Nursing Care of Child ATI Remediation Level 1 PDF

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Nursing Care of Child Remediation Level 1 Transcript remediation...

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Management of Care (2 items) Case Management (1 item) Hematologic Disorders: Immunizations for a Client Who Has Sickle Cell Anemia (RM NCC RN 11.0 Chp 21 Hematologic Disorders, Active Learning Template: Basic Concept) Sickle Cell Anemia (SCA) is the homozygous and most common form of Sickle Cell Disease (SCD). Manifestations of SCA result from RBC sickling, leading to increased blood viscosity, disruption of blood flow, and hypoxia of tissue. The tissue hypoxia causes ischemia which in-turn results in the patient having painful episodes. Maintaining up-to-date immunizations is important for patients with Sickle Cell Anemia.

Collaboration with Interdisciplinary Team (1 item) Head Injury: Priority Finding to Report for a Brain Tumor (RM NCC RN 11.0 Chp 14 Head Injury, Active Learning Template: System Disorder) Care is always centered around the extent of brain trauma. It is important to ensure the spine is stabilized to decrease further trauma or until spinal injury is ruled out. The patient’s vitals should be continuously monitored. Checking for LOC, the pupils, ICP, motor activity, sensory perception and verbal responses during frequent intervals.

Safety and Infection Control (1 item) Standard Precautions/Transmission-Based Precautions/Surgical Asepsis (1 item) Professional Responsibilities: Caring for a Child Who Has Pertussis (RM Leadership 8.0 Chp 3 Professional Responsibilities, Active Learning Template: Basic Concept) Pertussis is also known as whooping cough and is a very contagious respiratory infection common among children. Pertussis can be life threatening to infants and young children with weak immune systems. Early detection and treatment is important to prevent the bacteria from doing to much damage to the body and from the spread of infection to surrounding family members such as siblings. Diagnosis can be down through physical assessment and signs and symptoms and also with mucus samples and blood testing. Antibiotics is the typical treatment used and following the medication regime to the very detail is extremely important for the patient and family. The patient should also be kept hydrated to prevent hospitalization and encouraged to eat small, frequent meals to aid the body in recovery.

Health Promotion and Maintenance (3 items) Developmental Stages and Transitions (2 items) Health Promotion of Adolescents (12 to 20 Years): Expected Developmental Changes During Early Adolescence (RM NCC RN 11.0 Chp 7 Health Promotion of Adolescents (12 to 20 Years),Active Learning Template: Growth and Development)

During physical development in adolescents the final 20%-25% of height is achieved during puberty. Girls tend to stop growing 2-2.5 years after start of menarche. Boys stops growing around 18-20 years of age. With cognitive development, adolescents begin to be able to think through more than one category of variabilities at one time. They become imaginative, idealistic, and more creative. They begin to understand that one’s actions not only can affect self but other individuals as well. Health Promotion of Toddlers (1 to 3 Years): Reportable Findings (RM NCC RN 11.0 Chp 4 Health Promotion of Toddlers (1 to 3 Years),Active Learning Template: Growth and Development) Toddlers begin developing taste preferences and generally end up being picky eaters. Toddlers usually average around 11 to 12 hours of sleep a day including one nap. Maintaining a regular bedtime and bedtime routine is essential in aiding in the promotion of adequate sleep. Also, at 30 months the toddler should weigh at least four times the birth weight.

Health Promotion/Disease Prevention (1 item) Cancer Screening and Diagnostic Procedures: Teaching About Testicular Self-Examination (RM AMS RN 11.0 Chp 90 Cancer Screening and Diagnostic Procedures, Active Learning Template: Basic Concept) Screening and diagnostic procedures provide objective and subjective data about the patient. Screenings and diagnosis for cancer can involve self-examinations, invasive procedures, radiography, imagery, and lab testing. It is important t o get a health history and physical assessment of the patient, including any findings observed and reported by the patient. It is also important to get a family history from the patient of occurrences of cancers or genetic disorders. Inspecting for changes in color, symmetry, or body function should be noted. Palpating to detect masses or tissue abnormalities is something the patient should be demonstrated and educated on. Teaching the use of light, medium, and deep pressure is appropriate and allows the patient to learn how to stay involved in self-screenings to properly identify possible issues. Which can lead to early detection and life preservation.

