Unit 1 Flashcards
Infants
1 month- 1 yr
Toddlers
1-3 yrs
Preschoolers
3-6 yrs
School-Age Children
6-12 yrs
Adolescents
12-20 yrs
Family Theories: Family systems
- Family is viewed as a whole system, instead of the individual members.
- A change to one member affects the entire system.
- The system can both initiate and react to change.
- Too much and too little change can lead to dysfunction.
Family Theories: Family stress
- Describes stress as inevitable.
- Stressors can be expected or unexpected.
- Explains the reaction of a family to stressful events.
- Offers guidance for adapting to stress.
Family Theories: Developmental
- Views families as a small group that interacts with the larger social system.
- Emphasizes similarities and consistencies in how families develop and change.
- Uses Duvall’s family life cycle stages to describe the changes a family goes through over time.
- How the family functions in one stage has a direct effect on how the family will function in the next stage.
Family Composition: Traditional nuclear family
Married couple and their biological children (only full brothers and sisters)
Family Composition: Nuclear family
Two parents and their children (biological, adoptive, step, foster)
Family Composition: Single-parent family
One parent and one or more children
Family Composition: Blended family (also called reconstituted)
At least one stepparent, step sibling, or half-sibling
Family Composition: Extended family
At least one parent, one child, and other individuals either related or not
Family Composition: Gay/lesbian
Two members of the same sex who have children and a legal or common-law tie
Family Composition: Foster family
A child or children who have been placed in an approved living environment away from the family of origin- usually with one or two parents
Family Composition: Binuclear family
Parents who have terminated spousal roles but continue their parenting roles
Family Composition: Communal family
Individuals who share common ownership of property and goods and exchange services without monetary consideration.
Parenting styles: Dictatorial or authoritarian
-Parents try to control the child’s behaviors and attitudes through unquestioned rules and expectations.
Exp: The child is never allowed to watch TV on school nights
Parenting styles: Permissive
-Parents exert little or no control over the child’s behaviors, and consult the child when making decisions.
Exp: The child assists with deciding whether or not he will watch TV
Parenting styles: Democratic or authoritative
-Parents direct the child’s behavior by setting rules and explaining the reason for each rule setting.
-Parents negatively reinforce deviations from the rules.
Exp The child can watch TV for 1 hr on school nights after completing all of his homework and chores. The privilege is taken away but later reinstated based on new guildelines.
Parenting styles: Passive
-Parents are uninvolved, indifferent, and emotionally removed.
Exp: The child may watch TV whenever he wants.
Family assessment should include
- Hx- medical hx for parents, siblings, grandparents
- Structure- family members
- Developmental tasks
- Family characteristics- culture, religion, economic influences, behavior, attitudes
- Family stressors- expected and unexpected
- Environment- availability of and family interactions with community resources
- Family support systems
Temperature: 3-6 months
Routes: axillary, rectal
37.5 C (99.5 F)
Temperature: 1 yr
Routes: axillary, rectal
37.7 C (99.9 F)
Temperature: 3 yrs
Routes: axillary, tympanic, oral (if child is cooperative), rectal (if exact measurement is necessary)
37.2 C (99.0 F)
Temperature: 5 yrs
Routes: axillary, tympanic, oral (if child is cooperative), rectal (if exact measurement is necessary)
37.0 C (98.6 F)
Temperature: 7 yrs
Routes: oral, axillary, tympanic
36.8 C (98.2 F)
Temperature: 9-11 yrs
Routes: oral, axillary, tympanic
36.7 C (98.1 F)
Temperature: 13 yrs
Routes: oral, axillary, tympanic
36.6 C (97.9 F)
Pulse rates: Newborn
80-180/min
Pulse rates: 1 week-3 months
80-220/min
Pulse rates: 3 months-2 yrs
70-150/min
Pulse rates: 2-10 yrs
60-110/min
Pulse rates: 10 yrs +
50-90/min
Respirations: newborn- 1 yr
30-35/min
Respirations: 1-2 yrs
25-30/min
Respirations: 2-6 yrs
21-25/min
Respirations: 6-12 yrs
19-21/min
Respirations: 12 yrs+
16-19/min
BP: infants
65-80/40-50 mmHg
BP: 1 yr
Girls: 83-114/38-67 mmHg
Boys: 80-114/34-66 mmHg
BP: 3 yrs
Girls: 86-117/47-76 mmHg
Boys: 86-120/44-75 mmHg
BP: 6 yrs
Girls: 91-122/54-83 mmHg
Boys: 91-125/53-84 mmHg
BP: 10 yrs
Girls: 98-129/59-88 mmHg
Boys: 97-130/58-90 mmHg
BP: 16 yrs
Girls: 108-138/64-93 mmHg
Boys: 111-145/63-94 mmHg
Erect head posture is expected in infants after _____ months of age
4
Hair and scalp manifestations of nutritional deficiencies include:
hair that is stringy, dull, brittle, and dry
Posterior fontanel usually closes between ____ to ____ weeks of age.
