Midterm Exam Flashcards
What is growth
quantitative increase in physical size
What is development
qualitative increase in capability and functioning
What are the three most crucial aspects of growth and development used to plan healthcare for pediatrics
quantitative and qualitative changes in:
- body organ function
- ability to communicate
- performance of motor skills over time
in what two ways to skill develop in children
- head down
- center outward
What is cephalocaudal
refers to growth that occurs from the head downward
- infants learn head control before learning to sit
what is proximodistal
refers to development that occurs from the center of the body outward.
- infants learn to control their trunk before learning fine motor movements in the hands
What are Erikson’s stages of development
Birth-1 year: trust vs mistrust
1-3 years: Autonomy vs. shame & doubt
3-6 years: initiative vs guilt
6-12 years: industry vs inferiority
12-18 years: identity vs role confusion
Trust vs mistrust
Birth-1 year
infant establishes trust in the caregiver to provide them with food, shelter, and comfort
Autonomy vs shame & doubt
1-3 years
Toddler establishes autonomy by potty training, playing, and saying no.
Being overcriticized leads to shame and doubt
Initiative vs guilt
3-6 years
young child initiates new activities and ideas
overcriticizing leads to guilt
industry vs inferiority
6-12 years
middle childhood leads to feeling of pride in accomplishments like in sports or activities. Feelings of inferiority come from lack of accomplishments
identity vs role confusion
12-18 years
adolescents mature in their bodies and though processes. Sense of self develops. role confusion occurs when sense of self is not found
What is assimilation
incorporation of new experiences
what is accommodation
dealing with the changes of assimilation
What are Piaget’s stages of development
sensorimotor: 0-2 years
preoperational: 2-7 years
concrete operational: 7-11 years
formal operational: 11-15
What is the Sensorimotor stage
0-2 years
infant has basic reflexes coordinating sensory experiences with physical actions
what is the Preoperational stage
2-7 years
Child begins to represent the world with words and images
increased symbolic thinking
what is the Concrete Operational stage
7-11 years
child can reason with logic about concrete ideas
What is the Formal Operational stage
11-15 years
Teenager can reason with concrete and abstract thoughts
What do we base our plan on for the assessment of a newborn (0-1 month)
- presence or absence of reflexes
- attachment behaviors
- states of alertness
What are normal findings when assessing The physical growth of a newborn (0-1 months)
- gain 140-200g (5-7 oz)/wk
- grows 1.5 cm in 1st month
- head circumference increases 1.5 cm 1st month
What are normal findings when assessing The fine motor ability of a newborn (0-1 months)
- hold hand in fist
- draws legs/arms to body when crying
What are normal findings when assessing The Gross motor ability of a newborn (0-1 months)
- startle and rooting reflexes
- lift head briefly when prone
- alerts to high pitched voices
- comforts with touch
What are normal findings when assessing The Sensory ability of a newborn (0-1 months)
- prefers to look at faces and black & white geometric designs
- follows objects in line of vision
What do we base our plan on for the assessment of an infant (2-12 months)
- appropriate growth based on height and weight
- presence of tooth eruptions
- ability to walk and talk
- progression into toddlerhood
What are normal findings when assessing The physical growth of an infant (2-4 months)
- Gains 140–200 g (5–7 o z)/week
- Grows 1.5 c m/month
- Head circumference increases 1.5 cm/month
- Posterior fontanelle closes
- Ingests 120 mL/kg/day (2 oz/lb./day)
What are normal findings when assessing The fine motor ability of an infant (2-4 months)
- Holds rattle and other objects when placed in hand
- Looks at and plays with own fingers
- Brings hands to midline
What are normal findings when assessing The Gross motor ability of an infant (2-4 months)
- Moro (startle) reflex fading in strength
- Can turn from side to back and then return
- Decrease in head lag when pulled to sitting position; sits with head held in midline with some bobbing
- When prone, holds head and supports weight on forearms
What are normal findings when assessing The Sensory ability of an infant (2-4 months)
- Follows objects 180 degrees
- Turns head to look for voices and sounds
What are normal findings when assessing The physical growth of an infant (4-6 months)
- Gains 140–200 g (5–7 oz)/week
- Doubles birth weight at 5–6 months
- Grows 1.5 cm/month
- Head circumference increases 1.5 cm/month
- Teeth may begin erupting by 6 months
- Ingests 100 m L/k g/24 h r
What are normal findings when assessing The fine motor ability of an infant (4-6 months)
- Grasps rattles and other objects at will; drops them to pick up another offered object
- Mouths objects
- Holds feet and pulls to mouth
- Holds bottle
- Grasps with whole hand (palmar grasp)
- Manipulates objects
What are normal findings when assessing The Gross motor ability of an infant (4-6 months)
- Head held steady when sitting
- No head lag when pulled to sitting
- Turns from abdomen to back by 4 months and then back to abdomen by 6 months
- When held standing supports much of own weight
What are normal findings when assessing The Sensory ability of an infant (4-6 months)
