Post-assessment Pediatrics

A pediatric client is complaining of a sore throat and general weakness. The provider
diagnoses the client with Group A B-hemolytic streptococci (GABHS). Identify three (3)
manifestations of GABHS? What are interventions and teaching points to discuss with the
caregiver(s) and child about treatment of GABHS?
Some manifestations include erythema marginatum (rash), an increase in C-reactive protein,
nontender subcutaneous nodules of bony prominences.
Interventions include encourage bed rest, administer antibiotic as prescribed, encourage
nutritionally balanced meals, assess for chorea.
Some teaching points include: complete the entire course of antibiotics, keep the child hydrated,
encourage bed rest, and use warm saltwater gargles.
A nurse is caring for a client with leukemia who is undergoing a bone marrow aspiration.
What nursing actions should be taken pre and post procedure?
Pre-procedure: Assist the provider with the procedure. Topical anesthetic, such as a eutectic
mixture of local anesthetics (EMLA), may be applied over the biopsy area 45 min to 1 hr prior to
the procedure. Assist with positioning, it depends on the access site to be used (posterior or
anterior iliac crest is most common; tibia can be used in infants because it is easier to access and
hold the infant). A specimen is obtained by the provider.
Postprocedure: Apply pressure to the site for 5 to 10 min, then apply a pressure dressing. Assess
vital signs frequently. Monitor for signs of bleeding and infection for 24 hr.
A nurse is discharging a client home with the diagnosis of rheumatic fever. What education
should be provided to the caregivers of a child who is being discharged following this
diagnosis?
Promote rest during the acute phase. Provide information and reassurance related to the
development of chorea and its self-limiting nature. Encourage well-balanced meals. Seek
medical care if infection recurrence is suspected.
A nurse is preparing to administer the MMR immunization to a client. What are two (2)
contraindications for this vaccine?
Pregnancy and allergy to gelatin and neomycin.
A nurse is caring for a family with a passive parenting style. What are some guidelines the
nurse can provide to promote acceptable behavior in the children?
Set clear and realistic limits and expectations based on the developmental level of the child.
Validate the childs feelings, and offer sympathetic explanations. Provide role modeling and
reinforcement for appropriate behavior. Focus on the childs behavior when disciplining the
child.
Identify five (5) nursing actions for a client who is in a hip spica cast.
Perform range of motion with the unaffected extremities. Perform frequent assessment of skin
integrity, especially in the diaper area. Assess for pain control using an age-appropriate pain tool.
Intervene as indicated. Evaluate hydration status frequently. Assess elimination status daily.

A nurse is caring for a child with acute burn injuries. What solutions should the nurse
anticipate using during initial fluid replacement? How much urine output is required for
maintain renal perfusion during this period?
Fluid replacement is important during the first 24 hr. Isotonic crystalloid solutions (0.9% sodium
chloride or lactated Ringers solution) are used during the early stage of burn recovery. Colloid
solutions, such as albumin or synthetic plasma expanders (Hespan), may be used after the first 24
hr of burn recovery. Maintain urine output of 1 to 2 mL/kg/hr if the child weighs less than 30 kg
(66 lb). Maintain urine output of 30 mL/hr if the child weighs more than 30 kg (66 lb).
A nurse is providing education to an adolescent client with diabetes and his parents
regarding 'Sick Day Rules' while sick. What information should the nurse provide?
Monitor blood glucose levels every 3 hr. Continue to take insulin or oral antidiabetic agents.
Encourage sugar-free, non-caffeinated liquids to prevent dehydration. Meet carbohydrate needs
by eating soft foods if possible. If not, consume liquids that are equal to the usual carbohydrate
content. Test urine for ketones every 3 hr. Rest. Call the health care provider if: Blood glucose is
higher than 240 mg/dL. Fever higher than 38.9 C (102 F), fever does not respond to
acetaminophen (Tylenol), or fever lasts more than 12 hr. Positive ketones in the urine.
Disorientation or confusion occurs. Rapid breathing is experienced. Vomiting occurs more than
once. Diarrhea occurs more than five times or for longer than 24 hr. Liquids cannot be tolerated.
Illness lasts longer than 2 days.
Identify two (2) adverse effects of methylphenidate hydrochloride (Ritalin in the school
aged child.
CNS depression and bleeding
A nurse is caring for a child with a closed head injury. What clinical manifestations would
suggest deterioration in this client's condition?
Headache, alterations in pupillary response, and increased sleeping, which are a clinical
manifestation of increased intracranial pressure
Identify nursing actions in the immediate post-operative period of a client who had a cleft
palate repair.
Change the infants position frequently to facilitate breathing. The infant may be placed on the
abdomen in the immediate postoperative period. Maintain intravenous fluids until the infant is
able to eat and drink. Monitor packing, which is usually removed in 2 to 3 days. Avoid placing
objects (tongue depressor, pacifier) in the infants mouth after cleft palate repair. Elbow restraints
may needed to be used to prevent the infant from injuring the repair
A nurse is providing discharge teaching to the parents of a client following surgical
correction of hypospadias. What information should be provided?
Give your child a sponge bath for the first 7 days. As long as your child does not have a tube or
stent, he may take a bath in the bathtub after 7 days. Use only warm water for the first bath and
do not use soap. Give your child pain medication on a regular schedule, as prescribed by his
doctor, to keep him comfortable. Your child will go home with a clean bandage or dressing
around his penis. Leave the bandage in place. You do not need to change it. Keep the bandage as
dry as possible and change your childs diaper often. After bowel movements, wash your childs

