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Children's Health > EXAM #1 > Flashcards

EXAM #1 Flashcards

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1
Q

What are normal reflexes for a newborn/infant?

A

-Rooting: Searching for nipple/bottle
-Sucking
-Palmer & planter grasp
-Moro: startle reflex
-Babinski: spreading of toes

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2
Q

Whare are normal gross motor functions for a newborn/infant?

A

-Raise head & chest while on belly/ roll side to side at 3m
-No head lag 6m
-Turn over 7m
-sits unsupported 8m
-Crawl and pull up 8-9m

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3
Q

What are normal fine motor functions for an infant?

A
  • Transfer objects between hands, scribble, stack large object age 6-12m
  • Pincer grasp 9-12 m
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4
Q

What language development will be seen in an infant?

A
  • Crying, babbling, imitation; influenced by social interaction
  • Social smile 2m
  • Mama/dada 9-12m
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5
Q

What are gross and fine motor functions for a preschooler?

A
  • Dress self
  • Skip and hop on 1 foot
  • Throw and catch ball
  • Draw stick figure with 6 parts
  • Ties shoes,
  • Uses knife, fork, spoon
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6
Q

What are a few language/communications strategies to use for preschoolers?

A

-Stuttering is common
-Magical thinking, use word choice carefully

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7
Q

What physical changes will school aged patients go through?

A
  • GIRLS: hips broaden, pelvis widens, pubic hair grows, menarche possible before
    age 12
  • BOYS: muscular bodies, pubic hair growth, testes and scrotum changes, gynecomastia due to hormone changes
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8
Q

What is Erickson’s Trust vs Mistrust & what age does it occur?

A

-Newborn to 1 year
-Recognize that there are people that will meet their basic needs.
Result: Faith & Optimism

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9
Q

What is Erickson’s Autonomy vs Shame and Doubt & what age does it occur?

A

-1 year to 3 years
-Balance independence and
self-sufficiency against sense of uncertainty.
Result: Self control and power

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10
Q

What is Erickson’s Initiative vs Guilt & what age does it occur?

A

-3 years to 6 years
-Develop the resourcefulness to achieve and learn new things without receiving self-reproach.
Result: Direction and
purpose

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11
Q

What is Erickson’s Industry vs Inferiority & what age does it occur?

A

-6 years to 12
-Develop a sense of confidence through mastery of task. Can be hindered by a sense of inadequacy or inferiority.
Result: Competence

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12
Q

What is Erickson’s Identity vs Role Confusion & what age does it occur?

A

-12 to 18
-Acquiring a clear sense of self and purpose.
Result: Fidelity to others and individual values

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13
Q

What is Piaget’s Sensorimotor theory & at what age does it occur?

A

-Birth to age 2
-Primary means of cognition is through the senses

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14
Q

What is Piaget’s Preoperational theory & at what age does it occur?

A

-2 to 7)
-Takes into account the development of motor skills.
Divided into preconceptual and intuitive

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15
Q

What is Piaget’s Concrete operational theory & at what age does it occur?

A

-7 to 11)
-Able to organize thoughts into a logical order

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16
Q

What is Piaget’s Formal operational theory & at what age does it occur?

A

-11 to 15)
-Uses abstract thinking to handle difficult concepts and can analyze both sides of an issue

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17
Q

Nurition development for infants:

A

Breast milk or formula, intro solids 4-6 months, encourage self-feeding, finger foods, wean to cup 9-12 months, family meal time
No honey, milk or eggs until 12m

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18
Q

Nutrition development for toddlers:

A

family meals, allow self-feed and use cup, finger foods, 2-3 healthy snacks per day, do not force eating, allow some choices

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19
Q

How may an infant react to hospitalization? How do we manage it?

A

-Separation and stranger anxiety
-Primary nursing goal is to prevent and minimize separation
* Especially for children < 5 y/o
* Parents are not “visitors”
* Communicate with parents
* Familiar items from home
* Hold/cuddle/swaddle

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20
Q

How may a toddler react to hospitalization? How do we manage it?

