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
