Level 3 Exam 1 Ch. 14 Developmentally Appropriate Nursing Care Across Care Settings

newborn pulse rate? newborn respirations?

110-160/min depending on activity 30-35 respirations/min

genu valgum or knock knees are normal when

2-7 years of age

bow leggedness or genu varum is normal until what age

2/3 years old

A nurse on a pediatric unit is caring for a toddler. which of the following behaviors is an effect of hospitalization? SATA A. believes the experience is a punishment B. experiences separation anxiety C. displays intense emotions D. exhibits regressive behaviors E. manifests disturbance in body image

B,C,D preschoolers believe hospitalization is a punishment adolescents an experience body image disturbance

a nurse is caring for a preshooler. Which of the following is an expected behavior of a preschool-age child? a. describing manifestations of illness b. relating fears to magical thinking c. understanding cause of illness d. awareness of body function

B. are egocentric and relate fears to magical thinking preschoolers have little ability to describe manifestations and understand cause of illness. awareness of body function is a behavior of an adolescent

A nurse is teaching a guardian about parallel play in children. Which of the following statements should the nurse include in the teaching? A. children sit and observe others playing B. children exhibit organized play when in a group C. the child plays alone D. the child plays independent when in a group

D. onlooker is when the child observes others team play is organized play solitary play is when a child plays alone

A nurse is teaching a group of caregivers about separation anxiety. Which of the following information should the nurse include in the teaching? A. it is often observed in the school-age child B. detachment is the stage exhibited in the hospital C. it results in prolonged issues of adaptability D. kicking a stranger is an example

D. physical aggression toward strangers is a behavior seen in the protest stage of separation anxiety separation anxiety is commonly seen in the toddler. Permanent issues are rare and detachment is rarely seen in the hospital setting

how would you prepare a toddler for a procedure?

Describe the procedure to the parents, explaining what will happen and how long it will take. Use play to demonstrate the procedure to the toddler; encourage them to demonstrate or practice with a doll or teddy bear . Use simple, concrete language to describe the procedure and how it might feel to the toddler. Limit preparation to 5 to 10 minutes because of the child's short attention span Identify what restraints may be used and explain why they are needed. Allow parents to decide whether they would like to be present for the procedure. Parents may prefer to leave the room and return immediately after the procedure to comfort their child. Allow the parents to stroke their child or speak soothingly to their child if they remain in the room

how would you prepare an infant for a procedure?

Describe the procedure to the parents, explaining what will happen and how longit will take. Encourage the parent to stop you at any point if they have a question. Remind parents that infants often cry for reasons other than discomfort but be honest about any discomfort the infant may experience with the procedure. Identify what restraints may be used and give an explanation as to why they are needed. Allow parents to decide whether they would like to be present for the procedure. Parents may prefer to leave the room and return immediately following the procedure to comfort their child.

how would you prepare the adolescent for a procedure?

Describe the procedure, explaining exactly what will happen and how long it will take. Encourage the adolescent to stop you at any point if they have a question. Be honest. Describe potential risks and pain associated with the procedure, but don't dwell on it. Allow the adolescent to take as active a role as possible. Practicing positioning or demonstrating the equipment before the procedure helps give the adolescent a sense of control. Provide a peer video of the procedure if possible. If possible, let them make decisions like when the procedure should take place. Allow the adolescent the option of having a parent present. Offer tips for distraction such as deep breathing, relaxation, counting, or squeezing an object or parent's hand

faces pain rating scale

Happy and sad faces 0-10. 3 years and older

flacc scale

Leg position, activity, consolibility, facial expressions, crying 2mths-7yrs

how would you prepare a preschooler for a procedure?

Preschooler Explain the procedure in terminology the child can understand. Begin preparation immediately before the procedure so the child will not worry for hours or days. Use play to demonstrate the procedure to the child; encourage them to demonstrate or practice with a doll or teddy bear. Set limits for the child so they are aware of expectations. For example, tell them they can yell and scream as much as they want but must hold very still . Give legitimate choices to the child whenever possible. Allow parents to decide whether they would like to be present for the procedure. Parents mayprefer to leave the room and return immediately after the procedure to comfort their child. Allow the parents to stroke their child or speak soothingly to their child if they remain in the room. Use distraction techniques such as deep breathing, singing, or squeezing a parent's or nurse's hand.

how would you prepare a school age for a procedure?

