Exam 1 Outline Flashcards
Examination Prep
What are Erikson’s stages of Development?
- Trust vs Mistrust
- Autonomy vs Shame & Doubt
- Initiative vs Guilt
- Industry vs Inferiority
- Identity vs Role Confusion
- Intimacy vs Isolation
- Generatively vs Stagnation
- Ego Integrity vs Despair
Trusting Aunties Invite Important Insights Into Growing Elderly
- Trust vs Mistrust
- Autonomy vs Shame & Doubt
- Initiative vs Guilt
- Industry vs Inferiority
- Identity vs Role Confusion
- Intimacy vs Isolation
- Generatively vs Stagnation
- Ego Integrity vs Despair
Trust vs Mistrust
Infancy (1to 2) yrs
Trust: belief world is safe
Ex. mother and loving caregiver
Mistrust: world is unpredictable and dangerous
EX. don’t receive consistent care
Autonomy vs Shame & Doubt
Early childhood 2- 4 yrs old
Both parents are involved
Sense of independence and self control
building confidence or shame
Initiative vs Guilt
Preschool age 4 to 5 years
Try new things, learn basic principles
Learning from entire family
Learn to make decision through play and social interaction
Industry vs Inferiority
School Age 5 to 12 yrs
Discover difference from others
productive and elevate own work
Neighbors and School have most influence
Identity vs Role Confusion
Adolescence (13 to 19)
Different Social Roles
Identity Crisis
Peers and Role Models have most influence
Intimacy vs Isolation
Early Adulthood 20 to 40 years
let go of prior relationships
ability to love
friends and partners center to development
Generatively vs stagnation
adulthood 40 to 65 years
leisure time used in creativity
leading next generation
not able to deal with situations causes stagnation
work and home are main influences
Ego Integrity vs Despair
maturity 65 to death
look back at life
comparison with mankind
What are the stages of Piaget’s Theory of Cognitive Development
- Sensorimotor
- Pre-operational
- Concrete Operational
- Formal Operational
Some People Can Fly
- Sensorimotor
- Pre-operational
- Concrete Operational
- Formal Operational
Sensorimotor
Birth to 2 yrs old
learn through senses and movement
Develop Object permanence
What is Object Permanence
something continues to exist when it is out of sight
Pre-operational
2 to 7 years old
symbolic thoughts, magical thinking (wishes cause events to occur), animism
What is animism
treating inanimate object as alive
Concrete Operational
7 to 11 years
logical thought
understanding of cause and effect
learn conservatism
what is conservatism
matter does not change when its form is altered
ex. small cup of water vs large
Formal Operational
11 years to adulthood
engage in abstract though
engage in deductive reasoning, logic based problem solving
Infant Physical Growth
Infant Physical Growth : Weight
6 months = 2x weight
12 months = 3x weight
Infant physical growth: length
6 months = rapid length
12 months = increased by 50%
Infant Physical Growth: Head circumference
6 wks (2 months)= posterior frontal close
18 months (2 yrs)= anterior fontanel close
Toys for 2 months
black & white, high contrast
soft rattles
soft textured toys
soft hanging toys
Toys for 30 months yr old
Building block
shape sorter
pretend play toys (dolls, kitchen set)
push and pull toys (toy car with pull string)
picture books
Musical instruments
When can a infant start to point to body parts
around 18 to 24 months
When can a child draw a circle?
around 3 yrs old
when can a child start to point?
around 9 to 12 months
When does a child start to have a pincer grasp?
9 to 12 months
What is Meningitis?
Viral illness
contagious
Patho: infectious organism enter the CNS through bloodstream
Prevention meningococcal vaccination
S/S: fever, headache, nuchal rigidity, photophobia, positive Kernig and Brudzinski sign
Infant: poor feeding, bulging fontanels, high pitched crying
B.B.B.
