Test 3 Flashcards
Respiratory in infant
Airway is Narrow and more easily occluded
Obligatory nose breather
What is an infant’s cough typical characteristics
Unproductive- produce little mucus
What vs to assess in anemia
How to asess
Increase respiratory due to compensation
Count for full min
A child respiratory rate and depth in anemia can be impacted by what
Crying Physical activity Anxiety Anemia Acid base disturbances Fever CNS Aspirin toxicity
ARDs
Acute respiratory distress syndrome
Diagnosed how?
Treatment?
Bad
X-ray
Tx underlying cause
Respiratory disorders of lower airway
Nasopharyngytis
Pharyngitis
Tonsillitis
Mucus in lungs , reproductive system, gi system , heart , diagnosed by sweat test
Cystic fibrosis
What is rhinosinutis
Cold
Headache - worse when leaving forward
Closes down airway fast
Have intubation equipment available
Epiglottis
Four Ds of epiglottis
Dysphonia- horse voice
Drooling
Dysphasia
Distress
Can be fatal !!
Most common hernias in infants
S/s
When they resolve? How
Umbilical hernias ?
A symptomatic
Resolve by 3-5?yrs outpatient surgery
80% of all childhood hernias
Bulging esp when crying
How to repair?
Inguinal hernias
Surgery to repair
Hurt uncomfortable !!!
Rsv prevention
Hand hygiene!!
What are some Influences on Growth and Development
Nature
◦Describes the traits inherent in the infant
Nurture
◦Refers to the influence of external events
Principles of Childhood Growth and Development
Growth
◦Continuous adjustment in the size of the child, internally and externally
Development
◦Ongoing process of adapting throughout the lifespan
Cephalocaudal
◦Development is a progression from head to tail—top to bottom
Proximodistal
◦Development progresses from near to far and midline to periphery
Gross motor and fine motor skills
◦Gross motor skills, such as running, jumping, or riding a bike, provide the foundation for fine motor development, such as eating, coloring, or buttoning a shirt
Touchpoints
◦Periods during the first 3 years of life during which children’s spurts in development result in pronounced disruption in the family system
◦Brazelton also tracked the variations in these touchpoints and offered anticipatory guidance for parents and professionals who are moving with the child through the stages of development.
A theoretical approach explains, describes, and predicts the various aspects of growth and development
A developmental domain refers to a way of understanding the total child in relation to the mind, body, and spirit
Each child develops at his or her own pace, and the stages are not rigid
There is developmental variability within each child
Nonstage theories are less concerned with specific ages or timeframes but are focused on the process or trajectory of developing maturity
Jean Piaget: four stages
Cognitive theory
How an individual thinks and how thinking influences worldview
◦Sensorimotor (birth to age 2): cognition is through the senses
◦Preoperational (ages 2 to 7): development of motor skills
◦Concrete operational (ages 7 to 11): organize thought in a logical order
◦Formal operational (ages 11 to 15): abstract reasoning to handle difficult concepts
Learning theories
Behavioral: passive learner
◦J. B. Watson….Sought to understand observable behavior
◦B. F. Skinner…..Growth and development are a process of responding to stimuli within the environment
Social learning: emphasizes interplay within the environment
◦Albert Bandura….Learning occurs through observation and modeling
◦Lev Vygotsky….Culture has an impact on development
◦Urie Bronfenbrenner …..The social environment has an effect on development
Intelligent theories
Intelligence is the ability to learn or understand or to deal with new or trying situations by using reason
Howard Gardner: eight forms of intelligence ◦Bodily kinesthetic: movement ◦Interpersonal: relate to others ◦Intrapersonal: self-reflection ◦Linguistic: auditory ◦Logical-mathematical: “figure things out” ◦Musical: song or musical instrument ◦Naturalistic: natural animal world ◦Spatial: visual
Language development of infants
Infant
◦vocalize by babbling, cooing, and laughing
◦Responds to voices
Language development of one year old
◦Able to say 1 or more words
◦Understands simple instructions
◦Able to respond to their name
Language by age 2
◦Vocab of 50 words
◦Combine 2 simple words
◦Follow one step instructions
◦50% comprehension by others
Language by age 3
◦Combine 3 or more words in sentence
◦75% comprehension by others
Sigmund Freud (psychosexual) ◦Id (instinct), ego (identity and individual function), superego (regulates behavior) ◦
ORAL (Birth to 1 year) ◦Anal (1-3 years) ◦Phallic (3-6 years) ◦Latency (6-12 years) ◦Genital (12-18 years)
Psychosocial Development theory Erik Erikson (stages)
◦Trust vs. mistrust: birth–1 year (trust is learned)
◦Autonomy vs. shame and doubt: 1–3 years (balance independence and self-sufficiency)
◦Initiative vs. guilt: 3–6 years (resourcefulness to achieve and learn new things)
