Pediatrics

What are signs that nurses should be aware of that indicate the school aged child is under stress?

stomach pains or headache changes in sleep patterns or nightmares bedwetting changes in eating habits aggressive or stubborn behavior withdrawal or reluctance to participate Regression to earlier behaviors (thumb sucking) Trouble concentrating or changes in academic performance

Between ages 6 and 8 months, fear of stranger and ___________ become prominent and are related to infant's ability to discriminate between ______ and _______ people.

stranger anxiety; familiar and unfamiliar

Unrelieved pain may prolong the _______ response and adversely affect an infant's or child's recovery, whether it is from trauma, surgery, or disease.

stress

How can you decrease dependence on nonnutritive sucking in young infants?

sucking pleasure can be increased by prolonging feeding time

If a child has lengthy and repeated hospitalizations; developmental _______ can occur in response to stress; ________ may result from an underlying pathologic condition, the exacerbation of an illness, or medication side effects; and equipment requirements may impede _________, exploration, and independence.

regression; fatigue; mobility.

The retreat from one's present pattern of functioning to past levels of behavior is referred to as ______. When does this occur?

regression; occurs in instances of discomfort or stress (or any threat to their autonomy, such as illness) when one attempts to conserve psychic energy by reverting to patterns of behavior hat were successful in earlier stages of development

What is really important in preparation for catheterization?

relaxation techniques.

What are the nursing objectives for children with AOM?

relieving pain facilitating drainage when possible preventing complications or recurrence educating the family in care providing emotional support

The immaturity of the ______ structures also predisposes infants to dehydration and electrolyte imbalance. Complete maturity of the kidneys occurs during the latter half of the ______ year.

renal; second

Nursing care of the child with inhalation injury is the same as that for any child with _______.

respiratory distress.

What should be included in the respiratory assessment?

respiratory rate, depth and rhythm, heart rate, oxygenation, hydration status, body temperature, activity level, and level of comfort.

What are disruptions?

result from the breakdown of previously normal tissue. Congenital amputations caused by amniotic bands are examples.

Development of the _______, or conscience, begins toward the end of the toddler years and is a major task for ____________.

superego; preschoolers

What is mixed conductive-sensorineural hearing loss?

results from interference with transmission of sound in the middle ear and along neural pathways. It frequently results from recurrent otitis media and its complications.

Children who experience GABHS are at risk for what other illnesses?

rheumatic fever (RF)- an inflammatory disease of the heart, joints, and CNS acute glomerulonephritis (AGN)- an acute kidney infection It may also cause skin manifestations, including impetigo and pyoderma

What are symptoms of RSV?

rhinorrhea and low-grade fever often appear first. Conjunctivitis may also be present. In time, a cough may develop. Infants may have several days of URI symptoms or no symptoms except slight lethargy, poor feeding, or irritability.

Why is mixed foods such as casseroles rarely a favorite for toddlers?

ritualism of this age dictates certain principles in feeding practices. Toddlers like to have the same dish, cup, or spoon every time they eat and may reject a food simply because it is served in a different dish or because one food is touching the other food.

__________ is secreted in small amounts, but the majority of the digestive processes do not begin functioning until age _________, when drooling is common because of the poorly coordinated ________ reflex.

saliva; 3 months; swallow

When can children start to use concrete operations? (when children are able to use though processes to experience events and actions)

school age

It is important to place infants in a _______ position for sleep. While infants are awake, a _________ position is acceptable to enhance achievement of milestones such as __________, crawling, creeping, and turning over.

supine; prone; head control

What is the treatment of ARDS ? (Acute respiratory distress syndrome)

supportive measures to maintain adequate oxygenation and pulmonary perfusion, treatment of infection, and maintenance of adequate cardiac output. Many patients require mechanical ventilatory support.

Because tonsillitis is self-limiting, treatment of viral pharyngitis is _________.

symptomatic

___________ injury occurs from gases that are nontoxic to the airways (e.g. CO, hydrogen cyanide). However, these gases cause injury and death by interfering or inhibiting _________.

systemic; cellular respiration

What is the best approach that a stranger (such as a nurse) can take to minimize stranger fear?

talk softly, meet the child at eye level; maintain a safe distance from the infant; and avoid sudden, intrusive gestures, such as holding out the arms and smiling broadly.

What two ways of teaching is successful when educating a child with CI?

task analysis (each task is separated into its necessary components and each step is taught completely before proceeding to the next activity) and motivation.

Health promotion for adolescents consists mainly of what?

teaching the guidance to avoid risk-taking activities and health-damaging behaviors.

What are some essential things that school age children learn?

tell time, see the relationship of events in time (history), places in space (geography), ability to read, and do math.

What is gynecomastia?

temporary breast enlargement and tenderness. Common during mid puberty, occurring in up to one third of boys.

When children have Recurrent headaches, parents are taught to assess whether _____ or _____ performance demands are being avoided because of headache. Parents are taught to focus attention on _________ such as the use of relaxation techniques and maintenance of normal activity patterns.

school; social; adaptive coping

Children exposed to ____________ have an increased number of respiratory illnesses, increased respiratory symptoms (cough, sputum, wheezing) and reduced performance on pulmonary function tests.

second hand (passive) or environmental tobacco smoke

What refers to a personal, subjective judgement of one's worthiness derived from and influenced by the social groups in the immediate environment and individuals' perceptions of how they are valued by others.

self-esteem

The development of body image parallels _________ development.

sensorimotor

What are the most common findings in Down syndrome children?

separated sagittal suture small nose depressed nasal bridge high, arched, narrow palate Neck skin excess and laxity wide space between big and second toes plantar crease between big and second toes hyperflexibility and muscle weakness

During the sensorimotor phase of cognitive development, three crucial events take place. The first event involves ____________ in which infants learn to separate themselves from other objects in the environment. The second major accomplishment is achieving the concept of ______________, or the realization that objects that leave the visual field still exist. The last major intellectual achievement of this period is the ability to use _________, or ____________. This allows infants to think of an object or situation without actually experiencing it.

separation; object permanence; symbols or mental representation.

When a single anomaly leads to a cascade of additional anomalies, the pattern of defects is referred to as a what?

sequence

What is a general contraindication for all immunizations?

severe febrile illness

A child with asthma who sweats profusely, remains sitting upright, and refuses to lie down is in __________.

severe respiratory distress.

For children with RAP, parent training in how to avoid positive reinforcement of _______ behaviors and focus on rewarding ________ behaviors is important.

sick; healthy

The acute painful episode in _________ disease is the only pain syndrome in which opioids are considered he major therapy and are started in early childhood and continued throughout adult life.

sickle cell

What is the "guides" method for visually impaired children?

sighted human guide or a dog guide.

The infant's heart rhythm is often _________.

sinus arrhythmia (rate increases with inspiration and decreases with expiration)

How do you reduce the risk of OM?

sitting or holding an infant upright for feedings; maintaining routine childhood immunizations;exclusively breastfeeding until at least 6 months of age. Propping bottles is discouraged to avoid pooling of milk while the child is in the supine position. avoid washing the child's hair with bathtub water. eliminating tobacco smoke and known allergens

What is an effective way to prevent neonatal hypothermia in infants?

skin-to-skin (kangaroo care)

During adolescents, the growth spurts increase their need for _________.

sleep

What is a protective function in all organisms, that allows for repair and recovery of tissues after activity?

sleep

Although children with hearing-visual impairment achieve the usual motor milestones, their rate of development is ______. These children learn communication only with specialized _______.

slower; training

What is acute spasmodic laryngitis?

spasmodic croup Signs of inflammation are absent of mild and it is followed by an uneventful recovery. The child feels well the next day.

How can you obtain a urine specimen from an infant who is not toilet trained?

special urine collection bags with self-adhering material around the opening at the point of attachment are used. The bag is checked frequently and removed as soon as the specimen is available because the moist bag may become loosened on an active child. If the urine is not tested within 30 minutes the specimen is refrigerated or placed in a sterile container with a preservative. Use a syringe to remove the urine from the bag.

What are germ cells?

sperm and ova

How do we test for infectious mononucleosis?

spot test (mono spot)

Pulmonary complications are present in almost all children with CF. What are the symptoms of this?

stagnation of mucus in the airways, eventual bacterial colonization leading to destruction of the lung tissue.

When do prepubescent signs appear usually?

start to appear at about 9 years of age (particularly in girls) and are usually clearly evident in 11 to 12 year old children.

Recurrent headaches in children can be caused by several factors including....

tension; dental braces; imbalance or weakness of eye muscles, sinusitis, and other cranial infection or inflammation, increased ICP, epileptic attacks, drugs, obstructive sleep apnea, and rarely hypertension.

What are agents that cause birth defects when present in the prenatal environment, account for the majority of adverse intrauterine effects not attributable to genetic factors?

teratogens (like alcohol)

The first pubescent changes in boys are __________ accompanied by thinning, reddening, and increased looseness of the __________. Early puberty is also characterized by the initial appearance of _________. Penile enlargement begins, and testicular enlargement and pubic hair growth continue throughout mid puberty. During this period, there is also increasing __________, early voice changes, and development of early facial hair.

testicular enlargement; scrotum; pubic hair; muscularity

Diptheria vaccine is commonly administered in combination with ______ and_______ vaccines for children younger than _______ years.

tetanus; pertussis; 7

Developmentally, the term rapprochement means what?

the child moves away and returns for reassurance. This happens in toddlerhood

What is the most obvious early sign of bleeding after a tonsillectomy?

the child's continuous swallowing of the trickling blood. While the child is sleeping, note the frequency of swollowing.

What is ethnicity?

the classification of or affiliation with any of the basic groups or divisions of humankind or any heterogeneous population differentiated by customs, characteristics, language, or similar distinguishing factors such as family structure, food preferences, moral codes, and expression of emotion.

What is Acute viral nasopharyngitis?

the common cold. Caused by rhinovirus, RSV, adenoviruses, enteroviruses, influenza virus, and parainfluenza virus.

What is cultural relativity?

the concept that any behavior must be judged first in the context of the culture in which it occurs. Cultural factors such as belief systems and view of the world influence the patient's and family's response to health care.

The health and well-being of the child in the North American family is influenced by tow distinct contexts. What are they?

the context of family and the context of culture

What is collection of sputum or nasal discharge sometimes required for?

the diagnosis of respiratory infections, especially tuberculosis and respiratory syncytial virus (RSV)

What should informed consent include?

the expected care or treatment; potential risks, benefits, and alternatives; and what might happen if the patient chooses not to consent.

What is "temperament"?

the manner of thinking, behaving, or reacting characteristic of an individual. It refers to behavioral tendencies, not to discrete behavioral acts.

Why is warm or cool mist therapeutic for symptoms of respiratory discomfort?

the moisture soothes inflamed membranes and is beneficial when there is hoarseness or laryngeal involvement.

What is pulmonary edema?

the movement of fluid into the alveoli and interstitium of the lungs caused by extravasation of fluid from the pulmonary vasculature.

What is ritualism?

the need to maintain sameness and reliability, provides a sense of comfort

When is "preadolescence"?

the period of approximately 2 years that begins at the end of middle childhood and ends with the thirteenth birthday.

What is the most accurate means for measuring small amounts of medication?

the plastic disposable syringe, especially the tuberculin syringe for volumes less than 1 ml.

In children with chronic illness, particularly those with complex pain, what is the most important aspect of the assessment is what?

the relationship developed between the child and the family, and it is in developing this relationship that the pain team gets the sense of what the pain experience is like for the child and the family.

what is shear?

the result of the force of gravity pushing down on the body and friction of the body against a surface, such as bed or chair. The blood vessels in the area are stretched and may cause small vessel thrombosis and tissue death.

Attachment to their parents is increasingly evident during what time?

the second half of the first year.

How is the reaction to the TB skin test measured?

the size of the transverse diameter of induration, not the erythema, is measured

What is adenoidectomy? When is it recommended?

the surgical removal of the adenoids. For children who have hypertrophied adenoids that obstruct nasal breathing.

What are the signs and symptoms of CO poisoning?

the symptoms of CO poisoning are secondary to tissue hypoxia and vary with the level of COHb. Mild manifestations include headache, visual disturbances, irritability, and nausea; more severe intoxication causes confusion, hallucinations, ataxia and coma. The bright, cherry red lips and skin often described are less often observed; pallor and cyanosis are seen more frequently.

What is therapeutic holding?

the use of a secure, comfortable, temporary holding position that provides close physical contact with the parent or caregiver for 30 minutes or less. This helps avoid restraints

What is chest physical therapy (CPT)?

the use of postural drainage in combination with adjunctive techniques that are thought to enhance the clearance of mucus from the airway. Include manual percussion, vibration, and squeezing the chest; cough; forceful expiration, and breathing exercises. It should be done over the rib cage and should be painless.

What are pressure ulcers?

they can develop when the pressure on the skin and underlying tissues is greater than the capillary closing pressure, causing capillary occlusion. They most often occur over bony prominences.

Describe dramatic or pretend play

they can pretend and fantasize almost anything.

Why are preschoolers so afraid of intrusive experiences, especially those that disrupt the integrity of the skin?

they fear that if their skin is "broken", all or their blood and "insides" will leak out.

What can children with visual impairments do to compensate for inadequate stimulation? What should you do about these behaviors?

they may develop self-stimulatory actives, such as body rocking, finger flicking, or arm twirling. Discourage such habits because they delay the child's social acceptance.

What should the nurse know about a child who suddenly becomes agitated or an agitated child who suddenly becomes quiet?

they may have serious hypoxia and requires immediate intervention.

Why do middle childhood kids lie?

they tell stories, often exaggerating a story or situation as a means of impressing their family and friends. some children may lie to escape punishment or get out of difficulty

How can you treat Acute viral nasopharyngitis?

thre is no specific treatment, and effective vaccines are not available. Antipyretics may be indicated for mild fever and discomfort. Rest is recommended. A humidified environment and increasing oral fluids may be beneficial. Decongestants may be prescribed for children older than 12 months of age to shrink swollen nasal passages.

What are common physiologic signs of stress in school aged children?

tight muscles, hot or red in the face, jittery, fast heartbeat, breathing difficulties, headache, neck pain, and abdominal pain.

Starting at 18 months, _________ works well for managing temper tantrums.

time-outs

Burn pain is commonly experienced with intense _____ or ______ sensations when skin grafting is required. During the healing process, the tissue and nerve regenerate, the necrotic tissue is ______ until viable tissue is reached.

tingling; itching; excised

What is the goal for the child with clinically active TB?

to achieve sterilization of the TB lesion.

Why are foods an fluids restricted before surgery?

to avoid aspiration during anesthesia

Being responsible for school work helps children learn what?

to keep promises, meet deadlines, and succeed at their jobs as adults.

What is the overall goals for the child with asthma?

to maintain normal activity levels, maintain normal pulmonary function, prevent chronic symptoms and recurrent exacerbations, provide optimum drug therapy with minimum or no adverse effects, and assist the child in living as normal and happy life as possible.

Adolescents with bronchitis should be screened for _________ use.

tobacco or marijuana use

As a general rule of thumb, if the toy fits into a _______, it can be swallowed by a small child.

toilet paper card board roll

________ is the surgical removal of the palatine tonsils.

tonsillectomy

Behavior provides important information that cannot be obtained from self report. Behavioral assessment may provide a more complete picture of _______ experience when administered in conjunction with a subjective self-report measure.

total pain

What are some pleasure activities that a toddler explores?

touching certain body parts, genital fondling, rocking, swinging, hugging people and toys.

What is the leading cause of visual impairment?

trauma

At age 3, preschoolers can ride a ______, walk on ________, balance on one foot for a few _______, and do broad _______. By age 4 years, children can _______ and hop proficiently on one foot and catch a ball reliably. By age 5 years, children can skip on ________ feet and jump rope and being to _________ and _________.

tricycle; tiptoes; seconds; jumps skip alternate; skate; swim

By one year of age the infant's birth weight has ________.

tripled

T/F A parent can administer medication if a nurse prepares it and supervises the administration.

true

T/F Asthma is much easier to prevent than to treat an asthma episode

true

T/F By age 3 years, most children have been infected with respiratory syncytial virus (RSV) at least once.

true

T/F Care of the child with aspiration pneumonia is the same as that described for the child with pneumonia from other causes.

true

T/F Children are born with the mechanism and capacity to develop speech and language skills.

true

T/F Dietary fat in infants younger than age 6 months should not be restricted.

true

T/F Infants need to be played with, not merely allowed to play.

true

T/F The mortality rate of ARDS is high.

true

What is the most important indicator of whether a child has been infected with TB?

tuberculin skin test (TST) (PPD)

Describe small family child care home.

typically provides care and protection for up to six children for part of a 24 hour day and does not include informal arrangements such as exchange babysitting or caregivers in the child's own home.

How is influenza treated?

uncomplicated influenza in children usually requires only symptomatic treatment, including acetaminophen or ibuprofen for fever and sufficient fluids to maintain hydration. There is no "cure" for the flu. Symmetrel, Rimantadine, Zanamivir, and Tamiflu are drugs that can be effective in redcuing symptoms associated with the flu and may shorten the symptoms by 24 hours.

