Families Exam 3 Flashcards
Which type of parenting controls the child’s behavior through unquestioned rules/expectations?
dictatorial/authoritarian
Which type of parenting has little/no control over a child’s behavior?
permissive
Which type of parenting consults with the child when making decisions?
permissive
Which type of parenting directs the child’s behavior by setting rules and explaining their reasoning?
democratic/authoritative
Which type of parenting are the parents uninvolved or emotionally removed?
passive
Does a single parent family increase the risk of child abuse?
NO
What does a family assessment include? (7)
- history
- structure
- developmental tasks
- family characteristics
- family stressors
- environment
- family support system
When can a toddler stand independently?
12 months
What can a toddler do at 15 months?
- walk without help
- use a cup well
- build a tower of 2 blocks
When can a toddler run clumsily, jump in place with both feet, build a tower of 3-4 blocks, and turn 2-3 pages in a book?
18 months
When can a toddler walk up and down stairs?
2 years
How many blocks can a 2 year old stack?
6-7
When can a toddler turn pages in a book one at a time?
2 years
What can a toddler do at 2.5 years?
- jump across the floor
- tiptoe
- draw circles
What stages of cognitive development does a toddler experience? When does the stage change?
- sensorimotor to preoperational
- changes at 19-24 months
When is object permanence fully developmed?
toddlerhood
How many words does a 2 y/o know?
300
What type of sentences does a 2 y/o use? How many words are usually in a sentence?
- multiword sentences
- 2-3 words
What type of sentences does a 3 y/o use? How many words are usually in a sentence?
- simple sentences
- several words
What stage of psychosocial development is a toddler in?
autonomy vs. shame and doubt
What type of play do toddlers use?
parallel play
What age group does domestic mimicry occur?
toddlers
When do toddlers get the IPV (inactivated poliovirus), HIB (haemophilus influenzae type B), HCV (pneumococcal conjugate vaccine), MMR (measles/mumps/rubella), and varicella immunizations?
12-15 months
When is the third dose of the IPV vaccine given?
6-18 months
What immunization is given at 12-23 months?
Hep A (2 doses at least 6 months apart)
When is the DTaP (diphtheria, tetanus, pertussis) immunization given?
15-18 months
When is the yearly seasonal trivalent inactivated influenza vaccine given?
12-36 months
How and when is the live, attenuated influenza vaccine given?
- nasal spray
- 2 years or older
How much juice can a toddler have per day?
4-6 oz/day
How much milk can a toddler have per day?
24-28 oz/day
What is a serving size in a toddler?
1 tsp per year of age
What should be avoided in a toddler’s nutrition?
- high sugar/fat/sodium
- choking hazards
- eating/drinking while playing
Why should toddlers not have nuts, grapes, hot dogs, PB, raw carrots, tough meats, and popcorn?
choking hazards
How much sleep should toddlers get per day?
11-12 hours
What is eliminated in older toddlerhood?
naps
What are common injuries in toddlers?
- aspiration
- drowning
- falls
- sunburns
When do children start dressing independently?
preschool
At what age does a child stand on one foot? At what age do they skip and hop on one foot?
- stand: 3 y/o
- skip/hop: 4 y/o
When can a preschooler jump off the bottom step?
3 y/o
When can a preschooler ride a tricycle? When can a preschooler jump rope?
- tricycle: 3 y/o
- jump rope: 5 y/o
When can a preschooler walk backward?
5 y/o
What stage of cognitive development is a preschooler in?
preoperational
When does a child experience egocentric thoughts?
preschool
When does a child experience magical thinking?
preschool
When does a child know 2100 words?
by the end of their 5th year
How many words are in a sentence of a 3-4 y/o? A 4-5 y/o?
- 3-4: 3-4 word sentences
- 4-5: 4-5 word sentences
What stage of psychosocial development is a preschooler in?
initiative vs. guilt
When does a preschooler experience guilt?
when they think they have misbehaved or when they are unable to accomplish a task
What type of play do preschoolers use?
associative play
What immunizations does a 4-6 y/o receive?
