Quiz Units G, H, & I Flashcards
What is the leading cause of hospitalization in children?
Congenital (at birth) anomalies
When can meconium be tested for drugs/etc without consent?
If the baby is <2500 grams or mom had no prenatal care
What is a GAA?
Gestational Age Assessment
What happens to vernix as the baby ages in the womb?
It decreases
What do you look at in their hair?
Distribution. Receding is normal. Whirls of hair are not so normal
Should suture lines be mobile?
Yes
What is the normal size and shape of the anterior fontanel?
Diamond shaped and 2-3 cm in size
What is the normal size and shape of the posterior fontanel?
Triangular shaped and 1-2 cm in size
When do fontanels close?
Anterior at 18mo and posterior at 6wks-3mo
Describe the finger and toe nails of a newborn.
Toenails rarely extend past the end of the toe. Fingernails are longer as baby grows
How do you trim a baby’s nails?
Never use clippers because baby can’t feel if you clip skin. Use a file
Are mottling and the harlequin sign normal?
Yes
Visible jaundice in the first 24 hrs is _____ jaundice.
Pathological. Run serum lab tests
What are millia and are they normal?
White bumps on the face. They are normal. Don’t pick at them!!!
Should you wash vernix off?
No! It protects the baby.
Should you wear gloves when handling a newborn? Why?
Because baby has vagina juice on it!!! Yes, I had to go there.
Where do forceps marks usually appear?
Around the ears
What does vacuum assist often cause? What must be closely monitored if a cephalhematoma occurs?
Cephalhematoma. Bilirubin. As the blood breaks down, it can cause jaundice.
How can you differentiate between cephalhematoma and caput succedaneum?
Caput crosses suture lines because it is in the skin. Cephalhematoma stops at the suture line b/c it is in the bone
How can you differentiate between Telangiectatic nevi (stork bites) and a port wine stain?
Port wine stain doesn’t blanch when touched, nevi do.
What does erythema toxicum look like?
Raised papules, macules, and vesicles. No clinical significance and no treatment is necessary
What is a subgaleal hemorrhage?
It is bleeding within the inner surface of the scalp. NICU
What must be monitored with a subgaleal hemorrhage?
Serial head measurements, LOC, Hgb, Hct, bilirubin, if ears move forward it is bad.
What is the most common scalp lesion?
Capit succedaneum
What is a Mongolian spot and what must be done when it is noticed on a neonate?
They appear as dark spots, like a bruise, mostly on the back and trunk of darker skinned babies, and they MUST be documented
Where is a bulb syringe used first?
In the mouth
What is a very common birth injury? What is done for it?
Broken clavicle. Nothing. S/S are crepitus, crying when touched, sagging shoulder when held up
In Indiana, what newborn tests are mandatory?
Metabolic panel, hearing, cardiac (O2)
Which has a greater child mortality rate, Toddlers or infants?
Toddlers. Once they get mobile, they get into all kinds of trouble!!!
Which age group has the lowest mortality rate?
5-14
When is meconium automatically screened?
LBW babies (< 1/3 percentile, s/s of neonatal withdrawal, or unexplained abruption
What is the difference between neonatal and postnatal?
Neonatal is the first 28 days outside the womb and postnatal is from 28 days to 1 year
What is the leading cause of death for infants?
Mechanical suffocation
What is the leading cause of death for children over the age of 1?
MVA.
Explain “atraumatic” care.
Care with a minimum of trauma to the child. Use EMLA cream, bandaids, etc.
Once again, explain the 3 levels of prevention.
Primary (prevention: immunizations, seatbelts, helmets, clinics to prevent accidents), Secondary (catch it early: scoliosis/eye/hearing screening, newborn cardiac), Tertiary (fix you up after it happens: recovery, speech therapy)
What is a consanguineous definition of family?
Blood related
What is the affinal definition of family?
Marital
What are the 4 stages of a family?
Couples, child bearing, older child, and grown family
What is the difference between an authoritative and an authoritarian parenting style?
Authoritarian is a dictatorship. Authoritative is more democratic
What are the advantages of an authoritative style?
Better self-esteem and autonomy
What is the problem with the permissive (Laissez-faire) style?
Do not learn rules that teach impulse control
In what parenting style do the parents have little or no involvement in the child, and are more interested in themselves?
Uninvolved
Name the different grand parenting styles.
