Ped Unit 2 Assessment Fall

Correct Answer:

"Aspirin therapy should be given daily for several months as prescribed."

"The child should not receive any live vaccines for 6 months."

"Schedule the prescribed cardiac evaluations."

Explanation

"Aspirin therapy should be given daily for several months as prescribed."

 Children with Kawasaki disease are often treated with high-dose aspirin therapy during the acute phase and are typically continued on low-dose aspirin for several months to help reduce the risk of coronary artery aneurysms. It is essential for parents to follow the prescribed regimen and not discontinue it early.

"The child should not receive any live vaccines for 6 months."

Children who have received intravenous immunoglobulin (IVIG) as part of their treatment for Kawasaki disease should avoid live vaccines for 6 months after receiving the IVIG. This is to ensure that the immunoglobulin does not interfere with the efficacy of live vaccines, such as the MMR (measles, mumps, rubella) or varicella vaccines.

"Schedule the prescribed cardiac evaluations."

 Kawasaki disease can lead to coronary artery changes, and regular cardiac follow-up is essential to monitor for any complications, including coronary artery aneurysms. The nurse should emphasize the importance of cardiac evaluations as prescribed by the healthcare provider to assess heart function and vascular health.

Why the Other Options are Incorrect:

"Allow the child to be active daily to increase joint range of motion."

While some joint pain and stiffness can occur as a result of Kawasaki disease, it is not always appropriate to encourage unrestricted activity right away. The child may need rest and a more gradual return to activity. The goal is to avoid overexertion and further joint damage. Activity should be moderated based on the child's condition and any residual symptoms.

"Take the child's temperature twice daily."

 After the acute phase of Kawasaki disease, the need for regular temperature monitoring is not typically emphasized unless the child shows signs of a fever or infection. Parents should be instructed to monitor for signs of infection (such as fever) and to report any concerning symptoms to the healthcare provider. However, routine temperature checks twice daily are not a typical requirement for home care after the child is discharged, unless directed by the provider.

Summary:

Parents should be instructed to continue aspirin therapy, avoid live vaccines for 6 months, and schedule cardiac evaluations. Joint activity should be carefully managed, and regular temperature checks are not necessary unless there are specific concerns. Emphasis should be placed on following the prescribed care plan to monitor for complications and support recovery.​​​​​​​

Correct Answer: Preschool age

Explanation

Children in the preschool age (typically 3-5 years old) are at a stage where they often believe in the reversibility of death. At this stage, children may view death as temporary, believing that the person who has died can come back.  They might think that death is a form of sleep or that it can be undone. Their understanding of death is more magical and egocentric, meaning they might also believe their thoughts or behaviors could affect death (e.g., thinking they can make someone come back by wishing for it).  This belief in reversibility reflects their developmental stage, where they have not yet fully grasped the permanence of death.

Why the Other Options Are Incorrect:

Toddler:

Toddlers (around 1-3 years old) have very limited cognitive abilities to understand the concept of death. They may react to the absence of a loved one, but they don’t have the cognitive ability to understand it as a permanent or reversible event. Their understanding of death is very concrete and often involves confusion about the situation (e.g., they may not understand what it means to die at all)

School age:

School-aged children (around 6-12 years old) are beginning to understand that death is permanent and irreversible, but they also start to learn that it happens to everyone eventually. By this stage, they start understanding the finality of death and can grasp that it is not something that can be undone or avoided.

Adolescent:

Adolescents (13 years and older) are typically in the process of developing a more mature and abstract understanding of death. By this time, they understand that death is irreversible and that everyone will eventually die. However, this understanding may also involve complex emotional responses, but the belief in reversibility is not typical at this stage.

Summary:

Children in the preschool age range (3-5 years) are more likely to believe that death is reversible, viewing it as something temporary or fixable. As children grow older and enter the school-age years, they begin to understand that death is permanent and irreversible. Toddlers and adolescents are still in stages where their understanding of death is either non-existent (toddlers) or more mature but not centered around the idea of reversibility (adolescents).

Correct Answer: They work to minimize health-related barriers to learning.

Explanation

School nursing is a specialized practice aimed at promoting the health and well-being of students, which directly impacts their ability to succeed in school. One of the core goals of school nursing is to minimize health-related barriers that could interfere with a child's ability to learn. These barriers can include chronic illnesses, mental health issues, injuries, poor nutrition, or other health conditions that might impact a student's attendance, performance, or overall ability to engage in school activities. By addressing these health-related challenges, school nurses help ensure that children are physically and emotionally ready to succeed in the classroom. School nurses provide care that directly removes or reduces health-related barriers (such as administering medications, treating injuries, promoting mental health awareness, etc.), which can affect a child's ability to engage fully in school activities and academics. This intervention enables students to attend school more regularly, focus better in class, and participate more fully in their education.

