1. How to care for the child with a chronic condition or special needs. Give child choices, some sort of control/independence. Treat them like a normal kid. Mainstreaming: In school in a regular classroom. Do not separate these kids and make them feel different. Don’t focus on things they cannot do but rather focus on what they could do. . Use a more positive approach. Don’t focus on their chronological age because two six year olds will be different. Overall integration into society without stigmas.

2. Phases of reactions that parents go through related to a child with a chronic illness or disability
5 stages 1) Shock 2) Denial 3) Anger 4) Guilt 5) Acceptance. These 5 steps can happen over and over again. i.e., it’s prom night or communion and their child is not like all the other children and the parent may go through these steps again.

3. What is chronic sorrow? A parent dealing with a child with a chronic condition goes through the adjustment process and grief experience it does not happen in one experience. It may happen over and over again when different situations come up. Recurrent adjustment.

4. How to foster an environment of normalcy. Letting them go to a regular school, mainstreaming them, giving them control, treating them overall like a kid, not focusing on chronological age, do not compare to other kids in their age group.

5. Iron deficiency anemia Why does a child get it? We do not see it in the beginning with babies because they have iron stores. We treat it by giving them liquid iron and iron fortified cereals after 4-6 months. The iron preparation is given in liquid so be careful because it stains the teeth. Give it with a straw. Tarry stools means that the iron is being absorbed.

6. Sickle cell Anemia How do you recognize a vaso-occlusive crisis? It is very painful. It can’t go through the microvasculare system so there will be horrible pain and swelling. There is sequestration in the spleen and the spleen may become enlarged and may have to be removed.

7. B-thalassemia major (Cooley Anemia)- Causes anemia. All patients have the same look: macro-occlusion, same skin color, cheek bone prominence. These patients will need frequent transfusions and will therefore have a buildup of iron. In order to combat that we give them a chelating agent called Desperal. 8. Chelation therapy. Please refer to question number 7

9. Aplastic anemia: Pancytopenia: A low level of red blood cells (RBCs) is called anemia; a decreased number of white blood cell cells (WBCs) is called leukopenia; and an inadequate number of platelets is called thrombocytopenia (will have tendency to bleed). The entire bone marrow is wiped out. Thrombocytopenia: treat with platelets.

10. Treatment for Hemophilia: Hemophilia A: Missing factor 8 so give them factor 8 concentrate. Hemophilia B (christmas disease): Missing factor 9 so we give them factor 9 concentrate. (W/hemophilia we don’t give platelets b/c the prob. Is not lack of platelets its clotting problem)

11. DIC (Disseminated intravascular coagulation): Children ate sick and septic and may go into DIC and are bleeding; Give cryoprecipitate and FFP (fresh frozen plasma) they contain clotting factors (yellow in color.)

12. ITP (Idiopathic thrombocytopenia purpura): autoimmune: Because ITP is an autoimmune disease we usually wouldn’t give platelets. Give high dose steroids

13. Pathophysiology of Leukemia: Malignancy off the blood forming system (bone marrow). Lymphoblasts: immature lymphocytes are characteristics of leukemia. ALL: acute lymphoblastic leukemia. Proliferation of lymphoblasts. There are such high numbers of lymphoblasts that they crowd everything else out and the pt. will have pancytopenia. The bone expands and it is painful. The patient will also have multiple bruising. Kids have a lot of bone pain.

14. What causes bleeding and how to treat: Platelet count is low (thrombocytopenia) and the patient is bleeding so five them platelets. With patients that have leukemia and are thrombocytopenic give them platelet therapy.

15. Bone Marrow or Stem Cell Transplants: Autologous: received from self-Allogeneic: Received from donor. Stem cell, cord blood, & bone marrow. All have same preparation before transplant. The treatment beforehand will completely abate (kill) bone marrow. We also do this type of treatment when it comes to solid tumors like stage 4 breast cancer. (Transplant: collect from s/o and infuse it and then put it back in.)