Brudzinke
Brain Bending (Flexion)
Bending Knee
Indicated positive Brudzinki for meningitis
Kernig
Positive sign
K: knee
E: Extension
Painful
Indication of Meningitis via Labs
bacterial: cloudy low glucose, high protein, high WBC, gram positive
Viral: clear, normal glucose and protein, slightly elevated WBC, negative gram stain
Physical Assessment: Newborn
No illness
Poor muscle tone
weak cry
poor suck
refuses feeding/vomiting/diarrhea
possible fever: hypothermia
NO NUCHAL RIGIDITY
Physical Assessment: 3 months to 2 years
bulging fontanels
seizures
high pitched cry
pupuric/petechial rash
fever, irritability
poor feeding/vomtting
POSSIBLE NUCHAL RIGIDITY
Physical Assessment 2 years to adolescence
seizures
fever/chills
severe headache
vomiting
petechiall/purpuric rash
photophobia & Irritability = professes to drowsiness, delirium and coma
Involvement of joints
Chronic Draining Ear
NUCHAL RIGIDITY
KERNIG SIGN
BRUDZINSKI SIGN
Petechiae and Purpura Rash
Physical Exam Signs: Brudzinski Neck sign
Helps diagnose meningeal irritation: meningitis
Physical Exam:
1. pt lies flat on back (supine position)
2. flexion of neck (toward chest)
Positive: involuntarily flexes knees and hips when neck flexed
Negative: no involuntary flexion of the knees or hips when neck flexed
Physical Exam Signs: Nuchal Rigidity
refers to stiffness of the neck/limitation of flexion due to pain or resistance
associated with meningitis and inflammation
Positive: cannot flex the neck forward due to pain/stiffness present
Physical Exam: Kernig Sign
Assess for meningeal irritation/pain and resistance to leg extension when the hip is flexed
Physical Exam:
1. pt lies flat on back
2. examiner flex pt hip and knee to 90 degree
3. attempt to extend pt knee
Positive Sign: pain or resistance during extendtion of knee when hip is flexed.
Techniques to help patient feel better of meningitis
Create quiet, calm environment
Dim light
Limit Noise
Close Blinds
Positioning and comfort
Pain management
Hydration and nutrition
What are seziures?
abnormal , involuntary excessive electrical discharge of neurons within the brain
What are partial (focal) seizures?
involve one area of the brain
Types of Partial Seizures
Simple Partial Seizures with Motor Manifestation
Simple Partial Seizures with Sensory Manifestation
Complex Partial Seizures
Unclassified
Simple Partial with Motor Characteristics
Aversive Seizure
Rolandic
Simple Partial Sensory Characteristics
one part brain affected
No LOC
involuntary movement, change or in emotions
Unclassified Seizures
West Syndrome
Lennox-Gastaut Syndrome
Febrile Seizures
West Syndrome (infantile Spasms)
Peak: 3 to 7 months
Sudden, brief, symmetric muscle contractions
Flexed head, extended arms drawn up
Possible Nystagmus or eye deviation
Possible loss of consciousness
TREATMENT: ADRENOCOTICOTOP IC HORMONE
Infantile Spasms VERSUS Infantile Seizures
INFANTILE SPASMS
sudden, brief muscle jerks or spasms of head, neck, arm, trunk
occur in cluster
no loss of consciousness
onset 3 to 12 months
INFANTILE SEIZURES
localized jerking with altered consciousness
Lennox-Gastaut Syndrome
Mixture with cognitive defects
Hyperactive and aggressive behavior
poor prognosis
difficult to treat
Febrile Seziures
Associated with a sudden spike in temperature 38.9 to 40 (102 to 104)
15 to 20 second
TREATMENT:
Acetaminophen
ibuprofen
dress in light clothing
administer tepid sponge baths
What are generalized seziures?
