Test 1 Flashcards
(184 cards)
1
Q
What is the nurse’s role in health promotion?
A
Assessments, Emotional support, anticipatory guidance, teaching, child and family advocate, implement prevention strategies, and partner with families.
2
Q
What are the components of Health Promotion/Maintenance visits?
A
General observations, Physical assessment, growth, development, nutrition, physical activity, oral health, mental health, address parental concerns, and disease and injury prevention strategies.
3
Q
What occurs on the first HPM visit?
A
establish relationship, explain importance of regular visits, explain what will be done at each visit, and encourage parents to express concerns.
4
Q
What is done at a HPM visit for infants?
A
measure length, weight, HC
assess developmental milestones
provide anticipatory guidance
support development, promote safety.
5
Q
When does an infants weight double from birth weight?
A
5 months old
6
Q
When does an infants weight triple from birth weight?
A
1 year old
7
Q
What is a red flag in weights in infants?
A
a drop in percentile range for weight
8
Q
What is done at a HPM visit for young children?
A
weight and height, HC.
BMI starting at 2 years olds
Assess developmental milestones - developmental testing if needed
9
Q
What is percentile of growth is considered consistent growth?
A
5th-85th percentile
10
Q
What is done at an HPM visit for school age children?
A
weight, height, BP, BMI
vision, hearing screening
developmental milestones
11
Q
What are some developmental milestones for school age children?
A
school performance
rides 2-wheeler
jumps rope
can focus on any activity for longer periods
12
Q
What is done at an HMP visit for adolescents?
A
weight, height, BP, BMI
same growth percentile as childhood
assess- scoliosis, cholesterol, tanner staging, hct for females, sexual activity
teach BSE, TSE
13
Q
What are nutritional considerations with children?
A
transition from breast milk or formula - 1 year
introduce new foods gradually
avoid choking hazards
limit fruit juices
decreased intake normal for young child
obesity and eating disorders are concerns
teach healthy choices
14
Q
What to remember with physical activity of infants?
A
needs stimulating environment
activity helps develop muscles
encourage parents to play with infant
opportunities to interact with family
15
Q
What to remember with physical activity of young children?
A
these age groups normal active
toddlers- further motor development
preschoolers- gain coordination
discourage inactivity, limit “screen time”
need 60 minutes each daily - structured & unstructured
teach benefits of activity
16
Q
What to remember with physical activity of adolescents?
A
helps develop social skills, self esteem
60 minutes vigorous activity daily
encourage family participation
teach use of safety equipment
17
Q
What is the goal of physical activity in adolescents?
A
establishment of lifetime exercise routines
maintain healthy weight
18
Q
What to remember with oral health in infants?
A
nutrition important for teeth wipe gums with moist gauze 1-2/day no bottle at bedtime - prevent ECC 2 front teeth at 6 months teething comfort measures
19
Q
What to remember with oral health in young children?
A
start oral hygiene habits early first dentist visit by 1 year old, then Q 6 months brush twice, floss once a day assess teeth - 20 by age 2 sugar exposure?
20
Q
What to remember with oral health in adolescents?
A
lose teeth starting by age 6 continue to brush 2x & floss daily see dentist Q 6 months braces need extra care wisdom teeth evaluation
21
Q
What assess with mental health?
A
normal growth & development
family relationships, interactions, and communications
self-regulation behaviors & temperament
child’s social skills
self-concept/ self esteem
22
Q
What should you teach about mental health of children?
A
establishing routines and sleep patterns managing temper tantrums positive discipline providing socialization opportunities increasing independence
23
Q
How to prevent disease in infants?
A
monitor for infections - provide immunizations, reduce risk of SIDS
screenings for - metabolic & genetic diseases, vision & hearing, anemia, lead poisoning.
discourage parental smoking
goal is to prevent or treat diseases early
24
Q
How to prevent disease in the young child?
A
immunizations up to date
screenings continue
environmental hazards? smoking, lead exposure, drugs and alcohol
monitor for acute and chronic illnesses
25
How to prevent disease in school age children?
immunizations and screenings continue
personal hygiene practices
child more active in own health
teach how to prevent illness and injury
26
How to prevent disease in adolescents?
screening and follow up
| stress, depression, suicide risk, substance abuse
27
What are some teaching topics in adolescents for disease prevention?
