Families/Children Exam 3- Nursing Care of Children

- 7 years- 36.8˚ C (98.2˚ F) - 9 years- 36.7˚ C (98.1˚ F) Oral Axillary​​​​​​​

- 11 years- 36.7˚ C (98.1˚ F) - 13 years- 36.6˚ C (97.9˚ F) Tympanic

SCHOOL AGED (6 TO 12 YEARS) MALE systolic 96 to 106; 55 to 62 114 to 123; 74 to 81 FEMALE systolic 94 to 105; 56 to 62 111 to 123; 74 to 80

ADOLESCENT (13 TO 18 YEARS) less than 120 less than 80

A 2-year-old child is to receive eardrops. The nurse is teaching the parent about giving the eardrops. Which statement reflects the proper technique for administering eardrops to this child? A. Administer the drops without pulling on the ear lobe. B. Straighten the ear canal by pulling the lobe upward and back. C. Straighten the ear canal by pulling the pinna down and back. D. Straighten the ear canal by pulling the pinna upward and outward.

C

A nurse is preparing to care for a 5-year-old who has been placed in traction following a fracture of the femur. The nurse plans care, knowing that which of the following is the most appropriate activity for this child? A) Large picture books B) A radio C) Crayons and coloring book D) A sports video

C

During a well-child visit, the parent of a toddler expresses concern to the nurse that the toddler takes several hours to fall asleep at night. Which of the following recommendations should the nurse make? a) Vary the time the toddler goes to bed each night b) Allow the toddler to watch television before bedtime c) Provide the toddler with a favorite toy at bedtime. d) increase the toddlers activity prior to bedtime

C

Generally the earliest age at which puberty begins is: a. 13 years in girls, 13 years in boys b. 11 years in girls, 11 years in boys c. 10 years in girls; 12 years in boys d. 12 years in girls, 10 years in boys

C

The nurse is assessing a 24-month-old child. Which of the following findings would the nurse note as abnormal? A. The child has no interest in lacing her own shoes B. The child isn't toilet trained C. The child cannot build a tower of 3 blocks D. The child doesn't copy circles

C

A nurse is preparing to administer medication to a pre-school aged child. Which of the following actions should the nurse plan to take? Select all that apply. A. Ask the caregiver to state the child's name. B. Allow the caregiver to administer the medication. C. Calculate the safe dosage of the medication. D. Let the child pick a toy to hold during administration of the medication. E. Offer juice after the medication is administered.

C, D, E

Intravenous Assess venipuncture site per facility protocol and prior to administration of medications. Peripheral venous access devices (also called intermittent infusion devices, peripheral/saline/heparin locks) Use a 24- to 22-gauge catheter. Use for continuous and intermittent IV medication administration. Short-term IV therapy can be completed at home with the assistance of a home health nurse.

Central venous access devices (CVADS) Short term: non-tunneled catheter or peripherally inserted central catheters (PICC) require an x-ray to verify placement prior to use Long term: tunneled catheter or implanted infusion ports Provide atraumatic care Insert a PICC before multiple peripheral attempts. Use a transilluminator to assist in vein location. Avoid terminology (a "bee sting" or "stick"). Attach an extension tubing to decrease movement of the catheter. Use play therapy. Apply lidocaine and prilocaine topical ointment to the site for 60 min prior to attempt. Keep equipment out of site until procedure begins. Perform procedure in a treatment room. QPCC​​​​​​​ Use nonpharmacologic therapies. Allow guardians to stay if they prefer.​​​​​​​ Use therapeutic holding. Avoid using the dominant or sucking hand. Cover site with a protective cover that allows visibility of the IV site. Swaddle infants. Offer nonnutritive sucking to infants before, during, and after the procedure. Teach guardians how to properly care for device.

A nurse is completing a pain assessment on a 4-month-old infant. Which of the following pain scales should the nurse use? FACES FLACC Oucher Non-communicating children's pain checklist

FLACC

Pain assessment tool for evaluation by age:

FLACC: 2 months to 7 years Pain rated on a scale of 0 to 10. Assess behaviors of the child. face, legs, activity, crying, consolability

Family Assessment

History: Medical history for parents, siblings, grandparents Structure: Family members (mother, father, son) Developmental tasks: Tasks a family works on as the child grows (parents helping a school-age child develop peer relations) Family characteristics: Cultural, religious, and economic influences on behavior, attitudes, and actions Family stressors: Expected (birth of a child) and unexpected (illness, divorce, disability, or death of a family member) events that cause stress Environment: Availability of and family interactions with community resources Family support system: Availability of extended family, work and peer relationships, as well as social systems and community resources to assist the family in meeting needs or adapting to a stressor

Health Promotion of Adolescents (12 to 20 Years) Informed Consent: Can make decisions at 16 Physical Development The final 20% to 25% of height is achieved during puberty. Acne can appear during adolescence. Females stop growing at about 2 to 2.5 years after the onset of menarche. grow 5 to 20 cm (2 to 8 in) & gain 7 to 25 kg (15.5 to 55 lb). Males stop growing at around 18 to 20 years of age. grow 10 to 30 cm (4 to 12 in) and gain 7 to 30 kg (15.5 to 66 lb).

