foundations of nursing care of children Flashcards
what is family center care
- partnerships between families of children, nurses, and providers, in which the families and children benefit.
- Respecting cultural diversity, and incorporating cultural views in the plan of care.
- Understanding growth and developmental needs of children and their families.
- Working with all types of families.
- Collaborating with families regarding hospitalization, home, and community resources.
- Allowing families to serve as experts regarding their children’s health conditions.
family centered care
- Nurses should perform comprehensive family assessments to identify strengths and weaknesses.
- Members communicate well and listen to each other.
- There is affirmation and support for all members.
- There is a clear set of family rules, beliefs, and values.
- Members teach respect for others.
- There is a sense of trust.
pediatric physical assessment
- The nurse must alter exams to accommodate chronological age and developmental needs.
- Involve children and family members in examinations.
- Praise children for cooperation during exams.
what behaviors are obsered to determine childs readiness to cooperate
- Interacting with nurse
- Making eye contact
- Permitting physical touch
- Willingly sitting on the examination table.
how to make a safe environment
- Keep the room warm and well lit.
- Perform examinations in nonthreatening environments.
- Keep medical equipment out of sight.
- Provide privacy.
- Determine whether older school‑age children and adolescents prefer a caregiver to remain during examination.
start of the assessment
- Take time to play and develop rapport prior to beginning an examination.
- Explain each step of the examination to the child.
+Use age‑appropriate language.
+Demonstrate what will happen using dolls.
+Allow the child manipulate and handle equipment.
+Encourage the child to use equipment on others.
-Examine the child in a secure, comfortable position. For example, a toddler may sit on a parent’s lap if desired.
during assessment
Examine the child in an organized sequence when possible.
If the child is uncooperative, assess reasons, be firm and direct about expected behavior, complete the assessment quickly, and use a calm voice.
Encourage the child and family to ask questions during physical exams.
Discuss findings with family after the examination
physiologic growth and pulse rate
Newborn: 80 to 180/min (depending on activity)
1 week to 3 months: 80 to 220/min (depending on activity)
3 months to 2 years: 70 to 150/min (depending on activity)
2 to 10 years: 60 to 110/min (depending on activity)
10 years and older: 50 to 90/min (depending on activity)
respirations
Newborn to 1 year: 30 to 60/min 1 to 2 years: 25 to 30/min 3 to 6 years: 21 to 25/min 6 to 12 years: 19 to 21/min 12 years and older: 16 to 19/min
assessment findings for eyes
color vision should be assessed with what test?
Irises should be round with the permanent color manifesting around 6 to 12 months of age.
Might not be symmetric in newborns.
● Corneal light reflex should be symmetric.
● Cover/uncover test should demonstrate equal movement of the eyes.
● Six cardinal fields of gaze should demonstrate no nystagmus.
Color vision
● Should be assessed using the Ishihara color test or the Hardy-Rand-Rittler test.
● The child should be able to correctly identify shapes, symbols, or numbers.
ears/ internal ear assessment
- In infants and toddlers, pull the pinna down and back to visualize the tympanic membrane.
- In children older than 3 years of age, pull the pinna up and back to visualize.
- The tympanic membrane should be pearly pink, or gray.
mouth and tongue assessment findings
how many teeth by 1?
- Infants can have white coatings on their tongues from milk that can be easily removed.
- Children and adolescents should have pink, symmetric tongues that they are able to move beyond their lips.
- Infants should have six to eight teeth by 1 year of age.
- make sure pallet is closed by feeling it
hard and soft palates
tonsils and speach
what does speech delay start?
Hard and soft palates: Intact, firm, and concave
Tonsils
- Infants: Might not be able to visualize
- Children: Barely visible to prominent
Speech
- Infants: Strong cry
- Children and adolescents: Clear and articulate
- speech delay after 24 months
heart sounds
S1 and S2 heart sounds should be clear and crisp.
Sinus arrhythmias that are associated with respirations are common.
pulses
Infants: Brachial, temporal, and femoral pulses should be palpable, full, and localized.
Children and adolescents: Pulse locations and expected findings are the same as those in adults.
abdomen
- Without tenderness, no guarding. Peristaltic waves can be visible in thinner children.
- Symmetric and without protrusions around the umbilicus
- Infants and toddlers have rounded abdomens.
- Children and adolescents should have flat abdomens.
- Bowel sounds should be heard every 5 to 30 seconds.
- listen than palpate
- head and abdomen circumference should match
genitalia
Anus: Surrounding skin should be intact
Routine rectal exams are not done with the pediatric population.
MALE: Hair distribution is diamond shaped after puberty in adolescent males.
No pubic hair is noted in infants and small children.
3,6,12 month milestorn
3: turn head
6: sitting up
12: walking standing
penis
- Should appear straight.
- Urethral meatus should be at the tip of the penis.
- Foreskin might not be retractable in infants and small children.
- Enlargement of the penis occurs during adolescence.
Scrotum - The left testicle hangs slighter lower than the right.
- The inguinal canal should be absent of swelling
vagina
FEMALE:
- No pubic hair should be noted in infants or small children.
- Labia: Symmetric, without lesions
- Clitoris: Small, without bruising or edema
- Urethral meatus: Slit-like in appearance with no discharge
- Vaginal orifice: The hymen can be absent, or it can completely or partially cover the vaginal opening prior to sexual intercourse.
spine
toddlers and young children gait
older children gait
- Infants: Spines should be without dimples or tufts of hair. They should be midline with an overall C-shaped lateral curve.
- Toddlers appear squat with short legs and protuberant abdomens.
- Children should develop the cervical, thoracic, and lumbar curvatures like that of adults.
- Adolescents should remain midline (no scoliosis noted).
Gait
- Toddlers and young children: A bowlegged or knock-knee appearance is a common finding. Feet should face forward while walking.
- Older children and adolescents: A steady gait should be noted with even wear on the soles of shoes.
