Exam (elaborations)
Nurs 421 Hurley exam prep
- Course
- Nurs 421
- Institution
- University Of San Francisco
Questions and pointers/Topic points to guide you on exam 2
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1. Fluid balances: know the causes related to the pathological loss of fluids and retentionof fluids in children. Know the signs and symptoms of each and the related
interventions. Be able to calculate % of dehydration and quantities of oral and IV
rehydration. Be able to identify the signs of mild, moderate, and severe dehydration.
a.
2. Child Abuse/Non Accidental Trauma (NAT): Know the nurse’s clinical intervention in
child abuse and be able to identify the signs of NAT related to skeletal and soft tissue
injuries as well as burns. Identify the nurse’s legal responsibilities related to NAT.
i. Characteristic of child abusers -
1. Abused as children
2. Low frustration tolerance
3. Isolation (emotionally), poor self concept
4. Lack of parenting knowledge and interpersonal skills
5. Unmet emotional needs, substance abuse
6. Immaturity- impulsive, use kid to meet adults emotional needs,
constant craving for change and excitement
ii. Red flags -
1. Injury inconsistent with hx
2. Fx in infant that's not yet walking
3. Mult fx in various stages of healing
4. Post rib fx- hard to run backward quickly enough to create impact
to cause fx
5. FYI -> frequency of fx is: humerus > tibia (spiral d/t twisting) >
femur
6. Skeletal survey- XR
iii. Suspicion -
1. story doesn't explain injury, inconsistencies/parent blames sibling,
long interval btwn injury and tx, inappropriate rxn, unrealistic
expectations of child
iv. Dx of NAT -
1. Physical exam: injuries inconsistent with hx, mult injuries at
various stages of healing, burns/bruises, evidence of poor
caretaking
2. Skeletal survey- child less than 2 with any evidence of abuse,
child <5YO with suspicious fx, suspicious fx in child unable to
communicate
3. Head CT- kids with suspected intracranial injury
v. Bruise assessment -
1. Any bruise in non-ambulatory child is suspect
2. On cheeks, neck, back, UEs, ab are suspect (over bony As ok)
3. -Hard As to bruise
4. Bruises in diff stages of healing
5. Red > blue > yellow > green > brown > clear
, vi. Shaken baby syndrome -
1. Forceful shaking -> shearing injury to bridging veins
2. Retinal hemorrhages are dx
3. -Optic nerve pulled away from retina every time baby is shaken
4. s/s include: irritability, lethargy, vomiting, R changes,
unresponsive, sz
For the following diseases and conditions be prepared to:
3. Identify what the disease or condition is.
4. Identify how it occurs (pathophysiology unless it is idiopathic).
5. Identify the signs and symptoms of the disease or condition
(Assessment/Reassessment)
6. Identify if there are any specific diagnostics tests for the disease or condition.
7. Know the treatments/interventions for the disease or condition and how to evaluate if
these are effective for a specific child.
8. Know the specific nursing care involved for the disease or condition.
9. Know the teaching points to be given to the patient/family related to the disease or
condition.
a. Dehydration in children: signs and symptoms (Mild, Moderate, Severe)
i.
b. Oral rehydration, IV rehydration formulas (med calc related to these) have
basic calculators ready.
i. Oral rehydration -
, 1. Mild -
a. ORS 50 mL/kg over 4 hours
b. For each diarrheal stool, an additional 10 mL/kg (up to
240mL) is given
c. Q2H reassessment of the patient's hydration status and
ongoing losses
2. Moderate -
a. Medically supervised
b. ORS 100mL/kg over 4 hours
c. Q1H reassessment of the patient’s hydration status and
ongoing losses
3. Severe -
a. Med emergency
b. Requires emergent IV tx with rapid infusion of 20 mL/kg
isotonic saline (hypovolemic shock)
c. Don't give antidiarrheals to kids bc diarrhea is indicative of
pathogen present that the body is trying to rid of
d. Bfing is ok
ii. No juice/soda/plain water
iii. Pedialyte- electrolyte drink
c. Acute GastroEnteritis
i. Stomach and small intestine inflammation
ii. Viral, bacterial, parasitic cause
iii. Diagnose with increased BUN, specific gravity more concentrated,
electrolytes, stool culture and WBC, Ova and parasites in stool, UA
iv. Treatment to assess state of hydration, correct fluid/electrolytes, PO asap
to go home, prevention
d. FTT ( Failure to thrive)
i. Inadequate growth over time/chronic growth delay, weight or height under
5th percentile, sudden deceleration in growth curve, decreased muscle
mass, hypotonia, weakness, cachexia (tissue wasting)
ii. Organic Causes: Complications from other conditions like GERD,
premature birth, short bowel syndrome, AIDS, malabsorption
iii. Non organic causes: Generally caused by environment/social factors like
abuse (with holding food), formula preparation/alteration, food refusal
iv. Diagnosis/Treat: Measurement plot on growth chart, prenatal hx, patient
hx, check current home feeding practices, identify cause of FTT, correct
nutritional deficiencies
v. Hypotonia, weakness, cachexia
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