What is astigmatism?

unequal curvatures in refractive apparatus

Because of their unpredictable mood swings, adolescents are frequently labeled as _____, _____ and ______.

unstable, inconsistent, and unpredictable.

Expressed breast milk may be frozen for how long?

up to 6 months

What is the tapping method for visually impaired children?

use of a cane to survey the environment for directional and to avoid obstacles

What is child center-based care?

usually refers to a licensed daycare facility that provides care for six or more children for six or more hours in a 24 hour day.

What is weaning?

usually refers to relinquishing the breast or bottle for a cup. Generally, most infants show signs of readiness during the second half of the first year.

What is the prognosis for infectious mononucleosis?

usually self limiting and uncomplicated. Acute symptoms often disappear within 7 to 10 days and persistent fatigue subsides within 2 to 4 weeks.

To promote comfort, for older infants and children who can tolerate decongestants, ___________ nose drops may be administered. When?

vasoconstrictive; 15 to 20 minutes before feeding and bedtime.

What are the consequences of bullying?

victims of bullying often experience psychological distress such as worry, sadness, anxiety, depression, and nightmares, and can have increased self-harm behaviors, social isolation, suicidal ideation, and violent behaviors.

The respiratory tract is subject to a wide variety of infective organisms. Most infections are caused by __________, particularly __________, nonpolio enteroviruses, adenoviruses, parainfluenza viruses, and human metapneumoviruses.

viruses; respiratory syncytial virus (RSV)

Speech is learned through a multi sensory approach using ______, _____. _______, and ________ stimulation.

visual, tactile, kinesthetic, and auditory

Voluntary control of the anal and urethral sphincters is achieved sometime after the child is _____________, probably between ages ______ and _______.

walking; 18; 24

For children with refractive errors, the nurse helps them adjust to what?

wearing glasses

Adolescents should receive at a minimum an annual assessment of ______, _______ and _________ for age plotted on a standard growth reference chart.

weight, height, BMI

In children susceptible to asthma, inflammation causes recurrent episodes of what?

wheezing, breathlessness, chest tightness, and cough, especially at night or in the early morning.

When the lower airway is involved in bronchiolitis, classic manifestations include signs of altered air exchange, such as what?

wheezing, retractions, crackles, dyspnea, tachypnea, and diminished breath sounds.

What is acculturation?

when minority groups immigrate from another country, a certain degree of cultural and ethnic blending occurs through the involuntary process of acculturation, gradual changes produced in a culture by influence of another culture that cause one of both cultures to be more similar to each other.

When should teeth cleaning begin? How?

when the primary teeth erupt. By wiping with a damp cloth.

What is pneumothorax?

when there is an accumulation of air in the pleural space; this air increases intrapleural pressure, making it more difficult to expand the affected lung and thus the clinical manifestations of dyspnea, chest pain, and often back pain, labored respirations, tachycardia, and decreased O2 sats.

Th most common respiratory pathogens appear in epidemics during the ______ and _______ months.

winter and spring

The flu is more common in _______ months and has a _________ day incubation period.

winter; 1 to 3 day

When are most permanent teeth present?

with the appearance of the second permanent (12 year) molar

What does discipline and limit setting consist of for school aged children?

withholding privileges, requiring compensation, imposing penalties, and contracting can be used with great success.

Children with diminished vision often prefer to do close work without their glasses and compensate by bringing the object very near to their eyes. Should this be allowed?

yes. The exception is children with vision in only one eye, who should always wear glasses for protection.

How old must a child be to draw a heel stick?

younger than 6 months of age

After ______ years of age, children can be given low fate milk to reduce daily total fat.

2

Double the child's hight at the age of ________ years to estimate how tall he or she may be as an adult.

2

In the US, the recommended age for beginning primary immunizations of infants is within _________ weeks of birth, or in special circumstances, at birth.

2

What are the three distinct syndromes of pulmonary complications that may occur in children with inhalation injury?

1. early carbon monoxide (CO) poisoning 2. ARDS occurring at 24 to 48 hours or later in some cases 3. late complications of bronchopneumonia and pulmonary emboli

What are the high risk foods for FB aspiration? what are other high risk items?

(in order of frequency) hot dogs, round candies, peanuts, grapes, cookies, meats, caramels, carrots, peas, apples, celery, popcorn, sunflower seeds, orange seeds, cherry pits, watermelon seeds, gum, and peanut butter. burst latex balloons, plastic or glass beads, marbles, pen or marker caps, button or disc batteries, and coins.

How do you put an NG tube in a child?

-Place child supine with head slightly hyperflexed. -Measure the tube for approximate length and mare the point with a small piece of tape. -Lubricate tube with sterile water or lubricant and insert the tube. -Confirm placement -Stabilize the tube by taping it to the cheek -Warm formula to room temp -Pour formula into the barrel of the syringe attached to the feeding tube. -Flush the tube with sterile water -Cap or clamp the indwelling tubes to prevent loss of feeding. -Position child with the head elevated 30-45 degrees -Record the feeding

If a child is unable to take nourishment by mouth because of anomalies of the throat, esophagus, or bowel, they are frequently fed by way of a tube inserted how?

-orally or nasally into the stomach (orogastric (OG) or Nasogastric (NG) gavage) -duodenum-jejunum (enteral gavage) -by a tube inserted directly into the stomach (gasrostomy) or jejunum (jejunostomy)

What are ways to confirm nasogastric tube placement in pediatric patients?

-Accurate tube length measurement- nose-ear-midxiphoid-umbilicus (NEMU) -A pH of 6 or less supports that the tip of the tube is in the gastric location -Visual inspection of Aspirate- Gastric contents are clear, off-white, or tan or may be brown-tinged if blood is present. Respiratory secretions may look the same. Intestinal contents are often bile stained, light to dark hello, or greenish-brown. -Enzyme testing- aspirate testing of enzyme levels for bilirubin, pepsin, and trypsin -CO2 monitoring is a reliable method to determine incorrect tube placement in the respiratory tray -Gastric auscultation- should not be used without additional methods. Push air into the tube and listen for a rush of air in the stomach.

What are the symptoms of Acute viral nasopharyngitis?

-Fever -Irritability, restlessness -Poor feeding -Sneezing, chilling -nasal mucus (abundant) causing mouth breathing -vomit or diarrhea -Dryness and irritation of nose and throat initially (in older children) -Muscle aches (in older children) -Cough (sometimes in older children) They may last up to 10 days.

What are primary caregiver responsibilities for the child in the home?

-Managing the illness (providing daily hands on care) -Identifying accessing, and coordinating resources -Maintaining the integrity of the family unit -Maintaining self

What is the "early childhood" developmental period?

1 to 6 years Toddler- 1 to 3 years Preschool- 3 to 6 years

Hep A vaccine is now recommended for all children beginning at what age? The second dose given when?

1 year; no sooner than 6 months after he first dose.

It is recommended that toddlers have __________ of fruit each day.

1 cup

In the hospital, diapers are weighted to assess output, which should be at least _____________ up to 30 kg in weight. Then it should be at least ______ ml per hour in patients weighting more than 30 kg.

1 ml/kg/hr; 30

A general guide to serving sizes for toddlers is ________ of solid food per year of age, or _________________ of the adult portion size.

1 tbsp; one fourth to one third

The head circumference is usually equal to chest circumference by what age?

1 to 2 years

Foreign body aspiration can occur at any age but is most common in children of what age?

1 to 3 years of age

Preemptive analgesia has been demonstrated to lower what 5 things?

1. Lower postoperative pain 2. Lower analgesic requirement 3. Lower hospital stay 4. Lower complications after surgery 5. Minimize the risks for peripheral and CNS sensitization that can lead to persistent pain.

To obtain valid informed consent, health care providers must meet what three conditions?

1. The person must be capable of giving consent; he or she must be over the age of majority (usually 18) and must be considered competent 2. The person must receive the information needed to make an intelligent decision. 3. The person must act voluntarily when exercising freedom of choice without force, fraud, deceit, duress, or other forms of constrain or coercion.

Each degree of fever increases the basal metabolism by ______%, with a correspondingly increased _______ requirement.

10; fluid

Total sleep in two year olds averages about ______ hours a day. Most children reach an adult pattern of sleep by ______ years of age.

11 to 12; 3

What is the "later childhood" developmental period?

11-19 years Prepubertal- 10-13 years Adolescence- 13 to 18 years

By age _____ to ______ months old, most children have eliminated the second nap .

12 to 18 months

Beginning at approximately ______ of age, girls display a temperature that remains relatively stable, but the temperature in boys continues to ______ for a few more years.

12 years; fall

Any child who does not display such language skills as babbling or gesturing by ______ months, single words by ______ months, and two-word phrase by _______ months is recommended for immediate hearing and language evaluation. A sudden ________ in extant expressive speech is also a red-flag for further evaluation of ASD.

12; 16; 24; deterioration

Honey should be avoided in the first _______ months because of the risk of _________.

12; botulism

Concerns about pubertal delay should be considered for boys who exhibit no enlargement of the testes or scrotal changes by what age?

13 1/2 to 14 years.

The rear vehicle seat is the safest place for children younger than the age of __________ and booster seats should be used until _________ years of age.

13 years; 8

Calling children in from play ______ minutes before mealtime allows them ample opportunity to get ready for eating while settling down their active minds and bodies.

15

What is the total daily sleep for an infant?

15 hours

The physiologic ability to control the anal and urethral sphincters probably occurs somewhere between what ages?

18 and 24 months

Milk intake for toddlers should be _______ servings a day.

2 to 3

When is diagnosis of ASD usually made?

2 to 3 years

How should new foods be added to an infant's diet?

one at a time

Infants may take how many naps by the end of the first year.

one or two

Legal blindness or severe permanent visual impairment is defined as a visual acuity of _________ or lower or a visual field of _____ degrees or less in the better eye.

20/200; 20

Visual acuity of _______ is considered acceptable during the toddler years.

20/40

Partial sight or partial visual impairment is defined as a visual acuity between _______ and _______. The child can normally use normal-sized print because _________ is almost always better than ________.

20/70 and 20/200; near vision; distance vision

The epiglottal swelling from acute epiglottitis usually decreases after what therapy? When will the epiglottis be normal?

24 hours of antibiotic therapy; on the third day

The most critical period for speech development occurs between _____ and _____ years of age. During this period, children are using their rapidly growing vocabulary faster than they can produce the words.

2; 4

Children's TV programs are appropriate for some children over __________ years, who learn to associated words with ___________. However, total media time should be limited to ________ or less of quality programming per day.

2; visual images; 2 hours

Suctioning should be limited to about how many aspirations in one period?

3

What is the optimum dosage of an analgesic?

one that controls pain without causing severe side effects

By the end of the first year, the brain has increased in weight about ______ times.

2.5

Gender identity is developed by what age?

3 years

Self-report of pain is not sufficiently valid for children younger than ________ because many are not able to accurately self report pain.

3 years old

What is the most educational toy for a toddler?

one that fosters the interaction of an adult with a child in supportive unconditional play. Toys should not be substitutes for the attention of devoted caregivers, but toys an enhance these interactions.

What are the goals for CF?

prevent or minimize pulmonary complications ensure adequate nutrition for growth encourage appropriate physical activity promote a reasonable quality of life

To avoid rebound congestion, nose drops or sprays should not be administered for more than how long?

3 days

pumping milk away from home may be needed every __ to ___ hours to maintain adequate supply.

3 to 4

Identification of hearing loss within the first ________ to _____ months of life is essential to improve the language and educational outcomes for children with hearing impairments.

3 to 6

What should the nurse say to a parent who is expressing concern about what seems to be an "endless roller-coaster" of illness with their 3 year old?

They need reassurance that frequent colds are a normal part of childhood and that by 5 years of age, their children will have developed immunity to many viruses.

What are hospital policies on baby walkers?

They should not be used because they provide access to hazards, resulting in burns, falls, and poisonings.

During the latter part of the first year, most children sleep how often?

They sleep through the night and take 1 to 2 naps during the day

How is asthma diagnosed?

primarily on the basis of clinical manifestations, history, physical examination, and to a lesser extent, laboratory tests. Generally chronic cough in the absence of infection or diffuse wheezing during the expiratory phase of respiration is sufficient to establish a diagnosis. (and dyspnea)

What is adolescence?

regarded as the psychologic, social, and maturational process initiated by the pubertal changes.

What is the recommendations for the emergency treatment of the choking child?

abdominal thrusts for children older than 1 year and back blows and chest thrusts for children younger than 1 year of age.

What is farsightedness?

ability to see objects at a distance

What is nearsightedness?

ability to see objects clearly at close range but nat at a distance

The child is allowed rest for how long after each aspiration to allow oxygen saturation to return to normal; then the process is repeated until when?

30-60 seconds; until the trachea is lear

Parents should begin preparing their children for toilet training earlier than ________ months.

30; but there is no universal right age to begin toilet training or an absolute deadline to complete training.

The average newborn weighs from ______ to _____. In general, the birth weight doubles by _____ to _______ of age and triples by _______. By the age of _____ to _____, the birth weight usually quadruples.

3175 to 3400 g (7-7.5 lbs) 4-7 months the end of the first year 2-2.5

When eliciting a family health history, nurses should collect information about all family members within a minimum of how many generations? How long does this take?

3; 20-30 min

By the end of the first year, infants are able to tolerate ________ meals a day and an evening ______ and may have _______ to ______ bowel movements daily.

3; bottel; 1; 2

Before the age of _________ years, children with developmental delays are eligible for an early intervention program. The child can receive ___________ therapies as appropriate. After this age, the _____________ is responsible for providing this education.

3; rehabilitation; local school system

How much does a preschooler sleep?

about 12 hours a night and infrequently takes daytime naps.

When does the first permanent (secondary) teeth erupt?

about 6 years old with the "6 year old molar"

What are the symptoms of HAV?

abrupt onset,fever, malaise, anorexia, nausea, abdominal discomfort, dark urine, and jaundice

What are the three clinical observations that are predictive of epiglottitis?

absence of spontaneous cough, presence of drooling, and agitation.

What are options for pharmacologic management for mild pain ( <3 on 0-10 scale) or moderate pain (4 to 6 on 0-10 scale)?

acetaminophen (Tylenol, paracetamol) and NSAIDS are suitable

If the child is truly choking, the child can die within how long?

4 minutes

Sleep time declines slightly from ages _____ to ______ and then increases somewhat during the _________ growth spurt.

4 to 10 years pubertal

The addition of solid foods before _________ months is not recommended.

4 to 6

In adolescents, this is the time when the hormonal effect on the sebaceous glands produces ________. To them, even the most insignificant pimple may be viewed as a gross _______.

acne; disfigurement

What is one of the most common problems with a hearing aid?

acoustic feedback, an annoying whistle sound usually caused by improper fit of the ear mold.

The average weight gain during toddlerhood is __________ per year.

4-6 lbs

Children who have an acute febrile illness usually have limited ________. One of the cardinal sigs that the child is feeling better is the increase in ________.

activity; activity

During the early stage of adolescence, pressure to belong to a group is ___________.

intensified

The child with ARDS is cared for in the ___________ unit during the acute stages of the illness an involves close monitoring of _________ and respiratory status as well as cardiac __________, perfusion, fluid and electrolyte balance, and ________ function.

intensive care; oxygenation; output; renal

Most patients recover from bronchitis uneventfully in ________ days.

5 to 10

Practice sessions for toilet training should be limited to _________ minutes, and a parent should stay with the child, practicing _______ habits after every session.

5 to 8; sanitary

How is PPD administered?

5 tuberculin units using a 27 gauge needle and a 1 ml syringe intradermally into the volar aspect of the forearm.

What is preemptive analgesia?

involves administration of medications before the child experience the pain or before surgery is performed so that the sensory activation and changes in the pain pathways of the peripheral and CNS can be controlled.

What solid food should be introduced first?

iron fortified infant cereal because of its high iron content

Whole milk can cause ________ in infants.

iron-deficiency anemia

Somatic cells contain ______ autosomes (the _____ pairs of chromosomes that do not greatly influence sex determination at conception) and two sex chromosomes, ______ in females and _____ in males.

44; 22; XX; XY

The reaction to the TB skin test is determined when?

48 to 72 hours

To prevent burns, always check bathwater temperature; adjust water heater temp to what temp?

49C or 120F

Probably at no other time is the reproduction of adult behavior so faithful and absorbing as in ______ and _______ year old children. Toward the end of the preschool period, children are less satisfied with ___________ or pretend objects and enjoy doing the actual activity such as __________.

4; 5; make-believe; cooking

Children younger than ______ years should not use skateboards or in-line skates because they are not developmentally prepared to protect themseles from injury.

5

Suctioning should require no more than _____ seconds.

5

Breast milk may be stored in the refrigerator without danger of bacterial contamination for up to how long?

