peds test #1 Flashcards
1
Q
major goal of pediatric nursing
A
improve health care for all children
2
Q
_________ provide a framework for child health
A
healthy people 2020 health indicators
3
Q
what were the reasons for the development of family centered care
A
recognition that the emotional needs of hospitalized children went unmet
parents were not involved in the direct patent care of their children
children were not prepared for procedures and tests
4
Q
what’s needed for informed consent
A
decision maker most be of legal age, information must be at an appropriate level of education and language, must be voluntary, must have a witness
5
Q
assent
A
a child thought not to have full capacity to make freely chosen and informed decisions is asked their thoughts about treatment or participation in research trial
6
Q
research assent mat be requested as young as
A
7 years old
7
Q
exceptions to parental consent
A
assent and emancipated minor
8
Q
exception to confidentiality
A
someone is hurting them, they want to hurt someone, they want to hurt themselves
9
Q
mandated reports
A
suspected abuse must be made within 24 hours of awareness. nurse should call child protective services or police if immediate danger
10
Q
during fetal development what is the fastest growing body part
A
the head
11
Q
during childhood what is the most rapidly growing body part
A
the legs
12
Q
what happens to the trunk of the body during infancy vs adolescence
A
infancy the trunk predominates and during adolescence the trunk elongates again
13
Q
metabolism is highest in
A
newborns and decreases progressively
14
Q
most important adaptation response of infants
A
thermoregulation during transition to extra-uterine life
15
Q
as myelinization progresses
A
so does the Childs coordination and fine muscle movement
16
Q
myelinization of the spinal cord and nerves continues over
A
the first 2 years of life
17
Q
most important influence on growth
A
nutrition
18
Q
APP nutrition recommendations
A
breastfeeding for all infants until 1 year of age, vitamin D supplement 400iu/day for exclusively breast fed infants and for those who are formulae fed less than 32 ounces a day
19
Q
sensitive periods
A
when growth and development are more susceptible to positive or negative influences
20
Q
although development has a fixed and precise order it
A
does not progress at the same rate or pace
21
Q
development proceeds from the
A
simple to the complex and from the general to the specific
22
Q
development occurs in a _________ and a ________ progression
A
cephalocaudal and proximodistal progression
23
Q
cephalocaudal
A
head to toe
24
Q
proximodistal
A
from center outward
25
three common temperaments
easy child, difficult child, and slow to warm up child
26
which type of child is more prone to behavioral problems in early and middle childhood
slow to warm up child
27
freud psychosexual development
all human behavior is divided among 3 components: the id, ego, and superego and there are stages of psychosocial development
28
freud psychosocial development
oral stage, anal stage, phallic stage, latency period, genital stage
29
Piagets developmental stages
sensorimotor, preoperational, concrete operations, formal operations
30
sensorimotor stage
birth - 2 years = progress from reflex activity through repetitive behavior to initiative play
31
preoperational stage
2-7 years. egocentrism and concrete and tangible thinking, cannot reason beyond the observable
32
concrete operations
7-11 years less self centered and can consider points of view other than their own
33
formal operations
11-15 years - can think in abstract terms and thought is adaptable and flexible
34
Erikson theory
most widely accepted theory or personality development
35
each of Erikson's stages has
two components - favorable and unfavorable
36
birth weight increases by _____ by 1 year
birth weight triples by 1 yr
37
birth length by 1 yr
birth length increases by 50% at 1 yr
38
head size by 1 yr
head size increases by 33% by 1 yr
39
how fast should birth weight double in
5-6 months
40
posterior fontanel closes by
6-8 weeks (2 months)
41
anterior fontanel closes by
12-18 months
42
grasp reflex
2-3 months
43
palmar grasp
using the whole hand to grasp large objects 6-8 months
44
pincer grasp
using thumb and index finger 8-9 months
45
should have head control
4-6 months
46
should be rolling over
to back by 5 months and to belly by 6 months
47
should be sitting by
sit supported by 4 months and sit unsupported by 8 months
48
first means of verbal communication
crying
49
baby should not have solid food until
4-6 months
50
no juice until
6 months
51
immunizations are given at
2 months, 4 months, and 6 months
52
Hep b given
at birth and 4 and 6 months
53
babies can receive flu vaccine at
6 months
54
1 year vaccines
pneumococcal 13, MMR, varicella, and hep A
55
Nurse's role in immunization
educate parents, teach about doses of ibuprofen for relief, provide information on vaccine, administer vaccine, report any effect, document
56
contraindication for all immunizations
severe febrile illness or anaphylaxis
57
SIDS
defined as the sudden death of an infant younger than 1. is the 3rd leading cause of infant deaths
