Yikes

Question 1

Nursing process to implementing care

Answer 1

Assess
Plan
Implement
Evaluate

Question 2

Assess

Answer 2

Structure and function
Family as Context
Family as Client
Family as a System
Family As component of society

Question 3

Assess - AFSNAG (8)

Answer 3

Australian family strengths nursing assessment guide

1. Communication
2. Togetherness
3. Sharing activities
4. Affection
5. Support
6. Acceptance
7. Commitment
8. Resilience

Question 4

Plan

Answer 4

Short and long term goals
Open discussions
SMART goals
Who will be responsible

Question 5

Implement

Answer 5

Delivering care directly to patient (in hospital)
Who is responsible for implementing goals
Need to have knowledge, skill and ability

Question 6

Evaluate

Answer 6

Recognise changes in family
Identify need for any modifications 
Have goals been achieved
Were they effective
Goals need revision and updates

Question 7

Airway anatomy in children

Answer 7

Large occiput 
Neck flexion caused airway to be cut off
Head bobbing in respiratory distress
Teeth can be loose
Infant (less than 12 months) 
Less than 6 months means they breathe through nose only
Large tongue and large amount of soft tissue - cause oedema 
Larynx is soft
Cricoid ring is narrowest part of airway
Trachea is shorter. Less bronchioles
Prone to ear infections etc

Question 8

Airway Assessment

Answer 8

Stridor- upper airway obstructing due to group or foreign object
Look, listen, feel
How hard are they working to get air in
Intensity of stridor does NOT indicate severity of obstruction

Question 9

Airway positioning

Answer 9

Infants - put in neutral position

Children from ages 1-9 - sniffing position

Question 10

Breathing physiological and anatomy

Answer 10

Air tissue SA is less in infants
Diaphragm principal respiratory muscle in infants - children are abdominal breathers
Thin chest wall so hard to hear lung sounds
Ribs positioned more horizontal (decreased tidal volume)
Can’t lift ribs up and out
Increased effort for breathing

Question 11

When assessing child breathing

Answer 11

Check for
Effort of breathing - LOOK nasal flaring, head bobbing, respiratory rate and depth, accessory muscle use, tracheal tug and chest recession
Effectiveness of breathing - LOOK chest expansion, symmetry, trachea midline, abdominal excursion. LISTEN breath sounds, air movement, grunting, wheezing stridor
Effects of respiratory inadequacy - mental status (drowsiness or adjetated) heart rate (increased), skin colour (pale), oxygen saturation

Question 12

Effects of respiratory inadequacy (pre terminal)

Answer 12

Exhaustion
Bradycardia
Cyanosis (central) 
Silent chest
Hypotension

Question 13

Fixed SV in children

Answer 13

1.5mL/kg infants
75mL/kg adults
SV increases as heart size increases therefore HR decreases with age
Hypotension in children is pre terminal

Question 14

Circulation

Answer 14

Children exchange more than half of their extra cellular fluids daily - increased potential for dehydration
Must measure intake and output
BP and SVR increase with age
Higher metabolic rate
Renal tubule immaturity - can’t concentrate urine
Poo is more runny

Question 15

Norms for HR and BP

Answer 15

Infant - 110-160, 70-90
2-5 - 95-140, 80-100
5-12 - 80-120, 90-110
>12 - 60-100, 100-120

Question 16

Primary assessment process

Answer 16

Airway
Breathing
Circulation
Disability

Question 17

AVPU

Answer 17

Alert
Responds to voice
GCS is less than 8 when in the pu (worry about respiratory rate)
Responds to pain
Unresponsive

Question 18

QUESTT pain assessment

Answer 18

Question the child
Use a pain rating scale
Evaluate the behaviour and physiological changes
Secure parents involvement 
Take cause of pain into account
Take action and evaluate results

Question 19

3 stages of separation anxiety

Answer 19

Protest - reluctance to leave area
Despair - withdrawn “settled in”
Detachment- stop attaching to others

Question 20

Phase of protest

Answer 20

Cry
Scream
Search for parent with eyes
Cling to parent
Rejects contact with strangers
Verbal/physical attack strangers
Force parent to stay - “I’m gonna hate you if you go”
Protests may only stop when the child is exhausted

Question 21

Phase of despair

Answer 21

Be inactive
Withdrawn from others
Depressed
Uninterested in environment
Uncommunicative 
Regress to earlier behaviour
May start sucking thumb or wetting bed
Refuse to eat and drink

Question 22

Nurse care for separation anxiety

Answer 22

Set expectations 
Development of trust
Familiar objects
Build anticipation 
Parents can always say goodbye

Question 23

Phase of detachment

Answer 23

Appear happy
Form new but superficial relationships
Show an increase interest in their surroundings
Interacts with strangers or familiar care giver

Question 24

Paediatric mortality highest in children under 1 year

Stats:

Answer 24

Neonates: congenital, prematurity
Infants: SIDS, sepsis
Toddlers: trauma
Adolescents: risk taking behaviours

