ATI flashcards Children
Recommended immunizations for healthy infants at birth
*HepB
Recommended immunizations at 2 mos
*Hep B, Rota, DTap, Hib, PCV, IPV
Recommended immunizations at 4 mos
*Rota, DTaP, Hib, PCV, IPV
Recommended immunizations at 6 mos
*Hep B (6-12 mos), Rota, DTap, PCV, IPV (6-18 mos)
Recommended immunizations 12-15 mos
*Hib, PCV, IPV, MMR, Varicella
Recommended immunizations 12-23 mos
*Hep A, given at 2 doses at least 6 mos apart
Recommended immunizations 15-18 mos
*DTap
Children can receive a yearly TIV beginning at what age?
*6 mos
Recommended immunizations at 4-6 yrs
*DTap, IPV, MMR, Varicella
Recommended immunizations 11-12 yrs
*TDap, MMR, HPV, MCV4
Contraindications to MMR vaccine
During pregnancy, and children who are allergic to eggs, gelatin, and neomycin
- In children who have a history of thrombocytopenia or thrombocytopenic purpura
- Immunocompromised children
- Children with advanced HIV
- Children who recently received blood products or immunoglobulinseggs, gelatin, and neomycin
- In children who have a history of thrombocytopenia or thrombocytopenic purpura
- Immunocompromised children
- children with advanced HIV
- children who recently received blood products or immunoglobulins
Contraindications to DTap vaccine
- -Severe febrile illness
- A history of prior anaphylactic reaction to the DTaP vaccination
- An occurrence of encephalopathy 7 days after the administration of the DTaP immunization
- An occurrence of seizures within 3 days of the vaccination
- Uncontrollable crying that cannot be consoled by parents/caregiver; can usually last more than 3 hr and occurs within 48 hr of vaccination
Contraindications to IPV vaccine
- Allergy to neomycin (Mycifradin) and/or streptomycin
- Pregnancy usually a contraindication and must be decided on an individual basis
Contraindications to Hep A vaccine
- -Allergy to aluminum
- Pregnancy may be a contraindication
- C14-pregnancy may be a contraindication
Contraindications to Hep B vaccine
- Prior hx of anaphylactic reaction
- Allergy to Baker’s yeast
Contraindications to Varicella Vaccine
During pregnancy
- Children with cancer, such as leukemia or lymphomas
- Children with a hx of allergy to neomycin and/or gelatin
- Immunocompromised children, such as with HIV
- Children with congenital immunodeficiency
- Children taking immunosuppressive meds
Contraindications to PCV vaccine
-Hypersensitivity to diphtheria toxoid
Contraindications to influenza vaccine
- -acute febrile illness- vaccincation is deferred until symptoms resolve
- Hypersensitivity to eggs
- Immunocompromised children, such as with HIV
- Children on antibicrobial therapy
Contraindications to MCV 4 vaccine
*Hypersensitivity to components of the vaccine (e.g., diphtheria toxoid, latex); moderate to severe illness
If a vaccine is reconstituted, it should be used within how many minutes?
*30
IM vaccines are given to infants and young children in what muscle?
*vastus lateralis
IM vaccines are given in which muscle on older children, adolescents, and adults?
*deltoid
Interventions that maintain comfort after immunization
- -Use of nonopioid analgesic (acetaminophen or ibuprofen)
- Cool compress to injection site
- Gentle movement of involved extremity
There is a small risk of what vaccine virus being transmitted?
