EXAM #1 Flashcards
(128 cards)
1
Q
What are normal reflexes for a newborn/infant?
A
-Rooting: Searching for nipple/bottle
-Sucking
-Palmer & planter grasp
-Moro: startle reflex
-Babinski: spreading of toes
2
Q
Whare are normal gross motor functions for a newborn/infant?
A
-Raise head & chest while on belly/ roll side to side at 3m
-No head lag 6m
-Turn over 7m
-sits unsupported 8m
-Crawl and pull up 8-9m
3
Q
What are normal fine motor functions for an infant?
A
- Transfer objects between hands, scribble, stack large object age 6-12m
- Pincer grasp 9-12 m
4
Q
What language development will be seen in an infant?
A
- Crying, babbling, imitation; influenced by social interaction
- Social smile 2m
- Mama/dada 9-12m
5
Q
What are gross and fine motor functions for a preschooler?
A
- Dress self
- Skip and hop on 1 foot
- Throw and catch ball
- Draw stick figure with 6 parts
- Ties shoes,
- Uses knife, fork, spoon
6
Q
What are a few language/communications strategies to use for preschoolers?
A
-Stuttering is common
-Magical thinking, use word choice carefully
7
Q
What physical changes will school aged patients go through?
A
- GIRLS: hips broaden, pelvis widens, pubic hair grows, menarche possible before
age 12 - BOYS: muscular bodies, pubic hair growth, testes and scrotum changes, gynecomastia due to hormone changes
8
Q
What is Erickson’s Trust vs Mistrust & what age does it occur?
A
-Newborn to 1 year
-Recognize that there are people that will meet their basic needs.
Result: Faith & Optimism
9
Q
What is Erickson’s Autonomy vs Shame and Doubt & what age does it occur?
A
-1 year to 3 years
-Balance independence and
self-sufficiency against sense of uncertainty.
Result: Self control and power
10
Q
What is Erickson’s Initiative vs Guilt & what age does it occur?
A
-3 years to 6 years
-Develop the resourcefulness to achieve and learn new things without receiving self-reproach.
Result: Direction and
purpose
11
Q
What is Erickson’s Industry vs Inferiority & what age does it occur?
A
-6 years to 12
-Develop a sense of confidence through mastery of task. Can be hindered by a sense of inadequacy or inferiority.
Result: Competence
12
Q
What is Erickson’s Identity vs Role Confusion & what age does it occur?
A
-12 to 18
-Acquiring a clear sense of self and purpose.
Result: Fidelity to others and individual values
13
Q
What is Piaget’s Sensorimotor theory & at what age does it occur?
A
-Birth to age 2
-Primary means of cognition is through the senses
14
Q
What is Piaget’s Preoperational theory & at what age does it occur?
A
-2 to 7)
-Takes into account the development of motor skills.
Divided into preconceptual and intuitive
15
Q
What is Piaget’s Concrete operational theory & at what age does it occur?
A
-7 to 11)
-Able to organize thoughts into a logical order
16
Q
What is Piaget’s Formal operational theory & at what age does it occur?
A
-11 to 15)
-Uses abstract thinking to handle difficult concepts and can analyze both sides of an issue
17
Q
Nurition development for infants:
A
Breast milk or formula, intro solids 4-6 months, encourage self-feeding, finger foods, wean to cup 9-12 months, family meal time
No honey, milk or eggs until 12m
18
Q
Nutrition development for toddlers:
A
family meals, allow self-feed and use cup, finger foods, 2-3 healthy snacks per day, do not force eating, allow some choices
19
Q
How may an infant react to hospitalization? How do we manage it?
A
-Separation and stranger anxiety
-Primary nursing goal is to prevent and minimize separation
* Especially for children < 5 y/o
* Parents are not “visitors”
* Communicate with parents
* Familiar items from home
* Hold/cuddle/swaddle
20
Q
How may a toddler react to hospitalization? How do we manage it?
A
- Regression (normal), Tantrums & Separation anxiety
- Autonomy
- Daily routines and rituals
21
Q
How may a preschooler react to hospitalization? How do we manage it?
A
-May view hospitalization as punishment
* Egocentric and magical thinking typical of age
* Preoperational thought
* Simple explanation and choices
* Encourage child to ask questions
* Allow choices
22
Q
How may a school aged child react to hospitalization? How do we manage it?
