NURS 330 (PEDS) Flashcards
Jordan’s Principle
Puts the childs needs before the logistics and the money
30-36 months SPEECH AND LANGUAGE
Almost all speech understood by strangers
Infants PLAY
solitary
Potential “RED FLAGS” in infants
- frequently in “fisted position” after 6 months.
- too tight or too floppy.
- not bringing both hands to midline by 10 months.
- no pincer grasp by 10 months
- not smiling by 4 months
Toddlers (1-3 years) GROSS MOTOR
Begins walking with ease
Can run
Can kick and throw balls well
Can jump.
12 months FINE MOTOR
Transfers objects from hand to hand
24 months FINE MOTOR
can hold crayon/marker and begin to color, turns pages, builds towers of 6 blocks.
36 months FINE MOTOR
Copies circle/cross shapes, can color within the lines.
5 Years FINE MOTOR
starts to write letters, can draw a person.
Toddler PLAY
Parallel - beside each other, but not together
Potential “RED FLAGS” in toddlers
- not walking by 18 months
- unaware of environmental changes/routine
- poor/no eye contact
- difficulty calming self
- not responding to noise, sounds or familiar voices
- not engaging in pretend play
Preschool FINE MOTOR
- button clothing
- hold crayon
- build small blocks
- use scissors
- board games
- draws self-portrait
Preschool PLAY
Associative (interact with each other, become helpful)
Potential “RED FLAGS” in preschool
- lack of socialization/not playing
- can’t follow simple directions or carry out self-care tasks
- can’t undo big buttons
- can’t put on shoes by 3 years
School Age FINE MOTOR
- refined and more focused
- musical instruments
- focus in school
- smaller lego
School Age GROSS MOTOR
6-8 years: join sports teams
more coordinated (less falls/tumbles)
School Age COGNITIVE
- focus/concentrate for longer periods
- Gain independence
- can take part in cognitive activities
- reading/writing
School age PLAY
cooperative
Potential “RED FLAGS” school age
- lack of friends
- academic failure
- aggressive behaviour
- bullying/fighting
- abusive to animals
- overt sexual behaviour
Adolescence SOCIAL/COGNITIVE
- increased independence
- challenge authority
- increased reliance on peers
- mood swings
- become experimental
Potential “RED FLAGS” adolescence
- uninterested in family life
- anger
- suicidal thoughts
- addiction
- eating disorders
- accidents (increased risk taking)
How much should babies gain per week from 2-6months?
about 70-120g/wk
At what age should weight be doubled?
By about 5 months
At what age should weight be tripled?
By about 12 months
How much weight do typical adolescence gain?
about 7-25kg over 2-3 years (girls) and about 7-29.5kg over 2-3 years (boys)
Factors affecting growth and development
genetics, temperament, health-nutrition, intelligence, gender (boys slower than girls)
Autosomal dominant inheritance
Each child has 50% chance of developing disease (ex. huntingtons, braca breast cancer gene)
Autosomal recessive inheritance
Each child has 50% chance of being a carrier, and 25% chance of having the disorder (ex. cystic fibrosis)
X-linked recessive disorders
Males are at risk: each make has 50% chance of inheriting (ex. color blindness, hemophilia a, duchenne muscular dystrophy)
Numerical chromosome abnormality
entire chromosome is added and/or missing
Structural chromosome abnormality
part of chromosome added/missing OR abnormal rearrangement
Trisomy
extra copy of one chromosome (47)
Trisomy 21
Down Syndrome
Trisomy 13
Less common, more severe
Monosomy
Missing one chromosome (45)
Only monosomy compatible with life
Turners syndrome (single X chromosome)
Klinefelter Syndrome
Boys have an extra X chromosome.
Bowlby Attachment Theory
attachment = motivational-behavioural control system - infants need one special relationship for internal development.
Nursing role in immunization
educate, respect, and have a non-judegmental relationship
Immunization in PEDS
vaccines decrease chances AND severity of disease.
