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68 Cards in this Set

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How do you prepare a child for a physcial assessment based on their developmental needs?
There is the position
There is the psych prep
infant=supine or prone, in parents lap
4 to 6 months hopefully sitting up
toddler sitting or standing
school age sitting
adolsecent same as school child but does it w/o parents
psych prep has about 12 steps, pp. 741 Box 22-1
How to preform a physical exam in a seq appropriate to a child's age
infant=do scarry stuff last. toddler=use play while assessing
preschool=try head to toe, if acting up, go like toddler
school age=head to toe, respect for pricacy
adolescent=same as school kid
how to recognize normal finding for kids at various ages
NCHS-national center for health statistics Appendix D.
birth to 36 weight by age, etc
what do you have to allow for with NCHS charts on whats normal for a kid
if the child is going thru pruberty, all this goes out
how do you record the PA according to head to toe?
you will not get to do PA head to toe but chart it like you did. It keeps it organized, etc.
Hold do you hold an infant?
cradle hold
belly hold
hip hold
shoulder hold
how do you change a diaper?
make sure your got all your stuff first
baby on its back. unlease diaper. hold legs and pull butt up.
if theres lots of poo use upper half of diaper to wipe front to back.
slide diaper away out of reach
cleane the fanny don't use alcohol or gasoline to clean.
place that used stuff on top of soiled diaper, pile it up
slide clean diaper into place
apply ointments etc as doctors said
close new diaper
dispose of old diaper
wash hands
how do you bath a baby
prep bath...collect tools
turn water heater down to 120
allways test water w/ wrist or elbow, not hot, just warm
mild soap, cotton balls, rubber ducky, clean diaper nearby in water protecter thing like a shoe box.
if you forgot something you got to take baby with you NEVER leave alone!
don't answer phone or doorbell now, bad form
sponge bath new babys first
take take of his owwee if circumsized recently with only a sponze bath untill healed.
make sure baby can't slip in tub or sink or plastic tub
don't use bubble bath or detergent causes rashes
how do you dress baby
change diaper
dress in cotton body unit w/ short sleeves
if cold outside use turtle neck
pull on leggings pants dress
pull on socks
zip up jacket
put on a hat
morbidity
acute illness
any illness that causes a kid to miss school or causes a limitation
what is the situation if the child misses more than 5.3 days from their illness
this is being disabled
pneumonia will do this out more than 5.3 days = a disability
causes of illnesses
respiratory 50%
rsp's pneumonia etc
11% parasitic cuts infections
15% fractures or soft tissue
what are factors that influence illness?
economic access to health care
lbw (low birth weight)
kids born w/ chronic illnesses like ashma
foreign born are sicker
kids in daycare get sicker BUT will build immunity quicker
what is the greatest deterent to illness?
education
the more we educate parents the less they are sick AND not just infussing kids w/ tons of antibiotics
the BIG question w/ peds is:
do we treat immediately w/ antibiotics OR not?
10 years ago yes we do w/ peds
NOW tests show no this is not true SO...
new mobidity=

***************************
what age groups does is hit the most?
behavioral social etc that influneces health
other factors that lead to this statistic
(5-30% of all ped illness statistics)
ex economics in the household can they afford to go to doctor? blow off going to the doctor? 7-14 yrs are most affected w/ new mobidiity
more males than females
single parent families
kids w/ low reading skills
higher school absences. SO lower social eco level blow off school Latch key kids here
they are sick the statitics call it new mobidity b/c of social eco realities...more psyco issues too. no one home
no nurturing b/c their parents are too cranky when they come home
the function of a peds nurse has 3 philosophies but 2 we care about now are
we are taking care of a whole family ... our pt isn't just a child, its the whole family

2) is atrumatic care ... means we are going to try to cause harm to the child while preparing them for something
what is the definintion of a family?
whomever that kid defines that or them to be whatever!
aunts uncles best frient whatever
so the nurse must give:
support, respect,encourgement,enhance strength, and competency help
who
the family of the kid
we must present ourselves to the parents as equals NOT superior or inferior but as equals. even when what
when they themselves are not acting professional
we have to give the parent the right to decide they have to have a word in too
how do we support the child and parent in our role as nurse
by education
find the parents strong and weak points and build on them
again what is atrumatic care
***************************
to do no ...
curing someone take a long time and is stressful
so our job is to decrease this stress and provide as much atrumatic care as possible
*************************
goal is not to harm!
how do we achieve goal of do no harm?
min seperation from family
do everything together w/ the child and family in the hospital / office setting
if its a painful procedure we try to get a parent to stay in the room ...trust vs mistrust we want to kid to hate us and not their parents
ex we have to give a shot to the kid ... how do we give control back to the kid? we give them a choice NOT on time but what?
which doll do they want to hold
or the choice of where the shot will be given
not the time frame
were talking toddlers and preschool that know the shot is coming NOT infants
and we can trust the parent to hold the kid securely so we don't hurt them w/ the shot
do we hesitate w/ a peds shot?
