Exam 1 Flashcards
(177 cards)
1
Q
What age is infancy? What type of growth occurs?
A
0-1
Rapid growth
2
Q
What age is toddler? What type of growth occurs?
A
13 months - 35 months
growth slows down
3
Q
What age is preschool?
A
35 months - 5/6 years
4
Q
What age is school age? How many pounds are gained each year? How many inches?
A
6 - 12 years
5 lbs/year
2 inches/year
5
Q
What age is adolescence? What type of growth occurs?
A
Older than 13 years
Pubertal growth spurt
6
Q
What happens to weight and height in adolescence? Boys? Girls?
A
Final 20-25% of linear growth occurs
Boys: 4-12 inches
Girls: 2-8 inches
Weight: 15-60 pounds
7
Q
When do children lose all of their baby teeth?
A
School age: 6 - 12 years
8
Q
What is a major task for toddler age? What else occurs during toddler age?
A
potty training
Language rapidly increases
Children learn by mimicking adults and pretend play
9
Q
What is a major task for preschool?
A
school readiness
10
Q
What is object permanence?
A
Object still exists even if you can’t see it or touch it
11
Q
What is stranger/separation anxiety? When does it develop?
A
Infants ability to distinguish between caregivers and others so infant becomes distressed when separation of caregivers occur
6-8 months, 1-2 years
12
Q
Why does separation/stranger anxiety go away?
A
Separation of self from caregiver without distress is based on development of object permanence even if the parent is out of sight
13
Q
What is regression? Why does regression occur?
A
appearance of behavior that is from earlier stage of development
Often used to cope with stress or anxiety
14
Q
When does regression typically occur?
A
Children who welcome a new sibling
Toddlers
Preschoolers
15
Q
What is autonomy
A
The ability to function independently without the control of others
Act with own free will
16
Q
What is negativism?
A
the attitude of opposing or resisting direction of others
17
Q
What is egocentrism?
A
Complete absorption of self
Inability to understand that others have a different point of view
18
Q
What is magical thinking?
A
A Childs belief that he/she wishes or expects can affect what really happens
19
Q
What is animinsm?
A
inanimate objects gave human feeling sad emotions
20
Q
What is concrete operations? When does this occur?
A
a logical way of thinking/operating such as build things, problem solve, and symbolism
Occurs in school age
21
Q
What is formal operations?When does this occur?
A
systematically solve a problem in a logical and methodical way - abstract thinking and scientific thinking
Occurs in teens and young adults
22
Q
What is conservation?
A
ability to understand that properties of an objects do not change because of the order, form or appearance has changed
23
Q
What is imaginary audience?
A
individual believes that people around them are watching them
24
Q
What is family centered care?
A
innovative approach to planning, delivery and evaluation of healthcare that is grounded in mutually beneficial partnership among patients, families, and healthcare professionals
Parents are experts on childcare
Parent and child are co-client
25
What is a personal fable?
an adolescents belief that they are special and invulnerable
they are the only person that understands what they are going through
EX: " nothing happens to anyone else like it does to me"
26
What is hydrocephaly? What is a possible reason for this?
abnormally large head
Fontanelles may be full of fluid
27
What is microcephaly
abnormally small head
28
What is plagiocephaly? What can it be due to? How do you fix it?
when a baby develops a soft spot or flat spot on the head
Can be due to sleeping in same position most of the time
Can be fixed with a helmet and can lead to facial asymmetry if not fixed
29
What is development?
a fluid sequence of conditions that leads to a new skill, new motives for activities and patterns of behavior
30
What are two ways development occurs?
Cephalocaudal - head to toe
Proximodistal - core strength and trunk body movements before fine motor skills
31
What are milestones?
activities expected by a certain age
32
What is the authoritarian parenting style
Negative relationship
Control
Differing perspective not allowed
Communication generally only one way
33
What is the authoritative parenting style?
Positive relationship
Build mutual trust and respect
Both perspectives honored
Communication both ways
34
What is the permissive parenting style?
Negative relationship
Indulges child
Entitlement
Little control exercised
35
What is the uninvolved/neglectful parenting style?