A
- Boredom. Fears death, abandonment, permanent injury, bodily mutilation
- Increased need for attention
- Simple explanations and choices
- Respect privacy
- Encourage verbalization of fears
23
Q
How may an adolescent react to hospitalization? How do we manage it?
A
- Struggle for independence and liberation
- Decreased socialization & Separation from peer groups: encourage peer
visits, use of teen room - Body image concerns
- Loss of independence, rejects authority
- Need information about their conditions
- Be honest, explain in understandable terms, allow questions/verbalization of
fears/choices
24
Q
How do infants react to pain?
A
-Rigidity, thrashing, and arching
-Crying
-Facial grimace
-No understanding of relationship b/t stimuli & subsequent pain
Older infant:
-Withdrawal from painful stimuli
-Loud crying
-Physical resistance
25
What pain scale is appropriate for 12 and older?
Numeric pain scale
26
What pain scale is appropriate for infant to 3 years old?
FLACC
27
What pain scale is approprate for pre-school (4-6) to school-age (6-12) children?
Wong-Baker FACES
28
How will a young child respond to pain?
-Loud crying and screaminh
-"Ow"
-Thrashing of limbs
-Attempts to push away stimulus
29
How will a school aged child respond to pain?
-Stalling
-Muscle rigidity
-May use behaviors of younger child
30
How will adolescents react to pain?
-Less Vocal protest, less motor activity
-Increased muscle tension & body control
-More verbalizations
31
Pain management strategies for infants:
-Parents to comfort
-Distraction/comfort after procedure
-Swaddling, toys, singing, & pacifiers
32
Pain management strategies for preschoolers:
-Medical play/participation
-Tell them what they will see, hear and feel
-Paise and reward
33
Pain management strategies for school age:
-Distract with deep breathing, trivia, talking, holding hands, parental presence
-Explain procedure
-Allow play with equipment
-Allow participation
-Praise and reward
34
Pain management strategies for adolescents:
-Distract with imagery, tablet, talking, deep breathing, talking, jokes
-Ask pt for parental involement
-Allow participation
-Explain procedures
-Give choices
-Praise & reward
35
What can we give or do for mild pain?
-NSAID (ibuprofen)
-Non-opioid analgesic (Acetaminophen) Do NOT use with liver problems
-Comfort measures and distraction
36
What can we give or do for moderate pain?
-Distraction
-Regularly timed analgesics (mild opioids + acetaminophen)
37
What can we give or do for severe pain?
Strong analgesic like morphine
38
What are signs and symptoms of severe pain?
Pallor, sweating, dialated pupils, increase BP & RR, muscle tension
39
Ex of topical and local pain management
-EMLA (topical cream)
-Ice
-Intradermal local anesthetics
-Nerve distraction
TIMING is important
40
How can age-appropriate & therapeutic play help children?
-Decreases stress & provides relaxation
-Provides a sense of control & security
-Helps to lessen separation
-Release of tension
-Outlet for creativity
-Means to make therapeutic goals
41
Age appropriate play for infants:
-Solitary play
-Books, blocks, musical toys, mobiles, finger/hand games
42
Age appropriate play for toddlers:
Parallel play
- Push-pull, books, movies, coloring, matching games, ride on toys, imitative toys (dishes, house)
43
Age Appropriate play for preschoolers:
Associative play
-Role playing, simple board games, alphabet or color games
44
Age appropriate play for school age children:
Cooperative play
-Music, books, crafts, team sports, bike, skateboard, card/board games, video games, puzzles
45
Age appropriate play for adolescents:
Cooperative play
-Teams, video games, art, concerts, hanging out, social events
46
Common injuries & prevention for infants:
Head, fractures, burns, MVA, choking, suffocation
-Child-proofing, install car seat properly, warm bottles correctly, no cords or small toys, test water temp.
47
Common injuries & prevention for toddlers:
Falls, drowning, poisoning, burns
-Supervise, hot items and chemicals out of reach/locked, fenced in yard/pool
48
Common injuries & prevention for preschoolers
Poisoning, firearms, burns
-Teach about stranger danger, fire safety, check for unsafe objects on playground, wear helmets
49
Common injuries & prevention for school age children:
Sports, being struck, animal or insect bites
-Keep car doors locked, buddy system, do not swim alone
50
Common injuries & prevention for adolescents
Sports, being struck, overexertion, MVA
-Alcohol/drug education, safe driving, safety equipment, apply sunscreen
51
What are common, normal side effects for an immunization?
