Exam 3 Flashcards
What is the goal of family-centered care?
families and children benefit
What is a dictatorial or authoritarian style of parenting?
Controls the child’s behavior through unquestioned rules and expectations
What is a permissive style of parenting?
They have little or no control over a child’s behavior, they consult with the child when making decisions
What is a democratic or authoritative parenting style?
They direct the child’s behavior by setting rules and explaining the reason for each rule
What is a passive style of parenting?
The parents are uninvolved and emotionally removed
Does a single-parent family increase the risk for child abuse?
NO
When does gender identity develop?
by age 3
What stage of psychosocial development are toddlers in?
Autonomy vs shame and doubt
- they want independence and try to do everything for themselves
What are some age-appropriate activities for toddlers?
- parallel play
- domestic mimicry (playing house)
- toilet training
- temper tantrums
What immunizations should be given between 12-15 months?
IPV (polio)
HiB
PCV
MMR
varicella
What immunizations should be given between 12-23 months?
Hep A
- given in 2 doses at least 6 months apart
What vaccines should be given between 15-18 months?
DTaP
What vaccines should be given between 12-36 months?
inactivated flu vaccine
must be 2+ for attenuated flu vaccine (nasal spray)
How many hours a day should a toddler sleep?
11-12 hrs a day
naps are often eliminated in this stage
maintain a regular bedtime routine/time
What foods should be avoided due to a choking hazard in toddlers?
nuts
grapes
hot dogs
peanut butter
raw carrots
tough meats
popcorn
How many oz of milk should toddlers have a day?
24-28 oz
What should juice be limited to in toddlers?
4-6 oz/day
What is the age range for toddlers?
1-3 years
What is the age range for preschoolers?
3-6 years
What stage of psychosocial development are preschoolers in?
initiative vs guilt
they are energetic learners even though they do not have all the physical abilities
guilt occurs when they think they have misbehaved or unable to do something
What are age-appropriate activities for preschoolers?
associative play
playing pretend and dress-up
What should parents be aware of regarding social development?
do not usually have stranger anxiety which is not good because they will go home with anyone
have less separation anxiety
What immunizations should be given between 4-6 years?
DTaP
MMR
IPV
When should a preschooler start to get their annual flu vaccine?
3-6 years
How many grams of protein should be consumed per day?
13-19 g/day
How many hours of sleep should a preschoolers get a day?
12 hrs/day
What age range is an adolescent?
12-20 yrs old
During puberty, how many inches and lbs should a girl grow?
2-8 in
15.5-55 lbs
stops growing around 2-2.5 years after onset of period
What order does sexual maturation occur in with girls?
-breast development
-pubic hair growth
-axillary hair growth
- menstruation
During puberty, how many inches and lbs should a boy grow?
4-12 inches
15.5-66 lbs
stop growing around 18-20 years
In what order does sexual maturation occur in boys?
-testicular enlargement
-pubic hair growth
penile enlargment
-growth of axillary hair
-vocal changes
How many words should a toddler know by age 2?
300
At what age can a toddler stand independently?
12 months
At what age should you be able to walk without help, use a cup well and build a tower of 2 blocks?
15 months
At what age should you be able to run clumsily, jumps in place w/ both feet, turn 2-3 pages, and build a tower of 3-4 blocks?
18 months
At what age should you be able to walk up and down stairs, builds a tower of 6-7 blocks, turns pages in a book one at a time
2 years old
At what age should you be able to jump across the floor, takes a few steps on tiptoe, draws circles, and has good hand-finger coordination
2.5 years
What fine motor skills should be developed by 3-6 years?
-copying figures on paper
-dressing independently
-hold a pencil
At what age should you be able to ride a tricycle, jump off the bottom step and stand on one foot for a few seconds?
age 3
At what age should you be able to skip & hop on one foot, throw a ball overhead and catch a ball reliably?
4 years old
At what age should you be able to jump rope, walk backward (heel to toe), and throw and catch a ball with ease?
5 years old
What cognitive development stage is a preschooler in?
preoperational
-moves from totally egocentric to social awareness
-magical thinking transitions to thoughts are all-powerful and can cause events to occur
How many words should a child know at the end of age 5?