6-8
Anterior fontanel usually closes between ____ to ____ weeks of age.
12-18
Visual acuity may be difficult to assess in children younger than ____ yrs of age.
3
Peripheral visual fields should be:
Upward 50 degrees
Downward 70 degrees
Nasally 60 degrees
Temporally 90 degrees
The pinna of the ear should be pulled ____ and ____ for infants and toddlers
down and back
The pinna of the ear should be pulled ____ and ____ for children older than 3 yrs of age
up and back
Children and adolescents begin with ____ deciduous teeth and replace them with ____ permanent teeth
20
32
Female breasts typically develop between ____ to ____ yrs of age
10 to 14
Bowel sounds should be heard every ____ to ____ seconds
5 to 30
Infant reflexes:
Elicited by stroking an infant’s cheek or the edge of an infants mouth.
The infant turns her head toward the side that is touched and starts to suck.
Sucking and rooting reflexes
Birth-4 months
Infant reflexes:
Elicited by placing an object in an infants palm. The infant grasps the object.
Palmar grasp
Birth-3 months
Infant reflexes:
Elicited by touching the sole of an infants foot. The infants toes curl downward.
Plantar grasp
Birth-8 months
Infant reflexes:
Elicited by allowing the head and trunk of an infant in a semi-sitting position to fall backward to an angle of at least 30 degrees. The infants arms and legs symmetrically extend, then abduct while the fingers spread to form C shape.
Moro reflex
Birth-4 months
Infant reflexes:
Elicited by clapping hands or by a loud noise. The newborn will abduct arms at the elbows, and the hands will remain clenched.
Startle reflex
Birth-4 months
Infant reflexes:
Elicited by turning an infant’s head to one side. The infant extends the arm and leg on that side and flexes the arm and leg on the opposite side.
Tonic neck reflex (fencer position)
Birth-3-4 months
Infant reflexes:
Elicited by stroking the outer edge of the sole of an infant’s foot up toward the toes.
The infant’s toes fan upward and out.
Babinski reflex
Birth-1 yr
Infant reflexes:
Elicited by holding an infant upright with his feet touching a flat surface.
The infant makes stepping movements.
