PEDI--EXAM 1 Flashcards
The entire DNA sequence of an individual and the study
genome
the set of 46 chromosomes contains 22 pairs of _____.
autosomes
how many copies of autosomes?
2!
one from mom & one from dad
members of a chromosome pair are called
homologous chromosomes
which chromosome pare are the sex chromosomes?
23rd pair
picture of an individual’s chromosomes
karyotype
takes place in somatic or tissue cells of the body and represents how the body makes new cells.
mitosis
fertilized ovum
zygote
is also known as reduction division of the cell
meiosis
occurs only in the reproductive cells of the testes and ovaries and occurs only in the reproductive cells of the testes and ovaries and results in the formation of sperm and oocytes
meiosis
the formation of sperm and oocytes
gametes
a segment of a chromosome that can be identified with a particular function, most commonly production of one or more proteins
gene
different forms or versions of the nucleotide sequence because each gene copy is inherited form each parent
alleles
an individual who has two functionally identical alleles of a gene
homozygous
an individual who has 2 different alleles of the gene is said to be
heterozygous
may be apparent as a trait, such as curly hair or straight hair, or as signs or symptoms of a disease
phenotype
each individuals particular set of genes represents their _____.
genotype.
which statement indicates correct information has been given to the parents of a child having genetic screening? autosomal recessive characteristics:
affect males and females equally
in discussing concerns with a pregnant woman, which information is crucial for the nurse to collect to ensure the most accurate genetic information is available? select all that apply
- a family medical history 3 previous generations
- relationships btw any affected family members
- the birth history for any siblings of the baby
- a medical history for both mother and father
hyponatremia genetic referral concern?
speech problems
which will best facilitate genetic information from a child?
implement developmentally appropriate assessment skills
freud’s stages of development
oral anal phallic latency genital
age for oral
birth to 1 year
age for anal
1-3
phallic age
3-6
latency age
6-12
genital age
12 to adulthood
sucking on their finger or pacifier – baby gets pleasure and comfort through the mouth
oral
nursing considerations for oral stage
♣ Encourage breast feeding
♣ Offer bottle
potty training
anal
nursing considerations for anal
♣ Ask if they are toilet trained ♣ Any rituals about going to the potty ♣ Words they use for elimination ♣ Keep a normal pattern for elimination ♣ Do not start potty training during an illness
• – genitalia – noticing a difference between boys and girls – they may start touching themselves – relationship between sexes (parents)
phallic stage
phallic nursing considerations
♣ Determine if the child is more comfortable with male or female nurses
♣ Explain procedures that will involve the genitalia
♣ Keep the parents involved
PRIVACY
• – into the social thing, starting to understand their bodies better and they want privacy
latency
latency nursing considerations
♣ Provide them gowns
♣ Keep them covered
♣ They can keep their underwear on if at all possible
♣ Knock before you enter the room
• developing relationships, starting to mature sexually, have a surge of hormones, focus is on their genitalia function and relationships, time when parents should be encouraged to talk to their child about sex.
genital
nursing considerations for genital
♣ Enquire about significant friends ♣ Provide privacy for exams ♣ Educate about sexuality ♣ Gynecologic care for females ♣ Any changes ♣ Testicular exam for males.
freud viewed the personality as a structure with 3 parts
id
ego
superego
the basic sexual energy that is present at birth and drives the individual to seek pleasure
id
the realistic part of the person, which develops during infancy and searches for acceptable methods of meeting impulses
ego
the moral and ethical system, which develops in childhood and contains a set of values and a conscience
superego
freud’s defense mechanisms of children
regression
repression
rationalization
fantasy
o return to earlier behavior: toilet training
♣ Start having accidents in the hospital
regression
o involuntary forgetting: abused child
♣ With uncomfortable situations the abused child is not able to recall what happened
repression
unacceptable becomes acceptable: “He hit me first!”
rationalization
o mind creation to protect self: special powers, superman
fantasy
erikson’s stages of development
trust vs. mistrust autonomy vs. shame & doubt initiative vs. guilt industry vs. inferiority identity vs. role confusion
age for trust vs. mistrust
birth to 1 year
autonomy vs. shame & doubt age
1-3
initiative vs. guilt age
3-6
industry vs. inferiority age
6-12
identity vs. role confusion age
12-18
piaget’s theory of cognitive development
sensoriomotor
preoperational
concrete operational
formal operational
age for sensoriomotor
birth to 2
age for preoperational
2-7
age for concrete operational
7-11
age for formal operational
11 - adult
what to kids use during sensorimotor stage (birth - 2)
object permanence
they touch everything, they learn through their senses and their motor activities, learning about object permanence- just bc it’s out of sight doesn’t mean it’s gone
object permanence
what do they use in preoporational stage
egocentrism transductive reasoning magical thinking centration animism
if they were bad and weren’t listening then that’s why this happened),
transductive reasoning
(believe inanimate objects come to life – ex. Blood pressure cuff makes noises so it is going to eat their arm)
animism
• They think the reason something bad happens was because they said it or thought it.
