Week 1 - Pediatric Physical Exam Flashcards
Where is the apical pulse located?
2 part answer
over the mitral valve
4th intercostal space, left mid-clavicular
Which pulse gives you the best assessment when you can’t assess the apical pulse?
Brachial pulse
How long should you assess respirations for in PEDs
1 minute
Where are respirations assessed?
front, sides, back
What is the appropriate width for the bladder of a blood pressure cuff?
40% of the circumference of the upper arm (midway)
When can it be appropriate to assess BP on the leg
when child is <1 year
what are some comfort measures used in pediatrics?
- rattle
- sugar water
- pacifier
age-appropriate techniques: infant
- examine on parents lap
- comfort measures
age-appropriate techniques: toddler
- examine quickly
- let them play w/ equipment
age-appropriate techniques: preschooler
explain what you are doing
age-appropriate techniques: school-age
- privacy/modesty
- elicit their participation
age-appropriate techniques: adolescent
confidentiality
What is the Flax score, and when is it used?
Pain scale
used for non-verbal children
Newborn Reflexes: Rooting
3-4 months
Newborn Reflexes: Palmar Grasp
3-4 months
Newborn Reflexes: Plantar Grasp
8-10 months
Newborn Reflexes: Tonic Neck
3-4 months
Newborn Reflexes: Moro Refelx
4 months
Newborn Reflexes: Stepping
1 month
Newborn Reflexes: Babinski
1 year
US Children’s Bureau established
1912
Maternity & Infant act
1921
National School Lunch Program
1946
Head Start est.
1964
WIC est. (Women, Infants, Children)
1966/1974
SSI for Disabled Children
Supplemental Security Income
1976
Bright Futures
1990
FMLA
family and medical leave act
1993
Children’s Health Act
2000
Affordable Care Act
2010
Birth to Five: watch me thrive
2014
WHO definition of “Health”
A state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity
Role as Pediatric Nurse
Promote and assist the child and family in maintaining optimal levels of heath
How to carry out role as pediatric nurse:
- focus on the family (family-centered, culturally competent)
- Provide atraumatic therapeutic care (minimize physical/psychological stress for children/families)
- Use EBP (base plan of care on research)
3 ways to promote optimal levels of health/care:
- family-centered/competent care
- atraumatic care
- EBP
promote optimum growth + development through health…
health education
be an ___, an ___, and a ____
advocate, educator, manager
Serve pt.’s as a ____, _____, and ___
collaborator, care coordinator, consultant
What to know/do for Informed Consent
- does parent/guardian understand what they’re signing
- assess parent/legal guardians understanding (assess)
- clarify/resolve knowledge deficits
- ensure consent forms are signed/complete
- Serve as witness to consent process
- children >8 = assent form?
How old must a child be in order to sign an assent form?
> 8 yo
What is Pediatric Assent
takes into account the child’s perspective of how they want their healthcare to proceed
5 thins an Assent does:
- affirms child’s participation
- helps the child to understand their condition
- Informs child of their Tx/ care (what to expect)
- Cannot be unduly influenced
- ascertains child’s willingness to participate
T/F. A parent CANNOT override Assent.
False
T/F. The assent will NOT go in the child’s chart
False
Genetic influences on child health (4)
- Sex & gender
- Race
- Genetically linked diseases
- Temperament (genetic + environmental influences)
What is the Temperament Theory?
Describes how a child interacts w/ the environment
T/F- a child’s temperament has a corresponding influence on those around the child (positive or negative).
True
temperament may affect the family unit
T/F- a parent does NOT react to the child based upon the child’s temperament
False
(infants are characterized as easy, difficult or challenging, or slow to warm up
T/F- a child typically only fits into one temperament subgroup.
False
a child may be a combination of these types
What are the subgroups of “Temperament”? (3)
- easy
- difficult / challenging/ highly reactive
- slow to warm up
T/F- an assessment of temperament should be made initially, during the first encounter with the child.
False
temperament should be assessed after multiple encounters
T/F- a child who is highly reactive and reacts to new experiences by withdrawing in frustration is classified as having a “slow to warm up” temperament
False
(highly reactive and reacts to new experiences by withdrawing in frustration is classified as having a “difficult [challenging or highly reactive] temperament”
Rationale: children w/ a “slow to warm up” temperament may initially complain, react with mild passive resistance, need more time to warm up. “Easy” children adapt quickly to new experiences
Biological influences on health
- genetics
- in utero exposure to teratogens
- postpartum illness (mother cannot care for child)
- nutrition
- exposure to hazardous substances
- maturation
- exposure to stressful events
Lifestyle influences on child health
- patterns of eating
- exercise
- use of tobacco
- drugs
- alcohol
- methods of coping w/ stress
T/F- the lifestyle of parents doesn’t necessarily determine the lifestyle of the children.
False
e.g.- inactive parents who eat poorly teach their children the same behavior (results- diabetes, obesity, heart disease)
Types of stress affecting children:
- Societal (starting school, new babysitter)
- Family stress (conflict in home, divorce, new baby)
- Societal (poverty, lack of basic needs
- Physical (illness, trauma, normal growth/development
coping with stress may be expressed with which kind of symptoms?
somatic symptoms
can prior experience w/ stress contribute to ability to respond positively to stress?
yes
What is coping influenced by? (2 elements)
- Temperament
2. Developmental stage
What is Resilience?
The qualities that enable an individual to cope with adverse events and stress and still function completely and have positive outcomes
Two Protective factors promoting Resiliency
- Internal
2. External
Internal resiliency
ability to take control, be proactive and having responsibility for own decisions
- understanding/accepting own limits & abilities
- being goal-directed, knowing when to continue or stop
Externa Resiliancy
- having caring relationships
- having positive learning environments and positive influences in the community
4 barriers to health care
- Financial (lack of insurance, cost of med.’s)
- Ethnic (cultural expectations encourage obesity in children)
- Sociocultural (language/cultural barriers)
- Health care delivery system (fragmented care)
T/F- The role of the family is limited to providing physical care to child.
False
Rationale: parents (guardians) impart the rules and expected behaviors of society through teaching and discipline techniques as well as caring for the physical and emotional needs of the growing child
UNICEF/WHO - major problems for global child health (diseases)
- Acute respiratory infections (pneumonia)
- Malnutrition (micronutrient deficiency)
- Diarrhea (r/t lack of clean water/sanitation)
- vaccine-preventable disease (measles
- malaria
- preterm birth complications (birth asphyxia)
- poor health care of pregnant and nursing mothers
