Pedia Module Preschooler Neri

FAR EASTERN UNIVERSITY
INSTITUTE OF NURSING
Angela P. Neri BSN 209

PEDIA MODULE: PRESCHOOLER
TEST YOURSELF (ACTIVITY#001)
1.What is the most important aspect in the treatment of asthma?
2.What are the two categories of medications used in the treatment of asthma?
3.What are the routes of administration for many of the medications used to treat asthma?
Answer:
1. Among the four components of asthma treatment: a) monitoring objective testing to determine asthma
severity and control; b) education for self-management; c) control of environmental factors that contribute to
exacerbations and triggers; d) provide pharmacologic therapy with minimal or no adverse effect (NHLBI: Expert
Panel Report 2007). The primary aspect in asthma management is the prevention of airway inflammation.
Because inflammation is considered an early and persistent feature of asthma, the relationship of
inflammation to airway hyperresponsiveness and airway obstruction contributes to clinical symptoms.
2. Asthma medications are categorized into two general classes: long-term control medications which are the
preventive medications to achieve and maintain control of inflammation, quick-relief medications which are
the rescue medications to treat symptoms and exacerbations. Such long-term control medications used are
inhaled corticosteroids, cromolyn sodium and nedocromil, long-acting β2-agonists, methylxanthines, and
leukotriene modifiers. On the other hand, short-acting β2-agonists, anticholinergics, and systemic
corticosteroids are used as quick-relief medications. Long-term control medication and quick-relief medications
like β2-agonists, methylxanthines, and anticholinergics are often used in combination as bronchodilators that
relax bronchial smooth muscle and dilate the airways.
3. Routes of Administration for Asthma medications
 Oral (PO) – Ex. Ephedrine sulfate, Albuterol, Metaproterenol sulfate, Prednisone, Zafirlukast
Oral Inhalation:
 MDI Inhalation (Metered dose inhaler) – Ex. Epinephrine, Ipratropium, Bitolterol, Pirbuterol
 DPI Inhalation (Dry-powder inhaler) – Ex. Salmeterol, Budesonide, Fluticasone
 Inhalation – Ex. Indacaterol, Glycopyrrolate, Olodetarol, Umeclidinium, Vilanterol
 Inhalation via nebulizer – Ex. Arformoterol tartrate, Levalbuterol, Albuterol
 Subcutaneous (SC) – Ex. Omalizumab, Epinephrine, Terbutaline sulfate
 Intravenous (IV) – Ex. Reslizumab, Epinephrine, Theophylline
CASE STUDY (ACTIVITY#002)

Judalene Sta Maria (JS), age 6 arrived at the Emergency Department of FEU Hospital with her mother at 5 PM.
Her mother reported that she had become lethargic in recent days. Her mother became concerned when she
felt warm to the touch and hadn’t urinated as much as she normally would. The mother reports that Judy had
a strep throat 4 weeks ago, but she recovered and she was fine up to a few days ago. Assessment data:
Temperature 101.3°F +1 pitting edema bilaterally arms and legs. Slight edema around the eyes. Urine analysis
showed hematuria, proteinuria, and specific gravity is 1.034 g/mL. Blood serum shows elevated creatinine and
BUN. Urine culture and sensitivity is positive for streptococcal bacteria.
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Given the data:

1.Interpret the case provided
According to Pillitteri and Silbert-Flagg (2018), a child who has a history of “strep” throat caused by
Group A streptococcal infection, are most likely to develop Acute glomerulonephritis (AGN) 2-4 weeks after an
untreated preceding infection and mainly affects the pediatric from ages 3-10 yrs old. The child became at risk
to the condition because the parents either didn’t seek treatment after getting a strep throat or didn’t have a
follow-up check since she already recovered as her mother states. As a result, the child’s immune system
responds to Streptococcus bacteria by creating an antigen-antibody complexes which starts to collect in the
glomeruli. This action disrupts the blood flow in high pressure and causes inflammation that allow areas to
open letting protein and RBC drip down into Bowman’s capsule. This is the reason for sudden onset of
hematuria and proteinuria in the urine, which eventually causes Edema starting on the face up to extremities
because of low protein in the blood. Aside from the 2 primary results on the urine analysis, the low urine
specific gravity indicates a damage to the kidney’s tubules as the urine remains dilute on the disrupt filtration.
Another cause of this action is the decrease of blood to be filtered in kidney that increases the amounts of
blood waste in the urine (Hematuria) which include BUN and creatinine. On the decrease of filtration, it also
lowers the patient’s urinary output (oliguria). Lastly, the child’s mother reported signs such as becoming
lethargic and felt warm to touch as evidenced by the high temperature (101.3°F), are the nonspecific
symptoms that responds to effects of inflammation cause by the infection.
2.List down your Nursing intervention base on the case.

