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NURS 405 Exam 1 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Focuses of pediatric nursing

A

Treating disease, health promotion, and disease prevention

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2
Q

Anticipatory guidance definition

A

The process of understanding upcoming developmental needs and then teaching caretakers to meet those needs

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3
Q

Essential roles of pediatric nurse

A
  1. Understand physiological changes to child vs adult
  2. Recognize these differences quickly
  3. Apply developmental age to care
  4. Understand common conditions and anticipatory guidance/health promotion (maximize health outcomes)
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4
Q

Six standards of practice in nursing

A
  1. Assess patient
  2. Nursing diagnosis (NANDA)
  3. Identify outcomes
  4. Create a plan/interventions
  5. Implement interventions
  6. Evaluate
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5
Q

Family-centered care

A

Child and family are intertwined; child outcomes tie closely with family dynamics. Nurse supports this, often through therapeutic relationship.

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6
Q

Anterior fontanel closes:

A

At 12-18 months of age

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7
Q

Posterior fontanel closes:

A

At 2-3 months of age

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8
Q

Chief complaint:

A

Why they came in

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9
Q

History of present illness (HPI):

A

When did it start, how much does it bother you, what have you tried for relief, etc.

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10
Q

Past history (PMH):

A

Other conditions (associated or not), birth history for kids

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11
Q

Current health status:

A

Current other conditions

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12
Q

Familial/hereditary disease:

A

Predispositions

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13
Q

Review of systems:

A

Ask about a focused system and what’s going on

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14
Q

Psychosocial data:

A

Family assessment, home life, etc.

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15
Q

Developmental data:

A

Developmental age of patient

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16
Q

Considerations for newborn/infants (<6 months)

A
  1. Keep parent present
  2. Use distraction (i.e. noise)
  3. Look at activity level, mood, and responsiveness to handling (leave in parents’ arms if already there and you’re able to)
  4. Be flexible
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17
Q

Considerations for infants >6 months

A
  1. Increased separation/stranger anxiety
  2. Observe general activity, mood, and responsiveness
  3. Smile
  4. Use pacifier as needed
  5. Be flexible
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18
Q

Considerations for toddlers (1-3 years)

A
  1. Stranger anxiety (use caregiver)
  2. Explain each step of assessment
  3. Let patient have some control - may prevent child from acting out
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19
Q

Considerations for preschool (3-5 years)

A
  1. Involve play
  2. Give simple explanations
  3. Allow control
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20
Q

Considerations for school-age (6-12 years)

A
  1. Anticipate increased desire for modesty
  2. Privacy vs. parent/sibling present
  3. Head to toe assessment can begin here
  4. Explanations should be more logical and detailed
  5. Give empowerment/involvement
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21
Q

Considerations for adolescent (13-18 years)

A
  1. Modesty and privacy are important
  2. May have fear of something being permanent
  3. Continue with head to toe assessments
  4. Give reassurance
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22
Q

BMI can be measured after age:

A

2

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23
Q

BP can be measured after age:

A

3 for outpatient; may be used at any age for inpatient

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24
Q

Concerns of growth

A

Head circumference, height (should follow curve; concern if they go way high or way low off of the curve)

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25
Q

Skin assessment

A
  1. Inspection (even color distribution, bruising, abnormalities (flushing, cyanosis, pallor)), lesions
  2. Palpation (temp, texture, moistness, resilience, turgor, edema)
  3. Capillary refill (<2 seconds)
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26
Q

Hair assessment

A
  1. Inspection (color, distribution, abnormalities (lice), hair loss)
  2. Palpation (texture)
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27
Q

Head and face assessment

A
  1. Palpate skull sutures in <2 years old
  2. Palpate fontanels in 18 months or less (both closed by 18 months)
  3. Head circumference in <3 years
  4. Assess facial symmetry (droopy, even, etc.)
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28
Q

Eye assessment

A
  1. Inspect external structures (eye size/spacing, eyelids, eyelashes, eye color, pupils and pupillary response); variations in color of iris may indicate conditions
  2. Inspect eye muscles (extra ocular movements, corneal light reflex, cover uncover test)
  3. Check blink reflex and tracking in infants/toddlers
  4. Use standard visualization charts >3-4 years of age
  5. Inspect internal structures, red reflex, branching of blood vessels, optic disc margin, macula
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29
Q

Ear assessment

A
  1. Inspect external structures (position and characteristics)
  2. Inspect tympanic membrane (using otoscope)
  3. Perform age-appropriate hearing assessment: infant and toddler you make noise and check reaction; preschool and older children you whisper words and may use bone and air conduction of sound (Weber/Rinne)
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30
Q

Nose assessment

A
  1. in kids, nostrils are smaller and more easily obstructed - inspect and palpate patency
  2. inspect external nose - shape, size, symmetry, midline placement
  3. inspect internal nose - mucus membranes, nasal septum, discharge
  4. inspect sinuses/palpate
  5. assess smell with easily recognized smells (i.e. peppermint, orange, etc.)
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31
Q

