Exam 1 (Chapters 1-9) Flashcards
Family-Centered Care
Philosophy of health care in which a mutually beneficial partnership develops between families and the nurse, and also other health care professionals
Extended Kin Network Family
Specific form of an extended family in which two nuclear families of primary or unmarried kin live in proximity to each other
Authoritarian Parent
High control, low warmth
Child may become fearful, withdrawn, and unassertive
Girls passive and dependent, boys rebellious and aggressive
Authoritative Parent
Moderately high control, high warmth
Children are best adjusted, self-reliant, self-controlled, and socially competent
Higher self-esteem, better school performance
Permissive Parent
Low control, high warmth
Children are rebellious, aggressive, socially inept, self-indulgent, or impulsive
May be creative, active, and outgoing
Indifferent Parent
Low control, low warmth
Children have high expression of destructive impulses and delinquent behaviors
Neonatal Mortality Causes
Short gestation
LBW
Congenital malformations
Postneonatal Mortality Causes
SIDS
Congenital malformations
UNINTENTIONAL INJURIES
Infant Morbidity Causes
Injuries related to live birth
Acute bronchitis
Hemolytic jaundice
Pneumonia
LBW
Child Morbidity Causes
Asthma and pneumonia are most common causes
Effects of Divorce on Preschool Aged Children
Fear, anxiety, worry, self-blame, sorrow, grief, anger, regression, questioning, temper tantrums, loneliness
Effects of Divorce on School Aged Children
Sadness, insecurity, self-blame, guilt, resentment, behavioral problems, withdrawal from friends and activities
Effects of Divorce on Adolescents
Panic, fear, depression, guilt, risk-taking, fear of loneliness and abandonment, denial, anger, sadness, aggressiveness, skipping class, use of drugs and alcohol, sex
Eight Stages of Family Life Cycle
1: newly married
2: childbearing
3: families with preschool children
4: families with school aged children
5: families with teenagers
6: families launching young adults
7: middle aged parents
8: family in retirement and old age
Aneuploidy
Increase or decrease in number of chromosomes
Result of an error during cell division, most often with nondisjunction during meiosis
Nondisjunction
Paired homologous chromosomes that do not separate before migrating into egg or sperm cells
Examples of Aneuploidy
Turner Syndrome (monosomy)
Trisomy 13 (Patau Syndrome) and Trisomy 21 (Downs Syndrome)
Most monosomic/trisomic errors result in the loss of life
Mosaicism
Monosomy/trisomy during mitosis resulting in 2 separate cell line with different chromosomal makeup
Inversion
Chromosome breaks in two places and the piece between the breaks turns and reattaches within the same chromosome
Inversion of Factor VIII –> Hemophilia A
Deletion and Duplication
Unbalance rearrangement of chromosomes, may be incompatible with life
Cri du Chat is a large deletion of Chromosome 5 that results in microcephaly, intellectual disability, and cat-mewing cry
Translocation
Two nonhomologous chromosomes that exchange segments of DNA
Autosomal Dominant
Involve altered genes on autosomes rather than sex chromosomes
Individuals with AD disorders are heterozygous for the disease-producing gene; 50% chance affected parent passes on to child
Neurofibromatosis, Marfan Syndrome, Achondroplasia (dwarfism), Huntington Disease, familial hypercholesterolemia
Autosomal Recessive
Both copies of the same gene in an individual are altered
Both parents are carriers, child has 25% chance of inheriting, 50% chance of carrying, and 25% chance of being fine
Cystic Fibrosis, Sickle Cell Disease, Tay-Sachs, and most inborn errors of metabolism
X-Linked Disorders
Hemophilia A, Duchenne Muscular Dystrophy
Y-Linked Disorders
Contains genes related to spermatogenesis problems
Penetrance
Probability a gene will be expressed phenotypically
All-or-none concept
Variable Expressivity
Degree to which a phenotype is expressed
New Mutation
Occurs when there is no family history
Anticipation
Occurs when successive generations exhibit earlier onsets with more severe signs/symptoms
Minor Anomaly
Usual morphologic feature that is of no serious concern
Wide-set eyes, single palmar creases, cafe au lait, low anterior hairline, preauricular pits, broad face, mild proportionate short stature
Major Anomaly
Serious structural defect present at birth
Congenital heart defects, cleft lip/palate, myelomeningocoele, duodenal atresia, craniosynostosis
Syndrome
Collection of multiple anomalies
Principles of Growth and Development
Cephalocaudal (growth goes from head to toe)
Proximodistal (growth goes from core to periphery)
Freud’s Psychosexual Theory
Oral (birth-1 year): infant derives pleasure from mouth
Anal (1-3 years): control over secretions
Phallic (3-6 years): child works out relationships with parents
Latency (6-12 years): sexual energy is at rest
Genital (12-adulthood): mature sexuality achieved
Erikson’s Psychosocial Theory