In females, sexual maturation occurs in the following order. Breast development Pubic hair growth (some females experience hair growth before breast development) Axillary hair growth Menstruation In males, sexual maturation occurs in the following order. Testicular enlargement Pubic hair growth Penile enlargement Axillary hair growth Facial hair growth Vocal changes

A nurse is performing a developmental screening on a preschooler. Sort the following findings by the nurse into the correct motor skills category? Gross motor skills Fine motor skills Jumps off bottom step Catches ball reliably Uses scissors to cut out a picture Copies a circle Walks backwards with heel to toe Rides a tricycle Laces shoes Prints first name

Jumps off bottom step- gross Catches ball reliably- gross Uses scissors to cut out a picture- fine Copies a circle- fine Walks backwards with heel to toe- gross Rides a tricycle- gross Laces shoes- fine Prints first name- fine

Single-parent family:

One parent and one or more children Single parenting: Result of death, divorce, separation Risk of financial instability Provide support and referral to resources as indicated Increased stress- affects how they retain info. ------Finances ------Frustration ------Role changes ------Abandonment issues

A nurse is checking the vital signs of a 3-year-old child during a well-child visit. Which of the following findings should the nurse report to the provider? Temperature 37.2° C (99.0° F) Heart rate 106/min Respirations 30/min Blood pressure 93/52 mm Hg

Respirations

A nurse is providing education about the order of sexual maturation to a group of caregivers who have adolescent children. When teaching the caregivers, in which order should the nurse place sexual maturation of the male adolescent? Testicular enlargement Vocal changes Pubic hair growth Penile enlargement Growth of axillary hair

Testicular enlargement 1 Pubic hair growth 2 Penile enlargement 3 Growth of axillary hair 4 Vocal changes 5

A nurse is preparing to administer a hepatitis B immunization to an infant who is 9-months-old. Which site should the nurse use to administer the immunization? Deltoid Vastus lateralis Dorsogluteal Ventrogluteal

vastus lateralis

Normal Temp Ranges in Children - 3 months & 6 months 37.5˚ C (99.5˚ F) - 1 year- 37.7˚ C (99.9˚ F) Axillary​​​​​​​ Rectal (if exact measurement necessary)

- 3 years- 37.2˚ C (99.0˚ F) - 5 years- 37.0˚ C (98.6˚ F) Axillary Tympanic Oral (if child cooperative)​​​​​​​ Rectal (if exact measurement necessary)

A community health nurse is preparing an injury prevention program for the caregivers of toddlers who live in the community. Which of the following should the nurse include in the program? A. Hot water heater thermostats should be set below 49° C (120° F). B. Swimming lessons should begin at the age of 5. C. Crib mattresses should be kept in the middle position. D. Firearms do not need to be locked away as long as the child cannot reach them.

A

A nurse is providing teaching about expected changes during puberty to a group of guardians of early adolescent females. Which of the following statements by one of the guardians should the nurse identify as indicating an understanding of the teaching? A. "Females usually stop growing about 2 years after they have had their first menstrual period." B. "Females are expected to gain about 65 pounds during puberty." C. "Females experience menstruation prior to breast development." D. "Females typically grow more than 10 inches during puberty."

A

A nurse is teaching the parent of a toddler about home safety. Which of the following statements by the parent indicates an understanding of the teaching? a. "I lock my medications in the medicine cabinet." b. "I keep my child's crib mattress at the highest level." c. "I turn pot handles to the side of my stove while cooking." d. "I will give my child syrup of ipecac if she swallows something poisonous."

A

In terms of cognitive development the 5-year-old child would be expected to: a. Use magical thinking. b. Think abstractly. c. Understand conservation of matter. d. Be unable to comprehend another person's perspective.

A

Promoting sleep for a 3 yo. Which info should the RN give to parents? A. Follow a nightly routine and establish bedtime. B. Encourage active play prior to bedtime. C. Let the child remain awake until tired enough to go to sleep. D. Reward the child with a food treat just prior to sleep if the child goes to bed on time.

A

Which stage of development is most unstable and challenging regarding development of personal identity? A) Adolescence B) Toddler hood C) Childhood D) Infancy

A

A nurse is conducting a well-child visit with a 5-year-old child. Which of the following immunizations should the nurse plan to administer? (Select all that apply.) A. Diphtheria, tetanus, pertussis (DTaP) B. Inactivated poliovirus (IPV) C. Measles, mumps, rubella (MMR) D. Pneumococcal (PCV) E. Haemophilus influenzae type B (Hib)

A, B, C

A nurse is providing anticipatory guidance to the caregivers of a toddler. Which of the following should the nurse include? Select all that apply. A. Develop food habits that will prevent dental caries. B. A decrease in appetite is common in toddlers C. Expression of bedtime fears is common. D. Expect behaviors associated with negativism and ritualism. E. Annual screenings for phenylketonuria are important.

A, B, C, D

A nurse is performing a family assessment. Which of the following should the nurse include? (Select all that apply.) A.Medical history B.Parents' education level C.Child's physical growth D.Support systems E.Stressors

A, B, D, E

The nurse is caring for a 2-year-old child who returns to the hospital floor after undergoing an operation. Which nonverbal action implies that the child is in pain? Select all that apply. A. Loud crying B. Drowsiness C. Confused look D. Furrowed brow E. Puckering of lips

A, D, E

A nurse is reinforcing teaching about vital signs with the guardian of a 1-year-old toddler. Which of the following statements by the guardian indicates an understanding of the teaching? a) "My child's pulse could increase to 150 beats a minute with activity." b) "My child's temperature should be 96.8 degrees Fahrenheit." c) "My child should take 40 breaths a minute." d) "My child's pulse could get as low as 60 beats a minute while asleep."

