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220 Cards in this Set
- Front
- Back
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What are some infant mortality risks?
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low birth weigh, black race, male gender, short or long gestation, birth order, very young or older mother, maternal education
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What are some of the leading causes of mortality among children?
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motor vehicle crashes (#1), drowning, burns, poisoning, firearms
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What are some reasons for childhood morbitity?
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acute illness, chronic disease, disability
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What does family centered care mean?
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recognizes the faily as the constant for the child and that their needs also need to be addressed.
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What are the three key elements to family centered care?
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respect, collaboration and support
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What are the two basic concepts to family centered care?
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enabling and empowerment
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What is primary prevention?
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health promotion for prevention of disease or injury including: well0child clinics, immunizations programs, safety programs and sanitation measures
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What is secondary prevention?
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screening and early diagnosis of disease including: TB screenings, isolation of communicable illnesses and mental health counceling
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What is Tertiary prevention?
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interventions to optimize function for children with disability or chronic illness.
(pt. is already sick) Ex: rehab programs asthma management programs |
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Define Consanguineous
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blood relationship
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Define affinal
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marital relationship
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Define "family of origin"
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family in which you where born into
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Define "household"
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being used more frequently to define who the patient lives with
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Family is:
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whoever the patient considers it to be
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Explain the family systems theory
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the family is a system that continually interacts with its members and the environment. Problems do not lie in any one member but in the type of interactions used by the family Ex: child abuse
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Explain the famly stress theory
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When a family experiences too many stressors for it to cope adequately, a crisis ensues
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What is the developmental theory
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this theory addresses family change over time using family life cycle stages
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What are some things that can effect the transition into parenthood?
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age of the parents, involvement of the father, education related to parenting and support systems
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Define culture:
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a pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people
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Define socialization:
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the process by which children acquire the beliefs, values and behavoirs of a given society in order to function within that group
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There are two different types of social groups, what are they?
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primary groups (intimate, close contact such as family/peers)
Secondary groups (limited contact such as professional relationships) |
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How do cultural differences effect our healthcare?
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susceptibility to health problems, hereditary factors, socioeconomic factors, customs and folkways, food customs
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Many children suffer from separation anxiety in the hospital. What are the phases of this anxiety?
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Protest phase: cry and scream, cling to parent
despair phase: crying stops, evidence of depression Detachment phase: denial, resignation and malcontent |
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How can you minimize a childs anxiety in the hospital?
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perform family centered care, have the parents bring some items from home
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What are some ways to "normalize" the childs stay in the hospital?
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maintain the childs routine, if possible, let the child do as much as she/he can, have their school work brought to them, have visitors
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Explain the difference between growth and develepment
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Growth: is measureable (physical changes such as height, weight, bone size and dentition)
Development: is biologic, physiologic, cognitive and personality (internal) |
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Define cephalocaudal
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from head to toe
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Define proximodistal
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from center to out (fingers)
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Define differentiation
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means social or emotional
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Explain Freuds psychosexual development
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Id, ego, superego
sensual pleasures Anal (1-3 years) |
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Define Eriksons psychosocial development
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mastery of core conflict in sequential manner. Has two components: favorable and unfavorable. Progression to the next stage requires resolution of the current conflict but no conflict is ever mastered completely
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Define the stages of Eriksons psychosocial development theory
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Stage one (birth -1yr): Trust vs mistrust
Stage two(1-3yr) : automony vs. shame/doubt (expressing independance) Stage three (3-6yrs): initiative vs. guilt (enterprise, imagination, conscience) Stage four (6-12yrs): industry vs. inferiority Stage five (12-18yrs): identity vs. role confusion(who am I?) |
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What are Piagets cognitive development stages?
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1. sensorimotor (birth to 2yrs)- object permanence, cause and effect
2. preoperational (2-7yrs) - inability to put self in place of others 3. concrete operations (7-11yrs) - less self centered, logical coherent thought, socialized thinking 4. formal operations (11-15yrs) - abstract thinking, draw logical conclusions |
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What is language development directly related to?
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neurologic and cognitive development
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In what order do children learn to speak?
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nouns, verbs, adjectives, adverbs, pronouns
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What is meant by a "subjective attitude"?
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that it can be effected by what others say
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What are some influences on a childs self esteem?
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temperament and personality, opportunities for accomplishment of developmental tasks, significant others, social roles and expectations
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What is the difference between sympathetic and empathetic?