The primary goal of the nursing intervention centers on helping alleviate symptoms and allowing the
child to adjust to her sudden change in appearance and feeling.
Fatigue/ Activity Intolerance
 Organize a nursing care period for sleep and promote strict bed rest to avoid hypertension because activity
can lead to an increase in blood pressure.
 Provide a stimulating environment for the child to entertain and divert her from the abrupt serious illness.
Anxiety/Fear/ Risk for Altered Coping
 Also, as response to parent’s concerns, provide frequent reports of subtle positive changes to the child’s
condition.
 Allow the parents and child to express their anxiety and fears to address age-appropriate explanation of
the disease process and of the interventions.
 Educate the parents about the possible reoccurrence of strep throat that needs immediate urine culture so
it can be treated separately.
 Advise parents to perform follow up care visits to the hospital based on the health supervision, since the
child with mild edema and no hypertension is most likely to be treated at home. (Wong’s Nursing Care of
Infants and Children 2019)
Imbalanced fluid volume/ Imbalanced Nutrition/ Risk for Altered Breathing Pattern/ Risk for Injury
 Monitor fluid intake and output by informing the parents to record it.
 If the required amount of urine output (1ml</kg/hr) is not achieved, monitor the child for hyperkalemia
and restrict foods that are rich in potassium.
 Perform daily weight as this is the most accurate way to assess fluid status.
 Monitor skin for edema in the face and extremities, especially note for indication of pulmonary edema
upon auscultation of lung sounds.
 Encourage the child to change positions frequently to avoid breaking edematous skin.
 Administer prescribed diuretics that increases urine output and remove that excessive fluid, but it’s
contraindicated if renal impairment is present or occurred by a residual streptococcal infection.
 Administer prescribed antibiotic therapy, in this case penicillin is commonly the agent of choice because it’s
caused
 Monitor the values of creatinine, BUN, proteinuria, and specific gravity as these are indicative of kidney
and renal failure.
 Assess the urine color if it appears normal (yellowish to amber) or if it’s still hematuria (pink to “cola”).
 Establish a sodium and fluid restriction as prescribed to reduce the amount of protein lost but also consider
modifications according to child’s food tolerance.
3. Provide evaluation of your care

 Fatigue/ Activity Intolerance
During the acute phase children are generally content to lie in bed. As they begin to feel better and their
symptoms subside, they will want to be up and about. Thus, activities should be planned to allow for frequent
rest periods and avoidance of fatigue. Strenuous activity is also restricted until there is no evidence of
proteinuria or macroscopic hematuria.
 Anxiety/Fear/ Risk for Altered Coping
Glomerulonephritis is a frightening disease for both children and their parents because it begins so abruptly.
Children may be frightened by the initial hematuria and upset at the appearance of edema, which makes their
reflection in the mirror seem strange and often frightening to them. Children as early as preschool age can
identify that their condition is already serious due to the immense pain they’re feeling.
It is important for parents to know the schedule of follow-up visits upon discharge so this child’s condition will
be managed and be treated if complications occurs.
 Imbalanced fluid volume/ Imbalanced Nutrition/ Risk for Altered Breathing Pattern/ Risk for Injury
Assessment of the child’s appearance for signs of renal or kidney complication is an important nursing
function because the severity of the acute phase is variable and unpredictable. The regular measurement of
vital signs, urine analysis, blood serum, body weight, and intake and output are essential to monitor the
disease’s progress provide clues to the severity of the disease and early signs of complication. Taking daily
weight specifically helps to detect if fluid accumulation is continuing. The indication if the disease has
progressed to kidney failure (Azotemia), it reflects in elevated blood urea nitrogen (BUN) and creatinine levels
in at least 50% of glomerulonephritis cases.
With glomerulonephritis, dietary restriction is necessary to offset protein loss and increase urinary output.
Fluid and sodium or potassium restriction, if prescribed, are limited for children who experience edema and
during periods of oliguria. The loss of appetite associated with the disease usually limits the protein intake
sufficiently. In addition, diuretic and antibiotic therapy as prescribed will significantly helpful if edema and fluid
overload are present, and most importantly, remove all the streptococci infections present in the child’s
immune system. However, medications are poorly absorbed to prevent edematous skin break, so the child
needs frequent position changes while in bed. An atraumatic skin care such as placing soft gauze between skin
surfaces and checking for constricting tight parts by an elastic band at the waist, will help prevent skin irritation
and prevent skin breakdown since edematous doesn’t heal well, leading to secondary infection.
Test Taking skills (ACTIVITY#003)

