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Families > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

What is the goal of family-centered care?

A

families and children benefit

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2
Q

What is a dictatorial or authoritarian style of parenting?

A

Controls the child’s behavior through unquestioned rules and expectations

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3
Q

What is a permissive style of parenting?

A

They have little or no control over a child’s behavior, they consult with the child when making decisions

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4
Q

What is a democratic or authoritative parenting style?

A

They direct the child’s behavior by setting rules and explaining the reason for each rule

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5
Q

What is a passive style of parenting?

A

The parents are uninvolved and emotionally removed

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6
Q

Does a single-parent family increase the risk for child abuse?

A

NO

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7
Q

When does gender identity develop?

A

by age 3

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8
Q

What stage of psychosocial development are toddlers in?

A

Autonomy vs shame and doubt
- they want independence and try to do everything for themselves

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9
Q

What are some age-appropriate activities for toddlers?

A
  • parallel play
  • domestic mimicry (playing house)
  • toilet training
  • temper tantrums
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10
Q

What immunizations should be given between 12-15 months?

A

IPV (polio)
HiB
PCV
MMR
varicella

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11
Q

What immunizations should be given between 12-23 months?

A

Hep A
- given in 2 doses at least 6 months apart

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12
Q

What vaccines should be given between 15-18 months?

A

DTaP

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13
Q

What vaccines should be given between 12-36 months?

A

inactivated flu vaccine
must be 2+ for attenuated flu vaccine (nasal spray)

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14
Q

How many hours a day should a toddler sleep?

A

11-12 hrs a day
naps are often eliminated in this stage
maintain a regular bedtime routine/time

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15
Q

What foods should be avoided due to a choking hazard in toddlers?

A

nuts
grapes
hot dogs
peanut butter
raw carrots
tough meats
popcorn

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16
Q

How many oz of milk should toddlers have a day?

A

24-28 oz

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17
Q

What should juice be limited to in toddlers?

A

4-6 oz/day

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18
Q

What is the age range for toddlers?

A

1-3 years

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19
Q

What is the age range for preschoolers?

A

3-6 years

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20
Q

What stage of psychosocial development are preschoolers in?

A

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

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21
Q

What are age-appropriate activities for preschoolers?

A

associative play
playing pretend and dress-up

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22
Q

What should parents be aware of regarding social development?

A

do not usually have stranger anxiety which is not good because they will go home with anyone
have less separation anxiety

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23
Q

What immunizations should be given between 4-6 years?

A

DTaP
MMR
IPV

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24
Q

When should a preschooler start to get their annual flu vaccine?

A

3-6 years

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25
Q

How many grams of protein should be consumed per day?

A

13-19 g/day

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26
Q

How many hours of sleep should a preschoolers get a day?

A

12 hrs/day

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27
Q

What age range is an adolescent?

A

12-20 yrs old

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28
Q

During puberty, how many inches and lbs should a girl grow?

A

2-8 in
15.5-55 lbs
stops growing around 2-2.5 years after onset of period

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29
Q

What order does sexual maturation occur in with girls?

A

-breast development
-pubic hair growth
-axillary hair growth
- menstruation

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30
Q

During puberty, how many inches and lbs should a boy grow?

A

4-12 inches
15.5-66 lbs
stop growing around 18-20 years

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31
Q

In what order does sexual maturation occur in boys?

A

-testicular enlargement
-pubic hair growth
penile enlargment
-growth of axillary hair
-vocal changes

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32
Q

How many words should a toddler know by age 2?

A

300

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33
Q

At what age can a toddler stand independently?

A

12 months

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34
Q

At what age should you be able to walk without help, use a cup well and build a tower of 2 blocks?

A

15 months

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35
Q

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?

A

18 months

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36
Q

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

A

2 years old

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37
Q

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

A

2.5 years

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38
Q

What fine motor skills should be developed by 3-6 years?

A

-copying figures on paper
-dressing independently
-hold a pencil

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39
Q

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?

