Peds Study Guide
endotracheal and tracheal suctioning
only suction as needed position in high fowlers or fowlers select catheter 1/2 diameter of tube hyperoxygenate patient assess baseline breathsounds and vitals monitor O2
Parents share that their toddler often needs a snack in between meals. Which snack choice is nutritious enough to give the toddler energy but also may help prevent dental caries? Select all that apply.
orange slices cheese slices yogurt
During an extended stay in a hospital the nurse has observed a 5-year-old having several temper tantrums. How should the nurse address this behavior with the parents?
Is it common for your child to throw temper tantrums at home? We have observed behaviors several times here.
The nurse is examining an infant who is 4 days old. The nurse puts the infant in a semi-upright position and lets the head fall back (with immediate support). What infant reflex is the nurse testing
Moro reflex
The mother of a 1 month old baby is scheduling the next well child visit for her baby. Which statement by the mother indicates an understanding of the recommended appointment schedule?
My baby will need to be seen again when he's 2months old
During the toddler years, the child attempts to become autonomous. Which statement by a 3-year-old toddler's caregiver indicates that the toddler is developing autonomy?
My toddler uses the potty chair and is dry all day
Infant behavior is affected by
Parent-infant relationships and daily routines
Protective factors for newborns and infants are
Support networks Positive family relationships Adequate childcare
A new parent asks the nurse what she should look for when the baby starts to teethe. What should the nurse explain to the parent?
The child's gum line will be tender
The nurse is examining a 10-month-old boy who was born 10 weeks early. Which finding is cause for concern?
The child's head circumference
Toddlerhood
The important transitional stage after babyhood, from roughly 1 year to 2 1/2 years of age; defined by an intense attachment to caregivers and by an urgent need to become independent.
The nurse is conducting a physical examination of a 8-month-old infant. Which observation may be cause for concern about the infant's neurologic development?
The infant displays an asymmetric tonic neck reflex (fencing reflex).
The nurse is assessing development of a 4-month-old boy during a well-child visit. Which observation needs further investigation?
The infant responds to his mother when he sees her but not at other times when she is near.
The nurse is teaching a student how to instill ear drops into a 2 year old. What technique will the nurse demonstrate to the student?
The nurse pulls the ear down and back
toilet training
The training of a child to go from a diaper to using the toilet for bowel and bladder control
The nurse brings a 2-day-old newborn into the mother's room in the postpartum unit. The mother voices concern that the newborn's hands and feet "look a little blue." Which response by the nurse is best?
This is common for newborns up to several days of age. It happens because of the immature circulatory system trying to get used to being outside the uterus."
Safety Considerations for Toddlers
Toddlers are at greater risk for injury. Burns: -Keep hot objects out of reach and use back stove burners. -Lower hot water heater to 120°F. Falls: -Do not allow children to climb on furniture. -Supervise when on stairs and playground equipment Use gates at the top and bottom of the stairs. Motor vehicle safety: Ride forward facing in back seat in five-point harness from 2 to 4 years of age (rear facing before 2 years of age).
The nursing student identifies which technique as the correct one to use when giving oral medications to an infant?
Use a dropper and slowly inject the liquid into the side of the infant's mouth.
Physical Growth of Newborns and Infants: Head circumference
-Increases rapidly the first 6 months, then slows until 12 months.
The nurse is providing anticipatory guidance to parents of 18 month old girl. Which guidance will be most helpful for toilet teaching?
Advising them to use praise not scolding
Physical Growth of Newborns and Infants: Weight
-Lose 10% body weight the first week of life but regained by end of the 2nd week. -Gain 20 to 30 g per day for the first 3 months. -Weight doubles by 4 to 6 months, and triples by 12 months.
The nurse has just finished administering the DTaP vaccine to a 2-month-old and is educating the parent about immunization. Which statement is accurate?
