Week 2 Content Flashcards
IM injections for kids 3 years+ location
deltoid
Preschooler Growth
- More _______ posture
- Each year gains about ___ lbs
- Each year gains about ___ inches in height
- More slender posture
- Each year gains about 5 lbs
- Each year gains about 2.5 inches in height
Preschoolers SOCIAL/Cognitive progession
Learns ______ and shapes
Learns ________ identity
Learns colors and shapes
Learns sexual identity
Preschoolers: Physical: LEARN
Learns to ____ jump skip and hop
Rides a ________ -3yr
Can use ________ 4yr
Learns to run jump skip and hop
Rides a tricycle -3yr
Can use scissors 4yr
3-6 y.o safety
- _______ safety
- Helmets
- _______ safety
- ________ safety
- Appropriate ____ Seat
- Nutrition
- _______ Times
- Traffic safety
- Helmets
- Water safety
- Stranger safety
- Appropriate Car Seat
- Nutrition
- Screen Times
Preschooler DEVELOPMENT (theories)
SOCIAL - Erikson’s __________________
COGNITIVE - Piaget’s - _______________
SOCIAL - Erikson’s Initiative Vs Guilt
COGNITIVE - Piaget’s - Still pre-operational
Erikson—SOCIAL- Initiative vs Guilt
Example: Small successes with performance for example “when playing games” builds confidence and supports initiative to __________________ - When a child fails due to inappropriate expectations leads to _____ and loss of initiative
Example: Small successes with performance for example “when playing games” builds confidence and supports initiative to try new activities- When a child fails due to inappropriate expectations leads to guilt and loss of initiative
Piaget—Cognitive- Preoperational Thought (last 2-7 years)
Varying development during preschool years.
Pretends, ___________ is developing
Separation from Parents during Hospitalization
huge _______ during this stage.
Varying development during preschool years.
Pretends, Imagination is developing
Separation from Parents during Hospitalization
huge FEARS during this stage.
Preschooler : CARE ISSUES
Very ___________ : Thinks they cause their own illnesses by being bad
Thinks painful procedures are ___________
Fear of mutilation: BANDAIDES ARE GOOD
Very egocentric: Thinks they cause their own illnesses by being bad
Thinks painful procedures are punishment
Fear of mutilation: BANDAIDES ARE GOOD
Preschooler - ______________ is beneficial- for example show IV procedure using a doll .
Also helps for them to handle medical equipment
Medical play is beneficial- for example show IV procedure using a doll .
Also helps for them to handle medical equipment
Preschool age - pain tool
_________________
Wong Baker Faces
Well Preschooler visits:
Goal - pick up _______ _______: Interventions EARLY
Goal - pick up delays early: Interventions EARLY
Instructions for Use of FACES Pain Tool
Explain to the child that each face represents a person who has no pain (hurt), or some, or a lot of pain.
“Face 0 doesn’t hurt at all. Face 2 hurts just a little
bit. Face 4 hurts a little bit more” and so on.
Explain to the child that each face represents a person who has no pain (hurt), or some, or a lot of pain.
“Face 0 doesn’t hurt at all. Face 2 hurts just a little
bit. Face 4 hurts a little bit more” and so on.
Preschooler and Pain
- ___________ can be a useful tool at this age- books, music, IPAD… for painful procedures
- May ______ pain if they fear a shot
- Distraction can be a useful tool at this age- books, music, IPAD… for painful procedures
- May deny pain if they fear a shot
Pain - Children as young as ___ years of age are able to report the location and degree of pain
3
Remember that Chronic Pain such as Sickle Cell Pain
does not always present with _______________________________________
physiologic responses such as ↑RR and HR.
Leukemia - Cancer of the :
Blood and Bone Marrow
__________ - Among children (ages 0 to 14 years), the most common types of cancer
Leukemia
Leukemia is the Most __________ ___________ _________
Common Childhood Cancer
Leukemia: 4 Major Types- all have proliferation of immature WBCs
Type of Leukemia based mainly on whether:
*the leukemia is _______ or ________
*where the leukemia starts in ____________ or _____________
Type of Leukemia based mainly on whether:
*the leukemia is acute or chronic
*where the leukemia starts in myeloid cells or lymphoid cells.
