and the posterior fontanelle closes by..
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-Anterior 12-18 months
-Posterior 2-3months
Which of the following reflexes do we expect to have disappeared by about 4
months? (SATA)
A. Tonic Neck Reflex (Fencer's Position)
B. Sucking Reflex
C. Rooting Reflex
,D. Moro/Startle reflex
E. Palmar Grasp Reflex
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A-E are all correct. These reflexes are all expected to disappear by around
4 months of age.
At around what age should we expect an infant to roll from their stomach to their
back?
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4 months
Which hematological disorder presents with growth retardation, pathological
fractures, and skeletal deformities such as frontal bossing and maxillary prominence?
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Thalassemia presents with skeletal structure problems due
to iron overload and increased erythroid activity in the
bone marrow.
These problems include frontal bossing (an unusually
prominent forehead) and maxillary prominence (large
cheekbones). You may hear this referred to as "rodent-face"
which is an unkind, but somewhat accurate way to picture it.
A 30-month old toddler presents to your clinic with fatigue, malaise, and weight loss.
On assessment, you find a firm, non-tender abdominal mass that does not cause any
,pain. The child also has a fever, and complains of hematuria.
-What condition do you suspect?
-What laboratory tests/diagnostics would you anticipate being ordered?
-What are some priority nursing actions and treatments?
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-This fits with the symptom picture of a Wilms' tumor
(nephroblastoma) which is a kidney/abdomen malignancy.
Diagnosis typically occurs between 2-3 years of age.
-Labs and diagnostics include CBC, urinalysis, coagulation
studies, urine catecholamines, abdominal ultrasound,
abdominal CT, and an inferior venacavogram and bone
marrow aspiration r/o metastasis.
-Priority nursing action is to avoid palpating or causing
trauma to the tumor, which could result in metastasis.
Treatment is often surgical removal with chemo for residual
disease or metastasis.
A red reflex test is performed on a child, and it's found that their left eye has a yellow-
whitish glow. What might this indicate?
A. Retinoblastoma
B. Cataracts
C. Strabismus
D. ALL
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A. Retinoblastoma will result in a white or yellow-white glow
in one eye.
-Cataracts will typically present with a dulled red reflex.
-Strabismus will result in one eye being brighter than the
other, but both will be red.
-Acute Lymphocytic Leukemia is a blood cancer, and does
not affect the eyes.
, A nurse is assessing an infant who has recently recovered from a viral infection and
notes petechia on the face and torso. There are also several purpura and excessive
bruising. Which of the following is a priority action by the nurse?
A. Call child protective services and report the parents.
B. Document findings
C. Initiate a platelet transfusion.
D. Notify the provider and request a CBC.
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D. Notify the provider and request a CBC.
-This may be idiopathic thrombocytopenia purpura, which typically
presents a few weeks after a viral infection with petechiae, purpura, and
excessive bruising.
-Ordering a CBC will allow you to check the platelet levels, which will be
very low in a child with ITP (less than 50,000 is common).
1. What assessment findings would you expect with a child who has scoliosis?
2. What treatments are available for scoliosis?
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1. Asymmetry in scapula, ribs, flanks, shoulders, and hips. Improperly fitting
clothing with one leg appearing shorter than the other.
2. Treatment choice depends on the severity and location of the curvature.
Treatments include the following:
I. Bracing: These slow the progression of the curvature. Brace types include
Milwaukee, TLSO, Wilmington, and Charleston. These are worn for 23 hours
per day. Main concerns are skin integrity and client self-image.
II. Surgical fusion with rod placement: used for curvatures greater than 45
degrees.