Psychosocial Integrity (1 item) Grief and Loss (1 item) Death and Dying: Age-Appropriate Response to Death (RM NCC RN 11.0 Chp 11 Death and Dying,Active Learning Template: Growth and Development) Infants and toddlers up to age three years of age have little to no concept of death. For preschoolers 3 to 6 death ideation can manifest itself as guilt and shame due to the inability to fully understand the concept of death. Children 6 to 12 years of age start to respond with a more logical and factual explanation of death. They begin to understand the permanence of death itself. Adolescents 12 to 20 can have difficulty accepting death, often time running to peers for comfort rather than parents or family. They can also develop feelings of same and guilt as well due to physiological and mental changes they may be personally experiencing on top of dealing with a death of a family member or friend.

Basic Care and Comfort (3 items) Elimination (1 item)

Bowel Elimination: Evaluating Teaching About Encopresis (RM Fund 10.0 Chp 43 Bowel Elimination,Active Learning Template: System Disorder) Many factors can affect the bowel function and there are ton of interventions that can help with elimination of the bowels. Stool specimens are collected for both screenings and diagnostic tests for blood, bacteria and / or parasites. Encopresis is a condition where a child resist having a bowel movement. This occurrence can cause impacted stool to collect in the colon and rectum and lead to leakage. It is important to encouraged adequate amounts of fluid and high fiber foods, such as vegetables and fruits to help ease the symptoms caused from resisting to empty the bowels.

Mobility/Immobility (1 item) Fractures: Managing Care for a Client Who Has a Halo Vest Traction Device (RM NCC RN 11.0 Chp 27 Fractures,Active Learning Template: Therapeutic Procedure) A fracture occurs when the resistance between a bone and an applied force yields to stress, resulting in a cracked or broken bone. It is important to maintain ABCs and monitor vital signs, pain level, and neurological status. Administer tetanus and antibiotics for open fractures as well. Traction involves the use a pulling force to reduce a fracture, maintain alignment, and provide muscle rest. A halo traction or cervical traction uses a halo-type bar that encircles the patient’s head. Screws are inserted into the outer part of the skull. The halo is attached to either a bed traction or rods that are secured to a vest worn by the patient. Nursing actions are to maintain body alignment and provide pharmacological and nonpharmacological interventions for pain and muscle spasm management. It is also important to check skin integrity daily and document any findings.

Rest and Sleep (1 item) Health Promotion of the Preschoolers (3 to 6 Years): Teaching About Home Interventions for Night Terrors (RM NCC RN 11.0 Chp 5 Health Promotion of Preschoolers (3 to 6 Years),Active Learning Template: Basic Concept) On average preschoolers need about 12 hours of sleep per day. Sleep disturbances frequently occur during early childhood. These problems can range from difficulty to going to night terrors. Night terrors are episodes of screaming, intense fear, and flailing while still asleep. They are often paired with sleep walking and night mares are a known cause. It is considered a normal stage during child development as well. Locking doors and windows can assure safety of the child during one of these events. Interventions include a consistent bedtime routine, night-lights, and providing reassurance and giving the child a favorite toy for comfort measures.

Pharmacological and Parenteral Therapies (2 items) Expected Actions/Outcomes (1 item) Cardiovascular Disorders: Priority Finding for an Infant Who Is Receiving Furosemide (RM NCC RN 11.0 Chp 20 Cardiovascular Disorders,Active Learning Template: Medication) Furosemide is a potassium-wasting diuretic that rids the body of excess fluid and sodium. It is important to encourage diet high in potassium. The nurse should monitor the child’s I&O and weight daily. Adverse effects to watchout for are hypokalemia, nausea, vomiting, and dizziness. Monitor for signs of allergic

reactions like rash, hives, redness, swollen, blisters, and peeling of skin with or without fever. Signs of fluid and electrolyte problems such as mood changes, confusion, or muscle pain and/or weakness. Monitor for signs of high blood sugar such as confusion, feeling sleepy or thirstier, and passing urine more often than normal. Also, watch out for signs of liver damage such as dark urine, feeling tired, not hungry, and yellowing of eyes and/or skin.