Leukemia : 4 Major Types
- __________________ This is the most common type of leukemia in young children. (most commonly dx 2-5 years of age)
- ___________________ is the most common acute type of leukemia in adults
- Chronic lymphocytic leukemia (CLL)
- Chronic myelogenous leukemia (CML)
- Acute lymphocytic leukemia (ALL). This is the most common type of leukemia in young children. (most commonly dx 2-5 years of age)
- Acute myeloid leukemia (AML) is the most common acute type of leukemia in adults
- Chronic lymphocytic leukemia (CLL)
- Chronic myelogenous leukemia (CML)
Blood Cell Types: effected by Leukemia
Platelets: Also known as Thrombocytes
Platelets play a major role in ____________.
Low platelet count is ________________.
Platelets play a major role in blood clotting.
Low platelet count is THROMBOCYTOPENIA
Untreated Leukemia
* White blood cells never reach maturity and have no ability to fight infection
* The ___________ of white blood cells will invade (basically clog up) the liver , kidney and spleen and cause multi _______ _________
* Spleen over reacts removing good red blood cells and platelets
- White blood cells never reach maturity and have no ability to fight infection
- The proliferation of white blood cells will invade (basically clog up) the liver , kidney and spleen and cause multi organ failure
- Spleen over reacts removing good red blood cells and platelets
Lifespan of a platelet is ________
5-7 days
Blood cell types: effected by Leukemia
- RBC’s are responsible for _____________ _____________________. (lifespan is about 120 days)
oxygenation of bodily tissues
Blood cell types: effected by Leukemia
- WBC’s responsible for __________ ________:
- Neutrophils – (lifespan is 6-8 hrs)
- Monocytes- (lifespan is 8 hrs.)
- Eosinophils-mount the __________ response- (lifespan is 5-24 hrs
- WBC’s that make antibodies
- Lymphocytes – B and T cells (lifespan 1 week to a few months)
- Monocytes –kill and eats micro organisms and also boost immune system (lifespan 1-5 days)
- WBC’s responsible for fighting infection:
- Neutrophils – (lifespan is 6-8 hrs)
- Monocytes- (lifespan is 8 hrs.)
- Eosinophils-mount the allergic response- (lifespan is 5-24 hrs
- WBC’s that make antibodies
- Lymphocytes – B and T cells (lifespan 1 week to a few months)
- Monocytes –kill and eats micro organisms and also boost immune system (lifespan 1-5 days)
CBC : Patient with ALL
Patients present with signs of bone marrow failure
________- Pallor, weakness, persistent fatigue lethargy
______________ – bruising, petechial and bleeding
__________-fever and infection
Bone and joint pain
↑Liver and lymph nodes
Bone Marrow Aspirate will 80-90% immature Blasts (normal is 5%)
Anemia- Pallor, weakness, persistent fatigue lethargy
Thrombocytopenia – bruising, petechial and bleeding
Neutropenia-fever and infection
Bone and joint pain
↑Liver and lymph nodes
Bone Marrow Aspirate will 80-90% immature Blasts (normal is 5%)
______ _________ __________
*Will diagnose the type of Leukemia
*Once type of Leukemia is determined specific treatment can begin.
Bone Marrow Aspirate
Chemo and Radiation effects:
- The Hematopoietic system –bone marrow ___________
- The Gastrointestinal and the integumentary system
Both are composed of rapidly dividing cells. Therefore they are susceptible to the ________ effects of chemo and radiation.
- The Hematopoietic system –bone marrow suppression
- The Gastrointestinal and the integumentary system
Both are composed of rapidly dividing cells. Therefore they are susceptible to the cytotoxic effects of chemo and radiation.
The provider tells you to take a rectal temp on Bethany, because he wants the most accurate data possible. Your response is:
a) As you wish.
b) It could get messy; I really rather not.
c) She is too old for rectal temps.
d) It’s contraindicated for a patient in Bethany’s condition.
d) It’s contraindicated for a patient in Bethany’s condition.
SEVERE Neutropenia is defined as an absolute neutrophil count (ANC) < ____
500
Worse-case scenario from F&N
* _______ shock
* ____________ medicine.
- Septic shock
- Resuscitation medicine.
__________ Puncture - if meningitis is suspected
Lumbar
Thrombocytopenia
* ___________ suppression also results in decreased platelet count.
* Normal platlet count ___________________
- Bone marrow suppression also results in decreased platelet count.
- Normal platlet count 150,000-450,000 (150k-450k)
Mucositis (GI)
* ______ that have developed in the oral mucosa.
* Occurs in pts who have had _______ or radiation.
* Cell __________ occurs consequent to chemo and
radiation–initiates inflammatory response.
* Mucosa is vulnerable to trauma, ulceration and
infection.
- Sores that have developed in the oral mucosa.
- Occurs in pts who have had chemo or radiation.
