Peds exam 1: physical assessment and care for sick child Flashcards
What are key components of communicating with families?
- Encouraging the parents to talk
- Directing the focus
- Listening and cultural awareness
- Using silence
- Being empathetic
- Providing anticipatory guidance
- Avoiding blocks to communication
- Communicating through an interpreter
These components enhance effective communication with families.
What is a common characteristic of communication during the toddler stage?
Egocentric (analogies) and not wanting to lose control
Toddlers may relate experiences to themselves.
What types of history are taken during a pediatric assessment?
- Birth history
- Dietary history
- Previous illness, injuries, and operations
- Allergies
- Current medications
- Immunizations
- Growth and development
- Habits
- Reproductive health history
- Family health history
- Geographic location
- Family structure
- Psychosocial history
- Review of systems
A comprehensive history is essential for effective assessment.
What is the goal of pediatric assessment?
- Observe for readiness to cooperate
- Minimize stress and anxiety
- Foster trusting nurse-child-parent relationships
- Allow for maximum preparation of child
- Preserve security of parent-child relationship
- Maximize accuracy of assessment findings
These goals help in conducting a successful assessment.
What are normal vital signs for infants?
- Heart Rate: 80 to 160 bpm
- Respiration: 25-55 breaths per minute
- Blood Pressure: 65 to 100/45 to 65 mm Hg
- Temperature: 98.6 F (normal range 97.4 F to 99.6 F)
Vital signs vary by age and are crucial for health assessment.
What are normal vital signs for a child?
- Heart Rate: 60 to 120 bpm
- Respiration: 20-30 (1-5 yrs); 12-20 (6-11)
- Blood Pressure: 90 to 110/55 to 75 mm Hg
- Temperature: 98.6 F (normal range 97.4 F to 99.6 F)
Ages 1-11
What are normal vital signs for pre-teens/teens?
- Heart Rate: 60 to 100 bpm
- Respiration: 12-20 breaths per minute
- Blood Pressure: 110 to 135/65 to 85 mm Hg
- Temperature: 98.6 F (normal range 97.4 F to 99.6 F)
Ages 12 +
What are the components of a physical examination in pediatrics?
- Growth measurements
- Vital Signs
- General appearance
- Skin
- Lymph nodes
- Extremities
- Head and neck
- Eyes
- Ears
- Nose
- Mouth and throat
- Chest
- Abdomen
- Genitalia
- Back and extremities
- Neurologic assessment
Each component provides valuable information about the child’s health.
How is the pediatric assessment triangle structured?
- Circulation to skin (Color)
- Work of breathing (Position, retractions)
- Appearance (Mentation, consolability)
This triangle is an excellent indicator of a child’s clinical status.
What tests are used to detect strabismus?
Cover test
Corneal light refelx
Eye patch used to treat. Needs to be treated before 4-6 years. “Lazy eye”
Who is more likely to have color blindness?
Boys
What are mongolian spots?
A bruised looking skin on lower back and on butt. These kids are born with it and it is NOT a bruise. It is normal!
How do you pull the ears back to look in with an otoscope in a kid less than 3?
Down and back
Up and back if >3 years
What age can you see tonsils clearly?
School age
Where are the testes at in a baby if they haven’t descended?
The inguinal canal (Right groin area)
Needs to be surgically corrected if they are not coming down into scrotum.
What is enuresis?
Involuntary urination, especially at night
It is a common condition in children and can have various causes.
What are the types of hernias are common in babies?
- Diaphragmatic (short life expectancy because they outgrow their lungs)
- Abdominal wall
- Inguinal canal
Umbilical hernia is common in infants. Can hear bowel sounds through.
What is an inguinial hernia?
Enlarged scrotum is a sign. Needs surgery to be corrected.
What are the key aspects of the neurologic assessment in children?
- Cerebellar function
- Finger-to-nose test
- Heel-to-shin test
- Romberg test
- Reflexes
- Cranial nerves
Neurologic assessments help identify developmental and neurological issues.
True or False: Newborns do not feel pain.
False
True or False: Exposure to pain at an early age has little to no effect on the child.
False
True or False: The intensity of a child’s behavioral reaction indicates the intensity of the child’s pain.
False
True or False: Children are truthful when they are asked if they are experiencing pain.
False
True or False: Children learn to adapt to pain and painful procedures.