Stepping
Birth- 4 weeks
Romberg test
able to stand with slight swaying while eyes are closed
Cranial Nerve: I Olfactory
Expected findings Infants:
-Difficult to test
Expected findings children/adolescents:
-Identifies smells through each nostril individually
Cranial Nerve: II Optic
Expected findings Infants:
-Looks at face and tracks with eyes
Expected findings children/adolescents:
-Has intact visual acuity, peripheral vision, and color vision
Cranial Nerve: III Oculomotor
Expected findings Infants:
- Blinks in response to light
- Has pupils that are reactive to light
Expected findings children/adolescents:
-Has no nystagmus and PERRLA is intact
Cranial Nerve: IV Trochlear
Expected findings Infants:
-Looks at face and tracks with eyes
Expected findings children/adolescents:
-Has the ability to look down and in with eyes
Cranial Nerve: V Trigeminal
Expected findings Infants:
-Has rooting and sucking reflexes
Expected findings children/adolescents:
- Is able to clench teeth together
- Detects touch on face with eyes closed
Cranial Nerve: VI Abducens
Expected findings Infants:
-Looks at face and tracks with eyes
Expected findings children/adolescents:
-Is able to see laterally with eyes
Cranial Nerve: VII Facial
Expected findings Infants:
-Has symmetric facial movements
Expected findings children/adolescents:
- Has the ability to differentiate between salty and sweet on tongue
- Has symmetric facial movements
Cranial Nerve: VIII Acoustic
Expected findings Infants:
- Tracks a sound
- Blinks in response to a loud noise
Expected findings children/adolescents:
- Does not experience vertigo
- Has intact hearing
Cranial Nerve: IX Glossopharyngeal
Expected findings Infants:
-Has an intact gag reflex
Expected findings children/adolescents:
- Has an intact gag reflex
- Is able to taste sour sensations on back of tongue
Cranial Nerve: X Vagus
Expected findings Infants:
-Has no difficulties swallowing
Expected findings children/adolescents:
-Speech clear, no difficulties swallowing
Uvula is midline
Cranial Nerve: XI Spinal Accessory
Expected findings Infants:
-Moves shoulders symmetrically
Expected findings children/adolescents:
-Has equal strength of shoulder shrug against examiner’s hands
Cranial Nerve: XII Hypoglossal
Expected findings Infants:
- has no difficulties swallowing
- Opens mouth when nares are occluded
Expected findings children/adolescents:
- Has a tongue that is midline
- Is able to move tongue in all directions with equal strength against tongue blade resistance
Birth weight is at least _______ by the age of _____ months, and _______ by the age of _____ months.
doubled, 6
tripled, 12
Infants grow approximately ____ per month the first 6 months of life.
1 inch
Birth length increases by ____% by the age of 12 months.
50
Head circumference increases approx. ____ cm per month for the first 6 months.
1.5
Head circumference increases approx. ____ cm between 6-12 months of age.
0.5
Acetaminophen (Tylenol) and/or ibuprofen (Advil) are appropriate if irritability occurs during feeding and sleeping from teething, but should not be used for more than ____ days.
3
Gross and fine motor skills: 1 month
Gross:
Demonstrates head lag
Fine:
Has a grasp reflex
Gross and fine motor skills: 2 months
Gross:
Lifts head off mattress when prone
Fine:
Holds hands in an open position
Gross and fine motor skills: 3 months
Gross:
Raises head and shoulders off mattress when prone
Only slight head lag
Fine:
No longer has a grasp reflex
Keeps hands loosely open
Gross and fine motor skills: 4 months
Gross:
rolls from back to side
Fine:
Places objects in mouth
Gross and fine motor skills: 5 months
Gross:
Rolls form front to back
Fine:
Uses palmar grasp dominantly
Gross and fine motor skills: 6 months
Gross:
Rolls form back to front
Fine:
Holds bottle
Gross and fine motor skills: 7 months
Gross:
Bears full weight on feet
Fine:
Moves objects from hand to hand
Gross and fine motor skills: 8 months
Gross:
Sits unsupported
Fine:
Begins using pincer grasp
Gross and fine motor skills: 9 months
Gross:
Pulls to a standing position
Creeps on hands and knees instead of crawling
Fine:
Has a crude pincer grasp
Gross and fine motor skills: 10 months
Gross:
Changes from a prone to a sitting position
Fine:
Grasps rattle by its handle
Gross and fine motor skills: 11 months
Gross:
Walks while holding onto something
Fine:
Places objects into a container
Neat pincer grasp
Gross and fine motor skills: 12 months
Gross:
Sits down from a standing position without assistance
Fine:
Tries to build a two-bloc tower without success
Cognitive development: Piaget- Sensorimotor stage
- birth-24 months
- Separation, object permanence, and mental representation are the 3 important tasks accomplished.
