PEDIATRIC ILLNESS AND CONDITIONS
Chapter 40: Nursing Care of the Child With a Respiratory Disorder
1. Gloria is an 8-year-old girl who is admitted to the pediatric unit with a history of cystic fibrosis and difficulty breathing. (Learning Objectives 3, 4, and 6)
a. What would the nurse know to include in the health history?
b. When conducting a physical assessment on Gloria, what will the nurse do in relation to the child’s cystic fibrosis?
c. What tests would the nurse expect to be ordered for Gloria?
2. Jimmy Jones, age 6, is diagnosed with asthma. He has been hospitalized for 3 days for an acute exacerbation and is scheduled to go home tomorrow. (Learning Objectives 9 and 10)
a. What would the nurse know to include in a child/family teaching plan?
b. How can asthma affect a child’s self esteem?
Chapter 41: Nursing Care of the Child With a Cardiovascular Disorder
1. Baby boy Ellis, 2 hours old, is being evaluated in the newborn nursery by the nursing staff. Findings include T 37°C; apical heart rate 140 bpm; respirations 58 breaths per minute; BP (arms) 70/47, (calves) 62/39; head circumference 34 cm; chest circumference 31 cm; length 48 cm; weight 2,700 g. The infant is crying. (Learning Objectives 1, 2, 3, 4, and 8)
a. Based on the physical findings, what should be the nurse’s priority?
b. What assessments/tests should the nurse expect to be done on this infant?
c. What should the nurse include in the teaching plan for the parents of this infant?
2. Jennifer Collins, 13 years old, is admitted to the pediatric floor with a diagnosis of probable acute rheumatic fever.
a. What would the nurse include when performing an initial assessment?
b. What tests would the nurse expect to be done on Jennifer?
The diagnosis of acute rheumatic fever is confirmed.
c. What would the nurse be sure to include in the discharge teaching plan for Jennifer and her family?
Chapter 44: Nursing Care of the Child With a Neuromuscular Disorder
1. Pamela Souza, 6 years old, was born with cerebral palsy. Pamela suffers from general spasticity, mental impairment, impaired vision and hearing, and hydrocephalus. She has been admitted to the pediatric unit for evaluation of intrathecal spasticity control. (Learning Objectives 2, 3, 4, and 6)
a. Identify medications that might be used to help control Pamela’s spasticity.
b. What information would the nurse include in the health history?
c. What nursing interventions would be important in Pamela’s care?
d. What information would be important to include in a teaching plan for Pamela and her family?
2. Kyle Stephens, 15 years old, is brought to the emergency department by ambulance after a diving accident at a local lake. (Learning Objectives 1, 2, 3, 4, and 7)
a. What nursing assessments would be important for Kyle?
b. What diagnostic tests would the nurse expect to be ordered for Kyle?
Kyle is found to have crushed vertebrae at the S4-5 level with a partially severed spinal cord.
c. What would be important teaching points for Kyle and his family?
Chapter 49: Nursing Care of the Child With an Endocrine Disorder
1. Jalissa Twyman, 8 years old, was admitted to the pediatric intensive care unit with a closed head trauma after being involved in a bicycle/motor vehicle accident. Jalissa is unconscious. The nurses caring for Jalissa document a weight loss of 1.82 kg over a 24-hour period, decreased skin turgor, and dry mucous membranes. Urine output for the same 24-hour period is 3.5 L/m2. (Learning Objectives 1, 2, 3, 4, 5, and 7)
a. What further assessments should the nurse perform on Jalissa?
b. What laboratory tests would the nurse expect to be performed on Jalissa?
c. What nursing interventions should be done for Jalissa?
2. Aellai Gianopoulos, 13 years old, is brought to the clinic by her mother, who states that Aellai is losing her hair. Vital signs are as follows: T 98.4°F, HR 85, R 15, BP 121/78. Height is 64 in., and weight is 81.5 kg.
Aellai has an olive complexion marred by acne, large brown eyes, and long black hair that is very thin on the top of her head. Her breasts are small and she has an abundance of hair on her arms and legs. She reached puberty approximately 6 months ago. (Learning Objective 1, 2, 3, 4, 5, 7, and 8)
a. What other information should the nurse gather in the health history?
b. What laboratory tests would the nurse expect to be ordered for Aellai?
c. What should the nurse include in the teaching plan for Aellai and her family?
Running head: NURSING MANAGEMENT OF THE NEWBORN
NURSING MANAGEMENT OF THE NEWBORN 8
NAME: Adebola Amoo Ross
As a postpartum nurse your next client is an LGA baby boy who was born at 37 weeks’ gestation. He had Apgar scores of 8 and 9. He was circumcised. The mother is breast-feeding. Your unit requires a full assessment, screenings, discharge instructions, and documentation. (Learning Objectives 4, 7, 8, and 10)
1. Describe what a normal head-to-toe assessment would be for an infant born at 37 weeks’ gestation. What test is used to determine this gestational age? What is the scale used to determine the Apgar score, and are this baby’s scores normal?