5 days

The ability to willfully turn form the abdomen tot he back occurs around _____ months, and the ability to urn from the back to the abdomen occurs at approximately _____ months.

5; 6

Maternally derived iron stores are present for the first ________ to _______ months of life and gradually diminish, which accounts for lowered ______ levels toward the end of the first 6 months.

5; 6; hemoglobin

By ______ years of age, viral respiratory tract infections are less frequent but the incidence of ______________ and ___________ infections increases.

5; Mycoplasma pneumoniae; GABHS

Children who do not have nighttime dryness by the age of ______ years are likely to require intervention.

6

Fluoride supplementation should be considered for any child older than _________ whose drinking water is deficient in fluoride.

6 months

The influenza vaccine is now recommended annually for children of what age?

6 months to 18 years

The influenza vaccine is now recommended annually for children of what ages?

6 months to 18 years of age

What is the "middle childhood" developmental period?

6 to 11 or 12 years

School age children and adolescents should engage in ________ or more of moderate to vigorous physical activity daily.

60

Vacuum pressure for suctioning should range from ___ to ____ mm Hg for infants and children and from ____to ____ mm Hg for preterm infants. Unless secretions are thick and tenacious, the_________range of negative pressure is recommended.

60-100; 40-60; lower

Children between _________ months and _________ years of age react more severely to acute respiratory tract infections.

6; 3

During the first year of life, especially the initial _______ months, growth is very rapid. Infants usually double their birth weight by ________ months.

6; 6

Pain: Several cognitive skills, such as measurement, classification, and seriation (the ability to accurately place in ascending or descending oder), become explicit between approximately what ages? Older children are able to use what pain rating scale?

7 and 10 years of age; 0-10 numeric rating scale that is currently used by adolescents and adults.

By age _________, infants can sit alone, leaning forward on their hands for support. By age __________ they can sit well while unsupported and begin to explore their surrounding s in this position rather than in a lying position. By age _________, they can maneuver from a prone to a sitting position.

7; 8; 10

When children reach a height of ________ , they should sleep in a bed rather than a crib.

89 cm (35 in)

By what time do infants comprehend the meaning of the word "no" and obey simple commands.

9 to 10 months

Generally, by 3 to 4 months of age, most infants have developed a nocturnal pattern of sleep that last ___ to ____ hours.

9; 11

What are some preventive strategies to avoid CI?

adequate prenatal care; optimal medical care of high-risk newborns; rubella immunization; genetic counseling and prenatal screening, especially in terms of Down or fragile X syndrome; use of folic acid supplements to prevent neural tube defects during pregnancy and during childbearing years; newborn screening for treatable inborn errors of metabolism, such as congenital hypothyroidism, phenylketonuria, and galactosemia.

What is multimodal or balanced analgesia?

A combination of medications used for postoperative pain and may include NSAIDs, local anesthetics, non-opioids, and opioid analgesics to achieve optimum relief and minimize side effects.

What is CRIES?

A pain assessment tool used by nurses who work with premature and full-term infants in the neonatal intensive care. Crying Requiring increased oxygen increased vital signs expression sleeplessness

Sometimes true relationships may be concealed. Like in what situations?

adoption or misattributed paternity

At what age do children usually give up on daytime naps?

age 3

What is hospice care?

A program of palliative and supportive care services that provides physical, psychologic, social, and spiritual care for dying persons, their families and other loved ones.

What is Reactive attachment disorder (RAD)?

A psychologic and developmental problem that stems from maladaptive or absent attachment between the infant and parent and may persist into childhood and even adulthood.

Various formulas involving ______, _____ and _______ as the basis for calculations have been devised to determine children's drug dosages.

age, weight, and body surface area (BSA)

______________ are one of the most widely used interventions for reducing anxiety in children undergoing procedures.

age-appropriate explanations

The _____ is the usual portal of entry for the TB organism.

airway

Chronic inflammation of the airway can cause permanent damage (________________) to airway structures, which cannot be prevented by and is not responsive to current _______.

airway remodeling; treatments

What kind of solution are used for children receiving an enema?

isotonic Plain water is not used because, being hypotonic, it can cause rapid fluid shift and fluid overload.

What are some triggers tending to precipitate or aggravate asthma exacerbations?

allergens (trees, shrubs, weeks, grasses, molds pollens, air pollution, dust, mold) tobacco smoke, wool smoke, odors, sprays exercise cold air changes in weather or temp environmental change colds and infections cats, dogs, rodents, horses meds (aspirin, NSAIDs, antibiotics, beta blockers) Strong emotions (fear, anger, laughing, crying) Some foods Menses, pregnancy, thyroid disease

What are conditions that weaken defenses of the respiratory tract and predispose children to infection?

allergies preterm birth bronchopulmonary dysplasia (BPD) asthma history of RSV infection cardiac anomalies that cause pulmonary congestion cystic fibrosis (CF)

How can you make a child feel more comfortable when going into surgery?

allow them to wear underpants or pajama bottoms into the OR and removed after induction of anesthesia.

Because feeding is a learning process, as well as a means of nutrition, new foods are given ________ to allow the child to learn new _______ and _______. Food should not be mixed in the bottle and fed through a nipple with a large whole.

alone; tastes; textures

What is a peripheral lock?

also known as intermittent infusion devise or saline or heparin lock, is an alternative to a keep-open infusion when extended access to a vein is required without the need for continuous fluid. It is most frequently used for intermittent infusion of medication into a peripheral venous route.

Inhalation of small amounts of noxious irritants produces _________ and _________ damage that can lead to obstructive bronchiolitis.

alveolar; bronchiolar

How can you determine the severity of infiltration and extravasation?

amount of redness, blanching, the amount of swelling, pain, the quality of pulses below infiltration, capillary refill, and warmth or coolness of the area.

What is exercise-induced bronchospasm (EIB)?

an acute, reversible, usually self-terminating airway obstruction that develops during or after vigorous activity, and usually stops in another 20 to 30 minutes. symptoms are cough, shortness or breath, chest pain, or tightness, wheezing, and endurance problems during exercise.

What is infectious mononucleosis?

an acute, self-limiting infectious disease that is common among adolescents

What is cued speech?

an adjunct to straight lipreading. It uses hand signals to help the child with a hearing impairment distinguish between words that look alike when formed by the lips.

How do children get cystic fibrosis?

an inherited as an autosomal recessive gratin; the affected child inherits the defective gene from both parents, with an overall risk of one in four in both parents carrying the gene.

Pacifier use during painful procedures in newborns has been shown to produce an _____ effect.

analgesic

Valium and Versed are not _________ and should be used to enhance the effects of analgesics and not as a _______ for them.

analgesics; substitute

What are the drugs that require safeguards (double checked by another nurse before giving them to a child)?

antiarrhythmics, anticoagulants, chemotherapy agents, and insulin.

What is the therapeutic management of conductive hearing loss?

antibiotic therapy for acute otitis media or insertion of tympanostomy tubes for chronic otitis media.

During middle childhood, children may engage in what is considered to be __________ behavior. Previously well-behaved children may engage in ________, _________, and ___________.

antisocial; lying, stealing, cheating

What is a somatic cell?

any body cell other than sperm or ova

What is a restraint?

any method, physical or mechanical, which restricts a person's movement, physical activity, or normal access to his or her body.

What is bullying?

any recurring activity that intends to cause harm, distress, or control towards another in which there is a perceived imbalance of power between the aggressor(s) and the victim.

What is developmental delay?

any significant lag in a child's physical, cognitive, behavioral, emotional, or social development when compared to developmental norms.

What are examples of organic central auditory imperception?

aphasia, the inability to express ideas in any form, either written or verbal. agnosia, the inability to interpret sound correctly dysacusis, difficulty in processing details or discriminating among sounds.

What is dyslalia?

articulation problems

Children with influenza (or other similar viruses) should not receive _________ because of its possible link with Rey syndrome.

aspirin

Parents are encouraged to avoid administering ________ to any child unless specifically recommended by a health practitioner. ________ is safe for children and is the analgesic of choice.

aspirin; acetaminophen

If a patient is treated without consent, the hospital or health care provider may be charged with ______.

assault

Acculturation maybe referred to as __________, which is the process of developing a new culture.

assimilation

What is a nonrandom pattern of malformations for which a cause has not been determined called?

association

Preschoolers especially enjoy what kind of play?

associative play--group play in similar or identical activities but without rigid organization or rules.

What is the most common chronic disease, the primary cause of school absences, and the third leading cause of hospitalizations in children younger than the age of 15.

asthma

Among children with asthma, there is an association between parental cigarette smoking and what?

asthma exacerbations, trips to the ER, medication use, and impaired recovery after hospitalization for acute asthma.

What is animism? Who has this characteristic?

attributing lifelike qualities to inanimate objects Toddlers

What is Sick-child care?

availabe for times when children are ill. Often located in community hospitals or in work settings.

How can you prevent TB?

avoid contact with TB, maintain optimal health, avoid fatigue and debilitating infections. Pasteurization and routine testing of milk and elimination of diseased cattle have reduced the incidence of bovine TB

What are some important discharge instructions for tonsillitis?

avoid irritating and highly seasoned foods avoid gargles or vigorous toothbrushing avoid coughing or clearing throat use analgesics or ice collar for pain limit activity to decrease potential for bleeding

What is the treatment of bronchitis?

it requires only symptomatic treatment, including analgesics, antipyretics, and humidity. Cough suppressants may be useful to allow rest but can interfere with clearance of secretions.

What are the clinical manifestations of cystic fibrosis?

Abdominal distention vomiting failure to pass stools rapid development of dehydration large, bulky, loos, frothy, extremely foul smelling stools weight loss marked tissue wasting failure to grow Anemia Wheezy respirations Dy, nonproductive cough increased dyspnea cyanosis clubbing of fingers and toes

What are malformations?

Abnormal formations of organs or body parts resulting form an abnormal developmental process. Most malformations occur before 12 weeks of gestation. Cleft lip for example.

What should the nurse address when the parents are concerned for addiction when opioids are prescribes?

Address these concerns with assurance that any such risk is extremely low. Children do not have the cognitive ability to make the cause-effect associated and therefore cannot become addicted. The use of opioid analgesics early in life has not been demonstrated to increase the risk for addiction later in life. Infants and children, when treated appropriately with opioids, may be at risk for physical tolerance and physical dependence but not psychologic dependence or addiction

Describe skill-play.

After infants have developed the ability to grasp and manipulate, they persistently demonstrate and exercise their newly acquired abilities through skill play, repeating an action over and over again.

What are the tree zones used for PEFR?

After the personal best value has been established (in a 2 to 3 week period when the child's asthma is stable), the child's current PEFR on any occasion can be compared with the personal best value. Green (80-90% of personal best) signals all clear. Asthma is under reasonably good control. No symptoms present. The routine treatment plan for maintaining control can be followed. Yellow (50-79%) signals caution. Asthma is not well controlled. An acute exacerbation may be present. Maintenance therapy may need to be increased. Call the practitioner if the child stays in this zone. Red (<50% of personal best) signals a medical alert. Severe airway narrowing may be occurring. A short-acting bronchodilator should be administered. Notify the practitioner if the peak expiratory flow rate does not return immediately and stay in yellow or green zones.

What is a quick guide to assessment of deciduous teeth during the first 2 years?

Age of the child in months minus 6.

What is the nursing care management of TB?

Airborne precautions and a negative-pressure room are required for children who are contagious and hospitalized with active TB. Children with no cough and negative sputum smears can be hospitalized in a regular room.

Some toddlers have temper tantrums that include holding their breath. Should the parents worry?

Although holding one's breath may cause fainting from the lack of oxygen, the accumulation of carbon dioxide will stimulate the respiratory control center, resulting in no physical harm. Rarely, breath-holding spells can involve symmetric tonic-clonic movements, which can be frightening to parents; the child recovers quickly when the spell is over, and their is no residual damage.

What is ASL?

American sign language is a visual gesture language that uses hand signals that roughly correspond to specific words and concepts in the English language.

What is temperament?

An infant's behavioral style influences the type of interaction that occurs between the child and parents, especially the mother.

How is Bacterial tracheitis treated?

it requires vigorous management with oxygen therapy, antipyretics, and antibiotics. Many children require endotracheal intubation and mechanical ventilation; patients are closely monitored for impending respiratory failure if not intubation. Early recognition to prevent life-threating airway obstruction is essential.

________, the masculinizing hormones are secreted in small and gradually increasing amounts up to about ______ years of age, at which time there is a more rapid increase in both sexes, especially boys, until about age _____ years. These hormones appear to be responsible fore most of the rapid ______ changes of early adolescence.

Androgens; 7 or 9; 15; growth

___________ is the most common croup syndrome.

laryngotracheobronchitis (LBT)

Croup syndromes can affect the _______, _______ and ______.

larynx, trachea, and bronchi

What is LTBI?

latent tuberculosis infection. Indicates infection in a person who has a positive TST, no physical findings of disease, and normal chest radiograph findings.

Foods known as allergenic such as peanuts, eggs, fish, and seafood should be introduced when?

later than 12 months

What should school aged children do to manage their stress?

learn relaxation techniques such as deep-breathing exercises, progressive relaxation of muscle groups, and positive imagery to immediately reduce stress.

____________ vaccines are generally not administered to anyone with an altered immune system. Why?

live virus; because multiplication of the virus may be enhanced, causing severe illness.

The ______ is the most immature of all the GI organs throughout infancy.

liver

What aspects do children assess of themselves in forming an overall evaluation of their self esteem?

Competence- cognitive, physical, and social skills Sense of control- completes tasks needed to produce desired actions Moral worth-actions and behaviors met moral standards Worthiness of love and acceptance- worthy of love and acceptance from parents, other significant adults, siblings, and peers.

What does the "prenatal period" consist of?

Conception to birth. Germinal - conception to 2 weeks Embryonic- 2-8 weeks Fetal- 8-40 weeks

How is cystic fibrosis diagnosed?

based on a positive sweat chloride test result, absence of pancreatic enzymes, radiography, COPD, and family history.

What are possible side effects of vaccines?

local tenderness, erythema, swelling at the injection site; low-grade fever; and behavioral changes (drowsiness, fretfulness, eating less, prolonged or unusual cry)

Why are parents cautioned regarding over-the-counter "cold" remedies?

because these often include acetaminophen. Careful calculation of both the acetaminophen given separately and the acetaminophen in combination medications is necessary to avoid an overdose.

It is advisable to never allow a child to take a bottle of milk to _______. Why?

bed; Tis is a major cause of caries in deciduous teeth.

When is it recommended that newborns receive HepB vaccine?

before hospital discharge

When does the first attack of asthma commonly occur?

before the age of 5 years (sometimes in infancy)

In epilepsy, headaches often occur when?

before, during, or after a seizure attack

What is magical thinking? Who has this characteristic?

believing that thoughts are all-powerful and can cause events toddlers

For chest tubes, ensure that the drainage system is positioned where?

below the patient's chest and secured to the floor or bed.

When does the appearance of imaginary companions occur?

between ages 2 1/2 and 3 years.

What are congenital anomalies?

birth defects (deformations, disruptions, dysplasias, or malformations)

What are the five markers that signal a child's readiness to toilet train?

bladder readiness bowel readiness cognitive readiness motor readiness psychologic readiness

T/F Physical skills are typically delayed more than Verbal skills in children with CI.

False. Verbal skills are typically delayed more than other physical skills.

T/F Formula fed infants have a lower incidence of otitis media than do breast fed infants.

False. its just the opposite

T/F Physical maturity is correlated with emotional and social maturity.

False. not necessarily. Seven year old children who look like 10 year old children still will think and act like seven year old children.

Disorders of hearing are divided according to the ________ of the defect.

location

T/F An infant who does not pull to a standing position by 8 to 9 months of age should be further evaluated for possible developmental dysplasia of the hip.

False; 11 to 12

In infants up to 11 months of age and children with neurologic impairments, how can you elicit the swallow reflex for administration of liquid medication?

blowing a small puff of air in the face

A vital component of self-concept, _________ refers to the subjective concepts and attitudes that individuals have toward their own bodies.

body image

Children's dosages are most often expressed in units of measure per _______

body weight (mg/kg)

If breastfeeding is terminated before 5 or 6 months of age, weaning should be to a _______. Why? If breastfeeding is terminated later, weaning can be directly to a ______. Especially by ate ______ to ____ months.

bottle; to provide for the infant's continued sucking needs. Cup; 12 to 14

Which training is usually accomplished first, bowel or bladder?

bowel because it is of greater regularity and predictability.

How can you prevent sunburn?

Apply sunscreen with a sun protectant factor (SPF) of 15 or greater all year around while in the sun, dressing in protective clothing, avoiding sun exposure between 10am and 2 pm.

Describe Chronic sorrow.

As a part of the normalization process, home care nurses should be aware that parents may experience this as a parental stressor. It is a normal grief response associated with a living loss (the loss of a healthy child)that is a cyclical in nature.

The nurse should provide a ________ form for the child to sign, and the child should keep a copy. By including the child in the decision-making process and gaining his or her acceptance, staff members demonstrate _____ for the child.