58
SIDS risk factors
maternal smoking, co-sleeping, soft bedding, low birth weight, viral illness, males sex, sibling of SIDs victim
59
SIDS protective factors
breastfeeding, pacifier use, and supine sleeping
60
toddler proportional changes
birthweight quadruples by 2, grow about half their adult height, and chest circumference exceeds head circumference
61
internal ear is still straight and short, and larger lymphoid tissue is present which causes what to be common in toddlers
otitis media, tonsilliti, and URIs
62
SAFE PAD
suffocation/sleep position, asphyxia/animal bites, falls, electrical burns, poisoning, automobile safety, drowning
63
social development in toddlers
differentiation of self, recognition body image, and comprehend language much more
64
terrible twos
part of growing, exerting self control, and independence
65
what is the most distinguishing characteristic of play
imitation
66
parallel play
play independently but among other children
67
two important characteristics when searching for autonomy
negativism and ritualism
68
negativism
the persistent negative response to request
69
ritualism
the need to maintain sameness and reliability
70
every child should have an established dental home by
12 months of age
71
most chronic disease in children in the us
tooth decay
72
4th dose of DTAP
15-18 months
73
children ages 1-4 have the second highest rate of
deaths from accidental injuries in the US
74
boys are _____ than girls to die of accidental deaths
2 times
75
order of physical exam in children is often
altered to accommodate the Childs developmental needs
76
positioning of infant during physical exam
lay supine or prone on parents lap or exam table but if they can sit independently then have them sit on parents lap
77
positioning of toddler during physical exam
sitting or standing near parent
78
sequence of physical exam in infant
if quiet auscultate first then proceed in head to toe fashion, perform traumatic procedure last, elicit reflexes as body part is examined
79
sequence of physical exam in toddler
inspect through play, introduce equipment slowly, auscultate, percuss, palpate when quiet
80
sequence of physical exam in preschool
head to toe if cooperative
81
important to include _____ during a pediatric assessment
physiological measurement and comparison with normal values for each age group
82
children in the 5th percentile of BMI
underweight
83
healthy weight of BMI
5th - 84th percentile
84
85th -95th percentile in BMI
overweight children
85
where should head circumference be measured
slightly above the eyebrows and pinna of ears
86
head and chest circumference are ______ until 1-2 years
equal
87
growth charts
important assessment of health and nutritional status
88
deceleration in growth chart indicate
changing health status
89
temperature at birth is done through
axillary or rectal
90
temp at 2-5 yrs is done through
axillary, tympanic, oral, or rectal
91
EBP tells us that an accurate method for obtaining a correct reflection of core temp is either
rectally or orally
92
how do we take a pulse in a child under 2
by feeling the apical or brachial pulse
93
too small of BP cuff with read with
false high reading
94
too large a BP cuff will read with
false low reading
95
flattening of the occiput can indicate
the child continually lies in a position
96
significant head lag after 6 months strongly indicates
cerebral injury
97
palpate skull for
sutures, fontanels, fractures, and swelling
98
sunken fontanel indicates
dehydration
99
pulsating fontanel indicates
the child is either crying to has increased cranial pressure
100
normocephalic
normal size head
101
microcephalic
small head for body size and age
102
macrocephalic
abnormally large head
103
bossing
frontal enlargement
104
hypertelorism
eyes unusually wide spaced
105
hypotelorism
eyes are unusually close together
106
palpebral fissures
note general slant of lids
107
epicentral folds
may give impression of malalignment
108
pseudostrabismus
false appearance of crossed eyes
109
red reflex
can determine abnormalities such as cataracts and glaucoma and should be done on newborns prior to discharge
110
1 year visual acuity
20/40-20/70
111
4 year visual acuity
20/30-20/40
112
5 year visual acuity
20/20-20/30
113
AAP recommends visual acuity screening on
those 3 years and over
114
strabismus
"cross eye" - one eye deviates from the point of fixation
115
amblyopia
blindness from disuse
116
by 3-4 months infants should be able to do what with their eyes
fixate on one visual field with both eyes
117
tests to test for eye misalignment
corneal light reflex and cover test
118
corneal light reflex
shine light into patients eyes and light should fall symmetrically within each pupil
119
corneal light reflex also called
Hirschberg test
120
cover test
one eye covered and the movement of the uncovered eye is observed while the child looks at near and distant
121
how do you look in the ear of infants
pull pinna down and back
122
auditory brainstem response
sensors that measure the responses of the baby's acoustic nerve to sounds
123
OAC - otoacoustic
earplug that measures response of cochlea to clicking sounds
124
what to assess with nose, mouth, and throat
