219 Finals Pointers

Week 13 – Alterations with Infectious, Inflammatory and Immunologic Responses and

Cellular Aberrations
1. Asthma - Inflammatory process of the large airways, which results in heightened
airway reactivity.
a. Diagnostic exams – ABG, CBC (elevated Eosinophil count), Elevated IgE
levels and Pulmonary function tests (most accurate test for asthma)
b. Nursing Diagnosis – Ineffective airway clearance – too much mucus and
inflammation of the airways
c. Signs / Symptoms – Wheezing, Breathlessness, Dyspnea, Chest tightness
d. Treatment - Bronchodilators

2. Allergic rhinitis - Caused by a type I or immediate hypersensitivity immune

response
a. Causes: exposure to allergens such as dust, pollens
b. Signs / symptoms – sneezing, Nasal engorgement, Profuse watery nasal
discharge
c. Treatment – Sympathomimetic / decongestant drugs
3. Atopic dermatitis - eczema -
a. Diagnostic exam – assessment of lesions
b. Causes: exposure to allergens such as dust, pollens
c. Nursing diagnosis - Impaired skin integrity
d. Treatment – immunotherapy (It stimulates increased IgG to bind with
allergen-reactive sites, preventing mast cell–bound IgE reactions)
4. Juvenile idiopathic arthritis
a. Causes: unknown – genetics and environment
b. Signs / symptoms – inflammation of the joints, pain in the joints
c. Treatment – for pain – heat - encourage her to take a warm bath
5. Leukemia – Cancer of the blood-forming organs characterized by a proliferation
of abnormal white blood cells in the body.
a. Tumor
i. Benign- movable, does not invade or metastasize
ii. Malignant – irregular in shape, not movable, invades and
metastasize to other organs
b. Types
i. Acute lymphoblastic leukemia (ALL) – most common type of cancer
in children
ii. Acute myelogenous leukemia (AML)
c. Diagnostic exam
d. Causes: unknown, exposure to infectious agents; genetic factors
e. Signs / symptoms
i. ALL - lethargy, bruises, and lymphadenopathy
f. Treatment – Chemotherapy, Radiation
6. Hodgkin lymphoma
a. Diagnostic exam – lymph node biopsy
 b. Treatment –Chemotherapy – side effect – alophecia (hair loss) - affects
cancer cells and normal cells that multiply rapidly like hair follicles.
7. Brain tumor
a. Signs / symptoms – early signs - headache, vision changes, and vomiting
b. Treatment – Chemotherapy, Radiation ( not done for children aged 3
years old below)
Week 14- Alterations in Nutrition and Gastrointestinal, Metabolism and Endocrine
1. Hirschsprung’s disease
a. Signs / symptoms – no meconium passage in 24 hours
b. Treatment – Surgery - temporary colostomy - Providing pre- and
postoperative care
2. Hyperthyroidism – Grave’s Disease
a. Diagnostic exam – thyroid function test
b. Causes: – increased secretions of TSH from the pituitary gland
c. Signs / symptoms – losing weight despite eating constantly, trouble
sleeping, bulging eyes
d. Treatment – Thyroidectomy – nursing priority will be providing pre- and
postoperative care.
3. SIADH - retain fluid and develop hyponatremia secondary to the inability to
excrete dilute urine
a. Nursing diagnosis – fluid volume excess – restrict fluid intake
b. Signs / symptoms – oliguria
c. Treatment – Diuretics
4. GIgantism - hyperpituitarism
a. Causes: – hypersecretion of the growth hormone
b. Treatment – remove or reduce the size of the pituitary tumor
5. Tracheoesophageal fistula - is an abnormal connection between these two tubes
a. Nursing assessment - feeding into the stomach directly can also lead to
reflux and aspiration of stomach acid and food.
b. Nursing diagnosis – Aspiration of food
c. Treatment – Surgery - Providing pre- and postoperative care
i. Postsurgical management – instruct the parents to give antibiotics ,
elevate the head of the bed, give pacifier to satisfy the need to
suck, NPO until the swelling and wounds have healed.
6. Appendicitis - an inflammation of the appendix,
a. Diagnostic exam - ultrasound
b. Signs / symptoms – visceral pain
i. Rovsing's sign — palpation of the left lower quadrant increases the
pain felt in the right lower quadrant.
ii. Psoas sign — passive extension of the right thigh with the person in
the left lateral position elicits pain in the right lower quadrant.
c. Treatment – Appendectomy
7. Celiac disease - a chronic digestive and immune disorder that damages the small
intestine
a. Causes: . The disease is triggered by eating foods containing gluten
b. Signs / symptoms – steatorrhea – bulky, fatty stool
 c. Treatment – follow a gluten-free diet
8. Cushing syndrome - a disorder that occurs when your body makes too much of
the hormone cortisol over a long period of time
a. Causes: – excessive levels of circulating cortisol
b. Signs / symptoms – weight gain, fatty hump between the shoulders
c. Treatment – ketoconazole, mitotane (Lysodren) and metyrapone – control
excessive cortisol
9. Diabetes Mellitus
a. Diagnostic exam – glucose monitoring, OGTT
b. Signs / symptoms – polyuria, polydipsia, polyphagia
c. Treatment – Insulin – side effect - hypoglycemia – immediate
management at home will be giving the child a glass of orange juice.
i. Priority will be to maintain normal glucose level ( gluconeogenesis)
1. Document weight changes because of fatty acid
mobilization.
2. Evaluate the patient’s sensitivity to low room temperatures
because of decreased adipose tissue insulation.
3. Protect the patient from sources of infection because of
decreased cellular protein deposits.
10. Dehydration
a. Nursing diagnosis – Fluid volume deficit
b. Signs / symptoms – dry mucous membranes, lethargy, sunken eyeballs,
sunken fontanelles
c. Treatment – fluid replacement

