NSG 334 Peds chap. 2-5, 9, 11, 13-15

Temperament defined

"manner of thinking, behaving, or reacting characteristic of an individual"

birth history

(1) the mother's health during pregnancy, (2) the labor and delivery, and (3) the infant's condition immediately after birth

Sickle cell disease

Genetic disorder in which red blood cells have abnormal hemoglobin molecules and take on an abnormal shape. -acute symptoms are precipitated by certain conditions, such as a lowered oxygen tension, infection, or dehydration

communal family

Group of people living together to raise children and manage household; unrelated by blood or marriage

reduced or incomplete penetrance

Individual carries a disease-causing mutation but does not have clinical symptoms

Common PCA Drugs

Morphine, Hydromorphone, and Fentanyl

single-gene disorder

Mutation in one gene, causes one protein to be made incorrectly

measure child height

Occiput, scapulae, buttocks, and heels are in contact with vertical surface head in horizontal Frankfort plane (imaginary line from the lower border of the orbit through the highest point of the auditory meatus; the line is parallel to the headboard and perpendicular to the vertical surface

developmental pace

Periods of accelerated and decelerated growth Does not occur in all areas at the same pace Once a skill has been achieved, the focus will shift to another area; fast in infancy, slow in childhood, fast in adolescence, slow in adulthood

religion vs spirituality

Religion is a group practice of spirituality -spirituality is concerned with the deepest levels of human experience

Pierre Robin Sequence

The triad of cleft palate, mandibular micrognathia, and glossoptosis. First caused by a abnormal development of mandible....

PKU (phenylketonuria)

a condition that makes it impossible for babies to metabolize certain proteins (phenylalanine)

co-culture (subculture)

a culture that exists within a larger cultural context -ethnicity, social class, religion, schools, peer groups, nurses... many countless

sequence

a single anomaly leads to a cascade of additional anomalies

contiguous gene syndrome

a syndrome with a phenotype that is caused by deletion of multiple, neighboring genes

binuclear family

a type of family consisting of divorced parents living in two separate households but remaining one family in spirit for the sake of the children

Faces Pain Scale-revised (FPS-R) (self reporting)

-used for children over 4 -six faces from 0-5 w/no smiling face at 0 and no tears at 5

Functional Disability Inventory (FDI)

-used w/ chronic pain -assesses influence of pain on physical function

FLACC pain scale

0-10 scale F: Faces. L: Legs. A: Activity. C: Cry C: Consolability

Grading of pulses

0-Absent, unable to palpate +1-Diminished, weaker than expected +2-Brisk, expected +3-easy to palpate, not easily obliterated with pressure +4-Strong, bounding, unable to obliterate with moderate pressure

Developmental Age Periods

1- Prenatal (Conception to Birth-2 wks old): reflects mothers health/diet 2- Infancy (Birth to 12 months): most critical 3- Early Childhood ( 1 years to 6 years): activity and discovery period 4-Middle Childhood (6-11/12 years old): peer relationships development 5-Later Childhood (11-19 years old): transitional

CAM 5 classes

1. Biologically based: foods, special diets, herbal or plant preparations, vitamins, other supplements 2. Manipulative treatments: chiropractic, osteopathy, massage 3. Energy based: Reiki, bioelectric or magnetic treatments, pulsed fields, alternating and direct currents 4. Mind-body techniques: mental healing, expressive treatments, spiritual healing, hypnosis, relaxation 5. Alternative medical systems: homeopathy; naturopathy; Ayurvedic; traditional Chinese medicine, including acupuncture and moxibustion

Growth and Development Patterns

1. Cephalocaudal: development happens head to tail 2. Proximodistal: near (midline) to far (peripheral) development 3. differentiation: simple to more complex

Three Categories of Temperament

1. Easy child: even-tempered, regular and predictable in habits, positive to new stimuli, open and adaptable to change....40% 2. Difficult child: highly active, irritable, and irregular in habits, require more stability, adapt slowly to change and people, exhibit frequent periods of crying, frustration, and violent tantrums....10% 3. Slow-to-warm up: react negatively, mild intensity to new stimuli, adopt slowly but can be motivated, inactive and moody.....15% **35% have a mixture and/or are inconsistent**

3 components of body image

1.physiologic: perception of one's physical characteristics 2. psychological: values and attitudes towards the body, abilities, and ideals 3. social nature of one's image of self: self in relation to others

poverty

25% of kids receive food stamps -invisible poverty=lack of or inferior health care, limited job opportunities, absence of public services

Development Theory

8 stages defined by Duvall that each family develops through -family is a small group that interacts with larger cultural social system

time out

A disciplinary technique in which a child is separated from other people for a specified time.

race

A group of human beings distinguished by physical traits, blood types, genetic code patterns or genetically inherited characteristics.

authoritarian parenting

A parenting style in which the parents are demanding, expect unquestioned obedience, are not responsive to their children's desires, and communicate poorly with their children.