Question 25

4 main reasons why kids get seriously unwell and die

Answer 25

1. Fluid maldistribution - sepsis, anaphylaxis and spinal shock 2. Fluid loss - gastroenteritis, burns and blood loss 3. Respiratory distress - croup, asthma and foreign body 4. Respiratory desperation - seizure, poisoning and CNS depression

Question 26

Erickson’s

Answer 26

``` Infant - trust vs mistrust Toddler - autonomy vs doubt Pre schooler - initiative vs guilt School kid - industry vs inferiority Adolescent - identify vs role confusion ```

Question 27

Piaget’s stages

Answer 27

Semimotor stage Preoperational stage Concrete operations stage Formal operations stage - abstract, idealist and logic

Question 28

Gillick competence

Answer 28

Child achieves sufficient understanding and intelligence to understand the proposed treatment and consequences of the treatment their parents right to consent of their behalf ceases Doctor decides competence Treatment and consequences are understood and in best interest for patient

Question 29

HEADSSS Assessment

Answer 29

``` Home or housing Education or employment Activities Drugs/ dieting Sex and sexuality Suicide and depression Safety ```

Question 30

Family Systems Theory

Answer 30

Change in one individual will impact all persons within a family. Family as a social and emotional unit Helps with genograms Family can create balance between change and stability Contains boundaries (values, beliefs etc) Doesn’t prove explicit guidance for nurses and doesn’t provide a view of the family over time 1. All parts are interconnected; 2. Whole is more than sum of its parts; 3. There are boarders and family controls who goes in and out; 4. Systems sorted into subsystems

Question 31

Family development theory

Answer 31

Family move through expected stages Face predictable developmental tasks Nurses can assess the extent to which developmental milestone has been achieved by the family Doesn’t consider the experience of non-nuclear families or families facing impacts of non-normal events

Question 32

Structural/ Functional Family Theory

Answer 32

The structure facilitates the function Understanding family dynamics and how these influence the families purpose Doesn’t explain how families develop and manage over time Doesn’t have a cross cultural component nor reflects diverse family types Manifest Functions: placed intentionally to keep society moving forward Latent functions: unintended consequences

Question 33

Health priorities and social policies in Australia

Answer 33

National evidence-based antenatal care guidelines (care for healthy preg women) Australian National breastfeeding strategy (improve health of infants) National framework for universal child and family health services (0-8 year children and fam access to healthcare) National framework for protecting Australia’s children (reduce levels of child abuse and neglect) Family and domestic violence strategy (government response to violence)

Question 34

Tools used in child and family nursing (6)

Answer 34

1. Genograms 2. Ecograms (circle with multiple lines one) 3. Calgary Family Assessment Model (structural, developmental and functional) 4. Friedman Family Assessment Model (fam is subsystem and assesses values and stress) 5. Family Systems Stressor-Strength Inventory (big table showing from not applicable to high stress) 6. Australian Family Strengths Nursing Assessment guide (8 activities eg sharing activities)

Question 35

Natal definitions

Answer 35

``` Preconception: prior to pregnancy Prenatal: pregnancy to labour Gestation: number of weeks pregnant Perinatal: 20 weeks pregnant to 28 days after birth Postnatal: first 6 weeks after birth Neonate: first 4 weeks of life ```

Question 36

Pregnancy phases

Answer 36

``` Trimester 1 (0-12 weeks): hormones released Trimester 2 (13-27 weeks): begin to show Trimester 3 (28-40 weeks): random tightening of uterus (braxton hicks) increased movement of baby ```

Question 37

Stages of vagina birth

Answer 37

1st stage: 12-19 hours of labour. Regular contractions every 5-20 mins. Water breaks and mucus plug is discharged 2nd stage: labour lasts 20min-2hours. Cervix dilates 10cm. Baby delivered and umbilical cord cut 3rd stage: 5-30min mild contractions assist placenta to be delivered. During this stage baby can begin bonding through skin to skin touch and breast feeding. Uterus shrinks to control bleeding.

Question 38

Principles of growth and development

Answer 38

It is a continuous process from conception to death It proceeds in an orderly sequence but happens at different rates It is cephalocaudal (head to feet) It proceeds in a proximodistal manner (center outwards) Development of gross motor skills develops before fine motor skills

Question 39

Child abuse

Answer 39

4 types: emotional, neglect, physical and sexual Child protection act 1999 says nurses are mandatory reporters required to report a suspicion on whether a child has suffered, is suffering or risk of suffering significant harm caused by abuse and do not have a parent or guardian willing to protect child

Question 40

8 stages Erickson’s

Answer 40

``` Trust vs mistrust Autonomy vs shame Initiative vs guilt Industry vs inferiority Identity vs role confusion Intimacy vs isolation Generativity vs stagnation Integrity vs despair ```

Question 41

Piaget’s 4 stages

Answer 41

Sensory motor stage Preoperational stage Concrete operational stage Formal operational stage

Question 42

6 stages of play

Answer 42

``` Unoccupied Onlooker Solitary Parallel Associative Cooperative ```

Question 43

APGAR Assessment

Answer 43

0-3 is severe distress, 4-7 moderate distress, 7-10 all good Appearance (skin colour) Pulse (heart rate) Grimace (reflex response) Activity (spontaneous movement/ muscle tone) Respiration (breathing)