Peds exam 1 Flashcards
the nurse is assessing a 6 mo old infant. Which gross motor skill should be expected at this age?
-Sits unsupported
- can feed self with spoon
- creeps on hands and knees
- rolls from back to front
Rolls from back to front
A toddler’s mom asks when it is safe to place the car seat in a forward-facing position. The nurse’s best response is:
- after the toddler turns 2 and exceeds manufacturer’s height recommendations
-never, due to risk of the child unbuckling
-not unless there are safety locks in the car
- when weight of child is > 40 pounds
After toddler turns 2 and exceeds manufacturer height recommendations
Which of the following activity is most age-appropriate for a 4 year old in traction following a femur fracture?
- large picture book
- crayons and coloring book
- listening to music
-model airplanes
Crayons and coloring book
The nurse is assessing a 4-month-old infant. The nurse would anticipate finding which of the following? Pick 2
- positive babinski reflex
-presence of a crude pincer grasp
-open posterior fontanelle
- able to hold head erect
Able to hold head erect and positive babinski reflex.
A mom of a 3 yr old tells the nurse that the child constantly has temper tantrums. What is the nurse’s best response?
- punish child every time they say “no” to change the behavior
- set limits regarding expected behaviors
-allow the behavior because this is normal at this age
- ignore the child when this behavior occurs
Set limits regarding expected behaviors
The nurse is planning care for a 18 month old child. Which of the following should be included in the child’s care?
- hold and cuddle often
- allow the child to walk independently on the nursing unit
- encourage/allow child to feed self
- engage child in games with other children
Encourage/allow child to feed self
A nurse assesses the language development of a 6 mo old infant. Which demonstrates normal developmental achievement?
- uses simple words with meaning like “mama”
- coos when comforted
- babbles using simple vowel sounds
- links syllables together
Babbles using simple vowel sounds
A nurse is observing children playing in the hospital playroom. They would expect to see 4 year old children playing?
- sharing toys but doing their own thing
- with their own toys alongside other children
-competitive board games with other children
- alone with hand held computer games
Sharing toys but doing their own thing
While examining a 2 yr old, the nurse assesses that the anterior fontanelle is open. The nurse should?
- look for other signs of abuse
- ask about family Hx of craniosynastosis
-notify the provider
- document this as a normal finding
Notify the provider
A nurse is teaching parents about ear infections. Which anatomical feature predisposes children to this disorder?
- tympanic membrane
-external ear canal
-eustachian tubes
- nasopharynx
Eustachian tubes
Which of the following is the best method for performing a physical exam on a toddler?
- from abd to toes, then to head
- dismally to proximally
-from head to toe
-from least to most invasive
From least to most invasive
Which stressor is common in hospitalized toddlers?
Pick 3
- interrupted routine
- self-concept disturbance
- fear of being hurt
- social isolation
- sleep disturbance
Fear of being hurt, sleep disturbances, and interrupted routine
A preschooler is in what Ericsson’s stage of development?
- autonomy vs. shame and doubt
- industry vs inferiority
-initiative vs. guilt
- trust vs. mistrust
Initiative vs guilt
Animism is when preschoolers believe their thoughts are all powerful?
False(animism is like Toy Story- items come to life/have feelings)
“Baby teeth” are usually completely in by age 3?
True
Normal growth parameter for infant (Ht, Wt, HC)
Ht=19-21 in (inc 50% by 12 mo)
Wt=6-9lbs(doubles by 5 mo, triples by 12 mo)
HC=33-35 cm(inc 10 cm by 12 mo)
Anterior fontanelle closes
12-18 mo
posterior fontanel closes
6-8 weeks
What are the primitive reflexes?
Sucking/rooting, palmar grasp, plantar grasp, tonic neck or “fencing”, Moro, stepping, babinski
How many teeth by 12 mo
6-8
Language development 3 mo
Coos
Turns head to rattle sound
Seems to recognize caregiver voice
language development 6 mo
Babbles with vowels
Pleasure/displeasure
Responds to name
Distinguishes emotion based on voice
Language development by 12 mo
3-5 words
Understands simple commands
Recognizes words for common items
Nutrition for an infant
Vitamin D supplementation for first few days of life
Water/juices not needed for first 4 months
Breastfeeding=complete diet for 6 months
Iron supplementation for infants being exclusively breastfed for 4 months
When can an infant progress to solid foods?
