Midterm Flashcards
Define family centred care
An approach to planning, delivery, and evaluation of healthcare that is grounded in mutually beneficial partnerships among healthcare providers, patients, and families
What are the four core concepts of family centred care? Define each
Dignity and respect - honour a family’s wishes, in terms of cultural and religious practices and respecting their decision making
Information sharing - what content and information does a family need?
Collaboration - interdisciplinary collaboration; team working together to support the patient/family
Participation - involving families in the level they are comfortable with
What are the four developmental age groups and their ranges?
Infancy - Newborns span from birth to 28 days, and infants span from 1 to 12 months
Early childhood - Toddler is from 1-3 years and preschool is 3-6 years
Middle childhood - 6-10 years
Later childhood - prepubertal spans from 10-13 years and adolescence 13-18years
What are Freud’s five stages and their age ranges?
- Oral (derives pleasure from mouth) - birth to 1 year
- Anal (control over body secretions/potty training)- 1 to 3 years
- Phallic (works out parental relationships) - 3 to 6 years
- Latency (sexual energy is at rest) - 6 to 12 years
- Genital (mature sexually) - 12 years to adulthood
What are Piaget’s four stages and their respective ages?
- Sensorimotor - birth to 2 years
- Preoperational - 2 to 7 years
- Concrete operational - 7 to 11 years
- Formal operational - 11 years to adulthood
Define the sensorimotor and pre-operational stages of Piaget’s theory. Provide examples for each
- Sensorimotor is reflex activities and simple imitative behaviour (i.e., smiling back at an adult smiling at them)
- Pre-operational is egocentric behaviour, magical thinking, increasing ability to use symbols and language (i.e., focused on themselves, fear from imaginative thinking)
Define the concrete operational and formal operational stages of Piaget’s theory. Provide examples for each
- Concrete operational - thought process has become more logical and coherent, less self-centred (i.e., may now use medical play and medical explanations)
- Formal operational - thought process is more adaptable and flexible, contains abstract thought and test hypotheses (i.e., more advanced explanations are used)
List the first 5 stages of Erikson’s theory & age ranges
- Trust v mistrust - brith to 1 year
- Autonomy v shame/doubt - 1 to 3 years
- Initiative v guilt - 3 to 6 years
- Industry v inferiority - 6 to 12 years
- Identity v role confusion - 12 to 17 years
Briefly define trust v mistrust and autonomy v shame/doubt
Trust - baby develops a sense of trust when basic needs are met
Autonomy - the toddler becomes increasingly independent
Briefly define initiative v guilt, industry v inferiority, & identity v role confusion
Initiative - the child enjoys engaging in play and expressive activities
Industry - the school-aged child’s self-worth is linked to activities and participation in social groups
Identity - the adolescent is searching for their identity, reliant on peers more than family
What are the five minimum milestone expectations in infancy?
- Holds head up and supports weight with arms
- Can turn from side to back
- Follows objects and will turn head to look for voices and sounds
- Can hold head steady when sitting
- Supports most of weight when held standing
At what age do we expect to see furniture walking?
Around 1 year
What age do we observe full head turns?
4 months
At what age can babies sit independently?
6 months
What are the six minimum milestone expectations in toddlerhood?
- Scribbles on paper
- Throws a ball
- Likes to push and pull toys
- Can undress self and learning to dress self
- Learns how to pour
- Increasingly enjoys talking
What are the five minimum milestone expectations in preschool?
- Learn how to use scissors
- Brushes teeth, can close buttons, and tie shoes
- Rides a bicycle w/ or w/o training wheels
- Communicates with a widening array of people
- Enjoys playing with other children
What are the four minimum milestone expectations in school-age?
- enjoy taking part in activities that require practice (i.e., sports)
- have an ability to talk and discuss topics for increasing lengths of time
- can read and concentrate by filtering out surrounding sounds
- jumps rope and rollerblades
What are the four minimum milestone expectations in adolescence?
- eager to try new sports and activities
- may lack coordination, especially during growth spurts
- spend increasing amounts of time with peer group and friends
- can apply abstract thought analysis to conversations and have opinions
What are the four Rs that may occur during hospitalization in children? Define each
- Regression - hitting previous milestones (i.e., thumb sucking, bed wetting)
- Repression - blocking out memories or high stress moments
- Rationalization - trying to reason and understand why they are being hospitalized and connecting behaviours with illness
- Fantasy
What are key components/issues when assessing a toddler?
