Chapter 8, 33-35 Flashcards
What is infancy?
stage of life from birth to one year of age weigh on average 6.6-7.6 pounds doubling their weight in six months and triple in a year with the head equaling 25 % of body weight infants grow at growth plates at ends of bones. Transition from fetal circulation to pulmonary circulation within first minutes or hours after birth with very short, narrower, less stable and more easily obstructed than at other stage being a nose and diaphragm breather until 4 weeks of age with nasal congestion causing difficulty breathing and diaphragm more prone to injury because of its lack of rigidity
How much sleep does an infant need?
16-18 hours change to 4-6 a day and 9-10 at night 2-4 months infant sleep through night and easy to awaken
What are the vital signs of infant?
16-18 hours change to 4-6 a day and 9-10 at night 2-4 months infant sleep through night and easy to awaken
What is fontanelle?
soft spot on top of skull not fused at birth with posterior closing in 2-3 months, and anterior closing 9-18 months telling hydration by if is it slightly below surface of kull and if its sunken dehydration and if bulging might be pressure unless crying
What is the moro reflex?
when startled, an infant throws his arms out, spreads his fingers, then grabs with his fingers and arms
What is the palmar reflex?
when you place your finger in an infant’s palm, he will grasp it
What is a rooting reflex?
when you touch a hungry infant’s cheek, he will turn his head toward the side touched
What is a sucking reflex?
when you stroke a hungry infant’s lips, he will start sucking
what is bonding?
the sense that needs will be met
What is trust versus mistrust?
concept developed form an orderly, predictable environment versus a disorderly, irregular environment
What is scaffolding?
building on what one already knows
What is temperament?
the infant’s reaction to his environment
What is the toddler phase?
stage of life from 12-36 months. Physical, mental and social development continues with body systems continuing to grow and refine themselves developing individually. 98.6-99.6 gain 4.4 pounds a year. Vital- 80-130 beats/minute, 20-30 breaths/minute, 70-100 mmHG BP. pulmonary system branch and grow increasing alveolar, about 90% of bad adult brain weight with fine motor, muscle mass and bone density increase, toddler more susceptible to illness, all primary teeth by end
What is the preschool age?
stage of life from 3-5 years. Vitals 80-120 beats/minute, 80-110 mmHg. Comparing oneself to others
What is the school age?
stage of life from six to twelve years. 98.6 degrees, gaining 6.6 pounds per year and growing 2.4 inches a year replacing with permanent teeth. 70-100 beats/minute. Better decision making skills allowed to make more decisions on own. With developing self esteem and affected by popularity, rejection, emotional support, and neglect. Moral development based on what is right and wrong from punishment using internal self-control for cognitive growth
What is adolescence?
stage of life from 13-18 years and is the transition to adulthood. Have rapid 2-3 year growth spurts, with enlarging feet and hands, then arms and legs, chest and trunk enlarging in final stage girls finished by age 16 and boys 18. 55-105 beats/minute, 12-20 respirations a minute. Menstruation begins and breast develops. Time of serious family conflicts as they strive for independence and parents strive for control. Achieving more independence and develop own identity, interested in sex, wants to be treated like adult with comfort of childhood and body image is important where self destructive behavior begins. Capacity for logical, analytic, and abstract thinking develop as personal code of ethics
What is early adulthood?
stage of life from nineteen to forty years. Middle adulthood- stage of life from 41 to 60 years develops lifelong habits and routines with vital signs on average of 70 beats/minute, 16-20 respirations/minute. With peak physical between 19-26 years old at optimal performance. Highest level of job stress with love developing childbirth most common new challenges and stress and accidents the leading cause of death
What is middle adulthood?
stage of life from 41 to 60 years. Reflecting On how far they have come and where they want go go such as midlife crisis. Some vision problems, high cholesterol, and health with cancer developing and weight control for women: menopause with heart disease higher later on. Task oriented for accomplishing goals approaching problems as challenges, empty-nest syndrome increased freedom
What is late adulthood?
stage of life from 61+. Twilight years, with vitals depending upon physical and health condition, vascular less efficient, blood volume decreases, less tolerant of tachycardia, respiratory deterioration decreased metabolism, sleep-wake disrupted. Living conditions to live at home? Self worth is she good quality, financial burdens with limited income and increasing expenses, sees death and dying
What are the cardiovascular changes in the elderly?
degeneration of valves and muscles, thickening and narrowing or coronary arteries, degernation of the conduction system
What is degeneration of valves and muscles?
reduced stroke volume and cardiac output may lead to orthostatic hypotension, decreased brain perfusion and reduced tolerance of activity leading patient to complain of dizziness, fainting, or weakness from sitting or standing position and meds for high blood pressure contribute. Prevalence of congestive heart failure increases so assess lung sounds and check for edema
What is thickening and narrowing or coronary arteries?
dysrhythmias, decrease in maximum heart rate. Heart rate may be irregular or abnormally fast or slow. Heart rate may not increase as much in response to blood loss, especially if patient is taking certain medicines for heart problems or high blood pressure
What is the degernation of the conduction system?
Thickening and narrowing of coronary and systemic arteries with decreased delivery of oxygenated blood to tissues; increased risk of heart attack, stroke, aortic aneurysm, and peripheral artery disease. Determine whether any complaints or changes in mental status or neurological problems are new. Remember, a heart attack in elderly may not present with chest pain
What are changes to the respiratory system?
Decreased elasticity of lungs; Diminished cough and gag reflexes
what is decreased elasticity of lungs?
decrease lung volume;decreased activity of cilia- decreased ability to increase oxygen intake when needed; increased risk of pneumonia. Check patient’s o2 status and give o2 if needed
What is diminished cough and gag reflexes?
increased risk of aspiration paying particular attention to patient’s ability to swallow secretions; suction as necessary. The patient may not cough, even with pneumonia or other respiratory infections
What are the changes of the digestive system?
decreased moment of intestinal tract, and changes in the gastrointestinal lining?
