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Peds/OB - Nrsg 206 > Quiz Units G, H, & I > Flashcards

Quiz Units G, H, & I Flashcards

1
Q

What is the leading cause of hospitalization in children?

A

Congenital (at birth) anomalies

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2
Q

When can meconium be tested for drugs/etc without consent?

A

If the baby is <2500 grams or mom had no prenatal care

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3
Q

What is a GAA?

A

Gestational Age Assessment

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4
Q

What happens to vernix as the baby ages in the womb?

A

It decreases

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5
Q

What do you look at in their hair?

A

Distribution. Receding is normal. Whirls of hair are not so normal

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6
Q

Should suture lines be mobile?

A

Yes

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7
Q

What is the normal size and shape of the anterior fontanel?

A

Diamond shaped and 2-3 cm in size

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8
Q

What is the normal size and shape of the posterior fontanel?

A

Triangular shaped and 1-2 cm in size

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9
Q

When do fontanels close?

A

Anterior at 18mo and posterior at 6wks-3mo

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10
Q

Describe the finger and toe nails of a newborn.

A

Toenails rarely extend past the end of the toe. Fingernails are longer as baby grows

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11
Q

How do you trim a baby’s nails?

A

Never use clippers because baby can’t feel if you clip skin. Use a file

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12
Q

Are mottling and the harlequin sign normal?

A

Yes

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13
Q

Visible jaundice in the first 24 hrs is _____ jaundice.

A

Pathological. Run serum lab tests

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14
Q

What are millia and are they normal?

A

White bumps on the face. They are normal. Don’t pick at them!!!

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15
Q

Should you wash vernix off?

A

No! It protects the baby.

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16
Q

Should you wear gloves when handling a newborn? Why?

A

Because baby has vagina juice on it!!! Yes, I had to go there.

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17
Q

Where do forceps marks usually appear?

A

Around the ears

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18
Q

What does vacuum assist often cause? What must be closely monitored if a cephalhematoma occurs?

A

Cephalhematoma. Bilirubin. As the blood breaks down, it can cause jaundice.

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19
Q

How can you differentiate between cephalhematoma and caput succedaneum?

A

Caput crosses suture lines because it is in the skin. Cephalhematoma stops at the suture line b/c it is in the bone

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20
Q

How can you differentiate between Telangiectatic nevi (stork bites) and a port wine stain?

A

Port wine stain doesn’t blanch when touched, nevi do.

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21
Q

What does erythema toxicum look like?

A

Raised papules, macules, and vesicles. No clinical significance and no treatment is necessary

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22
Q

What is a subgaleal hemorrhage?

A

It is bleeding within the inner surface of the scalp. NICU

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23
Q

What must be monitored with a subgaleal hemorrhage?

A

Serial head measurements, LOC, Hgb, Hct, bilirubin, if ears move forward it is bad.

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24
Q

What is the most common scalp lesion?

A

Capit succedaneum

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25
Q

What is a Mongolian spot and what must be done when it is noticed on a neonate?

A

They appear as dark spots, like a bruise, mostly on the back and trunk of darker skinned babies, and they MUST be documented

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26
Q

Where is a bulb syringe used first?

A

In the mouth

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27
Q

What is a very common birth injury? What is done for it?

A

Broken clavicle. Nothing. S/S are crepitus, crying when touched, sagging shoulder when held up

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28
Q

In Indiana, what newborn tests are mandatory?

A

Metabolic panel, hearing, cardiac (O2)

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29
Q

Which has a greater child mortality rate, Toddlers or infants?

A

Toddlers. Once they get mobile, they get into all kinds of trouble!!!

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30
Q

Which age group has the lowest mortality rate?

A

5-14

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31
Q

When is meconium automatically screened?

A

LBW babies (< 1/3 percentile, s/s of neonatal withdrawal, or unexplained abruption

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32
Q

What is the difference between neonatal and postnatal?

A

Neonatal is the first 28 days outside the womb and postnatal is from 28 days to 1 year

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33
Q

What is the leading cause of death for infants?

A

Mechanical suffocation

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34
Q

What is the leading cause of death for children over the age of 1?

A

MVA.

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35
Q

Explain “atraumatic” care.

A

Care with a minimum of trauma to the child. Use EMLA cream, bandaids, etc.

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36
Q

Once again, explain the 3 levels of prevention.

A

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)

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37
Q

What is a consanguineous definition of family?

A

Blood related

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38
Q

What is the affinal definition of family?

A

Marital

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39
Q

What are the 4 stages of a family?

A

Couples, child bearing, older child, and grown family

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40
Q

What is the difference between an authoritative and an authoritarian parenting style?