- Examines complex visual images
- Watches the course of a falling object
What are normal findings when assessing The physical growth of an infant (6-8 months)
- Gains 85–140 g (3–5 oz)/week
- Grows 1 c m /month
- Growth rate slower than first 6 months
What are normal findings when assessing The fine motor ability of an infant (6-8 months)
- Bangs objects held in hands
- Transfers objects from one hand to the other
- Beginning pincer grasp at times
What are normal findings when assessing The Gross motor ability of an infant (6-8 months)
- Inborn reflexes extinguished
- Sits alone steadily without support by 8 months
- Likes to bounce on legs when held in standing position
What are normal findings when assessing The Sensory ability of an infant (6-8 months)
- Responds readily to sounds
- Recognizes own name and responds by looking and smiling
- Enjoys small and complex objects at play
What are normal findings when assessing The physical growth of an infant (8-10 months)
- Gains 85–140 g (3–5 oz)/week
- Grows 1 cm/month
What are normal findings when assessing The fine motor ability of an infant (8-10 months)
- Picks up small objects
- Uses pincer grasp well
What are normal findings when assessing The Gross motor ability of an infant (8-10 months)
- Crawls or pulls whole body along floor by arms
- Creeps by using hands and knees to keep trunk off floor
- Pulls self to standing and sitting by 10 months
- Recovers balance when sitting
What are normal findings when assessing The Sensory ability of an infant (8-10 months)
- Understands words such as “no” and “cracker”
- May say one word in addition to “mama” and “dada”
What are normal findings when assessing The physical growth of an infant (10-12 months)
- Gains 85–140 g (3–5 o z)/week
- Grows 1 c m/month
- Head circumference equals chest circumference
- Triples birth weight by 1 year
What are normal findings when assessing The fine motor ability of an infant (10-12 months)
- May hold crayon or pencil and make mark on paper
- Places objects into containers through holes
What are normal findings when assessing The Gross motor ability of an infant (10-12 months)
- Stands alone
- Walks holding onto furniture
- Sits down from standing
What are normal findings when assessing The Sensory ability of an infant (10-12 months)
- Plays peek-a-boo and patty cake
How do we plan an assessment for a toddler (1-3 years)
assessment based on:
- Increasing verbal ability and skill at walking
- Ability to control elimination
- Tooth eruption
- Increasing independence
What are normal findings when assessing The physical growth of a toddler (1-2 years)
- Gains 227 g (8 oz) or more per month
- Grows 9–12 cm (3.5–5 in.) during this year
- Anterior fontanelle closes
What are normal findings when assessing The fine motor ability of a toddler (1-2 years)
- By end of second year, builds a tower of four blocks
- Scribbles on paper
- Can undress self
- Throws a ball
What are normal findings when assessing The Gross motor ability of a toddler (1-2 years)
- Runs
- Shows growing ability to walk and finally walks with ease
- Walks up and down stairs a few months after learning to walk with ease
- Likes push-and-pull toys
What are normal findings when assessing The Sensory ability of a toddler (1-2 years)
- Visual acuity 20/50
What are normal findings when assessing The physical growth of a toddler (2-3 years)
- Gains 1.4–2.3 kg (3–5 lb.)/year
- Grows 5–6.5 cm (2–2.5 in.)/year
What are normal findings when assessing The fine motor ability of a toddler (2-3 years)
- Draws a circle and other rudimentary forms
- Learns to pour
- Learning to dress self
What are normal findings when assessing The Gross motor ability of a toddler (2-3 years)
- Jumps
- Kicks ball
- Throws ball overhand
What are normal findings when it comes to the types of play and toys a toddler (1-3 years) would enjoy
- Refines fine motor skills by use of cloth books, large pencil and paper, wooden puzzles
- Facilitates imitative behavior by playing kitchen, grocery shopping, toy telephone
- Learns gross motor activities by riding Big Wheel tricycle, playing with soft ball and bat, molding water and sand, tossing ball or bean bag
- Cognitive skills develop with exposure to educational television shows, music, stories, and books
What are normal findings when it comes to the types of communication a toddler (1-3 years) would be learning
- Increasingly enjoys talking
- Exponential growth of vocabulary, especially when spoken and read to
- Needs to release stress by pounding board, frequent gross motor activities, and occasional temper tantrums
- Likes contact with other children and learns interpersonal skills
How do we plan an assessment for a preschooler (3-6 years)
assessment based on:
- Presence of preoperational thought
- Use of dramatic play
- Increasing command of language and a corresponding increase in curiosity about the environment
What are normal findings when assessing The physical growth of a preschooler (3-6 years)
- Gains 1.5–2.5 kg (3–5 lb)/year
- Grows 4–6 cm/year
What are normal findings when assessing The fine motor ability of a preschooler (3-6 years)
- Uses scissors
- Draws circle, square, cross
- Draws at least a six-part person
- Enjoys art projects such as pasting, stringing beads, using clay
- Learns to tie shoes at end of preschool years (C)
- Buttons clothes
- Brushes teeth
- Uses spoon, fork, knife
- Eats three meals with snacks