A.

A nurse is providing education about developmental milestones of a toddler with a newly licensed nurse. Sort the following developmental milestones according to the child's age. - 12 months or 24 months Ability to run Kicks a ball Attempts to build a tower of 2 blocks Walks up a couple of stairs Eats with a spoon Drinks from a lidless cup Place a block in a container

Ability to run - 24 Months Kicks a ball- 24 Months Attempts to build a tower of 2 blocks- 12 months Walks up a couple of stairs- 24 Months Eats with a spoon - 24 Months Drinks from a lidless cup - 12 Months Place a block in a container -12 months

Sleep and Rest about 9 hours of sleep each night; need 9-11 hours Sleep habits change with puberty due to increased metabolism and rapid growth. stay up late, sleep in later in the morning, & can sleep more than during the school-age years. During periods of active growth, the need for sleep increases. Sleep habits can change with puberty due to increased metabolism and rapid growth during the adolescent years. Sleep deprivation is a concern with many adolescents; discuss the importance of sleep and encourage adequate rest.

Age-Appropriate Activities QPCC​​​​​​​ Nonviolent video games Nonviolent music Sports Caring for a pet Career-training programs Reading Social interaction (going to movies, school dances, electronic messaging, and social media)

A child who has been receiving morphine by the intravenous (IV) route will now start receiving it orally. In order for equianalgesia (equal analgesic effect) to be achieved, the oral dose will be A. same as the IV dose. B. greater than the IV dose. C. one half of the IV dose. D. one fourth of the IV dose.

B

A nurse is assessing a 2½-year-old toddler at a well-child visit. Which of the following findings should the nurse report to the provider? A. Height increased by 7.5 cm (3 in) in the past year. B. Head circumference exceeds chest circumference. C. Anterior and posterior fontanels are closed. D. Current weight equals four times the birth weight

B

A nurse is assessing a 6-month-old infant. Which of the following reflexes should the infant exhibit? A. Moro B. Plantar grasp C. Stepping D. Tonic neck

B

A nurse is evaluating the developmental level of a 2-year-old. Which of the following does the nurse expect to observe in this child? A) Uses a fork to eat B) Uses a cup to drink C) Uses a knife for cutting food D) Pours own milk into a cup

B

A nurse is performing a physical assessment on a 6-month-old infant. Which of the following reflexes should the nurse expect to find? a. Stepping b. Babinski c. Extrusion d. Moro

B

A nurse is preparing an education program for a group of caregivers of preschool-age children about promoting optimum nutrition. Which of the following information should the nurse include in the teaching? A. Total fat intake should equal 20% of total daily caloric intake. B. Average calorie intake should be 1,400 calories per day. C. Daily intake of fruits and vegetables should total 2 servings. D. Healthy diets include a total of 8 g protein each day.

B

The nurse teaches parents how to help their children learn impulse control and cooperative behaviors. This would occur during which of the stages of development defined by Erikson? A.Trust versus mistrust B.Initiative versus guilt C.Industry versus inferiority D.Autonomy vs. Shame and doubt

B

The typical play activity in which toddlers engage is called: a. Solitary b. Parallel c. Associative d. Cooperative

B

When developing a plan of care for a male adolescent, the nurse considers the child's psychosocial needs. During adolescence, psychosocial development focuses on: A. Becoming industrious B. Establishing an identity C. Achieving intimacy D. Developing initiative

B

Which is an important consideration when using the FACES Pain Rating Scale with children? A. Children color the face with the color they choose to best describe their pain. B. The scale can be used with most children as young as 3 years of age. C. The scale is not appropriate for use with adolescents. D. The scale is useful in pain assessment but is not as accurate when assessing physiologic responses.

B

A nurse is performing a developmental screening on an 18-month-old. Which of the following skills should the nurse expect the toddler to be able to perform? (Select all that apply.) A. Removes few articles of their clothing B. Attempts using a spoon C. Walks independently without holding onto furniture D. Jumps off ground using both feet E. Turns pages in book one at time

B & C

Which of the following immunization booster vaccines should be considered for a 12 year old adolescent who has completed all recommended routine childhood vaccinations? Select all that apply. a. DTap b. Tdap c. Meningococcal d. Pneumococcal e. Hepatitis B

B & C

A nurse is teaching a guardian of an infant about the administration of oral medications. Which of the following should the nurse include in the teaching? Select all that apply. A. Use a universal dropper for medication administration. B. Ask the pharmacy to add flavoring to the medication. C. Add the medication to a formula bottle before feeding. D. Use the nipple of a bottle to administer the medication. E. Hold the infant in a semi-reclining position.

B, D, E

**Sleep and Rest On average, about 12 hr of sleep/day day, & infrequently take daytime naps. Sleep disturbances frequently occur during early childhood, & problems range from difficulty going to bed to night terrors. Recommended interventions vary but can include the following.​​​​​: Keep a consistent bedtime routine. Use a night light in the room. Provide the child with a favorite toy. Leave a drink of water by the bed. Reassure preschoolers who are frightened but discourage sleeping with parents. Ignore attention-seeking behaviors. Injury Prevention ​​​​​​​ Bodily harm: - Firearms should be kept in locked cabinets or containers. - taught stranger safety. - taught to wear protective equipment (helmet, pads). - Preschoolers are less prone to falls due to improved fine and gross motor skills, coordination, and balance.

