Peds 2 exam Flashcards

Question

Levels of care facilities

Answer 1

* Level I (basic) nursery- Manages uncomplicated pregnancies with expected normal deliveries and well infants * Level II (specialty) nurseries- designed to care for newborn infants who require some additional medical management such as phototherapy for jaundice, intravenous antibiotics or tube feedings. A neonatologist is usually on staff, these units typically lack the equipment and additional expertise such as pediatric surgeon or cardiologist * Level III (subspecialty) nurseries- have necessary equipment and trained personnel in the NICU and other hospital departments to care for all potential neonatal conditions and emergencies * Level IV- unofficial classification used to designate NICUs that offer current rescue technologies, although some interventions used initially for rescue (ventilation) or inhaled nitric oxide have become a standard of care after continued proven success

Answer 2

* NICU positioners include cloth, foam, water-based gel, bean bags and bendable rods * Z-flo fluidized neonatal positioners- made of microspheres encased in polyurethane. This allows contoured support, adapt and accommodates NICU medical equipment’s, facilitates skin integrity by reducing body pressure point or friction

Answer 3

• Deep sleep (non-rapid eye movement (NREM)- slow states changes, regular breathing, startles with some delay and lowest oxygen consumption • Light sleep (rapid eye movement (REM)- Low activity level, random movements and startles, respirations irregular and abdominal intermittent sucking movements, eyes closed, rapid eye movement, higher oxygen consumption Awake States • Drowsy or Semi-dozing- eyelids fluttering, eyes open or closed, mild startles, delayed response to sensory stimuli, fusing, more rapid and shallow breathing • Quiet Alert- with bright look, focuses attention on source of stimulation, minimal motor activity, may have some delay in response, minimal motor activity • Active Alert- eyes open, considerable motor activity, thrusting movement of extremities, spontaneous startles • Crying- intense and difficult to disrupt with external stimuli. Respirations rapid, shallow and irregular

Answer 4

Theory of understanding preterm behaviors and emerging capabilities of preterm infants to organize and control their behavior. Five interdependent subsystems include autonomic, motor, state, attention-interaction and self-regulation. Caregivers use the observations to modify the environment and facilitate the infant’s organization and well-being - Forms the basis for individualized, developmentally appropriate, family-centered care

Answer 5

Thermoregulation equipment • Radiant warmer- open bed with overhead heat source. Used during medical workup of new admission of critically ill infants • Incubator (isolette)- used to provide warmth, allows calories to be used for growth and healing • Open crib- bassinet style bed, no external heat source, infant is dressed in clothes and swaddled Oxygen therapy with assisted ventilation • Bag and Mask ventilation- used for resuscitation of an infant at delivery, during acute deterioration or to increase oxygenation • CPAP- endotracheal or nasopharyngeal tube provides positive pressure and is used to keep the alveoli and airways from collapsing in an infant with RDS, pulmonary edema or apnea • Mechanical ventilation- controls or assists breathing • ECMO- Life support system that uses a modified heart-lung byoass to provide nearly total lung rest and minimize barotrauma. It is a rescue technology. Oxygen therapy without assisted ventilation • High-flow nasal cannula- warmed and humidified oxygen or room air. Used to improve gas exchange or reduce work of breathing • Nasal cannula- humidified oxygen delivered by flexible nasal cannula with small prongs that fit into the nares. Used for infants requiring supplemental oxygen without positive pressure support • Oxygen hood- plastic hood with flow of warm humidified oxygen placed over the infant’s head and possibly upper trunk. Used for infants who are breathing independently but need a higher concentration of oxygen than 21% room air

Answer 6

After birth, demands are suddenly made on the preterm newborn to breath, regulate body temperature, move against the effects of gravity, adjust to bright light and unmuffled noise, cope with invasive or painful procedures and endure frequent sleep disruption and deprivation. Infant is unable to adjust to and organize the overwhelming stimuli and demands of the environment. Review table 22.2

Answer 7

• Thermoregulation- Infants are predisposed to excessive heat loss and are vulnerable to cold stress from several causes such as thin skin, reduced insulating subcutaneous fat. Interventions include radiant warmers, incubators, humidity, pre-warming items that contact the baby, positioning aids, clothes and swaddling