DTaP, MMR, IPV
How much protein should a preschooler have each day?
13-19g
How much sleep does a preschooler need?
12 hrs/day
When are sleep disturbances common?
preschool
What are common injuries in preschoolers?
- bodily harm
- burns
- drowning
- motor vehicle injury
When do girls stop growing?
2-2.5 years after the onset of puberty
How much do girls grow during adolescence?
2-8 inches
How much weight do girls gain during adolescence?
15.5-55 lbs
What order does sexual maturation occur in girls?
- breasts
- pubic hair
- axillary hair
- menstruation
When do boys stop growing?
18-20 y/o
How much do boys grow during adolescence?
4-12 inches
How much weight do boys gain during adolescence?
15.5-66 lbs
What order does sexual maturation occur in boys?
- testicular enlargement
- pubic hair
- penile enlargement
- axillary hair
- facial hair
- vocal changes
What stage of cognitive development are adolescents in?
formal operations
What do adolescents use to make decisions?
formal logic
What stage of psychosocial development are adolescents in?
identity vs. role confusion
Adolescents experience rapid growth and high metabolism. What needs to be increased due to this?
nutrients such as calcium, iron, protein, and zinc
Should food ever be used as a reward?
NO
Who needs the most sleep?
adolescents
What are common injuries in adolescents?
- bodily harm
- motor vehicle injury
Which reflex lasts 8 months after birth?
plantar grasp
Which reflex lasts 1 yr after birth?
babinski
Which reflex lasts 4 weeks after birth?
stepping
What is dosage calculation based on?
age, body weight, body surface area
What is the preferred method of medication administration?
oral
Where should oral medications be given?
in the back and side of the mouth
What should be used to give oral medications?
a calibrated cup or oral syringe
What should NOT be used to give oral medications?
a spoon or bottle
What should you do to the pinna when giving otic medications to ages 3 years and younger?
pull pinna DOWN and back
What should you do to the pinna when giving otic medications to ages 3 years and older?
pull pinna UP and back
How much can be injected for SQ medications?
< 0.5 ml
What is the recommended spot to give IM meds?
vastus lateralis (outer thigh)
How much can an infant IM injection be? How much can a child IM injection be?
- I: 0.5 ml
- C: 2 ml
What gauge IV can be used?
24-20
What procedure should be done in a treatment room?
central line insertion
What should be applied 1 hr before insertion of a central line?
Emla/lidocaine
What can be done to calm children for central line/IV insertion?
- swaddle infants
- play therapy
- nonnutritive sucking
Where should procedures not be done?
“safe places” such as a playroom, or the child’s room/bed
What is a mummy board used for?
to strap the child down before injections
What age group is the FLACC pain scale used for?
2 months-7 years
When can the FACES pain scale start being used?
3 years old
What age group is the OUCHER pain scale used for?
3-13 years
What does the OUCHER pain scale use to rate pain?
photos of children
What is the first line medication used to treat mild to moderate pain?
acetaminophen and NSAIDS
What is the second line medication used to treat moderate to severe pain?
opioids (morphine, fentanyl, oxycodone)
What pain medication cannot be used in children?
aspirin
What are early signs of respiratory distress?
- tachypnea
- tachycardia
- use of accessory muscles
- nasal flaring
- restlessness
- pallor
What are late signs of respiratory distress?
- bradypnea
- bradycardia
- cyanosis
- confusion
- stupor
- hyper/hypotension
How can oxygenation and ventilation be assessed/monitored?
- RR
- respiratory effort
- SaO2
What characteristics of secretions are looked at for trachs?
- thickness
- quantity
- odor
- color
How do you know when to suction?
pt coughing
When should hyperoxygenation be done for suctioning?
before
How long can you suction at one time for an infant?
no more than 5 seconds
How long can you suction at one time for a child?
no longer than 10 seconds
How long should you wait between suctioning attempts?
