PEDS exam 1

what two systems does cystic fibrosis affect

GI because of no pancreatic enzymes too much mucus production so affects respiratory

vaccines for 1-1.5 years

MAD HPV MMR Hep A DTAP Haemophilus INfluenzae PCV Varicella

med administration to preschoolers (3-5) toddlers

Offer choices! improves cooperation o They like imagination allow them to be nurse/doctor and handle equipment o Use topical anesthetic creams to numb the site to reduce pain when doing IM injections

school aged signs of separation anxiety

School and friends: need contact with family and peers

how do toddlers learn 1-3

Simple education, allow to see equipment, picture books ·13 months to 3 years

11-12 year old vaccines

Tdap, HPV, Meningococcal Tada Human Man

preschooler signs of separation anxiety

Uncooperative: will not allow nurse to do anything

4-6 year old vaccines

Varicella DTAP IPV MMR VERY DIM (its gets very dim outside at 4-6 pm)

passive immunity

actual antibodies introduced into the body the body is not challenged to create its own antibodies several ways to achieve passive immunity Transplacental transmission (1-2months of pregnancy) breast milk , IG, not permanent !! TEMPORARY!!!

adolescent age thinking

appearance is important because they want to be cool dont want to admit fear can describe pain clearly

at what age do children talk incessantly and remember and imitate actions or gesture s

at 2 years ( terrible two's are full of children talking too much)

extended family

at least one parent, one or more children and one or more of the members of the family that is not the parents or the children

blended family

at least one step parent, step sibling or half sibling

family stress theory strengths

can predict family behavior in response to stressors focuses on the positives

compliance in newborns

compliance is high in the newborn because they have a flexible rib cage and can easily distort the rib cage and shows intercostal muscle use

school age thinking

concerned about their body disability and death may compare to what grandparent had at the end of their life wants to know reasons otherwise will procrastinate - help with wound healing hte sooner you get up the sooner you can go home - they can describe pain

acquired immunity

developed immunity is from the vaccine and can be either active or passive

the theory that states one individual in the families performance can affect the other's int he family also states that the family tries to reach equilibrium when entering a new life cycle stage and strives towards balance and homeostasis

developmental theory

airway changes/considerations in children

diameter of the airway is smaller in young children and is subject to narrowing and edematous mucous membranes from increase production of secretions organism can also move more rapidly down the respiratory tract of children since they are closer together **also the short and open eustachian tube in infants allow for ear infections easier

t o f, RR will be slower in neonates due to decreased elastic recoild

falsem more rapid

developmental theory

families develop and change over time in similar and consistent patterns the family should perform time specific tasks set by themselves and otehrs

periods of rapid growth and change and period of relative stability

family system theories

theory that described too little change and to much can by dysfunctional for a family

family systems theory

why do peds get stressed out in the hospital

feelings of separation, loss of control, bodily injury and pain

how do toddlers exhibit separation

goal directed behavior ie. goal is to keep mom with them and they will plead with them to stay, physically try to keep them there, and tantrums, etc

family stresstheory strengths

good for any type of family but more difficult to determine cause and effect relationship

according to piaget how will children show pain

if in preverbal stage then high pitched cry if verbal then will show what hurts with either ear tugging or point to the place that hurts

example of object permanence

if you place a toy under a blanket, the child who has achieved object permanence knows it is there and can actively seek it. know the object is still there even if it is hidden

what will the stages of despair look like in a child

inactive withdraw from others is depressed, sad lacks interest in environment is uncommunicative regresses to earlier behavior (thumb sucking, bedwetting etc.)

how does respiratory disease affect different ages

limited surface area for gas exchange as an infant little elastic recoil as well

communication strategies for preschoolers 3-5 years

little bit more understanding they like imagination so allow to be nurse or doctor or handle equipment preschoolers are often uncooperative during drug admin utilize strategies to win cooperative is offering choices

traditional nuclear family

married couple and biological children

preschoolers separation

may develop substitute trust in adults. Refusing to eat, difficulty sleeping, crying quietly for parents, asking for parents, and withdrawing from others.