- they are stranger shy, cautious, anxious, and wary
- keep the parent nearby
- demonstrate the assessment on parent or yourself first
- don’t ask if you can examine the toddler because they will say no
- save instruments until the end
At what age is a child usually cooperative in an assessment, if their parent is nearby?
Preschoolers (3-6 years)
Can parents be asked to leave during an adolescent assessment?
Yes
What components are part of the paediatric assessment triangle? Explain each
- Appearance - Positioning, comfort in position, emotional responses
- Work of breathing - Rapid, apnea, relaxed
- Circulation - Pale, pink, cyanotic, circulatory colour
What does the pediatric assessment triangle allow us to do/see?
It gives us a baseline visual of how the child is doing, prior to making physical contact - their general appearance and behaviour
How/what do we assess skin and hair?
Temperature, texture, rashes, lesions, moles, ulcers, burns, incisions, dressings, and skin pigmentation
When do we draw borders on dressings?
If shadowing is present
How should the anterior and posterior fontanels feel on assessment? What does sunken or bulging indicate?
Flush/flat on the head
Sunken - dehydration
Bulging - cerebral/intercranial swelling
What age does the posterior fontanel close? Anterior?
Posterior closes after two months and anterior after 1-2 years
Who is the expert for a child’s LOC presentation?
The parents
What is acrocyanosis?
Cyanosis of the periphery that is normal in newborns
What is a normal HR in newborns?
110-160 bpm
What two vital signs will change first in children prior to BP?
HR and temperature
What is the latest vital sign to change when a child is unwell?
BP
What is the number one reason children get hospitalized in Lethbridge?
Influenza and RSV
What is QUESTT? What is it used for?
Question the child
Use pain rating scales
Evaluate behavoir and physiological changes
Secure the parents’ involvement
Take into consideration - cause of pain
Take action and evaluate results
What is the FLACC scale? What populations is it best for?
Face - no facial expression, occasional grimace, or consistent frowning/jaw clenching
Leg - Normal position/relaxed, uneasy/restless/tense, kicking or legs drawn up
Activity - lying/normal position, squirming/shifting back and forth, tense, arched/rigid
Cry - no cry, moans/whimpers, crying constantly/screams/sobs
Consolability - content/relaxed, reassured by touch/hugging/distractible, difficult to console or comfort
What populations is the FLACC scale best for?
Good choice for neonates, infants, toddlers, and any non-verbal children
What age/population is the FACES scale best for?
Best choice for preschool and earlier school-aged
Why might the FACES scale be problematic to use?
Children may point to the face they like the most rather than the one they feel
What age/population is the VAS scale best for?
School-aged or adolescents
What is the VAS scale?
Visual analog scale
A continuum of numbers from 0 (no pain) to 10 (worst pain)
How can we explain the numerical scale to children so they understand what each number may represent?
” a mosquito bite feels like a 1 and then goes to a 0 “
How early should women begin to start taking folic acid?
up to 3 months prior to conception
What components are part of preconception planning?
- complete health hx
- evaluate pre-existing medical conditions and medications
- prenatal vitamins
- safe food handling and environmental risks
- avoid alcohol and smoking
How long is the ovum viable for in the fallopian tube?
viable for 24 hours
How long is sperm viable in the vagina?
Viable for 48 to 72 hours (highly fertile for 24 hours)
What is Nagele’s rule? How is it calculated?
The way we calculate a due date
First of last menstrual period and subtract 3 months and add 7 days
What % of babies are born on their due date?
Less than 10%
What is the prenatal doctor visit schedule during gestation?
Every 4 weeks for the first 28 weeks
Every 2 weeks from 28-36 weeks
Every week after 36 weeks
What 4 general things are assessed in a prenatal visit?
- vital signs and weight
- uterine size and fetal heartbeat
- urinalysis, blood tests, GBS
- expected physiological stage of pregnancy
What does gravida + TPAL stand for?
Gravida - any pregnancy, regardless of duration, including present pregnancy
T - number of term infants born (38-42 weeks)
P - number of preterm infants born, after 20 weeks but before end of 37 weeks
A - number of pregnancies ending in either spontaneous or therapeutic abortion
L - number of current living children
Are stillbirths prior to 20 weeks considered in TPAL?