Active immunization
Vaccines
Passive immunization
admin of antibodies from humans or animals
Respiratory Differences in PEDS
- lack of bony structures
- abdominal breathers (rely on diaphragm)
- appear barrel-chested
- Obligatory nose breathers until 3 months
- smaller airways, shorter distance to lower tract
- trachea short and angle at bronchus is acute, smallest at cricoid until 8 years
- smaller lung capacity and few alveoli
- underdeveloped intercostal muscles
- large tongue and tonsils
Asthma
Chronic airway inflammatory disease - infiltration of airway T-cells, mast cells, basophils, macrophages, and eosinophils.
Airflow Obstruction caused by…
- bronchial (airway) hyperresonsiveness
- airway edema
- mucous production
S&S of Asthma
- narrow airways
- longer expiration (wheezing)
- increase resp rates
- hypoxia (decreased oxygen)
- alveolar hyperinflation
- decreased perfusion
Silent Asthma
frequent coughing (at night) when secretions pool.
Severe Persistent Asthma
symptoms during the day, nighttime awakening, SABA several times/day, normal activity limited.
Chances for child if 1 parent has asthma
50% chance for child
Chances for child if 2 parents have asthma
75% chance for child
Asthma symptom triggers
exercise, cold air, hot humid air, strong fumes, emotional upsets, smoking, hormones
Inflammatory asthma triggers
Resp viral infections, dust mites, animals, cockroaches, moulds, pollens, air pollutants
Protective factors from asthma
large family, later brith order, childcare attendance, dog in the house, live on farm.
Diagnostic procedures for asthma
pulse ox, chest x-ray, blood gases, pulmonary function, peak expiratory flow rate, allergy testing.
SABA (Short-acting beta-agonist)
Ventolin = rescue medication (salbuterol)
LABA (Long-acting beta-agonist)
Pre-exercise (salmeterol)
Anticholinergic (ipratropium or atrovent)
inhibit broncho-constriction and decrease mucous production
Oral corticosteroid
used in bursts to manage uncontrolled asthma
Mild PRAM 0-3
Salbutamol q30-60min x1-2 doses, oral steroids
Moderate PRAM 4-7
Salbutamol q30min x2-3 doses, oral steroids, ipratropium.
Severe PRAM 8-12
Salbutamol and ipratropium q20min x 3 doses, PO steroids, IV methylprednisone, continuous SABA, IV magnesium sulfate.
ERIKSON
PSYCHOSOCIAL
- infant-18months: trust vs mistrust
- 18months -3years: autonomy vs shame/doubt
- 3-5years: initiative vs guilt
- 5-13years: industry vs inferiority
PIAGET
COGNITIVE
- infant-2years: SENSORIMOTOR (understand world through sense/actions)
- 2-7years: PREOPERATIONAL (understand worlds through language and mental images)
- 7-12 years: CONCRETE OPERATIONAL (understand world through logical thinking
- 12+ years: FORMAL OPERATION (understand world through hypothetical thinking and science)
KOHLBERG
MORAL
- infancy: obedience/punishment
- pre-school: self-interest
- School-age: conformity and interpersonal accord, authority and soical order
- Teens: social contract
- Adults: universal principles
FREUD
PSYCHOSEXUAL
- infant-12months: oral stage (mouth suckling)
- 1-3years: anal stage (elimination)
- 3-6years: Phallic (genitals)
- 7-11years: Latency (sexual interest, social skill)
- Puberty: Genital (sexual awakening)
BOWLBY
ATTACHMENT
- Birth-6weeks: pre-attachment
- 6week-6/8months: attachment-in-the-making
- 6/8 months - 18/24 months: clear-cut attachment
- 24 months +: goal-corrected partnership
Birth SOCIAL
Quiets when fed/comforted, makes eye contact
Birth SELF-HELP
Alert: interested in sights and sounds
Birth GROSS MOTOR
Wiggles and kicks, thrusts arms and legs in play
Birth FINE MOTOR
Looks at objects or faces
Birth LANGUAGE
Cries, makes small throaty sounds
1 month SOCIAL
Social smile
1 month GROSS MOTOR
Lefts head and chest when lying on stomach
1 month FINE MOTOR
Follows moving objects with eyes