A

age 3

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40
Q

At what age should you be able to skip & hop on one foot, throw a ball overhead and catch a ball reliably?

A

4 years old

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41
Q

At what age should you be able to jump rope, walk backward (heel to toe), and throw and catch a ball with ease?

A

5 years old

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42
Q

What cognitive development stage is a preschooler in?

A

preoperational
-moves from totally egocentric to social awareness
-magical thinking transitions to thoughts are all-powerful and can cause events to occur

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43
Q

How many words should a child know at the end of age 5?

A

2,100 words

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44
Q

What age can speak in 3-4 word sentences?

A

3-4 year olds

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45
Q

What age can speak in 4-5 word sentences?

A

4-5 year olds

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46
Q

At what age do children begin to be more willing to try new foods?

A

year 5

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47
Q

What stage of cognitive development are adolescents in? and what does it mean?

A

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

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48
Q

What psychosocial development stage are adolescents in?

A

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

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49
Q

What additional supplements do adolescents need?

A

calcium
iron
protein
zinc

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50
Q

How should you administer meds to children?

A

on the side of the mouth
never use a spoon
never when they are lying down

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51
Q

How much can you inject into subQ fat of a child?

A

0.5mL

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52
Q

What muscle is recommended for IM injections?

A

vastus lateralis

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53
Q

What gauge needle should be used for a IM inj?

A

22-25

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54
Q

How much can you inject IM to an infant?

A

0.5mL

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55
Q

How much can you inject IM to a child?

A

2mL

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56
Q

What are the most important elements of pain control w/ children?

A

distraction
play therapy

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57
Q

Where should you NOT perform procedures?

A

in safe places such as their bedroom/playroom
-use the exam room or another room in home

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58
Q

What ages should you use the FLACC pain scale for, and what does it stand for?

A

2 months to 7 yrs
Faces
Legs
Activity
Crying
Consolability

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59
Q

What ages should you use the FACES pain scale for?

A

3 yrs and older

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60
Q

What ages should you use the OUCHER pain scale for and what is it?

A

3-13 years
-photos of children, different racial/ethnic groups can be represented

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61
Q

How many liters of O2 can a nasal cannula use?

A

1-6 L/min

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62
Q

How many liters of O2 can a face mask use?

A

5-10 L/min

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63
Q

What are some early sings of respiratory distress in children?

A

-restlessness
-pallor
-tachypnea
-tachycardia
-use accessory muscles
-nasal flaring

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64
Q

What are some late signs of respiratory distress in children?

A

-cyanosis
-bradycardia
-bradypnea
-confusion
-stupor
-hyper/hypotension

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65
Q

What should you monitor with trach care?

A

RR effort, SaO2 (oxygenation)
thickness, amount, color, and odor of mucous
stoma and surrounding skin

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66
Q

When should you listen while suctioning?

A

before and after

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67
Q

What should you do before suctioning someone with a trach?

A

hyperoxygenate

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68
Q

What technique should you use when suctioning?

A

aseptic technique

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69
Q

How long should you suction for infants?

A

<5 seconds

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70
Q

How long should you suction for children?

A

<10 seconds

71
Q

What should you clean a trach with?

A

soap and water

72
Q

How often should you change non-disposable trach tubes?

A

6-8 weeks

73
Q

how often should you provide oral care with a trach?

A

every 2 hours

74
Q

How often should you provide trach care?

A

every 8 hours

75
Q

What is bacterial epiglottis normally caused by?

A

Haemophilus influenza

76
Q

What are the priority manifestations of bacterial epiglottis?

A
  • high fever
  • no cough bc airway is blocked
  • drooling
  • tongue hanging out
  • tripod position
  • dysphonia
  • dysphagia
  • inspiratory stridor
77
Q

What are the priority interventions for bacterial epiglottis?

A
  • 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
78
Q

What are some nursing interventions for bacterial epiglottis?

A
  • keep pt and family calm
  • humidified O2
  • corticosteroids
  • antibiotics through IV
  • droplet isolation
79
Q

What are the priority manifestations of acute laryngotracheobronchitis?