Burns Hot water thermostats should be set at or below 49° C (120° F). Working smoke detectors should be kept in the home. Preschoolers should have sunscreen applied when outside. Drowning not be left unattended in bathtubs. closely supervised when near the pool or any other body of water. Preschoolers should be taught to swim. Motor-vehicle injuries Preschoolers should use a federally approved car restraint according to the manufacturer recommendations. forward-facing car seat is outgrown, transitions to a booster seat. It is recommended that children use an approved car restraint system until they achieve a height of 145 cm (4 feet, 9 in) or 8 to 12 years old. Safest area for children- backseat of the car. Supervise preschool-age children when playing outside, & do not allow them to play near a curb or parked cars. Teach pedestrian safety rules to preschool-age children. Stand back from curb while waiting to cross the street. Before crossing the street, look left, then right, then left again. Travel on the left, facing traffic, when there are no sidewalks. At night, wear light-colored clothing with fluorescent materials attached.

Injury Prevention: Bodily harm Annual psychologic screenings to identify depression, anxiety, suicidal ideations, & substance use. Keep firearms unloaded & in a locked cabinet or box. Teach proper use of sporting equipment prior to use. Insist on helmet use and/or pads when roller skating, skateboarding, bicycling, riding scooters, skiing, and snowboarding. Be aware of changes in mood. Monitor for self-harm in adolescents who are at risk. Watch for the following: Poor school performance, Lack of interest in things that were of interest to the adolescent in the past, Social isolation, Disturbances in sleep or appetite, Expression of suicidal thoughts​​​​​​​ Discuss non-violent conflict resolution strategies. Discuss bullying, including cyberbullying. Warn about the risk of sexual predators, who often communicate through electronic interactions. Substance use disorder Monitor for indications of substanc

Burns Teach fire safety. Apply sunscreen when outside. Avoid tanning beds. Drowning Teach adolescents to swim. Teach adolescents not to swim alone. Motor-vehicle injuries Encourage attendance at drivers' education courses. Emphasize the need for adherence to seat belt use. Insist on helmet use with bicycles, motorcycles, skateboards, roller skates, and snowboards. Discourage use of cell phones while driving & enforce laws regarding use. Teach the dangers of combining substance use with driving. Role model desired behavior.

Which drug is usually the best choice for patient-controlled analgesia (PCA) for a child in the immediate postoperative period? A. Codeine B. Methadone C. Morphine D. Meperidine

C

a nurse is assessing a 3 y/o child during a well-child exam. which of the following findings should the nurse report to the provider? a. the child wets the bed when sleeping b. the child cannot catch a ball c. the child cannot walk on tiptoe d. the child builds a tower of 10 cubes

C 3 y/o- ride tricycles, jump off bottom step, stand on one foot for a few seconds 4 y/o- skips & hops on one foot, throws ball overhead, catches ball reliably 5 y/o- jumps rope, walks backward heel-toe, throws & catches ball w/ease

The nurse is measuring 4 mL of a liquid cough elixir for a child. Which method is most appropriate? Using a teaspoon to measure and administer Holding the medication cup at eye level and filling it to the desired level Withdrawing the elixir from the container using a syringe without a needle attached Withdrawing the elixir from the container using a calibrated oral syringe

Calibrated oral syringe

Infant Assessment

Circulatory system - Neck veins - Clubbing of fingers, peripheral cyanosis - Edema - Blood pressure, pulses, capillary refill - Heart sounds ----S1 louder over apex & S2 louder over base ----Sinus arrythmias associated w/ respirations are common ----Splitting of S2 & S3 expected in some children - Pulses - Infants = brachial, temporal, femoral - Children & adolescents ± same as adults - Abdomen: Infants & toddlers = round abdomen - Spine: Without dimples or tufts of hair - Overall C-shaped lateral curve - Neuro: Infant reflexes, Cranial reflexes, DTRs

A nurse is providing teaching to the caregiver of a preschool-age child about methods to promote sleep. Which of the following statements by the caregiver should the nurse identify as indicating an understanding of the teaching? A. "I will sleep in the bed with my child if they wake up during the night." B. "I will let my child stay up an additional 2 hours on weekend nights." C. "I will let my child watch television for 30 minutes just before bedtime each night." D. "I will keep a dim lamp on in my child's room during the night."

D

The most consistent indicator of pain in infants is A. increased respirations. B. increased heart rate. C. clenching the teeth and lips. D. a facial expression of discomfort.

D

The nurse is assisting the parent of a 6-month-old infant to administer an oral liquid medication. The parent asks why the medication can't be given in a bottle of formula to make it taste better. How will the nurse respond? "Adding a medication to the formula will cause the formula to curdle." "Formula and medications can form toxic compounds if mixed together." "The infant may not always take the entire bottle of formula." "This may cause the infant to refuse formula in the future."

Doesn't take the entire bottle

Partnership between families and health care professionals with a common goal: the benefit of the child/patient

Family-Centered Care

A nurse is planning care for a 12-year-old child following a surgical procedure. Which of the following actions should the nurse include in the plan of care? Administer NSAIDs for pain greater than 7 on a scale of 0 to 10. Administer intranasal analgesics PRN. Administer IM analgesics for pain. Administer IV analgesics on a schedule.

