Flashcards in Test 1 Deck (184):
What is the nurse's role in health promotion?
Assessments, Emotional support, anticipatory guidance, teaching, child and family advocate, implement prevention strategies, and partner with families.
What are the components of Health Promotion/Maintenance visits?
General observations, Physical assessment, growth, development, nutrition, physical activity, oral health, mental health, address parental concerns, and disease and injury prevention strategies.
What occurs on the first HPM visit?
establish relationship, explain importance of regular visits, explain what will be done at each visit, and encourage parents to express concerns.
What is done at a HPM visit for infants?
measure length, weight, HC
assess developmental milestones
provide anticipatory guidance
support development, promote safety.
When does an infants weight double from birth weight?
5 months old
When does an infants weight triple from birth weight?
1 year old
What is a red flag in weights in infants?
a drop in percentile range for weight
What is done at a HPM visit for young children?
weight and height, HC.
BMI starting at 2 years olds
Assess developmental milestones - developmental testing if needed
What is percentile of growth is considered consistent growth?
What is done at an HPM visit for school age children?
weight, height, BP, BMI
vision, hearing screening
What are some developmental milestones for school age children?
can focus on any activity for longer periods
What is done at an HMP visit for adolescents?
weight, height, BP, BMI
same growth percentile as childhood
assess- scoliosis, cholesterol, tanner staging, hct for females, sexual activity
teach BSE, TSE
What are nutritional considerations with children?
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
What to remember with physical activity of infants?
needs stimulating environment
activity helps develop muscles
encourage parents to play with infant
opportunities to interact with family
What to remember with physical activity of young children?
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
What to remember with physical activity of adolescents?
helps develop social skills, self esteem
60 minutes vigorous activity daily
encourage family participation
teach use of safety equipment
What is the goal of physical activity in adolescents?
establishment of lifetime exercise routines
maintain healthy weight
What to remember with oral health in infants?
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
What to remember with oral health in young children?
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
What to remember with oral health in adolescents?
lose teeth starting by age 6
continue to brush 2x & floss daily
see dentist Q 6 months
braces need extra care
wisdom teeth evaluation
What assess with mental health?
normal growth & development
family relationships, interactions, and communications
self-regulation behaviors & temperament
child's social skills
self-concept/ self esteem
What should you teach about mental health of children?
establishing routines and sleep patterns
managing temper tantrums
providing socialization opportunities
How to prevent disease in infants?
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
How to prevent disease in the young child?
immunizations up to date
environmental hazards? smoking, lead exposure, drugs and alcohol
monitor for acute and chronic illnesses
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
How to prevent disease in adolescents?
screening and follow up
stress, depression, suicide risk, substance abuse
What are some teaching topics in adolescents for disease prevention?
risks of smoking, alcohol, drugs
prevention of STDs and pregnancy
use of sunscreen
prevention of diabetes and heart disease
What are common childhood injuries?
choking hazards: infants, young toddlers
motor vehicle accidents
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
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
How to prevent injuries in school age children?
know emergency phone numbers
leave guns alone
protective sporting gear
safety with matches, fire
know how to swim well
safe outside play, bike safety
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
What is the primary purposes of HP activities?
prevent disease and injury
detect and treat disease early
Why is hospitalization a stressful time for child & family?
disruption of routine and health status
involves many fears and emotions
A child's response to hospitalization is related to...
child's developmental age
seriousness of diagnosis
support people available
What are some child responses to hospitalizations?
aggression, regression, nightmares, irritability, bed-wetting, altered sleep
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
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.
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.
What is the developmental stage of infants?
trust vs mistrust
What is the developmental stage of toddlers?
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
What is the developmental stage of preschool age children?
How do school age children understand illness?
better understanding of causes of illness
usually very cooperative
still needs parent's support
What is the developmental stage of school age children?
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
What is the developmental stage of adolescents?
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
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
What are strategies to promote coping, enhancing hospitalization?
preparation for hospitalization & procedures
rooming in - parent involvement in care
child life programs
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
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
What are some opportunities for therapeutic play?
incorporate play into care
allow time just for play
consult child life specialists
How can nurses reduce stress of hospitalization?
family centered care
developmentally appropriate care
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
What is the difference in pharmacokinetics related to?
% body fat
% body water
liver and renal function
permeability of skin
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
How are pediatric meds dosed?
body surface area
How are pediatric doses calculated?
Why are children under medicated?
complexities of pain assessments in children.
misconceptions about pain in children
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
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
What age can the FACES pain rating scale be used?
age 3 and up
What age can the oucher scale be used?
ages 3 and up
What age can the poker chip tool be used?
ages 4 and up
What age can the numeric scale be used?
