Final Blueprint Pt. 1 Flashcards
Infant growth and development (0-3 months)
Physical: 1 inch/month, 1 oz/day, head control, hand to mouth, posterior fontanel closes, temp regulation, reflexes, increasing head control, and increasingly relaxed extremities.
Psychosocial: trust v. mistrust, social smile, sleep 16-18 H/day, and need to suck
Cognitive: sensorimotor, observing, cry primary communication, and cooing and babbling
Major milestone: adjusting to life
Nutrition: teething begins around 3 months and breast milk or formula + iron
Risks: back to sleep, dropping, and car seat backward facing
Infant growth and development (4-6 months)
Physical: 1 inch/month, 1 oz/day, birth wt doubled, roll over, reaches for toys, palmar grasp, transfers objects, sit with support, holds bottle, and drooling
Psychosocial: trust v. mistrust, laugh, self-comfort, stranger danger, sleep through night, and 2 naps/day.
Cognitive: sensorimotor, track objects, babbling, recognizes name, and imitates sounds
Major milestone: sleeps through night and increasing body control
Nutrition: teething continues, breast milk or formula and intro solid foods at 6 months.
Risks: back to sleep and dropping
Infant growth and development (7-9 months)
Physical: ½ inch/ month, 3-5 oz/wk, sit w/o support, creep/crawls, pincer grasp begins, no head lag, stands w/ support, bangs objects, and hand-mouth coordination.
Psychosocial: trust v. mistrust, imitation, turn taking games and songs, and stranger anxiety
Cognitive: sensorimotor, object permanence begins, and learns “NO”.
Major milestone: responds to discipline
Nutrition: begin brushing after feeds, intro foods one at a time, and begin self feed
Risks: back to sleep, crawl, choking, biting, burns, poison, and drowning
infant growth and development (10-12 months)
Physical: ½ inch/month, 3-5 oz/wk, triple birth wt by 12 months, cruising, 1st steps, wave bye-bye, pincer grasp established, grasp spoon, and drink from cup.
Psychosocial: trust v. mistrust, separation anxiety, security item, loves an audience, and expresses all emotions
Cognitive: sensorimotor, exploring environment, 1-5 words, and gestures
Major milestone: walking
Nutrition: wean to table foods
Risks: walks, fall risk, choking, burns, poison, and drowning
toddler growth and development (1-3 years)
Physical: 5” in year 2, 2.5” in year 3, stairs, running and jumps, scribbles, rides tricycle, and anterior fontanel closes from 15-18 months
Psychosocial: autonomy v. shame and doubt, sleep difficulties, and separation anxiety
Cognitive: sensorimotor, preconceptual, rituals, parallel play, 2-3 word sentences, 900 word vocab, and 11,000 words a day
Major milestone: independence, toilet training, and temper tantrums
Nutrition: 20 teeth, 1st dental exam, brush BID, poor appetite, 3 meals, 2 snacks, 1 tsp/year of age, and finger foods
Risks: walks, fall risk, car seat forward facing, burns, poison, drowning, and MVC
preschooler growth and development (3-5 yo)
Physical: 2.5” year, double birth length by 4 years, ADLs, hand dominance, enuresis, skip, and printing/scissors
Psychosocial: initiative v. guilt, increase aware of others, imaginary friends, social play and sharing, anticipatory play, modest about body, exaggerates, and develops conscience
Cognitive: preconceptual, causality, body image, time, letter, and number aware, 6-8 word sentence, and tells stories
Major milestone: friends
Nutrition: begin flossing daily, annual dental exams, 3 meals, 2 snacks daily, 1 tbs/ year of age, food jags, manners, plain foods, and small appetite
Risks: falls, asphyxiation, lacerations, and MVC
school age growth and development (6-12 yo)
Physical: 2.5” year, cursive, small building toys, and puberty
Psychosocial: industry v. inferiority, friends, group play and sports, competitive, and cooperative play
Cognitive: concrete operations, cause and effect, reading and writes, and follows 3 step directions
Major milestone: school influences
Nutrition: permanent teeth erupt at 6-7 yo, replaced 4 year until 12 yo, 3 meals, 2 snacks, and appetite increases
Risks: booster to back seat, burns, drowning, MVC, and fractures
adolescent growth and development (13-18 yo)
Physical: growth spurt (2-8” girls and 4-12” boys), breast at 10 yo, menstruating 3 years after, testicular maturation at 10-15 yo, muscle growth and strength, and motor coordination increases
Psychosocial: identity v. role confusion, values, independence, privacy, close peer relations, rapid changing moods, and parental conflicts
Cognitive: formal operations, abstract thinking, analyze and synthesize, and understand duty and obligation
Major milestone: risk taking
Nutrition: wisdom teeth and eating disorders
Risks: risk taking, HEADS risks (home, education, activities, drugs, sexual activity and identity, suicide and depression), firearms, and sport injuries
(birth to 18-24 months): motor activity w/o use of symbols. All things learned are based on experiences, or trial/error. Object permanence.