Language development:
- Crying is the first form of verbal communication
- Vocalizes with cooing noises
- Responds to noises
- Turns head to the sound of a rattle
- Laughs and squeals
- Pronounces single-syllable words
- Begins speaking two-word phrases and progresses to speaking three-word phrases
- Says 3-5 words and comprehends “no” by the age of 1 year.
Cognitive development: Psychosocial Development: Ericsson- Trust vs. Mistrust
- Birth-1 yr
- Trust is developed by meeting comfort, feeding, stimulation, and caring needs.
- Mistrust develops if needs are inadequately or inconsistently met, or if needs are continuously met before being vocalized by the infant.
Separation anxiety begins around
4-8 months
Stranger fear becomes evident between
6-8 months
Nocturnal sleep pattern is established by
3-4 months of age
Infant sleeps ____ hr daily and ____ hr at night around the age of 4 months
14-15
9-11
Infant sleeps through the night and takes 1-2 naps during the day by the age of ____ months
12
Hot water thermostats should be set at or below ____ C ( ____ F) to prevent burns from occurring.
49 C (120 F)
Infants and toddlers remain in a rear-facing car seat until the age of _____ yrs or the height recommended by the manufacturer.
2
Crib slats should be no farther apart than _____ cm to prevent suffocation.
6
Crib mobiles or crib gyms should be removed by _____ months of age
4-5
At 30 months of age toddlers should weigh ____ times their birth weight.
4
Toddlers grow about ___cm (___in) per year
7.5 cm (3 in)
Head circumference and chest circumference are usually equal by ____ to ___ yrs of age
1-2
15 month motor skills
- walks without help
- creeps up stairs
- uses a cup well
- builds a tower of two blocks
18 month motor skills
- assumes a standing position
- throws a ball overhand
- jumps up and down with both feet
- manages a spoon without rotation
- turns pages in a book, two or three at a time
2 yr motor skills
- walks up and down stairs by placing both feet on each step
- builds a tower of six or seven blocks
2.5 yr motor skills
- jumps across the floor using both feet and off a chair or step
- stands on one foot momentarily
- draws circles
- has good hand-finger coordination
language increases to about ____ words by the age of 2 yrs.
300
Toddlers develop gender identity by ___ yrs of age.
3
Age-appropriate activities for toddlers
- filling and emptying containers
- playing with blocks
- looking at books
- push-pull toys
- tossing balls
- finger paints
- large-piece puzzles
- thick crayons
Immunizations: 12-15 months
- Inactivated poliovirus (IPV) (third dose between 6-18 months)
- Haemophilus influenza type B (Hib)
- pneumococcal vaccine (PCV)
- MMR
- Varicella
Immunizations: 12-23 months
-Hep A, given in 2 doses at least 6 months apart
Immunizations: 15-18 months
-Diphtheria and tetanus toxoids and pertussis (DTaP)
Immunizations: 12-36 months
- Yearly seasonal trivalent inactivated influenza vaccine (TIV)
- Live, attenuated influenza vaccine (LAIV) by nasal spray (at 2 yrs of age)
Toddlers should consume ____ to ____ oz of milk per day
24-30, and may switch from drinking whole milk to drinking low-fat milk after 2 yrs of age
Juice consumption for toddlers should be limited to ___ to ___ oz per day
4-6
Food serving size should be ____ tbsp for each year of age
1
Foods that are potential chocking hazards are:
- Nuts
- Grapes
- Hot dogs
- PB
- Raw carrots
- Tough meats
- Popcorn
Toddler average ____ to ____ hrs of sleep per day, including 1 nap.