30-60 seconds
What should you clean a trach with?
soap and water
How often should non-disposable trach tubes be replaced?
q 6-8 weeks
How often should oral hygiene be done in a trach patient? How often should trach care be done?
- O: q2h
- T: q8h
What should be kept at the bedside of trach patients in case of emergency?
same size and one size smaller trach
What can a cuffed trach tube pressure be at?
< 20 mmHg
What can haemophilus influenza cause?
bacterial epiglottis
What are manifestations of bacterial epiglottis?
- no cough
- drooling
- tongue hanging out
- tripod position
- high fever
- inspiratory stridor
- dysphonia
- dysphagia
Should you assess the airway of a patient with bacterial epiglottis?
NO
What type of precautions should a patient with bacterial epiglottis be on?
droplet
What can be given to a patient with bacterial epiglottis?
- humidified O2
- corticosteroids
- antibiotics
What respiratory disorder can be caused by RSV, influenza A&B, mycoplasma pneumonia, or parainfluenza types 1/2/3?
acute laryngotracheobronchitis
What are manifestations of acute laryngotracheobronchitis?
- barky cough
- hoarseness
- low grade fever
- nasal flaring
- retractions
- tachypnea/dyspnea
When would corticosteroids, fluid, oxygen, and nebulized racemic epinephrine be used?
acute laryngotracheobronchitis
What is acute spasmodic laryngitis (nonbacterial) caused by?
allergens
What are manifestations of acute spasmodic laryngitis?
- croupy, barky cough
- hoarseness
- dyspnea
- nighttime episodes of laryngeal obstruction
What causes bronchiolitis?
RSV
What stage of bronchiolitis has manifestations of fever, tachypnea, retractions, and trouble feeding?
progression
What stage of bronchiolitis has manifestations of sneezing, runny nose, coughing, wheezing, and possible eye/ear infection?
initial
What stage of bronchiolitis has manifestations of tachypnea, apneic spells, and cyanosis?
severe
Where is inspiratory stridor heard when caused by bronchiolitis?
the throat
How can you tell if there is hypoxemia/respiratory distress from bronchiolitis?
- increased HR, RR
- retractions
- nasal flaring
- use of accessory muscles
How should you suction a patient with bronchiolitis?
- nose
- only if wheezing and before feeding
What tx is not recommended for bronchiolitis?
bronchodilators and CPT
What can you give to a patient with bronchiolitis if they are throwing up from feedings?
pedialyte
When is an ASO titer increased?
if there is a streptococcal infection present
What specimens should be collected for pneumonia?
- blood cultures
- nasopharyngeal specimens
- ASO titer
What interventions can be done for pneumonia?
- rest, fluids
- culture, antibiotics
- O2, continuous pulse ox
- antipyretics for fever
Tonsilitis can cause hemorrhage. What are the s/sx of hemorrhage?
- bleeding
- hemoptysis
- bright red emesis
- repeated swallowing/clearing of throat
What should be done before a tonsillectomy?
NPO status
Why should the HOB be elevated after a tonsillectomy?
facilitates drainage
When is bleeding most common after a tonsillectomy?
- w/in first 72 hours
- days 7-10
What are tetracaine lollipops used for?
tonsilitis/tonsillectomy
When is an ice collar used?
tonsilitis/tonsillectomy
What should be avoided in the diet of someone with tonsilitis/after a tonsillectomy?
- red liquids
- citrus juices
- milk-based foods
When should you avoid coughing, throat clearing, and nose blowing?
tonsilitis/tonsillectomy
Can you use a straw after a tonsillectomy?
NO
How long does recovery from a tonsillectomy take?
14 days
What can be present in vomit after a tonsillectomy?
clots, blood tinged mucus
Can you become dehydrated after with tonsilitis/tonsillectomy?
YES
What causes a mechanical obstruction of organs with cystic fibrosis?
too much thick, tenacious mucus
Can patients with cystic fibrosis cough up secretions and clear their airway?
