NSG 3600 Paediatrics Exam 4 | Complete Solutions | Galen College of Nursing

Pediatrics Exam 4
Unit 9 Neurological and Cognitive, Endocrine
Chapter 25: Cognitive/Psychosocial Impairment pg. 847, ADHD: 855-856, Downs: 848, Autism: 848, 866-868,
Maltreatment: 857-859
Chapter 19: Endocrine pg. 633, DM1 pg. 665-672, DM2: 672, DKA: 674-677, Precocious Puberty: 648-649,
PKU: 864 + 360, Hypothyroidism: 653-654
Medications: Levothyroxine, Dextroamphetamine & Amphetamine & Lisdexamfetamine, Methylphenidate
Cognitive/Psychosocial Impairment
 ADHD
o Pathophysiology/Etiology:
 Unknown cause
 Neurotransmitters DA (dopamine) and NE (norepinephrine) are thought to be involved
o Clinical Manifestations:
 Inattention
 Behaviors displaying hyperactivity
 Impulsivity
o Diagnosis:
 Medical & developmental history
 Physical exam
 Vision& hearing assessment
 Detailed neurological evaluation
 Behavior checklists
o Management: Three-Pronged Approach
 Pharmacologic/medication:
 Psychostimulants:
o Methylphenidate
o Dextroamphetamine
o Amphetamine
o Lisdexamfetamine
 Behavioral Therapy
 Prevention of undesired behavior/parenting skills
 Counseling
 Peer group work
 Family therapy
 Environmental Manipulation:
 Environment modified to allow the child to be successful

, Down Syndrome, Trisomy 21
o Pathophysiology/Etiology:
 Most common chromosomal abnormality: 47 chromosomes present, usually as Trisomy
of the 21st pair
 Changes in the development of the body & brain
o Clinical Manifestations:
 Poor muscle tone
 Wide-spaced nipples
 Slanting eyes
 Hyperflexibility of the joints
 Flat bridge of the nose
 Short neck with extra folds of the skin
 Small statures
 Low-set ears
 Simian crease
 Protruding tongue
 Cardiac: valve disease
 Renal and radial abnormalities
 Decreased immune function
o Diagnosis:
 Chromosomal blood test
 Low level of alpha-fetoprotein
 DNA or karyotyping reveals 3 copies of chromosome 21
o Management:
 Therapeutic/Nursing Management
 Assist new parents with information & resources
 Early intervention

, ASD (Autism Spectrum Disorder)
o Pathophysiology:
 Continuum of disorders that involve limitations in social relatedness, verbal & nonverbal
communications, & range of interest & behaviors
o Etiology:
 Unknown (not immunizations)
o Clinical Manifestations:
 Impairment in social reciprocity
 Inability to maintain eye contact
 Impaired communication
 Restrictive or repetitive behaviors, interests, or activities
o Diagnosis:
 “First Signs” program
o Management:
 Therapeutic/Nursing Management
 Early Intervention
 Be aware of the child’s physical boundaries & reluctance to be touched by
others
 Routine is VERY important
 Education:
 CDC ALARM acronym as a means of understanding autism & its treatment
o A = autism is prevalent
o L = listen to patients/parents
o A = act early
o R = refer
o M = monitor
 Maltreatment of Children
o Pathophysiology/Etiology:
 Includes abuse and neglect of a child less than 18 years of age by anyone who is a
caregiver or in a custodial role
 Physical, sexual, emotional abuse, or neglect
o Clinical Manifestations:

, o Diagnosis:
 H&P
 X-ray
 Serum chem labs for infection, drug induction, toxicity
o Management:
 Therapeutic/Nursing Management
 Identify risk factors related to maltreatment
 Teach parents and caregivers appropriate ways to discipline the child, about the
use of alcohol and drugs during pregnancy, and discourage caregivers from
substance use
 Educate children and adolescents about the body and personal boundaries
 Report suspected child abuse to the local enforcement agency and/or follow
clinical agency guidelines for reporting

Endocrine
 Type 1 Diabetes
o Pathophysiology/Etiology:
 Not preventable
 Autoimmune disease that causes destruction of pancreatic cells that produce insulin
o Clinical Manifestations:
 Polyuria
 Polydipsia
 Polyphagia
 Skinny/weight loss
o Diagnosis:
 Blood glucose:
 < 2 yr: 60-100 mg/dL
 >2yr: 70-110 mg/dL
 HgBA1c:
 <6%
o Management: