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160 Cards in this Set

  • Front
  • Back
Toddler age is from:
1-3 years
Anterior fontanel closes at what age?
12-18 months. Typically closer to 18 months.
True or False: You should ignore temper tantrums, head banging, or rocking?
True
Psychosocial developments of a toddler include:
-egocentricity
-follow parents (peek-a-boo and hide and seek help the child develop trust)
-separation anxiety
-transitional objects
-parallel play
Cognitive development of a toddler include:
-object permanence
-ritualistic behavior
-magical thinking
-curious
-lack of sharing
-recognizes self in mirror
Motor skills of a toddler include:
-very active
-use arms to balance
-typically walk by 15 mo
-climbs stairs (21mo)
-runs and jumps (2 yo)
-ride tricycle (3 yo)
-difficulty coordinating swallowing and speaking
When do first molars erupt?
toddler years (1-3)
When brushing a toddlers teeth, what should be used with the toothbrush?
water and not toothpaste. Fluoride can be used PRN until 12 yrs old
What is the language development like in a 2 yr old and a 3 yr old?
> 400 words with 2-3 word phrases; >11k words with 4-5 word sentences
what type of behavioral changes can be seen in a toddler?
-use of "no" frequently
-temper tantrums
-assertive
-frustration can ensue
-immediate gratification wanted
What is toilet training dependent upon in a toddler?
-physical readiness
-emotional readiness
-shows interest
What is important for the parent to teach the child who is toilet training?
teach the importance and proper technique of hand washing
What are the immunizations that children should have to prevent communicable diseases?
-Hep B (3) birth, 1mo, and 6 mo
-DTAP (4) 2, 4, 6, & 12 mo
-Hib (2) 2 & 4 mo
-IPV (4) 2, 4, 6-18 mo and 4-6 yrs
-MMR (2) 12-15 mo and 11-12 yrs
-varicella (1-2) after 1 yr, second if the first was received after 13 yrs
how many oz of milk per day should a toddler consume?
24
What is the typically amount of sleep a toddler should get each night and is it necessary for the child to take a nap?
12 hours and it's not necessary but vital to growth and development
What is one way for a toddler to overcome sleep anxiety such as afraid of the dark?
bedtime rituals and security objects (blankie or stuffed animal)
What are some important safety interventions to implement for a toddler?
-move out of crib once child can climb out
-lock cabinets
-do not leave unattended around water
-safety plugs and safety gates
-check for sizes of toys and food
What age range is the preschool child?
3-5 years
How much does the child's birth length increase by the age of 4?
it doubles
Psychosocial development of a preschooler includes:
-identifies with same sex
-role plays, plays with dolls
-body integrity
-begins to share
-imaginary playmates
-very important to use disciplinary actions such as timeout
Cognitive development of a preschooler includes:
-4-5 word sentences
-one idea at a time
-time, numbers, letters, and colors
In the preschool child, what kind of nutritional behaviors will be established?
-regular meal times
-variety in diet
-ensure breakfast
-mildly flavored single food dishes
What signs will indicate a preschooler is ready for Kindergarten?
-picks up after self
-tolerates separation from parents
-listens and follows directions
-speaks in correct, complete sentences
When a toddler has an illness/hospitalization, he/she may have separation anxiety. What are the three types?
protest stage, despair, detachment
The school age range for children is:
5-12 years old
What is/are the main causes of death in school age children?
accidents
Bones grow faster than muscles in the school age child. What are these children more prone to?
bone fractures
Some psychosocial development facts of the school age child include:
-plays with peers
-does family activities
-fantasy play and daydreaming
-fear of death and school
Some cognitive development facts of the school age child include:
-time and space
-cause and effect
-nesting
-numbers
-read and spell
The adolescent child ranges in age from:
12-18 years
The 3 stages for psychosocial development for the school age child are:
Early (11-14 yr)
Middle (15-17 yr)
Late (18-20 yr)
what kind of cognitive development will the school age child have?
abstract thinking, ability to analyze, logical, and at the level of an adult in late adolesence
What are some high risk behaviors of the adolescent child?
intentional/nonintentional injuries, smoking, drug abuse, alcohol abuse, sexual activity, and nutrition activity
Is it important for the school aged child to maintain a sense of control while sick or hospitalized?
Yes, this will help enhance their self-esteem.
What is one of the biggest issues with the adolescent child who may be hospitalized?
Anything that may involve their peers. Such as, not getting to see them, how they look to them, and even possibly losing them.
