Ped Unit 2 Assessment Fall

Correct Answer: CRIES Scale for Neonatal Postoperative Pain Assessment.

Explanation

The CRIES Scale is a tool specifically designed for assessing neonatal postoperative pain. It evaluates pain based on the following five parameters:

Cry (the infant's crying)

Requires increased oxygen administration

Increased vital signs (heart rate and blood pressure)

Expression (facial expression)

Sleeplessness (changes in sleep patterns)

The nurse is assessing the infant's facial expression, body movement, sleep, vocal ability, consolability, and response to touch, which directly corresponds to the CRIES scale.

Why the Other Options are Incorrect:

Riley Infant Pain Scale: This scale is used for assessing pain in infants and children but focuses more on general pain behaviors rather than neonatal postoperative pain.

Pain Observation Scale for Young Children: This scale is used for children who are unable to communicate verbally, but it is not specifically designed for neonates or postoperative pain.

FLACC Behavioral Scale for Postoperative Pain in Young Children: While the FLACC scale assesses behaviors for pain, it is typically used for older infants and young children, not specifically for neonates.

Summary:

The nurse is using the CRIES Scale for Neonatal Postoperative Pain Assessment, which is specifically designed for newborns to assess their pain based on facial expression, body movement, sleep, vocalization, and response to stimuli.

Correct Answers:

Fatigues easily after a short walk home from school

A tendency to squat

Periorbital edema

Explanation

These findings are suggestive of a cardiovascular disorder:

Fatigues easily after a short walk home from school

Fatigue is a common symptom in children with heart disease because the heart is not efficiently pumping blood, leading to a decreased oxygen supply to the tissues. If a child fatigues easily with minimal exertion, this could indicate heart failure or other cardiovascular issues.

A tendency to squat

Squatting is a common behavior in children with certain congenital heart defects, particularly those that cause decreased pulmonary blood flow (e.g., Tetralogy of Fallot). Squatting helps increase venous return to the heart and can improve oxygenation when the child experiences cyanosis (lack of oxygenated blood).

Periorbital edema:

Periorbital edema (swelling around the eyes) is a sign of fluid retention, which can occur in heart failure when the heart is unable to pump effectively, leading to congestion and fluid accumulation in various tissues.

Why the other options are incorrect:

A lack of perspiration

Lack of perspiration is not a typical indicator of a cardiovascular disorder. Children with cardiovascular issues may perspire excessively due to the stress on the heart or due to the body working harder to circulate blood.

Frequent voiding:

Frequent urination is not directly associated with cardiovascular disorders. It could be linked to other conditions, such as diabetes mellitus or urinary tract infections, but it is not a common sign of cardiovascular disease.

Bouts of hyperactivity:

Hyperactivity is generally not associated with cardiovascular disorders. It is more commonly linked to attention-deficit hyperactivity disorder (ADHD) or other behavioral issues, rather than heart conditions.

Summary:

The findings that would suggest a cardiovascular disorder in this child are fatigue after minimal exertion, a tendency to squat, and periorbital edema. These symptoms point toward potential heart failure, poor oxygenation, or congenital heart defects that should be further evaluated.

Correct Answer: "Notify the practitioner for decreased respiratory status and changes in assessment."

Explanation

Foreign body aspiration in a 2-year-old is a medical emergency that requires immediate intervention if there are signs of respiratory distress. The priority nursing action is to notify the practitioner if the child shows signs of worsening respiratory status, such as:

Stridor, wheezing, or persistent coughing

Increased work of breathing (nasal flaring, retractions, tachypnea)

Cyanosis or decreased oxygen saturation

Altered level of consciousness due to hypoxia

Early recognition and prompt medical intervention (such as bronchoscopy for object removal) can prevent complete airway obstruction and respiratory failure.

Explanation of Why the Other Options Are Incorrect:

"Administer oxygen and reposition the child."

While oxygen may be necessary in severe cases, it is not the first priority. If the airway is completely obstructed, administering oxygen will not be effective. Back blows and chest thrusts (for infants) or the Heimlich maneuver (for older children) are prioritized for immediate action. Repositioning may help if the foreign body is partially obstructing the airway, but it does not address the root cause, which is removing the object.

"Assess the child's vital signs."

While vital signs are important in ongoing monitoring, assessment alone does not directly address the emergency. If the child is struggling to breathe, immediate intervention is required rather than waiting for a full assessment.

 "Provide education on prevention and safety."

