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Fall - Pediatrics > Class four > Flashcards

Class four Flashcards

1
Q

What are developmental considerations for approaching infants?

A

Sensory motor stage so need soothing environment
Sense of safety from consistency
Develop trust and security/safety from primary caregiver

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2
Q

What are major fears in the hospital for infants?

A

Separation from primary caregiver

Develops around 6 months

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3
Q

What are some tip for approaching infants?

A

Soft voice
Soothing environment so avoid making any loud noises
Feel secure with swaddling
Animated facial expressions
Baby games - 9-12 m. object permanence so games like peak-a-boo
Do quiet parts of exam first
Include parent as much as possible

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4
Q

What are some developmental concerns for approaching toddlers?

A

Sensorimotor to pre-operatinos so solid understanding of environment and awareness of own body
Autonomy
Slow to warm up

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5
Q

What are major fears in the hospital of toddlers?

A

Strangers in including nurses usually until age 2
Loss of autonomy and restricted movement (stress if being forced to do something they don’t want to do)

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6
Q

What are tips for approaching a toddler?

A

Establish rapport with parents FIRST
Approach with caution
Medical play and distraction such as with the otoscope or BP cuff
Examine HEENT last
Offer choices (no yes/no questions b/c will say no)
Allow patient to sit in parents lap while being approached
Get down to eye level

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7
Q

What are developmental considerations for approaching a preschool or early childhood age child?

A

Initiative vs. guilt so want to start learning how to do things and get involved with can help
Magical thinking and animism
Very primitive ideas about their bodies
Literal interpretations

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8
Q

What are major fears in the hospital for preschool or early childhood age children?

A

Separation from parents
Being alone
Body mutilation (terrified that anything coming at them is going to hurt)
Loss of competence and initiative

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9
Q

What are tips when approaching a preschool or early childhood age child?

A

Address parent first b/c may still be slow to warm up
Positive attitude and more animated
Medical play
Give them a task such as holding a bandaid
Offer choices
Imaginary play and animism such as super heroes, characters and stuff animals (talking about these can break the ice)

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10
Q

What are developmental consideration for approaching a school age child?

A

Industry vs. inferiority so they want to be good at stuff, development of self confidence, want them to be proud of the things they do
Eager to learn and please
Concrete operations

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11
Q

What are major fears in the hospital for school age children?

A

Loss of bodily control (accidents)
Loss of independence
Fear of being different
Loss of competence

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12
Q

What are tips for approaching a school age child?

A

Talk to parent and the patient
Ask them about thier hobbies like sports, school, collecting things (learn to categorize at this age)
Give them the opportunity to ask questions
DO NOT lie such as don’t tell them something won’t hurt if it will
Be silly

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13
Q

What are some developmental considerations when approaching adolescents and young adults?

A

Identity - trying to establish independence and autonomy
Believe they are invincible
Can be vague or stoic about needs so many not admit fear or pain –> seem withdrawn and rude
Slow to warm up sometimes
Formal operations
Perceived audience

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14
Q

What are some major fears in the hospital for adolescents and young adults?

A

Isolation from peers and feeling different from peers
Dependency on adult caregivers
FOMO
Death
Loss of privacy (very important!!)

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15
Q

What are some tips for approaching adolescents and young adults?

A

Approach the patient first so right away they know that they are an equal part in their care
Ask about interests such as school, friends, music
Be authentic - don’t try to act cool just be yourself
Do not lie

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16
Q

What is an adverse childhood event?

A

Traumatic event that can have negative lasting effects on health and wellbeing

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17
Q

What if a child has 4 or more adverse childhood events during early childhood?

A

Can lead to disruption in development so they can become impulsive, seek high risk behaviors like drugs which leads to drastically reducing the lifespan

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18
Q

What are the type of abuse?

A

Physical abuse
Sexual abuse
Emotional abuse
Neglect

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19
Q

What is the type of abuse you will see most commonly in hospitals?

A

Neglect

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20
Q

What are the dynamics of child abuse?

A

Child
Parent
Crisis or triggering event
Potential for abuse like multiple risk factors

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21
Q

What are parental risk factors for child abuse?

A
  1. PMH of abuse/neglect as child
  2. Poor socialization/emotional and social isolation
  3. Poor parenting skills
  4. Limited ability to deal with stress/negative emotions
  5. Poor conflict resolution skills
  6. Substance abuse
  7. Rigid family role (dominant parent)
  8. Sudden life crisis (loss of job)
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22
Q

What are child risk factors?