Mouth/throat assessment

A

Mouth: inspect lips, teeth, gums, buccal mucosa, tongue, hard and soft palate, and tonsils; inspect for odors; inspect suck reflex in infants for strength
Throat: inspect color, swelling, lesions, tonsils

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32
Q

Neck assessment

A
  1. make sure trachea is midline and symmetrical
  2. check range of motion
  3. palpate cervical lymph nodes and thyroid
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33
Q

Chest/lung assessment

A
  1. inspect size, shape, movement, respiratory effort (use of accessory muscles - the higher up it is, the more concerning), respiratory rate (remember this is age-dependent)
  2. palpate chest wall and for tactile remits/hyperresonance
  3. auscultate (intensity, pitch, rhythm of breath sounds - absent breath sounds = TROUBLE)
  4. Percuss
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34
Q

Heart assessment

A
  1. Inspect apical pulse (much more reliable in kids than in adults); inspect capillary refill, skin color, respiratory distress
  2. Palpate apical pulse and extremity pulses
  3. auscultate rhythm and rate, heart sounds, splitting of heart sounds (splitting in s2 is ok at young age), murmurs
  4. BP if >3 years old outpatient and in all inpatient
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35
Q

Abdominal assessment

A
  1. Inspect shape, contour, abdominal movement, inguinal area
  2. Auscultate bowel sounds
  3. percuss dullness vs. tympani (more tympani over stomach, more dullness over liver when felt)
  4. Palpate lightly first, then deep
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36
Q

Musculoskeletal assessment

A
  1. Inspect bones, muscle joints for alignment, contour, skin folds (important for infants for hip dysplasia - asymmetric skin folds is considered an early clinical sign for diagnosing hip dysplasia), length, deformities, size, discoloration, ease of movement
  2. Inspect lower extremities (hips, skin folds, legs, feet). in legs, look for genu varum vs. genu valgum
  3. inspect upper extremities (alignment, nails, count fingers and creases)
  4. palpate muscle tone (hypertonic/spastic or low tone/unable to hold something), masses, tenderness
  5. posture/alignment of spinal cord
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37
Q

Nervous system assessment

A
  1. cognitive function (behavior, expressions, communication, memory, level of consciousness
  2. cerebellar function (balance, coordination, gait)
  3. cranial nerve function (olfactory, optic, etc.)
  4. sensory function (superficial tactile sensation, superficial pain sensation)
  5. infant primitive reflexes
  6. superficial/deep tendon reflexes
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38
Q

infant age

A

birth-1 year

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39
Q

toddler age

A

1-2 years

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40
Q

preschooler age

A

3-5 years

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41
Q

school-age age

A

6-12 years

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42
Q

adolescent age

A

13-18 years

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43
Q

infant stressors

A

separation anxiety (especially 6-9 months), stranger anxiety, sleep deprivation, and sensory overload

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44
Q

infant care recommendations

A

encourage parent presence, eliminate excess noise, do the least unpleasant thing first, and bring security item from home

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45
Q

toddler stressors

A

separation anxiety, loss of self-control, and fears (of dark, injury, etc.)

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46
Q

toddler care recommendations

A

encourage parent presence in care, allow choices when possible (i.e. when doing vitals), and explain things in simple terms (only explain just before the event, not in advance)

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47
Q

preschool stressors

A

fear (huge in this age group), guilt (as they do not understand cause and effect), and may see hospitalization as a punishment

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48
Q

preschool care recommendations

A

create a routine with the family, encourage with play, encourage choices/independence, encourage parent involvement (as they know the child best)

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49
Q

school-age stressors

A

privacy/modesty, fear of injury/pain/death, and separation anxiety

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50
Q

school-age care recommendations

A

honesty about procedures (they are rational and do understand cause and effect), promote child participation in care, encourage creative activities (i.e. music, art, etc. that are in line with child’s hobbies), and use child life specialist

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51
Q

adolescent stressors

A

loss of independence/privacy/control (at this age they know what they want), fear of injury (associated with body image), and separation from peers, school, and home

52
Q

adolescent care recommendations

A

encourage social/coping skills, and allow visiting hours/internet/phone access/etc.