What are normal findings when assessing The Gross motor ability of a preschooler (3-6 years)
- Throws a ball overhand
- Climbs well
- Rides bicycle
What are normal findings when assessing The Sensory ability of a preschooler (3-6 years)
- Visual acuity continues to improve
- Can focus on and learn letters and numbers
What are normal findings when it comes to the types of play and toys a preschooler (3-6 years) would enjoy
- Associative play is facilitated by simple games, puzzles, nursery rhymes, songs
- Dramatic play is fostered by dolls and doll clothes, play houses and hospitals, dress-up clothes, puppets
Stress is relieved by pens, paper, glue, scissors - Cognitive growth is fostered by educational television shows, music, stories, and books
What are normal findings when it comes to the types of communication a preschooler (3-6 years) would be learning
- All parts of speech are developed and used, occasionally incorrectly
- Communicates with a widening array of people
- Play with other children is a favorite activity
- Health professionals can:
- Verbalize and explain procedures to children
- Use drawings and stories to explain care
- Use accurate names for body functions
- Allow the child to talk, ask questions, and make choices
How do we plan an assessment for a school aged child (6-12 years)
Assessment based on:
- Growing interest in peer group and extracurricular activities
- Growth spurt occurring earlier in girls than boys
- Ability to think about solutions and determine the best among several alternatives
- Understanding of the concept of conservation
What are normal findings when assessing The physical growth of a school-aged (6-12 years) child
- Gains 1.4–2.2 kg (3–5 lb) /year
- Grows 4–6 cm/year
What are normal findings when assessing The fine motor ability of a school-aged (6-12 years) child
- Enjoys craft projects
- Plays card and board games
What are normal findings when assessing The Gross motor ability of a school-aged (6-12 years) child
- Rides two-wheeler
- Jumps rope
- Roller skates or ice skates
What are normal findings when assessing The Sensory ability of a school-aged (6-12 years) child
- Can read
- Able to concentrate for longer periods on activities by filtering out surrounding sounds
What are normal findings when it comes to the activities a school-aged (6-12 years) child would enjoy
- Gross motor development is fostered by ball sports, skating, dance lessons, water and snow skiing/boarding, biking
- A sense of industry is fostered by playing a musical instrument, gathering collections, starting hobbies, playing board and video games
- Cognitive growth is facilitated by reading, crafts, word puzzles, schoolwork
What are normal findings when it comes to the types of communication a school-aged (6-12 years) child would be learning
- Mature use of language
- Ability to converse and discuss topics for increasing lengths of time
- Spends many hours at school and with friends in sports or other activities
Health professionals can:
- Assess child’s knowledge before teaching
- Allow the child to select rewards following procedures
- Teach techniques such as counting or visualization to
manage difficult situations
- Include both parent and child in healthcare decisions
How do we plan an assessment for an adolescent (12-18 years)
Assessment based on:
- Child undergoing identity formation
- Sexual maturity nearing completion
- Formal operational thought processes becoming possible
- Importance of peer relationships and seriousness of romantic or emotional relationships
- Knowledge that privacy, confidentiality, and honesty are means to gain trust in adolescent patients
What are normal findings when assessing The physical growth of an adolescent (12-18 years)
- Variation in age of growth spurt
- During growth spurt, girls gain 7–25 kg and grow 2.5–20 cm
- boys gain approximately 7–29.5 kg and grow 11–30 cm
What are normal findings when assessing The fine motor ability of an adolescent (12-18 years)
Skills are well developed
What are normal findings when assessing The Gross motor ability of an adolescent (12-18 years)
- New sports activities attempted and muscle development continues
- Some lack of coordination common during growth spurt
What are normal findings when assessing The Sensory ability of an adolescent (12-18 years)
Fully developed
What are normal findings when it comes to the activities an adolescent (12-18 years) would enjoy
- Sports—ball games, gymnastics, water and snow skiing/boarding, swimming, school sports
- School activities—drama, yearbook, class office, club participation
- Quiet activities—reading, schoolwork, television, computer, video games, music
What are normal findings when it comes to the types of communication an adolescent (12-18 years) would be learning
- Increasing communication and time with peer group—movies, dances, driving, eating out, attending sports events
- Applying abstract thought and analysis in conversations at home and school
What are the different functions of play
Contributes to physical, cognitive, emotional, and social development
Stress reliever for child/family
Pain relief/distracter
Barometer of illness
What kind of play does an infant usually participate in
solitary play
What kind of play does a toddler usually participate in
parallel play
(two toddler play with similar objects side by side)
What kind of play does a preschooler usually participate in
associative play
(interact with their playmates)