A
  1. Under 3 years old
  2. Separation at birth
  3. Unplanned/unwanted pregnancy
  4. SGA, congenital abnormalities, chronic medication condition
  5. Difficult temperament like ADHD, oppositional, defiant, colicky baby
  6. Foster and adopted children
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23
Q

What are common situations that trigger abuse?

A

Prolonged crying

Potty training

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24
Q

What are some red flags for abuse in a patients history?

A
  1. Injury unexplained by hx
  2. Injury or explanation inconsistent w/ developmental age (requires certain motor control that child doesn’t have yet)
  3. Absent, changing or evolving hx
  4. Caregiver delay in seeking medical care
  5. Unusual affect of caregiver in response to child injury like blowing it off, feel responsible
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25
Q

What are some warning signs of abuse?

A

Changes in behavior

Distrust
Fear
Detachment
Depression
Not wanting to go home with caregiver
Poor eating/sleeping
School failure when previously excelled
Acting out
Loss of interest in activities

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26
Q

What are the nursing responsibilities for suspected child abuse?

A

Report (mandatory)
Know organizational policies
Recognize abuse
Assess for injuries and photo injuries on whole body
Refer
Educate
Prevent

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27
Q

What is NOT the nursing role in suspected child abuse cases?

A

Not to determine who the abuser is
Not to judge parents

28
Q

What are some documentation tips for child abuse cases?

A

Detailed hx of injury as reported by caregiver - can use exact quotes
Document objective findings in detail so you can states quotes of what is said but can’t start parents are not acting appropriate

29
Q

Does the hx given correlate with?

A
  1. Severity of the injury
  2. Age of injury (multiple injuries in different stages of healing)
  3. Location of injury (bony or soft tissue)
  4. Pattern of injury (bite mark?)
  5. Developmental age of child and expected play patterns
30
Q

What are some communication strategies that can be helpful for documenting suspected abuse cases?

A

Stick to the fact and objective finding
Focus on the injury and not the how
Maintain neutral
Avoid word “abuse” to prevent escalation
Focus on child and make sure they are safe
Start convo w/ positive acknowledgment (I know you’re concerned, I can see you love your child)

31
Q

What are some examples of communication strategies that can be helpful in suspected abuse cases?

A

… But as a mandatory reporter, I have to report any injury that may have been intentional
… But the team is worried someone intentionally hurt your child
… But its usual to see this injury this age of child. Do you have any concerns about how your child was injured?
… But were concerned about your child injury and when this happens out policy is to request an evaluation form the child protection team

32
Q

What families do you provide education and prevention to about child abuse?

A

Families that are screened and identified as at-risk families such as seem chaotic, not much structure, lots of stress, children with complex medical need

33
Q

What do you do once a family is recognized as at-risk?

A

Refer resources (community, inpatient, school)
Parental counseling (especially with PMH of abuse as child)
Child counseling and support

34
Q

What should be done during child counseling and support?

A

Let children know that it is not their fault because children often feel guilty that they got their caregiver in trouble
Teach them that abuse is wrong
Give them permission to share secrets
Help them with age appropriate play

35
Q

When choosing language you should consider..

A

Developmental level
Anxiety/fear level
Trauma
Pain
Primary language
Previous medical experiences

36
Q

What are some things you can do while communicating with all children?

A

Be honest
Get down on the Childs level
Only make promises you can keep
Offer choices only when available
State suggests to a child in positive manner (tell them what you want them to do instead of saying don’t do something)
Praises specific actions/behaviors
Allow children to have their own experiences without remediation
Avoid words with judgment (brave/strong)

37
Q

How should you explain a procedure to children?

A

Ask what they know/think is going on
First, then statements wit h preschool and developmental delays
Step-by-step with sensory information with school age and up
Give a job
Offer realistic choices
Develop a coping plan

38
Q

What does developing a coping plan look like?

A

Identify a comfort position
Distraction (iPad, book, toy)
Comfort item like blanket or stuffed animal
Soothing music
Deep breathing exercises like blowing a pin wheel
Counting, singing, looking at a book
Talking, holding someone’s hand

39
Q

What are the benefits of supporting positioning?