IV analgesics on schedule

15 mos Walks without help- gross motor skill Creep up stairs- gross Uses cup well- fine motor skill Builds tower of 2 blocks- fine 18 mos Runs clumsily; falls often- bumps & bruises Throws ball overhand Jumps in place with both feet Pulls and pushes toys Manages a spoon without rotation- fine Turns pages in a book, 2-3 at a time- fine Builds tower of 3 or 4 blocks- fine 2 years Walks up and down stairs by placing both feet on each step Builds tower of 6-7 blocks- fine Turns pages of books one at a time- fine 2.5 yrs Jumps across floor and off of a chair or step using both feet Stands on one foot momentarily Takes a few steps on tiptoe Draws circles- fine Has good hand-finger coordination-fine

Immunizations 12 to 15 months: inactivated poliovirus (third dose between 6 to 18 months) Haemophilus influenzae type B pneumococcal conjugate vaccine measles, mumps, and rubella varicella 12 to 23 months: hepatitis A (Hep A) given in two doses at least 6 months apart 15 to 18 months: diphtheria, tetanus, and acellular pertussis 12 to 36 months: yearly seasonal inactivated influenza vaccine live, attenuated flu vaccine by nasal spray (must be 2 years or older) Sleep and Rest - average 11 to 12 hr of sleep/day, including one nap. - Naps often are eliminated in older toddlerhood. - Resistance to bedtime & expression of fears are common in this age group. - Maintain a regular bedtime/bedtime routines are helpful to promote sleep.

Social Development - No stranger anxiety plus less separation anxiety - Prolonged separation = anxiety- decrease with play/toys - Pretend play is healthy; magical thinking - Associative play - Egocentric to social awareness Reportable Findings Regression- Previous immature behaviors/develop habits Regress to play like a toddler, rather than preschooler Nose picking, bed wetting, thumb sucking

Immunizations 4 to 6 Years: DTaP, MMR, varicella and inactivated poliovirus (IPV) 3 to 6 Years: Yearly seasonal influenza vaccine; inactivated influenza vaccine; or live, attenuated influenza vaccine by nasal spray Nutrition Preschoolers mildly active: estimated caloric intake range from 1200 to 1400 kcal/day. Finicky eating can remain a behavior , but often by 5 years of age they become more willing to sample different foods. Preschoolers need 13 to 19 g/day of protein (2- to 4-oz equivalents), in addition to 700 to 1000 mg/day of calcium and19 to 25 g/fay of fiber. Total fat should be 30% of total caloric intake over several days. The American Academy of Pediatrics recommends a 5-2-1-0 framework, which includes that preschoolers have 5 servings of fruits/vegetables per day, 2 hr or less of screen time, 0 servings of sugar-sweetened beverages, and 1 hr of physical activity per day.

Nutrition: - consume 16-24 oz of milk/day, and may switch from drinking whole milk to drinking low-fat milk after 2 years of age. Breastfeeding can continue for up to 2 years of age or longer if desired. - Juice consumption- limited to 4 to 6 oz per day. - 1 cup of fruit daily. - Food serving size- 1 tbsp for each year of age, or ¼ to 1/3 of an adult portion. - prefer finger foods because of increasing autonomy. - potential choking hazards (nuts, grapes, hot dogs, peanut butter, raw carrots, dried beans, tough meats, popcorn) should be avoided. - Adult supervision should always be provided during snack/mealtimes. - cut into small, bite-size pieces - easier to swallow & to prevent choking. not be allowed to engage in drinking or eating during play activities or while lying down.

Injury Prevention Aspiration of foreign objects Small objects (grapes, coins, colored beads, candy) that can become lodged in the throat should be avoided. Toys that have small parts should be kept out of reach. Age-appropriate toys should be provided. Clothing should be checked for safety hazards (loose buttons). Balloons should be kept away from toddlers. Parents should know emergency procedures for choking. Bodily harm Sharp objects should be kept out of reach. Firearms should be kept in locked boxes or cabinets. Toddlers should not be left unattended with any animals present. Toddlers should be taught stranger safety.

Infant Reflexes Sucking and Rooting Reflexes Elicited by stroking an infant's cheek or the edge of an infant's mouthThe infant turns their head toward the side that is touched and starts to suck. Birth to 4 months Palmar Grasp Elicited by placing an object in an infant's palmThe infant grasps the object. Birth to 4 months Plantar Grasp** Elicited by touching the sole of an infant's footThe infant's toes curl downward. Birth to 8 months

Moro Reflex Elicited by allowing the head and trunk of an infant in a semi‑sittingposition to fall backward to an angle of at least 30°The infant's arms and legs symmetrically extend, thenabduct while fingers spread to form C shape. Birth to 4 months Tonic Neck Reflex (Fencer Position) Elicited by turning an infant's head to one sideThe infant extends the arm and leg on that side andflexes the arm and leg on the opposite side. Birth to 3 to 4 months Babinski Reflex** Elicited by stroking the outer edge of the sole of an infant's foot up toward the toesThe infant's toes fan upward and out. Birth to 1 year Stepping** Elicited by holding an infant upright with his feet touching a flat surfaceThe infant makes stepping movements. Birth to 4 weeks

Burns The temperature of bath water should be checked. Thermostats on hot water heaters should be turned down to less than 49° C (120° F). Working smoke detectors should be kept in the home. Pot handles-turned toward the back of the stove. Electrical outlets covered. Toddlers should wear sunscreen when outside. Drowning Toddlers should not be left unattended in bathtubs. Toilet lids kept closed. closely supervised when near pools or any other body of water. Toddlers should be taught to swim Falls Doors/windows kept locked. Crib mattresses kept in the lowest position with the rails all the way up. Safety gates should be used across the top & bottom of stairs.

