis caused by Polycythemia is a complication, iron deficiency
anemia develops because of decreased appetite and increased energy required
just suck or eat, bacterial endocarditis can occur and is prevented with
prophylactic antibiotics therapy.
○ A temporary shunt is placed on successful new borns or premature infants. Open
heart surgery allows for total correction of all defects and is usually performed,
with excellent results, at 4 months to 2 years of age.
26. PDA
○ Patent Ductus Arteriosus
○ Can indicate a left heart syndrome
○ Signs and symptoms
■ Full and bounding radial pulse
■ Wide pulse pressure (difference between systolic and diastolic blood
pressure)
■ Murmur
○ Treatment
■ IV treatment
■ Ibuprofen therapy
■ Indomethacin
1. These two therapies close PDA
2. It causes the blood vessels to constrict which then closes the duct
27. Digoxin in children
○ Do not administer if a pedi patient’s pulse is less than 100 beats per minute.
○ Vomiting is a key sign of digoxin toxicity.
28. CHF pg 629
○ Early signs of congestive heart failure in infants:
■ Tachycardia at rest
■ Fatigue during feeding
■ Sweating around scalp and forehead
■ Dyspnea
■ Sudden weight gain
○ Signs and symptoms
 ■ Cyanosis, pallor, rapid respirations, rapid pulse, feeding difficulties,
fatigue, a weak cry, excessive perspiration, failure to gain weight, edema,
and frequent respiratory infections.
29. Sickle cell disease (Ch. 27 Pg. 641-643)
○ Blood transfusions & and Increase in fluids.
○ Sickle cell anemia
○ Inherited from both parents.
○ Does not appear until last part of first year of life.
○ May be unusual swelling of fingers and toes. Hemoglobin levels range from 6 to
9 g/dL or lower
○ Signs and Symptoms
■ Pale, tires easily, and has little appetite severe abdominal pain and
muscle spasm’s leg pain or painful swollen joints and hypoxia may be
seen.
■ Fever vomiting hematuria convulsions, Stiff neck coma or paralysis can
result
■ Children with sickle cell disease have a risk for stroke
○ Treatment and Nursing Care
■ Demerol is not recommended can cause seizures
■ Every effort is made to combat dehydration and acidosis
■ Record intake and output
30. Thalassemia
○ Usually misdiagnosed as iron deficiency anemia.
○ Hereditary blood disorders in which the patient's body cannot produce sufficient
adult hemoglobin
○ Minor:
■ Inherited by one parent
■ Associated with mild anemia
■ Pt. is pale, and spleen may be enlarged.
■ May be going undetected
○ Major: (more serious)
■ “Cooley's anemia”
■ Two thalassemia genes are inherited
■ Pt. is hypoxic, pale, poor appetite, FEVER.
■ Jaundice
■ Liver enlarges and spleen grows enormously.
■ Diagnosis is aided by a family history of thalassemia, radiographic bone
growth studies and blood tests.
○ treatment/nursing care:
■ Goals:
 1. Maintain hemoglobin levels at 9.5 dL to prevent overgrowth of
bone marrow and result in deformities.
2. Provide for growth and development and normal physical activity.
■ Hematopoietic stem cell transplantation can provide cure if an HLA
matched donor is available.
■ Main treatment is frequent blood transfusions to maintain the hemoglobin
level.
■ Nursing measures:
1. Long term care
2. Observation of the patient during blood transfusion.
3. Monitoring of vital signs
4. Home care arrangements
31. Kawasaki disease pg 636
○ Inflammation of the heart vessels and can lead to an aneurism.
○ Leading cause of acquired cardiovascular disease in the u.s.
○ Mild asymptomatic viral infection in children with a genetic predisposition.
○ Onset is abrupt:
■ Fever 104 or higher that does not respond with antibiotics or antipyretics,
and last more than 5 days.
■ Conjunctivitis w/out discharge
■ Strawberry tongue
■ Inflamed mouth and pharyngeal membranes
■ Enlarged nontender lymph nodes
■ Skin rash
■ Peeling of palms and soles.
○ Child is irritable and may develop signs of cardiac problems.