◦Industry vs. inferiority: 6–12 years (sense of confidence through mastery of tasks)
◦Identity vs. role confusion: 12–18 years (forging ahead and acquiring a clear sense of self )
Moral Development Theories:
Perception About Right and Wrong
Jean Piaget: progression of moral thinking in children based on the ability to reason and understand the environment
◦Two stages:
< 11 years old: experience right and wrong as concrete (good or bad)
•> 11 years old: rules are important but are not always absolute or “carved in stone “
Perception of right and wrong
Lawrence Kohlberg
◦Three levels:
- Preconventional : thinking is concrete and egocentric
- Conventional: incorporation of social and interpersonal relationships
- Postconventional: social contract and individual rights and universal principles
Moral Development Theories:
Perception About Right and Wrong (cont’d)
Carol Gilligan
◦Two tracts:
Male: autonomy and justice
•Female: caring and relationship
Newborn and Infant
Birth to 12 Months
Cognitive development Language development Biological development Psychosocial development Moral Development Physical development Discipline Anticipatory guidance
Toddler (1 to 3 Years)
Language development Physical development Cognitive development Language development Psychosocial development Moral Development Discipline Anticipatory guidance
Early Childhood (Preschooler: 3 to 6 Years
Physical development Cognitive development Language development Psychosocial development Moral Development Discipline Anticipatory guidance
School-Age Child (6 to 12 Years)
Physical development Cognitive development Language development Psychosocial development Moral Development Discipline Anticipatory guidance
Adolescence (12 to 19 Years)
Physical development Cognitive development Language development Psychosocial development Moral Development Discipline Anticipatory guidance
Gathering the Child’s Health History
Establish a relationship with the patient and family
•Culturally competent care
•Health Insurance Portability and Accountability Act (HIPAA)
•Asking questions
•OLD CAT
•SODA
Comprehensive Health History of child
Family medical and social history •Past medical history •Immunizations •Developmental milestones •Denver II screening test
Patterns of daily activities
•Sleep
•Nutrition
•Play, activities, and schoolwork
Review of Systems in peds
General •Skin •Head, eyes, ears, nose, and throat •Neck •Chest •Cardiovascular •Gastrointestinal •Genitourinary •Musculoskeletal •Neurological •Endocrine
Health Assessment
•Anthropometric measurements
- Length
- Weight
- Body mass index
- Head circumference
- Skinfold thickness
Vitals in peds
Temperature
•Pulse
•Respirations
•Blood pressure
Physical Assessment
And fontanels?
General assess?
Ear assess?
Eye assessment?
Triangle back of head
Diamond - front of head
General impression
•Skin assessment
•Head assessment
•Neck assessment
Eye assessment
•Visual acuity
•Ocular alignment
•Color blindness
- Ear assessment
- Hearing screening
- Rinne test
- Screening techniques for children
•Nose/sinus assessment
Throat/mouth assessment
- Chest assessment
- Retractions
- Lung assessment
- Breath sounds
- Important respiratory signals
- Cardiac assessment
- Abdominal assessment
Genitourinary and perineal assessment
- Female genitalia
- Male genitalia
- Anal examination
- Musculoskeletal assessment
- Neurological assessment
- Cultural assessment
The Child in Pain
•Pain assessment and management
Appropriate pain scale •Mild, moderate, severe •Acute, chronic •Myths about pain management •Pain management strategies
Wonkers face scale , Flacc for nonverbal
Understanding the child with a disability:
Emotional concerns •Disruption of normal routines •“Bad news” •Financial implications •Developmental concerns •Constant support needed •Regression or “maturity beyond years”
Physical concerns
•Fluid and electrolyte changes
•Procedures that are worrisome or painful
•Lifetime of corrective procedures
•Several different medical specialists may be involved
- Pharmacotherapeutic regimens
- Family must learn to care for the physical needs of the child
Caregiver fatigue
•Disability takes it toll on entire family
•Respite care agencies provide short-term relief
•Multiple visits to clinics, hospitals, or rehabilitation centers
•Extra requirements to accomplish normal daily activities
•Trouble sleeping
- Resiliency
- Nurses can help parents and children develop resiliency and positive self-esteem by fostering a mix of love and nurturing in the face of overwhelming stressors
Several options for the delivery of nursing care in the hospital setting:
Hospital •Children’s hospital •Day hospital •24-hour observation unit •Ambulatory surgery center •Fast-track care •Emergency department •Critical care unit
Reasons for Accessing Medical Care
Epistaxis (nosebleed) •Poisoning due to ingestion of medicine •Common toxic ingestions •Acetaminophen (Tylenol) •Lead poisoning