- Cell destruction occurs consequent to chemo and
radiation–initiates inflammatory response. - Mucosa is vulnerable to trauma, ulceration and
infection.
diarrhea treatment…
* Avoid ____ foods, and those high in ______ (osmotic).
- Avoid fatty foods, and those high in sugar (osmotic).
SICKLE CELL ANEMIA
AUTOSOMAL _____________ INHERITED DISEASE
RECESSIVE
______ AFRICAN AMERICANS CARRY THE SCD TRAIT
1 IN 13
SICKLE CELL ANEMIA
HEMOGLOBIN ___ REPLACES NORMAL HEMOGLOBIN
- HEMOGLOBIN S IS VULNERABLE- LIFESPAN <___ DAYS- CHRONIC ANEMIA
- ↑__________ OCCURS
-DEHYDRATION
-COLD WEATHER (CAUSES VASOCONSTRICTION)
-STRESS
HEMOGLOBIN S REPLACES NORMAL HEMOGLOBIN
- HEMOGLOBIN S IS VULNERABLE- LIFESPAN <40 DAYS- CHRONIC ANEMIA
- ↑SICKLING OCCURS
-DEHYDRATION
-COLD WEATHER (CAUSES VASOCONSTRICTION)
-STRESS
VASA OCCLUSIVE CRISIS
SICKLING RBCS ___________ AND _________
- BONE INFARCTS
- NECROSIS OF FEMORAL HEAD
- ISCHEMIC STROKE
- ACUTE CHEST SYNDROME
- PULMONARY HYPERTENSION
- PRIAPISM
SICKLING RBCS CLUMP UP AND OBSTRUCT
- BONE INFARCTS
- NECROSIS OF FEMORAL HEAD
- ISCHEMIC STROKE
- ACUTE CHEST SYNDROME
- PULMONARY HYPERTENSION
- PRIAPISM
SCD - PAIN CRISIS
- _______ 10/10 PAIN
- ABDOMEN
- THORACIC
- MUSCLE
- BONE
SEVERE
____________
- A MYELOSUPPRESSIVE AGENT; THE ONLY EFFECTIVE DRUG PROVEN TO REDUCE FREQUENCY OF PAINFUL EPISODES. (SCD)
- IT RAISES THE LEVEL OF NORMAL HEMOGLOBIN F AND THE HEMOGLOBIN LEVEL. IT USUALLY DECREASES THE RATE OF PAINFUL EPISODES BY 50 %.
HYDROXYUREA
IRON DEFICIENCY ANEMIA
DUE TO _________________, CHILDREN NEED MORE IRON THAN ADULTS
RAPID GROWTH
IRON HELPS RBCS _______ __________
CARRY HEMOGLOBIN
IRON DEFICIENCY ANEMIA
SERUM _____________ LEVELS ARE LOW
HEMOGLOBIN
IRON DEFICIENCY ANEMIA CAUSES:
INADEQUATE FETAL _______
LIMITED _________ INTAKE
CHRONIC _______ LOSS
POOR ____________ BY THE BODY- (CELIAC’S, CRONE’S, ULCERATIVE COLITIS)
INADEQUATE FETAL STORES
LIMITED DIETARY INTAKE
CHRONIC BLOOD LOSS
POOR UTILIZATION BY THE BODY- (CELIAC’S, CRONE’S, ULCERATIVE COLITIS)
MOST COMMON AGES - IRON DEFICIENCY ANEMIA
* AGE 12-36 MONTHS OLD
* ADOLESCENT FEMALES
- AGE 12-36 MONTHS OLD
- ADOLESCENT FEMALES
CBC with Iron Deficiency Anemia
↓ Low ________
↓ Low mean corpuscular volume (MCV)
↓ Low mean corpuscular hemoglobin concentration (MCHC)
↑ Elevated platelet count (>450,000/μL) in many cases.
↓ Low Hemoglobin
↓ Low mean corpuscular volume (MCV)
↓ Low mean corpuscular hemoglobin concentration (MCHC)
↑ Elevated platelet count (>450,000/μL) in many cases.
