Test 4-Peds Flashcards
Motor vehicle accidents (MVAs) are the number one threat in which age group?
Adolescence
What are two mechanisms that can provide protection in a MVA?
- car seats
- seat belts
Which age group is at the highest risk of drowning?
Infants and Toddlers
Which population is vulnerable to choking?
Younger population
Infants are most at risk for suffocation due to what?
Laying face down in a crib
Who are at risk of choking on foods, balloons, or plastic bags?
young children
What must a healthcare professional do as soon as they find an equipment is not working?
Label it as nonworking
Where should nonworking equipment be placed?
In a space specifically for repair; away from patient care
Any kind of outside electronic equipment brought in by the patient must have what happen to it?
Inspected by the engineering department before being plugged into a wall outlet
What is the RACE response?
Rescue, Alarm, Contain, Extinguish
Where do sharps injuries typically take place?
- In a high stress environment
- a place that has frequent use of needles
What are three ways to prevent a sharps injury?
- use of a needless system
- NEVER recap a needle once used on a patient
- sharps awareness (know where needle is at all times)
Any stick on puncture injury carries risk of what?
- Hep Viruses
- HIV
- Bloodborne pathogens
What three ways can violence present itself in the workplace?
- verbal
- making threats
- physical attack (often last resort)
What is the key prevention in workplace violence?
Recognizing behavioral patterns (identifies opportunities to intervene early)
What are 5 things you should do to prevent workplace violence?
- remain calm/provide reassurance
- validate frustrations by hearing concerns
- be mindful of body language
- speak cautiously (gentle)
- have boundaries
What are 5 things you should NOT do in the event of workplace violence?
- respond with anger
- be defensive
- turn your back
- touch an unrestrained patient
- wear loose jewelry or things hanging from body
In RACE, what should you do in R?
Rescue- The very first step of your emergency evacuation plan is ensuring all people inside the premises are taken to safety.
In RACE, what should you do in A?
Alarm- Informing emergency services and sounding all internal alarms.
In RACE, what should you do in C?
Contain- Once people are evacuated and the authorities are informed, your focus should move to containing the fire
In RACE, what should you do in E?
Extinguish- Staff who are trained should operate fire extinguishers and other fire fighting equipment and attempt to put out the blaze as best as possible, without putting themselves in danger.
What is does the fall risk acronym of DAME stand for?
D- Drugs and Alcohol
A- Age Related Changes
M- Medical Factors
E- Environmental Factors
In DAME, what assessment should be done in D?
D-Drugs and Alcohol
- look and see what meds the patient takes; how many
- side effects of meds
- med interactions
- does the patient drink alcohol?
In DAME, what assessment should be done in A?
A-Age Related Changes
- Evaluate patient’s gait
- Do they have sensory impairment?
- Any vision/hearing loss?
- Urinary frequency/incontinence
- is neuropathy present?
In DAME, what assessment should be done in M?
M- Medical factors
- Review pt’s med hx
- Look at reason for being admitted
- What they’re being treated for
- Any dysfunctions?
In DAME, what assessment should be done in E?
E- Environmental Factors
- Do their shoes fit well?
- Evaluate cleanliness of home
- Evaluate for spills or trip hazards
- Lightening of living environment should be assessed
What is are the three levels of fall risk?
- Low
- Moderate
- High
How is the level of fall risk determined?
By what kind and how many interventions are needed
Name 5 HOSPITAL fall risk preventions
- keep call light within reach
- use fall mats next to patient’s bed
- use visual cues to alert staff of pt’s fall risk (colored socks/signs)
- Manage medications to reduce side effects
- Use a bed/chair alarm to alert if patient gets up
Name 5 HOME fall risk preventions
- Keep assistive devices nearby
- Reduce clutter/clear pathways
- Encourage use of home-installed assistive devices
- Educate pt to not rush getting up
- Evaluate pt for proper fitting shoes
If a patient begins to fall, what should a person do?
Help the patient safely complete fall (protect their head)
What kind of restraints are the standard of care?
No restraints; a restraint-free environment is the standard
When should restraints be applied?
- If the patient’s behavior is interfering with their ability to receive medical treatment
- Pt is attempting to cause harm to self or others
When are behavioral restraints used?
Used for patients who are threat to themselves or others’ safety
Example of a patient who needs behavioral restraints?
Patient experiencing psychotic episode
When are medical restraints used?
When a patient is confused and is interfering with medical interventions
Example of a patient who needs medical restraints
A patient pulling out IVs or tubes
What kind of intervention are restraints?
Dependent
How often does an order for restraints need renewed?
Every 24 hours
When can the application or removal of restraints be delegated?
Only for short periods of time (ex: if pt needs to use restroom)
Skin assessment while restrained and need for restraints is whose responsibility?