Family Systems Theory

A perspective on family functioning that emphasizes interconnections among different family relationships (such as marital, parent-child, sibling). -problems exist in interactions not individual -family viewed as a whole but member's able to distinguish themselves. -problem solved by changing the feedback

developmental tasks

A set of skills and competencies specific to each developmental stage that children must accomplish or master to function effectively with their environment.

Ethnicity

A social division based on national origin, religion, language, and often race that share common characteristics differentiating them from other groups

Social Character of Play

A. Onlooker Play: want to watch but not interact (watching sibling bounce ball) B. Solitary Play: like to play in a room full of children but make no effort to play with or interact with other children C. Parallel Play: like solitary play, but they now play with similar toys and now play beside but not with D. Associative play: Now play with each other without organization or rules or goals. Ex: play with dolls and borrow/share each others outfits E. Cooperative Play: organized, group play with discussion, planning, goal oriented. Leader-follower relationship established

Communicating with children

Address parent first. Then talk to the child and parent but go about activities that do not involve the child directly, thus allowing the child to observe from a safe position. If the child has a special toy or doll, "talk" to the doll first. Ask simple questions, such as "Does your teddy bear have a name?" to ease the child into conversation. • Allow children time to feel comfortable. • Avoid sudden or rapid advances, broad smiles, extended eye contact, and other gestures that may be seen as threatening. • Talk to the parent if the child is initially shy. • Communicate through transition objects (such as dolls, puppets, and stuffed animals) before questioning a young child directly. • Give older children the opportunity to talk without the parents present. •Assume a position that is at eye level with the child • Speak in a quiet, unhurried, and confident voice. • Speak clearly, be specific, and use simple words and short sentences. • State directions and suggestions positively. • Offer a choice only when one exists. • Be honest with children. • Allow children to express their concerns and fears. • Use a variety of communication techniques

foster parents

Adults who temporarily accept responsibility and provide care for children who would not otherwise have a safe, secure home.

cultural humility

An acknowledgement of one's own barriers to true intercultural understanding.

Reconstituted family

Children from different marriages becoming one family after their divorced parents marry each other

Family assessment

Family interview, survey, or discussion used to obtain the families insights regarding a patient, especially a child; family history, relationships, concerns, needs, resources

Creative Communication Techniques with Children

*I messages-avoid you... *third person technique-when he..., he feels sad *facilitative response- you feel--- because--- *Storytelling-ask child to tell story about... *Mutual storytelling-child tells story and nurse tells story but with nicer spin *Bibliotherapy-read story with underlying message *Dreams-ask about dream and what he thinks it means *What if .... *Three wishes game *Rating game-1-10 how .... *Word association game-- clouds---outside, hospital--needles *Sentence completion *Pros and cons list-ie 5 good, 5 bad *Writing-journal, letter that never gets mailed *Drawing-one of most valuable forms of communication *Magic-establish rapport or distraction *Play-universal language of children, build rapport and useful during examination

Anthropometry

*an essential parameter of nutritional status *measurement of height, weight, head circumference, proportions, skinfold thickness, and arm circumference in children. Height and head circumference reflect past nutrition, whereas weight, skinfold thickness, and arm circumference reflect present nutritional status, especially of protein and fat reserves. Skinfold thickness is a measurement of the body's fat content because approximately half the body's total fat stores are directly beneath the skin. The upper arm muscle circumference is correlated with measurements of total muscle mass. Because muscle serves as the body's major protein reserve, this measurement is considered an index of the body's protein stores

sensitive periords

-1st 3mo of prenatal life for physical growth and development -psychosocial development: 1st year with primary socialization and social attachments

External Proportions of Growth and Development

-2 mo fetal: head is 50% of total body length -Infancy: growth of trunk predominates with legs most rapid growth -adolescence: trunk elongates -newborns: lower limbs = 1/3 of body length -adults: lower limbs = 1/2 of body length