Motor-vehicle injuries Infants/toddlers remain in a rear-facing car seat until the age of 2 years or the height/weight recommended by the manufacturer. Toddlers over the age of 2 years, or who exceed the height recommendations for rear-facing car seats, are moved to a forward-facing car seat. Safest area for infants/children is the backseat of the car. Do not place rear-facing car seats in the front seat of vehicles with deployable passenger airbags. Poisoning Exposure to lead paint should be avoided. Safety locks placed on cabinets that contain cleaners/other chemicals. The phone number for a poison control center kept near the phone. Meds should be kept in childproof containers, away from the reach of toddlers. A working carbon monoxide detector should be placed in the home. Suffocation Plastic bags should be avoided. Crib mattresses should fit tightly. Crib slats should be no farther apart than 6 cm (2.375 in). Pillows should be kept out of cribs.

Optic Supine or sitting position. Extend the child's head & ask the child to look up. Pull the lower eyelid downward and apply medication in the conjunctiva pocket. Administer ointments from the inner to outer canthus of the eye preferably before nap or bedtime. Provide atraumatic care. If infants clench their eyes closed, place the drops in the nasal corner. When the infant opens his eyes, the medication will enter the eye. Apply light pressure to the lacrimal conjunctiva of the eye for 1 min to prevent unpleasant taste. Play games with younger children. Otic Place in a prone or supine position with the affected ear upward. Children younger than 3 years: pull the pinna downward and straight back. Children older than 3 years: pull the pinna upward and back. Provide atraumatic care. Allow refrigerated medications to warm to room temperature prior to administration. Massage the outer area for a few minutes followin

Nasal Remove mucus prior to administration. Position the child with the head hyperextended. Use a football hold for infants. Provide atraumatic care. Insert the tip into the naris vertically, then angle it prior to administration. Play games with younger children. Aerosol Use a mask for younger children. Provide atraumatic care. Allow guardians to hold the child during treatment. Use distraction. Rectal Provide lubrication to the medication by using warm water or other lubricant, if the medication is not pre-lubricated. Insert beyond both rectal sphincters (small child less than 0.5 inches, older child 1 inch). Hold the buttocks gently together for 5 to 10 min. If necessary to half the dose, cut the medication lengthwise.

***Pulse Rate for children

Newborn (birth to 4 weeks): 110 to 160/min Infant (1 to 12 months): 90 to 160/min Toddler (1 to 2 years): 80 to 140/min Preschooler (3 to 5 years): 70 to 120/min​​​​​​​ School aged (6 to 12 years): 60 to 110/min Adolescent (13 to 18 years): 50 to 100/min

***Respirations

Newborn (birth to 4 weeks): 30 to 60/min Infant (1 to 12 months): 25 to 60/min Toddler (1 to 2 years): 25 to 30/min Preschooler (3 to 5 years): 20 to 25/min School aged (6 to 12 years): 20 to 25/min Adolescent (13 to 18 years): 16 to 20/min

Oucher: 3 to 13 years Pain rated on a scale of 0 to 5 using six photographs. Substitute 0, 2, 4, 6, 8, 10 for 0 to 5 to convert to the 0 to 10 scale. Have the child organize the photographs in order of no pain to the worst pain; ask the child to choose a picture that best describes how they are feeling.

Non-communicating children's pain checklist: 3 years and older Behaviors are observed for 10 min. Six subcategories are each scored on a scale of 0 to 3. Subcategories: Activity, body and limbs, facial, physiological, social, vocal Cutoff scores: 6 to 10 indicates mild pain; 11 or higher indicated moderate to severe pain

FACES: 3 years and older Pain rated on a scale of 0 to 5 using a diagram of six faces. Substitute 0, 2, 4, 6, 8, 10 for 0 to 5 to convert to the 0 to 10 scale. Explain each face to the child; ask the child to choose a face that best describes how they are feeling.

Numeric scale: 5 years and older Pain rated on a scale of 0 to 10. Explain to the child that 0 means "no pain" and 10 means "worst pain." Have the child verbally report a number or point to their leve of pain on a visual scale.

Psychosocial Development ***Erikson: identity vs. role confusion- Social relationships Adolescents often try different roles/experiences to develop a sense of personal identity and come to view themselves as unique individuals. Group identity: Adolescents become part of a peer group that greatly influences behavior. Success = sense of competence Failure = feelings of inferiority Immunizations Yearly seasonal influenza vaccine: Inactivated influenza vaccine or live, attenuated influenza vaccine by nasal spray. Recommendation can be season-specific. Meningococcal vaccine: receive 2nd dose @ 16 years of age if received 1st dose received at 11-12 years of age.