2,100 words
What age can speak in 3-4 word sentences?
3-4 year olds
What age can speak in 4-5 word sentences?
4-5 year olds
At what age do children begin to be more willing to try new foods?
year 5
What stage of cognitive development are adolescents in? and what does it mean?
formal operations
think through more than 2 categories of variables concurrently
longer attention span
highly imaginative and idealistic
use formal logic to make decisions and think beyond current circumstances
What psychosocial development stage are adolescents in?
identity vs role confusion
-develop a sense of personal identity and come to see themselves as a unique individual
-become part of a peer group
What additional supplements do adolescents need?
calcium
iron
protein
zinc
How should you administer meds to children?
on the side of the mouth
never use a spoon
never when they are lying down
How much can you inject into subQ fat of a child?
0.5mL
What muscle is recommended for IM injections?
vastus lateralis
What gauge needle should be used for a IM inj?
22-25
How much can you inject IM to an infant?
0.5mL
How much can you inject IM to a child?
2mL
What are the most important elements of pain control w/ children?
distraction
play therapy
Where should you NOT perform procedures?
in safe places such as their bedroom/playroom
-use the exam room or another room in home
What ages should you use the FLACC pain scale for, and what does it stand for?
2 months to 7 yrs
Faces
Legs
Activity
Crying
Consolability
What ages should you use the FACES pain scale for?
3 yrs and older
What ages should you use the OUCHER pain scale for and what is it?
3-13 years
-photos of children, different racial/ethnic groups can be represented
How many liters of O2 can a nasal cannula use?
1-6 L/min
How many liters of O2 can a face mask use?
5-10 L/min
What are some early sings of respiratory distress in children?
-restlessness
-pallor
-tachypnea
-tachycardia
-use accessory muscles
-nasal flaring
What are some late signs of respiratory distress in children?
-cyanosis
-bradycardia
-bradypnea
-confusion
-stupor
-hyper/hypotension
What should you monitor with trach care?
RR effort, SaO2 (oxygenation)
thickness, amount, color, and odor of mucous
stoma and surrounding skin
When should you listen while suctioning?
before and after
What should you do before suctioning someone with a trach?
hyperoxygenate
What technique should you use when suctioning?
aseptic technique
How long should you suction for infants?
<5 seconds
How long should you suction for children?
<10 seconds
What should you clean a trach with?
soap and water
How often should you change non-disposable trach tubes?
6-8 weeks
how often should you provide oral care with a trach?
every 2 hours
How often should you provide trach care?
every 8 hours
What is bacterial epiglottis normally caused by?
Haemophilus influenza
What are the priority manifestations of bacterial epiglottis?
- high fever
- no cough bc airway is blocked
- drooling
- tongue hanging out
- tripod position
- dysphonia
- dysphagia
- inspiratory stridor
What are the priority interventions for bacterial epiglottis?
- protect the airway
- have emergency airway equipment at the bedside
- prepare for intubation (Priority!!!!)
- DO NOT assess the airway
- don’t start an IV until they are intubated
What are some nursing interventions for bacterial epiglottis?
- keep pt and family calm
- humidified O2
- corticosteroids
- antibiotics through IV
- droplet isolation
What are the priority manifestations of acute laryngotracheobronchitis?
- low-grade fever
- hoarseness
- barky cough
- dyspnea
nasal flaring - retractions
- tachypnea
What are the priority interventions for laryngotracheobronchitis?
- humidity with cool mist
- oxygen
- nebulized racemic epi
- corticosteroids
- encourage fluids
What is acute spasmodic laryngitis?
characterized by paroxysmal attacks of laryngeal; obstruction that occur mainly at night
- self-limiting
- can be caused by allergens
What are the priority manifestations of acute spasmodic laryngitis?
- croupy, barky cough
- difficulty breathing
- hoarseness
- nighttime episodes of laryngeal obstruction
What are the priority interventions for acute spasmodic laryngitis?
- humidity with cool mist
- oxygen
- nebulized racemic epi
- corticosteroids
- encourage fluids
What is the causative agent of bronchiolitis?
RSV
What are the initial symptoms of bronchiolitis?
