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Nursing school level 2 > peds test #1 > Flashcards

peds test #1 Flashcards

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1
Q

major goal of pediatric nursing

A

improve health care for all children

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2
Q

_________ provide a framework for child health

A

healthy people 2020 health indicators

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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

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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

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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

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6
Q

research assent mat be requested as young as

A

7 years old

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7
Q

exceptions to parental consent

A

assent and emancipated minor

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8
Q

exception to confidentiality

A

someone is hurting them, they want to hurt someone, they want to hurt themselves

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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

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10
Q

during fetal development what is the fastest growing body part

A

the head

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11
Q

during childhood what is the most rapidly growing body part

A

the legs

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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

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13
Q

metabolism is highest in

A

newborns and decreases progressively

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14
Q

most important adaptation response of infants

A

thermoregulation during transition to extra-uterine life

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15
Q

as myelinization progresses

A

so does the Childs coordination and fine muscle movement

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16
Q

myelinization of the spinal cord and nerves continues over

A

the first 2 years of life

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17
Q

most important influence on growth

A

nutrition

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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

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19
Q

sensitive periods

A

when growth and development are more susceptible to positive or negative influences

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20
Q

although development has a fixed and precise order it

A

does not progress at the same rate or pace

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21
Q

development proceeds from the

A

simple to the complex and from the general to the specific

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22
Q

development occurs in a _________ and a ________ progression

A

cephalocaudal and proximodistal progression

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23
Q

cephalocaudal

A

head to toe

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24
Q

proximodistal

A

from center outward

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25
Q

three common temperaments

A

easy child, difficult child, and slow to warm up child

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26
Q

which type of child is more prone to behavioral problems in early and middle childhood

A

slow to warm up child

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27
Q

freud psychosexual development

A

all human behavior is divided among 3 components: the id, ego, and superego and there are stages of psychosocial development

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28
Q

freud psychosocial development

A

oral stage, anal stage, phallic stage, latency period, genital stage

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29
Q

Piagets developmental stages

A

sensorimotor, preoperational, concrete operations, formal operations

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30
Q

sensorimotor stage

A

birth - 2 years = progress from reflex activity through repetitive behavior to initiative play

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31
Q

preoperational stage

A

2-7 years. egocentrism and concrete and tangible thinking, cannot reason beyond the observable

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32
Q

concrete operations

A

7-11 years less self centered and can consider points of view other than their own

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33
Q

formal operations

A

11-15 years - can think in abstract terms and thought is adaptable and flexible

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34
Q

Erikson theory

A

most widely accepted theory or personality development

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35
Q

each of Erikson’s stages has

A

two components - favorable and unfavorable

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36
Q

birth weight increases by _____ by 1 year

A

birth weight triples by 1 yr

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37
Q

birth length by 1 yr

A

birth length increases by 50% at 1 yr

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38
Q

head size by 1 yr

A

head size increases by 33% by 1 yr

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39
Q

how fast should birth weight double in

A

5-6 months

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40
Q

posterior fontanel closes by

A

6-8 weeks (2 months)

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41
Q

anterior fontanel closes by

A

12-18 months

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42
Q

grasp reflex

A

2-3 months

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43
Q

palmar grasp

A

using the whole hand to grasp large objects 6-8 months

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44
Q

pincer grasp

A

using thumb and index finger 8-9 months

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45
Q

should have head control

A

4-6 months

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46
Q

should be rolling over

A

to back by 5 months and to belly by 6 months

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47
Q

should be sitting by

A

sit supported by 4 months and sit unsupported by 8 months

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48
Q

first means of verbal communication

A

crying

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49
Q

baby should not have solid food until

A

4-6 months

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50
Q

no juice until

A

6 months

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51
Q

immunizations are given at

A

2 months, 4 months, and 6 months

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52
Q

Hep b given

A

at birth and 4 and 6 months

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53
Q

babies can receive flu vaccine at

A

6 months

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54
Q

1 year vaccines

A

pneumococcal 13, MMR, varicella, and hep A

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55
Q

Nurse’s role in immunization

A

educate parents, teach about doses of ibuprofen for relief, provide information on vaccine, administer vaccine, report any effect, document

