Feb 23, 2024 NURS 6501 Knowledge Check Pediatrics
NURS 6501 Knowledge Check Pediatrics NURS 6501 Knowledge Check Pediatrics Scenario 2: Sickle Cell Disease (SCD) A 15-year-old male with known sickle cell disease (SCD) present to the ER in sickle cell crisis. The patient is crying with pain and states this is the third acute episode he has had in the last 10-months. Both parents are present and appear very anxious and teary eyed. A diagnosis of acute sickle cell crisis was made. Question 1. Discuss the genetic basis for SCD. Your Answer: Sickle Cell Disease (SCD) is a genetic disorder caused by a specific mutation in the gene that codes for hemoglobin, the protein responsible for carrying oxygen in red blood cells. The genetic basis of SCD lies in a single nucleotide change in the hemoglobin gene, leading to the production of abnormal hemoglobin molecules. Here’s How the Genetic Basis of SCD Works Normal Hemoglobin and Gene Mutation: Hemoglobin is made up of four protein subunits, with each subunit containing a molecule of heme (which binds to oxygen) and a protein called globin. In a normal individual, two of these subunits are alpha-globin chains, and the other two are beta-globin chains. The gene responsible for encoding the beta-globin chain is located on chromosome 11. However, in individuals with SCD, a mutation occurs in this gene. Hemoglobin S Mutation: The most common type of SCD is caused by a point mutation in the beta-globin gene. This mutation results in the substitution of a single amino acid in the beta-globin chain. Specifically, the amino acid glutamic acid is replaced by valine at the sixth position of the beta-globin chain. Hemoglobin S Formation: This single amino acid change in the beta-globin chain alters the way hemoglobin molecules interact with each other. Under conditions of low oxygen, dehydration, or other stressors, the abnormal hemoglobin molecules (hemoglobin S or HbS) have a tendency to stick together and form long, rigid structures known as polymers. This process is referred to as polymerization. Sickling of Red Blood Cells: As the HbS molecules polymerize, they cause the red blood cells to change shape from their normal, flexible disc-like form to a sickle or crescent shape. These sickle-shaped cells are less pliable and can get trapped in small blood vessels, leading to vaso-occlusion and impaired blood flow. Vaso-Occlusive Events: The accumulation of sickle cells in blood vessels can block the flow of blood and result in tissue ischemia (lack of blood supply). This phenomenon gives rise to the pain and other complications associated with SCD crises. Inheritance: Sickle Cell Disease is inherited in an autosomal recessive manner. This means that an individual must inherit two copies of the mutated gene (one from each parent) to have the full-blown disease. If an individual inherits one normal gene and one mutated gene, they are said to have sickle cell trait, which generally has milder symptoms. Scenario 1: Acute Lymphoblastic Leukemia (ALL) An 11-year-old boy is brought to the clinic by his parents who states that the boy has not been eating and listless. The mother also notes that he has been easily bruising without trauma as he says he is too tired to go out and play. He says his bones hurt sometimes. Mother states the child has had intermittent fevers that respond to acetaminophen. Maternal history negative for pre, intra, or post-partum problems. PMH: Negative. Easily reached developmental milestones. PE: reveals a thin, very pale child who has bruises on his arms and legs in no particular pattern. LABS: CBC revealed Hemoglobin of 6.9/dl, hematocrit of 19%, and platelet count of 80,000/mm3. The CMP demonstrated a blood urea nitrogen (BUN) of 34m g/dl and creatinine of 2.9 mg/dl. DIAGNOSIS: acute leukemia and renal failure and immediately refers the patient to the Emergency Room where a pediatric hematologist has been consulted and is waiting for the boy and his parents. CONFIRMED DX: acute lymphoblastic leukemia (ALL) was made after extensive testing. Question 1. Explain what ALL is? Selected Answer: Acute lymphocytic leukemia (ALL) is also called acute lymphoblastic leukemia. Acute means that leukemia can progress quickly and, if not treated, would probably be fatal within a few months. Lymphocytic means it develops from immature forms of lymphocytes, a type of white blood cell. ALL is a malignant, clonal disease of the bone marrow in which early lymphoid precursors proliferate and replace the normal hematopoietic cells of the marrow. In most cases, the leukemia cells invade the blood quickly. They can also sometimes spread to other parts of the body, including the lymph nodes, liver, spleen, central nervous system, and testicles (in males). Acute lymphocytic leukemia is the most