4-6 mo
What must happen before an infant can progress to solid foods?
4-6 mo, extrusion reflex must be extinguished
food intro for infants
Infant cereals first(rice, barley, oatmeal.. usually rice cereal first), fruits, then veggies
One new food every 3-5 days to allow to determine allergies
If not breastfeeding, then formula must be…..
Iron fortified
Fruit juice for infants…
Limited to 2-4oz/day at 6 mo
Foods to avoid-infant
Honey, unpasteurized drinks/food, cow’s milk, food/drinks with added sugar, caffeinated drinks
Sensory development for infant
Sight-nearsighted, prefers contrasts, full color vision by 7 mo
Hearing- acute as an adult at birth
Smell and taste-prefer sweet, can differentiate smell and taste of mothers breast milk by day 7
Touch- prefers soft sensations, soothing strokes, can tell caregiver’s mood by touch
Psychosocial development is what theory?
Erickson’s
Erickson’s theory is…
Psychosocial development
What stage of Erickson’s are infants?
trust vs. mistrust
Quality of caregiver and needs being met
Gross and fine motor skills 4 mo
Rolls from back to side
Head control
Grasps objects with both hands
Gross and fine motor skills 6 mo
Rolls from back to front
Holds bottle
Gross and fine motor skills 9 mo
Sits unsupported, creeps on hands/knees, has crude pincer grasp
Gross and fine motor skills 12 mo
Sits down from standing, walks with one hand/on own, attempts 2 block tower, can turn pages in book (multiple), feeds self with cup and spoon
Piaget major tasks for infant
Separation (separate themselves from objects in environment), object permanence (object leaves visual field but still exists), mental representation ( visualize things not physically present)
When does separation anxiety present in infants and why?
8 mo and because of object permanence
When does object permanence develop in infants?
8 mo
Piaget discusses…
Cognitive development
Piaget stage for infants
Sensorimotor; learn about themselves and world through developing sensory and motor capabilities
Age-appropriate play activities for infants
Rattles, soft stuffed toys, mirrors, teething toys, being read to, brightly colored toys, soothing music
what are infants susceptible to?
URI, heat loss, dehydration
Type of play for toddlers
Parallel
language development- toddlers
50-300 words by 2 yo
Echolalia and telegraphic speech
Age-appropriate toys for toddlers
Push-pull toys, messy play, books, blocks/balls, filling/emptying containers. Thick crayons, large piece puzzle
Erikson’s theory for toddlers
Autonomy vs. shame and doubt
Erikson’s components for toddlers
Egocentrism
Ritualism
Independence
Negativism
Temper tantrums
Regression
Egocentrism
Unable to see things from other’s perspectives
Ritualism
Like consistency and routine
Cognitive development for toddlers (Piaget)
Sensorimotor into preoperational
-Symbolic thought (pretend object represents something else-broomstick=horse)
Domestic mimicry
Limited attention span
Speech patterns for toddlers
Echolalia and telegraphic speech
Safety/ anticipatory guidance/education for parents for toddlers
Car seat rear facing until age 2 in backseat
Childproof environment
Establishing independence and following boundaries
Nutrition/eating habits for toddlers
Weaning from bottle 12-15 mo
Food jags
Picky eaters
Finger foods
Iron deficiency
Physiologic anorexia
Ritualism
Negativism
Toddlers- “No” and “Mine”- expresses independence
Regression
Reverting backwards in behaviors or stages in times of high stress
Transitional objects-toddlers
Teddy bears, blankets, etc for comfort and soothing-familiarity. Use in care
car seat safety/education-toddler
Rear facing until the age of two in back seat
Preschool fears (what and why)
Dark, pain, unknown, “monsters”, losing parts of their body/mutilation, hospitalization, nightmares common- super active imagination
Piaget’s theory for preschoolers
Preconceptual into intuitive
Piaget’s major tasks for preschoolers
Magical thinking
Imaginary friends
Animism
Time (in relation to daily events)
Language development-preschooler
2,000 word vocabulary 5 word sentences
Magical thinking-preschoolers
thoughts are all powerful; certain actions they take will include the world around them (step on a crack…pink blanket keeps monsters away)
Animism
Giving life-like qualities to inanimate objects (ToyStory)