Week 15 – Alterations in Perception and Coordination, Musculoskeletal and

Neuromuscular dysfunction
1. Seizures - abnormal, sudden, excessive discharge of electrical activity within the
brain
a. Types
i. Grand mal- tonic-clonic movements
ii. Petit mal – absence seizure - blank expression during these
episodes
b. Causes: – loss of consciousness, uncontrolled body movement, changes
in behavior, sensation, and autonomic system.
c. Nursing assessment
i. note the duration of the seizure
ii. seizure progression and type of movements
iii. changes in pupil size or eye deviation
d. Treatment – phenytoin (Dilantin) - scrupulous oral hygiene
e. Seizure management
i. Initial priority - Clear the area of any hazards
ii. Placing an airway, oxygen, and suction equipment at the bedside.
iii. Padding the side rails of the bed.
iv. Having intravenous equipment ready for insertion of IV catheter.
v. Do not restrain the clients limbs
 2. Hydrocephalus -
a. Types :
i. Communicating hydrocephalus - there is a flow of cerebrospinal
fluid between the brain cells and the ventricles, which do not empty
properly into the spinal cord.
b. Nursing assessment – presence of lumbosacral meningomyelocele
c. Signs / symptoms – Slow progressive hydrocephalus - rapid thready pulse
3. Developmental dysplasia of the hips
a. Diagnostic exam – Ortolani sign for newborn
b. Nursing assessment - in a supine position with hips and knees flexed, the
right knee is higher than the left; there are more gluteal and thigh folds on
the left than the right – possible left hip dislocation
c. Treatment – Surgery, hip spica
4. Fracture
a. Types:
i. Greenstick – not complete ossification of the bone, and the bone
bends and just partially breaks
ii. Spiral – broken with a twisting motion.
iii. Complete - crushed into two or more pieces
b. Diagnostic exam – X-ray
c. Nursing priority - assess and immobilized the affected area
d. Treatment – cast

5. Glasgow coma scale - use to assess the client's level of consciousness

Based on the assessment a score will indicate the level of consciousness.

Week 16 -
BLS/ CPR Triage/ Acuity
Life threatening conditions assessment
CPR – begin immediately when a patient manifested no pulse or heartbeat
- Chest compressions
i. Depth - infant – 1 ½ inches
ii. Ratio – 15 compressions : 2 rescue breaths (multiple rescuer)
- Sequence
1. Verify the scene is safe
 2. Check for responsiveness
3. Check for pulse and breathing
4. Call for help
5. Perform high-quality CPR
6. Attach AED as soon as available and follow its prompts
7. Continue CPR until qualified personnel arrives or signs of life return

Priority - Ensure a safe environment for the patient and the nurse when rendering
emergency treatment outside the hospital
- A – airway
- B – breathing
- C – circulation
- Assess level of consciousness – assessment (assess for neurologic deficits)
i. Cerebral function and cranial nerves
ii. Cardinal fields of gaze
iii. Reflexes and sensory system
TRIAGE – use to prioritize patient care
- Type of illness or injury
- Urgency of the patient’s condition

Example : a child ingested parents morphine drugs – acuity level - emergent (level 2)
Head injuries – assessment should include
1. Reaction of pupils
2. Level of consciousness
3. Temperature, Pulse, and respiratory rates

Week 17
The objectives of IMCI were:
1. Reduce deaths of children below 5 years old
2. Reduce frequency and severity of illness and disability
3. It contributes to growth and development
IMCI Case Management includes the following
4. Assessment,
5. classification,
6. treatment,
7. counsel
Danger signs
8. Cough or difficult breathing
 a. nurse should count the number of breaths per minute when the child is still
sleeping – child must be calm
b. note for stridor
9. Stridor
10. Diarrhea
a. Assess for – restlessness, irritability, if abnormally sleepy, sunken eyes
b. Persistent diarrhea – diarrhea of 14 days or more
c. Dysentery – advise the parents to seek consultation immediately if the child
is not able to drink or breastfed, become sicker, develops fever, drinking
poorly.
d. Moderate diarrhea – ( no bacterial infection, diarrhea for 2 days, with a
tinge of blood, moderate signs of dehydration ) - can be treated at the
health center
11. Fever
a. Severe dengue hemorrhagic fever - fever for 4 days, cold and clammy skin,
persistent abdominal pain
12. Pneumonia - has no danger sign, no chest indrawing and tachypnea
13. Anemia
a. Predisposing factors
i. Infection
ii. Malaria
iii. Hookworm / whipworm

IMCI standards for the treatment of simple cough and cold

1. Soothe the throat and relieve the cough
2. If coughing for more than 2 weeks, do a tuberculin test and refer for possible TB
or asthma
3. Advise mother when to return immediately
4. Follow-up in 5 days if not improving
The nurse should assess the child for the following
1. Ability to drink or to breastfeed
2. Presence of vomiting and frequency
3. Presence of convulsion
Hypoglycemia – management - Keep the child warm and refer immediately