NUR 208 / NUR208 Exam 2 Version 2 (2026–2027 Updated) Mental Health Nursing | Complete Questions and Answers | Verified Accurate Solutions | Grade A -Fortis

…..DLDD NUR 208 / NUR208 Exam 2 Version 2 (2026–2027 Updated) Mental Health Nursing | Complete Questions and Answers | Verified Accurate Solutions | Grade A -Fortis Q. Which of the following is mostly to be emphasized in a favor assist suicide ANSWERS the importance of dignity Q. Denies....paralyzed ANSWERS power of attorney, advanced directive Q. On 30th birthday Suzie made statement it not to be on life support ANSWERS living will Q. Late stage pancreatic Cancer , reject drugs ANSWERS euthanization Q. What is true of gender difference in widowhood ANSWERS women more likely to be widowed than men Q. Janice lost mom in car crash, left in daze and emotional distress and pain for year ANSWERS chronic grief Q. After death of daughter, went to therapy, after year her grief followed grief pattern what made her go to this conclusion ANSWERS after experiencing distress and pain by end of year accepted the loss Q. According to grief model loss of loved ones, grief starts with ANSWERS disbelief Q. 3mo ago, 55 yo chronic illness devastated initially speaks about issues and says death around corner of which state ANSWERS acceptance Q. Sense of being out of body and vision bright lights is concept of ANSWERS near death experience Q. In nursing home improve hospice care with comfort, workers will attend meeting and most likely receive ANSWERS counseling and therapy to alleviate physical pain and anxiety Q. Daughter of 80yo man used his pain med ANSWERS elder abuse Q. Whether or not living with adult child depends on ANSWERS quality of relationship in past Q. Which of the following is true about old adults aging in place ANSWERS live with or without assisstance Q. Older adults are happy or more satisfied than life of younger adults ANSWERS happiness high at 18, decline after 50 Q. True of alzheimers ANSWERS gradually robs patient development and intelligence decrease ability to control bodily functions Q. Enhances life of elderly people ad solves problems elderly face which is the study of ANSWERS gerentology Q. Gianna 45yo, full time job, difficult raising two sons, required to take care of in laws who have chronic conditions ANSWERS sandwich Q. 50 yo nicole children move out, all her life she cared for them, after they moved out, she could pursue acting and decided to go to workshop ANSWERS empty nest Q. Helen dreamed to become actor, 41yo has career has not shaped life, time is running out, her stressful period illustrates ANSWERS mid life crisis Q. Christine 40yo female, retired firefighter, works with family, decided to take part time job BLS instructor ANSWERS bridge retirement Q. Practice often followed by middle age parents cut back work hours ANSWERS phase retirement Q. In the context of post formal thought process, unlike younger adults, more mature adults ANSWERS integrate logic with intuition and emotion Q. Roxanne 50 yo, menopause, low estrogen, BMI 19, most likely to have ANSWERS rapid bone loss Q. True of psychosocial connection of economic status and health ANSWERS unlike people with low those with high have better support and get better medical attention when they need it Q. 61 yo female, stroke, admitted to hospital, tell husband high glucose level, which can cause stroke, most likely hase ANSWERS type 2 DM Q. In context of changing in reproduction, middle aged men ANSWERS ED Q. Bertha 49 yo, female, does not get monthly vaginal bleeding for a year ANSWERS menopause Q. True of bone loss in middle adulthood ANSWERS smoking, alcohol use in early adulthood tend to speed up bone loss Q. True statement about male involvement in parenthood ANSWERS when women work more and get paid more, fathers tend to step in and get more involved Q. True about timing of event of development of psychosocial ANSWERS holds back course of development occurs in someones life Q. Content of psychosocial development, normative crisis of young adulthood is ANSWERS intimacy vs. isolation Q. Identify true state about secure ethnic identity ANSWERS high self esteem Q. Why do transgender people have higher depression, suicide, and ED rates ANSWERS response to rejection, stigma, social pressure Q. According to CDC, infertility is defined as not seeing baby for how long after how long ANSWERS 1 yr Q. Common ways STIs occur ANSWERS casual sex in college students Q. Which of the following is true about depression in young adults ANSWERS adolescence is a sensitive period for the onset of depressive disorders Q. Compulsive drinkers for the last 4 years ANSWERS undergo detox and rehab center Q. Which of the following is true about social integrations ANSWERS act of engagement in a broad range of social relations Q. Research states, better education are more health than less education ANSWERS people who are less effulent are more likely to smoke than high Q. Which of the following are true about alcohol amongst young adults ANSWERS college students tend to drink more frequently and heavily Primary reason people cant stop tobacco use addiction Joe is in study, sleep deprivation, 4 hrs of sleep, 5 days, which change is expected because of sleep deprivation ability to avoid distractions decreases Research conclude individuals that are secure in relationship use more adaptive coping skills martha overcomes the grief of losing her mom with her husband Which of the following is recommended for physical activity in adults 18-64 should do 75-100 min a week Losing loss of low pitched hearing low-frequency loss Specific type euthanasia if they insert a needle to kill active euthanasia Assessing skin breakdown -nasal cannula, remove sat off foot every couple hrs, check IV (soft, hard, crys when touched) Children’s understanding of health and illness -Young children have limited knowledge about the body and its relation to health and illness -Knowledge of a child's understanding of health and illness is essential in assisting a child to adapt to the hospital experience -Infants, toddlers, and preschoolers lack the cognitive skills to understand hospitalizations and likely will exhibit regressive behaviors Significant stressors for hospitalized children of all ages -Separation from parents or peers -Loss of self control, autonomy, and privacy -Painful and/or invasive procedures -Fear of bodily injury Goals of nursing care of the hospitalized child -prevent or minimize physical stressors (EMLA cream, therapeutic hugging, pain management) -prevent or minimize parent-child separation (room in accommodations, presence during procedures) -Promote a sense of control for child and family (home routine, primary nursing, allow choices, securtiy items) -Utilize excellent communication skills (update on plan of care, provide literature, provide suggestions) How can you prevent or minimize physical stressors in a child - EMLA cream - therapeutic hugging - pain management How can you prevent or minimize parent- child separation - Room in accommodations - presence during procedures How can you promote a sense of control for child and family - Home routine - Primary nursing -Allow choices - security items How can you utilize excellent communication skills - Update on plan of care -provide literature -provide suggestions Toddler -Most at risk because they realize their routine has been disrupted, so encourage continued rituals if possible Infant -Stranger anxiety- provide consistent caregivers Infant -Provide means of oral stimulation with pacifiers, toys, etc Infant -Minimize sensory overload- cluster care! Toddler -Separation anxiety-significant protest Toddler -Autonomy is threatened- offer choices when possible Toddler -Fears of bodily