exam 1 Flashcards
Know what informed consent is and how it affects nursing care
Informed consent is the formal authorization of the parent or guardian to allow care or procedure for their child. Healthcare workers are responsible for identifying who can sign consent for a child.
When can a minor seek their own care?
Emancipated minors: these patients typically are self-supporting adolescents (under age 18) or those who
may be married, pregnant, or incarcerated and are not subject to parental control
Mature minors: these are adolescents who may give independent consent to receive or refuse treatment
fro a limited number of conditions. These conditions often include: testing and treating sexually transmitted infections (STIs), contraception cervices, substance abuse, and mental health care
What does assent mean?
Assent is the voluntary agreement to accept treatment or participate in research. To
give assent, a child must have a basic understanding of what will be done and what is required for
participation
Who is the pediatric patient? What does “family centered care” mean?
Children < 18, take the family’s wants and needs into consideration as well as the patient
Understand leading causes of mortality and morbidity for each age group
Under 1 year: Suffocation
1 to 4 years: Drowning
5 to 9 years: Motor vehicle
10 to 14 years: Motor vehicle
15 to 19 years: Motor vehicle
What things can nurses do to positively affect morbidity and mortality?
- Pediatric medications are based on the patient’s weight – dosage errors are a major concern.
- Pediatric patients also have immature physiology which affects their ability to metabolize and excrete
medications - Environmental hazards pose additional risks to pediatric patients: crib rails, cords, sleep habitats
- Parents play a very important role in the care of children. It is important to work WITH them to help
provide the safest environment for patients.
Know what a safe sleep environment is and why we care about it
ABC- alone, back, crib
- same room next to parents, no pillows, blankets, toys
Know the effects of hospitalization on each age
Infant: Unaware of illness and its effects only see a deviation from their normal life, Sense stress and anxiety in loved ones, Awareness of self as separate from parents by 6-8 months leading to separation anxiety and stranger anxiety which is exacerbating if the parent is not staying with the child.
Toddlers: Separation from parents and disruption of routine are major stressors and fears, May see illness as punishment
School-age: Beginning understanding of body functions and foster a sense of industry, Stressful procedures can lead to regression or behavior changes
Adolescents: Understands complex nature of illness and often fear results of it, Fear of missing out with friends and peers, Concerned with effects of illness on appearance/body image
How does hospitalization affect parents? Siblings?
Parents:
Disbelief, anger, guilt
Fear, anxiety
Frustration
Depression
Family processes disrupted
Parental roles may be altered
Burdens of missed work, additional expenses, caring for siblings
Siblings:
Confusion
Guilt
Anger
Jealousy
Rejection
Know how to give pediatric medications (oral, IV, IM, ear gtts, eye gtts)
IV: hand, feet, ac,scalp- hourly checks due to increased risk of infiltration
IM: vastus lateralis is preferred no more than 1-2 ml, no gluteus Maximus
Eye: stabilize head by resting wrist of forehead, keep at room temp
Ear: Stabilize hand by resting wrist on head, Pull pinna up from children >3yr or down for kids under <3yr
How can we prepare children for procedures? Does this change based on age?
Infant: explain procedure and reason to parents, allow parents to be present and parents may sooth baby
Toddler: Give explanation just before procedure, since toddler’s concept of time is limited. Explain that child did nothing wrong; the procedure is simply necessary
Preschool: Give simple explanations of procedure. Basic drawings may be useful. While providing supervision, allow the child to touch and play with equipment to be used, if possible
School age:Clear, thorough explanations are helpful. Use drawings, pictures, books, and contact with equipment. Teach stress-reduction techniques such as deep breathing and visualization. Offer a choice of reward after procedure is completed.
Adolescent: Give clear explanations orally and in writing. Teach stress-reduction techniques. Explore fear of certain procedures, such as staple removal or venipuncture.
up to what age do you use length instead of height for measuring a child?
up to two years
up to what age do you measure head circumference?
up to age 3
up to what age do you measure chest circumference?
up to age 1
what happens to an infant’s weight in the first year?
weight doubles by 6 months and triples by a year
Normal hr range for children
Neonate: 100-180
infant: 100-160
toddler: 80-110
preschool: 70-110
school age: 65-110
adolescent: 60-90
how do you count respirations for a child under 6?
watch rise and fall of belly because thoracic muscles are immature
normal RR for children
infant: 30-60
toddler: 24-40
preschool: 22-34
school age: 18-30
adolescent: 12-16
temperature for hypo and hyperthermia in children
less than 36.5 C (97.7 F) or greater than 38 C (100.4 F)
normal bp calculation for children
90 + (2x age in years)
how should fontanelles feel during an examination
normal: flat and soft
increased icp: tense and above the margin of skull
dehydration: sunken fontanelles
when do fontanelles close?
