.N315 Review Questions Part 2
Quiz format -- same as the first; 35 Mult choice, 3 short answer/ short essay
Family-centered care of ill children
1. What is the role of Registered Nurses in working with families who are raising children with
chronic illness, disabilities, or special health care needs?
2. How would you integrate developmental support into caring for
a. Infants who are ill, disabled, or have special health care needs:
Infants gain a sense of trust in the world through rhythmis and reciprocal patters of contact & feeding,
resulting in bonding. They need a secure pattern of restful sleep, satisfaction of oral and nutritional
needs, relaxation of body systems, and spontaneous response to communication and gentle stimuli. The
caregiver infant attachment is critical for psychological health.
b. Toddlers who are ill, disabled, or have special health care needs
Need opportunites to explore, with consistent routines. Disruption in usual routines contributes to loss of
control, toddler feels insecure, regression in toilet training and refusal to eat and separation anxiety are
common reactions in hospitalized toddlers.
c. Preschoolers who are ill, disabled, or have special health care needs
Do not understand body integrity, interpret words literally, and have active imagination. Egocentric
(some personal action or thought caused their illness → guilt, shame. Concrete, egocentric and magical
thinking limits their ability to understand so communication and interventions must be on their level.
d. School-aged children who are ill, disabled, or have special health care needs
To develop confidence through sense of industry. More realistic understanding of the reasons for illness
and can better comprehend explanations. Concern about disability, death, & fear hurt and pain. Can
understand cause-and-effect and how it relates to their illness. They like to be involved, give them
opportunities to maintain independence, retain a sense of control, enhance self-esteem, and continue to
work toward achieving sense of industry.
e. Adolescents who are ill, disabled, or have special health care needs
Adolescents fear injury and pain, appearance is important to them, concered with illness and how it
affects their body image.
3. What do parents who are raising children with chronic illness, disabilities, or special health care
needs report to be major stressors in their lives? How do families cope? What does the journey of
adaptation involve for them?
Assessment and management of pain in children
4. What are some assessment tools used to measure pain in preverbal/nonverbal children? In
young verbal children? In older children?
Pain assessment: behavioral(FLACC), physiological, self-reports(verbal children >age 3)
Children 5-12years: Faces pain scales, Oucher, graphic rating scales (pieces of hurt tool-poker chips,
how many pieces of hurt), verbal rating scales, visual analog scale
8 years and older: numeric rating scale (0-10),
5. Discuss the use of the “Oucher”. For what age group is it intended? How is it used?
5-12 year olds, faces of neutral expression for no pain to faces with tears for most pain possible.
6. Discuss the use of the FLACC scale and other pain assessment tools used in neonates and infants.
What physiological and behavioral measurements are indicative of the pain response in neonates
and infants?
Physiological: Facial expressions of discomfort, grimacing, crying, pull on ear when experiencing
ear pain, move head from side to side suggesting head pain, lie on one side and draw their knees
up to the abdomem, limp, avoidance of weight bearing, guarding or refusing to move area of body.
Inspect skin for flushing, diaphoresis, increases in pulse, HR, RR, & BP.
Behavioral: irritability, restlessness, clenching teeth or fists, body stiffness, increased muscle
tension, changes in behavior, cultural background.
Premature infant pain profile (PIPP)-preterm and neonates (28-40weeks): brow bulge, eye
squeeze, nasolabial furrow, HR, O2 sat.
CRIES-cries, requires increased oxygen, increased vital signs, expression, and sleeplessness.
FLACC: behavioral scale, 2 months and up. Faces, Legs, Activity, Cry, Consolabilily.
7. What is EMLA cream and how does it work?
Topical anesthesitc, decreases pain for child who is receiving injection.
8. What are appropriate OTC analgesics to use with children? Acetaminophen (nonopioid a
9. Identify and briedly describe 10 non-pharmacologic approaches to pain relief that are useful when
working with infants and children.
10. How does one do an infant massage?
Child maltreatment
11. What are the legal roles of Registered Nurses re reporting suspected child maltreatment in Nova
Scotia? (Read the Act of the NS Legislature as posted on Moodle)
12. What is “spanking”? What does the Canadian Criminal Code say about spanking? Can parents be
prosecuted for spanking children in Canada? (Read the Act of Parliament as posted on Moodle).
What does the Canadian Pediatric Society say about spanking and children’s health? Every
schoolteacher, parent or person standing in the place of a parent is justified in using force by way
of correction toward a pupil or child, as the case may be, who is under his care, if the force does
not exceed what is reasonable under the circumstances. CPS and PHAC discourage use of
spanking.