Answer 8

* Average= 2500 grams (5.5 pounds) 1pound=450gm * Low birth weight= 1500-2500 (3.3-5.5 pounds) * Very low= 1000-1500 (2.2-3.3pounds) * Extremely low- under 1000 (2.2) * Appropriate for gestational age AGA 10% to 90% on growth chart * Small for gestational age SGA= below 10% * Large for gestational age LGA= above 90%

Answer 9

* Gestational age refers to the total number of weeks the infant was in utero before birth. Confirmed by date of last menstrual cycle or ultrasonography or physical exam of the infant * Full term range is 37 or 38 to 42 weeks * Pre-term is an infant born before 37 weeks, infant born btw 34-37 weeks is late-preterm * Infant born after 42 weeks is post-term * Post-conceptional age- refers to the infant’s age in relation to when conception occurred. Obtained by adding the weeks since birth to the infants gestational age. PCA is commonly used until 40-44 weeks * Chronologic age refers to the infant’s actual age since birth * Adjusted age- refers to how old the infant would be if born at term rather than prematurely

Answer 10

- -Preterm infants- infants born prematurely - -Neonatal intensive care unit- a complex and highly specialized hospital unit designed to care for infants who are born prematurely or care critically ill - -Individualized developmental supportive care- Begins at birth rather than when the baby is medically stable. Support includes a protective and preventive component of care that is not inherent in the traditional rehab model. Protection from inappropriate sensory input is often more important that interventions or interactions. - -Preterm infant neurobehavioral organization- autonomic, motor, state, attention-interaction, self-regulation - -Synactive theory of development- refer to the bottom - -Neonatal medical complications—respiratory distress syndrome, sleep apnea - -Neuromotor and neurobehavioral development - -Therapeutic positioning- simulates the flexed, contained, midline posture of the infant in utero - -Nutritive sucking- bottle feeding, coordinated with breathing - -Nonnutritive sucking- dry sucking such as on a fist or pacifier. Does not disrupt breathing - -Cue-based feeding- based on active infant participation rather than caregiver manipulations, more positive outcomes. The infants feeding readiness, neurobehavioral organization and medical status are monitored prior to engaging the child in feeding

Answer 11

* 4 months-primitive squeeze, thumb adducted * 5 months- palmar grasp * 7 months- radial palmar (opposed grasp) * 9 months- Radial digital, wrist extended * 10 months - pincer grasp * 12 months- fine pincer grasp

Answer 12

The part of the hand/fingers used in the grasping pattern: ulnar grasp to palmar grasp to radial grasp The location of the object on the hand surface: palmar contact to finger surface contact to finger pad contact The muscle activity used in grasp- use of long finger flexors to increasing control of intrinsic muscles with extrinsic muscles Ability to stabilize the wrist in a slightly extended position is important for grasp patterns along with slight supination

Answer 13

• Napier proposed two basic terms to describe hand movements that include nonprehensile (involves pushing or lifting an object with the fingers or the entire hand) and prehensile (involve grasp of an object and may be subdivided according to the purpose of the grasp- precision or power) movements. • Precision grasps- involves opposition of the thumb to fingertips (holds small objects) • Power grasp involves the use of the entire hand (holds larger objects) • Grasps with no thumb opposition include hook grasp, power grasp and lateral pinch, patterns that use thumb opposition include tip and palmar pinches • Hook grasp- Used when strength of grasp must be maintained to carry objects • Power grasp- Used to control tools or other objects, facilitate precision handling with this grasp, stabilizes with the ulnar, controls object with the radial • Lateral pinch- used to exert power on or with a small object • Two standard pinches include the pad-to-pad/two-point pinch/pincer grasp or the three-point pinch/three-jaw chuck grasp • Tip pinch- opposition of the tip of the thumb and tip of the index finger. Used to obtain small objects Types of palmar grasps • Spherical grasp-Finger abduction and some degree of flexion at the MCP and IP joints. The hypothenar eminence lifts to assist the cupping of the hand for control of the object. This suggests the child’s ability to balance control intrinsic and extrinsic hand muscles • Cylindrical grasp- the transverse arch is flattened to allow the fingers to hold against the object. The fingers are slightly abducted; IP and MCP joint flexion is graded according to the size of the object. When additional force is required more of the palmar surface of the hand contacts the object. • Disk grasp- Incorporates finger abduction that is graded, hyperextension of the MCP joints and flexion of the IP joints. Only the pads of the fingers contact the object