What kind of questions are most beneficial when talking to children?
open ended questions rather than yes or no
If a nurse use different methods to present information, it enhances:
comprehension
When communicating with families, it is important to:
-involve the whole family
-encourage families to write down questions
-give verbal and nonverbal messages showing openness
-encourage feedback
Also, when talking with a child or explaining something, it is important to speak how?
in words or phrases that child may understand
what are some special needs of the adolescent child that need to be watched for?
autonomy, privacy, and body image
where do most accidents with children occur and are they preventable?
near the home and yes
what should parents teach their children about medicine?
that it is not candy
______ ______ incidence is decreasing because its use is no longer recommended in children:
ASA poising
what is a toxic blood level of ASA? Therapeutic blood levels are:
>30mg/dL; 15-30mg/dL
Signs and symptoms of ASA poisoning are:
hyperapnea
fever
decreased serum glucose lvl
GI irritation
Petechiae
blood loss
irritability
tinnitus
what are some important interventions for ASA poisoning?
maintain patent airway, gastric lavage, hydration, and administer calcium and potassium supp.
what is one of the significant problems for acetaminophen poisoning? What are the 3 stages of toxicity?
hepatotoxicity; initial (2-4 hours post), latent (1-2 days post), hepatic involvement (3-4 days post)
what are the two main things to check for with acetaminophen toxicity?
liver function and neurological status
What agent is administered as an antidote with acetaminophen toxicity?
mucomyst. It binds with the breakdown product so that it won't bind to liver cells
what happens with lead poisoning?
lead replaces calcium in bones and increases permeability in CNS membranes
when is lead poisoning confirmed?
2 positive blood lead levels of > 10 mcg/dL
what is the most serious side effect of lead poisoning?
irreversible neuro damage
most important things to assess for are:
bone pain, s/sx of anemia, neuro changes
What do you want to administer in a child who has lead poisoning?
chelating agent (EDTA BAL)
what is family-centered care?
where the child and family are viewed as one unit
how is family-centered care achieved?
families are given choices, are allowed to provide input, respected and strengths are recognized
what are some special areas of concern for children?
developmental tasks, nutrition, language, safety, and pain perception
growth and development facts for children:
-infancy--->fast growth (esp. brain)
-toddler-preschool--->slow growth (trunk)
-school age--->slow growth (limbs)
-adolescence--->rapid growth (trunk, gonads, associated tissue)
Cognitive development (Piaget) stages of mental activity:
1. sensorimotor (birth-2yr).): reflex, repetitive, imitative behaviors
2.preoperational (2-7 yr): egocentric, magical thinking, increased use of symbols & language
3. concrete operational (7-11 yr): logical, coherent, less egocentric, use of inductive reasoning
4. formal operational (12-15 yr): rapid body changes, preoccupied with self-looks, tries to meet expectations of peers, tries to develop own identity
Psychosocial Theory (Erickson) Personality Changes:
1. Trust vs. mistrust (birth – 1 yr): primary caregiver meets needs
2. Autonomy vs. shame and doubt (1-3): control of body functions, inc. independence
3. Initiative vs. guilt (3-5): learns about world through play, develops conscious
4. Industry vs. inferiority (6-12): forms social relationships, follows rules, competition
5. Identity vs. role confusion (12-18): rapid body changes, preoccupied with self-looks, tries to meet expectations of peers, tries to develop own identity
What are the 3 portions of the human mind according to Freud?
Id, ego, and superego
What are the five stages of psychosexual theory (Freud)?
1. Oral (birth – 1 yr): seeks pleasure through sucking, biting, etc.
2. Anal (1-3): toilet training, controls excreta
3. Phalic (3-6): interested in genitals, discovers difference in boys & girls
4. Latency (6-12): concentrates on playing and learning
5. Genitalia (12 and older): system reaches sexual maturity
moral development (Kohlberg), is the development of:
right and wrong
what are the 3 levels of Kohlberg's moral development?
1. Preconventional (2-7 yr): attempts to follow rules and adjust behavior
2. Conventional (7-12): seeks conformity, follows fixes rules
3. Postconventional (12 and older): strives to build a personal and functional value system independent of peers and authorities
if mental and chronological age differe, which age is used?
mental age
what is the bone age used for?
looking at tarsals and carpals to determine ossification if chronilogical age is being questioned
what are the eight stages of family development?
1. Marriage Unit
2.Family w/infant
3.Family w/preschooler
4.Family w/child enters school
5.Family w/teenager
6.Family w/child leaves home
7.Family w/last child leaves home
8.Parents start retirement, ends with death of spouse
when it comes to emotional communication, boys are:
less expressive or narrower in verbal and nonverbal behaviors
what is significant to know about a sexually abusive family?
the father and daughter may have a coalition that replaces the spousal relationship
what is the best way to assess how much pain a child is experiencing?
watch for specific actions that may indicate pain (crying, grimacing, irritable, anger, etc). Also, diferentiate between pathological pain and growing pains
what types of meds are used for pain in children?
morphine, ibuprofen, codeine, EMLA
what age does the posterior fontanel close?
