Exam 3 Flashcards
1
Q
Schema
A
Individuals cognitive structure or framework of thought
2
Q
Eriksons infancy stage
A
Birth-18mo
Trust vs mistrust
Attachment to primary caregiver
3
Q
Eriksons early childhood
A
18mo-3yrs
Autonomy vs shame and doubt
Gaining control over self and environment
4
Q
Eriksons late childhood (preschool)
A
3-6yrs
Initiative vs guilt
Becoming purposeful and directive
Start lying, give choices, imaginary friend
5
Q
Eriksons school age
A
6-12yrs
Industry vs inferiority
Developing social, physical, and learning skills
6
Q
Eriksons adolescence stage
A
12-20 yrs
Identity vs role confusion
Developing identity
7
Q
Interventions to help in infancy stage (eriksons)
A
Hold and touch infant regularly
Comfort after painful procedures
Meet basic needs
Play active role when infant is hospitalized
8
Q
Interventions to help in the early childhood stage
A
Allow self-feeding
Child removes and puts on own clothes
Let child make choices, ensuring safety
9
Q
Interventions to help in the late childhood stage
A
Offer medical equipment for play
Respect child’s choices and expressions of feelings
10
Q
Interventions for school age stage
A
Encourage to continue schoolwork when hospitalized
Bring fav activities to hospital
11
Q
Interventions for adolescence stage
A
Health history and exams without parent
Allow choice in plan of care
12
Q
Sensorimotor
A
Birth-2yrs
Learns reality and how it works
Infant doesn’t recognize objects to exist if out of visual field
13
Q
Preoperational stage
A
2-7yrs
Thinks in terms of past, present, future
Solutions to problems
Egocentric
Requires concrete examples
14
Q
Concrete operational stage
A
7-11yrs
Classify, order and sort facts
Solves concrete problems with logic
Abstract thinking
Starts thinking how others may view a situation
15
Q
Formal operational stage
A
11yrs-adult
Thinks abstractly and logically
16
Q
Vaccines at birth
A
Hep B (1st dose)
17
Q
Vaccines at 1 month
A
Hep B (2nd dose)
18
Q
Vaccines at 2 months
A
IPV(polio), DTaP, Hib, PCV, Rotavirus (RV)
19
Q
Vaccines at 2 and 4 months
A
DTaP, Hib, IPV (polio), PCV, RV (rotavirus)
20
Q
Vaccines at 6 months
A
DTap, Hib, HepB, IPV, PCV, RV
21
Q
Vaccines at 12-15 months
A
Hib, PCV, MMR, Hep A (1st dose), varicella
22
Q
Vaccines at 15-18 months
A
DTap
23
Q
Vaccines at 18-33 months
A
Hep A (2nd dose- 6-18 months after 1st dose)
24
Q
Vaccines at 4-6 yrs
A
DTaP, IPV, MMR, varicella
25
Vaccine at 11-12 yrs
MMR (If not given at 4-6 yrs old), Tdap, MCV4, HPV (2nd dose 2 months later and 3rd dose 6 months after 1st dose)
26
flu vaccine in children
given yearly starting at age 6 months
27
Hep B vaccine
IM
contraindicated if allergy to aluminum hydroxide or yeast
28
Rotavirus vaccine (RV)
PO to replicate in infant's gut
held if severe vomiting or diarrhea
29
Haemophilus influenzae type b (Hib)
IM
protects against infections caused by H. influenzae
30
MMR
SubQ
contraindicated if allergy to gelatin, eggs or neomycin
31
Baby weight
doubled at 5-6 months
tripled at 12 months
32
When is the head circumference equal to the chest
1-2yrs old
33
When does the anterior fontanel close
18 months
34
When does the posterior fontanel close
4 months
35
1 yr old VS
T 97-99
HR 90-130
R 20-40
BP 90/56
36
When are solid foods introduced
5-6 months
one at a time to identify allergens
37
Honey in children
avoid adding in formula, water, or other fluid to avoid botulism
38
infant skills at 2-3 months
smiles
turns head side to side
follows objects
holds head in midline
39
infant skills at 4-5 months
grasp objects
switches objects from hands
rolls over
begins to show memory
aware of unfamiliar surroundings
40
skills at 6-7 months
creeps
sits with support
imitates
exhibits fear of strangers
holds arms out
mood swings
waves bye
41
skills at 8-9 months
sits steadily unsupported
crawls
stands while holding on
begins to stand without help
Teething
Mama/dada
42
skills at 10-11 months
change from prone to sitting
walks while holding onto furniture
stands securely
entertains self for periods of time
43
skills at 12-13 months
walks with one hand held
takes few steps without falling
drinks from a cup
3-5 words
44
skills at 14-15 months