"Bring her back for the second dose when she is 4 months old."
protective reflexes
-Develop after the disappearance of primitive reflexes. -Not present until after 12 months of age. -Assessed in toddlers and older children.
Toddler-Specific Nursing Interventions
-Encourage parents to provide routine care for the child (changing diapers and feeding). -Encourage the child's autonomy by offering appropriate choices. -Provide consistency in assigning caregivers.
Piaget Cognitive Development
1. sensorimotor 2. pre-operational 3. concrete operational 4. formal operational
Infancy IMPACT OF HOSPITALIZATION
-Experiences stranger anxiety between 6 to 8 months of age -Displays physical behaviors as expressions of discomfort due to inability to verbalize -Can experience sleep deprivation due to strange noises, monitoring devices, and procedures -Can experience anxiety due to the unfamiliar environment and fear of the unknown
Physical Variants in Newborns and Infants #2
-Incomplete bone ossification -Benign metatarsus adductus is normal. -Passive immunity until 6 months of age -Born with high levels of fetal hemoglobin (HbF) and physiological anemia. -Skin variants include salmon patches, Mongolian spots, etc.
The nurse is providing anticipatory guidance to the parent of a 2-month-old infant in relation to growth and development. Which statement from the parent demonstrates proper understanding?
"I can expect my infant to be able to raise the head up when on the stomach within the next month."
The parents of a newborn diagnosed with a chronic illness ask the nurse, "How will this effect our newborn's growth and development?" Which nursing response is most appropriate?
"It is common for newborn with chronic illnesses to grow and develop at a slower pace."
After the nurse provides education to new parents about appropriate sleeping habits for infants, which statement by a parent would indicate to the nurse that teaching needs to reoccur?
"My husband gave the baby a special bear that I will place in the crib
The nurse is interviewing a 3-year-old girl who tells the nurse: "Want go potty." The parents tell the nurse that their daughter often speaks in this type of broken speech. What would be the nurse's appropriate response to this concern?
"This is a normal, common speech pattern in the 3-year-old and is called telegraphic speech."
A mother of a 2-year-old girl is asking her friend when she should start potty training the child. The mother expresses concern about the high cost of diapers and training pants and would really like to have her trained as soon as possible. Which advice by the friend would be considered the best response?
"When she is uncomfortable in her wet diaper and brings a clean diaper to you, that's a good indication she is ready for potty training
The father of a 2-year-old girl tells the nurse that he and his wife would like to begin toilet training their daughter soon. He asks when the right time is to begin this process. What should the nurse say in response?
"When she starts tugging on a wet or dirty diaper, she is letting you know she's ready."
The school nurse is assessing a 15-year-old female client. The client states, "I just want to be pretty and to look like everyone else." Which response by the nurse is appropriate?
"You seem concerned. Let's talk about your feelings."
The nurse is discussing vaccination for Haemophiles influenzae type B (Hib) with the mother of a 6-month-old child. Which of the following comments provides the most compelling reason to get the vaccination?
"Young children are especially susceptible to these bacteria."
amblyopia
(lazy eye) is a reduction in or loss of vision that usually occurs in children who strongly favor one eye
Physical Growth of Newborns and Infants: Length
- Grow 1.5 to 2.5 cm per month for first 6 months. - Grow 1 cm per month for months 6 to 12
Physical Growth of Toddlers
- growth is in spurts not linear - protruding abdomen and lumbar lordosis from underdeveloped abdominal muscles - bowleggedness (leg muscles must bear the weight of the relatively large trunk) - height at 2 yrs is about half of expected adult height
Pain Assessment of Toddlers
-Assess pain through valid and reliable pain scales. -Incorporate caregiver input in pain assessment. -FLACC scale -Toddlers react to painless procedures the same way as for painful procedures. -Encourage toddler to use words for pain -"Ouchie," "Boo-boo," "It hurts."