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Sympathetic: to feel sorry for someone (non therapeutic)
Empathetic: ability to understand a persons experience, having feelings and emotions in common |
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In the first 6 months, how weight should the average baby gain? in one year?
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5-7 ounces/week, doubles birth weight by six months, triples birth weight by one year
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How long/tall should the baby grow in the first 6 months? by one year?
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2.5 cm/month, 50% increase in length by one year (mostly truncal)
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How much should the babys head circumference increase in the first 6 months? in the first year?
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1.5 cm/month, 1.5cm/month during the second 6 months, 30% head circumference increase by the first year
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What are a babies milestones during the first year?
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1 month: smiles, 2 months: coos, 3 months: head control
4 months: rolls (usually front to back), 5 months: hands to midline, 6 months: sits, 7 months: crawls, 8 months: pincer grasp, 9 months: pulls to stand, 10 months: stands alone, 11 months: cruises, 12 months: walks |
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What is a babies first form of communication?
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crying
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What are some language red flags for an infant?
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at four months: no communication
at 6-9 months: loss of previous language, hearing concerns |
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When can a baby start to imitate sounds?
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approximately 8 months
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What language should a one year old be capable of?
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3- 4 words with meaning
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What are rickets?
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lack of vitamin D
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What is the preferred nutrition for an infant up to six months>
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breast milk
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When should you start to give a child cow's milk?
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one year
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What are some injury preventions that you could educate the parents of an infant on?
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SIDS, aspiration of foreign objects, motor vehicle injuries, falls, poisoning, burns, drowning
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How much weight does a toddler (12-36 months) generally gain?
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4-6lbs/year, birth weight should be quadrupled by 2 and a half
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How should a toddlers (12-36 months) height increase?
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about 3 inches per year
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What are the milestones for a toddler (12-36 months)?
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12: walk alone
24: up/down stairs, not alternating 36: stand on one foot, tiptoe, climb stairs alternating feet. 18: throw ball, keep balance 24: build towers 36: draw circles |
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What are some language red flags for a toddler (12-36months)?
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12 months: no verbal routines, no mama or dada, loss of previous milestones
15-18 months: no single words, poor understanding 24 months: less then 50 words, no 2 word sentences, less then 50 words intelligible to strangers 36 months: more than 75% unintelligible to strangers, flat intonation, echolalia |
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How do you know when a child is ready to be potty trained?
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he/she has voluntary sphincter control, able to stay dry for 2 hours, can remove own clothing, willingness to please parents, curiosity about others going potty, doesn't like dirty or wet diapers on
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What is the #1 cause of toddler deaths?
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injuries
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How much weight should a preschooler gain per year?
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5 lbs per year
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What is the average height increase for a preschooler?
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2 1/2 to 3 inches per year
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What are some milestones for a preschooler?
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walking, running, climbing, jumping, refined eye-hand and muscle coordination, dresses self, ties shoes by 5 years, often challenges values but overall wants to please,
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What are some language problems that you might notice in a preschooler?
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stuttering, stammering or dyslalia ( can't articulate words)
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What is the average weight gain for a school aged child (6-12 yrs)?
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4.5 - 6.5 lbs per year
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What is the average growth in height for a shool aged child(6-12yrs)?
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2 inches per year
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In relation to a school aged childs moral development, what quides most of their choices?
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rewards and punishments
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How much sleep should a preschooler get?
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12 hours per night
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How much sleep should a school aged child get?
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approx. 9.5 hours per night
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What is the most common cause of severe injury and death in school aged children?
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motor vehicle accidents
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In an adolescent, what does the hypothalamus stimulate the pituitary gland to do?
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1. stimulate the gonads to produce sperm in boys and produce, mature and release ova in females
2. secret sex-appropriate hormones |
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What are androgens?
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masculizing hormones
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What are thelarche?
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breast buds
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what are adrenarche?
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pubic hair
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What is the single greatest cause of serious and fatal injuries teens?
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motor vehicle accidents
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Give some examples of UPPER respiratory tract infections common in children
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URI, sinusitis, thrush,pharyngitis, tonsillitis and croup
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Give some examples of LOWER respiratory tract infections common in children
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tracheitis, pneumonia, influenza, asthma
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What is the #1 casue of pneumonia in children?
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pneumoniae (bacterial-s)
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What is tachypenia?
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a fast respiratory rate
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What is bradypenia?