A
  • Regression (normal), Tantrums & Separation anxiety
  • Autonomy
  • Daily routines and rituals
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21
Q

How may a preschooler react to hospitalization? How do we manage it?

A

-May view hospitalization as punishment
* Egocentric and magical thinking typical of age
* Preoperational thought
* Simple explanation and choices
* Encourage child to ask questions
* Allow choices

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22
Q

How may a school aged child react to hospitalization? How do we manage it?

A
  • Boredom. Fears death, abandonment, permanent injury, bodily mutilation
  • Increased need for attention
  • Simple explanations and choices
  • Respect privacy
  • Encourage verbalization of fears
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23
Q

How may an adolescent react to hospitalization? How do we manage it?

A
  • Struggle for independence and liberation
  • Decreased socialization & Separation from peer groups: encourage peer
    visits, use of teen room
  • Body image concerns
  • Loss of independence, rejects authority
  • Need information about their conditions
  • Be honest, explain in understandable terms, allow questions/verbalization of
    fears/choices
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24
Q

How do infants react to pain?

A

-Rigidity, thrashing, and arching
-Crying
-Facial grimace
-No understanding of relationship b/t stimuli & subsequent pain

Older infant:
-Withdrawal from painful stimuli
-Loud crying
-Physical resistance

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25
Q

What pain scale is appropriate for 12 and older?

A

Numeric pain scale

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26
Q

What pain scale is appropriate for infant to 3 years old?

A

FLACC

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27
Q

What pain scale is approprate for pre-school (4-6) to school-age (6-12) children?

A

Wong-Baker FACES

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28
Q

How will a young child respond to pain?

A

-Loud crying and screaminh
-“Ow”
-Thrashing of limbs
-Attempts to push away stimulus

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29
Q

How will a school aged child respond to pain?

A

-Stalling
-Muscle rigidity
-May use behaviors of younger child

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30
Q

How will adolescents react to pain?

A

-Less Vocal protest, less motor activity
-Increased muscle tension & body control
-More verbalizations

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31
Q

Pain management strategies for infants:

A

-Parents to comfort
-Distraction/comfort after procedure
-Swaddling, toys, singing, & pacifiers

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32
Q

Pain management strategies for preschoolers:

A

-Medical play/participation
-Tell them what they will see, hear and feel
-Paise and reward

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33
Q

Pain management strategies for school age:

A

-Distract with deep breathing, trivia, talking, holding hands, parental presence
-Explain procedure
-Allow play with equipment
-Allow participation
-Praise and reward

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34
Q

Pain management strategies for adolescents:

A

-Distract with imagery, tablet, talking, deep breathing, talking, jokes
-Ask pt for parental involement
-Allow participation
-Explain procedures
-Give choices
-Praise & reward

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35
Q

What can we give or do for mild pain?

A

-NSAID (ibuprofen)
-Non-opioid analgesic (Acetaminophen) Do NOT use with liver problems
-Comfort measures and distraction

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36
Q

What can we give or do for moderate pain?

A

-Distraction
-Regularly timed analgesics (mild opioids + acetaminophen)

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37
Q

What can we give or do for severe pain?

A

Strong analgesic like morphine

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38
Q

What are signs and symptoms of severe pain?

A

Pallor, sweating, dialated pupils, increase BP & RR, muscle tension

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39
Q

Ex of topical and local pain management

A

-EMLA (topical cream)
-Ice
-Intradermal local anesthetics
-Nerve distraction
TIMING is important

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40
Q

How can age-appropriate & therapeutic play help children?