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56
Q

contraindication for all immunizations

A

severe febrile illness or anaphylaxis

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57
Q

SIDS

A

defined as the sudden death of an infant younger than 1. is the 3rd leading cause of infant deaths

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58
Q

SIDS risk factors

A

maternal smoking, co-sleeping, soft bedding, low birth weight, viral illness, males sex, sibling of SIDs victim

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59
Q

SIDS protective factors

A

breastfeeding, pacifier use, and supine sleeping

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60
Q

toddler proportional changes

A

birthweight quadruples by 2, grow about half their adult height, and chest circumference exceeds head circumference

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61
Q

internal ear is still straight and short, and larger lymphoid tissue is present which causes what to be common in toddlers

A

otitis media, tonsilliti, and URIs

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62
Q

SAFE PAD

A

suffocation/sleep position, asphyxia/animal bites, falls, electrical burns, poisoning, automobile safety, drowning

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63
Q

social development in toddlers

A

differentiation of self, recognition body image, and comprehend language much more

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64
Q

terrible twos

A

part of growing, exerting self control, and independence

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65
Q

what is the most distinguishing characteristic of play

A

imitation

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66
Q

parallel play

A

play independently but among other children

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67
Q

two important characteristics when searching for autonomy

A

negativism and ritualism

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68
Q

negativism

A

the persistent negative response to request

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69
Q

ritualism

A

the need to maintain sameness and reliability

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70
Q

every child should have an established dental home by

A

12 months of age

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71
Q

most chronic disease in children in the us

A

tooth decay

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72
Q

4th dose of DTAP

A

15-18 months

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73
Q

children ages 1-4 have the second highest rate of

A

deaths from accidental injuries in the US

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74
Q

boys are _____ than girls to die of accidental deaths

A

2 times

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75
Q

order of physical exam in children is often

A

altered to accommodate the Childs developmental needs

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76
Q

positioning of infant during physical exam

A

lay supine or prone on parents lap or exam table but if they can sit independently then have them sit on parents lap

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77
Q

positioning of toddler during physical exam

A

sitting or standing near parent

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78
Q

sequence of physical exam in infant

A

if quiet auscultate first then proceed in head to toe fashion, perform traumatic procedure last, elicit reflexes as body part is examined

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79
Q

sequence of physical exam in toddler

A

inspect through play, introduce equipment slowly, auscultate, percuss, palpate when quiet

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80
Q

sequence of physical exam in preschool

A

head to toe if cooperative

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81
Q

important to include _____ during a pediatric assessment

A

physiological measurement and comparison with normal values for each age group

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82
Q

children in the 5th percentile of BMI

A

underweight

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83
Q

healthy weight of BMI

A

5th - 84th percentile

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84
Q

85th -95th percentile in BMI

A

overweight children

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85
Q

where should head circumference be measured

A

slightly above the eyebrows and pinna of ears

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86
Q

head and chest circumference are ______ until 1-2 years

A

equal

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87
Q

growth charts

A

important assessment of health and nutritional status

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88
Q

deceleration in growth chart indicate

A

changing health status

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89
Q

temperature at birth is done through

A

axillary or rectal

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90
Q

temp at 2-5 yrs is done through

A

axillary, tympanic, oral, or rectal

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91
Q

EBP tells us that an accurate method for obtaining a correct reflection of core temp is either

A

rectally or orally

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92
Q

how do we take a pulse in a child under 2

A

by feeling the apical or brachial pulse

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93
Q

too small of BP cuff with read with

A

false high reading

94
Q

too large a BP cuff will read with

A

false low reading

95
Q

flattening of the occiput can indicate

A

the child continually lies in a position

96
Q

significant head lag after 6 months strongly indicates

A

cerebral injury

97
Q

palpate skull for

A

sutures, fontanels, fractures, and swelling

98
Q

sunken fontanel indicates

A

dehydration

99
Q

pulsating fontanel indicates

A

the child is either crying to has increased cranial pressure

100
Q

normocephalic

A

normal size head

101
Q

microcephalic

A

small head for body size and age

102
Q

macrocephalic

A

abnormally large head

103
Q

bossing

A

frontal enlargement

104
Q

hypertelorism

A

eyes unusually wide spaced

105
Q

hypotelorism

A

eyes are unusually close together

106
Q

palpebral fissures

A

note general slant of lids

107
Q

epicentral folds

A

may give impression of malalignment

108
Q

pseudostrabismus

A

false appearance of crossed eyes

109
Q

red reflex

A

can determine abnormalities such as cataracts and glaucoma and should be done on newborns prior to discharge