Formal (parents discipline), informal (some discipline and lots of play), surrogate (assume the parental role), wisdom (bestowed by family/customs) and distant.
What are the three phases children go through with a divorce?
Acute, transitional (lifestyle changes, relationships change), stabilizing
What is overburdened child syndrome?
A child takes on the parental role (caregiver) so mom/dad doesn’t fall apart, usually during or after a divorce
When does the head grow the most? Trunk? Limbs?
During fetal life. During infancy. During childhood
By what month of life do all reflexes fade?
By the age of 6 months
What replaces reflexes?
Purposeful movement
How much do babies grow in the first year? By age 2?
They triple their birth weight. Increase height to 50% of adult height (at age 2 1/2 for boys)
Do babies crawl before they sit?
No. As a general rule, they sit, creep, stand, walk, then run
What is the major task of the family?
To nurture children to become healthy, responsible, creative adults.
Describe the developmental pace of kids.
They go through a precise, fixed, order, but it does not progress at the same rate
What reflexes fade by 4 months?
Babinski (3 mo), Palmar grasp (3 mo), and Moro (3-4 mo)
How are skills and behaviors developed?
By practicing
What are some developmental milestones of a 12 month old?
Pincer grasp, stand, walk holding a finger, simple words
What are some developmental milestones of an 18 month old?
Running, exploring, 4 block towers, scribble, 10 words, know body parts, feed themselves, seek help when in trouble, pucker for a kiss.
What are some developmental milestones of a 3 year old?
Ride a trike, stand briefly on 1 foot, 10 block towers, 3 block bridge, copy circle/cross, count, know age and sex, repeat 3 numbers, sentence of 6 syllables, simple games, wash hands
How do we measure height of a child?
We measure the height if a child standing up. In infants, we measure their LENGTH in the recumbent position.
What are the 7 percentile levels?
5, 10, 25, 50, 75, 90, 95
When do we intervene according to weight or height changes?
If they increase/decrease 1-2 percentile levels from average, or 2 percentile levels or more from their established level
How much do babies grow in height the first 6 months?
1 inch per month
What is defined as “A manner of thinking, behaving, or reacting that is characteristic to an individual”?
Temperament
What are the 3 types of child temperament? Describe the attributes of each type.
Easy child: even tempered, regular, predictable. Difficult child: highly active, irritable, irregular habits. Slow-to-warm-up child: react negatively and with mild intensity to new stimuli; unless pressured, adapt slowly with repeated contact
Define associative play.
This is when a child is interested in the play of others, but doesn’t participate. Lots of interaction
What are the functions of play?
Sensorimotor (all senses) and intellectual development, creativity, self-awaremess, therapeutic, and moral
What should be the child’s primary source of strength and support?
The family
What is the greatest risk to health during childhood?
MVA
What is the greatest risk for black, male, and teenagers?
Gunshot
What are some risk factors for poor school performance?
Single parent, low income, English as a second language, other siblings dropped out, home alone for 2 hours or more per day
What are the 3 phases of separation anxiety?
Protest (cry, scream, clingy), despair (stop crying, evidence of depression), detachment (denial, resignation, may seriously affect parental attachment, superficial relationships)
With a toddler, what can loss of control cause?
Regression, negativity, temper tantrums
With a preschooler, what can loss of control cause?
Egocentric and magical thinking, may view illness as punishment, preoperational thought (role playing)
With a school age child, what can loss of control cause?
Boredom, fear of death, abandonment, permanent injury, and they strive for independence and productivity
With an adolescent child, what can loss of control cause?
Struggle for independence and liberation, separation from peers, anger/frustration, need information
When does the ability to feel pain develop?
It is present at birth. Preemies have an increased sensitivity to pain
How does a young infant respond to pain?
Rigidity, thrashing, crying, grimace
What risk factors increase vulnerability to stress in the hospital?
Difficult temperament, age (6mo-5yrs), male, low intelligence, multiple stressors
Are children undertreated for pain? Why?
Yes. Fear of addiction or respiratory depression.
What is “FLACC”?
It is a pain rating scale for young children. Facial expression, legs, activity, cry, consolability
What are some other s/s of pain in an infant?
Increased need for O2, increased vitals
How old must a child be to use the faces pain scale?
3
What acronym describes the steps necessary to assess pain in children?
