1a pediatrics basic concepts11-2010rh.ppt

8/19/2019 1a Pediatrics Basic Concepts11-2010rh.ppt

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How Much Do You Know

About Pediatrics


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Some Differences • Obvious- body size differences• Treating a child is not like treating a

miniature adult.• Children are minors• Often have to treat the parents and

sometimes, the family , rather than just thechild


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1. How many soft spots are there on the

newborns head?


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wo


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!. "hen should and infant be able to sitalone without support?


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# months


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$. At what a%e should a child be able to

use scissors well?


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& years


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&. 'ist $ safety issues for adolescents


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M(A

Substance abuseSuicide)homicide


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*. +ne ounce ,------------mls

+ne teaspoon,----------mls


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+ne ounce , $ mls

+ne teaspoon , * mls


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/. 'ist fi0e thin%s you would measure

when e aminin% an infant.


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1. Head circumference

!. 2hest circumference$. Abdominal %irth&. "ei%ht

*. 'en%th


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3. he a%e ran%e for an infant is defined

as which of the followin% time spans?

1. ne born to ! months

". 1 month to 1 year !. ne born to # months$. ! months to 1% months


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1. ne born to ! months

!. 1 month to 1 year !. ne born to # months$. ! months to 1% months


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#. "hat are acceptable treatments for achild with fe0er?

1. giving a fever reducer ith Tylenol or&otrin

". a cold bath!. rubbing alcohol

$. all of the above


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1. giving a fever reducer ith Tylenol or&otrin

". a cold bath!. rubbing alcohol

$. all of the above


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4. "hen can you start your 5ids on lowfat mil5?

1. ' months

". 1" months!. 1( months$. "-! years


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1. ' months

". 1" months!. 1( months&. !6$ years


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1 . 7oys can possibly start puberty ata%e...

1. ) years

". ' years!. 1% years$. 1# years


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1. ) years

!. 4 years!. 1% years$. 1# years


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1. bet een ) and 1" years

". bet een ( and 1# years$. between # and 1$ years$. bet een ' and 1$ years


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1!. 7asic first aid for a burn includes...

1. cooling the burn ith butter ". cooling the burn ith cold ater

!. cooling the burn ith ice$. cooling the burn ith ice ater


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1. cooling the burn ith butter

!. coolin% the burn with cold water !. cooling the burn ith ice$. cooling the burn ith ice ater


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1$. How many ounces of fruit 8uiceshould a $ year old ha0e each day?

1. $-# ounces

". (-1* ounces!. 1$-1# ounces$. "*-"$ ounces


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1. &6/ ounces". (-1* ounces!. 1$-1# ounces$. "*-"$ ounces


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1&. How many words does the typical !year old 5now?

1. "% ords". %* ords!. 1%* ords$. "%* ords


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1. "% ords!. * words!. 1%* ords$. "%* ords


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1*. 2hic5enpo can be...

1. +revented ith the ariva vaccine". reactivated to cause hingles

!. a serious and life threatening infection$. all of the above


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1. +revented ith the ariva vaccine

". reactivated to cause hingles!. a serious and life threatening infection&. all of the abo0e


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1/. he nurse is preparin% to %i0e an in8ectionto a preschooler. he nurse has selected

the deltoid muscle. "hat is the ma imumamount of solution that the nurse can %i0ein the deltoid of a preschooler?

1. *."% m/". *.% m/

!. *.*% m/$. 1 m/


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1. *."% m/!. .* m'!. *.*% m/$. 1 m/


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13. he 9pstein67arr 0irus is responsible forwhich of the followin%?

1. erythema infectiosum". mum+s!. infectious mononucleosis$. roseola


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1. erythema infectiosum

". mum+s$. infectious mononucleosis$. roseola


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1#. "hich of the followin% tests is used india%nosin% polio?

1. nasal culture". arterial blood gases!. stool or throat culture$. magnetic resonance imaging 0& 23


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1. nasal culture

". arterial blood gases$. stool or throat culture $. magnetic resonance imaging 0& 23


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14. "hich of the followin% methods is the mostreliable method of dia%nosin% dehydration

in children?

1. s+ecific gravity of urine

". skin turgor !. blood +ressure changes$. eight loss


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1. s+ecific gravity of urine

". skin turgor !. blood +ressure changes&. wei%ht loss


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! . he ma8ority of cases of acute

%astroenteritis in children under !years old in the :nited States arecaused by;

1. higella". almonella!. rotavirus

$. 4iardia


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!1. "hich type of burn is most common inchildren?

1. electrical". radiation

!. chemical$. thermal


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1. electrical

". radiation!. chemical&. thermal


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!!.


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1. male, full-term, ) months old

!. male twin= premature= & months old!. female, full-term, ( months old$. female, single birth, $ months old


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!&. he period of toddlerhood is from 1!

months to;

1. 1% months

". "$ months!. 1( months$. !# months


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1. 1% months

". "$ months!. 1( months&. $/ months


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1. 1*

!. !!. !*$. $*


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!/. After an >( infiltrated= what lesiondoes this !6year6old boy ha0e?


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He has a lar%e ulcer ulceration@


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!3. his patient has herpes simple .Describe this rash?


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his patient has clustered vesicles .


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!#. his 46year6old boy fell off of his bi5e."hat is the name of this s5in lesion?


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He has an abrasion.


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Welcome to Pediatric


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Welcome to PediatricNursing


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5ursing Care of Children6asic Conce+ts


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esource Materials

• 7T2 8nit 1 0Ch. 1-113• aunders Cha+ter ")-"(, !'• osdahl Cha+ter )1-)$• 9o er9oint 1a• 9ractice :uestions•

7++licable ;andouts• :uizzes

i


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opics

• ying• 4ro th and >evelo+ment Theories


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"HA >S A 'Y?• T o or more +eo+le related by blood or marriage

ho reside together or • &ore broadly-t o or more individuals ho come

together for the +ur+ose of nurturing.

5uclear T o +arents and their children

ingle-+arent One +arent and one or more children

6lended 7t least one ste+ +arent, ste+sibling, or half-sibling

@ tended 7t least one +arent and 1 or more children and otherindividuals

ame-se Common tie bet een t o members of the same seith or ithout children


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C %


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Ceno%ram• 7 diagram of relationshi+s bet een family

membersA medical history


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Parentin%

2 lt l A


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2ultural Awareness• Cultural and religious beliefs have an im+act on

the interaction of family members. (Culture-a style of behavior patterns, beliefs,

and products of human work. i.e. art, music withina given community or population)

• eligion, ethnicity, race, stereoty+ing, +rejudice,bias, ethnocentrism

• Communication, dietary +references, and dress

are influenced by culture• >ifferences in language, habits, customs,attitudes, and beliefs can lead to feelings ofisolation and loneliness in children.


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2ultural 2ompetence

• efers to the ability of the nurse tounderstand and effectively res+ond to theneeds of +atients and families from differentcultural backgrounds

• 5urse needs to understand her o n culturalbackground and biases

• 5urse should be a are of, sensitive to, anda++reciative of cultural differences

• 5onverbal behaviors 0chart 7T2 +.113

l d


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2ulture and Bursin%

• eligion= +iritual=>eath rituals• 9ain• 5utrition• Communication•


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Pediatric Assessment


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Pediatric Assessment

@ amination of the child begins from the first contact. Boushould observe the behavior of the child and +arent by using

visual cues to make a +ro+er assessment.


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Premature >nfant

Physical Assessment


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Physical Assessment

• 7lter e am to meet child?s develo+mental needs• 9erform invasive +ortions last

• 5onthreatening environmentA +rovide +rivacy• 8se activities that can be +erceived as games to

engage the child• 2nvolve the child and family member0s3 in the

e amination• 9raise the child for coo+eration during the e am• 7dolescents may +refer to be e amined ithout

family members +resent.

Physical Assessment


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Physical Assessment• ;ide any threatening e ui+ment +rior to the e am

• Dee+ room arm and ell lit• Tell the child hat to e +ect as the +hysical e am is

being +erformed• 8se the +arent?s la+ if desired• 7llo child and +arents to ask uestions• Know e pected 0ital si%ns for each a%e %roup• Dno e +ected +hysical findings=4eneral

a++earance


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uestion

7 nurse is caring for a '-month-old infant.ank the follo ing assessments in the

order in hich the nurse should +erform

them. EEEE 7 illary tem+erature EEEE es+iratory rate EEEE Feight EEEE ;eart rate


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Answer

EE $ EE 7 illary tem+erature EE 1 EE es+iratory rate EE ! EE Feight EE " EE ;eart rate


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"hich statement accurately describes the best methodfor assessin% a 1!6month6old?

1.The nurse should assess the child on the e aminingtable.".The nurse should assess the child in a head-to-toe

se uence.!.The nurse should have the child?s mother assist inholding her do n.$.The nurse should assess the child hile she is in her

mother?s la+.


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"hich statement accurately describes the best methodfor assessin% a 1!6month6old?

1.The nurse should assess the child on the e aminingtable.".The nurse should assess the child in a head-to-toe

se uence.!.The nurse should have the child?s mother assist inholding her do n.&. he nurse should assess the child while she is in her

motherEs lap.


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Physical Assessment


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Physical Assessment indin%s• 7nthro+ometric &easurements 0 eight, length or

height, head circumference3• 4eneral a++earance 0gro th, hygiene, distress, odors,muscle tone, eye contact, s+eech, follo s commands3

• kin and hair characteristics 0color, tem+erature,te ture, moistness, turgor, lesions, C


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• 7bdomen 0sha+e, umbilicus, abdominal movement,masses, 3

•2nguinal, +erineal areas 0genitalia, urethral and vaginalo+enings, vaginal discharge, +ubertal develo+ment3

• 6ones, muscles, joints 0 O&, +osture, muscle strength,s+inal alignment3

•8++er=/o er e tremities 0arms, legs, hands, nails,hi+s, feet3

• Cognitive function=Cerebellar function 06ehavior,/OC, Communication, balance and coordination, gait3

• ensory function 0+ain, tactile3• Cranial nerve function 0refle es, dee+ tendon3

B b fl


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Bewborn efle es

• ucking and rooting refle es 0$ months3• 9almar gras+ 0# months3• 9lantar gras+ 0( months3• &oro refle 0startle3 0$ months3• Tonic neck refle 0!-$ months3

• 6abinski refle 01 year-after " yrG5euro3• te++ing 01 month3

S5in ur%or and 2apillary efill


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S5in ur%or and 2apillary efill

onsil SiFe with >nfection


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onsil SiFe with >nfection


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9yes


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9yes


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9 amination of Mouth


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9 amination of Mouth


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'ymph nodes


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ymph nodes

9 aminin% the Abdomen


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9 aminin% the Cenitalia


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anner Sta%es of De0elopment


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anner Sta%es of De0elopment

Heart ate


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• 7+ical is recommended

• Count 1 full minute• /isten for irregularities document and re+ort

Apical Pulse


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p


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9 amination of 2hest


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9 amination of 2hest

h h l f $


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A nurse is chec5in% the 0ital si%ns of a $6year6old child durin% a well6child 0isit."hich of the followin% findin%s should thenurse report to the pro0ider?

1.Tem+erature !)."J C 0'(.'J


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A nurse is chec5in% the 0ital si%ns of a $6year6old child durin% a well6child 0isit."hich of the followin% findin%s should thenurse report to the pro0ider?

1.Tem+erature !)."J C 0'(.'J


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Ad0entitious 7reath Sounds


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ype Description 2ause


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7 09ectus e cavatum3 6 09ectus carinatum3


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Whaley and Wong

7lood Pressure


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O lemperature


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• Oral I / cavity 0K age $3

• A illary I 7 illa ith direct skin contact ! min.

• ectal

I Only hen another method cannot be used I 5ot in ne borns, cancer, diarrhea I /ubricated ti+ inserted L-M N ! min.

• Tym+anic

I a+id 0" sec3, noninvasive, convenient• Tem+oral

I can across forehead

p

emperature


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Position for takingaxillary temperature. 7 illary

'#.# I '(.* <

Oral ').# I '(.# <

ectal or tym+anic'(.# I 1**.*

<

Palpation of Peripheral Pulses


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Head 2ircumference


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Head circumference is measured by wrapping thepapertape over the eyebrows and the around theoccipital


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Measurin% len%th6hei%ht


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7ody Mass inde is alsomeasured in the older child

Measurin% >nfant "ei%ht


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>ouble birth eigh by about # monthsTri+le birth eight by 1 year

A nurse is assessin% a 1!6month6old infant at


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A nurse is assessin% a 1!6month6old infant ata well6child 0isit. "hich of the followin%

findin%s should the nurse report to thepro0ider?