involved the entire brain
Risk Factors for Seizures
cerebral Edema
Febrile episode
intracranial infection/hemorrhage
cyst/tumor in brain
lead poisoning
metabolic conditions
tetanus, shigella, salmonella
Risk factors for Epilepsy
Congenital Defect
Anoxia
Trauma
Hemorrhage
Infection
Hypoglycemic injury
migraine
uremia
cardiovascular dysfunction
Seizure Causes Mnemonic: VITAMIN
V– Vascular: stroke, embolic stroke
I–Infection: meningitis, encephalitis, cerebral malaria
T–Trauma: head injuries
A— AV malformations: cavernous alformation
M– Metabolic: hypoglycemia, hyponatremia, hypoxia
I– Idiopathic
N–Neoplasms: primary or secondaries
Others: sleep deprivation, drug overdose, fever, eclampsia, hyrocephalus, multiple scerlosis
What are the generalized motor Seizures
Atonic
Clonic
Tonic
Mycoclonic
Tonic-clonic
What is Atonic Seizures
DROP seizures consisting of sudden loss of muscle tone
(falls unexpectedly)
Atonic Seizures Characteristics
Drop Attacks
2 to 5 years of age
muscle tone is lost for few second (falls)
period of confusion follows
What is a clonic Seizure?
repetitive jerking or twitching
What is a Tonic Seizure ?
sudden stiffness and rigidity of muscles
What is a Myoclonic Seizure
short, jerking movement of muscles resembling muscle spasms
Myoclonic Seizures Characteristics
Variety of Seizures episodes
brief contraction of muscle or groups of muscle
symmetric or asymmetric involvement
No Postictal State
might not lose consciousness
involve only face and trunk or more extremities
What is a Tonic-Clonic Seizure
sudden stiffness (tonic) and repetitive jerking (clonic)
Tonic-Clonic Seizures Characteristics
10 to 20 second duration
loss of consciousness
eye roll upward
tonic contraction of entire body: arms flexed/leg and head extended
piercing cry
thoracic and abdominal muscles contraction
mouth snaps shut and tongue can be bitten
flushing
loss of swallowing reflux
increased salivation
apnea leading to cyanosis
ONSET WITHOUT WARNING
Tonic-clonic Seizures examples: Clonic
30 to 50 seconds
violent jerky movement of the body
foaming in the mouth
rhythmic contraction/relaxation of trunk and extremities
incontinent of urine or feces
gradual slowing of movement until cessation
Tonic-clonic Seizures examples: Postictal State
30 minutes
remain semiconscious: arouses with difficulty
impairment of fine motor movement
headache, vomiting, visual, speech difficulties
confused for several hours
lack of coordination
sleeps for several hours, feels tired, complain of sore muscles
no recollection of seizures
What are the generalized non-motor seizures
Typical Absence seizures
Atypical Absence seizures
Eyelid myoclonia
What is typical absence seizures
affected person stops what they are doing and stare intto space
eyelid fluttering
short duration 10 seconds
Absence Seizures characteristics
Onset: 4 to 12 and ceases by teenage years
LOC (level of consciousness) 5 to 10 seconds
blank stare, motionless
resembles day dreaming
can drop items
automatisms
momentarily confused
can immediately resume previous activities
what is an atypical absence seizures
longer duration
staring into space, lipsmacking, repetitive hand movement such as wringing
what is eyelid myoclonia seziure
brief twitches of eyelid
Nursing Care for During Seizures
Protection from injury
position: maintain airway
watch the clock
note onset, time, characteristics
Do not restrain a child
loosen restriction clothing
DO NOT attempt to put anything in child mouth
prepare for oxygenation
remove glasses
remain calm and stay with the child
Nursing Care for Post-Seizures
Side-lying
check for breathing
position of head and tongue
neuro checks
allow for rest
reorient due to confusion or agitation
remain with the client
don’t offer food or beverage until fully awake
encourage child to describe the period
Client Education for Seizures
Periodic lab testing
DONT ABRUPTLY stop medication
adhere to medication regimen
medication interaction
helmets during sports
water safety
avoid triggers
ketogenic diet
Ketogenic Diet
