Peadiatrics

Question 1

What is family-centered care?

Answer 1

• Based on the tenets of Attachment Theory
• Recognizes family as constant in child’s life
• Systems must support, respect, encourage and enhance the family’s strength and competence
• Need so family must be addressed

Question 2

What are some stressors of Hospitalization?

Answer 2

Separation anxiety
- Protest phase - crying and screaming, clinging to parent
- Despair phase - crying stops; evidence of depression
Detachment (denial) phase - resignation but not contentment; superficial adjustment, may seriously affect attachment to the parent after separation

Question 3

What are some things infant needs when there is a loss of control?

Answer 3

• Trust
• Consistent loving caregivers
• Daily routines

Question 4

What are preschooler needs when there is a loss of control?

Answer 4

• Egocentric and magical thinking is typical of this age
• May view illness or hospitalization as punishment for misdeeds
  Preoperational thought

Question 5

What are school-age children needs?

Answer 5

• Striving for independence and productivity
  Fears of death, abandonment, permanent injury
• Boredom

Question 6

What are adolescent needs?

Answer 6

• Struggle for independence and liberation
• Separation from the peer group
• May respond with anger and frustration
• Need for information about their condition

Question 7

How to normalise the hospital environment?

Answer 7

• Maintain the child’s routine, if possible
• Time structuring
• Self-care (age appropriate)
• Schoolwork
• Friends and visitors
• Introductions to other patient’s and their families
• Helping out the staff

Question 8

What are the normal values after 1 week of birth?

Answer 8

RR: 30-60
PR: 100-160
Systolic BP: 50-70

Question 9

What are the normal values of a 1-6 week infant?

Answer 9

RR: 30-60
PR: 100-160
Systolic BP: 70-95

Question 10

What are the normal values of a 6 months infant?

Answer 10

RR: 25-40
PR: 90-120
Systolic BP: 80-100

Question 11

What are the normal values of a 1-year-old?

Answer 11

RR: 20-30
PR: 90-120
Systolic BP: 80-100

Question 12

What are the normal values of a 3-year-old?

Answer 12

RR: 20-30
PR: 80-120
Systolic BP: 80-110

Question 13

What are the normal values of a 6-year-old

Answer 13

RR: 18-25
PR: 70-110
Systolic BP: 80-110

Question 14

What are the normal values of a 10-year-old

Answer 14

RR: 15-20
PR: 60-90
Systolic BP: 90-120

Question 15

What are some important factors for normal values?

Answer 15

• Patients normal should always be considered
• HR, BP & RR will increase during fever and stress
• RR on infants count for 60 seconds
• In clinically decompensating child BP last to change
• Bradycardia in children- ominous sign - usually from hypoxia

Question 16

How to prepare a child for procedures?

Answer 16

Main goal is to decrease anxiety, promote cooperation, and support coping skills

• Psychological preparation
• Establish trust and provide support
• Parental presence and support
• Explanation to the child

Question 17

How to perform procedures for children?

Answer 17

• Use of the treatment room for procedures
• Expect success, best person for the job
• Involve the child - let the child help if able
• Provide distraction; use of play in procedures - age appropriate
• Encourage expression of feelings
• Provide support and encouragement through procedure; rewards help
• Prepare the family

Question 18

What are the risks for developing illnesses throughout the ages?

Answer 18

• Younger than 3 months - maternal antibodies offer protection
• 3-6 months - the infection rate increases
• Toddlers and preschoolers - high rate of viral infections
• Older than 5 years- increase in GABHS and Mycoplasma pneumoniae infections
• Increased immunity develops with age

Question 19

What is the difference between a child’s airways or an adults?

Answer 19

• Diameter of airways are smaller
• Distance between structures is shorter, allows organisms to rapidly move down
• Short and open eustachian tubes

Question 20

What are some respiratory problems in children?

Answer 20

• Croup syndromes
• Bronchitis
• Bronchiolitis
• Asthma
• Epiglottis

Question 21

What are the clinical manifestations of respiratory infections?

Answer 21

• Varies with age
• Generalised signs and symptoms and local manifestations differ in young children
• Fever
• Anorexia
• Cough, sore throat, nasal blockage or discharge
• Adventitious respiratory sounds

Question 22

What are some nursing interventions for respiratory infections?

Answer 22

• Ease the respiratory effort
• Manage fever
• Promote rest and comfort
• Control infection
• Promote hydration and nutrition
• Provide family support and teaching

Question 23

What are Croup Syndromes - URTI?

Answer 23

• Characterized by hoarseness, barking cough, inspiratory stridor, and varying degrees of respiratory distress
• Affects the larynx, trachea, and bronchi
• Problematic in infants and small children due to smaller diameter of airways

Question 24

What is acute epiglottitis?

Answer 24

• Sore throat, pain, tripod positioning, retractions
• Inspiratory stridor, mild hypoxia, distress
• Potential for respiratory obstruction

Question 25

How to prevent acute epiglottitis?

Answer 25

Haemophilus influenzae type b (Hib) vaccine

Question 26

What is the therapeutic management for acute epiglottitis?

Answer 26

- Presumptive diagnosis of epiglottitis constitutes a medical emergency - Should not be examined until anesthetist presents as immediate intubation or tracheostomy may be indicated for airway obstruction - Keep patient calm, comfortable and minimise any distress

Question 27

What is bronchiolitis?

Answer 27

- Respiratory syncytial virus (RSV) - Causes childhood pneumonia as well - Acute viral infection, bronchiolar level - Rare in children over 2 years; usually 3-6 months - Spread by hand to eye, nose and other mucus membranes

Question 28

What is febrile convulsion/ seizures?

Answer 28

- Most occurs 6 months to 3 years - Boys are affected twice as often - Most are generalised, last least than 5 minutes - 30% of children have one occurrence - Cause uncertain, rarely any long-term effects and are relatively harmless - >38.8 degree and occurs during temp rise - Accompanying illness; otitis media, respiratory infections

Question 29

What is the nursing management for febrile convulsions/seizures?

Answer 29

- Stay calm - Think safety during and after seizure - Call for help - If lasting more than 5 minutes, doctor consultation - Observe and examine for origin of fever - Parental support and education - don't put anything in the mouth, don't put them in a cold bath or shower; loosen clothes around face and neck

Question 30

What are signs of distress to look out for in a child?

Answer 30

Appearance: - Abnormal tones - Decreased interactiveness - Decreased consolobility - Abnormal look/gaze - Abnormal speech/cry Circulation to skin - Pallor - Motting - Cyanosis Work of breathing - Abnormal sounds - Abnormal position - Retrations - Flaring - Apnea/gasping

Question 31

What does CUPS stand for in paediatrics?

Answer 31

``` Measures the severity of the illness C - critical U - unstable P - potentially unstable S - stable ```

Question 32

What are key assessments you need to consider when caring for a child?

Answer 32

- Health history - previous hospitilisation, immunisation status, medications - Nutrition - Feeding appetite, allergies, food diary - Family structure - family dynamics, culture (family norms), potential abuse - Physical - weight, vital signs, level of consciousness, skin color, temperature - Developmental - sensor & motor movements for age, interaction, physiological development

Question 33

What is AVPU?

Answer 33

A - awake and alert V - responsive to verbal stimuli P - responsive to painful stimuli U - completely unresponsive