Answer the following questions

D. 1.) To remain aware of client needs and advocate for the client nurses must do which of the following?
A.Monitor lab results
B.Note side effects from medications
C.Explore historical data
D.All of the above
B. 2.) What is the most frequent type of cancer in children other than immature blood cell overgrowth?
A.Lymphomas
B.Leukemia
C.Rhabdomyosarcoma
D.Gliomas
A. 3.) The oncogenic virus theory states which of the following?

A.There is a familial predisposition for cell mutation
B.Previous cancer produces high risk for cancer
C.Cancer development is caused by exposure to carcinogenic organisms
D.All of the above
C. 4.) An assessment of a child with cancer includes but is not limited to which of the following?
A.Determining religious philosophy
B.Assessing political views
C.Reviewing diagnostic test findings
D.None of the above
A. 5.) Bone marrow aspiration is also known as which of the following?

A.Biopsy
B.Metastasis
C.Cachexia
D.Ewing sarcoma
A. 6.) What is Osteogenic sarcoma?

A.Malignant long-bone tumor
B.Malignant tumor of the spine
C.Malignant tumor in the bone marrow
D.Benign tumor of the knee
C. 7.) When caring for children with cancer and their families, what should the nurse do?
A.Explain procedures in terms only the parent will understand to protect the child.
B.Do not contact families and allow them their privacy after discharge.
C.Reinforce physician’s explanations of diagnosis and treatment plans.
D.None of the above.
A. 8.) When explaining treatment protocol to parents, what should the nurse stress?
A.Child should be included as age and maturity permits.
B.Parents should be told to continue with regular immunizations.
C.Parents should push the child to eat favorite foods when feeling nauseated.
D.b and c only.
D 9.) The care needs of families of children with cancer include the following:
A.Stabilization of child’s weight during chemotherapy
B.Referral for family counseling
C.A maintenance of activity within the child’s tolerance
D.All of the above
C. 10.) Soft, bland diets, and saltwater rinses are used to relieve the pain of which of the following?
A.Toothaches
B.Malignant tumors
C.Mucosal ulcerations
D.Hemorrhagic cystitis
CASE STUDY (ACTIVITY#004)

Mother brings 5-year, 3-month-old female to be assessed by the primary health-care practitioner
Subjective Data
• Child is seen playing with dolls in the waiting room while pretending to give the baby a bottle and wrapping
the baby in a blanket
• Mother states, “Everything seems fine, but I noticed that my daughter’s urine is pink. I first saw it yesterday
evening.”
• “She has had a couple of colds this year, but nothing out of the ordinary. What do you think is going on?”
Objective Data Nursing Assessment
• Since birth, the child’s well-child checks have been within normal limits, including weight, height, and head
circumferences all at the 50th percentile
• Child is up to date on all immunizations
• Mass palpated in left upper quadrant—child exhibits minimal guarding
• Ultrasound results
• Presumed Wilms’ tumor noted in left kidney
Vital Signs
Temperature: 98.8°F (Convert to C) ̊ _________
Heart rate: 100 bpm
Respiratory rate: 26 rpm
Blood pressure: 106/66 mm Hg
Lab Results
Complete blood count