Developmental Patterns of Newborns and Infants
-Cephalocaudal pattern: Attainment of skills from head to toe -Proximodistal pattern: Attainment of skills from trunk out to extremities -Gains gross motor before fine motor skills.
nasal suctioning
-Clean technique -Use a mushroom tip catheter
Communication and Speech of Newborns and Infants
-Communicate through crying. -Different pitches of cries based on needs. -Begin "cooing" at 2 months of age. -Babbles by 6 months of age. -Copies sounds at 9 months of age. -Says a few words by 12 months of age. -By 12 months of age, can use simple gestures and follow simple directions.
Atopic Dermatitis (Eczema)
-Most common chronic skin condition in children -More likely to have allergies and asthma Symptoms: -Severely dry skin -Erythematous patches -Extreme pruritus -Thickening of the skin Treat by identifying and avoiding triggers. Keep skin hydrated. Use topical corticosteroids if environmental changes are not effective.
Risks to newborns and infants are found in
-Tobacco exposure -Food and housing insecurity -Parental substance abuse
Physical Variants in Toddlers
-Toddler stage: 12 to 36 months of age. -All 20 baby teeth should be present by 3 years of age. -Myelination of brain is complete at 24 months. -Hand preference at 2 to 3 years of age. -Diaphragmatic breathing. -Point of maximal impulse at fourth intercostal space, midclavicular line. -Blood pressure increases and heart rate decreases as toddler grows and develops. -Decreased stool frequency (usually once daily). -Protruding abdomen.
Health Assessment of Toddlers
-Visits conducted at: 15 months, 18 months, 2 years, 2.5 years, and 3 years. -Be flexible during the assessment. -Gather information through play. -Provide distractions (singing, toys, pictures, etc.). -Allow toddler to touch safe medical equipment. -Do not ask permission. -Use positive reinforcement and praise. -Perform invasive procedures last. -To inspect the pinna of the ear, pull it back and down. -Explain procedures in simple, concrete, and positive term
More Physical Variants in Toddlers
-Wide gait and flat feet -Potbelly appearance, lordosis, bowed legs -Immature adaptive immunity; increased risk of both viral and bacterial infections -Normal hemoglobin ratio at 12 months of age
infant oral health
-educate pregnant mom about importance of infant's oral health -discuss eruption of teeth/ teething -teething causing child to experience mild irritability, increased salivation, and a low grade fever -have baby teeth on chilled teething ring or washcloth to relieve some discomfort -do NOT use OTC teeth products with benzocaine -do NOT use homeopathic teeth tablets or gels -Encourage dental exam by 12 months of age or when first tooth erupts; establishing a dental home is crucial for ECC prevention/intervention -discuss infant daily oral hygiene, fluoride exposure, nutrition/diet, oral habits (pacifier/thumb sucking), speech development, dental trauma and injury avoidance
Physical Variants in Newborns and Infants
-inspect the pinna of the ear, pull it back and down. -Normally appears barrel chested (1:1 anteroposterior transverse diameter). -Diaphragmatic (belly) breathing. -Irregular respirations with occasional pauses. -Acrocyanosis may be present in newborns. -Heart rate is often irregular. -Presence of S3 may be audible. Asymptomatic murmurs are often present and normal
Hyperopia (farsightedness)
-sees distant objects clearly but not objects that are close -because of accommodation, not usually detected until age 7
pulse oximetry
noninvasive method of measuring oxygen in the blood by using a device that attaches to the fingertip
infant fever
100.4 degrees F (38C) only give antipyretic if symptomatic do not give cool bath monitor for poor perfusion, hyperventilation, or hypoventilation
potty training
18-24 months encourage instead of fear
alarming for toddlers
2-3 word sentences
The nurse is preparing to assess a 2-year-old at a well-child visit and notes the child was 22 lbs (9.98 kg) and 24 in (60.96 cm) tall at 1 year old. The nurse determines the child is following a normal pattern of growth after obtaining which set of current measurements?