bottom with warm water and gently pat dry. Do not use diaper wipes that have alcohol because
they can sting.
What is a myringotomy? How is this procedure performed and what post-operative care
should the nurse provide?
Myringotomy is a surgical procedure of the eardrum or tympanic membrane to relieve pressure
or drain fluid. Myringotomy and placement of tympanoplasty tubes may be indicated for a child
who has multiple episodes of otitis media. This procedure may now be performed by laser
treatment and it is performed in an outpatient setting with the administration of general
anesthesia. It is usually completed in 15 min. A small incision is made in the tympanic
membrane, and tiny plastic or metal tubes are placed into the eardrum to equalize pressure and
minimize effusion. Recovery takes place in a PACU, and discharge usually occurs within 1 hr.
The tubes come out spontaneously (usually in 6 to 12 months). The nurse should assess if there is
an increase in ear drainage, pain, fever (>100) or bleeding. Assess speech and hearing. Assist
with getting out of bed safely.
A nurse is caring for an infant client with suspected Respiratory syncytial virus (RSV).
Identify two (2) initial clinical manifestations of RSV.
Rhinorrhea and coughing that progress toward wheezing, increased respiratory rate, nasal flaring,
retractions, and cyanosis.
A nurse is educating an adolescent client about self-monitored blood glucose (SMBG).
What information should be included in this education?
Teach how to use the quality control to check the accuracy of the strips. Educate about keeping a
record of the SMBG that includes time, date, serum glucose level, insulin dose, food intake, and
other events that may alter glucose metabolism, such as activity level or illness.
A nurse is providing discharge education to a client and his family following an episode of
sickle cell crisis. What information should the nurse include in this client's discharge plan?
Provide emotional support, and refer to social services if appropriate.
Teach child and family about manifestations of crisis and infection (vaso-occlusive,
sequestration, aplastic, hyperhemolytic). Advise the family of the importance of promoting rest
and providing adequate nutrition for the child. Encourage the child and family to maintain good
hand hygiene and avoid individuals with colds/infection/viruses. Give specific directions
regarding fluid intake requirements, such as how many bottles or glasses of fluid should be
consumed daily. Provide information about genetic counseling. Encourage maintenance of up-todate immunizations. Advise the child to wear a medical identification wristband or medical
identification tags.
A nurse is caring for a client with meningitis. Identify four (4) priority interventions for
the client who has meningitis.
Isolate the client as soon as meningitis is suspected, and maintain droplet precautions per facility
protocol. Monitor vital signs, urine output, fluid status, pain level, neurologic status, and head
circumference (for infants). Correct fluid volume deficits and then restrict fluids until no
evidence of increased ICP and serum sodium levels within the expected range. Maintain NPO

status if the client has a decreased level of consciousness. Assess for presence of petechia or a
purpuric-type rash, which requires immediate medical attention.