walks alone
crawl upstairs
shows emotions like anger and affection
will explore away from parent in familiar surroundings
45
infant play
solitary
soft stuffed animals
crib mobiles
rattles
water toys
push toys when able to walk
46
skills at 12-13 months
walk with one hand held
47
skills by 2 yrs old
running
vocab of 300 words
48
skills by 3 yrs old
walks backwards and hops on one foot
49
toddler play
parallel and therapeutic play
push-pull toys, blocks, sand, finger paints and bubbles, large balls, crayons, dolls, toy telephones, cloth books, wooden puzzles
50
preschooler skills
hop, skip, run smoothly
balance
alternates feet when climbing stairs
age 6- ties shoes
asks "why" questions
3 yrs old: 3-4 word sentences
4 yrs old: 5-6 word sentences
51
preschooler play
cooperative
imaginary friends
build and creates things - simple and imaginative
understands sharing
dress up, paints, paper, crayons
52
school age play
competitive
rules and rituals are important in games
drawing, collecting, pets, guessing games, board games, TV, reading, radio, PC games
53
cholesterol levels for children (2-19)
total <170
LDL <110
HDL >45
54
Early signs of HF
tachycardia
tachypnea
scalp sweating
fatigue/irritability
sudden weight gain
respiratory distress
55
digoxin in children
level- 0.8-2
hold if HR <90 for infants and <70 in older children
monitor K because low K can cause toxicity
56
signs of dig toxicity
anorexia
poor feeding
N&V
bradycardia
dysrhythmias
57
dig administration
1 hr before or 2 hours after feedings
58
manifestations of decreased CO
activity intolerance
decreased peripheral pulses
feeding difficulties
hypotension
irritability/restless/lethargy
oliguria
pale, cool extremities
tachycardia
59
Atrial septal defect (ASD)
Abnormal opening between right and left atria: increased flow of oxygenated blood into right side of heart
60
Atrial septal defect (ASD) symptos
could be asymptomatic
right heart enlargement
signs of HF
Decreased CO
61
Management of Atrial septal defect (ASD)
closed during cardiac cath
open repair with bypass performed before school age
62
Atrioventricular septum defect
incomplete fusion of the endocardial cushions
most common in down syndrome
63
Atrioventricular septum defect symptoms
murmur
mild-mod HF
cyanosis increases with crying
decreased CO
64
Managing Atrioventricular septum defect
pulm artery banding for severe sx
complete repair with bypass
65
Patent ductus arteriosis
failure of the shunt connecting the aorta and pulm artery to close within first weeks of life
66
symptoms of Patent ductus arteriosis
machinery-like murmur
asymptomatic or signs of HF
widened pulse pressure and bounding pulses
decreased CO
Increased pulm blood flow
67
Managing Patent ductus arteriosis
indomethacin to close patent ductus in premies
cardiac cath
68
Ventricular septal defect
abnormal opening between right and left ventricles
many close spontaneously during first year of life
69
symptoms of Ventricular septal defect
murmur
Signs of HF
decreased CO
70
aortic stenosis
commonly caused by malformed cusps
causes resistance to blood flow from lft ventricle into aorta= decreased CO
71
Signs of aortic stenosis
murmur
decreased CO
activity intolerance
chest pain
dizziness when standing for long periods
72
coarctation of the aorta
narrowing near insertion of ductus arteriosus
73
signs of coarctation of the aorta
BP higher in upper extremities than lower
bounding pulses in arms
weak/absent femoral pulses
cool lower extremities
HF
decreased CO
HA, dizziness, fainting
epistaxis from HTN
74
Managing coarctation of the aorta
balloon angioplasty - restenosis can occur
75
pulmonary stenosis
narrowing at entrance of pulmonary artery
resistance causes right ventricular hypertrophy and decreased pulmonary blood flow
76
pulmonary atresia
extreme form of pulmonary stenosis: total fusion and no blood flow to the lungs
77
symptoms of pulmonary stenosis
murmur
cyanotic
decreased CO
HF
78
tetralogy of fallot
four defects- VSD, pulm stenosis, overriding aorta and right ventricular hypertrophy
79
signs of tetralogy of fallot
acute cyanosis at birth or mild cyanosis that progresses over first year of life