Tenderness, erythema, swelling, low-grade fever, drowsiness, anorexia, prolonged crying
52
Immunization contraindications:
-Severe febrile illness
-Allergies
-Severely immunocompromised children
53
Etiology & s/s of Varicella (Chicken Pox)
Varicella Zoster virus
-Rash on trunk & face, Lesions being as macule and progress to vesicle then crust, pruritis
54
Which infectious diseases require contact & airborne precautions?
Varicella (Chicken Pox) & Rubeola (Measles)
55
Nursing care for Varicella (Chicken Pox):
-Supportive (anti-pruritic lotions, baths, antihistamines)
-Oral acyclovir to shorten duration
56
Etiology & s/s of Rubella (German/ 3 days measles)
Rubeola Virus
-Sore throat, lymphadenopathy, mild fever, fine light pink maculopapular rash to face, chest to body.
57
Nursing care for Rubella (German/3 day measles)
-Supportive (antipyretic)
-Educate on isolation (1 week after rash starts)
58
Etiology & s/s of Rubeola (measles)
Morbillivirus
-Moderate fever, cough, conjunctivitis, photophobia, Koplick's spots appear 2 days b/f rash, fever to 105, rash fades & temp drops 4-7 days
59
Nursing care for Rubeola (measles)
Supportive (antipyretics, bedrest and fluids)
60
Etiology & s/s of Haemophilus Influenza Type B
Haemophilus Influenza Type B Bacteria
-Upper RI, OM, sinusitis
61
Nursing care for Haemophilus Influenza Type B
Antibiotics
62
Etiology & s/s for Influenza
Virus A, B, or C
-Rapid onset of high fever, myalgia, HA, sore throat, nonproductive cough
63
Nursing care for influenza
-Supportive (antipyretics)
-Isolation until s/s subside
64
Etiology & s/s of Mumps
Paramyxovirus
-Mild & systemic-low-grade fever, malaise, anorexia, ear pain, HA, parotid glands enlarge
65
Etiology & s/s for Pertussis (Whooping Cough)
Bordatella pertussis bacteria
-Mild respiratory illness with whooping cough
66
Nursing care for Pertussis (Whooping Cough)
-Antibiotics
-Keep open airway
-Monitor oxyen saturation
-Treat family & anyone in contact
67
Etiology, s/s, & isolation for Tetanus
Clostridium tetani
-HA, Stiff neck & jaw that become muscle spasms, may progress in the body and lead to seizures
-Standard
68
Nursing care for Tetanus:
-Antibiotics
-Surgical debridement
-Tetanus immune globulin (TIG)
69
Etiology & s/s of Scarlet Fever
-Group A beta-hemolytic streptococci, often follows pharyngeal infection with GAS
-Acute onset fever, sore fever, rhinitis, tender cervical nodes, sandpaper-like rash appears (12-48 hrs after onset. Fades 3-4 days, tips of toes and finger peel, day 5-5 a bright red strawberry tongue apperance
70
Nursing care for Scarlet Fever
Antibiotics
-Can return to school after 24 hours on antibiotics
-Supportive care for pharyngitis & fever
71
Etiology & s/s pneumococcal disease
Streptococcus pneumonia bacteria
-URI, high fever, pleuritic chest pain, cough, chills, dyspnea, dry or productive cough with hemoptysis
72
Nursing care for pneumococcal disease
Penicillin or other, IVF
73
Etiology, mode of transportation, & s/s for Mononucleosis
Epstein-Barr Virus
- Saliva/blood
-Fever, pharyngitis, cervical and occipital lymphadenopathy
74
Dx & nursing care for Mononucleosis
-Monospot test
-Bedrest & avoidance of contact sports
-Steriods if there are respiratory difficulties
75
What is an important physiological effect that occurs witht the immobilized child?
Increased risk for developing venous stasis
76
Nursing management for an immobilized child
-Activities to maintain/increase strength
-Prevent skin breakdown
-Nutrition (High protein/calories)
-Distractions
-Support
77
What kind of vitamins/food should be provided to the immobilized child?
Hight protein, Vitamin D, and Calcium (sun/fortified foods, dairy, fiber)
78
What are the clinical manifestations of clubfoot?
* Plantar flexed
* Inverted heel
* Adducted forefoot
* Rigid
79
Medical interventions for Club foot
Try stretching 1st for 4-12 months q week
* Casting (serial) 6-12 weeks
* Browne splint 24 hs per day til 3 YOA
* Tenotomy in severe cases
80
Nursing interventions for clubfoot
* Passive ROM
* Neurovascular assessment
* Pain management
* Cast care and follow up
* Overcorrection/Reoccurrence
* Growth & development delay
* Reposition q 2 hours & elevate
* Double Diaper
81
What is Legg-Calve Perthes Disease?