 Prevention education is important after the acute situation is resolved to avoid future occurrences, but it is not a priority during the emergency. The immediate focus is on ensuring the airway is clear and managing respiratory distress

Summary:

Foreign body aspiration is a life-threatening emergency in young children. The priority intervention is to notify the practitioner if respiratory status declines, as immediate medical intervention (such as bronchoscopy) may be needed. Administering oxygen may help but does not resolve airway obstruction. Assessing vital signs is important but secondary to addressing the obstruction. Prevention education is crucial for the future but not during an acute event. 

Correct Answer: Enlist the aid of a child life specialist.

Explanation

A child life specialist is trained to provide age-appropriate activities and support to help children cope with hospitalization and long-term care situations. They can engage the child in therapeutic play, provide distraction, and offer creative outlets that are developmentally appropriate. This intervention directly addresses the nursing diagnosis of deficient diversional activity by focusing on both emotional well-being and engagement during prolonged bed rest.

Why the other options are less suitable:

Offer the child reading materials: While beneficial, this option may not fully address the child's lack of participation in multiple activities. Reading alone might not be engaging enough for a 10-year-old in traction.

Encourage the child to complete his homework: Homework may feel like an obligation rather than a diversion, potentially increasing frustration rather than relieving boredom.

Ask for the parents' assistance: While parental involvement is important, it may not be sufficient on its own. Parents might not have the resources or training to provide structured, engaging diversions like a child life specialist can.

Summary 

Child life specialists can help create a care plan tailored to the child’s interests and developmental level, ensuring a holistic approach to managing boredom and promoting emotional well-being.

Correct Answer: Aortic stenosis

Explanation

Narrowed pulse pressure (a smaller difference between systolic and diastolic blood pressures) can be associated with several cardiovascular conditions, and in this case, aortic stenosis is the most likely cause. Aortic stenosis is a condition where the aortic valve is narrowed, causing a decrease in the blood flow from the left ventricle into the aorta. This narrowing leads to increased resistance during systole and can result in a lower systolic pressure or an increase in diastolic pressure, resulting in a narrower pulse pressure.

Why the other options are incorrect:

Patent ductus arteriosus (PDA):

In PDA, there is an abnormal connection between the aorta and pulmonary artery, which usually causes a wide pulse pressure (the difference between systolic and diastolic pressure is larger) rather than a narrowed pulse pressure. This happens because of the continuous blood flow from the aorta to the pulmonary artery.

Aortic insufficiency (aortic regurgitation):

Aortic insufficiency, where the aortic valve does not close properly, leads to blood flowing back into the left ventricle during diastole, which typically results in a wide pulse pressure. The systolic pressure can remain high due to the increased stroke volume, while diastolic pressure falls because of the regurgitation, leading to a wider pulse pressure.

Complete heart block:

In complete heart block, the electrical conduction system of the heart is disrupted, causing a slower heart rate and possibly irregularities in the heart's rhythm. However, complete heart block is generally not associated with a significant change in pulse pressure, as it primarily affects heart rate and rhythm rather than directly impacting the pressure difference between systolic and diastolic blood pressure.

Summary:

A narrowed pulse pressure is most commonly associated with aortic stenosis, where the narrowed aortic valve causes increased resistance to blood flow, affecting the pressure difference between systolic and diastolic readings. Other conditions, like PDA and aortic insufficiency, tend to be associated with a widened pulse pressure.

Correct Answer: The child.

Explanation

During a physical examination following a comprehensive health history, the primary focus should be on the child. The nurse’s goal is to assess the child's physical health, including vital signs, growth measurements, and examination of body systems (such as the respiratory, cardiovascular, and gastrointestinal systems). This evaluation is essential to confirm or further investigate any concerns raised during the health history.

Why the Other Options are Wrong

The parents: While parents provide valuable information about the child's health history and are important for supporting the child during the examination, the focus of the physical examination is on the child, not the parents.

Chief complaint: The chief complaint is important in guiding the examination, but the physical examination itself involves evaluating the child's overall health and body systems, not just focusing on the specific complaint. The nurse will address the chief complaint during the examination but also conduct a thorough evaluation of the child's health.

Developmental age: While developmental age is important to consider in terms of understanding developmental milestones and tailoring the examination to the child’s stage, the physical examination focuses primarily on assessing the child’s health, including the body systems, not just their developmental age.

Summary:

The focus of the physical examination after a comprehensive health history is on the child, as the nurse needs to assess the child's overall physical health, development, and any concerns related to the chief complaint. Although factors like developmental age and the chief complaint guide the examination, the child’s physical health takes precedence during the examination.

Correct Answer: A child with juvenile arthritis.