A

-Decreases stress & provides relaxation
-Provides a sense of control & security
-Helps to lessen separation
-Release of tension
-Outlet for creativity
-Means to make therapeutic goals

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41
Q

Age appropriate play for infants:

A

-Solitary play
-Books, blocks, musical toys, mobiles, finger/hand games

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42
Q

Age appropriate play for toddlers:

A

Parallel play
- Push-pull, books, movies, coloring, matching games, ride on toys, imitative toys (dishes, house)

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43
Q

Age Appropriate play for preschoolers:

A

Associative play
-Role playing, simple board games, alphabet or color games

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44
Q

Age appropriate play for school age children:

A

Cooperative play
-Music, books, crafts, team sports, bike, skateboard, card/board games, video games, puzzles

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45
Q

Age appropriate play for adolescents:

A

Cooperative play
-Teams, video games, art, concerts, hanging out, social events

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46
Q

Common injuries & prevention for infants:

A

Head, fractures, burns, MVA, choking, suffocation
-Child-proofing, install car seat properly, warm bottles correctly, no cords or small toys, test water temp.

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47
Q

Common injuries & prevention for toddlers:

A

Falls, drowning, poisoning, burns
-Supervise, hot items and chemicals out of reach/locked, fenced in yard/pool

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48
Q

Common injuries & prevention for preschoolers

A

Poisoning, firearms, burns
-Teach about stranger danger, fire safety, check for unsafe objects on playground, wear helmets

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49
Q

Common injuries & prevention for school age children:

A

Sports, being struck, animal or insect bites
-Keep car doors locked, buddy system, do not swim alone

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50
Q

Common injuries & prevention for adolescents

A

Sports, being struck, overexertion, MVA
-Alcohol/drug education, safe driving, safety equipment, apply sunscreen

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51
Q

What are common, normal side effects for an immunization?

A

Tenderness, erythema, swelling, low-grade fever, drowsiness, anorexia, prolonged crying

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52
Q

Immunization contraindications:

A

-Severe febrile illness
-Allergies
-Severely immunocompromised children

53
Q

Etiology & s/s of Varicella (Chicken Pox)

A

Varicella Zoster virus
-Rash on trunk & face, Lesions being as macule and progress to vesicle then crust, pruritis

54
Q

Which infectious diseases require contact & airborne precautions?

A

Varicella (Chicken Pox) & Rubeola (Measles)

55
Q

Nursing care for Varicella (Chicken Pox):

A

-Supportive (anti-pruritic lotions, baths, antihistamines)
-Oral acyclovir to shorten duration

56
Q

Etiology & s/s of Rubella (German/ 3 days measles)

A

Rubeola Virus
-Sore throat, lymphadenopathy, mild fever, fine light pink maculopapular rash to face, chest to body.

57
Q

Nursing care for Rubella (German/3 day measles)

A

-Supportive (antipyretic)
-Educate on isolation (1 week after rash starts)

58
Q

Etiology & s/s of Rubeola (measles)

A

Morbillivirus
-Moderate fever, cough, conjunctivitis, photophobia, Koplick’s spots appear 2 days b/f rash, fever to 105, rash fades & temp drops 4-7 days

59
Q

Nursing care for Rubeola (measles)

A

Supportive (antipyretics, bedrest and fluids)

60
Q

Etiology & s/s of Haemophilus Influenza Type B

A

Haemophilus Influenza Type B Bacteria
-Upper RI, OM, sinusitis

61
Q

Nursing care for Haemophilus Influenza Type B

A

Antibiotics

62
Q

Etiology & s/s for Influenza

A

Virus A, B, or C
-Rapid onset of high fever, myalgia, HA, sore throat, nonproductive cough

63
Q

Nursing care for influenza

A

-Supportive (antipyretics)
-Isolation until s/s subside

64
Q

Etiology & s/s of Mumps

A

Paramyxovirus
-Mild & systemic-low-grade fever, malaise, anorexia, ear pain, HA, parotid glands enlarge

65
Q

Etiology & s/s for Pertussis (Whooping Cough)

A

Bordatella pertussis bacteria
-Mild respiratory illness with whooping cough

66
Q

Nursing care for Pertussis (Whooping Cough)

A

-Antibiotics
-Keep open airway
-Monitor oxyen saturation
-Treat family & anyone in contact

67
Q

Etiology, s/s, & isolation for Tetanus

A

Clostridium tetani
-HA, Stiff neck & jaw that become muscle spasms, may progress in the body and lead to seizures
-Standard

