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51 Cards in this Set
- Front
- Back
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If you walk into a room with a large family, what can the nurse do to get things going? What are other important aspects of communicating with parents? (5)
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-use an ice breaker (i.e - a compliment will show you notice)
-privacy/confidential, listen, cultural aware, use silence, empathy. |
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When dealing with children, what is one thing that the nurse should NEVER do?
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-give the child options (by saing "ok?"), using analogies-give reward options(choices) appropriately
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What can they do instead? Nurse should make sure to__ when dealing with children?(7) Consideration for older children?
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-communicate at child's level, get on eye level, tell truth, be gentle, be clear, be positive, avoid long sentences (big words) -talk without parents present
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For infants, what are examples of non verbal cues? What is infant's primary way of communication?(3)
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-grimace, knees up -crying (hunger, discomfort, loneliness)
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For early childhood, what should be focus of communication?(4) Be aware of? Most modest age?
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-the child, what/how/why, recognizable words, consistent (dont smile when doing painful procedures) -your non verbal communication -4-5
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What should the nurse remember when communicating with adolescents?(3) What is developmental regression?
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-be honest, aware of privacy needs, importance of peers -change behavior response to hospital due to stress
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What are some beneficial ways that playing can be used to work with children?(5)
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-therapeutic intervention, stress relief, pain relief, distracter, barometer of serious illness
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When doing head to toe exam for children, what should be kept in mind?
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-perform least obtrusive first to most obtrusive last
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What are the goals of pediatric assessment?(4)
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-minimize stress/anxiety associated w/various body part(assessments), trusting nurse-child-parent relationship, max prep for child, accurate findings
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In preparing a child for a painful procedure, what can the nurse do to ensure it goes smoothly?
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-find child's perception of painful procedure, cooperate with parent, use age-appropriate technique. (use playing to go through procedure-paper-doll technique)
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For infants up to 36 months, what type of growth measurements are used? after 37? It's essential to do what during this assessment? What is considered outside of parameters?
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-recumbent height, weight and head circumference(+chest & ab circum) -standing height+weight
-plot on growth chart by gender and note prematurity -<5th or >95th percentile for height, weight, head |
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It's important for the nurse to know what about growth? (3) What should nurse do with growth values?
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-ethnic differences, expected growth rates at various ages, significance of head circumference measurements -compare values for each age group
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A nurse is asked to take an infant's apical heart rate, how long should she count? In what order should the nurse perform vital signs for infants and toddlers?
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-60 seconds -Respirations, Apical HR, BP, Temp
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At what age should you NOT use a tympanic temperature? How do you insert in ear appropriately?
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-infants younger than 3 months -pull ear backward slightly, gently place in(aim probe toward eye on opposite side of head)
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What are the top three most accurate temperature devices?
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-Digital thermometer, tympanic, temporal
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A nurse is about to place a cuff on a patient with an IV, what should she remember? Importance of cuff selection? BP interpretation depends on?
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-don't use the arm with the IV! - is it the right size? -age range
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What is the most common blood pressure measurement?
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-Bracheal artery, radial artery, popliteal artery, dorsalis/post tib artery
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For physical assessment, what should be noted about checking hair? chest? abdomen? retractions?
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-lice -circumference -circumference -where they occur
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For infants, at what point do primitive lung buds develop? when do the airways reach the same level as adults? What is surfactant? When does it develop?
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-5 weeks, 16 weeks -lipid substance needed for inflation of airsacs -32 weeks
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When does the respiratory first function ? What is the ductus arteriosus?
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-upon immediate emergence from the womb - links the pulmonary artery and aorta
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What is related to increased otitis media, respiratory infections, and asthma for children?
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-exposure to tobacco smoke
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For pediatric history of respiratory, how many colds are expected per year? What is the danger of new foods introduced to children? Why would you want to child proof your home?
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-4 to 6 - possible allergic reaction - at risk for aspiration, poison, injury
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How can you make the most of a sleeping infant? What if they wake up crying?
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-inspect and listen to lung sounds -it's ok because it enhances tactile fremitus and auscultation BS
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What is the AP:TD of an infant? When does it change? If it doesn't change? What is Harrisons groove?
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1:1 (barrel chest) -by 6 years old -may be sign of chronic asthma of cystic fibrosis -horizontal groove in rib cage(from sternum to midaxillary; normal in some children)
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What is the first respiratory assessment called? When are the parameters measured? What might depressed respirations be due to in newborn?
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-Apgar scoring system - at 1 and 5 minutes after birth -maternal drugs, interruption of uterine blood, obstruction of bronchus w/mucus
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What is the apgar score for a newborn in good condition? What score for a newborn needed more resuscitation and close observation? severely depressed, full resuscitation, ventilation assistance?