Assent; respect

When should the first dentist visit occur?

At six months of age or within 6 months of the eruption of the first tooth.

Toddlers should be encouraged to drink from a cup when? Toddlers should be weaned from a bottle by when?

At the first birthday; 14 months of age.

T/F Comforting the infant too much or meeting his or her needs will result in a spoiled child.

Flase. There is no evidence that supports this.

_________, an essential mineral for building caries-resistant teeth, is needed beginning at 6 months of age if the infant does not receive water with adequate fluoride content.

Fluoride

How do you diagnose foreign body aspiration?

bronchoscopy is required for definitive diagnosis of objects in the larynx and trachea.

When does crying tend to decrease? (from up to hours a day)

by 12 weeks

In infants younger than 3 months of age who are febrile, urine specimens should be collected how?

by catheterization

How can you assess adequate circulation before arterial puncture?

by observing capillary refill or performing the allen test, a procedure that assesses the circulation of the radial, ulnar, or brachial arteries.

When is the eruption of the deciduous (primary) teeth complete?

by the beginning of the preschool period

How is Hep A virus (HAV) spread?

by the fecal-oral route

Why is it important to promote hydration in children with respiratory dysfunction?

Because dehydration is a potential complication when children have respiratory tract infections and are febrile or anorectic, especially when vomiting or diarrhea is present. Rapid respiratory rate that accompanies such illnesses precludes adequate oral fluid intake. The presence of fever increases the total body fluid turnover in infants.

How can you avoid behavioral outbursts in children with ASD?

Because physical contact often upsets these children, minimal holding and eye contact may be necessary

Substituting skim or low-fat milk is unacceptable in infants younger that 6 months. Why?

Because the essential fatty acids are inadequate, and the solute concentration of protein and electrolytes, such as sodium, is too high.

Why is it true that often, a nurse is the first on eto recognize the need for genetic evaluation?

Because they often identify an inherited disorder in a family history or by noting physical, cognitive, or behavioral abnormalities when performing a nursing assessment.

When does the "school years" start and end?

Begins with entrance into the school environment. Physiologically begins with the shedding of the first deciduous tooth and end at puberty with the acquisition of the final permanent teeth.

What does the "infancy period" consist of?

Birth to 12 months Neonatal- Birth to 27 or 28 days Infancy- 1 to 12 months

During the second half of the first year, what should optimally be the primary source of nutrition.

Breast milk

What are the effects of tanning the skin?

long term effects include premature aging of the skin; increased risk of skin cancer; and, in susceptible individuals,photo toxic reactions.

_________ is responsible for more than half of all fatal inhalation poisonings in the US.

CO (colorless, odorless gas with an affinity for hemoglobin 230 times greater than oxygen)

What are the two categories of asthma medications?

long-term control medications (preventative) to achieve and maintain control of inflammation, and quick-relief medications (rescue) to treat symptoms of exacerbations.

What are the clinical manifestations of tonsillitis?

Caused by inflammation. As the palatine tonsils enlarge from edema, they may meet in the midline, obstructing he passage of air or food. The child has difficulty swallowing and breathing. It is difficult or impossible for air to pass from the nose to the throat. As a result, the child breaths through the mouth.

______________ includes all hearing losses that are not linked to defects in the conductive or sensorineural structures. They are usually divided into organic or functional losses. What is organic type of central auditory imperception? What is functional type of central auditory imperception?

Central auditory imperception the defect involves the reception of auditory stimuli along the central pathways and the expression of the message into meaningful communication. no organic lesion exists to explain a central auditory loss.

Adolescents find it hard to believe that sex can exist without ________, therefore, they view each relationship as ______.

love; real love

____________ involves gases that may be generated during the combustion of materials such as clothing, furniture,and floor coverings

Chemical injury

What children are at greater risk than other children for under-treatment of pain because they have medical problems that may cause pain and undergo painful procedures?

Children who have significant difficulties in communicating with others about their pain include those with significant neurologic impairments (cerebral palsy), mental retardation, metabolic disorders, autism, severe brain injury, and communication barriers (critically ill children who are on ventilators or are heavily sedated)

How will nurses and medical professionals need to later their methods for children with ASD?

Children with ASD need to be introduced slowly to new situations, with visits with staff caregivers kept short whenever possible. Because these children have difficulty organizing there behavior and redirecting their energy, they need to be told directly what to do. Communications should be at the child's developmental level, brief, and concrete.

The first primary teeth to erupt are the ________, which appear at approximately _________ of age.

lower central incisors; 6-10 months

____________ are anti-inflammatory drugs used to treat reversible airflow obstruction, control symptoms, and reduce bronchial hyper-responsiveness in chronic asthma.

Corticosteroids

________ of care is an important factor in health care delivery system today.

Cost

Give a list of diseases that may require ongoing health care needs as a result of the disease, it's treatment, or the side effects of it's treatment.

cancer, kidney disorders, cystic fibrosis, spina bifida, cardiac and respiratory disorders, go disorders, neurogenerative diseases, and HIV infection

What are the signs of severe distress when a child is choking?

cannot speak, becomes cyanotic and collapses

Continuous monitoring of the child's ______ status is essential during the immediate postoperative period.

cardiopulmonary

The child with status asthmaticus should be placed on continuous _____________ and __________________ monitoring.

cardiorespiratory (including blood pressure) and pulse oximetry

A valuable tool for nurse case managers is the ________, which is a multidisciplinary care plan aimed at measuring the quality of patient care outcomes derived from standardized patient outcomes.

care path

How is pain controlled for circumcision?

caudal or penile blocks are used before the procedure. Then the patient's parents are instructed how to apply lidocaine gels for the first 24-36 hours afterwards.

What is a vesicant agent?

causes varying degrees of cellular damage when even minute amounts escape into surrounding tissue.

______________ is a general term that encompasses any type of mental difficulty or deficiency.

Cognitive impairment (CI)

What may be a means of relieving pain and suffering when there is no feasible or acceptable means of providing analgesia that preserves alertness?

Continuous sedation

____________ opioids facilitate ATC dosing and improve sleep. They are also associated with lower incidence of nausea, sedation, and breakthrough pain.

Controlled-released

What is cultural shock?

characterized by the inability to respond to or function within a new or strange situation. It can occur when the values and beliefs of a new cultural setting are radically different from those of the person's native culture.

______ and _________ is often part of the therapy for smoke inhalation, as well as mechanical ventilation if needed.

chest percussion and postural drainage.

Who will develop dyslalia?

children pressured into producing sounds ahead of their developmental level. Or they might revert to using infantile speech.

Who should not receive the influenza vaccine?

children who have reported anaphylactic hypersensitivity to eggs

Who is the influenza vaccine contraindicated for?

children with Guillain-Barre syndrome, children who are immunocompromised, have reactive airway disease, are receiving immunosuppressive therapy, have a febrile illness, are receiving aspirin therapy, have a chronic respiratory condition, have received a live vaccine in the previous 28 days, are pregnant, or who have had anaphylactic reactions to egg.

For which children are medical-surgical restraints used?

children with an artificial airway or airway adjunct for delivery of oxygen, indwelling catheters, tubes, drains, lines, pacemaker wires, or suture ties.

What is permanency planning?

children with special health care needs obtain permanent family placement and ongoing relationship with caring adults.

All objects within reach of children younger than 3 years of age should pass the _____ test.

choke tube

Genetic disorders can be caused by ______ abnormalities as seen in Turner syndrome, Down syndrome, or velocardiofacial syndrome; singe-gene mutations as seen in sickle cell anemia, neurofibromatosis, or Duchenne muscular dystrophy; a combination of genetic and environmental factors.

chromosome

Pain that persists for 3 moths or more or beyond the expected period of healing is defined as what?

chronic pain

Poorly controlled acute pain can predispose patients to what?

chronic pain syndromes

School-age children develop _________ skills. They can group and sort objects according to the attributes they share, place things in a sensible and logical order, and hold a concept in mind while making decisions based on that concept.

classification

What are the contraindications of tonsillectomy or adenoidectomy?

cleft palate; acute infections at the time of surgery; uncontrolled systemic diseases or blood dyscrasias; poor anesthetic risk.

What are the methods for assessing compliance in patients?

clinical judgement, self-reporting, direct observation, monitoring appointments, monitoring therapeutic response, pill counts, chemical assay (plasma drug levels)

What are the five components of cultural competence?

Cultural awareness- a cognitive process through which the nurse appreciates and is sensitive to the cultural values of the patient and family Cultural knowledge- the foundation the nurse builds through formal and informal education that includes world views of different cultures, values, beliefs, and perceptions about health and illness Cultural skill- the ability to include cultural data in the nursing assessment through the collection of cultural data in the health interview and observations Cultural encounter- the process through which the nurse seeks opportunities to engage in cross-cultural interactions directly or indirectly Cultural desire- the genuine and sincere motivation to work effectively with minority clients

_________ is a rich context through which people view and respond to their world. It is composed of individuals who share a set of values, beliefs, practices, social relationships, laws, politics, economics, and norms of behavior that are learned, integrative, social, and satisfying.

Culture

Casein in milk causes the milk to form _________. Why?

Curds. Curds are coagulated semisolid particles of milk. The curds cause milk to be retained in the stomach long enough for digestion to occur.

Individuals who have severe, unrelieved pain become intenly focused on fiding relief. Sometimes behaviors such has _______ make patients appear to others to be preoccupied with obtaining opioids.

clock watching

Genes are segments of _______ that specify for _______, segments of proteins or strands of _________ necessary to control physiologic function or characteristics.

DNA; proteins; RNA

If sudden deterioration of an intubated patient occurs, consider what etiologies?

DOPE: Displacement- the tube is not in the trachea or has moved into a bronchus Obstruction- secretions or kinking of the tube Pneumothorax- chest trauma, barotraumas, or noncompliant lung disease Equipment failure- check the oxygen source, Ambu bag, and ventilator.

Continuous __________ may be instituted for pneumonia when purulent fluid is aspirated. If a large amount of purulent drainage is obtained, an appropriate ________ may be instilled into the chest cavity.

closed chest drainage; antibiotic

What are autism spectrum disorders (ASDs)?

complex neurodevelpmental disorders of unknown etiology composed of qualitative alterations in social interaction and verbal impairment with repetitive, restricted, and stereotype behavioral patterns.

Children's _______ vocabulary is greater than their __________ vocabulary.

comprehension (what they understand); expressed (what they can say)

_______ is always a hazard when children have a fever or anorexia, especially when accompanied by vomiting or diarrhea.

Dehydration

What is the principle oral problem in children and adolescents?

Dental caries (cavities)

What is the concept of normalization?

Describes the process whereby families of children with chronic illness over time begin to perceive the child and their family life as normal.

________ is a gradual change and expansion; advancement form lower to more advanced stages of complexity; the emerging and expanding of the individual's capacities through growth, maturation, and learning.

Development

In the absence of clear-cut evidence of CI, ti is more appropriate to use a diagnosis of ______________.

Developmental delay

_________ is the processes by which early cells and structures are systematically modified and altered to achieve specific characteristic physical and chemical properties; sometimes used to describe the trend of mass to specific; development from simple to more complex activities and functions.

Differentiation

___________, such as vocalization, facial expression, and body movement, have been associated with pain.

Distress behaviors

__________ or middle-ear hearing loss results from interference of transmission of sound to the middle ear. It is the most common of all types of hearing loss and most frequently a result of recurrent serous ________. This type of hearing impairment involves mainly interference with _________ of sound.

conductive; otitis media; loudness

Among individuals with CI, a sizable proportion of the cases are linked to ______,______, or _______.

Downs Syndrome, fragile X syndrome, fetal alcohol syndrome

In the newborn and early infancy periods, few signs of CI are present, with the exception of ____________. After this stage, however, delayed ___________ are the major clues to CI.

Downs syndrome; developmental milestones

What is the most common eye infection?

conjunctivitis

How can parents help a child with sleep problems?

consistent bedtime ritual ignore attention-seeking behavior and not take the child into the parent's bed or allow the child to stay up past a reasonable hour. keeping a light on in the room providing transitional objects such as a favorite toy. leaving a drink of water by the bed. helping child slow down before bedtime bath or story before bed "after this story, it is time for bed"

What is the most frequent symptom after pain medications are administered?

constipation

What does the lower respiratory tract consist of?

lower trachea, mainstem bronchi, segmental bronchi, sub-segmental bronchioles, terminal bronchioles, and alveoli.

Describe separation anxiety.

During the early second half of the first year, infants protest when placed in their cribs, and a short time later, they object when there mothers leave the room. Infants may not notice the mother's absence if they are absorbed in an activity. However, when they realize her absence, they protest. From this point on, they become alert to her activities and whereabouts. By 11 to 12 months, they are able to anticipate her imminent departure by watching her behaviors and then begin to protest before she leaves.

What are early behavioral signs of suggestive cognitive impairment?

Dysmorphic features Irritability or unresponsiveness to contact abnormal eye contact gross motor delay decreased alertness to voice or movement language difficulties or delay feeding difficulties.

What are suitable toys for preschoolers?

Easy construction sets, large blocks of various sizes and shapes, a counting frame, alphabet or number flash cards, paints, crayons, simple carpentry tools, musical toys, illustrated books, simple sewing or handicraft sets, large puzzles, and clay.

What are the nursing guidelines for interviewing adolescents?

Ensure confidentiality Offer a nonthreatening explanation for the questions that you ask Avoid assumptions, judgments, and lectures Ask open-ended questions Begin with less sensitive issues Clarify terms

Parents should respect their teenager's independence and move toward the role of _________ about health issues while maintaining some level of involvement throughout adolescence.

consultant

What precautions are initiated for RSV?

contact and standard are used. Droplet is recommended.

Preschoolers' thinking is often described as what?

magical thinking

_________, the feminizing hormone, is found in low quantities during childhood. This hormone is secreted in slowly increasing amounts until about age ______ years.

Estrogen; 11

What are four ways to ensure cooperation before a procedure?

Expect success, involve the child (give them choices), provide distraction (favorite songs, books, toys), Allow expression of feelings

Pertussis is highly _________ and is particularly threatening in __________, who have a higher morbidity and mortality rate.

contagious; young infants

Tantrums are an indication of the child's inability to do what?

control emotions

What are examples of functional type of hearing loss?

conversion hysteria, infantile autism, and childhood schizophrenia

T/F You should freeze liquid filled teething rings to help with inflammation.

False

T/F Exaggerating pronunciation or speaking in an altered rhythm will enhance comprehension in children with hearing impairments.

False.

T/F To aid a child who is choking, a blind sweep of the child's mouth should be performed.

False. A blind sweep should never be performed because it may lodge the agent farther into the airway.

T/F Stealing is an unexpected behavior in young children.

False. As with other ethically related behavior, stealing is not unexpected. But they are equally as likely to give away something valuable that belongs to them

T/F School aged children should compete in sports that are segregated by gender.

False. Before puberty, there is no essential difference in strength and size between girls and boys, making these precautions unnecessary.

T/F Breastfeeding is a contraindication of all vaccines.

False. Breastfeeding is not a contraindication for any vaccine.

T/F Oral rehydration solutions such as Infalyte or Pedialyte, should be considered for infants, and fluids with caffeine such as coffee or tea should be considered for older children.

False. Caffeinated beverages should be avoided because they may act as diuretics and promote fluid loss. A low-carbohydrate flavored drink should be considered instead.

T/F Infants, young children, and children who are weak, paralyzed, agitated, confused, sedated, or cognitively impaired may be lift unattended on treatment tables, scales, or in treatment areas because they are incapable of mobility.

False. Even premature infants are capable of surprising mobility.

T/F Ice water is indicated for elevated temperatures from hyperthermia.

False. Ice water and alcohol are potentially dangerous solutions. Small frequent sips of clear liquids is appropriate along with reduced activity.

T/F Daycare attendance and exposure to second hand smoke decreases the likelihood of infection.

False. It increases

T/F Acute epiglottitis usually goes away on its own in a couple of days.

False. It is a medical emergency!

T/F Assent is a legal requirement.

False. It is an ethical requirement to protect the rights of children

T/F Legal blindness is a medical diagnosis determined by the child's pediatrician.

False. It is not a medical diagnosis but a legal definition.

T/F It is sufficient to place a mobile over a crib and toys in a play yard for a child's optimum social, emotional, and intellectual development.

False. It is not sufficient

T/F Families susceptible to respiratory infections should have steam vaporizers in their home.

False. It is often discouraged because of the hazards related to their use

T/F Bronchitis is a bacterial lower respiratory infection.

False. It is usually viral

T/F Fruit juices may be introduced at 6 months of age.

False. Many juices do not provide sufficient and appropriate caloric intake for infants younger than 12 months of age; such drinks may replace the nutrients in breast milk and lead to growth or health problems.

T/F School age children need to be fed more promptly and more frequently than preschool children.

False. Maturity of the GI system is reflected in fewer stomach upsets; better maintenance of blood glucose levels; and an increased stomach capacity, which permits retention of food for longer periods.