- sneezing to clear the airway
- runny nose
- coughing
- wheezing
- possible eye/ear infection
What are the symptoms of bronchiolitis as the illness progresses?
- fever
- tachypnea
- retractions
- trouble feeding
What are the severe symptoms of bronchiolitis?
- tachypnea (>70)
- apneic spells
- cyanosis
What are the priority findings of bronchiolitis?
- inspiratory stridor
- hypoxemia/ resp. distress
- lethargic
What is the priority action for bronchiolitis?
SUCTION
What are the nursing interventions for PNA?
- rest & fluids
- culture before antibiotics
- O2/continuous pulse ox
- antipyretic for fever
What diet should a child be on post tonsil removal?
- clear liquids
- avoid red-colored liquids, citrus or milk
- advance to soft, bland foods
What nursing interventions should be done after a tonsillectomy?
-elevate HOB (drainage)
-assess for bleeding ( frequent swallowing), this will happen w/in the 1st 72 hours or days 7-10 bc they eat restricted foods
- comfort measures (liquid analgesics & tetracaine lollipops, ice collar, ice chips/sips of water)
What should you teach your patient who just had a tonsillectomy?
- no coughing, throat clearing or nose blowing
- avoid straws
-avoid irritating foods (highly seasoned/acidic) - there can be clots or blood-tinged mucus in vomit
- recovery takes 14 days
- report bleeding
What are some complications for a tonsillectomy?
- hemorrhage (watch for frequent swallowing)
- dehydration (give oral fluids)
- chronic infection (fever)
What is cystic fibrosis?
The mucous glands secrete too much thick mucous which leads to a mechanical obstruction of organs
- pancreas
- lungs
- liver
- small intestine
- reproductive system
These patients cannot cough up secretions and clear their airway
What are some expected findings/causes of cystic fibrosis?
- thick secretions
- hx of resp. infections/growth failure
- meconium ileus at birth
What are the early signs of CF?
wheezing
rhonchi
cough
What are the signs of increased involvement with CF?
dyspnea
obstructive emphysema
atelectasis on chest x-ray
What are the signs of advanced involvement of CF?
cyanosis
barrel-shaped chest
clubbing of fingers/toes
What are the GI findings related to CF?
steatorrhea
cant gain or lose weight
deficiency in vitamins A, D, E, K and anemia
What will sweat and tears have more of with CF?
high content of sodium and chloride
What is the chloride level of a child with CF?
> 60
What is the chloride level of an infant with CF?
> 40
What is the sodium level for patients with CF?
> 90
When should you not do chest physiotherapy with CF?
before or after meals
What does dornase alfa help CF with?
decreases the viscosity of mucous and improves lung function
What should you educate the parents on about dornase alfa?
-how to use the nebulizer
-admin once or twice a day
-stored in the fridge in a foil packet
-inform them that it is effective if the child’s secretions are easier to cough up & are thinner
What other medication can be given to patients with CF?
Aminoglycosides
-through their IV or aerosol nebulizer
What kind of diet should a CF patient be on?
high protein
high calories
What extra supplements should a CF patient take?
Vitamins A, D, E, K (fat-soluble)
pancreatic enzyme ( take before meals and snacks, take with high-fat foods, swallow or sprinkle on food, should have 1-2 stools a day)
What are some allergens?
mold
dust
grass
pollen
trees
tobacco smoke
What are triggers for asthma?
allergens
exercise
animal hair/dander
meds
seasonal allergies
stress/anxiety
What are expected findings of asthma?
-chest tightness
- dyspnea
- wheezing
- crackles
- cough
- sweating
- low O2 sat
- accessory muscles
What are priority findings to report for asthma?
silent chest (they are not breathing at all)
What do we not do with asthma patients?
intubate
What do peak flow meters measure?
amount of air that can be forcefully exhaled in 1 second
What is albuterol used for with asthma?
acute exacerbations
used before exercise
-it is working if there is a decreased effort to breath, RR decreases, O2 sat goes up, good lung sounds, and talking
What are some expected side effects of albuterol?
tachycardia
HA
nervousness
tremors
What are some adverse effects of albuterol?
bronchospasm
What should you do after inhalation of corticosteroids?