13. Identify 5-10 ‘red flags’ of potential child neglect. Neglect-the failure of parent to prove for child’s
basic needs and an adequate level of care. Language delay, attachment problems, negative view of
self and others, social withdraw, isolation, avoidance of social interactions, confusion in
interpreting emotions of others, Deprived of food, appropriate nutrition, weather appropriate
clothing & shelter, safe environment & supervision, medical care, education, stimulation, failure to
thrive from poor physical, dental, mental health, patterns of injury from lack of supervision,
personal hygiene.
14. Identify 5-10 ‘red flags’ of potential emotional abuse of children. Failure to meet child’s needs for
affection, attention and emotional nurturance, impairing or destroying child’s self-esteem:
Rejection, isolating, terrorizing, ignoring, corrupting, verbally assaulting or over pressuring a
child, growth failure, growth failure, sleep disorders, eating disorders, self-stimulating
behaviors(rocking, sucking), social withdraw, extremes of behaviors(over compliant, passive or
aggressive, antisocial behaviors, cruelty to animals/people.
15. Identify 5-10 ‘red flags’ of potential sexual abuse of children: bruises or bleeding around genitalia
or mouth and throat; torn, stained, bloody undergarments; pain & itching or odor in genital area;
pregnancy in young adults, promiscuity, age-inappropriate sexual play, overtly seductive behavior,
withdraw, sexualized play, anxiety & clinging, sudden onset of phobias (beards, red jackets,
places), rapid personality changes, running away from home, substance use, suicidal ideation,
rapidly declining school performance.
16. What is Munchhausen syndrome by proxy? Parent fabricates symptoms of a child’s medical
problem, numerous medical tests. Biological mother with health care training. Physical and
emotional harm inflicted on child for the gratification of the caregiver. Symptoms are observed
only by the care giver: seizures, GI disorders, altered mental status, may progress to death.
17. What is shaken baby syndrome? Shaking causes intracranial trauma: vomiting, irritability,
seizures, unresponsiveness. Lifelong neurological disorders or fatal. Families need support to
prevent this.
Neuro
18. Review A&P of the brain and spinal cord (Bio 251/252) Include infant head -- fontanels and
suture lines :
Development of brain and spinal cord in first 3 – 4 weeks, beginning with neural tube closure, genetic
disorders, infection, teratogens, & malnutrition = malformation of brain and spinal cord (CNS). Nervous
system is complete but immature at birth, neurons not fully myelinated, speed and accuracy (fine & gross
motor) increases as myelination increases. Prominate cranial sutures or barley palpable anterior
fontanel. Anterior fontanel open until 12 to 18 months to accommodate rapid brain growth, but may
close as early as 9 months. Primitive reflexes diminish over first few months to give way to protective
reflexes, except for Babinski (1 year). Persistence of primitive reflexes may indicate neurological
abnormality. Myelination complete at 24 months (improved coordination, equilibrium, sphincter control.
Brain growth is complete by age 10, head is longer, growth of facial bones changes proportions. Occular
muscle control, peripheral vision, & color discrimination fully developed by age 7.
Posterior fontanel closes by 2 months, anterior fontanel closes by 12-18months.
Root
Birth to 3 months
Suck
Birth to 2-5 months
Moro
Birth to 4 months
Asymmetric tonic neck
Birth to 4 months
Palmar grasp
Birth to 4-6 months
Plantar grasp
Birth to 9 months
Babinski
Step
Neck righting
Parachute sideways
Parachute forward
Parachute backward
Birth to 12 months
Birth 4-8 weeks
4-6 months -persists
6 month - persists
6-7 months - persists
9-10 months - persists.
19. Review principles of neuro assessment (Nurs 275). Include infant reflexes.
20. Review neurodevelopment norms (Psych 260 and Unit II of your current Ateah et al text)
re speech acquisition, walking, and self-toileting.
Newborns: ability to move sequentially through states of consciousness slowly reassures that immature
neurological system is intact. (deep sleep, light sleep, drowsiness, quiet alert state, active alert state,
crying).