Negative relationship
Non-existent
No communication
No parenting
36
What is level of activity?
intensity and frequency of motion during play, eating, bathing, dressing, or sleeping
37
What is adaptability?
ease or difficulty in adjusting to a new stimulus
38
What is the response to stimuli?
The amount of stimulation necessary to invoke a response
39
What are the characteristics of an easy child temperament?
Approachable
Positive mood
adaptable but predictable
Console easily
40
What are the characteristics of a slow to warm up child temperament?
Shy
Less adaptable
Irregular routines
41
What are the characteristics of an difficult child temperament?
Negative
Avoid interactions
Highly active
Reacts poorly to change
42
What is a good discipline method for an infant?
redirection
6 months - they understand the word "no"
43
What is a good discipline method for a preschool?
reasoning
44
What is a age is time out an appropriate form of discipline?
Toddler, preschooler
45
When is modeling good behavior an appropriate way to discipline?
Toddler and above
46
What is a good discipline method for early adolescent?
consequences
47
When is a behavior modification a good discipline method?
School age/adolescent
48
What does a successful family need?
Provide basic needs for child - food and shelter
Provide emotional needs
Provide safety and structure for growth and development
49
What are risk factors for a dysfunctional family?
```
Martial conflict
Violence even if not occurring to child
Substance abuse
Adolescent parents
Chronically ill child/special needs
```
50
What are some traits of high risk families and how do they display at the bedside?
Poor communication skills -- arguing
Lack of flexibility/adaptability -- withdrawn child with poor coping skills and fear
Poor conflict resolution -- child w/ poor coping skills
Operate in crisis mode -- chaotic routine
51
What the effects of a child with a chronic illness?
Impacts child growth and development
Care can change rapidly to meet the growth and development
52
What are 6 child risk factors for child abuse/neglect
1. Under 3 years old
2. Separation at birth
3. Unplanned/unwanted pregnancy
4. SGA, congenital abnormalities, or chronic medical condition
5. Difficult temperament (ADHD)
6. Foster and adopted children
53
What are 7 parental risk factors for child abuse/neglect?
1. Hx or previous abuse/neglect as a child
2. Poor socialization/emotional and social isolation
3. Poor parenting skills
4. Limited ability to deal w/ stress/negative emotions (poor conflict resolution)
5. Alcohol or substance abuse
6. Rigid family roles - dominant parent
7. Sudden life crisis (loss of job)
54
What are some red flags of abuse in a patients history?
1. Injury unexplained by hx
2. Injury or explanation inconsistent with age
3. Absent, changing or evolving hx
4. Caregiver delay in seeking medical care
5. Unusual affect of caregiver in response to child's injury
55
What are 9 warning signs of abuse?
Change in behavior of the child such as
1. Distrust
2. Fearful
3. Acting out
4. Resists going home/with caregiver
5. Loss of interest in activities
6. Depression
7. Detachment
8. Poor sleeping/eating
9. School failure when previously excelled
56
What is the nurse's role in suspect abuse (6)?
1. Report (mandatory)
2. Recognize abuse
3. Assess for injuries (photos)
4. Refer
5. Educate
6. Prevent
57
What are some triggers for abuse?
Prolonged crying of an infant
Potty training
58
What are some types of abuse?
1. Physical
2. Emotional
3. Sexual
4. Neglect
59
What are some medication absorption considerations for pediatrics?
1. Gastric pH is HIGH in neonates
2. Gastric emptying is intermittent and unpredictable in infants
3. Gastric emptying is slower in older children
4. Intestinal motility is decreased in neonates
5. Intestinal motility is increased in older infants/children
6. Bile acid/biliary fx is diminished in neonates
7. Pancreatic enzymes are variable in infants < 3 m.
60
What are some medication metabolism considerations for pediatrics?
1. Metabolism is less mature in premature/newborns
2. The younger the child, the more doses needed to achieve 24 hour stability (smaller doses at greater frequency)
3. Adult level renal fx takes 1-2 years to develop
61
What are some medication distribution considerations for pediatrics?
1. Neonates have a higher proportion of total body water
2. Protein count in lower in preterm/newborns
3. BBB matures around 2 years old
62
What is the concern regarding BBB taking 2 years to mature regarding drug therapy?