Trust v. Mistrust (birth-1 year): task is to establish trust in those providing care
Autonomy v. Shame and Doubt (1-3 years): autonomy shown by controlling excretions, saying no, directing motor activity
Initiative v. Guilt (3-6 years): initiation of new activities
Industry v. Inferiority (6-12 years): child takes pride in accomplishments and develops new interests
Identity v. Role Confusion (12-18 years): thoughts are more complex, finds a definition of self
Piaget’s Cognitive Development Theory
Sensorimotor (birth-2 years): use of senses to drive motor activity
Preoperational (2-7 years): words/symbols used, no logic
Concrete Operational (7-11 years): accurate understanding of cause and effect, conversation is learned
Formal Operational (11-adulthood): mature intellectual thought
Kohlberg’s Theory of Moral Development
Preconventional (4-7 years): decisions based on desire to please others to avoid punishment
Conventional (7-12 years): conscience becomes important, rules must be followed
Postconventional (12 and older): internalized ethical standards, social responsibility recognized
Infant Physical Growth and Development
Weight doubles by 5 months and triples by 1 year
Height increases by 1 foot
Teeth erupt at 6 months, 6-8 teeth by 1 year
Kidney and liver maturation
Nervous system allows to sit, stand, and walk and sensory function increases
Infant Psychosocial Development
Engage in solitary play
Reflexes –> manipulation
Engage in two-way communication, understand more words than they can speak
Temperament usually fits the environment
Abnormalities are caused by decreased hearing, developmental delay, or decreased verbal stimulation
Toddler Physical Growth and Development
Decreased rate of growth, decreased food consumption
Pot-bellied, walk with a wide gait
20 teeth at 33 months
Gross motor develops rapidly (running, kicking, riding) and increased control of elimination patterns
Toddler Cognitive Development
Object permanence is well-developed
Pre-operational thought
Toddler Psychosocial Development
Parallel play, increased motor activities
Retains temperamental characteristics from infancy, independence increases
Imitate speech intonations and words, use expressive jargon
Preschool Child Physical Growth and Development
Grow steadily, most growth in long bones of arms/legs
Physical skills develop (throw a ball, hold a bat)
Preschool Child Cognitive Development
Pre-operational thought
Symbols used and understood
Preschool Child Psychosocial Development
Associative play, large motor activities, dramatic play
Temperament from infancy persists, egocentricity
Vocabulary grows to 2000 words
School-Aged Child Physical Growth and Development
Decreased fat, increased muscle, mature immune system, increased leg length
Nutritional needs increase
School-Aged Child Cognitive Development
Concrete operational thought, learns conversation
Considers alternative solutions to problems
Relies on concrete experiences
School-Aged Child Psychosocial Development
Cooperative play, high social component
Enduring aspects of temperament continue to manifest
Able to correct pronunciation/grammatical erros
Aware of sexual differences, interested in sexual issues
Adolescent Physical Growth and Development
Growth spurts around 10 (female) and 13 (male)
Accompanies by increased breast size and pubic hair in girls and increased penis/testes size and pubic hair in males
Adolescent Cognitive Development
Formal operational thought, independent thought
Adolescent Psychosocial Development
Temperament from childhood remains stable
Uses and understands all parts of speech
Quest for self-identity
Give privacy during assessments
Newborn Assessment
Keep the parent present, use distractions, observe activity, keep sequence flexible
Assess with newborn on the table and parent next to them
Invasive assessments should be done last
Infant Assessment
Examine on the parent’s lap, smile and talk soothingly, use toys/pacifier, begin with feet and hands before moving to the trunk
Toddler Assessment
Keep toddlers with parents, avoid asking toddler for permission, give choices, observe neuro/muscular by watching them play
Begin at the feet and move up, use instruments last
Preschool Child Assessment
Assess willingness to separate from the parent, leave underpants on until the genital examination, give simple explanations, offer choices, use distractions, give positive feedback with cooperation
Order of the exam may vary
School-Aged Child Assessment
Have them sit on the exam table, offer gown to cover underwear, allow privacy
Do head-to-toe assessment, demonstrate equipment, offer choices, teach as you go
Adolescent Assessment
Give gown, allow privacy, provide modesty
Head-to-toe assessment, provide reassurance
Top Mortalities of Infants < 1 Year
- Congenital anomalies
- Preterm birth
- SIDS
Top Mortalities of Infants 1 Year Old
- Unintentional Injury (Suffocation)
- Congenital anomalies
- Homicide
Top Mortalities of Children 1-4 Years Old
- Unintentional injury
- Congenital anomalies