Infants(birth-1 year): critical brain growth & continued myelination. Involuntary movement →voluntary
control, immature vocalizations and crying →ability to speak. States of consciousness
Object permanence by 8 months, by 12 months infant knows they are separate from caregiver and can
see themselves in mirror, throw/bang/drop/shake objects, imitate gestures, knows how to use certain
objects correctly (phone to ear). By 12 month the infant should be able to eat with fingers and assist with
dressing
Newborns: prefer human faces, imitate facial expressions, prefers contrast(black and white stripes), eyes
wander occasionally cross.
1 month: can recognize sounds and people they know best.
4 months:binocularity- ability to fuse two ocular images in one picture
7 months: full color vision, distance vision, ability to tract objects.
Baby coos (1-3months), simple vowel sounds, laughs, vocalizes in response to voices, response to name &
“no”(4-5 months), squealing and yelling (6 months), babbling begins and progresses to strings (mama,
dada) without meaning, able to respond to simple commands,(9-12 months) attaches meaning to
mama/dada, and starts to imitate other speech sounds. (12 months) two to three recognizable works
with meaning, recognizes objects by name, imitates animal sounds. By age 2 vocabulary of 50 words,
“what/why”.
By age 3 telegraphic speech, toddler walks heel to toe, stuttering onset 2 – 4 years and most children will
recover without therapy, f/v/s/z mastered by age 5, sh/l/th/r until age 6 or later.
21. Identify 30+ indicators of developmental delay in infancy and early childhood in terms of
language acquisition, social behaviors, and motor skills (see your textbook about ‘warning
signs’ throughout Unit II). These would be indicators that further neuropsych evaluation is
indicated so that early intervention programs could be initiated.
Warning signs: young infant does not respond to loud noises; child does not focus on a near
object;,
3 months
4 months
6 months.
8 months
12
months
18
months
2 years
3 years
4 years
5 years
Does not smile at people,,
infant does not start to make sounds or babble by, does not turn to
locate sound Infant does not make sound,
infant crosses eyes most of the time, dose not laugh or squeal
Dose not babble, refuses to cuddle, dose not enjoy people, no interest in
peek-a-boo
Does not use a single word with meaning,
Not walking, not speaking 15 words, does not understand the function
of common household items
Does not use 2 word sentences, does not imitate actions, follow basic
instructions, cannot push toy with wheels.
Difficult stairs, frequent falling, cannot build tower >4 blocks, difficulty
with small objects and separation, cannot copy circle, dose not engage
in make believe play, cannot communicate in short phrases, little
interest in other children, unclear speech, persistent drooling
Cannot jump, ride a tricycle, stack 4 blocks, throw ball over hand, grasp
crayon, difficulty scribbling, does not use 3-4 word sentences, cannot
use “me/you” appropriately, ignores other children, will not respond to
people outside the family, resists using toilet/dressing/sleeping, does
not engage in fantasy play.
Unhappy or sad often, no interest in playing with others, unable to
separate from parents, aggressive, fearful, timid, unusually passive.
Cannot build tower of 6-8 blocks, easily distracted, cannot concentrate
>5 mins, rarely engages in fantasy play, trouble with eating, sleeping,
toileting, cannot use plural or past tense, cannot brush teeth, wash or
dry hands, or undress.
Identify the general incidence, causes, symptoms, pathophys, usual medical treatment, and
nursing considerations for:
22. Autism spectrum disorders (autism, asperger’s, and PDD-NOS) (essay question on this--read the
articles as well as the text and view the video on moodle about ABA for autism)
23. Down syndrome
24. Fragile X syndrome: Most common inherited cause of intellectual disability, caused by abnormal
gene on X chromosome, woman can be carries but men exhibit the trait, long face with prominent
jaw, large protruding ears, outburst, large testies, hyperactivity, short attention span, problems
with abstract reasoning, sequential processing & math
25. Head trauma (know what assessments are indicated post-injury; define: decorticate and
decerebrate posturing): head injury is the most common cause of death and disability in
childhood. Assement: past medical hx, events surrounding the injury (mental status, LOC,
irritability, lethargy, abdnormal behavior, vomiting, seizures, headache, vision changes, neck pain.
ABC, Glasgow coma scale, vitals, pupillary response, lscerations, bleeding, CSF leak, bruising. Fixed
and dilated/constricted, or sluggish pupillary reaction to light warrants prompt intervention. NPO
until extent of injury has been determined. Mild to Moderate head injury (teach caregivers to stay
with child for first 24h; wake every 2 hour to ensure they move normally, recognize and responds;
ER if headache gets worse, repeated dizziness, irritablilit, vomiting>2times, clumsiness or
difficulty walking, oozing fluis from ears/nose, unequal sized pupils). Severe Head injury(maintain
quiet environment, manage pain, hemorrhage, infection, cerebral edema). Decorticate posturing:
damage of cerebral cortex, adduction of arms, flexing at the elbows with arms over chest and
flexion of the wrist with hands fisted.
