Midterm Flashcards
Importance of play when a child is ill or hospitalized
children may miss out on other social interactions and feel isolated so play is important
- helps nurse build relationship with child
- good for child mental, physical, social and emotional development
safety and comfort measures to be implemented when feeding infants and young children
- small amounts of food are introduced at first (1tsp), placed on the back of the tongue
- pureed foods are common at first and gradually thickened and amount of solid food are gradually increased as infant/child becomes familiar
- single ingredient foods are introduced to determine allergies
- to determine tolerance, one kind of food if offered in a 4 day- 1 week period
- new food should not be introduced when sick because adverse responses may not be effectively assessed
bottle mouth carries (cavities)
often common in infants and toddlers, results from leaving the bottle in all night or day with a sweet or milk beverage
what needs to be documented related to child’s nutritional and oral are needs
- injuries to the mouth
- inadequate balance of diet
- discolouration of teeth or tooth decay
- child’s oral hygiene routine
Causes, S&S, Interventions and teachings associated with poisonings
causes: medications, cleaning supplies, chemicals, gardening supplies, plants
S&S: restlessness, agitation, seizures, coma, airway obstruction, hypoventilation, hypoxia, abdominal pain, difficulty swallowing, nausea , vomiting, pallor, constipation
Interventions: remove access to poison, prevent further absorption, call the poison control centre, provide supportive care and seek medical attention asap
Legalities and circumstances for use of restraints or protective devices
- must have a dr or physicians orders
- must be explained to child and parents or guardian
- correct documentation about time, device use, location, childs reaction and circulatory checks, and why its being used
- may be used on a child or infant who is incompliant, aggressive, combative or is unable to calm down
safety and comfort issues related to use of restraints
- trauma
- may restrict circulation
- ## may cause rash or irritation from constant rubbing
documentation relating to restraints or protective devices
- correct time. device use, its location, child’s reaction and circulation checks, why it was used and when it will be taken off or when the child will be checked on
Signs of child abuse
Appearance: disheveled, unhygenic, not dressed properly for the weather, body type or age, brusies
Child’s behaviour: inappropriate language use, low self-esteem, talks down about self, social isolation, child displays sexualized behaviour
Parents or caretakers behaviour: does story match up to childs injuries, are they clingy to the child and watch very closely to what the child says or tries to speak for them
legal and ethical responsibilities if abuse is suspected
- must report suspicions of child abuse to local authorities
Documentation should be:
- factual and objective
- maintain confidentiality
- note observed interactions between child and caregiver
behavioural indicators of pain in infants and children
- distressed facial expressions
- irritability to touch
- crying with or without tears
- tense body
- screaming or groaning
- may withdraw from interactions with their surroundings
nursing assessments that should be reported and documented
- abnormal vital signs
- concerns from caregivers that are not normal for the child
- any physical concerns (sunken in fontanelle from dehydration or bulging which is ICP)
- rashes or lesions
- lung and heart sounds upon auscultation
information about physical assessment of the child that should be included with health teachings
- extreme irritability and pupils that are unequal should be reported right away as they the child could be hypotensive
- mottling of the skin of the extremities may be normal in young children because of their immature temperature control mechanisms
- skin should be assessed for rashes and lesions
- abdomen should not be distended or tender
urine specimen collection from an infant or small child
- clean and dry the infants skin, avoid putting anything on the skin
- apply the urine collector to the tiny area of skin between the anus and perineum. Fit the remainder of the urine collector to the rest of the genital area
- recover the specimen, drain the bag into a clean beaker or specimen bottle by removing the tab in the lower corner or seal the specimen inside the collector itself by folding the sticky adhesive together
- place the collector with specimen in a plastic bag
- small infants, a cotton ball may be placed at the opening of the collector, aspirating the cotton ball with a syringe can retrieve even a small amount of urine
- replace infants clean diaper, position in crib and raise side rails.