murmur
acute episodes of cyanosis (blue/tet spells) while crying, feeding or pooping
clubbing of fingers (children)
poor growth
squatting (knee to chest)
80
tricuspid atresia
failure of tricuspid to develop
complete mixing of oxygenated and deoxygenated blood in left side of heart= decreased pulm blood flow
81
signs of tricuspid atresia
cyanosis
tachycardia
dyspnea
clubbing (children)
82
hypoplastic left heart syndrome
underdevelopment of left side of heart
83
signs of hypoplastic left heart syndrome
mild cyanosis and signs of HF until arteriosus closes- leads to cardio collapse- fatal first few months of life if left untreated
84
Pre-op cardiac cath
accurate ht and wt
check for allergy to iodine
assess for diaper rash (if entry through femoral artery)
85
Post op cardiac cath
monitor o2 for 4 hrs
assess lower extremity pulses and color/temp
86
rheumatic fever
inflammatory autoimmune disease that affects connective tissue of the heart, joints, skin, blood vessels and CNS
ask about sore throat- often manifests 2-6 wks after untreated group A strep
87
S/S of rheumatic fever
chorea
fever
carditis
erythema marginatum ( skin lesions on trunk and spreading horizontally
abd pain
subQ nodules (over joints)
polyarthritis
elevated ESR
88
chorea
involuntary movements of extremities and face
affects speech
89
managing rheumatic fever
joint pain- alt heat and cold presses
massaging
bedrest if febrile
seizure precautions if chorea
need abt prophylaxis before dental work
90
kawasaki disease
acute systemic inflammatory illness
cause unknown but may be from organism or toxin
aneurysms can develop
91
acute stage of kawasaki disease
fever
conjunctival hyperemia
mucositis (cracked red lips and strawberry tongue)
Peeling skin
swelling of hands and feet and erythema of palms and soles
rash
enlargement of cervical lymph nodes
increased irritability
arthritis
gallop sounds and tachycardia
92
subacute stage of kawasaki disease
begins when fever resolves
cracking lips and fissures
desquamation (peeling) of skin on tips of the fingers and toes
joint pain
thrombocytosis
93
epiglottitis
bacterial form of croup
most freq in 2-8 yrs old
onset abrupt- mostly in winter
emergency- can lead to airway obstruction
94
symptoms of epiglottitis
high fever
sore, red, inflamed throat
pain when swallowing
absence of spontaneous cough
dysphonia (muffled voice)
dyspnea and drooling
agitation
retractions
inspiratory stridor
tachycardia
tripod positioning
95
edu for epiglottitis
dont take temp orally
dont place in supine position
no throat culture
96
laryngotracheobronchitis (croup)
viral or bacterial
freq in 5yrs old or less
97
croup stage 1
low grade fever
hoarseness
seal bark/brassy cough
inspiratory stridor
fear
irritability and restlessness
98
croup stage 2
continuous respiratory stridor
retractions
accessory muscles
crackles +wheezing
labored respirations
99
stage 3 croup
continued restlessness
anxiety
pallor
sweaty
tachypnea
signs of anoxia and hypercapnia
100
stage 4 croup
intermittent cyanosis progressing to consistent cyanosis
apneic episodes progressing to cessation of breathing
101
edu for croup
use cool air vaporizer or breathe in cool, fridge air
no cough/cold medicine
102
bronchitis symptoms
fever
dry, hacking nonproductive cough worse at night
103
RSV- Respiratory syncytial virus
viral infection that can cause bronchiolitis
spread by droplet
primarily in fall, winter and spring
any age- but most problems in younger than 6 months
104
RSV signs
signs of common cold
eye/ear drainage
wheezing
air hunger
periods of cyanosis
105
cystic fibrosis
exocrine glands excrete extra thick secretions that can cause obstruction
106
Tx for bacterial pneumonia
tent
suctioning
chest physiotherapy before meals
postural drainage Every four hours
child should lay on affected side
droplet isolation
closed chest drainage if purulent fluid
107
Sweat chloride test
For cystic fibrosis
High levels of chloride indicate positive test
Cl >60 or >40 in infants
108
Cystic fibrosis signs
Child tastes “salty”
109
High risk conditions for SIDS
Prone position
Soft bedding
Overheating
Co-sleeping
Mom smoked cigarettes