11-12
Thermostats on hot water heaters should be turned down to
49 C (120 F) or below
School-age children will gain about ___ to ___ kg (___ to ____ lb) per year
2-3 kg (4.4-6.6 lb)
School-age children will grow about ____ cm (___ in) per year
5 cm (2 in)
Onset of physiologic changes begins around the age of _____
9
Age appropriate activities 6-9 yrs
- Play simple board and number games
- Play hopscotch
- Jump rope
- Collect rocks, stamps, cards, coins, or stuffed animals
- Ride bicycles
- Build simple models
- Join organized sports (for skill building)
Age appropriate activities 9-12 yrs
- Make crafts
- Build models
- Collect things/engage in hobbies
- Solve jigsaw puzzles
- Play board and card games
- Join organized competitive sports
If not given between 4-5 yrs, children should receive the following vaccines by 6 yrs of age
DTaP, IPV, MMR, varicella
Immunizations: 11-12 yrs
Tdap
HPV2 OR HPV4 in 3 doses for females
HPV4 for males
Meningococcal (MCV4)
School-age children should be screened for ______ by examining for a lateral curvature of the spine before and during growth spurts.
Scoliosis
Obesity is an increasing concern of school-age children and it predisposes them to low self-esteem, diabetes, heart disease, and high BP. Advise parents to:
- Avoid using food as a reward
- Emphasize physical activity
- Ensure that a balanced diet is consumed by following the U.S. dept. of Agriculture’s healthy diet recommendations
- Teach children to make healthy food selections for meals and snacks
- Avoid eating fast-food frequently
- Avoid skipping meals
- Model healthy behaviors
Approximately ___hrs of sleep is needed each night at the age of 12 years
9
It is recommended that children use an approved car restraint system until they achieve a height of ___cm (__4 ft, __in)
145 cm (4 ft, 9 in)
Gross motor skills: 3 yr old
- Rides a tricycle
- Jumps off bottom step
- Stands on one foot for a few seconds
Gross motor skills: 4 yr old
- Skips and hops on one foot
- Throws ball overhead
Gross motor skills: 5 yr old
- Jumps rope
- walks backward with heel to toe
- Throw and catches a ball with ease
Parallel play shifts to ________ play during 3-6 yrs (preschoolers)
associative
Appropriate activities for preschoolers (3-6 yrs)
- Playing ball
- putting puzzles together
- riding tricycles
- playing pretend and dress-up activities
- role playing
- painting
- simple sewing
- reading books
- wading pools
- skating
- computer programs
- electronic games
Eruption of primary teeth is finalized by the ____________ yrs
beginning of the preschool
On average, preschoolers need about _____ hrs of sleep per day
12
Immunizations: 4-6 yrs
DTaP, MMR, varicella, IPV
Immunizations: 3-6 yrs
yearly seasonal influenza; trivalent inactivated influenza vaccine (TIV); or live, attenuated influenza vaccine (LAIV)
Oral medication administration
- Preferred administration route for children
- Use an oral syringe for small amounts, medication cup for large amounts
- Avoid mixing medication with formula
- Hold infant in a semi reclining position
- Hold small child in upright position
- Stroke the infant under the chin to promote swallowing while holding cheeks together
- Use a nipple to allow infant to suck medication
Administering medications via feeding tube
- Confirm placement
- Use liquid formulation
- Do not add medication to formula bag
- Flush with water to clear tubing of residual medication
Optic medication administration
- Place child in a supine or sitting position
- Extend head and ask child to look up
- Pull the lower eye lid downward and apply medication in the pocket
- Administer ointments before nap or bedtime
- If infants clinch their eyes closed, place drops in the nasal corner
Otic medication administration
- Place the child in a prone or supine position with affected ear upward
- Children younger than 3 yrs pull pinna down and back
- Children older than 3 yrs pull pinna upward and back
- Allow refrigerated meds to come to room temp
- Massage the outer area for a few minutes following administration
Nasal medication administration
- Postion the child with the head extended
- Use a football hold for infants
- Insert the tip into the naris vertically, then angle it prior to administration
Aerosol medication administration
- Use mask for younger children
- Allow parents to hold during treatment
- Use distraction
Rectal medication administration
- Insert beyond the rectum