1.Closed anterior fontanel".@ru+tion of si teeth!.6irth eight has doubled

$.6irth length increased by %*

A nurse is assessin% a 1!6month6old infant at


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A nurse is assessin% a 1!6month6old infant ata well6child 0isit. "hich of the followin%

findin%s should the nurse report to thepro0ider?

1.Closed anterior fontanel".@ru+tion of si teeth$.7irth wei%ht has doubled

$.6irth length increased by %*

Measure the chest with a tape measure placed8ust under the a illa and at the nipple line


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8ust under the a illa and at the nipple line.


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2ommon Milestones


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Principles of Crowth and De0elopmentHealth Promotion


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Health Promotion

• 4ro th is an orderly +rocess, occurring insystematic fashion.

• ates and +atterns of gro th are s+ecific to

certain +arts of the body.• Fide individual differences e ist in gro th

rates.

• 4ro th and develo+ment influence by amulti+le factors.


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Crowth Pattern


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Key Definitions


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• Crowth - increase in size of structure• De0elopment - Q com+le ity in thought,

behavior, skill, or functionA includes gro thA+rocess that continues over time

• 2ephalocaudal - head-to-toe +rogressionof gro th and develo+ment• Pro imodistal - trunk-to-+eri+hery

+rogression of gro th and develo+ment• De0elopmental tas5 -skill or com+etency

uni ue to a stage of develo+ment

De0elopmental as5s


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Physical 0sit, alk, cra l, motor develo+ment,sensory develo+ment3

Psycholo%ical 0imitation, trust, self-esteem,socialization3

2o%niti0e 0recognition, follo ing direction,conce+ts of time and s+ace, magicalthinking, abstract thought3

2ommon Milestones to Know


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• Closure of anterior=+osterior fontanel• oubling and tri+ling of eight

• itting u+ ithout su++ort• Falking• iding a tricycle

• u++orting o n head• 9incer gras+


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Physical De0elopment


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• 9osterior fontanel closes R "-! mos.• ize tracked by eight, length, head

circumference• Cross motor s5ills

-;olds head u+- olls over 0%-# mos.3-;olds head steady hen sitting 0# mos.3-4ets to sitting aloneA +ulls u+ to standing 0' mos.3- tands holding on or alone 01" mos.3-# mos. doubles birth eight

A%e Cross


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1 month ;ead lag 4ras+ refle

" months /ifts head off mattress ;olds hand o+en! months aises head and shoulders /ooses gras+ refle$ months olls back to side 9uts objects in mouth% months olls front to back 4ras+s

# months olls back to front ;olds bottle) months 6ears full eight Objects hand to hand( months its unsu++orted 6egins +incer gras+' months 9ulls to standing 4ood +incer gras+

1* months Changes +rone to sitting 4ras+s rattle by handle11 months Falks holding on Object in container 1" months its from standing Tries "-block to er

Head 2ontrol G Head Lag


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Newborn Age 6 months


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Head 2ontrol

Hypotonia


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Sittin% :p


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Age months

Age ! months

7ge # months

Ambulation


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"# month old

Nine to " $months


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• 6rings hands together • 4ras+s rattle• /ooks for items that are dro++ed from vie• Transfers objects 0# mos.3• 9incer gras+ 0' mos.3• 6angs t o toys together 0' mos.3• Can nest one object inside another 01"

mos.3


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2o%niti0e De0elopment


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>nitial refle es replaced by 0oluntary

mo0ements-Object +ermanence 0S+eek-a-booN3G ' months->iscrimination bet een +ersons-Com+rehension of ord meanings

'an%ua%e- es+onds to noises- SooosN and SaahsN-/aughs and s ueals

-Turns head to sound of rattle-9ronounces single syllable ords- 6egins "-! ord +hrases

Psychosocial De0elopment9 l i l


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9ersonal- ocial

-6onding ith +arents during first month- egards faces- miles in res+onse to others- egards o n hands-Forks to reach toys-rinks from a cu+ ith handles

e+aration 7n iety-latter half of first year tranger


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• 9rotest• >es+air • >enial or detachment

I @ncourage and +lan to have +arents be +artof care

I es+ect infant?s usual schedule as much as

+ossible

7ody >ma%e 2han%es


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• &outh is a +leasure +roducer • ;ands and feet objects of +lay• >iscovers smiling causes others to react

A%e Appropriate Acti0ities


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• olitary +lay• hort attention s+ans• Toys that stimulate the senses and

encourage develo+ment- attles, mobiles, teething toys-5esting toys-9at-a-cake, balls- eading books


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Butrition


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• 6reastfeeding recommended• 2ron-fortified formulas• Co ?s milk 5OT recommended• olidsH 2ntroduced # mos.

-2ron fortified cereals -9ureed=strained foods one at a time ->ecrease milk=formula as solids increase -Feaning hen can drink from cu+ #mos

• &ilk, eggs, heat, citrus fruits, +eanuts, +eanutbutter, and honey should be delayed until the firstyear of life.

7reastfeedin% offers many physical and emotionalbenefits for the infant. his new mother is learnin% to


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breastfeed her baby.


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9arly childhood caries. hischild has had ma8or tooth decayrelated to sleepin% as an infantand toddler while suc5in%bottles of 8uice and mil5.

Health Promotion and Pre0ention


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• ;y+erbilirubinemia 0immature liver3 GUaundice• Child 7buse 0+hysical, emotional, neglect, se ual3• >entitionH #-( teeth by end of first year • >mmuniFations;

-6irth ;e+ 6 -" mos. ;e+ 6, ota, >Ta9, ;ib, 9C , 29 -$ mos. ota, >Ta9, ;ib, 9C , 29

-# mos. ;e+ 6, ota, >Ta9, 9C , 29 -#-1" mos.


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• Diaper rash treatment and pre0ention

-Change dia+ers fre uently -Cleanse ith ater, dry thoroughly -8se of skin barriers

->ia+er o+en to air hen +ossible

>n8ury Pre0ention


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• uffocation Plastic ba%s= balloons= firm crib= bac5 tosleep@

• ro ning lea0in% unattended in bathtub@

>nfant Seats


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• 2nfants should use a++roved rear-facing carseats in the back seat, +referably in the middle,0a ay from air bags and side im+act3.

• 2nfants should be in rear facing car seats for thefirst year of life and until they eigh '.1 kg 0"*

lb3.• 2t is recommended to have infants ride rearfacing until they have reached the eight limitallo ed for the car seat 0as long as the to+ of theinfant?s head does not e tend above the to+ ofthe seat back3.

• 7 five-+oint harness or T-shield should be +art ofa convertible restraint.

Health Promotion oddler 1! h $


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1! months to $ years

heorist ype of De0elopment Sta%e

@rikson 9sychosocial 7utonomy vs.shame


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the followin% fine motor s5ills should the infantbe able to perform? Select all that apply.@

1.4ras+ a rattle by the handle

".Try building a t o-block to er !.8se a crude +incer gras+$.9lace objects into a container %.&ove objects from hand to hand

A nurse is performin% a de0elopmentalscreenin% on a 1 6month6old infant. "hich of


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the followin% fine motor s5ills should the infantbe able to perform? Select all that apply.@

1.Crasp a rattle by the handle

".Try building a t o-block to er $.:se a crude pincer %rasp$.9lace objects into a container *.Mo0e ob8ects from hand to hand

Physical De0elopment• A t i f t l l b 1# f %


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• Anterior fontanel closes by 1# mos. of a%e

• 7t 1" mos. tri+les birth eight• !* mos. four times birth eight

1% months Falks ithout hel+ 8ses cu+ ell

6uilds to er " blocks1( months 7ssumes a standing

+osition&anages s+oonTurns +ages in book

" years Falks u+ and do nstairs

To er of #-) blocks

".% years Uum+s both feettands 1 foot

momentarily

>ra s circles4ood hand-fingercoordination

De0elopmental S5ills


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• teady gait• Climbing stairs• Uum+ing, standing on 1 foot for

short +eriods

• tacking blocks increasinglyhigher numbers

• >ra ing stick figure

• 8ndressing and feeding self • Toilet training


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A%e6appropriate Acti0ities


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• 9arallel +lay•


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• 9icky eatersG Sfood jagsN

• Toddlers should consume "$ to !* oz of milk +er day• &ay s itch from drinking hole milk to drinking lo -fat

milk 0" fat3 at " years of age• Uuice consum+tion should be limited to $ to # oz +er

day• 7++ro+riate finger foods include ri+e bananasA toast

stri+sA graham crackersA cheese cubesA noodlesA and+eeled chunks of a++les, +ears, or +eaches

•


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• Child 7buse• 8++er res+iratory infections, otitis media• Tem+er tantrums• Toilet training• >isci+line 0 ell defined boundaries3• >mmuniFations; 1"-1% mos. Hib. P2(= >P(= MM = (aricella 1"-"! mos. Hep A 1%-1( mos. D aP 1"-!# mos. n8ury Pre0ention


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• >ro ning unattended in bathtub= pool super0ision@•


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• Toddlers should be in a++roved rear-facing car seats in the back seat until they

eigh '.1 kg 0"* lb3. Toddlers may then sit

in a++roved for ard-facing car seats in theback seat. Toddlers may usually remain incar seats until $ years of age and=or $* lb

ed


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• 5ot alking by 1% months• 5ot running by "* months• 5o mature +incer by 1" months• 5ot understanding SnoN by 11 months•


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Sta%es of De0elopment


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heorist ype of De0elopment Sta%e

@rikson 9sychosocial 2nitiative vs. 4uilt


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2o%niti0e De0elopment


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• 9reconce+tualH Uudgment, artificialism,animism, imminent justice

• 2ntuitiveH Classification, cause and effect

• /anguageH ocab continues to increase,sentences, color identification, likes talking

• TimeH Conce+ts of +ast, +resent and

futureA Com+rehension of days of eek


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A%e6appropriate Acti0ities


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• 7ssociative +lay• 9laying ball• 9uzzles• iding tricycles

• 9retend and dress-u+• ole +lay• 9ainting• e ing and beading• eading books

Butrition


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• Ty+ically consumes half the calories of anadult

• Continue to be +icky u+ to age %•

9arents need to ensure balanced nutrition



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• Child abuse• Otitis media• 7ccidents 0+oisoning and dro ning3

• lee+ disturbances 0night terrors3• ision screening• 2mmunizationsH $ to # years ->Ta9, 2 9, && , aricella, flu vaccine

>n8ury Pre0ention


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• >ro ning 09ool safety3• 9oisoning• &otor vehicles

-7++roved car seat -6ooster seat 85T2/ adult seat belts fit

correctly

ed fla%s; Preschool


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• 2nability to +erform self-care tasks, handashing sim+le dressing, daytime toileting

• /ack of socialization• 8nable to +lay ith other children

• 7ble to follo directions during e am• 9erformance evaluation of +re-school teacher

for kindergarten readiness

Health Promotion School6A%e 2hild* to 1! years


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heorist ype of De0elopment Sta%e@rikson 9sychosocial 2ndustry vs.

2nferiority


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• 4ains $.$- (.( lbs +er year • 4ro s about " inches +er year •


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• Friting skills im+rove•


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g

I 8nderstands time, days, seasons I >efines many ords, understands rules of grammar I Classifies more com+le information I 8nderstands emotions

• Self6concept)7ody >ma%e I >evelo+ healthy self-res+ect by finding out the areasthey e cel

I 5eed encouragement

I olidification of body image I Curiosity about se ualityH se education I @m+hasis on modesty, +rivacy

Psychosocial De0elopment


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• ense of industry achieved throughachievements in learning• ame-se com+anions• &ost friends are from school• &ay rival same-se +arent• 5ervous behaviors 0nail-biting3•


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• Com+etitive and coo+erative +lay• im+le board and number, card games• ;o+scotch, jum+ ro+e• Collect rocks, stam+s, cards, coins• ide bicycles• 6uild sim+le models• Organized s+orts

• Uigsa +uzzles• ;obbies



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• @ating adult +ro+ortion foodsA needsuality nutritious snacks• Child abuse

• coliosis• Obesity• Cancers

• es+iratory 2nfections• 7sthma



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• 2mmunizationsH >Ta+ if not R $-%yrs 2 9 &&

aricella 7ge 11-" Tda+, && , ;9 , &C $• ubstance abuse 0Teach children to say SnoN3• >ental health 06rushing, flossing, regular check u+s,

a++ro+riate snacks3

>n8ury Pre0ention


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•


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• chool failure• /ack of friends• ocial isolation

