Peds Ch 1,18,19,20
Which parental statement about newborn and infant stooling patterns indicates the need for further education?
"A breastfed baby will stool only once per day."
A nurse is providing nutrition education for a toddler-aged child. What statement by the parent requires further education?
"We let our toddler drink as much milk as he wants."
anticipatory guidance for play
*cheating to win *Minimizing technology *Safe toy selection *Protective equipment
Assent
-Feedback from a child 7 more than years of age regarding medical treatment -Includes child in decision-making process -Child is asked if he/she has any questions or concerns -Not ALL children are developmentally ready
Sleeping requirements for a toddler
-No co-sleeping -may have fear of the dark and separation anxiety at bedtime so they may want to sleep with an adult
Anatomical Differences between pediatric and adult patients 11-13 of 13.
11.Young infants can not shiver and rapidly experience hypothermia. Important to dress and wrap young infants appropriately. 12.Young children have immature immune systems. 13.Difficult to evaluate pain. Challenging to assess and treat dyspnea, fatigue, sleep problems, nausea and emotional distress. Must use vitals and pediatric specific tools to measure some symptoms like pain.
preschool sleep requirements
12 hours
How much sleep does a toddler need?
14 hours plus a nap
Dehydration
A serious reduction in the body's water content
Signs of mild dehydration
Hard to asses because infants vitals will remain close to normal
Causes of infant dehydration
Large body surface area, immature kidney function, and susceptibility to gastrointestinal infections, especially viruses.
What kind of play do toddler's play?
Parallel play: they will play near or alongside another toddler but will not yet share toys.
Medical Play for a preschooler
Preschoolers have a measurable reduction of stress and anxiety while hospitalized if they are offered the opportunity to participate in medical play.
Signs and symptoms of FTT
When a child measured weight and height consistently fall below the 5th percent on a national growth chart
Signs and symptoms of colic
abdominal pain and cramping
Encopresis
also called fecal incontinence or soiling, is a medical diagnosis given to children 4 years or older who had previously achieved potty training and is now soiling his or her clothing during the day.
nightmare
are scare dreams that may awaken the child, produce crying, and require reassurance and comfort.
night terrors
causes the child to demonstrates great fear, thrashing arms and legs, yelling, and possibly running or walking out of their room or even out of the house.
Signs of moderate dehydration
elevated heart rate, deeper respirations, and decreased urinary out-put
sniffing position
flexion of neck, extension of head
Erikson's Theory :Preschooler
initiative vs guilt
Piaget's Theory
sensorimotor, preoperational, concrete operational, formal operational
SUIDS
sudden unexpected infant death syndrome infants less then 1 year old
Erikson's Theory :Infant
trust vs mistrust
food jags
when a child will only eat the same food meal after meal
Which parental statement regarding the sleep needs of a toddler indicates the need for additional education from the nurse?
"I should expect my child to sleep 14 hours each night in addition to an afternoon nap."
Lower Teeth for an infant
*2nd Primary molar: 23-31mos. *1st Primary molar: 14-18mos. *Canine(cuspid): 17-23mos. *Lateral incisor: 10-16mos. *Central incisor: 6-10mos.
Infant Nutrition
*Breast or formula feed for the first 6 months *6 months introduce cereals *Green veggies *Yellow and Orange *Fruits *10 months Lean meats and egg yolk *No cow's milk till 1
Upper Teeth for an infant
*Central incisor: 8-12mos. *Lateral incisor: 9-13mos. *Canine(cuspid): 16-22mos. *1st Primary molar: 13-19mos. *2nd Primary molar: 25-33mos.
Children's patterns of development
*Cephalocaudal: Development is from head to toe. Lift heads before crawling, standing, and walking *Proximal-distal: Development is from the trunk to the distal extremities. Moves arms and legs before picking up objects. *General to specific: Completes simple tasks before more difficult ones.
Communication development for and infant
*Cooing at 1-2 mos. *Laughing at 2-4 mos. *Sounds at 3-4mos. *Imitative sounds at 6 mos. *1 to 2 words at 12mos. (Ma Ma, Da Da, NO)
Family centered care
*Empowerment-Interaction between family and health care providers where family maintains sense of control over their lives *Enabling-Providing opportunities for family members to master the child's care
Vital signs for a preschooler
*Heart rate 65 to 110 *Respirations 20 to 25 *BP 95 to 110 over 60 to 75
The parents are distressed because their breastfed infant is hospitalized. Which hospital policies would assist the parents in maintaining breastfeeding? (Select all that apply.)
*Labeling and storage of breast milk is performed. *A breast pump and storage place are provided to the parents.