110
Q

1 year visual acuity

A

20/40-20/70

111
Q

4 year visual acuity

A

20/30-20/40

112
Q

5 year visual acuity

A

20/20-20/30

113
Q

AAP recommends visual acuity screening on

A

those 3 years and over

114
Q

strabismus

A

“cross eye” - one eye deviates from the point of fixation

115
Q

amblyopia

A

blindness from disuse

116
Q

by 3-4 months infants should be able to do what with their eyes

A

fixate on one visual field with both eyes

117
Q

tests to test for eye misalignment

A

corneal light reflex and cover test

118
Q

corneal light reflex

A

shine light into patients eyes and light should fall symmetrically within each pupil

119
Q

corneal light reflex also called

A

Hirschberg test

120
Q

cover test

A

one eye covered and the movement of the uncovered eye is observed while the child looks at near and distant

121
Q

how do you look in the ear of infants

A

pull pinna down and back

122
Q

auditory brainstem response

A

sensors that measure the responses of the baby’s acoustic nerve to sounds

123
Q

OAC - otoacoustic

A

earplug that measures response of cochlea to clicking sounds

124
Q

what to assess with nose, mouth, and throat

A

nasal flaring, mucous membranes, teeth, gums, tonsils

125
Q

children younger than 6 will have what type of respiratory movements

A

abdominal

126
Q

apical pulse in children younger than 7

A

midclavicular line at the fourth intercostal space

127
Q

tanner stages

A

describe the stages of pubertal growth. there are 5 stages. 1=immature and 5=mature

128
Q

tanner stages in girls

A

describe development based on breast size and shape and distribution of pubic hair

129
Q

tanner stages in boys

A

describe development based on the size and shape of the penis and scream and the distribution of hair

130
Q

a newborns back is in a _____ shape

A

c shape from thoracic to pelvic region

131
Q

neurologic assessment on toddlers

A

cerebellar function, cranial nerves, and reflexes

132
Q

it is important to test reflexes because

A

if primitive reflexes are still there, loss of reflexes, or hyperactivity of reflexes is usually a reflection of cerebral insult

133
Q

most neuro information about infants and small children is gained through

A

observation of spontaneous and elicited reflex responses

134
Q

neuro red flags

A

delayed or deviation from expected milestones and persistence or reappearance of reflexes that normally disappear

135
Q

primitive reflexes

A

controlled by lower brain function at birth which disappear at certain ages

136
Q

testing sucking reflex

A

Touch infants lip, cheek, or corner of mouth with nipple of finger; infant turns head toward stimulus and opens mouth

137
Q

moro reflex

A

place infant supine on flat surface. clap your hands and baby should extend arms our and look startled. begins disappearing at 8 wks

138
Q

babinski reflex

A

stroke upward on sole beginning at heel. toes should hyperextend and fan outward

139
Q

what happens with glucose during that last 2 months of fetal life

A

glucose is stored as glycogen in the liver and used after birth

140
Q

newborn brain depends on ________ for 90% of its needs

A

glucose metabolism

141
Q

decrease in glucose results in an increase in

A

epinephrine, norepinephrine, glucagon, and insulin

142
Q

hypoglycemia occurs with levels less than

A

45 mg/dL

143
Q

normal neonatal temp

A

97.7-98.6 F

144
Q

unconjugated bilirubin

A

fat soluble and non-excretable. this binds to albumin

145
Q

rapid utilization of brown fat can lead to

A

metabolic acidosis/hypoglycemia

146
Q

why do newborns get hyperbilirubinemia

A

they have a higher hat, lower bilirubin clearance, shorter RBC life span and more immature liver

