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PEDRIATIC NURSING
Infant: Erikson Stage โ ANS trust vs mistrust Toddler: Erikson Stage โ ANS autonomy vs shame Preschooler: Erikson Stage โ ANS initiative vs guilt School Ager: Erickson Stage โ ANS industry vs inferiority Adolescent: Erikson Stage โ ANS ego identity vs roll confusion What is the major goal of pediatric nursing? โ ANS To improve the quality of healthcare for children and their families Pediatric nursing involves the practice of ___________ health care. โ ANS preventative An infant who is 6 months of age should have ________ his or her body weight โ ANS doubled In which state of nutrition is lead-poisoning worse? โ ANS Anemia Motor development of a normal 6-month old. โ ANS Can transfer objects from one hand to another By _________ to ______ months of age, head control is well established. โ ANS 4 to 6 Blood-lead level of < 5 โ ANS reassess or rescreen 1 year, unless exposure status changes Blood-lead level > 70 - ANSIMMEDIATELY provide medical treatment and begin coordination of care, clinical management, environmental investigation, and lead hazard control What is Chelation therapy? โ ANS use of a chemical compound that combines with the metal poisoning for rapid and safe excretion What two agents have been used for chelation therapy? โ ANS calcium disodium edetate (IM) and succimer (19 day oral tx) What are important nursing interventions with chelation therapy? - ANS- renal, hepatic, and hematologic patterns should be monitored
- adequate hydration is essential because chelates are excreted via the kidney The infant is in Erikson's stage of developing a sense of trust. What are the crucial elements for achievement of this task? โ ANS Infant needs care, familiarity, comfort
and nourishment. Consistency and responsiveness is essential for trust development How are chelation agents administered? โ ANS Deeply into large muscle mass How can a nurse decrease the amount of pain of chelation therapy (injections)? - ANS- Distraction
- local anesthetic Separation anxiety begins between ________ and __________ months. โ ANS 4 and 8 What are the infant's first means of verbal communication? โ ANS crying At what age can an infant ascribe meaning to a word? - ANS10 or 11 months For infants, stimulation (in the form of play) is as important for ___________ growth as food is for biological growth. โ ANS cognitive What is the cut-off for putting an infant on their back to sleep? - ANS1 year To prevent SIDs, the American Academy of Pediatrics recommends that healthy infants be placed in the __________ position to sleep. โ ANS supine; "on their backs" Some studies have found that _______________ in infants is a protective factor against the occurrence of SIDS. โ ANS immunizations What period of time defines toddlerhood? - ANS12 to 36 months The toddler has a less well-developed abdominal musculature and short legs, giving him or her a(n) ____________ appearance. โ ANS Potbellied If a mom is breastfeeding, how long should she wait to introduce the pacifier? - ANS3- weeks T or F: The respiratory and heart rates and the blood pressure increase during the toddler years. โ ANS False One of the prominent changes in the GI system during the toddler period is the voluntary control of _______________. โ ANS Elimination What has help reduce the risk of plagiocephaly (flattened skull) in infants? โ ANS Tummy Time The physiologic ability to control the sphincters probably occurs between ages _________ and __________ months. โ ANS 18 and 24
- dwelling in urban areas
- living in older homes The _______ system is the most at risk for being damaged when young children are exposed to lead. โ ANS neurologic What are some of the long-term neurocognitive signs in lead poisoning? - ANS- developmental delays
- lowered IQ
- reading skills deficits
- visual-spacial problems
- visual-motor problems -learning disabilities
- effects on physical growth and efficiency At what age do infants begin cruising? โ ANS 8-11 months What is cruising? โ ANS shuffling along while holding onto furniture What is head lag? โ ANS when you try to pull a baby from a lying down to a sitting up position When does a child usually start to walk? โ ANS 9 - 12 months (usually 12) What are some acute signs of lead poisoning? - ANS- N/V
- Constipation
- anorexia
- abdominal pain
- hypophosphatemia -glycoscouria
- aminoaciduria What is the most important nursing goal related to lead poisoning? โ ANS prevention of initial or further poisoning Physiologically, the middle years begin with the shedding of _____________ and end at puberty, with the acquisition of the final __________________. โ ANS deciduous tooth; permanent teeth The average age of puberty in girls is _________. - ANS What is the average age of puberty for boys? โ ANS 12 Describe the younger school age (6 or 7 year) child's perception of rules and judgement actions. โ ANS Interpret accidents and misfortunes as punishment for misdeeds What is one of the most important socializing agents in the school aged years? โ ANS friends
What is the second most important socializing agent in children? (after the family) โ ANS school What can contribute to bullying? โ ANS poor relationships with peers and lack of group identification When does bullying most frequently occur? โ ANS unstructured school time (recess, gym, hallways, bus, lunch) When does adolescence begin and end? โ ANS begins with the appearance of secondary characteristics (11 or 12) and ends with cessation of body growth ( or 20) What assessment tool is used to determine maturity level based on sex characteristics and stages of genital development? โ ANS Tanner Stages What are the first pubescent changes in boys? โ ANS testicular enlargement and initial appearance of pubic hair Feelings of immortality serve what important developmental function during adolescence? โ ANS Give them the courage to separate from their parents and become independent What is the highest risk group for poisoning? - ANSToddlers and preschoolers Where can young children find poisonous substances? โ ANS Cabinets Cleaning supplies What are you going to instruct parents to do to prevent against poisoning? โ ANS Call poison control What resource do parents need to have readily available for poisoning? โ ANS Poison Control What are the two most obvious physical changes that occur during adolescence? โ ANS increased physical growth and appearance/development of secondary sex characteristics A trend in the care of children with special needs is to focus on the child's ___________ rather than his or her chronological age or diagnosis.... thus stressing the child's strengths rather than his disabilities โ ANS Developmental level Part of family centered care is having ___________ and ___________ between parents and nurses โ ANS Communication and negotiaton Clinicians needs to know that siblings of children with chronic illness are at risk for ____________ - ANS fears, anger, embarrassment