False
True or False: Children experience more adverse effects of narcotic analgesics than adults do.
False
True or False: Children are more prone to addiction to narcotic analgesics.
False
What are the two types of pediatric pain?
- Acute
- Chronic
Chronic pain from cancer, sickle cell, autoimmune disease, migraines, etc.
List factors influencing pain in children.
- Age/gender
- Cognitive level
- Temperament of child
- Previous pain experiences
- Family
- Culture
How do infants show pain?
Flex extremities, cry
How do toddlers show pain?
Change in behavior!
-Cry
-Say “ouchie”
How do preschoolers show pain?
They usually tell you but may be scared to. Think they did something wrong.
What may unmanaged pain lead to?
- Potential long-term physiologic consequences
- Psychosocial consequences
- Behavioral consequences
What is the age range for using the FACES pain scale?
3 years and older
Self-reporting scale. Looking at their face
What is the age range for using the OUCHER pain scale?
3 to 13 years
Need to use clear wording
What is the age range for using the Numerical Rating Scale (NRS)?
8 years and up
What are the behavioral pain rating scales?
- Neonatal Infant Pain Scale NIPS
- Flacc: 2 month-7 years (kids who don’t/can’t speak)
- NPASS
Which pain scale would the nurse use when assessing a healthy 4-year-old client?
- FACES
What is the most reliable indicator of a 2.5-year-old’s pain?
- Crying and sobbing
- Changes in behavior
What are the categories of pharmacologic pain management?
- Nonopioids
- Opioids
- Coanalgesic drugs
What are methods of administering analgesia?
- Patient-controlled analgesia
- Epidural analgesia
- Transmucosal and transdermal analgesia
List nonpharmacologic pain management techniques.
- Distraction (toddlers!)
- Relaxation (school age and up)
- Guided imagery (school age and up)
- Cutaneous stimulation (any age)
- Containment and swaddling (infants)
- Nonnutritive sucking (infants)
- Kangaroo care- skin to skin (infants)
What are common pain states in children?
- Painful and invasive procedures
- Postoperative pain
- Burn pain
- Recurrent headaches
- Recurrent abdominal pain
- Pain associated with sickle cell disease
- Cancer pain
What is a key symptom of cancer in children?
Pain
What is the comfort management approach for pain and sedation in end-of-life care?
A combination of opioids and adjuvant analgesics
What are appropriate pain scales to use for a 10-year-old?
- Numerical rating scale
- FACES
What is a major stressor for hospitalized children?
Loss of control
Loss of control increases perception of threat and impacts coping skills.
What are the phases of separation anxiety?
- Protest phase (crying/screaming)
- Despair phase (depressed-nursing interventions)
- Detachment phase (denial-involve social work. Why cant parent visit?)
Each phase indicates different emotional responses to separation from parents. Usually goes in order
What factors increase a child’s vulnerability to stressors during hospitalization?
- ‘Difficult’ temperament (thrown off easy- BIG emotions)
- Age (6 months-5 years)
- Gender (male struggles more)
- Below-average intelligence
- Multiple and continuing stresses (frequent hospitalizations)
- Home life issues
What are common parental reactions to a child’s hospitalization?
- Overall sense of helplessness
- Questioning the skills of staff
- Accepting the reality of hospitalization
- Dealing with fear
- Coping with uncertainty
- Seeking reassurance
Parents often struggle emotionally during their child’s hospitalization.
What is the nurse’s role in preparing a child for hospitalization?
- Preparing child for admission
- Preventing or minimizing separation
- Preventing or minimizing parental absence
- Minimizing loss of control
- Promoting freedom of movement
- Maintaining child’s routine
- Encouraging independence and industry
Effective preparation can significantly help the child cope.
What services do child life specialists provide?
- Therapeutic play
- Activities to support normal growth and development
- Sibling support
- Advocacy
- Grief/bereavement support
- Tours and information programs
- Outpatient consultations
Child life specialists are vital in helping families cope with hospitalization. Provide atraumatic care.
Why is the calculation for Body Surface Area (BSA) based on weight and height?
BSA is often calculated to determine medication dosages from an adult dosed drug.
Often used in chemo
What are the alternative methods to restrain a child?
- Diversional activities
- Parental participation
- Therapeutic holding
Alternative methods should be considered before using restraints.
