Exam 3 - Peds Flashcards by Kaitlyn Nelson

Place in order the sequence of maturational changes for girls. Begin with the first change seen, sequencing to the last change.

a. Growth of pubic hair
b. Rapid increase in height and weight
c. Breast changes
d. Menstruation
e. Appearance of axillary hair

C, B, A, E, D

breast changes > rapid increase in weight + height > pubic hair > axillary hair > menstruation

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Which describes the cognitive abilities of school-age children? (Select all that apply.)

A. Have developed the ability to reason abstractly
B. Are capable of scientific reasoning and formal logic
C. Developed the ability to understand relational term and concepts
D. Have a mastery of the concept of conservation
E. Have a steady reduction in egocentricity

C, D, E

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When teaching injury prevention during the school-age years, which would the nurse include?

A. Promote the fear of strangers.
B. Basic rules of water safety.
C. Avoidance of microwave cooking.
D. Emphasize the negative aspects of competitive sports.

fuccckkkkk, sorry if you looked at these earlier. it said C but it’s most definitely not.

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Which would the nurse expect of a healthy 3-year-old child?

A. Jump rope
B. Ride a two-wheel bicycle
C. Skip on alternate feet
D. Balance on one foot for a few seconds

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According to Piaget, which describes magical thinking common in preschool age children?

A. Events have cause and effect.
B. God is like an imaginary friend.
C. Thoughts are all-powerful.
D. If the skin is broken, the child’s insides will come out.

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Which play is most typical of the preschool period?

A. Solitary
B. Parallel
C. Associative
D. Team

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Which is descriptive of a toddler’s cognitive development at age 20 months?

A. Searches for an object only if he or she sees it being hidden
B. Realizes that “out of sight” is not out of reach
C. Puts objects into a container but cannot take them out
D. Understands the passage of time, such as “just a minute” and “in an hour”

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Which characteristic best describes the gross motor skills of a 24-month-old child?

A. Skips and can hop in place on one foot
B. Rides tricycle and broad jumps
C. Jumps with both feet and stands on one foot momentarily
D. Walks up and down stairs and runs with a wide stance

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Which is the leading cause of death during the toddler period?

A. Unintentional injuries
B. Infectious diseases
C. Congenital disorders
D. Childhood diseases

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A nurse is assessing a 12-month-old infant. Which statement best describes the infant’s physical development a nurse would expect to find?

A. Anterior fontanel closes by age 6 to 10 months.
B. Binocularity is well established by age 8 months.
C. Birth weight triples by age 1 year.
D. Maternal iron stores persist during the first 12 months of life.

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At which age can most infants sit steadily unsupported?

A. 4 months
B. 6 months
C. 8 months
D. 10 months

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In terms of gross motor development, which would the nurse expect a 5-month-old infant to do? (Select all that apply.)

A. Roll from abdomen to back. 
B. Put feet in mouth when supine. 
C. Roll from back to abdomen. 
D. Sit erect without support. 
E. Move from prone to sitting position. 
F. Adjust posture to reach an object.

A, B

back to abdomen: 6 mo
sit erect w/o support: 8 mo
prone to sitting: 10 mo
adjust posture to reach: 8 mo

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The nurse is caring for a 5-year-old child who is scheduled for a tonsillectomy. Which action should the nurse include in the child’s postoperative care plan? (Select all that apply.)

A. Notify the surgeon if the child swallows frequently.
B. Apply a heat collar to the child for pain relief.
C. Place the child on the abdomen until fully awake.
D. Prepare for oral liquids immediately following procedure.
E. Encourage the child to cough frequently.

A, C

swallowing frequently could indicate hemorrhage
(abdomen until fully awake for drainage)

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Parents have understood teaching about prevention of childhood otitis media if they make which statement? (Select all that apply.)

A. “We will avoid second hand smoke.”
B. “Breastfeeding will be discontinued after 4 months of age.”
C. “We will place the child flat right after feedings.”
D. “A conjugate vaccine may be administered.”
E. “We will adminster medications as prescribed.”

A, D, E

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G+D. what age can:

track objects with eyes

1 month

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G+D. what age:

smile
lift head off mattress when prone

2 months

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G+D. what age:

turn head to sounds
make cooing & babbling sounds

3 months

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G+D. what age:

roll abdomen to back
puts feet in mouth when lying supine

5 months

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G+D. what age:

Rolls from back to front
Sit WITH support

6 months

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when do 1st teeth usually come in?

around 6-9 months

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G+D. what age:

sits WITHOUT support

8 months

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G+D. what age:

Pincer grasp
Creeps on hands and knees

9 months

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G+D. what age:

Go from prone to sitting
Stand while holding on to furniture
Lift one foot while standing

10 months

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G+D. what age:

Turn pages in a book
Walks with one hand held

12 months

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G+D. what age: walk w/o help 2 block tower Use cup

15 months

G+D. what age: Throw ball overhand 3 block tower

18 months

G+D. what age: 6-7 block tower Turn doorknob 2-3 word phrases (“all done!”) Turn book pages

2 yrs

G+D. what age: Jump w/both feet Draw circles

2.5 yrs

at what age do children usually have all of their baby teeth in?