A

Authoritarian is a dictatorship. Authoritative is more democratic

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41
Q

What are the advantages of an authoritative style?

A

Better self-esteem and autonomy

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42
Q

What is the problem with the permissive (Laissez-faire) style?

A

Do not learn rules that teach impulse control

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43
Q

In what parenting style do the parents have little or no involvement in the child, and are more interested in themselves?

A

Uninvolved

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44
Q

Name the different grand parenting styles.

A

Formal (parents discipline), informal (some discipline and lots of play), surrogate (assume the parental role), wisdom (bestowed by family/customs) and distant.

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45
Q

What are the three phases children go through with a divorce?

A

Acute, transitional (lifestyle changes, relationships change), stabilizing

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46
Q

What is overburdened child syndrome?

A

A child takes on the parental role (caregiver) so mom/dad doesn’t fall apart, usually during or after a divorce

47
Q

When does the head grow the most? Trunk? Limbs?

A

During fetal life. During infancy. During childhood

48
Q

By what month of life do all reflexes fade?

A

By the age of 6 months

49
Q

What replaces reflexes?

A

Purposeful movement

50
Q

How much do babies grow in the first year? By age 2?

A

They triple their birth weight. Increase height to 50% of adult height (at age 2 1/2 for boys)

51
Q

Do babies crawl before they sit?

A

No. As a general rule, they sit, creep, stand, walk, then run

52
Q

What is the major task of the family?

A

To nurture children to become healthy, responsible, creative adults.

53
Q

Describe the developmental pace of kids.

A

They go through a precise, fixed, order, but it does not progress at the same rate

54
Q

What reflexes fade by 4 months?

A

Babinski (3 mo), Palmar grasp (3 mo), and Moro (3-4 mo)

55
Q

How are skills and behaviors developed?

A

By practicing

56
Q

What are some developmental milestones of a 12 month old?

A

Pincer grasp, stand, walk holding a finger, simple words

57
Q

What are some developmental milestones of an 18 month old?

A

Running, exploring, 4 block towers, scribble, 10 words, know body parts, feed themselves, seek help when in trouble, pucker for a kiss.

58
Q

What are some developmental milestones of a 3 year old?

A

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

59
Q

How do we measure height of a child?

A

We measure the height if a child standing up. In infants, we measure their LENGTH in the recumbent position.

60
Q

What are the 7 percentile levels?

A

5, 10, 25, 50, 75, 90, 95

61
Q

When do we intervene according to weight or height changes?

A

If they increase/decrease 1-2 percentile levels from average, or 2 percentile levels or more from their established level

62
Q

How much do babies grow in height the first 6 months?

A

1 inch per month

63
Q

What is defined as “A manner of thinking, behaving, or reacting that is characteristic to an individual”?

A

Temperament

64
Q

What are the 3 types of child temperament? Describe the attributes of each type.

A

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

65
Q

Define associative play.

A

This is when a child is interested in the play of others, but doesn’t participate. Lots of interaction

66
Q

What are the functions of play?

A

Sensorimotor (all senses) and intellectual development, creativity, self-awaremess, therapeutic, and moral

67
Q

What should be the child’s primary source of strength and support?

A

The family

68
Q

What is the greatest risk to health during childhood?

A

MVA

69
Q

What is the greatest risk for black, male, and teenagers?

A

Gunshot

70
Q

What are some risk factors for poor school performance?

A

Single parent, low income, English as a second language, other siblings dropped out, home alone for 2 hours or more per day

71
Q

What are the 3 phases of separation anxiety?

A

Protest (cry, scream, clingy), despair (stop crying, evidence of depression), detachment (denial, resignation, may seriously affect parental attachment, superficial relationships)

72
Q

With a toddler, what can loss of control cause?

A

Regression, negativity, temper tantrums

73
Q

With a preschooler, what can loss of control cause?

A

Egocentric and magical thinking, may view illness as punishment, preoperational thought (role playing)

74
Q

With a school age child, what can loss of control cause?

A

Boredom, fear of death, abandonment, permanent injury, and they strive for independence and productivity

75
Q

With an adolescent child, what can loss of control cause?

A

Struggle for independence and liberation, separation from peers, anger/frustration, need information

76
Q

When does the ability to feel pain develop?

A

It is present at birth. Preemies have an increased sensitivity to pain

77
Q

How does a young infant respond to pain?

A

Rigidity, thrashing, crying, grimace

78
Q

What risk factors increase vulnerability to stress in the hospital?