What is decreased movement of the intestinal tract?
decreased secretion of stomach acid, decreased sensation of taste, difficulty chewing and swallowing, decreased food absorption leading to constipation, bowel obstruction, weight loss and malnutrition. Maintains high index of suspicion for bowel obstruction, even with vague or minimal complaints of abdominal pain, fullness, constipation, or bloating
What are the changes in the gastrointestinal lining?
ncreased risk of cancers, relaxation of sphincters- increased risk of gastrointestinal bleeding, gastroesophageal reflux (heartburn), and fecal incontinence. Ask about blood in stool, black tarry stools or vomiting coffee grounds
What changes occur on the liver and kidneys?
Decreased breakdown and clearance of medications; decreased production of clotting factors and other blood proteins
What are the decreased breakdown and clearance of medications?
Decreased breakdown and clearance of medications; decreased production of clotting factors and other blood proteins- increased risk of drug toxicity and drug interactions; increased edema; decreased blood clotting. Always be suspicious of drug toxicity or interactions as a cause of altered mental status and other complaints with patients more prone to uncontrolled bleeding.
What are the changes in the endocrine system?
diminished thyroid function, and changes in insulin production?
What is diminished thyroid function?
decreased energy metabolism, problems with temperature regulation. Patients are more prone to both heat and cold related emergencies, even in relatively mild temperatures indoor or outdoordecreased energy metabolism, problems with temperature regulation. Patients are more prone to both heat and cold related emergencies, even in relatively mild temperatures indoor or outdoor
What is the pancras, or changes in insulin production or functions?
changes in insulin production or functions- more prone to type 2 diabetes and hyperglycemia. Consider diabetic emergencies as a cause of altered mental status
What are changes in the musculoskeletal system?
Decreased muscle mass and strength and Decreased bone mass and strength;
What are decreased muscle mass and strength?
arthritis- weakness, more prone to falls, unable to get up from falls, decreased mobility; patients may be less able to care for self. Assess for injuries from falls and immobility leading to decubitus ulcers (bedsores) and increased risk for pulmonary embolism
What are decreased bone mass and strength?
especially a problem in females- fractures may occur with minimal force and sometimes with little pain. Handle patients gently; assess for fractures after apparently minor mechanism of injury placing more padding because of strange looking structures
What are changes in the nervous system?
Decreased pain sensation, Decreased reaction and cognitive processing times, Increased risk of dementia, Increased risk of depression and sleep disorders
What are decreased pain sensation?
patients may sustain injury, such as hot water burns, without realizing it; patients may experience diffuse or vague pain, even with serious illness. Take all complaints of pain seriously and realize that conditions such as myocardial infarction may not have typical pain pattern sin elderly patient sor may not result in a complaint of pain at all
what are decreased reaction and cognitive processing times?
less able to avoid injury so assess for injuries allowing time for patient to follow instructions
What are the risks of dementia?
patients may be prone to injury, wandering away, being take advantage of, or abused; patients may neglect themselves. Carefully assess the patient’s degree of orientation, and be aware of signs of neglect and abuse
what are the risk of depression and sleep disorders?
may attempt suicide or neglect self; elderly with sleep disorders are more likely to be physically abused but don’t rule out medication overdoses or other types of self-harm in the elderly
What is integumentary system changes?
The skin becomes thin, dry, and fragile; nails become weak and brittle; hair becomes dry and more sparse- making it easily bruised and torn. Assess for using sof injury even with minor trauma nad handle them carefully.
What are some tips to communicate with the elderly?
ask how they felt this week versus last. Ask patient first and bystanders if not getting good info from, use title speak on same level, so they can hear you and speak loud. Acknowledge person’s fears reassure caregiver and loved one. Lock up house, care of pets, if true that most patients do well and return home hand on forearm talk about what done over course of lifetime
What changes to they have with their eyes?
Decreased vision, including poor night vision, peripheral vision, and farsightedness; possible blindness- from cataracts, glaucoma, and retinal degeneration meaning there is an increased risk for falls and other injuries, difficulty reading medication directions and signing consent forms. Position in front adjust lighting to reduce glare, find glasses, and help walking
What are their changes in hearing?
Decreased hearing, especially for higher-pitched sounds- shrinkage of structures in ear (lead to dizziness or difficulty with balance0 leading to difficulty hearing other. If television or radio it too loud turn down and speak clearly assisting with hearing aids if necessary
What are the changes in speech?
stroke, poor-fitting dentures, patient may become frustrated if cannot make themselves understood. Ask to put in dentures or ask to write
What do you do for scene size up for elderly?
is it well kept, what is the temperature, find out normal mental status if no life threats give time to talk asking one question at time. In physical exam explain what going to do before doing it replace clothing you remove as soon as possible with varying thresholds of pain
What are the scene size up for elderly with airway?
May be difficult to extend head and flex neck of older patient because of arthritis don’t force head back but pull jaw forward. If insecure dentures remove otherwise keep
What are the scene size up for elderly with breathing?
high risk of foreign body obstruction, poor chewed food and denture. If unable to ventilate reposition head and try again
What are the scene size up for elderly with circulation?
radial pulse is often irregularly irregular no cycle from dysrhythmia
What are the scene size up for elderly with priority?
not severe symptoms, keeping high index of suspicion. May not have normal pupils from surgery and systole is unusually high. Have patient take a few deep breaths if gets rid of cackles and may not have abdominal pain so be throughout in exam. Check for edema and fractures of wrist, humerus, and hip are common as well as spine in accidents and may not fit on backboard. They diminish slowly so really compar.