Varicella
parenting style in which parents try to control their children’s behaviors & attitudes through unquestioned rules & expectations
*dictatorial or authoritarian
parenting style in which parents exert little or no control over their children’s behaviors
*permissive or laissez-faire
parenting style inwhich parents direct children’s behavior by setting rules and explaining the reason for each rule setting; parents also negatively reinforce deviations from the rules
*authoritative or democratic
expected temp of infants
*T: 36.5 to 37.5 degrees C (97.7 to 99.5 degrees F)
expected pulse of infants
*P: 120-160/min
expected respiratory rate of infants
*R: 23-50/min
expected BP of infants
*BP: for the 90th percentile taken by oscillometry is 110/71 mm Hg
expected temp of children
*T: 36-38 degrees C (96.8 -100.4 degrees F)
expected pulse of children
*P: 75-100/min
expected respiratory rate of children
*R: 20-30/ min
expected BP of children
*BP:for ages 2-5, BP reading for the 90th percentile is 112/66. Normal BP is any reading that is less than the 90th percentile adjusted for ht & wt.
expected VS of adolescents
T: 36-38 degrees C (96.8-100.4 degrees F)
reflex in which the infant turns head to side when cheek of mouth is touched
*rooting
expected age for rooting reflex
*birth to 6 mos
relex in which infant will grasp object when palm is touched
*palmar grasp
expected age for palmar grasp reflex
*birth to 4 mos
reflex in which toes curl downward when sole of foot is touched
*plantar grasp
expected age for plantar grasp
*birth to 8 mos
reflex in which the legs flex, arms and hands extend when startled by loud noise
*moro
expected age for moro reflex
*birth to 6 mos
extension of the arm & leg on the side when the head is turned to that side with flexion of the arm and leg of the opposite side
*asymmetric tonic neck reflex (fencer position)
expected age for tonic neck reflex
*birth to 3-4 mos
What did Erikson, Freud, and Piaget name the stage of the development for infants?
*Erikson: Trust vs. Mistrust
Freud: Oral
Piaget: Sensorimotor
The infant’s posterior fontal closes at what age?
2-3 mos
How much wt does an infant gain?
- -0.7 kg (1.5 lbs) per mo the 1st 6 mos
- 0.3 kg (0.75 lbs) per mo the last 6 mos
When does an infant triple his/her birth wt?
*end of the 1st yr
How tall does an infant grow?
- 2.5 cm (1 in) per mo the 1st 6 mos
1. 25 cm (0.5 in) per mo the last 6 mos
The circumference of an infant’s head increases by how much during the 1st 6 mos?
*.25 cm (0.5 in) per mo
holds head up
3 mos)
rolls over
5-6 mos)
holds head steady when sitting
transfers object from one hand to the other
rakes finger food with hand
6 mos)
gets to sitting position alone & can pull up to standing position
uses thumb and forefinger to grasp item
bangs 2 toys together
9 mos)
stands holding on / alone
nests one object into another
12 mos)
stands alone
12 mos)
When will infants be able to distingush themselves as being separate from parents?
*by the end of the 1st year
The infant discovers that what part of his/her body is a pleasure producer?
*mouth
Piaget’s sensorimotor period for an infant is characterized by
*intial reflexes replaced by voluntary movements that are self-centered on having needs met.
what is object permanence?
*when the infant realizes that an obect still exists even when it is no longer in view
When does object permanance occur in an infant?
*b/t 6-12 mos
When does separation anxiety develop in an infant?
*the latter half of the 1st yr
Infants engage in what kind of play?
*solitary
What are appropriate toys for infants?
- -rattles
- mobiles
- teething toys
- nesting toys
- playing pat-a-cake
- playing with balls
- reading books
Crib slats should be no further apart than
*6 cm (2.4 in)
Infants should be in rear facing car seats until
*they weigh 20 lbs and are 1 yr old
When can solids be introduced to an infant?
*when the infant doubles the birth wt (5-6 mos)
commonly caused by immaturity of the liver and is observed as jaundice
*hyperbilirubinemia
If left untreated hyperbilirubinemia can cause
*brain damage
How many teeth errupt in the infant’s mouth by the end of the 1st yr?
6 to 8
What did Erikson, Freud, and Piaget name the stage of the development for toddlers?
- -Erikson: autonomy vs. shame
- Freud: anal
- Piaget: sensorimotor transitions to preoperational
The toddler’s anterior fontanel closes by what age?