Decerebrate
posturing: damage of the midbrain, extension and pronation of arms with legs extended.
26. Meningitis: an infection of the membranes and fluid covering the brain and spinal cord caused by
bacteria or viral. Bacterial begins with fever and processes rapidly lethargy & unresponsiveness
because of increasing pressure on the brain, irritability & fussiness due to headache/pain from
inflammation around the brain, vomiting, stiff neck, bulging fontanel <18months). Droplets from
cough or sneezes that reach the nose and mouth of another child 1 meter away. Virus in saliva and
stool. Fever + limp, less responsive, more withdrawn than usual, poor color, stiff neck, high
pitched scream/cry or cries very weakly, quickly spreading purple or deep red rash. Isolation
precautions, vitals, IV access and hydration, antibiotics& corticosteroids, Lumbar puncture CSF
cuture, notify public health, antibiotic/immunization for others, no longer contagious after 24h of
antibiotics.
Seizure disorders (epilepsy, know the types): Partial seizures account for a large portion of childhood
seizures, they are simple or complex and involve only one area of the brain.
Simple partial
Colonic or tonic movements of face, neck, extremities.
Numbness, tingling, paresthesia, pain, 10-20s, conscious
and may verbalize during the seizure.
complex partial
Automatic purposeful movements: lip smacking, chewing,
(progress from simple)
swallowing, salivation, picking or pulling bedsheets or
clothes, rubbing objects, running/walking in repetitive
fashion.
status epilepticus).
Emergency, consciousness does not return between
prolonged or clustered seizures can lead to respiratory
arrest. ABC, anticonvulsants (lorazepam, diazepam,
phenytoin), blood glucose and electrolytes.
General seizures involve the entire brain., ,
infantile spasms
Seen at 3-12months, stops by 2-4years. Sudden jerk followed by
stiffening: head flexed, arms extended, legs drawn up, arms
fling out, knees pulled up body bends forward (jackknife
seizures). Infants may stop developing and loss skills. Steroids
and anticonvulsants for treatment.
absence seizures
Girls>boys age 5. Sudden stop of motor activity or speech with
(petit mal)
blank facial expression, rhythmic twitching of mouth, blinking
of eyelids. Myoclonic movements of face, fingers, extremities,
tonic-clonic (grand
mal)
myoclonic
atonic
loss of body tone. 30 secs, subtle changes in behavior may be
mistaken for inattentiveness.
Aura, LOC preceded by piercing cry, entire body tonic
contractions followed by rhythmic clonic contractions
alternating with relaxation of all muscle groups. Cyanosis, bite
tongue, loss of sphincter control. Postictal phase: deep sleep
30mins to 2 hours, responds only to painful stimuli. No memory
of seizure, headache, fatigue. Safety is primary concern.
Motor cortex may occur with other seizures. Sudden, brief,
massive muscle jerks that may involve the whole body or one
body part.
Drop attacks, lennox-gastaut syndrome, sudden loss of muscle
tone, sudden drop of the head, will regain consciousness within
a few secs-mins, can result injury from violent fall.
27. Cerebral palsy: Abnormal development of or damage to the motor areas of the brain.
Spastic
Hypertonicity & permanent contractures. Hemiplegia (both
extremities on one side), Quadriplegia(all 4 extremities),
Paraplegia(lower extremities). Most common, exaggeration of deep
tension reflex, continuation of primary reflexes & failure to progress to
protective reflexes.
Dyskinetic Abnormal involuntary movements. infant is limp and flaccid, slow
worm-like writhing or twisting. All four extremities, face, neck, &
tongue. ↑movement during periods of stress, dysarthria, drooling.
ataxic
Affects balance and depth perception, rare, poor coordination,
unsteady gait, wide-based gait.
mixed
Combination of above, most commonly spastic and athetoid(is a slow,
involuntary, convoluted, writhing movements of the fingers, hands,
toes, and feet and in some cases, arms, legs, neck and tongue)
28. Neural tube defect effect spinal cord development and are closed (spina bifida occulta) or open
(myelomeningocoele). Spina bifida occulta: defect of vertebral bodies without protrusion of the
spinal cord or meninges. Not visible externally, no adverse effects, common anomaly in
lumbosacral area, dimpling, patches of hair, discoloration if skin. Myelomeningocoele: Most
severe form of neural tube defect, the neural tube fails to close at the end of the 4th week of
gestation, “spina bifida’, ↑risk for meningitis, hypoxia, hemorrhage, absent function beyond defect
(paralysis, orthopedic deformities, incontinence). Due to downward displacement of the brain into
the cervical spine, CSF is blocked causing hydrocephalus.