Red blood cell count:3.6 million/mm3
Hemoglobin: 11 g/dL
Hematocrit: 33%
White blood cell count: 10,000/mm3
Platelet count: 225,000/mm3
Urine: within normal limits except
Red blood cells: 10 (normal less than or equal to 2)
Health-Care Provider’s Orders

• Admit to pediatric unit
• Prepare for surgery in a.m.
• NPO after midnight
•Modified bed rest
• Absolutely no one is to palpate the abdomen.
CASE STUDY QUESTIONS

A. What subjective assessments indicate that this client is experiencing a health alteration?
1. “She has had a couple of colds this year, but nothing out of the ordinary”, verbalized by the mother about
her child.
2. “but I noticed that my daughter’s urine is pink.”, verbalized by the mother about her child.
B. What objective assessments indicate that this client is experiencing a health alteration?
1. The child manifest pain when mass is palpated in left upper quadrant of the abdomen.
2. Blood pressure at the 90th percentile based on age, that means prehypertensive systolic and diastolic.
3. Red blood cell count is below normal range of 4.5-5.5 million/mm3.
4. Ultrasound results shows a mass in the left kidney
5. Hematocrit below normal value of 34%
6. Hemoglobin below normal value of 11.0 g/dL
7. Red blood cells in the urine with a value of 10
Reference for Laboratory normal values:

- Hockenberry, M.; Wilson, D; Rodgers, C. Wong’s Nursing Care of Infants and Children (2019) 2nd Philippine
Edition: Elsevier Saunders
-WHO and UNICEF 1998
C. After analyzing the data that has been collected, what primary nursing diagnosis should the nurse assign
to this client?
1. Risk for Injury related to child’s age’s vulnerability to tumor as evidenced by mass in the left kidney.
D. What interventions should the nurse plan and/or implement to meet this child’s and her family’s need?
1. Establish and provide a postoperative care after notifying the hospital for surgery.
2. Teach the parents to not put any pressure on the child’s abdomen where the site mass is located to avoid
rupturing the tumor.
3. Provide a health education appropriate to the child’s age, regarding the equipment or anything seen in the
hospital.
4. Respond to parents’ questions and concern about the child’s condition and clinical procedure necessary.
5. After every assessment or procedure, provide an emotional support to the child with a reward for her good
behavior, especially giving emphasize in an appropriate-age language that the hospitalization, medication, and
surgery will make her feel better and make any pain go away.
E. What client outcomes should the nurse evaluate regarding the effectiveness of the nursing interventions?
1. The child doesn’t communicate that she’s sick because she has been “bad”
2. The child’s parents verbalize that they understand the diagnosis and the purpose for hospitalization and
procedures including surgery.
3. The parents express worries and fear about the child’s current health status but doesn’t frighten their child.
4. The parents verbalized that applying pressure to the child’s abdomen is forbidden and always requires care .
5. The child express to be comfortable and aware around the equipment in the hospital.
F. What physiological characteristics should the child exhibit before being discharged home (from the
hospital)?
1. Normal vital signs and normal laboratory results, especially no presence of blood in urine
2. Manifest consistent weight upon admission with normal intake & output.
3. Patient’s abdomen manifests no signs of swelling.
4. Absence of any inflammation signs
5. Shows no signs of bleeding or redness in the surgical cut.
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FAR EASTERN UNIVERSITY

Angela P. Neri BSN 209

CASE STUDY (ACTIVITY#002)

Given the data:

2.List down your Nursing intervention base on the case.

3. Provide evaluation of your care

Test Taking skills (ACTIVITY#003)

Answer the following questions

A. 3.) The oncogenic virus theory states which of the following?

A. 5.) Bone marrow aspiration is also known as which of the following?

A. 6.) What is Osteogenic sarcoma?

D.None of the above.

CASE STUDY (ACTIVITY#004)

Complete blood count

Health-Care Provider’s Orders

CASE STUDY QUESTIONS

Reference for Laboratory normal values:

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