A

Promotes sense of control in child, parent and caregiver
Emotional support
Physical closeness
Normalcy
Decreases vulnerability
Decreases anxiety caused by separation
Extremity is safely immobilized
Increased cooperation
Fewer staff needed for procedures

40
Q

What are some things that should be considered before communicating life-changing information?

A

Plan
Timing
Support system
Small amount of information to start
Questions that can’t be answered

41
Q

How should you ask clarifying questions to children?

A

Avoid yes/no questions

Open ended questions

42
Q

What is the second leading cause of death in children between ages of10-14 and 15-24?

A

Childhood depression

43
Q

What are signs of anxiety and depression in children?

A
  1. Refuse to go to school
    Be excessively clingy
  2. Feel sick
  3. Worry bad things will happen to people they love
44
Q

What are signs of anxiety and depression in teenagers??

A
  1. Misunderstood
  2. Moody
  3. Becomes solitary
  4. Act very negative
  5. Social withdrawal and loss of interest
  6. Excessively harsh view of themselves
  7. Sadness and despair
  8. Anger and irritability
  9. Change sleep/eating patterns
45
Q

What is the nurses role r/t depression?

A

Screen and recognize it
Report ot provider
Tell family if they feel that the teen is a safety concern to themselves or others

46
Q

What is the impact of chronic illness on family?

A

Medicalization of home
Chronic and acute stress
Routine of family life disrupted (school, work, errands, childcare for siblings)
Economic implications
Interpersonal relationships (increased divorce rates)

47
Q

Is the quality of life better for the child or family?

A

For the child because family is doing everything for the child and not for themselves
Child is very resilient and wants to be a kid

48
Q

What are protective factors for the strain chronic illness puts on families?

A

Mentoring/support groups
Parental relationship quality
School connectedness
School RN
Resilience of child

49
Q

What is there more chronic illness in children?

A

More preemies and more life saving measures that are keeping really sick kids alive

50
Q

What are some chronic illness that increase the burden on school system?

A

Asthma
Obesity
Poor oral health
Food allergies
Epilepsy

51
Q

What are SDOH and implications regarding chronic diseases?

A

Higher prevalence of urban communities, at or below poverty, racial/ethnic disparities

52
Q

Are there more missed days of school d/t chronic illness? What keeps them from attending school?

A

School performance is affected because there is a lot of missed days

Sometimes the parents perception of illness can affect school attendance as even if their child feels well, they will sometimes keep them home

53
Q

What is the impact of chronic illness on school?

A

Impaired cognitive function d/t physical s/s, medication side effects, hard to pay attention, fear/worry/anxiety

Impaired social functioning d/t isolation and insecurity, emotional stress, had to build relationships with interruptions

54
Q

What is the nursing goals of care for children with chronic illness?

A

Promote highest degree of health and functioning
Promote normalcy for child
Preserve family structure/optimize dynamics and coping

55
Q

How can nurses help to promote normal childhood developmental in abnormal circumstances?

A

Using developmentally appropriate communication
Using a team approach including social work, child life specialist, mentors, peer groups, pastoral care, family support

56
Q

What are some school health services for children with chronic illness?

A

School RN and counselor
Child and family centered advocacy
Improve school re-entry and attendance (IEP, advocate, parents feel secure w/ RN onsite)
Comprehensive care coordination (med admin, additional resources)

57
Q

At what age can children in CO consent to their own mental health care (accepting or refusing treatment)?
What is the exception?

A

12 yrs

If they are actively suicidal

58
Q

At what age does HIPPA apply to all health information?

A

18 yrs +

59
Q

At what age can children consent to medical treatment (excluding mental health services) ?

A

18 yrs

60
Q

What is protected or sensitive health info?

A

Mental health and reproductive health

61
Q

A mom wants access to her 16 yr old dental records, does she have the right?

A

Yes (unless its mental health records, she can request them)

62
Q

What is assent?

A

Necessary if a child is 7 years or older
Child has been fully informed about the procedure and concurs with those giving informed consent

63
Q

What is informed consent?

A

Legal and ethical requirement that child and the parent/guardian completely understand the proposed procedure/treatment including the benefits and risks

64
Q

What is self-concept?

A

mental image of self including body image, subjective self, ideal self, and social self

65
Q

What factors influence children’s body image and self-esteem?

A
  1. Sense of competency
  2. Facial, ethnic, and spiritual identity
  3. Family/friends
  4. Relationships/friendships
  5. Education/employment
  6. Emotions

Fall - Pediatrics (15 decks)

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