injury, fear of dark, immobilization and loss of self- control. Preschooler -Greatest stressors for this group are fears; fear of being alone, fear of the dark, abandoment, and fear of bodily injury Preschooler Stage of initiative vs. guilt, stage- encourage independence and offer choices Preschooler -Encourage room in, phone calls if cant stay, provide idea of when to expect parents return Preschooler -Provide honest information to develop trust School age -rely on parents for support and understanding School age - Stressors include loss of control of bodily functions, privacy issues, concerns related to death and separation from family/friends School age - Provide honest info School age - Industry vs. inferioity- self worth from involvement in activities. Allow child to participate in care as much as possible. Adolescent - Appearance and body image are the focus for this age group Adolescent - Identity and independence is important. Frustration and anger due to increase dependence on parents. Adolescent -Staff should respect need for privacy and independence. Knock- ask permission before assessments and procedures Adolescent -Careful listening, Encourage discussion of thoughts and feelings Adolescent - Allow visits and interaction with peers Family responses to hospitalization - Disruption of family routine - Change in parental roles - Roles of family members change - Family need to recieve information about child's condition - Cultural influences - Effect on siblings Effects on siblings -May receive less attention from overwhelmed parents - Younger siblings may feel guilty and confused -Allow siblings to express feelings - May experience nightmares about ill sibling - Provide age appropriate info about siblings illness - Encourage siblings to visit. Prepare siblings about what to expect - If unable to visit, provide other means of communication Family assessment - Determine family roles - Assess knowledge of childs conditon -Assess support systems (finances, coping strategies, access to health care) - Effects on siblings Child life specialists (cls) - Specially trained individual who provides programs that prepare children for hospitalization, surgery and other procedures that could be painful - Works with health care team and parents to promote the childs well-being Preparation for procedures - Children need preparation before the procedure, support during the procedure and after the procedure -Use positions that are comforting the child- therapeutic hugging -May use distraction methods- bubbles, music, video - Utilize child life specialist Before the procedure - Use age appropriate description and explanation for procedure - Inform where procedure will occur (radiology, treatment room) - Introduce strange equipment (MRI, CT scan) -Discuss length of procedure, strange noises, taste, smell, etc. - Inform the child if there will be pain - Allow the child to cry or scream Before the procedure: Psychological - Involve therapeutic play - Consider child's temperament, coping strategies, and developmental stage - Establish trust and provide support - Include child's parents for comfort - Give short, simple explanations. Avoid double meaning or confusing words. Confusing words -ICU (I see you), "specail room with your own nurse" - Stool (like you sit on) "poop" or childs word for it" - Urine (you're in) "Pee" or childs word for it" -Shot (children are scared of shots), "Medcation under the skin" During the procedure - Use firm, positive approach - Encourage cooperation by involving child in decision making - allow choices if possible - allow child to express feelings of anger, anxiety, fear, frustration - explain importance of holding still - use distraction methods - use comforting positions After the procedure - Hold and comfort the child - cuddle and soothe infants - encourage expression of feelings through play (dramatic play) - praise child for appropriate behavior during the procedure and after Pain management - Effective pain treatment is the right of every infant and child - culture and social learning influence the child's expression of pain - utilize age approriate pain assessment scales (FLACC, FACES, numeric) - non pharm methods and pharm interventions Wong- baker faces pain scale - 0- no hurt - 2- hurts a little bit - 4- hurts little more - 6 - hurts even more - 8 - hurts whole lot - 10- hurts worst FLACC pain scale - Face 0 - no particular expression or smile 1 - Occasional grimace or frown, withdrawn, disintenested 2 - Frequent to constant frown, quivering chin, clenched jaw -Legs 0- Normal position or relaxed 1- Unesasy, restless, tense 2- Kicking or legs drawn up - Activity 0- Lying quietly, normal postion, moves easily 1- Squirming, shifting back and forth, tense 2- Arched, rigid, or jerking - Cry 0- No cry (awake or asleep) 1- Moans or whimpers; occasional complaint 2- crying steadily, screams or sobs, frequent complaints - Consolability 0- content, relaxed 1- Reassured by occasional touching, hugging, or being talked to; distractible 2- Difficult to console or comfort *Results are from 0-10 Communication - Effective communication with children and their parents is crucial in providing quality nursing care - Leads to increased knowledge for the child and family - Nurses must communicate with different ages of children and their parents - Effective communication and teaching can help foster feelings of control and improve the ability to cope. Communication with parents - Be honest, parents want to feel valuved and equal partners in the health care team - Allow parents to express concerns and ask questions - explain equipment and procedures thoroughly - explain short- term and long- term effects - teach and encourage parental involvement in care Communication with children - Introduce yourself. Allow the child time to 'warm up' to you. Talk to parents first - Smile, use clear, calm words and phrases - Communicate at child's eye level - spend time and incorporate play with younger children - allow children to express feelings and thoughts - offer choices when they exist - Ask permission if you need to approach the child Use of play - Play is significant part of childhood, and hospitalization increases the value of play - Play allows the child to learn about health, express anxieties, and achieve a sense of mastery over situations Therapeutic play - Play that allows child to deal with fears, concerns, and stressors of hospitalization - benefits the child and health care team - child has a sense of control of occurrences during play - control helps reduce the child's stress and anxiety about events - child's coping methods can be observed - child's knowledge of illness or injury can be assessed- use of drawings Dramatic play - medical situation encountered are re enacted by the child in order to cope with painful tx or intrusice procedures - use of bandages, syringes without needles, stethoscope, and uniforms help encourage dramatic play Play therapy - mental health tech. used to treat children with mental health problems. To be performed by a specialist. Denver II developmental assessment tool - monitors childs dev. progress - administer to children from birth to 6 years of age - Denver II should be used for diagnostic purposes only when administers by specifcally trained personnel - Allows for prompt id and referall for eval. Denver dev. screening tool four major categories - Personal- social - Fine motor- adaptive - Gross motor - Language -Its a sreening test (not an IQ) test Denver dev. screening tool advantage and weakness - AV- it is easy to use and can be used by both professionals and medical assistants - WN- Identifying delays in children of different cultures/ lower SES groups A 4-year-old is seen in the