- remove gloves perform hand hygiene
- label specimen container for transport to lab according to hospital protocol
- document in medical record amount of urine collected and time sent to laboratory
information to be reported and documented related to a urine of stool specimen
- amount of urine or stool collected, the time it was sent to the lab, colour, consistency odour and purpose of collection
- any abnormalities in the lab results should be reported such as bacteria. high protein urine levels
Edema
- blood flow to the kidneys is decreased and the glomerular filtration rate slows
- this causes both fluid and sodium to be retained. this can cause puffiness about the eyes and occasionally the legs, feet and abdomen and urine output may decrease
Hypernatremia
causes: inadequate fluid intake or losses, diabetes, vomiting or diarrhea and excessive sweating
S&S: thirst, decreased urine output, confusion, lethargy or coma and seizures
Hyponatremia
causes: water intoxication, diarrhea and vomiting
S&S: anorexia, muscle weakness, headache, confusion, lethargy, coma, frequent seizures under 6 months
Treatment: oral electrolyte fluids, hypertonic saline infusions, monitor serum Na levels, assess LOC
Hyperkalemia
Causes: renal disease, metabolic acidosis case by diarrhea, IV overload, blood transfusion, medications, prolonged nausea and vomiting, burns and rhabdomyolysis
S&S: muscle weakness, diarrhea, mental confusion, abdominal cramping, cardiac arrhythmias to cardiac arrest, respiratory failure and numbness of extremities
Treatment: monitor urine output , stop IV infusions contains k+, observe SOB, restrict k+ rich foods, IV insulin, IV glucose, hemodialysis k+ wasting diuretics, salbutamol
hypokalemia
causes: diuretics, CHF, nephrotic syndrome, diarrhea, prolonger NPO status, vomiting and naso gastric suctioning
S&S: muscle weakness, lethargy, kidney and respiratory failure, cardiac arrhythmias, heart failure
Hypocalcemia
causes: chronic generalized malnutrition, diet low in vit D and calcium, uremic syndrome, burns or wound drainage, acute pancreatitis
S&S: serum levels in infants and preterm babies, numbness and tingling of extremities, tremors and cramps
hypercalcemia
causes: TPN with excess calcium, prolonged immobility, mega doses of vit A and D, disease process (malignancy, hyperparathyroidism)
S&S: nausea, vomiting, constipation, fatigue and skeletal muscle weakness, confusion, cardiac arrhythmias
Treatment: serum calcium levels, Gi functioning, LOC, increase fluid intake, high fiber diet, avoid calcium rich foods, weight bearing exercises
metabolic acidosis
causes: child has ingested acids, ASA or antifreeze, ketoacidosis, kidney disease
S&S: increased respirations, confusions, headache, cardiac issues
Metabolic alkalosis
causes: hypokalemia, severe vomiting, pyloric stenosis, removal of gastric contents
S&S: decreased respiratory rate, cramping, confusion, lethargy
information to report and document related to fluid and electrolyte imbalance
- vital signs
- intake/output
- daily weight
- skin turgor/temp, fontanelles, mucous membranes
- level of consciousness
Clubfoot
Aka TEV (talipes equinovarus) One of most common skeletal deformities Foot is generally adducted and there Is a short or tight Achilles tendon Causes: unknown but possibly due to abnormal fetal development during week 9&10, family tendency, leads to abnormal muscles and joints and contractures of soft tissues Treatment: passive massage and stretching Serial casting, splinting, special boots, surgical intervention
Hip Dysplasia
Abnormality of the hip joints which can develop in utero, infancy or childhood
Untreated can lead to permanent disability
Diagnosis: usually discovered at birth or periodic health exam during 1st and 2nd month of life
Ortolanis Sign (click heard birth to 3 month)
Shortening of leg
Difficulty walking or weight bearing
Xrays unreliable until 3-6 months
Treatment: splinting pavlik harness
Bryant’s traction hips are flexed 90 degree position with buttocks off bed for 2-3 weeks followed by hip spica cast
Surgical: closed reduction under GA
A nurse is performing a physical assessment on an infant. The infant has good head control with no head lag, sits with support, and is able to roll from back to abdomen unassisted. The nurse is aware that the infant is likely within which age group
7 to 8 months
the best and richest play for an infant is when
the caregiver is involved in the play and responds to the child
a caregiver whose baby has separation anxiety and stranger anxiety asks the nurse how old babies are when these anxieties go away. The best reply by the nurse is that stranger and separation anxiety emerge at appro 8-12 months of age and will disappear at
36 months
a family is planning to integrate solid foods into the infants diet. Which food would be recommended for an infant
cereal
a toddler is suspected to have compromised circulating blood volume. Which assessment would be the most important for the nurse to assess specifically for the evaluation of circulating blood volume
inspection of capillary refill
Which factor is the most important in prevention of pediatric obesity
parental influences in developing food attitudes and practices
the parents of a toddler who is a “picky eater” are seeking advice from the nurse. What would the nurse suggest
provide a snack every 1 to 2 hours
parents ask the pediatric nurse how soon before surgery they need to prepare their school-age child for it. Whats the best answer
2 - 4 days before the surgery
what approach would be best for the nurse to use when routinely asking adolescents about drug use?
Use a matter of fact, nonjudgemental approach
when communicating with children with special needs (physical or cognitive impairments), the nurse realizes that it is most imperative to
involve families and assess the child’s skills and abilities
developmental dysplasia of the hip (DDH) can be assessed until an infant is 1 year of age. The test used to assess for DDH is
barlows maneuver