NO
When does wheezing, rhonchi, and cough occur with cystic fibrosis?
early
What is seen on a CXR of a patient with increased cystic fibrosis?
obstructive emphysema and atelectasis
What are manifestations of advanced cystic fibrosis?
- cyanosis
- barrel-shaped chest
- clubbing
What are other findings of cystic fibrosis?
- steatorrhea
- weight gain/loss failure
- vitamin A, D, E, K deficiency
- anemia
What test is done to diagnose cystic fibrosis?
sweat chloride test
What is the chloride level of an infant with cystic fibrosis? What is the chloride level for other ages?
- infants < 3 months: > 40
- other ages: > 60
What is the sodium level with cystic fibrosis?
> 90
When should CPT be done for a patient with cystic fibrosis?
with inhaled meds, NOT before/after meals
What cystic fibrosis medication makes it easier to cough up and thins secretions?
dornase alfa
How often is dornase alfa given by nebulizer?
once or twice a day
How should dornase alfa be stored?
in the fridge in a foil packet
How should aminoglycosides be given for a patient with cystic fibrosis?
IV or aerosol nebulizer
When should pancreatic enzymes (pancrelipase) be given? How should they be given?
- before meals and snacks
- can swallow or sprinkle onto high fat food
How can you check adequate dosing of pancrelipase?
check stool (1-2/day)
What vitamins does a CF patient need?
fat soluble (A, D, E, K)
What do allergens, exercise, animals, stress/anxiety trigger?
asthma
Are chest tightness, dyspnea, wheezing, crackles, cough, sweating, use of accessory muscles, and decreased O2 sat expected or abnormal findings of asthma?
expected
What is a bad/abnormal finding of asthma?
silent chest
Should you intubate a patient with asthma?
NO
What measures the amount of air that can be forcefully exhaled in 1 second?
peak flow meter
What do you have to ensure before using a peak flow meter?
it is zeroed
When should a peak flow meter be used?
at the same time everyday
How should the child be positioned to use the peak flow meter?
standing up straight
How many times should the peak flow meter be used?
3 times with 30 seconds in between
What is the green zone with a peak flow meter?
80-100%
What is the yellow zone with a peak flow meter?
50-80%
What is the red zone with a peak flow meter?
< 50%
What should be done if red zone is identified after the peak flow meter?
- rescue inhaler
- ER
- call Dr
What are tachycardia, tremors, HA, and nervousness expected side effects of?
albuterol
How do you know if albuterol is working?
- decreased RR
- increased O2 sat
- good lung sounds
- talking
- no use of accessory muscles or nasal flaring
How can sores be prevented?
rinsing the mouth
How can asthma exacerbations be prevented?
- get rid of carpet
- avoid triggers
- regular exercise
- do not wash in bleach
- annual flu shot
What do you need to know about a drowning incident?
- location and time of submersion
- type and temp of fluid
- body temperature
- physical injuries
What are cerebral edema and respiratory distress complications of?
drowning
What is maternal smoking a risk factor for?
SIDS
What are prematurity and low APGAR scores a risk factor for?
SIDS
How should an infant sleep?
- on back
- no pillows/quilts/stuffed animals
- head uncovered
- with pacifier
- on a firm, tight-fitting mattress
- NO co-sleeping
What age is most at risk for poisoning?
< 6 y/o
When does N/V, sweating, and pallor occur with acetaminophen poisoning?
2-4 hours after ingestion
When would improvement be seen with acetaminophen poisoning?
24-36 hours after ingestion
What can occur 36 hours-7 days after acetaminophen ingestion? (hepatic)
- RUQ pain
- jaundice
- coagulation disturbances
- confusion
What s/sx occur with acute aspirin poisoning?
- tinnitus
- seizures
- oliguria
- N/V
- tachypnea
- disorientation
What poisoning would bleeding tendencies, dehydration, and seizures be seen with?
chronic aspirin poisoning
When does the initial phase of supplemental iron poisoning occur?
30 minutes-6 hours after ingestion
When would V/D, hematemesis, gastric pain, and bloody stools be seen with supplemental iron poisoning?
the initial phase
When does the latency/improvement phase occur with supplemental iron poisoning?