sensorimotor
(2-7 yo): development of language, memory, and imagination. Intelligence is both egocentric and intuitive. Symbolic thought.
preoperational
(7-11 yo): more logical and methodical manipulation of symbols. Less egocentric, and more aware of the outside world and events. Operational thought.
concrete operational
(adolescence – adult): use of symbols to relate to abstract concepts. Able to make hypotheses and grasp abstract concepts and relations. Abstract concepts.
formal operational
erikson stage 1
Trust v. Mistrust (Birth – 12-18 months) – a sense of trust and security
erikson stage 2
Autonomy v. Shame and Doubt (18 months – 3 yo) – feelings of independence lead to belief in yourself and your abilities
erikson stage 3
Initiative v. Guilt (3-5 yo) – self-confidence; the ability to take the initiative and make decisions
erikson stage 4
Industry v. Inferiority (5-12 yo) – feelings of pride and accomplishment
erikson stage 5
Identity v. Confusion (12-18 yo) – a strong sense of identity; a clear picture of your future
what are the dehydration types?
Isotonic: lose electrolytes and H2O =, primary form in kids, lose circulating blood volume, Na+ normal, biggest concern = shock
Hypotonic: lose more electrolytes than H2O, Na+ < 135
Hypertonic: H2O loss in excess of electrolytes, most dangerous type, Na+ > 150, seizures more likely
what is dehydration degree?
For each 1% wt loss = 10mL/kg of fluid lost
Take per sickness wt and current wt
Early sign – tachycardia
Mild = <50 mL/kg (cap <2 secs)
Moderate = 50-90 mL/kg (cap 2-3 secs)
Severe = >100 mL/kg (cap >3 secs)
what is the dehydration management?
Oral (when alert and awake) rapid replacement over 4-6H
IV (unable to ingest enough fluid) rapid expansion of the ECG to prevent shock (20 mL/kg), 0.9% NS (NO D5W – H2O follows sugar), and expansion, replace deficits, and maintenance.
what is the oral rehydration of diarrhea?
when alert and awake, rapid replacement over 4-6H
Oral rehydration therapy (1st):
Use Pedialyte (1/2 str Gatorade)
Not clear liquids/ no caffeine
Not BRAT diet
No juice (high osmolarity)
NPO (spray mouth)
IVT (add K+ to IV with adequate UOP)
Intraosseous infusion (emergent)
Central venous lines (apply pressure)
what are the H2O depletion labs?
High urine specific gravity
Increased BUN, HCT, Na+, and serum osmolarity
Variable serum electrolytes
what are the H2O excess labs?
Low urine SG
Decreased HCT and serum electrolytes
what are the fluid needs for a child?
Body wt (kg): amt of fluid per day
1-10 = 100 mL/kg
11-20 = 1000 mL + 50 mL/kg for each kg > 10 kg
>20 = 1500 mL + 20 mL/kg for each kg > 20 kg
what is the renal diet?
ESRD – most effective means besides dialysis for reducing quality of waste requiring renal excretion, low in protein, K+, Na+, phosphorus, high in carbs, unrestricted amount of fat, limit fresh fruit and veggies (hyperkalemic), and high in Ca+.
what is the celiac diet?
Gluten-free diet (gluten = substance found in wheat and other grains, may be found in a variety of foods including breads, cakes, cereals, pasta, and commercial dairy products). Appropriate foods include rice, corn, eggs, quinoa, fruit, popsicles, H2O, chicken, beef, gluten free bread. Avoid: gluten, wheat, barley, rye, oats, and beer.
what is increased ICP?
typically, cranium = 80% brain, 10% CSF, and 10% blood. Change in one = compensate by change in another. In ICP: tumor or lesion taking space accumulated fluid or blood, edema.
what are the early S/S of increased ICP?
headaches, diplopia (blurred vision), N/V (concussion), vertigo, and seizures.
what are the infant S/S of increased ICP?
wide sutures, tense or bulging fontanels, high pitched cry, and setting-sun sign (eyes look like sunsets).
what are the late S/S of increased ICP?
bradycardia, LOC, decreased motor response, diminished response to pain, Cushing’s reflex (slow pulse and increased BP, irregular respirations, wide pulse pressure, difference in SBP * DBP) – impending sign of doom in head trauma
what is the safe dosage range for Acetaminophen (Tylenol)?
10-15 mg/kg/dose not to exceed 5 doses in 24 H
what is the patho and CM for wilm’s tumor?
patho: nephroblastoma (most common malignant renal and intra-abdominal tumor in childhood. Peaks at 3 yo, no method of identifying gene carriers currently, slightly favors L kidney and 10% both kidneys.