preoperational
what to they use in concrete operational (7-11)
conservation
starting to understand things a little bit more. Their arm will still be there when they take the cast off, etc. better understanding of cause and effect. Like to manipulate objects, see things and touch them
conservation
• abstract thinking keep them up to date with what’s going on with their care. Consider different outcomes or alternatives
Formal operational (11-adult)
kohlberg’s stages of moral development
preconventional
conventional
postconventional
preconventional age
4-7
conventional age
7-11
postconventional age
12 and up
what do they want in pre conventional stage (4-7)
avoid punishment
please others
what do they want in conventional stage (7-11)
they want to please others by following rules, they want to be good.
what do they do in post conventional stage (12 and older)
develop their own ethical standards and principles;
look at 2 different approaches and make a decision
pavlov’s theory
positive and negative reinforcement
positive reinforcement
will encourage good behavior
negative reinforcement
get rid of behavior such as scolding
environmental systems
microsystem mesosystem exosystem macrosystem chronosystem
♣ Daily consistent relationships at home or school that affects the child; as well as the child affecting them
microsystem
♣ These are microsystem relationships with each other; home affects school performance, etc.
mesosystem
♣ Settings that the child are not in daily contact with but they do still influence the child. Ex. Parents work – If parents can’t take off to go to a child’s field trip. Parents can’t take off of work when their child is sick because they don’t have any sick time is another example.
exosystem
♣ Cultural, political and faith influences
macrosystem
♣ Time when the child is growing up effects the views of health and illness
macrosystem
♣ Time when the child is growing up effects the views of health and illness
chronosystems
generally moderate in activity; shows regularity in patterns of eating, sleeping, and elimination; and is usually positive in mood and when subjected to new stimuli
adapts to new situations and is able to accept rules and work well with others.
schedule for eating, sleep, and pooping
“easy” temperament
displays irregular schedules for eating, sleeping, and elimination; adapts slowly to new situations and persons; and displays a predominantly negative mood
intense reactions to the environment are common
the “difficult” child
has reactions of mild intensity and slow adaptability to new situations.
the child displays initial withdrawal followed by gradual, quiet, and slow interaction with the environment
the “slow-to-warm-up” child
• Their ability to function with health responses with significant stressful situations
resiliency model
resiliency model
developmental and situational stresses healthy functioning protective factors risk factors adjustment adaptation assessment application to nursing care
• Physical growth milestones
2-4 months:
o Posterior fontanel closes
o Holds rattle and plays and looks at own fingers
o Rolls from side to back then returns to side
o Holds head up and supports weight on forearms when on stomach
o Follows objects 180 degrees and turns head toward voices or sounds
• Physical growth milestones
4-6 months:
o Birth weight doubled by 6 months
o Teething
o Puts objects in mouth, holds bottle, pulls feet to mouth
o Can roll from stomach to back by 4 months and back over to stomach by 6 months
o Able to hold head up when sitting
o Watches falling objects
• Physical growth milestones
6-8 months:
o Likes to bang objects while holding them o Can move objects between hands o Sits without support by 8 months o Bounces when held in standing position o Looks and smiles when name spoken
• Physical growth milestones
8-10 months:
o Can pick up small objects by using pincer grasp o Crawls or creeps o Pulls up to standing by 10 months o Recognizes sound o Says mama and dada
• Physical growth milestones
10-12 months:
o Birth weight triples by 1 year
o Can hold crayon, places blocks into containers with holes
o Stands alone, walks holding furniture, sits from standing
o Plays peek a boo and patty cake
• Physical growth milestones
1-2 years:
o Birth weight quadrupled by 2 years o Pot-bellied appearance o Anterior fontanel closes o Can scribble, build 4 block tower, undress self, throw ball, push/pull toys o Runs, walks up and down stairs
• Physical growth milestones
2-3 years:
o Has approximately 20 teeth by 3 years
o Can draw simple shapes
o Learning to dress self
o Jumps, kicks a ball and throws it overhand
weight by 6 months
should be double the birth weight
when should baby be able to roll from stomach to back
4 months
roll from back to stomach by?