68
Q

Nursing care for Tetanus:

A

-Antibiotics
-Surgical debridement
-Tetanus immune globulin (TIG)

69
Q

Etiology & s/s of Scarlet Fever

A

-Group A beta-hemolytic streptococci, often follows pharyngeal infection with GAS
-Acute onset fever, sore fever, rhinitis, tender cervical nodes, sandpaper-like rash appears (12-48 hrs after onset. Fades 3-4 days, tips of toes and finger peel, day 5-5 a bright red strawberry tongue apperance

70
Q

Nursing care for Scarlet Fever

A

Antibiotics
-Can return to school after 24 hours on antibiotics
-Supportive care for pharyngitis & fever

71
Q

Etiology & s/s pneumococcal disease

A

Streptococcus pneumonia bacteria
-URI, high fever, pleuritic chest pain, cough, chills, dyspnea, dry or productive cough with hemoptysis

72
Q

Nursing care for pneumococcal disease

A

Penicillin or other, IVF

73
Q

Etiology, mode of transportation, & s/s for Mononucleosis

A

Epstein-Barr Virus
- Saliva/blood
-Fever, pharyngitis, cervical and occipital lymphadenopathy

74
Q

Dx & nursing care for Mononucleosis

A

-Monospot test
-Bedrest & avoidance of contact sports
-Steriods if there are respiratory difficulties

75
Q

What is an important physiological effect that occurs witht the immobilized child?

A

Increased risk for developing venous stasis

76
Q

Nursing management for an immobilized child

A

-Activities to maintain/increase strength
-Prevent skin breakdown
-Nutrition (High protein/calories)
-Distractions
-Support

77
Q

What kind of vitamins/food should be provided to the immobilized child?

A

Hight protein, Vitamin D, and Calcium (sun/fortified foods, dairy, fiber)

78
Q

What are the clinical manifestations of clubfoot?

A
  • Plantar flexed
  • Inverted heel
  • Adducted forefoot
  • Rigid
79
Q

Medical interventions for Club foot

A

Try stretching 1st for 4-12 months q week
* Casting (serial) 6-12 weeks
* Browne splint 24 hs per day til 3 YOA
* Tenotomy in severe cases

80
Q

Nursing interventions for clubfoot

A
  • Passive ROM
  • Neurovascular assessment
  • Pain management
  • Cast care and follow up
  • Overcorrection/Reoccurrence
  • Growth & development delay
  • Reposition q 2 hours & elevate
  • Double Diaper
81
Q

What is Legg-Calve Perthes Disease?

A

Avascular necrosis of the femoral head

82
Q

What is Slipped Capital Femoral Epiphysis Disease?

A

Occurs when the femoral epiphysis slips through the epiphysis (growth plate).

83
Q

What are the clinical manifestations of Legg-Calve Perthes Disease?

A

-Hip soreness or stiffness
-Pain that increases with activity and decreases with rest
-Painful limp
-Quads atrophy
-Joint dysfunction
-Limited ROM

84
Q

Medical care for Legg-Calve Perthes Disease

A

-Non-weight bearing at first
-Montreal abductor cast for a yr+ or use of Toronto brace
-Osteotomy (most common)

85
Q

Nursing care for Legg-Calve Perthes Disease

A

-History
-Focused Assessment, neurovascular checks
-Pain management
-Skin care

86
Q

Education/Discharge instructions for Legg-Calve Perthes Disease

A

-Conservative therapy
-Avoid weight bearing and maintain mobility restrictions

87
Q

Clinical manifestations for Slipped Capital Femoral Epiphysis Disease:

A

-Appears gradually
-Pain in the groin or reffered pain to the thigh or knee
-Pain during internal rotation of the hip
-Hip does not fully rotate
-Shorter leg on affected side
-Limp favoring affected side

88
Q

Nursing care for Slipped Capital Femoral Epiphysis Disease:

A

-No weight bearing
-No ROM
-Bedrest with traction to decrease synovitis

89
Q

Medical interventions for Slipped Capital Femoral Epiphysis Disease:

A

-Pinning bone across epiphyseal plate
-Bear weight after 1 week
-Osteotomy (severe)

90
Q

General medical interventions for fractures:

A
  • Closed reduction; immobilization
  • Open reduction/internal fixation; immobilization
91
Q

General Nursing interventions for fractures:

A
  • History
  • Perform neurovascular checks
  • Perform pin care
  • Administer antibiotics and pain medication
  • Prevent complications
92
Q

General education/discharge information for fractures:

A
  • Immobilization care (clean & dry)
  • Home environment
  • Nutrition (increased calcium and Vitamin D)
  • Use of immobilization and assistive devices
93
Q

Neurovascular assessment

A

-Pain & point of tenderness
-Sensation (paresthesia)
-Motion (movement distal to the fracture site)
-Temp
-Capillary refill
-Color
-Pulses (distal)

94
Q

When to seek medical care for neurological assessment:

A

Numbness, tingling and capillary refill longer than 3 seconds

95
Q

What is a sprain? S/S?

A

Overstreching or tearing of ligaments
-Pain, swelling, bruising, or instability

96
Q

What is a strain? S/S?

A

Overstreching or tearing of muscles or tendons
-Pain, limited motion, muscle spasms/cramping, swelling

97
Q

Medical interventions for soft tissue injury:

A

Immobilization & consut PT

98
Q

Nursing interventions for soft tissue injury:

A

-RICE
-Pain management
-EDU
-Physical activity restrictions for 2-3W

99
Q

Medical intervention for Polydactyly/Syndactyly

A

Surgery (remove or separate digits)

99
Q

What is Polydactyly/Syndactyly?

A
  • Poly: more than the normal number of fingers or toes.
  • Syn: two or more phalanges are fused together
100
Q

Nursing interventions for Polydactyly/Syndactyly

A
  • Provide comfort, pain medication
  • Neurovascular assessments/bleeding
  • Infection prevention, pin care, antibiotics
  • Child/family support
101
Q

How to dx osteomyelitis:

A

X-ray, Lab, Blood Cultures

102
Q

Clinical manifestations for osteomyelitis:

A

Pain at rest, Brodie abscess, muscle spasm, redness, swelling, self-limiting motion of affected limb

103
Q

Medical interventions for osteomyelitis:

A
  • Debridement of bone, stabilization with Kirshner wire
104
Q

Nursing interventions for osteomyelitis:

A
  • Administer course of broad-spectrum antibiotics (educate on compliance)
  • Blood cultures
  • Monitor laboratory values
  • Palliative measures, such as rest, oral pain medication, good
    nutrition, and diversionary activities
  • Postoperative nursing care
105
Q

Etiology of Juvenile arthritis:

A
  • Autoimmune inflammatory process with unknown
    origin and thought to be triggered by an infection.
  • Peak onset 1-3yo and 8-12yo
  • Females twice as likely as males
  • Leading cause of blindness and disability in children
106
Q

Clinical Manifestations of Juvenile Arthritis

A
  • Swollen, tender, warm joints
  • Limited ROM
  • Malaise, fatigue, lethargy
  • Fever
  • Stiffness, especially in the morning or after long periods of rest
107
Q

How to dx Juvenile Arthritis:

A
  • Labs: WBC, ESR
  • XRAY/Bone scan
108
Q

Medical interventions for Juvenile Arthritis

A
  • Medications
  • PT
  • Surgical is not usually indicated unless joint replacement is needed
109
Q

Nursing interventions for Juvenile Arthritis:

A
  • Age dependent, provide distraction and supportive care
  • Active & Passive ROM
  • Pain management
  • Pain-NSAIDS (Ibuprofen, Naproxen), distraction, Child-Life Department
  • Steroids-Glucocorticoid (Prednisone)
  • Disease Modifying Antirheumatic Drugs (DMARDS)- Methotrexate, Cyclophosphamide, Remicade
110
Q

Education/Discharge instructions for Juvenile Arthritis:

A
  • Exercise to gain muscle strength (isometric such as planks or wallsits)
  • Positioning & preserve joint functions
  • Use of heat/cold
  • Diet high in fiber, protein, calcium, and fluids.
111
Q

Duchenne Muscular Dystrophy Clinical Manifestations

A
  • Gower’s sign: inability to sit in the floor and get up
  • Muscle wasting and weakness
  • Respiratory changes
  • Waddling, wide-based gait
  • Calf muscles are weak and hypertrophied
  • Leg, pelvis, arm, shoulder and cardiac muscles are weak and hypertrophied
112
Q

How to dx Duchenne Muscular Dystrophy

A

Muscle Biopsy & electromyelogram

113
Q

Medical interventions for Duchenne Muscular Dystrophy

A
  • Antibiotics (tend to get pneumonia due to decrease in strength of the accessory muscles)
  • Coordinate with PT, OT, RT
  • Surgical intervention usually not required
114
Q

Nursing interventions for Duchenne Muscular Dystrophy

A
  • Help patient maintain independent living for as long as possible
  • Prevent respiratory infections
  • Monitor skin
  • Ensure good nutrition
  • Assess mobility
  • Foster independence and self-care
  • Provide emotional support
115
Q

Education for Duchenne Muscular Dystrophy

A
  • Related to disease progression and nursing care
  • Support groups
  • Hospice
116
Q

Clinical manifestations of scoliosis

A

Asymmetric changes in spine
* Uneven shoulders
* Shoulder / scapular prominence
* Rib / chest hump while bending
* C or S shaped spine

117
Q

Collaborative care for scoliosis:

A
  • Bracing (must wear for 23hrs/day)
  • Exercise/PT will help back muscles gain strength
118
Q

Considerations for Spinal fusion surgery (Scoliosis)

A
  • PCA pain pumps or epidurals are helpful for first couple days. Switch to oral Post-op day 3 (Combination products like Percocet, Norco, etc.)
  • Passive ROM very important
  • Ambulation usually around post-op day 5
  • Must use log-rolling technique
  • HOB no more than 30 degrees without brace on
  • No twisting or bending, no lifting of heavy objects, no contact sports for 2 years
  • Child can return to school in 4-weeks after surgery
119
Q

Developmental Dysplasia of the Hip: Etiology

A
  • The acetabulum is flat, rather than round and cuplike in shape
  • Breech position can increase likelihood
120
Q

Clinical Manifestations & Dx for Developmental Dysplasia of the Hip:

A
  • Asymmetric skin folds
  • Barlow + Ortolani maneuvers
  • Ultrasound
  • CT
121
Q

Collaborative Care for Developmental Dysplasia of the Hip:

A
  • Pavlik harness
  • Hip spica cast
122
Q

Pavlik Harness

A
  • Newborn to 6 months for abduction of the hip
  • It’s a chest strap, two shoulder straps and two stirrups made of canvas, Velcro and buckles
  • The harness places the femur in the socket at the correct angle and keeps the legs apart
  • Recommend that the baby wear it 24 hours a day for 6 to 12 weeks
123
Q

Hip Spica Cast

A
  • Ages 6 to 24 months
  • In case of dislocation unrecognized until child begins to stand and walk; use traction and cast immobilization (spica)
  • A surgical closed reduction is done, and child is in a hip spica for 12 weeks usually
124
Q

Cast care

A
  • No fingertips, “palm”
  • No dryer
  • Elevate & reposition q 2 hours
  • Observe for bleeding or discharge
  • Neurovascular checks
  • Monitor for compartment syndrome 5 Ps

Education/Discharge
* Cast care at home
* Prevent foreign objects in cast

125
Q

Metatarsus Adductus (Varus)

A

Congenital foot deformity
Can be manually manipulated back to neutral position

126
Q

Clinical manifestations of Metatarsus Adductus (Varus)

A

-High arch
-Visible curved leg and separated big toe
-Forefoot turned inward

127
Q

Treatment for Matatarsus Adductus (Varus)

A

Stretching of the turned foot or wearing shoes of the opposite foot

Children's Health (4 decks)

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