WCF Exam 1 Flashcards
Family centered care
Entire family is involved in the patient’s care
Use therapeutic communication and include everyone in the decision making process
Barriers to family centered care
Communication, divorced parents, different caregivers, work schedules, and education level
Health promotion
Preventing illness/disease, increase well-being
Anticipatory guidance
Get them ready for the next stage of development
Increase in size
growth
Increase capabilities and ability to adapt
development
How pediatric patients grow & develop
physically, cognitively, socially, and emotionally
Cephalocaudal
head to tail
Proximodistal
Trunk to limbs & fingers/toes
-near to far
-midline to periphery
Gross motor to Fine motor
Walking, running, throwing to writing, buttoning a shirt, grasping small objects
Birth to 1 year
Infant
1 to 3 years
Toddler
3 to 5-6 years
Preschool
6 to 12 years
School-age
12 to 18 years
Adolescent
ERICKSON’S THEORY OF PSYCHOSOCIAL DEVELOPMENT
Trust vs Mistrust
Basic needs must be met, & trust must be learned
■ “Hold me, feed me, take care of me”
Birth to 1 year
ERICKSON’S THEORY OF PSYCHOSOCIAL DEVELOPMENT
Autonomy vs Shame
Controlling body excretions, “no”, balance independence &
self-sufficiency
■ “Watch me do this myself
1 to 3 years
ERICKSON’S THEORY OF PSYCHOSOCIAL DEVELOPMENT
Initiative vs Guilt
Exploring world, creating, resourcefulness to achieve & learn new things
■ “I want to help you; I can do it too”
3 to 6 years
ERICKSON’S THEORY OF PSYCHOSOCIAL DEVELOPMENT
Industry vs Inferiority
New activities, sports, school, sense of confidence
■ “I want to fit in” “What are the rules?”
6 to 12 years
ERICKSON’S THEORY OF PSYCHOSOCIAL DEVELOPMENT
Identity vs Role Confusion
New sense of identity, clear sense of self
■ “I just want my friends” “Who cares, so what”
12 to 18 years
PIAGET’S THEORY OF COGNITIVE DEVELOPMENT
Sensorimotor
Learns from sensory input, language skills
■ Looking, hearing, touching, mouthing, grasping
Infant to 2 years
PIAGET’S THEORY OF COGNITIVE DEVELOPMENT
Preoperational
Increasing verbal limitations in thought. Development of motor skills
■ Using words & images to represent things. Gradually evolves into pretend
play
2 to 6 years
PIAGET’S THEORY OF COGNITIVE DEVELOPMENT
Concrete operational
Organize thought in logical order. Manipulates objects
■ Grasping concrete analogies. Performing math operations
7 to 11 years
PIAGET’S THEORY OF COGNITIVE DEVELOPMENT
Formal operational
Mature, abstract thought & reasoning to handle difficult concepts
■ Looking at moral reasoning
12 years to adulthood
-No head control, flexed position, hands closed but has strong grasp
-Communicates by cooing, babbling, & crying
Newborn
Birth to 1 mos
-Birth weight doubled
-Holds head more erect
-Sits supported
-Rolls over
-Can move objects from hand to hand
-Discovers self- plays with hands, feet, mouth
-Begins to support self in tripod position
-Communicates by cooing, babbling
3 to 6 months
-Birth weight is tripled
-Head and chest circumference are the same
-Creeps, pulls self up on objects, teetering (begins to take steps with assistance)
-Uses pincer grasp
-Begins to hold and release objects (throw)
-Waves bye-bye
-Can understand “no,” say “mama” dada”
-Stranger anxiety
9 to 12 months
Solitary play
Infant
Parallel Play
-Imitate behaviors
-Trade toys and words
Toddler
-Gains about 1.4kg – 2.3kg per year
-Height increases about 3 inches per year
-Walks, climbs, runs, jumps
-Holds objects such as utensils, draws, begins to undress self
Physical changes of toddler
-Temper tantrums, “NO”
-Enjoys pictures, reading aloud & naming objects
Age 1: uses 1word commands, can follow 1 step direction
Age 2: uses 2 words and follows 2-word commands
Age 3: uses 3 words and follows 3-word commands
Cognitive and sensory function of toddler
What can a toddler play with?