School age Explain procedure in terminology the child can understand. Preparation can begin in advance of procedure because they have a good concept of time May use play to demonstrate the procedure and if possible, have the child demonstrate on and practice positioning with a doll or teddy bear. Allow the child to touch and explore equipment to be used and involve the child in simple tasks during the procedure when possible Set limits for the child so they are aware of expectations. For example, tell them they can yell and scream as much as they want but must hold very still. Give choices whenever possible. Allow parents and child to decide together whether parents will stay for the procedure. Allow the parents to stroke their child or speak soothingly to their child if they remain in the room. Teach techniques like deep breathing, counting, reciting a silly rhyme, or anything else that might help distract and relax the child during the procedure

what is romberg test?

Tests the client's equilibrium, client stands with feet together and arms at sides eyes open and then closed. Client should be able to maintain the position for 20 secs with minimal or no swaying

chest vs. belly breathers

abdominal/diaphragmatic breathing less than 7 years of age older chlidren are thoracic breathers

what should you consider for pediatric pain management?

anticipate painful procedures and plan accordingly consider appropriate route for type of pain to treat to determine timing of treatment: topical, oral, injection, IV

infant: trust and sensorimotor thought things to consider

attachment to parent stranger anxiety sensorimotor phase of learning increased muscle control memory for past experiences imitation of gestures

what would you do for a pediatric history?

chief complaint use of culturally appropriate care comprehensive health history family medical/social history past medical history immunizagtions developmental milestones patterns of daily activities review of systems

infants to 6 years breathe with

diaphragm

preschooler: initiative and preoperational thought

egocentric fear of bodily harm animism increased language skills limited concept or time/frustration hospitalization seen as punishment

toddler: autonomy and sensorimotor/preoperational thought

egocentric thinking negative behavior animism limited language skills limited concept of time striving for independence

what is atraumatic care of the pediatric patient

embracing the concepts of family centered care or patient and family centered care is essential family centered care supports the around the clock presence and participation of parents in care hospitalizations is often a traumatic experience for a child

what are some concerns when caring for a child with a disability?

emotional concerns: raising a child with a disability is distressing bc of the disruption of the normal routine developmental concerns: many congenital problems are repaired surgically either shortly after birth or once the child is physically developed and strong enough physical concerns: can pose various physical concerns as often, abnormalities affect several body systems caregiver fatigue: caring for a child with a significant disability takes its toll on the entire family

in growth and development what are we looking for that helps children develop?

fine motor and gross motor skills hand eye coordination communication skills social skills problem-solving skills memory development

children and adolescents have

flat abdomens

what are some ways to gather a childs health history while establishing a relationship with the patient and family?

for an infant/non verbal child: health history is obtained from those who accompany the child young children need to feel secure before engaging in conversation school aged may choose to be interviewed w/o parent in room adolescents need to know that certain conversations can take place w/o parents knowledge

assessment in children? vitals?

general impression skin head neck eye visual ocular ear temp pulse respirations blood pressure

pediatric HEENT

head: suture lines fontanelles (posterior closes by 3 mo, anterior by 18 mo) eyes: symmetry of size and shape, pupil size, shape, reactivity, visual acuity testing at 3 years if able to understand directions, test with and w/o glasses ears: look for symmetrical size/ placement, when inspecting tympanic membrane pull pinna down under 3 and up and back older than 3 years

what are anthropometric measurements

height, weight, body mass index, infant heat circumference.

when could treatment without parental consent happen?

