Editing Pediatric Nursing – RN Flashcards (section)

== Emergencies and complication management ==

;What is absolutely contraindicated in suspected epiglottitis, and what is the priority?
:Do not inspect the throat, obtain a throat culture, or place anything in the mouth, because laryngospasm and complete obstruction may follow. Keep the child upright and calm in the caregiver's lap, give nothing by mouth, provide oxygen if tolerated, and get skilled airway personnel and equipment to the bedside immediately.

;Differentiate croup from epiglottitis.
:Croup is viral with gradual onset, low-grade fever, barking cough, hoarseness, inspiratory stridor, and a steeple sign; it is treated with dexamethasone and nebulized epinephrine. Epiglottitis is abrupt, with high fever, a toxic appearance, drooling, dysphagia, dysphonia, distress, tripod positioning, and no cough; it is an airway emergency.

;Why is a "silent chest" in an asthma exacerbation an emergency?
:Wheezing requires turbulent airflow. Loss of wheezing while work of breathing increases means airflow has fallen too low to generate sound, indicating severe obstruction and impending respiratory failure.

;What is the feared complication of Kawasaki disease, and how is it managed and monitored?
:Coronary artery aneurysm. Treat with intravenous immunoglobulin plus aspirin and obtain serial echocardiograms. Because IVIG confers passive antibody, defer live vaccines such as MMR and varicella for about 11 months.

;Distinguish pyloric stenosis from intussusception.
:Pyloric stenosis: 3 to 6 weeks old, non-bilious projectile vomiting with immediate hunger, olive-shaped right upper quadrant mass, visible peristalsis, hypochloremic hypokalemic metabolic alkalosis; treated by pyloromyotomy. Intussusception: 3 months to 3 years, colicky pain with knees drawn up alternating with calm intervals, sausage-shaped mass, currant jelly stools; treated by air or contrast enema. Passage of a normal brown stool suggests spontaneous reduction and must be reported at once.

;Which prescriptions should the RN question in sickle cell vaso-occlusive crisis?
:Cold applications (worsen sickling; use warmth), fluid restriction (hydration is essential), and meperidine (normeperidine accumulation lowers the seizure threshold). Appropriate care includes hydration above maintenance, oxygen, warmth, rest, and scheduled or patient-controlled opioid analgesia.

;What defines splenic sequestration crisis and why is it urgent?
:Rapid pooling of blood in the spleen with a rapidly enlarging, tender spleen, falling hemoglobin, tachycardia, pallor, and hypovolemic shock. It can be fatal within hours and requires immediate volume resuscitation and transfusion.

;Summarize nursing care in suspected bacterial meningitis.
:Initiate droplet precautions on suspicion and continue for 24 hours after effective antibiotics; assist with lumbar puncture and give antibiotics promptly; keep the environment quiet and dim and cluster care; elevate the head of the bed slightly with the head midline; institute seizure precautions; monitor neurologic status, fluid balance, and for syndrome of inappropriate antidiuretic hormone.

;How should the RN manage a hypercyanotic "tet" spell in tetralogy of Fallot?
:Place the infant in the knee-chest position, which raises systemic vascular resistance and reduces right-to-left shunting, administer oxygen, calm the infant, and notify the provider. Morphine and fluids may be ordered.

;What findings suggest heart failure in an infant?
:Poor feeding with diaphoresis during feeds, tachypnea, tachycardia, hepatomegaly, periorbital edema, poor weight gain, and fatigue. Infants show fluid overload in the liver and periorbital tissue rather than as dependent leg edema.

;Why is aspirin avoided in children with viral illness?
:Salicylate exposure during influenza or varicella is associated with Reye syndrome, an acute encephalopathy with fatty degeneration of the liver. Kawasaki disease is the notable exception in which aspirin is deliberately used.

;What is the RN's obligation when child maltreatment is suspected?
:Nurses are mandated reporters and must report reasonable suspicion; proof is not required and is not the nurse's role. Ensure the child's immediate safety, document objectively with direct quotations and body maps, avoid confronting the caregiver, and interview the child separately with trained personnel.

[[Category:Pediatric Nursing]]
[[Category:Registered Nurse (NCLEX-RN)]]
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