PEDS EXAM 3 TEST RATED 100% CORRECT

PEDS EXAM 3 TEST RATED 100% CORRECTPEDS EXAM 3 TEST RATED 100% CORRECT HEPATOLOGICAL - ANSWER Epistaxis - ANSWER short, isolated occurrences of nosebleeds -common in childhood -although it is rarely an emergency, it can cause the child and caregivers anxiety Epistaxis: Risk factors - ANSWER -trauma, such as picking or rubbing the nose, can cause mucous membranes in the nose, which are vascular and fragile, to tear and bleed -low humidity, allergic rhinitis, upper respiratory infections, blunt injury, or a foreign body in the nose can precipitate a nose bleed -medications that affect clotting factors can increase bleeding -can be the result of underlying diseases (von Willebrand disease, hemophilia, idiopathic thrombocytopenia, purpura, leukemia) Epistaxis: Expected Findings - ANSWER -history of bleeding gums or blood in body fluids or stool -history of trauma, illness, allergies, or placing foreign bodies in the nose -active bleeding from the nose ESTUDY -restlessness and agitation Epistaxis: Nursing Care - ANSWER -maintain a calm demeanor with the child and family -have the child sit up with the head tilted slightly forward to prevent aspiration of blood -apply pressure to the lower nose with the thumb and forefinger for at least 10 min -in needed, pack cotton or tissue into the side of the nose that is bleeding -encourage the child to breathe through their mouth while their nose is bleeding -apply ice across the bridge of the nose if bleeding continues Epistaxis: Client Education - ANSWER -for recurrences, remind the child to sit up and slightly forward so blood does not flow down the throat and cause coughing -inform the family that bleeding usually stops within 10 min Epistaxis: Complications - ANSWER -hemorrhage -nursing actions: provide support to the child during packing -client education: instruct the child and family to seek medical care if bleeding lasts longer than 30 min, and that repeated episodes require further evaluation for bleeding disorders Iron Deficiency Anemia ESTUDY - ANSWER -most common hematologic disorder in children -in infants and adolescents, the most common cause is inadequate intake of dietary iron -it school aged children, most common cause is blood loss -usually w/o enough iron, synthesis of the HGB is disturbed, resulting in anemia Iron Deficiency Anemia: Expected Findings - ANSWER -tachycardia -pallor -brittle, spoon shaped fingernails -fatigue, irritability, and muscle weakness -systolic heart murmur -lethargy (early sign) -weakness -irritability -decreased interest in play -mild, moderate, and severe Iron Deficiency Anemia: Patient Centered Care - ANSWER -provide iron supplements for preterm and low-birth-weight infants by the age of 2 months -provide iron supplements to full term infants by the age of 4-6 months -recommend iron fortified formula for infants when solids are introduced -modify the infants diet to include high iron and vitamin C -monitor formula intake for infants (limit formula intake to 32 oz a day, allow frequent rest periods) ESTUDY -if packed RBCs are required, follow protocols for administration Iron Supplements: Nursing Considerations - ANSWER -give 1 hr before or 2 gr after milk or antacid to prevent decreased absorption -GI upset (diarrhea, constipation, nausea) is common at the start of therapy and will decrease over time -if tolerated, administer iron supplements on an empty stomach -give with vitamin C to increase absorption -use a straw with liquid preparation to prevent staining of teeth -use a z-track into deep muscle for parenteral injections and do NOT massage after injection Iron Deficiency Anemia: Client Education - ANSWER -advise the family that diarrhea, constipation, or nausea can occur at the start of therapy -provide information regarding appropriate iron administration -increase fiber and fluids in constipation develops -to prevent overdose, store no more than 1 month supply in child-proof bottle out of reach of children -encourage parents to allow the child to rest -inform parents that the length of treatment will be determined by the child's response to the treatment and if HgB levels are not increased after 1 month of therapy, further evaluation is warranted -instruct parents to return for follow up lab tests to determine the effectiveness of treatment -black stool is normal, means iron is working -don't mix iron in a bottle b/c baby may not finish the bottle and won't like the taste -if med is liquid, give through straw so it won't stay in the teeth Dietary sources of iron for infants and older children ESTUDY - ANSWER -infants: iron-fortified cereals and formula -older children: dried beans and lentils; peanut butter; green, leafy vegetables; iron-fortified breads and flour; poultry; and red meat Iron Deficiency Anemia: Complications - ANSWER Developmental delays -nursing actions: assess level of functioning, improve nutritional intake, refer to appropriate dietary services and provide support to the family Sickle Cell Anemia - ANSWER -hemoglobin S -autosomal recessive disorder -sickling of RBCs-- decreases O2 in the blood and vasoconstriction -vaso-occlusive-crisis -primary treatment is prevention of crisis -increased blood viscosity, obstruction of blood flow, and tissue hypoxia -tissue hypoxia causes tissue ischemia which results in pain -increased destruction of RBCs occur -manage with optimal hydration, acetaminophen, Motrin, and possibly Morphine -does not decrease life span -teach to avoid causes of crisis