27 lbs and 27 in (68.58 cm) tall
The nursing is assessing a 9month old child who was born at 32 weeks gestation. Th nurse is aware that the child's growth and development expectations would be at what age group?
7 months old
In working with infants, the nurse would expect the posterior fontanel to be closed in an infant who is which age?
3 monthsThe posterior fontanel is usually closed by the second or third month of life.
The mother of a 4-month-old infant is working with the nurse to schedule well-child visits for her son. The mother would expect to schedule the next visit for her son at which age?
6 months
Working with Toddler Fear in a Clinical Environment
=Toddlers fear intrusive procedures and try to protect their bodies from being harmed -it is important for the nurse to understand how to talk to toddlers to help alleviate these fears. -Before any procedures, allow the toddler to touch safe medical equipment to see that it is not harmful. -Use positive words.
A nurse is teaching a group of parents about possible manifestations of Down syndrome. Which of the following findings should the nurse include in the teachings?
A child who has Down syndrome will exhibit a protruding abdomen A child who has Down syndrome will exhibit small features(broad, short feet and hands) A child who has Down syndrome will exhibit hyperflexibility and hypotonia.
oxygen toxicity
A condition of excessive oxygen consumption resulting in cellular and tissue damage.
nasal cannula
A device that delivers low concentrations of oxygen through two prongs that rest in the patient's nostrils.
A nurse in busy pediatric clinic is educating a group of parents about nutritional needs of this age group. Which concepts should be included in this educational presentation? Select all that apply
Active busy toddlers may need up to 1,400 cal/day Try to limit the fat intake to less than 35% of total calories Milk is still important to incorporate in their diet for bone health
The neonatal nurse assesses newborns for iron-deficiency anemia. Which newborn is at highest risk for this disorder?
A premature newborn
The nurse is explaining Kohlberg's theory of moral development to the parent of a toddler. The nurse tells the parents that in the preconventional level of moral development, what factor motivates obedience? A.Avoidance of punishment B.Peer pressure C.Wanting to do what is right D.Parents' behaviors
A. Avoidance of punishment Toddlers are in the preconventional level of moral development. They do not understand the concept of right and wrong. Their behavior is driven by the desire to avoid punishment and get rewards
Which of the following motor development milestones would you expect an infant to attain first? A. Opens and closes hands B. Uses a raking grasp C. Picks up objects with pincer grasp D. Feeds self with a spoon
A. Opens and closes hands An infant learns to open and close their hands at 2 months of age. They use a raking grasp at 6 months, a pincer grasp at 9 months, and feed themselves with a spoon at 12 months.
Strabismus - Esotropia (inward deviation of eye); Exotropia (outward deviation of eye)
Abnormal corneal light reflex or cover test Misaligned eyes Frowning or squinting Difficulty seeing print clearly one eye closed to enable better vision Head tilted to one side Headache, dizziness, diplopia, photophobia and crossed eyes
fontanelles
Areas where the infant's skull has not fused together -Posterior: smaller, closes between 2 and 3 months -Anterior: larger, closes between 12 and 18 months
Nursing indications for tracheotomy
Assess oxygenation ventilation and vital signs hourly assess thickness quantity odor in color of secretions assess the stoma and skin surrounding the stoma for signs of inflammation provide adequate humidification do not suction routinely maintain surgical aseptic technique provide oral hygiene every 2 hours reposition the client every 2 hours to prevent atelectasis and pneumonia keep an emergency tracheostomy tube at the bedside
When the nurse performs a head to toe assessment on a 2 year old child, when would examination of the child's ear occur?
At the end of the exam in case the child gets upset
The nurse is assessing the cardiac sounds of a child. Which action would the nurse incorporate into the assessment?
