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46 Cards in this Set
- Front
- Back
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How does "enabling" work in a positive way? |
Creates opportunities and measures
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What are the most common diagnoses in children and adolescants? |
Respiratory! -Pneumonia -Asthma -Acute bronchitis |
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After respiratory, what body system is most likely to cause pediatric illness? |
Digestive |
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What are some examples of stressors in the hospital setting? |
-Seperation -Fear of the unknown -Loss of control and autonomy -Bodily injury resulting from discomfort and pain -Fear of death
(Children have limited coping mechanisms) |
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What are the three stages included in seperation anxiety within hospitalization? |
1. Protest Phase 2. Despair Phase 3. Detachment Phase |
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What are some signs a child is in the "protest phase" of anxiety? |
Cry and scream (inconsolable), can last hours to days Cling to parent May reject caregiver Toddlers: attempt to escape |
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What are some signs a child is in the "despair phase" of seperation anxiety? |
Crying stops Evidence of depression Child is sad, lonely, uninterested in food and play Hopeless "Superficial calm" Quiet/Withdrawn Refusal to eat, drink Intermittent Crying Intense reaction to parent return
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What are some signs that a child is in the "detachment/denial" phase of seperation anxiety? |
-Might "appear" to have adjusted. -Increased activity, interest in surroundings yet detached. -Transient attachment to nurses -Preoccupied with toys, food, possessions -"Promiscuous sociability" -Indifferent response to parents (even rejecting)
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What does Erikson believe to be the social/emotional development happening in infancy? |
Trust vs. Mistrust, Hope -Need consistent loving caregivers, daily routines, comfort crying infant |
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What does Erikson believe to be the social/emotional development happening in early childhood? |
Autonomy vs. Shame/doubt, Willpower -Give the child choices -Daily routines -Loss of control may contribute to regressiong of behavior |
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What does Erikson believe to be the social/emotional development happening in play/preschooler age? |
Initiative vs Guilt, Purpose -Egocentric and magical thinking is typical -May view illness or hospitalization as pinushment
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What does Erikson believe to be the social/emotional development happening in school age? |
Industry vs inferiority, competency -Strive for independence and productivity -Fear death, abandonment, permanent injury -Prone to boredom
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What does Erikson believe to be the social/emotional development happening in Adolescence? |
Ego identity vs Confusion, Fidelity (use third person questions) -Struggle for independence and liberation -Seperation from peer group, may respond with anger and frustration -Need for information about condition and to participate in decisions |
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What does Erikson believe to be the social/emotional development happening in young adulthood? |
Intimacy vs isolation, Love
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What does Erikson believe to be the social/emotional development happening in Middle adulthood? |
Generativity vs Stagnation, Care |
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What does Erikson believe to be the social/emotional development happening in matured adulthood? |
Ego identity vs despair, wisdom |
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What are some strategies to help with seperation anxiety? |
-Prepare for hospitalization -Parents come, not visitors -Parents need to say goodbye, not sneak away -Familiar items from home -Maintain child routine -Encourage self care |
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What are some strategies for promotiong family centered care? |
-Recongized family as a constant in the childs life -Systems must support, respect, encourage and enhance the families strength and competence -Needs of all family members must be addressed -Enabling-create opportunities and measures -Empowerment-maintain/acquire sense of control over life -Atraumatic care: do no harm |
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When giving a child medication what is the drug dosage based on? |
dosage per kilogram of body weight |
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For an intramusclar injection what are the preferred routes? |
Vastus lateralis(mid section of the lateral thigh) and ventrogluteal |
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What do you AVOID when giving IM injections? |
Gluteal: Sciatic nerve,gluteal not done until 3 yrs of age and child has been walking for awhile.
Deltoid Nerves |
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What volumes and size needles are used in infants/children? |
Small Volumes: 0.5 mL infant. 1-2 mL child
Small Needles: 24g (22-25g), 1/2"-1" in length |
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What are some things to know with collection bag application and S/G and dipstick? |
-Adhesive portion is applied to exposed and dried perineum first -Bag adheres firmly around the perineal area -Cut slit through disposable diaper and pull bag through to check/prevent from losing sample
-S.G./ dipstix- put cotton balls in the diaper, withdraw with syringe |
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What are examples of restraints? |
-Jacket restraints -Limb/elbow restraints "No-no's" -Infant seats, high chairs, strollers -Therapeutic holding (parent holds while you do procedure) -Mummy restraints or swadle restraint |
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Where are common IV placement locations in infants? |
-Frontal vein (forehead) -Superficial temporal vein (side of head by ear) -Forearms (Basic, cephalic, dorsal veins) -Great saphenous vein (lower calf) -Dorsal venous arch,median marginal vein (top foot) |
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What are some overall variations when doing a physical assessment on a child? |
-Great then or equal to 5 y.o. can do normal head to toe -2-3 y.o. save most invasive for last aka mouth and eyes -Keep mom and dad with child during assessment -Peds: "Pediatric Assessment Triangle" (appearance, breathing and circulation) |
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What are some abnormal findings when assessing appearance? |
-skin is like the 5th vital sign -cap refil > 2 secs -mottled skin -weak/absent pulses, pale, cool extremities -cyanosis is a late sign of shock -large body surface area to weight, if theyre sick they lose heat really fast.