nasal flaring, mucous membranes, teeth, gums, tonsils
125
children younger than 6 will have what type of respiratory movements
abdominal
126
apical pulse in children younger than 7
midclavicular line at the fourth intercostal space
127
tanner stages
describe the stages of pubertal growth. there are 5 stages. 1=immature and 5=mature
128
tanner stages in girls
describe development based on breast size and shape and distribution of pubic hair
129
tanner stages in boys
describe development based on the size and shape of the penis and scream and the distribution of hair
130
a newborns back is in a _____ shape
c shape from thoracic to pelvic region
131
neurologic assessment on toddlers
cerebellar function, cranial nerves, and reflexes
132
it is important to test reflexes because
if primitive reflexes are still there, loss of reflexes, or hyperactivity of reflexes is usually a reflection of cerebral insult
133
most neuro information about infants and small children is gained through
observation of spontaneous and elicited reflex responses
134
neuro red flags
delayed or deviation from expected milestones and persistence or reappearance of reflexes that normally disappear
135
primitive reflexes
controlled by lower brain function at birth which disappear at certain ages
136
testing sucking reflex
Touch infants lip, cheek, or corner of mouth with nipple of finger; infant turns head toward stimulus and opens mouth
137
moro reflex
place infant supine on flat surface. clap your hands and baby should extend arms our and look startled. begins disappearing at 8 wks
138
babinski reflex
stroke upward on sole beginning at heel. toes should hyperextend and fan outward
139
what happens with glucose during that last 2 months of fetal life
glucose is stored as glycogen in the liver and used after birth
140
newborn brain depends on ________ for 90% of its needs
glucose metabolism
141
decrease in glucose results in an increase in
epinephrine, norepinephrine, glucagon, and insulin
142
hypoglycemia occurs with levels less than
45 mg/dL
143
normal neonatal temp
97.7-98.6 F
144
unconjugated bilirubin
fat soluble and non-excretable. this binds to albumin
145
rapid utilization of brown fat can lead to
metabolic acidosis/hypoglycemia
146
why do newborns get hyperbilirubinemia
they have a higher hat, lower bilirubin clearance, shorter RBC life span and more immature liver
147
kernicterus
increase levels of unconjugated bilirubin saturate the albumin binding sites across the blood brain barrier and results in life threatening buildup of bilirubin in the brain
148
neonatal abstinence syndrome
neonate exposed to addictive illegal or prescription drugs prenatally
149
DDST
used at 1 month to 60 years to measure social, fine, and gross motor skills
150
pharmacokinetics
study of what the body does to a drug
151
pharmacodynamics
study of what a drug does to the body
152
what may be needed in toddlers to reach therapeutic dosages because of a greater metabolizing capacity
larger dosages or more frequent dosing
153
what do you need to think about in children with meds that are excreted by the kidney
they cannot concentrate urine as well so medications can circulate longer and reach toxic blood levels
154
what can formula and breast milk do to med absorption
if the med needs a more acidic environment it may has a decreased absorption because the kids ph won't be as acidic, but meds that need more of an alkaline environment may have a increased absorption
155
nursing interventions intramuscular injection
apply local anesthetic cream, use smallest gauge possible, and vests laterals is usually recommended site
156
most commonly used behavioral pain measure for below 3 years old
FLACC
157
FLACC
face, leg activity, cry, consolability. measures pain by quantifying pain behaviors with scores ranging from 0-10
158
for mild (less than 3) to moderate (4-6) pain what should be given
acetaminophen and or NSAID
159
for moderate (5-6) to severe (7-10) pain what should be given
opioids
160
optimum dosage of an analgesic
one that controls pain without causing severe side effects
161
children metabolize drugs _______ than adults
more rapidly
162
dosages are usually calculated by
body weight
163
non-pharmacological interventions for infants
containment, positioning, non-nutritive sucking, kangaroo care
164
nonopioid medications
acetaminophen, ibuprofen, ketorolac, and aspirin but aspirin is not recommended for use in children
165
aspirin in children is associated with
reye syndrome
166
most common oral opioids
hydrocodone and oxytocin's (Percocet)
167
what opioid should not be given to children
codeine
168
preferred IV opioid for children
morphine
169
respiratory depression in children happens how long after opioid use
7 minutes
170
what med can reverse sedation if needed
naloxone (narcan)
171
fentanyl compared to morphine
fentanyl has a shorter half life and is 50-100 times more potent than morphine
172
methadone metabolizes
very slowly so it has a long duration
173
what type pf pain control is not recommended in children
IM injection or intranasal medications
174
what is used to provide pain managements peripherally and centrally with less side effects