• 7ggressive behaviorH fights, fire setting, animalabuse

Health Promotion Adolescent1! to ! years


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Sta%es of De0elopment


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heorist ype of De0elopmentSta%e

@rikson 9sychosocial 2dentity vs. oleconfusion


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• 7cne•


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I 7bstract thought, deal ith +rinci+les I @valuate uality of o n thinking I /onger attention s+an I 9eer grou+ jargon

• Psychosocial De0elopment I >evelo+s a sense of +ersonal identity I &ay become a +ar of a +eer grou+ that influences

behavior

I Fork habits begin to solidify I 2ncreased interest in the o++osite se I isky behaviorsA often vie themselves as invincible

Moral)Self62oncept)7ody >ma%e


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• ules are not seen as absolutes• ;aving healthy relationshi+s ith +eers, family,teachers

• 2dentifies skill or talent• 9artici+ation in s+orts or hobbies, community• Concerned ith lean bodies +ortrayed in the

media•

Com+aring +ubertal develo+ment• Common to have de+ression or eating disordersdue to +oor body image

• Adolescent I 7s teenagers gain inde+endence they begin to

challenge values


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challenge values

I Critical of adult authority I elies on +eer relationshi+ I &ood s ings es+ecially in early adolescents

• Adolescent 7eha0ioral Problems I 7nore ia I 7ttention deficit I 7nger issues I uicide

• A%e Appropriate Acti0ities I 5onviolent video games I 5onviolent musicI +orts


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I +orts I Caring for a +et I Career-training +rograms I eading I ocial events 0movies, school dances3

• Butrition I a+id gro thA high metabolismH tend to be deficient iniron, calcium, and vitamins 7 and C

I @ating disorders• 7nore ia nervosa

• 6ulimia• Obesity 0diet high in fat ithout ade uate activity3



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• 2mmunizationsH Tda9, ;9 , ;e+ 6, 2 9, && ,aricella, &C $07bove if not R 1"-"*3

• coliosis

• Child abuse• &otor vehicles leading cause of death• ;omicides " nd leading cause of death

• ubstance 7buse• e ual e +erimentation, T>?s, 9regnancy


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Adolescent eachin%• elationshi+s

li I T ? 72


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• e uality I T>?s = 72>• ubstance use and abuse• 4ang activity• >riving• 7ccess to ea+ons

A nurse is pro0idin% anticipatory %uidance tothe parent of a 1$6year6old. he nurse shouldrecommend which of the followin% screenin%s


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for the adolescent? Select all that apply.@

1.6ody mass inde".6lood lead level!.;eight$.Feight%. coliosis

A nurse is pro0idin% anticipatory %uidance tothe parent of a 1$6year6old. he nurse shouldrecommend which of the followin% screenin%s


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for the adolescent? Select all that apply.@

1.7ody mass inde".6lood lead level$.Hei%ht&."ei%ht*.Scoliosis


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y joint and muscle, muscle coordination, gross=fine motor skill, kinestheticstimulation3

-Cognitive develo+ment 0senses, numbers, colors, sha+es,te tures, +roblem solving, critical thinking, hand-eye coordination, creativity,im+ortance of objects3

- ocial develo+ment 0social skills, right from rong, roles3-@motional develo+ment 0sense of belonging, co+ingstrategies, self-a areness, sense of security and self- orth3

-&oral develo+ment 0ethical behavior, sharing, a arenessof feeling of others, self-a areness- ho they are in +ers+ective ofthe orld3

ypes of Play• Solitary 06egins in infancy and is common in

toddlers3


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toddlers3• Parallel 02nvolves child +laying ne t to another

child but not ith that child-Characteristic oftoddlers, no sharing3

• Associati0e 02nteraction ith other children-6egins late toddlerhood and e tends through+reschool years3

• 2ooperati0e 0Organized +lay of grou+s, usuallyinvolves a leader

• +nloo5er 0Child is a bystander, observes butdoes not join in3

Play• herapeutic

I 4uided by health care team to assist child in co+ing ith


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y g

hos+italization3 I u+ervised +lay ith medical e ui+ment to be used ith child I @nhances com+liance ith thera+y and nursing care I 9rovides emotional outlet during stressful +eriods

• Dramatic I 7n emotional outlet I 9rovides child ith o++ortunity to act out stressful events I 8sed by +sychologists as a means of communicating

traumatic events

A nurse is teachin% a parent about parallel play inchildren. "hich of the followin% statements bythe nurse should be included in the teachin%?


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the nurse should be included in the teachin%?

1.SChildren sit and observe others +laying.N".SChildren e hibit organized +lay hen in a grou+.N

!.SThe child +lays alone.N$.SThe child +lays inde+endently hen in a grou+.N

A nurse is teachin% a parent about parallel play inchildren. "hich of the followin% statements bythe nurse should be included in the teachin%?


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the nurse should be included in the teachin%?

1.SChildren sit and observe others +laying.N".SChildren e hibit organized +lay hen in a grou+.N

!.SThe child +lays alone.N&. he child plays independently when in a%roup.I

Pediatric Medications

i%htsI of medication administration;


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• olume• Techni ue=a++roach

• >ocumentation• ight to refuse• ight to kno

+otential side effects

• Client• &edication

• >ose• Time• oute• >ocumentation

i%htsI of medication administration;

ADM>B>S A >+B +< M9D>2A >+BS

• 9ediatric dosages are based on body eight


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• 9ediatric dosages are based on body eight,6 7, and maturation of body organs

• 5eonates and infants have immature kidneyand liver function, alkaline gastric juices, and an

immature blood-barrier • ome med dosages are based on age• Children have W gastric acid +roduction and

slo er gastric em+tying• 9ediatric clients are more sensitive tomedications

• They have Q absor+tion of to+ical meds• They have lo er blood +ressure• They have higher body ater content


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• They have higher body- ater content• They have W serum +rotein-binding sites 0until

age 13• ;igher risk for medication errors

• /imited sites for 2 medications• Check for med food allergies, have a++ro+riate

dose, evaluate child?s coo+eration and tissueintegrity

+ A' M9D>2A >+BS

• /i uids, +ills, tablets, and ca+lets.


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, , ,• >o not mi meds ith formula• 9referred route, measured in milliliters % m/ 01 ts+3A !* m/ 01 oz3

• 8se +lastic, needleless syringes, medicine cu+• Crush tablets and dissolve• >o not crush enteric-coated or time-released

tablets• >ivide tablets only if scored


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+ptic= +tic= Basal• Farm to room tem+erature.