```
risks of smoking, alcohol, drugs
prevention of STDs and pregnancy
BSE, TSE
use of sunscreen
prevention of diabetes and heart disease
```
28
What are common childhood injuries?
```
choking hazards: infants, young toddlers
falls
burns
drowning
poisoning
motor vehicle accidents
```
29
How to prevent injuries in infants?
avoid small toys and choking foods
baby proof house early, gates on stairs
don't place unsecured on high surfaces
temp of bath water and formula, outlet covers
don't leave alone in bath, monitor closely around water
secure medications/harmful chemicals
30
How to prevent injuries in young children?
supervise closely! safe climbing toys
turn pot handles inward, use screen on fireplace
preschool = teach "stop, drop, roll" 911
monitor near H2O, empty buckets, pool covers, and swim lessons
preschool = teach not to go in H2O
child-resistant containers and cabinets
preschool = safety with strangers
31
How to prevent injuries in school age children?
```
know emergency phone numbers
leave guns alone
stranger safety
protective sporting gear
safety with matches, fire
know how to swim well
safe outside play, bike safety
```
32
How to prevent injuries in adolescents?
MVC- never text and drive, don't drive tired. use seat belts
Sporting injuries- protective gear, helmets, knee pads
Drowning- buddy system, don't overestimate abilities, use caution with diving
33
What is the primary purposes of HP activities?
prevent disease and injury
| detect and treat disease early
34
Why is hospitalization a stressful time for child & family?
disruption of routine and health status
| involves many fears and emotions
35
A child's response to hospitalization is related to...
```
child's developmental age
previous experience
coping skills
seriousness of diagnosis
support people available
```
36
What are some child responses to hospitalizations?
aggression, regression, nightmares, irritability, bed-wetting, altered sleep
37
What is the general pediatric RN role?
understand development and understand stressors & how child views illness
so we can: use a family-centered approach to care, provide developmentally appropriate care, and reduce the stress of hospitalization of child and family
38
How does an infant understand illness?
no awareness of illness.
sense parent's anxiety.
more traumatic if parent is not present.
if mom is not right, baby can feel and react, causing stress.
39
How do toddlers understand illness?
fear pain and changes to their bodies.
realize change in routine but do not know why.
view pain as punishment.
reduce anxiety with parent around.
40
What is the developmental stage of infants?
trust vs mistrust
41
What is the developmental stage of toddlers?
autonomy
42
How do preschool age children understand illness?
```
greatest stressors are their fears
rituals/routines sill important
intrusive procedures threatening
use play to explain
be careful how you word things
teach what to expect
make it more like home
```
43
What is the developmental stage of preschool age children?
initiative
44
How do school age children understand illness?
```
better understanding of causes of illness
usually very cooperative
still needs parent's support
privacy important
build trust
```
45
What is the developmental stage of school age children?
industry/inferiority
46
How do adolescents understand illness?
understands complexities of illness
perceives illness as it effects body image
independence and privacy important
may be frustrated with dependence on parents
appearance is important
should be an active participate in care
47
What is the developmental stage of adolescents?
identity/role confusion
48
What are common stressors for hospitalized children?
separation from family
loss of control, autonomy, privacy
painful and/or invasive procedures
fear of bodily injury and disfigurement
49
What can nurses do to reduce fear?
```
prepare child for procedures
explain on child's level
do procedure quickly
use treatment room
comfort measures during
comfort, praise, reward afterwards
```
50
What are strategies to promote coping, enhancing hospitalization?
preparation for hospitalization & procedures
rooming in - parent involvement in care
child life programs
therapeutic play
51
Why is play so important?
play is the work of children.
it is absolutely essential for growth and development
during the acute phase of illness, children don't usually wan to play
52
What are the functions of therapeutic play?
helps child feel more secure in strange environment
provides a means of accomplishing therapeutic goals
allows expression of feelings
53
What are some opportunities for therapeutic play?
incorporate play into care
allow time just for play
age-appropriate toys
consult child life specialists
54
How can nurses reduce stress of hospitalization?
family centered care
| developmentally appropriate care
55
What are some issues with medicating children?
increased number and more unusual side effects
less able to tolerate adverse effects
many drugs not yet approved for pediatric use
communication issues
56
What is the difference in pharmacokinetics related to?