common type of cancer in children, and treatments result in a good chance of a cure. Acute lymphocytic leukemia can also occur in adults, though the chance of a cure is greatly reduced. Signs and symptoms of acute lymphocytic leukemia may include: bleeding from the gums, bone pain, fever, frequent infections, frequent or severe nosebleeds, lumps caused by swollen lymph nodes in and around the neck, armpits, abdomen or groin, pale skin, shortness of breath, weakness, fatigue or a general decrease in energy. Correct Answer: Acute lymphoblastic leukemia (ALL) is a malignant (clonal) disease of the bone marrow in which early lymphoid precursors proliferate and replace the normal hematopoietic cells of the marrow. ALL is the most common type of cancer and leukemia in children in the United States. The malignant cells of acute lymphoblastic leukemia (ALL) are lymphoid precursor cells (ie, lymphoblasts) that are arrested in an early stage of development. This arrest is caused by an abnormal expression of genes, often as a result of chromosomal translocations or abnormalities of chromosome number. These aberrant lymphoblasts proliferate, reducing the number of the normal marrow elements that produce other blood cell lines (red blood cells, platelets, and neutrophils). Consequently, anemia, thrombocytopenia, and neutropenia occur, although typically to a lesser degree than is seen in acute myeloid leukemia. Lymphoblasts can also infiltrate outside the marrow, particularly in the liver, spleen, and lymph nodes, resulting in enlargement of the latter organs. Response Feedback: [None Given] · Question 2 4 out of 4 points Scenario 1: Acute Lymphoblastic Leukemia (ALL) An 11-year-old boy is brought to the clinic by his parents who states that the boy has not been eating and listless. The mother also notes that he has been easily bruising without trauma as he says he is too tired to go out and play. He says his bones hurt sometimes. Mother states the child has had intermittent fevers that respond to acetaminophen. Maternal history negative for pre, intra, or post-partum problems. PMH: Negative. Easily reached developmental milestones. PE: reveals a thin, very pale child who has bruises on his arms and legs in no particular pattern. LABS: CBC revealed Hemoglobin of 6.9/dl, hematocrit of 19%, and platelet count of 80,000/mm3. The CMP demonstrated a blood urea nitrogen (BUN) of 34m g/dl and creatinine of 2.9 mg/dl. DIAGNOSIS: acute leukemia and renal failure and immediately refers the patient to the Emergency Room where a pediatric hematologist has been consulted and is waiting for the boy and his parents. CONFIRMED DX: acute lymphoblastic leukemia (ALL) was made after extensive testing. Question 1. Why does ARF occur in some patients with ALL? Selected Answer: Renal injury in ALL is common and can occur through many different mechanisms, including prerenal acute kidney injury, acute tubular necrosis, reno-vascular disease, obstruction, glomerulonephritis, and parenchymal infiltration of tumor cells. Although renal involvement is not uncommon in ALL, renal failure is rarely a presenting symptom in ALL and is thought to be a poor prognosis indicator. Leukemic may lead to significant impairment of renal function if it is bilateral and diffuse, particularly involving the cortical region. Acute renal failure in patients with acute leukemia is usually a consequence of a chemotherapeutic regimen, leading to tumor lysis syndrome—the tumor lysis syndrome results in acute uric acid and calcium phosphate nephropathy. The most common form of kidney injury in leukemia is related to prerenal AKI in the setting of volume depletion. When infiltration is suspected, kidney biopsy is typically recommended as the extent of infiltration can give prognostic information regarding the malignancy as the rate of infiltration parallels the stage and grade of the disease Correct Answer: Renal failure as a result of hyperuricemia can be associated with ALL, particularly at diagnosis or during active treatment. Uric levels rise as an end product of purine metabolism from cellular destruction. Because the major excretory pathway is through the kidneys, urates can precipitate Response Feedback: [None Given] Scenario 1: Acute Lymphoblastic Leukemia (ALL) An 11-year-old boy is brought to the clinic by his parents who states that the boy has not been eating and listless. The mother also notes that he has been easily bruising without trauma as he says he is too tired to go out and play. He says his bones hurt sometimes. Mother states the child has had intermittent fevers that respond to acetaminophen. Maternal history negative for pre, intra, or post-partum problems. PMH: Negative. Easily reached developmental milestones. PE: reveals a thin, very pale child who has bruises on his arms and legs in no particular pattern. LABS: CBC revealed Hemoglobin of 6.9/dl, hematocrit of 19%, and platelet count of 80,000/mm3. The CMP demonstrated a blood urea nitrogen (BUN) of 34m g/dl and creatinine of 2.9 mg/dl. DIAGNOSIS: acute leukemia and renal failure and immediately refers the patient to the Emergency Room where a pediatric hematologist has been consulted and is waiting for the boy and his parents. CONFIRMED DX: acute lymphoblastic leukemia (ALL) was made after extensive testing. Question 1. Explain what ALL is? Selected Answer: Acute lymphocytic leukemia (ALL) is also called acute lymphoblastic leukemia. Acute means that leukemia can progress quickly and, if not treated, would probably be fatal within a few months. Lymphocytic means it develops from immature forms of lymphocytes, a type of white blood cell. ALL is a malignant, clonal disease of the bone marrow in which early lymphoid precursors proliferate and replace the normal hematopoietic cells of the marrow. In most cases, the leukemia cells invade the blood quickly. They can also sometimes spread to other parts of the body, including the lymph nodes, liver, spleen, central nervous system, and testicles (in males). Acute lymphocytic leukemia is the most common type of cancer in children, and treatments result in a good chance of a cure. Acute lymphocytic leukemia can also occur in adults, though the chance of a cure is greatly reduced. Signs and symptoms of acute lymphocytic leukemia may include: bleeding from the gums, bone pain, fever, frequent infections, frequent or severe nosebleeds, lumps caused by swollen lymph nodes in and around the neck, armpits, abdomen or groin, pale skin, shortness of breath, weakness, fatigue or a general decrease in energy. Correct Answer: Acute lymphoblastic leukemia (ALL) is a malignant (clonal) disease of the bone marrow in which early lymphoid precursors proliferate and replace the normal hematopoietic cells of the marrow. ALL is the most common type of cancer and leukemia in children in the United States. The malignant cells of acute lymphoblastic leukemia (ALL) are lymphoid precursor cells (ie, lymphoblasts) that are arrested in an early stage of development. This arrest is caused by an abnormal expression of genes, often as a result of chromosomal translocations or abnormalities of chromosome number. These aberrant lymphoblasts proliferate, reducing the number of the normal marrow elements that produce other blood cell lines (red blood cells, platelets, and neutrophils). Consequently, anemia, thrombocytopenia, and neutropenia occur, although typically to a lesser degree than is seen in acute myeloid leukemia. Lymphoblasts can also infiltrate outside the marrow, particularly in the liver, spleen, and lymph nodes, resulting in enlargement of the latter organs. Response Feedback: [None Given] Pediatric disorders can present unique challenges to patients, families, and healthcare providers. Disorders in these areas are complicated by the fact that young patients can have difficulties communicating symptoms. Furthermore, the manner in which disease and disorders manifest in children may be unique. Click here to ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT ON NURS 6501 Knowledge Check Pediatrics APRNs working to support these patients and their loved ones must demonstrate not only support and compassion, but expertise to communicate and guide understanding of diagnoses and treatment plans. This includes an understanding of disease and disorders at the pediatric level. Struggling to Meet Your Deadline? Get your assignment on NURS 6501 Knowledge Check Pediatrics done on time by medical experts. Don’t wait – ORDER NOW! Meet my deadline This week, you examine pathophysiology in pediatrics. You apply key terms, concepts, and principles in this area to demonstrate an understanding of the impact they have on altered physiology in children.Learning Objectives NURS 6501 Knowledge Check Pediatrics Students will: Analyze concepts and principles of pathophysiology across the lifespan Learning Resources Required Readings (click to expand/reduce) McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier. Chapter 14: Cancer in Children, including Summary ReviewChapter 20: Alterations of Neurologic Function in Children (stop at Childhood tumors); Summary ReviewChapter 34: Alterations of Cardiovascular Function in Children (stop at Defects decreasing pulmonary blood flow); Summary ReviewChapter 37: Alterations of Pulmonary Function in Children (stop at Congenital malformations); Summary ReviewChapter 40: Alterations of Renal and Urinary Tract Function in Children, including Summary ReviewChapter 43: Alterations of Digestive Function in Children, including Summary ReviewChapter 46: Alterations of Musculoskeletal Function in Children (stop at Avascular diseases); (start at Cerebral palsy) (musculoskeletal tumors in children); Summary ReviewChapter 48: Alterations of the Integument in Children, including Summary ReviewNURS 6501 Knowledge Check Pediatrics Chapter 50: Shock, Multiple Organ Dysfunction Syndrome, and Burns in Children, including Summary Review U.S. National Library of Medicine. (2019). Normal growth and development. Retrieved from https://medlineplus.gov/ency/article/002456.htm Document: NURS 6501 Final Exam Review (PDF document) Note: Use this document to help you as you review for your Final Exam in Week 11. Required Media (click to expand/reduce) Knowledge Check: Pediatrics In this exercise, you will complete a 10- to 20-essay type question Knowledge Check to gauge your understanding of this module’s content. Possible topics covered in this Knowledge Check include:Growth and developmentNormal growth patternsScoliosis (ortho)KawasakiAlterations in childrenCongenital (heart syndrome)PDAsSudden Infant Death Syndrome (SIDS)AsthmaLead poisoning and effects on neurological functioningSickle cellHemophilia Photo Credit: laflor / E+ / Getty Images (Note: It is strongly recommended that you take the Knowledge Check at least 48 hours before taking the Final Exam.)Complete the Knowledge Check By Day 5 of Week 11 To complete this Knowledge Check: Module 8 Knowledge Check Final Exam This 101-question exam is a test of your knowledge in preparation for your certification exam. No outside resources, including books, notes, websites, or any other type of resource, are to be used to complete this exam. You are expected to comply with Walden University’s Code of Conduct. This exam will be on topics covered in Weeks 7, 8, 9, 10, and 11. Prior to starting the exam, you should review all of your materials. This exam is timed with a limit of 2 hours for completion. When time is up, your exam will automatically submit. (Note: It is strongly recommended that you take the Knowledge Check at least 48 hours before taking the Final Exam.) Photo Credit: Getty Images By Day 7 of Week 11 Complete and submit your Final Exam. To complete your exam: Final Exam What’s Coming Up? Congratulations! After you have finished all of the assignments for this week, you have completed the course. Please submit your Course Evaluation by Day 7. Results Displayed All Answers, Submitted Answers, Correct Answers, Feedback, Incorrectly Answered Questions Question 1 1 out of 1 points Correct An adolescent that uses anabolic steroids to increase muscle mass is at risk for developing which type of cancer?Selected Answer:Correct Hepatocellular carcinomaAnswers: Neuroblastoma Acute myelogenous leukemia Vaginal adenocarcinoma Correct Hepatocellular carcinomaQuestion 2 1 out of 1 points Correct Which of the following about Roseaola is FALSE?Selected Answer:Correct severely pruriticAnswers: is also known as exanthema subitum Correct severely pruritic rash appears after high fever Most common in infantsQuestion 3 1 out of 1 points Correct Children who have inherited deficiencies of antithrombin III or proteins C or S have increased risk for _______________Selected Answer:Correct ThrombosisAnswers: Hemorrhage Sickle cell anemia Correct Thrombosis AnemiaQuestion 4 0 out of 1 points Incorrect Which of the following characteristics of Impetigo is FALSE?Selected Answer:Incorrect Commonly caused by staphylococciAnswers:Correct Is mildly contagious Commonly caused by staphylococci class lesions are honey colored crusts Outbreaks usually begin with vesiclesQuestion 5 1 out of 1 points Correct A child with Fanconi anemia is at risk for developing which type of cancer?Selected Answer:Correct Acute myelogenous leukemiaAnswers: Neuroblastoma Correct Acute myelogenous leukemia Vaginal adenocarcinoma Hepatocellular carcinomaQuestion 6 1 out of 1 points Correct Children who have atopic dermatitis often have elevated levels of ______________________.Selected Answer:Correct IgEAnswers:Correct IgE IgM IgG IgN Question 7 1 out of 1 points Correct What is the function of G6PD?Selected Answer:Correct It is a normal enzyme that protects erythrocytes from oxidative damageAnswers: It is an enzyme that causes the breakdown of red blood cells Correct It is a normal enzyme that protects erythrocytes from oxidative damage It is an enzyme that causes the formation of red blood cells It is an enzyme that inhibits coagulationQuestion 8 1 out of 1 points Correct During the first five years of life, the respiratory system continues to develop and the number of what structure increases?Selected Answer:Correct alveoliAnswers: conducting airways Correct alveoli bronchi Bronchioles Question 9 1 out of 1 points Correct Red, round, and scaling patches with a clear center that occur mostly on the face, trunk, and limbs in an asymmetrical distribution describes which of the following conditions?Selected Answer:Correct Tinea corporisAnswers: Atopic dermatitis Correct Tinea corporis Impetigo Staphylococcal scalded-skin syndromeQuestion 10 1 out of 1 points Correct Rotavirus is the leading cause of what symptom in infants and young children?Selected Answer:Correct acute diarrheaAnswers:Correct acute diarrhea necrotizing enterocolitis constipation Abdominal painQuestion 11 1 out of 1 points Correct A ventricular septal defect will cause what type of blood shunting?Selected Answer:Correct Left to rightAnswers:Correct Left to right Right to left No shuntQuestion 12 1 out of 1 points Correct Respiratory distress syndrome in the newborn is caused by the deficiency of what substance?Selected Answer:Correct surfactantAnswers: fibrin hemoglobin Correct surfactant Iron Question 13 1 out of 1 points Correct The most common cause of chronic hepatitis in children is:Selected Answer:Correct B and CAnswers: A and B A and C Correct B and C B and DQuestion 14 1 out of 1 points Correct Von Willebrand disease is a genetic condition that causes: (thrombotic, hemorrhagic) condition.Selected Answer:Correct hemorrhageAnswers: thrombosis Correct hemorrhage anemia InfectionQuestion 15 1 out of 1 points Correct What medication should a child with G6PD deficiency avoid because it can trigger a hemorrhage?Selected Answer:Correct aspirinAnswers: Vitamin D iron penicillin Correct AspirinQuestion 16 1 out of 1 points Correct Pruritic linear lesions that itch more at night that may have more vesicles and papules describes which of the following conditions?Selected Answer:Correct ScabiesAnswers: Atopic dermatitis Tinea corporis Impetigo Correct ScabiesQuestion 17 1 out of 1 points Correct Children with Down’s Syndrome has an increased risk of developing which type of cancer?Selected Answer:Correct LeukemiaAnswers: Retinoblastoma Correct Leukemia Wilms tumor NeuroblastomaQuestion 18 1 out of 1 points Correct Which of the following is true of people that have sickle cell anemia?Selected Answer:Correct People who have sickle cell anemia have two copies of the mutated gene and produce only hemoglobin SAnswers:Correct People who have sickle cell anemia have two copies of the mutated gene and produce only hemoglobin S People who have sickle cell anemia have one mutated gene and produce a mixture of hemoglobin A and hemoglobin S People who have sickle cell anemia have one copy of the mutated gene and produce only hemoglobin A People who have sickle cell anemia have two copies of the mutated gene and produce a mixture of hemoglobin A and hemoglobin SQuestion 19 1 out of 1 points Correct The development of Kawasaki disease in young children is caused by:Selected Answer:Correct vasculitis of unknown causeAnswers:Correct vasculitis of unknown cause Epstein Barr Virus Genetic malformation Medication interationQuestion 20 1 out of 1 points Correct Cerebral palsy involves what type of defects?Selected Answer:Correct motorAnswers:Correct motor sensory cognitive developmental Question 5 4 out of 4 points Scenario 3: Hemophilia 8-month infant is brought into the office due to a swollen right knee and excessive bruising. The parents have noticed bruising about a month ago but thought the bruising was due to the attempts to crawl. They became concerned when the baby woke up with a swollen knee. Infant up to date on all immunizations, has not had any medical problems since birth and has met all developmental milestones. FH: negative for any history of bleeding disorders or other major genetic diseases. PE: within normal limits except for obvious bruising on the extremities and right knee. Knee is swollen but no warmth appreciated. Range of motion of knee limited due to the swelling. DIAGNOSIS: hemophilia A. Question 1. What is the pathophysiology of Hemophilia Selected Answer: Hemophilia is the most prevalent severe hereditary bleeding disorder and is characterized by the inability to form thrombi in response to injury, resulting in continuous bleeding. Both hemophilia A and B result from mutations in the F8 gene and F9 gene. Changes or mutations of the genes result in deficiency or dysfunction of clotting factors VIII and IX, respectively. Specifically, “inversions in introns 1 and 22 of the factor VIII gene are the most frequently observed mutations and account for most severe cases of hemophilia A” . Another type of mutation that may result in hemophilia is a point mutation. In this instance, a single nucleotide in the DNA is added, deleted, or changed. When these alterations take place, the amino acid chain is typically destroyed. Otherwise, the protein chain can disrupt protein function, inhibit intracellular processi
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