What kind of play do school-aged children usually participate in
cooperative play
(team sports)
What type of “play” do adolescents usually participate in
More independent of parents at this age
same sex friend groups
romantic relationship also common at this age
What is temperament and what are the three types of personalities of children
Matter of thinking, behavior, or reacting as a characteristic
- easy temperament
- difficult temperament
- slow-to-warm-up temperament
What are the characteristics of an “easy temperament” child
- Generally moderate in activity
- Shows regularity in patterns of eating, sleeping, and elimination
- Usually positive in mood
- Adapts to new situations when subjected to new stimuli
- Able to accept rules
- Works well with others
What are the characteristics of a “Difficult temperament” child
- Displays irregular schedules for eating, sleeping, and elimination
- Adapts slowly to new situations and persons
- Displays a predominantly negative mood
- Intense reactions to the environment common
What are the characteristics of a “slow-to-warm-up temperament” child
- Initial withdrawal, followed by gradual, quiet, slow interaction with the environment
- Adapts slowly to new situations
- Mild reactions to environment
What are the characteristics of a “mixed temperament” child
Some of each personality type’s characteristics apparent
How should parents adapt to an extremely active child
Plan periods of active play several times a day. Have restful periods before bedtime to foster sleep.
How should parents adapt to a shy child
Allow time to adapt at own pace to new people and situations
How should parents adapt to an easily stimulated child
Have quiet room for sleeping for an infant. Have quiet room for homework for a school-age child
How should parents adapt to a child with a short attention span
Provide projects that can be completed in a short period. Gradually encourage longer periods at activities
What are the nutritional needs for a preterm infant
- High calorie/kg needs (as much as 160mL/kg/day)
- Fluid needs adjusted to infant’s condition (dehydration is a huge risk due to increased surface area to mass ratio and renal insufficiency)
- Specialized feeding methods (eating disorders common)
- Assess tolerance to formula
- monitor growth
What are the nutritional needs for a full term infant
- Fluid requirements still high (140-160 mL/kg/day)
- High metabolic rate and growth (At 1 month, need 100-115 kcal/kg/day)
- Receive about 50% of calories from fat
- Breastmilk is the recommended nutritional source
- Breastmilk breaks down quickly so breastfed babies feed often
why is breastmilk better than formula
- Easily digested and well absorbed
- Contains essential amino acids
- Rich in essential fatty acids
- Better bioavailability of iron and calcium
- Promotes GI function and helps immune defense
- Mother-baby bonding
- Cost effective
what are some different types of formula
- milk based
- soy based
- specialized for phenylketonuria (PKU)
- hypoallergenic
What is weaning and when do we do this
The transition from breast of bottle feeding to cup feeding of liquids
- 8-9 months
- by 1 year baby should be using a sippy cup
- emotional for baby and mother
What are complimentary foods and when do we give this
solid foods given in addition to milk/formula
- about 6 months
- needs to be able to hold self up with support and be able to turn away from food when full
Types of this are:
- 1/4 cup cereal 2x a day
- fruits and veggies
- meats and proteins
- finger foods
What are the nutritional needs for a toddler and preschooler
High metabolic demands of infant slow down
physiologic anorexia - seems as though child isn’t eating enough
Only needs one tbsp of each food per year of age
16-24 oz of milk/day
whole milk until 2 years then 2% (too much milk can be bad)
juice intake should be limited (1-4: 4 oz/day) (4-6: 4-6 oz/day)
should sit at a high chair or table to encourage behavior and reduce risk of choking
What are the nutritional needs for a school-aged child
Needs increase with growth spurts (girls: 10 or 11) (boys: 11 or 12)
may be resistant to new food items
encourage good choices, but let them choose (encourage freedom)
encourage eating together with family at home and with peers when at school to encourage intake
What are the nutritional needs for an adolescent
increased growth = increased caloric need
males need 3000 cal/day females need 2000 cal/day
provide foods that teens like but that are also nutritious
What is food security, food insecurity, and childhood hunger
food security: access to enough food at all times to be healthy and active
food insecurity: low quantity or quality foods available
childhood hunger:
- leading cause is poverty
- 1 in 5 children in the US is considered poor
- nurses can screen and intervene in this
what is body mass index (BMI)
A measure of body fat based of=n height and weight
- overweight: 85th-94th percentile for BMI (17% of American children)
- obese: 95th percentile for BMI (17% of American children)
What are some reasons why American children are overweight or obese
- Decreased exercise patterns
- Television and other screen-based activities
- Percentage of calories as fat
- Snacking and fast food
What is Celiac disease (what does it do)
An immunologic disorder that involves an intolerance to gluten causing chronic malabsorption
Affects intestinal absorption of fat, protein, carbohydrates, calcium, iron, folate, vitamin A, D, E, K, B12