```
muscle mass
% body fat
% body water
liver and renal function
permeability of skin
```
57
What increases the risk of med error in children?
```
no standard dose
wide range of weights
dosage calculations more complex
misplaced decimal = possible OD -> death
measurement of liquid meds
```
58
How are pediatric meds dosed?
by weight
by age
body surface area
59
How are pediatric doses calculated?
mg/kg/dose
| mg/kg/day
60
Why are children under medicated?
complexities of pain assessments in children.
| misconceptions about pain in children
61
What are some truths about pain in infants?
nerve pathways intake by 20 weeks gestation
have behavioral and physiologic cues indicating pain
newborns and premature infants may have greater sensitivity
62
What is the requirements for using self-report pain assessment tools?
needs to be conscious and verbal
must understand concept of more/less
must understand concept of larger/smaller
must understand numbers/language skills
63
What age can the FACES pain rating scale be used?
age 3 and up
64
What age can the oucher scale be used?
ages 3 and up
65
What age can the poker chip tool be used?
ages 4 and up
66
What age can the numeric scale be used?
5 and older
67
What age can the word graphic rating scale be used?
school aged child - must read
68
When can self report pain scales not work?
<3 years old
preverbal
uncooperative child
unresponsive child
69
What are behavioral indicators of pain?
facial grimacing, irritability, posturing, restlessness or agitation, lethargy or withdrawal, sleep disturbances, and short attention span.
70
What are the nurse report pain scale used for nonverbal children?
neonatal infant pain scale (NIPS)
| FLACC
71
When is the Neonatal infant pain scale used?
28 days of life, used longer in the NICU
72
When is the FLACC pain scale used?
children 2 months to 7 years.
| can be modified to use in children with intellectual disability
73
What does the CRIES pain scale use?
combine physiologic and behavioral cues to assess pain
74
What is an at risk newborn?
one who is susceptible to illness or even death because of dysmaturity, immaturity, physical disorders, or complications during or after birth.
75
What puts a newborn at risk?
```
SGA/IUGR
LGA or IDM
Pre-term
post-term
pregnancy or birth complications
exposure to drugs, toxins, infections
congenital abnormalities
```
76
What are common NICU diagnoses?
```
prematurity
respiratory distress (RDS, TTN, apnea, MAS)
infections
hypoglycemia (SGA, LGA, IDM, preterm)
drug withdrawal (NAS)
seizures
IUGR
```
77
What are common concerns with preterm infants?
immature systems put infant at risk for numerous problems.
78
What happens during a newborns first breath?
fills lungs with air, gets fluid out
79
What is the respiratory rate of an infant?
30-60 breathes per minute
80
What is normal breathing for infants?
periodic breathing
obligatory nose breathers
apnea less than 20 seconds is normal
81
What is the cause of respiratory distress syndrome?
low-level or absence of surfactant - common in preemies
82
What are signs and symptoms of respiratory distress syndrome?
nasal flaring, retractions, grunting, tachypnea, cyanosis, apnea = causes severe distress, preventing exchange of o2 and co2, leading to hypoxia, respiratory acidosis, metabolic acidosis
83
What is the treatment for respiratory distress syndrome?
prevent if possible
surfactant replacement - survanta, exosurf, curosurf
support oxygenation and ventilation- oxyhood, nasal CPAP, ventilator
UAC for ABG monitoring
correct acid base abnormalities
supportive care
84
What are complications of RDS?
respiratory failure, bronchopulmonary dysplasia (BPD), Patent Ductus arteriosus (PDA), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH)
85
What is Apnea of Prematurity (AOP)?
no breath for 20 seconds, common in preemies
86
What is the nursing care for Apnea of Prematurity?
monitor closely. document all A and B events. gentle stimulation. blowby or bag oxygen if needed.
methylxanthine meds help prevent apnea
87
What is transient tachypnea (TTN)?