Medication Administration (1 item) Cardiovascular Disorders: Evaluating Parent Understanding of Digoxin Administration (RM NCC RN 11.0 Chp 20 Cardiovascular Disorders,Active Learning Template: Medication) Digoxin improves myocardial contractility. Generally, if the infant’s pulse is less than 90/min the medication should not be given. For children hold digoxin if pulse is less than 70/min. Monitor for signs of toxicity which include bradycardia, dysrhythmias, nausea, vomiting, or anorexia. If toxicity occurs administer Digoxin Immune Fab (Digibind), this is the antidote. Parents should be educated on the importance of pulse ranges and checking the child’s pulse before administration of the medication. Direct oral elixir should be given toward the side and back of mouth when administering. Give water after giving digoxin to prevent tooth decay. If child vomits, do not give another dose.

Reduction of Risk Potential (3 items) System Specific Assessments (1 item) Blood Neoplasms: Analyzing Data for a Child Who Has Acute Lymphocytic Leukemia (RM NCC RN 11.0 Chp 40 Blood Neoplasms,Active Learning Template: System Disorder) Leukemia is a term for a group of malignancies that affect the bone marrow and lymphatic system. Peak onset in children is between ages 2 and 5 years old. Leukemia is classified by the type of WBCs that become neoplastic. Risk factors include leukemia being the most common cancer in children, male sex, Caucasian and Hispanic ethnicity, family history, and children with trisomy 21 (down syndrome). Early manifestations include low-grade fever, pallor, increased bleeding and petechiae, listlessness, enlarged liver, lymph nodes, and joints, and unsteady gait. Late manifestations include pain, hematuria, ulcers of the mouth, enlarged kidneys and testes, and manifestations of increased intraocular pressure. Bone marrow aspiration and biopsy analysis is the most effective diagnostic procedure. If leukemia is present, the specimen will show prolific quantities of immature leukemia blast cells and protein markers indicating the specific type of leukemia.

Therapeutic Procedures (2 items) Complications of Infants: Creating a Plan of Care for a Toddler Who Is Recovering Following a Routine Surgical Procedure (RM NCC RN 11.0 Chp 42 Complications of Infants,Active Learning Template: Basic Concept) It is important for a nurse to identify complications and implement appropriate interventions for complications of newborns and infants after a procedure. Emotional support for the parents is important for the plan of care as well. Preoperative nursing actions include preparing the family for the newborn’s surgery. Postoperative care includes monitoring vitals, I&O, weight, manifestations of infection, and

providing pain management. Educate the parents on homecare and depending on the newborn’s disability, ROM techniques. Gastrointestinal Structural and Inflammatory Disorders: Planning Postoperative Care for Meckel Diverticulum (RM NCC RN 11.0 Chp 23: Gastrointestinal Structural and Inflammatory Disorders,Active Learning Template: System Disorder) Inflammatory disorders include appendicitis and Meckel’s diverticulum. Meckel’s diverticulum is a complication resulting from failure of the omphalomesenteric duct to fuse during embryonic development. Expected findings include painless, rectal bleeding, abdominal pain, and bloody, mucus stools. Postoperative care includes assessing respiratory status and maintaining airway, monitoring vitals, observing for signs of infection, auscultating for bowel sounds and function, giving IV fluids and antibiotics, and maintaining NG tube to a low, continuous suction.

Physiological Adaptation (9 items) Hemodynamics (2 items) Cardiovascular Disorders: Expected Findings of Heart Failure (RM NCC RN 11.0 Chp 20 Cardiovascular Disorders,Active Learning Template: System Disorder) Heart failure occurs when the heart is unable to pump adequate blood to meet the metabolic and physical demands of the body. Due to lifestyles and socioeconomic conditions, the incidence of hyperlipidemia is on the rise in children. This is leading to obesity in childhood and heart disease in adulthood. Anatomic defects pf the heart prevents normal blood flow to the pulmonary and/or systemic system. Defects are categorized by blood flow patterns in the heart. Increased pulmonary blood flow: ASD, VSD, PDA, decreased pulmonary blood flow: Tetralogy of Fallot and tricuspid atresia, obstruction of blood flow: coarctation of aorta, pulmonary stenosis, aortic stenosis, and mixed blood flow: Transportation of the great arteries, truncus arteriosus, and hypoplastic left heart syndrome. Hematologic Disorders: Planning Care for a Child Who is Experiencing Sickle Cell Crisis (RM NCC RN 11.0 Chp 21 Hematologic Disorders,Active Learning Template: System Disorder) Nursing care for Sickle Cell Crisis includes promoting rest to decrease oxygen consumption, administering oxygen as prescribed if hypoxia is present. Treat mild to moderate pain with ibuprofen or acetaminophen. For management of severe pain use opioid analgesics. Apply comfort measures such as warm packs onto painful joints. Get a schedule set up to administer analgesics to help prevent pain from Sickle Cell Crisis.

