Final Blueprint Pt. 1

Question 1

Infant growth and development (0-3 months)

Answer 1

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

Question 2

Infant growth and development (4-6 months)

Answer 2

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

Question 3

Infant growth and development (7-9 months)

Answer 3

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

Question 4

infant growth and development (10-12 months)

Answer 4

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

Question 5

toddler growth and development (1-3 years)

Answer 5

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

Question 6

preschooler growth and development (3-5 yo)

Answer 6

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

Question 7

school age growth and development (6-12 yo)

Answer 7

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

Question 8

adolescent growth and development (13-18 yo)

Answer 8

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

Question 9

(birth to 18-24 months): motor activity w/o use of symbols. All things learned are based on experiences, or trial/error. Object permanence.

Answer 9

sensorimotor

Question 10

(2-7 yo): development of language, memory, and imagination. Intelligence is both egocentric and intuitive. Symbolic thought.

Answer 10

preoperational

Question 11

(7-11 yo): more logical and methodical manipulation of symbols. Less egocentric, and more aware of the outside world and events. Operational thought.

Answer 11

concrete operational

Question 12

(adolescence – adult): use of symbols to relate to abstract concepts. Able to make hypotheses and grasp abstract concepts and relations. Abstract concepts.

Answer 12

formal operational

Question 13

erikson stage 1

Answer 13

Trust v. Mistrust (Birth – 12-18 months) – a sense of trust and security

Question 14

erikson stage 2

Answer 14

Autonomy v. Shame and Doubt (18 months – 3 yo) – feelings of independence lead to belief in yourself and your abilities

Question 15

erikson stage 3

Answer 15

Initiative v. Guilt (3-5 yo) – self-confidence; the ability to take the initiative and make decisions

Question 16

erikson stage 4

Answer 16

Industry v. Inferiority (5-12 yo) – feelings of pride and accomplishment

Question 17

erikson stage 5

Answer 17

Identity v. Confusion (12-18 yo) – a strong sense of identity; a clear picture of your future

Question 18

what are the dehydration types?

Answer 18

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

Question 19

what is dehydration degree?

Answer 19

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)

Question 20

what is the dehydration management?

Answer 20

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.

Question 21

what is the oral rehydration of diarrhea?

Answer 21

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)

Question 22

what are the H2O depletion labs?

Answer 22

High urine specific gravity

Increased BUN, HCT, Na+, and serum osmolarity

Variable serum electrolytes

Question 23

what are the H2O excess labs?

Answer 23

Low urine SG

Decreased HCT and serum electrolytes

Question 24

what are the fluid needs for a child?

Answer 24

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

Question 25

what is the renal diet?

Answer 25

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+.

Question 26

what is the celiac diet?

Answer 26

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.

Question 27

what is increased ICP?

Answer 27

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.

Question 28

what are the early S/S of increased ICP?

Answer 28

headaches, diplopia (blurred vision), N/V (concussion), vertigo, and seizures.

Question 29

what are the infant S/S of increased ICP?

Answer 29

wide sutures, tense or bulging fontanels, high pitched cry, and setting-sun sign (eyes look like sunsets).

Question 30

what are the late S/S of increased ICP?

Answer 30

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

Question 31

what is the safe dosage range for Acetaminophen (Tylenol)?

Answer 31

10-15 mg/kg/dose not to exceed 5 doses in 24 H

Question 32

what is the patho and CM for wilm’s tumor?

Answer 32

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.

Question 33

what is the DX and care for wilms tumor?

Answer 33

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.

Question 34

what is pyloric stenosis and the TX for it?

Answer 34

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.

Question 35

what are the hallmark signs for pyloric stenosis?

Answer 35

projectile vomit, moveable olive-shaped mass in epigastrium

Question 36

what is important to know about pertussis?

Answer 36

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

Question 37

what is asthma and its patho?

Answer 37

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.

Question 38

what are the DX and S/S of asthma?

Answer 38

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.

Question 39

what is the care and meds for asthma?

Answer 39

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.

Question 40

what is cystic fibrosis and its etiology and patho?

Answer 40

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)

Question 41

what are the DX and care for cystic fibrosis?

Answer 41

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.

Question 42

what are the meds and edu for cystic fibrosis?

Answer 42

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.

Question 43

what is bronchiolitis and its patho?

Answer 43

: 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.

Question 44

what are the DX and CMs for bronchiolitis?

Answer 44

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.

Question 45

what is the care and edu for bronchiolitis?

Answer 45

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.