Exam 1 Flashcards
Why do children need more nutrients per pound than adults? How many calories per pound does an infant require? What does an adult require?
their basic metabolic rate is faster, and they must take in not only enough to maintain body tissues but also enough to allow for growth.
120 kcal/kg of body weight per day
a30 to 35 kcal/kg of body weight per day
What percentage of water in an adult is extracellular? In an infant? What are the implications?
3% of total body water
water is closer to 40%
This means that an infant does not have as much water stored in the cells as does an adult and so is more likely to lose a devastating amount of body water with diarrhea or vomiting.
How does a child’s body’s response to disease differ from an adult’s? Why? What are common systemic responses children have with many diagnoses? How does is affect diagnosing disease?
tend to respond to disease systemically rather than locally
Because a child’s body is always growing
fever, vomiting, and diarrhea
nausea and vomiting occur so frequently in children with any type of illness that these symptoms do not have the diagnostic value that they may have in adults.
What are the differences in sleep stages for infants and adolescents?
most of sleep for infants is in REM sleep, whereas late adolescents have the least amount of this type of sleep.
What is considered sensory deprivation? How does it tend to present in children? How is sensory overload similar?
Sensory deprivation is the condition of being deprived of, or lacking, adequate sensory, social, physical, or cognitive stimulation.
children tend to lose the ability to make decisions and become easily confused and depressed.
Children with sensory overload react similarly to those with sensory deprivation or feel confused, are unable to make decisions, and feel severely fatigued
What are 3 types of therapeutic play? What can be the purpose of dramatic play in a medical setting? What age begins to benefit most from this type of play? Why?
Energy release
Dramatic play
Creative play
Dramatic play is acting out an anxiety-producing situation.
It is most effective with preschool children because they are at the peak of imagination.
What are the rights of an emancipated minor? What about living independently, married, are a parent or are serving in the military?
A minor who is emancipated by the state is considered to have the same legal rights as an adult and may consent to treatment.
Adolescents who are living independently, are married, are parents, and/or are serving with the armed forces are generally considered legally emancipated and able to provide informed consent or refusal for their own medical care
In terms of consent, what is the protocol in emergency situations with no parent present?
In emergent or life-threatening situations, when a legal guardian or parent is unavailable to consent, the Emergency Medical Treatment and Active Labor Act mandates that a medical screening examination and delivery of appropriate
What is the protocol for adolescents in terms of treatment for things of a sexual nature? Does consenting to ensure confidentiality? What other areas could this extend to, depending on the atate?
All 50 states recognize an adolescent’s right to consent for healthcare needs related to sexual activity, including treatment of sexually transmitted infections, contraceptive services, and prenatal care
however, consenting to these services does not always guarantee confidentiality.
mental health or substance use healthcare,
What is assent? What are the 4 criteria for assent according to the APA?
Child’s “consent” for medical care, their involvement
(a) helping the patient achieve a developmentally appropriate awareness of the nature of their condition
(b) telling the patient what they can expect with tests and treatment(s)
(c) making a clinical assessment of the patient’s understanding of the situation and the factors influencing how they are responding
(d) soliciting an expression of the patient’s willingness to accept the proposed care.
What are the NPO timelines for breastfed infants and formula fed infants? Why?
4 hours for breast milk
6 hours for formula
Infants can become dehydrated quickly
Where is the heart rate taken on a baby (1 year or less)? Why? Were, on an infant, is the HR most distinct? By what age has it moved to the 5th intercostal space? What is the best practice for the most accurate reading?
apical pulse (i.e., listening at the heart apex through a stethoscope)
radial (i.e., wrist) pulse is too faint to be palpated accurately.
In an infant, the point of maximum intensity, is just above and outside the left nipple (i.e., just lateral to the midclavicular line at the third or fourth intercostal space).
By 7 years of age, it is at the fourth or fifth interspace at the midclavicular line as in adults.
For greatest accuracy, count the pulse rate for 1 full minute.
At what age is BP routinly measured in office?
3 yrs
1 gram equals how many mL?
1 mL (this is how you can weight things like diapers and get a liquid measurement)
What are site instructions for IM injections of infants? What is the best portion of this site? Why should the gluteal site be avoided? What are the sites used for older children and adults?
For IM injections in infants, the preferred site for administration is the vastus lateralis muscle of the anterior thigh
Use the lateral aspect rather than the medial portion because this site is not as tender and should cause less pain.
risk of damage to the sciatic nerve
In older children, as in adults, the deltoid muscle or a ventrogluteal site
What is the formula for fluid administration in children? How is that calculated for a child weighing 26 kg, for example? How does that translate into an hourly rate?