T/F Home health care of children is restricted to children with chronic health care needs.

False. Short-term intermittent therapies such as phototherapy, apnea monitoring, chemotherapy, and IV antibiotic administration may be successfully provide in a home.

T/F Females maintain a temperature slightly below that of males throughout life.

False. Slightly above

T/F Toddlers practice solitary play.

False. Solitary play is during infancy which progresses to parallel play in toddlerhood.

T/F Preschoolers no longer require assistance and supervision with brushing and flossing their teeth.

False. These tasks should be performed by the parents

T/F Infants who are breastfed beyond 4-6 months of age typically gain more weight than those who are bottle fed, yet their head circumference is than adequate.

False. They gain less weight and their head circumference is more than adequate.

T/F Children should be taught to discard their toothbrushes immediately after symptoms of strep throat show up.

False. They should discard their toothbrushes after they have been taking antibiotics for 24 hours.

What are signs and symptoms associated with respiratory tract infections in infants and small children?

Fever (first sign) Poor feeding and anorexia Vomiting Diarrhea (often with viral infections) Abdominal pain (common complaint) Nasal blockage Nasal discharge-- may be thin and water (rhinorrhea) or thick and purulent Cough (may be evident only in acute phase) Respiratory sounds Sore throat Meningismus- meningeal signs without infection of the meninges (headache, pain and stiffness in the back and neck)

What are respiratory sounds associated with respiratory disease?

cough hoarseness grunting stridor wheezing

What are clinical manifestations of asthma?

cough shortness of breath prolonged expiratory phase audible wheeze red ears lips deep, dark red color cyanosis or nail beds restlessness apprehension prominent sweating older children sitting upright with shoulders in a hunched over position, hands on the bed or chair, and arms braced speaking with short panting phrases hyper-resonance on percussion coarse, loud breath sounds crackles Barrel chest elevated shoulders use of accessory muscles of respiration.

When is bronchial drainage performed?

Four times daily. Before meals to minimize the chance of vomiting and at bedtime.

What is acute streptococcal pharyngitis?

GABHS (Group A Beta-Haemolytic Streptococcus) infection of the upper airway (strep throat)

What illness would you suspect if your child had these symptoms: Abrupt onset. pharyngitis, headache, fever, abdominal pain. The tonsils and pharynx are inflamed and covered with exudate on the second day of illness. What other symptoms might there be?

GABHS (strep throat). Other symptoms may include: The tongue may appear edematous and red, and the child may have fine sandpaper rash on the trunk, axillae, elbows, and groin as seen in scarlet fever. The uvula is edematous and red. Pain can be relatively mild to severe enough to make swallowing difficult. Clinical manifestations usually subside in 3 to 5 days.

__________ (propelling forward with the belly on the floor) progresses to __________ on hands and knees (with the belly off the floor) by 9 months.

crawling; creeping

Some viral or bacterial agents produce a mild illness in older children but severe lower respiratory tract illness or _________ in infants.

croup

What are the symptoms of bacterial tracheitis?

croupy cough, stridor unaffected by position, toxicity, absence of drooling, and high fever. thick, purulent tracheal secretions are common and respiratory difficulties are secondary to these copious secretions. The child's white cell count will be elevated.

What is infant's first means of verbal communication?

crying

What can cause pneumonias in: Neonates Infants Preschool children School age children

Group B strep RSV RSV, influenza M. pneumonia, Chlamydia pneumonia, M. tuberculosis, and respiratory viruses.

What are the most frequently reported pain behaviors in children with communication and cognitive impairments?

crying, being less active; seeking comfort; moaning; not cooperating; being irritable; being stiff, spastic, tense or rigid; sleeping less; being difficult to satisfy or pacify; flinching or moving a body part away; and being agitated or fidgety.

What puts the child at risk for aspiration of medication?

crying, especially if laying down

School is the center of ________ wherein the cultural standards of the larger group are disseminated to the local community.

cultural diffusion.

Any sweet liquid such as fruit juice, should be given in a _______ and not at _____.

cup; bedtime

What is the rate of head growth during the first 6 months?

Head circumference increases approximately 1.5 cm per month for the first 6 months.

Additional therapies in acute asthma attacks include the use of IV ______________ , a potent muscle relaxant that acts to decrease inflammation and improves pulmonary function and peak flow rate among pediatric patients treated in the ED with moderate to severe asthma.

magnesium sulfate.

____________ involves thermal injury to the upper airway. Air has low specific heat; therefore, the injury goes no farther than the upper airway. Reflex closure of the _________ prevents injury to the lower airway.

Heat injury; glottis

What is a black eye? What should you do for a black eye?

Hematoma of the eye; apply ice for first 24 hours to reduce swelling if no hyphema is present. Refer to an ophthalmologist immediately if hyphema is present. Have child rest with eyes closed.

_________ may occur after tonsillectomy surgery as a result of tissue sloughing from the healing process. Any sign of ___________ warrants immediate medical attention.

Hemorrhage; bleeding

What is the major objective in medical management of acute laryngotracheobronchitis?

maintaining the airway and providing adequate respiratory exchange. The application of humidity with cool mist provides relief for most children. A cool-air vaporizer can be used at him. Nebulized epinephrine is often used in children with severe disease, stridor at rest, retractions, or difficulty breathing.

What are general signs of pneumonia?

High fever Cough (unproductive to productive w/white sputum Tachypnea Crackles and rales Dullness with percussion Chest pain retractions nasal flaring pallor to cyanosis Diffuse or patchy infiltration on Chest radiography irritable, restless, malaise, lethargy Anorexia, vomiting, diarrhea, abdominal pain

What is the most desirable complete diet for infants during the first 6 months.

Human milk.

What is neuropathic pain?

Pain that is described as electric or shock-like, stabbing or burning; signs of neurologic involvement (paralysis, neuralgia, pain hypersensitivity) other than those associated with the progression of the cancer; and the location of the solid organ cancer consistent with neurologic damage

Recurrent abdominal pain or functional abdominal pain is defined as what?

Pain that occurs at least once per month for 3 consecutive months accompanied by pain-free periods and is severe enough that it interferes with a child's normal activities.

What is the difference between hyperpyrexia and hyperthermia?

Hyperpyrexia (Fever) is an elevation in set point such that body temp is regulated at a higher level; may be arbitrarily defined as temp above 38C (100.4F) Hyperthermia is body temp exceeding the set point, which usually results from the body or external conditions creating more heat than the body can eliminated, such as in heat stroke, aspirin toxicity, seizures, or hyperthyroidism.

For the patient with pulmonary edema, close monitoring of ___________, electrolytes and comfort is important.

I&O

Where/how is the HepB vaccine given?

IM in the vastus laterals in newborns or in the deltoid for older infants and children.

What is the recommended drug therapy for treating TB?

INH, rifampin, and pyrazinamide

When should parents notify a health professional when their child is experiencing signs of respiratory infection?

If complications occur of the child does not improve within 2 or 3 days.

When is it legal to treat a minor without parent's consent?

In a life threatening emergency, or if child abuse or neglect is suspected

What is egocentrism? Who has this characteristic?

Inability to envision situations from perspectives other than one's own. Toddlers

What is infiltration?

Inadvertent administration of a nonvesicant solution or medication into surrounding tissue.

What is Extravasation?

Inadvertent administration of vesicant solution or medication into surrounding tissue.

What is glaucoma?

Increased intraocular pressure. Increased pressure on optic nerve causes eventual atrophy and severe permanent visual impairment.

How must infants be transported for extended trips?

Infants and children should be securely transported in a suitable conveyance. Never carried outside the unit.

A change in vital signs that demands immediate attention in the preoperative period is caused by what?

malignant hyperthermia (MH)-a potentially fatal pharmacogenic disorder involving a defective calcium channel in the sarcoplasmic reticulum membrane.

Before undergoing any invasive procedure, the patient or the patient's legal surrogate must receive sufficient information on which to make an informed health care decision. What is this called?

Informed consent

____________ replaces the term "mental retardation" (MR).

Intellectual disability

What are the four categories of Asthma? (based on the symptoms indicators of disease severity)

Intermittent- symptoms less than 2 days a week. Nighttime awakenings less than 2 nights per month. No interference with normal activity. Use of short acting B-agonist for symptom control less than 2 days a week. Mild-symptoms greater than 2 times a eek but less than 1 time per day. Nighttime symptoms 1 to 2 times a month. Minor limitation/interference with normal activity. Use of short acting B agonist for symptom control >2 days per week but not daily. Persistent Moderate persistent- Daily symptoms. Nighttime symptoms 3 to 4 times a month. Some limitation with normal activity. Use of short acting B agonist for symptom control daily. Severe persistent- Symptoms are continual throughout the day. Frequent nighttime symptoms (more than once a week). Interference with daily activity is extremely limited. Use of short acting B agonist for symptom control is several times a day.

What is the therapeutic management of sensorineural hearing loss?

It is less satisfactory because the defect is not one of intensity of sound, hearing aids are of less value in this type of defect. The use of cochlear implants provides a sensation of hearing for individuals who have severe or profound hearing loss.

How can you help prevent "food jags" in toddlers?

It is recommended that parents present food in various physical forms.

How should parents react to their school aged child lying, cheating or stealing?

It is seldom helpful to trap children into admission by asking directly if they committed the offense. children do not take responsibility for these behaviors until the end of middle childhood. It is wise not to attempt to attach a hidden or deep meaning to the stealing. Have the child pay back the money or return the stolen items. If children's personal rights are respected, they are likely to respect the rights of others.

____________ is apparent when the child displays signs of respiratory distress and a suction catheter cannot be passed to the end of the tube despite several attempts and instillation of saline. This situation requires an immediate ________.

Life-threatening occlusion; immediate tube change

what is friction?

damage is usually limited to the epidermal and upper layers. occurs when the surface of the skin rubs against another surface, such as bed sheets. It most often occurs over the elbows, heels, or occiput. By itself, friction cannot cause tissue necrosis.

What are school aged children afraid of?

dare, excessive worry about past behavior, self-consciousness, social withdrawal, and an excessive need for reassurance.

What are preschoolers afraid of?

dark, being left alone, large animals, ghosts, castration, annihilation.

Describe unoccupied behavior play.

daydream, fiddle with clothes or other objects, or walk aimlessly

What are some conditions that decrease resistance to pathogens?

deficiencies of the immune system malnutrition anemia fatigue chilling of the body

Pregnancy is a contraindication to ________ vaccines.

MMR.

Excessive consumption of fruit juices and other sweetened beverages has been associated with adverse health effects such as what?

dental carries, GI conditions such as chronic diarrhea, and diets poor in nutritive value.

The emotional functioning domain most often refers to _____ and _____ because they are elevated in children with chronic and recurrent pain. ________ is also common in chronic and recurrent pain.

depression; anxiety; sleep disruption

What are "latchkey children"?

describe children who are left to care for themselves before or after school without the supervision of an adult.

_________ is an increase in competence and adaptability; aging; usually used to describe a qualitative change; a change in the complexity of a structure that makes it possible for that structure to begin functioning; to function at a higher level.

Maturation

Describe large family child care homes.

May provide care for 8 to 12 children.

What is the pathophysiology of otitis media?

Mechanical or functional obstruction of the eustachian tube causes accumulation of secretions in the middle ear.

Parents of adolescents need support and guidance to help them through this trying time. they need to understand the changes taking place and to accept the expected behaviors that accompany the process of _____________. Parents may need help to "_______" and to promote the changed relationship form one of ________ to ___________.

detachment; let go; dependence; mutuality

What is the greatest danger to children with the flu?

development of a secondary infection

What is the cause of down syndrome?

Most cases of down syndrome are attributable to an extra chromosome 21 (group G), thus the name nonfamilial trisomy 21. These children are born to parents of all ages, there is a statistically greater risk in older women.

Drugs frequently used to relieve anxiety, cause sedation and provide amnesia are....

diazepam (Valium) and midazolam (Versed)

Many of the familial, social, and environmental factors known to cause milked impairment are__________. Counseling and education can reduce or eliminate factors such as poor _________, ___________, and ____________ abuse, which increase the risk of prematurity and _____________.

preventable; nutrition; cigarette smoking; chemical; intrauterine growth restriction.

A guiding principle in pain management is that ___________ of pain is always better than treatment.

prevention

Overeating and under-eating during adolescents presents special problems. When they experience the normal increase in weight and fat deposition of the growth spurt, teenage girls often resort to __________. The desire for a slim figure and fear of becoming "fat" prompt teenage girls to embark on nutritionally inadequate reducing regimens that drain their ________ and deprive their growing bodies of essential __________.

dieting; energy; nutrients.

Boys who bully tend to use physical force, referred to as ________ bullying, but girls usually use ________ bullying methods, such as exclusion, gossip, or rumors.

direct; indirect

In RSV, dilation of bronchial passages on inspiration allows sufficient space for intake of air, but narrowing of the passages on expiration prevents air from leaving their lungs. Thus, air is trapped ________ to the obstruction and causes progressive ___________.

distal; overinflation (emphysema)

By 4 or 5 years of age, they need little if any assistance with _______, ________ or ___________.

dressing,e ting, or toileting.

What is the evidence that a child is teething?

drooling, gum rubbing, increased finger sucking, or biting on hard objects. Others are very irritable, have difficulty sleeping, and refuse to eat solid foods.

Pediatric home care nurses have two distinct areas of implementation of care. What are they?

Nurses who perform intermittent skilled nursing visits may see many different types of numbers of patients each day. These nurses typically have a caseload assigned to them and accept responsibility for implementing the care plan. Nurses who perform private-duty nursing or block nursing are usually assigned individual patients, and they remain in the home for a predetermined time (8 to 12 hour blocks). The care plan is implemented over the course of the time in the home.

How can parents assess their child's level of hydration?

Observe the frequency of voiding and notify the nurse if there is insufficient voiding. Counting the number of wet diapers in a 24 hour period is a satisfactory method to assess output in infants and toddlers.

What is therapeutic play?

One of the most effective interventions which includes well-supervised activities such as permitting the child to give an injection to a doll or stuffed toy to reduce the stress of injections.

Wht is an emancipated minor?

One who is legally under the age of majority but is recognized as having the legal capacity of an adult under circumstances prescribed by state law, such as pregnancy, marriage, high school graduation, independently living, or military service.

Children are able to increase participation with other in which types of play?

Onlooker play- watch what other children are doing. Solitary play- children play alone with other children in the same area. They enjoy the presence of other children but make no effort to speak with them. Parallel play- children play independently among other children. They play with toys similar to those around them but not being influenced by the other children. Associative play- children play together and are engaged in a similar or even identical activity but there is no organization, division of labor, leadership, or mutual goal . Cooperative play- organized, and children play in a group with other children. They discuss and play activities for the purposes of accomplishing an end.

What are the options for pharmacologic management for moderate (5 to 6) to severe (7 to 10) pain?

Opioids are needed. A combination (acetaminophen with codeine) works better in some cases because non-opioids act at the peripheral nervous system, and opioids act at the CNS. Oxycodone is available. Morphine is considered the gold standard for the management of severe pain. When morphine is not suitable opioid, drugs such as hydromorphone (Dilaudid) and fentanyl (Sublimaze) are effective substitutes.

Teething infants show more mouthing and _________ than non-teething infants. A topical anesthetic such as _______, cold or frozen teething rings, and hard crackers or bread can alleviate _______ during teething.

drooling; benzocaine; pain

When should you verify placement of an intubation?

during each transport and when patients are moved to different beds.

What is the therapeutic management for streptococcal sore throat?

Oral penicillin is prescribed for at least 10 days. IM benzathine penicillin G is an appropriate therapy, but it is painful and is not the first choice for children. Oral erythromycin is indicated for children who are allergic to penicillin.

Describe the personality, cognitive, and moral development theories: PSYCHOSEXUAL (FREUD) Infancy-Brith-1 year Toddlerhood- 1-3 years Early childhood 3-6 years Middle childhood 6-12 years Adolescence 12-18 years

Oral- the major source of pleasure seeking is centered on oral activities such as sucking, biting, chewing, and vocalizing. Anal- Interest during the second year of life centers in the anal region as sphincter muscles develop and children are able to withhold or expel fecal material at will. Phallic- During the phallic stage, the genitalia become an interesting and sensitive area of the body. Children recognize differences between the sexes and become curious about the dissimilarities. Latency- during the latency period, children elaborate on previously acquired trains and skills. Physical and psychic energy are channeled into acquisition of knowledge and vigorous play. Genital- the last significant stage begins at puberty with maturation of reproductive system and production of sex hormones. The genital organs become the major source of sexual tensions and pleasures, but energies are also invested in forming friendships and preparing for marriage.

When does prepubescence occur?

during preadolescence

When should you do the skin assessment for the child?

during their bath

when do sex-role behavior become increasingly common? What does this mean?

during toddlerhood (the second year). Identification with the parent of the same gender becomes apparent by this time and represents the child's intellectual ability to differentiate different models of behavior and to imitate them appropriately

What are the clinical manifestations of otitis media?

