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Flashcards in Pediatrics 4 Deck (40):

Approaches for a 5 year old who is cognitively impaired (1068)

Break up each small task into small, specific steps, because the child will not always be able to understand the task as a whole.


The 4 levels of cognitive impairment and the IQ that goes with it: (1067)

Mild: 50-70

Moderate: 40-50

Severe: 25-40

Profound: <25


Major criteria for diagnosing a child as being cognitively impaired (1068)

Failing to achieve developmental milestones at an appropriate age.

Diagnostic studies: neuro examination, CT scan, serum metabolite screening, developmental screening tests, standardized intellectual tests, chromosomal and genetic screening.


Nursing major focus in supporting a family with a cognitively impaired child (1068)

Promoting optimal development and providing the family with support, education, and referrals.

Encourage parents to keep their focus on the normal needs of all children - love, social interaction, and play.


Cause of Down's Syndrome (1069)

Trisomy 21 - an additional chromosome on the 21st pair.


Types of abuse included in child abuse (1073)

Physical - intentional bodily harm by the caregiver.

Emotional - intentional impairment or destruction of the mental or emotional state of the child.

Sexual - commission of a sexual offense by a person responsible for the child's care for their own sexual gratification.


What does the law say about a nurse reporting child abuse (1072)

Carefully document any manifestations of abuse in the medical record along with the caretaker's explanation of the findings.

Obligated to be alert to, assess, and report any abusive situations to proper authorities.


Suggestions to help parents with "school avoidance" (1074)

Be firm in the morning.

Bring somatic complaints to the attention of the health care provider. If no organic cause then send child to school.

Reassure child that nothing is wrong physically.

Explain to the child that school attendance is non-negotiable.

Provide support and reassurance to the child who is anxious about peer or academic issues.


What is Ritalin and what is it used for (1076)

Medication for improving the behaviors of children with ADHD.

Ritalin (methylphenidate) is a widely used psychostimulant.


What things could cause depression in a child (1076)

Disturbance in family dynamics.

A family move.

Death of a loved one.


Abuse or maltreatment.


What kinds of questions could you ask a depressed adolescent you think may be suicidal (1076, 1077)

Have you considered suicide?

How long have you been depressed?

Do you have a current psychiatric disorder?


Tricyclic antidepressants (1077)

Serotonin reuptake inhibitors (SRIs)
Fluoxetine (Prozac)
Trazodone (Desyrel)
Sertraline (Zoloft)
Bupropion (Wellbutrin)
Venlafaxine (Effexor)
Paroxetine (Paxil)


Signs of symptoms with recurrent abdominal pain (RAP) (1079)

Afebrile, vomiting, and constipation.

Abdominal pain is usually non-specific, or complaints of episodic periumbilical or epigastric pain unrelated to eating, defecation, or exercise.


How often are children seen for RAP condition (1079)

Psychogenic RAP presents with episodes of recurrent abdominal pain occurring monthly for at least 3 consecutive months after other causes have been ruled out.


Characteristics of autism (1071)

Hallmark sign: inability to maintain eye contact with another person. Avoidance of body contact.

Display limited functional play and sometimes interact with toys in an unusual manner. Performing distorted body movements.

They are usually constipated.


How long do Down's Syndrome patients usually live (1070)

55+ years


Autistic that excels in other subjects (1071)



Most important nursing intervention when treating for "maltreatment" (1072)

Most important role for any health care provider is identification of a child who is being mistreated.


Nursing intervention for someone with "school avoidance" (1074)

Attendance in school is non-negotiable and send them to school. Provide support and reassurance to a child that is anxious about peer or academic issues.


Most common developmental disability is (1067)

Cognitive impairment


Care for a child with special needs - characteristics you would expect to find with your assessment (1075)

Manifest problems with speech, behavior, motor coordination. Failure to master basic grade appropriate skills, progressive decline in school performance.

Delayed acquisition of language milestones, deficient social skills, avoidance behavior, frustration, disorganization, and somnolence.


Statistical rate of Down's Syndrome occurrence (1068)

Most common chromosomal abnormality:

1 in 600 to 800 live birth incidence.