2-12 hours after ingestion
When would metabolic acidosis, hyperglycemia, bleeding, fever, shock, and death occur with supplemental iron poisoning?
the systemic phase
When does the systemic phase of supplemental iron poisoning occur?
4-24 hours after ingestion
When does the hepatic phase of supplemental iron poisoning occur? What are the s/sx?
- 48-96 hours after ingestion
- seizures, coma
What are gas, kerosene, lighter fluid, paint thinner, and turpentine examples of?
hydrocarbons
What can occur with hydrocarbon poisoning?
- gagging
- choking
- coughing
- cyanosis
- grunting
- retractions
What type of poisoning causes pain and burning in the mouth, throat, and stomach?
corrosives
What are household cleaners, batteries, denture cleaners, and bleach examples of?
corrosives
What type of poisoning causes edematous lips and tongue, a pharynx with white mucous membranes, vomiting with hemoptysis, and drooling?
corrosives
What are characteristics of someone experiencing low-dose lead poisoning?
- distractable
- impulsive
- hyperactive
- hearing impaired
- mild intellectual difficulty
What can high-dose lead poisoning cause?
- cognitive delays
- blindness
- paralysis
- S/C/D
What is important to monitor with all types of poisoning? (3)
- vitals
- O2 sat
- I&O’s
What is the antidote for acetaminophen poisoning?
acetylcystine
What are gastric lavage, activated charcoal, and sodium bicarbonate antidotes for?
aspirin poisoning
How should severe aspirin poisoning be treated?
hemodialysis
What type of poisoning is treated with chelation therapy using deferoxamine mesylate?
supplemental iron poisoning
What type of poisonings should you NOT induce vomiting?
hydrocarbons and corrosives
What has to be done before gastric decontamination with hydrocarbon poisoning?
intubation with a cuffed ET tube
Should a patient with corrosive poisoning be NPO?
YES
Should you attempt to neutralize acid with corrosive poisoning?
NO
What type of poisoning is treated with chelation therapy using calcium EDTA?
lead poisoning
Should you tell a child that medications are candy or take your medications in front of them?
NO
What type of thermometers should be used?
non-mercury
What type of paint should be eliminated?
lead-based
Which congenital heart diseases have a left-to-right shunt?
- patent ductus arteriosus (PDA)
- atrial septal defect (ASD)
Which congenital heart diseases have cyanosis LATER?
- patent ductus arteriosus (PDA)
- atrial septal defect (ASD)
What does not close with PDA?
the pulmonary artery and aorta
What happens to the septum between the atria with ASD?
there is a hole
What congenital heart disease causes a murmur that sounds like a continuous machine hum that is louder under the left clavicle?
PDA
What congenital heart disease causes a murmur that is loud and harsh with a fixed split-second heart sound?
ASD
What medication can be given for PDA?
indomethacin
What can be inserted during the cardiac catheterization to occlude the PDA?
coils
What is the nonsurgical tx for ASD?
closure during the cardiac catheterization
When is a thoracoscopic repair done?
surgical tx of PDA
When is a patch closure done?
surgical tx of ASD
Will a patient with PDA have weak pulses or bounding pulses?
bounding
What defects are included in tetralogy of fallot?
- PULMONARY stenosis
- VENTRICULAR septal defect
- overriding aorta
- right VENTRICULAR hypertrophy
What is an obstruction of blood flow from the ventricles to the lungs?
pulmonary stenosis
Where is the hole with a ventricular septal defect?
in the septum between the ventricles
Where does the aorta receive blood from when it is overriding?
the right ventricle
What shunt occurs with TOF?
right to left
When does cyanosis occur with TOF?
NOW (@ birth and progresses over 1st year of life)
When is a systolic murmur heard?