Auscultate the heart rate at the point of maximal impulse (PMI) to best interpret the cardiac sounds
The nurse is assessing a 2-year-old boy during a well child visit. The nurse correctly identifies the child's current stage of Erickson's growth and development as
Autonomy versus shame and doubt
A nurse is assessing a child. Which of the following is an early indication of hypoxemia? .a. non productive cough b. hypoventilation c. nasal flaring d. nasal stiffness
C. nasal flaring
The nurse is assessing gross and fine motor development in a 2-year-old child. Which of the following developmental milestones would the nurse expect to observe in this child? A.Turns a door handle B.Stacks objects C.Pedals a tricycle D.Undresses self
B. Stacks objects A 2-year-old child should be able to stack objects, copy circles and lines, turn pages, run, kick a ball, and jump with two feet. The other milestones are appropriate for a 3-year-old child.
When performing neurological reflexes on the infant, which primitive reflex will be present longest?
Babinski
A newborn requires skin care that includes bathing. Besides hygiene, what is another reason for bathing the newborn?
Bathing is a time for bonding with the parents
When assessing the vision of a 2-month-old, the nurse would use which of the following?
Black-and-white checkerboard
The mother of a 3-year-old child tells the clinic nurse that her child insists on having a bottle at naptime and bedtime. Which of the following interventions should the nurse suggest to the mother? A.Only allow the bottle if it contains juice. B.Only allow the bottle if it contains milk. C.Do not allow the child to have the bottle. Only allow the bottle at night but not at naptimes
C. Do not allow the child to have the bottle. A child should never be allowed to take a bottle to bed because of the increased risk of acute otitis media and dental caries. In addition, children should transition from a bottle to a cup at 15-months of age.
Nutrition for toddlers
Change from formula or breastmilk to cow's milk at 12 months. Use nonflavored whole milk until 2 years of age. Have toddler drink from a cup instead of a bottle. Do not allow a bottle at naptime or bedtime. Physiological anorexia from decreased caloric needs Food jags: Times a toddler will only eat certain foods then suddenly refuse to eat those foods anymore Common around age 3 Picky eating is common. Offer a variety of healthy foods and do not force the child to eat. Limit milk to 24 oz per day or less to prevent anemia.
36 months gross motor
Climbs well Pedals tricycle Runs easily Walks up and down stairs with alternate feet Bends over easily without falling
A nurse is presenting a class on discipline for a group for a group of parents of toddlers. What information would be important for the nurse to teach this group? Select all that apply
Consistency in the rules is important so the child understands what is expected. Even at this young age, children need boundaries. If a child does something wrong, the parent must address the behavior immediately so the child understands what they did wrong
The pediatric nurse is performing a head-to-toe exam on a 2-year-old child during a well child assessment. Which method will the nurse use to accurately determine the child's heart rate?
Counting the apical rate
The nurse is providing education to the woman about foods commonly associated with allergies in infants and young children. What items should be included in this list?
Cow's milk Peanut butter Strawberries
A nurse is working with occupational therapy to plan what developmentally-appropriate toys should be given to her 10-month-old patient. Which of the following toys would be most appropriate? A. Unbreakable mirror B. Mobile with highly contrasted pattern C.A toy bar for the infant to bat at D. Board books
D. Board books Board books, toys that make noise or light up, soft dolls, teething toys, and large blocks are all appropriate toys for older infants. The other toys would be given to a younger infant, aged 6 months old or less.
A nurse is caring for a child who is receiving oxygen. Which of the following is a clinical manifestation of oxygen toxicity A. increase blood pressure B. hyperventilation see C. decreased paco2 d. unconsciousness
D. Unconsciousness
Anisometropia
Different refractive strength in each eye Headache and vertigo Excessive eye rubbing Poor school performance
Temperament of Newborns and Infants
Easy temperament: -Quickly establishes routines -Generally happy and adapts easily Difficult temperament: -Requires high levels of activity -Fussiness and crying are common Slow to warm up temperament: -Middle level of fussiness
Social and Emotional Development #1
Egocentric: -Believe the world revolves around them -Focused on self only -Understand actions can hurt others at 3 years of age -Imitate behaviors of others -May throw temper tantrums -Encourage caregivers to offer choices to foster independence May experience separation anxiety Risk factors for emotional and behavioral problems include: -Poverty -Maternal depression -Exposure to toxic substances
A 3-year-old is admitted to the hospital for pneumonia. Which intervention would be most effective in reducing separation anxiety?