Fine/gross motor play
building blocks, scribbling w/crayons, push & pull toys, up & down stairs
Associative play/playing together
Learns rules
Begins to pick up on gender differences
Preschooler
-Gains about 1.5kg – 2.5kg per year
-Height increases about 4-6cm (1.5-2.5 inches) per year
-Walks, climbs, runs, jumps easier
-Tie shoes, fasten buttons
-Draws stick figures
-Can use scissors
Physical changes of preschooler
-Visual acuity sharpens- can focus on letters and numbers
-Concrete thinking
-“Why”, enjoys rhymes, vocabulary 1500-2000 words
Cognitive and sensory function of preschooler
What can preschooler play with?
Fine/gross motor play
-Dramatic play, puppets
-Reading together (learning letters)
-Crafts, can use scissors
-Large motor activities
-Bicycle, climbing, swinging
-Gains about 4-6 pounds per year
-Height increases about 2 inches per year
-Walks, climbs, runs, jumps with precise coordination.
-Additional activities such as swimming, dancing
-Fine dexterity improves- writing, playing instruments, crafting
Physical changes of school age
-Thinking becomes more logical, solve problems
-“why” goes to “how”
-Visually acuity reaches 20/20
-Vocabulary 8,000 to 15,000 words
Cognitive and sensory function of school age
Cooperative play
Goal oriented (winning/losing)
School age
What can school age play with?
Puzzles, reading, games (card and board games)
-Weight: Girls about 15-55 pounds, Boys increases 15-66 pounds
-Height: Girls increase about 2-8 inches, Boys increase about 4-12 inches
-Secondary sex characteristics develop
-Endurance and coordination start to peak
-Fine dexterity sharpens allowing for effortless manipulation of objects
Physical changes of adolescents
-Can think in abstract terms, hypothesize
-Can use future time perspective
-Vocabulary of 50,000 words
Cognitive and sensory function of adolescent
Psychosocial development of adolescent
-Mainly guided by peer influence
-Push pull dynamic with parental/caregiver units
-Continues with cooperative play (bargaining, negotiating)
Components of pedi assessment
General health hx:
Nutrition
PMH including birth history
Play/activity/sleeping patterns
Family History
Social/Psychosocial history
Immunizations-UTD?
Developmental milestones
Physical exam:
Assessment
Vital signs
Measurements
Physical assessment should be completed with _________ invasive to _________ invasive.
least to most
Physical Assessment Approach
-Start with non-invasive procedures
-Save ears, throat, etc. for last
-Separation anxiety – always keep parent close
-Examine in parent’s lap for as much of exam
-Neurologic portion of exam will include several more reflex assessments
Infant
Physical Assessment Approach
Allow child to remain in parent’s lap
Let child get comfortable/used to being in room, before starting
Don’t ask for permission to perform exam
Give choices when possible.
Use distractions when needed.
Toddler
Physical Assessment Approach
More cooperative
Sense of body image
Fear of mutilation
Use simple explanations
Have child participate
Use games
Preschool
Physical Assessment Approach
Child should sit up on the table.
Explain what you are doing
Take the opportunity to teach about the body
School Age
Physical Assessment Approach
Do physical examination alone
Teen may request parent’s presence
Talk with teen throughout exam
Good opportunity to provide teaching about maturing body, physical changes.
Be non-judgmental
Confidentiality
Cover sensitive topics when parents are out of room.
Adolescent
Height is always documented in _________ and weight is always documented in ________.
centimeters (cm), kilograms (kg)
The Hospitalized Pedi Family
Caregiver Issues
Anxiety/fear
Disrupts routines
Role changes
Financial strain
Discharge/caring at home
The Hospitalized Pedi Family
Sibling Issues
Little attention from parents
Perception of illness (Lack of understanding, Feel guilty)
Nightmares, behavioral problems
The Hospitalized Pedi Family
Patient Issues
Separation and/or stranger anxiety- fear of being alone
Immobilization
Sensory overload
Loss of control
Painful procedures
Fear of the dark
Loss of privacy/bodily functions
Fear of death
Fear of altered body image
Pediatric Coping Mechanisms
Regression, repression, rationalization, & fantasy
Comfort positions to reduce stress and anxiety for pedi pt
Back to chest bear hug, Frog hold, Chest to chest bear hug, and Side support hold
Pedi procedural support
Educate- Age-appropriate, allow questions & expression of fears
Appropriate Environment- Treatment rooms, positioning
Comfort- Caregivers at bedside, pain management, bottle feed
Play therapy- Role playing, role modeling, dolls, toys, distraction….utilize child-life specialist
Rewards & prizes
Safety is a major concern based on developmental level.
True
Pedi Med Admin 6 Rights
Same as adult
Right pt, drug, dose, route, time, and documentation
Can you administer a medication in a baby’s bottle?
No!