in the abscense of parents or legal guardians in emergencies: life threatening, care should not be withheld document any and all efforts made to obtain consent parent refusal to give consent for life-saving treatment requires notification to CPS evaluation for child abuse/ neglect can occur w/o parent consent and without notification to the state prior to evaluation

school age: industry and concrete thought

increased language skills interest in acquiring knowledge improved concept of time increased self-control stiving for industry developing relationships with peers

adolescent: identity and abstract thought

increasing abstract thought/reasoning consciousness of appearance concerned more with present than future striving for independence developing peer relationships/group identities

what would you assess for neuromuscular

infant reflexes cerebellar function: assess on children/adolescents, finger to nose, heel to shin, Romberg test

umbilical hernias are common in

infants and African American children

how would you conduct a systematic order of exam

least invasive to most reserve head to toe order for the older child

what are the apical pulse locations for less than 7 years? older than 7 years?

less than 7 is the 4th intercostal space medial to the left midclavicular line older than 7 is 5th intercostal space at the left midclavicular line

what is a retraction?

moving a body part in the posterior direction could signify respiratory distress, severe asthma attack, enterovirus D68 infection

what is involved in a pediatric skin assessment ?

note birthmarks Mongolian spots (blue spots lower back) ecchymosis learning to walk movements not as coordinated forehead, knees, shins, lower arms be alert to balding on an infant

how do you assess family dynamics?

observe the behaviors between child and parent questions to consider establish good rapport with parent conduct interview in a comfortable room with seating available for parent

when a child is unable to take adequate nutrition by mouth, an alternate feeding method is used to maintain and promote growth in the child enteral feedings: through the nose, mouth or directly into the digestive system

orogastric/nasogastric: the tube is inserted and then removed at the end of bolus feed gastrostomy: enteral tube feedings over a longer period of time, such as with oral feeding aversions or neurological dysfunction, a GT is an alternative to the nasogastric ostomies: ostomy is a surgical opening from either the small/large bowel to the surface of the abdomen to allow for fecal elimination

child restraints

parents and child need to be informed why once restraint is applied, the condition of the skin and circulation of the affected extremity must be checked and documented, every 15 minutes for 1 hour after initial application and then every 1 to 2 hours to ensure the child's safety (mummy, elbow, mitten)

how can a nurse decrease hospital stress for children?

play therapy: helps to ease stress of hospitilization and decrease child's fear and anxiety guided imagery: the mind helps the body maintain a relaxed state with the help of all 5 senses role modeling: the child learns certain behaviors by observing the behavior of others

what is informed consent

providing the patient with the necessary knowledge to make a decision regarding health care and the benefits and risks of treatment or refusal of treatment must be able to give consent must receive the information needed to make an intelligent decision the person must act voluntarily when exercising freedom of choice

infants and toddlers have

rounded abdomens

s1 is heard best at? s2 is heard best at? s3 is?

s1- apex (tricuspid, mitral areas) s2- base (aortic, pulmonic areas) s3 is a normal finding in children

in all 50 states adolescents can consent to treatment without parents knowledge for the following:

sexually transmitted infections mental health services alcohol/drug dependency pregnancy contraceptive advice

management of infant pain?

sucrose: activates opioid pathways, resulting in release of endogenous opioids used in in infants up to one year utilize prior to any needle stick procedures administer on pacifier 2 minutes prior to procedure (heel sticks, immunizations, iv insertion, venipuncture) may be used for procedures longer than 5 minutes contraindications: sucrose intolerance ( CSID congenital sucrase-isomaltose deficiency), fructose intolerance, glucose-galactose malabsorption

what is in a general assessment for children?

systematic developmental age vs chronological age be honest take note of cleanliness of clothing: is the child dressed appropriately, signs of neglect vs physical abuse vs sexual abuse

the legal age of consent is 18, an exception is made for those younger than 18 if?

they are married already a parent self-supporting member of the military

children BMI

underweight less than 5th percentile healthy = 5th-85th% overweight = 85th-95th obese = >95th%

pediatric specimen collections

urine samples: urine bag, clean catch, voiding stimulation, catheter, suprapubic aspirate stool samples blood samples throat culture (swabs) nasal culture (covid) cerebrospinal fluid collection

what does assent mean?

willingness to participate