CM: associated with aniridia (no iris), hemihypertrophy (1 side of body larger). Bechwith-wiedemann syndrome (overgrowth syndrome), metastasis is rare.
what is the DX and care for wilms tumor?
Dx: with radiographic studies, abd U/S, hematologic and biochemical studies, urinalysis.
Care: surgery ASAP removing tumor (keep encapsulated), affected kidney, and adjacent adrenal gland, may reoccur in lung, DO NOT PALPATE, post-op at risk for bowel obstruction, and family and child support.
what is pyloric stenosis and the TX for it?
hypertrophy of circular muscle of pylorus causing constriction of pylorus and obstruction of gastric outlet.
pyloromyotomy – laparotomy – relatively uncomplicated surgery, feeding 4-6H post op, progressing from glucose or electrolyte fluid to formula within 24H of surgery, and discharge home 2nd day post-op.
what are the hallmark signs for pyloric stenosis?
projectile vomit, moveable olive-shaped mass in epigastrium
what is important to know about pertussis?
Whooping cough
droplet and contact
S/S: runny nose, cough that becomes more severe and spasms, flushing, cyanosis, and vomit
Complications: is shared
Treat: ABX and steroids
what is asthma and its patho?
Chronic inflammatory disorder in which airways narrow and are hyperreactive to stimuli that do not affect non-asthmatic people
Patho: exposure to irritants causes constriction of bronchial smooth muscle, edema, increased secretions of thick mucus, and airway narrow. Expirations through the narrow lumen is impaired, result in air trapping and hyperinflation of the alveoli. Trigger.
what are the DX and S/S of asthma?
Dx: chest Xray, symptoms, pulmonary function test
S/S: wheeze and dry cough, prolonged expiration, restless, fatigue, tachypnea, cyanosis, marked resp. distress, chronic use of accessory muscles for respiration leads to barrel chest shape.
what is the care and meds for asthma?
Nursing care: assess resp. status, admin humidified O2 PRN, monitor pulse ox, maintain IV access, avoid cold liquids to avoid bronchospasms, position high fowlers and cluster nursing care, and sudden cessation of wheeze and decreased breath sounds indicates worsening.
Meds: bronchodilators, anti-inflammatory agents (steroids), IV fluids, O2. Albuterol inhaler and steroids = Dekatron and Methylperone.
what is cystic fibrosis and its etiology and patho?
multisystem disorder of exocrine glands, increased production of thick mucus in bronchioles, small intestines, and pancreatic and bile ducts.
Etiology: inherited autosomal recessive trait, usually dx in infancy and early childhood, and life expectancy increasing > 30 YO.
Patho: increased viscosity of secretions, lungs (atelectasis), clogged pancreatic ducts, and absence of pancreatic enzymes in small intestines (unable to absorb fats and proteins)
what are the DX and care for cystic fibrosis?
Dx: sweat test, 72H fecal fat, chest Xray, and prenatal DNA of amniotic fluid
Nursing: HX of frequent respiratory infections, assess skin turgor, hydration status, provide high calorie, high protein foods, admin pancreatic enzymes with all meals and snacks, admin fat soluble vitamins (A, E, D, K), and avoid pulmonary treatment after meals to decrease the chance of vomit.
what are the meds and edu for cystic fibrosis?
Meds: ABX (treat pulmonary infection), pancreatic enzymes for fat absorption, fat soluble vitamins A, E, D, K, mucolytics (to decrease viscosity of sputum), and bronchodilators (to improve lung function).
Education: avoid exposure to respiratory infection, chest percussion and postural drainage, high-calorie and high protein diet, activity and exercise will loosen secretions, and genetic counseling.
what is bronchiolitis and its patho?
: inflammation of bronchioles with edema and excess accumulation of mucus, air trapping and atelectasis result from increased airway resistance because of small, obstructed bronchioles, and major cause of hospitalization in infants.
Patho: RSV is primary causative organism, spread by contract with contaminated objects, not airborne but can live for several hours on nonporous surfaces, and most prevalent during 1st 2 yrs of life.
what are the DX and CMs for bronchiolitis?
Dx: nasopharyngeal swab (culture) is obtained to ID causative virus and chest Xray may be norm or indicate hyperinflation or nonspecific inflammation.
CM: worsening of an upper respiratory tract infection with tachypnea, retraction, LG fever, anorexia, thick nasal secretions, and increasingly labored breathing, older infants may have a frequent dry cough, and lungs reveal wheeze or crackles.
what is the care and edu for bronchiolitis?
Nursing: complete resp assessment, provide humidified O2, pulse ox, clear nasal passages with bulb syringe or deep nasal suction, cluster nursing care, IV fluid, I and O, wt daily, and contact precautions.
Education: encourage parents to assist in infant care, teach parents to use bulb syringe, teach parents about frequent PO fluids, instruct parents to notify the HCP if the kid refuses to eat or breathing becomes worse, and avoid smoking and strict handwashing.