1. Side effect considerations
2. Drug to treat sepsis will penetrate the brain
3. Drugs can accumulate in the brain tissue
63
What is the leading cause of death in children 1-19 years old?
unintentional injuries
64
How is growth evaluate in the pediatric population? What is the normal range?
interpreted via percentiles
5%-85% is normal
65
What is the height increase during the first year? 2-5 years?
1/2 inch (2-3 cm)/month for the first year
2-3 inches/year
66
How does weight change during the first year?
Average 30gram/day (1oz/day)
Doubles birth weight in 6 months
Triples birth weight in 12 months
67
How long do you measure head circumference? Why on until then?
The first 2 years of life - should measure in portion to rest of body
Fontanelles and the suture lines should be fused together by 12-18 months but most importantly by 2 years old
68
What is the purpose of milestone monitoring? How is it done?
The purpose is to screen
```
Done by parents or non-clinical caregiver
Subjective
<30 minutes
Ages and stages questionaire
Milestone tracking
```
69
What is the purpose of milestone screening and assessments?
Purpose is to diagnose
Specific intervals (9,18,24 months)
Denver II (DDST)
Increased objectivity
> 1 hour/comprehensive
70
What are nature factors that influence growth and development?
Non-modifiable
Genetics
71
What are nurture factors that influence growth and development?
Modifiable
Social determinants of health (poverty)
Interpersonal interactions
72
What is failure to thrive?
What G/D milestones fall below expected standards
Weight <5th percentile
"Falls off" the growth curve
Accompanied by at least 1 developmental delay
73
Why is it important that nurses know the normal growth and development patterns?
1. Nurses can identify if there is abnormal G/D patterns and need further screening
2. Nurse can create a plan of care to meet the developmental stage the child is currently in
74
What is the most critical time in development?
Infant/toddler/preschool (early childhood)
From age 1 -5 is the most critical
90% of the brain is developed during this time
75
Erikson: Trust vs. mistrust
Infant - 18 months
If needs are dependably met, infants can develop trust
76
Erikson: Autonomy vs. Shame/doubt
18 months - 3 years
Toddlers learn to exercise will and do thing for themselves but doubt their abilities
77
Erikson: Initiative vs. guilt
3 - 5 years
Preschoolers learn to initiate tasks and carry out plans or they feel guilty about their efforts to be independent
78
Erikson: Industry vs. Inferiority
5 - 13 years
Children lean the pleasure of applying themselves to tasks or they feel inferior
79
Erikson: Identity vs. Role confusion
13 - 21 years
Teenagers work to find a sense of self by testing roles and building an identity or they become confused about who they are
80
Erikson: intimacy vs. isolation
21 years and up
Young adults struggle to form close relationships and intimate love or they feel socially isolated
81
Piagets: Sensorimotor
Birth - 2 years
Explores the world through sense and actions
Looking, hearing, touching, mouthing, and grasping
Tasks: Object permanence and stranger anxiety
82
Piagets: Preoperational
2 - 7 years old
Represents and refers to objects and events with words or images. Use intuition rather than logical reasoning. Believes inanimate objects have human feeling
Tasks: Pretend play, egocentrism, animism, magical thinking, language development
83
Piagets: Concrete operations
7 - 11 years old
Conserve, reverse their thinking, and classify objects. Think logically and understand analogies but only about concrete events
Tasks: Conservation, mathematical transformations
84
Piagets: Formal operations
12 years old and up
Uses abstract reasoning about hypothetical events/situations, considers logical possibilities and systematically examines/test hypotheses
Tasks: abstract logic, potential for mature moral reasoning
85
What are the 5 functions of play?
1. Physical development
2. Cognitive development
3. Emotional development
4. Social development
5. Moral development
86
What is solitary play? What age plays this way?
Infants
Independent play
Child plays alone with toys
Self-entertaining
Rattles, balls, blocks, mobiles
87
What is parallel play? What age plays this way?
Toddlers
Kids play near each other but are not interacting with each other
Different toys
Not sharing (egocentric)
Stay in your lane play
88
What is associative play? What age plays this way?
Preschool
Group play without group goals
Sharing
Playing with same toys but no formal organization
89
What is cooperative play? What age plays this way?
School age
Joint goal to activity
Games with concrete rules
90
What is onlooker play?