29. Hydrocephalus is not an illness but a symptom of an underlying brain disorder. CSF accumulates
in ventricles causing them to enlarge. A ventriculoperitoneal shunt catheter is placed in enlarged
ventricle to shunt CSF to peritoneal membrane to be absorbed in bodys circulation.
30. Anencephaly is a defect in brain development resulting in small or missing brain hemisphere, skill,
and scalp, when the upper end of the neural tube fails to close during 3-4th week of gestation.
Majority are stillborn. Use of an infant cap, assisting with anticipatory grieving and decision
making related to end of life care.
31. Duchenne Muscular Dystrophy the most common childhood form of muscle dystrophy, gene
mutation results in absent dystrophin, a protein critical for muscle cells, . Boys with DMD are
often late in walking (18 months), progressive muscle weakness and wasting at ages 3-7,
emlarged calves, . Waddling gait, lordosis, frequent falls, inability to ride bike, loss of independent
ambulation by age 9-11, slow progressive muscle weakness through teenage years, death from
failure of respiratory muscles or infection.
32. Craniosynostosis is the premature closure of cranial sutures. Normal brain development will
occur, surgical correction allows for normal skull growth & appearance of head & face. Palpable
bony ridge.
33. What is increased intracranial pressure (IIP)? What are signs and symptoms of IIP in infants and
young children? In older children and adolescents? IIP may occur with many neurologic
disorders, head trauma, hydrocephalus, infection, tumor, intracranial hemorrhage. Posterior
fontanel closes by 2 months, anterior fontanel closes by 12-18motnsh. In hydrocephalus widening
of the fontanels, palpable tension & increased head circumference. Non palpable fontanels in a
skull of normal size/shape are not a concern. In craniosynostosis (premature fusion of skull bone),
skull growth continues parallel to fused suture and is restricted perpendicular resulting in
abnormal skull shape. Auscultate for bruit in temporal regions, benign in children<4 years, or with
acute febrile illness. Early signs: headache, vomiting(projectile), blurred vision, diplopia, dizziness,
↓pulse/RR, ↑BP, ↓pupil reaction time, changes in loc, irritability. Infants (bulging tense fontanel,
wide suture and ↑ head circ., dilated scalp veins, high pitched cry). Late signs: ↓loc, bradycarida,
irregular respirations, cheyne-stokes respirations(rapid breathing followed by none), decerebrate
or decorticate posturing, fixed & dilated pupils.
34. What is meant by ‘neurodiversity’? What are some ‘different ways of being smart’? Linguistic
(word smart), Logical-mathematical (logic smart), naturalist (nature smart), spatial (picture
smart), bodily-kinesthetic (body smart), musical(music smart), interpersonal (people smart),
intrapersonal (self-smart).
35. What are dyslexia, dyscalculia, dysgraphia, and visio-spatial (nonverbal) learning
disability?Identify 5 adaptations that schools can implement to maximize learning and
potential for children with learning disabilities.
Dyslexia (difficulty with reading, writing, and spelling), Dyscalculia (difficulty with math and
computation), Dysgraphia (difficulty with penmanship, fine motor control, dexterity, and
coordination of pencil), Visio-spatial/nonverbal (difficulty in organizing visual information into
meaningful patterns and understanding how they might change as they rotate and move through
space. They might also have difficulty with visual memory).
Each child needs an individualized education plan given to school
Infectious diseases
36. Review physiology of immune system and immune response. What is cellular immunity?
Humoral immunity? Passive humoral immunity? Cellular immunity is functional at birth and as
the infant is exposed overtime, humoral immunity develops.
Cellular immunity: cell mediated immune response, T cells, does not recognize antigens, attack
infected or foreign cells, does not cross placenta.
Humoural Immunity: Antibody protection, B cells, secrete antibodies to viruses and bacteria,
antibodies mark antigen cell for distruction, do not destroy forien cells, crosses placenta in the
form of IgG.
Passive humoral immunity: most of newborns IgG is acquired transplacentally from the mother.