Why the Other Options Are Incorrect

They coordinate all school health programs:

While school nurses are involved in coordinating health programs (such as vaccination clinics or health screenings), this is just one aspect of their role. The overall strategy to achieve student success involves more than just coordinating programs; it focuses on directly removing health barriers to learning.

They link community health services:

School nurses do collaborate with community health services, but this is a part of the broader strategy. Their primary focus is more on minimizing health-related barriers within the school environment itself, rather than solely acting as a liaison to community services.

They promote student health and safety:

While promoting health and safety is important and part of the school nurse's role, the specific emphasis in this context is on minimizing barriers that directly affect learning. Promoting health and safety is a broad goal, but the focus here is on how those actions facilitate academic success.

Summary:

School nurses work to ensure that health-related issues do not interfere with a child's ability to learn, thereby enhancing their academic success. This is achieved by minimizing health barriers such as chronic conditions, injuries, or emotional challenges that may hinder learning. While school nurses also promote health, coordinate health programs, and collaborate with community services, their central role in supporting student success is by addressing these barriers.

Correct Vaccine for a 4-year-old Child is: Varicella (VAR)

Explanation

Varicella (VAR): The varicella vaccine, which protects against chickenpox, is given to children in two doses. The first dose is typically administered at 12-15 months of age, and the second dose is given at 4-6 years of age. Therefore, a 4-year-old child is due for the second dose of the varicella vaccine.

Why the Other Options are Incorrect:

Meningococcal (MCV4): The meningococcal vaccine (MCV4) is typically administered to children starting at age 11-12 years, with a booster dose at age 16. It is not given to a 4-year-old child.

Hepatitis B (HepB): The Hepatitis B vaccine is typically given in a series of three doses starting at birth, with subsequent doses at 1-2 months and 6-18 months of age. By age 4, the child should already have received all necessary doses of the HepB vaccine.

Haemophilus influenza type b (Hib): The Hib vaccine is typically administered to infants in a series of doses at 2, 4, and 6 months of age, with a final booster dose at 12-15 months. By age 4, the child should have completed the Hib vaccine series.

Summary:

For a 4-year-old child, the Varicella (VAR) vaccine is the correct one to administer. The other vaccines mentioned (Meningococcal, Hepatitis B, and Hib) are either not due at this age or have already been given in earlier years.

Correct Answer: "Raise the caloric density of the feeding beyond 20 calories per ounce."

Explanation

Infants with congenital heart disease often struggle to grow and develop properly due to the increased energy demands caused by their condition. One way to support their growth is by increasing the caloric density of their feedings, which means providing more calories in a smaller volume of milk. This helps ensure they receive adequate nutrition despite potentially struggling with feeding for longer periods or consuming enough volume. Raising the caloric density beyond 20 calories per ounce is a common strategy in managing infants with congenital heart disease. This approach helps the infant obtain more calories without needing to consume larger volumes of milk, which can be tiring or difficult due to their respiratory or cardiac status.

Why the other options are incorrect:

Suggest that the infant should receive commercial formula rather than breast milk:

Breast milk provides excellent nutrition and immune support for infants, especially for those with heart disease. In many cases, it’s preferred over formula unless there is a specific medical reason for switching. Formula may be used if higher caloric content or other specific nutritional needs are required, but breast milk should not be discouraged unless needed for specific medical reasons.

Feed the infant at a minimum of every 2 hours:

While frequent feedings are often important for infants with congenital heart disease, feeding every 2 hours may not always be necessary and could increase fatigue for the infant. The key focus is often on improving the caloric density of each feeding rather than increasing the frequency of feedings.

Increase the length of the feeding sessions to 45 to 50 minutes:

Lengthening feeding times may not be helpful for infants with congenital heart disease, as they may tire easily and struggle with extended feedings. Infants may require shorter, more frequent feedings rather than extended feeding durations.

Summary:

For an infant with congenital heart disease who is not growing adequately, the best approach is to raise the caloric density of their feedings beyond 20 calories per ounce to ensure they are receiving adequate nutrition while minimizing the volume of milk they need to consume. This can support their growth and development without overwhelming their cardiac or respiratory systems.

Correct Answer: "He must be positioned on his tummy as much as possible."

Explanation

While tummy time is essential for the development of a 3-month-old baby, the phrase "as much as possible" may indicate a misunderstanding. Newborns and young infants should have short, supervised tummy time sessions starting from about 2 to 3 weeks of age, typically about 2 to 3 times a day, gradually increasing the duration as the infant grows stronger. Overdoing tummy time without considering the baby's tolerance and comfort can be overwhelming and may not be advisable.

Why the other responses are correct:

"I need to watch him during his tummy time." This is an appropriate response. Babies should always be supervised during tummy time to ensure their safety.