> 60 breathes per minute.
usually around 80.
seen in C-section babies
88
What is the cause of transient tachypnea?
slow absorption of lung fluid or excess fluid in lungs
89
What is the signs and symptoms of transient tachypnea?
grunting, nasal flaring, mild retractions, mild cyanosis, tachypnea
90
What is the treatment for transient tachypnea?
oxygen, possible IVFs, time, NPO if RR >60
91
Who is more likely to experience transient tachypnea?
c/s infants, large infants, and babies born to diabetic mothers
92
What is the general respiratory nursing care?
```
monitor respiratory status frequently
cardiac/resp and O2 sat monitors
O2 therapy - warmed and humidified
chest PT and suction
monitor blood gases
monitor UAC, IVs
```
93
What is the major concern of thermoregulation?
heat loss
94
What is heat loss in preemies related to?
```
greater body surface area to weight
thinner skin
reduced subcutaneous fat
extended posture
decreased vasoconstriction
```
95
What is the effects of hypothermia (cold stress)?
pulmonary vasoconstriction
increase O2 demand
leads to hypoglycemia
metabolic acidosis can result in death
96
What is the best prevention for hypothermia?
keep baby warm
97
What is importance of a neutral thermal environment?
minimizes energy expenditure
minimizes O2 consumption
facilitates growth
98
What are the hepatic/hematologic concerns with preemies?
immature liver:
| hypoglycemia, low iron stores, elevated bilirubin levels
99
What is the cardiac problems with preemies?
ductus arteriosus may remain open = PDA
100
What is the normal heart rate of a newborn?
120-180 bpm
101
What is the normal resting/sleeping heart rate of a newborn?
100-120 bpm
102
What is the blood volume of an infant?
80-100 mL/kg
103
What is hypoglycemia of a newborn?
<40-45
104
What are symptoms of hypoglycemia?
jitteriness - full term
lethargy - pre term
poor feeding
hypothermia
105
What are some concerns with the renal system in preemies?
risk for fluid overload
risk for dehydration
risk for metabolic acidosis
reduced ability to excrete drugs
106
What are some GI concerns with preemies?
higher caloric need
numerous feeding issues
can't break down protiens
calcium & phosphorus deficiency
107
What are some feeding issues with preemies?
small stomach, coordinating suck, swallow, breathe, and GERD.
108
What is a GI complication of preemies?
necrotizing enterocolitis
109
What are feeding methods of the high risk neonate?
TPN
gavage feedings - OG or NG
nipple or breast
110
What is necrotizing enterocolitis?
inflammatory bowel disease.
potentially life threatening
can deteriorate rapidly
111
What is necrotizing enterocolitis related to?
ischemia & inflammation - hypoxic event
bacterial colonization
enteral feedings
immature GI mucosa - premature gut
112
What are some assessment findings of necrotizing enterocolitis?
abdominal distention
residuals/vomiting
instability of temp, BP, and apnea
xray = air in bowel wall
113
What is the treatment for Necrotizing enterocolitis?
```
NPO, IVFs, TPN.
N to decompress stomach
antibiotics
supportive care
possible surgery
```
114
What is the concerns with the immunologic system of a preemie?
increased risk of infection related to decreased immunity, increase in invasive procedures, and thin skin surface.
115
How do you prevent infection in a preemie?
handwashing, careful assessment, prophylactic antibiotics. strict asepsis with IVs, oxygen tubing changed frequently. isolettes and warmers changed frequently. use of scrubs, gowns, & gloves.
116
What are some concerns with the neuro/sensory of a preemie?
Intracranial hemorrhage, intraventricular hemorrhage. hydrocephalus. ROP. CP or LD.
117
What is Retinopathy of prematurity related to?
use of oxygen & prematurity
118
What is a complication of retinopathy of prematurity?
retinal detachment & blindness
119
What is the treatment of ROP?
cryotherapy or laser treatment.
| scleral buckling for detachment.
120
What is the priority assessment needs of high risk neonates?
respirations, circulation, control of body temp, nutrition/fluids, prevent infection, family support, and developmental care/teaching
121
What are common NICU medications?
antibiotics - prophylactic
Caffeine- for AOP
Surfactant- for RDS, reduces surface tension
steroids- to get off ventilator
sedation- pain relief
volume expanders- albumin & packed RBCs, decrease BP
inotropic drugs - dopamine & dobutamine, increase contractibility of heart to maintain BP
122
What are the principles of nursing care for high risk neonates?