Otalgia (earache) Fever (may or may not) Purulent discharge (otorrhea) Crying irritability Difficult to comfort loss of appetite

_________ injuries are common in adolescents and result in more time missed from the activity than fractures.

Overuse

What should you tell the parent who is concerned whether they should encourage the child's clinging, dependent behavior when around strangers.

Parents need to be reassured that such behavior is healthy, desirable, and necessary for the child's optimal emotional development.

Laryngotracheal obstruction from foreign body aspiration most commonly causes what symptoms?

dyspnea, cough, stridor, and hoarseness because of decreased air entry. Cyanosis may occur if the obstruction becomes worse.

A special form of tooth decay in children between 18 months and 3 years of age is what?

early childhood caries (ECC); this often occurs when a child is routinely given a bottle of milk or juice at nap-time or bedtime or uses the bottle as a pacifier while awake.

_____________ increases the risk of persistent middle ear effusion by enhancing attachment of the pathogens that cause otitis tot he respiratory epithelium in the middle ear space, by prolonging the inflammatory response, and by impeding drainage through the eustachian tube.

Passive smoking

What is a PICC line?

Peripherally inserted central catheters can be used for short-term to moderate-length therapy. These catheters consist of silicone or polymer material and are placed by specially trained nurses or physicians. The most common insertion site is above the antecubital area. The catheter is threaded either with or without a guidewire into the superior vena cava

How is growth and development affected in children with moderate to severe forms of CF?

Physical growth may be restricted as a result of decreased absorption of nutrients, including vitamins and fat; increased oxygen demands for pulmonary function; and delayed bone growth. The usual pattern is one of growth failure (failure to thrive) with increased weight loss despite an increased appetite and gradual deterioration of the respiratory system.

Describe social-affective play.

Play begins here. Infants take pleasure in relationships with people. As adults talk, touch, nuzzle, and in various ways elicit responses from an infant, the infant soon learns to provoke parental emotions and responses with such behaviors as smiling, cooing, or initiating games and activities.

ASD impairments range from mild to severe. It is manifested during ________, primarily from _____ to ______ months of age.

early childhood. 18-36 months

Who, specifically are sensitive to the stresses of being different from their peers?

early-maturing girls and late maturing boys

What kinds of skills of independence is evident in a 15 month old toddler?

eed themselves, drink well from a covered cup, and manage a spoon with considerable spilling, put their arms or feet out for dressing and pull off their shoes and socks.

Erikson focuses on the development of the ______, which may be though of as reason or common sense, during the toddler phase. Children struggle to deal with the impulses of the _______ and attempt to tolerate frustration and learn socially acceptable ways of interacting with the environment. The ego is evident as children are able to tolerate delayed _________. Toddlers also have a rudimentary beginning of the _______, or conscience, which is the incorporation of the morals of society and the process of acculturation.

ego; id; gratification; superego

By late puberty the first ________ occurs.

ejaculation

__________ implies that children cannot think in terms of operations- the ability to manipulate objects in relation to each other in a local fashion. Rather, toddlers think primarily on the basis of their perception of an _________. Problem solving is based on what they ______ or ______ directly rather than on what they recall about objects and events.

Pre operational thought; even; see; hear

__________ may have a significant role in helping the GI tract establish a "good" bacterial colonization in the gut to prevent many illnesses.

Probiotics

T/F When epiglottitis is suspected, the nurse should attempt to visualize the epiglottis directly with a tongue depressor and take a throat culture.

false. the nurse should not do these things. They should refer the child for medical evaluation immediately.

What is Tolerance? How can you treat it?

occurs when the dose of an opioid needs to be increased to achieve the same analgesic effects that was previously achieved at a lower does. It may develop after 10 to 21 days of morphine administration. Treatment of tolerance involves increasing the dose or decreasing the duration between doses. Treatment of physical dependence involves gradually reducing the dose over several days to prevent withdrawal symptoms.

What is total parenteral nutrition therapy (TPN)?

Provides for the total nutritional needs of infants and children. Involves IV infusion of highly concentrated solutions of protein, glucose, and other nutrients. The solution is infused through conventional tubing with a special filter attached to remove particulate matter or microorganisms that may have contaminated the solution.

What is the biggest challenge in the management of burn pain?

Providing proper analgesia without interfering with the patient's awareness during and after painful procedures such as dressing changes, wound debridement, cleansing, and physical therapy sessions

Other than respiratory depression and constipation, what is another side effect that is common after opioids? What can you treat it with?

Pruritus form epidural or IV infusion. Can be treated with low doses of IV naloxone, nalbuphine, or diphenhydramine.

The two viruses most likely to precipitate otitis media are ______ and ______.

RSV and influenza

Why do adolescents seem to slump and fail to sit up right?

Rapid skeletal growth is often associated with slower muscular growth, and as a result, some teenagers may appear awkward or slump.

How should parents react to imaginary friends?

Realize that it is normal, safe, and a sign of healthy imagination. They should agree to simple request such as setting an extra place at the table but they should not allow the child to use the playmate to avoid punishment or responsibility.

________ is an effective technique of discipline and limit setting in school aged children.

Reasoning

Speech requires what two types of skills?

Receptive skills - hearing and interpretation Expressive skills - facial muscle coordination

What is the etiology of hearing impairment?

family history of childhood hearing impairment, anatomic malformations of the head or neck, low birth weight, severe perinatal asphyxia, perinatal infection (herpes, syphilis, toxoplasmosis, bacterial meningitis), chronic ear infection, cerebral palsy, Down syndrome, prolonged neonatal oxygen supplementation, or administration of ototoxic drugs. Sensorineural hearing loss may be a result of continuous humming noises or high noise levels associated with incubators, oxygen hoods, or intensive care units, especially when combined with the use of potentially ototoxic antibiotics. Very loud, brief noise, such as gunfire, can cause immediate, severe, and permanent loss of hearing.

What is the biggest threat to successful breastfeeding in employed mothers?

fatigue

How can a parent deal with negativism of toddlers?

Reduce the opportunities for a "no" answer.

What is home car?

Refers to care provided for children with simple or complex health care needs and their families in their places of residence for the purpose of promoting, maintaining, or resorting health or for maximizing the level of independence while minimizing the effects of disability and illness, including terminal illness.

__________ infections account for the majority of acute illnesses in children.

Respiratory tract

________ care provides temporary relief to parents and allows a break from the responsibilities of caring for the child on a daily basis.

Respite

During which period does facial proportions change as the face grows faster in relation to the remainder of the cranium? The skull and brain grow very slowly during this period and increase little in size.

School age.

Describe the personality, cognitive, and moral development theories: COGNITIVE DEVELOPMENT (PIAGET) Infancy-Brith-1 year Toddlerhood- 1-3 years Early childhood 3-6 years Middle childhood 6-12 years Adolescence 12-18 years

Sensorimotor Preoperational thought, perconceptual phase Preoperational thought, intuitive phase Concrete operations Formal operations

______________ hearing loss involves damage to the inner ear structures or the auditory nerve. The most common causes are defects of inner ear structures or infection, administration of ______ drugs, or exposure to excessive _______.

Sensorineural; ototoxic; noise

T/F Regular dental supervision and continued fluoride supplementation are integral parts of the health maintenance program of school aged children

True

T/F Separate informed permissions must be obtained for each surgical or diagnostic procedure.

True

T/F Stimulation is as important for psychosocial growth as food is for physical growth.

True

T/F The cause of Autism is unknown.

True

T/F The domains for the assessment of chronic or recurrent pain are the same for acute pain.

True

T/F The frequency with which sugar is consumed is more important than the total amount eaten.

True

T/F The presence of a minor illnesses such as the common cold is not a contraindication for vaccines.

True

T/F The same nurse who explained the procedure should also assist in the procedure.

True

T/F nasopharyngitis is so widespread in the general population that it is impossible to prevent.

True

T/F Toddlers are much less likely than infants to try new foods.

True because of their appearance, texture, or smell, not just their taste.

Describe withdrawal symptoms after opioids?

Symptoms of withdrawal occur at 24 hours after abrupt discontinuation and reach a peak within 72 hours. Symptoms of withdrawal include signs of neurologic excitability (irritability, tremors, seizures, increased motor tone, insomnia), GI dysfunction (nausea, vomiting, diarrhea, abdominal cramps), and autonomic dysfunction (sweating, fever, chills, tachypnea, nasal congestion, rhinitis).

T/F Nighttime bladder control normally takes several months to years after daytime training begins.

True because the sleep cycel needs to matrue so the child can awake in time to urinate.

T/F down syndrome can be diagnosed by the clinical manifestations alone.

True, but a chromosome analysis should be done to confirm genetic abnormality.

T/F Most children recover from primary TB infection and death seldom occurs in treated children.

True, except in cases of tuberculous meningitis

T/F Beyond the newborn period, many drugs are metabolized more rapidly by the liver, necessitating larger doses or mare frequent administration.

True.

T/F Children need to hear form adults that they did the best they could do in the situation no matter how they behaved.

True.

T/F Explanations for procedures should be short, simple, and appropriate to the child's level of comprehension.

True.

T/F Quick-relief and long-term medications are often used in combination.

True.

T/F To collect a stool sample, stool should be collected without contamination with urine.

True.

T/F RAP is common in children and only 10% of children with RAP have an identifiable organic cause for their pain symptoms.

True. (Recurrent abdominal pain)

________ is a form of play for toddlers who enjoy musical toys such as CD players, talking dolls and animals, and toy telephones.

Talking

T/F Children are at higher risk of ineffective response to anesthesia because of higher anxiety.

True. Anxiety associated with stranger anxiety (infants), separation anxiety (toddlers and preschoolers), and fear of injury or death (adolescents)

T/F Children infected with TB can go to school/daycare.

True. Asymptomatic children with TB can attend school or daycare facilities if they are receiving pharmacotherapy.

T/F Children with strep throat are considered infectious to others.

True. At the onset of symptoms and up to 24 hours after initiation of antibiotic therapy.

Who has the responsibility for adequately informing parents of the nature, prevalence, and risks of the disease; the type immunization product to be used; the expected benefits, and the risk of side effects of the vaccine?

The Nurse

How can you reduce bruising after venipuncture?

The arm should be extended, not flexed, while pressure is applied for a few minutes after venipuncture in the antecubital fossa.

What is the etiology of CI?

The causes are primarily genetic, biochemical, and infectious.

T/F Fluids by mouth is contraindicated for children with bronchiolitis.

True. Because of tachypnea, weakness, and fatigue; therefore, IV fluids may be used until the acute stage of the disease has passed.

T/F Healthy full-term infants younger than age 3 months are presumed to have a lower infection rate than older infants.

True. Because of the protective function of maternal antibodies.

T/F Children with severe permanent visual impairments do not learn to play automatically.

True. Because they cannot imitate others or actively explore the environment as sighted children do.

What are the clinical manifestations of Acute epiglottitis?

The child usually goes to bed asymptomatic to awaken later, complaining of sore throat and pain on swallowing. The child has a fever; appears sicker than clinical findings suggest; and insists on sitting upright and leaning forward with the chin thrust out, mouth open, and tongue protruding (tripod position). Drooling of saliva is common because of the difficulty or pain on swallowing and excessive secretions. The child is irritable; extremely restless; and has an anxious, apprehensive, and frightened expression. The voice is thick and muffled, with a frog-like croaking sound on inspiration, but the child is not hoarse. The throat is red and inflamed, and a distinctive large, cherry red, edematous epiglottis is visible on careful throat inspection.

T/F Lymphoid tissues contained in the lymph nodes, thymus, spleen, tonsils, adenoids, and blood lymphocytes are well developed at birth.

True. But they are small and they increase rapidly to reach adult dimensions by age 6

T/F The effectiveness of analgesics can be enhanced by a supportive attitude toward the child.

True. By reinforcing the cause and effect of medication and analgesia, the nurse can condition the child to expect pain relief, provided the regimen is likely to be effective.

T/F Children in daycare centers have more illnesses than children not in daycare centers.

True. Especially gi tract infections; respiratory tract infections; and hep A.

T/F Verbal consent may be obtained via the telephone

True. In the presence of two witnesses.

T/F The oxygen saturation (SaO2) will be normal even with smoke inhalation injury or CO poisoning.

True. It will be normal because the device measures only oxygenated and deoxygenated hemoglobin; it does not measure dysfunctional hemoglobin such as COHb.

T/F It can be dangerous to have peer group attachments that are too strong.

True. Peer pressures force some children tot take risks or engage in behaviors that are against their better judgment or gang violence

T/F During tantrums, parents should ignore the behavior.

True. Provided that the behavior is not injurious to the child.

T/F For a toddler, body parts, especially those related to elimination and reproduction should be called by their correct names.

True. Respect for the body should be practiced.

T/F The heart grows less rapidly than does the rest of the body.

True. The heart weight is usually doubled by 1 year of age in comparison with body weight, which triples during the same period. The size of the heart is still large in comparison to the chest cavity.

T/F The introduction of solid foods into the infant's diet before one year old is primarily for taste and chewing experience, not for growth.

True. The majority of infant's caloric needs are derive from the primary milk source, therefore, solids should not be perceived as a substitute for milk until the child is older than 12 months.

Temperament has no implications of good or bad. Most children can be placed into one of three common categories based on their overall pattern of temperamental attributes. What are they?

The easy child- easygoing children are even tempered, are regular and predictable in their habits, and have a positive approach to new stimuli. They are open and adaptable to change and display a mild to moderately intense mood that is typically positive. Approximately 40% of children fall into this category. The difficult child- difficult children are highly active, irritable, and irregular in their habits. Negative withdrawal responses are typically, and they require a more structured environment. These children adapt slowly to new routines, people and situations. Mood expressions are usually intense and primarily negative. They exhibit frequent periods of crying, and frustration often produces violent tantrums. This group represents about 10% of children. The slow-to-warm-up child

T/F Middle childhood kids know that lying and cheating is wrong.

True. They are quick to tell on others when they detect cheating.

T/F Cool liquids are encouraged to reduce the temperature in young children.

True. This also minimizes the chances of dehydration.

T/F In asthma, the airflow limitation or obstruction is reversible.

True. either spontaneously or with treatment.

What is the adolescent growth spurt?

The final 20% to 25% of height is achieved during puberty, and most of this growth occurs during a 24 to 36 months period. It occurs earlier in girls

T/F Anatomic differences influence the response to respiratory tract infections.

True. the diameter of the airways is smaller in young children and subject to considerable narrowing from edematous mucous membranes and increased production of secretions. Organisms may move rapidly down the shorter respiratory tract of younger children, causing more extensive involvement.

What are transitional objects?

favorite blanket or toy, provide security for children, especially when they are separated from their parens, dealing with a new stress, or just fatigued.

What are the clinical manifestations of TB?

fever malaise anorexia weight loss cough aching pain and tightness in the chest increased respiratory rate diminished breath sounds and crackles dullness to percussion pallor, anemia, weakness

Sibling rivalry tends to be most pronounced in ________ chidden, who experience ____________ (loss of sole parental attention).

first; dethronement

What is centration? Who has this characteristic?

focusing on one aspect rather than considering all possible alternatives. Toddlers

When are flu affected persons most infectious?

for the 24 hours before and after the onset of symptoms

The hypotonicity of muscles and hyperextensibility of joints of a child with Down syndrome can cause what problems? How can these problems be prevented?

The limp, flaccid extremities resemble the posture of a rag doll and as a result, holding the infant is difficult. The extended body position promotes heat loss and parents are encouraged to swaddle or wrap the infant tightly before picking up the child. Decreased muscle tone compromises respiratory expansion. In addition, the underdeveloped nasal bone causes a chronic problem of inadequate draining or mucus. This causes the child to breathe by mouth which can increase the susceptibility to upper respiratory tract infections. Parents should clear the nose with a bulb syringe, rinse mouth with water after feedings, increase fluid intake, and use a cool-mist vaporizer to keep the mucous membranes moist.

What types of foods are not appropriate for mixing with meds?

formula, healthy foods, or essential foods should not be mixed because they might subsequently refuse those items. Meds should be mixed in honey, sherbet, ice cream, etc.

_____ and _____ contribute to pressure ulcers.

friction and pressure

How is RSV transmitted?

from exposure to contaminated secretions

Mistrust can result from either too much or too little ________. If parents always meet their children's needs before the children signal their readiness, infants will never learn to test their ability to control the environment. If the delay is prolonged, infants will experience constant frustration and eventually mistrust the others in their efforts to satisfy them.

frustration.

What is the Denver II?

The most widely used developmental screening tests for young children. Each item is evaluated to determine whether significant differences exist on the basis of sex, ethnic group, maternal education, and place of residence.

What factors greatly influence an infant's growth?

genetic, metabolic, environmental, nutritional factors

When is bed wetting normal?

girls up to 4 years and boys up to 5 years

If both eye ointment and drops are ordered for a child, how will you give them?

give drops first, wait 3 minutes, and then apply the ointment to allow each drug to work. When possible, administer eye ointments before bedtime or nap time because the child's vision will be blurred temporarily.