6 months
sit without support by which age?
8 months
pulls up to standing by
10 months
birth weight ____ by 1 year
triples
birth weight ___ by 2 years
quadrupled
how many teeth by 3 years
20
uses parallel play
toddler 1-3 years
looses first deciduous tooth around __ years
6
cooperative play
school age 6-12
♣ Don’t use then when trying to speak to someone and educate them.
medical jargon
forms of nonverbal communication
paralanguage gestures touch personal space facial expression body language eye contact physical appearance
o Ability to perceive another person’s experience from their view “putting self in their shoes”
empathy
• Communication with infants is still primarily ______.
nonverbal
how to talk to infant
high-pitched soft tone
where to let the infant sit during the assessment
with the parents on their lap
toddler & preschooler cognitive development
magical thinking
how do toddlers & preschoolers express themselves?
dramatic play & drawing
who to talk to first with toddlers & preschoolers?
acknowledge child but speak with parents first
how to sit when talking to toddlers & preschoolers
@ eye level
can you talk about procedures in front of the preschooler or toddler?
not if its scary
• now able to use logic
o Begin to understand others’ viewpoints
o Begin to understand cause-effect
o Understanding of body functions
school age children
can school age children interpret nonverbal messages?
YES
- Abstract thinking without full adult comprehension
* Interpretation of medical terminology is limited
adolescents
strategies to facilitate rapport and data collection
introduction purpose of interview use open and close-ended questions timing of questions privacy nonverbal communication observations honesty language
• Past health and illness history/ages of occurrence examples:
o Birth history
o Communicable diseases and illnesses
o Hospitalizations and surgery
o Injuries
how many generations for genetic FH
3
Sequence of Examination for young children
foot to head
Sequence of Examination
for older children
head to toe
• Infants Under 6 Months of Age
o Encourage the parents to participate in the exam
o Distract the infant with toys
o Use gentle warm hands and warm stethoscope
• Do procedures that provoke crying when
at end of exam
when to auscultate on under 6 month olds
when quiet or sleeping
where to keep the baby over 6 months old during the assessment
as close to parent as possible to alleviate separation anxiety
when to examine ears, eyes, & mouth for toddlers?
end of the exam
what to do before examining toddler?
o Demonstrate instruments on parent or other before examining child
• Head circumference Done until the child is
2-3 years
o Length Children under 2
= supine position even if they are able to stand
o Standing scale for what age groups
♣ Preschooler and older
• Head circumference done until
child is 2-3
anterior fontanel
12-18 months
posterior fontanel
2-3 months
• Child ___ years old and older for six cardinals fields
3
• See if an infant reaches for objects when you place it in front of their _____.
face
Pinna back & up for
over 3years
pinna down & back for `
under 3years
♣ A child 6 months or younger will not automatically open up their mouth if?
their nose is stuffy
♣ Common to feel mobile form lymph nodes up to
1 cm
♣ Warm tender nodes could be
infection
2 y/o chest
oval shaped
check chest circumference until about ____ years
2
how to heck HR on infants and children
full minute & apical pulse
• Up until about 6 years they breath with their
diaphragm
♣ auscultate for At least ___ minutes before saying they don’t have bowel signs
5
♣ female Pubic hair Usually will not develop before ___ years old
8
male pubic hair usually will not develop before __ years old
9
scale used to measure male puberty and sexual maturation
tanner scale
check posture and spinal alignment for ____ in school aged children
scoliosis
how to check lower extremity musculoskeletal system on a child
have child stand on one leg then the other
how to check lower extremity musculoskeletal system on an infant
ortilani-barlow maneuver
legs should be straight by___ years old
4
• By ____ years old you should be able to understand the child clearly
3
• Test memory by about ___ years old
4
o how to check Sensory functioning
♣ Close their eyes and touch them with something – tell them to point where they felt it
♣ Pain sensation check at ____ years and older
4
♣ Moro (startle)reflex disappears by about ___ years old
6
♣ Palmer grasp disappears by ___ months
3
♣ Plantar (grasp with toes) disappears by ___ months
8
♣ Babinskis response – normal under
2 years old
skin turgor for a baby
chest or abdomen
♣ If fontanels are bulging-
increased intracranial pressure
♣ Sunken fontanels -
dehydration
♣ When we listen for breath sounds, we listen
anterior and posterior
• Psychological impact of disaster on Infants, toddlers, and preschoolers
♣ Fear, separation anxiety, regression
♣ They may have a change in their sleeping or eating patterns
• Nightmares, fear the dark, separation anxiety, regression
♣ Whole family may be together in a shelter but it is not their normal atmosphere.
