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)