16. Side effects from chemotherapy: Hair loss: Prepare the child tell them they will lose their hair. School age child: Go shopping before they lost their hair so they can match color and style of hair. There is no way to prevent hair loss. Tell them a couple of weeks after chemo stops their hair will grow back. However, sometimes it can grow back a different color and different texture.
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17. Tumor lysis syndrome: Giving chemo for leukemia in induction phase and so many lymphoblasts get killed at once and they release purines in their death and the purines cause an increase in uric acid. Those uric acid crystals block the kidney and cause renal failure. Therefore, the patient has to be very well hydrated, check I&O (especially output) make sure urine is dilute, check specific gravity. Give bicarbonate to make sure patient not becoming acidic (metabolic acidosis)

18. Brain Tumors: Classic symptoms: Vomiting every morning and headaches. A lot of times associate this with psychological like the child doesn’t want to go to school. Monitor for increased ICP, monitor neuro status, check LOC, check pupils, head circumference, hand grips. Use seizure precautions like padded side rails and always have suctioning at bedside. If patient is at home: make sure to have emergency medication: give valium rectally if patient having a seizure.

19. What are malignant cells? Fast dividing cells. This is why when chemo is given all fast dividing cells are killed including hair cells and mucosal GI lining.

20. Cancer screening: Warning signs of cancer: breast lumps, dry hacking cough for a long time, skin lesions that are not healing, blood in stool or urine. For children cancer screenings don’t help because their cancers are embryonic in nature. 21. Different phases of chemotherapy: Induction phase: To produce a remission

22. Clinical manifestations of Hodgkin’s disease: Painless lump by lymph nodes. Diagnosis is made only by biopsy. Characteristic of HD is Reed Sternberg cells. Some people have type A and some have type B. Type A is asymptomatic and Type B is symptomatic w/fever and night sweats.

23. Different periods when contracting an infectious disease: Prodromal, incubation 24. Chicken pox- incubation, treatment, and when is child not communicable. Different phases: Long incubation up to 21 days. Person becomes contagious right before the rash breaks out. Once the person is exposed they have up to 21 days to get the chicken pox. Incubation period: When a person is exposed til they get it (21 days). Prodromal phase: The time before a person becomes sick. Communicable phase: The person is contagious until every single lesion is crusted over. Only once they are all crusted over if the person no longer contagious. 25. Caring for an infant with an infection: monitor v/s, watch for a temperature, and give antipyretics when have temp. Monitor LOC. Kids don’t crash as fast as adults do, they smolder but then they crash they go downhill fast. Children are able to compensate better than adults can. Make sure they are getting water for hydration, monitor I&O because they may have diarrhea. They may also have insensible water loss from their fever (lead to dehydration).
26. Common organism that causes cellulitis in children: Staph, Strep, MRSA

27. Rocky Mountain spotted fever and Lyme’s Disease: Transmitted from a tic (Lyme disease)

28. Gonorrhea: Can cause sterility if not treated. Usually symptomatic. It has to be reported to the DOH and all sexual contacts must be treated.

29. Herpes: First outbreak is painful vesicles, itching, pain, fever, lymphadenopathy (swollen glands). Even w/no lesions it can be transmitted because of viral shedding so there is always a chance that it can be given to the partner. No vaginal delivery. Be very careful during childbirth because it can be given to the infant6. Treatment is oral and topical: Valtrex and Acyclovir.

30. Care of the patient with HIV: Use standard precautions with everyone. Treat e/o like they have AIDS. Use PPE when handling bodily fluids, use shield over eyes and gowns if you think you will be splashed. Use retractable needles, don’t recap needles. All needles go into sharps. HIV patient avoid eating raw fruits, vegetables, and salads b/c r/f infection.

31. How to diagnose HIV/AIDS: If the ELISA test is positive then confirm it with a western blot. (Test w/ELISA and do a western blot confirmation) The person who does the testing has to have training in pre and post HIV counseling.

32. Care of the patient receiving allergy testing: Monitor pt. for reaction such as anaphylaxis watch their breathing. Look for hives, respiratory distress, and the patient feeling a sense of doom, anxious. They will initially have an increase in blood pressure and then it will crash. Always make sure the crash cart is right in the room when allergy testing ids being performed. Emergency equipment necessary for anaphylaxis treatment: O2, suctioning, epinephrine1-1,000, hydrocortisone, solumedrol, and nebulizer treatment.