Skip generation
Grandparents parenting grandchildren
Bowen’s Family System Theory
Families tend to be dependent on each other to an extent.
What happens to one person will have a positive or negative impact on the other members, including their feelings and what their thinking about.
Primary Prevention/Intervention
Health promotion –> Disease prevention
Healthy habits, vaccines
Secondary Prevention/Intervention
Early detection
Pap smear, mammogram
Tertiary Prevention/Intervention
Health restoration
Inpatient or outpatient treatment, doula postpartum home care
Types of Minimal Intervention Contraceptive
Abstinence, fertility awareness (FAM), lactational amenorrhea method (LAM)
Effectiveness of minimal intervention contraceptives
71-75%
98% LAM
Advantages & disadvantages of minimal intervention contraceptives
Advantages: no tools needed, easy to start and stop
Disadvantages: planning/calculations, high failure rate, limited time of use
Types of Barrier Contraceptive
Condoms, Diaphragm/cervical cap, sponge
Effectiveness of barrier contraceptives
80-85%
Advantages & disadvantages of barrier contraceptives
Advantages: no meds, easy to start and stop
Disadvantages: fitting required, messy, planning, high failure rate
Types of Hormonal (Combined) Contraceptives
pills daily, patch weekly, ring monthly
Effectiveness of hormonal (combined) contraceptives
95%
Advantages & disadvantages of hormonal (combined) contraceptives
Advantages: cycle control, treatment for GYN disorders, easy to start and stop
Disadvantages: side effects, weight gain, mood changes, contraindications (Smokers increased risk of blood clots due to estrogen), no protection against STIs
Types of Hormonal (Progestin only) Contraceptives
Mini pill (POP) daily, Depo injection every 3 mos, Nexplanon impant every 3 yrs
Effectiveness of hormonal (progestin only) contraceptives
92-99%
Advantages & disadvantages of hormonal (progestin only) contraceptives
Advantages: no estrogen side effects, fewer contraindications, longer coverage (injection and implant)
Disadvantages: unpredictable bleeding, precise use required (POP), delay in fertility (Depo), requires placement/removal procedure (Nexplanon implant)
Types of IUDS Contraceptives
Progestin (Mirena, Skyla, Liletta, Kyleena) 3-5 yrs
Non-Progestin (Paragard) 10yrs
Effectiveness of IUDs contraceptives
98-99%
Advantages & disadvantages of IUDs contraceptives
Advantages: longer coverage, minimal bleeding (progestin), normal menstrual cycles (non-progestin)
Disadvantages: requires placement/removal procedure, side effects- weight gain & mood changes, risk of perforation, irregular menses (progestin), heavy & painful menses (non-progestin)
For pts with HA/migraines & hypertension, avoid contraceptive options with
estrogen
Types of Permanent Contraceptive
Bilateral tubal ligation (BTL), Vasectomy
Effectiveness of permanent contraceptives
96-99%
Advantages & disadvantages of permanent contraceptives
Advantages: definitive procedure, no hormonal side effects
Disadvantages: requires placement procedure/surgery, definitive procedure, complications, side effects
Can a vasectomy be reversed?
Yes
Clinical termination of pregnancy (abortion) procedures
Performed to deliberately end a pregnancy before the fetus reaches a viable age
Meds: Mifeprex/Methotrexate
Usually done < 9 weeks
Surgical: Vacuum aspiration
Usually done by 12 weeks
Average time of conception
6 months
Considered __________ with active cycle monitoring after one year.
infertile
Pre-conceptual health promotion
-med evaluation
-prenatals
-genetic factors
Female fertility factors
-ovulation
-anatomy/uterus
Male fertility factors
-azoospermia (no measurable sperm in semen)
Treatment for infertility
-Address inhibiting factors
-Facilitation/team approach
-Assisted reproduction: Invitro Fertilization (IVF) Intrauterine insemination (IUI)
Presumptive signs of pregnancy
What does the pt feel?
P- period absent (amenorrhea)
R- really tired (fatigue)
E- enlarged breast
S- sore breast
U- urination increased
M- movement of fetus in uterus (quickening or fluttery sensation in lower abdomen; 20th week in first-time moms, maybe a little earlier in 2nd time moms)
E- emesis and nausea
Probable signs of pregnancy
What does the provider observe?
P- positive pregnancy test
R- returning of fetus against fingers when uterus is pushed during palpation) “eternal ballottement”
O- outline of fetus can be palpated
B- Braxton Hicks contractions (false labor)
A- a softening of the cervix (“Goodell’s sign”)
B- bluish color to the vulva, cervix, vagina (“Chadwick’s sign”)
L- lower uterine segment becomes soft (“Hegar’s sign”)
E- enlarged uterus
Positive signs of pregnancy
What do the tests confirm?