TOF
What do tet spells include?
acute cyanosis and hypoxia
What is a big sign of tet spells/SOB?
squatting
When should a child be placed in the knee-to-chest position?
when having a tet spell
What medication should be given for tet spells?
morphine
What should be done for TOF until primary repair can be done?
shunt placement
When should a complete repair for TOF be done?
within the first year of life
Should a lot of fluids be given to a child with TOF?
NO
What happens to vital signs with heart failure?
- increased HR (tachycardia)
- increased RR (tachypnea)
- decreased BP (hypotension)
What causes cool extremities with weak pulses, gallop rhythm, and cardiomegaly?
HF, impaired myocardial function
What causes grunting, wheezing, cough, cyanosis, retractions, and nasal flaring?
HF, pulmonary congestion
What causes hepatomegaly, peripheral edema, ascites, JVD, and weight gain?
HF, systemic venous congestion
What causes cyanosis, clubbing, poor weight gain, and polycythemia?
HF, hypoxemia
What infant and child HR should you hold digoxin for?
- infant: <90
- child: <70
What can bradycardia, dysrhythmias, N/V, and anorexia indicate?
dig toxicity
How often should digoxin be administered?
q12h
How can tooth decay from digoxin be prevented?
put med in side/back of mouth and follow up with water
Should you double/increase dig dose or readminister if the child throws it up/spits it out?
NO
Can a diaper rash be a reason to cancel a cardiac catheterization?
yes
What allergies should be assessed before a cardiac catheterization?
iodine and shellfish
How long before a cardiac catheterization should the patient be NPO?
4-6 hours
What pulses should be located and marked before a cardiac catheterization?
dorsalis pedis and posterior tibial on both legs
What should be done continuously after a cardiac catheterization?
cardiac monitoring and O2 sat
What should be assessed for 1 full minute after a cardiac catheterization?
HR and RR
When should quality and symmetry of pulses and temp and color of extremity be assessed?
post cardiac catheterization
What can indicate an arterial obstruction after a cardiac catheterization?
cool with blanching
Why should voiding be encouraged after cardiac catheterization?
to excrete contrast medium
What medications need to have BP and HR monitored?
captopril and metoprolol
After what medication should you watch for hyperkalemia?
captopril
After what medication should you watch for hypokalemia?
furosemide, encourage increased potassium diet
What can occur 2-6 weeks after an untreated or partially treated upper respiratory infection with GABHS?
rheumatic fever
What does the Jones criteria say is needed to be diagnosed with rheumatic fever?
2 major criteria or 1 major with 2 minor criteria following acute GABHS infection
What are major criteria for rheumatic fever?
- carditis
- SQ nodules
- polyarthritis
- erythema marginatum
- chorea
What are minor criteria for rheumatic fever?
- fever
- arthralgia
What is polyarthritis?
large joints with painful swelling
What is a pink, nonpruritic rash that does not itch and appears/disappears rapidly?
erythema marginatum
Where is erythema marginatum most common?
on the trunk and inner surfaces of the extemities
What is chorea?
involuntary purposeless movements
Where does chorea occur?
the extremities and face
What happens to a patient with rheumatic fever’s ASO titer, CRP, and ESR?
elevated
How long do patient’s with rheumatic fever have to be on bed rest?
until their ESr is normal
Will chorea go away?
YES
What is the priority for cyanotic children?
stop or prevent crying
How can energy expenditure be minimized in cardiac patients?
- cluster care
- small, frequent meals
- only bathe PRN
What children should take potassium supplements, have daily weights done, and possibly have sodium and fluid restrictions?
cardiac
What can keeping the car seat at a 45-degree angle, sleeping with pillows, and being in a semi-fowlers/fowlers position when awake help with?
decreasing the workload on the heart
What type of nipple should be used for cardiac infants?
a soft preemie nipple or regular nipple without a slit
What type of feeding should be done if the baby is not consuming enough?
gavage
How much should caloric density increase?
gradually from 20-30 cal/oz
What should you alternate with if the baby is not getting enough nutrients from breastfeeding?
- high-density formula
- iron-fortified breast milk
How should you pick up a baby with cardiac problems?
under the shoulders and butt, not under the arms