Avascular necrosis of the femoral head
82
What is Slipped Capital Femoral Epiphysis Disease?
Occurs when the femoral epiphysis slips through the epiphysis (growth plate).
83
What are the clinical manifestations of Legg-Calve Perthes Disease?
-Hip soreness or stiffness
-Pain that increases with activity and decreases with rest
-Painful limp
-Quads atrophy
-Joint dysfunction
-Limited ROM
84
Medical care for Legg-Calve Perthes Disease
-Non-weight bearing at first
-Montreal abductor cast for a yr+ or use of Toronto brace
-Osteotomy (most common)
85
Nursing care for Legg-Calve Perthes Disease
-History
-Focused Assessment, neurovascular checks
-Pain management
-Skin care
86
Education/Discharge instructions for Legg-Calve Perthes Disease
-Conservative therapy
-Avoid weight bearing and maintain mobility restrictions
87
Clinical manifestations for Slipped Capital Femoral Epiphysis Disease:
-Appears gradually
-Pain in the groin or reffered pain to the thigh or knee
-Pain during internal rotation of the hip
-Hip does not fully rotate
-Shorter leg on affected side
-Limp favoring affected side
88
Nursing care for Slipped Capital Femoral Epiphysis Disease:
-No weight bearing
-No ROM
-Bedrest with traction to decrease synovitis
89
Medical interventions for Slipped Capital Femoral Epiphysis Disease:
-Pinning bone across epiphyseal plate
-Bear weight after 1 week
-Osteotomy (severe)
90
General medical interventions for fractures:
* Closed reduction; immobilization
* Open reduction/internal fixation; immobilization
91
General Nursing interventions for fractures:
* History
* Perform neurovascular checks
* Perform pin care
* Administer antibiotics and pain medication
* Prevent complications
92
General education/discharge information for fractures:
* Immobilization care (clean & dry)
* Home environment
* Nutrition (increased calcium and Vitamin D)
* Use of immobilization and assistive devices
93
Neurovascular assessment
-Pain & point of tenderness
-Sensation (paresthesia)
-Motion (movement distal to the fracture site)
-Temp
-Capillary refill
-Color
-Pulses (distal)
94
When to seek medical care for neurological assessment:
Numbness, tingling and capillary refill longer than 3 seconds
95
What is a sprain? S/S?
Overstreching or tearing of ligaments
-Pain, swelling, bruising, or instability
96
What is a strain? S/S?
Overstreching or tearing of muscles or tendons
-Pain, limited motion, muscle spasms/cramping, swelling
97
Medical interventions for soft tissue injury:
Immobilization & consut PT
98
Nursing interventions for soft tissue injury:
-RICE
-Pain management
-EDU
-Physical activity restrictions for 2-3W
99
Medical intervention for Polydactyly/Syndactyly
Surgery (remove or separate digits)
99
What is Polydactyly/Syndactyly?
* Poly: more than the normal number of fingers or toes.
* Syn: two or more phalanges are fused together
100
Nursing interventions for Polydactyly/Syndactyly
* Provide comfort, pain medication
* Neurovascular assessments/bleeding
* Infection prevention, pin care, antibiotics
* Child/family support
101
How to dx osteomyelitis:
X-ray, Lab, Blood Cultures
102
Clinical manifestations for osteomyelitis:
Pain at rest, Brodie abscess, muscle spasm, redness, swelling, self-limiting motion of affected limb
103
Medical interventions for osteomyelitis:
* Debridement of bone, stabilization with Kirshner wire
104
Nursing interventions for osteomyelitis:
* Administer course of broad-spectrum antibiotics (educate on compliance)
* Blood cultures
* Monitor laboratory values
* Palliative measures, such as rest, oral pain medication, good
nutrition, and diversionary activities
* Postoperative nursing care
105
Etiology of Juvenile arthritis:
* Autoimmune inflammatory process with unknown
origin and thought to be triggered by an infection.