F- fetal movements felt by provider
E- electronic device detects fetal heart sounds (Doppler)
T- the delivery of baby
U- ultrasound detects fetus
S- see visible movement of baby by provider
What is Nagele’s Rule?
1st day LMP –> Minus 3 months –> Plus 7 days
What is an EDD?
Estimated Delivery Date Pregnancy Wheel
Pre-embryonic period
First 2 weeks after conception
Rapid cellular multiplication and differentiation
Fertilization
Cellular multiplication
Embryonic period
From 3rd week after fertilization through end of 8th week
Fetus at 8 weeks
Carries oxygenated blood from placenta to fetus
umbilical vein
Removes waste, deoxygenated blood from fetus to placenta
umbilical artery
Placenta does
EVERYTHINGGGGGGGG
Protects fetus
Provides oxygenation, nutrition, waste elimination, and hormones
Placenta is fully functional at
12 weeks
Early protective structures
amniotic membranes
Fetal urine and lung secretions primary contributors
amniotic fluids
Conception to 12 weeks
First Trimester
Can hear heartbeat on doppler by
week 10
Face with recognizable features by
week 10
13 to 27 weeks
Second Trimester
Fluttery feeling, similar to gas
quickening
Lubricant for the lungs, prevent alveoli from collapsing
surfactant
Quickening and lanugo by
week 20
Fetal respiratory movements and surfactant production by
week 24
28 to 40 weeks
Third Trimester
Uterine changes
Increased vascularity- more blood flow
Dilation of blood vessels
Hyperplasia (Increase in uterine tissue by increased number of cells)
Hypertrophy (Increase in uterine tissue by increased size of cells)
Development of decidua (Thick uterine membrane lining
Cervical changes
Chadwick’s sign
Leukorrhea
Hager’s sign
Goodell’s sign
Chadwick’s sign
violet-blue color of mucosa and cervix
Leukorrhea
white discharge
Hager’s sign
softening of lower uterine segment
Goodell’s sign
softening of cervical tip
Vaginal prep for eventual delivery
Thicker mucosa
Looser connective tissue
Hypertrophy muscles
Lengthening of vaginal vault
Colostrum
1st breastmilk, rich w/nutrients and fats
Breast changes
Fullness
Heaviness
Vessel dilation
Heightened sensitivity
Areolae more pigmented
Montgomery’s tubercles
Colostrum
Integumentary (skin) changes
Chloasma
Linea nigra
Striae gravidarum
Chloasma
the mask of pregnancy, can be permanent
Neurological changes
Decreased attention span/concentration/memory
Headaches/Carpal tunnel syndrome/sciatica
Syncope
Musculoskeletal changes
Lordosis
Diastasis recti abdominis
Cardiovascular changes
BP changes (supine hypertension)
Stasis of blood in lower extremities
Cardiac hypertrophy
Palpitations
Anemia
Increased plasma
Respiratory changes
Increased O2 consumption
Elevated diaphragm
Increased chest circumference –> dyspnea
Nasal stuffiness, congestion
Epistaxis
Renal changes
Enlarged renal pelvis
Kidneys work harder to filter increased blood volume
Upper GI changes
N/V in early pregnancy
Pica- non-food eating
Gums bleeding
Difficulty swallowing
Heartburn
Lower GI changes
Abd discomfort
distention, cramping, constipation, gas, pelvic pressure
Total # of pregnancies
Gravida
Total # of viable pregnancies after 20 weeks
Para
Nulligravida
woman has never experienced a pregnancy
Primigravida
woman pregnant for the first time
Multigravida
woman is pregnant for the third (or more) time
GTPAL
G=Gravidity (# of pregnancies)
T=Term (37-42 weeks)
P=Preterm (20-36.6 weeks)
A=Abortion (miscarriage or abortion 0-19.6 weeks)
L=Living (# of children)
When is the first prenatal visit?