Child observes others playing
| Child may ask questions of the other players but does not attempt to join the play
91
What is familiarization and symbolic play?
Technique used to relieve fears of children
| Primary type of play used in healthcare settings
92
What is a child's response to hospitalization affected by?
1. Perception of events
2. Age
3. Development level
4. Cognitive ability
5. Preparation
6. Previous experiences
7. Coping skills
8. Parent and family responses
93
What are major fears of a hospitalized child?
1. Separation anxiety
2. Fear of pain or mutilation
3. Fear of the unknown
4. Loss of control
94
What are the stages of separation anxiety?
Protest
Despair
Detachment
95
What age is head control gained? Gross or fine motor skill?
1-3 months
Gross motor skill
96
What age is core strength/rolling/no head lag developed? Gross or fine motor skill?
4-6 months
Gross motor skill
97
What age can a child sit up without support? Gross or fine motor skill?
6-9 months
Gross motor skill
98
What age does a child start crawling/cruising? Gross or fine motor skill?
9-12 months
Gross motor skill
99
What age does a child start walking? Gross or fine motor skill?
12-15 months
Gross motor skill
100
What age does a child put their hand to mouth? Gross or fine motor skill?
2-4 months
Fine motor skill
101
What age can a child hand grasp? Gross or fine motor skill?
Palmer: 6 months
Pincer: 9 months
Fine motor skill
102
What age can a child transfer objects between hands? Gross or fine motor skill?
6-8 months
Fine motor skill
103
What age can a child track object with vision and hearing and attend voices to faces? Gross or fine motor skill?
2-4 months
Fine motor skill
104
What are major safety concerns regarding babies?
SIDS
Car seat
Smoke exposure
Chocking
105
When does a child start teething?
6-12 months
106
Where does a baby get their nutrition from?
Breast milk/formula for first 6 months
Introduce solids at 4-6 months
Vitamin D
Iron supplements
107
At what ages do infants get vaccines?
```
1 month
2 months
4 months
6 months
9 months
12 months
```
108
How many hours is an infant sleeping during the first 1-2 months?
18-22 hours
109
When can a child physiologically sleep through the night?
6-9 month
110
What are the ABCs for safe sleep?
A: always sleep your baby
B: on their back
C: in a clear cot or sleep space
111
What toddler milestones are at 15 months?
Walks without help
Uses cups
Stacks 2 blocks
112
What toddler milestones are at 18 months?
Throws ball
Clumsy run
Uses spoon/scribbles
113
What toddler milestones are at 24 months?
Alternates feet on stairs
2 words sentences
300+ vocabulary
Knows vocabulary
114
What occurs psychosocially in toddlers?
```
Independence increases
Egocentrism - "mine!"
Negativism - "NO"
Temper tantrums escalate (frustration)
Discipline should be consistent and encourage good behavior
```
115
What does language look like as a toddler?
2 years: 2 word long phrase
| 3 years: 3 word long phrases
116
What milestones occur in the preschool (4-6) age?
```
Gross motor skills refined like balancing and hopping on one foot or ride bike with training wheels
Dresses/undresses themselves
Uses scissors
Draws figures
Counting and letters
```
117
What is the speech and vision of a preschooler?
Speech is 75% understandable
Stutters when excited
3 word sentences
20/20 vision
118
What occurs psychosocially in preschoolers?
```
Independence and initiative
Begin to share and develop empathy
Asks "WHY?"
Tantrums start to decrease
Language develops
Discipline
```
119
What are some considerations for toddlers and preschoolers?
1. Body image develops
2. Dental care/annual health exams
3. School readiness
120
What are some major safety concerns for toddlers and preschoolers?
Gross motor skills increase but there is lack of coordination which can lead to
```
Falls
Car seat safety
Injury
Drowning
Poison
Burns
Choking
```
121
What does sleep look like for toddlers and preschoolers?
Sleeps through the night (12 hours) and naps during the day are eventually eliminated
122
What is the nutrition and elimination for toddlers and preschoolers?
Decreased need for calories
Picky eaters
Establish potty training
123
What are milestones for school age children?
Gross motor skill more refined
```
Biking
Skipping
Athletic skill/coordination increases
Collecting things
Hobbies/interests develop
```
124
What concrete operations develop in school age children?