what children experience separation of anxiety

middle infancy throughout preschool years and especially children ages 6-30 months

who is cystic fibrosis most common in?

most common in white people autosomal recessive train meaning both parents have to have it 1 in 4 chance

natural immunity

natural and receives from exposure to illness itself

binuclear family

parents are no longer together but still parent the child

SIDS risk factors

prone sleeping position soft bedding, overbundling, overheating prematurity twin of sibling who died of SIDS LBW or IUGR recent illness lack of breastfeeding maternal smoking, drug abuse, infection

developmental theory strengths

provides a dynamic rather than static, view of family addresses both changes within family and changes in family as a social system over its life history also anticipates potential stressors that normally accompany transitions to various stages and when problems may peak bc of the lack of resources

when is a child at most risk for anoxic spell

pt with tetraology of fallot, and just finished crying or feeding; anytime where the oxygen demand is higher than the oxygen available

major cause of illness during childhood

respiratory illnesses

how do you want to communicate with a toddler ( 1-3 years old)

simple education picture books allow to see equipment toddlers can swallow liquid forms of drugs and older toddlers can chew oral drugs having a parent nearby usually helps the Childs cooperative during drug therapy are likely to be anxious or uncooperative during administration of rectal suppositories

when do children recognize parents and start to fear strangers

stranger danger at 6 months !!

family stress theory

stress is inevitable part of the family ore vent if it is positive stress can have a cumulative effect on the family normal stress and unexpected stress over the life cycle ** basically any change can cause some stress to the family

SIDS

sudden and unexpected death of an apparently healthy infant during sleep

atraumatic care

therapeutic care that minimizes or eliminates the psychological and physical distress experienced by children and their families in the health care system

how to speak to children 13-16 years

they are more worried about looking cool missing friends etc offer them control whenever impossible and let them make choices they are sensitive about their bodies and their independence make it your responsibility to make them take their medications- but dont let them think that you dont trust them * not likely to give something rectal because of embarrassment

school age nursing considerations (6-12)

they have a greater knowledge and can relate health and wellness education to science classes o Demonstrate and teach to them o Offer choices to help the school aged patient exercise control o Takes pride on accomplishment such as receiving an injection without incident o Oral drugs (liquid or chewable), many children school aged can swallow pills

how to talk to school age children 6-12 year old

they have more knowledge already so they can relate what you tell them to wellness education and science classes demonstrate and teach to them, offer choices to help the school aged children and let them exercise control ! they take pride in accomplishment such as receiving an injection without incident

how does separation anxiety look in peds

they will cry, scream, search for parent with eyes, clings to parents, avoid and reject contact with strangers

preschoolers thinking

they will fear mutilation magical thinking about bandaids, think that they can cure everything and fear that they will bleed if you take it off - can also deny any pain

how will a child show detachment

they will go from showing interest in surrounding with strangers or familiar caregivers then they will only have superficial relationships when fully detached, they seem happy but it is superficial ** rarely seen in hospitalized children

infants and toddlers separation anxiety

they will protest where the child cries and screams to get parents to stay and have Despair where child is withdrawn or it may not have an effect; tend to detach and gives up

how do children protest in toddlerhood

they will verbally attack strangers and physically attack will want to escape and find parents attempt to force parent away can last days-hours

at what age do children benefit from having a parent near by

toddlers 1-3 Having a parent nearby usually helps the child's cooperative during drug therapy o Are likely to be anxious or uncooperative during administration of rectal suppositories

limitations of developmental theory

traditional model more easily applied to two parent families with children

nuclear family

two parents but dont have to be married and their children who can either be biological, step, adoptive or fostered

adolescents separation anxiety

want to be cool, so try not to show fear. This can cause them to be ambivalent about wanting parents around. Usually anxiety about missing friends.