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• To instill the solution in a child under $ yearsof age, +ull the +inna of the ear do n andback.

• 2n a child o0er $ , the +inna is +ulled u+ andback.

• ;ave +arent hold child

• ;y+ere tend child?s neck for nasal meds

Subcutaneous)>ntradermal


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• &ay a++ly local anesthetic +rior to injection• 8se !=( to %=(A "#-!* gauge needle• Change needed if used to +uncture rubber

to+ of vial• 2nject small volumes 0u+ to *.% m/ 3• :G '*X angle or $% angle if minimal :

tissue• 2ntradermal G 1%X angle to form SblebN

>B AM:S2:'A >BJ92 >+BS• The vastus lateralis for children V " years


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• 7fter age "G ventral gluteal site 0 " ml 3• >eltoid 0 1 ml 3• Children have re+orted that injections are the

most stressful and +ainful e +eriences ofhealth care.• ee chart 7T2 +. 1*!

Position for >M >n8ection


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>B A(9B+:S M9D>2A >+BS

• Children are at risk for fluid overload


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Children are at risk for fluid overload.• 7ll children receiving 2 fluids should receive

those fluids through a volumetric infusion +um+.• ite assessment includes color of site, tension

of skin, and skin tem+erature.• 9eri+heral venous access• Central venous access

Pediatric Pain Mana%ement

• 5urses are accountable for the assessment of


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+ainA considered the 5 th vital sign• 9ain is hat ever the child says it is• @ffectiveness of treatment should evaluated in

timely manner • 7ssessment more difficult in infants and younger

children• Tem+orary changes in vital signs associated ith

an iety and +ain• Children receiving o+iates need to be monitoredclosely for res+iratory de+ression

Assessment of Pain


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• ubjective dataH uality, intensity, strength,severity, timing, location, aggravatingfactors, associated sym+toms

• Objective dataH


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0


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B>PS


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Bon6pharmacolo%ic Measures

•


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9ositioning• 6reathing and rela ation techni ues• +linting• Calm environment 0lo noise, W lighting3

• 2ce• Farm blankets• 4uided imagery• >istraction 0video games, cartoons, video3• ;olding, rocking• ucrose +acifiers for infants during +rocedures

2opin% with HospitaliFation


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• 2nfantH tranger an iety #-1( mos. &ay e +erience slee+ de+rivation• ToddlerH @ +erience se+aration an iety• 9reschoolerH &ay e +erience se+aration an iety


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;os+italization is stressful for both +arent andchild• The family is also a client hen the child is ill• &ust deal ith se+aration, loss of control, bodily

injury, and +ain• e+aration an iety• egressionH +rotest 0crying3

des+air 0 ithdra n and uiet3 detachment 0lack of +rotest3

• 7dolescent H

2opin% with HospitaliFation


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I e+aration from +eers I ocial isolation I


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Allowin% the child to dress up as adoctor or a nurse helps prepare the child

for the hospitaliFation e perience.


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he childEs an iety and fear often will bereduced if the nurse e plains what is %oin% tohappen and demonstrates how the procedure


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will be done by usin% a doll.

A%e6 elated >nter0entions

• 2nterventions should be


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based on thedevelo+mental level of thechild

• Teach family hat toe +ect

• @ncourage +arents to stayduring hos+ital stay

• See A > p. 1!*

Death and Dyin%


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he Dyin% 2hildHow Death is Percei0ed


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• 2nfants and toddlers have no clear conce+t ofdeath.

• 9reschoolers may vie death as a kind of slee+.•

chool-age children begin develo+ing theconce+t of death as final.• 7dolescents may have an adult-like conce+t of

death

• A > p.1$! chart@

The nurse canH

he Dyin% 2hild


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• 9romotesocialization.

• 9rovide avenues forself-e +ression.

• >eal directly ith thechild?s uestions.

• 7llo death to occurith dignity.

• See A > p%. 1$$61$*

•


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%rie0in%.• Denial= an%er= and

depression.• Parents ha0e many fears.• eli%ious rituals= such as

baptism and blessin% of anill infant= may pro0ide %reatcomfort to the family.

• Siblin%s ha0e fear= %rief=may show resentment

•


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remains ith the child.• 5urse should use o+enness and honesty ith

the child and family.


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Burses can pro0ide families with a memento ofthe child who dies by creatin% a plaster cast of

the childEs hand= or a hand or foot print.


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• e uires confidence, em+athy, andcom+etence.

he Burse of the Dyin% 2hild


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• &ust manage +ersonal stress.• &ust be comfortable ith o n mortality.• @ +eriences denial, anger, de+ression, guilt,

and ambivalence.

Any uestions or 2omments?


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6asic Conce+ts evie

1. "hat de0elopment sta%e is the sense ofindustry?


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1. 7dolescent". 9reschool!. chool-age$. Toddler

1. "hat de0elopment sta%e is the sense ofindustry?


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1. 7dolescent". 9reschool$. School6a%e$. Toddler


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!. 7y what a%e does the a0era%e baby tripletheir birth wei%ht?


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1. ' months!. 1! months

!. 1% months$. 1( months

$. he normal heart rate bpm@ for a newbornis;


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1. '*-1"*". )*-1**!. (*-1"*$. 1**-1#*

$. he normal heart rate bpm@ for a newbornis;


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1. '*-1"*". )*-1**!. (*-1"*&. 1 61/

&. he normal respiratory rate for a 1 to /6wee5 old is;


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1. 1(-"%". !(-#(!. "*-!*$. !*-#*

&. he normal respiratory rate for a 1 to /6wee5 old is;


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1. 1(-"%". !(-#(!. "*-!*&. $ 6/

*. wo 5ids are playin% ne t to each other= butaren t sharin% their toys or playin% to%ether.

hey are li5ely...


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1. ne borns". toddlers!. +reschoolers$. school age children

*. wo 5ids are playin% ne t to each other= butaren t sharin% their toys or playin% to%ether.

hey are li5ely...


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1. ne borns!. toddlers!. +reschoolers$. school age children

/. An assessment of the s5ull of a normal 1 6month6old baby should identify which of thefollowin%?


