NRSG 421 PEDS FINAL EXAM
QUESTIONS WITH CORRECT ANSWERS
Safe use of essential oils - ANS-Get a trusted brand, allergies especially if topical
Patient teaching regarding use of alternative treatments: - ANS-Should always be approved by a
physician before starting
Just because something is "natural" does not mean it is safe
Low risk versus high risk alternative therapies/treatments: - ANS-When possible choose the least
invasive way to deliver a treatment (e.g. aromatherapy of oils would be safer than ingesting or topical
administration)
Low risk: aromatherapy, balneotherapy (water therapy), biofeedback, reflexology reiki, ayurvedic
medicine (combo holistic)
High risk: acupuncture, hypnosis, ingestion, topicals
Pathophysiology of type I diabetes: - ANS-Characterized by destruction of the beta cells, usually leading
to absolute insulin deficiency
autoimmunity , genetics, and environmental factors (can follow a viral infection) contribute to
destruction of beta cells, onset typically in childhood and adolescence but can occur at any age, most
DM of childhood is type 1
Deficiency of insulin, glucose is unable to enter the cell and remains in the blood, causing hyperglycemia
When serum glucose exceeds the renal threshold, glucose spills into urine (glycosurie), cells break down
protein for conversion to glucose by the liver (gluconeogenesis)
*insulin brings glucose and K+ into cells*
Causes and s/s of DKA: - ANS-Causes: insulin deficiency, in association with increased levels of
counterregulatory hormones (glucagon, growth hormone, cortisol, catecholamines), and *dehydration*,
electrolyte imbalance, acidosis are the primary causes
S/S: kussmaul respirations (rapid, deep), anion gap (12+), dysrhythmias, ketonuria, fruity breath, N/V,
muscle cramping (low K+), frequent urination, extreme thirst, hyperglycemia, abdominal pain,
confusion.
Expected lab results of child with hypothyroidism: - ANS-Low T3 and T4, high TSH
Normal blood glucose levels for a child: - ANS-A1C of less than 7.5%
Target blood glucose 90-130 mg/dl before meals
Target blood glucose levels 90-150 at bedtime and overnight
,Glycemic target must be tailored to the individual patient (prepubertal may need more insulin due to
increased metabolic rate)
Treatment of child with type 1 diabetes and hypoglycemia: - ANS-15 g in 15 min and recheck in 15 min,
orange juice
Glucagon IM if unconscious
Expected lab results for a child with Cushing's syndrome: - ANS-High levels of ACTH levels, high levels of
cortisol and glucocorticoids (FBG, electrolytes, 24-hour urine)
X-ray may show osteoporosis and skull films to look for enlargement of sella turcica
Appropriate interventions for a child with Cushing's: - ANS-Depends on etiology:
Surgery (for adrenal or pituitary tumors)
Slow wean off of steroids (for exogenous steroid preparations) to prevent adrenal crisis
Replacement of GH, ADH, TH, gonadotropins, and steroids
S/S of cushing's - ANS-Excessive hair growth, hirsutism, moon face, red cheeks
Centrally located fat distribution: truncal obesity, pendulous abdomen with red striae, dorsocervical fat
pad
Slowed linear growth, poor wound healing (immune suppression, low cortisol and increased glucose cx
more bacteria), ecchymoses
S/S of low and high blood glucose - ANS-Hypoglycemia: cool and clammy, diaphoresis, tremulousness,
tachycardia, hunger, weakness, pallor, and dizziness; HA, irritability, poor coordination, combativeness,
double vision, and confusion; unconsciousness and seizures
Hyperglycemia: hot and dry, polyuria, polydipsia, polyphagia, HA, malaise
age appropriate self care for a child with type I diabetes - ANS-Nutrition
Exercise
Teach pt and family how to manage hypoglycemic episodes
Illness management
Management of DKA
Remember developmental stage and adolescence wanting to be independent: preschool (caregiver does
it all), school-age (share responsibility)
Labs associated with hyperglycemia (BS, K, HgA1C) and causes for abnormalities - ANS-BS: > 130 before
meals, > 150 before bed and overnight; caused by too little insulin
K: < 3.5 due to peeing it out with the glycosuria
HgA1C: >7.5% due to excess glucose in the blood and binding to RBCs
Identifying actual, potential and perceived losses: - ANS-Actual: any loss of a person or object that can
no longer be felt, heard, known, or experienced
Ex: loss of body part, losing earrings
Potential: anticipated, likely to happen in the future
Ex. daughter will die soon
Perceived: loss that is uniquely defined by the grieving client; occurs when someone perceives that loss
of someone or something they are attached to has occurred
Anything that is thought of as a loss
, Stages of grief and potential behaviors associated with each stage: - ANS-Normal grief:
Kubler Ross: denial/shock, anger, bargaining, depression, acceptance
Bowlby: protest, despair, detachment (transitional objects)
Engel: shock/disbelief, develop awareness, restitution, resolve the loss, idealization
S/S: somatic distress, sense of unreality, preoccupation with image of the one who died, preoccupation
with guilt, irritability and anger in response to others, talks a great deal about the person who has died,
restlessness, inability to sit still, changes patterns of activities
Morbid grief:
S/S: delay of reaction, distorted reactions (illness, symptoms of deceased), alterations in relationships
with others, hostility against specific persons, agitated depression
Worden's 4 stages of loss - ANS-To accept the reality of the loss
Coming to terms with loss, may still have shock or disbelief, acceptance may simply mean a mark of the
moment we are ready to begin our journey of healing
To work through the pain and grief
Must be willing to go through it not around it, feel all of the feels, complex
To adjust to a new environment
Resume normal routine, learning new skills to adapt
To find an enduring connection with the deceased while moving forward with life
Allowing for thoughts and memories while simultaneously engaging in the activities that are meaningful
to us and that bring us pleasure
Ages associated with infant loss related to SIDS: - ANS-The risk for SIDS peaks between 2 and 3 months
of age, and it occurs more often in male infants than in females (< 1 year old)
Interventions for a parent experiencing loss of a newborn: - ANS-One way to recognize appropriate care
for children and their families in regard to their spiritual and cultural needs is listening to what they are
most fearful about
Different cultural and spiritual backgrounds may cause different kinds of fear in the child and family
Address those fears and let the child and family express any emotions that may go along with those
fears.
Assessing appropriate cultural and spiritual beliefs in regards to touch and comfort. Depending on their
background, holding family members may be an appropriate way to care for them during a time of loss.
Recognize and care for children and families by giving them time to grieve and express emotions alone.
Give them time to themselves, and when you are in the room, be attentive but not obtrusive.
Interventions included in palliative care for a child: - ANS-Help meet their needs in any way - talk or play
Don't treat them like adults
Don't lie, let them understand they are not responsible
Give them permission to rest, have parents at bedside, comfort care
Healthy communication with a children or parents related to loss: - ANS-Explain cause, allow children to
attend funeral, allow children to express feelings and fears, teach children about death and about life,
QUESTIONS WITH CORRECT ANSWERS
Safe use of essential oils - ANS-Get a trusted brand, allergies especially if topical
Patient teaching regarding use of alternative treatments: - ANS-Should always be approved by a
physician before starting
Just because something is "natural" does not mean it is safe
Low risk versus high risk alternative therapies/treatments: - ANS-When possible choose the least
invasive way to deliver a treatment (e.g. aromatherapy of oils would be safer than ingesting or topical
administration)
Low risk: aromatherapy, balneotherapy (water therapy), biofeedback, reflexology reiki, ayurvedic
medicine (combo holistic)
High risk: acupuncture, hypnosis, ingestion, topicals
Pathophysiology of type I diabetes: - ANS-Characterized by destruction of the beta cells, usually leading
to absolute insulin deficiency
autoimmunity , genetics, and environmental factors (can follow a viral infection) contribute to
destruction of beta cells, onset typically in childhood and adolescence but can occur at any age, most
DM of childhood is type 1
Deficiency of insulin, glucose is unable to enter the cell and remains in the blood, causing hyperglycemia
When serum glucose exceeds the renal threshold, glucose spills into urine (glycosurie), cells break down
protein for conversion to glucose by the liver (gluconeogenesis)
*insulin brings glucose and K+ into cells*
Causes and s/s of DKA: - ANS-Causes: insulin deficiency, in association with increased levels of
counterregulatory hormones (glucagon, growth hormone, cortisol, catecholamines), and *dehydration*,
electrolyte imbalance, acidosis are the primary causes
S/S: kussmaul respirations (rapid, deep), anion gap (12+), dysrhythmias, ketonuria, fruity breath, N/V,
muscle cramping (low K+), frequent urination, extreme thirst, hyperglycemia, abdominal pain,
confusion.