Ways to Decrease the Stress of Hospitalization
Theuraputic Play
Guided imagery
Role modeling
Parents With a Hospitalized Child
Parents with a hospitalized child often need to debrief and tell their story about the events that led to their child’s hospitalization
•Seeking parental advice about the best way to approach their child, acknowledging parental need for involvement, and anticipating stressful events are integral to appropriately caring for the child in a family-centered manner
•The communication between the pediatric nurse and family members must be genuine, and the plan of care must include resources available in the hospital as well as the community
Holistic Nursing Care for the Child
Bathing
Feeding
Rest
Safety
Medication administration
Infection control
Emotional support
Bathing
•Assess home practices and preferences
•Bathe an infant using a portable tub
•A sponge bath is given to a child who is feeling ill or has tubes, drains, or dressings
•Give a bed bath if a tub bath is contraindicated
•Water temperature should not exceed 100°F (37.8°C)
•Never leave a child alone
•Shampooing is based on family preferences
•Observe parent–child interaction during bath
•Assess language and social skills
•Assess skin and muscle tone
•Bathing is a way for the child to become acquainted with the nurse
Feeding
•Formula-fed infants require no more than 24 to 32 ounces of iron-fortified formula a day
•Assess food preferences for the older child
•Children are prescribed a diet “as tolerated”
•Foods also important for their fluid content
•Encourage parents to bring food from home
•Average daily caloric requirements for children
•0–1 mo: 100–110 kcal/kg/day
•2–4 mo: 90–100 kcal/kg/day
•5–60 mo: 70–90 kcal/kg/day
•> 5 years: 1,500 kcal for first 20 kg + 25 kcal for each additional kg/day
Rest •Assess normal sleep patterns •Allow child and family to “sleep in” •Provide uninterrupted nap time •Safety measures •Keep toxic materials out of reach •Verify child’s identify by checking name band •Know whereabouts of child on the unit •Provide safe environment •Transport child safely
Safety measures (cont’d)
•Restraint devices on highchairs, strollers, and beds are kept in locked and lowest position
•Crib and bed side rails are elevated
•Bubble tops may be needed
•Medication administration
•Consider developmental level of child
•Administering medications to infant may require additional assistance
Medication administration (cont’d)
•Infant needs immediate cuddling and comfort after medication administration
•Toddler may consider medications to be punishment
•To increase compliance of toddler, it may be necessary for nurse to allow parent to administer the oral medications
•Oral medications in cup or syringe can be self-administered by the preschooler under direct and close supervision
•The school-age child is far more cooperative
Medication administration (cont’d)
◦Nurse must be patient and allow time for more complex questions from adolescent
◦ Education of child and parent about medications being administered is important
◦Always use “6 rights” of medication administration (right patient, right medication, right dose, right route, right time, and right documentation
Infection control measures
◦Use good hand hygiene
◦Isolation precautions include standard precautions and transmission-based precautions
◦Use diversionary activities for child in isolation
◦Place isolation guidelines on door with step-by-step instructions
•Fever-reducing measures
◦Antipyretics
◦Environmental measures
Emotional and spiritual support •Be “in the moment” •Convey a caring attitude •Listen •Clarify misconceptions •Help family develop coping strategies
Preparing Children for Procedures
Explaining procedures •Preparing an infant, toddler, preschooler, school-age child, and adolescent for procedure •Distraction •Environment •Preparing the parent •Use developmentally appropriate words
- Provides patient with necessary knowledge to make decision regarding health care
- Implies that person understands benefits and risks of treatment or refusal of treatment
- Legal age is required
- Required before diagnostic procedures, medical treatments or surgical procedures, immunizations, or any treatment with inherent risks
Informed consent
•Dehydration •Fluid maintenance or replacement •Before diagnostic testing •Blood product placement •Medication administration •Preoperatively •Types •Peripheral line •Normal saline locks Types (cont’d) •Central venous access devices •Peripherally inserted central catheter line (PICC) •Vascular access port (Infus-A-Port)
•Monitor for signs and symptoms of infection: change in temperature, erythema, edema, pain at IV site, tenderness on palpation
Intravenous lines
Measuring intake and output
•
Vomiting, diarrhea, fever, NG suctioning, draining wounds, burns, presurgical patients and children with cardiac, renal or respiratory illness