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1. Closure of the +osterior fontanel". Closure of the anterior fontanel!. Overla+ of cranial bones$. Ossification of the sutures

/. An assessment of the s5ull of a normal 1 6month6old baby should identify which of thefollowin%?


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1. 2losure of the posterior fontanel ". Closure of the anterior fontanel!. Overla+ of cranial bones$. Ossification of the sutures

3. he nurse has wei%hed a newborn inpreparation for the newborn s dischar%e. henurse informs the parents that the newborn

i%h ! 3 5% hi h i L i0 l t t


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wei%hs !.3 5% which is eLui0alent toappro imately

1. # lb

". ) lb!. ( lb$. ' lb

3. he nurse has wei%hed a newborn inpreparation for the newborn s dischar%e. henurse informs the parents that the newborn

i%h ! 3 5% hi h i L i0 l t t


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wei%hs !.3 5% which is eLui0alent toappro imately

1. / lb

". ) lb!. ( lb$. ' lb

#. he nurse is reinforcin% teachin% with theparents of a newborn who reLuires apneamonitorin%. he nurse should reinforce that

h th l d th


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when the alarm sounds on the apneamonitor= the parent should first

1. silence the alarm". look at the ne born!. gently ta+ the ne bornPs foot$. gras+ the bulb syringe

#. he nurse is reinforcin% teachin% with theparents of a newborn who reLuires apneamonitorin%. he nurse should reinforce that

hen the alarm so nds on the apnea


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when the alarm sounds on the apneamonitor= the parent should first

1. silence the alarm!. loo5 at the newborn!. gently ta+ the ne bornPs foot$. gras+ the bulb syringe

4. he nurse in the newborn nursery has 8ustrecei0ed report. "hich of the followin% infantsshould the nurse see first?


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". A two$day$old infant lying %uietly alert with aheart rate of "!&.

. A one$day$old infant crying and the anterior

fontanel is bulging.#. A " $hour old infant being held' therespirations are (& breaths per minute andirregular.

(. A )ve$hour$old infant sleeping with the handsand feet blue bilaterally.

4. he nurse in the newborn nursery has 8ustrecei0ed report. "hich of the followin% infantsshould the nurse see first?

f


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1. A two-day-old infant lying quietly alertwith a heart rate of 185.

. A one$day$old infant crying and the anterior

fontanel is bulging.#. A " $hour old infant being held' therespirations are (& breaths per minute andirregular.

(. A )ve$hour$old infant sleeping with the handsand feet blue bilaterally.

1 . "hat is the most appropriate nursin%inter0ention for a newborn e periencin%acrocyanosis?


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1. 7dminister 2 fluids.". uction vigorously.

!. 9lace in the Trendelenburg +osition.$. 7ssess tem+erature.

1 . "hat is the most appropriate nursin%inter0ention for a newborn e periencin%acrocyanosis?


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1. 7dminister 2 fluids.". uction vigorously.

!. 9lace in the Trendelenburg +osition.&. Assess temperature.

11. "hich is the preferred method of ta5in% anewborn s temperature?

1 ectal


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1. ectal". Tym+anic!. 7 illary

$. Oral

11. "hich is the preferred method of ta5in% anewborn s temperature?

1 ectal


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1. ectal". Tym+anic$. A illary

$. Oral

1!. he nurse notes that a *6month6old hassi%nificant head la% when she attempts topull the infant to a sittin% position. 7ased onthis assessment= the nurse reco%niFes thatthe infant;


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the infant;

1. ;as some degree of mental retardation.

". 5eeds further assessment and evaluation.!. ;as been neglected by the +arents.$. 2s develo+ing normally.

1!. he nurse notes that a *6month6old hassi%nificant head la% when she attempts topull the infant to a sittin% position. 7ased onthis assessment= the nurse reco%niFes thatthe infant;


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the infant;

1. ;as some degree of mental retardation.

!. Beeds further assessment and e0aluation.!. ;as been neglected by the +arents.$. 2s develo+ing normally.

1$. "hich nursin% inter0ention is mostde0elopmentally appropriate for ahospitaliFed 1 6year6old?


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1. @ncourage de+endency on +arents hile thechild is hos+italized.

". Obtain a com+lete health history from the child.!. @ncourage the child to +lay ith safe medical

e ui+ment.$. 7llo the child to assist ith dressing changes.

1$. "hich nursin% inter0ention is mostde0elopmentally appropriate for ahospitaliFed 1 6year6old?


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1. @ncourage de+endency on +arents hile thechild is hos+italized.

". Obtain a com+lete health history from the child.!. @ncourage the child to +lay ith safe medical

e ui+ment.&. Allow the child to assist with dressin%

chan%es.

1&. he nurse notes that a /6month6old infantwho wei%hed 3 pounds at birth now wei%hs1* pounds. "hat is the nurse s e0aluation of

the infant s current wei%ht?


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1. The infantPs eight is a++ro+riate for his age.". The infant needs eekly follo -u+ to assess

eight.!. The infant has been consuming more calories

than needed.$. The infant should be hos+italized for failure to

thrive.

1&. he nurse notes that a /6month6old infantwho wei%hed 3 pounds at birth now wei%hs1* pounds. "hat is the nurse s e0aluation of



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1. he infant s wei%ht is appropriate for his a%e.". The infant needs eekly follo -u+ to assess

eight.!. The infant has been consuming more calories

than needed.$. The infant should be hos+italized for failure to

thrive.

1*. "hich action by the parents of a 1/6month6oldtoddler indicates that they understand how to bestminimiFe separation an iety durin% their childEs

hospitaliFation?


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hospitaliFation?

1. The +arents bring the child?s favorite tot to the hos+ital". The +arent e +lain all the +rocedures to the child

!. The +arents remain ith the child during the hos+italstay

$. The +arents bring the siblings to visit the child

1*. "hich action by the parents of a 1/6month6oldtoddler indicates that they understand how to bestminimiFe separation an iety durin% their childEshospitaliFation?


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1. The +arents bring the child?s favorite toy to the hos+ital". The +arent e +lain all the +rocedures to the child

$. he parents remain with the child durin% thehospital stay

$. The +arents bring the siblings to visit the child

1/. he nurse is assessin% a /6month6old infantdurin% a well6child 0isit. he nurse ma5es all of

the followin% obser0ations "hich of thefollowin% assessments made by the nurse is an


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the followin% obser0ations. hich of thefollowin% assessments made by the nurse is anarea of concern indicatin% a need for furthere0aluation?