COW’S MILK AND IRON DEFICIENCY ANEMIA
* AT ABOUT ___ MONTHS MOST INFANTS CAN CHANGE FROM FORMULA TO WHOLE MILK
* COW’S MILK INTERFERES WITH IRON ABSORPTION
* IRON SUPPLEMENTS SHOULD NOT BE GIVEN WITH COW’S MILK
* LIMIT COW’S MILK INTAKE TO 24-32 OZ PER DAY
12
Otitis Media
- Infection of ______________
- Common illness, highest incidence 6 months to 2 years
- Accumulation of pus and mucus behind _________, blocking eustachian tubes causing pain, swelling
- Decreased risk of otitis media with pneumococcal and influenza vaccinations, breast feeding and
avoiding tobacco smoke
- Infection of the middle ear
- Common illness, highest incidence 6 months to 2 years
- Accumulation of pus and mucus behind eardrum, blocking eustachian tubes causing pain, swelling
- Decreased risk of otitis media with pneumococcal and influenza vaccinations, breast feeding and
avoiding tobacco smoke
Otitis Media
Risk ________ ______ if chronic/persistent condition untreated
hearing loss
Tonsillitis
- Tonsils ________ from viral or bacterial infections
- Sore throat can interfere with breathing, nasal and sinus drainage, sleeping, swallowing, speaking and hearing.
- _________ treatment necessary if related to
streptococcal infection (strep throat) can lead to rheumatic heart disease and glomerulonephritis - Refer all children with sore throats for throat _________ to prevent complications from step infection
- Tonsils inflamed from viral or bacterial infections
- Sore throat can interfere with breathing, nasal and sinus drainage, sleeping, swallowing, speaking and hearing.
- Antibiotic treatment necessary if related to
streptococcal infection (strep throat) can lead to rheumatic heart disease and glomerulonephritis - Refer all children with sore throats for throat cultures to prevent complications from step infection
Chronically enlarged tonsils can cause upper airway obstruction that leads to ____________
sleep apnea
___________ for multiple recurrent infections as well as sleep apnea
Tonsillectomy
Laryngotracheobronchitis (croup)
* A _____ infection that leads to swelling of the throat
viral
Epiglottitis - Severe life-threatening __________ _________ of the epiglottis
- Progresses rapidly, causing acute upper airway ____________
Severe life-threatening bacterial infection of the epiglottis
- Progresses rapidly, causing acute upper airway obstruction
Epiglottitis
Do not examine throat (no tongue blade or any object in throat) because of risk of :
obstructing the airway completely
_________ : Prevented by DTaP- Violent “Staccato” Coughing
- Whooping Cough
- Highly Contagious
- Bacterium Bordetella Pertussis
- Droplet Isolation
- Still around most likely due to waning immunity in adults
- Deadly risk for newborn too young for immunization
Pertussis
Bronchiolitis
Prolonged ___________ _______ of respiration
expiratory phase
___________ ________ is the largest cause of Cardiac Arrest in children
Respiratory Arrest
Pneumonias
- Localized Infection of _______ Immune response causes ____________
Alveoli become filled with fluid/mucous
- Results in _________ of alveoli
- The more alveoli effected the worse the symptoms.
- Causes:
Bacterial/Viral
Fungal
Aspiration
- Localized Infection of alveoli Immune response causes inflammation
Alveoli become filled with fluid/mucous
- Results in collapse of alveoli
- The more alveoli effected the worse the symptoms.
- Causes:
Bacterial/Viral
Fungal
Aspiration
Asthma - ___________ Inflammatory and reactive airway disease that is commonly chronic
Leading cause of disease related school __________
A combination of genetic and environmental factors
Diagnosis based on pattern of symptoms and response to treatment
Generalized Inflammatory and reactive airway disease that is commonly chronic
Leading cause of disease related school absenteeism
A combination of genetic and environmental factors
Diagnosis based on pattern of symptoms and response to treatment
ASTHMA: Nursing Assessment
Breath sounds:
Early ___________ wheezing;
Inspiratory wheezing occurs with __________ condition-
_______ of Breath sounds is ominous
Early EXPIRATORY wheezing;
Inspiratory wheezing occurs with worsening condition- Loss of Breath sounds is ominous
Cystic Fibrosis (CF) - Autosomal-recessive disease causes dysfunction of the __________ glands
- Tenacious ________ production obstructs vital structures
Multiple problems from the exocrine dysfunction
- Lung insufficiency (most critical problem)
- Pancreatic insufficiency
- Increased loss of sodium and chloride in sweat
Cystic Fibrosis (CF) - Autosomal-recessive disease causes dysfunction of the exocrine glands
- Tenacious mucus production obstructs vital structures
Multiple problems from the exocrine dysfunction
- Lung insufficiency (most critical problem)
- Pancreatic insufficiency
- Increased loss of sodium and chloride in sweat
Immunizations at 4-6 years
DTaP
IPV
Influenza yearly
MMR
Varicella
Wong baker is used
to assess preschool age kids for pain
[faces scale]
Fever in immunosuppressed kid -
> 38 celcius (axillary)
RSV SIGNS AND SYMPTOMS