```
decrease physiologic stressors
increase growth and development
constant observation for subtle changes
interpretation of lab data & coordinating interventions
conserve infant's energy
provide developmental stimulation & sleep cycles
assist family in attachment behaviors
support and teach families
```
123
What are examples of communicable diseases?
```
whooping cough - pertussis
measles - rubeola
chicken pox - varicella
mumps - parotitis
fifths disease - erythema infectiosum
```
124
What to remember about live injected vaccines?
if not give together, should be separated by atleast 4 weeks.
125
What are some reactions to vaccines?
local - pain, swelling, redness at injection site
systemic - fever, irritability, malaise, HA, rash, anorexia
allergic or severe - can be life-threatening, anaphylaxis, seizures, paralysis
126
What is the role of the nurse in immunizations?
encourage vaccination.
screen patients to identify contraindications.
identify vaccines indicated.
education - VIS and consent signed
administer vaccines
treat and report adverse reactions to VAERS
follow up
127
What is assessed in the screening for immunizations?
serious medical condition. problems with immune system. allergies to food or meds. reactions after previous vaccines. steroids, chemo, radiation in last 3 months. close contacts with immune deficiency. blood products in last year. pregnancy.
128
What are contraindications of immunizations?
acute illness with HIGH fever 103 <
hx of hypersensitivity reaction to that particular vaccine or components.
MMR & Varicella vaccines - immunoglobulin treatment in last 3-11 months, immunodeficiency, or pregnancy
129
When is it safe to immunize?
```
mild to moderate illness
disease exposure
antibiotic therapy
breast feeding
premature birth
most allergies
family history of vaccine reaction
```
130
What is included in parent education on vaccines?
recommendations for vaccines, possible side effects, contraindications, management of reactions, and when to call 911.
131
When do you call 911 after vaccines?
facial or throat swelling, respiratory symptoms, child unresponsive.
132
What to remember when administering vaccines?
```
restrain safely.
25% sucrose water and pacifier for infants
pressure at site 10 second before injection
EMLA or vapocoolant spray
offer distraction
two nurses at same time, over quickly
older child can choose which arm or leg
comfort and praise afterwards
```
133
When is HepB vaccine done?
birth,
1-2 months
6-18 months
134
When is the Rotavirus vaccine done?
2 months
4 months
6 months
135
When is the DTaP vaccine done?
```
2 months
4months
6 months
15-18 months
4-6 years
```
136
When is the Hib vaccine given?
2 months
4 months
6 months
12-15 months
137
When is the pneumococcal vaccine given?
2 months
4 months
6 months
12-15 months
138
When is the polio vaccine given?
2 months
4months
6-18 months
4-6 years
139
When is the influenza vaccine given?
6 months +
| yearly
140
When is the MMR vaccine given?
12-15 months
| 4-6 years
141
When is the varicella vaccine given?
12-15 months
| 4-6 years
142
When is the HepA vaccine given?
12-24 months
143
How do you document vaccines?
dose, route, site.
vaccine, manufacturer, lot #, expiration
name & address of provider; name & title of nurse
record for clinic & parent
144
What is some general nursing care common to all infections?
```
prevent spread of infection
rash care
manage fever
provide comfort, encourage rest
assess for and manage symptoms
encourage fluids
diversional activities.
```
145
What is included in rash care?
```
prevent scratching
oral antihistamines
aveeno baths (oatmeal)
caladryl lotion (calimine)
change linens frequently
keep fingernails clean & short
```
146
What is the most common symptom of infection in children?
fever
147
What is the definition of fever?
body temp over 101.4
148
What is the benefit of fever?
low grade, body fighting infection
149
How do you treat a fever?
antipyretics - acetaminophen or ibuprofen, NOT NSAIDs
remove unnecessary clothing
encourage increased PO fluid intake - offer favorites, small amounts frequently
150
When do febrile seizures occur?
in infants & young children
due to rapid rise in temperature
brief
do not recur with the same illness
151
What happens if you give aspirin to a child with a viral infection?
reyes syndrome
152
How is varicella (chicken pox) spread?
airborne or direct contact with lesions
153
When is varicella contagious?