Nurse
What are the primary defenses of the immune system?
- the skin
- normal flora of the skin and GI tract
- cilia (in the respiratory tract)
- chemical composition of tears and saliva
- acidity of vaginal fluids or urine
What are the secondary defenses of the immune system?
-Immune cells within our body (ex: WBCs or systemic responses that are activated by inflammation pathway)
What are the tertiary defenses of the immune system?
-things we provider our patients in order to provide immunity (ex: immunizations) [external interventions]
What PPE is required for contact precautions?
- standard precautions
- hand hygiene
- gloves
- gown
What PPE is required for droplet precautions?
- *standard precautions
- hand hygiene
- gloves
- gown
- mask
What PPE is required for airborne precautions?
- private room with negative pressure
- N95 mask
Tuberculosis requires what kind of isolation precautions?
- Private room
- Immunization can be offered
- Airborne droplet precautions (N95 mask/room with negative pressure)
Lice requires what kind of isolation precautions?
- Contact precautions (gloves, gown)
- can be cohorted with pt with same condition
Measles requires what kind of isolation precautions?
- Private room
- Immunization can be offered
- Airborne droplet precautions (N95 mask/room with negative pressure)
Influenza requires what kind of isolation precautions?
- Droplet precautions (gloves, gown, mask)
- Remain 3 feet away if possible
- Can be cohorted with pt with same condition
MRSA requires what kind of isolation precautions?
- Contact precautions (gloves, gown)
- can be cohorted with pt with same condition
Chicken pox requires what kind of isolation precautions?
- Private room
- Immunization can be offered
- Airborne droplet precautions (N95 mask/room with negative pressure)
CDiff requires what kind of isolation precautions?
- Contact precautions (gloves, gown)
- can be cohorted with pt with same condition
Meningitis requires what kind of isolation precautions?
- Droplet precautions (gloves, gown, mask)
- Remain 3 feet away if possible
- Can be cohorted with pt with same condition
What do objective assessments of infection include? (4)
- Physical appearance
- Physical assessment findings
- Vital Signs
- Labs
What does a CBC look for in an infection?
WBC count- elevated if infection is present
What do cultures look for in an infection?
presence of bacteria
What do titers look for in an infection?
Previous exposure to a pathogen
What does C-reactive protein (CRP) and Erythrocyte Sedimentation Rate (ESR) look for in an infection?
Chronic inflammation
What two age groups are at the highest risk of infections?
- infants
- elderly
What risk factor will inhibit the secondary defenses of the immune system intentionally?
- chemotherapy
- immunosuppressants
- steroids
What two vital signs will be elevated as part of the immune system?
- Temperature
- Heart rate
What actually cleans the hands when using soap and water?
Friction and rinsing
What is a never event?
An event that is preventable, but presents serious risk
The freedom to choose and make decisions
autonomy
Actions that will benefit others
beneficence
Avoid causing harm (intentionally or unintentionally)
Non-maleficence
Acting fairly to all
Justice
Telling the truth
Veracity
Keeping promises; maintaining confidentiality
Fidelity
T/F: Informed consent must be witnessed
True
Children over what age may sign an assent form
8 years old
Affirms the child’s participation and helps the child understand his or health- ensures the child is not unduly influenced
Assent form
Teaching and rewarding desirable behavior and decreasing or eliminating undesirable behavior
Discipline
A negative consequence applied for undesirable behavior
Punishment
What are three appropriate discipline strategies?
- maintain a positive/supportive child/caregiver relationship
- use positive reinforcements
- remove positive reinforcements for negative behaviors
Freud’s oral passive stage is typically geared to what age group?
1-6 months
Freud’s oral aggressive stage is geared to what age group?
6 months-1 year
What happens in the oral passive stage?
Infant receives gratification through sucking/eating
What happens in the oral aggressive stage?