53
Q

family stressors

A

parental role change (now they are not the ones that are caring for the child), stress of missing work/expenses/other siblings/guilt (especially if hospitalization is result of injury/accident)

54
Q

family care recommendations

A

give regular updates on the child’s condition, encourage/support/resources, build trusting relationship, assess resources (including finances and family dynamics)

55
Q

explanation of procedure for infant

A

none, explain to parents

56
Q

explanation of procedure for toddler

A

give explanation just before procedure

57
Q

explanation of procedure for school-age

A

simple/short explanations, drawings; explain right before procedure and change words as needed to meet their understanding

58
Q

explanation of procedure for adolescent

A

oral and written clear/complete explanation; may give explanation in advance

59
Q

pediatric early warning systems (PEWS) scale

A

evaluates for decompensation ahead of vital signs (behavioral, CV, respiratory); higher scale is more concerning

60
Q

discharge begins:

A

at admission

61
Q

response to pain <6 months

A

jerky movements, chin quiver, crying

62
Q

response to pain 6-12 months

A

facial grimace, disturbed sleep, irritable, crying, arching back

63
Q

response to pain 1-3 years

A

aggressive behavior (as they cannot verbally explain yet), disturbed sleep, crying/screaming, “booboo”

64
Q

response to pain 3-6 years

A

more localized description of pain, aggressive behavior, etc.

65
Q

response to pain 7-9 years

A

clench fist, withdrawn, specifies location/type/intensity/characteristics

66
Q

response to pain 10-12 years

A

stress/anxiety, try to be brave/appear brave, describes pain accurately and reliably

67
Q

response to pain 13-18 years

A

controlled behavioral response, sophisticated descriptions

68
Q

rapid/shallow breathing in response to pain may lead to

A

alkalosis/hypoxia

69
Q

increased metabolic rate/perspiration in response to pain may lead to

A

fluid/electrolyte loss

70
Q

depressed immune system in response to pain may lead to

A

increased risk of infection

71
Q

nausea/anorexia in response to pain may lead to

A

poor/inadequate nutrition

72
Q

increased pain sensitivity in response to pain may lead to

A

memory of painful experiences

73
Q

fentanyl patch

A

use in >12 year olds, used for continuous pain control. onset = 12-24 hours, duration = 72 hours

74
Q

IV therapy

A

fastest route, continuous meds provide stable live. reassess in 15-30 mins

75
Q

oral therapy

A

convenient and cost effective but takes 1-2 hours to reach peak effect. reassess between 30-60 minutes (pain should at least be minimized by this point)

76
Q

topical/transdermal therapy

A

anesthetics should be applied one hour before procedure and will numb in 15 mins

77
Q

PCA therapy

A

often used after injury or for chronic conditions and is computerized/controlled by patient. use in older school age and adolescents at appropriate developmental age. parents should not control these.

78
Q

opioid therapy

A

given for severe pain (may be oral, subQ, IM, IV). side effects = sedation, N/V, constipation, urinary retention, respiratory depression (this is urgent). examples = morphine, codeine, hydromorphone, methadone, oxycodone, fentanyl

79
Q

NSAID therapy

A

used for mild to moderate and chronic pain. used especially for bone/inflammatory disease. not given in <6 months unless indicated and should not be given with kidney disease. primarily oral (but may also be IV or IM). examples = aspirin (never give <19 years), Motrin, naproxen, ketorolac.

80
Q

acetaminophen/tylenol therapy

A

used for mild/moderate and chronic pain (but is not anti-inflammatory). give every 4-6 hours (and may alternate with NSAIDs). do not use in patients with liver disease. watch for double dosing as many meds also contain acetaminophen.

81
Q

Nonpharm therapy

A

relaxation, distraction, breathing, sucrose solution (infants), application of heat/cold, etc.

82
Q

Anxiolysis definition

A

minimal sedation (awake but relaxed) and not fully aware

83
Q

moderate sedation

A

low dose so child can self-maintain airway and has appropriate response to stimuli

84
Q

deep sedation

A

controlled state of unconsciousness, intubated; sedation drugs include benzodiazepines, barbiturates, analgesics. Monitor respiration, color/appearance, and vitals with sedation.

85
Q

pain med reassessment times

A

IV: 15 mins
IM: 30 mins
oral/nonpharm: 30-60 mins

86
Q

cephalocaudal development

A

head to foot development (i.e. kids gain head control before they begin walking; meet one milestone before they can move on)

87
Q

proximodistal development

A

muscle control goes from the trunk out (i.e. kids learn to sit up before they start standing)

88
Q

Freud theory focus

A

unconscious thought

89
Q

freud stages of development

A 
oral (birth-1 year)
anal (1-3 years)
phallic (3-6 years)
latency (6-12 years)
genital (12-adulthood)
*think that freud basically follows normal age groups we study*
90
Q

freud’s oral stage

A

(birth-1 year): infant derives pleasure from the mouth (i.e. sucking and eating). disruption at this stage causes emotional issues or impaired bonding with the parent/caregiver. for example, offer pacifier.

91
Q

freud’s anal stage

A

(1-3 years): potty training, the child derives pleasure from control over body secretions; kids may be constipated often at this age.

92
Q

freud’s phallic stage

A

(3-6 years): genitalia focus for kids, working out relationship with parents (child identifies here with parent of the opposite sex but by the end of this stage identifies with the same sex parent). accommodate for children who want to be with male or female nurses.