Exposure to tobacco smoke after birth
110
projectile vomiting can indicate what
pyloric stenosis or increased ICP
111
rotavirus
serious gastroenteritis
most severe in children 3-24 months
enteric isolation- effective handwashing
112
severe dehydration
NPO to rest bowl
fluid replacement by IV
If K ordered, have child void before administering and check renal function
113
cleft lip/palate
abnormal opening in the lip or palate
cause is hereditary and environmental factors (radiation or rubella virus, maternal smoking, teratogenic meds)
114
cleft lip/palate Tx
closure usually performed by age 3 -6 months
repair usually around 1 year old to help speech development
at risk for developing freq otitis media which can lead to hearing loss
115
cleft palate/lip management
infant held upright and direct bottle to side and back of mouth
feed small amounts and burp freq
116
post op cleft lip repair
metal appliance or adhesive strips applied for lip protection
avoid prone position- position upright and on the back
clean surgical site after feedings with NS
elbow restraints
117
post op cleft palate repair
oral packing secured to palate (removed in 2-3 days)
tongue stitch may be needed to prevent obstructing airway
softelbow or jacket restraints
no suctioning in mouth or putting anything in the mouth (temp, pacifiers, straws)
118
esophageal atresia
esophagus doesn't develop all the way to the stomach- ends with a fistula to trachea or small pouch
119
esophageal atresia signs
Apnea >15 sec
frothy saliva in mouth and nose and excessive drooling
coughing + chocking during feedings
unexplained cyanosis
regurgitation and vomiting
abdominal distention
increased resp distress during and after feeding
120
nursing interventions for esophageal atresia
supine upright position
NPO
keep pouch empty by intermittent or continuous suctioning
suction accumulated secretions from mouth and nose
121
gastrostomy tube after esophageal atresia repair
purulent drainage= anastomotic leak
attached to gravity until infant can tolerate feedings and anastomosis is healed (5-7 days)
esophogram before feedings to check integrity of esophagus
122
signs of aspiration
drooling, coughing, and dyspnea after feeding
122
Managing GERD in infants
keep baby upright for 20-30 min after feedings
semisupine (car seat) increases reflux
small frequent feedings with predigested formula
thickened formula (cross-cut the nipple)
123
hypertrophic pyloric stenosis
narrowing of canal between the stomach and duodenum
develops first few weeks of life
124
hypertrophic pyloric stenosis signs
projectile vomiting
vomit contains milk, mucous or blood-tinged... no bile
peristaltic waves visible from left to right across epigastrium
olive shaped mass to the right of umbilicus
125
signs of lactose intolerance
abd distention
crampy, abd pain; colic
diarrhea and excessive flatus
126
signs of celiac disease
steatorrhea
acute diarrhea
anorexia
abd pain and distention
muscle wasting in buttocks and extremities
vomiting
anemia
irritability
127
what to substitute for gluten
corn, rice and millet
128
signs of appendicitis
pain in umbilical area descending to RLQ (Mcburneys point)
rebound tenderness
side-lying and abd guarding
129
Hirschsprungs disease
mechanical obstruction because of inadequate motility in intestinal segment
absence of ganglionic cells
130
signs of Hirschsprungs disease
newborns: failure to pass meconium, refusal to suck, abd distention, bile-stained vomit
children: ribbon like stool, alt constipation and diarrhea, vomiting, abd distention
delayed growth
131
intussusception
telescoping of bowel
132
signs of intussusception
colicky abd pain - knees to abd
vomiting gastric contents
jelly-like stools
hyper or hypoactive bowel sounds
sausage shaped mass in RUQ
133
omphalocele
herniation of abdominal contents through umbilical ring
protrusion is covered by translucent sac that may contain bowel
rupture of sac results in evisceration
134
interventions for omphalocele
after birth, protrusion covered with sterile gauze soaked in NS and plastic wrap applied on top
prepare for surgery
135
gastroschosis
herniation of the intestine is lateral to the umbilical ring