○ Labs: elevated c reactive protein, esr, and WBC
○ Treatment:
■ IVIG administered early in the illness can prevent the development of
coronary artery pathology.
■ Salicylate therapy is prescribed
■ If no response to IVIG and aspirin, a second dose of IVIG may be
prescribed
○ Nursing care:
■ Symptomatic and supportive
■ Low dose aspirin therapy may be prescribed to prevent clot formation.
■ Compliance is necessary.
■ Educated parents on CPR.
32. Radiation pg 649
○ Radiation and Chemotherapy can target specific cells (cancer cells)
○ “At high doses, radiation therapy kills cancer cells or slows their growth by
damaging their DNA. Cancer cells whose DNA is damaged beyond repair stop
 dividing or die. When the damaged cells die, they are broken down and removed
by the body. Radiation therapy does not kill cancer cells right away.” (Google)
33. Chemotherapy 649
○ Includes the following components:
■ Induction period
■ CNS prophylaxis for high risk patients
■ Maintenance
■ Reinduction therapy (if relapse occurs)
■ Extramedullary disease therapy
○ Can lead to peripheral neuropathy of the lower extremities.
34. Iron deficiency anemia
○ Can be caused by giving a baby too much milk and not enough iron.
35. Cardiac diet
○ A cardiac deformity in a child will make them too exhausted to eat. Inability to
suckle, versus breathing.
36. Hypoplastic left heart syndrome pg 628-629
○ Underdevelopment of the left side of the heart, usually resulting in an absent to
nonfunctional left ventricle and hypoplasia of the ascending aorta.
○ Can be diagnosed before birth and infant is placed on the transplant list so
surgery can be performed right after birth.
○ The survival of the infant depends on a patent foramen ovale and ductus
arteriosus to provide a pathway for oxygenated blood to the general body
system.
○ Signs and Symptoms:
■ Grayish blue color of the skin and mucous membranes and signs of CHF
(dyspnea, weak pulses, and a cardiac murmur).
○ Prostaglandin E1 is given to maintain a patent ductus.
○ Immunosuppressive therapy is used to prevent transplant organ rejection.
37. Hemophilia
○ Patient is allowed to only participate in swimming activities.
○ No contact sports.
○ RICE the extremity.
38. Thrombocytopenia
○ Occurs when platelet is less than 100,000
39. Types of chemotherapy regimens
○ Prednisone, vincristine, sulfate, daunorubicin, or L-asparaginase.
○ Steroid prednisone has the effects of masking the symptoms of infection,
increasing fluid retention, inducing personality changes, and causing the child’s
face to take on a moon-shaped appearance.
 ○ Methotrexate a nd 6-mercaptopurine are useful in maintaining remissions
because they act against chemicals vital to the life of a WBC.
■ Nausea, diarrhea, rash, hair loss, fever, anuria, anemia, and bone
marrow depression.
40. Tonsillectomy
○ Only recommended if persistent airway obstruction, repeated infections, or
difficulty in breathing occurs
○ Not performed during acute infectious episodes because inflamed tissue
responds poorly to surgery
○ Report loose teeth because danger of aspiration (anesthesiologist)
○ Frequent swallowing while the child is sleeping is an early sign of bleeding after
procedure
■ Increased pulse rate, RR, restlessness
■ Vomiting of bright red blood
○ Avoid brown or red colored drinks
○ Ice pops are good
○ Child is kept quiet throughout the day
○ Avoid coughing, clearing of the throat, and blowing nose
■ Gargling and seasoned foods are also avoided
41. AIDS in the child pg 762
○ Children usually acquire AIDS/HIV through:
■ Contact with an infected mother at birth (Approx. 90% of cases in infants).
■ Sexual contact with an infected person
■ Use of contaminated needles or contact with infected blood.
○ Mothers are highly recommended to get tested and counseled.
■ HAART high active antiretroviral therapy.
○ Antiretroviral drugs have been approved to use in children.
○ Dosage ranges differ from those for adults because of reduced absorption,
increased elimination, and an immature liver.
○ Monitoring for blood levels is essential.
○ Dosages for adolescents are based on the Tanner Stage of Development rather
than age.