5 and older
What age can the word graphic rating scale be used?
school aged child - must read
When can self report pain scales not work?
<3 years old
What are behavioral indicators of pain?
facial grimacing, irritability, posturing, restlessness or agitation, lethargy or withdrawal, sleep disturbances, and short attention span.
What are the nurse report pain scale used for nonverbal children?
neonatal infant pain scale (NIPS)
When is the Neonatal infant pain scale used?
28 days of life, used longer in the NICU
When is the FLACC pain scale used?
children 2 months to 7 years.
can be modified to use in children with intellectual disability
What does the CRIES pain scale use?
combine physiologic and behavioral cues to assess pain
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.
What puts a newborn at risk?
LGA or IDM
pregnancy or birth complications
exposure to drugs, toxins, infections
What are common NICU diagnoses?
respiratory distress (RDS, TTN, apnea, MAS)
hypoglycemia (SGA, LGA, IDM, preterm)
drug withdrawal (NAS)
What are common concerns with preterm infants?
immature systems put infant at risk for numerous problems.
What happens during a newborns first breath?
fills lungs with air, gets fluid out
What is the respiratory rate of an infant?
30-60 breathes per minute
What is normal breathing for infants?
obligatory nose breathers
apnea less than 20 seconds is normal
What is the cause of respiratory distress syndrome?
low-level or absence of surfactant - common in preemies
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
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
What are complications of RDS?
respiratory failure, bronchopulmonary dysplasia (BPD), Patent Ductus arteriosus (PDA), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH)
What is Apnea of Prematurity (AOP)?
no breath for 20 seconds, common in preemies
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
What is transient tachypnea (TTN)?
> 60 breathes per minute.
usually around 80.
seen in C-section babies
What is the cause of transient tachypnea?
slow absorption of lung fluid or excess fluid in lungs
What is the signs and symptoms of transient tachypnea?
grunting, nasal flaring, mild retractions, mild cyanosis, tachypnea
What is the treatment for transient tachypnea?
oxygen, possible IVFs, time, NPO if RR >60
Who is more likely to experience transient tachypnea?
c/s infants, large infants, and babies born to diabetic mothers
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
What is the major concern of thermoregulation?
What is heat loss in preemies related to?
greater body surface area to weight
reduced subcutaneous fat
What is the effects of hypothermia (cold stress)?
increase O2 demand
leads to hypoglycemia
metabolic acidosis can result in death
What is the best prevention for hypothermia?
keep baby warm
What is importance of a neutral thermal environment?
minimizes energy expenditure
minimizes O2 consumption
What are the hepatic/hematologic concerns with preemies?
hypoglycemia, low iron stores, elevated bilirubin levels
What is the cardiac problems with preemies?
ductus arteriosus may remain open = PDA
What is the normal heart rate of a newborn?
What is the normal resting/sleeping heart rate of a newborn?
What is the blood volume of an infant?
What is hypoglycemia of a newborn?
What are symptoms of hypoglycemia?
jitteriness - full term
lethargy - pre term
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
What are some GI concerns with preemies?
higher caloric need
numerous feeding issues
can't break down protiens
calcium & phosphorus deficiency
What are some feeding issues with preemies?
small stomach, coordinating suck, swallow, breathe, and GERD.
What is a GI complication of preemies?
What are feeding methods of the high risk neonate?
gavage feedings - OG or NG
nipple or breast
What is necrotizing enterocolitis?
inflammatory bowel disease.
potentially life threatening
can deteriorate rapidly
What is necrotizing enterocolitis related to?
ischemia & inflammation - hypoxic event
immature GI mucosa - premature gut
What are some assessment findings of necrotizing enterocolitis?
instability of temp, BP, and apnea
xray = air in bowel wall
What is the treatment for Necrotizing enterocolitis?
NPO, IVFs, TPN.
N to decompress stomach
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.
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.
What are some concerns with the neuro/sensory of a preemie?
Intracranial hemorrhage, intraventricular hemorrhage. hydrocephalus. ROP. CP or LD.
What is Retinopathy of prematurity related to?
use of oxygen & prematurity
What is a complication of retinopathy of prematurity?
retinal detachment & blindness
What is the treatment of ROP?
cryotherapy or laser treatment.
scleral buckling for detachment.
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
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
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
What are examples of communicable diseases?
whooping cough - pertussis
measles - rubeola
chicken pox - varicella
mumps - parotitis
fifths disease - erythema infectiosum
What to remember about live injected vaccines?
if not give together, should be separated by atleast 4 weeks.