Types of play- preschooler
Associative- begin to share,acknowledge, copy, and work with one another yet do not share same focus- not cohesive
Age-appropriate toys-preschoolers
Play pretend, dress-up, reading books, messy play, arts and crafts, puzzles, riding tricycles
Appropriate atraumatic care- preschooler
Story telling, puppets, simple terms, allow choices, imaginative play, speak honestly
Health promotion- sleep and rest, dental health for preschoolers
Need 12 hr/day
Bedtime rituals, resist bedtime- nightmares significant due to magical thinking
Dental health Q 6 mo baby teeth completely in by 3
Lose teeth 5-6
Trauma to teeth common
Cognitive development (Piaget’s major tasks)- school-age
concrete operations
Piaget’s major tasks for school-age children
principle of conservation, classify and sort objects, reversibility, can tell time
Erickson’s theory for school-age
industry vs. inferiority
reversibility-school age children
numbers or objects can be changed or returned to their original state
classify and sort objects-school age children
common for them to start a “collection””
Developmental concern topics-school age
bullying, tobacco and alcohol use, school refusal, TV/video games, internet
Relationships/peers groups school age
awareness of themselves in relation to others, feeling accepted/not different is very important, peer pressure and conformity begins/BFFs
very interested in how other view their body
Nutrition promotion/obesity for school age
risk factors: HEAVY
(high caloric diet, exercise lacking, accessibility to healthy foods limited, view food as a way to deal with stress, and your genetics/family dynamics)
caloric needs decrease
Bullying awareness/signs of bullying school age
unexplained injuries/missing items, fakes illness (to avoid school), poor grades, behavioral changes(depressed, angry, SI)
Assessment of systems (how they change) school age
-girls usually taller than boys
-sex characteristics appear in middle school age.
-brain growth complete by 10. -frontal sinuses by 7.
-abdominal breathing to diaphragmatic breathing
-20 baby teeth replaced by 28-32 permanent teeth
-screened for scoliosis
growth plates begin to close
Play types for school age
cooperative
Age-appropriate toys for school age
arts and crafts, build simple models, collect rocks and cards, board games, video games
hospitalization and illness/care of hospitalized adolescent
increased ability to understand cause and effect
-perceptions of illness severity based on degree of body image changes
-provide factual information
-include in planning of care
-encourage contact with peer group
Erikson’s theory-adolescents
identity vs role confusion
piaget’s theory-adolescents
formal operations
-abstract thinking (possibilities and hypothetical situations, less egocentric)
-can view selves as invincible->risk taking behaviors
Assessment of systems (how do they change, boys vs girls)-adolescents
girls: puberty=9-10, grow 2-8 in and gain 15-55lb, rapid before period and ceases 2-2.5 years after first period, fat deposit inc
boys: puberty=10-11, grow 4-12 in and gain 15-65 lbs stops growing 18-20 yrs, muscle mass inc
Assessment/puberty order of maturation
Girls:breast development–>pubic hair–>axillary hair–> menstruation
boys: testicular enlargement->pubic hair growth-> penile enlargement->axillary hair growth->facial hair–>vocal changes
Hormones of puberty
GnRH, FSH,LH, Estrogen, testosterone , progesterone
Safety and developmental concerns (leading causes of death/risk factors, Suicide)- adolescents
unintentional injuries=leading cause of death
MVA=leading cause of injury death
poisoning-due to opioid overdose-2nd leading cause of injury death
deaths from firearms 15-19 y/o rising
suicide=2nd leading cause of death-monitor for changes in mood and self harm:
-poor school performance
-lack of interest in things that were of interest in the past
-social isolation
-disturbances in sleep/appetite
=expression of SI
Nutrition requirements (important vitamins/minerals)- adolescents
average 2,000 calories
calcium1300mg/daily
males 11mg daily iron
females 15mg daily iron
bulimia and anorexia common (self image/body image and peer approval)
Health promotion-sexual health- adolescents
contraception and safe sex practices- risk for STIs and pregnancy