What is required for the use of physical restraints?
- Reordered every hour
- Child must be assessed every 15 minutes
Monitoring is essential for the safety of the child.
What is informed consent?
A legal process to ensure that a patient or their guardian understands the risks and benefits of a treatment. The parent gets it if under 18. Doctor explains it.
Informed consent is crucial in medical ethics.
What is emancipation?
A child separated from the parents and is in charge of their own medical choices. Usually atleast 16 years.
-Military
-Graduated HS
-Parents consent
-Married
-Court
How do you care for an infant regarding hospitalization?
- Parent involvement crucial
- Make sure nothing is left in the crib
- Rails need to be up especially for the older infants
- Someone should be at bedside almost all the time if not constant
When does separation anxiety and stranger anxiety occur?
- Separation: 6 months
- Stranger: 4 months
How would you administer meds to an infant?
- Oral first choice- mix into small amount of formula and finish with the rest of the bottle
- Limit topical first 6 months- absorption unpredictable
- IV not ideal
- IM into thighs- 0.5mL or less
- Avoid rectal for 1st month but good after if PO is CI
What should be avoided when interacting with toddlers regarding medical equipment?
Do not share the scary equipment
This helps reduce anxiety in toddlers.
How would you administer meds to a toddler?
- Oral preferred
- Involve them in topical use
- IM and IV not ideal
- Rectal ok if oral is CI (sore throat)
How do you care for a toddler in the hospital?
- Parent involvement
- Give them choices
- Use distraction
- Initiate convo w/ parents first then focus on child- Ask questions and start slow
- SAFETY!- active, watch closely, cords, IV’s, falls
- Prep for procedures immediately before and do not do in room
NO concept of time
Fill in the blank: Preschoolers are concerned with body _______.
[integrity]
This concern can affect their response to medical procedures.
How do you care for a preschooler in the hospital?
- Parent involvement
- Use events as a form of time (ex. after dinner)
- Play therapy very useful (will draw fears)
- DONT use analogies
- 1 direction at a time
- Ensure them that they didnt do anything wrong
- Can have regression (normal)
- Very fearful (magical thinking!)
- Prep for procedures 1-2 hours prior
What meds would be used with a preschool aged child?
- Oral preferred
- IM and IV are scary
- Topical is good and reliable
- Rectal makes them hesitant (more modest(
What should be done to prepare school-age children for procedures?
Explain what is happening clearly and concisely
* 1-2 days prior
* no lying/distraction (unless requested)
School-age children benefit from understanding the procedure.
How do you care for a school aged child in the hospital?
- Parent involvement (may need privacy)
- Worried about friends and school
- They want to learn and be involved
- Allow them more freedom (can collect specimens on own, use bathroom alone)
- Suicide risk depending on child
- Talk directly to the child
- Good w/ reasoning and cause/effect
How would you administer meds to a school aged child?
- Oral- can possibly swallow pills (opens opportunity to more meds)
- Avoid rectal (modestly)
- They use reasoning for the use of topical, IM and IV meds
What is a key consideration when communicating with adolescents in a hospital setting?
Provide privacy
Respecting privacy is essential for building trust with adolescents.
How do you care for an adolescent in the hospital?
- Treat them like an adult
- Parents will most likely be wanted around unless otherwise stated
- May not want to know everything
- PRIVACY IS IMPORTANT
- Pay attention to subtle hints
- Do not want to be different from peers
What med routes are appropriate for an adolescent?
- Numbing may be wanted for IM or IV
- Oral preffered (pills)
- Avoid rectal
- Topical is good
What is the trend related to the viability of preterm infants?
Increasing viability of preterm infants
22 weeks
What technological advancement has contributed to the care of children with chronic illnesses?
Portability of life-sustaining technology
They can live longer lives with this diagnosis.
What is a significant trend in the care of children with chronic diseases?
Rise in the numbers of children with complex and chronic diseases
r/t advancements in technology
How does the developmental focus change when in a child will a complex disease?
Less focus on the timeline of the milestones. They will hit them at their own pace.
What is essential for effective communication between families and healthcare providers?
Open communication!
* Allow the family to have opinions and a say in the care
* Provide the same info as the doctors
* Be sensitive
* Answer questions
What is a major impact of a child’s chronic illness on the parents?