○ Birth control should be available because most antiretroviral drugs are
teratogenic.
42. Fexofenadine
○ A medication used versus benadryl for children
43. Idiopathic thrombocytopenic purpura
■ Patho
1. Acquired platelet disorder
2. Cause is unknown
 3. Autoimmune system reaction to a virus
4. Platelets become coated with antiplatelet antibody are seen as
foreign material and are eventually destroyed by the spleen
5. Occurs in all age groups but mainly between 1 to 4 years of age
■ Manifestations
1. Classic symptoms is slowed blood clotting and easy bruising
2. 30% of pts also have nosebleeds
3. May have been a recent history of viral respiratory infection
4. Exposure and onset is about 2 to 4 weeks
5. Platelet count is below 20,000/mm3
6. Anemia may be present
■ Treatment and Nursing Care
1. When platelet count is low, greatest danger is spontaneous
intracranial bleeding
2. Neurological assessments are part of care
3. Treatment is not indicated in most cases
4. Drugs that interfere with platelet function should be avoided to
prevent bleeding
a. Aspirin
b. Phenylbutazone (butazolidin)
c. Phenacetin
5. Activity is limited to prevent bruising
6. Focus on observing for signs of bleeding
a. Use soft toothbrush for oral hygiene
7. Corticosteroids such as prednisone may be prescribed as first line
of treatment
8. All children must keep recommended immunizations against the
viral diseases of childhood current to prevent this complication
from occurring
44. Croup pg 597
○ General term applied to a number of conditions whose chief symptom is a
carking (crouping)
○ Acute laryngotracheobronchitis is the most common
○ Area below the glottis is firm cartilage and therefore cannot expand outward
when edema occurs, as other regions of the respiratory tract can.
○ Can be benign or acute.
○ Benign
■ Frightening but rarely life threatening
○ Acute croup
■ can develop into a respiratory emergency.
■ largnotracheobronchitis
45. Epiglottis pg 598
○ Swelling of the tissues above the vocal cords.
 ○ Caused by H. influenzae type B.
○ Occurs in children 3 to 6 years of age.
○ Life threatening medical emergency.
○ Symptoms
■ Abrupt
■ Child insists on sitting up and leaning forward with mouth open
■ Drooling
■ Difficulty in swallowing
■ Wide eyed
■ Restless
■ Frog like croaking sound in inspiration
○ Inspection of the throat shows an enlarged, reddened edematous epiglottis.
■ Avoid examining with tongue blade and can cause a laryngospasm and
result in sudden respiratory arrest.
○ Nurse's responsibility to be sure that a tracheotomy set at the bedside before any
examination of the throat is attempted.
○ Treatment:
■ Immediate tracheostomy or endotracheal intubation and oxygen to
prevent hypoxia, brain damage, and sudden death caused by respiratory
arrest.
46. Tracheostomy
○ When dealing with a patient who has epiglottis, a tracheostomy set is always set
onto the side of bed for safety precautions.
○ A tracheostomy neck collar, Must be within 1 Finger Width.
47. Rheumatic fever
○ ASO titer test is used.
○ Involving the joints, heart, CNS, skin, and subcutaneous tissue
○ Destruction of connective tissue
○ Peak between 5 and 15 eyras of age
○ World wide in lower income families
○ Symptoms:
■ Mild to severe and may not occur for 1 to 6 weeks after a strep throat
infection.
■ Wandering joint pains, skin
■ Eruptions, chorea (nervous disorder), and inflammation of the heart.
■ Abdominal pain often mistaken for appendicitis
■ Fever varies from slight to very high
■ Elevated ASO titer
■ Rheumatic carditis:
1. Inflammation of the heart
 2. Manifestations of RF that can be fatal.
3. Irregular, low grade fever, pale, listless, poor appetite.
○ Diagnosis:
■ Jones criteria:
1. Must have two major:
a. Corditis
b. Polyarthritis
c. Erythema marginatum
d. Chorea
e. Subcutaneous nodules
2. One major and two minor:
a. Fever
b. Arthralgia
c. Previous history of RF disease
d. Elevated erythrocyte sedimentation rate
e. Leukocytosis
f. Abnormal ECG
g. Positive test for c reactive protein (CRP)
3. Plus a history of strep infection.
■ Mnemonic for jones criteria on page: 633.