100–50–20 mL/kg per day
For example, a child who weighs 26 kg would receive
100 mL for first 10 kg (1,000 mL)
plus 50 mL for the next 10 kg (500 mL)
and 20 mL for the remaining 6 kg (120 mL). Those three numbers added together 1,000 + 500 + 120 = 1,620 mL
This is the amount dosed per 24 hours, so divide 1,620 mL by 24 hours to get the hourly rate
What are pediatric medication doses based on?
age, body weight and in some cases body surface area
How can you help promote swallowing when administering medication in an infant?
stroke under the child while holding cheeks together
What is the max IM dosage for infants and children?
0.5 mL
2 mL
What is the typical size catheter for peripherial IVs?
24-22 guage
What are the developmental characterisitcs of feeling pain in infants?
loud cry
rigid, thrashing body
withdrawal from a painful stimulus
expressions of eyes closed tightly, furrowed eyebrows, mouth open wide, etc
lack os association between stimulus and pain
What are the developmental characteristics of feeling pain in toddlers?
loud cry or screaming
verbal expressions
Thrashing
attempt to push away the stimulus
noncooperation
clinging
anxiety anticipating pain
request for physical comfort
What are the developmental characteristics of feeling pain in school-age children? Adolescents?
stalling
muscular rigidity
similar to a toddler, but less intense in anticipation but more intense with painful stimulus
more verbal with less protest
muscle tension
At what age can children self-repot pain more accurately?
age 4
What is the pain assessment tool for ages 2 months to 7 years? When does the 0-10 numeric scale become appropriate to use? The FACES scale is good for what age group? What about the OUCHER scale?
FLACC
Face
Legs
Activity
Cry
Controllability
around 5 years
ages 3 and older
3-13 years
What are 6 things to observe when assessing ques of pain?
vocal
social
facial
activity
body and limbs
physiological
Are IM injections an appropriate form of pain control in children?
no
Are intranasal injections recommeneded in children younger than 18?
no
At what age can fentanyl be used? How is respiratory depression treated?
12 yrs
naloxone
What are some nonpharmacological measures for managing pain?
distractions: play, stories, etc
relaxations: holding, breathing tech. etc.
guided imagery
positive self-talk
behavioral contracting: reward, limits for cooperation
containment: swaddle, place rolled blankets around the child
nonnutritive sucking: sucrose pacifier
kangaroo care: skin to skin
complementary and alternative medicine: food, massage, mind-body tech., etc.
What are 3 behavioral responses with separation anxiety?
protest
despair
detachment
What are social character of play and thier typical age group?
onlooker: child observing others
solitary: child playing alone
parallel: plays independently but among others, toddlers
associative: play together without organization, preschoolers
team play: organized playing in groups, school age
How do children ages birth-3 years understand death and grief?
little to no concept
egocentric
mirror parental emotions
regression
act in response to changes
How do children ages 3-6 respond to death and grief? School age children?
egocentric
magical thinking
interpret separation as punishment
view dying as temporary
start to respond logically anf factually
begin to have adult concept of death
experience fear
fear displayed in uncooperative behavior
curious
adult-like concept
difficulty accepting
rely more on peers
can be uable to relate to peers and parents
stress
guilt and shame
depression
How do infants react to hospitalization which require nursing interventions?
Cannot verbalize discomfort
Separation anxiety (4-8months)
Stranger anxiety (6-8 months)
Poor sleep due to monitors & lack of sleep schedule
Irritability from sensory overload and strangers
Provide consistent caregivers
How do infants react to hospitalization which require nursing interventions?
Cannot verbalize discomfort
Separation anxiety (4-8months)
Stranger anxiety (6-8 months)
Poor sleep due to monitors & lack of sleep schedule
Irritability from sensory overload and strangers
Provide consistent caregivers
How do preschoolers react to medical care? Nursing interventions?
Magical thinking
May believe illness is a punishment
Fears:
Fear of unknown
Fear of abandonment
Fear of mutilation
Avoid medical jargon
Provide choices
How do children differ from adults in terms of med administration?
Often do not understand medicine will make them feel better
Focus on the taste or route of administration
Metabolism is much faster than an adult
Excretion can be much slower (due to immature liver/kidneys)
Children are all sizes (not one size fits all):
Poor reporters of adverse effects
What are methods of administering oral meds to infants?
Use nipple for infant to suck
Administer in the side of mouth in small amounts with syringe
Hold infant in semi-reclining position (like feeding)
Avoid mixing with milk or formula
Ask for flavoring, if possible
What are methods for med administration for children under the age of 9?
Liquids, chewable, or meltaway
Upright position for small children
Ask for flavoring, if possible
Can use ice chips to practice swallowing pills
Offer juice or snack after administration