- They may not get the positive feedback that a normal child would give
- Mourning the “perfect” child
- VERY hard on marriages
How are the siblings impacted by the chronic illness?
- May resent the sick sibling
- Mourn loss of their sibling in a diagnosis at an older age
- NEGATIVELY impacted in many ways!
-May be expected to help care
-Fewer financial abilities for them
-Less attention
-Fewer time for recreational activities
What family structure may experience unique challenges in managing chronic illness?
Single-parent families
What type of stressors may families face concurrently with chronic illness?
- Other kids
- Finances
- Marriage
What are coping mechanisms for families managing chronic illness?
Good and bad
- Good: approachment- questions, adking for help, understanding of diagnosis and care
- Bad: avoidment- don’t trust diagnosis, physicican hopping, unrealistic expectations
What is crucial for empowering parents of children with chronic illness?
Parental empowerment
Involve them and make them know they are capabale of the care and strong
What are common parental responses to the diagnosis of chronic illness?
- Shock and denial
- Adjustment- this is real
- Reintegration
- Acknowledgment- facebook group, etc.
Suggest therapy!
This is the usual sequence of reactions.
What influences a child’s responses to their diagnosis?
How the parents respond!
-Child usually follows in their behaviors (good or bad)
What daily activities may change in children with chronic conditions?
- Diet changes
- Bowel and bladder programs
- Activity
- Etc.
What safety considerations are important for transportation?
Modification regarding car safety
What sometimes gets forgotten when a kid has a chronic illness?
All the usual health care!
-Hearing
-Vision
-Dental
-Immunizations
What is crucial for effective communication in emergencies?
Parents knowing what is going on with their child
-Diagnosis
-Meds
-Change in behavior
What perspective do infants have about death?
None
What perspective do toddlers have about death?
Don’t understant the concept that its permanent.
-Affects their routine and that impacts them heavily!
What perspective do preschoolers have about death?
They don’t fully understand that its permanent, but they think they caused it.
What age group begins to understand the concept of death more clearly?
School Age
Responds well to logical explainations.
6-8 think some devil caused it while 9-10 have an adult understanding.
What age group struggles with coping related to their impending death?
Adolescent
Still trying to figure out who they are
When does palliative care treatment start?
It starts at diagnosis!
What is a key focus in managing care for dying children?
Pain and symptom management
What is a critical aspect of decision-making at the end of life?
- Ethical considerations: assisted suicide?
- Physicians make the decision (hopefully agreed upon)
- Parents have a large say
- The dying child has a say too (where it takes place)
What considerations are important when providing care at the end of life?
Ethical considerations
What are possible treatment options for terminally ill children?
Hospital, Home health, hospice
Parents and children decide together if possible (plans can change and its ok)
What is a common fear among parents of dying children?
Fear of pain and suffering
No max dose at end of life. TREAT the pain!
What need do parents and siblings have in the context of end-of-life care?
Parents’ and siblings’ need for education and support
-Educate parents and have them help care if possible
-LET the siblings know and care (depends on age)
-Siblings may start to resent that child
What fear may parents experience regarding the death of their child?
Fear of dying alone or of not being present when the child dies
Reassure parents that you will call if anythin changes and a nurse is always there
What is a significant concern for families regarding end-of-life?
Fear of actual death
What physical signs indicate the approaching death of a child?
- Senses fade (hearing is last to go)
- Confused/slurred speech
- Loss of bowel and bladder control
- No appetite
- Difficulty swallowing
- Cheyne-stokes respirations
How is grief described in terms of individual experience?
Highly individualized
-A PROCESS
What type of grief starts at the terminal diagnosis?
Anticipatory grief
What type of grief goes 1 year and longer after the death of a person?
Complicated grief
Trouble sleeping, anger, depression, denial
What is long-lasting grief?
Chronic grief
What term describes the grief that continues to impact daily life as they watch others living?
Shadow grief
Wathcing dead child’s friends hit milestones increases greif and the what its questions of their childs life
What is a common reaction of nurses caring for dying children?
Most stressful aspect of nursing
-You cant mourn like the parents at that moment
-Showing emotion is okay, but dont overstep
How do nurses’ responses to dying children compare to families?
Response similar to that of family members
What self-care measure may nurses take after a child’s death?
Attend funeral service if invited