Encourage rooming-in.
Mark is a 2-month-old infant who is receiving formula. He has inconsolable crying, is gassy, and constantly draws his legs up. It has been determined that Mark has colic. Which of the following would be most appropriate?
Encourage the use of a different formula to assess for sensitivity.
The nurse is caring for an infant who was injured in a severe automobile accident. The child experienced several fractures and is in significant pain. The child's mother questions if this will impact her child later in life. What information should be provided by the nurse?
Experiences with pain even in infancy can influence an individual's response to pain later
The nurse is assessing 2 year old twins .The parent states, "My twins will not play with each other, only along side each other. Which action will the nurse take first?
Explain that this normal behavior for toddlers
Pain scale for infants: FLACC
FLACC scale used most w/ infant F- face L- legs A- activity C- cry C- consolability -Each domain scored 0 to 2 -Scores 0 to 10; higher score indicates more pain
Is the following statement true or false? A FLACC score of 8 indicates mild pain.
False The FLACC scale is scored on a 0 to 10 scale, with 0 indicating no pain and 10 indicating the worst pain possible. A score of 8 would indicate severe pain and should be treated using developmentally-appropriate pain control techniques.
A nurse is assessing a Babinski reflex in a 2 day old newborn. Which findings by the nurse would indicate a positive finding?
Fanning of the infants toes.
Oxygen hood
Flow range: 7-14 L/min to prevent CO2 buildup Oxygen may later with higher FiO2 in the lower layers
Apical sections of the upper lobes
Fowler's position
Cataracts
Gray opacity of the lens which prevents light from entering into the eye Decreased ability to see clearly Possible loss of peripheral vision Nystagmus strabismus Absence of red reflex Infant: inability to reach and grab objects(a rattle toy)
A stay-at-home father wants to purchase commercial toddler meals because his 16-month-old girl recently choked on table food. Which food items will the nurse suggest not be given to this child? Select all that apply.
Hard foods such as nuts, raw carrots, and popcorn To offer soft round foods safely, cut hot dogs in uneven pieces and quarter grapes and cherry tomatoes. This prevents food impacting in an airway. Avoid the hard and sticky foods due to aspiration and airway occlusion risks. The cooked vegetables listed are safe as are the soft fruits.
A nurse is assessing a child who has myopia. Which of the following findings should the nurse expect?
Headaches photophobia poor school performance
Physical Growth of Toddlers 2
Height: -Grow 5 inches (12.7 cm) from 12 months to 2 years of age. -Grow 2 to 3 inches (5-7.6 cm) from 2 to 3 years of age. -Measure standing height at 3 years of age. Weight: -Perform sitting weight until 3 years of age. -Gain 5 pounds (2.3 kg) per year. Head circumference: Increases by 2 cm from 12 to 24 months.
The parent of a toddler is frustrated because the toddler insist on brushing his own teeth and being left alone in the bathtub. What advice should the nurse provide to the parent about these expectations?
Helping teeth brushing encourages autonomy.
. The nurse is using a postoperative pain management scale to determine if a newborn recovering from emergency surgery is experiencing pain. Which observations indicate that the child is experiencing level 3 pain this time? (Select all that apply.)
High-pitched cry Baby is grimacing Baby has not fallen asleep
A nurse is conducting a class for new mothers about infants and nutrition. one of the women ask: What is the best nutrition for my 3 month old infant? which responds by the nurse would be appropriate?