1 month LANGUAGE
Cries in a special way when hungry
2 month SOCIAL
Recognizes mother
2 month SELF-HELP
Reacts to sight of bottle or breast
2 month GROSS MOTOR
Holds head steady when held sitting
2 months FINE MOTOR
Holds objects put in hand
2 months LANGUAGE
makes sounds - ah, eh, ugh
3 months SOCIAL
Recognizes familiar adults
3 months SELF-HELP
increased activity when shown a toy
3 months GROSS MOTOR
Makes crawling movements
3 months FINE MOTOR
Holds up hand and looks at it
3 months LANGUAGE
laughs out loud, squeals
4 months SOCIAL
Interested in his/her image in mirror, smiles, playful
4 months SELF-HELP
Reaches for objects
4 months GROSS MOTOR
Pivots around when lying on stomach
4 months FINE MOTOR
Puts toys or other objects in mouth
4 months LANGUAGE
ah-goo
5 months SOCIAL
Reacts differently to strangers
5 months GROSS MOTOR
Rolls from stomach to back
5 months FINE MOTOR
Picks up objects with one hand
5 months LANGUAGE
Responds to voices, turns head toward a voice
6 months SOCIAL
Reaches for familiar persons
6 months SELF-HELP
Looks for object after it disappears from sight or falls
6 months GROSS MOTOR
Rolls over from back to stomach
6 months FINE MOTOR
Transfers objects from one hand to the other
6 months LANGUAGE
Babbles, responds to name, turns and looks
7 months SOCIAL
Gets upset and cries if left alone
7 months SELF-HELP
Feeds self cracker/cookie
7 months GROSS MOTOR
Sits alone, steady
7 months FINE MOTOR
Holds two objects (one in each hand) at the same time, brings two objects together
7 months LANGUAGE
Makes sounds like da, ba, ga, ka, ma
8 months SOCIAL
Plays “peek-a-boo”
8 months GROSS MOTOR
Moves forward while on stomach
8 months FINE MOTOR
Uses forefinger to poke, push or roll small objects
8 months LANGUAGE
Makes sounds like mama, dada, baba
9 months SOCIAL
Waves bye-bye
9 months SELF-HELP
Resists having toy taken away
9 months GROSS MOTOR
Crawls on hands and knees, pulls self to standing position
9 months FINE MOTOR
Picks up small objects using thumb and finger grasp
9 months LANGUAGE
Imitates sounds that you make
10 months SOCIAL
Plays “patty-cake”
10 months SELF-HELP
Picks up spoon by handle
10 months GROSS MOTOR
Walks around playpen or furniture while holding on
11 months GROSS MOTOR
Stands alone briefly
11 months FINE MOTOR
Puts small objects in cup or other container
11 months LANGUAGE
Understands phrases such as “No” and “all gone”
12 months SOCIAL
Imitates simple acts such as hugging or loving a doll
12 months SELF-HELP
Helps a little when being dressed
12 months GROSS MOTOR
Stands alone, steady
12 months FINE MOTOR
Turns pages of a book a few at a time
12 months LANGUAGE
Says mama or dada for parent
13 months SOCIAL
Plays with other children
13 months SELF-HELP
Lifts cup to mouth and drinks
13 months GROSS MOTOR
Walks without help
13 months FINE MOTOR
Builds tower of 2 or more blocks
13 months LANGUAGE
Shakes head to express “no”, hands objects to you when asked
14 months SOCIAL
gives kisses
14 months SELF-HELP
Insists on feeding self
14 months GROSS MOTOR
Climbs up chairs or other furniture
14 months FINE MOTOR
Marks with pencil or crayon
14 months LANGUAGE
Asks for food or drink with sounds or words
15 months SOCIAL
Greets people with hi or similar
15 months SELF-HELP
Feeds self with a spoon
15 months GROSS MOTOR
runs
15 months FINE MOTOR
scribbles with pencil or crayon
15 months LANGUAGE
says 2 words besides mama or dada, makes sounds in sequences that sounds like sentences
18 months SOCIAL
Sometimes says “no” when interfered with
18 months SELF-HELP
Eats with a fork
18 months GROSS MOTOR
Kicks a ball forward, good balance and coordination
18 months FINE MOTOR
Builds tower of 4 or more blocks
18 months LANGUAGE
Uses 5 or more words as names of things, follows simple instruction.