○ Treatment:
■ Aimed at preventing permanent damage to the heart.
■ Antibacterial therapy, physical and mental rest, relief of pain and fever,
and management of cardiac failure should if occur.
■ Eliminating the streptococcal infection
■ Penicillin is drug of choice
■ Aspirin is the drug of choice for join disease w/out evidence of carditis.
■ Bed rest during the initial attack is recommended until the ESR returns to
normal levels.
■ Ensure as few interruptions as possible to prevent tiring the patient.
1. Bed cradle can be used to prevent pressure on painful extremities.
2. Maintaining healthy teeth and preventing cavities is of special
importance (at risk for subacute bacterial endocarditis)
3. Prophylactic antibiotic treatment is required before any dental
procedure.
■ Prevention:
1. All throat infections should be cultured
2. Close medical supervision and follow up care are essential
3. Prevention of infection and prompt treatment of group a beta
hemolytic strep infections to prevent the occurrence of RF.
48. Epistaxis
○ Have patient lean forward and pinch the bridge of the nose to stop the bleeding.
○ Cold packs can be used to constrict the blood vessels to stop the bleeding.
49. Pancreatic enzymes
○ In relevance to cystic fibrosis, the patient does not secrete enough pancreatic
enzymes to aid in the digestive system to break down food.
50. Pneumonia pg 601-602
○ Breathing is shallow, the blood stream is denied sufficient oxygen
○ Group B streptococci is the most common cause of pneumonia in newborns
whereas chlamydia is the most common cause of pneumonia in infants 3 weeks
to 3 months of age.
○ The incidence of H. influenzae type B infection has been decreasing with current
immunization programs.
○ Immunocompromised children may develop pneumonia caused by a ram-
negative organism or a fungus such a s pneumocystis jiroveci.
○ PVC 13 is recommended for children younger than 2 years of age and is given at
2, 4, 6, 12, and 15 months of age.
○ PPSV23 is given to children older than 2 years of age who have a chronic
disease or are immunosuppressed.
○ Airborne infection isolation precautions are recommended in the care and
treatment.
○ Tachypnea is present in infants (40-80 breaths/min)and in older children (30-50
breaths/min)
○ Chest pain, sternal retraction, frequent coughing, flaring nostrils, poor appetite
and lies on the affected side.
○ X-rays, WBC differential, and culture specimens may be obtained from the nose,
throat, or sputum.
○ Antipyretics, oxygen, fluid intake increased, Pediazole is prescribed, however
amoxicillin is the drug of choice for up to 5 years of age.
○ REst, fluids and cough suppressants before bedtime. Smoking should be
avoided around the child. Proper use and disposal of tissue.s, covering the
mouth during a cough, and the modeling of proper handwashing techniques are
preventative measures the nurse should teach the family.
51. Bronchiolitis Pg. 599
○ Patho
■ Viral infection of the small airways called bronchioles
■ 6 months to 2 years of age
■ Obstruction often leads to atelectasis
1. Gas exchange is impaired and hypoxia occurs
○ Manifestations
■ Upper resp. Infection or cold with a mild fever and serous (Clear) nasal
discharge is followed by the development of a wheezing cough and signs
of respiratory distress
■ Increase of respiratory rate interferes with successful feeding
 1. Infant may become irritable and dehydrated
■ RSV is a causative organism
■ Infants with bronchiolitis may develop a hyperreactive airway or asthma
later in life
○ Treatment and Nursing Care
■ Symptomatic and similar to treatment of croup
■ Semi fowlers with hyperextended neck
■ Oral feedings are often supplemented by IV fluids
■ I&Os are recorded
■ Bronchodilating aerosol therapy and high humidity tents
52. Oxygen therapy Pg. 610
○ Oxygen is a drug, and administration should be correlated with monitoring of O2
saturation levels
○ Too little results in hypoxia (clubbing of the fingers, restlessness indicates
respiratory distress)
○ Too much can result in lung damage