*18 mos
At 30 mos, the toddler should weigh how many times his birth wt?
*4
The toddler grow by how much per yr?
*7.5 cm (3 in)
12 mos to 3 yrs
*toddler
birth to 28 days
*neonate
1 mo to 1 year
*infant
3 to 5 yrs
*preschooler
5 to 12 yrs
*Schoolage
12 to 20 yrs
*adolescent
- development of steady gait
- clinbing stairs
- jumping & standing on one foot for short periods
- stacking blocks in increasingly higher numbers
- drawing stick figures
- undressing & feeding self
- toilet training
-development of steady gait
Toddlers develop gender identity by what age?
*3 yrs
Toddlers engage in what kind of play?
*parallel
The toddler should drink how many glasses of cow’s milk per day?
*3 or 4
What did Erikson, Freud, and Piaget name the stage of the development for the preschooler?
- -Erikson: Initiative vs. guilt
- Frued: Phallic
- Piaget: Preoperational
- Frued: Phalliciaget: Preoperational
The preschoold should gain how much wt per yr?
*2.25 kg (5lbs)
The preschooler should grow how much per yr?
*6.2 to 7.5 cm (2.5-3 in)
The greatest fear of a preschooler
*bodily harm
What two phases of preoperational thinking do preschoolers develop and at what ages?
- preconceptual (2-4 yrs)
- intuitive (4 yrs)
When may a child comprehend the days of the week?
*by the end of preschool yrs
Preschoolers engage in what kind of play?
*associative
age-appropriate activities for preschoolers
playing ball
- putting puzzles together
- riding tricycles
- pretend and dressup activities
- role play
- painting
- sewing cards and beads
- reading books
Laws mays vary from state to state and requirements for a child in a car/booster seat may be up to
*80 lbs and a ht of 4 ft 9 in
A preschooler consumes ____ the amount of an adult.
*half
Preschoolers may continue being picky eaters up to what age?
*5 yrs
The average preschooler needs how many hrs of sleep a day?
*12
What did Erikson, Freud, and Piaget name the stage of the development for school-age children?
- Erikson: industry vs. inferiority
- Freud: Latency
- Piaget: Concrete operations
The school-age child will gain how much per year?
*2 to 4 kg (4.4 to 8.8 lbs)
The school age child will grow by how much per yr?
*5 cm (2 in)
There is typically a wt gain b/w what ages prior to the changes in ht that come after this age.
*10 to 12 yrs
School age children may rival which parent?
*same sex
School age children engage in what kind of play?
*competitive and cooperative
Children less than what age are safest in the back seat?
*13 yrs
The child eats an adult poportions of food by the end of
*school-age years
What did Erikson, Freud, and Piaget name the stage of the development for adolescents?
- -Erikson: identity vs. role confusion
- Freud: Genital
- Piaget: Formal operations
Females reach 95% of their adult ht by___ while males reach 95% of their adult ht by___.
*13 yrs, 15yrs
Nutrients that tend to be deficient in adolescents
*iron, calcium, vitamin A&C
Leading cause of death in adolescents
*motor vehicle crashes
Homicides are the second leading cause of death among adolescents and most prevalent among male adolescent acquaintances with
*a firearm.
Suicide is the 3rd leading cause of death among adolescents. Depressed and socially-isolated adolescents may demonstrate changes in behavior which include:
- poor school performance
- lack of interest
- tearullness and not interacting with others
- disturbances in sleep or appetite
- expression of suicidal thoughts
leading contributor to motor vecle fatalities among adolescents
substance abuse
preterm infants and small for gestational age infants require how many kcal per day?
- 50 to 60 kcal/kg per day (parenteral
- 75 kcal/kg per day orally
Nutritional needs of infants -birth to 1 yr
breast milk or formula
Nutritional needs of infants -4 to 6 mos
iron-fortified cereal
Nutritional needs of infants -6 to 8 mos
yellow veggies, fruits
Nutritional needs of infants -8 to 10 mos
meats
What foods are usually delayed until after an infant is 12 mos?