anterior: 2-4 months
posterior: by 18 months
sunset sign
sclera is seen between upper eyelid and iris- sign of hydrocephalus
tanner staging
stage 1- prepubertal: no sexual hair, flat appearing chest with raised nipple
stage 2- 8-11.5 years: pubic hair appears, testicular enlargement and breast bud forms
stage 3- 11.5-13 years: coarsening of pubic hair, penis size increases, breasts enlarge
stage 4- 13-15 years: coarse hair across pubis, penis width increases, breasts enlarge with raised areola
stage 5 - >15 years: coarse hair across pubis and thigh, adult penis and breast size
How do we provide family centered care in pediatrics?
Value the input of the family including their past experiences and
perception of the patient and the illness as the parents’ perspective can be critical to quality care.
developmental response to illness for an infant
Unaware of illness and its effects only see a deviation from their normal life
◦ Encourage normal wake/sleep cycles, feeding times, and typical daily activities
◦ Sense stress and anxiety in loved ones
◦ Provide family-centered care and encourage participation from family to reduce anxiety
◦ Awareness of self as separate from parents by 6-8 months leading to separation anxiety and stranger anxiety
developmental response to illness for a toddler?
Separation from parents and disruption of routine are major stressors and fears
◦ Encourage participation and maintenance of home routines
◦ May see illness as punishment
◦ Has incorrect cause-and-effect perceptions
◦ Calmly explain source of illness and no fault to child
developmental response to illness for a school age child
Beginning understanding of body functions
◦ Foster sense of industry.
◦ Encourage participation in care, continued schoolwork, and arts/crafts
◦ Stressful procedures can lead to regression or behavior changes.
Developmental Response to
Illness
developmental response to illness for an adolescent?
Understands complex nature of illness and often fear results of it
◦ Fear of missing out with friends and peers
◦ Encourage participation in play room, school
◦ Concerned with effects of illness on appearance/body image
◦ Respect need for privacy and independence
◦ Careful listening by nurse
◦ Partner with family and adolescent in care
What are Erikson’s stages of development
Birth-1 year: trust vs mistrust
1-3 years: Autonomy vs. shame & doubt
3-6 years: initiative vs guilt
6-12 years: industry vs inferiority
12-18 years: identity vs role confusion
What are Piaget’s stages of development
sensorimotor: 0-2 years
preoperational: 2-7 years
concrete operational: 7-11 years
formal operational: 11-15
milestones for birth-1 month
-gain 5-7 oz per week
- hold hand in fist
-alerts to high pitched voices
-comforts with touch
-follows objects in line of sight
milestones for 2-4 months
-posterior fontanelles close
- holds objects when placed in hand
-brings hand to midline
-can turn from side to side
-holds head when prone
milestones for 4-6 months
-doubles birth weight at 5-6 months
-teeth begin erupting by 6 months
- holds bottle
-grasps with full hand
-no head lag when pulled to sitting
- when held standing supports most of own weight
milestones for 6-8 months
-growth rate slower than first 6 months
- begins pincer grasp
-inborn reflexes exstinguish
- sits alone steadily by 8 months
- responds to name
milestone for 8-10 months
-crawling
-pulls self to standing and sitting by 10 months
-may say one word in addition to mama and dada
milestone for 10-12 months
-triples birth weight by one year
- may hold marker and draw a mark on paper
-stands alone
milestone for 1-2 years
-anterior fontanelle closes
- by the end of second year, build 4 stack of blocks
-walks with ease
milestones for 2-3 years
-draws a circle
-dresses self
-jumps
type of play for an infant
solitary play- plays alone without others
type of play for a toddler
parallel play- plays with similar object side by side
type of play for a preschooler
associative play-interact with playmates (one cuts one glues)
type of play for school-age
cooperative play- tug of war
what is goodness of fit
Are the parents’ expectations
of their child’s behavior consistent with the
child’s temperament type
health promotion
refers to activities that increase well-being and enhance
wellness or health (screening,immunizations, preventing injury, education)
nutrition for infants
breast milk
breast milk storage
up to 4 hours at room temp, 4 days refrigerated, no microwave
When should breast or bottle-feeding be weened
8-9 months
when should complementary foods be introduced
6 months
what is celiac disease
chronic malabsorption resulting from gluten intolerance
pain scale for newborns and infants (<1)
NIPS- neonatal infant pain scale
pain scale for toddlers (up to 4)
FLACC- face, legs, activity,cry,consolability
pain scale for 4-5 y/o
faces wong baker
ibuprofen dose for peds
10mg/kg q6
