Peds Exam 1 (cont) Flashcards
Communication with parents
Ask open ended questions!
Provide anticipatory guidance
Communication with infant (0-1)
Speak to child in soft calm voice. Explain procedures to caregiver. Keep child appropriate toys. Keep child with parent of possible. Encourage questions
Communication with child (1-3)
same as 0-1.
Talk to child at eye level.
Allow to touch equipment.
Animism.
Communication with child (3-5)
Explain procedure and unfamiliar objects.
Allow to touch equipment.
Allow choices if possible.
Encourage use of comforting objects (animism)
Offer a badge of courage (stickers)
Reassure that procedures aren’t punishment.
Communication with child 6-12
Explain procedures and how they can help
Allow choices when possible
Explain if procedure is painful and why it is necessary
Use correct terminology
Watch for nonverbal signs an need for support
Praise for good support
Infant milestones
5-6mo- can roll from abdomen to back
Beginning of tooth eruption
12-15mo- begins to walk (concern if not walking by 18 months)
Infant safety
Always keep crib rails up.
Car seat rear facing until 1 ur or 20lbs
Toddler milestones
Uses stairs. Runs clumsily. Throws objects to floor Points to objects Dresses self May attend to toilet needs
Toddler safety
Lock cabinets Check size of toy parts an food particles Use safety plugs in outlets Use safety gates on stairs Use child safety seats
Preschooler milestones
Dresses without help. Builds tower of blocks. Ties shoes (age 5) Throw ball overhand Hops on one foot Skips (age 5) Uses full sentences Increased attention span
School age milestones
Develops sense of morality Plays with Peers Develops body image Begins Lying, cheating, stealing Gross and fine motor skills are well developed
Adolescent milestones
Sexual maturation
Physical growth spurt
Compares self with others
Wild mood swings
Adolescent safety
High risk behaviors: Driving Sex Smoking Drug abuse Alcohol abuse Suicide Homicide
Importance of play
Child’s work
Learn their roles
Learn how to relate to things and situations
Essential to mental, emotional, social well-being
Play activities
Infant- solitary play
Toddler- parallel play
Preschooler- cooperative play with other children. Dramatic play.
School age- able to play games by rules. Great physical activity. Sports. Puzzles, board games.
Later school age- gangs of same sex. Likes competitive games.
Adolescent- peer group contact extremely important. Boy girl relationships in social activities. Sports events. Dances. Games.
Erikson stages
Trust vs. mistrust
Infant (0-1)
Establishment of basic trust dominates the first year of life And describes all of the child’s satisfying experiences at this age.
Mistrust develops when trust-promoting experiences are deficient or basic needs are in adequately met.
Autonomy vs. Doubt and shame
Toddler (1-3)
Autonomy durin the toddler period is centered on children’s increasing Ability to control their bodies, themselves, and environment. Doubt and shame arise when children are made to feel self conscious, when their choices are disastrous, when others shame them.
Initiative vs. guilt
Preschooler (3-5)
Initiative is characterized by vigorous, intrusive behavior, enterprise and strong imagination. They develop a conscious (inner voice). When they feel their activities are bad it produces a sense of guilt.
Industry vs. inferiority
School-age (6-11)
In industry, children are ready to work and produce. They want to feel sense of achievement.
Feelings of inferiority may develop if too much is expected of them or if they believe they cannot measure up to the standards set for them
By others
Identity vs. role confusion
Adolescent (12-18)
Identity is characterized by rapid physical changes. Adolescents struggle to fit the roles they hope to play with the current roles and fashion adopted by peers. Inability to solve core conflicts result in role confusion.
Tylenol poisoning (acetaminophen) Treatment
Activated charcoal or concentrated mucomyst.
Tr to mix charcoal with coke or sugary substance.
Where to keep poisonous substances (cleaning products, meds)
Out of reach and Locked up
Lead poisoning
Travels to brain and causes developmental delay.
Affects renal and liver functions.
Also is toxic and causes anemia.
Anemia is often first sign of lead poisoning.
Tx for lead poisoning
Chelation therapy- EDTA given IM, causes free lead to be excreted in urine. Also removes calcium.