A
  • low-grade fever
  • hoarseness
  • barky cough
  • dyspnea
    nasal flaring
  • retractions
  • tachypnea
80
Q

What are the priority interventions for laryngotracheobronchitis?

A
  • humidity with cool mist
  • oxygen
  • nebulized racemic epi
  • corticosteroids
  • encourage fluids
81
Q

What is acute spasmodic laryngitis?

A

characterized by paroxysmal attacks of laryngeal; obstruction that occur mainly at night
- self-limiting
- can be caused by allergens

82
Q

What are the priority manifestations of acute spasmodic laryngitis?

A
  • croupy, barky cough
  • difficulty breathing
  • hoarseness
  • nighttime episodes of laryngeal obstruction
83
Q

What are the priority interventions for acute spasmodic laryngitis?

A
  • humidity with cool mist
  • oxygen
  • nebulized racemic epi
  • corticosteroids
  • encourage fluids
84
Q

What is the causative agent of bronchiolitis?

A

RSV

85
Q

What are the initial symptoms of bronchiolitis?

A
  • sneezing to clear the airway
  • runny nose
  • coughing
  • wheezing
  • possible eye/ear infection
86
Q

What are the symptoms of bronchiolitis as the illness progresses?

A
  • fever
  • tachypnea
  • retractions
  • trouble feeding
87
Q

What are the severe symptoms of bronchiolitis?

A
  • tachypnea (>70)
  • apneic spells
  • cyanosis
88
Q

What are the priority findings of bronchiolitis?

A
  • inspiratory stridor
  • hypoxemia/ resp. distress
  • lethargic
89
Q

What is the priority action for bronchiolitis?

A

SUCTION

90
Q

What are the nursing interventions for PNA?

A
  • rest & fluids
  • culture before antibiotics
  • O2/continuous pulse ox
  • antipyretic for fever
91
Q

What diet should a child be on post tonsil removal?

A
  • clear liquids
  • avoid red-colored liquids, citrus or milk
  • advance to soft, bland foods
92
Q

What nursing interventions should be done after a tonsillectomy?

A

-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)

93
Q

What should you teach your patient who just had a tonsillectomy?

A
  • 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
94
Q

What are some complications for a tonsillectomy?

A
  • hemorrhage (watch for frequent swallowing)
  • dehydration (give oral fluids)
  • chronic infection (fever)
95
Q

What is cystic fibrosis?

A

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

96
Q

What are some expected findings/causes of cystic fibrosis?

A
  • thick secretions
  • hx of resp. infections/growth failure
  • meconium ileus at birth
97
Q

What are the early signs of CF?

A

wheezing
rhonchi
cough

98
Q

What are the signs of increased involvement with CF?

A

dyspnea
obstructive emphysema
atelectasis on chest x-ray

99
Q

What are the signs of advanced involvement of CF?

A

cyanosis
barrel-shaped chest
clubbing of fingers/toes

100
Q

What are the GI findings related to CF?

A

steatorrhea
cant gain or lose weight
deficiency in vitamins A, D, E, K and anemia

101
Q

What will sweat and tears have more of with CF?

A

high content of sodium and chloride

102
Q

What is the chloride level of a child with CF?

A

> 60

103
Q

What is the chloride level of an infant with CF?

A

> 40

104
Q

What is the sodium level for patients with CF?

A

> 90

105
Q

When should you not do chest physiotherapy with CF?

A

before or after meals

106
Q

What does dornase alfa help CF with?

A

decreases the viscosity of mucous and improves lung function

107
Q

What should you educate the parents on about dornase alfa?

A

-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

108
Q

What other medication can be given to patients with CF?

A

Aminoglycosides
-through their IV or aerosol nebulizer

109
Q

What kind of diet should a CF patient be on?

A

high protein
high calories

110
Q

What extra supplements should a CF patient take?

A

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)

111
Q

What are some allergens?

A

mold
dust
grass
pollen
trees
tobacco smoke

112
Q

What are triggers for asthma?