QUESTT. Question the child, use a pain rating scale, evaluate behavior, secure patient involvement, take cause of pain into account, take action and evaluate results
What are some non-pharm measures to control pain in a neonate?
Swaddle, midline, pacifier, holding, rocking
Do placebos work?
They often work short term
What is a drawback of using EMLA cream before starting an IV?
It takes 30-60 minutes to take effect
How is a “chronic” illness defined?
Interferes with ADL’s more than 3 months in 1 yr, or hospitalized for more than 1 month within 1 yr
What are the most common types of childhood disabilities?
Respiratory, speech, special senses (hearing, vision), and intelligence
When are the family most stressed by a child with a disability?
At 1st dx, at each developmental milestone, when starting school, when child reaches full attainment, at adolescence, when thinking about future placement, at the death of the parents.
How do we differentiate btwn a developmental delay and a developmental disability?
A developmental delayis simply delayed maturation, while a developmental disability is a mental or physical impairment that occurs before the age of 22
How would you define a disability?
A functional limitation that interferes with a personal ability (walk, lift, hear, learn, etc.)
What is the difference btwn approach behaviors and avoidance behaviors?
Approach behaviors move toward adjustment and resolution to the crisis. Avoidance behaviors avoid dealing with the situation, by being hostile to staff, refuse tx, unrealistic future plans, no change in lifestyle to compensate for the disability
Is the reaction of shock and denial a good reaction or a bad reaction to the stress of discovering a disability?
It can be good, if it turns into acceptance within a reasonable amount of time
What are the 4 parental reactions she mentioned?
Overprotection (cater to), rejection (they detach emotionally), denial, acceptance
If we are to engage in therapeutic communication in these situations, what is the one thing we must never do and what one thing MUST we do?
We must never give advice and we must always us active listening
What are some examples of therapeutic communication?
Ask open ended questions, focus on their feelings, use neutral responses, reflect/restate/rephrase verbalizations of the pt
How do we “actively” listen?
Maintain eye contact, be attentive both verbally and non-verbally
What are the 5 principles of good communication that she mentioned?
Appropriate, adaptive, concise, credible, simple
How do we guide them with proper communication?
Encourage positive behaviors and discourage negative behaviors
What are some pitfalls to proper communication?
Giving advice, talking about yourself, telling the pt he/she is wrong, entering delusions, false reassurance (“it will be ok”), cliche’s, giving approval, asking why, changing the subject, defending the health care team members, talking fast, giving opinions, words like nice, bad, right, wrong, should, and ought
What is a positive sign of coping in an adult?
Family cohesiveness, increased self-esteem, and resilience
What are some negative signs of adult coping?
Depression, poor school performance, role confusion, poor quality of life
How much morphine is given for mild, moderate, and severe pain in a preterm infant?
Mild = 0-2 mcg/kg/h. Moderate = 2-5 mcg/kg/h. Severe = 5-10 mcg/kg/h.
What are some signs of positive coping for a child?
Focus on what they can do, comply with tx, independence, talk about others who are worse off
What are some negative signs of coping for a child?
Withdrawal, focus on what they can’t do/restriction, moody, poor adaptation
How much morphine is given for mild, moderate or severe pain in a term newborn?
Mild = 0-5 mcg/kg/h. Moderate = 5-10 mcg/kg/h. Severe = 10-20 mcg/kg/h
What are Kubler-Ross’s 5 stages of grief?
Denial, anger, bargaining, depression and acceptance
What are the 2 types of “ambiguous” loss?
Physically absent/psychologically present (spinal injury) and physically present/psychologically absent (Alzheimer’s)
When an individual is dying, what sense is lost last?
Hearing
How much morphine is given to older infants for mild, moderate, and severe pain?
Mild = 0-10 mcg/kg/h. Moderate = 10-20 mcg/kg/h. Severe = 15-30 mcg/kg/h
When morphine is administered to an infant, what is our greatest concern?
Respiratory depression
What are some s/s of complicated/abnormal grief?
Extreme focus on the lost person, can’t accept the loss, numb, detached, preoccupation with the loss, inability to enjoy life and tryst others
What are some risk factors for complicated grief?
Unexpected/violent death, inadequate support, traumatic childhood, dependent personality, anxiety, lack of resilience
Define “complicated” grief.
A heightened state of mourning that lasts longer than normal