Safety and injury prevention for infants
*Pet safety *Sunscreen (not till after 6mos.) *Toy safety *Crib safety *Drowning (can happen in 1 to 2 in of water) *Poisonings *Burns
The three stages of separation anxiety
*Protest: child may cry and cling *Despair: child becomes quite and may refuse to eat or participate in activities *Detachment or denial: starts to interact again
The parent of a 2-year-old toddler asks about appropriate toys. Which toys would be recommended to promote spatial relationships? (Select all that apply.)
*Toys where shapes fit into openings *Sets of colorful nesting cups
Discipline during toddler years
*may act out due to frustration and can't verbalize it. *ignore unwanted behaviors *positive reinforcement for good behavior *distractions *routines simple and consistent *setting reasonable limits *follow through
Sleep patterns and requirements for an infant
- Young Infants 22 to 23 hours of sleep per day - Older Infants 16 hours of sleep per day including 2 naps - Between 4-6 months infants will begin to sleep through the night
Discipline for toddlers
- protects from harm, teaches self control and respect - good behavior results in praise and affection
Car Seat Safety Guidelines
-All children under 13 is to ride in the back seat -Turn air bag off if they have to sit up front -Properly secure car seat and belts with booster seats -Seat belts at all times
Transitional stool
-As the meconium is passed, the stool changes in color and consistency -Occurs at about 3 days of life -Consistency is less thick and sticky -Color is green/brown to yellow/brown
Formula Stools
-Color and odor of formula stools depend on the formula fed -Consistency is soft
Breast milk Stools
-Color is orange-yellow -Consistency is soft and even -Appears after the fourth day of life -Breastfed newborns will have several stools a day
consent
-Patient/family understands and accepts risk and benefits of procedure *18 years and older -Written consent must be signed by health-care provider and adult patient before procedure/treatment *Children -Legal caregiver, parent or guardian signs consent
Normal vital signs in newborn
-Temperature: 36.5° to 37.3° C (97.7° to 99.1° F) axillary -Apical pulse: 120 to 160 bpm ; by first year 100-120bpm -Respirations: 30 to 60 breaths/min -BP ranges from 50 to 75 systolic over 30 to 45 diastolic ; Rises to an average of 90/60 by 12mos.
First Stool "Meconium"
-Usually passed in first few days of life -Consistency is thick and sticky -Color is black/green
Toilet training for a toddler
-readiness to toilet train: may watch the adult on the toilet, positive reinforcement, potty chair, and staying dry
Anatomical Differences between pediatric and adult patients 1-5 of 13.
1.Airways are anatomically smaller 2.Nose breathers for the 1st several weeks of life. 3.Heads are disproportionality larger 4.Their large posterior head bone (occiput) makes airway occlusion more likely 5.Their poorly developed intercostal chest muscles leads to fatigue and increase the risk of respiratory failure.
At which age should the nurse suggest introducing rice cereal to the infant's diet?
6 months
Anatomical Differences between pediatric and adult patients 6-10 of 13.
6.Childern have less tidal volume in their lungs 7.And larger body surface area resulting in greater heat loss and greater insensible water loss. 8.Childern have less circulating blood volume than do adults. 9.Higher glucose needs with poor glycogen stores results in higher metabolic rate. 10.Children have a relatively healthy cardiovascular system. Rarely cardiac arrest initially. Usually respiratory arrest in nature.
Autism Spectrum Disorder (ASD)
A disorder characterized by deficits in social relatedness and communication skills that are often accompanied by repetitive, ritualistic behavior.
Food lags and jags
A phrase used to describe how a young child goes through phases of not experiencing hunger and therefore refusing to eat, or taking in a reduced number of calories.
Preconceptual thinking
A young child's judgment of their environment by visual experiences.
Which type of play should the nurse encourage when providing age-appropriate care to a preschool-aged child?
Associative
What kind of play do preschooler's play?
Associative play, which does not have a common goal like cooperative or organized play. *Interact and engage in common activities with loose or organization and rules *Are willing to exchange materials, with hesitation, until each child finished with ones he or she is playing with *May attempt to control or limit participation
A nurse is teaching parents about the growing independence of toddlerhood. Which term would the nurse use to describe this behavior?
Autonomy
A parent shares that his preschool-age child experiences nocturnal enuresis and asks the nurse about things that may help the problem. Which intervention would be appropriate for the nurse to suggest initially?
Decrease evening fluid intake.
Cleaning infants teeth
Do Not use fluoridated toothpaste, Use a wet wash cloth to clean their teeth.
nutrition for preschoolers
Focus on a healthy, well-rounded diet. Incorporate fruits, vegetables, whole grains, and lean proteins. Requires 1,200 to 1,400 calories per day. Avoid foods high in fat and sugar. Three meals and one to two snacks per day. Involve child in meal preparation and offer choices when possible. Do not fix separate meals; this encourages picky eating. Do not force intake if child is not hungry.