Wong-Baker FACES

-6 cartoon faces from - smiling face no pain to tearful face pain -most commonly used in hospitals

Adolescent communication

-Abstract thinking without full adult comprehension; may waver between childlike and adultlike -Interpretation of MEDICAL terminology is limited -Drive for independence; Trust and understanding build rapport -need for privacy; may need to interview separately from parent

Coanalgesic Drugs

-Antidepressants: Amitriptyline or Nortriptyline; for neuropathic pain -Anticonvulsants: Gabapentin, Carbamazepine; for neuropathic pain -Anxiolytics: Lorazepan, Diazepam; for muscle spasms -Corticosteroids: Dexamethasone; for increased ICP, spinal or nerve, or bony metastasis Others: clonidine, mexiletine

Opioid Analgesics for children mod pain

-Morphine -Fentanyl -Hydromorphone -Methadone -Oxycodone -start 1/4 to 1/3 recommended dose for children

Functions of Play

-Sensorimotor development: predominant form of play in infancy. -Intellectual development: education of color, shapes, sizes, directions, abstract concepts, etc -Socialization: teaches roles, morals, values, and ethics -Creativity -Self-awareness -Therapeutic value: place to express emotions, experiment, and learn about self and others -Morality

drawing interpretation of child

-Spontaneous drawing--free drawing -Directed drawing involves a more specific direction, such as "draw a person" or the "three themes" approach (state three things about child and ask the child to choose one and draw a picture). *Use spontaneous drawings and evaluate more than one drawing whenever possible. *Interpret the drawings in light of other available information about child and family, including the child's age and stage of development. *Interpret the drawings as a whole rather than focusing on specific details of the drawings. *Consider individual elements of the drawings that may be significant: • Sex of figure drawn first: Usually relates to the child's perception of his or her own sex role • Size of individual figures: Expresses importance, power, or authority • Order in which figures are drawn: Expresses priority in terms of importance • Child's position in relation to other family members: Expresses feelings of status or alliance • Exclusion of a member: May denote feeling of not belonging or desire to eliminate • Accentuated parts: Usually express concern for areas of special importance (e.g., large hands may be a sign of aggression) • Absence of or rudimentary arms and hands: Suggest timidity, passivity, or intellectual immaturity; tiny, unstable feet may express insecurity; and hidden hands may mean guilt feelings • Placement of drawing on the page and type of stroke: Free use of paper and firm, continuous strokes express security, whereas drawings restricted to a small area and lightly drawn in broken or wavering lines may be signs of insecurity • Erasures, shading, or cross-hatching: Expresses ambivalence, concern, or anxiety with a particular area

NSAIDs for children mild to mod pain

-acetaminophen -choline magnesium trisalicylate - ibuprofen -naproxen -indomethacin -diclofenac

General Trends in Weight

-avg newborn wt: 3175-3400g or 7 - 7.5 lbs -birth wt dbls by 4-7 mo -birth wt triples by 1 yr -by 2 -2.5 yrs: birth wt. quadruples -after, normal wt gain is 4.4 - 6 lbs/ yr

skeletal or bone age

-best determined w/ radiologic determination of osseous maturation of hands and wrists in children <6 yrs old

temperature regulation

-can be a result of hypoglycemia, elevated bilirubin, metabolic acidosis, etc. -treatment is kangaroo care -individual differences of 0.5 - 1 * F are normal -by 12 yrs old, girls have stabilized -boys continue to fall for a few more years and remain colder than girls -infants produce more heat per unit and can overheat when playing if heavily clothed

Classifications of play

-directional trend that builds on the last accomplishment A. Social-affective play: infants learn to interact with parents with coos and smiles B. Sense-pleasure play: infants interact with environment and their senses (light, color, motion, tastes, smells, textures, etc). C. Skill Play: new dextrality (grasp and manipulate) allows for repeated play to build skills (shapes match whole) D. Unoccupied behavior: distracted behavior (squirrel) E. Dramatic, or pretend, play: begins in late infancy (11-13 mo); allow children to interact in a safe way (using a phone, driving a car, etc). F. Games: imitative games (pat-a-cake and peek-a-boo), formal games (ring-around-a-rosy and london bridge), and competitive games like catch or baseball all play a role for interaction and cognitive development

Early childhood communication (under 5)