injections with preschoolers 3-5 years

when an IM injection must be given, the use of topic anesthetic creams to numb the site reduces pain several sites may be used for IM injections in preschoolers, most commonly the vastus lateralis, rectus femoris, and deltoid sites**** When IV drug therapy is necessary, peripheral sites are selected for the preschooler

fear of pain and injury in infants and toddlers

will react to pain even if it is not painful so you can see an increase in BP, HR, RR

when should eye care be given to a child

within 1 hour of birth ** can call social services if they deny

Risk factors for illness in children (6)

§Homeless children § Poverty § Low birth weight children § Chronic disease § Foreign born §Nutrition

toddler ages

1-3 years

vaccines for 4 months

DR HIP DTAP Rotovirus Haemophilus Influenzae IPV PCV

vaccination schedules for birth

Hep B

single parent family

a family in which only one parent is present to care for the children

when does the grasp reflex start to fade

by month 2

when do maternal antibodies go away

healthy full term infants younger than 3 months still have maternal antibodies and risk for infection increases from 3-6 months when maternal antibodies ware off

vaccine preventable diseases

measles, rubella, pertussis, influenzaHPV vaccines w cervical cancer

anterior fontanelle stays open until

open until 12-18 months

how to give injection to 6-12 years old

oral drugs may still be provided in liquid form or chewable tablets. many school aged children can also swallow pills the deltoid site is recommended for an IM injection in the school aged children

posterior fontanelle closes when

stays open until 6-8 weeks

injection sites for toddlers (1-3 years0

the vastus lateralis and rectus femoris remain the IM injection site of choice for toddlers older toddles can chew drugs

polygamous family

two wives or two husbands

active immunity

when the body has an immunologic response. ie exposed through vaccine or if you are actually exposed to it

when does a baby's weight double

0-6 months and triples 6-12 months

at what age can a child turn their head to the side when prone

1 months

when can children start to turn pages in a book ( not singular pages)

1 year

when do children start to attempt to stand alone and at this age they may attempt their first step alone

1 year

when do children start to try to build two block towers but will fail

1 year

difference in cause of death of infancy vs 1 year +

1 year + is car accidents for leading cause under 1 year (neonatal is low birth weight)

assumes standing position at ___ months without support

15 months

when do children always drop and throw things at the floor, can use a cup well and rotate spoon!

15 months

when do children start to imitate cleaning, folding clothes, etc

15 months

6-7 tower cubes, and one page of a book at a time, turns doorknob as well

2 years

goes up and down stairs alone with 2 feet on each step

2 years

can now draw circles, cross and names what has been drawing ** can also set a table

3 years

can ride a tricycle, jump off bottom step, stands on one foot for a few seconds, goes up the stairs on alternating feet may try to dance

3. years

when can children roll back to their side

4 months

when do children lose their head lag

4 months and can balance their head now

when can a child roll back to abdomen

6 months !

what age can a child pick up a dropped object and manipulate said object ( ie. hold a bottle, rattle, etc.)

6 months!! 6 months = i can now hold 6 toys

when can a child sit unsupported and can stand when holding onto furniture

8 months

when do children start to have anxiety over parents, especially their mothers

8 months

when does pincer grasp start

8 months

When does object permanence develop?

8-12 months

family systems theory

A change in any one part of a family system affects all other parts of the family system ** the family is seen as a unit or system where one change to one affects the rest

most common illness' in children

Acute illness: limits activity and needs medical attention (respiratory illness is 50% of illnesses)

why do we give vitamin K

Administered to prevent hemorrhagic disease, right after birth. - catalyze the synthesis of prothrombin in the liver, which is needed for clotting

vaccines at 6 months

B DR HIP + flu shot Hep B DTAP Rotavirus Haemophilus Influenzae IPV (polio) PCV (pneumococcal) + flu shot