Class one Flashcards

1
Q

What is family centered care?

A

healthcare that is mutually beneficial to patients, families, and healthcare professionals regarding the planning, delivery and evaluations of care

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2
Q

What is the goal of family centered care?

A

Strength-based approach - what in the family can we build on? Reduce?
Shared decision making

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3
Q

Why is caring for children different than adults?

A

Children are being taken care of by parents therefore they need to be an active part of the team and parental concerns should be taken seriously
Kids want to be kids! Kids are not just small adults

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4
Q

What is the role of the nurse regarding family centered care?

A

Appreciated developmental needs of a child and family and adapt the play accordingly
Goal is not to make the family depending instead it its to make the family feel like the expert using the strengths based approach

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5
Q

What is the role of the pediatric nurse?

A

Assess: family functioning, strengths, support needs, family dynamics and health behaviors
Educate: Supports families and educate w/o creating dependence, parents as experts, advocate child needs
Promote: anticipatory guidance
Collaborate: as equal partners w/ parents, encourage parental enrollment from start to end, boundaries

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6
Q

What is Lilian ward?

A

Developed the model for community health nursing
Focused on maternal childcare in the home and community

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7
Q

What are the principles of pediatric care?

A

G&D
Health promotion and nutrition
Family focus
Child advocacy
Communication
Community care (WIC, schools camps, home heath, primary care)

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8
Q

What is a systems-based model?

A

Interpersonal/individual factors
Institutional and organizational factors
Community factors
Public policy factors

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9
Q

What is the poverty cycle?

A

Family in poverty
Child grows up in poverty
is significantly disadvantaged in education and skills
Struggles to get a job
Fall to escape the poverty cycle

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10
Q

How do you break the cycle of poverty?

A

Increase protective factors such as access to care, high school degree, positive parenting, and family planning
Decrease risk factors

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11
Q

How does education help break the cycle of poverty?

A

Most important
Opens up job opportunities that have insurance –> healthcare access

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12
Q

How do we define family?

A

Anyone that provides care for the child
Anyone that lives with the child

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13
Q

What is a strengths-based approach?

A

Assess family composition/structure and lifecycle
Assess family functioning
Assess and increase protective factors (barriers and resources)

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14
Q

What is shared-decision making in pediatrics?

A

Parent/child dyad as patient
Parents are the experts on child’s care
Involve kids in exam/plan of care as much as possible
Not just about pt, also working with care giver

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15
Q

What characteristics make a successful family?

A

Provide basic needs for child like food and shelter
Provide emotional needs and support for child
Provide safety adds structure for growth and development

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16
Q

What are the determinants of health? What do they affect?

A

Culture
Geography
Education
Socioeconomic variables
Financial stability
Access to technology
Genetics

These factors affect how successful families function

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17
Q

What are traits that make for a successful family?

A

Adults agree on major child rearing decisions (consistency bt/n caregivers)
Open communication
Flexible roles and rules
Spend time together as a family, but encourage independence
Help each other
Know how to find resources
Extended family/friend/spiritual support

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18
Q

What are traits of a high risk family?

A

Marital conflict
Violence
Substance abuse
Adolescent parents
Chronically ill child/special needs

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19
Q

What can high risk families exhibit?

A

Poor communication skills
Lack flexibility/adaptability
Poor conflict resolution
Operate in crisis mode
Family in total isolation

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20
Q

What do high risk families look like at the bedside?

A

Arguing
Child quiet, withdrawn, poor coping, fear
Distrust of medical team
Chaotic routine
Child demeanor changes when parents are around

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21
Q

What are some biases in healthcare?

A

Age of parents
Socioemconomic status of parents
Educational level of parents
Race and ethnicity
Urban vs. Rural
Religious background (Jehovahs witness)
Single parents
Sexuality
Substance abuse

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22
Q

What are the characteristics of child temperament?

A

Level of activity
Routines: sleep, eat elimination
Adaptability
Response to stimuli (does a change set them off?)
Mood
Distractibility
Attention span

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23
Q

What is the easy child temperment?

A

Approachable/friendly
Positive attitude
Adaptable but predictable
Console easily

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24
Q

What is the slow to warm up child temperament?

A

Shy
Less adaptable
Irregular routines

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25
Q

What is the difficult child temperament?

A

Avoid interactions
Negative mood
React poorly to change
Highly active

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26
Q

What is the permissive parenting style?

A

“Whatever you want”

Low expectations
Few rules
Indulgent
Accepting
Lenient
Avoids communication
Competing priorities

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27
Q

What is the authoritative parenting style?

A

“Let’s discuss this”
High expectations
Clear standards
Assertive
Democratic
Flexible
Responsive
Warm

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28
Q

What is the uninvolved parenting style?