- Homicide
Top Mortalities of Children 5-14 Years Old
- Unintentional injury (motor vehicle accident)
- Cancer
- Congenital anomalies
Top Mortalities of 15-24 Year Olds
- Unintentional injury (motor vehicle accident)
- Suicide
- Homicide
New Morbidity
The effects of society and societal health on children
Pediatric Assessment Triad
Appearance
Breathing
Circulation
Pain Assessment
Use pain scales with faces and colors
If non-responsive or nonverbal, use objective scales such as FLACC or CRIES, account for muscle tone, grimacing, vital signs, guarding
Rough Bladder Capacity
Child’s age plus 2 is normally the amount of ounces of bladder capacity they have
Diet/Energy Needs of Infants
100 kcal/kg/day
S1
Beginning of systole, closing of the AV valves
Heard best at the apex with the diaphragm
S2
Ending of systole and beginning of diastole, closing of the semilunar valves
Heard best at the base with the diaphragm
Physiologic Split S2
Normal in pediatrics, particularly the younger the child
Split resolves as the child ages
Know it’s physiologic if the split becomes longer with inspiration
Heard best in the pulmonic region with the diaphragm
Pathologic Split S2
Not a normal variance
Fixed split (no change with inspiration), Paradoxical split (less pronounced with inspiration)
Heard best in pulmonic region with the diaphragm
Fixed is usually a septal defect, paradoxical is usually a pathological problem causing delayed aortic closure
Pathologic S3
Separate heart sound, diastolic gallup
Comes at the end of S2
Marker of ventricular overload or systolic dysfunction
Low-pitched, more likely to be heard with the bell
Pathologic S4
Comes at the end of diastole, right before systole
Indicator of poor diastolic function
Seen in conditions such as uncontrolled HTN, persistent/recurrent myocardial ischemia
Soft and low pitched, heard best with the bell
MR. PASS, MVP
Mitral regurgitation, physiologic aortic stenosis (Systolic)
Mitral valve prolapse
MS. ARD
Mitral stenosis, aortic regurgitation (Diastolic)
Grading Murmurs
Grade 1: very faint
Grade 2: quiet but immediately heard
Grade 3: moderately loud, same volume as S1 and S2, without a thrill
Grade 4: moderately loud with a thrill
Grade 5: very loud with a thrill
Grade 6: audible without a stethoscope
Growth/Development Surveillance for Newborns/Infants
Be alert for infants that demonstrate changes in percentile
Signs of developmental delay merit immediate investigation
Introduce foods that foster growth, encourage developmental toys, demonstrate gross/fine motor skills
Nutrition of Newborns/Infants
Hemoglobin/hematocrit can be performed at 9-12 months
Newborn (support breastfeeding), 1 month (reinforce breastfeeding), 2 months (begin cleaning infant gums, teach how to prepare formula), 4 months (introduce first foods between 4-6 months), 9 months (encourage self-feeding)
Mental/Spiritual Health of Newborns/Infants
Stranger anxiety/separation anxiety occurs at 6 months
Learn how to self-regulate
Immunizations of Newborns/Infants
Hep B (birth, 1-2 months, 6-18 months)
Hep A (12 months, 18 months)
DTP (2 months, 4 months, 6 months)
Rotavirus (2 months, 4 months)
Influenzae haemophilus (2 months, 4 months, 6 months)
Polio (2 months, 4 months, 6-18 months)
Pneumococcal (2 months, 4 months, 6 months)
When Families Should Call HCP for Newborns/Infants
Axillary temperature > 99.3 degrees Fahrenheit
Seizure
Skin rash
Change in behavior
Irritability
Lethargy
Failure to eat
Vomiting
Diarrhea
Dehydration
Cough
Nutrition for the Toddler and Preschooler
1 year (wean child from bottle, use whole milk, limit juice, limit high fat and sugar)
2 year (encourage total removal from bottle, offer child-sized utensils, 2-3 servings of milk per day)
3 year (teach normal intake, decrease snacks, encourage child in food preparation)
4 year (involve child in snack selection, decrease fat)
Physical Activity for the Toddler and Preschooler
Minimum of 60 minutes of unstructured play, minimum 60 minutes of structured play, maximum 60 minutes of sedentary life
Motor activities encouraged
Kinesthesia develops (sense of one’s own body position/movement)
Oral Health for the Toddler and Preschooler
Dentist visit by 1 year of age
20 deciduous teeth by 2 years, begin to lose by the end of preschool
Mental/Spiritual Health of the Toddler and Preschooler
Good at self-regulation
Need 10-12 hours of sleep per night
Potential Hazards for the Toddler and Preschooler
Falls, poisoning, burns, drowning, MVA
Mental/Spiritual Health of the School-Aged Child
Self-esteem, self-concept, body image, sexuality
Immunizations for the School-Aged Child
TDAP (11 year old visit)
HPV (three dose series at 9 years or older)
Meningococcal (11 years)
Hazards for the School-Aged Child
MVA, firearms, burns, assault
Nutrition for the Adolescent
5 fruits and vegetables daily, whole grain, three meals a day, decreased fat and sugar, 2-3 servings of dairy
Physical Activity of the Adolescent
60 minutes daily is recommended
