Exam 1 Flashcards
Erikson’s stages listed in order
-Trust vs. Mistrust
- Autonomy vs. shame and doubt
- Initiative vs. guilt
- Industry vs. inferiority
- Identity vs. confusion
Trust vs. Mistrust
Birth to 18 months
Autonomy vs. Shame and doubt
18 months to 3 years
Initiative vs. guilt
3-5 years
Industry vs. Inferiority
5-12 years
Identity vs confusion
12-18 years
List Piaget’s stages in order
- Sensorimotor stage
- Preopertational stage
- Concrete Operational stage
- Formal operational stage
Sensorimotor stage
- birth to 24 months old
- Motor activity w/o use of symbols
- all things learned through experiences or trial and error
- goal is object permanence
Pre-operational Stage
- 2-7 years old
- Development of language, memory, and imagination
- Intelligence is both egocentric and intuitive
- Goal is symbolic thought
Concrete Operation stage
- 7-11 years old
- More logical and methodical manipulation of symbols
- less egocentric + more aware of outside world and events
- goal is operational thought
Formal operational stage
- Adolesence to adulthood
- Use of symbols to relate to abstract concepts
- able to make hypotheses and grasp abstract concepts and relationships
- Goal is abstract concepts
Hep B Immunization dates
- A birth
- between 1-2 months
- between 6-18 months
RV (rotavirus) immunization dates
- 2 months
- 4 months
- 6 months
DTap immunization dates
- 2 months
- 4 months
- 6 months
- between 15-18 months
- 4-6 years
Hib immunization dates
- 2 months
- 4 months
- 6 months
- between 12- 15 months
PCV13 (pneumococcal) immunization dates
- 2 months
- 4 months
- 6 months
- between 12- 15 months
IPV (inactivated polio vaccine)
Subcutaneous
- 2 months
- 4 months
- between 6-18 months
- 4-6 years
Influenza immunization dates
Yearly starting at 6 months
MMR immunization dates
- between 12-15 months
- 4-6 years
(Same as varicella)
Varicella immunization dates
- between 12-15 months
- 4-6 years
(Same as MMR)
Hep A immunization dates
- between 12-23 months
Second dose 6 months later
Asthma
(Patho, Dignostic tests, Sx, nursing care, medication, and family education)
Patho:
chronic inflammatory disorder in which airways narrow and become hyperactive to stimuli that don’t affect individuals without asthma
Diagnostic tests:
Chest x-ray and pulmonary function tests
Symptoms:
- wheezing
- dry cough
- prolonged expiration
- restlessness
- fatigue
- tachypnea
- cyanosis
Medication:
- bronchodilators
- steroids
Family Education:
-Teach to identify and avoid triggers
- Check peak flow daily
- keep rescue inhaler w/ patient at all times
RSV
- Most frequent cause of hospitalization in children <1 yo
- severe RSV infections in first year of life are a significant risk factor for the development of asthma
Patho:
- RSV is transmitted from exposure to contaminated secretions (can live on fomites for several hours and on hands for 30 minutes)
- usually begins with a URI after incubation of about 5-8 days
Symtoms:
- Rhinorrhea and low grade fever appear first
- OM and conjunctivitis may also be present
- contagious for 3-8 days some patients with weakened immune systems can be contagious for as long as 4 weeks
Diagnostic test:
- Hyperinflation of the lungs is seen usually on chest x-ray
- DFA
- ELISA for RSV antigen detection
Cystic fibrosis
Patho:
- multisystem disorder of exocrine glands
- increased production of thick mucus in bronchioles, small intestines, and pancreatic and bile ducts
- lungs — actelectasis
- clogged pancreatic ducts
- absence of pancreatic enzymes in small intestines (unable to absorb fats + protein)
Etiology:
- inherited of autosomal recessive trait (usually diagnosed in infancy/early childhood)
- life expectancy increasing ~30 years now
Diagnosis:
- sweat test
- 72 hours fecal fat
- Chest x-ray
- prenatal DNA of amniotic
Treatment:
- antibiotics — treat pulmonary infection
- pancreatic enzymes — for fat absorption
- fat soluble vitamins A, E, D, K
- MUCOLYTICS to decrease viscosity of sputum
- bronchodilators
Signs and symptoms:
- cough, sputum, dyspnea, decreased SpO2, crackles or wheezes in lungs, cyanosis, digital clubbing, bulky frothy foul-smelling stools (steatorrhea), meconium ileus
Nursing care:
- assess hydration status
- provide high calorie high protein foods
- administer pancreatic enzymes with all meals and snacks
- avoid pulmonary treatments after meals to decrease the chance of vomiting
- chest percussion and postural drainage
-activity and exercise will loosen secretions
Epiglottitis
Patho:
- inflammation and swelling of epiglottis (primarily affecting children b/t ages 2-8)
- Bacteria (usually haemophilus influenzae) cause epiglottis to become cherry red and so swollen that it obstructs airway
Symptoms:
- child has sore throat + unable to swallow
- secretions pool in pharynx and larynx
- Onset is sudden with high fever, sore throat, and pain w/ swallowing
-dysphonia, dsyphagia, drooling of saliva
- anxious, restless, insists on sitting upright with chin thrust out, mouth open, and in tripod position
Diagnosis:
- EXAMINATION OF THE THROAT IS CONTRAINDICATED (physical manipulation of hypersensitive airway muscles may result in spasm + complete obstruction)
- lateral neck x-ray confirms enlarged epiglottis
- CBC, blood cultures
Nursing care:
-NPO, IV fluids for hydration
-assess for resp. Distress continuously
- dont leave child unattended!
