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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?
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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 |
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How to preform a physical exam in a seq appropriate to a child's age
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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 |
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how to recognize normal finding for kids at various ages
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NCHS-national center for health statistics Appendix D.
birth to 36 weight by age, etc |
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what do you have to allow for with NCHS charts on whats normal for a kid
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if the child is going thru pruberty, all this goes out
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how do you record the PA according to head to toe?
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you will not get to do PA head to toe but chart it like you did. It keeps it organized, etc.
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Hold do you hold an infant?
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cradle hold
belly hold hip hold shoulder hold |
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how do you change a diaper?
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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 |
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how do you bath a baby
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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 |
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how do you dress baby
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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 |
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morbidity
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acute illness
any illness that causes a kid to miss school or causes a limitation |
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what is the situation if the child misses more than 5.3 days from their illness
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this is being disabled
pneumonia will do this out more than 5.3 days = a disability |
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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 |
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what is the greatest deterent to illness?
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education
the more we educate parents the less they are sick AND not just infussing kids w/ tons of antibiotics |
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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... |
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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 |
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the function of a peds nurse has 3 philosophies but 2 we care about now are
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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 |
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what is the definintion of a family?
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whomever that kid defines that or them to be whatever!
aunts uncles best frient whatever |
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so the nurse must give:
support, respect,encourgement,enhance strength, and competency help who |
the family of the kid
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we must present ourselves to the parents as equals NOT superior or inferior but as equals. even when what
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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 |
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how do we support the child and parent in our role as nurse
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by education
find the parents strong and weak points and build on them |
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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! |
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how do we achieve goal of do no harm?
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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 |
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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?
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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 |
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do we hesitate w/ a peds shot?
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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 |
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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 |
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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
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case management is coordination the care of a pt from being to end at their stay ie. planning scheduling tests what?
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whatever to get the kid in and out and home as fast as possible.
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family structure will ..
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impact the direction of the nursing care
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peds nurses will document the interaction b/t the parent and kid BUT nurse has to remain ...
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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 |
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THIS STUFF IS IMPORTANT B/C THE PARENT CAN SUE THE NURSE FOR...
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DIFIMATION OF CHARACTER IN CIVIL COURT SO YOU MUST BE CAREFUL...TELL EITHER DOCTOR OR SOCIAL WORKER WHAT YOU HAVE SEEN AND DOCUMENT
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WHAT IS ETHNOCENTRISM
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ONE ON'S ETHNIC GROUP IS SUPERIOR
WE AS NURSES MUST EVALUATE OUR OWN FEELINGS AND THEN THE CULTURE GROUP TOO AND REMAIN NEUTRAL. |
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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
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THE JAPANESSE DAD WILL NIT PIC THE NURSE W/ QUESTIONS BUT FADE BACK. THE HISPANIC BOSS OF THE FAMILY IS THE
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DAD SO ALL QUESTIONS GO TO HIM
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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 ...
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YOU GIVE CARE TO THEIR FAMILY MEMBER
MEXICAN PEOPLE WILL USUALLY HAVE A MALE IN CHARGE SO CONSULT WITH THEM |
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NAVAHOS DON'T LIKE STRANGERS AROUND AN INFANT B/C ...
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WE MIGHT CAUSE THEM HARM
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MEXICANS DON'T LIKE A STRANGER TO ADMIRE A CHILD W/O ...
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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 |
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IF YOU DON'T UNDERSTAND YOUR FORIEN PATIENT DO WHAT
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GET AN INTERPRITER
THEY ARE TRAINED IN THIS |
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HOW CAN YOU MAKE A KID FEEL BETTER IN A STRANGE ENVIROMENT?
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DO IT WITH FOOD
SO MAYBE HAVE PARENTS BRING THAT TO THE ROOM IF KID WANTS THAT |
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WHATS WITH AMERICAN KID THAT WON'T EAT THE HOSPITAL FOOD BUT LIKES JUNK FOOD WHAT DO WE DO HERE
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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? |
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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 |
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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 |
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3RD PART OF DIRECTONAL TRENDS IS CALLED DIFFERNTATION
WHATS THIS **************************** |
WE CAN DO SIMPLE STUFF B/F COMPLEX STUFF
EX |
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SEQUENTIAL IS G & D IS ...
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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! |
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DEVELOPMENT TRENDS IS ITS GROWTH. SLOW TIME IS AROUND MIDDLE CHILD = 7 8 9 AND ALLERATE WHEN?
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ADOLESCENT 10 11 12 13 GROWTH SPURT
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A SENSITIVE PERIOD IS THE PHSYCIAL DEVELOPMENT OF THE CNS CENTRAL NERVOUS SYSTEM IS INFLUENCED BY HIS ENVIORMENT
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HIS ENVIROMENT MUST BE THERE TO ADVANCE. YOU HAVE TO SHOW A KID HOW TO DO THINGS W/H DEVELOPS HIS CNS
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THE FIRST 3 MONTHS OF AN INFANTS GROWTH IS VERY SENSIVIVE. SO ..
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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. |
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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 |
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there is neuro development again from infancy to early childhood so it is so important here why?
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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
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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
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there are comm strategies w/ parents and also wit kids pp126 wong box 6-2 what is this
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techniques to block comm w/ nurse! dad was a master
socializing giving advise defending stereotyped comments changing focus forming prejudged conclusions |
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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 |
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with adoscents they want to shock you w/ peircings and tatoos so if your not shocked what will be their reaction?
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they will accept you if your not shocked so don't overreact to critizise, and youll be fine
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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 |
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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
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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.
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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 ************************ |
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what is the seq for listening to bowel tones?
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we don't do palpation THEN listen b/c we would then increase the tone!
do listen first then palpate |
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the prepereaton for a phycial for a child is ...
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more phsc than physical
so establish trust and provide support provide explanations |
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a kid has to see confidence in you OR ...
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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 |
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what do you do after the procedure / surgery
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encourage expressions of feelings
praise the child |
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what is malignant hyperthermia
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genetic condition were anastetic triggers a muscle reaction near where it coming and kills the patient b/c if it hits the heart, right?
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when a kid has tonsils out what colors are ok and not ok to give after surgery?
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dont give red it maskes any bleeding
yellow orange and brown seve jello green all ok ***************************** |
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what is the max dosage for pain for a kid?
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max dosage is 40mG/kg
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what age can we give adult meds
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12 years old
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what is skeletal growth
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ACCURATE MEASUREMENT OF GEN DEVELOPMENT. BONE FORMATIN BEGINS 2ND MONTH FETAL LIFE
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WHAT IS NEUROLOGICAL MATURATION
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GROWS MORE RAPIDLY BEFORE BIRTH. THEN AGAIN FROM INFANCY TO EARLY CHILDHOOD
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DEVELOPMENTATL PACE
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FIXED ORDER OF DEVELOPEMENT BUT ONE BABY CAN BE SLOWER OR LONGER BUT DOESN'T HAVE TO BE AT THE SAME PACE AS ANOTHER
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SENSITIVE PERIODS IS THE CENTRAL NERVOUS THING
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FIRST 3 MONTHS VERY SENSIVITVE
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