Final Exam Flashcards
Erikson stage for toddlers
Autonomy vs shame and doubt
Achieves autonomy and self control
Separates from parent/caregiver
Withstands delayed gratification
Negativism abounds
Erikson stage for infants
Trust vs Mistrust
Piaget stage for toddlers
Sensorimotor
Differentiates self from objects
Increased object permanence
Uses all senses to explore environment
Places items in and out of containers
Imitates domestic chores
Imitation is more symbolic
Erikson stage for preschool
Initiative vs guilt
Age: 3-6
Likes to please parents
Begins to plan activities, make up games
Initiates activities with others
Enjoys sports, shopping, cooking, working
Negotiates soln to conflicts
Piaget stage for pre-school
Preoperational stage
Age: 2-7
Erikson stage for school-aged
Industry vs inferiority
Interested in how things are made and run
Success in personal and social tasks
Increased activities outside home
Increased interaction with peers
Needs support and encouragement from important people in child’s life
Inferiority occurs with repeated failures with little support or trust from those who are important to the child
Piaget stage for school-aged
Concrete operational
Learns by manipulated concrete objects
Lacks ability to think abstractly
Learns that certain characteristics of objects remain constant
Understands concepts of time
Starts collections of items
Kohlberg stage for school-aged
Conventional
Age 7-10: interpersonal conforming, “good child, bad child”
Age 10-12: “law and order”
An act is wrong bc it brings punishment
Beh is completely right or wrong
Does not understand the reason behind rules
If child and adult differ in opinions, the adult is right
Can put self in another person’s position
Begins to exercise the “golden rule”
Erikson stage for adolescents
Identity vs role confusion
Focuses on bodily changes
Experiences frequent mood changes
Importance places on conformity to peer norms and peer acceptance
Strives to master skills within peer groups
Defining boundaries with parents and authority figures
Piaget stage for adolescent
Formal operational stage
Egocentrical thinking
Kohlberg stage for adolescent
Postconventional
What are live virus vaccines
Attenuated (weakened) form of the virus
Closest thing to a natural infection
Ex. MMR, varicella
What are killed virus vaccines
Use organisms that have been killed but can still elicit an immune response
Ex. Inactivated polio
What are toxoid vaccines
Use the actual toxin for the vaccine instead of the organism itself to begin the antibody process
Ex. Tetanus
What are recombinant vaccines
Use genetic altered form of the microbe instead of the whole organism
Ex. Hepatitis B
What are conjugate vaccines
These are made by combining a weak antigen (typically polysaccharides) with a strong antigen (typically proteins) to illicit the immune response
Ex. Prevnar, Hib
Nursing management of vaccines
Must obtain parental consent this includes providing parents with information on the vaccines being given
Know patient’s medical hx. Do they have any chronic illnesses that would prevent a certain type of vaccine?
Has child had a previous serious rxn?
Previous vaccination record for the child
Document appropriately
Report any adverse events
Vaccine contraindications
Any hx of severe allergic rxn (anaphylaxis) to prior vaccine dose
Severe immunodeficiency patients should not receive live vaccinations
Egg allergy is no longer a strict contraindication for the MMR
There are protocols for egg allergic pts and the flu vaccine. This has made it possible for the majority of egg allergy pts to tolerate the flu vaccine
Vaccine nursing considerations
Mild fever or mild illness such as a cold are not contraindications to receiving immunizations
Redness, swelling, and pain at the site of injection along with mild fever after immunization is normal
Some vaccinations can cause other “normal” rxns
Prophylactic Tylenol is NO longer recommended
Injectable live virus vaccines MUST be given SQ
Inactive virus vaccines are typically given IM but can be given SQ in some instances
Asthma triggers
Infection (viruses)
Irritants
GERD
Allergies
Cold Exercise
Asthma obstructive mechanisms
Inflammatory response
Mucus production
Bronchial muscle contraction in response to foreign stimuli
Asthma symptoms
Classic signs: dyspnea, wheezing, cough
Cough –> cough with mild wheeze –> worsening wheeze with mild difficulty with breathing- particularly with exertion –> difficulty with breathing with severe wheeze at rest
What is status asthmaticus
Unrelenting, respiratory distress with bronchospasms unresponsive to tx measures
Asthma diagnosis
Based on hx of recurrent problems
Pulmonary function tests (PFTs)
Can do methacholine challenge if unsure of dx
Peak expiratory flow rate (PEFR)
Asthma assessment
Tripod position
Use of accessory muscles
Speak in short, panting phrases
Breath sounds are coarse- often with decreased airflow
Inspiratory/expiratory wheezing
Asthma severity classification
Tx & education based on severity classification:
intermittent
mild persistent
mod persistent
severe persistent
Chronic asthma management
B-agonist prn (albuterol or xopenex)
Trigger avoidance
Asthma controller medications
Inhaled corticosteroids
Long-acting bronchodilators
Leukotriene modifiers- singulair/montelukast
Oral prednisone -long term is rare
Allergy shots- desensitization to allergens if allergies play a major role
Patho of bronchiolitis/RSV
Virus invades mucosal cells
Cells die: debris
Irritation leads to increased mucus & bronchospasm
Air trapping
S/S of bronchiolitis
Infant <1 yr
Recent upper respiratory infection exposure
Gradual onset of respiratory distress
Crackles throughout
Expiratory wheezing
Extreme tachypnea (60-100)
Cyanosis
Typically worsen for 5 days
Bronchiolitis treatment/management
Viruses won’t respond to antibiotics, respiratory treatments, or steroids
Suction, position, avoid over stressing
Humidified oxygen
Monitor cardiac apnea
IV fluids (NPO) if poor intake or tachypnea
Physical abuse signs
Bruises on uncommonly injured surfaces
Hand shape marks & bruising
Bite marks
Rope, belt, or cord marks, usually seen on the mouth, buttocks, legs, back & arms
Multiple bruises or fractures in various stages of healing
Submersion burns
Physical abuse sign
Scald burns with clear lines of demarcation (glove or stocking distribution)
Shaken baby syndrome S/S
Difficulty breathing or apnea
Cyanosis
Irritability
Seizures
Vomiting
Inability to make sounds
Extreme sleepiness or unable to arouse
Moxibustion
involves the burning of mugwort, a small spongy herb, to facilitate healing
Coining
Alternative treatment for minor illnesses-involves rubbing heated oil on the skin and then rubbing a coin over the area in a linear fashion until a red mark is seen
Cupping
Alternative therapy in which heated glass cups are applied to the skin along the meridians of the boy, creating suction as a way of stimulating the flow of energy
Nursing documentation for physical abuse
describe what you see
measure and record bruises
document parent demeanor
photographs
document who and when report is made