33. Angioedema: Very dangerous because airway gets blocked. Put scope down patient throat to see if airway is closing. Always have a trach kit ready when doing this.

34. Respiratory complications Inhalation burns: Major emergency because can lose airway. Monitor patient’s saturation, give O2, monitor voice, RR, the depth and rate of breathing. The pt. is at risk for major fluid losses, stress ulcers because of stress on the body there will be an increase in acid in the stomach. The pt. will receive gastric ulcer prophylaxis like H2 histamine blockers.
35. Electrical Burn: Usually has an entrance and exit. Most worried about cardiac problems. Get the person away from the electrical current: Initiate CPR, and do EKG.

36. Full thickness burn- recognition: Escher. All layers of the skin are affected.

37. What happens physiologically with burns? Fluid shifts, Edema

38. Nursing care for burn patients: Debridement, water baths, sterile bandages, anti-microbial ointment like silvadine. Tetanus shots: They can get tetani

39. SLE (Lupus): Multisystem, butterfly rash. Need 4 out of 11 things for diagnosis.
40. Scleroderma: hardening of the skin. Uncommon chronic, inflammatory, autoimmune connective tissue disease. Associated with a high mortality rate. Inflamed tissues become fibrotic and then sclerotic or hard. Renal involvement is the leading cause of death. Respiratory involvement and HTN are common. Does not respond well to steroids and immunosuppressants. Diffuse cutaneous Systemic sclerosis- skin thickening on the trunk, face, and proximal and distal extremities (over most of body). Limited cutaneous Systemic sclerosis: thickened skin limited to sites distal to the face, neck, and distal extremities.

41. Hyperthyroidism- Treatment. Control hyperthyroidism with iodine, radioiodine, thyroidectomy (very highly vascular surgery). Diet: Increase calories, proteins, and carbs.
42. Diabetic Emergencies: Two different types 1) DKA: type I diabetics, results in metabolic acidosis. The patient will have ketones, kaussmaul respirations, fruity breath and a high glucose (200-400). HHNS: Type II diabetics, NO metabolic acidosis, NO ketones, will have an extremely high glucose level (can be even 600)
43. Signs and symptoms of diabetes: Polyuria, polydipsia, and polyphagia. Glycosated hemoglobin (hgb A1C): monitors compliance over a certain time period (3 months). A random elevated finger stick (testing for sugar) will tell you nothing.
44. Addison’s disease: Adrenal insufficiency. Autoimmune is the leading cause. Primary is rare. Results from insufficient secretion of glucocorticoid and mineralocorticoids. Assessment: Increase pigmentation due to increase ACTH and MSH, body hair, hypoglycemia, hyperkalemia (primary) will result in dysrhythmias and cardiac arrest, hypotension so r/f falls, hypercalcemia r/f kidney stones and abnormal heart rhythm. Meds: IV hydrocortisone succinate
45. Growth hormone: Over production of GH results in acromegaly. May be slow progression early detection and treatment are necessary. GH Excess- Increased lip and nose size, prominent brow ridge, and increased head, hand and feet. Skeletal thickness, hypertrophy of skin, and enlargement of organs, liver and heart. Skeletal changes are permanent. Bone thinning and bone cell overgrowth occur slowly. GH blocks the action of insulin-Leads to hyperglycemia. Changed facial features, increased sweating, sleep apnea, HTN, lethargy, photophobia, headaches, weight gain.
46. Cushing’s syndrome: Hypercoticoism: increase cortisol levels (from adrenal cortex). Affects all body systems. An increase in total body fat resulting in truncal obesity, buffalo hump, and moon face. Decreased muscle mass and muscle strength, thin skin, and fragile capillaries. Bone density loss so r/f fractures and osteoporosis. Inflammation and immune response protections are reduced. Increase androgen production = acne, hirsutism Oligomenorrhea. The patient will have thinning skin so be careful w/skin breakdown. Diet: Low carb because hyperglycemic, low sodium, and low calories. Patient will also have delayed wound healing. In men will have a decrease in testosterone leading to gynecomastia so will be at r/f body disturbance.