1-2 days before rash until all lesions are crusted over
154
What symptoms are associated with varicella?
acute onset, mild fever, malaise, anorexia, HA, mild abdominal pain, and skin rash
155
What are some complications of varicella?
secondary infection, thrombocytopenia, reyes syndrome.
156
What are some characteristics of varicella rash?
```
rash begins on truck, scalp, face
macule -> papule -> vesicle -> crust over
1-5 days of eruption = itchy
lesions at all stages
oral lesions affect PO intake
crusts can last 1-3 weeks
```
157
What is the nursing care of varicella?
```
airborne and contact precautions
rash care
change linens frequently
acyclovir for immunocompromised
vaccination
immunoglobin for exposed NB & unimmunized children
```
158
How is fifth disease spread?
respiratory secretions & blood
159
When is fifth disease contagious?
week before symptoms
160
When is fifth disease no longer contagious?
once rash appears
161
What are the symptoms of fifth disease?
2-3 days = mild symptoms, HA, fever, malaise
then 1-7 days no S&S
then slapped face appearance
1-4 days later = lace-like symmetric erythematous, maculopapular rash on trunk and limbs
1-3 weeks rash fades
162
What are complications of fifth disease?
patients with hemolytic conditions (SCA) can have transient crisis
163
What is the nursing care of fifth disease?
standard and droplet precautions
oatmeal/aveeno baths for pruritus
protect from sunlight
164
How is measles (rubeola) spread?
direct contact w/droplet or airborne
165
When is measles contagious?
4 days pre rash to 4 days after rash appears
166
What are symptoms of measles?
prodrome: anorexia, malaise.
| koplik's spots appear in mouth. high fever, conjunctivitis, coryza, cough, rash
167
What characteristics of measles?
maculopapular rash 4-7 days after prodrome
starts on face, spreads to trunk and extremities.
symptoms gradually subside in 4-7 days
168
What are complications of measles?
diarrhea, OM, pneumonia, bronchitis, LTB, encephalitis, death.
169
What is the nursing care for measles?
```
airborne precautions
careful respiratory assessment
cool mist vaporizer
suction gently
photophobia- dim lights, shades
skin care- clean and dry, no soaps
```
170
What is mumps (parotitis)?
inflammation of parotid gland
171
How is mumps spread?
contact with or inhalation of respiratory droplets
172
When is mumps contagious?
up to 7 days before swelling until 9 days after
173
What are some signs and symptoms of mumps?
malaise, fever, & parotid gland swelling
| earache, HA, pain w/chewing, decreased appetite, and activity.
174
What are complications of mumps?
orchitis in post pubertal males
viral meningitis
stiff neck, photophobia, HA
175
What is the nursing care for mumps?
```
standard and droplet precautions
soft & blended foods - avoid foods that increase salivary flow
warm or cool compresses to parotid area
assess for meningeal irritation
scrotal support if testicular swelling
```
176
How is pertussis (whooping cough) spread?
respiratory droplet & contact with secretions
177
When is pertussis contagious?
1 week after exposure until 5 days into antibiotic treatment
| most contagious before paroxysmal cough
178
What are the complications of pertussis?
pneumonia, atelectasis, OM, encephalopathy, seizures, death.
179
What are the stages of pertussis?
catarrhal stage 0-2 weeks
paroxysmal stage 1-6 weeks
convalescent stage 6-10 weeks
180
What are the symptoms of the catarrhal stage of pertussis?
runny nose, low grade fever, mild nonproductive cough
181
What are the symptoms of the paroxysmal stage of pertussis?
whooping cough, more severe at night
182
What are the symptoms of the convalescent stage of pertussis?
coughing spells gradually subside
183
What is the treatment of pertussis?
macrolide antibiotics - erythromycin, azithromycin
corticosteroids prn
treat close contacts
184
What is the nursing care for pertussis?
droplet precautions until antibiotics for 5 days
cardiac monitor and pulse ox
observe coughing spells - O2 prn
crash cart?
humidification, gentle suctioning prn
reduce crying
teach parents s/s of respiratory failure and dehydration