- Hold the buttocks gently together for 5-10 min
- Halve the medication lengthwise, if necessary
- Perform quickly
- Use distraction
Injection medication administration
- Change needle if it pierced a rubber stopper
- Secure the infant prior to injections
- Assess the need for assistance
- Avoid tracking the medication
Intradermal medication administration
- Administer on the inside surface of the forearm
- Use a TB syringe with a 26-30 gauge needle with an intradermal bevel
- Insert needle at a 15 degree angle
- Do not aspirate
Subcutaneous (SQ) medication administration
- Give anywhere in the SQ tissue
- Inject volumes of less than 0.5 mL
- Use a 1 mL syringe with a 26-30 gauge needle
- Insert at a 90 degree angle
- Use a 45 degree angle for children who are thin
- Check policy for aspiration practices
Intramuscular (IM) medication administration
- Use a 22-25 gauge, 1/2-1 inch needle
- Vastus lateralis is the recommended site in infants and small children
IM medication administration
Vastus lateralis
- Position the child supine, side lying, or sitting
- Inject up to 0.5 mL for infants
- Inject up to 2 mL in children
IM medication administration
Ventrogluteal
- Position the child supine, side lying, or prone
- Inject up to 0.5 mL for infants
- Inject up to 2 mL in children
IM medication administration
Deltoid
- Position the child sitting or standing
- Inject up to 1 mL
Intravenous (IV) medication administration
Peripheral venous access device
- Use a 24-20 gauge catheter
- Use a combination and intermittent IV medication administration
- A child who requires short-term IV therapy may complete it at home with the assistance of a home health nurse
Intravenous (IV) medication administration
Central venous access device
- Short term: non tunneled catheter or peripherally inserted central catheters (PICC
- Long term: tunneled catheter or implanted infusion ports
Atraumatic care
the use of interventions that minimize or eliminate physical and psychological distress
Developmental characteristics of pain:
young infant
- Loud cry
- Rigid body or thrashing
- Local reflex withdrawal from pain stimulus
- Expression of pain (eyes tightly closed, mouth open in a squarish shape, eyebrows lowered and drawn together)
- Lack of association between stimulus and pain
Developmental characteristics of pain:
older infant
- Loud cry
- Deliberate withdrawal from pain
- Facial expression of pain
Developmental characteristics of pain:
toddler
- Loud cry or screaming
- Verbal expression of pain
- Thrashing of extremities
- Attempt to push away or avoid stimulus
- Noncooperation
- Clinging to significant person
- Behaviors occur in anticipation of painful stimulus
Developmental characteristics of pain:
school-age child
- Stalling behavior
- Muscle rigidity
- Any behaviors of the toddler, but less intense in the anticipatory phase and more intense with painful stimulus
Developmental characteristics of pain:
adolescent
- More verbal expression of pain with less protest
- Muscle tension with body control
When is self-report of pain used for children?
older than 4 yrs of age
FLACC pain assessment tool
- Used for 2 months-7 yrs of age
- Pain rated on scale of 0-10
- Assess behaviors of the child
FACES pain assessment tool
- Used for 3 yrs of age and older
- Pain is rated on a scale of 0-5 using a diagram of 6 faces
- Explain each face and ask the child to choose a face that best describes how they are feeling
Outer pain assessment tool
- Used for 3-13 yrs of age
- Pain is rated on a scale of 0-5 using 6 photographs
- Have the child organize pics in order of no pain to the worst pain, then have them choose the pic that best describes how they feel
Numeric scale pain assessment tool
- Used for 5 yrs of age and older
- Pain is rated on a scale of 0-10
- Child reports number and points to it on the scale
- 0 = no pain, 10 = worst pain
Non-communicating children’s pain checklist
- Used for 3-18 yrs of age
- Behaviors observed for 10 min
- 6 subcategories scored from 0-3
- Subcategories include vocal, social, facial, body and limb, physiological, each with observable behaviors to be scored
- 11 or higher = moderate- severe pain
- 6-10 = mild pain
Non pharmacological measure to help with pain in children
- Distraction
- Relaxation
- Guided imagery
- Positive self-talk
- Behavioral contracting
- Containment
- Nonnutritive sucking
- Kangaroo care
- Complementary and alternative medicine