rinse mouth
What should you educate your patient about asthma?
get rid of carpet
avoid triggers
encourage regular exercise
do not wash things in bleach
What are the nursing actions for drownings?
admin O2 (possibly ventilation)
CPT
monitor for cerebral edema and resp distress
Education to prevent drownings?
lock toilet seats
do not leave children unattended in pool or bathtub
even a small amount of water can lead to drowning (1in)
What are the risk factors for SIDS?
maternal smoking during pregnancy
2nd-hand smoke
co-sleeping
prone or side sleeping
premature
low APGAR score
family hx of SIDS
What are the nursing interventions for SIDS?
provide support
plan a home health visit
refer to support groups
counseling
What should you educate about to prevent SIDS?
have baby sleep on their back
avoid tobacco
prevent overheating
use a firm mattress and tight sheet
no pillows, stuffed animals or blankets in bed
offer pacifier to sleep
avoid co-sleeping
What are the risk factors for poisoning?
children younger than 6 years
improperly stored meds, chemicals, substances
exposure to plants, cosmetics and heavy metals
What are the expected findings of acetaminophen poisoning?
2-4 hrs after: N/V, sweating, pallor
24-36 hrs after: improvement
36hrs-7days after: (hepatic stage) RUQ pain, confusion, stupor, jaundice, coagulation problems
final stage: death or gradual recovery
What are the expected finding of aspirin poisoning?
acute: N/V, disorientation, diaphoresis, tachypnea, tinnitus, oliguria, seizures
chronic: subtle versions of acute, bleeding, dehydration, seizures
What are the expected findings of supplemental iron poisoning?
initial period: 30 min-6 hrs, N/V/D hematemesis, gastric pain, bloody stools
latency period: (2-12 hours) improvement in condition
systemic toxicity period: (4-24 hrs) metabolic acidosis, hyperglycemic, bleeding, fever, shock, death
hepatic injury stage: (48-96hrs) seizure and coma
What are the expected findings of hydrocarbon poisoning?
gagging/choking
coughing
N/V
lethargic/weakness
tachypnea
cyanosis
grunting
retractions
What are hydrocarbons?
gasoline
kerosene
lighter fluid
paint thinner
turpentine
What are corrosives?
household cleaners
batteries
denture cleaners
bleach
What are the expected findings for corrosive poisoning?
pain/burning in mouth, throat, stomach
edematous lips, tongue & pharynx with white mucous membranes
violent vomiting w/ hemoptysis
drooling, anxiety, shock
What are the expected findings for lead poisoning?
low-dose: distractibility, impulsive, hyperactive, hearing impairment, mild intellectual difficulty
high dose: cognitive delays, blindness, paralysis, coma, seizure, death
other s/sx: kidney impairment, impaired calcium function, anemia
Treatment for acetaminophen poisoning?
admin antidote: acetylcysteine
Treatment for aspirin poisoning?
activated charcoal
gastric lavage
sodium bicarbonate
Treatment for supplemental iron poisoning?
emesis or lavage
chelation therapy using deferoxamine mesylate
Treatment for Hydrocarbon poisoning?
DO NOT induce vomiting
intubation w/ cuffed endotracheal tube before any gastric decontamination
treatment of chemical PNA
Treatment for corrosive poisoning?
airway maintenance
NPO
DON’T attempt to neutralize acid
DO NOT induce vomiting
give analgesics for pain
Treatment for lead poisoning?
chelation therapy using calcium EDTA
What is a patent ductus arteriosus (PDA)?
pulmonary artery and aorta don’t close
left to right shunt
increased pulmonary blood flow
cyanosis later
What are the signs/symptoms of patent ductus arteriosus?
murmur (cont machine hum, louder under left clavicle)
wide pulse pressure & bounding pulses
possibly asymptomatic
heart failure
What are the tx options for PDA?
nonsurgical: admin indomethacin (helps close off pathway), insert coils to occlude PDA during cath
surgical: thoracoscopic repair
What is an atrial septal defect?
it is a hole in the septum b/w the atria
left to right shunt
increased pulmonary blood flow
cyanosis later
What are the s/sx of ASD?
loud, harsh murmur with a fixed split-second heart sound
heart failure
possibly asymptomatic
What are the treatment options for ASD?
nonsurgical: closure during cardiac cath
surgical: patch closure
What is a tetralogy of fallot?