Answer 14

Reach (12-22 weeks) - Grasp - Carry - Voluntary release (9 months)- requires control of extensors - In-hand manipulation (1-2 years)- Require ability to control the arches of the palm - Bilateral hand use

Answer 15

Neuromaturational theory- The brainstem structures develop first as evidenced by reflexive responses of the newborn, which are controlled by neural pathways in the brainstem. Cortical structures appear to develop later as evidenced by the coordinated and planned actions of the child. Increase in control is not only due to development and myelination of the midbrain and cortical structures but also inhibition of brainstem control of movement. • Movement progresses from primitive reflex patterns to voluntary and controlled movements. Motor reflexes provide the first methods of interaction with the environment. They subside as balance, postural reactions and voluntary motor control emerge • Low-level skills are prerequisites for certain high level skills. Infants develop motor control in a cephalocaudal direction with head control maturing first followed by trunk control sufficient for independent sitting and finally pelvic control sufficient for standing and walking

Answer 16

A systems approach • Assessment and intervention strategies must recognize the inherent complexity of task performance. A picture of the ways performance components, environmental and task factors affect performance of the tasks the child wants to accomplish • The focus of assessment and intervention is on the interaction of the person, environment and occupation • The therapy process focuses on identification and change of child, task or environmental constraints that prevent the achievement of desired activity • Therapist identifies playful activities that would motivate the child, are developmentally appropriate, match the child and family’s goal, provide a challenge to current skills levels and match an expected outcome • Focus on changing environments and occupations, best accomplished in a natural or realistic environment • Therapeutic effect and positive outcomes are determined by the child’s engagement in the activity, makes it meaningful -Cognitive approaches • Top down or occupation based approaches • This model builds on bandura’s research. Supporting the importance of self-efficacy and establishing goals to motivate individual achievement • Not suitable for individuals under 5 because of the emphasis on the development of metacognitive skills and knowledge • Therapist does not give instructions, rather they use process questions. Uses a problem solving framework • Focuses on occupations the child wishes to perform • Plan for transfer and generalization of the strategies that the child has learned -Adaptation and Compensation interventions- see above -Psychosocial approaches • Focus on the development of self, on family and peer relationships and on the aspects of the social and cultural environment that influence each of these -Coping model • Use of coping resources that enable the child to meet challenges posed by the environment. Improve ability to cope with stress. • Internal coping resources include coping style, beliefs, values, physical and affective states and developmental skills • External coping resources include human supports and materials and environmental supports -Social skills training • Interventions that develop positive coping strategies in children and adolescents with psychosocial dysfunctions can be essential for promoting the ability to participate in social interactions and relationships • Outcome include improved self-esteem and confidence • Improves self-esteem, positive affect, problem-solving and social behaviors -Motor learning and skill acquisition- see above -NDT- see above

Answer 17

Behavioral Theories • Skinner emphasizes operant conditioning/learning. Stated that behavior is a result of the environmental control of the individual, culture and species. Reinforcement is used to modify behavior. Behavior is strengthened and maintained when it results in positive reinforcement, if absent and therefore is negative, positive behaviors may be extinguished. • Shaping- involves breaking down a complex behavior into components and reinforcing each behavior individually and systemically until it approximates the desired behavior • Incidental teaching- a play environment is created to stimulate the young child’s interest and curiosity. It is important that toys used be developmentally appropriate with both novel and familiar toys • Pivotal response training- to teach children a set of pivotal behaviors believed to be central to learning. Outcome includes increase in motivation, attention, persistence to task, initiation of interaction and positive affect Social Cognitive Theories • Explains learning that occurs in social context • Bandura- children can learn by observing behaviors • Children learn indirectly by observing how their peers behaviors are rewarded or punished, therefore direct reinforcement is not always needed The influence of motivation and self-efficacy- When children experience success in learning situations, they are more likely to seek out optimal challenges. Children who experience repeated failure begin to avoid challenges and are less likely to seek out new learning situations. Motivation to learn is developed through outcome expectancy and person goals and casual attributions. Self-efficacy beliefs contribute to motivation. Dynamic systems theory – infants assemble motor skills for perceiving and acting. To develop motor skills, infants must perceive something in the environment that motivates them to act and use their perceptions to fine tune their environment