A

allergens
exercise
animal hair/dander
meds
seasonal allergies
stress/anxiety

113
Q

What are expected findings of asthma?

A

-chest tightness
- dyspnea
- wheezing
- crackles
- cough
- sweating
- low O2 sat
- accessory muscles

114
Q

What are priority findings to report for asthma?

A

silent chest (they are not breathing at all)

115
Q

What do we not do with asthma patients?

A

intubate

116
Q

What do peak flow meters measure?

A

amount of air that can be forcefully exhaled in 1 second

117
Q

What is albuterol used for with asthma?

A

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

118
Q

What are some expected side effects of albuterol?

A

tachycardia
HA
nervousness
tremors

119
Q

What are some adverse effects of albuterol?

A

bronchospasm

120
Q

What should you do after inhalation of corticosteroids?

A

rinse mouth

121
Q

What should you educate your patient about asthma?

A

get rid of carpet
avoid triggers
encourage regular exercise
do not wash things in bleach

122
Q

What are the nursing actions for drownings?

A

admin O2 (possibly ventilation)
CPT
monitor for cerebral edema and resp distress

123
Q

Education to prevent drownings?

A

lock toilet seats
do not leave children unattended in pool or bathtub
even a small amount of water can lead to drowning (1in)

124
Q

What are the risk factors for SIDS?

A

maternal smoking during pregnancy
2nd-hand smoke
co-sleeping
prone or side sleeping
premature
low APGAR score
family hx of SIDS

125
Q

What are the nursing interventions for SIDS?

A

provide support
plan a home health visit
refer to support groups
counseling

126
Q

What should you educate about to prevent SIDS?

A

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

127
Q

What are the risk factors for poisoning?

A

children younger than 6 years
improperly stored meds, chemicals, substances
exposure to plants, cosmetics and heavy metals

128
Q

What are the expected findings of acetaminophen poisoning?

A

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

129
Q

What are the expected finding of aspirin poisoning?

A

acute: N/V, disorientation, diaphoresis, tachypnea, tinnitus, oliguria, seizures
chronic: subtle versions of acute, bleeding, dehydration, seizures

130
Q

What are the expected findings of supplemental iron poisoning?

A

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

131
Q

What are the expected findings of hydrocarbon poisoning?

A

gagging/choking
coughing
N/V
lethargic/weakness
tachypnea
cyanosis
grunting
retractions

132
Q

What are hydrocarbons?

A

gasoline
kerosene
lighter fluid
paint thinner
turpentine

133
Q

What are corrosives?

A

household cleaners
batteries
denture cleaners
bleach

134
Q

What are the expected findings for corrosive poisoning?

A

pain/burning in mouth, throat, stomach
edematous lips, tongue & pharynx with white mucous membranes
violent vomiting w/ hemoptysis
drooling, anxiety, shock

135
Q

What are the expected findings for lead poisoning?

A

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

136
Q

Treatment for acetaminophen poisoning?

A

admin antidote: acetylcysteine

137
Q

Treatment for aspirin poisoning?

A

activated charcoal
gastric lavage
sodium bicarbonate

138
Q

Treatment for supplemental iron poisoning?

A

emesis or lavage
chelation therapy using deferoxamine mesylate

139
Q

Treatment for Hydrocarbon poisoning?

A

DO NOT induce vomiting
intubation w/ cuffed endotracheal tube before any gastric decontamination
treatment of chemical PNA

140
Q

Treatment for corrosive poisoning?

A

airway maintenance
NPO
DON’T attempt to neutralize acid
DO NOT induce vomiting
give analgesics for pain

141
Q

Treatment for lead poisoning?

A

chelation therapy using calcium EDTA

142
Q

What is a patent ductus arteriosus (PDA)?

A

pulmonary artery and aorta don’t close
left to right shunt
increased pulmonary blood flow
cyanosis later

143
Q

What are the signs/symptoms of patent ductus arteriosus?