used for children younger than 8 years of age with myoclonic or absence seizures
high fat, low carbs, low protein diet causing ketosis as body uses fat for metabolism
ketosis slow electrical impulses that cause seizures
What are types of CROUP (Upper Airway)
acute laryngotracheobronchitis
acute spasmodic laryngitis
Generalized Croup Characteristics
hoarseness
cough: barking or brassy
degree of inspiratory stridor
degrees of respiratory distress
obstruction in the larynx (swelling)
affecting trachea, larynx, bronchi
Croup: Acute Laryngotracheobronchitis
most common
6 months to 5 years
causative organism are viral agent
preceded by uri
gradual onset with low fever
barky cough, stridor, wheezing, retraction
inflammation of mucosa lining the larynx and trachea causing narrowing of the airway
more common in boys than girls
Croup: acute spasmodic laryngitis
spasmodic/midnight/twilight
occurs at night
recurrent paroxysmal attacks of laryngeal obstruction
1 to 3 years old
allergies and hypersensitivity
Management of Croup at Home
warm mist from hot running water in a closed bathroom
humidification: cool mist, outdoors, open freezer door
Management of Croup at Hospital
PO or IV fluids
high humidity with cool mists
nebulizer treatments
corticosteroids
Nursing care Measures for Children with Croup
Assess respiratory status
Positioning
Humidifie air
administration of medications
fluid encouragement
monitor worsening symptoms
Patient Education of Croup
recognizing early signs
encouragement of cool mist and humidifier
if difficulty breathing occurs immediate medical attention needed
Calming child
Upper Airway: Acute Epiglottis
onset abruption
supraglottic obstruction
MEDICAL EMERGENCY
rapidly progress to severe respiratory distress
child goes to bed asymptomatic and awaken with sore throat and painful swallowing
Acute Epiglottis symptoms
fever
appears sicker than clinical finding
drooling tripod position
irritable
anxious
restless
retractions
thickened or muffled voice
throat is red and inflamed
epiglottis large, cherry red, edematous
Emergency Of EPIGLOTTIS
due to inflammation of epiglottis and rapid progression for complete airway obstruction causing respiratory failure
1. potential for rapid airway obstruction
2. rapid deterioration of breathing
3. risk of sudden and complete airway obstruction
4. high risk of respiratory failure
What is Asthma
chronic inflammatory disorder of the airways characterized by bronchial hyper responsiveness, recurring symptoms and airway obstruction
Characteristics of Asthma
chronic inflammatory disorder of airways and obstruction of the bronchial tree
inflammatory process are mast cells, eosinophils, T-lymphocytes
Pathophysiology of Asthma
Chronic inflammatory process
hypersensitivity of bronchioles to irritants
bronchospasm and mucus production leading to air trapping
respiratory failure
What are the hypersensitivity of bronchioles to irritants?
INTRINSIC
strong emotions, exercise, conditions (GERD, fistula), endocrine factors (thyroid disease, menses, pregnancy)
EXTRINSIC
food allergy (dairy, nuts), plants (weed, trees, pollens) dust, mites, animals (cat, dogs), exposure to chemicals
virus or infection
What are types of bronchospasm and mucus production leading to air trapping
hypoxemia
hyper ventilation
obstruction
What is the Course of Asthma Attack
Environmental Factors
to
Provoking airway inflammation
to
Resulting in coughing, wheezing, chest tightness, breathlessness
to
progress to airway hyper- responsiveness
to
obstruction to partial to total
Symptoms of Asthma
Dyspnea
Cough
Inspiratory wheezing
SOB
prolonged Expiration
Accessory Muscle Use
Tripod Positioning
Hyper resonance or Percussion
Cyanosis to nail beds
Tripod positioning
Inhaler Instructions for Asthma
Metered-dose: pressurized canister to release a fixed dose of medication
Dry powder inhaler: deliver medication in form of power and take deep breaths
Nebulizer: delivery of medication in a mist form
What is Cystic Fibrosis
Diagnosing Cystic Fibrosis
Family History
Positive Sweat Chloride test
absence of pancreatic enzymes