- reactions to the child
- available resources
- concurrent stress within family Does the age of onset influence the impact of a chronic illness? - ANSyes Identify two maladaptive coping patterns found in children with special needs that are associated with poorer adaptation โ ANS
- "feels different and withdraws"
- "irritable, moody, and acts out" How can having a sense of hope help adolescent children with special needs? โ ANS It can increase participation in health-seeking behaviors and improve a sense of well being Why must assessment of the family and child with special needs be a continuous process? โ ANS Because factors affecting the family's response can change at any time during the illness Identify a way in which the nurse can promote the normal development in children with special needs. โ ANS By encouraging self-care abilities in both activities of daily living and medical regimen What is one of the most difficult adjustments of parents with a special needs child? โ ANS The ability to set future goals for the child It is important that the nurse makes the distinctoin between ________________ that are related to disability and those that are result of normal body development. โ ANS body changes What is known to be the long term impact of adverse childhood experiences? โ ANS -drug use -alcoholism
- high number of sexual partners -poor general health
- depression -suicide attempt
- STD
- physical inactivity and severe obesity
- chronic diseases as adults What are the different categories of development? โ ANS
- physical
- social/emotional
- cognitive
- communication
- adaptive
Locomotion, prehension, perception development: Month 1 โ ANS chin up, hand held closed, fingers move without coordination, able to focus on sharply contrasted mobile from above locomotion, prehension, perception development: month 2 โ ANS chest up, elevates self with arms, hand held open most of the time, imitates expression, selectively responds to patterns and shapes, self-centered locomotion, prehension, perception development: month 4 โ ANS rolls over at will, reaches for overhead objects with fingers (hit and miss action), perceives differences in facial expressions locomotion, prehension, perception development: month 5 โ ANS sits alone momentarily, picks up toy with squeeze action locomotion, prehension, perception development: month 6 โ ANS sits alone steadily with hands forward for support, grasps with thumb on one side and 3 fingers on other, separation anxiety begins locomotion prehension and perception development: month 8 โ ANS sits with support, pulls to standing position, thumb and index finger can hold something without pressing into palm, can transfer from one hand to the other, can distinguish happy from fearful face locomotion prehension and perception development: month 9 โ ANS creeps, uses finger to explore what eyes see, hand to mouth coordination, fears strangers, recognizes self as separate from parent locomotion prehension and perception development: month 10 โ ANS walks when led, can release from grasp one toy at a time, separation anxiety peaks locomotion prehension and perception development: month 11 โ ANS stands alone and can sit from standing, pincer action enables infant to pick up small objects, locomotion prehension and perception development: month 12 โ ANS walks 3 steps, hand obeys direction from mind, can attempt to feed self, grasp onto parent because anticipation of being left with stranger locomotion prehension and perception development: month 15 โ ANS can walk up stairs with support, mind is 100% control of hands, builds tower of 2 cubes What sleep pattern should infants have sustained by 3 months? โ ANS 12- 5 am In a semi wakened state what can parents do to console baby back to sleep? โ ANS gentle body patting or pacifier
How can ordinal position influence development? โ ANS may influence age and rapidity of mastering developmental tasks personality โ ANS unique combination of characteristics that result in the individuals recurrent pattern of behavior What behavioral relationship do infants learn at an early age? โ ANS cause and effect At what age do infants establish object permanence? โ ANS 7 months What is a game you can play with infants to help them develop the concept of object permanence? โ ANS peek-a-boo Can infants retain memory of traumatic experiences? โ ANS Yes What will an infants reaction be when placed face-to-face with an adult? โ ANS mimic facial expression; turn away when tired of stimulation; try to get adults attention if they want more attention When does the process of attachment with mother and infant begin? โ ANS when mother feels fetus moving in the womb When does stranger anxiety peak with infants? โ ANS 9 months of age (stranger, babysitter, substitute care giver) At what age can infants begin to trust that the parents will return? โ ANS 18 months; due to memory development What happens to infants who have parents who provide inconsistent responses to their needs? โ ANS they may become clingy, angry and rebellious Steps of accepting separation between parents and infant โ ANS
- having baby sleep in own bed or own room