nonopioid combined with opioid
175
SIDS has reduced by 40% by
putting babies down to sleep on their backs
176
terminal diagnosis can be from
trauma or physiologic cause
177
child life therapist
help nurse provide developmentally appropriate interventions for patients and siblings
178
respiratory infection rate increases between
3-6 months because maternal stores disappear at this time
179
most respiratory infectious agents in are caused by
viruses like RSV, enterovirus, adenovirus, parainfluenza, HMPV
180
newborns are obligate nose breathers until
4 weeks
181
differences in respiratory systemin newborns
upper airway is shorter and more narrow, larynx is more flexible, larger tonsils and lymph tissue, underdeveloped intercostal muscles
182
treatment of allergic rhinitis
remove allergen, antihistamines, decongestants, leukotreine inhibitors (Singulair)
183
nasopharyngitis
common cold or strep throat - streptococcal pharyngitis
184
otitis media
most prevalent disease of early childhood with the highest rate in winter. inflammation/infection in the ear
185
infectious mononucleosis
kissing disease "mono"
186
symptoms of infectious mononucleosis
fever, exudative pharyngitis, lymphadenopathy (occipital), hepatosplenomegaly
187
principal cause of infectious mononucleosis
epstein barr virus
188
what do you have to tell kids not to do during infectious mononucleosis
no contact sports/play for 4 weeks due to splenomegaly
189
treatment for infectious mononucleosis
rest, nutrition, and supportive treatment
190
laryngomalacia
congenital laryngeal cartilage abnormality that causes upper airway obstruction
191
laryngomalacia treatment
will resolve without treatment by 18-24 months of age
192
croup syndrome
mucosal inflammation and edema causing narrowing of the airway
193
treatment for croup
racemic epinephrine - dexamethasone
194
epiglottitis
abrupt and rapidly progressive. can be life threatening and bacterial
195
symptoms of epiglottitis
drooling, muffled voice with frog like croaking on inspiration, fever, sore throat, irritable
196
what do you not want to do with epiglottitis
do not attempt to visualize airway
197
thumb sign
enlarged epiglottis on x ray
198
laryngotracheobronchitis
a type of croup characterized by hoarseness and cough described as barky
199
treatment of laryngotracheobronchitis
racemic epinephrin, steroids, antibiotics, helix, cool mist and humidification
200
most common cause of hospitalization under 1 year of age
RSV - respiratory syncytial virus
201
bronchiolitis diagnostics
ABGs, chest xray, pulse ox, and Reagant testing
202
reagant testing
nasal swab
203
RSV prevention
good hand washing and synagis
204
synagis
monoclonal antibody in vulnerable populations monthly
205
pneumonia clinical manifestations
vary depending on the etiology, age, systemic reaction, extent of disease, and degree of obstruction
206
prevention of pneumonia
pneumococcal vaccine, hand washing, good overall health
207
pertussis
whooping cough
208
whooping cough is caused by
bordetella pertussis
209
whooping cough prevented by
vaccine
210
peak the for foreign body aspiration in children is younger than
3
211
diagnostics for foreign body aspiration
fluoroscopy and chest radiography
212
what causes chronic lung disease of infancy
neonates receive high flow oxygen or ventilator which causes damages and thickening of the lungs
213
apnea
cessation of breathing for 20 seconds or longer
214
clinical manifestations of apnea
ALTE - apparent Life Threatening Event characterized by apnea, color change, chiding, or gagging
215
asthma severity classifications
mild intermittent, mild persistant, moderate persistent, and servere persistent
216
mild intermittent asthma
symptoms less than twice per week
217
mild persistent asthma
symptoms more than twice per week but less than once per day
218
moderate persistent asthma
symptoms more than twice per week
219
severe persistent asthma
continual symptoms
220
status asthmaticus
medical emergency with respiratory failure and death if untreated
221
goals of asthma management
prevent exacerbation, provide acute asthma care, relieve bronchospasm, master self-management
222
cystic fibrosis
autosomal recessive disorder of the exocrine glands that leads to abnormal accumulation of viscous and mucus
223
characteristic of cystic fibrosis
chloride production by sweat glands
224
mean survival of cystic fibrosis patients
mid 30s
225
normal chloride sweat test compared to cystic fibrosis
normal = 40 mEq/L and cystic fibrosis is 60 mEq/L
226
cystic fibrosis and respirations
excessive mucus production leads to secondary bacterial infections. overtime leads to respiratory failure
227
physical manifestations that occur over time with cystic fibrosis
digital clubbing, barrel chest, and nasal polyps
228
cystic fibrosis and the GI tract
thick mucus in pancreatic duct blocks enzymes responsible for digestion of nutrients this decreases release of amylase, trypsin and lipase
229
cystic fibrosis and reproduction
men =sterility
| females = fertility problems
230
interventions with cystic fibrosis
daily pulmonary hygiene and diet (high protein, fat soluble vitamins, pancreatic enzymes)