4 defects that cause mixed blood flow
What are the four defects involved in tetralogy of fallout?
- pulmonary stenosis
- ventricular septal defect
- Overriding aorta
- right ventricular hypertrophy
What are the s/sx of tetralogy of fallot?
cyanosis at birth which progresses over the 1st year of life
systolic murmur
tet spells: episodes of acute cyanosis & hypoxia
What can you do to help alleviate tet spells?
knee to chest position
call for help
calm the child (crying can cause a tet spell)
admin morphine
What are the treatment options for tetralogy of fallot?
shunt placement until they are able to undergo primary repair
complete repair w/in 1st year of life
do not give a lot of fluids at once bc it’ll just go right to left
What are the signs of heart failure in children?
impaired myocardial function
- sweating, tachycardia, fatigue, pallor, cool extremities w/ weak pulses, hypotension, cardiomegaly
pulmonary congestion
- tachypnea, dyspnea, retractions, nasal flaring, cyanosis, cough, orthopnea
Systemic venous congestion
- hepatomegaly, peripheral edema, ascites, JVD, weight gain
manifestations of hypoxemia
-seen w/ right to left heart defects (TOF)
- cyanosis, poor weight gain, clubbing, polycthemia
What is polycythemia in heart failure?
Compensatory mechanism
-body says to produce more RBCs because O2 is low, this makes the blood thicker
What are the nursing interventions for heart failure?
bed rest
put child in car seat or hold them at 45 degree angle
allow them to sleep w/ pillows, elevate head when sleeping
semi fowlers or fowlers when awake
keep restraints low and loose on abdomen
How often should an infant be fed with HF?
every 3 hours
use a soft premie nipple or regular nipple w/o a slit
How should you pick up an infant post surgery w/ HF?
under shoulders and buttock
What does pre-op care consist of for cardiac catheterization?
hx & physical exam
look for evidence of infection
assess allergies to shellfish or iodine
NPO 4-6 hours prior
baseline VS
admin pre-sedation
What should you assess for post cardiac cath?
bradycardia
dysrhythmias
hypoTN
hypoxemia
heart and lungs for one min
pulses for equality
temp & color of extremity
insertion site
What should you educate the parents on following cardiac cath?
monitor site for infection
no tub baths until dr says
don’t lift their child under their arms
- lift at the head or hips
nursing actions with administering digoxin
check apical pulse for 1 min and hold of <90 in infants and <70 in children
watch for toxicity (bradycardia, N/V, anorexia, arrhythmias)
do not give a second dose if they throw up
hypokalemia increase the risk of toxicity
can cause tooth decay so direct elixir to side/back of mouth
Function of Captopril?
reduce afterload by causing vasodilation
Nursing actions for Captopril?
monitor BP before & after
watch for hyperkalemia
function of metoprolol
decrease HR & BP
promote vasodilation
Nursing actions for metoprolol
monitor BP and pulse before admin
side effects: dizzy, hypoTN, HA
Nursing actions for Furosemide
encourage a diet high in potassium
monitor I&O
daily weights
side effects: hypokalemia, N/V, dizziness
What is rheumatic fever?
inflammatory disease that occurs as a reaction to Group A beta-hemolytic strep GABHS infection of the throat
What are the risk factors associated with Rheumatic fever?
untreated or partially treated upper respiratory infection (strep) w/ GABHS
What diagnostic is the most reliable for rheumatic fever?
Serum Antistreptolysin-O Titer
- elevated or rising
What is jones criteria?
Made if the child has 2 major or if they have 1 major and 2 minor following an acute GABHS infection
What is the major criteria for rheumatic fever?
carditis (chest pain)
SQ nodules
polyarthritis
rash (erythema marginatrum)
chorea (involuntary movements of extremities and face muscles)
What are the minor criteria for rheumatic fever?
fever
arthralgia (pain in joint)
What should the nurse educate the parents on regarding chorea?
it is self-limiting and will resolve over time