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a slow respiratory rate
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What types of conditions could cause tachypenia?
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heart or lung disease, lung infections and anemia
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What type of conditions could cause bradypenia?
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DKA, liver failure, respiratory failure
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What is hypopenia?
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slow and shallow breathing
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What is hyperpenia?
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increased depth and rate of breathing
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For what reasons would they perform a bronchoscopy on a child?
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either diagnosic or therapeutic (foreign body)
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What are some complications that you should look for after a child has a bronchoscopy?
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hemorrhage and respiratory distress
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What are some symptoms to look for if you suspect that a child has a respiratory infection?
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fever, cervical lymphadenopathy, sputum, erythema, bad breath
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What is Nasopharyngitis?
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the common cold, very common in children
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What could be some signs/symptoms of pharyngitis/tonsillitis?
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sore throat, fever, headache, abdominal pain
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What is otitis media?
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ear infection
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What is the number one cause of ear infections?
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s. pneumoniae
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How is otitis media treated?
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high dose of amoxicillin initially, then 2nd line drug
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What is otits media with effusion (OME)?
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fluid in the middle ear without infection
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What are some of the signs/symptoms of OME?
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sounds are muffled, feeling of fullness in ears, possible reduced hearing and delay of speech
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How do you treat OME?
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typmanostomy tubes
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Explain croup
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narrowing of the airway resulting in stridor
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What are some signs and symptoms of croup?
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gradual onset of fever, laryngeal and tracheal inflammation causes narrowing of the airway, inspiratory stidor, suprasternal retractions
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What is bronchiolitis?
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acute swelling of bronchioles with the limina filling with exudate and mucus
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What are some of the signs of bronchiolitis (RSV)?
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starts as a URI, progresses with wheezing, coughing, tachypnea, apnea (sometimes the only symptom)
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How do we treat bronchiolitis (RSV)?
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mist therapy and oxygen, IV or oral fluid
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What do we NOT use to treat a baby with bronchiolitis?
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bronchodilators and steroids
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What are some of the signs and symptoms of pneumonia in a child?
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fever, tachypnea, cough, chest pain, malaise, LOOKS SICK, often presents with fever and abdominal pain.
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How do we treat bacterial pneumonia?
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antibiotic therapy, liberal fluid intake, rest, antipyretics
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what are some complications of pneumonia?
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pleural effusion, empyema, pneumothorax
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what are the s/s of respiratory distress?
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tachypnea (greater than 60 in infants), nasal flaring, retractions (substernal and intercostal), cyanosis, grunting, mental status or speech changes, restlessness, confusion
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You suspect that your pt. is in respiratory distress, their O2 stats are dropping, what should you do?
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you can raise the O2 until the team gets there.
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What medications do you use for a pt. that is in respiratory distress?
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albuterol, epi
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Define respiratory failure
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failure of the lungs to function properly causing severe hypoxemia and/or hypercapnia (too much CO2)
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What are some reasons that a pt. might experience respiratory failure?
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gas exchange impairment, ventilation impairment
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What are some of the symptoms of respiratory failure?
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restlessness, cyanosis, arrythmia, tachypnea, tachycardia, SOB, mental confusion, headache, gasping for breath, increased use of neck muscles, coma
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Define asthma
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chronic, reversible inflammatory airway disorder, involving mast cells, leukotrienes, eosinophils
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What is asthma charaterized by?
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airflow obstruction, bronchospasm, mucosal edema, increased mucus production and airway remodeling, airway hyperresponsiveness, sensitivity to allergens
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What are some of the manifestations of asthma?
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cough (dry, hacky or productive), tachypnea, expiratory wheezing, restlessness, anxiety, sweating, hunched-over, panting phrases, fatigue
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What is one of the earliest signs of asthma?
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coughing, especially nocturnal
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How is asthma catergorized?
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Mild intermittent, mild persistent, moderate persistent, severe persistent
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Regarding asthma, define "mild intermittent"
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has symptoms less than 2x/week, nocturnal less than 2x per month, pulmonary function greater than 80% normal
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Regaring asthma, define "mild persistant"
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symptoms greater than 2x/wk, not daily, nocturnal greater than 2x per month, pulmonary function greater than 80% normal
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Regarding asthma, define "moderate persistent"
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symptoms daily, nocturnal greater than 1x/wk, pulmonary function 60 - 80% normal
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Regarding asthma, define "severe persistent"
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symptoms continuous, frequently at night, activity limitations, pulmonary function less than 60% normal
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What are some "rescue" medicines for asthma? What does "rescue" mean?