A

murmur (cont machine hum, louder under left clavicle)
wide pulse pressure & bounding pulses
possibly asymptomatic
heart failure

144
Q

What are the tx options for PDA?

A

nonsurgical: admin indomethacin (helps close off pathway), insert coils to occlude PDA during cath
surgical: thoracoscopic repair

145
Q

What is an atrial septal defect?

A

it is a hole in the septum b/w the atria
left to right shunt
increased pulmonary blood flow
cyanosis later

146
Q

What are the s/sx of ASD?

A

loud, harsh murmur with a fixed split-second heart sound
heart failure
possibly asymptomatic

147
Q

What are the treatment options for ASD?

A

nonsurgical: closure during cardiac cath
surgical: patch closure

148
Q

What is a tetralogy of fallot?

A

4 defects that cause mixed blood flow

149
Q

What are the four defects involved in tetralogy of fallout?

A
  • pulmonary stenosis
  • ventricular septal defect
  • Overriding aorta
  • right ventricular hypertrophy
150
Q

What are the s/sx of tetralogy of fallot?

A

cyanosis at birth which progresses over the 1st year of life
systolic murmur
tet spells: episodes of acute cyanosis & hypoxia

151
Q

What can you do to help alleviate tet spells?

A

knee to chest position
call for help
calm the child (crying can cause a tet spell)
admin morphine

152
Q

What are the treatment options for tetralogy of fallot?

A

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

153
Q

What are the signs of heart failure in children?

A

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

154
Q

What is polycythemia in heart failure?

A

Compensatory mechanism
-body says to produce more RBCs because O2 is low, this makes the blood thicker

155
Q

What are the nursing interventions for heart failure?

A

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

156
Q

How often should an infant be fed with HF?

A

every 3 hours
use a soft premie nipple or regular nipple w/o a slit

157
Q

How should you pick up an infant post surgery w/ HF?

A

under shoulders and buttock

158
Q

What does pre-op care consist of for cardiac catheterization?

A

hx & physical exam
look for evidence of infection
assess allergies to shellfish or iodine
NPO 4-6 hours prior
baseline VS
admin pre-sedation

159
Q

What should you assess for post cardiac cath?

A

bradycardia
dysrhythmias
hypoTN
hypoxemia
heart and lungs for one min
pulses for equality
temp & color of extremity
insertion site

160
Q

What should you educate the parents on following cardiac cath?

A

monitor site for infection
no tub baths until dr says
don’t lift their child under their arms
- lift at the head or hips

161
Q

nursing actions with administering digoxin

A

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

162
Q

Function of Captopril?

A

reduce afterload by causing vasodilation

163
Q

Nursing actions for Captopril?

A

monitor BP before & after
watch for hyperkalemia

164
Q

function of metoprolol

A

decrease HR & BP
promote vasodilation

165
Q

Nursing actions for metoprolol

A

monitor BP and pulse before admin
side effects: dizzy, hypoTN, HA

166
Q

Nursing actions for Furosemide

A

encourage a diet high in potassium
monitor I&O
daily weights
side effects: hypokalemia, N/V, dizziness

167
Q

What is rheumatic fever?

A

inflammatory disease that occurs as a reaction to Group A beta-hemolytic strep GABHS infection of the throat

168
Q

What are the risk factors associated with Rheumatic fever?

A

untreated or partially treated upper respiratory infection (strep) w/ GABHS

169
Q

What diagnostic is the most reliable for rheumatic fever?

A

Serum Antistreptolysin-O Titer
- elevated or rising

170
Q

What is jones criteria?

A

Made if the child has 2 major or if they have 1 major and 2 minor following an acute GABHS infection

171
Q

What is the major criteria for rheumatic fever?

A

carditis (chest pain)
SQ nodules
polyarthritis
rash (erythema marginatrum)
chorea (involuntary movements of extremities and face muscles)

172
Q

What are the minor criteria for rheumatic fever?

A

fever
arthralgia (pain in joint)

173
Q

What should the nurse educate the parents on regarding chorea?

A

it is self-limiting and will resolve over time

Families (8 decks)

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