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What are some things to know about breathing when assessing an infant? |
-Newborns are obligate nose breathers for the first few months -Metabolic rate higher in peds -Newborn airways size of pinkys, easier to plug up -Sniffing position: put smalled rolled towel behind infants shoulder to help breathe better |
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Circulation in infants? |
-Cardiaca output: only way increased is when a child gets tachycardic -Hypotension is a late sign of shock |
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What are some things to know about an infants head in assessments? |
-Posterior fontanels close at 6-19 months -check head circumfrance up to 36 months -Large head circumfrance may indicate excess CSF, hemangioma, brain tumor, hydrocephalus, bleed from head trauma -Shape: "Back to Sleep" when parents put their babies on their backs 24/7, can be fixed with helmets
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What are some things to know about an infants ears when doing an assessment? |
-< 3 years old eustachian tubes are short, wide, horizantal making prone to ear infections, usually secondary to upper respiratory infections. -if too many infections for too long can lead to hearing loss, can lead to developmental speech issues -low set ears can indicate down syndrome -to inspect ears for kids younger than 3 y.o. pull ears down and back -to inspect for kids older than 3 y.o. pull ears up and back -ears form around the same time that kidneys due |
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What to know about eyes in infant assessment? |
-Check for red reflex, lack of redreflex can suggest eye tumor -Check for strabismuc by shining penlight, light should bounce off equally on both eyes -Lacrimation doesn't begin until 2-3 months |
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What to know about mouth/throat in infants? |
-Bottle mouth: can develop extreme tooth decay if baby sleeps with bottles -Moist mucous membrane are sign of goof hydration -Tonsils: lymphatic peak growth at 10 years, tonsil size graded +1 to +4 --> +4 means kissing tonsils that are touching and need to be removed |
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What to know about an infants abdomen? |
-Liver border may be 1 cm lower in infants -Umbilical hernia is most common in kids at younger age and african americans
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What to know about musculoskeletal in infants? |
-developmental dysplasia of the hip (hip may be dislocated at birth, can be fixed) -if hip not fixed, might get scoliosis, need to wear a harness |
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Neuro in infants? |
-Brain cells: once you lose them, dont get them back -Kids brain tissues more prone to infection -Brain doesnt finish developing till 20's (teens impulsive, amygdala still developing) -Neuroplasticity- if a 3 y.o. versus a 30 y.o. gets head trauma, a 3y.o. more likely to recover bc brain is still developing -Assess for bells palsy (facial asymmetry) |
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Genetalia in infants? |
-Assess for gross deformities -Testicals should both drop by 1 y.o. or else higher risk for testicular cancer/infertility -Inguinal hernies common in baby bos |
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How to interpret growth chart?
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-Recumbent length is for infants UP TO 36 m/o plus the weight and head circumfrance -Standing height is AFTER 36 m/o -Growth chart: plot by gender and prematurity if appropriate -Less than 5th percentile and greater than 95th considered outside parameters for height, weight, head circumfrance |
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What are child physical assessment red flags? |
-Infants can have sternal retractions if they cant breathe -Cyanosis and hypotension are late signs of shock, skin signs and tachycardia will be seen way before this -Child isnt developing milestones anymore, strange abnormal cry, flaccidity, paradoxal irritability (when put baby down they stop crying, cry when picked up again-sign of meningitis) |
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Risk factors for SIDS? |
Low APGAR, low SES, male, african american, smoking family, native american, springtime, hispanics, preemies, soft bedding, overheating, young mothesr, poor prenatal care, substance abuse moms, one or more ALTE (apparent life threatening event) -majority of cases from parents sleeping with baby in bed
-NOT risk factors: using pacifiers, breastfeeding, having one or more sibling dies from SIDS |
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What is ALTE? |
Apparent Life Threatening Event
Some combo of: apnea, limpnesss, color change, choking/gagging |
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Where do you check skin turgor in infants? |
Belly |
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What are some signs of shock? |
Early signs: cap refill > 2 secs, poor/absent pulses to extremities, decreased skin temp, abnormal color, tachycardia
Late signs: hypotension, cyanosis |
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What are signs of respiratory distress? |
-Tachypnea, decrease air exchange -Grunting, nasal flaring, sternal retractions, head bobbing, abdominal retractions, lower LOC (low pO2 and high pCO2 means they are not expelling enough CO2 --> losing consciousness) |
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Signs of decreased level consciousness |
Might be r/t shock Primary neuro issue Increase CO2 |
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Hypoglycemia in peds |
in peds can happen very quickly |