gluten products: barley, rye, wheat, oats
dietary restriction results in return to normal growth
What is the prevalence of Celiac disease in children
1:133 people have celiac disease, more common in children with Down Syndrome or Turner Syndrome
Usually presents 6 months to 2 years
diagnosed by:
- measurement of fecal fat content
- duodenal biopsy
- resolution of symptoms
What are the signs and symptoms of Celiac disease
- chronic diarrhea
- growth impairment
- abdominal distention
What is PICA and what are the signs and symptoms
An eating disorder characterized by ingestion of nonfood items such as peeling paint, paper, soil, coffee grounds
Signs and symptoms:
- Iron & zinc deficiencies indicative of heavy metal poisoning
how do we treat PICA
- removing access to substances
- ensuring adequate/nutritious diet
- correcting nutritional deficiencies
What was found in the stomach of the man with the most famous case of PICA
What is “failure to thrive” (criteria)
- height and weight measurements fall below the third or fifth percentile
OR
- a downward change in growth across two major growth percentiles
AND
- is associated with abnormal growth and development
What are some causes of failure to thrive
- Inadequate energy intake
- Inadequate nutrition absorption
- Increase metabolic demands
- Defective nutrient utilization
what is anorexia nervosa
An eating disorder characterized by not taking in enough calories/nutrients:
- Patient typically demonstrate a preoccupation with weight, weight loss, and exercise
- Often involves psychologic aspect, need for control and aim for perfection
What are some clinical manifestations (S/S) of anorexia nervosa
- Cold
- Dizziness
- Constipation, bloating
- Abdominal distention
- Irregular menses (periods)
What is bulimia nervosa
Eating disorder characterized by binge eating and purging
- considered a “silent” disorder because it is very easily concealed
What are the clinical manifestations of bulimia nervosa
- Eroded tooth enamel
- Gum recession and caries
- Calluses on back of hand
- Abdominal distention
- Esophageal tears/Esophagitis
What are some treatment methods for bulimia nervosa
- cognitive behavioral therapy
- physiologic care
What is total parenteral nutrition
Nutrition introduced directly into the blood stream
Requires a central venous line (CVL)
includes:
- glucose
- salt
- amino acids
Lipids are given with TPN and are not included in TPN bags (fat emulsion)
When do we use TPN
- Congenital malformation of GI tract
- GI malabsorption
- Burns
- Severe sepsis
- Oncology
What is the difference between heath promotion, health maintenance, and health supervision
promotion: activities that increase well-being and enhance wellness or health
maintenance: preserve present state of health (stay the same)
- screenings
- immunizations
- prevention of injury/disease
supervision: evaluation and education through childhood well visits
- prevention
- growth/development surveillance
- health promotion included in this as well
What are we looking for at a well visit for an newborn/infant
- child/parent contact (physical, vocal, eye contact)
- baby’s response to nurse (eye contact, movement, vocal)
- relaxed vs stressed parents
- expected behavior of child?
- how does the parent deal with other children at the visit
- how does the parent deal with the sick child emotionally
- is parent dealing with post-partum depression
- assess parents and child
What is a developmental delay
when the child isn’t meeting milestones
- “early on Michigan” can help infants and children from birth t three years with developmental delays and disabilities
What are we looking for when it comes to oral health for a infant well visit
- tooth eruptions
- inform parents not to prop bottles
- wipe gums with soft gauze 2x daily
- offer guidance about teething
- mother nutrition important to oral health when breast feeding
- recommended to go to dentist 6 months after first tooth eruption
How do we assess the mental health of an infant
stranger anxiety
- happens because of expected attachment to parents
- common around 6 months of age
separation anxiety
- 6 mo-1 year
self regulation/soothing
- thumb sucking
- pacifiers
- swaddling
What is the period of PURPLE crying (define)
A German research topic used to educate parents and reduce instances of death from shaken baby syndrome
- babies will cry for no reason
- it will be worse in month 2 and be better around mo 3-5
- comforting doesn’t always stop crying but is important
Period of PURPLE crying pneumonic
P - peak of crying (more each week, most in month 2, less in months 3-5)
U - unexpected (may be for no reason; can come and go)
R - resists soothing (wont stop no matter what)
P - pain-like face (looks like baby is in pain even when its not)
L - long-lasting (can last for as much as 5 hours a day or more)
E - evening (more in late afternoon and night time)
What are the most important topic of risk prevention to teach new parents
Safe sleep/suffocation:
- lay on back to sleep
- no co-sleeping
- no bumpers, blankets, or pillows in crib
Homicide/non-accidental trauma:
- shaken baby syndrome (don’t shake when crying)
Motor vehicle injury:
- rear facing until they outgrow their car seat (3-4 years)
- make sure car seat is anchored to seat
- do not reuse car seats
What are we looking for at a well visit for a toddler/preschooler
- does parent respond to child’s questions?