Answer 18

Piaget and Cognitive Development- • Concerned with adaptation of the individual in response to ongoing environmental experiences. • Adaptation examined through a child’s relationship with human and nonhuman objects. • Children are intrinsically motivated to learn, they act on rather than react to • Use of schema to how they represented objects and events • Cognition developed from simple-complex, concrete-abstract, personal-worldly concerns Vygotsky and the zone of proximal development • Social interaction has an influence on cognitive development • Zone of proximal development- Range of tasks that are too difficult for the child to achieve alone but can achieve with guidance and assistance of adults or more skilled children • Scaffolding involves adjusting the level of guidance to fit the child’s performance • When the OT understands the zone of proximal development and scaffolding his learning, they can design an optimal activity to promote the child’s learning Maslow and the hierarchy of basic needs • Outlined a hierarchy of basic needs that is believed to follow a longitudinal sequence (refer to notes) • Each of the needs serve as a motivator to achieve a higher level of human potential. Must satisfy their basic needs before they are motivated by or interested in other life goals

Answer 19

Developmental theories explain and describe the components of a person as they relate to occupational performance. Developmental theories emphasize the maturation of the CNS as it interacts with the social and physical environment Guides OT approaches utilized during the intervention process for successful outcomes

Answer 20

- -Foundational theories- These are theories that have formed the basis for theories and approaches to guide OT interventions and methods - -Risk and Resilience- Resilience is defined as the characteristic of an individual who achieves a positive outcome in the context of risk or factors known to be associated with negative outcomes. Resilience is a dynamic process that is refined over time through ongoing transactions between a child and the environment. Risk factors for children include socioeconomic disadvantage, negative parental relationships, parental mental or physical illness and the lack of extended family support. Child protective factors include strong self-esteem, positive communication skills, positive outcomes include intelligence, emotion regulation, temperament, coping strategies and attention - -WHO-ICF- The ICF views human functioning at 3 levels that include the body (structure + function), person (activities) and society (participation). Environmental factors can have an influence on health and functioning. ICF model- functioning, disability, and health depict the dynamic interaction between the person and their environment at all levels of functioning. - -Developmental theories- Explain and describe the components of a person as they relate to occupational performance - -Learning and systems theories- Theories that integrate concepts about people, their environments and their occupations. The primary process that results in developmental change is learning. Developmental theories emphasize maturation of the CNS as it interacts with the social and physical environment. Learning is the acquisition of knowledge, skills and occupations through experience that leads to permanent change in behavior and performance. - -Dynamic systems theory- An ecological approach that insists that the motor system is self-organizing. Learning does not occur just in the brain and that the body and environment are all constantly changing and simultaneously influencing each other. Behavior such as motor skills are not predetermined in the CNS, motor behavior is an interaction is emerging from the dynamic cooperation of the many subsystems in a task-specific context - -Adaptation approaches- Adapting the demands of the task or modifying the environment so that they are congruent with the child’s ability level. Adaptations involve modifying the occupation so that it is easier to perform using AT devices or changing the physical or social environment - -Social skills training- Interventions that develop positive coping strategies in children and adolescents with psychosocial dysfunctions to facilitate occupational performance such as social interactions and relationships. Results offer support for social skills interventions in improving self-esteem, positive affect, problem-solving and social behaviors with individuals with depression, schizo, autism and TBI. - -Motor Learning and Skill Acquisition- Helping achieve goal-directed functional actions involved in movement and balance. It is an occupation-based approach. - -Neurodevelopmental theory- Focuses on problems with postural control and motor coordination. Facilitate postural control and movement synergies to inhibit or constrain motor patterns. Focuses on changing movement patterns to achieve the most energy-efficient performance for the individual in the context of age-appropriate tasks. - -Sensory integrations- Seeks to provide the child with enhanced opportunity for controlled sensory input with a particular emphasis on vestibular, proprioceptive and tactile input in the context of meaningful activity. This intervention facilitates adaptive responses.

Answer 21

The family is involved in decisions and care concerning the child. Trust is developed and mutual respect. Family centered care increases parent satisfaction, enhances child psychological adjustment.

Peds 2 exam Flashcards

(45 cards)