Nutrition Rapid growth/high metabolism require increases in quality nutrients, and make adolescents unable to tolerate caloric restrictions. During times of rapid growth, additional calcium, iron, protein, and zinc are needed. Inadequate intake of folic acid, vitamin B6, vitamin A, iron, calcium, and zinc is common.​​​​​​​ Overeating/undereating present challenges during the adolescent years. Yearly assessments of height, weight, and BMI for age are needed in order to identify nutritional issues and intervene early.​​​​​​​​​​​​​​ Overweight and obesity rates are of particular concern; anorexia and bulimia are common in this age group as well. Advise parents to: Avoid using food as a reward. Emphasize physical activity. Ensure that a balanced diet is consumed by following the U.S. Department of Agriculture's healthy diet recommendations.​​​​​​​ Encourage adolescents to make healthy food selections for meals and snacks.

Medication Administration: Notify the provider if medication dosage is determined to be outside the safe dosage range, and for any questions about medication preparation or route. Double-check high-risk and facility-regulated medications with another nurse. Use two client identifiers prior to administration: client name & date of birth. Use guardian(s) for verification of infants or nonverbal children. Two identifiers from the ID band must be confirmed: client name, date of birth, or hospital identification number. Computers may also be used to scan the child's ID band for electronic record updating. Determine parental involvement with administration. Allow the child to make appropriate choices regarding administration (choosing the left or right leg, whether the guardian or nurse will administer the medication). Prepare the child according to age and developmental stage.

Oral preferred for children. Available liquids, chewables, & meltaways Determine the child's ability to swallow pills. Kids cannot reliably swallow pills until 5-6 y/o Use the smallest measuring device for doses of liquid medication. Use an oral medication syringe for smaller amounts, and a medication cup for larger amounts. Avoid measuring liquid medication in a teaspoon/tablespoon. Use rigid plastic cups instead of paper cups for liquid medications. Avoid mixing medication with formula or putting it in a bottle of formula because the infant might not take the entire feeding, and the medication can alter the taste of the formula. Hold the infant in a semi-reclining position Hold the small child in an upright position to prevent aspiration. Administer the medication in the side of the mouth in small amounts- allows the infant/child to swallow. Only use the droppers that come with the medication for measurement. Stroke the infant under the chin to promote swallowing while holding cheeks together. Teach the child to swallow tablets that aren't available in liquid form and can't be crushed. Teach in short sessions using verbal instruction, demonstration, and positive reinforcement. Provide atraumatic care. Mix the medication in a small amount of sweet nonessential food (applesauce or sherbet). Offer juice, a soft drink, or snack after administration. Add flavoring to medications as available. Use a nipple to allow the infant to suck the medication. Reward small child with a prize or sticker afterwards.​​​​​​​

Health Promotion of Toddlers (1 to 3 Years)

Physical Development Anterior fontanels- close by 18 months of age. Weight: At 30 months of age, weigh four times their birth weight. Toddlers gain approximately 1.8 to 2.7 kg (4 to 6 lb) per year. Height: Toddlers grow about 7.5 cm (3 in) per year. Head circumference & chest circumference are usually equal by 1 to 2 years of age. Psychosocial Development ***Erikson: autonomy versus shame and doubt- toilet training Independence is paramount- attempting to do everything for themselves. often use negativism/negative responses, as they begin to express their independence Ritualism/maintaining routines and reliability, provides a sense of comfort for toddlers. Toilet training & temper tantrums

Health Promotion of Preschoolers (3 to 6 Years) Physical Development Weight: Preschoolers should gain about 2 to 3 kg (4.5 to 6.5 lb) per year.Height: Preschoolers should grow about 6.4 to 9 cm (2.5 to 3.5 in) per year. 20 teeth by 33 mo.

Psychosocial Development ***Erikson: initiative vs. guilt- Exploration Preschoolers become energetic learners, despite not having all the physical abilities necessary to be successful at everything. Guilt when preschoolers believe they have misbehaved or when they are unable to accomplish a task. Guiding preschoolers to attempt activities within their capabilities while setting limits is important. Begin to assert control and power over environment = initiative Gross motor 3 y/o- ride tricycles, jump off bottom step, stand on one foot for a few seconds 4 y/o- skips & hops on one foot, throws ball overhead, catches ball reliably 5 y/o- jumps rope, walks backward heel-toe, throws & catches ball w/ease Fine motor Dresses independently Holds a pencil, draw s self or others Plays simple board games

Transdermal/topical Ensure the skin is dry/intact. Apply to the body or major muscle (try to hide from smaller children). Assess skin site of administration regularly. Rotate sites frequently. Injection Change needle if it pierced a rubber stopper on a vial. Secure the infant or child prior to injections. Assess the need for assistance. Avoid tracking of medication. When selecting sites, consider the following. Medication amount, viscosity, and type Muscle mass, condition, access of site, and potential for contamination Treatment course and number of injections Age and size of child Intradermal Administer on the inside surface of the forearm. Use a TB syringe with 26- to 30-gauge needle with an intradermal bevel. Insert needle at 15° angle. Do not aspirate.