93
Q

freud’s latency stage

A

(6-12 years): sexual energy is at rest and is channeled into productive activities, learning skills, etc. Support modesty in this stage. the chid places emphasis on privacy and understanding the body.

94
Q

freud’s genital stage

A

(12-adulthood): the adolescent’s focus is on genital function and relationships. ensure privacy and education. testicular exams for boys.

95
Q

Erikson theory focus

A

psychosocial

96
Q

Erikson stages of development

A

trust vs. mistrust (birth-1 year)
autonomy vs. shame and doubt (1-3 years)
initiative vs. guilt (3-6 years)
industry vs. inferiority (6-12 years)
identity vs. role confusion (12-18 years)
think that Erickson basically follows normal age groups we study

97
Q

erikson’s trust vs. mistrust

A

(birth-1 year): ability of infant to trust others (parents are providing food, comfort, shelter, etc.)

98
Q

erikson’s autonomy vs. shame and doubt

A

(1-3 years): toddlers start to develop self control and start wanting independence (includes potty training). may have doubt/shame if no independence

99
Q

erikson’s initiative vs. guilt

A

(3-6 years): child is learning limits, exploring, trying to develop new things. may have guilt/lack of purpose if they do not gain independence. the child likes to initiate play activities

100
Q

erikson’s industry vs. inferiority

A

(6-12 years): industry is a sense of confidence and purpose. kids here develop hobbies, interests, and creativity. the child gains a sense of self-worth from involvement in activities.

101
Q

erikson’s identity vs. role confusion

A

the adolescent’s search for self-identity leads to independence from parents and reliance on peers.

102
Q

Piaget theory focus

A

cognitive

103
Q

Piaget’s stages of development

A

sensorimotor (birth-2 years)
preoperational (2-7 years)
concrete operational (7-11 years)
formal operational (11 years-adulthood)

104
Q

Piaget’s sensorimotor stage

A

(birth-2 years): children learn through senses and motor activities. learning how things work. use manipulative toys.

105
Q

Piaget’s preoperational stage

A

(2-7 years): children start to think by using symbols such as words and letters. they are not totally logical, still magical. they can only really think of one thing at a time.

106
Q

Piaget’s concrete operational stage

A

(7-11 years): kids develop mental processes. kids begin to understand basic reasoning and how things relate to one another. more logic and less magical thinking.

107
Q

Piaget’s formal operational stage

A

(11-adulthood): kids can think abstractly/theoretically and can take multiple perspectives to a situation.

108
Q

Kohlberg’s theory focus

A

moral development

109
Q

kohlberg’s theory stages

A

preconventional (4-7 years)
conventional (7-12 years)
post conventional (12 years +)

110
Q

kohlberg’s preconventional stage

A

(4-7 years): avoiding punishment, wanting to please others. rule following.

111
Q

kohlber’s conventional stage

A

(7-12 years): sense of conscience develops. begin to understand right and wrong - not just doing what parents say.

112
Q

kohlberg’s post conventional stage

A

(12+ years): set internal/ethical standards and gain sense of social responsibility.

113
Q

birth weight changes

A

at 5-6 months, birthweight doubles; by one year, birthweight triples

114
Q

tooth eruption

A

6-10 months: central lower
8-10 months: central upper
9-13 months: lateral upper
10-16 months: lateral lower

115
Q

why give vaccines early in life

A

immune system mainly from mother first 6 months of life, longer if breastfeeding (antibodies are passed on)

116
Q

infant gross motor skills developed:

A

posture, head control, sitting, standing, walking

117
Q

infant fine motor skills:

A

starts with palm grasp and raking motion, moves to pincer grasp (two fingers)

118
Q

newborn reflex (trunk incurvature)

A

until 2 months: finger run down spine trunk flexes and pelvis swings toward stimulated side

119
Q

newborn reflex (tonic neck)

A

until 2-3 months: when head is turned, extremities on same side extend outward, opposite side flexes

120
Q

newborn reflex (grasping)

A

until 3-4 months: grasp fingers placed in hand

121
Q

newborn reflex (rooting)

A

until 3-4 months: cheek is stroked, turns head in direction of stroke

122
Q

newborn reflex (moro/startle)

A

until 4-6 months: lifted high and suddenly lowered; arms and legs extend and abduct while fingers spread to form a “c”

123
Q

newborn reflex (sucking)

A

until 6 months: occurs when nipple placed in mouth

124
Q

newborn reflex (babinski sign)

A

until 2 years: sole on side of small toe is stroked, toes fan upward (negative may indicate nerve problems)

125
Q

newborn reflex (stepping)

A

until variable times: hold upright with feet touching flat surface, dancing or stepping occurs

NURS 405 Exam 1 (2 decks)

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