A

“I really don’t care”

No expectations
Few rules
Absent
Passive
Neglectful
Uninterested
Competing priorities

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29
Q

What is the authoritarian parenting style?

A

“Because I said so”

High expectations
Clear rules
Forceful
Autocratic
Rigid
Punishment
Limited warmth

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30
Q

What is the importance of nurses learning about discipline?

A

They can teach parents that discipline is about teaching and self-regulating their behavior

Parents should set expectations and rewards

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31
Q

What usually happens regarding the way a child acts in the hospital?

A

They usually act out due to being under stress so you should warn parents that this is normal

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32
Q

What are the most critical years in an individual’s life?

A

the first 5 years because of the neuroplasticity in the brain

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33
Q

Are growth and development separate?

A

Growth is physical
Development is mental
If you are not physically growing, then you cannot support mental growth

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34
Q

What are the norms of development?

A

Occurs in an orderly sequence but can vary per child
Individualized
Direction and continuous - on a spectrum
Becomes increasing differentiated, integrated and complex

35
Q

What is growth? Is it objective or subjective?

A

Physical size of a whole, parts, or an increase in number/size of cells

Measure objectively

36
Q

What are things that measure growth?

A
  1. Height
  2. Weight
  3. Head circumference
  4. Growth charts to compare to norms and self over time
37
Q

What are growth charts interpreted as?

A

Percentitles

38
Q

How much weight does an infant gain per day in the first year of life?

A

30 grams or an ounce per day

39
Q

What is the weight of a baby at 6 months? 12 months?

A

Birth weight doubles at 6 months
Birth weight triples at 12 months

40
Q

What is the height increase per month in the first year?

A

2-3 cms or 1/2 inch per year

41
Q

What age does growth slow down after infancy? What is the height/weight gain each year during those ages?

A

Between ages 2-5

4-5 lbs/year
2-3 inches/year

42
Q

What percentile is considered under weight? Over weight? Obese?

A

Under: under the 5th percentile
Over: over the 90th percentile
Obese: 95th percentile

43
Q

What is the percentile that is normal? What is focused on when looking at percentiles?

A

5%-85%

Trends over time

44
Q

What is development?

A

A fluid sequence of conditions that leads to a new skill, motives for activities and patterns of behavior that were built from pervious ones

45
Q

What is a milestone?

A

Activities that are expected by a certain age

46
Q

What are some characteristics of milestones?

A

Measurement less concrete
Advanced or delayed
Different domains can develop at different pace

47
Q

What are the two ways that children develop?

A

Cephalocaudal: head to toe

Proximodistal: midline out. Big muscles first then small muscles

48
Q

What are some types of language milestones?

A

Expressive: make sounds
Receptive: listen and interpret (hearing test is done in nurses before go home to ensure you can hearing)

49
Q

What are some motor/physical milestones?

A

Gross
Fine
Reflexes

50
Q

What is monitoring? What is the purpose of monitoring?

A

Parents or non-clinical caregivers
Subjective
Less than 30 minutes
Ages and stages questionnaire
Milestone tracking

Purpose: screening

51
Q

What is screening and assessment? What is the purpose?

A

Professional performs (developmental specialist)
Specified intervals (9, 18, 24 months)
Denver II (DDST)
Increased objectivity
More than an hour and very comprehensive

Purpose: Diagnostic

52
Q

Erikson: Trust vs. mistrust

A

infant to 18 months

If needs are dependably met, infants develop trust

53
Q

Erikson: Autonomy vs. shame/doubt

A

18 months -3 years

Toddlers exercise will to do things for themselves or doubt their abilities

54
Q

Erikson: Initiative vs. guilt

A

3 years - 5 years

Preschoolers learn to initiate tasks and carry out plans or they feel guilty about their efforts to be independent

55
Q

Erikson: Industry vs. inferiority

A

5 years - 13 years

Children learn pleasure about applying themselves or feel inferior

56
Q

Erikson: Identity vs. confusion

A

13 years - 21 years

Develop a sense of self and understanding their identity or confused on who they are

57
Q

Erikson: intimacy vs. isolation

A

21 and up

Struggle to form close relationships and intimate love or socially isolated

58
Q

Piaget: Sensorimotor

A

Birth - 2

Explore word through sense and actions

Looking, hearing, touching, mouthing, grasping

Tasks: object permanence and stranger anxiety

59
Q

Piaget: preoperational

A

2 years - 7 years

Represent and refer to objects with words and images. Intuition rather than logic. Inanimate objects have feelings and emotions.

Tasks: Animism, magical thinking, pretend play, egocentrism

60
Q

Piaget: concrete operations

A

7 years - 11 years

Conservation, reverse thinking, classify/organize objects, think logically, concrete events (no what ifs)

Tasks: conservationism, mathematical transformations

61
Q

Piaget: Formal operations

A

12 years and up

Abstract thought. Hypothetical situations/events. Consider logical possibilities. Examine/test hypotheses

Tasks: abstract thought, potential for mature and moral reasoning

62
Q

What is serve and return?