What can you do for your teething infant?

give the child a cold teething ring, topical anesthetic ointments, systemic analgesics such as acetaminophen or ibuprofen can be given for no more than 2 days.

Weaning should be __________ by replacing one bottle or breastfeeding session at a time.

gradual

What is secondary social group?

groups that have limited, intermittent contact and generally less concern for members' behavior. These groups offer little in terms of support or pressure toward conformity except in rigidly limited areas.

_________ is an increase in number and size of cells as they divide and synthesize new preens; results in increases size and weight of the whole or any of its parts.

growth

What is the role of the physician or nurse while obtaining consent?

The physician explains the procedure, risks, benefits, and alternatives. The nurse witnesses the patient's, parent's or legal guardian's signature on the consent form and may reinforce what the patient has been told.

How do you administer ear drops? How can you place ear drops deep into the ear canal without contaminating the tip of the dropper?

The pinna is pulled upward and back. Place a disposable ear speculum in the canal and administer the drops through the speculum. Position the bottle so that the drops fall against the side of the ear canal. Gentle massage of the area immediately anterior to the ear facilitates the entry of drops into the ear canal.

Why might toddlers protest vital signs being taken?

The procedure itself does not hurt but it represents an intrusion into the child's personal space, which elicits a strong protest.

Some newborns are born with blisters on their hands. What can this be from?

They are sucking blisters from in utero sucking activity.

When encountering family expressions of chronic sorrow such as _______ and ________, home care nurses should develop evidence-based strategies to facilitate positive coping.

gult and depression

What are friendships like in school age children?

They have "best friends" with whom they share secrete, private jokes, and adventures; they come to one another's aid in times o trouble. They also fight, threaten each other, break up, and reunite

Why are anithistamines largely ineffective in treating nasopharyngitis?

They have a weak atropine-like effect that dries secretions, but they can cause drowsiness or paradoxically, have a stimulatory effect on children.

what are the benefits of hom care programs?

They lead to greater parent satisfaction, improved quality of life and a reduction in length of hospital stay.

The tracheostomy stoma is kept clean and dry, and crusted secretions around the stoma may be gently removed with what?

half-strength hydrogen peroxide

In most girls, the initial indication of puberty is the appearance of breast buds, an event known as _________, which occurs between 8 and 13 years. This is followed by growth of pubic hair on the ______, known as _________.

Thelarche; mons pubis; adrenarche

What is the nursing care management of ASD?

There is no cure, but the most promising results have been through highly structured and intensive behavior modification programs. The objective in treatment is to promote positive reinforcement, increase social awareness of others, teach verbal communication skills, and decrease unacceptable behavior.

What do rules and rituals mean to school aged children?

These children need conformity. Children begin to see the need for rules, and their games have fixed and unvarying rules that may be bizarre and extraordinarily rigid. They also like team play because it satisfies their need for peer interaction. Team play can also contribute to children's social, intellectual, and skill growth.

What are some treatment strategies to improve compliance?

These strategies relate to the child's refusal or inability to take the prescribed medication. You may need to crush med or use liquid instead of pills to swallow. You may have to change med times to a reasonable hour.

What are some behavioral strategies to improve compliance?

They are designed to modify behavior directly. Use positive reinforcement, or disciplinary techniques.

What is a primary social group?

has intimate, continued, face-to-face contact; mutual support of members; and the ability to order or constrain a considerable proportion of individual members' behavior. (family and peer group)

What is pleural effusion?

occurs when there is an excessive accumulation of fluid in the pleural space. The diagnosis is made by chest radiography, and the treatment involves evacuation of the fluid by needle aspiration followed by insertion of a chest tube to a closed drainage.

What is the best approach in dealing with regression?

ignore it while praising existing patterns of appropriate behavior.

What is Domestic mimicry?

imitating household activities

Probably the most characteristic and pervasive preschool activity is ________, ________, and ______ play.

imitative, imaginative, dramatic

When sweets are eaten, they are less damaging to the teeth if consumed when?

immediately after a meal rather than as a snack between meals.

What are relative indications for a tonsillectomy?

Three or more tonsil infections per year, persistent foul taste or breath caused by chronic tonsillitis, unilateral tonsil hypertrophy presumed to be malignant, and chronic tonsillitis in a streptococcus carrier who fails to respond to antibiotics.

What do you do in the event of infiltration or extravasation?

immediately stop the infusion, elevate the extremity, notify the practitioner, and initiate the ordered treatment as soon as possible. Remove the line when it is no longer needed.

The inability of the infant's immune system to produce ___________ in the mucosal lining of the respiratory system provides less protection against _________.

immunoglobulin A (IgA); infection

What are chest tubes used for?

To removed fluid or air from the pleural or pericardial space.

What does imitation mean for a toddler?

Toddlers are acutely aware of other's actions and attempt to copy them in gestures and in words.

When you start using toothpaste, how much should be used?

a "smear" for children younger than 2 years and a "pea-size" amount for those 2 to 5 years old.

What is post-pubescence?

a 1 to 2 year period after puberty during which skeletal growth is completed and reproductive functions become fairly well established.

What is Asthma?

a chronic inflammatory disorder of the airways characterized by recurring symptoms, airway obstruction, and bronchial hyper-responsiveness.

What is bacterial tracheitis?

a disease occurring in children younger than 3 years of age and may cause airway obstruction that is severe enough to cause respiratory arrest.

What is Croup?

a general term applied to a symptom complex characterized by hoarseness, a resonant cough described as "barking" or "brassy", varying degrees of inspiratory stridor, and varying degrees of respiratory distress resulting from swelling or obstruction in the region of the larynx.

What is visual impairment?

a general term that encompasses both partial sight and legal blindness

What is status asthmaticus?

a medical emergency that can result in respiratory failure and death if untreated. albuterol and epinephrine treatments are considered.

What is the most frequently used measure of pain intensity for children ages 3 to 4?

a pictoral faces pain scale.

T/F ASD is usually a severely disabling condition and most require lifelong adult supervision.

True

T/F Breastfed infants usually sleep for shorter periods, with more frequent waking, especially during the night.

True

T/F CI is a permanent impairment encompassing cognitive ability and adaptive behavior that are functioning significantly below average.

True

T/F ECC is now considered to be an infectious disease of childhood.

True

T/F Early introduction of foods other than maternal milk in the first 6 months of life predisposes children to an increased risk for food allergy development.

True

T/F Exposure to tobacco smoke during childhood may also contribute to the development of chronic lung disease in the adult.

True

T/F Few children have night wetting episodes after daytime dryness is totally achieved.

True

T/F For chest tube suctioning, there should be gentle, continuous bubbling in the suction control chamber.

True

T/F For toddlers quality of food is more important than quantity.

True

T/F In adolescence, adult values are reached fora ll formed elements of the blood.

True

T/F Infants do not have the head control to lift their heads out of the depression of an object and therefore risk suffocation in the prone position early in infancy.

True

T/F Iron-fortified cereals and iron-rich foods are recommended for all children older than 6 months of age.

True

T/F Management of pain should be a priority for all clinicians.

True

T/F Once a person reacts positively to PPD, he or she will always react positively.

True

T/F Oral steroids have proven effective in the treatment of croup.

True

T/F Pulse oximeter measurement should be performed on all children as routine physical assessment.

True

Describe the personality, cognitive, and moral development theories: PSYCHOSOCIAL (ERIKSON) Infancy-Brith-1 year Toddlerhood- 1-3 years Early childhood 3-6 years Middle childhood 6-12 years Adolescence 12-18 years

Trust vs mistrust Autonomy vs Shame and doubt- They development of autonomy during the toddler period is centered on children's increasing ability to control their bodies, themselves, and their environment. They want to do things for themselves but outcomes are not always favorable. Initiative vs guilt- Children develop a conscience. No longer guided only by outsiders, they have an inner voice that warns and threatens. Children sometimes undertake goals or activities that are in conflict with those of parents or others, and being made feel that their activates are bad produces a sense of guilt. Industry vs Inferiority-Children are ready to be workers and produces. They want to engage in taste and activities that they can carry through to completion; they need and want real achievement. Feelings of inadequacy and inferiority may develop when too much is expected of them. Identity vs role confusion-the development of identity is characterized by rapid and marked physical changes. Previous trust in their bodies is shaken, and children become overly preoccupied with the way they appear in the eyes of others compared with their own self-concept. Adolescents struggle to fit the roles they have played and those they hope to play.

____________ is the second leading cause of death from an infectious disease.

Tuberculosis (TB)

How is plearsure demonstrated for the first three months?

a quieting attitude (1 month), a smile (2 months), a squeal (3 months)

What is a developmental task?

a set of skills and competencies peculiar to each developmental stage that children must accomplish or master to deal effectively with their environment.

What is a recognized pattern of anomalies resulting from a single specific cause called?

a syndrome

What is the early intervention program?

a systematic program of therapy exercises, and activities designed to address developmental delays in disabled children to help achieve their full potentials.

What are the manifestations of acute laryngotracheobronchitis?

inflammation of the mucosa lining the larynx and trachea causes a narrowing of the airway. When the airway is significantly narrowed, it produces the characteristic inspiratory stridor and suprasternal retractions. Other classic manifestations are cough and hoarseness. Symptoms of hypoxia become evident.

Evidence indicates that the ___________, a white oily substance that coats term infants' bodies and is often found in abundance in creases of the axilla and groin, has innate ____________ properties that serve to protect newborns form ____________.

Vernix caseosa; immunologic; infection

What is the therapeutic management of OM?

Waiting up to 72 hours for spontaneous resolution is safe and appropriate management of AOM in healthy infants older than 6 months and children. When antibiotics are warranted, oral amoxicillin in high doses is the treatment of choice for initial episodes of AOM in children who have not received antibiotics within the past months.

How can you reduce the discomfort associated with IM injections for children?

Warming the injectate, using lidocaine as a diluent, and applying ice and pressure to the site immediately before the procedure.

What can trigger MH in susceptible children?

inhaled anesthetics and the muscle relaxant succinylcholine

What are deformations?

often caused by extrinsic mechanical forces on normally developing tissue. (Club foot)

What is tonsillitis?

often occurs with pharyngitis. Because of the abundant lymphoid tissue and the frequency of URIs, tonsillitis is a common cause of illness in young children. It may be viral or bacterial.

When are adolescents are entitled to consent to treatment without the parent's knowledge?

When one or more "medically emancipated" conditions such as STIs, mental health serves, alcohol and drug dependency, pregnancy, and contraceptive advice.

What is epidermal stripping?

When the epidermis is unintentionally removed when tape is removed. They are usually shallow and irregularly shaped. Tape should be placed so that there is no tension, traction, or wrinkles on the skin.

When is bronchial (Postural) drainage indicated?

Whenever excessive fluid or mucus in the bronchi is not being removed by normal ciliary activity and cough.

What is Pertussis?

Whooping cough. an acute respiratory tract infection which in the past primarily occurred in children younger than 4 years of age who were not immunized.

What is finger spelling?

Words are spelled letter by letter into the child's hand, and the child spells into the other person's hand.

Do toddlers have mental symbolization? What does this mean?

Yes, they closely associate an object with a specific event. "a needle is something that hurts"

How can you prevent ECC?

eliminating the bedtime bottle completely, feeding the last bottle before bedtime, substituting a bottle of water for milk or juice, not using the bottle as a pacifier, and never coating pacifiers in sweet substances. Juice in bottles, especially commercially available ready to use bottles, is discouraged. Juice should always be offered in a cup to avoid prolonging the bottle-feeding habit.

The child who is suspected of having epiglottis should be examined in a setting where what is readily available?

emergency airway equipment

What is work-based group care?

employers recognize the benefit of providing high-quality and convenient child care to their employees.

Pertussis can result in what three things?

encephalopathy, seizures, and pneumonia

How can you help prevent RSV?

encourage breastfeeding, avoid passive smoke exposure, promote hand washing.

Breastfed infants tend to self-regulate _______ intake.

energy

What causes extrinsic obstruction of the eustachian tubes?

enlarged adenoids or nasopharyngeal tumors

What is the initial sign of phlebitis?

erythema (redness) at the insertion site. Pain may or may not be present.

What are our subcultural influences?

ethnicity, minority-group membership, socioeconomic class, schools, communities, peer cultures, bicultural, mass media

_______ is the emotional attitude that one's own ethnic group is superior to others; that on's values, beliefs, and perceptions are the correct ones, and that the groups ways of living and behaving are the best way.

ethnocentrism

The relatively short and open ___________ in infants and young children allows pathogens easy access to the middle ear.

eustachian tube.

Otitis media is primarily a result of malfunctioning ___________.

eustachian tubes

Behavioral restraints for children must be recorded how often?

every 1 to 2 hours

Although their thinking may not be mature, preschoolers search constantly for _______ and ________ that are logical and reasonable to them. The word "______" seems to supplant the word "___", which was common in toddlerhood.

explanations; reasons; why; no

Physical distinction between the sexes is made on the basis of distinguishing characteristics. What are the primary sex characteristics? What are the secondary sex characteristics?

external and internal organs that carry out the reproductive functions. (ovaries, uterus, breasts, penis, testes) the changes that occur throughout the body as a result of hormonal changes. (voice alterations, development of facial and pubertal hair, fat deposits) but that play no direct part in reproduction.

What is the symptoms of pulmonary edema?

extreme shortness of breath, cyanosis, tachypnea, diminished breath sounds, anxiety, agitation, confusion, diaphoresis, orthopnea, respiratory crackles, expiratory wheezing, heart murmur, S3 gallop, cool peripheries, jugular venous distention, nocturnal dyspnea, cough, pink fro hey sputum, tachycardia, hypertension, and hypotension.

What are symptoms of infectious mononucleosis?

exudative pharyngitis, lymphadenopathy, hepatosplenomegaly, and increase in atypical lymphocytes. fever headache epistaxis malaise fatigue chills low-grade fever loss of appetite puffy eyes

One hallmark characteristic of autism is the inability to maintain ________ with another person. Parents of autistic children have noted that their infants had avoidance of _________ contact, and _______ delay at a very early age. Children with ASD also display limited functional _______ and may have significant ________ symptoms.

eye contact; body; language; play; GI

T/F Peers are the primary influence in adolescent's lives.

false. The parents remain the primary influence, but peers assume a more significant role than they did during childhood.

T/F Signs of teething include fever, vomiting, or diarrhea.

false. These are signs of illness and may warrant futher investiagion

T/F Kid's toothpaste is recommended for infants.

false. just use water.

Children should have their hair brushed and combed at least how often?

once a day

The most pronounced changes that indicate increasing maturity in children are a decreased ___________ in relation to standing height, a decrease in ___________ in relation to height, and an increase in ____________ in relation to hight.

head circumference; waist circumference; leg length

What is the rate of height increases during the first 6 months of life?

height increases by 1 inch a month during the first 6 months of life.

What is hyphema?

hemorrhage into anterior chamber of the eye; visible fluid meniscus across iris; more easily seen in light-colored than in brown eyes.

Because unclotted blood is required for venipuncture, use only ________ collection tubes or syringes.

heparinized.

What should the patient with pulmonary edema be in to promote lung expansion?

high fowler

The concept of time is still incompletely understood in preschool years, the child interprets it according to what? Avoid using what words to refer to time?

his or her own frame of reference. yesterday, tomorrow, next week, or specific days of the week.

Because infants and young children are unable to retain the solution after an enema, what must the nurse do?

hold the buttocks together for a short time to retain the fluid

What kids of foods should be avoided in toddlers?

hot dogs, grapes, peas, carrots, popcorn, fruit gel snacks should be avoided until the child is able to chew them effectively.

What is self-concept?

how an individual describe himself. It includes all notions, beliefs, and convictions that constitute an individual's self-knowledge and that influence that individual's relationship with others. It is not present at birth but develops gradually

Oxygen is dry and therefore must be ____.

humidified

How do you treat status asthmaticus?

humidified oxygen is given to maintain oxygen saturation greater than 90%. Inhaled aerosolized short acting B2 agonists are recommend for all patients. A systemic corticosteroid may also be given to decrease the effects of inflammation.

How is bronchiolitis treated?

humidified oxygen, adequate fluid intake, airway maintenance, and medications. Most kids can be managed at home. humidified mist may be used. Routine chest percussion and postural drainage (CPT) is not recommended. Nasal suctioning is beneficial.

What are symptoms of MH?

hypercarbia, elevated temp, tachycardia, tachypnea, acidosis, muscle rigidity, and rhabdomyolysis

In healthy neonates, hypothermia can result in several negative metabolic consequences such as ________, _______, and _______.

hypoglycemia, elevated bilirubin levels, and metabolic acidosis.