The newborn exhibits passive immunity to antigens to which the mother had developed
antibodies, transplacental IgG (25 day half-life),
37. Why does breastfeeding protect infants from infectious diseases? The breastfeed infant will
acquire passive transfer of maternal immunity via breast milk, and will be better protected during
hypogammaglobinemia phase (2-6 months). By 8 years IgG should reach adult levels.
38. Why are infants and young children more susceptible to infection than older children and adults?
Healthy full-term infants have immature immune system (WBC, lymphatic), decreased
inflammatory response, and increased susceptibility to infection.
Newborns have components of cellular immunity, as they are born with WBC, but have decreased
inflammatory response, and may not show fever the way older children do, cannot localize
infection well. Humoral immunity occurs after exposure or vaccine, Passive humoral
immunity(antibodies acquired from mother) exisits at birth extended with breastfeeding but
temporary, so vaccinations need to start in the young infant at 2 months!
39. Identify the “links in the chain” of infection. Chain of infection is the process by which organisms
are spread. Infectious agent (the organism), Reservoir (place where the organism can thrive),
portal of exit/mode of transmission, portal of entry(break in skin, exposed mucous membrane),
susceptible host (immune system cannot resist the pathogen, young children, stressed, tired,
undernourished, immunocomprimised, very old)
Identify the diseases to which infants and children are (ideally) immunized in Nova Scotia: 1. DTaPIPV-Hib (Diphtheria, tetanus, acellular , pertussis (whooping cough), polio, and Haemophilus
influenzae type b vaccine) 2. Pneumococcal conjugate vaccine 3. Meningococcal group C conjugate
vaccine. 4. MMRV(Measles, mumps, rubella and varicella vaccine) 5. Tdap-IPV(Tetanus, diphtheria,
acellular pertussis (whooping cough), and polio vaccine)
40. Review principles of community health infectious disease control.Handwashing, immunization,
proper handling and preparation of food, judious antibiotic use, prompt recognition, treatment,
report communicable diseases.
41. Review ideal practices of hand hygiene in hospitals and clinical care settings.
42. Explain the physiology of fever and how antipyretics work. Infection & inflammation stimulate
release of endogenous pyrogens which act on the hypothalamus, trigger prostaglandin production
and increases body temperature. Oral>37.5C, Rectal>38, Axillary>37.3. Antipyretics
(acetaminophen, ibuprofen) decrease the temperature set point (in children with raised temp) by
inhibiting the production of prostaglandins, leading to heat loss (through vasodilation and
sweating) resulting in reduction of fever.
43. What are febrile seizures and how are they prevented and treated. Febrile seizure are the most
common type of seizure during childhood. A rapid rise in temp >39.0, generalized tonic –clonic
seizure of a few second to 10 mins, followed by postictal period of drowsiness. Children<5 years
of age, peak incidence (18-24 months), rare to see in children<6months. Febrile seizures may
indicate a serious underlying infectious disease (LP to rule out meningitis or sepsis) . Antipyretics
do not prevent. Children who experience one or more febrile seizure are at no greater risk for
developing epilepsy then rest of population.
44. Describe comfort promotion techniques for fever. Identify safe OTC antipyretic medication for
children. In infants over 3 months, fever<39C does not require treatment. Antipyretics provide
symptomatic relief but do not change course of infection. The use of acetaminophen & ibuprofen
effective and safe with appropriate dose. Watch for dehydration, increase fluid intake, dress child
lightly, avoid warm binding clothes or blankets, give antipyretic prior to tepid bathing in warm
room, ensure sponge does not produce shivering(cause body to produce more heat), tepid water,
not cold water or alcohol.
45. What are the TORCH infections and how can they be prevented?
Toxoplasmosis: fetus contract through placenta from improper handling of cat litter or ingestion of
contaminated meats.
Other (syphilis), Rubella (congenital rubella syndrome associated with thickening of lens→blindness,
heart defect, bone anomalies),
Cytomegalovirus: leading cause of perinatal infection, herpes virus can infect fetus without maternal
symptoms. Stillbirth, sensoryneuro, hepatic, & developmental damage.
Herpes.
46. What is infant sepsis? Explain the pathophysiology of infant sepsis? Sepsis is a systemic over
response to infection.
47. Be able to discriminate between childhood infections that can be safely managed by parents at
home, those that require a visit to an MD/NP, and those that require immediate ER assessment
and care. Seek medical assistance: fever<6months, lethargic, irritable, cranky regardless of temp,
wheezing or persistent coughing, fever>3days,fever>40.6, those who are immunocomprimised.