147
Q

kernicterus

A

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
Q

neonatal abstinence syndrome

A

neonate exposed to addictive illegal or prescription drugs prenatally

149
Q

DDST

A

used at 1 month to 60 years to measure social, fine, and gross motor skills

150
Q

pharmacokinetics

A

study of what the body does to a drug

151
Q

pharmacodynamics

A

study of what a drug does to the body

152
Q

what may be needed in toddlers to reach therapeutic dosages because of a greater metabolizing capacity

A

larger dosages or more frequent dosing

153
Q

what do you need to think about in children with meds that are excreted by the kidney

A

they cannot concentrate urine as well so medications can circulate longer and reach toxic blood levels

154
Q

what can formula and breast milk do to med absorption

A

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
Q

nursing interventions intramuscular injection

A

apply local anesthetic cream, use smallest gauge possible, and vests laterals is usually recommended site

156
Q

most commonly used behavioral pain measure for below 3 years old

A

FLACC

157
Q

FLACC

A

face, leg activity, cry, consolability. measures pain by quantifying pain behaviors with scores ranging from 0-10

158
Q

for mild (less than 3) to moderate (4-6) pain what should be given

A

acetaminophen and or NSAID

159
Q

for moderate (5-6) to severe (7-10) pain what should be given

A

opioids

160
Q

optimum dosage of an analgesic

A

one that controls pain without causing severe side effects

161
Q

children metabolize drugs _______ than adults

A

more rapidly

162
Q

dosages are usually calculated by

A

body weight

163
Q

non-pharmacological interventions for infants

A

containment, positioning, non-nutritive sucking, kangaroo care

164
Q

nonopioid medications

A

acetaminophen, ibuprofen, ketorolac, and aspirin but aspirin is not recommended for use in children

165
Q

aspirin in children is associated with

A

reye syndrome

166
Q

most common oral opioids

A

hydrocodone and oxytocin’s (Percocet)

167
Q

what opioid should not be given to children

A

codeine

168
Q

preferred IV opioid for children

A

morphine

169
Q

respiratory depression in children happens how long after opioid use

A

7 minutes

170
Q

what med can reverse sedation if needed

A

naloxone (narcan)

171
Q

fentanyl compared to morphine

A

fentanyl has a shorter half life and is 50-100 times more potent than morphine

172
Q

methadone metabolizes

A

very slowly so it has a long duration

173
Q

what type pf pain control is not recommended in children

A

IM injection or intranasal medications

174
Q

what is used to provide pain managements peripherally and centrally with less side effects

A

nonopioid combined with opioid

175
Q

SIDS has reduced by 40% by

A

putting babies down to sleep on their backs

176
Q

terminal diagnosis can be from

A

trauma or physiologic cause

177
Q

child life therapist

A

help nurse provide developmentally appropriate interventions for patients and siblings

178
Q

respiratory infection rate increases between

A

3-6 months because maternal stores disappear at this time

179
Q

most respiratory infectious agents in are caused by

A

viruses like RSV, enterovirus, adenovirus, parainfluenza, HMPV

180
Q

newborns are obligate nose breathers until

A

4 weeks

181
Q

differences in respiratory systemin newborns

A

upper airway is shorter and more narrow, larynx is more flexible, larger tonsils and lymph tissue, underdeveloped intercostal muscles

182
Q

treatment of allergic rhinitis

A

remove allergen, antihistamines, decongestants, leukotreine inhibitors (Singulair)

183
Q

nasopharyngitis

A

common cold or strep throat - streptococcal pharyngitis

184
Q

otitis media

A

most prevalent disease of early childhood with the highest rate in winter. inflammation/infection in the ear

185
Q

infectious mononucleosis

A

kissing disease “mono”