Newborn suspected of having Down's Syndrome; hallmark appearance (1069)

Small, round skull with a flat occiput. Upward slanting eyes with epicanthal folds, broad flat nose, protruding tongue, short thick neck, hypotonic extremities, mottled skin, low set ears, and simian crease on palmar side of the hands.


Diagnostic test to confirm Down's Syndrome (1070)

Chromosomal analysis of trisomy 21.


Primary nursing goal for a child with Down's (1070)

Supporting the family at the time of diagnosis, referring the child and family to agencies that provide support and services.


Expected behaviors of a child diagnosed with ADHD (1075)

Decreased attention span, impulsivity, failure to follow instructions, hyperactivity, poor self-regulation, noncompliance, aggression, fidgeting, immature play, failure to follow rules, lack of turn taking, easily distracted by external stimuli.

Additionally, antisocial, lying, cheating, stealing, anxiety, sleep disturbances, poor relationships, limited fine motor skills.


What signs do you need to watch for in the first two weeks of antidepressant medication treatment (1077)

Beware of suicidal tendencies during the first two weeks of treatment with antidepressants.


Types of therapeutic nursing interventions for child with moderate to severe autism (1071)

Highly structured and intensive behavior modification programs. Promote positive reinforcement, increase social awareness of others, teach verbal communication skills, and decrease unacceptable behaviors.

Decreasing stimulation using a private room, avoiding extraneous auditory and visual distractions, and encouraging parents to bring in possessions the child recognizes. Minimum holding, minimum eye contact.

Providing a structured routine to follow is key to managing autism.


What tasks does a child with moderate cognitive impairment struggle with (1068)

Delays in motor, social, cognitive, and language skills.

Difficulty with complex tasks or multi-step tasks.


Kinds of factors that influence the personality and development of the child (1067)

Genetic composition, environmental, social support, and culture.


Congenital defects associated with Down's Syndrome (1070)

Prone to upper respiratory infections, frequent otitis media, congenital heart defects, leukemia, immune dysfunction, thyroid dysfunction (congenital hypothyroidism).


Common finding during assessment of a RAP patient (1079)

Afebrile, occasional vomiting, constipation, nonspecific abdominal pain, episodic periumbilical or epigastric pain (unrelated to eating, defecation, or exercise).


Which children are most at risk for abuse (1071)

This problem occurs at ever level of society. Not confined to one socioeconomic level, race or religion.


Typical findings for child abuse - Physical Neglect (1073)

Begging, stealing, stays at school, alcohol or drugs, fatigue.


Typical findings for child abuse - Physical Abuse (1073)

Frequent injuries, wary of adults, apprehension to crying, fear of going home, concealing clothing, low self-esteem, suicide attempts.


Typical findings for child abuse - Sexual Abuse (1073)

Nonspecific symptoms (abdominal pain), promiscuity, withdrawal, fantasy, sexual knowledge, poor peer relationships, prostitution, rape, fear of touch, suicide attempts, low self-esteem, masturbation.


Typical findings for child abuse - Emotional Neglect (1073)

Stranger anxiety, emotional withdrawal, lag in emotional and intellectual development, suicide attempts.


Things to look for in a child that has been sexually abused (1073)

Difficulty walking or sitting, torn stained bloody undergarments, pain or pruritus in genital area, bleeding of genitalia including vagina or anus, STDs, pregnancy, discharge from sexual organs, foreign bodies in vagina or rectum, presence of semen, UTI.


Parent teaching for a child with ADHD (1076)

Discipline, set limits, provide rewards, establish strict daily routine, dangers of controversial therapies, importance of accident prevention and safety, increased supervision, develop educational plan, reasons and importance for medication, importance of follow-up routine for medication.


Nursing interventions for adolescent admitted for overdose (1077, 1078)

Overdose is the most common method of suicide.

Be direct in asking about thoughts of death and suicide; will often be surprisingly open in communication. Help child develop positive coping strategies in stressful situation.

Maintain open airway, maintain cardiac function, monitor for effective medication treatment, treat any dysrhythmias.