```
Logical but understands kid jokes
Understands math
Tells time
Problem solving
Empathy and morals
Classificaiton
Rules
```
125
What are characteristics of school age children?
1. Not ready to abandon parental control (want to please parents)
2. Increasing importance of peers
3. Sec roles emerging with co-ed play and relationships develop
4. Formation of groups and clubs
126
What occurs psychosocially in school age?
Eager to participate and please
Want to be good at something
Parental/peer approval is strong motivator
Inferiority can develop
Lack of sense of accomplishment
All children feel some degree of inferiority regarding skills they cannot master
127
What formal operations develop in adolescence?
```
Abstract thinking
Decision making increases
Understand implication of choices
Plan for future
Moral and ethical development is more complex
```
128
What is age is early adolescence? Middle? Late?
Early: 11 - 14 years
Middle: 15 - 17 years
Late: 18 - 20 years
129
What is the task of adolescence?
Standing out while still fitting in
130
Which age group is most likely to be non-adherent with medication or medical plan? Why?
adolescence
Due to adolescent egocentrism and self-absorption
131
During a physical assessment, what do you measure to compare for norms for age and gender?
Height
BP
Weight
BMI
132
When does mental health screenings start to occur?
Begins at 12 year visit
Screens for suicidal/homicidal ideation
133
When is dyslipidemia looked for in school age/adolescent?
1 time between 9 and 11
| 1 time between 17 and 21
134
When is hearing checked in school age/adolescent?
once between 11 and 14
| once between 15 and 17
135
What is vision check in school age/adolescent?
12 year visit
136
What questions should be asked to school age/adolescent?
Tobacco/vaping/alcohol/elicit/and/or prescription drug use
| Piercings/Tattoos/Self harm
137
What is a females first sign of puberty? When is does menarche occur?
First sign: Great bud (Thelarache)
Menarche: 2 years after thelarache around 9-13 years
138
What is precocious puberty
When a female has menarche before 9 years old
139
When do females reach their adult height? Males?
Females: adult height after 2 years of menarche
Males: Growth continues through 18-20 years old
140
What is a males first sign of puberty? When does their voice deepen?
First sign: testicular enlargement
Voice depends at 10.5-16 years old
141
Do females or males become sexually mature first?
Females
142
What is the HEADDS assessment?
A teen health assessment
```
H: home
E: education
A: activity
DD: drugs/depression/diet
S: sexuality/suicide/self-esteem/sleep
```
143
What is the second leading cause of death for child between the ages of 10-14 and 15-24?
Childhood depression
144
What are warning signs depression in children?
1. Refusal to go to school
2. Be excessively clingy
3. Feel sick
4. Worry bad things will happen to the people they love
145
What are warning signs for depression in teenagers?
1. Misunderstood
2. Moody
3. Become solitary
4. Act very negative
5. Social withdrawal and loss of interest in previously enjoyed activities
6. Excessively harsh view of themself
7. Feel sadness/despair
8. Anger and irritability
9. Changes to sleep and eating patterns
146
What is the BMI for childhood obesity?
BMI above 95%
147
What are risk factors for SIDS?
1. Preemies
2. Hx of apnea or CPR
3. Low birth weight
4. Low Apgar scores
5. Second hand smoke exposure
6. Cosleeping
7. Males
8. Recent illness
148
What is assent?
Necessary if the child is 7 years or older
| Child has been fully informed about the procedure and concurs with those giving informed consent
149
What is informed consent?
legal and ethical requirement that the child and the parent/guardian completely understand the proposed procedure or treatments including the benefits and risks
150
What are some communication techniques when communicating with an infant?
```
Calm, soft voice
Be responsive to cries
Turn taking (adult imitate baby noises)
Explain to infant what you are doing
SLOW approach
```
151
What are some communication techniques when communicating with a toddler?
Learn toddlers words for common items and use them
Describe activities and procedures
Use picture books
Use play
Prep should be immediately before the event
152
What are some communication techniques when communicating with a preschooler?
Seek opportunities to offer choices
Use play to explain procedures and activities
Speak in simple sentences
Prep is limited to 1-3 hours before
153
What are some communication techniques when communicating with a school age child?