Prevention and teaching for colic
Fruit juices should not be given. Colic can start as early as 2 weeks old and last till 6 months old. Encourage the parent to take time away from the crying.
toddler vital signs
Heart rate: 70-110 Resp: 20-30 BP: 90-105 over 55-70 Temp: 37.2
Safety and injury prevention for toddlers
Home and kitchen safety: poisonous items, hot water, pots on stove, gates and barriers -Pets -Swimming pools -Medications -Car seat
Prevention and teaching for FTT
Identify the knowledge base of the parents concerning infant nutrition. Educate them on the infants nutritional needs and provide a feeding environment free of stress. You can also add high calorie supplements and formula.
Socialize at the table with toddlers.
Include the children at the table, booster or high chair, praise participation, may need to leave before everyone is done.
The LPN/LVN is reinforcing teaching to a parent about avoiding drowning accidents with a 9-month-old infant. Which bath safety information would the nurse reinforce?
Infants can drown in 1 to 2 inches of water.
imaginary friends
Make-believe friends who exist only in a child's imagination, the friends are companions may be harmless and somewhat comforting for the child.
anthropometric measurements
Measurements or estimates of physical aspects of the body such as height, weight, circumferences, and body composition.
Therapeutic communication
Nurses support autonomy, allowing patient to make their own decisions. Helps clarify patient's values and viewpoints.
Family relations with toddlers
Preschoolers desire to please the significant people in their lives. They want to conform to the patterns, rules, and expectations of the family structure and fit in as an important part of the family dynamics.
Which action should the nurse include when providing education regarding methods to enhance health promotion during a scheduled health maintenance visit for a 4-year-old child?
Recognizing that food fads and jags are common
stranger anxiety
Starts at about 9 mos. the older infant protests when he or she is given over to someone else to be held and fears the new person in their presence.
Infants will have about 6 to 8 teeth erupt during the first year of life. How to help discomfort?
Teething rings and ones that can be frozen. Do not use other objects that they can choke on and supervise them when using the teething rings.
The LPN/LVN is reviewing gross motor skills with a parent of a child who is 4 years of age. When the LPN/LVN asks about certain developmental tasks, the parent states, "I become agitated because he takes so long to do simple things, so I just do it myself." Which concern would the LPN/LVN share with the parent?
The child will become less willing to attempt a new motor skill.
The LPN is assisting an RN in working with a family whose 4-year-old child is experiencing encopresis. Which long-term goal would the LPN understand to be appropriate for the RN to set?
The child will have normal bowel movements regularly.
The nurse is assessing a 2-month-old infant. The infant's growth rate is plotted below the 5th percentile on a national growth chart for the second consecutive month. Which observation would indicate the infant is most likely to have non-organic failure to thrive (FTT)?
The family lives below the poverty line.
Prevention and teaching for infant dehydration
The infant must consume adequate fluids daily. Teach families to provide adequate breast milk and formula. Infants that are sick add additional fluids.
Physical growth and development
The physical development of the infant from the newborn period through the first year is astounding. -The infant will triple his or her birth weight and double the birth length in the first 12 months.
Thermoregulation
The process of maintaining a core body temperature, is a challenge for the newborn and is considered absolutely crucial for survival.
The LPN/LVN is reviewing actions for socializing a toddler at meal times who is 18 months of age. Which suggestion would the LPN/LVN review?
The toddler should be included in conversation.
seperation anxiety
When a toddler must be left alone in a hospital environment, having the parent leave a personal item to reduce the toddler's fear of separation.
failure to thrive (FTT)
a condition in which infants become malnourished and fail to grow or gain weight for no obvious medical reason and can delay developmental and emotional functioning
Erikson's Theory :Toddler
autonomy vs shame/doubt
Object Permanence (Piaget)
concept, gained in infancy, that objects continue to exist even when they are hidden from view (hide and seek, peek-a-boo, and challenges to object permanence)
Colic
excessive, inconsolable crying by a young infant for no apparent reason for more then 3 hours , 3 days a week, and for more then 3 weeks
anticipatory guidance
for the family of preschooler continues to focus on health and safety as it did for toddlers. Preschoolers although more cautious then toddlers, can still end up in unsafe situations concerning traffic, swimming, and other hazards.
enuresis
is inappropriate voiding after a child is successfully toilet trained.
Iron-deficiency anemia in toddlers
is the most common childhood form of anemia, anemia is not typically classified as a disease process but rather a manifestation of an underlying condition. *(if they consume to much milk can put them at a risk for iron-deficiency)*
Signs of severe dehydration
same as moderate signs plus delayed capillary refill time, absent tears, dry mucous membranes, and sunken fontanels. Lower BP is late sign of dehydration.