OCTC Pediatric Nursing NSG 213
Pediatric Nursing Exam 3: Comprehensive Review Guide
Master the essential concepts of pediatric hematological, musculoskeletal, and dermatological disorders, plus end-of-life care to excel in your nursing exams and clinical practice.
Introduction: Navigating Pediatric Nursing Challenges
Pediatric nursing demands specialized knowledge and skills to provide effective care for children from infancy through adolescence. Each developmental stage presents unique physiological and psychological considerations that influence assessment, treatment, and family education.
Exam 3 covers four critical areas that form the foundation of specialized pediatric care: hematological disorders, musculoskeletal conditions, dermatological issues, and the sensitive topic of end-of-life care for children.
Understanding these complex areas requires both theoretical knowledge and practical application skills to ensure optimal outcomes for pediatric patients and their families.
Chapter 20: Hematological Disorders in Pediatrics
Hematological Disorders
Assess and manage pediatric blood disorders including sickle cell disease, hemophilia, leukemia, and anemia presentations unique to children.
1
Iron Deficiency & Sickle Cell Anemia
Iron deficiency anemia manifests with pallor, fatigue, and decreased appetite. Nursing priorities include iron supplementation education and dietary modification.
Sickle cell anemia presents with vaso-occlusive crises, requiring pain management, hydration, and preventive teaching to avoid triggers like dehydration and extreme temperatures.
2
Leukemia
Childhood leukemia presents with bone pain, fatigue, fever, and bruising. Nursing care focuses on infection prevention, managing chemotherapy side effects, and providing emotional support during prolonged treatment.
Recognize early signs of neutropenic fever (T>38.3°C) and implement protective isolation protocols when appropriate.
3
Thrombocytopenia
Immune thrombocytopenic purpura (ITP) causes petechiae, purpura, and potential bleeding. Nursing priorities include bleeding precautions, monitoring platelet counts, and educating families about activity restrictions.
Assess for signs of intracranial hemorrhage, including headache, vomiting, and altered mental status.
Chapter 21: Musculoskeletal Disorders in Pediatrics
Musculoskeletal Disorders
Recognize and develop care plans for developmental dysplasia of the hip, scoliosis, osteogenesis imperfecta, and juvenile idiopathic arthritis.
Pediatric musculoskeletal disorders require specialized assessment techniques and treatment approaches to address growing bones and developing skeletal structures.
Fractures
Children's bones have greater elasticity and faster healing. Nursing care includes neurovascular assessments, proper cast care, and pain management. For traction cases, maintain alignment and prevent complications like pressure injuries.
Scoliosis
Early detection through screening is critical. Nursing interventions include monitoring brace compliance (16-23 hours daily for effectiveness), skin assessment for pressure points, and psychological support for body image concerns during adolescence.
Clubfoot
Treatment begins shortly after birth with serial casting. Nurses must educate parents on cast care, perform skin assessments, and provide emotional support during the lengthy correction process. Post-correction, foot abduction braces maintain alignment.
Chapter 22: Dermatological Disorders in Pediatrics
Dermatological Disorders
Identify common pediatric skin conditions including atopic dermatitis, contact dermatitis, and infectious rashes requiring specialized nursing interventions.
Bacterial & Fungal Infections
Impetigo presents as honey-colored crusted lesions requiring topical or oral antibiotics. Nursing care focuses on proper skin cleansing, medication application, and preventing spread to other children. Fungal infections like tinea corporis (ringworm) require antifungal treatment and education on preventing reinfection.
Eczema (Atopic Dermatitis)
This chronic, pruritic condition requires a comprehensive approach. Nursing interventions include moisturizing within 3 minutes after bathing, teaching proper topical steroid application, identifying and eliminating triggers, and implementing "soak and seal" techniques. Preventing the itch-scratch cycle is essential for healing.
Contact Dermatitis
Appears as well-demarcated erythema at points of contact with allergens or irritants. Nursing care involves identifying and removing the offending agent, applying prescribed treatments, and implementing prevention strategies through family education about common triggers like metals, plants, and chemicals.
Chapter 5: End-of-Life Care in Pediatrics
Pediatric End of Life
Understand palliative care principles, symptom management, family support, and ethical considerations in pediatric end-of-life nursing.

End-of-life care for children is one of the most challenging aspects of pediatric nursing, requiring exceptional emotional intelligence and communication skills to support both the child and family through this difficult journey.
Palliative Care Principles
Focuses on improving quality of life through pain and symptom management while addressing psychological, social, and spiritual needs. Begins at diagnosis of life-limiting illness and continues regardless of treatment path.
Hospice Care
Specialized care for children with terminal illness with prognosis of 6 months or less. Nursing responsibilities include coordinating interdisciplinary care, managing symptoms, and supporting family decisions about location of care.
Family Support
Nurses provide anticipatory guidance about the dying process, facilitate memory-making activities, and offer cultural and spiritual support. Addressing siblings' needs and connecting families with bereavement resources are essential components.
Symptom Management
Pain assessment using age-appropriate tools guides pharmacological interventions. Dyspnea, seizures, and anxiety require prompt recognition and treatment. Complementary therapies like music therapy may provide additional comfort.
Key Nursing Considerations
Family-Centered Care
The cornerstone of pediatric nursing involves recognizing parents as essential partners in care planning and delivery. Nurses must facilitate open communication, provide emotional support during crises, and empower families through education and involvement in care decisions.
Consider developmental stages when communicating with children, using age-appropriate explanations and therapeutic play to reduce anxiety and promote cooperation with treatments.
Pain Management
Accurate assessment using validated pediatric pain scales is essential. Implement both pharmacological approaches (appropriate dosing based on weight) and non-pharmacological interventions (distraction, guided imagery, positioning).
Medication Safety
Calculate pediatric dosages carefully using mg/kg formulas and verify with another nurse. Monitor closely for adverse effects, as children may have unpredictable responses to medications. Ensure appropriate administration techniques for different developmental stages.
Preparing for Success: Study Strategies
Critical Thinking Exercises
Practice applying nursing process to case scenarios involving pediatric hematological, musculoskeletal, and dermatological disorders. Focus on prioritizing assessments and interventions for each condition.
Concept Mapping
Create visual connections between pathophysiology, clinical manifestations, and nursing interventions for complex conditions like sickle cell anemia or leukemia to strengthen understanding of disease processes.
Lab Value Review
Master pediatric-specific normal ranges for CBC, platelets, and other key values essential for recognizing and monitoring hematological disorders. Create flashcards with normal values and critical findings.
Remember that successful pediatric nursing requires both scientific knowledge and compassionate care. As you prepare for Exam 3, focus on understanding the unique needs of children with these conditions and their families.
Combine these study materials with practice questions, clinical experiences, and peer discussions to develop the critical thinking skills needed for pediatric nursing excellence. Your commitment to mastering these concepts will translate directly to improved patient outcomes in your future practice.