no membrane covers the exposed bowel
loosely wrapped in plastic drape with soaked NS pads underneath- dont directly wrap around the exposed bowel is contraindicated
136
hydrocele
abd fluid in scrotal sac
137
encopresis
constipation and fecal incontinence
138
signs of encopresis
soiling clothing
scratching or rubbing anal area
fecal odor
social withdrawal
139
imperforate anus
incomplete development or absence of anus
140
signs of imperforate anus
failure to pass meconium
absence or stenosis of anal canal
presence of anal membrane
external fistula to perineum
141
Hep A
usually occurs in preschoolers or school age children less that 15
if asymptomatic, can still spread to others
2 series vaccine
142
Hep B
mostly acquired during birth if mom has it
2 series vaccine
143
Hep C
transmission at birth from mom
usually asymptomatic
chronic condition
144
Hep D
occurs in children already infected with Hep B and can lead to cirrhosis
145
Hep E
uncommon in children
146
Hep vaccines cause what immunity
passive immunity
147
Signs of hepatitis
RUQ pain
dark urine, pale stools
itchy
jaundice
148
teaching for hepatitis
not isolated unless incontinent of stool
discouraged from sharing toys
disinfect diaper changing table with bleach and water
noninfectious 1 week after onset of jaundice
149
giardiasis
commonly from crowded environments (daycares/classrooms)
150
signs of giardiasis
diarrhea and vomiting
anorexia
failure to thrive
abd cramps and intermittent loose stools and constipation
steatorrhea
151
pinworms
in temperate climate zones and transmitted in crowded environments
152
signs of pinworms
intense perineal itching
irritable, restlessness
poor sleeping
bed wetting
153
causes of glomerulonephritis
most common- strep infection 1-2 weeks before condition develops
154
signs of glomerulonephritis
periorbital and facial edema
anorexia
decreased UO
cola-colored urine or hematuria
pallor
hypertension
proteinuria- foam in urine
increased BUN and Crt
increased anti-streptolysin O titer
155
nursing interventions for glomerulonephritis
restrict Na
Restrict K due to inability to filter it out
seizure precautions due to HTN encephalopathy
report HA, bloody urine and edema
156
nephrotic syndrome
massive proteinuria
hypoalbuminemia
hyperlipidemia
edema
157
nephrotic syndrome signs
wt gain
facial swelling or any edema
decreased UO
ascites
dark, frothy urine
BP normal or slightly decreased
low protein in blood
158
enuresis
"bed-wetting"
child unable to control bladder function when they have been able to before or at an age where they are expected to be able to (older than 5)
159
managing enuresis
limit fluid at night
encourage to void before bed
160
NIPS scale
Less than 2 months
161
FLACC scale
2 months- 7 yrs
162
Wong-baker faces
3-4 yr olds
163
Wong-baker faces
3-4 yr olds
164
Numeric scale
Used in 8yrs old or older
Must be able to count and understand value of numbers
165
Ear assessment in children
<3 pinna down and back
>3 pinna up and back
166
Unoccupied play
Infant
No purpose- random movement
167
Solitary play
Infant/toddler
Play alone with their interest focused on own activity
168
Onlooker play
Toddler
Watch other people play but don’t interact
169
Parallel play
Toddler 1-3
Play independently but next to each other
170
Associative play
Preschooler 3-6
Play together but with no group goal
Ex. Kick ball around
171
Cooperative play
School age 6-12
Organized, plays in groups
Ex. Sports, board games
172
Stepping reflex gone by
1month
173
Rooting/sucking reflex gone by
3-4 months
174
Palmer reflex gone by
3-4 months
175
Tonic neck reflex gone by
3-4 months
176
Moro/startle reflex gone by
6 months
177
Plantar reflex gone by
8 months
178
Crawling reflex gone by
6 wks
Reappears when learning to walk
179
Babinksi reflex gone by
1 yr old
180
Pharyngitis
From strep A
Needs Abts
181
Pharyngitis signs
Sore throat
HA
Fever
Rash
Abd pain
182
Teaching for pharyngitis
No school for 24 hrs after abt
183
Teaching for post op tonsillectomy
No red dyes
No milk, citrus, hot fluids or soda
Freq swallowing=bleeding
Coughing, crying and screaming can cause bleeding
REPORT persistent ear ache