• Psychological impact of disaster on school-aged
♣ Sadness, anger, fear
♣ Fearful for themselves or their family
♣ Loss of usual interests
♣ May act out
• Psychological impact of disaster on adolescents
♣ Decreased interest in usual activities ♣ They may act out or step up to the plate and be part of the clean-up etc. ♣ Risky behavior ♣ Acting out ♣ Sadness and anger ♣ Somatic complaints • Headache • Stomach ache
♣ _____ may be more readily absorbed in children’s thin skin
Toxins
♣ Children breath faster so they might breath in more
toxins
o Pediatric drugs/supplies for disaster
♣ 3 day supply of food, water, etc.
♣ Bring medications, toys, diapers, baby formula, etc. to the shelter.
o will fear pain, invasive procedures, and mutilation of their bodies
toddlers
o fear being alone, the dark, being abandoned as well as mutilation
school age child
o fear a change in their body image, bodily injury, disability, pain, death, and separation from their friends and home, and loss of privacy and their independence.
adolescents
(when a child returns to an earlier behavior such as sucking thumb)
regression
(involuntary forgetting)
repression
(putting things off)
postponement
• Therapeutic play Addresses fears, concerns how?
♣ Give them a piece of paper to draw their concerns
respiratory changes due to pain in children
♣ Alkalosis
♣ Retained secretions
♣ Decreases oxygen saturation
o Neurological changes due to pain in children
♣ Increase in heart rate, blood sugar, cortisol levels
♣ Altered sleep patterns
metabolic changes due to pain in children
♣ Increase in fluid and electrolyte losses
• Fever, increased respiration, perspiration
♣ Delayed wound healing because of pain
o Infant behavior due to pain
♣ Cry, not eating right, irritable, restless, etc.
toddlers behavior due to pain
♣ Aggressive behavior
♣ Physical resistance
♣ Cry
♣ Can’t describe pain but may say ouch or boo-boo
preschooler behavior due to pain
♣ They may deny pain so they may not say a lot
♣ May believe the nurse or parent already knows they are hurting
♣ Aggressive behavior
school age behavior due to pain
♣ Tell you where their pain is and describe it
♣ A lot of times they try to be brave
♣ May withdraw emotionally
school age behavior due to pain 10-12 years old
- Describe their pain a little bit more
- Trying to be brave
- May pretend they are comfortable, but the pain and anxiety could cause some regression
adolescents behavior due to pain
♣ A lot of times they think that the nurse should know when they’re hurting so they may not complain about anything
♣ Try to control their responses to pain
♣ May use distraction with them as well
Neonatal characteristic facial responses to pain include
bulged brow; eyes squeezed shut; furrowed nasolabial creases; open, angular, squarish lips and mouth; taut tongue; and a quivering chin.
Memories of past pain can trigger _____
anxiety
o FLACC
♣ Face, legs, activity, crying, consolability
♣ Observe the child during routine care for about 1-5 minutes and pick the behavior that goes along with each category.
FLACC scale
which age groups use the FLACC scale
infants
toddlers
preschoolers
which age group uses the OUCHER pain scale
all but infants
toddlers use the FLACC scale, oucher scale, and…..
faces pain rating scale
preschoolers use FLACC scale,oucher scale, faces pain rating scale and?
poker chips
• School age painting scale
o Oucher o Faces Pain Rating scale o Poker Chip o Word Graphic o Visual analogue
♣ Numeric pain scale
♣ Horizontal line numbered 1-10
visual analogue
• Adolescent pain scales
o Oucher o Faces Pain Rating Scale o Poker Chip o Word Graphic o Visual analogue o Adolescent pediatric pain tool
o for less severe pain or chronic pain
NSAIDs
o For severe pain
o Have the correct dosing for weight
side effects: Sedations, N/V, urinary retention, constipation
opioids
heat/cold therapies can treat
muscle spasms & bleeding
how to evaluate after pain meds are given
o Assess the pain 15-30 minutes and then 1 hour after a PO medication
what is the preferred route for meds
oral
can you mix the meds in a bottle?
NO
what is preferred over the IM route
IV
purpose of sedation
to control pain during a procedure
light sedation
child able to support airway
talk normally
moderate sedation
conscious sedation
can maintain airway
purposeful response to vocal or tactile stimuli
deep sedation
cannot support airway
ventilate or oral airway
bag mask