A

Difficult temperament, age (6mo-5yrs), male, low intelligence, multiple stressors

79
Q

Are children undertreated for pain? Why?

A

Yes. Fear of addiction or respiratory depression.

80
Q

What is “FLACC”?

A

It is a pain rating scale for young children. Facial expression, legs, activity, cry, consolability

81
Q

What are some other s/s of pain in an infant?

A

Increased need for O2, increased vitals

82
Q

How old must a child be to use the faces pain scale?

A

3

83
Q

What acronym describes the steps necessary to assess pain in children?

A

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

84
Q

What are some non-pharm measures to control pain in a neonate?

A

Swaddle, midline, pacifier, holding, rocking

85
Q

Do placebos work?

A

They often work short term

86
Q

What is a drawback of using EMLA cream before starting an IV?

A

It takes 30-60 minutes to take effect

87
Q

How is a “chronic” illness defined?

A

Interferes with ADL’s more than 3 months in 1 yr, or hospitalized for more than 1 month within 1 yr

88
Q

What are the most common types of childhood disabilities?

A

Respiratory, speech, special senses (hearing, vision), and intelligence

89
Q

When are the family most stressed by a child with a disability?

A

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.

90
Q

How do we differentiate btwn a developmental delay and a developmental disability?

A

A developmental delayis simply delayed maturation, while a developmental disability is a mental or physical impairment that occurs before the age of 22

91
Q

How would you define a disability?

A

A functional limitation that interferes with a personal ability (walk, lift, hear, learn, etc.)

92
Q

What is the difference btwn approach behaviors and avoidance behaviors?

A

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

93
Q

Is the reaction of shock and denial a good reaction or a bad reaction to the stress of discovering a disability?

A

It can be good, if it turns into acceptance within a reasonable amount of time

94
Q

What are the 4 parental reactions she mentioned?

A

Overprotection (cater to), rejection (they detach emotionally), denial, acceptance

95
Q

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?

A

We must never give advice and we must always us active listening

96
Q

What are some examples of therapeutic communication?

A

Ask open ended questions, focus on their feelings, use neutral responses, reflect/restate/rephrase verbalizations of the pt

97
Q

How do we “actively” listen?

A

Maintain eye contact, be attentive both verbally and non-verbally

98
Q

What are the 5 principles of good communication that she mentioned?

A

Appropriate, adaptive, concise, credible, simple

99
Q

How do we guide them with proper communication?

A

Encourage positive behaviors and discourage negative behaviors

100
Q

What are some pitfalls to proper communication?

A

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

101
Q

What is a positive sign of coping in an adult?

A

Family cohesiveness, increased self-esteem, and resilience

102
Q

What are some negative signs of adult coping?

A

Depression, poor school performance, role confusion, poor quality of life

103
Q

How much morphine is given for mild, moderate, and severe pain in a preterm infant?

A

Mild = 0-2 mcg/kg/h. Moderate = 2-5 mcg/kg/h. Severe = 5-10 mcg/kg/h.

104
Q

What are some signs of positive coping for a child?

A

Focus on what they can do, comply with tx, independence, talk about others who are worse off

105
Q

What are some negative signs of coping for a child?

A

Withdrawal, focus on what they can’t do/restriction, moody, poor adaptation

106
Q

How much morphine is given for mild, moderate or severe pain in a term newborn?

A

Mild = 0-5 mcg/kg/h. Moderate = 5-10 mcg/kg/h. Severe = 10-20 mcg/kg/h

107
Q

What are Kubler-Ross’s 5 stages of grief?

A

Denial, anger, bargaining, depression and acceptance

108
Q

What are the 2 types of “ambiguous” loss?

A

Physically absent/psychologically present (spinal injury) and physically present/psychologically absent (Alzheimer’s)

109
Q

When an individual is dying, what sense is lost last?

A

Hearing

110
Q

How much morphine is given to older infants for mild, moderate, and severe pain?

A

Mild = 0-10 mcg/kg/h. Moderate = 10-20 mcg/kg/h. Severe = 15-30 mcg/kg/h

111
Q

When morphine is administered to an infant, what is our greatest concern?

A

Respiratory depression

112
Q

What are some s/s of complicated/abnormal grief?

A

Extreme focus on the lost person, can’t accept the loss, numb, detached, preoccupation with the loss, inability to enjoy life and tryst others

113
Q

What are some risk factors for complicated grief?

A

Unexpected/violent death, inadequate support, traumatic childhood, dependent personality, anxiety, lack of resilience

114
Q

Define “complicated” grief.

A

A heightened state of mourning that lasts longer than normal

Peds/OB - Nrsg 206 (7 decks)

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