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it means to treat acute symptoms and exacerbations, albuterol and Xopenex and theophylline
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What are some long term controller medications and what do they do?
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they are used to achieve and maintain control of inflammation, inhaled corticosteriods, inhaled NSAIDs, oral leukotriene modifiers, long acting Beta2 agonists
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What are some of the side effects of short acting beta2 agonist (rescue meds) used for asthma?
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tremors, tachycardia, insomnia, dry mouth, hypertension
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How often should the rescue meds be taken for asthma?
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they should not be taken any more than 4x per daily
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Regarding asthma, what do the "rescue" meds do for the patient?
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dilate smooth muscle, decrease spasms
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What is an example of a corticosteriod used in acute exacerbations?
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Prednisolone
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If a pt. is on the long acting beta2 agonist FLUTICASONE/SOLMETEROL what things should you tell the pt. to do?
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discontinue rescue bronchodilator and restart only if acute exacerbation occurs
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Why are inhaled corticosteroids given to a pt. with asthma?
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to prevent symptoms and suppression, control and reversal of inflammation
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Give some examples of inhaled corticosteriods
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flovent, pulmicort, cromolyn sodium
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What does administering an NSAID to a pt. with asthma do for them?
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stablizes mast cell mebrane and inhibits inflammatory mediator release
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What do leukotriene modifiers good for?
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prevention of bronchospasms, mucosal edema and increased secretions caused by the leukotrienes
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What is an example of a leukotriene modifier?
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singulair
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What is EIB (exercise induced bronchospasm)?
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acute bronchospasms that occur 5-10 minutes after ending exercise and usually resolves in 20-30 minutes
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What is a good exercise to recommend to a person who experiences EIB?
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swimming
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What is status asthmaticus?
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increasing distress despite treatment
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When using an inhaled steroid what is there a risk of?
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oral candidiasis (yeast infection)
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What is Cystic Fibrosis?
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an autosomal recessive disorder of exocrine glands, not sex linked, both parents are carriers
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Explain autosomal recessive disorder
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lungs are normal at birth, recurrent infections with inflammation and viscous mucus causing obstruction, difficult to expectorate/ coughing
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What are some of the respiratory effects of Autosomal recessive disorder?
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structural damage of lungs, poor gas exchange, chronic hypoxia with clubbing, hypercapnia, pulmonary hypertension(can result in respiratory failure)
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What is the life expectancy of a person with Autosomal recessive disorder?
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approx. 35 years, a lung transplant is needed at some point
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What happens with pancreatic insufficiency?
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ducts are blocked by thick secretions
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How does pancreatic insufficiency present?
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grasey, bulky stools (from undigested fat), failure to thrive (FTT), poor weight gain, malabsorption of vitamins A,D,E and K
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What are some hepatic effects of CF?
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viscous bile, clogged bile ducts, gallstones and if extensive, can lead to obstructive cirrhosis and/or portal hypertension
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What are some diagnostic tests used to diagnose cystic fibrosis?
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sweat test, chest x-ray, PFTs or fecal fat testing
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What does postural drainage do?
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removes excess fluid and mucus from the lungs, decreases vomiting
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Explain aerosol treatments
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bonchodilators, steroids and antibiotics inhaled allowing direct distribution into the airway. It reduces the amt of medication needed
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What type of diet is recommended for a pt. with CF?
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high caloric, high protein diet plus snacks
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What is Dysphasia?
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difficulty swallowing
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What is FTT (failure to thrive)?
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it is a sign of inadequate growth resulting from inability to obtain or use calories required for growth
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Regarding FTT, what is meant by "organic"?
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a physical cause if found for the FTT
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Regarding FTT, what is meant by "nonorganic"?
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unrelated to disease, often psychosocial
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Regarding FTT, what is meant by "idiopathic"?
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unexplained by organic or environmental etiologies
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What is ESSR?
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Enlarged nipple, Stimulate suck, Swallow appropriately, Rest
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How would you care for a pt. with a cleft lip/palate?
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establishment of good self esteem, meticulous mouth care, speech therapy, social service support
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What is esophageal atresia?
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when the esophagus fails to develop into a continuous tube from the mouth to the stomach
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How is a TE or TEF diagnosed?
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diagnosis is based on symptoms and barium study
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What are the symptoms of a TE or TEF?