2 months
what type of postural and protective reflexes are learned during1-4 months?
blink, parachute, cough, swallow, gag
what are the 3 different smile types and what age do they occur?
instinctual (2 mo), social (3 mo), and laughs (4 mo)
birth weight doubles at what age?
5-6 months
birth weight triples at what age?
12 months
stranger anxiety may begin:
at age 5-6 months
why is a child at risk for aspiration from age 7-9 months?
development of pincer grasp and child will put anything in their mouth
object permanence is achieved at what age?
7-9 months
length will double by what age?
12 months
what are some typical behaviors exhibited by a 12 month old?
-first steps begin
-up to 5 words known
-claps hands and waves bye
-enjoys books and blocks
-wean from bottle and breast
what are the 6 checks in an infant assessment?
1. head and chest circum.
2. reflex controlled behavior
3. post. fontanel closed by 4 mo
4. 5-6 months: birth weight doubled, signs of attachment to parents
5. 7-9 months: object permanence
6. 10-12 months:birth weight tripled, length doubled
solid foods shouldn't be introduced until:
6 months of age
propping of bottles can lead to what?
increased ear infections and rotting of teeth
why is it important to wait 4-7 days after introducing a new food into the child's diet?
to check for any allergic reactions to the food
The child should be in a rear facing car seat until? forward facing car seat until? booster seat?
< 20 lbs up to 1 year; > 20lbs; > 40lbs
what are some responses that children have to illnesses?
anger from pain, fear of pain or mutilation, loss of control, guilt, regression, fear of the unknown
what do most children associate pain with?
shots
the 3 stages of infant response to separation anxiety are:
protest, despair, detachment
an infant's response to loss of control can lead to:
a regression in feeding, playing, and bedtime
what are some impacts of an illness on a family?
family environment (home, school, work) and stage of family development (Duvall's stages)
what are some helpful coping behaviors of a child with an illness? what are some coping mechanisms?
words, descriptions, phrases; may ignore or negate the event; breathing, distraction, imagery
what two types of hormones does the thyroid secrete?
thyroid hormone (made of thyroxin (T4) and triiodothyronine (T3)) and thyrocalcitonin
thyroid disorders include:
hyperthyroidism and hypothyroidism with possible disturbances in TSH
There are two types of juvenile hypothyroidism, what are they?
congenital (Congenital hypoplastic thyroid gland) and acquired (partial or complet thyroidectomy for CA or thyrotoxicosis and treatment of Hodkin's or other malignancy)
clinical manifestations of juvenile hypothyroidism include:
decelerated growth, constipation, sleepiness, myxedemetous skin changes (dry skin, sparse hair, periorbital edema)
juvenile hypothyroidism treatment includes:
oral thyroid hormone replacement, make sure compliance is achieved for medication regimen
What happens with ketoacidosis?
glucose is unavaliable for cellular metabolism, so the body breaks down alternate sources of energy and ketones are released and found in the urine (ketosuria) and released by the lungs (acetone breath)
Kussmaul respirations are:
hyperventilation due to metabolic acidosis. the body increases the rate and depth of respirations to rid the body of excess CO2
diabetes mellitus is:
the total or partial deficiency of insulin and is considered the most common endocrine disorder in children
when does DM peak in children?
early adolescence
what are the 3 major groups of DM?
type 1, type 2, and maturity onset diabetes of the young (MODY)
Type 1 diabetes is also known as:
childhood diabetes because the onset is typicall during childhood
What type of cells are being destroyed in type 1 DM?
beta cells of the pancrease
Type 2 diabetes is from:
insulin resistance
Children of what race/culture are more at risk for diabetes type 2?
native american, hispanic, and african-american
At what age does MODY typically occur?
generally before 25 years of age
MODY is transmitted as:
an autosomal-dominant disorder with foundation of a naturally abnormal insulin
what is the prominent factor of etiology for type 1 DM?
hereditary predisposition with a specific even such as viral infection
why does glucose spill into the urine with DM?
the serum glucose exceeds the renal threshhold
what happens with glucogenesis?
cells breakdown protein for conversion to glucose by the liver
why is DKA considered a pediatric emergency?
there is progressive deterioration with dehydration, electrolyte imbalance, acidosis, coma, and potentially death
what are some long-term complications of DM?
microvascular: nephropath and retinopathy

macrovascular: neuropathy
MODY is similar to:
type 2 diabetes, especially with obese teens
MODY can be treated with:
oral hypoglycemics and diet
what is the number treatment therapy for type 1 diabetes?
insulin
the glucose goal range should be:
80-120 mg/dL
how often should the blood sugar be checked?