clinic for a sore throat. The most likely causative agent in the child's mind is that he. -Yelled at his brother -Preschoolers understand some concepts of being sick, but not the cause of illness. They are likely to think that they are sick as a result of something that they have done. They frequently will view illness as punishment. An infant has been NPO for surgery for 4 hours, and does not have an intravenous line. The nurse receives a call from the operating room with the information that the surgery has been postponed due to an emergency. Which is the priority action for the nurse? -Call the physician to see if the infant needs to have an intravenous line started. -It is best to keep the infant NPO and consult the physician to see if an intravenous line is needed. The infant who is NPO is at high risk for dehydration. The nurse does not know how much longer it will be before surgery. The nurse cannot make the decision to feed the infant independently. Feeding the infant could postpone the surgery further should an operating room become available sooner than expected. A 5-year-old is in the playroom when the respiratory therapist arrives on the Pediatric Unit to give the child a scheduled breathing treatment. Which action should the nurse take? -Assist the child back to his room for the treatment, but reassure him that he may return when the procedure is completed. -Scheduled respiratory treatments should be performed on time, but the child should be allowed to return to the playroom as soon as the procedure is completed. In planning care for a hospitalized school-age child, which action will promote a sense of industry in this child? -Allow the child to assist with her care. -Allowing the child to participate in care will decrease the sense of loss of control and increase a sense of industry. The nurse needs to administer a medication in tablet form to a 4-year-old. Which action is appropriate? -Crush the tablet and mix it in a teaspoon of applesauce. -The medication should be crushed and mixed with a very small amount of food, not juice. The nurse must perform a procedure on a toddler. Which technique is most appropriate when performing the procedure? -Allow the child to cry or scream. -The child should be allowed to cry or scream during the procedure The parents of a critically injured child wish to stay in the room while the child is receiving emergency care. Which action should the nurse take? -Allow the parents to stay with the child -Parents should be allowed to stay with their child if they wish to do so. This position is supported by the Emergency Nurses Association, and is a key aspect of family-centered care. A 2-year-old child recently diagnosed with a seizure disorder will be discharged home on an anticovusant. Which action by the mother best demonstrates understanding of how to give the medication? The mother: -Draws up the medication correctly in an oral syringe and administers it to the child. -The best way for the mother to demonstrate understanding is to actually draw up and give the medication. A child is being discharged from the hospital after a 3-week stay following a motor vehicle accident. The mother expresses concern about caring for the child's wounds at home. She has demonstrated appropriate technique with medication administration and wound care. Which is the priority nursing diagnosis? -Parental anxiety related to care of the child at home -While all of the diagnoses might have been appropriate at some point, the current focus is the mother's anxiety about caring for the child at home. The priority is to develop a plan to assist in relieving the anxiety. Prior to assessing infant - hx, name, age, any machines in room , how they did last 24 hours, introduce self to parents, is baby sleeping or awake, check IV bands Assessing infants head - anterior frontals (soft, flat, bulding, sucken) Assessing infants heart - underneath gown, PMI, right below hip for 60 seconds for S1/S2, any abnormal sounds or murmurs Assessing infants respirations - count RR by looking at abdomen and nose - (infants less than 4 months are nose breathers so look for patency of nose) Assessing infants lungs - clear breath sounds, crackles, wheezles, courses -retractions between ribs, adbomen muscles, clavialar muscles, any assessory muscles -listen to posteir side and side to side Assessing infants abdomen - round, flat, distended THEN listen in all four quadrants, normal, hyper/hypo active. -if absent bowl sounds, listen for five minutes before declearing absent, and report to provider if still not sounds Assessing infants periferal pulses -RR, LR pulse, strong, weak, bounding, infants bracial pulse, capillary refill (pink, cynotic, clubbing) cap refill 3 sec. -pedal pulses, skin color, texture, warmth psychological stages of adjustment to a life threatening dx -ever changing set of behaviors that surface as the need for the aries -not linar stages, can go from stage 1 to 2 and back to 1 -support people in the stage that they are in psychological stages -shock and disbelief (denial) -adjustment : anger and guilt (may occur and recur at any time, may be directed at health care worker) : bargaining (attempt to postpone the inevitable), : depression (for past losses and anticipated or impending losses) -Acceptane : "A new normal" Stages of grief for anticipated loss of a child - Shock and disbelief - Expressions of grief - disorganization and despair - reorganization (resolution of grief may take years) Effect of life- threatening illness or disability on the psychosocial development of the child - The childs future, not just the illness, must be viewed as the priority -a child who is not just free of illness, but who is developmentally appropriate for age and well adjusted to the experience of having such an illness Cancer -leading cause of death from disease in children ages 3-15 and the 2nd cause from all causes. Long- term psychosocial consequences - factors related to FEWER adjustment problems; : young age of diagnosis : short course of tx/ minimal side effects : adsence of relapse or recurrence : absence of unresolved concerns about outcome of disease High risk for adjustment problems - Older age of diagnosis - Tx with cranial radiation - Residence in single parent household -The family plays a primary role in adaptation to childhood cancer survival. Nursing interventions to promote family's optimal adjustment - support parents in dealing with own feelings - provide guidance to parents about telling the child the dx (explanation tailored to child's cognitive ability, based on knowledge child already has- "honest" vs. "cruel" truth) - encourage parent to maintain discipline - provide info about support groups if the family desires and is ready for this -relate the child's understanding of death to his/her developmental level. - use childrens literature to help child/ family deal with death and grief Ex. of child literature that helps with child/ family deal with death and grief - Charleottes Web by E.B white - The tenth good thing about barney by judith viorst - the fall of freddie the leaf by leo buscaglia Etiologic (cause) factors re: cancer - ionizing radiation - DES (diethylstilbesterol) - (non steriod estrogen) - Genetic base - Chromosomal abnormalities - Immune deficiencies - Family tendency of clustering Cardinal sx of cancer in children -Fever -pain -mass - purpura (A rash of purple spots due to small blood vessels leaking blood into the skin, joints, intestines, or organs) - changes in balance, gait, personality Fever - Leukemia, lymphoma, neuroblastoma, wilm's tumor Pain - Leukemia, bone and brain Mass - Wilm's, neruroblastoma, lymphoma purpura - leukemia, neuroblastoma Changes in balance, gait, personality - brain tumors Chemotherapy -Most agents work by interrupting or altering cells preparing for or actively involved in cellular reproduction - can affect both normal and malignant cells - more active cells are more sensitive to chemo (both ca and normal cells) - given over an extended period of time: each time an agent given, it only destroys a fixed percentage of cells - given in combo with other agents: maximizes "cell kill", minimized side effects, decreases resistance to specific agents General side effects of chemo in GI system - rapidly dividing cells of GI system: : nausea and vomiting : anorexia and wt loss : mucositis (painful inflammation and ulceration of the mucous membranes lining the digestive tract) : constipation (vincristine) : General side effects of chemo in hair follicles - Alopecia (many children will prefer hats, ball caps, and scarves rather than wigs) General side effects of chemo in bone marrow (suppression) - Anemia - fatigue - Neutropenia - risk of infection (neutropenic precautions) - thrombocytopenia - low pts increase risk of bleeding. Other side effects of chemo - Neurologic complications - photosensitivity - electrolyte disturbances - hemorrhagic cystitis (inflammation of the bladder defined by lower urinary tract symptoms) - fever Cell damage from chemo - massive cellular damage from cytotoxic therapy releases large amounts of uric acid, which can accumulate and precipitate in renal tubules causing tubular obstruction- ****ALLOPURINOL may be given to control increasing uric acid. Radiation - For curative purposes - for palliation (relieves sx by shrinking the size of the tumor) - "Indirect hit" ionizes water molecules in cell, knocking off an electron. - forms "free radicals" which are toxic to cells - not as effective as "direct hit" - greater chance of recurrence - maximum effect occurs just prior to and during cellular division - well oxygenated cells are more sensitive to radiation, because O2 combines with free radicals to form toxic peroxide compounds - tumor cells frequently hypoxic = reason radiation pt may need transfustions Action of radiation - "Direct hit" damages key molecules in tumor cell - cell becomes unable to reproduce DNA or RNA - most effective Acute side effects of radiation - skin and mucosal inflammation - tissue edema and infammation - pneumonitis - nausea and vomiting - enteritis (A chronic inflammatory bowel disease that affects the lining of the digestive trac) - myelosuppression (condition in which bone marrow activity is decreased, resulting in fewer red blood cells, white blood cells, and platelets) - alopecia New treatments - Biotherapy: use of biologic response modifiers- agents or interventions that modify relationships between tumor and host by therapeutically changing host's biologic response to tumor cells. -Bone marrow transplantation: lethal doses of chemo often combined with radiation given to rid body of all cancer cells - once free of malignant cells and immune system suppressed to prevent rejection of transplanted marrow, donor marrow cells or cells stored fm pts own marrow given by IV transfusion. Long-term effects of chemotherapy - second malignancy (secondary ca) - liver cirrhosis (Chronic liver damage from a variety of causes leading to scarring and liver failure) - gonadal dysfunction - chromosome abberations - adrenal dysfunction - chronic cysititis - white and grey matter dysfunction - Soft tissue and visceral fibrosis - endocrine dysfunction - dental probs - cataracts - bony growth delay - white and grey matter dysfunction Leukemia - malignant hematopoietic disease in which poorly differentiated lymphocytes (blast cells), replace normal bone marrow elements - Leads to anemia, neutropenia, thrombocytopenia - most common form of childhood cancer (acute lymphoblastic leukemia - ALL) - 25% of all childhood ca - Peak onset 4 years of age - Classified by cell type and differentiation - 75% of childhood leukemia is ALL Leukemia- clinical manifestations - sx related to bone marrow suppression (anemia, neutropenia, thrombocytopenia) - sx related to invasion of bone marrow (bone and joint pain) - sx caused by hypermetabolism (anorexia) Leukemia- definitive dx - bone marrow biopsy or aspiration - central nervous sx involvement dx by lumbar puncture Leukemia- tx - Remission induction therapy : prednisone : vincristine : L- Asparaginase : Daunorubicin - Central nervous system prophylaxis : intrathecal administration of methotrexate and other chemotherapeutic agents Consolidation therapy - L- asparaginase - Doxorubicin Delayed intensification - Vincristine - Ara- C - Cyclophosphamide Maintenance therapy - Oral 6- mercaptopurine - IM methotrexate Reinduction - relapse - Prednisone - Vincristine - Combination of chemo drugs NOT previously used - Bone marrow transplantation becomes a tx option Lymphomas - Hodgkins disease - Non- Hodgkin lymphoma Hodgkin disease - Originates in lymphoid system and primarily involves lymph nodes - Metastasizes to: spleen, liver, bone marrow, lungs, mediastinum (a membranous partition between two body cavities or two parts of an organ, especially that between the lungs) - Main sx: non-tender, firm lymphadenopathy - Affects primarily 15-19 years old (adolescent) -confined to lymph so better than non hodgkins Hodgkins disease dx - based on clinical manifestation and lymph node bipspy (showing evidence of Steinberg- Reed cells) Hodgkins disease tx - radiation and chemo, depending on stage - 90% survival rate Non- Hodgkin lymphoma - Affects children less than 15 years (peak age 7-11 years) - Diffuse rather than nodular - cell type poorly or un- differentiated - dissemination occurs early, often, and rapidly (poorer prognosis) -Mediastinal involvement and invasion of meninges Non- Hodgkin lymphoma clinical manifestations - depend on anatomic site and extent of involvement Non- Hodgkin lymphoma tx - some combo of surgery, radiation, and chemo. Tumors of central or autonomic nervous system - Brain tumors: Most common solid tumors (2nd to leukemia in overall occurrence) - typed according to cell in which tumor has its origin or according to location (ex: Astrocytoma- cells astrocytes, medulloblastoma) Brain tumors - in children, majority of brain tumors are infratentorial (60%)- occur in posterior 1/3 of brain, primarily in cerebellum and brain stem - leads to frequency of sx of increased ICP. - remaining tumors in supratentorial area,- anterior 2/3 of brain, mainly cerebrum Brain tumor s/sx - Increased ICP - headache upon awakening - vomiting not related to eating - problems with balance/ walking Brain tumor tx - surgery - radiaiton - chemo Post-op of brain tumors - Observation for signs of complication: ICP, meningitis, respiratory tract infection (infectious state suspected if febrile state occurs 1-2 days after surgery), urine output (risk of diabetes insipidus). -Postitioning 1st 24-48 hours to prevent pressure on operative site, reduce ICP, and avoid aspiration - Infratentorial tumors: position flat and on side - Supratentorial tumors: position with head elevated above heart to facilitate CSF drainage and decrease excessive blood flow to brain. Neuroblastoma - Tumors originate from embryonic neural crest cells that give rise to adrenal medulla and sympathetic nervous system. - Majority develop in adrenal gland or retroperitoneal sympathetic chain (primary site within abdomen) - "silent" tumor, -70% dx after metastasis with first signs caused by involvement in nonprimary site - prognosis poor, younger the child, the better the prognosis Neuroblastoma tx - surgery to remove as much tumor as possible and biopsy for staging - radiation and chemo post-op. - radiation may impair brain development in children 3 Wims's tumor (nephroblastoma) - abdominal