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The 3 C's: coughing, choking, cyanosis
increased salivation and drooling, frothing, apnea, resp. distress after feeding, abd. distention from swallowing air |
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What are some complications for a child with a repaired TEF?
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strictures, esophageal motility disorders, GERD
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Explain HPS (hypertrophic pyloric stenosis)
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hypertrophy and hyperplasia of pyloric sphincter muscle produces obstruction between stomach and duodenum
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What are some of the clinical manifestations of HPS (hypertrophic pyloric stenosis)?
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non- bilious vomiting, dehydration (decr. NA,K), metabolic alkalosis (decr. CL, incr. pH and CO2)
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What are the physical signs you might find on a patient with HPS?
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olive shaped mass felt in upper abdomen
visible peristalsis |
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What is GER (gastroesophageal reflux)?
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passive transfer of stomach contents into esophagus due to relaxation of the lower esophageal sphincter
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What is GER usually due to?
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transient relaxation of LES, incompetent LES, anatomic disruption of esophagogastric junction
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What is the most common sign of GER in infants?
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postprandial (after eating) regurgitation
can be a simple wet burp to persistent vomiting |
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What are some ways that they diagnose GER?
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UGI (barium fluoroscopy), upper endoscopy, pH probe monitoring for 18-24 hours, gastroesophageal scintigraphy
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What is celiac disease and what should the pt. do if diagnosed with it?
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Intolerance for the protein gluten
The pt. needs to get rid of all gluten in his/her diet for life |
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What are some of the early signs of Celiac disease?
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steatorrhea (fatty stools), foul smelling, greasy, frothy stools
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What are some of the classic features in an infant diagnosed with Celiac disease?
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Chronic diarrhea, malabsorption, abdominal pain and FTT
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What are some symptoms of protein deficiency?
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muscle wasting and abdominal distension, delayed dentition and bone density changes
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How is Celiac's disease diagnosed?
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Measurement of fecal fat content, duodenal biopsy, put pt. on gluten free diet and see if symptoms go away, serum screening tests
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Which is lost more readily, ECF or ICF?
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ECF and can cause significant dehydration which can lead to decreased blood volume and hypovolemic shock
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How much of a preterm infants body is water? a full term infant?
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preterm: 90%
full term: 75% |
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What are sensible losses?
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body fluid losses that you can see: urine, fecal output, drainage from NG, ostomy, chest tubes
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What are insensible losses?
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body fluid losses that you can't see: respirations, evaporation through the skin
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What types of treatments in the hospital could increase insensible water loss?
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radiant warmers, phototherapy, skin defects and skin breakdown(burns), fever, increased respiratory rate, elevated room temperature
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What are the daily fluid requirements for infants?
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weight: 1-10kg
100ml/kg/d Weight: 11-20kg 1000ml + 50ml/kg/d for each kg more than 10 weight: over 20kg 1500ml + 20ml/kg/d for each kg more than 20 |
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What is the primary solute in ECF?
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NA+
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How is dehydration classified?
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Isotonic: = concentration
Hypotonic: decreased concentration of NA+ Hypertonic: increase concentration of NA+ |
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What is the primary type of dehydration found in children and what is it usually caused by?
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Isotonic - usually caused by gastroenteritis
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What are some of the s/s of isotonic dehydration in children?
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tachycardia, mottling, cool extremities, sunken fontanel and/or eyes decrease BP, increased pulse
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What is hypovolemic shock?
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when a pt goes into severe dehydration
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What are some of the causes of Hypotonic dehydration?
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Inadequate electrolye intake, excessive water intake
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Explain the s/s of hypotonic dehydration
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symptoms are circulatory in nature
Hypothermia, hyporeflexia, weakness, shock occurs more frequently |
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What is the most dangerous type of dehydration for a child to get?
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hypertonic dehydration
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What are the symptoms of hypertonic dehydration?
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symptoms are neurologic
lethargy with somnolence if left alone, profound overreaction to stimuli, seizure, brain damage, coma |
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What are the diffent degrees of dehydration and what are thier symptoms?
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Mild: thirst
moderate: more thirsty, dry membranes, less tears, tachycardia, irritability, slowed cap. refill, oliguria, cool skin Severe: intense thirst, no tears, sunken eyes, tachypenia,decreased BP, lethargy, very slow cap refill, sunken fontanel, oliguria or anuria, cold skin, tenting, cyanotic |
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As a nurse, how do you assess for dehydration?
