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Module 5 > Assessment and Intervention > Flashcards

Assessment and Intervention Flashcards

1
Q

what things should you consider when obtaining a consent for someone younger than 21 (2)

A

parent or legal guardian will sign consent

any one who takes the child to the hospital can give consent

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2
Q

what can help the child develop coping skills

A

imagery
distraction
relaxation

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3
Q

when allowing the child handle objects that will be used in their care, what does this help do

A

helps to develop familiarity with the objects and helps reduce the threat often associated with their use

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4
Q

what can “play” be used to do

A

express feelings, teach, reach a therapeutic goal (child give shot to doll), have fun

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5
Q

when should you tell the child their are getting a procedure

A

the younger the child the closer to the procedure

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6
Q

what should we do for the parents who DO want to stay with the child

A

give them a job to do

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7
Q

what should we do for the parents who DONT want to be present with child

A

tell them how long it will take, and where they need to wait

also we need to respect their choice

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8
Q

where can the procedure take place and how should it go

A

treatment room
playroom
should be organization and confident

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9
Q

after the procedure what should be done

A

praise the child
reward the child
allow child to talk about what happened
return to see the child shortly after procedure

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10
Q

what should be done to measure recumbent length for birth-2 years

A

hold head in midline
push knees flat and fully extended
mark paper and measure between marks

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11
Q

when measuring height or stature in children older than 2 years of age what should be done

A

standing up they should be touching in 3 points against wall or measuring device

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12
Q

who are platform scales used for

A

infants and very young children (weigh infants nude)

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13
Q

in failure to thrive babies what may ftt be a result of

A 
physical problems
psychosocial issues
poverty
health beliefs
family stress
feeding issues
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14
Q

what percentile do the ftt babies fall on

A

weight less than 5th percentile

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15
Q

what should you ask the parent of an ftt baby

A

diet history
parent height
physical
assessment of meal time rituals, behaviors
take a look at parent child interaction
(R?O lead toxicity, anemia, ova and parasites

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16
Q

what is the nursing care management with an ftt baby

A

provide positive feedings
doc childs behavior and parent child interaction during feeding
provide primary core of nurses
introduce new foods slowly

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17
Q

when assessing the pt what should you do first (atraumatic care)

A 
1st= respirations
2nd= heart rate
last= blood pressure and temp
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18
Q

what is best practice when obtaining a pulse

A

apical pulse for 1 full minute

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19
Q

if a child is in-between blood pressure cuff sizes what should the nurse do

A

choose the bigger one

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20
Q

what blood pressure location is least invasive

A

dorsalis pedis artery because its farther from the core

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21
Q

what factors affect body temp

A

active exercise
stress
crying
environment

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22
Q

what is the first thing that should be given to a child with fever

A

antipyretics

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23
Q

when can you start interventions related to fever

A

an hour after antipyretics are given

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24
Q

what things can be done after antipyretics have not sufficiently lowered the temp of child

A

minimal clothing
increasing air circulation
applying cool, moist compresses (do not use if causes shivering)

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25
Q

caused by prolonged and repetitive contact with an irritant or combination or irritants

A

diaper dermatitis “diaper rash”

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26
Q

white patches on the tongue, palate, and inner aspects of the cheeks that do not scrape off

A

oral candidiasis (thrush)

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27
Q

when will thrush start going away

A

may take 2 months to resolve but in the meantime it may spread

28
Q

if a child has thrush what should be given 4 times a day

A

nystatin

29
Q

what is important to know about administering nystatin

A

give after feeding so it doesn’t get washed down
swab over surface of oral mucosa and tongue
swallow remainder

30
Q

if the child with thrush is breastfed who should be treated

A

both mother and baby

31
Q

how should bottles, nipples and pacifiers be cleaned if the child has thrush

A

boil for 20 minutes (spores are resistant to heat)

32
Q

when should the posterior fontanel be closed

A

by 2 months of age

33
Q

when should the anterior fontanel be closed

A

by 12-18 months of age

34
Q

what is know as the red reflex

A

fundus

35
Q

when should the child have binocular vision

A

4 months

36
Q

one eye does not fixate correspondingly

A

strabismus

37
Q

lazy eye, brain started turning off and eventually that eye will become blind

A

amblyopia

38
Q

when looking at the ear what is important

A

the top of ear is aligned with outer corner of eye

39
Q

low set ears usually indicate

A

autism

40
Q

why are children more prone to ear infections

A

because they have wide open flat lying eustachian tubes and that is great for bacteria to get into

41
Q

for access to canal of a child less than 3 years what should you do

A

pull pinna down and back

42
Q

for access to canal of child older than 3 years what should you do

A

pull pinna up and back

43
Q

what is it called when the chest bones are sunken in

A

excavatum

44
Q

what is it called when the chest bones are sticking out

A

carinatum

45
Q

where can you check the pulse rate on a child

A

less than 7= fourth intercostal

greater than 7= fifth intercostal

46
Q

what is a normal finding when listening to a childs heart

A

sinus arrhythmia

47
Q

what are 6 signs of respiratory failure

A 
nasal flaring
retractions
cyanosis
asthma (wheezing)
grunting
crackles
48
Q

if pt is nearing respiratory failure what mask will be most beneficial

A

non rebreather

49
Q

what 5 things should be done when suctioning a trach

A
  • suction should be 1/2 diameter of tube
  • humidify before and after procedure with 100% O2
  • < 5 seconds down and for infants and <10 for children
  • rest 30-60 sec between
  • always monitor pulse ox during procedure
50
Q

what fluid is preferred for an enema

A

isotonic fluid (DO NOT GIVE tap water)

51
Q

1Gm of wet diaper weight=

A

1mL of urine

52
Q

what is the minimum acceptable urine output formula for an infant (birth-2)

A

1mL/kg/hr

53
Q

what is the minimum acceptable urine output for a child (2 and greater)

A

0.5mL/kg/hr

54
Q

how often should you assess IV site

A

every 1-2 hrs

55
Q

for implanted ports how often are they heparinized

A

once a month or after an infusion

56
Q

for broviac (tunneled catheter) how often are they heparinized

A

daily

57
Q

what should pediatric “rate to be infused” be set

A

for 2 hours of fluid and attend to IV alarms promptly because their iv sites can clot and or infiltrate really fast

58
Q

what are the 8 s/s of a hemolytic reaction (after administration of blood products)

A 
sudden severe HA
chills
fever
shaking
N/V
chest tightness
flank pain 
if there is a reaction turn off blood, maintain IV of NS
59
Q

when using an oral syringe for oral medications where should it be placed

A

to side of tongue so it goes back of mouth and give slowly (NEVER mix medication in milk bottle or formula because they may not finish it)

60
Q

for a baby, what amount can you inject into one muscle

A

no more than 0.5- may need to split into two injects if volume is too much

61
Q

for a small child, what amount can you inject into one muscle

A

1 mL is appropriate

62
Q

for children, what amount can you inject into one muscle

A

never inject more than 2mL into their muscle

63
Q

can painful injections be mixed with lidocaine

A

yes but there has to be an order

64
Q

what is the preferred method of IM administration for infants and children

A

vastus lateralus (90 degree angle)

65
Q

for a deltoid what volume should you never exceed

A

1 mL of fluid

66
Q

what are the scared points of children before surgery

A

taking off their gown, taking off underwear, giving up their transitional item

Module 5 (18 decks)

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