-keep intubation equipment available
Medications:
-antibiotics
-antipyretics
-corticosteroids
Education:
-discuss importance of Hib vaccine and ensure parents that the reoccurrence of epiglottitis is uncommon
Hemolytic Uremic Anemia
Triad of HUS: Anemia, thrombocytopenia, renal failure
Patho:
- primary site endothelial lining of the small glomerular arterioles-swell and occluded w/ deposits of platelets and fibrin clots
- RBC are damaged moving through partially occluded blood vessels
- Damaged RBC are removed by spleen causing acute hemolytic anemia and thrombocytopenia
Clinical manifestations:
- primarily in 6mo-5yo
- begins with gastro infection or URI
- associated with e. Coli (acquired in undercooked beef, unpasteurized milk or fruit juice, greens or drinking/swimming in sewage contaminated water)
Treatment:
- hemodialysis or peritoneal dialysis
-FFP and plasmaphereis, fresh/washed packed cells
Hirschsprung
Patho:
- congenital absence of ganglion cells
- Nerve cells are missing in the large intestines so stool can’t be moved + becomes blocked
- Colon becomes a “mega colon”
Clinical manifestations:
- No meconium within 1st 24-48 hours
- Distended abdomen & vomiting
- Signs of enterocolitis
- Chronic constipation
- RIBBON-LIKE, FOUL-SMELLING STOOL
Post op:
- NPO + NG suction
- Ostomy-temporary
Pyloric Stenosis
Patho:
- Hypertrophy of circular muscle of pylorus which causes the constriction of pylorus and obstruction of gastric outlet
Clinical manifestations:
- Projectile vomiting
- moveable olive-shaped mass in epigastrium
Treatment:
-pyloromyotomy
-laparotomy (relatively uncomplicated surgery)
- Feeding 4-6 hours postop, progressing from glucose or electrolyte fluid to formula within 24 hours of surgery
- Discharge home 2nd postop day
Vomiting
- Common in children; self-limiting
- Requires no specific treatment unless complications occur (dehydration, electrolyte imbalances, aspiration)
Associated with
- infectious disease
- increased ICP
- Toxic ingestion
- food intolerance and allergy
- mechanical obstruction of GI tract
- Metabolic disorder
Rotavirus
-most common in children 3mo-24mo
-fecal - oral transmitted
- fever
- starts with vomiting then watery, grassy green foul smelling diarrhea
- oral preventative given with immunizations at 2 months, 4 months, and 6 months
Salmonella
- bacterial
- person to person or under cooked chicken
- June-August
- Hamsters, turtles, dogs, and cats carry it too
- Nausea, vomiting, abdominal pain, BLOODY DIARRHEA
-fever
-may become septic
Shigella
-fever, fatigue, anorexia
-cramps abdominal pain preceding watery or bloody diarrhea
-do not give antidiarrheal medications!!!
GERD
GER: transfer of gastric contents into the esophagus
GERD: tissue damage from GER
Symptoms:
-poor weight gain
-esophagitis
-persistent respiratory symptoms or complications
-spitting up/vomiting
-difficulty swallowing
-chest pain + heart burn
Treatment:
- avoid trigger foods (citrus, caffeine, etc.)
- weight control
- small frequent meals
- thickened feeds
- elevate HOB for 1 hour after feed
-PPI’s-omeprazole, H2 receptor inhibitors-ranitidine
Hepatitis B vaccination contraindication
Bakers yeast allergy
Rotavirus
- most common cause of severe diarrhea
- incubation period is approx. 2 days
Signs + Symptoms: - vomiting and watery diarrhea for 3-8 days and fever and abdominal pain occur frequently
Diphtheria
- contact transmission
- thick, bluish white to gray patches cover the tonsils
- fever, anorexia, malaise, cough, hoarseness, odor, sore throat
Complications:
-myocarditis, ascending paralysis
Treatments:
-IV antitoxin, Pencillin
Tetanus
- Exists as spore in dirt, dust, animal excrema
- endotoxin attacks the nervous system
Symptoms:
- stiff neck and jaw, facial spasms, difficulty swallowing, and MUSCLE RIGIDITY
- opisthotonus (back arch)
- lock jaw and muscle spasm (sardonic spasm)
Treatment:
- tetanus immunoglobulin, tetanus toxoid, ICU care, paralysis, ventilator
Pertussis
- Transmitted through droplets (direct contact)
- runny nose, cough that becomes more severe and spasms, flushing, cyanosis, vomiting
Treatment:
- antibiotics
- steroids
HPV
- most common STI
Vaccine:
3 IM shots at
- 11-12 years old, 2 months later, and 6 months later
Poliomyelitis
3 types of polio
Symptoms:
- fever, headache, stiff neck, progressive weakness, respiratory difficulties, paralysis
Complications:
- respiratory arrest
- Permanent motor paralysis
Fifth’s Disease
caused by human parvovirus 19
Droplet precautions
Comes in 3 stages and first stage is redness to cheeks
Symptoms:
- “Slapped cheek”
- lacy rash on trunk and limbs
- some fetal defects