- whole milk
- eggs
- strawberries
- wheat
- corn
- fish
- nut products
Nutritional needs of toddlers
- -finger foods; 3 meals and 2 snacks per day
- limit fruit juice to 4 to 6 oz/ day due to sugar content
Nutritional needs of preschoolers
-3 meals and 2 to 3 snacks per day from all areas of the food pyramid
Nutritional needs of adolescents
*2,000 to 3,000 kcal/day
Children express what through play?
*feelings and fears
child observing others
*onlooker
child playing alone
*solitary
child playing independently, but among other children (characteristic of a toddler)
*parallel
children playing together without organization (characterisitic of preschoolers)
*associative
organized playing in groups (characterisitic of school-age children)
*cooperative
Pediatric doses are based on what 3 things?
- -body wt
- BSA
- maturation of body organs
greatest factor that affects medication response in the pediatric ct
*organ system immaturity
preferred route of med administration for children
*oral
preferred measurement of meds for children
*mL
When administering otic meds in children, you should pull the auricle
*down and back
SQ and IM injections for children require using what size needle/gauge?
*3/8 to 5/8-in needle, 26 to 30 gauge
up to how much med can be adminitered in a child?
*0.5 mL
site usually recommended for adminitering IM injections for infants and children less that 2 yrs
*vastus lateralus
After age 2, what site can be used of IM injections and can accomodate fluid up to 2 mL?
*ventrogluteal
the deltoid site has a smaller muscle mass and can only accomodate up to how many mL of fluid?
*1
FLACC (Face, Legs, Activity, Cry, Consolability) pain assessment tool can be used for children of what ages?
*2 mos to 7 yrs
FACES pain scale can be used during what ages?
*3 yrs and older
Visual Analog Scale (VAS) can be used for children during what ages?
*7 yrs and older
The infant experiences stanger anxiety b/w what mos of age?
*6 to 18
early clinical s/sx of hypoxemia
- tachypnea
- tachycardia
- restlessness
- pallor of the skin and mucous membranes
- elevated BP
- sx of respiratory distress
late clinical s/sx of hypoxemia
- confusion and stupor
- cyanosis of skin and mucous membranes
- bradypnea
- bradycardia
- hypotension
- cardiac dysrhythmias
Some illness states may allow for an oxygen saturation of
*85 to 89%
Acceptable level of SaO2 may range from
*91 to 100%
SaO2 levels less than ___% require nursing intervention to assist the child to regain normal SaO2 levels.
*91
SaO2 results less than ___% are considered an emergency.
*86
Life threatening SaO2 results may start at levelsl less that____%
*80
Suction catheters should be ____ the size in diameter of a child’s tracheostomy tube.
*half
When suctioning a child’s tracheostomy tube, how far should you advance the suction cath?
*To the end of the tracheostomy tube or no more than 0.5 cm beyond the end
suction pressure for infants and children
*60 to 100 mm Hg
suction pressure for infants who are premature
*40 to 60 mm Hg
An oxygen hood is a small plastic hood that fits over the infant’s head to deliver oxygen with a flow rate of ____ to prevent carbon dioxide buildup.
*4 to 5 L/min
An oxygen tent is a large plastic tent that fits over a crib or bed that can provide oxygen and humidity if prescribed and is used on children older than _____ mos.
*2 to 3
S/Sx of oxygen toxicity
- nonproductive cough
- substernal pain
- nasal stuffiness
- N/V
- fatigue
- headache
- sore throat
- hypoventilation
chronic inflammatory disorder of the airways that involves mast cells, eosinophils & T lymphocytes; intermittent and irreversible airflow obstruction that affects the bronchioles in which the child experiences wheezing, breathlessness, chest tightness, & coughing.