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look at general appearance: vital signs, skin fontanel, weight, check labs
intake and output |
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What symptoms might a pt. be experiencing that might lead to dehydration?
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diarrhea, vomiting, fever, sweating
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What is gastroenteritis?
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inflammation of gastrointestinal tract
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Is gastroenteritis viral or bacterial?
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it can be either
If bacterial: usually salmonella If viral: rotavirus |
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What would be some indications that your patient need to be on parenteral rehydration?
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ORS treatment fails, severe dehydration, shock, uncontrolled vomiting, inability to drink,
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When is diarrhea considered to be "chronic"?
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when it lasts for more than 2 weeks
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What is Chronic diarrhea usually associated with?
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malabsorption disorders, anatomic defect, motility defects,hypersensitivity or allergic reaction, IBD,
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What is chronic Non-specific diarrhea (CNSD)?
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loose stools with undigested food, normal growth
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What is edema?
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excess fluid in the interstitial space
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How is edema first observed?
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periorbital (eyes)
occipital genital sacral (bedridden) |
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What are some causes of edema in children?
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intake exceeds output
altered fluid mechanisms such as kidney or cardiovascular disease) trauma (head injury) impeded venous return (constricted dressing) |
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What is a hernia?
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a protrusion of a portion of an organ or organs through an abnormal opening
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What is an incarcerated or strangulated hernia?
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a hernia which contricts blood vessels
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What is a diaphragmatic hernia?
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herniation of abdominal organs through the diaphragm
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What are some of the signs of a diaphragmatic hernia?
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resp. distress (biggest sign), dyspnea, tachypnea, impaired cardiac output
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What are the two types of abdominal wall defects?
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gastroschisis and omphalocele
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What is an abdominal wall defect?
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weakness or incomplete closure of the abdominal wall around the umbilicus
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Explain Gastroschisis
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it is a herniation of abdominal wall contents outside othe body through this defect. WITHOUT A PERITONEAL SAC COVERING THE ORGANS
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What is used to diagnose gastroschisis and why do we want to diagnose as early as possible?
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diagnosis is suspected by an elevated MSAFP and confirmed by a prenatal ultrasound or at birth.
We want to diagnose this problem as soon as possible to allow for transfer to a perinatal center with specialist for delivery and treatment |
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How do we treat a baby with gastroschisis?
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protection of exposed viscera, radiant warmer and IV fluids, antibiotics to prevent infection
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What is an Omphalocele?
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intra-abdominal contents herniate through the base of the umbilical cord and ARE COVERED BY PERITONEAL SAC
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What is Hirschsprungs disease?
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congenital aganglionic megacolon
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What are some of the s/s of Hirschsprungs disease?
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decreased peristalsis at site, abdominal distension, vomiting, inability to pass stool, no meconium passed, bilious emesis, refusal to feed, possible ribbin shaped stool
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How is Hirschsprungs disease diagnosed?
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barium studies, anorectal mamometry, rectal biopsy (this is how they make the actual diagnosis)
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How do we treat Hirschsprungs disease in infants?
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surgery
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How do we treat Hirschsprungs disease in older children?
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prevention of constipation, isotonic enemas, stool softeners, surgery
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What is intussusception?
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a portion of the intestine prolapses and then telescopes into another portion
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Where is the most common place for intussusception?
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ileocecal valve
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How do we diagnose intussusception?
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H/P, pt. will have red "current jelly" stools, long cylindrical mass in RUQ, abdominal ultrasound, stool guiac
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How do we treat intussesception?
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Sometimes it can resolve on its own, enemas
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What is malrotation?
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abnormal rotation of the intestine around the superior mesenteric artery during development
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What is Volvulus?
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twisting of the intestine around itself
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How do we diagnose either a malrotation or a volvulus?
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upper GI, consider any infant with bilious vomiting
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What is necrotizing enterocolitis?
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Acute inflammatory disease of bowel
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What is the greatest risk factor for necrotizing enterocolitis?
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prematurity
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What are the s/s of NEC?
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abdominal distension, bilious vomiting, bloody diarrhea
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What are some signs of sepsis in relation to NEC?
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hypothermia, hyoptension, lethargy, apnea
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What is the primary cause of "short bowel syndrome"?
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NEC
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What is short bowel syndrome?
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a decreased ability to absorb and digest a regular diet because of a shortened small intestine
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