- is child engaging in age appropriate play?
- does parent have age appropriate toys?
- how does child interact with staff?
- does parent engage child while waiting?
- is child alert and observant of environment?
- obtain BMI starting age 2
- obtain BP to screen for HTN age 3
What is the ages ad stages questionnaire
A parent-completed questionnaire that pinpoints developmental progress in children from 1 month to 5.5 years
What should oral health look like in a toddler/preschooler
should be seeing a dentist every 6 months from age 1
- exam includes cleaning, using fluoride, and screening for cavities (caries)
- by 2-5 years, can use a pea size of fluoride toothpaste
- by 2 years, has 20 primary (deciduous) teeth
- by age 2-4 child stops sucking thumb/using pacifier
What should mental health look like in a toddler/preschooler
Self-regulation and soothing
- adequate sleep needed for this
- positive discipline
self-esteem builds with accomplishments
- potty training
- brushing own teeth
growing independence/differentiation of self from caregiver
- gender and sexuality (learned in school with peers)
- common to ask questions about kissing, body parts, and relationships
- important to be honest and use correct name for body parts
What are the most important topics for risk prevention in a toddler/preschooler
Drowning
- leading cause of death in children 1-4
- bathtubs, pools, and empty buckets are sources of this
- swimming classes recommended but do not prevent drowning
Motor vehicle accidents
- use car seat until they grow out of it
- make sure seat belts are properly fastened
Burns
- make sure water isn’t too hot before bathing
- make sure to keep children away from hot stoves
What does sleep look like for a toddler/preschooler
Should sleep 9-11 hours a night and may nap once/day
- regular sleep schedule is important for positive behaviors
- nightmares and night terrors are common at this age
What is the difference between a nightmare and a night terror
nightmare - bad dream you wake up from and remember
night terror - you move and talk in your sleep but don’t wake up. usually don’t remember after waking up
How do parents assess for readiness for toilet training
- ability to stay dry for 2 hours
- can remove own clothes
- willingness to please parents (positive reinforcement)
- curiosity about parents/sibling toilet habits
- impatient with set/soiled diapers
How should parents discipline a toddler/preschooler
- provide guidance on how parent deals with difficult behavior
- positive discipline is essential to develop sense of right and wrong
- parents role model acceptable behavior
What is the difference between positive and negative discipline
positive: Good for kids
- focus on good behaviors
- role model good behaviors
negative: Bad for kids
- spanking
- punishments
- corporal punishments
What are we looking for at a well visit for school-aged/adolescents
- how does parent interact with child
- what tone do they use when speaking to the child
- do they praise or criticize child
- should be partnering with child
- look for stressful changes like divorce, remarriages, separations, ill siblings or grandparents
- nurse encourages adolescents to answer questions
Which health screening are done for school aged children/adolescents during a well visit
- Vision
- Hearing
- Hgb/Hct
- Lead
- Lipid screening (10 years old)
- STI (13 years old/sexually active)
- Scoliosis
What does oral health look like in school aged children and adolescents
- sees a dentist every 6 months
- eruption of permanent teeth begin
- first tooth lost at age 6 (on average)
- brushing and flossing should be done everyday
- braces and orthodontics as needed
- education about reducing sugar to prevent cavities
What does mental health look like for school aged children and adolescents
- school age work on self regulation and problem solving
- developing new skill builds self-esteem
- body image and sexuality developed by adolescence
- develops faith
- participate in planning and helping around the home
What are the most important topics of risk prevention in school aged children and adolescents
More independence and activities leads to injury
- leading cause of death is MVAs (sit in back seat and use a booster seat until 4 feet 9 inches tall, use helmets and elbow/knee pads when riding bikes)
- second is drowning, guns, and suicide (gun safety education for parents, self esteem and bullying education for kids)
- assault happens more in adolescence than any other age group (teach kids not to meet strangers from online and to say no to drugs and alcohol)
How do parents talk to school-aged kids about sexuality
Children have many misconceptions about sexuality, bodies of men and women, and sex
- may begin to ask questions
- answer questions truthfully and fully
- they usually learn about sex from the media
How should parents talk to adolescents about sexuality
- ask directly if they have had and sexual activity
- focus on birth control and prevention of STIs
What does proper sleep look like for school-aged children and adolescents
- go to bed and wake up at same time each day
- follow bedtime routine
