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Indications of SIADH - - Lethargy, cheyne-stokes respirations, confusion. When
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blood sodium serum drops lower, seizures, coma and death can occur.
Manifestations of fluid vol excess: tachycardia, distended neck veins, weight gain w/o
edema, crackles in lungs, intake is greater than output, and poss. HTN
Planning care for child after tonsillectomy - - Provide ice collar for comfort measure
and reduce swelling.
Post Op Care of Cleft Lip - - Avoid sucking on nipple or pacifier, or using spoons, fork
or other objects that may damage incision site.
Apply elbow restraints and assess skin, provide movement, and comfort.
Use hydrogen peroxide to clean site.
Gently suction secretions from mouth and nasopharynx.
Teaching about juvenile idiopathic arthritis - - Encourage child to participate in
physical therapy program.
Encourage activity as tolerated, full ROM.
Encourage warm baths, apply heat and moisture to affect joints prior to exercise.
Collab with school nurse and teachers to arrange for care during school day.
Viral Meningitis - - Expected manifestation: nuchal rigidity
Brain Tumor - - Identifying Manifestations:
-Severe headaches upon awakening, coughing, and straining.
, -Change in personality, inability to manage emotions.
-Nausea with or w/o vomiting
-Ataxia or clumsy movement
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Left sided heart failure - - Pulmonary manifestations:
-edema to left side of the heart
-crackles heard on lungs, wheezes
-cyanosis
-dysnpea
-blood tinged sputum
-tachypnea or tachycardia
What is a "tet" spell? - - An episode of severe hypoxia and cyanosis in a child with
tetralogy of fallot
What is Tetrology of Fallot? - - a congential malformation of the heart marked by four
abnormalities: defect in the interventricular septum, pulmonary artery stenosis,
dextroposition of the aorta, and right ventricular hypertrophy
What cause delayed diagnosis of sickle cell anemia can be from the presence of fetal
hemoglobin during their first year of life? - - high hemoglobin prevents blood from
sickling of red blood cells in the infant
Prioritizing nursing actions for an 8 YO who swallowed twelve 325mg Tylenol tablets in
order - - ensure a patent airway, prepare to administer activated charcoal, complete
a history of event and physical exam, and lastly check blood acetaminophen levels