* Peak onset 1-3yo and 8-12yo
* Females twice as likely as males
* Leading cause of blindness and disability in children
106
Clinical Manifestations of Juvenile Arthritis
* Swollen, tender, warm joints
* Limited ROM
* Malaise, fatigue, lethargy
* Fever
* Stiffness, especially in the morning or after long periods of rest
107
How to dx Juvenile Arthritis:
* Labs: WBC, ESR
* XRAY/Bone scan
108
Medical interventions for Juvenile Arthritis
* Medications
* PT
* Surgical is not usually indicated unless joint replacement is needed
109
Nursing interventions for Juvenile Arthritis:
* Age dependent, provide distraction and supportive care
* Active & Passive ROM
* Pain management
* Pain-NSAIDS (Ibuprofen, Naproxen), distraction, Child-Life Department
* Steroids-Glucocorticoid (Prednisone)
* Disease Modifying Antirheumatic Drugs (DMARDS)- Methotrexate, Cyclophosphamide, Remicade
110
Education/Discharge instructions for Juvenile Arthritis:
* Exercise to gain muscle strength (isometric such as planks or wallsits)
* Positioning & preserve joint functions
* Use of heat/cold
* Diet high in fiber, protein, calcium, and fluids.
111
Duchenne Muscular Dystrophy Clinical Manifestations
* Gower’s sign: inability to sit in the floor and get up
* Muscle wasting and weakness
* Respiratory changes
* Waddling, wide-based gait
* Calf muscles are weak and hypertrophied
* Leg, pelvis, arm, shoulder and cardiac muscles are weak and hypertrophied
112
How to dx Duchenne Muscular Dystrophy
Muscle Biopsy & electromyelogram
113
Medical interventions for Duchenne Muscular Dystrophy
* Antibiotics (tend to get pneumonia due to decrease in strength of the accessory muscles)
* Coordinate with PT, OT, RT
* Surgical intervention usually not required
114
Nursing interventions for Duchenne Muscular Dystrophy
* Help patient maintain independent living for as long as possible
* Prevent respiratory infections
* Monitor skin
* Ensure good nutrition
* Assess mobility
* Foster independence and self-care
* Provide emotional support
115
Education for Duchenne Muscular Dystrophy
* Related to disease progression and nursing care
* Support groups
* Hospice
116
Clinical manifestations of scoliosis
Asymmetric changes in spine
* Uneven shoulders
* Shoulder / scapular prominence
* Rib / chest hump while bending
* C or S shaped spine
117
Collaborative care for scoliosis:
* Bracing (must wear for 23hrs/day)
* Exercise/PT will help back muscles gain strength
118
Considerations for Spinal fusion surgery (Scoliosis)
* PCA pain pumps or epidurals are helpful for first couple days. Switch to oral Post-op day 3 (Combination products like Percocet, Norco, etc.)
* Passive ROM very important
* Ambulation usually around post-op day 5
* Must use log-rolling technique
* HOB no more than 30 degrees without brace on
* No twisting or bending, no lifting of heavy objects, no contact sports for 2 years
* Child can return to school in 4-weeks after surgery
119
Developmental Dysplasia of the Hip: Etiology
* The acetabulum is flat, rather than round and cuplike in shape
* Breech position can increase likelihood
120
Clinical Manifestations & Dx for Developmental Dysplasia of the Hip:
* Asymmetric skin folds
* Barlow + Ortolani maneuvers
* Ultrasound
* CT
121
Collaborative Care for Developmental Dysplasia of the Hip:
* Pavlik harness
* Hip spica cast
122
Pavlik Harness
* Newborn to 6 months for abduction of the hip
* It's a chest strap, two shoulder straps and two stirrups made of canvas, Velcro and buckles
* The harness places the femur in the socket at the correct angle and keeps the legs apart
* Recommend that the baby wear it 24 hours a day for 6 to 12 weeks
123
Hip Spica Cast
* Ages 6 to 24 months
* In case of dislocation unrecognized until child begins to stand and walk; use traction and cast immobilization (spica)
* A surgical closed reduction is done, and child is in a hip spica for 12 weeks usually
124
Cast care
* No fingertips, “palm”
* No dryer
* Elevate & reposition q 2 hours
* Observe for bleeding or discharge
* Neurovascular checks
* Monitor for compartment syndrome 5 Ps
Education/Discharge
* Cast care at home
* Prevent foreign objects in cast
125
Metatarsus Adductus (Varus)
Congenital foot deformity
Can be manually manipulated back to neutral position
126
Clinical manifestations of Metatarsus Adductus (Varus)
-High arch
-Visible curved leg and separated big toe
-Forefoot turned inward
127
Treatment for Matatarsus Adductus (Varus)
Stretching of the turned foot or wearing shoes of the opposite foot