Medications to an infant
Place syringe or dropper along the side of the tongue
IM injections in vastus lateralis (thigh) try to have someone with u
Mix med with small amount of sugary substance
Do not give meds to crying child for fear of aspiration.
Ear- infant- down and back
Older child - up an out
Most common type of burns
Scalding is common, flash is most deadly!
Chemical burns
Acids or alkali - flush with large amounts of water
First degree burns (sun burn)
Epidermis
Protective fx of skin is intact
Pain is predominant
Heals in 5-10 days without scarring
Second degree burn (partial thickness)
Epidermis and varying degree of dermis.
Painful to air!
Wound is moist, red, blistered
Heals in 14 dAys, some scarring
Third degree (full thickness)
Entire epidermis, dermis, subq tissue
Nerve endings, sweat glands, hair follicles destroyed.
No pain at site of injury
As healing occurs pain becomes severe
Surgical intervention removes Eschar and graft
Fourth degree ( full thickness and underlying tissue)
Involves muscle, fascia, and bone.
Appears dull and dry
Ligaments, Tendon and bones exposed.
Nerve endings are damaged so pain receptors don’t work.
Severity of burns determined by
Total body surface area- all body parts divided into % of the whole. Account for small children’s larger heads and smaller extremities.
Severe burns may cause
Growth retardation because of lack of movements and not getting nutrients you need.
Most important Major burn management
Airway!!!
100% oxygen
Intubate if respiratory distress
Facial burns- elevate HOB 80-90 to reduce swelling and risk of airway obstruction.
Signs of airway swelling: strider, cough, hoarseness.
1 pain med for burns
Morphine via IV or fentanyl
Nutrition for burns
High calorie and high protein
What complications to avoid with burns
Infection and hypovolemia (increase HR and sunken fontenel)
Shaken baby syndrome (s/s)
Large head to body ratio Weak neck muscles Large amounts of h2o in brain ICP- widened pulse pressure, Bradycardia, irregular resp status. Vomiting/ not eating. Retinal bleeds Irritable Abnormal temp
Sexual abuse (abuser is normally)
Usually male.
Usually familiar to family
Gains trust
Demands secrecy.
Nurses job for child abuse
Nurse is the mandated reported. They must report to proper authorities. Objective facts only and be careful not to contaminate witness.
Varicella vaccine (chicken pox)
Given at 12-15mo
2nd dose 4-6 yo
Not given with aids or leukemia because it is live vaccine
Hep B vaccine
First dose at birth
2nd- one month later
3rd- 6 months after 1st dose
HIB vaccine
(Protects against bacterial meningitis, epiglottis, bacterial pneumonia, sepsis)
Given at 2,4,6 and 12-15 months
MMR vaccine
Given at 12-15 months, booster given at 4-6 years old
Varicella (chicken pox)
Transmission- thru direct contact, droplet, contaminated objects
Incubation period- 2-3 weeks
They are not considered contagious once they are crusted over.
Epiglottis
Emergency situation! No throat culture until airway is clear.
Abrupt onset, severe stridor, high fever, hoarseness, very sore throat.
Drooling/ difficulty swallowing. Sits upright, leans forward, chin trust out, mouth open
Most likely will be intubated bc complete obstruction may occur.
Cystic fibrosis genetics
Both mom and dad are carriers. 1 in 4 children will have CF.
Cystic fibrosis
Results in MECHANICAL OBSTRUCTION due to increased viscosity of mucous gland secretions.
Respiratory tract and pancreas affected. Prevents pancreatic enzymes to enter duodenum resulting in steatorrhea and azotorrhea.
They look like a mini COPDer: barrel chest, clubbing, cyanotic look
Cystic fibrosis diet
Well balanced. High in calories and high in protein.
Fat soluble vitamins ADEK
Respiratory syncytial virus (RSV)
Can lead to bronchiolitis and asthma.
Occurs in bronchioles usually during winter and spring in children less then 2yo.
How to clear airway on an infant
Saline drops and bulb syringe
How to promote cough and deep breathing for children
Blow bubbles
Anticipatory guidance
Teach parents what’s going to happen next
Ex. Baby will begin to walk start baby proofing