GI System Growth and Development
- Structurally complete at birth but immature
- Sucking = reflex until 6 wk
- stomach capacity increases
- intestinal motility is high in newborns (increased stools)
- Enzyme secretions increase (pancreatic enzymes start developing at 4 months)
- Liver matures in first 12 months
- by age 2 - 3 meals/day
- Excretory control by age 2-3 years
Necrotizing enterocolitis (NEC)
Most common and severe GI disorder in preterm neonates.
Caused by intestinal ischemia, viral or bacterial infection
Symptoms of NEC
Vomit, blood diarrhea, ABD distention, feeding intolerance, irritability OR lethargy
Treatment of NEC
SVS or IV fluids, IV antibiotics immediately, surgical resection
Complications of NEC
Malabsorption, short-bowel syndrome, scarring/narrowing bowel, bowel obstruction, ABD scarring, problems with long-term TPN
Complications in Premature babies
intraventricular hemorrhage (IVH)
retinopathy
feeding & nutrition problems
anemia
resp distress syndrome
Types of Central Venous Catheters
- Short-Term (percutaneous)
- Tunneled
- PICC
- Implanted
- Hemodialysis
CVC Complications
Air embolism, occlusion, infection, malposition or external cath damage, extravasation
Causes of Acute diarrhea
VIRAL: rotovirus, norwalk, adenovirus, cytomegalovirus
BACTERIAL: salmonella, ecoli, shigella, c. diff
Treatment for Dehydration
NS bolus, then run D5NS to include sodium and glucose
Cleft Lip & Palate
1/700 babies
lip - 5-6wk gest
palate - 7-9wk gest
Complications of cleft palate
susceptible to colds, hearing loss, speech defect, dental cavities, tooth defects, otitis media, feeding difficulties
Hirchsprung (congenital aganglionic megacolon)
Absense of autonomic parasympathetic ganglion cells of colon - no peristalsis
Symptoms of Hirchsprung
CONSTIPATION
presents in first 6wks of life
Newborn: no meconium in 24 hours, bilous vomiting, ABD distention, failure to thrive
Older child: hx of constipation, ABD distention, failure to thrive
Treatment of Hirchsprung
surgical repair to remove dysfunctional part of bowel and re -connect
Tracheosophageal Fistula
Abnormal opening between trachea and esophagus
Symptoms of Tracheoesophageal fistula
Excess amniotic fluid, excess saliva, feed comes right back up
Diagnosing Tracheoesophageal fistula
catheter into esophagus, barium swallow test
Treatment of Tracheoesophageal fistula
Close fistula and anastomize esophagus
Imperforated Anus
Passage of feces obstructed by structural anomaly of anus/rectum
Diagnosis of imperforated anus
Inspect perineum, rectal atresia
Symptoms of imperforated anus
nausea/vomiting, ABD distention, failure to pass meconium at birth)
Treatment of Imperforated anus
Stop mouth feeds, surgery to close fistula and create an anal opening
Intussuseption
One portion of the bowel slides/invaginates into the next
Symptoms of Intussuseption
Nausea and vomiting, “currant jelly” and gelatinous stool, pain
Treatment of Intussuseption
Barium Enema
Pyloric Stenosis
Hypertrophy of circular pylorus muscle - stenosis of passage between stomach and duodenum (obstructs the lumen of the stomach)
Symptoms of Pyloric Stenosis
Projectile vomiting!! irritability, FTT, dehydration
Nissen Fundoplication
Surgery for babies with severe acid reflux - wrap the stomach around itself to tighten