During 4-8 weeks
Frequency of prenatal visits during first trimester
Conception to 12 weeks
every 4 weeks
Frequency of prenatal visits during second trimester
13 to 27 weeks
every 4 weeks
Frequency of prenatal visits during third trimester
28 weeks to birth
every two weeks until 36 weeks, then it changes to every week
Common pregnancy misconception re: diet
Eating for two
How much water should you drink during pregnancy
8-10 glasses per day
Caloric increase during pregnancy
300kcal/day
Recommended weight gain for underweight women during pregnancy
28-40lbs
Recommended weight gain for normal weight women during pregnancy
25-35lbs
Recommended weight gain for overweight women during pregnancy
12-25lbs
Recommended weight gain for obese women during pregnancy
11-20lbs
Health promotion for pregnant women
Continue exercising- low impact, non-contact
Lifestyle- low stress, safe environment, discontinue smoking/alcohol use, substance abuse
Meds- caution
First Trimester Testing
Screening Tests
-DNA testing
-Dating ultrasound
-H&H
-Blood type/Rh factor
-Syphilis test (RPR)
-Rubella
-Hep B screen
-HIV
Diagnostic Tests
-CVS
Second Trimester Testing
Screening Tests
-MSQS
-Anatomy scan (U/S)
Diagnostic Tests
-Amniocentesis
Third Trimester Testing
Screening Tests
-Fetal kick counts
-GTT
-GBS
-H&H
-Blood type
-Syphilis test (RPR)
Advanced Fetal Assessment
-Ultrasound/growth
-NST/BPP
-Doppler studies
Diagnostic testing will be completed if there are
abnormal findings during screening
Screening
Identify if pt is at risk
Diagnostic
more invasive & confirmation of presence of disorder
Screening completed at first OB appointment
H&H and Syphilis test (RPR)
Is free fetal DNA testing routine?
No
When can fetal DNA testing be completed?
as early as 10 weeks
What does fetal DNA testing check for?
Trisomy 13, 18, and 21
Indications for fetal DNA testing
High risk pt
-maternal age 35 or older
-hx of chromosomal anomalies
-suggestive results from U/S
-positive results from other serum tests
When is nuchal translucency (NT) by ultrasound completed?
11-14 weeks
Increased risk of trisomy 13, 18, and 21 if the measurement is greater than
3mm
Does NT check for neural tubes defect?
No, still need AFP testing
Is chronic villus sampling (CVS) routine?
No, it is a diagnostic test
What does CVS check for?
genetic disorders
Does CVS check for neural tube defects?
No
Is CVS non-invasive?
It is very invasive and only completed if absolutely necessary
Risk of CVS
spontaneous abortion
When is CVS completed?
10-13 weeks
When is Maternal Serum Quad screening completed? Is it routine?
Valid results from 15-22 weeks, yes
If AFP results are high, think
NTDs
If AFP results are low, think
down syndrome
Why is AFP not usually used in multiple pregnancies?
Hormone levels are high in cases of pregnancies of multiples (twins/triplets/etc)
Is a positive AFP test diagnostic?
No, requires further follow up such as amniocentesis
What hormones are being looked at in MSQS?
Estradiol, Inhibin-A, Hcg, and AFP
When is the anatomy scan completed? Is it routine?
18-22 weeks, yes
Diagnostic testing completed during second trimester (15+ weeks)
Amniocentesis
What does amniocentesis check for?
Trisomy 13, 18, and 21
Open NTDs
Hemolytic disease
Risks of amniocentesis
Spontaneous abortion (miscarriage) and infection
When is Gestational Diabetes (GTT) screening completed? Is it routine?
24-28 weeks, yes
What does GTT check for?
gestational diabetes
When is a 3hr GTT completed?
If failed 1hr GTT
Thresholds of GTT
<130-140mg/dL no GDM
>130-140mg/dL then 3hr GTT needs to be completed
Is 3hr GTT non fasted- or fasted?
fasted
If two values are above the designated thresholds
GDM
When is GBS screening completed? Is it routine?
36-37 weeks, yes
For GBS, what is swabbed?
vagina and butt
What does GBS screening check for?
overgrowth of group B streptococcus
What is fetal kick counts used for?
monitor fetal movements and well-being
How early can FHR be heard on doppler?
@ 10 weeks
Advanced fetal assessment
NST (start here)
BPP (biophysical profile)
Doppler studies
Are advanced fetal assessments routine? Why is it completed?
Not routine; fetus not growing, decreased movement
Do you want a reactive or non-reactive stress test result?
REACTIVE
Reactive NST
2 or more accelerations of 15 BPM lasting 15 seconds within a 20min time frame
Normal FHR
110-160 BPM
Non-reactive NST
Doesn’t meet criteria for reactivity, indicates the need for further testing –> biophysical profile
Perfect score of BPP
8/8
Fetal Parameters of BPP
Muscle tone, movement, breathing pattern, amniotic fluid volume, and reactive NST
BPP score of 4/8 means
baby is in distress