tumor - most frequent intraabdominal tumor of childhood and most common type renal ca - peak incidence at 3 years of age - evidence of genetic inheritance as autosomal dominant trait Wim's tumor clinical manifestations - presenting sx- swelling or mass in abdomen, firm, nontender, confined to one side and deep within flank - parent discover during bathing/ dressing Wims tumor pre-op - tumor not palpated unless absolutely necessary since manipulation may cause dissemination of ca cells to adjacent and distant sites Wims tumor tx - surgery (remove affected kidney) and chemo. - radiation, depending on age of child Malignant bone tumors - osterosarcoma - ewing's sarcoma - peak age of bone tumors 15-19 years - can arise from any tissue involved in bone growth Malignant bone tumor clinical manifestations - localized pain in affected area/ may by severe or dull/ often relieved by flexed position - often noticed by child limping, curtailing own physical activity, unable to hold heavy objects -*** pulmonary metastasis is the most common complication of primary bone tumors OSTEROSARCOMA vs. ewing's sarcoma - osterosarcoma most common - generally in metaphysis of long bone, especially those of lower extremities - tx usually involves chemotherapy and a "limb sparing" surgical procedure or sometimes radical surgical amputation osterosarcoma vs. EWING"S SARCOMA - arises in marrow spaces of bone - principal sites: shafts of long bones, trunk bones, and skull - tx: intensive radiation and chemo (surgery if possible - if can remove entire bone). How do you educate parent in shock and disbelief - short, repeative - if provider educating parent stay in room to repeat what provider said because they arent fully paying attention shock and disbelief (denial) - can show sense of hope as long as they dont stay in s/d for a long period of time What psychological stage does parents show how to medicate/feed pt etc. - acceptance Parent just got news their child doesn't have long left and says she excited to take child back home, what do you response - you dont have to respond at all Is it okay to cry with pt -yes, as long as they are not consulling you what do you say if pt says "this isnt fair for my child to go through this" -You're right its not what do you encourage no matter what stage they are in -normal growth and development How does preschoolers look at death - death isnt perminent wilms tumor is ca of the? -kidney leukemia chemo drug vincristine causes - constipation What labs and lab values will show anemia, neutropenia, or thrombocytopenia - Drug used for gault - allopurinol -prior to drug that effects kidney what do you do? -prior to drug that effects hearing? - IV bolus - Hearing test In A.L.L do not have bone marrow transplant unless -Relapse Leukemia tx takes about how long -three years When do anterior frontanals close - by 18 months Can mom give meds to baby? -Yes, but have to watch mom give baby meds and doc that mom wanted to give med to mom Do you have to have a restraint order to restrain baby while give iv med? -No How do you mix up crushed meds? - Do not mix with more than 1 bite, b/c then not know what amount was ate Where is IM injected b/4 one year old - Fatus lateralus (thigh) IM after one year old - Unless havent walked yet use ventroglutrol (side of glut) IM 3 yrs or older - Less than 1 ml like vacc or flu shot in arm Why do you need to watch NG tube water temp -Cold causes cramping - Hot causes buring Standard formula - 20 kcal per oz , record in ML How do you record breast feeding, baby food in chart - time on what breast - ml Weighing diapers - use an unused diaper to 0 out scale, place wet diaper on scale, assess odor, color, blood, remove whips - DOC in ML not grams Play for an infant - soft ( more fm home because cant wash with just spray) - bright color - tactile, touch, feel, visual, sounds - in sensory motor stage - soft books bc hand grasp - have to be able to be cleaned - moblies in crib Play for a toddler - items that move so they can walk - more activiity - pop up and push down books - more cardboard books, # books Play for preschoolers - Coloring books - sunglasses for dress up - kitchen food, pretend food, cleaning - magical thinking (wands, stuffed animals are real) Play for school aged - Small amount of toys - crafts - sequenced -concrete -task driven - collect items - jounals Play for adolescents - Phone - cards - video games - music with ear phones Medical play - operation, dolls - bubbles or pin wheels for ashthma managment bc blowing out expands lungs Head and chest cm should be? - The same/ close to the same size Infant - birth - 12 months - teaching parents Toddlers - 1- 3 years - tell right before procedure - brief sent for teaching -use struffed animals, wagon ride - in protest stage Preschoolers - 3-5 years - "fix or help" your throat - watch words - direct sent to them and parents - books,pics, drawing, dolls School age - 5-13 years - prepare a head of time - direct, concrete - videos, diagrams, touch equipment, models adolescent - 13-18 years - take like adult, communicate, teach back, videos, - privacy - biggest concern is body image and how soon can they go back to social life When does the neural tube close? - neural tube closure 21-28 days after conception Neural tubes may be prevented mostly by? - Folic acid supplements during the periconceptional period - 400mcg of folic acid taken during the periconceptional period protects against most neural tube defects (over the counter mult vit with folic acid and fully fortified breakfast cereals) Myelomeningocele - hernial protrusion of sac like cyst containing meninges, spinal fluid, and a portion of the spinal cord with nerves - severity of defect varies - often associated with hydrocephalus Myelomeningcele prenatal dx - US and elevated alpha- fetoprotien (AFP) Myelomeningcele pre-op - Prevent infection and trauma to fragile cyst : sterile, saline moist non adherent dressing to prevent drying : Prone postiion - education and support for parents - surgery usually done in 24 hours Myelomeningcele post op - Monitor VS, I/Os, observe bowel and bladder function, nourishment, signs of infection - prone or side- lying position - observe for signs of hydrocephalus - teach about latex allergy Hydrocephalus - Abnormal accumulation of cerebrospinal fluid (CSF) within the ventricles - Imbalance between the amount of CSF produced and rate at which it is absorbed - causes ventricles to enlarge and pressure inside head to increase - may be present at birth (ex. obstruction of cerebral aqueduct) Cerebral spinal fluid - CSF produced in the ventricles, circulates through the ventricular system, and is obsorbed into the bloodstream - CSF constantly circulates and protects brain and spinal cord against injury Hydrocephalus may be acquired: - spina bifida - intraventricular hemorrhage - meningitis - head trauma - tumors - cysts Hydrocephalus communicating - impaired absorption of CSF within the subarachnoid space Hydrocephalus noncommunicating - Obstruction to the flow of CSF within the ventricles Hydrocephalus tx - Relief of hydrocephalus (VP shunt) - tx of complications - Management of probs r/t effect of disorder on psychomotor development Hydrocephalus pre op - Observe carefully for sx of increased ICP (bulging fontanel/ vomiting in infant) - daily head circumference - small freq feedings - prepare for dx tests (CT and MRI) Hydrocephalus post op - positioned on unoperated side - keep flat initailly (too rapid drainage- can lead to subdural hematoma) - Increases ICP: elevation of HOB or sitting postion - Carefully monitor I/O - watch for infection/ shunt malfunction - teach sx of shunt malfunction/ infection (persistent infection requires shunt removal/ revision) - avoid sedation initially : level of consciousness is significant observation Ventriculoperitoneal shunt (VP shunt) - Insertion of a catheter with a valve into a lateral ventricle and tunneled under scalp, down the neck. - Insertaion of another catheter into the peritoneum via a small incision, tunneled upward to a pnt where it is joined with the other catheter. - Valves designed to open at a predetermined inter ventricular pressure (to drain CSF) and close when pressure falls below that level Meningitis - Viral and bacterial (infants have increased risk of developing systemic infections) - caused by variety of bacterial agents (HIB, streptococcus pneumonia, neisseria meningitides) - occurs as extension of a variety of bacterial infections (vascular dissemination fm focus of infection elsewhere in body). - abrupt onset of sx in children and adolecents Meningitis dx - by CSF analysis - increased CSF pressure - fluid may be cloudy vs. clear - increased protein in CSF - low glucose level in CSF - postive culture of CSF if bacterial Meningitis clinical manifestations - Nuchal rigidity : (sensation of soreness or discomfort in the neck when trying to move it or turn the head from side to side), which may progress to opisthotonus (spasm of the muscles causing backward arching of the head, neck, and spine) - Kernig reflex : reflex contraction and pain in hamstring muscles when attempting to extend leg, after flexing the thigh upon the body - Brudzinski : flexing childs head, while he is supine position, causes pain or involuntary flexion of knees. Meningitis tx - Isolation (first 24 hours- until 24 hours of antibiotic therapy if bacterial) FIRST THING TO DO IF EXPECT MEN. - antimicrobial therapy (until CSF normal) - optimum hydration - maintenance of ventilation - decrease of increased ICP - management of bacterial shock - control of seizures - control of extremes of temp - correction of anemia - tx of complications Reye's syndrome - acute metabolic encepthalopathy - fever, profoundly impaired consciousness with impaired hepatic function - epidemiology: 2 months to adolescents (greater 6-11 years) Reyes syndrome etiology - follows common viral illness: :ex : influenza and varicella, from which child seems to be recovering **- Has been associated with aspirin taken during prodromal illness (NO aspirin through adolescence - tyenol/ ibuprofen instead) Reyes syndrome patho - liver enlargement, increased blood levels of ammonia ( leads to edema of brain), encephalopathy, cerebral dysfunction and death. - those who recover have little to no adverse effects Seizures - Brief paroxysmal behavior due to excessive, abnormal discharge of neurons Epilepsy - recurrent seizure/ unprovoked Classifications of seizures - partial - generalized Parital seizures - (focal- one part of brain- may or may not alter consciousness) - simple partial -special sensory -complex partial seizures Generalized seizures -( involves entire brain and alters consciousness) - tonic clonic (grand mal, involves a loss of consciousness and violent muscle contractions) - absence (petit mal) - atonic and akinetic (drop attacks) - myoclonic (A sudden, involuntary muscle jerk, shake, or spasm) - infantile spasm (poor outlook for normal intelligence) Seizure tx - discover and correct cause when possible (most are idiopathic , (diseases or condition)) - control seizure and decrease freq - help the child who has recurrent seizures live as normal a life as possible. Seizure control - admin of appropriate anticonvulsant drug or combo of drugs, in a dosage that provides desired effect, w/o causing undesirable side effects (therapeutic level) - Drug dosage may be increased as child grows - Single drug therapy recommended - drug increased/ decreased gradually Anti- convulsant meds - Phenobarbital - Dilantin ** good oral care, watch for gum hyperplasia - Ativan - Valium Seizure control when meds dont work - Surgery after invasive EEG and brain mapping to remove abnormal brain tissue - Ketogentic diet - Vagal nerve stimulation Ketogenic diet - High ratio of fat to carb and protein (usally 4:1 or 3:1) - Limited fluid intake - Absolute adherence necessary - Anticonvulsant effect may result fm ketosis, acidsis, dehydration, or electrolyte alterations in the brain - Most affective in pt with mycoclonic epilepsy* - considered when other forms of therapy have failed - rarely used prior to 1st year of life, with most effectiveness in 2-5 age group. Three risk factors that cause reyes syndrom - chicken pox -flu - asprin use A school-age child is being seen in the oncology clinic for possible Hodgkin's disease. During the course of the nursing assessment, which findings would be expected? Select all that apply. -painless cervical nodes - fever -complaints of night sweats A child has been diagnosed with Wilms' tumor, and is being treated with chemotherapy. Because many chemotherapeutic agents cause bone marrow depression, before administering the chemotherapy, the nurse will determine if this child has any infection-fighting capability by monitoring the: -Absolute nerutrophil count (ANC) -The absolute neutrophil count (ANC) uses both the segmented (mature) and banded (immature) neutrophils as a measure of the body's infection-fighting count (ANC). A child has cancer, and has been treated with chemotherapy. The latest lab value indicates the white blood cell count is very low. The nurse would expect to administer: - Filgrastim (Neupogen) -increases prod of neutrophils by the bone marrow A child has thrombocytopenia secondary to chemotherapy treatments. The nurse should not: - Admin intramuscular (IM) injections, bc risk of bleeding A child undergoing chemotherapeutic treatment for cancer is being admitted to the hospital for fever and possible sepsis. Cultures, antibiotics, and acetaminophen (Tylenol) have been ordered for this child. Which order should the nurse do first? - obtain cultures - because management of infections is critical, and since a child on chemotherapy has lowered immune status, unusual agents can be identified. Cultures can help identify the causative agents before treatment is started. A child has been diagnosed with Wilms' tumor. Preoperative nursing care would involve: - careful bathing and handling -The tumor should never be palpated. Careful bathing and handling are important nursing considerations. Palpating the tumor can cause a piece of the tumor to dislodge. An adolescent is receiving methotrexate chemotherapy after undergoing limb salvage surgery for osteogenic sarcoma. The nurse knows the teen understands the purpose of leucovorin therapy after the methotrexate if the teen says: - "I know I will be taking the leucovorin every 6 hours for about the next 3 days." -Leucovorin (citrovorum factor) is a form of folic acid that helps to protect normal cells from the destructive action of methotrexate. It is started within 24 hours of methotrexate administration and is given along with hydration therapy. Usual administration is every 6 hours up to 72 hours, or until serum methotrexate is at the desired level. A child recently has been diagnosed with leukemia. The child's sibling is expressing feelings of anger and guilt. This reaction by the sibling is: - Normal, as the sibling is affected too, and anger and guilt are expected feelings. -A diagnosis of cancer affects the whole family, and initial feelings experienced by the sibling might be anger and guilt. Seldom will the sibling be unaffected; the response is not abnormal. A preschool-age child is being seen in the oncology clinic for a suspected diagnosis of cancer. A common reaction preschool-age children have to a diagnosis of cancer is: -Thoughts that they caused their illness and are being punished. The nurse