2. As the discharging nurse, you are responsible for what screenings in an infant in the first 24 to 48 hours? What immunizations would be required?
3. What discharge instructions would be pertinent to this mother? How would you educate her or the family?
4. How would you document your discharge teaching? Write a sample narrative of your teaching.
Definition of the Diagnosis
A new born baby usually undergoes several tests in order to detect any disorders that might need immediate medical attention (Susan, Terri & Susan, 2009). The test begins with physical examination which includes measurement of weight, length and head circumference. The heart rate, muscle tone, skin color, reflexes and breathing effort is also examined and scores of between 0 and 10 are given using the Apgar scale depending on the observed conditions. A baby with good health has an Apgar score above 7 whereas an Apgar score below 5 indicates that the baby may need immediate medical care. The gestation age is determined using the Ballard scale. It could either be small for gestation age (SGA), appropriate for gestation age (AGA) or large for gestation age (LGA). LGA’s refers to babies or infants whose age or gender is larger than expected or their birth weight greater than the 90th percentile. Some of the common risks in LGA infants include birth trauma, diabetes mellitus, metatarsus, adductus and hip subluxation (Angelica , Flaminia , Mania, Simona, Sara , & Cristina, 2014). Gestation diabetes is the common cause of LGA babies, other causes include, excessive maternal weight gain, fetal sex, increased gestation age and use of amoxicillin and pivambicillin antibiotics during pregnancy (Lawrence, 2017).
Common Signs and Symptoms
The common signs and symptoms for LGA babies are those that are related to the complications that may occur.
Potential Complications
Some of the potential complications associated with LGA newborns are birth injuries, perinatal asphyxia, difficult delivery, meconium aspiration, low Apgar score, lung problems, hypoglycemia, birth defects, and polycythemia (Cervellin, Comelli , Bonfanti, Numeroso , & Lippi, 2019).
Head to Toe Assessment
Vital Signs: Temperature, 98.6°F; blood pressure, 45/80 mm Hg; heartbeat, 160 beats/min; respiratory rate, 60 breaths/min, oxygen saturation 100% on room air
HEENT:
Head: the average head circumference of 33 to 35cm, overriding sutures, caput succedaneum
Eye: visual acuity 20/400, normal red reflex, no discharge, white sclera.
Ear: normal configuration that is a third angle of the eye and response to sound
Nose: symmetrical
Mouth: normal configuration; Epstein’s pearl, no cleft palate.
Neck: normal rotation.
Chest: average circumference of 30 to 33 cm, clear heart and lung sounds.
Abdomen: slight protrusion, cord drying, 3 umbilical vessels, liver 2 cm below costal margin, presence of bowel sounds.
Skin: pink skin, erythema toxicum, Mongolian spots, acrocynosis, milia
Genitalia: an open and properly placed urethra; presence of testes in the scrotum.
Limbs: presence of limbs, pink nails and no deformities.
NANDA Nursing Diagnosis
1. Birth injuries
2. Hypoglycemia
3. Lung problems
4. Heart diseases
5. Obesity
Infant screening
1. Otoacoustic emissions (OAE) test and auditory brain stem response (ABR)
The OAE tests is used to determine the response of some parts of the ear to sound while the ABR test is used to evaluate the auditory brain stem and brains response to sound (Angelica et al., 2014).
Desired outcome
Normal hearing
Interventions and rationale
1. Place a miniature earphone and a microphone on the baby’s ear and play a sound.
Rationale: Back reflection of an echo into the ear canal shows normal hearing
Place Band-Aid-electrodes on the baby’s head
Rationale: sound response indicates normal hearing
2. Pulse oximetry test
The pulse ox is a non-invasive test that measures the amount of oxygen in the blood.
Desired outcome
Normal oxygen levels.
Interventions and rationale
Place a pulse CO oximeter on the baby’s skin. The CO oximeter measures the fractional oxyhemoglobin.
Rationale: an oxygen saturation level of more than eighty-nine percent is an indication of healthy individual.
3. Bilirubin test
A jaundiced look on the baby would indicate bilirubin test is required.
Immunization Vaccines
· BCG vaccine
· Hepatitis B
· OPV
Discharge Instructions
· Keep the circumcision wound dry and clean and apply ointment daily.
· Breast feeding of the baby every two or three hours’ time
· Avoid any other food apart from the breast milk
· Wrap the baby to maintain normal temperatures
· Bathing the baby daily and take good care of the umbilical cord
· Contact the doctor in case of any abnormal signs and symptoms.
Documentation of the Discharge Teaching
The discharging teaching is done using the Focus, data, action, Response way. Mother of a circumcised LGA baby boy born at 37 weeks…