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-7 to 10
-3 to 6 -0 to 2 |
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What might retraction of sternum and intercostal muscles be an indication of?
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-increased respiratory effort: atelectasis, pneumonia, asthma
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Normal breath rates for newborn? What conditions accompany rapid respiratory rates? (5)
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30-40(60 spike), -pneumonia, fever, pain, HD, anemia
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What would be an early sign of heart failure for an infant? When is the best time to count respirations:?
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-tachypnea 50-100 breaths per minute -asleep
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For palpation: when might asymmetric expansion occur? When might Crepitus occur? What might you observe in infants with rickets or scurvy? Can you percuss an infant?
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-pneumothorax or ahragmatic hernia -with forceps delivery from fractured clavicle -round knobs at costochondral junctions(Rachitic rosary) -no
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What type of breath sounds can you auscultate in an infant? Diminished breath sounds is an indication of? (4)
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-Bronchovessicular -pnemonia, atelectasis, pleural effusion, pneumothorax
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What type of adventitous sounds are heard in the immediate newborn? why?
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-fine crackles - thin chest wall
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Pneumonia, bronchiolitis, or atelectasis can be indicated by?
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-persistent fine crackles scattered over chest
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Crackles in only upper lung field with infants indicate? only lower? An obstruction of an infant's lower airway might cause what?
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-cystic fibrosis, heart failure -expiratory wheezing
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When would you suspect diaphragmatic hernia? A child gets something stuck in their throat, what would you expect to happen?
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-persistent peristaltic/diminished breath sounds on same side -Stridor sound(Croup, acute epiglottitis, foreign body aspiration)
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When does the fetal heart beat begin? What is the foramen ovale? rerouted? what pumps the right side?
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-3 weeks gestation -opening in atrial septum rerouted to left side of heart(aorta)2/3 shunt -pulmonary artery(right) through ductus arteriosus, 1/3 shunt
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When do the foramen ovale and ductus arteriosus close? Describe placement of heart for infant vs adult?** When does the heart reach adult position?
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-first hour, 10-15 hours(up to 48 hours) -more horizontal (higher apex at 4 ics) -7 years old
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What would be an indication of heart disease for infants? Blue spells during exercise for children can be an indication of?
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-fatigue during feeding, diaphoretic, falls asleep(dyspneic) -cyanosis
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If shunts failed to close, what conditions may be present? If a baby has cyanosis at or after birth, what does this signal. What are the three most important signs of infant heart failure?
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-patent ductus arteriosus, atrial septal defect -oxygen desaturation of congenital HD -tachycardia, tachypnea, liver enlargement (engorged veins, gallop rhythm, pulsus alternans)
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What conditions can displace the apex of the heart? (4)
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-cardiac enlargement( to left), pneumothorax(away from affected side), diaphragmatic hernia (to right), dextrocardia (shifts right)
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Normal heart rate at birth? for infants? Persistent tachycardia for newborns & infants? Bradycardia?
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100-180, 120-140 ->200, >150 -<90, <60
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What is an expected heart rhythm of infants? How do S2&S1 sounds differ in infants?
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-sinus arrhythmia (phasic speed up or slow down as breathing) -S2 (higher pitch, sharper than S1)
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Why are murmurs common in newborns within first three days? after? This sounds like what? Splitting of S2 after height of inspiration is _____?
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-fetal shunt closure -need further evaluation -PDA murmur =machinery like sounds -common in newborns (few hours)
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What are cardiac signs that may indicate HD? (6)
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-poor wt gain, developmental delay, tachycardia/pnea, DOE, cyanosis, clubbing
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In palpating the apical impulse,where do you expect to find it in: Up to 4yo, 4-6, 7+
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-4ICS L of MCL -4ICS MCL, 5ICS R of MCL
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What is a venous hum? pathology? sound characteristics? Use which part of stethescope? Does respiration affect venous hum? How to make it sound louder?
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-turbulent blood flow in JV system -none, common in healthy kids -continuous low pitched, soft hum (loudest at diastole) (bell) -no -have child stand up
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What type of murmurs are common in children? sound characteristics?
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-innocent murmurs (30% occurence) -soft, medium pitch, vibratory
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If infant has PDA, what can you usually palpate? murmur sound? what causes pda?
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-thrill left upper sternal border -machinery -channel stays open (Pulmonary artery to aorta)
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What condition is associated with Atrial Septal Defect in children and young adults? What causes?
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-DOE and mild fatigue -increased blood flow via pulmonic valve
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What congenital heart defect is associated with severe cyanosis? what causes?
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-tetralogy of fallot -blood doesn't get into pulmonary system, thus no oxygenation
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What is coarctation of the aorta? results in? What is the hallmark?
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-severe narrowing of the descending aort -increases work load on left ventricle -UE 20mmHg > LE
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