No, they are not accounted for
where does the umbilical cord develop from?
The amnion
what is Wharton’s jelly?
specialized connective tissue that protects the blood vessels of the UC
where does the placenta originate from?
Develops at the site where the embryo attaches to uterine wall at 3rd week of conception
When does the fetal heart begin beating?
4 weeks
At what age in utero do all body organs form?
8 weeks
At what point can the fetal heart rate be detected?
8-12 weeks
At what point can the sex of baby be detected?
16 weeks
At what age can the fetal heart beat be detected?
20 weeks
When does the mother begin to experience quickening ? What is quickening?
20 weeks - rapid movements of the baby
At what age are vernix and lanugo first present?
20 weeks
When does the baby develop a ‘regular schedule’?
20 weeks
What are lanugo and vernix?
lanugo - hair around the baby’s body
vernix - thick, cheesy substance on the skin
When do respiratory and sucking movements begin in utero?
24 weeks
When will the baby weigh 1lb 10oz/780g in utero?
24 weeks
When is surfactant developed in utero?
28 weeks
what is surfactant?
a protective mechanism that lines the lungs in babies
When can baby breathe and eyes open/close?
28 weeks
When are fingernails and toenails formed?
32 weeks
When is subcutaneous fat developing in utero?
32 weeks
When will the baby receive antibodies from the mother in utero?
38+ weeks
What weeks make up the first trimester?
Weeks 1-12
What are common symptoms associated with first trimester (10)?
extreme fatigue, tender and swollen breasts, nausea and vomiting, taste changes, mood swings, constipation, urinary frequency, headache, heartburn, and weight changes
What are presumptive signs?
changes in the body, but we cannot confirm they are pregnant
Often these symptoms cause women to go to the doctor or take a pregnancy test
What weeks make up the 2nd trimester?
Weeks 13-28
What symptoms are involved in the 2nd trimester (9)?
Body aches, stretch marks, darkening skin around the nipples, linea nigra, darker patches on the face, carpal tunnel syndrome, insomnia, itchiness, swelling of the ankles/fingers/face
what is linea nigra?
vertical line on the abdomen
What causes darkening of the nipples in the second trimester?
Hormonal changes
What weeks are the 3rd trimester?
Weeks 29-40+
What symptoms are common in the third trimester (9)?
SOB, heartburn, swelling, hemorrhoids, tender breasts w/ or w/o colostrum leakage, umbilical protrusion, difficulty sleeping, lightening, Braxton Hicks
What is lightening in the 3rd trimester?
baby is descending into the pelvic space
How often can women exercise during pregnancy?
5x per week for 30 minutes per day
What HR should exercise not exceed in pregnancy?
150 bpm
What can pelvic physiotherapy be helpful for and when can it be started?
Can be started pre or post-natal and is helpful for urine retention and muscle tone
How long after delivery should women wait to exercise?
4-6 weeks
After a C-section, how much heavy lifting can women do?
Nothing greater than 10lbs
What sexual positions should be avoided during pregnancy? Why?
Supine or prone
These positions may compress the vena cava
How long should sex be abstained for after delivery?
4-6 weeks
What is the safe amount of caffeine/coffee intake per day during pregnancy?
1-2 cups per day
What 4 foods should be avoided during pregnancy?
unpasteurized dairy products, raw fish, raw eggs, and deli meats
How many extra calories should be added in the 2nd and 3rd trimesters?
2nd = +340kcal
3rd = +452kcal
What should the total weight gain be during pregnancy?
25-40lbs
How many additional calories should women have in the first six months of breastfeeding and after six months of breastfeeding?
First six months, +330kcal per day
> 6months, +400kcal per day
Why should women take folic acid?
reduces the incidence of spina bifida
What 5 things are tested/done in a prenatal screening?
blood tests, GBS, urinalysis, STIs/HIV, and ultrasound
at what week is the gestational diabetes test done?
24-28 weeks
When is WinRho required?
If mom is Rh negative and baby is Rh positive
When is GBS tested for? How is it tested?
36 weeks
Vaginal and rectal swab
How is GBS treated and when?
If positive, they will be treated in labour 3 hours prior to delivery with 2 doses of Penicillin
(first is 5 million and second is 2.5 million units)
What is the GBS protocol for premature babies?
Women are always treated for GBS, even if negative, as they won’t be tested in time
