Exam 1 Flashcards
when is the fastest growth period in peds?
infancy is the fastest growth period, followed by adolescence
cephalocaudal
head to tail (brain develops first)
proximodistal
center to periphery (control of trunk first, then fine motor control of hands and feet comes at the end of infancy)
head lag
at one month
head should come in line with body when you pull baby to sitting
2 mos
baby can help you pull them to sitting by pulling arms inward
4 mos
able to maintain a 90 degree angle when prone
4 mos
can turn head while prone
6 mos
start to put arms out to support upper body
2mos
can maintain sitting pos with help
4 mos
sits lopsided without assistance
7 mos
sits upright on his own
8 mos
when can an infant stand holding onto furniture?
9 mos
can toddle and walk
7 mos
can maneuver a certain direction when walking with assistance
10 mos
when should you stop using a mobile that secures to the side of the crib?
6 mos
when is a child ready for solid foods?
7 months
when do first teeth typically sprout?
7 mos
When should you expect a baby to say “mama” and “dada”?
8-9 mos
when does an infant smile and laugh
3 mos
knows object permanence
9 mos
finds hidden objects easily
10 mos
imitates other’s activities
12 mos
when do kids start to see color?
3 mos
uses cup well
15 mos
binocular vision developed
15 mos
refers to self and knows own name
15 mos
jumps in place
18 mos
identifies geometric forms
18 mos
50% of adult height, brain 90% adult size; goes up stairs (with two feet on each step), runs well with wide stance, holds crayon, follows simple directions, can use short sentences; able to speak 300 words
24 mos
4 times birth weight, good hand finger coordination
30 months
can copy a circle and remembers/repeats three numbers
36 mos
skips and hops on one foot
4 yrs
throws and catches balls
5 years
gains 4-5 lbs/year and 2-3”
preschool growth and development
imitative and dramatic play; associative play (interaction with each other) imitates same sex roles in play, provide toys to develop skills (tricycle, clay, paints, swings, balls,) parental supervision of TV (an hour a day-TV takes away from gross and fine motor development)
preschool play
parallel play
toddlers
gains 5 lbs a year, height 1-2”/year
vision 20/20 by 6-7 years old, myopia may appear by 8 years old. secondary sex characteristics begin at age 10 for girls, 12 for boys, greenstick fractures common, loose first teeth around age 6
school age growth and development
cooperative play on a team, develops sense of accomplishment
school-age play
oral temp at what age?
4 yrs
where is the apex of heart in kids
4-5th intercostal space, midclavicular line (heart shifted up and to the left)
posterior fontanel closes
2-3 mos
anterior fontanel closes
12-18 mos
losa ears
indicator of down’s syndrome or other neuro/genetic d/o
why are respiratory probs so prevalent in children?
preemies lack surfactant shorter distance between structures smaller airway diameter fewer alveoli neonates are obligate nose-breathers less cartilage in airway walls immature breathing muscles thinner chest wall higher metabolic rate (requires more oxygen) total body response to respiratory infection (high fever, vomiting, diarrhea)
major signs of respiratory distress
tachypneic, anxiety, expiratory grunting, use of accessory muscles, nasal flaring, retractions, tachycardia
what causes wheezing?
inflammation, constriction of airway
what causes rhonchi?
obstruction, often fluid, sounds rough
respiratory assessment
respirations skin color cough LOC pulse hydration
Respiratory Failure
is a clinical state of inadequate oxygenation, ventilation, or both
Respiratory Arrest:
the absence of breathing
how do you determine LOC in a non-communicable child?
Pediatric GCS
alertness
verbal
movement
preventing respiratory distress in children
Avoid exposure to known infection
Good handwashing and hygiene
Good hydration to keep secretions thin
Identify known triggers for asthma
Outline dosage, administration, and adverse reactions to medications
Explain rationale for breathing exercises for all hospitalized patients
Otitis Media
most common illness in infants and young children
rare after age 6
risk Factors: young age, day care, formula feedings, smoking exposure
If over age 2, palliative care 3 days and reassess (AAP); no OTC Rx other than Tylenol
USUALLY OF VIRAL ORIGIN!!!! WHAT?!?!
Cystic Fibrosis
most important characteristic of the disease for a nurse to teach about is thick respiratory mucous. (ALL secretions are thickened: GI, reproductive, etc)
CF is a multisystem disorder of exocrine glands
First sign of Disease: meconium ileus (no stool in the first 24-48 hours of life)
sweat test:
frequent respiratory infections, dyspnea, clubbing, fatty stools, stunted growth
Asthma
chronic inflammation of airway as reaction to “triggers”
calm them down, bronchodilator (albuterol-smooth muscle relaxer) or Xopenex (levalbuterol) if allergic to albuterol. ensure circulation.