fecal fat test
LFTs elevated
chest X-ray
Diagnosis of Early Infancy
sweat Cl- test
DNA identification of Mutant Genes
Abnormal Nasal Potential Difference Measurements
Screening of Newborn Cystic Fibrosis
Detect an abnormal chloride secretion in sweat
CFTR Gene Mutation
IRT (Immunoreactive Tryspinogen)
DNA Analysis of F508 Gene Mutation
Carrier Screening of Cystic Fibrosis
F508 GENE
70% ni Caucasian population
30% in African American population
Enzyme Administration for Children with Cystic Fibrosis
prescribed pancreatic enzyme replacement therapy to aid in digestion of food and ensure they receive adequate nutrition
given due to
pancreatic insufficiency developing which leads to malnutrition, poor growth, fatigue
&
ensure they can break down food properly absorb the nutrients needed for growth, maintain healthy weight
Aid in digestion, nutrient absorption, promotion of health growth, maintain energy levels
Concussion: Nursing Care Measures
- Monitor for worsening symptoms
- perform regular neurological assessments (glasgow coma scale)
- promotion of mental and physical rest in the first 24 to 48 hrs
- gradual return to activity after being asymptomatic 2 to 48 hr
- education on symptom management
Concussion: Patient education for prevention
educate on importance of avoiding second impact syndrome
not to return to sports or physical activities too soon
Reye Syndrome Labs findings
Elevated Liver Enzymes: indicate liver dysfunction
Hyperammonemia: elevation of ammonia level
Hypoglycemia: low blood sugar
Prolonged PT: indicating clotting problems
Reye Syndrome: Mannitol Administration
Mannitol given to reduce intracranial pressure where brain swelling is a concern
works by drawing fluid out of the brain into the bloodstream for excretion by the kidneys
SID Prevention (Sudden Infant Death Syndrome)
place infant on their backs to sleep
avoid soft bedding, pillow, or stuffed toys in crib
sleeping in crib in the same room not same bed
avoid overheating
offer a pacifier during sleep to reduce risk
Toddler Burn Prevention
Keep hot items out of reach
Supervise toddler near hot appliances
cover electrical outlet
installations of safety gates like kitchen
Poisoning/indigestion Preventions
Store household cleaning products and medications in childproof containers
Keep hazardous substances locked
educate parents of safe disposal of old meds
use child-resistant caps on medicine bottles
Post-op Tonsillectomy Care: Nursing Care Measures
Pain management (acetaminophen/ibuprofen)
Hydration
Monitor bleeding (swallowing, restlessness, vomiting blood)
Positioning: semi-upright to prevent choking
Education
Pneumonia Signs & Symptoms
Cough: green or yellow
Fever
SOB: increased respiratory rate
chest pain/tightness
fatigue/loss of appetite
Pneumonia: Progression of Infection
worsening cough/difficult breathing
increased work of breathing
signs of sepsis (persistnet fever, tachycardia, low blood pressure)
Pneumonia: Hospitalization reasons
Severe respiratory distress : ventilation/oxygenation
Inability to maintain hydration or persistent vomiting
high fever not responding to treatment
Respiratory Distress Signs and Symptoms
increased respiratory rate or effort
nasal flaring, retractions of the chest wall
grunting or wheezing
cyanosis (blueish lips/face/extremities)
decreased breath sounds or stridor
Respiratory syncytial virus: risk factors for complications
prematurity (infant born before 37 weeks)
chronic lung disease
heart disease
Immune system compromise
<6 month infants & elderly at more risk
Respiratory syncytial virus: Reason for hospitalization
severe respiratory distress: supplement oxygen, intubation
Dehydration: inability to maintain oral intake/vomting/diarrhea
Increased work of breathing: nasal flaring, grunting, retraction
Respiratory syncytial virus: Transmission
Direct Contact: respiratory secretion (droplets from coughing or sneezing)
Contaminated Surfaces: surviving on surfaces for several hours
Spread through hands: virus transfer when touching infected surfaces and touching the face