A

Parents can support development by teaching children when they try to engage, a parent can return and engage

Do not engage after a serve can lead to developmental delays

63
Q

What is nature?

A

Non-modifiable

Genetics

64
Q

What is nurture?

A

Modifiable

SDOH
Interpersonal interactions

65
Q

What is failure to thrive?

A

Growth and developmental milestones fall below standards

Weight less than 5th percentile
Falls off growth curve
At least one developmental delay

66
Q

What is the nurses roles in failure to thrive?

A

Recognize normal patterns of development
Assess for red flags in G&D
Assess SDOH, family functioning and interactions
Support family to promote Childs health

67
Q

What are the causes of failure to thrive?

A

Organic - medical reason
Non-organic - no physical cause, environmental - 80%

68
Q

What is anticipatory guidance? What is the purpose?

A

Used to support a child’s health
Something hasn’t happened yet but educating on it to prevent it

69
Q

What Is the gastric pH in infants? What does this affect?

A

Gastric pH is high in neonates (less acidic)

Affects drug absorption because it decreases the absorption of medications that are acidic but increases absorption of medications that are alkaline

70
Q

What is the gastric emptying time in children? What does the affect?

A

Intermittent and unpredictable in infants
Slower in older children

Affects drug absorption because slower pace –> prolonged time that it take the medication to reach the intestinal absorption site

71
Q

What is the intestinal motility in children? What does this affect?

A

Intestinal motility is decreased in neonates
Intestinal motility is increased in older infants and children

Affects drug absorption because the longer the time that the drug is in transit in the intestine –> more medication absorption and a shortened time –> less medication absorption

72
Q

What is the bile enzyme activity in children? What does this affect?

A

Bile acid pool and billiard fx is diminished in neonates

Pancreatic enzymes variable in infants less than 3 months old

Affects drug absorption because some medications require a specific enzyme for dissolution and absorption and that enzyme might not be available

73
Q

What is different regarding body fluid in children? What does this affect?

A

Neonates have a higher proportion for total body water - relates to water solubility of drugs

Affects distribution of drugs because children will need a higher dose of water soluble drugs to achieve the desired effect

74
Q

What is the different in proteins in children? What does this affect?

A

Lower albumin levels in preterm/newborns

Affects distribution of drugs because medications bind to albumin, only free non bound meds can be absorbed –> more free drugs in preterm/newborns altering the amount of drug need for the therapeutic effect and increases chance of SE

75
Q

What is the concern regarding the BBB and drugs? When does it mature?

A

Side effect considerations
Drugs to treat neonatal sepsis will penetrate the brain
Drugs can accumulate in the brain tissue
Allows drugs to get to the CNS

Matures around 2 years old

76
Q

What organ metabolizes drugs?

A

Liver

77
Q

Why is metabolism different in children?

A

Metabolism is less mature in premature/newborns so may not metabolize drugs as well
Metabolism of pain meds is increased in older infants, toddlers and preschoolers so it takes more to achieve 24 hour stability (smaller doses more frequently given or larger doses)

78
Q

What is elimination different in children?

A

Glomerular filtration and tubular function are reduced at birth
Gradual increase in renal fx to adult level (about 1-2 years)
This causes the drugs not to be filtered out of the blood –> medication circling longer and reach toxic levels

79
Q

What are developmental considerations for administration?

A

Approach appropriate to developmental level
Consider route
Positive reinforcement
Teaching both child and family

80
Q

Which age group is going to be the easiest to give medications to?

A

School age because they are very eager to please

81
Q

What are developmental considerations for med administration for infants?

A

Administer meds before infant feeds
Offer med in small amount of formula/cereal/fruit
Via spoon or syringe
Parents can give but nurse must be in room and observe med being given

82
Q

What are developmental concerns for med administration for toddlers/preschool?

A

Simple explanations
Offer options: how and where they take medicine
Small cup or spoon
Ask parent how child takes meds
May have to restrain in lap and give small amount while hold cheeks together until swallows
For injection - 2nd nurse
Safety holds for restraint

83
Q

How do you determine for a medication dose is safe?

A

Step 1: Convert lb to kg
Step 2: Plug pt. weight into the dosing formula
Step 3: Calculate the answer to the dosing formula
Step 4: Compare the ordered dose to the answer from the dosing formula to determine if it is safe ­ (the ordered dose should fall WITHIN or BELOW the answer to your dosing formula)

84
Q

What is the formula for daily fluid maintenance?

A

100 ml for first 10 kg
50 ml for second 10 kg
20 ml for all kg after the first 20