Expected lab results of child with hypothyroidism: - ANS-Low T3 and T4, high TSH
Normal blood glucose levels for a child: - ANS-A1C of less than 7.5%
Target blood glucose 90-130 mg/dl before meals
Target blood glucose levels 90-150 at bedtime and overnight
,Glycemic target must be tailored to the individual patient (prepubertal may need more insulin due to
increased metabolic rate)
Treatment of child with type 1 diabetes and hypoglycemia: - ANS-15 g in 15 min and recheck in 15 min,
orange juice
Glucagon IM if unconscious
Expected lab results for a child with Cushing's syndrome: - ANS-High levels of ACTH levels, high levels of
cortisol and glucocorticoids (FBG, electrolytes, 24-hour urine)
X-ray may show osteoporosis and skull films to look for enlargement of sella turcica
Appropriate interventions for a child with Cushing's: - ANS-Depends on etiology:
Surgery (for adrenal or pituitary tumors)
Slow wean off of steroids (for exogenous steroid preparations) to prevent adrenal crisis
Replacement of GH, ADH, TH, gonadotropins, and steroids
S/S of cushing's - ANS-Excessive hair growth, hirsutism, moon face, red cheeks
Centrally located fat distribution: truncal obesity, pendulous abdomen with red striae, dorsocervical fat
pad
Slowed linear growth, poor wound healing (immune suppression, low cortisol and increased glucose cx
more bacteria), ecchymoses
S/S of low and high blood glucose - ANS-Hypoglycemia: cool and clammy, diaphoresis, tremulousness,
tachycardia, hunger, weakness, pallor, and dizziness; HA, irritability, poor coordination, combativeness,
double vision, and confusion; unconsciousness and seizures
Hyperglycemia: hot and dry, polyuria, polydipsia, polyphagia, HA, malaise
age appropriate self care for a child with type I diabetes - ANS-Nutrition
Exercise
Teach pt and family how to manage hypoglycemic episodes
Illness management
Management of DKA
Remember developmental stage and adolescence wanting to be independent: preschool (caregiver does
it all), school-age (share responsibility)
Labs associated with hyperglycemia (BS, K, HgA1C) and causes for abnormalities - ANS-BS: > 130 before
meals, > 150 before bed and overnight; caused by too little insulin
K: < 3.5 due to peeing it out with the glycosuria
HgA1C: >7.5% due to excess glucose in the blood and binding to RBCs
Identifying actual, potential and perceived losses: - ANS-Actual: any loss of a person or object that can
no longer be felt, heard, known, or experienced
Ex: loss of body part, losing earrings
Potential: anticipated, likely to happen in the future
Ex. daughter will die soon
Perceived: loss that is uniquely defined by the grieving client; occurs when someone perceives that loss
of someone or something they are attached to has occurred
Anything that is thought of as a loss
, Stages of grief and potential behaviors associated with each stage: - ANS-Normal grief:
Kubler Ross: denial/shock, anger, bargaining, depression, acceptance
Bowlby: protest, despair, detachment (transitional objects)
Engel: shock/disbelief, develop awareness, restitution, resolve the loss, idealization
S/S: somatic distress, sense of unreality, preoccupation with image of the one who died, preoccupation
with guilt, irritability and anger in response to others, talks a great deal about the person who has died,
restlessness, inability to sit still, changes patterns of activities
Morbid grief:
S/S: delay of reaction, distorted reactions (illness, symptoms of deceased), alterations in relationships
with others, hostility against specific persons, agitated depression
Worden's 4 stages of loss - ANS-To accept the reality of the loss
Coming to terms with loss, may still have shock or disbelief, acceptance may simply mean a mark of the
moment we are ready to begin our journey of healing
To work through the pain and grief
Must be willing to go through it not around it, feel all of the feels, complex
To adjust to a new environment
Resume normal routine, learning new skills to adapt
To find an enduring connection with the deceased while moving forward with life
Allowing for thoughts and memories while simultaneously engaging in the activities that are meaningful
to us and that bring us pleasure
Ages associated with infant loss related to SIDS: - ANS-The risk for SIDS peaks between 2 and 3 months
of age, and it occurs more often in male infants than in females (< 1 year old)
Interventions for a parent experiencing loss of a newborn: - ANS-One way to recognize appropriate care
for children and their families in regard to their spiritual and cultural needs is listening to what they are
most fearful about
Different cultural and spiritual backgrounds may cause different kinds of fear in the child and family
Address those fears and let the child and family express any emotions that may go along with those
fears.
Assessing appropriate cultural and spiritual beliefs in regards to touch and comfort. Depending on their
background, holding family members may be an appropriate way to care for them during a time of loss.
Recognize and care for children and families by giving them time to grieve and express emotions alone.
Give them time to themselves, and when you are in the room, be attentive but not obtrusive.
Interventions included in palliative care for a child: - ANS-Help meet their needs in any way - talk or play
Don't treat them like adults
Don't lie, let them understand they are not responsible
Give them permission to rest, have parents at bedside, comfort care
Healthy communication with a children or parents related to loss: - ANS-Explain cause, allow children to
attend funeral, allow children to express feelings and fears, teach children about death and about life,