Use visual explanations
Encourage critical thinking
Establish limits and set consequences
Prep 1-5 days in advance
154
What are some communication techniques when communicating with an adolescent?
Engage in their interests
Use visual explanations
Prep 1 weeks before
Respect privacy needs
155
How should you approach an assessment in pediatrics?
Kid is in charge!
Start with the least invasive/painful task first
Use familiarization play (such as letting children hold/touch stethoscope first)
156
What is the doorway assessment?
1. Weight (nourishment)
2. Neuro (cognitive awareness)
3. Respiratory (any distress?)
4. Standing without assistance (development)
5. Color and extremities
157
What is the crying assessment?
1. Resp status
2. Cardiac
3. Neuro/development (high pitched could mean increase ICP)
4. Emotional status
5. Communication
158
What does the anterior fontanelle close?
Closes LAST because it is the biggest and allows for the most head growth
159
When does the posterior fontanelle close?
Closes a 2 months - very small
160
What are some pediatric assessment finding that would be expected?
1. Higher baseline metabolic demands
2. Poor autoregulation
3. Primitive reflexes
4. Soft spots (fontanelles)
5. Disproportionate head to body ratio
6. Disproportionate facial features
7. More significant fluid volume shifts (increase risk for F&E imbalances)
161
What would poor auto regulation look like in pediatrics?
1. Mottling form poor temp regulation (white and red spots on limbs)
2. RR/HR (differing VS in peds)
3. High water content
4. Increased insensible water losses
162
What 3 areas are assessed in the PEWS score?
1. Cardiovascular
2. REspiratory
3. Behavioral
163
Why is it important for nurses to know the PEW score?
Children decompensated very quiclly
Improves response time/early intervention
Improves team communication
Improves outcomes
164
What PEW score requires immediate action?
a score above 2
165
What are pain assessment scales?
1. FLACC (7 and younger)
2. CRIES (3 and younger)
3. Wong baker face scale
4. Numeric pain scale
166
What are some non-charm pain management?
1. Distraction
2. Relaxation
3. Guided Imagery
4. Positive self-talk
5. Containment
6. Nonnutritive sucking
7. Sucrose
8. Pet therapy
9. Music therapy
10. Play
11. Application of heat or cold
167
What are some pharm management options for severe pain and non-severe pain?
Non-severe pain: treat with a non-opioid (NSAID, Tylenol)
| Moderate to severe: opioid (morphine)
168
Will children and adolescents become addicted to opioids if introduced to them at such a young age?
No it is myth
169
What are language developmental milestones at 3m? 6m? 9m? 12m? 18m? 2 years? 3 years? 4 years?
3m: 3 letters (coo)
6m: 6 letters (babble)
9m: 9 letters (imitation)
12m: 1-2 words
18m: 18 words
2 years: 2 phrases
3 years: 3 phrases
4 years: >4 phrases
170
How do you approach preforming a physical exam on children across all age groups?
1. Explain all procedures
2. Develop a coping plan
3. Supportive positioning
4. Communicating sensitive or life-changing information
5. Clarifying questions
6. Distraction options
171
What are appropriate communication strategies with all children?
1. Be honest
2. Get down on child's level
3. Only make promises you can keep
4. Offer choices only when choices are available
5. State suggestions to child in a positive manner
6. Avoid words with judgment attached
7. Praise specific actions./behaviors
8. Allow children to experience situations w/o predetermination
172
What are the rapid periods of growth?
Infancy and puberty
173
What are the slower periods of growth?
Middle and late childhood
174
What is self-concept?
mental image of self including body image, subjective self, ideal self, and social self
175
What factors influence children's body image and self-esteem?
1. Sense of competency
2. Facial, ethnic, and spiritual identity
3. Family/friends
4. Relationships/friendships
5. Education/employment
6. Emotions
176
What can you do to reduce the risk of school age and adolescents getting hurt during play?
1. Wear protection gear (helmets, knee pads, elbow pads, eat)
2. Ensuring great education about driving a motor vehicle
3. Checking toys to make sure the are safe
177
How can you support family centered care?
Parents are the experts on child’s care (with
exceptions)
Parents and child are a co-client
Involve kids in exam/plan of care as much as
possible
Kids want to be kids!
Kids are not just small adults