When assessing a mechanically ventilated patient, a heart rate that is too fast or too slow is a possible indication of what?

hypoxemia, air leak, or low cardiac output

Progressive obstruction from acute epiglottitis leads to hypo_____, hyper________, and acidosis followed by decreased _________; reduced level of consciousness; and when obstruction becomes more or less complete, a rather sudden ________.

hypoxia; hypercapnia; muscle tone; death

What are effective ways to treat otitis media pain in children?

ibuprofen three times a day, warm compresses using oatmeal or warm stones, local anesthetic combinations

HOw is AOM diagnosed?

if visual inspection of the tympanic membrane reveals a purulent discolored effusion and a bulging or full, opacified, or reddened immobile membrane.

When is the flu vaccine given?

in early fall before the flu season begins and is repeated yearly for ongoing protection.

Where does much of adolescents search for identity take place?

in front of a mirror

When is the incidence of pertussis more common?

in spring and summer months

When do most episodes of OM occur?

in the first 24 months of life

The risk for diagnosis of early-onset asthma in the first 3 years of life is associated with what?

in utero exposure to maternal smoking; grand-maternal smoking.

What is Inability to conserve? Who has this characteristic?

inability to understand the idea that a mass can be changed in size, shape, volume, or length without losing or adding to the origin mass. If two lines of equal length are presented in such a way that one appears longer than the other, child will stated that one line is longer even if the chid measures both lines with a ruler and fines that each ahas the same length. toddler

What is irreversibility? Who has this characteristic?

inability to undo or reverse the actions initiated physically. When told to stop doing something, such as talking, child is unable to think of a positive activity toddler

In adolescence, the size and strength of the heart, blood volume, and systolic blood pressure __________, and the pulse rate and basal heat production _________.

increase; decrease

Infants respond to noxious stimuli through physiologic indicators such as... and behavioral indicators such as...

increased heart rate and blood pressure, variability in heart rate and intracranial pressure, decreases in SaO2 and skin blood flow. muscle rigidity, facial expression, crying, withdrawal, and sleeplessness

What are signs of mucus partially occluding the airway?

increased heart rate, a rise in respiratory effort, a drop in SaO2, cyanosis, and an increase in the positive inspiratory pressure on the ventilator.

What are early signs of impending airway obstruction?

increased pulse and respiratory rate; substernal, suprasternal, and intercostal retractions; flaring nares; and increased restlessness.

What is maternal cigarette smoking associated with?

increased respiratory symptoms and illness in children; decreased fetal growth; increased deliveries of low-birth weight, preterm, and stillborn infants; and greater incidence of SIDS.

What are the clinical features characteristic of cystic fibrosis?

increased viscosity of mucous gland secretions striking elevation of sweat electrolytes increase in several organic an enzymatic constituents of saliva abnormalities in autonomic nervous system function

What are some organizational strategies to improve compliance?

increasing frequency of appointments, designating a primary practitioner, reducing cost of meds, use pill dispensers, set alarms, etc

What does a positive PPD reaction mean?

indicates that the individual has been infected and has developed sensitivity to the TB. The test is usually positive 2 to 10 seeks after initial infection within the organism. It does not confirm the presence of active disease.

What indicates a positive TB skin test?

induration >5 mm for children in close contact with known or suspected contagious cases of TB or children that are suspected to have TB. Or children that have HIV induration >10 mm for children at increased risk of disseminated disease (have other conditions) or children at an increased risk of exposure (in high prevalence locations or exposed to adults who have HIV induration >15 mm for children 4 years of age or older without any risk factors.

Influenza is frequently most sever in ___________.

infants

Who is at risk for RAD?

infants who have been victims of physical or sexual abuse or neglect; infants exposed to parental alcoholism, mental illness, and substance abuse and infants who have experienced the absence of a consistent primary caregiver as a result of foster care, institutionalization, parental abandonment,or parental incarceration.

What causes intrinsic obstruction of the eustachian tubes?

infection or allergy

What are the risks of body piercings?

infection, cyst, or keloid formation, bleeding, dermatitis, or metal allergy. using the same unsterilized needle to pierce body parts of multiple teenager presents the same risk of HIV, hep C, and hep B virus transmission as occurs with other needle sharing activities.

What is bronchitis?

inflammation of the large airways, which is frequently associated with URIs. It is a mild, self-limiting disease.

For most children, washing the hair and scalp how often is sufficient unless there is an indication for more frequent washing, such as after a high fever and profuse sweating?

once or twice weekly

Some sickle cell patients whose pain is managed poorly will ry to persuade medical staff to give them more analgesic, engage in clock watching, and request specific medications or dosages. These patients are often perceived as _______ and ________. How should nurses treat this behavior?

manipulative and demanding; Because these patients have a lifelong experience with pain, they are knowledgeable about the medications and doses that are effective. Therefore, the nurse should respect their requests for specific medications and doses and not interpret this as indications of drug-seeking behavior.

What is "in-home care" for infants?

may consist of a full time babysitter who lives in the home, a full-time babysitter who comes to the home, cooperative arrangements such as exchange babysitting, or family daycare.

What can unrelieved pain lead to?

may lead to potential long-term physiologic, psychosocial, and behavioral consequences

What is the peak expiratory flow rate (PEFR) used for?

measures the maximum flow of air that can be forcefully exhaled per second.

The initial appearance of menstruation, or __________, occurs about _____ years after the appearance of the first pubescent changes.

menarche; 2 years

Body temperature, reflecting _______, decreases over the course of development.

metabolism

Many asthma medications are given by inhalation with a nebulizer or a ___________.

metered-dose inhaler (MDI)

When is the ideal time for sex education?

middle childhood

Many adolescents are under the incorrect impression that the "safe" time for sexual intercourse is when?

midway between menstrual periods

What is the therapeutic management of infectious mononucleosis?

mild analgesics to relieve headache, fever, and malaise rest is encouraged for fatigue Antibiotics are contraindicated

What is the life expectancy for those with down syndrome?

more than 80% survive to age 60 and beyond

How is pertussis treated?

most children can be managed at home; care is supportive in nature, including encouraging hydration and administering antipyretics. Admission to the hospital occurs if respiratory symptoms are sever or if apnea occurs. Teratment with antibiotics.

Specific differences within a gene are called ______ if they are rare within a population or are called _______ if they are found within more than 1% of a particular population.

mutations; polymorphisms

During adolescence, the parent-child relationship changes form one of protection-dependency to one of ________.

mutual affection and equality

Most discomfort of nasopharyngitis is related to the _________.

nasal obstruction

Infants with RSV often have copius _________, making breathing and breast-feeding or bottle feeding difficult.

nasal secretions

Endotracheal intubation can be accomplished by the _____, _____, or ______ routes. Which is preferred?

nasal, oral, direct tracheal Nasal. Although it is more difficult to place, it is preferred because it facilitates oral hygiene and provides more stable fixation, which reduces complications.

___________ is usually considered for the child with epiglottitis with severe respiratory distress.

nasotracheal intubation or tracheostomy

What is the most frequent causes for an infant to require ostomies?

necrotizing enterocolitis and imperforate anus, and less often, Hirschsprung disease.

As toddlers attempt to express their will, they often act with __________, the persistent negative response to requests.

negativism.

The basal metabolic rate (BMR) is highest in _______, the BMR closely relates to the proportion of ______ to _____, which changes as the body increases in size.

newborn infants; surface area; body mass

To use behavioral restraints, an order must be obtained how long after the initiation of behavioral restraints?

no longer than 1 hour

Describe sense-pleasure play.

nonsocial stimulating experience that originates from without. Object in the environment-light and color, taste and odors, textures and consistenciesNn's attention, stimulate their senses, and give pleasure.

Where are the best sites for IVs in young children?

not in joints, not on the hands, not on the feet of children learning how to walk. The forearm or the scalp are the best choices.

What is the single most important influence on growth?

nutrition

Basic ongoing assessment of the mechanically ventilated patient includes what?

observing the chest rise and fall for symmetry, bilateral breath sounds, level of consciousness, capillary refill, skin color, and vital signs.

What is the nursing care management for Strep throat?

obtain a throat swab for culture. Cold or warm compresses to the neck may provide relief. Warm saline gargles may offer relief of throat discomfort. Acetaminphen and ibuprofen may be effective in decreasing the throat pain.

In the second half of the first year, 100% Fruit juice can be offered from a cup for its rich source of vitamin C and as a substitute for milk for _______ feeding a day.

one

What does a one year old's sentences look like? A two year old's? A three year old's?

one word sentences (holophrases) such as "up" most of their vocalizations are unintelligible Multiword sentences such as "mamma go bye-bye" or "all gone". Most of their speech is understandable. put words together into simple sentences, begin to master grammatical rules, acquire five or six new words daily, know their age and gender, and can count three objects correctly.

By what age can infants walk with one hand held?

one year

How often is suctioning carried out?

only as often as needed to keep the tube patent.

What are cataracts?

opacity of crystalline lens prevents light rays from entering eye and refracting on retina

How do you treat eye infections?

ophthalmic antibiotics Severe infections may require systemic antibiotic therapy. Steroids are used cautiously because they exacerbate viral infections such as herpes

Although both nonopioids and opioids have side effects, the major concern is with effects from _________. __________ is the most serious complication and is most likely to occur in sedated patients.

opioids; respiratory depression

What does the upper respiratory tract consist of?

oronasopharynx, pharynx, larynx, and upper part of the trachea

Pacifier use has ben associated with an increased risk of _______.

otitis media

In toddlers, the internal structures of the ear and throat continue to be short and straight, and the lymphoid tissue of tonsils and adenoids continues to be large. As a result, what infections are common?

otitis media, tonsillitis, and upper respiratory tract infections

How can you treat pulmonary edema?

oxygen therapy, PEEP, CPAP, and intubation with ventilatory support if respiratory failure occurs. Morphine may be prescribed to relieve dyspnea.

Nursing care for RSV is aimed at monitoring _________ with pulse oximetry, ensuring any ________ therapy is optimized by using a small _______ for delivery, and providing information for the family.

oxygenation; bronchodilator; mask

Culture plays a critical role in the _____ behaviors that facilitate children's development.

parenting

What is mutual play?

parents can provide tactile and kinesthetic experiences, maximize verbal and language abilities, and offer praise and encouragement for exploration of the world. It strengthens the relationship between parent and child.

When a standard or protocol states that immobilization is required 100% of the time as a part of the procedure or post-procedural care process, the restraint devise is considered what?

part of routine care. For example, the postoperative use of elbow restraints after a cleft lip repair.

What is patient-controlled analgesia?

patient controls the amount and frequency of the analgesic, which is typically delivered through a special infusion device.

One of the most important features of injecting vaccines is adequate __________ of the __________ for deposition of the drug intramuscularly and not __________.

penetration; muscle; subcutaneously

The child with infectious mononucleosis is advised to limit exposure to who?

people outside of the family

What is the etiology of visual impairments?

perinatal infections (herpes, Chlamydia, gonococci, rubella, syphilis, toxoplasmosis); retinopathy of prematurity; trauma; postnatal infections (meningitis); and disorders such as sickle cell disease

What are the predominant characteristics of bronchitis?

persistent dry, hacking cough (worse at night) becoming productive in 2-3 days.

Nurses should report immediately an y child with what signs of spinal cord compression?

persistent neck pain loss of established motor skills and bladder or bowel control changes in sensation

What specific respiratory tract infection are infants susceptible to by 3 months of age?

pertussis

Play should provide for what types of development?

physical, social, and mental development

At approximately 18 months of age, most toddlers manifest a decreased nutritional need with a decreased appetite, a phenomenon known as _________. They become _______, fussy eaters with strong taste preferences. They may eat large amounts one day and almost nothing the next. If family members refuse something, the toddler is likely to ______ the response. In essence, mealtime is more closely associated with ___________ components than with nutritional ones.

physiologic anorexia; picky; imitate; psychologic

What is the treatment of children with smoke inhalation injury?

place the child on humidified 100% oxygen as quickly as possible and monitor for s&s of respiratory distress and impending failure. Baseline ABGs and COHb levels are obtained. Intubation equipment should be readily available.

How can you childproof the control panels on ventilators, pumps, monitors and other equipment?

plastic tape, covers, or panels to cover control knobs or buttons reduces the risk of accidental changes in settings. Keep electrical cords short and out of reach.

Mastery of gross and fine motor skills is evident in all phases of toddlers' activity, such as what?

play, dressing, language comprehension, response to discipline, social interaction, and propensity for injuries.

How do children learn things that no one can teach them?

play. In play, children continually practice the complicated, stressful processes of living, communicating, and achieving satisfactory relationships with other people.

In addition to family history, nurses caring for children and families should also collect what kind of histories?

pregnancy, labor and delivery, perinatal, medical, and developmental.

What is the most upsetting event for children has been the ______.

preoperative injection

How is pneumonia treated?

primarily supportive and symptomatic treatment but necessitates thorough respiratory assessment and administration of supplemental oxygen, fluids, and antibiotics. Fever is controlled with a cool environment and antipyretics. Suctioning to maintain patent airway. Chest percussion, postural drainage, and nebulized bronchodilator treatments may be prescribed depending on the child's condition.

The intrauterine environment can have a __________ and ________ effect on developing fetuses with or without chromosome or singe-gene abnormalities.

profound and permanent

A common GI complication associated with CF is what?

prolapse of the rectum

How can you prevent bronchospasm?

protect child from respiratory tract infections read food labels for allergens Annual influenza vaccinations breathing exercises and controlled breathing are taught

What are pulmonary function tests' purpose?

provide an objective method of evaluating the presence and degree of lung disease, as well as the response to therapy.

What should nurses do for parents who need to quit smoking?

provide parents with affordable smoking cessation education resources, including the appropriate use of smoking cessation pharmacologic aids.

Girls may be considered to have __________ if breast development has not occurred by age _______ years of if menarche has not occurred within _________ years of the onset of breast development.

pubertal delay; 13; 4

Pain associated with surgery to the chest or abdominal regions may result in __________ complications. Pain leads to decreased muscle movement in the _________ and abdominal area and leads to decreased _________ volume, _______ capacity, functional ________ capacity, and _________ ventilation. The patient is unable to __________ and clear secretions, and the risk for complications such as ______ and ________ is high.

pulmonary; thorax; tidal; vital; residual; alveolar; cough; pneumonia; atelectasis

What are appropriate toys for toddlers?

push-pull toys, straddle trucks or cycles, a small gym and slide, balls of various sizes, riding toys, dolls, action figures, building blocks, finger paints; thick crayons, chalk, puzzles with large, simple pieces

Very simply, growth can be viewed as a _____ change and development as a _____ change.

quantitative; qualitative

Manipulative, constructive, creative, and educational toys provide for _____ activities, __________ development, and ________ expression.

quiet; fine motor; self

Children (except infants younger than about 3 to 6 months) metabolize drugs more ________ than adults; younger children may require ________ doses of opioids to achieve the same analgesic effect.

rapidly; higher

What is the best way to positively affect language development?

reading, storytelling, and interactive adult-child communication. NOT TELEVISION

For preschoolers, make-believe is _______ during play and only becomes fantasy when the toys are __________ or the dress-up clothes are __________. It is no wonder that _________ playmates are so much a part of this age period.

reality; put away; taken off; imaginary

It is recommended that all infants and toddlers ride in ________ facing car seats until they reach the age of _______ or the weight of ________.

rear; 2 years; 35 lbs

What is transductive reasoning? Who has this characteristic?

reasoning from the particular to the particular (child refuses to eat a food because something previously eaten did not taste good. Toddlers

What is Global organization? Who has this characteristic?

reasoning that changing any one part of the whole changes the entire whole toddlers

What do preschoolers know of body image?

recognize that individuals have desirable and undesirable appearances. They recognize differences in skin color and racial identity and are vulnerable to learning prejudices and biases. They are aware of the meaning of words such as pretty or ugly.

What are absolute indications for a tonsillectomy?

recurrent peri-tonsillar abscesses, airway obstruction, tonsillitis resulting in febrile convulsions, and tonsils requiring tissue pathology.

What is puberty?

referes to the maturational, hormonal, and growth process that occurs when the reproductive organs begin to function and the secondary sex characteristics develop. The point of sexual maturity is achieved, marked by the first menstrual flow in girls.

What is compliance/adherence?

refers to the extent to which the patient's behavior coincides with the prescribed regimen in terms of taking medication, following diets, or executing other lifestyle changes.

Grasping occurs during the first 2 to 3 months as a ________ and gradually becomes ________ by 5 months

reflex; voluntary

The first stage, from birth to one month, is identified by infants' use of _________ (sucking, rooting, grasping, crying). The second stage, from 1 to 4 months, ___________, marks the beginning of the replacement of reflexes behavior with voluntary acts. The _____________ stage is a continuation of primary circular reactions and lasts until 8 months of age. Grasping and holding now become shaking, banging, and pulling.

reflexes; primary circular reactions; secondary circular reactions

_________ errors are the most common types of visual disorders in children.

refractive

What are evidence of respiratory complications?

refusal to take oral fluids decreased urination evidence of earache RR faster than 50 to 60 breaths/min in a toddler or older child. Fever over 101F Listlessness confusion persistent cough wheezing poor sleep patterns.