-egocentric-only see things from their view. Unable to relate to other's experiences. -Vocal communication limited so let them touch and examine articles. -Everything is direct and concrete to small children. They are unable to work with abstractions and interpret words literally. A little stick in the arm -use simple, direct language rather than phrases that might be misinterpreted by a small child

chronic pain

-episode of pain that lasts for 3 months or longer in peds (6 for adults); may be intermittent or continuous -most common is complex regional pain syndrome or daily headaches

IV Morphine and Fentanyl

-give morphine over 5 minutes -give fentanyl over 3-5 minutes

Neurologic Maturation

-grows proportionately more rapidly before birth -is sometimes used as an indicator of maturational age

BMR

-highest in infants -1 * fever increases BMR 10% and water requirements -slightly higher in boys throughout life -BMR of infants is 108 kcal/kg -BMR of maturity is 40-45 kcal/kg -water requirements remain 1.5 ml/calorie

Sleep and Rest

-latter part of 1st year, babies begin to sleep through the night w/ 1-2 naps during the day - 12-18 mo old, 2nd nap is eliminated -by age 3, naps are eliminated

COMFORT scale

-measures 8 indicators over 2 min -scores each 1-5 w/total score range of 8-40 -17-26 means pt is sedated well and pain rating is low 1. Alertness 2. Calmness/agitation 3. Respiratory response 4. Physical movement 5. Blood pressure 6. Heart rate 7. muscle tone 8. facial tension

Psychosocial Development (Erikson)

-most widely accepted -each stage has two components: favorable and unfavorable -there are 8 stages, book discusses 5 as is related to childhood 1. Trust vs. Mistrust--birth to 1yr: time of getting and taking in through all senses 2. Autonomy vs. Shame and doubt--1-3 yrs: centered on children's increasing ability to control their bodies, themselves, and environment; favorable outcomes--self-control and willpower 3. Initiative vs. Guilt--3-6 yrs: explore world with all senses and powers; develop a conscience; favorable outcomes--direction and purpose 4. Industry vs. Inferiority--6-12 yrs: ready to work and produce; learn to work with others; learn rules 5. Identity vs. Role Confusion--12-18 yrs: Rapid and marked physical changes; outcomes--successful mastery of devotion and fidelity to others and values and ideologies

Pediatric Pain Questionnaire (PPQ)

-multidimensional for pain assessment of pt and parent -measures 8 areas: 1. pain history 2. pain language 3. colors children associate with pain 4. emotions children experience 5. worst pain experiences 6. ways children cope with pain 7. positive aspects of pain 8. location of current pain

Adolescent Pediatric Pain Tool (APPT)

-multidimensional pain instrument for children and adolescents that is used to assess three dimensions of pain: a. Location b. Intensity c. Quality -Rang of 0-56

Opoid Withdrawal symptoms

-occur 24 hr after cold turkey; peak at 72 hrs -sx: neuro--irritability, tremors, seizures, increased muscle tone, insomnia gastro--n/v, diarrhea, abdominal cramps autonomic--sweating, fever, chills, tachypnea, nasal congestion, rhinitis -wean over 5-10 days for short term use, longer for long term (20% day 1, 5-10% following days as tolerated) -tolerance may develop after 10-21 days

Congenital Abnormalities

-occurs in 2-4% of births -classified as: a. Deformations: often caused by extrinsic mechanical forces (ex- club foot from uterine constraint) b. Disruptions: breakdown of previously normal tissue (ex-amputations by amniotic bands) c. Dysplasias: abnormal organization of cells into a particular tissue type (ex- extra teeth, toes, etc) d. malformations: abnormal formations of organs or body parts resulting from abnormal development (ex-cleft lip)

Visual Analog Scale (VAS)

-ratio-level scale of a 100-mm line anchored on each end with words or symbols -often used with older children and adults

communication infancy

-readily respond to any firm, gentle handling and quiet, calm speech. -Loud, harsh sounds and sudden movements are frightening. -cry for wants

School age children communication

-rely less on what they see and more on what they know when faced with new problems, want explanations and reasons for everything but require no verification beyond that, want to know why an object exists, why it is used, how it works, and the intent and purpose of its user. -show kid BP cuff and how moves arrow, let him squeeze it, say 'I want to see how far the arrow moves when the cuff squeezes your arm' -heightened concern about body integrity and personal possessions. -encourage them to speak needs and concerns.

adopted child

-should be told before entering school, when ready, around when asking where babies come from -adolescence can be trying

Growth w/Down Syndrome

-slower growth between 6 mo- 3 yrs -slower growth in adolescence -puberty occurs earlier -shorter stature in general