Asthma
manifestations of asthma
- mucosal edema
- bronchoconstriction (from bronchospasm)
- excessive secretion production
Most accurate tests for diagnosing asthma and its severity
*pulmonary function tests (PFTs)
bronchodilators given orally or by inhalation for asthma that may be used for short-term prophylaxis, relief of acute attacks, and long term control; act by selectively activating the beta2 receptors in the bronchial smooth muscle resulting in bronchodilation in which bronchospasm is relieved, histamine release is inhibited, and ciliary motility is increased.
*beta 2 adrenergic agonists
beta 2 adrenergic agonist that is inhaled, short acting, and has therapeutic uses of:
*albuterol (Proventil, Ventolin)
beta 2 adrenergic agonist that is inhaled, long acting, and has therapeutic uses of:
*salmeterol (Serevent)
beta 2 adrenergic agonist that is oral, long-acting and has therapeutic uses of:
*terbutaline (Brethine)
These meds prevent inflammation, suppress airway mucous production, & promote responsiveness of beta 2 receptors in the bronchial tree; they do not provide immediate effects, but rather promote decreased frequency & severity of exacerbations & acute attacks.
*Glucocorticoids
Inhaled glucocorticoids for asthma
- beclomethasone diproprionate (QVAR)
- budesonide (Pulmicort, Turbuhaler)
- fluticasone propionate (Flovent)
SE of inhaled glucocorticoids
- difficulty speaking
- hoarseness
- candidiasis
Oral glucocorticoid used short-term (3-10 days following acute asthma attack)
prednisone (Deltasone)
When a child is prescribed an inhaled beta 2 agonist and an inhaled glucocorticoid, the child should inhale the beta 2 agonist before the glucocorticoid because
*the betas agonist promotes bronchodilation & enhances absorption of the glucocorticoid
When a child is asymptomatic, indicating that asthma is under control with current tx plan, what Percent of Personal Best PEFR and zone is he in?
*80 to 100% - green zone
What sx and interventions are presented in a child showing 50 to 79 % of personal Best PEFR in the yellow zone?
- aution
- The child may be experiencing worsening of sx or an acute asthma attack.
- increased maintanence therapy is needed.
- carefully monitor the child
- contact PCP if PEFR does not improve.
What sx and interventions are presented in a child showing less than 50% of personal Best PEFR in the red zone?
- Alert
- Administer a short-acting bronchodilator
- contact PCP if PEFR does no immediately improve
life-threatening episode of airway obstruction that is often unresponsive to common tx
*status asthmaticus
s/sx of status asthmaticus
- extreme wheezing
- labored breathing
- use of accessory muscles
- distended neck veins
- risk for cardiac and/or respiratory arrest
tonsils removed during a tonsillectomy
*palatine tonsils located on both sides of the oropharynx
tonsils removed suring an adenoidectomy
*pharyngeal tonsils aka adenoids
occurs when the tonsils become inflamed and reddened and small patches of yellowish pus may become visible
*acute tonsillitis
S/Sx of tonsillitis
- hx of otitis media and hearing difficulties
- reports of sore throat with difficulty swallowing
- presence of fever
- tonsil inflammation with redness and edema
- mouth odor
- mouth breathing
- snoring
- nasal qualities in the voice
symptomatic tx for viral tonsillitis
- rest
- fluids
- warm salt-water gargles
- acetaminophen or ibuprofem for pain
A child who just had a tonsillectomy can have no swimming for how long?
*2 wks.
Full recovery after a tonsillectomy usually occurs within how long?
*10 days to 2 wks
Maternal antibodies offer protection to the infant up to around how many mos?
*3
Viral infections are common in the _____ and ___, with the incidence of these infections decreasing by age 5.
*-toddler, preschooler
Children with asthma have a greater incidence of respiratory infections during what type of weather?
*cold
RSV and other common respiratory infections are more common in what seasons?
*winter and spring
Infections caused by Mycoplasma pneumoniae are more frequent during what seasons?
*autumn and early winter