no the faster we get in and get out the better
dart fast and get it over
b/c this min injury and pain
the slower you dart the more it hurts
we respect the kids privacy too w/ a drawn curtain
also consider what kind of play activity why
to ease the kids stress
like a doll that you can play like what the kid is going to get do it with the doll
do we tell them not to cry?
do we tell them to act like a big boy?
we want them to let those feelings out
case management is coordination the care of a pt from being to end at their stay ie. planning scheduling tests what?
whatever to get the kid in and out and home as fast as possible.
family structure will ..
impact the direction of the nursing care
peds nurses will document the interaction b/t the parent and kid BUT nurse has to remain ...
neutral
that said, if the kid fears his parents, thats a clue and we might have to get social services involved
YOU CAN NOT GO BY HEAR SAY WE HAVE TO ACTUALLY SEE SOMETHING WITNESS IT OR WE CANNOT DO ANYTHING ABOUT STUFF
YOU CAN TELL A SOCIAL WORKER YOUR FEARS BUT NO ONE CAN DO ANYTHING B/C THE CHILD COULD BE MANIPULATING THE SITUATION
THIS STUFF IS IMPORTANT B/C THE PARENT CAN SUE THE NURSE FOR...
DIFIMATION OF CHARACTER IN CIVIL COURT SO YOU MUST BE CAREFUL...TELL EITHER DOCTOR OR SOCIAL WORKER WHAT YOU HAVE SEEN AND DOCUMENT
WHAT IS ETHNOCENTRISM
ONE ON'S ETHNIC GROUP IS SUPERIOR
WE AS NURSES MUST EVALUATE OUR OWN FEELINGS AND THEN THE CULTURE GROUP TOO AND REMAIN NEUTRAL.
EX OF CUSTOMS:
CHINESSE THINK THE ILLNESS OF A KID AFFECTS THEM NOW AND IN THE FUTURE SO ...
AFTER AN ILLNESS THEY MAY CHANGE SAVING MONEY TO SEND THAT KID TO STANFORD
THE JAPANESSE DAD WILL NIT PIC THE NURSE W/ QUESTIONS BUT FADE BACK. THE HISPANIC BOSS OF THE FAMILY IS THE
DAD SO ALL QUESTIONS GO TO HIM
NON AMERICAN FAMILIES BELEIVE THEY ARE IN CHARGE OF THEIR FAMILY MEMBERS AND NOT US PUNK NURSES SO EXPECT THEM TO CONSULT B/T THEMSELVES B/F ...
YOU GIVE CARE TO THEIR FAMILY MEMBER
MEXICAN PEOPLE WILL USUALLY HAVE A MALE IN CHARGE SO CONSULT WITH THEM
NAVAHOS DON'T LIKE STRANGERS AROUND AN INFANT B/C ...
WE MIGHT CAUSE THEM HARM
MEXICANS DON'T LIKE A STRANGER TO ADMIRE A CHILD W/O ...
TOUCHING THE CHILD!
SO DON'T WALK UP AND SAY WHAT A PRETTY BABY W / O TOUCHING THEM B/C OF THE EVIL EYE YOU COULD PUT A SPELL ON IT
IF YOU DON'T UNDERSTAND YOUR FORIEN PATIENT DO WHAT
GET AN INTERPRITER
THEY ARE TRAINED IN THIS
HOW CAN YOU MAKE A KID FEEL BETTER IN A STRANGE ENVIROMENT?
DO IT WITH FOOD
SO MAYBE HAVE PARENTS BRING THAT TO THE ROOM IF KID WANTS THAT
WHATS WITH AMERICAN KID THAT WON'T EAT THE HOSPITAL FOOD BUT LIKES JUNK FOOD WHAT DO WE DO HERE
**************************
GET HIM THE JUNK FOOD B/C WE NEED HIM TO EAT THEY NEED CALORIES TO HEAL
PROTEIN IS PROTEIN
****************************
IF THIS IS ALL THEY WILL EAT?
DEVELOPMENTAL INFLUENCES IN KIDS
TRENDS IN G & D
WHAT IS DIRECTIONAL TRENDS?
1ST TREND IN DIRECTIONAL
****************************8
THE HEAD TO TOE GROWTH
MOST APPARENT B/F BIRTH
THE KID WILL LIFT ITS HEAD B/F ANYTHING ELSE
NEXT IS PROXIMAL DISTAL OR NEAR TO FAR W/H IS MIDLINE TO PERIPHERY GROWTH
*****************************
EX THEY WILL HAVE WHAT///
CONTROL OF THEIR SHOULDER B/F CONTROL OF THEIR ARM OR HAND
KID WILL HAVE GROSS MOTOR CONTROL B/F FINE MOTOR CONTROL
EX
3RD PART OF DIRECTONAL TRENDS IS CALLED DIFFERNTATION
WHATS THIS
****************************
WE CAN DO SIMPLE STUFF B/F COMPLEX STUFF
EX
SEQUENTIAL IS G & D IS ...
G & D IS IN A DIFFEFENT SEQUENCE AND WE DON'T DIVIATE FROM THIS SEQUIENCE
THE GROSS HAS TO DEVELOP FIRST B/F FINE
SEEN IN ABUSED KIDS THAT HAVE TO GO IN REVERSE AND STEP BACK AND DELVOPE SOMETHING MISSING IN THE INFANCY STAGE AND THEN MOVE FORWARD!
DEVELOPMENT TRENDS IS ITS GROWTH. SLOW TIME IS AROUND MIDDLE CHILD = 7 8 9 AND ALLERATE WHEN?
ADOLESCENT 10 11 12 13 GROWTH SPURT
A SENSITIVE PERIOD IS THE PHSYCIAL DEVELOPMENT OF THE CNS CENTRAL NERVOUS SYSTEM IS INFLUENCED BY HIS ENVIORMENT
EXPAND
HIS ENVIROMENT MUST BE THERE TO ADVANCE. YOU HAVE TO SHOW A KID HOW TO DO THINGS W/H DEVELOPS HIS CNS
THE FIRST 3 MONTHS OF AN INFANTS GROWTH IS VERY SENSIVIVE. SO ..
WE NEED TO INTERACT W/ THE INFANT IN THOSE FIRST 3 MONTHS
PSYC SOCIAL DEVELOPMENT IS 1ST YEAR
THIS IS WHEN THEY GET INITIAL SOCIAL ATTACHMENTS AND EST TRUST.
there are developmental influences
**************************
2 of them. theres skeletal growth, an accurate measurment of general development why
we can measure their skeletal and see if their enviroment is supporting that! it is a great indication of support
bone growth b/g 2nd month of fetal life so a pregnancy should be healthy and so is his life after birth in his family
there is neuro development again from infancy to early childhood so it is so important here why?
from infancy to early childhood the huge growth of the neuro so we must expose them to reading to them going to school to art museums to music they are taking it all in but then the growth slows
know Eriksons development ***************************
she said that the kid must master one level before going to the next level per erikson
its a simple quistion about erickson on the test
**********************
there are comm strategies w/ parents and also wit kids pp126 wong box 6-2 what is this
techniques to block comm w/ nurse! dad was a master
socializing
giving advise
defending
stereotyped comments
changing focus
forming prejudged conclusions
then there is comm w/ the kid
we go to the Erikson thing
infancy is nonverbal
early childhood <5, egocentric, the focus is them
school age explanations are needed and reasoning why why why how does this work
what about adolescents?
they are not quiet adults
they are not kids either
so you will get a mix so they may want to discuss stuff alone so show genuine intrest
with adoscents they want to shock you w/ peircings and tatoos so if your not shocked what will be their reaction?
they will accept you if your not shocked so don't overreact to critizise, and youll be fine
**************************
review physical assessment of all age groups so the assessment is head to toe and true to a point but ...
flexible to the age and maturity of the kid
***************************
if you have a toddler who is quiet on moms lap what is the first thing you want to do?
listen to heart and lungs b/c that quietness will not last
listen to heart and lungs and bowel sounds before kid gets rilled up. *****************
so this is what...
one of the times we don't follow the head to toe assessement thing
***************************
showing them the stethscope letting them hear your own heart etc b/f listening to theirs for what age groups?
early school age group or preschool age they like to test everything out.5 6 7 year old we would show them the cuff etc.
*****************************
point of maximun inpulse
PMI
what is this
the heart
for an adult 7 and older it is 5th intercostal space mid clavivular line
below 7 its the 4th intercostal space and just lateral to the mid claviciual line
************************
what is the seq for listening to bowel tones?
we don't do palpation THEN listen b/c we would then increase the tone!
do listen first then palpate
the prepereaton for a phycial for a child is ...
more phsc than physical
so establish trust and provide support
provide explanations
a kid has to see confidence in you OR ...
they won't co operate with you and nurses can sometime panic with a kid so ...
expect success
involve the kid
provide distraction w/ a toy
allow expression of feelings like after telling them about a procedure and they cry
what do you do after the procedure / surgery
encourage expressions of feelings
praise the child
what is malignant hyperthermia
genetic condition were anastetic triggers a muscle reaction near where it coming and kills the patient b/c if it hits the heart, right?
when a kid has tonsils out what colors are ok and not ok to give after surgery?
dont give red it maskes any bleeding
yellow orange and brown seve jello green all ok
*****************************
what is the max dosage for pain for a kid?
****************************
max dosage is 40mG/kg
***************************
what age can we give adult meds
12 years old
what is skeletal growth
***************************
ACCURATE MEASUREMENT OF GEN DEVELOPMENT. BONE FORMATIN BEGINS 2ND MONTH FETAL LIFE
WHAT IS NEUROLOGICAL MATURATION
GROWS MORE RAPIDLY BEFORE BIRTH. THEN AGAIN FROM INFANCY TO EARLY CHILDHOOD
DEVELOPMENTATL PACE
FIXED ORDER OF DEVELOPEMENT BUT ONE BABY CAN BE SLOWER OR LONGER BUT DOESN'T HAVE TO BE AT THE SAME PACE AS ANOTHER
SENSITIVE PERIODS IS THE CENTRAL NERVOUS THING
FIRST 3 MONTHS VERY SENSIVITVE