Lymphoid Tissues

-small in relation of body size but well developed at birth -reach adult dimensions at 6 yr old -maximum development at age 10-12 yr w/ size being 2 x that of adults -rapid decline in size happens shortly after

Cognitive Development (Piaget)

-stages derived from and build on previous stage (4) 1. Sensorimotor-- birth to 2 yrs: governed by sensations, infants learn sense of self and cause and effect. Also learn permanence (objects exist even when not seen) 2. Preoperational--2-7 yrs: characterized by intellectual development (egocentrism but not selfish, just in place of another). Later stages develop intuitive (if I go to bed then the cars do to) thoughts and transductive (occurs together so must be related) reasoning. 3. Concrete operations--7-11 yrs: thought is increasingly logical and coherent. Conservation is developed (physical factors remain the same but outward appearance may change). Can work thorough problems simultaneously. Inductive reasoning starts. Can think of others 4. Formal operations--11-15 yrs: can think in abstract terms, symbols, and draw logical conclusions.

Numeric Rating Scale (NRS)

-standard 0-10 scale -most widely used for children over 8 yrs old

Pediatric Quality of Life Scale (PedsQL) OR PEDMIDAS

-use for children <7 -PEDMIDAS is good for children with chronic migraines

stage of divorce

acute-decision to divorce, stressful transitional-altered fam relationship, economic stress stabilizing-stable, functioning unit; many remarry

Temperature

axillary-up to 1 month rectal-gold standard oral-5 y/o + ear (aural)-not precise temporal artery temp (TAT)-not accurate for detecting fevers under 38 C (100.4F)

Linear growth

best stable measurement of general growth and occurs almost entirely as result of skeletal growth

discipline

means 'to teach' -'limit setting' establishes rules or guidelines for behavior -testing limits allows children to know the extent can manipulate environment and gain reassurance that someone is there to protect them from harm

association

nonrandom pattern of malformations for which a cause has not been determined

sequence of exam

normally head to toe but deviates when necessary for kiddo

make paper doll outline of child

child lies on exam table and has outline traced, then nurse shows how exam will be done on patient

Minimizing Misbehavior

desire attention, power, defiance, feeling of inadequacy -rules not clear or consistently applied -structure interactions to minimize issues

qualitative change

development

General height tip for infant

double birth height to determine avg height at age 2

Family Stress Theory

explains how families react to stressful events and suggests factors that promote adaptation to stress -when too many stressors, adaption necessary or crisis ensues. -allows for cause and effect logic. -focuses on positive contribution of resources, coping, and social support

Quantitive change

growth

ceiling effect

higher doses will not give more pain relief for NSAIDS

variable expressivity

individuals with the same genotype have related phenotypes that vary in intensity

recurrent pain

involves episodes of discomfort interspersed with periods in which the individual is relatively pain-free, that recur every three months or more

children of divorce

parental loss, increased stress, economic loss, mental health and competence of parents post divorce, exposure to parental conflict, may have lasting marriage if marry person whose parents didn't divorce. Most don't suffer long term issues. -feel emotions similar to natural disaster-loss, grief, vulnerable to forces beyond their control -sometimes caught in the middle as messangers -telling child-best with whole family, crying by parents good, anger from kids normal, touch is reassuring, will want answers

authoritative parenting

parenting style characterized by emotional warmth, high standards for behavior, explanation and consistent enforcement of rules, and inclusion of children in decision making

health beliefs

patient's personal beliefs about levels of wellness that can motivate or impede participation in changing risk factors, participating in care, and selecting care options

syndrome

recognized pattern of anomalies resulting from a single specific cause

Genes

segments of DNA that contain genetic information necessary to control a certain physiologic function or characteristic -often referred to as sites or loci which indicates a physical or geographic location on a chromosome -particular form of a gene is called an allele which may lead to noticeable or unnoticeable differences -scientests now conclude that many or most diseases are a result of predisposition that is triggered by the enviornment

permissive parenting

style of parenting in which parent makes few, if any demands on a child's behavior

skinfold thickness

technique to assess body composition by measuring a double thickness of skin at specific body sites

chief complaint

the main reason for the patient's visit

history of present illness

the story of the patient's problem that include details of onset, a complete interval history, the present status, and the reason for seeking help now

Pain in Neonates (CRIES)

use CRIES C-crying R- requiring increased oxygen I-increased vital signs E- expression S-sleeplessness -scored 0-10, 4 being excessive, 10 being bad