Infant bites for pleasure
Erikson’s Trust Vs Mistrust
- Birth to One Year
- “Hope”
- Quality of Caregiver (biggest impact)
- Negative: Fear or suspicion
Erikson’s Autonomy Vs Shame and Doubt
- Ages 1-3
- “Will”
- Begins to assert independence
- Encourage child to problem solve
- Negative: shame
Erikson’s Initiative Vs Guilty
- Ages 4-6
- Learns to take initiative
- “Purpose”
- Can feel guilt if not living up to expectations
- Negative: Inadequacy
Erikson’s Industry vs Inferiority
- Ages 6-12
- Learns difference of work/play
- “Competence”
- Negative: Inferiority
Erikson’s Identity vs Role Confusion
- Ages 12-20
- “Fidelity”
- Role confusion can occur
- Explores independence
- Negative: Rebellion
- Behavior and judgements based on experience
- Obedience=reward
- Withholding love leads to guilt
- Obedience vs Punishment
- Ages 3-7
Kohlberg’s Premoral or Preconventional Stage
- Wants to follow rules (8-10) “Good Boy”
- Believes in rules for good relationships (10-12) “Law and Order”
Kohlberg’s Conventional Level
- View of morality transcends laws and rules
- Believes in higher rules/values
- Self acceptable principles
- Adult
Kohlberg’s Post conventional Level
- Ethical principles and conscience governs acts
- Not everyone reaches this stage
- Adult
Kohlberg’s Human Rights Concept
- Cognitive ability
- Sensorimotor 0-2 years
- Reflexes: Birth to 4 months
Piaget Sensorimotor: Cognitive Abilitiy
- 1-4 months
- Coordinating sensation and then repeating them for pleasure
- Voluntary activity replaces reflex
- Object permanence begins at 4 months
Piaget Sensorimotor: Primary Circular Reactions
- 4-12 months
- Focused more on the words/repeats action (4-8 mo)
- Intentional actions (8-12 mo)
- Associates acts with response
- Object permanence by 9 months
Piaget Sensorimotor: Secondary Circular
- Early representational thought
- Mental operations done by trial and error
- Judges right from wrong by amount of damage done
Piaget’s Preoperational
- Connects things that are unrelated if they occur together or appear similar
- Egocentric
- Transductive Reasoning
- Ages 2-4
Piaget’s Preoperational Though
- No logical thinking/magical thinking
- Centration (look at one thought at a time)
- Animism
- Intuitive Thought
- Time—poor concept of time
- Ages 4-7
Piaget Preoperational Thought
- Starts to think logically but no abstract though
- Begins to understand cause and effect
- Considers alternative solutions
- Can articulate processes
- Learns different view points
- Ages 7-11
Piaget Concrete Operational Thoughts
- Deductive logic
- Considers themselves to be exceptional
- Hypothetical reasoning
- 11 years-adult
Piaget Formal Operations/Abstract Thought
What are the four types of parenting styles?
- Authoritative
- Authoritarian
- Permissive
- Rejecting/neglecting
Signs and symptoms of lead poisoning
- blood levels 5ug/ml or higher
- headaches
- irritability
- cognitive impairments
- stomach pain
- problems with coordination
- problems with language and speech
- inattentiveness
- hearing problems
- seizures
What are 4 toilet training tips?
- Use gentle approach (no criticism)
- Remain calm and positive
- If potty is unavailable, face forward on toilet
- Use potty after meal
* Diaper may still be needed at night
Tripod sits
6 months
Sits from standing position; walks independently
12 months
Pulls to stand; “Cruises”
10 months
Sits unsupported
8 months
Sits alone with some use of hands
7 months
Crawls; abdomen off the floor
9 months
What age does stranger anxiety typically begin to develop?
8 months
Coos, other vocalizations, and demonstrates differentiated crying
1-3 months
Simple vowel sounds, laughs aloud, performs “raspberries,” responds to his or her name and “no”
4-5 months
Squealing and yelling; may express joy or displeasure
6 months
Attaches meaning to mama and dada; tries to imitate sounds
9-12 months
1-3 recognizable words, recognizes objects by name, may say “ugh-oh”
12 months
Begins to babble
8 months
Improves head control
2 months
Fists mostly clenched
1 month
First real smile
2 months
Holds hands in front of face; hands open
3 months
Bats at objects, lifts head and looks around; rolls from prone to supine
4 months
By ____ months, infant should double their birthweight.
6
Grasps rattles; rolls from supine to prone and back
5 months
Releases object to grasp another object
6 months
Transfers objects from one hand to another and enjoys interactive games
7 months
Offers objects to others and releases them
11 months
Fine pincer grasp; puts objects in container and takes them out
10 months
Infants typically triple their birthweight by which age?
1 year old
Cups, bowls, buckets, large building blocks, balls, dolls, board books with large pictures, and toy telephones are all great toys for which age group?
12 months
Bangs objects together
9 months
Climbs upstairs with help; pulls toys while walking
18 months
Can begin to run; knows how to kick a ball; climbs up and down furniture without assistance
24 months
Stacks blocks, puts things in slots, turn pages, remove shoes/socks, can build four blocks
18 months
Can build tower of 6/7 blocks, turns knobs, puts pegs in holes
24 months
Can follow a one-step command without gesture; understands 100-150 words; repeats words they hear
15 months
Vocabulary of 40-50 words
24 months
Understands “no,” can comprehend 200 words, uses 5-20 words
18 months
Can stand on tiptoe
24 months
Vocabulary of 150-300 words
2 years old
Climbs well, pedals tricycle, runs easily, walks up and down stairs with alternate feet, bends easily without falling
3 years
Can build tower of 9-10 blocks
3 years
Has a 1000 word vocabulary
3 years
Throws ball overhead, draws circles and squares, can speak in complete sentences
4 years
Counts to 10
5 years
Somersaults and swings well; can understand most speech-vocabulary of 2100 words
5 years
Stands on one foot for 5+ seconds
4 years
How long should a car seat face backward?
