NURS209 MODULE 2- Pediatric Care Challenges

SPOTLIGHT: PEDIATRIC CARE CHALLENGES

SELECTED RESPIRATORY CONDITIONS

TONSILITIS & TONSILLECTOMY

Please select True (T) or False (F) for the following statements:
1. The tonsils play a role in antibody formation________
2. Young children are susceptible to respiratory infections because they have
smaller tonsils______
3. The causative organism for Tonsillitis may be Viral or Bacterial__________
4. Tonsillectomy is the removal of Tonsils and Adenoids ________
5. Throat cultures can eliminate the need for unnecessary antibiotic
treatment_______
6. Tonsillectomy will be postponed in a child with acute respiratory infection
________
7. Warm salt-water gargles are encouraged after the child has
tonsillectomy________
8. A cool mist vaporizer keeps the mucous membrane moist during mouth
breathing_______
9. In Canada, Codeine is commonly used to treat children experiencing pain
_______
10. Tonsillectomy and Adenoidectomy is recommended after a child has two
episodes of respiratory infections in a year _______
11. Post-tonsillectomy, the child is suctioned quite often to remove any
secretions_________
12. Post-tonsillectomy, analgesics must be given on an as needed basis because
each child is unique and have varied experiences of pain_________
13. Post-tonsillectomy, cool water, flavored popsicles and citrus fruits should be
encouraged ____
14. Post-tonsillectomy, encourage milk, ice-cream and puddings_______
15. Post-tonsillectomy, the child who is restless and having frequent swallowing
may be showing signs of post-operative hemorrhage_______
16. Airway obstruction is a possible complication after tonsillectomy______
17. Post-tonsillectomy, avoid coughing, clearing of the throat or using a
suctioning__
18. Post-tonsillectomy, immediately encourage increased physical activity to
help the child return to normalcy as soon as possible _______
 19. Post-tonsillectomy, natural juices such as beets (rich in iron and vitamins)
are encouraged to help fast recovery _______
20. Post-tonsillectomy, the nurse must report severe earache, stiff neck and fever
immediately_______

OTITIS MEDIA
Please select True (T) or False (F) for the following statements:
1. Otitis Media may follow a respiratory infection of RSV or influenza ___
2. Otitis Media is most common in children older than 7 years _________
3. Children who live in a household with smokers are at high risk for Otitis
Media _________
4. Bottle-feeding puts all children at risk for Otitis Media_______
Predisposing factors to Otitis Media include day care attendance and if a
child has a cleft lip /palate ______
5. The Eustachian tube allows secretions produced in the middle ear to drain
into the nasopharynx_______
6. Children with Acute Otitis media require comprehensive assessment and
management of pain______
7. A Myringotomy is a surgical incision performed to provide drainage of
infected middle ear fluid in the presence of complications _____
8. Tympanostomy tubes facilitate continued drainage and allow ventilation of
the middle ear_____
9. If tympanostomy tubes falls out, it requires immediate intervention, and the
physician need to be informed immediately______
10. Maintaining childhood immunizations will reduce Otitis Media ________

11. A school nurse is observing a child, and he is concerned that the child may be
having Otitis Media. What objective data may indicate that?

12. A 9-month-old infant is hospitalized for monitoring of OM related

complications.
What interventions would promote emotional needs of the infant?
a. .
b. .
c. .

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CYSTIC FIBROSIS

R J is a 13-yr old girl with Cystic Fibrosis. She is admitted to the hospital with
suspected respiratory infection. On admission color is pale with bluish-tinged
nail beds, respiratory rate 30 and somewhat labored T38.8.P- 90 R-28 SPO2-
88% on room air; crackles noted throughout; thorax has a barrel chest
appearance. RJ is very thin; she weighs 25 kg. and complains of having
steatorrhea. Her parents are very distressed and worried as it is her 3rd
hospitalization in 2 months.

1. State 5 priority nursing interventions (NI)

a. .
b. .
c. .
d. .
e. .
2. What other system requires priority interventions? State 5 NI of that system.
a. .
b. .
c. .
d. .
e. .
3. Nursing student asks the primary nurse how CF is diagnosed?
What would be the nurse’s accurate reply and rationale?

BRONCHOLITIS AND RESPIRATORY SYNCYTIVAL VIRUS (RSV)

Please select True (T) or False (F) for the following statements.
1. For a child with bronchiolitis, interventions are aimed at treating symptoms
and include airway maintenance, cool humidified air and oxygen, adequate
fluid intake, and medications ___
2. For a hospitalized child with RSV, promote visitation to playroom, to avoid
isolation and ensuring the child wears a mask while in the playroom___
3. Ensure that nurses caring for a child with RSV do not care for other, high-risk
children. ___
4. Use mainly respiratory precautions during care__
5. Periodic suctioning may be necessary if nasal secretions are copious; use of a
bulb syringe for suctioning may be effective. Suctioning should be done
before feeding to promote comfort and adequate intake. ____
6. Cough suppressants are administered with caution because they can
interfere with the clearance of respiratory secretions. ___