Subcutaneous Give anywhere there is adequate subcutaneous tissue. Common sites- lateral aspect of the upper arm, abdomen, and anterior thigh. Inject volumes of less than 0.5 mL. Use a 1 mL syringe with a 26- to 30-gauge needle. Insert at a 90° angle. Use a 45° angle for children who are thin. Check policy for aspiration practices. Intramuscular- causes the most concern for children Use a 22- to 25-gauge, 5/8 to 1.5-inch needle. - Vastus lateralis Recommended site in infants and small children who have minimal muscle mass. Position the child supine, side-lying, or sitting. Inject up to 0.5 mL for infants.​​​​​​​​​​​​​​ Inject up to 2 mL for children. - Ventrogluteal Position the child supine, side-lying, or prone. Inject 0.5 to 1 mL, depending on muscle size of infant. Inject up to 2 mL in children. - Deltoid Explain the procedure to the child and guardians. Inject up to 1 mL. - Provide atraumatic care Apply lidocaine and prilocaine topical ointment to the site for 60 min prior to injection. Change needle after puncturing a rubber stopper. Use the smallest gauge of needle possible. QPCC​​​​​​​ Use therapeutic hugging Secure the child firmly to decrease movement of the needle while injecting. Use distraction. Encourage guardians to hold the child after. Offer praise Use play therapy. Offer sucrose pacifiers to infants.

***Blood Pressure NEWBORN (FULL TERM: BIRTH TO 4 WEEKS) systolic greater than - 64 diastolic greater than - 41 INFANT (1 MONTH TO 12 MONTHS) systolic greater than 85 diastolic greater than 50

TODDLER (1 YEAR TO 2 YEARS) MALE: systolic 85 to 91; diastolic 37 to 46 - 103 to 109; 56 to 65 FEMALE: systolic 86 to 89; diastolic 40 to 49 - 104 to 107; 58 to 67 PRESCHOOLER (3 TO 5 YEARS) MALE systolic 91 to 98; diastolic 46 to 53 109 to 112; 65 to 72 FEMALE systolic 89 to 93; diastolic 49 to 54 107 to 110; 67 to 72

For children above 3 months of age with mild pain, the first step is to administer a non-opioid. Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used for mild pain. The second step for children who have moderate or severe pain is to administer a strong opioid. Morphine is the drug of choice.

Use non-opioid and opioid medications. Acetaminophen and NSAIDs are acceptable for mild to moderate pain; over 3 months of age Ibuprofen: CANNOT HAVE until > 6 mo. NO ASPIRIN due to Reyes syndrome Opioids are acceptable for moderate to severe pain. Medications used include morphine sulfate, hydromorphone, and fentanyl. Fentanyl = older than 12 Rapid relief = IV bolus Oral meds take 1-2 hours for peak effects Not suited for kids in pain requiring rapid relief/fluctuating pain IM injections- Not recommended Combining a non-opioid and an opioid medication treats pain peripherally and centrally. This offers greater analgesia with fewer adverse effects (respiratory depression, constipation, nausea).​​​​​​​ Opioid adverse effects Nursing actions ​​​​​​​ Administer stool softeners for constipation. Monitor child for respiratory depression and sedation.

PAIN MANAGEMENT Developmental characteristics

Young infant Loud cry Rigid body or thrashing Local reflex withdrawal from pain stimulus Expressions of pain (eyes tightly closed, mouth open in a squarish shape, eyebrows lowered and drawn together) Lack of association between stimulus and pain Older infant Loud cry Deliberate withdrawal from pain Facial expression of pain Toddler Loud cry or screaming Verbal expressions of pain Thrashing of extremities Attempt to push away or avoid stimulus Noncooperation Clinging to a significant person Behaviors occur in anticipation of painful stimulus Requests physical comfort School-age child Stalling behavior Muscular rigidity Any behaviors of the toddler, but less intense in the anticipatory phase and more intense with painful stimulus Adolescent More verbal expressions of pain with less protest Muscle tension with body control

A 5-year-old child with a high fever is vomiting. The doctor orders acetaminophen 80 mg per rectum. Which of the following actions by the nurse is appropriate? Insert the medication into the rectum, and place the child in semi-Fowler's position. Position the child on the right side with the upper leg bent. After inserting the medication, hold the child's buttocks together. Request that the health-care practitioner change the order to oral acetaminophen.

keep buttocks together

A nurse is assessing an infant who has otitis media for pain. Which of the following should the nurse identify as findings of pain in an infant? Select all that apply. Pursed lips Loud cry Lowered eyebrows Rigid body Pushes away stimulus

loud cry lowered eyebrows rigid body

A nurse is caring for an adolescent whose guardian expresses concerns about the child sleeping such long hours. Which of the following conditions should the nurse inform the guardian as requiring additional sleep during adolescence? Sleep terrors Rapid growth Elevated zinc levels Slowed metabolism

rapid growths

A nurse is performing a developmental screening on a 3-year-old child. Which of the following gross motor skills should the nurse expect the child to perform? Ride a tricycle Hop on one foot Jump rope Throw a ball overhead

ride tricycle

A nurse is planning to administer the influenza vaccine to a toddler. Which of the following actions should the nurse take? Administer subcutaneously in the abdomen. Use a 20-gauge needle. Divide the medication into two injections. Place the child in the supine position.

supine

A nurse is to administer ear drops into the right ear of a 6-year-old child. Which of the following actions by the nurse is appropriate? Nurse has the child lie supine for one-half hr after administering the medication. Nurse rubs the area behind the ear after administering the medication. Nurse warms the medication in the microwave. Nurse pulls the pinna of the ear up and back.

up and back