- cannot make up for lost sleep by sleeping in
- avoid caffeine several hours before sleep
- wind down for 1-2 hours before sleep
- prohibit screen time when in bed
- avoid naps in late afternoon/evening
- darken room for sleep
What are some misconceptions about pain in children
(these are incorrect things about pain in children)
- children do not feel pain at the same intensity as adult because of immature nervous system
- parent exaggerate or aggravate their children’s pain
- children are not in pain if they are distracted or sleeping
- repeated experience with pain leads to pain tolerance and coping
- infants/children have no memory of pain
- children recover more quickly than adults
- giving narcotics is addictive and dangerous
How can we tell that an infant is in pain
less than 6 months: grimacing , poor feeding
greater than 6 months: crying, irritability, restlessness
How can we tell that a toddler is in pain
- aggressive behavior
- physical resistance
How can we tell that a school aged child is in pain
7-9 years: rigid, still, emotional withdrawal
10-12 years: may project bravery, may regress
How can we tell that an adolescent is in pain
- controlled behavioral response
- may find a distraction/deny pain
What are some physiologic effects of pain in children
Respiratory
- tachypnea leading to respiratory alkalosis
- retained secretions and decreased O2 saturation due to decreased lung expansion
Neurologic
- increase in HR
- increase in blood sugar
- increase in cortisol levels
- altered sleep leading to irritability
Metabolic
- increased fluid/electrolyte losses
- decreased release of insulin
Immune
- decreased inflammatory response
GI
- Decrease GI motility leading to nausea, poor PO intake, and ileus
Why don’t kids report pain
- limited vocabulary/experience
- trying to be brave
- they assume the nurse knows they are in pain
- afraid treatment will be worse than the pain
What is NIPS
Neonatal infant pain scale
- score of > 3 = pain
What is the FLACC scale
Face, legs, activity, cry, consolability
- pain scale for toddlers/preschoolers
- 0-3 = none/mild
- 4-6 = moderate
- 7-10 = severe
What is the Wong-Baker FACES pain scale
Pictures of faces for children to point at
- pain scale for 4-5 year olds
- from no hurt to hurts the worst ever
What are some opioids given to children for pain
Given for severe pain usually after surgery or after severe injury
- morphine
- fentanyl
- dilaudid
Tramadol and codeine should not be given to children under 12
Naloxone (Narcan) is the reversal agent
What are some common side effects of opioids in children
- Sedation
- Nausea, vomiting
- Constipation
- Urinary retention
- Itching (pruritis)
What is a PCA pump
Patient controlled analgesia
- good for patients over 6 years old
- pain relief controlled by the patient
- patient needs to be able to push the button
- patient needs to understand that its for pain relief
- patient needs to be able to report pain using a pain scale
What are some non-opioid medications given to children for pain
NSAIDS
- Motrin (ibuprofen): 10 mg/kg PO Q6 PRN
- Aleve (Naproxen)
- Toradol (ketorolac)
Tylenol (acetaminophen): 15 mg/kg PO, PR, IV Q4-6 PRN
can give these along with opioids to maintain pain relief
What are some types of anesthetics given to children
Topical and Local
- EMLA (eutectic mixture of local anesthetics) cream; topical
(lidocaine and prilocaine mixture)
- J-tip (needless injections; pressurized gas into subQ tissue; local)
- LET (lidocaine, epinephrine, and tetracaine; topical)
What are some non-pharmacologic treatments for pain in children
- distraction
- guided imagery
- breathing exercises
- cutaneous stimulation (non-pain impulses compete with pain impulses; gate theory)
- sucrose solution (stimulate opioid receptors with sweet tastes in infants/neonates)
- hot and cold therapy (ice pack, heating pad)
What are some responses a child can have for a sibling in the hospital
- confusion
- guilt
- anger
- jealousy
- rejection
How do nurses prepare and administer procedural care for an infant
prepare:
- teach parent of procedure
- tell them they can touch a foot or cheek and talk to reassure
- allow parents to be present for procedures
During:
- immobilize securely and gently
- do not have parent hold infant during procedure
- perform quickly; use distractions
- ask parent to comfort infant after
How do nurses prepare and administer procedural care for a toddler
Prepare:
- explain procedure to toddler just before
- explain they did nothing wrong
- explain that procedure is necessary
During:
- perform in treatment room
- immobilize securely
- give short explanation in positive manner
- avoid giving choices
- allow child to cry or scream
- comfort child after with a reward like a favorite drink or sticker
How do nurses prepare and administer procedural care for a preschooler
Prepare:
- give simple explanation; drawings
- allow child to see and touch equipment
- inform child that body will be the same after procedure
During:
- perform in treatment room and immobilize securely
- give short explanations in positive manner
- encourage control by having child count to 10