Explanation

Juvenile arthritis (JA) is a chronic condition characterized by inflammation of the joints, which causes pain and can result in limited movement. Nonopioid analgesics, such as NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen or acetaminophen, are commonly used to manage mild to moderate pain and inflammation associated with JA. They work by reducing inflammation and providing pain relief. However, for more severe pain or flare-ups where inflammation is significant, stronger medications may be required. Disease-modifying antirheumatic drugs (DMARDs) or biologic agents are typically used to address the underlying autoimmune condition, while opioid analgesics might be used for severe pain that does not respond to nonopioids.

Why nonopioid analgesics are appropriate in juvenile arthritis:

NSAIDs are commonly prescribed for their anti-inflammatory properties, which help reduce pain and swelling in conditions like juvenile arthritis. They are typically considered first-line medications for managing arthritis pain in children. Acetaminophen can be used for mild pain relief if inflammation is not a significant factor.

Why the other options are incorrect:

A child with end-stage cancer

A child with end-stage cancer would likely experience severe, chronic pain, which typically requires opioid analgesics. While nonopioid analgesics may be part of the pain management plan, they are generally not enough to control the severe pain of end-stage cancer.

A child with a broken arm

A child with a broken arm may experience moderate pain, and nonopioid analgesics like acetaminophen or ibuprofen may be sufficient for pain relief. However, if the pain is severe, opioid analgesics might be needed temporarily for better pain control.

A child with severe postoperative pain

Severe postoperative pain typically requires opioid analgesics to provide adequate pain control. Nonopioid analgesics can be used as adjuncts to opioids, but they are usually not effective alone for managing severe pain.

Summary:

For a child with juvenile arthritis, nonopioid analgesics (NSAIDs or acetaminophen) are effective for managing mild to moderate pain and inflammation. In more severe cases, other treatments or stronger medications, such as DMARDs or biologics, may be used.

The Correct Statement: Severe, prolonged episodes of coughing is a characteristic manifestation of this infection.

Explanation

This is the hallmark symptom of pertussis (whooping cough). The cough is typically severe, with fits of coughing followed by a "whooping" sound as the person struggles to breathe in air. The cough can last for several weeks and is often most noticeable in infants and young children.

Why the Other Options are Incorrect:

A painful, stiff neck is a common manifestation of this infection: A painful, stiff neck is not characteristic of pertussis. This symptom is more commonly associated with conditions such as meningitis, not pertussis.

An antiviral medication is administered to treat this infection: Pertussis is caused by a bacterial infection (Bordetella pertussis), not a viral one. Therefore, antibiotics (e.g., azithromycin or erythromycin) are used to treat pertussis, not antiviral medications.

Prophylactic treatment is offered to those who have been in close contact with an infected child in the past 60 days: The recommended time frame for prophylactic treatment is typically 21 days, not 60 days. Close contacts (especially those at high risk like infants or pregnant women) should receive prophylactic antibiotics within 21 days of exposure to prevent the spread of the infection.

Summary:

The characteristic manifestation of pertussis is severe, prolonged episodes of coughing, and antibiotics are used to treat the infection, not antivirals. Prophylactic antibiotics should be administered to close contacts within 21 days, not 60 days.

Correct Answer: "Once transitioned into a booster seat, we will allow our child to ride in the front seat of the car."

Explanation

Booster seat and front seat safety: The American Academy of Pediatrics (AAP) recommends that children should remain in a booster seat until they are at least 4 feet 9 inches tall, which typically occurs between ages 8 and 12. Even after transitioning out of the booster seat, children should still ride in the back seat until they are at least 13 years old for optimal safety. The front seat airbag and the seat belt system are not designed to protect smaller children adequately.

Why the other options are correct:

"We will use a booster seat until our child is tall enough for the seatbelt to fit properly.": This is accurate and reflects the current safety guidelines, which recommend using a booster seat until the child is tall enough (around 4 feet 9 inches) and the seatbelt fits properly across the child's lap and chest.

"We will ensure our child wears a helmet while riding a bicycle.": This is correct. Helmets are crucial for preventing head injuries while riding a bike, and it is recommended that children wear helmets for all cycling activities.

"We will teach our child to avoid running into the street without looking.": This is an appropriate safety measure. Teaching children pedestrian safety, including looking both ways before crossing the street, is essential in preventing injuries.

Summary:

The statement "Once transitioned into a booster seat, we will allow our child to ride in the front seat of the car" indicates that the parents need additional teaching regarding vehicle safety. Children should remain in the back seat until they are at least 13 years old, even after transitioning out of a booster seat.