Acute LTB
Inflammation of airway following viral infection
Gradual onset*
Symptoms worsen at night
Discharge when able to take oral fluids and no stridor at rest
croupy seal cough
Epiglottitis
Inflammation of epiglottitis, usually after respiratory infection Sudden onset* Usually 2-8 years DO NOT EXAMINE THROAT!** may further irritate throat and constrict airway more; drooling (cant swallow), cherry red epiglottis, tongue hanging out with stridor, coughing Constant respiratory assessment Always be ready for intubation give bronchodilators #1 cause is Hflu (vaccine avail)
Pneumonia
Inflammation of the lungs
Mild fever and runny nose wheezing, retractions, tachypnea
Usually due to RSV, M. pneumoniae
Bronchitis/Bronchiolitis
Inflammation of Bronchioles OR trachea/bronchi
RSV
Recent URI (anorexia, thick secretions, distress)
Copious secretions
Educate parents on how to use bulb syringe and suction
Foreign Body Aspiration
Inhalation of foreign body
Most common age is 1-3 yrs
Most common objects: hot dogs, coins, raisins, grapes, toys, rocks
Usually lodges in right main stem bronchus
Sudden coughing/gagging –>symptoms of respiratory infection
Education!
meconium ileus
first sign of CF in a newborn: abd distension, vomiting, failure to pass stools, rapid development of dehydration
pulmonary manifestations of CF
initial sign: wheezy respirations, dry, nonproductive cough
Eventually: increased dyspnea, paroxysmal cough, evidence of obstructive emphysema and patchy areas of atelectasis
Progressiove: overinflated, barrel-shaped chest, cyanosis, clubbing, repeated episodes of bronchitis and bronchopneumonia
sweat test
(pilocarpine iontophoresis) consistent finding of abnormally high sodium and chloride concentrations in sweat is a unique characteristic of CF; a sweat chloride > 60 mEq/L is diagnostic of CF
treatment of CF
aggressive pulmoanry toileting, diet 150% RDA, pancrease enzyme with meals
what is overall goal of asthma?
prevent attacks
RSV vaccine
respiratory synctial virus
synagis
RSV
fever, copius secretions, respiratory distress, decreased appetite.
tracheostomy
usually seen with vocal cord paralysis, BPD, or neuro deficit
Must have extra trach (one same size and one a size smaller), suction catheters, and vent bag at bedside.
Normal Denver II
no delays and only 1 caution
Suspect Denver II (retest in 1-2 weeks)
2+cautions, 1+delay
if suspect after retest, then consider referral
Untestable Denver II
3+refusals to left of age line (retest in 1-2 weeks)
what do you tell parent before administering Denver II?
not an IQ test
purpose of test compares your child’s development to other children
reassure that the child is not expected to perform ALL items
What do you ask before administering Denver II?
were they premature, and what is their birthday
What do you ask after completing Denver II?
was your child’s behavior today typical?
when do you score a test item with NO?
no opportunity. when child has not been given a chance to learn that item: prepare cereal
What is the difference between a caution and a delay?
a delay is a futured item that lies completely to the left of the age line (shade it), and a caution is a futured item that lies ON the age line. mark this with a C to the right of the item.
The “Art” of pediatric nursing
learn to build on a family’s strengths
minimize physical and psychological pain (atraumatic care)
Balance involvement with families
healthy people 2010 victories
access to quality health services
environmental health
immunization and infectious diseases
occupational safety and health
healthy people 2010 defeat
nutrition and overweight
peds health indicators
immunization status second hand smoke exposure infant deaths and preterm births obesity teen depression oral care
number one cause of death in children over 1 year
injuries and accidents; teach parents about safety and accident/injury prevention!!
biggest preventable health concerns today for children
nutrition, obesity and DM II
immunizations
dental care (low-income families)
what is the most common cause of death in children UNDER 1 year?
disorders relating to short gestation and unspecified low birth weight SIDS maternal complications of pregnancy sepsis respiratory distress circulatory diseases accidents **educate on good prenatal care and genetic screening!
2 essential areas of focus for parents
interpersonal skills and a basic understanding of childhood growth and development
3 basic types of parenting/discipline
authoritarian: do what i say without question
permissive: only intervenes if danger is imminent
authoritative: leader of the family, allow some freedom, but with limits. Prevalent parenting style in our American society
3 special concerns for adoptive families
attachment
telling the child he/she was adopted
identity formation during adolescence
a child’s self-concept is influenced by
his or her beliefs about who he/she is and how he/she fits into society
what families are at highest risk for health problems?
homeless, migrant, and poverty-affected families
mormon/LDS children religious consideration
may refuse to remove sacred gowns
Hindu religious consideration
don’t remove the red/colored thread around wrist
Muslim children
same sex bathing
Christian Science and Jehovah’s Witnesses
medical care refusal-document!!
moxibustion
Moxibustion is a form of heat therapy in which dried plant materials called “moxa” are burned on or very near the surface of the skin. The intention is to warm and invigorate the flow of Qi in the body and dispel certain pathogenic influences.
emancipated minor
1) TX resident
2) 17 years of age, or at least 16 yrs, living separate and apart from parents
3) must be self-supporting and managing their own financial affairs
* *Emancipated minors can give consent for their own medical procedures
mature minor doctrine
mature minors may give consent to medical procedures
number one need of caregivers
information
to be legal, informed consent must be
- competent and sound mind
- recieve relevant information in order to make such a decision
- act voluntarily and without coersion
gold standard for sterile urine collection in pediatrics
suprapubic tap
order of blood draw
blood culture tube gets filled first so as not to contaminate the sample