1. 7bsence of &oro refle .". Closed +osterior fontanel.!. T o +ound eight gain in " months.

$. &oderate head lag hen +ulled to sitting +osition.

1/. he nurse is assessin% a /6month6old infantdurin% a well6child 0isit. he nurse ma5es all ofthe followin% obser0ations. "hich of the followin%assessments made by the nurse is an area of


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assessments made by the nurse is an area ofconcern indicatin% a need for further e0aluation?

1. 7bsence of &oro refle .". Closed +osterior fontanel.!. T o +ound eight gain in " months.&. Moderate head la% when pulled to sittin%

position.

13. A nurse is assessin% a !6year6old boy with thefollowin% 0ital si%ns; temperature 43.#N <a illary= apical pulse 1 = respirations !# breathsper minute= blood pressure 1!*)# . "hich actionby the nurse would be most appropriate?


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by the nurse would be most appropriate?

1. eevaluate the child?s tem+erature in 1 hour.

". e+ort the blood +ressure to the +hysician.!. 7ssess for additional signs of res+iratory distress in

the child.$. >etermine hy the child has tachycardia.

13. A nurse is assessin% a !6year6old boy with thefollowin% 0ital si%ns; temperature 43.#N <a illary= apical pulse 1 = respirations !# breathsper minute= blood pressure 1!*)# . "hich actionby the nurse would be most appropriate?


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by the nurse would be most appropriate?

1. eevaluate the child?s tem+erature in 1 hour.

!. eport the blood pressure to the physician.!. 7ssess for additional signs of res+iratory distress in

the child.$. >etermine hy the child has tachycardia.

1#. A nurse plans to offer an infant a pacifierdurin% the period he is BP+. he rationale forthis inter0ention is based on which theorist?


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1. 9iaget". @rikson

!.


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1. 9iaget". @rikson

$.


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p pp p p yshould ta5e into consideration hisde0elopmental tas5= which is;

1. Trust vs. mistrust". 2ntimacy vs. isolation!. 7utonomy vs. doubt and shame

$. 2dentity vs. role and confusion

14. he new mother as5s the nurse whether or notshe should pic5 up the baby when he cries.Accordin% to 9ri5sonEs theory of psychosocialde0elopment= the nurseEs most appropriate reply


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p pp p p yshould ta5e into consideration hisde0elopmental tas5= which is;

1. rust 0s. mistrust". 2ntimacy vs. isolation!. 7utonomy vs. doubt and shame

$. 2dentity vs. role and confusion

! . he neonatal or newborn period of life isdefined as the first;

1 "$ hours


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1. $ hours". ) days!. $( hours$. "( days

! . he neonatal or newborn period of life isdefined as the first;

1 "$ hours


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1. $ hours". ) days!. $( hours&. !# days

!1. A nurse is assessin% the psychosocialde0elopment of a toddler. he nurse is awarethat this sta%e is characteriFed by which of thefollowin%?


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1.2maginary +laymates

".@rikson?s stage of initiative versus guilt!.>emonstrations of se ual curiosity$.5egative behaviors characterized by the need

for autonomy

!1. A nurse is assessin% the psychosocialde0elopment of a toddler. he nurse is awarethat this sta%e is characteriFed by which of thefollowin%?


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1. 2maginary +laymates

".@rikson?s stage of initiative versus guilt!.>emonstrations of se ual curiosity&.Be%ati0e beha0iors characteriFed by the need

for autonomy

!!. A nurse is collectin% data from a $ monthold. "hich of the followin% findin%s should bereported to the pro0ider?


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1. 8nable to raise head hen in +rone +osition".8nable to sit ithout su++ort

!.8nable to +ick u+ an object ith his fingers$.8nable to bring an object to mouth

!!. A nurse is collectin% data from a $ monthold. "hich of the followin% findin%s should bereported to the pro0ider?


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1. :nable to raise head when in prone position".8nable to sit ithout su++ort

!.8nable to +ick u+ an object ith his fingers$.8nable to bring an object to mouth

!$. "hat should be the e pected wei%ht of aninfant at 1! months of a%e whose birth wei%htwas $/ %rams?


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1.%#** grams.".)"** grams.!.11 kilograms.$.1% kilograms.

!$. "hat should be the e pected wei%ht of aninfant at 1! months of a%e whose birth wei%htwas $/ %rams?


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1.%#** grams.".)"** grams.$.11 5ilo%rams.$.1% kilograms.

!&. A nurse performs a head6to6toe assessmenton a newborn. "hich findin% should be of%reatest concern to the nurse?


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1.Ca+illary refill time of " seconds.".Transient mottling of the skin.

!.2rregular res+irations.$.5egative 6abinski refle .

!&. A nurse performs a head6to6toe assessmenton a newborn. "hich findin% should be of%reatest concern to the nurse?


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1.Ca+illary refill time of " seconds.".Transient mottling of the skin.

!.2rregular res+irations.&.Be%ati0e 7abins5i refle .

!*. he nurse is performin% a physicalassessment on a /6month6old baby. "hichOndin% should the nurse understand asabnormal for this child?


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1.The child?s +osterior fontanel is o+en.

".The child?s anterior fontanel is o+en.!.The child has the beginning signs of tootheru+tion.

$.The child is able to track and follo objects.

!*. he nurse is performin% a physicalassessment on a /6month6old baby. "hichOndin% should the nurse understand asabnormal for this child?


297/299

1. he childEs posterior fontanel is open.

".The child?s anterior fontanel is o+en.!.The child has the beginning signs of tootheru+tion.

$.The child is able to track and follo objects.

!/. "hich de0elopmental milestones would the nursee pect a 1 6 month6 old infant to display durin% aroutine health maintenance 0isit? Select all that apply;

1.;olding his head erect


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1.;olding his head erect". elf- feeding!. >emonstrating good bo el and bladder control

$. itting on a firm surface ithout su++ort%.6earing the majority of his eight on his legs#.Falking alone

!/. "hich de0elopmental milestones would the nursee pect a 1 6 month6 old infant to display durin% aroutine health maintenance 0isit? Select all that apply;

1.Holdin% his head erect


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.Holdin% his head erect". elf- feeding!. >emonstrating good bo el and bladder control

&.Sittin% on a firm surface without support* 7earin% the ma8ority of his wei%ht on his le%s

1a pediatrics basic concepts11-2010rh.ppt

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