is working with children in hospice care. The mother of a young child with cancer talks with the nurse about the future holiday celebrations she will miss with her child. The nurse assesses that the mother is experiencing: -Anticipatory loss. -Anticipatory loss is experienced before the loss actually transpires. The nurse is assessing a 10-year-old Emergency Department client's level of consciousness. Which questions would be important to ask the child or the parent? Select all that apply. - has the child had recent head trauma - has the child been sick - has the child been huffing or ingesting any household products - has the child ever had a brain tumor or shunt -A complete history is very important when assessing a child for altered levels of consciousness. Head trauma, illness, drug use, and medical history are a few of the valid points when assessing levels of consciousness Parents bring a 3-year-old to the Emergency Department, stating the child just had her first seizure. The seizure lasted less than 5 minutes, and involved jerking movements over the entire body. Prior to the seizure, the child had been sick, and started running a fever. Based on the description, the nurse suspects that the child experienced which type of seizure? -Febrile seizure -Febrile seizures usually are associated with fevers. A generalized or partial seizure also has jerking movements, but is not necessarily associated with a fever. Status epilepticus is when the seizure lasts longer than 30 minutes. What seizure lasts over 30 minutes? - Status epilepticus A 5-year-old is admitted to the hospital with suspected meningitis. Which nursing intervention would be included in the child's plan of care? -Dim the lights and quiet the room as needed. -Due to the neurologic sequela of this disease, reducing external stimuli is extremely important. Lights should be dim, and the room quiet. Food usually is held initially, and IV fluids initiated. Head circumference usually is performed only for children younger than 2 years old. When evaluating a child who complains of headaches, which description would lead the nurse to suspect migraine headaches? -Headaches aStress-related headaches are tension headaches. -Using certain medications more than three times per week can trigger headaches. Sinus headaches do not have an aura, while migraine headaches often do have an ated with an aura prior to onset - Which consideration would be important in planning nursing care for an infant following surgical insertion of a ventriculoperitoneal shunt? -The infant is placed in a flat, supine position immediately after surgery. -There are no surgical sites in the foot for ventriculoatrial shunt surgery. Volume expanders are not indicated, and can increase risk of increased ICP. The child's pain always should be managed, regardless of age. The infant never should have nuchal rigidity; it indicates meningeal irritation due to infection or increased ICP. The infant is placed in a flat position and the head of bed gradually is elevated to prevent rapid cerebrospinal fluid drainage. A nurse is providing discharge teaching to the family of a child who just had a ventriculoperitoneal shunt placed. Which statements would indicate the parents understand the teaching? -We should let our doctor know if the child complains of double vision." -The parents should be taught that there is a risk of the child developing seizures, even if the shunt is functioning properly. All children with this condition should be referred to early-intervention programs for tracking developmental milestones and appropriate therapy. Diplopia (double vision) should be reported to the physician immediately because this could be a sign of a shunt problem. A shunt malfunction can occur at any time A nurse is caring for an infant with myelomeningocele following surgical postoperative repair. Which would be an important nursing intervention for this patient? -Assess the surgical site for cerebral spinal fluid leakage and symptoms of infection. -Covering the defect with sterile, saline-soaked gauze is a preoperative intervention. After surgery, the site should be checked for cerebral spinal fluid leakage and infection. Head circumference should be measured daily for signs of increased developing hydrocephalus. The child should never be placed supine prior to surgery, due to the location of the lesion. There should be no ROM to hips; place the patient in an abducted position to prevent congenital hip dysplasia. How do you assess hydration? - cap refill - frontanles flat - # of diapers -I/O - mucus membranes What is Hirshspruges disease next step? - surgrey to remove the ganglionic portion of his bowel, a temp colostomy placed until bowel heals so baby can grow. Ostomy care - beefy red, no swelling, skin intergrity - measure out put by syring to put out liquid stool Post op care for Hirshspurgs - ostomy care, diaper below ostomy, fever/infection (mood, lethargic, not eating), pain scale FLACC Most important for nurse care in an infant following surgical repair of cleft lip. - Admin pain meds as needed Cleft lip/ palate - longer nipples but can use reg if baby can still suck, squizze bottles to help with suction esp for cleft palate When does baby have surgry for cleft lip - first weeks/ months Post op for cleft lip surgrey - supine postion, NOT prone - pain mangement - swaddled so cant put hands in mouth - elbow restraints Do you need restraint order for elbow restratints? -Yes Cleft palate surgrey is when? - later in life, 1 year Cleft palate - risk for aspiration - rinse out mouth after feedings ESP. post op - raise hob - sinus infection/ ears - failure to thrieve because of low feedings - speech - teeth complications Cleft palate post op - rinse out mouth - prone because incision on outside so not worry about rubbing it - swaddle/ elbow restraints so not put hands in mouth Whats most consistent with condition of esophageal atresia - nb coughed excessing during attempts of feeding, drooling, vomiting when feeding, emesis same as it went in and not take much in, aspiration risk Fesula vs atresia - F - abnormal connection - A - complete disconnect, absent Which pt would you suspect to have pyloric stenosis - infant with projectile vomiting but still hungry - 1 month to over 2 years - emeis - non bilus, goes back in the deudeum b/c can pass through most common issue noted with hishspurges disease - urgency to have bowel movement after eating Fatty stools - cylic - cystic fibrosis Child has intussusception bowel movement and nurse inspects stools, most likely doc stoop as? - current jelly like -"current" - blood -"jelly like"- mucus what is intussception - small intestine backs up and folds on self 14 year old with ciliac, pt understands diet by ordering - cheese, banana slices, rice cakes, whole milk Gluten is in - wheat, oats, farley, toast, pancakes, sausage links, pastreys Umbilical hernia - dont do much, reduces on own and just concerned if not reduce reducible hernia - contents can be easily manibulated back into abdominal - often in premies potential complications related to infant dx with a diaphramatic hernia - underdeveloped lungs - intestinal issues - cardiac issues physical findings indicated appenditis - persistant RLQ pain with rebound tenderness - sweaty, vomiting, guarding, fever sx of nephrotic syndrome - proteinuria, frothy - edema around eyes/hands/ feet - b/c cells dont have protein in body, fluid shifts causing swelling, heart rate and blood pressure drop, malaise What causes nephrotic syndrome? -autoimmune syndrome - nephrotic syndrome tx - limiting sodium, -dieritics -replace iv albumin along with a diretic like lasics with it, daily wts side effect of prednisone -being hungry what is prednisone