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SAFETY & ANAPHYLAXIS
Please select True (T) or False (F) for the following statements:
1. Anaphylaxis results from an interaction of an allergen a and a patient who is
hypersensitive to that allergen______
2. With severe reaction, only one system of the body is affected _________
3. Exposure to the antigen may be by injection, inhalation, ingestion or skin
contact______
4. Common allergens associated with anaphylaxis are drugs, latex, foods,
venom and biological agents_______
5. Clinical symptoms usually occur an hour after exposure to the antigen________
6. Cutaneous signs of flushing and urticaria are some late signs of a
reaction________
7. Early signs of anaphylaxis are urticaria and pruritus ____________
8. Rapid recognition and institution of treatment of anaphylaxis will ensure a
successful outcome________
9. Establishing an airway is the first concern________
10. Epinephrine is given subcutaneously or intravenously to treat
anaphylaxis_______

11. Discuss prevention of an anaphylactic reaction:

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SELECTED GASTROINTESTINAL CONDITIONS IN CHILDREN

DEHYDRATION
1. Create a Critical Thinking Framework to depict the priority clinical
manifestations, nursing diagnoses and nursing interventions for this case.
A mother brought her 3-month-old child to the emergency room with vomiting
and diarrhea. The child is underweight and is quite irritable. The nurse also
found out that this was the first time that the mother has sought health care for
herself and her child since the birth of the child. The mother is a new immigrant
to Canada.
a. Priority Assessment

b. Priority Diagnostic Tests

c. Priority Nursing Interventions

2. Surya is a school age boy that has been assessed in ED for nausea and
vomiting. He is unable to keep oral liquids. IV fluids are indicated, and the nurse
needs to start IV to promote hydration. Surya is upset and moves his arm away
from the nurse. What approach could the nurse try with Surya to

APPENDICITIS
1. What test involves palpation of the point that is one-third the distance from the
anterior superior iliac spine to the umbilicus. Tenderness at this point is a positive sign
of appendicitis.

2. What strategy can a nurse use to promote lung expansion and prevent
respiratory complications in a young child post appendicitis?

3. What may be a complication from a perforated appendix? State clinical

manifestations of this complication.

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SELECTED NEUROLOGICAL AND NEUROMUSCULAR CONDITIONS

MENINGITIS
1. What are the 3 main types of Meningitis
a. .
b. .
c. .

2. What are the clinical manifestations of bacterial meningitis?

3. What is the diagnostic test for bacterial meningitis?

4. Discuss the prevention of the Meningitis

FEBRILE SEIZURE
Please select True (T) or False (F) for the following statements:
1. Antipyretic therapy will be effective in preventing febrile seizures________
2. Long-term anti-seizure medications are often given to children with febrile
seizure to prevent the seizures ________
3. The Healthcare provider should be informed immediately if the seizure last
over three minutes.
4. Tepid sponge baths should be used to lower the temperature ________
5. Promoting client safety is a priority for children with Febrile Seizures______
6. Febrile seizure is usually caused by an infection__________
7. What steps should the nurse take if the child is having a seizure?

CEREBRAL PALSY
Please select True (T) or False (F) for the following statements:

1. Cerebral Palsy is a group of permanent disorders of the development of

movement and posture______
2. Cerebral Palsy is the most common permanent physical disability of
childhood______
3. Pre-natal Etiology of Cerebral Palsy include bacterial meningitis, encephalitis
and ‘shaken baby syndrome’_______

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 4. What is the goal of pediatric client living with CP?

5. Thomas is a 5-year-old boy with CP in a primary care clinic scheduled for a

routine assessment. The nurse wants to listen to Thomas’s bowel sounds.
What strategy can a nurse implement to facilitate trust and therapeutic
interaction?
a. .
b. .

AUTISM SPECTRUM DISORDERS

Please select True (T) or False (F) for the following statements:

1. Autism is one of the most common developmental disabilities________

2. The exact etiology of Autism is unknown ________
3. Autistic behaviors are usually first noticed in late childhood________
4. Behavioral and communication strategies are quite similar for all children
with Autism _______
5. New medication and treatments are now available to cure Autism________
6. Children with ASD respond very well to highly stimulating
environments_______
7. The child with Autism may be mute or repeat words or phrases ___________
8. The infant with Autism may resist cuddling, lack contact and has little
change in facial expression _______
9. The child may be aggressive, hyperactive and may injury self____________
10. Stress the importance of rigid unchanging routines for children with ASD
________
11. Autism may be caused by the Measles, Mumps. Rubella MMR) vaccine_________
12. Children with ASD often play and interact with toys in a normal way
____________
13. Children with ASD often experience gastro-intestinal
problems_________________
14. Children with ASD excel in memory, art, music, mathematical or puzzle
building_______
15. There is universal screening for Autism in Canada_________
16. Encourage the parents to cuddle with child to promote parental-child
bonding_________
17. Communication with the child with ASD should be very detailed and age-
appropriate _____

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 18. Referral to the Autistic Society of Canada may help the parents deal with the
shame and guilt about the disease of ASD __________

BONUS QUESTION: WORDS & MEANINGS

1. MECONIUM
2. STETHOREA
3. NUCHAL RIGIDITY
4. URTICARIA
5. ANGIOEDEMA
6. SEPARATATION ANXIETY