2.5 yrs

G+D. what age: rides a tricycle

3 yrs (3 wheels = 3 yrs)

G+D. what age: skip + hop

4 yrs

G+D. what age: jump rope walk backwards

5 yrs

what is 1st leading cause of death in ages 1-4?

unintentional injuries *congenital abnormalities are 2nd*

child should be in rear facing car seat until what age?

erikson infant

trust vs mistrust

erikson toddler

autonomy vs shame + doubt

erikson preschool

initiative vs guilt

erikson school-age

industry vs inferiority

erikson adolescent

identity vs role confusion

what erikson stage does this represent? developing a sense of trust when caregivers give reliable care “Is my world safe?”

trust vs mistrust (infant)

what erikson stage does this represent? Develop sense of personal control of skills; INDEPENDENCE “Can i do things by myself or will I always have to rely on others?”

autonomy vs shame + doubt | toddler

what erikson stage does this represent? Assert power over the environment “Am I good or am I bad?”

initiative vs guilt | preschool

what erikson stage does this represent? School activities become important; learning to cope with new social + academic demands

industry vs inferiority | school age

what is a way we can help school age children not feel inferior? (re: erikson)

positive reinforcement

what erikson stage does this represent? Sense of self + personal identity developed Social relationships are paramount “Who am I and where am I going?” Peers very important + body image becomes very important

identity vs role confusion | adolsecent

piaget stage: birth through 2 years

sensorimotor (learning about world through senses)

piaget stage: toddler through early childhood (7)

preoperational "PREschool = PREoperational"

piaget stage: 7-11 yrs

concrete operational

piaget stage: adolescent through adulthood

formal operational

psychosocial stages created by who?

erikson

cognitive stages created by who?

piaget

what is main accomplishment of sensorimotor stage

object permanence

when does object permanence develop?

9 months

piaget stage: ``` represents things with words + images Intuitive rather than logical Pretend play Egocentric Magical thinking ```

preoperational

re: piaget, what is magical thinking? what's an example?

thoughts are powerful + can cause events to occur (can be positive or negative) ex: if they said something bad about sibling and they ended up in hospital, they would think it was their fault)

piaget stage: give life-like qualities to inanimate objects: “the tricycle is bad because I fell off of it”

preoperational | example is a form of magical thinking

piaget stage: thinking logically + conceptually Can do math + solve problems

concrete operational

which piaget stage does understanding of "conservation" happen in?

concrete operational | school age

re: piaget, what is conservation?

ex: same amount of water in different size + shape container

piaget stage: abstract thinking thinking about their future

formal operational

type of play for toddler

parallel

type of play for preschool

associative

type of play for school age

team

when is pretend play very common? (play kitchen, play grocery store, etc)

preschool

around what time should solid foods be introduced to infant? how should it be done?

~ 6 months 1 new food at a time to assess for allergies or intolerances

what is limit for juice in infancy stage?

4-6 oz

cows milk shouldn't be given until what age?

12 months

normal newborn pulse

110-160

normal newborn RR

30-60

normal newborn temp

97.7-98.9

how do vital signs change as infant grows?

HR + RR decrease w/age BP increases w/age ex adolescent: HR 55-85, RR 12-20, BP 110-120/65-80

how should exam/assessment be performed on kid?

do "scariest" thing last ex: listen to heart and lung sounds/RR before messing with head/face/nose

birth weight should be doubled by when?

6 months

birth weight should be tripled by when?

12 months

when does posterior fontanel close?

2-3 months

when does anterior fontanel close?

12-18 months

re: atraumatic care, where should painful procedures be performed?

procedure room. NOT in patient room, bed or playroom *let these spaces stay safe for them*

what pain assessment tool would be good for young children (infants to 7 yrs)?