Until at least 2 years old
What are three things to consider when installing a car seat?
- Correct type
- Position of the child in the carseat
- Properly securing carseat to vehicle
- Mobiles with contrasting colors
- Unbreakable mirror
- Soft music via tape or music box
- Soft, bright colored toys
0-1 months
- Bright mobile
- Unbreakable mirror
- Rattles
- Singing by parent/caregiver
- High contrast patterns in books or images
1-4 months
- Plastic cups, bowls, or buckets
- Large building blocks
- Busy boxes
- Balls
- Dolls
- Board books
- Toy telephone
- Push-pull toys
- Stacking toys
8-12 months
- Fabric or board books
- Different types of music
- Easy to hold toys (fancy rattles)
- Floating, squirting bath toys
- Soft dolls or animals
4-7 months
- familiar household items (bowls, cups, utensils, ect)
- child-size household item toys (kitchen, broom, ect)
- blocks, cars, trucks, animals, plastic figures
- manipulative toys with handles and knobs
- Gross motor toys
- tapes or cd players
- chalk, crayons, finger paints
- bath toys
Toddler toys
- Blocks
- Jigsaw puzzles
- Creativity supplies (chalk, paint, ect)
- Puppets
- Dress up clothes
- Bath toys
- Sandbox
- Dolls
- Blocks, legos, cars/trucks, plastic animals
- Simple board games
- Dollhouse
Preschool toys
Breastmilk or formula until how old?
6 months of age
Soft and mashed food for infants until when
teeth erupt
Food can be introduced when _______
tongue extrusion reflex disappears
What foods should an infant avoid?
- honey
- popcorn
- small hard foods
- foods that can cause allergic reactions
What should be the total daily fat intake for toddlers?
20-30% of total calories
What should be the total fat intake for preschoolers?
10-35% of total calories
What should the nutritional breakdown of carbs, proteins and fats be for school age children and adolescents?
- 45-65% carbs
- 10-30% proteins
- 25-35% fats
Infants usually engage in this kind of play
Solitary
What is solitary play?
Play where the infant does not share or directly play with other infants
What type of play do toddlers usually engage in?
Parallel play (play alongside other children rather than cooperatively)
What type of play do preschoolers engage in?
- Associative play (engaged in mutual activity, but not working towards a common goal)
- Cooperative play (using imagination to play with friends)
What type of play do school aged children and adolescents usually engage in?
- Cooperative play
- Team play (sports)
- Solitary play (video games)
Which age group should be offered 3 full meals and two snacks a day?
Toddlers
What is the least effective disciplining method?
Spanking
Adolescents engage in what kind of behavior?
Risky
-Education about substance abuse, sexual health, and tobacco is important for this age group
What are the five barriers to care?
- Financial
- Ethnic
- Sociocultural
- Health Care Delivery System
- Personal Biases
Follows a series of two independent commands; 150-300 word vocabulary
30 months
Follows a 3-part command; speech understood by family; asks “why?”; 3-4 word sentences; 1000 words
3 years
Teens require what increased nutrients
Calcium, Zinc, Iron
Preschooler up until the age of 4, should sit in what kind of car seat?
Forward-facing with harness and top tether
What are the booster seat recommendations?
- Up until 4’9” (57 inches)
- And ages 8-12 are reached
Children should not sit in the front seat of a car until what age?
13 years old
When can a child sit with only a seatbelt?
-After he/she reaches 57 inches
What are the common fears of a toddler?
- Loss of parents
- Fear of strangers
- Toddlers may also be afraid of loud noises or afraid of the dark
What are common fears of preschoolers?
- Loud noises
- Imaginary monsters
- Afraid of people they do not know
- Afraid of the dark
- Body mutilation
What are common fears of school age children?
- Real life things (death, natural disasters, getting hurt)
- Fear of being kidnapped
- Dogs or other animals
When punishing an adolescent, what should the parent/caregiver do?
Incorporate autonomy with the teen
Which theorist is based on the concept of rule-following?
Kohlberg
A child cries out that the CT scan is going to eat her, what kind of behavior is the child displaying?
Animism
What is the major challenge of formation to an adolescent’s identity?
Changing bodies
What is the most important consideration when a nurse is educating a child?
Their developmental level