- leaving baby with babysitter or relative (develops autonomy and coping skills) What should nurse be aware of when assessing for child abuse? โ ANS inconsistent statements about injuries, bruises at various stages of healing, or delay in seeking care What does reading to infants and children do? โ ANS promotes language development When does the pincer action occur? โ ANS 9 months; infant grasps with the thumb and forefinger ABCs of Safe Sleep for infants โ ANS
- on their Backs
- in the Crib Why is it so important to know your professional code of ethics? โ ANS
- protects yourself legally
- protects patient What are some examples of when ethical principles can be challenged in the pediatric setting? โ ANS
- blood transfusions -families who want to leave AMA
- children who do not want to be hospitalized Define informed consent. โ ANS the legal and ethical requirement that the patient or the patient's legal guardian receive sufficient information on which to make an informed health decision What 3 conditions must be met for informed consent to be valid and legal? โ ANS
- The person must be capable of giving consent, must be over the age majority (18 yrs old), and must be considered competent
- the person must receive the information necessary to make an intelligent decision
- the person must act voluntarily when exercising the freedom of choice, without force, fraud, deceit, or other forms of constraint or coercion Is one universal consent sufficient when there are multiple procedures in one surgery? โ ANS NO Define emancipated minor โ ANS One who is legally under the age of majority but is recognized as having the legal capacity of an adult under circumstances determined by law (Ex. marriage, pregnancy) What are the key factors to consider when preparing for discharge and teaching for the caregivers of the ped. patient? โ ANS home environment, education, health management, scheduling follow ups Studies indicate that toddlers up to 24 months of age are safer riding in the convertible seats in the _______ position. โ ANS rear facing position Children should use specially designed restraints until they are ___________ tall or are _________ to ________ years old. โ ANS 4ft 9 in. ; 1 - 12 years old What are 3 types of adaptive child restraints used for children with disabilities? โ ANS
- Car bed restraints
- E-Z on vest
- HIPPO Car seat (spica cast)
How can you get verbal consent? โ ANS 2 people witness conversation; second person has to witness the ENTIRE conversation
- recap and double check the conversation is with the right person, right info. and procedure What is urgent consent? โ ANS when an invasive procedure requires consent but guardian in not available to give it; procedure can be done if pt would die without it... documentation must be PERFECT What are the different rights of teens? โ ANS
- birth control without parents knowing
- pregnancy and prenatal care
- tested for HIV AIDS
- mental health w/o consent if 16 or older -abortions require parent signature How many mL are in an ounce? โ ANS 30 mL What is the primary management of failure to thrive? โ ANS reversing the cause of the growth failure Some parents parents with infants with failure to thrive are at increased risk for attachment problems because of โ ANS isolation, social crisis, inadequate support systems, and poor parenting role models growing up What is the most common hematologic disorder of infancy and childhood? โ ANS anemia Therapeutic management for anemia focus on? โ ANS increasing the amount of supplemental iron How would the nurse instruct the parent to administer oral iron supplement to their child? โ ANS It should be given as prescribed in 2 divided doses, between meals with citrus fruit or juice to increase absorption What us the objective of the medical management of anemia? โ ANS to reverse the anemia by treating the underlying cause to make up for the deficiency At what age are children most at risk for anemia due to cows milk being a staple of their diet? - ANS12 - 36 months What are some side effects of oral iron therapy? โ ANS vomiting, diarrhea, stools turning green, staining of teeth What should the nurse educate breast-feeding moms in relation to iron? โ ANS iron supplementation should be included when exclusively breast feeding. (iron fortified formula for bottle feeding)
What color do stools turn when proper level of iron supplementation is reached? โ ANS tarry green What 4 populations are at risk for Vit D deficiency or rickets? โ ANS
- children exclusively fed by breastfeeding and mom has VIt D deficiency
- children with dark skin pigmentation who aren't exposed to a lot of sunlight
- children with diets that have low sources of Vit D or calcium
- children that have milk products not supplemented with VIt D How is rickets prevented in exclusively breast fed infants? โ ANS 400 IU of vit D daily beginning shortly after birth and continued until infant is consuming 1 L a day of fortified formula What is the recommended type of measurement for screening children for obesity? โ ANS BMI What 8 health conditions are related to childhood obesity? โ ANS
- elevated blood cholesterol
- high BP
- respiratory disorders
- orthopedic conditions
- cholelithiasis
- some types of adult-onset cancer
- nonalcoholic fatty liver disease
- an increase in type 2 diabetes What does obesity result from? โ ANS caloric intake that constantly exceeds caloric requirements and expenditure What is the dominant feature in childhood obesity? โ ANS over eating (adult life is lack of exercise) In children with deformities in both cleft lip and palet, what is repaired first? โ ANS Lip The incident of cleft lip or pallet is twice as frequent when mother.... โ ANS smokes during pregnancy what is the most immediate nursing care when when working with a patient with cleft palet or lip? โ ANS Feeding What causes infant botulism? โ ANS The ingestion of spores or vegetative cells What are some prime sources of botulism? โ ANS inadequately cooked or improperly canned food, honey, light or dark corn syrup, breastfed infants who are exposed to nonhuman milk What are some common symptoms of infant botulism? โ ANS constipation generalize weakness/decrease in spontaneous movements