- allow child to cry
- praise child for cooperation and going through with it
- encourage child to explore procedure by drawing afterwards
How do nurses prepare and administer procedural care for a school aged child
Prepare:
- Clear thorough explanation with drawings
- teach deep breathing techniques to reduce stress
- offer choice of reward for after
During:
- be ready to immobilize if needed
- explain whats happening throughout
- help with stress relief techniques
- praise for cooperation
How do nurses prepare and administer procedural care for an adolescent
Prepare:
- Give clear explanations in writing and verbally
- teach stress-reducing techniques
- explore fear of certain procedures
During:
- assist with self-control of body position
- assist with stress-relief techniques
- explain expected outcome and results afterwards
What are some common IV start sites in children
- hands
- feet
- AC
- scalp
Hourly IV assessments required because of ease of infiltration
What are some common IM injection sites in children
Vastus lateralis (no more than 1-2 mL at a time) PREFERRED
Deltoid (no more than 0.5 mL at a time)
use Z track method to prevent seepage (pull subQ tissue over, inject, pull out needle, then let tissue go)
When treating pediatric patients in the hospital, what s the very first thing you obtain
History
- ask patient age appropriate questions
- ask open ended questions to get parents perception of the illness “what brought you in today”
- ask closed ended questions to get clarification of info “how high was the fever”
How do nurses perform a physical exam on children
young children: foot to head and outward to inward
older children: head to toe
infants < 6 months: keep parent close by
Infants > 6 months: stranger anxiety; parent holds them
toddler: stranger anxiety; keep parent with child
preschooler: assess if can be separated from parent
school-age: want to learn about exam
adolescents: modesty is very important’ away from parent unless they ask them to be there
What is the normal heart rate when awake and asleep for each developmental stage: neonate, infant, toddler, preschooler, school-aged, adolescent
What is the normal respiratory rate for each developmental stage: neonate, infant, toddler, preschooler, school-aged, adolescent
What is the normal SYSTOLIC blood pressure when for each developmental stage: neonate, infant, toddler, preschooler, school-aged, adolescent
for children > 1 year
90 mmHg + (2 X age in yrs.)
(1 year old = 92)
What is a fontanelle and when do they usually close
Spaces between the sutures of the skull that haven’t completely formed yet (anterior an posterior)
- bulging = increase ICP
- depressed = dehydration
Anterior closes = 1-2 years (usually 18 months)
Posterior closes = 2-4 months
What is the sunset sign
when they eyer=s are open, you can see the sclera between the iris and the eyelid (super open eyes)
may indicate retracted eyelids or hydrocephalus
What is the red reflex
When shining a light into the eye, you will see a red spot indicating a normal retina
if you see white instead of red, it is referred to a leukocoria and is indicative of retinoblastoma
How can you indicate hearing loss in an infant
- no startle response to loud noises
- does not turn toward sound by 4 months
- babbles as infant but doesn’t keep babbling as they get older or does not develop speech sounds by 6 months
How can you indicate hearing loss in a young child
- no speech by 2 years of age
- speech sounds not distinct
When assessing a child’s nose, what does nasal flaring mean
When trying to breathe, the nostril opens wider to get more air
this is indicative of respiratory distress
head bobbing can also be indicative of respiratory distress
What do the different types of nasal drainage mean in a child
- clear
- mucus
- blood
What are some concerning abnormalities found when assessing a child’s range of motion
torticullis: contraction of the muscles causing the head to turn to one side; seen shortly after birth
meningismus: meningitis symptoms that occur after febrile infection in children
What are some abnormalities seen in the inspection of the chest in children
Pectus carnatus (pigeon chest)
- chest is peaked outward in the middle
- increases anterior/posterior diameter
Pectus Excavatum (funnel chest)
- chest is depressed at the bottom
- decreases anterior/posterior diameter
What are the tanner stages of puberty and breast/pubic hair growth in children-adolescents
- breast budding usually occurs between the ages of 9-14
- breast buds earlier than that is warrant for evaluation
- presence of pubic hair before age 8-9 is uncommon
- delayed enlargement of testicles after 14 needs evaluation
What are the primitive reflexes in children
moro reflex (startle) - extend arms when startled
rooting reflex - turning head (nipple seeking) when stroking cheek
sucking reflex - sucking when roof of mouth is touched
palmar reflex - curling fingers when stroking palm
tonic neck reflex - when on their back the head will turn towards extended arm and leg and other arm and leg will flex
babinski reflex - when stroking bottom of foot, toes extend