186
Q

symptoms of infectious mononucleosis

A

fever, exudative pharyngitis, lymphadenopathy (occipital), hepatosplenomegaly

187
Q

principal cause of infectious mononucleosis

A

epstein barr virus

188
Q

what do you have to tell kids not to do during infectious mononucleosis

A

no contact sports/play for 4 weeks due to splenomegaly

189
Q

treatment for infectious mononucleosis

A

rest, nutrition, and supportive treatment

190
Q

laryngomalacia

A

congenital laryngeal cartilage abnormality that causes upper airway obstruction

191
Q

laryngomalacia treatment

A

will resolve without treatment by 18-24 months of age

192
Q

croup syndrome

A

mucosal inflammation and edema causing narrowing of the airway

193
Q

treatment for croup

A

racemic epinephrine - dexamethasone

194
Q

epiglottitis

A

abrupt and rapidly progressive. can be life threatening and bacterial

195
Q

symptoms of epiglottitis

A

drooling, muffled voice with frog like croaking on inspiration, fever, sore throat, irritable

196
Q

what do you not want to do with epiglottitis

A

do not attempt to visualize airway

197
Q

thumb sign

A

enlarged epiglottis on x ray

198
Q

laryngotracheobronchitis

A

a type of croup characterized by hoarseness and cough described as barky

199
Q

treatment of laryngotracheobronchitis

A

racemic epinephrin, steroids, antibiotics, helix, cool mist and humidification

200
Q

most common cause of hospitalization under 1 year of age

A

RSV - respiratory syncytial virus

201
Q

bronchiolitis diagnostics

A

ABGs, chest xray, pulse ox, and Reagant testing

202
Q

reagant testing

A

nasal swab

203
Q

RSV prevention

A

good hand washing and synagis

204
Q

synagis

A

monoclonal antibody in vulnerable populations monthly

205
Q

pneumonia clinical manifestations

A

vary depending on the etiology, age, systemic reaction, extent of disease, and degree of obstruction

206
Q

prevention of pneumonia

A

pneumococcal vaccine, hand washing, good overall health

207
Q

pertussis

A

whooping cough

208
Q

whooping cough is caused by

A

bordetella pertussis

209
Q

whooping cough prevented by

A

vaccine

210
Q

peak the for foreign body aspiration in children is younger than

A

3

211
Q

diagnostics for foreign body aspiration

A

fluoroscopy and chest radiography

212
Q

what causes chronic lung disease of infancy

A

neonates receive high flow oxygen or ventilator which causes damages and thickening of the lungs

213
Q

apnea

A

cessation of breathing for 20 seconds or longer

214
Q

clinical manifestations of apnea

A

ALTE - apparent Life Threatening Event characterized by apnea, color change, chiding, or gagging

215
Q

asthma severity classifications

A

mild intermittent, mild persistant, moderate persistent, and servere persistent

216
Q

mild intermittent asthma

A

symptoms less than twice per week

217
Q

mild persistent asthma

A

symptoms more than twice per week but less than once per day

218
Q

moderate persistent asthma

A

symptoms more than twice per week

219
Q

severe persistent asthma

A

continual symptoms

220
Q

status asthmaticus

A

medical emergency with respiratory failure and death if untreated

221
Q

goals of asthma management

A

prevent exacerbation, provide acute asthma care, relieve bronchospasm, master self-management

222
Q

cystic fibrosis

A

autosomal recessive disorder of the exocrine glands that leads to abnormal accumulation of viscous and mucus

223
Q

characteristic of cystic fibrosis

A

chloride production by sweat glands

224
Q

mean survival of cystic fibrosis patients

A

mid 30s

225
Q

normal chloride sweat test compared to cystic fibrosis

A

normal = 40 mEq/L and cystic fibrosis is 60 mEq/L

226
Q

cystic fibrosis and respirations

A

excessive mucus production leads to secondary bacterial infections. overtime leads to respiratory failure

227
Q

physical manifestations that occur over time with cystic fibrosis

A

digital clubbing, barrel chest, and nasal polyps

228
Q

cystic fibrosis and the GI tract

A

thick mucus in pancreatic duct blocks enzymes responsible for digestion of nutrients this decreases release of amylase, trypsin and lipase

229
Q

cystic fibrosis and reproduction

A

men =sterility

females = fertility problems

230
Q

interventions with cystic fibrosis

A

daily pulmonary hygiene and diet (high protein, fat soluble vitamins, pancreatic enzymes)

Nursing school level 2 (15 decks)

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