MCN Exam 3 Latest Update -

MCN Exam 3 Latest Update - Exam from Credible Source with 220 Questions and 100% Verified Detailed Correct Answers Guaranteed A+ Approved by Professor

Abusive head trauma - CORRECT ANSWER: ** Leading cause of death from trauma in

kids < 2yo

Crying = #1 trigger

Acquired heart dz: Acute rheumatic fever - CORRECT ANSWER: An autoimmune response to a previous group A strep infxn (pharyngitis). Often develops 2-4 wks after strep/URI infxn.

Assessment:

• previous strep infxn

DX: based on JONES criteria (must have 2 major, or 1 major and 2 minor criteria)

- MAJOR:

• joints (polyarthritis)
• carditis
• nodules (lymphadenopathy)
• erythema marginatum
• sydenhams chorea (involuntary jerking movements)

- MINOR:

• fever
• ESR elevated
• long PR interval
• arthralgia 1 / 4

Nursing mgmt:

• Abx (10d of penicillin)
• corticosteroids

- REST!

• pain mgmt
• if valvular complications involved (mitral regurg. or aortic stenosis)
• prophylactic Abx lifelong before invasive procedures
• if no valvular complications involved
• prophylactic Abx for 5 yrs, or until 21 yo, before invasive

procedures.

Acquired heart dz: Heart Failure - CORRECT ANSWER: S/S:

• sweating
• swelling of hands, feet, eyes
• breathing problems
• poor growth
• cyanosis
• tachycardia
• poor feeding

Nursing mgmt:

• promote oxygenation
• promote nutrition (small more frequent meals)
• promote rest
• support heart fxn (daily wt, I&O, meds, assessments)
• promote tissue perfusion w/ positioning

- r/f infxn :infective endocarditis 2 / 4

• must receive prophylactic Abx before invasive procedure

Medications:

1. DIGOXIN

• increases contraction force, decreases HR

** Hold for older kids HR < 60, Young kids HR < 70, infants HR < 90 **

• given BID 12 hr apart ( 1 hr before food, or 2 hr after food)
• if missed dose > 4 hr or child vomits, wait until next dose. If 2 doses missed, contact

MD

** Toxicity s/s: N/V, decreased appetite, bradycardia, drowsiness, lethargy

• FUROSEMIDE (Lasix)
• r/f hypokalemia (increases r/f digoxin toxicity)

Acquired heart dz: HTN - CORRECT ANSWER: Screening starts @ 3yo

• BP norms based on age, gender, and height.

** Needs 3 separate high BP reads before can officially dx w/ HTN

Kids 1-13yo

• Normal BP < 90th percentile
• Elevated BP is > 90th but < 95th percentiles

Kids > 13 yo, follow adult BP guidelines

Primary vs Secondary HTN

• HTN > 95th percentile

Manage with diet and exercise, meds only if diet/exercise aren't effective

• / 4

Acquired heart dz: Hyperlipidemia (HLD) - CORRECT ANSWER: Assessment:

• Starts @ 24 mo for infants w/ RFs present (FHx of HLD or CVD, early unexplained

death of relative, or no FHx/Hx available)

• Universal screening begins @ 9-11 yo
• 2nd screening @ 18-20 yo

Elevated levels:

Total chol > 200 LDL >/= 130

Mgmt and edu:

• manage with diet and exercise
• track BMI
• 60 min/day exercise
• meds PRN if diet and exercise aren't working

Acquired heart dz: Kawasaki - CORRECT ANSWER: ** LEADING CAUSE OF

ACQUIRED HEART DZ IN KIDS**

Acute systemic vasculitis, unknown cause

DX: based on clinical assessment

• fever of at least 5 days

AND 4 of the following...

• bilateral conjunctivitis (eye infxn)
• changes to lips or oral mucosa (dry chapped lips, strawberry tongue)
• changes to extremities (reddened palms/soles, edema, desquamation/peeling)
• polymorphous rash
• cervical lymphadenopathy
• / 4