q3h during illness and whenever glucose is >240 mg/dL
other therapeutic managements for type 1 include:
diet, exercise, teaching family how to respond to hypoglycemia, and management of DKA
what is a major patient education task the nurse should teach the patient and family about diabetes type 1?
insulin therapy: types, duration, onset, and rotation of injection sites
Aside from insulin therapy teaching, what is also important to teach the pt. and family about diabetes?
glucose monitoring
abnormal development of the hip is called:
dysplasia of the hip
when can dysplasia occur?
as a fetus, infant, or child
what are three predisposing factors of dysplasia of the hip?
physiologic (intrauterine positioning), mechanical (breech or multiple fetuses), and genetic
goal of a pt that has dysplasia of the hip is to:
begin when it's first recognized and restore normal function and structure
Treatment of dysplasia of the hip according to age:
newborn-6 months: pavlik harness worn until the hip is stable

6-18 months: reduction by traction, surgery, then cast

older child: operative reduction with cast placement
what are some nursing considerations for dysplasia of the hip?
perform visual and physical exam at birth, perform checks at routine doctors visits, educate parents on treatment methods
abnormal development of the hip is called:
dysplasia of the hip
when can dysplasia occur?
as a fetus, infant, or child
what are three predisposing factors of dysplasia of the hip?
physiologic (intrauterine positioning), mechanical (breech or multiple fetuses), and genetic
goal of a pt that has dysplasia of the hip is to:
begin when it's first recognized and restore normal function and structure
Treatment of dysplasia of the hip according to age:
newborn-6 months: pavlik harness worn until the hip is stable

6-18 months: reduction by traction, surgery, then cast

older child: operative reduction with cast placement
what are some nursing considerations for dysplasia of the hip?
perform visual and physical exam at birth, perform checks at routine doctors visits, educate parents on treatment methods
what can club foot be associated with and how can it be detected?
it may be associated with hip dysplasia and can be detected by U/S prenatally or at birth by visual exam
what are the 3 stages of treatment for club foot?
correct the deformity, maintain the correction, and follow-up observation
what is the first form of treatment for club foot and how long is it implemented for? if the first treatment is unsuccesful, what is done next?
serial casting is done until 8-12 weeks. if this doesn't correct the problem, surgery will be done. (6-12 months)
what is scoliosis?
spinal deformity involving curvature of the spine causing rib asymmetry
age of onset is classified 1 of 3 ways:
infantile (birth-3 yrs), juvenile (childhood), adolescent (growth spurt during adolescence)
what might be a clue that a child has possible scoliosis?
they say "my clothes don't fit right"
scholiosis is caused by:
idiopathic reasons or associated w/ other neuromuscular disorders
if an x-ray is done to determine scoliosis, what position should the child be in?
standing, measuring the angle curvature
what are some possible treatments for scoliosis?
bracing and exercise or surgical management
why is compliance with treatment an issue for scoliosis patients?
usually involves the adolescent child not wanting to feel different
how does surgical treatment work to fix scoliosis?
realignment and straigtening with internal fixation and instrumentation. can be combined with bony fusion
what is done post-op for a patient that had scoliosis?
log rolled to prevent spinal motion and molded plastic jacket for spinal stabilization
how are the vertebrae fused together in surgery of scoliosis?
bone from the iliac crest are placed across the vertebrae
what are some post-op assessments to be done from scoliosis surgery?
VS, neuro status, I&O, pressure relieving beds, skin care, pain control
how soon is the pt going to be d/c after surgery?
within 1 week without any complications
what are some complications from scoliosis surgery?
neurologic or spinal cord injury, infection, hypotension from acute blood loss, hardware failure
what is muscular dystrophy?
a disorder involving a large group of muscles that involves gradual degeneration of muscle fibers.
how is duchenne MD inherited?
as a X-linked trait
what do most duchenne MD pt's have?
calf muscle hypertrophy
signs and symptoms of duchenne:
-progression until death from resp or cardiac failure
-unsteady gait
-enlarged muscles
why is the serum creatine phosphokinase elevated in duchenne patients?
CK is found in the muscles and as the muscles get broken down, increased amounts of CK are released in the blood
is there a cure for duchenne MD?
no, but steroids can be used to help maintain optimal muscle function
what is something a pt with duchenne MD can do to help maintain muscle function and prevent contractures?
physical therapy and occupational therapy with at home exercising
what are the two peak ages of onset for juvenile rheumatoid arthritis (JRA)?
- 1-3 yrs
-8-10 yrs
is there a difinitive test that can be done for JRA?
no, based on exclusion of other disorders
Can JRA be cured? If so/not, what can be done to help?
there isn't a cure, but pain control and ROM can be done to help
what are some typical meds for JRA pt's?
NSAIDS, corticosteroids, NSAIDS w/ methotrexate (be aware of teen girls, very toxic to fetus of girl becomes pregnant)