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
What is the role of the nurse in immunizations?
screen patients to identify contraindications.
identify vaccines indicated.
education - VIS and consent signed
treat and report adverse reactions to VAERS
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.
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
When is it safe to immunize?
mild to moderate illness
family history of vaccine reaction
What is included in parent education on vaccines?
recommendations for vaccines, possible side effects, contraindications, management of reactions, and when to call 911.
When do you call 911 after vaccines?
facial or throat swelling, respiratory symptoms, child unresponsive.
What to remember when administering vaccines?
25% sucrose water and pacifier for infants
pressure at site 10 second before injection
EMLA or vapocoolant spray
two nurses at same time, over quickly
older child can choose which arm or leg
comfort and praise afterwards
When is HepB vaccine done?
When is the Rotavirus vaccine done?
When is the DTaP vaccine done?
When is the Hib vaccine given?
When is the pneumococcal vaccine given?
When is the polio vaccine given?
When is the influenza vaccine given?
6 months +
When is the MMR vaccine given?
When is the varicella vaccine given?
When is the HepA vaccine given?
How do you document vaccines?
dose, route, site.
vaccine, manufacturer, lot #, expiration
name & address of provider; name & title of nurse
record for clinic & parent
What is some general nursing care common to all infections?
prevent spread of infection
provide comfort, encourage rest
assess for and manage symptoms
What is included in rash care?
aveeno baths (oatmeal)
caladryl lotion (calimine)
change linens frequently
keep fingernails clean & short
What is the most common symptom of infection in children?
What is the definition of fever?
body temp over 101.4
What is the benefit of fever?
low grade, body fighting infection
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
When do febrile seizures occur?
in infants & young children
due to rapid rise in temperature
do not recur with the same illness
What happens if you give aspirin to a child with a viral infection?
How is varicella (chicken pox) spread?
airborne or direct contact with lesions
When is varicella contagious?
1-2 days before rash until all lesions are crusted over
What symptoms are associated with varicella?
acute onset, mild fever, malaise, anorexia, HA, mild abdominal pain, and skin rash
What are some complications of varicella?
secondary infection, thrombocytopenia, reyes syndrome.
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
What is the nursing care of varicella?
airborne and contact precautions
change linens frequently
acyclovir for immunocompromised
immunoglobin for exposed NB & unimmunized children
How is fifth disease spread?
respiratory secretions & blood
When is fifth disease contagious?
week before symptoms
When is fifth disease no longer contagious?
once rash appears
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
What are complications of fifth disease?
patients with hemolytic conditions (SCA) can have transient crisis
What is the nursing care of fifth disease?
standard and droplet precautions
oatmeal/aveeno baths for pruritus
protect from sunlight
How is measles (rubeola) spread?
direct contact w/droplet or airborne
When is measles contagious?
4 days pre rash to 4 days after rash appears
What are symptoms of measles?
prodrome: anorexia, malaise.
koplik's spots appear in mouth. high fever, conjunctivitis, coryza, cough, rash
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
What are complications of measles?
diarrhea, OM, pneumonia, bronchitis, LTB, encephalitis, death.
What is the nursing care for measles?
careful respiratory assessment
cool mist vaporizer
photophobia- dim lights, shades
skin care- clean and dry, no soaps
What is mumps (parotitis)?
inflammation of parotid gland
How is mumps spread?
contact with or inhalation of respiratory droplets
When is mumps contagious?
up to 7 days before swelling until 9 days after
What are some signs and symptoms of mumps?
malaise, fever, & parotid gland swelling
earache, HA, pain w/chewing, decreased appetite, and activity.
What are complications of mumps?
orchitis in post pubertal males
stiff neck, photophobia, HA
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
How is pertussis (whooping cough) spread?
respiratory droplet & contact with secretions
When is pertussis contagious?
1 week after exposure until 5 days into antibiotic treatment
most contagious before paroxysmal cough
What are the complications of pertussis?
pneumonia, atelectasis, OM, encephalopathy, seizures, death.
What are the stages of pertussis?
catarrhal stage 0-2 weeks
paroxysmal stage 1-6 weeks
convalescent stage 6-10 weeks
What are the symptoms of the catarrhal stage of pertussis?
runny nose, low grade fever, mild nonproductive cough
What are the symptoms of the paroxysmal stage of pertussis?
whooping cough, more severe at night
What are the symptoms of the convalescent stage of pertussis?
coughing spells gradually subside
What is the treatment of pertussis?
macrolide antibiotics - erythromycin, azithromycin
treat close contacts