Alterations in Body Systems (1 item) Cardiovascular Disorders: Identifying the Location of a Patent Ductus Arteriosus (RM NCC RN 11.0 Chp 20 Cardiovascular Disorders,Active Learning Template: System Disorder) Patent Ductus Arteriosus is a condition where the normal fetal circulation conduit between the pulmonary artery and aorta fails to close and results in increased blood flow. The patent ductus arteriosus results in a left to right shunt in the atria. Symptoms of PDA can include wide pulse pressures, bounding pulses, and systolic murmurs that can lead to heart failure.

Illness Management (3 items) Blood Neoplasms: Identifying Effective Treatment for a Child Who Has Acute Lymphoblastic Leukemia (RM NCC RN 11.0 Chp 40 Blood Neoplasms,Active Learning Template: System Disorder) Bone marrow aspiration or biopsy is the most definitive diagnostic procedure for acute lymphoblastic leukemia. Corticosteroids can be used as treatment and to minimize side effects from treatment. Chemotherapy is administered in different phases to treat leukemia, including maintenance, induction/remission and intensification therapies. Communicable Diseases: Varicella Management (RM NCC RN 11.0 Chp 36 Communicable Diseases,Active Learning Template: System Disorder) Provide calamine lotion and keep skin clean and dry. Give child mittens if they cannot resist scratching. Tepid baths are helpful and dressing the child in loose fitting clothing will help with irritation. Educate parents and patient about changing linens daily, keep fingernails clean and short, and teach good oral hygiene. Fractures: Evaluating Understanding of Cast Care (RM NCC RN 11.0 Chp 27 Fractures,Active Learning Template: Therapeutic Procedure) There are different types of casts ranging from long-leg, short-leg, bilateral long-leg, long-arm, short-arm, shoulder-spica, 1 ½ spica, full spica, and single spica. Plaster of Paris casts are heavy, not water-resistant, and can take 10 to 72 hours to dry. Synthetic fiberglass casts are light, water-resistant, and dry within 5 to 20 minutes. Teach parents and patients to report pain that is extremely severe and does not subside one hour after administration of pain medication. Reinforce skin and perineal care with spica casts. Cleanse with a damp cloth if cast becomes soiled.

Medical Emergencies (2 items) Acute and Infectious Respiratory Illnesses: Caring for a Child Who Has Epiglottitis (RM NCC RN 11.0 Chp 17 Acute and Infections Respiratory Illnesses,Active Learning Template: System Disorder) Be aware of epiglottitis manifestations including cough, drooling, dysphonia, and dysphagia. Maintain a patent airway, monitor continuous oximetry and prepare for intubation. Administer medications like corticosteroids and antibiotics as prescribed and maintain droplet precautions for first 24hrs after being initiated. Pediatric Emergencies: Priority Action for Submersion Injury (RM NCC RN 11.0 Chp 43 Pediatric Emergencies,Active Learning Template: System Disorder) Asphyxiation while a child is submerged in fluid can occur in any standing body of water that is atleast one inch deep. This includes the bathtub, bucket, toilet, pool, pond, and lake. Submersion injury (nearlydrowning) incidents are those in which children have survived 24 hours after being fully submerged in fluid. Nursing care may include administration of oxygen, possibly needing mechanical ventilation. Monitoring vital signs is a major priority, providing chest physiotherapy may be required. Monitor for

possible complications that can occur after 24 hours after the accident. Complications to watch for include cerebral edema and respiratory distress.

Pathophysiology (1 item) Cancer Disorders: Manifestations of Hodgkin's Lymphoma (RM AMS RN 11.0 Chp 92 Cancer Disorders,Active Learning Template: System Disorder) Manifestations of Hodgkin’s lymphoma include: large painless nodes, fever, drenching, night sweats, and unexplained weight loss. As the disease progresses enlargement of the spleen and liver can be seen as well as anemia. A Past Epstein Barr infection and being male are at greater risk of developing Hodgkin’s Lymphoma...