For the following, identify/discuss: the causative organism (virus, bacteria, parasite, toxin…);
vulnerable populations of children; signs and symptoms, expected progression of disease, medical
treatment options; nursing implications in prevention; nursing implications in treatment.
48. Diphtheria: cornynebacterium diphtheria. A pseudomemnrane forms over pharynx, uvula, tonsils,
and soft palate which can obstruct airway. Neck becomes edematous with lymphadenopathy.
Unimmunized children<15 years. Treatment: antibiotics, diphtheria antitoxin, and airway support.
49. Pertussis: Bordetella pertussis. Unimmunized children<1 year. Seizures, pneumonia, encephalitis,
infants <6 months greatest risk for death. 7-10 days of cold symptoms, paroxysmal coughing spells
can last for 1-4 weeks. “Whooping” with cyanosis and tongue protrusion. Infants are fearful during
paroxysmal but rest well in between.
50. Tetanus: Clostridium Tetani spores enter wound and release neurotoxin. Tetanus immunoglobulin
prophllaxis booster every 10 years. Painful muscle spasms progress in descending fashion
beginning at the jaw, back & neck muscles most affected sever enough to cause fractures, difficulty
swallowing, breathing, stiff neck, long difficult recovery. Neonatal tetanus most common form
worldwide from nonsterile cutting of umbilical cord, circumcisions.
51. Polio highly infectious poliovirus invades CNS causing asymmetric paralysis affecting leg more
than arms, respiratory problems. No cure, oral live vaccine shed in feces for 6 weeks in
Afghanistan, India, Africa.
52. Hemophylus influenza Type B: Hib is a type of bacteria that can cause neningitits,
epiglottis(airway blocking), pneumonia, sepsis in children<5 years. Sore throat, drooling, inability
to swallow, difficulty breathing worse when laying down. IV antibiotics.
53. Measles: can cause encephalitites and neurological damage
54. Mumps: Paramyxovirus causes fever and inflammation of parotid gland & testicles. Unimmunized
children 5 - 19 years. Meningoencephalitits, seizures, auditory neuritis, deafness. Droplets
contagious 1 to 7 days prior to onset, 7 to 9 days after swelling begins.
55. Rubella: Measles in secretions. swollen lymph nodes, rash begins on face & spreads quickly down
neck, trunk, extremities, rash may appear pinpoint, fever, cough, inflammation of mucous
membranes lining the nose, conjunctivitis. Koplik spots ( clustered, white lesions on the buccal
mucosa), erythematous maculopapular rash.
56. Varicella Zoster (chickenpox): Herpes virus, airborn droplets and through contact with skin
lesions. Can become dormant in sensory nerve ganglia and become reactivated as shingles.
Vesicular rash, Unvaccinated children < 12 years. Complications more common in adolescents and
pregnant woman, scarring, pneumonia, otitis media, septic arthritis. Lesions begin as red
macules→vesicles, pustules→ crust over. Acetaminophen & fluids, fingernails short, cool compress,
baking soda bath, respiratory isolation.
57. Meningococcal septicemia/ meningococcal meningitis : meningococcal bacteria can cause
meningitis and sepsis, can progress rapidly causing shock(inadequate blood flow, loc), death from
shock can occur 6-12 hours after first sign of illness. A distinctive rash of small red spots, spread
rapidly, turn from deep red to large purple spots, looks like bruises, occurs few hours after fever.
Group B causes most of infections <2 years. Most spread occurs via hcp.
58. Malaria: temp>20 degrees, parasitic spread by mosquitos, blood transfusion, needles, infected
mother to child. High fever, shaking chills, flu-like illness, sever anemia(loss of RBC), death.
Prevention prohyllaxis for travelers, insecticide-treated mosquito nets. Treatment: chloroquine,
quinine, doxycycline, clindamycin.
59. Lyme disease: spirochete borrelia burgdorferi via bite black-legged tick. Reported incidence
highest in children 5-10. Chills, fever → muscle, joint pain → neurocognitive symptoms. Treatment
doxycycline, amoxicillin. Prevention: cover skin, insect repellent, inspect skin
60. Rabies: once symptomatic is almost always fatal, post-exposure prophyllaxis immune globulin and
rabies vaccine infiltrated in and around the wound in series of IM injections. Rabies virus affects
CNS of warm blooded animals, bats, raccoons, skunks, foxes.