used for - steriod - suppress immune syndrome - tells body to diaresis Symp of UTI in a neonate - stretching of the kidney opending on dorsal side of penis - epispadius opening on ventral side of penis hypospadius Priority nursing dx for acute glomerulnephritis (AGN) - fluid volume imbalance s/sx of acute glomerulonephritis (AGN) - edema on eyes/ hands/ feet - bloody urine (tea colored), urgency What causes glomerlulonephritis (AGN) - strep, infam response in kidney manifestations present in acute glomerulonephritits - Azotemia (high waste products in blood) nursing interventions tx pt with AGN - accurate daily wts nursing interventions most impt when tx pt with nephrotic syndrome - accurate intake/ output What is nephrotic syndrome? A kidney disorder that causes the body to excrete too much protein in the urine. educate parents with child who has UTI to? - take all antibiotic as ordered dx of nephrotic sydrome, assess for - edema urine culture, not toilet trained, collect urine by? - in and out cath because CULTURE -if just a urine collection, use a urine collection bag - most common club foot deformitiy - falipes equinovarus priority nursing intervention when preforming cast care - neurovascular checks - cap refill, pulses, circulation, color, temp most common type hip dysplasia - subluxation (partially dislocated) - rolls asyemetric, glutel folds, legs pulled up and out and clicks, limited abduction on all sides, shortened limb on effected side impt to teach paretns of pt using the pavlik harness -proper postitioning to hold infant - for hip dysplasia, early nb days, it doesnt work then need of surgrey - during day wear for 23 hours attention should be reported to physican of 6 year old cast - child feels hands alseep - 6 yr olds can talk and explain dx of osteomyelitits, serum lab value supports dx - postive blood cultures - infection of bone - how do you tx osteromyelitis - IV antibotics most common side effect of NSAID - stomach ulcers priority nursing dx with adolescent dx with scoliosis - disturbed body image 5 yr child with pain, warmth, tenderness in R knee, fever, gaurding knee, what nurse do first? - obatin a through hx fm parents 15 yr old with juvenial arthrisits. most impt teaching home are? - impt of social interaction with friends - NSAIDS/ steriods - autoimmue diesease with imflam repsonse Shock and disbelief education -short, what the NEED to kw, repeative shock and disbelief statements - dont need tx" - going to another doctor (not ready to accept) - look how better he/she looks (when they arent better) adjustment statments - this isnt fair - blamming - yelling at nurse for being late on meds -US: how is it for you to hear about this dx Acceptance - Asking questions - ready to make it their normal number one sx of ICP - vomiting How do we kw a shunt is not working - lethargic, fever, stop draining, return ICP - 2 yr: ant frontalies bulging, head circumrance increases, vomiting Infants ericksons stage -trust infants pigets stage - sensory/motor (looking) infants - object performance - dept on caregiver - recognition of parent (6 months) and stranger anxiety to 18 months How do you prepare for a procedure for infant - parent teaching - touch - soft speaking - gradually ease into it - talk about it RIGHT BEFORE Post op procedure for infant - sothing, comfort Toddler ericksons stage - autonomy (everythings self) Toddler pignets stage - sensory/motor, push/ pull Toddlers - dont understand sharing, parrell play, separation aneixty is high Preparing a procedure for a toddler - RIGHT BEFORE - walk into room with med - dont ask will you do it - dont offer choices if none are avalible - surrange or cup, what do you want after procudure Pre school ericksons stage - inituiative Pre school pigets stage - concrete thinking Pre schoolers - dont understand time -death is not permanant - magical thinking - encourage indep and ofer choices Prepare procdure to pre schoolers - going into another room - take a nap when you get there - what they are going to see, hear, feel -DOLLS, hands on equipment - explain mask or let them where one because other people will have one - guided imagery school age ericksons stage - industry (completing a task) school age pigets stage - concepts, concrete operations school age - models - kw what/ where body things are - dm, own injections of insulin - self cath teachings - teach to do things with condition School age prepaing for procedure - models see where stomach/ heart/ etc is - talk about procdure DAYS - more printed material Adolescent ericksons stage - identity adolescents pigets - formal operations, capable to think abstractly adolescents - invinsible - body image - peers Prepare procedure - weeks ahead to adapt to social life Ketogenic diet - need supplementation of calcium, multvitamins, minerals, and iron - limit fluids to maintain specific gravity @ 1.020 -1.025 - limit fluids to no more than 120 cc at one time, with 2 hours between intake - diet sodas, cannot contain caffeine or aspartame, bc both inhibit ketosis - limit diet soda (b/c of carbs) to 180 cc/ day - If seizure free for 1-2 years, wean off diet over 3-6 months vagal nerve stimulation - chronic, intermittent electrical stimulation of the mid- cervical segment of the left vagus nerve - occurs automatically at set intervals during waking and sleep - generated by a pacemaker- like device implanted below the clavicle and coiled around vagus nerve - progamming by medical professional with laptop computer and magnetic transducer (wand) placed over implanted generator - pt can trigger single train of stimuli by placing hand-held magnet over generator and them removing magnet Status epilepticus - continuous seizures lasting greater than 30 minutes or series of seizures fm which child does not return to full level of consciousness - supportive care status epilepticus risks for - hypoxia, hypoglycemia leading to brain damage s status epilepticus meds - Ativan (Lorazepan) replacing Valium as drug of choice Seizures observations critical - note time, characteristics, what occured before and after Serizures protect child fm injury - do not move or try to restrain (force should not be exerted in an attempt to place solid object between teeth) - ease to floor - respiratory concerns/ suction equipt available, esp during status epilepticus cerebral palsy (CP) - result of damage to the cerebral cortex - impaired neuromuscular control that results fm non- progressive abnormality in pyramidal motor system - permanent physical disability - primary disturbance is abnormal muscle tone/ coordination caused by variety of prenatal, perinatal, and postnatal events - cause is not always obvious Cerebral palsy classifications - spastic - dyskinetic - ataxic - mixed spastic hypertonicity dyskinetic - abnormal involuntary movement (athetosis: slow, wormlike, writhing movements) ataxic - wide- based gait mixed -spasticity and athetosis cerebral palsy tx - multi- disciplinary (medical, nursing, pt, speech, ocupational, nutrition) - tx of sx and prevention of complications cerebral palsy - est. locomation, communication, and self help - gain optimum appearance and integration of motor functions - correct associated defects as effectively as possible (contractures) - provide educational opportunities adapted to child's needs - Nutrition: extra calories to meet increased energy needs r/t increased muscle act. - intelligence may NOT be affected - communication may be a significant issue What is a UTI - clinical condition that is characterized by the presence of bacteria in the urine along with systemic sx of infection - may involve the bladder, urethra, ureters, renal pelvis, calyces and renal parenchyma Factors that contribute to UTI - obstructions - voidin