FLACC

what does FLACC encompass?

``` Face Legs Activity Cry Consolability ```

what pain scale is this? Photographs that include cultural differences to help identify more

OUCHER scale

what pain scale is this? 0-10 pain scale AND faces

visual analog scale

asthma patho (simple)

hyperresponsiveness --> edema, mucus, narrowing of airway

what testing is used to determine severity classification for asthma?

pulmonary fxn test

asthma severity classification: symptoms <2days/week, waking up with symptoms <2days/month, SABA use <2days/week, no limit on activity

intermittent

asthma severity classification: symptoms > 2days/week, waking up with symptoms <3-4 days/month, SABA use >2days/week, minor limitations on activity

mild persistent

asthma severity classification: symptoms daily, waking up with symptoms >1/week, SABA use daily, some activity limitations

moderate persistent

asthma severity classification: symptoms multiple times/day, waking up with symptoms almost nightly, SABA use multiple times/day, extremely limited activity

severe persistent

how do you use a peak flow meter? (6)

1. Ensure marker is zeroed 2. Remove food or gum 3. Stand up straight 4. Close lips around mouth piece 5. Blow out as hard + quickly as possible; 3x 6. Record highest #

SE of SABA meds

irritability, insomnia, tremors, nervousness

what should a person do after using an inhaled glucocorticoid?

rinse (to prevent thrush in mouth)

name some triggers for asthma (7)

1. exercise 2. smoke 3. allergens 4. pollutants 5. extreme temperatures 6. infections 7. strong emotions/stress

what is CF?

autosomal recessive lower airway disease that causes thick mucus; impacts gas exchange + many other systems of the body

what transport is affected by CF?

NaCl and H2O --> makes very thick and sticky mucus

what is meconium ileus and what could it indicate?

meconium ileus: no meconium stool in expected timeframe (first 72 hrs) could mean: newborn has CF

how does CF impact GI and pancreas?

mucus impacts pancreas ability to produce enzymes and breakdown fat/other foods --> steatorrhea

what manifestations might you see in a patient with malnutrition r/t CF?

protuberant abdomen, thin extremities, anemia

how does CF impact fertility?

mucus blocks vas deferens (AMAB) + prevents implantation (AFAB)

what is one of the biggest concerns with CF?

infection risk!!! (b/c of all the stagnant mucus)

what diagnostic tool can we use for CF?

Quantitative Sweat Chloride skin test

what is positive result for CF with Quantitative Sweat Chloride skin test?

>60 mEq/L

what are nutritional interventions for CF? (3)

1. small, high calorie, high protein meals 2. pancreatic enzymes w/food 3. infants: predigested formula

interventions for CF r/t respiratory (4)

1. Chest PT 2. bronchodilators 3. mucolytics 4. ABX (if resp infection)

what would be good exercise option for someone with CF?

swimming

when should we give pancreatic enzymes to patient with CF?

right before or with meals/snacks

group of disorders affecting larynx, trachea + bronchi

croup disorders

s+s of croup (6)

1. Barky, seal-like cough 2. Inspiratory stridor (usually worse @ night) 3. Wheezing 4. retractions 5. nasal flaring 6. hypoxemia

interventions for croup (4)

1. humidified O2 2. cool mist 3. Monitor O2 sats 4. Calm (environment) + comfort (prevent crying)

epiglottitis is caused by what?

Hib (bacteria) *MEDICAL EMERGENCY*

What are the 4 D's of epiglottitis?

Drooling Dysphagia Dysphonia Dyspnea

priority intervention for epiglottitis

protect AIRWAY!!! no tongue blades, cultures, anything that could obstruct airway, etc

what precautions would someone be on for epiglottitis?

droplet

priority assessment after tonsillectomy

assess gag reflex | ABC!

what 3 manifestations could indicate hemorrhage after tonsillectomy?

1. excessive swallowing 2. excessive clearing of the throat 3. visible bright red bleeding

what can we use post op tonsillectomy for pain, inflammation + vasoconstriction?

ice collar around neck

what food items should be avoided after tonsillectomy to prevent confusion and distinguish from bleeding complications ?

red or brown liquids/foods

what is otitis media? what is otitis media with effusion?

OM: middle ear infection OME: fluid in the middle ear

when is OM common?

first 24 months of life + when kids enter school

OM is less common in infants that _________

breastfeed

these s+s could indicate what: Fever, crying, tugging, rubbing, irritable, not eating well, nausea + other differences in temperaments

otitis media

these s+s could indicate what: Fullness in ear, popping when swallowing, hearing loss, balance issues, tinnitus

otitis media with effusion (fluid in middle ear)

what is usual intervention / care for otitis media?

"watchful waiting" + comfort measures most clear up on own in a few days. keep an eye on fever and kid and ride it out unless they get worse

how can parents be educated to help children avoid otitis media?

1. stay up to date with vaccines | 2. don't bottle prop or lay down when eating

administering ear drops to kid that's less than 3 years old (re: pinna)

pull pinna DOWN and back

untreated streptococcal infection leading to a systemic inflammatory disease

rheumatic fever

what organ does rheumatic fever greatly impact?

heart

what assessment questions would you ask if you suspected rheumatic fever?

recent strep infection? Sore throat recently? Any family with recent strep? assess Heart sounds, joint pain, rash

what diagnostic tool would you use for rheumatic fever

ASO titer (would indicate recent strep infection)

bacterial infection → vesicles w/honey colored crust

impetigo

interventions for impetigo (5)

1. topical ABX 2. hand hygiene 3. contact isolation 4. avoid scratching of lesions 5. proper washing of things coming in contact with lesions

interventions for lice

OTC lice shampoo for live lice (doesn’t get nits) + nit comb to remove nits from hair

small mite burrows into skin - intense itching (esp @ night)

scabies

interventions for contact dermatitis (2)

1. remove irritant | 2. thoroughly wash area w/soap + water

allergic + inflammatory response →patches of red, edema, itching

atopic dermatitis (eczema)

interventions for eczema (4 - things to avoid and things to do)

1. avoid bubble baths, soaps, perfumes, fabric softeners, wool or synthetic fabrics 2. tepid water baths with mild soaps 3. cotton clothing 4. topical steroid ointments

name some contraindications for a kid to receive a vaccine

1. severe allergic rxn to vaccine in the past 2. severe fever or illness (common cold and mild illness doesn't count) 3. no live vaccines for immunocompromised (varicella or MMR)