Essays:
1) 5 definitions about a clinical problem/illness
2) about autism spectrum disorder
3) a case study involving planning developmentally appropriate/supportive care for an ill
child at age -x22.
Autism spectrum disorders (autism, asperger’s, and PDD-NOS) (essay question on this-read the articles as well as the text and view the video on moodle about ABA for autism)
Autism is the most common neurological disorder affecting children, and one of the most common
developmental disabilities. 1:150 children (health Canada). Spectrum of autism disorders range
from mild (asperger’s syndrome) to severe. Autisitc behavior in infancy developmental delay, or at
12-36 months when the child regresses or loses previously acquired skills. Maybe caused by
genetics, brain abnormalities, altered chemistry, virus, toxic chemicals.
1. Social impairment of age-appropirate social skills and social interaction: poor eye contact,
inability to use nonverbal gestures(pointing/waving). Lack pretend play, does not develop
peer relationships, isolated from social world,
2. language/communication delayed, echolalia(immediate and involuntary repetition of words or
phrases just spoken by others) is common.
3. Repetitive and stereotyped patterns of behavior, interest, and activities. Repetitive play, lining
up cars over and over, hand-flapping. Change is difficult and may result in tantrums.
4. Treatment through behavioral and communication therapy, highly structured educational
environment, stimulants for hyperactivity, or antipsychotic for aggressive behaviors.
Asperger’s Syndrome: language skills are unimpaired with average or above average intellectual
function. May not appear as socially withdrawn, but approach others in socially inappropriate and
eccentric ways (difficult with jokes, metaphors).
Pervasive Developmental Disorders Not Otherwise Specified (PDD-NOS): atypical or high functioning
autism. Fewer repetitive behaviors than children with ‘classic autism’ and more delayed language than
AD.
Spends hours in repetitive activity, resists cuddling, lack eye contact, failure to look at objects pointed to,
or point to themselves indifferent to touch or affection, little change in facial expressions. Toddlers may
display hyperactivity, aggression, tantrums, self-injury (head banging, hand biting), hypersensitivity to
sounds, smells, touch, hyposensitivity to pain, easily frustrated, moodiness, overstimulated, unusual
behavior (hand flapping or spinning). Large prominent, posteriorly rotated ears, hypo/hyper pigmented
lesions, asymmetry in nerve function, hyper/hypotonic deep tendon reflexes, toe-walking, loose gait,
poor communication. Warning signs: not babbling, pointing, or using gestures by 12 months, no single
word by 16 months, no two-word by 24 months, losing language or social skills at any age. Emotional
support, professional guidance, and education about the disorder. Child< 36 months early intervention
program. Stress importance of rigid unchanging routines. Asses parents need for respite care and positive
feedback.
Nursing strategies that prepare children and their families for this experience while at the same time
minimizing negative effects. These strategies include : identifying the needs through assessment of
nonverbal and verbal behaviors, validating the information with accurate interpretation and providing
appropriate responses and interventions. Assessing the learning needs of the child and family.
Regression (returning to previous stages of development). Separation anxiety, 8 months to 3 years, hours
to days, protest, despair, denial(detachment)=coping mechanisms.
Nurses must assume responsibility for the care of children who are hospitalized by maintaining good
partnerships with families, nurses can support parents by providing accurate timely information and an
explanation of treatment plans, and by supporting the parents ability to stay with their child at all times.
The initial contact with children and their families can serve as a foundation for a trusting relationship.
The first encounter should be unthreatening and friendly, approach with open hands without medical
equipment. Let child interact and get to know you before. Be genuine, listen, use fav toys/shows to
establish rapport, allow child to participate in conversation, a trusting relationship built by using
appropriate language, games, play, singing during procedure, prepare for procedures and provide
explanation & encouragement, use play and age appropriate communication.
Nursing care must begin by establishing a trusting, caring relationship with the child and family.
Introduce yourself, smile, give title, ask what they preferred to be called, eye contact at appropriate level,
start with family first so child can see that the family trusts you, and communicate with children at age
appropriate level. Orientation to hospital unit and introductions, confirm vital info (allergies, medications
taken at home, previous illness) place child close to nurses’ station. Developmentally appropriate
support, education, and resources bases on the principles of family-centered care. Pain management
crucial, use appropriate pain assessment tools. Breathing exercises (blowing pinwheel, cotton ball
&straw, dolls, roleplay).