"I need to change his head position while he is in an upright chair." This is an appropriate response. Changing head positions frequently while the baby is in a supported position (like in a chair or during sleep) can help prevent flat spots from developing due to prolonged pressure on one side of the head.

 "His head has flattened due to the pressure of his head position." This is a correct statement. Flat head syndrome (positional plagiocephaly) is often caused by pressure on one side of the skull when a baby spends too much time lying on their back or in one position.

Summary

Tummy time is crucial for infants to help prevent flat head syndrome (plagiocephaly) and promote motor skill development, but the phrase "as much as possible" may imply overdoing tummy time, which could be uncomfortable or overwhelming for the baby. It's important to encourage supervised tummy time in reasonable amounts.

Correct Answer: Management includes administration of aspirin and IVIG.

Explanation

Kawasaki disease is a vasculitis that primarily affects children and can lead to complications such as coronary artery aneurysms if not treated properly. The standard treatment for Kawasaki disease includes:

Aspirin: To reduce inflammation and fever, and also to prevent blood clots from forming in the coronary arteries.

Intravenous immunoglobulin (IVIG): To reduce inflammation and decrease the risk of heart complications, particularly coronary artery aneurysms.

Why the Other Options Are Incorrect:

"Joint pain is a permanent problem."

Joint pain in Kawasaki disease is temporary and typically resolves with treatment. Joint involvement is common in the acute phase but does not result in permanent problems.

"Antibiotics should be administered every 8 hours by IV."

Kawasaki disease is not caused by a bacterial infection, so antibiotics are not part of the treatment. The focus of treatment is on reducing inflammation and preventing cardiovascular complications.

"Steroid creams are used for the hand peeling."

Hand peeling (desquamation) is a symptom of Kawasaki disease that usually resolves on its own. Steroid creams are not used for this symptom. The primary treatment focuses on addressing the systemic inflammation with IVIG and aspirin rather than treating the skin manifestations with topical steroids.

Summary:

For a child with Kawasaki disease, the correct treatment includes aspirin and intravenous immunoglobulin (IVIG). Joint pain is temporary, antibiotics are not used, and steroid creams are not indicated for skin peeling.

Correct Answer: "slows and strengthens the heartbeat."

Explanation

Digoxin is a cardiac glycoside used to treat heart failure and certain types of arrhythmias in infants and children. It works by slowing the heart rate (by increasing vagal tone) and strengthening the heart's contractions. This helps improve the heart's ability to pump blood more efficiently, especially in conditions like heart failure.

Why the other options are incorrect:

Increases the heart rate:

Digoxin does not increase the heart rate. In fact, one of its primary actions is to decrease the heart rate by affecting the electrical conduction system of the heart, particularly by increasing vagal tone.

Thickens the walls of the myocardium:

Digoxin does not directly cause thickening of the myocardium (heart muscle). The drug affects the force and rate of the heart's contractions but does not cause structural changes in the heart muscle itself.

Prevents subacute bacterial endocarditis:

Digoxin is not used for the prevention of subacute bacterial endocarditis. Preventive antibiotic therapy is used for that purpose, not digoxin. Digoxin specifically affects heart function.

Summary:

The primary action of digoxin is to slow and strengthen the heartbeat, which is crucial for improving cardiac output, particularly in conditions like heart failure or certain arrhythmias. It does not increase the heart rate, cause myocardial thickening, or prevent bacterial endocarditis.

Correct Answer: Endocrine.

Explanation

Increased appetite (polyphagia) and increased thirst (polydipsia) are common symptoms associated with endocrine disorders, particularly diabetes mellitus. These symptoms occur when there is an imbalance in hormones that regulate metabolism and fluid balance, such as insulin in diabetes. By asking about these symptoms, the nurse is assessing the functioning of the endocrine system.

Why the Other Options are Wrong:

Genitourinary: The genitourinary system involves the kidneys, bladder, and urinary tract. While increased thirst and appetite could be linked to hydration issues or diabetes, they are not directly related to genitourinary issues unless there are also symptoms like frequent urination (polyuria) present.

Hematologic: The hematologic system refers to the blood and blood-forming organs, including the production of red and white blood cells and platelets. Increased appetite and thirst are not typical symptoms of hematologic disorders, though they can be seen in conditions like anemia when the body is compensating for low oxygen levels, but that is not the primary focus in this case.

 Neurologic: The neurologic system includes the brain, spinal cord, and nerves. While the neurologic system can influence appetite or thirst through brain signaling, increased thirst and appetite are not typically the primary symptoms of neurological conditions unless associated with specific brain injuries or disorders that affect the hypothalamus.

Summary:

The nurse is assessing the endocrine system by asking about increased appetite and thirst, as these can be indicators of endocrine disorders, especially diabetes. These symptoms are often associated with disruptions in hormone regulation and metabolism.