Human milk is the best nutrition for your child
Glaucoma
Increase ocular pressure in eye Loss of peripheral vision Perception of halos around objects Red eye Excessive tearing(epiphora) Photophobia Spasmodic winking( blepharospasm) Corneal haziness Enlargement of eyeball (buphthalmos) Possible pain Red reflex of the eye will appear gray to green
A mother brings her 2-year-old child to the pediatrician's office, voicing concerns about her toddler's growth over the last year. According to the child's records, the toddler has gained 6 pounds (2.7 kg) and grown 2.5 in (6.25 cm) since his last visit a year ago. How should the nurse respond to this mother's concerns?
Inform the mother that her toddler's growth is within normal limits and there is nothing to be worried about.
The parents of a newborn are deciding if they want their newborn circumcised. the parents ask the nurse if their newborn can feel any pain during the procedure. How should the nurse respond?
It is hard to know for sure, but research shows that it is possible for newborns to experience pain.
after teaching the mother of a 13 month old boy about suggestions for bathing and hygiene , the nurse determines that the teachings was unsuccessful when the mother states which of the following?
It might be best to give him a bath in the evening
The nurse is assessing Julie, a 3-month-old infant. Which developmental milestone would the nurse expect?
Julie can hold her head erect and steady.
A mother is concerned about her infant spitting up. Which suggestion would be most appropriate?
Keep the baby sitting up for about 30 minutes afterwards
Hypoxia
Low oxygen saturation of the body, not enough oxygen in the blood
A nurse is teaching an adolescent to self-administer a corticosteroid medication using a meter-dose inhaler. Which of the following instructions should the nurse include?
MDIs require shaking for 3 to 4 seconds prior to use to aerosolize the medication the client should breathe in slowly to administer the medication into lungs corticosteroids can cause oral fungal infections
The nurse in a community clinic is caring for a 6th month old and parent. Which nursing intervention is priority?
Monitoring the infant's weight and height
NIPS pain scale
N - Neonatal I - Infant P - Pain S - Scale - similar to CRIES INCLUDES - facial expression - arm movement - cry - leg movement - respiration - arousal -Scale of 0 to 1 for all except cry, which is scored 0 to 2. -Maximum score of 7; higher score indicates more pain.
Common treatment methods for children with respiratory issues are
Nebulized aerosol therapy metered dose inhaler or dry powder inhaler chest physio therapy oxygen therapy suctioning artificial airway
The nurse caring for a 3 year old client is having a very difficult time persuading the child to take an oral medication. The child yells "yucky" every time the nurse approaches with the medication. Which of the following is the best approach to take when giving medication to a resistant toddler?
Offer the child a popsicle to numb the mouth and decrease the bad taste of the medicine.
The parents of a 2-year-old boy report to the nurse because their child is "such a picky eater." Which recommendation would be most helpful for developing healthy eating habits in this child?
Offering a variety of foods along with the food the child likes
Complication of oxygen therapy
Oxygen is combustible
A parent with a 2-year-old invites a friend with a toddler over for a play date when they notice their children are not really interacting while playing. The children are playing side-by-side when one toddler gets up and grabs a toy car out of the hands of the other toddler, which results in both toddlers crying. To prevent this from occurring again, which intervention should the parents make?
Parents should ensure that toys in front of each child are "similar" to prevent fighting over one toy.
A nurse is discussing oral care with a parents of a 4 year old. The nurse determines that the parents are performing this aspect of their child's care appropriately when they state that they use this amount of toothpaste?
Pea-sized
The nursing instructor is conducting a clinical session on the proper techniques for assessing a child's head circumference. The instructor should point out which factor concerning this assessment?
Place the tape measurer around the head above the eyebrows.
The mother of a 3 year old is considering the following purchases as a birthday present. Which toy would the nurse suggest as the most age appropriate choice?
Pounding bench
The nurse is teaching the parents of a 3-year-old child how to help the child complete the developmental task of initiative versus guilt. Which nursing example is the appropriate task and instruction?
Praise the child when demonstrating correct dressing, eating, and toileting independently
The nurse is teaching the parents of a 3-year-old child how to help the child complete the developmental task of initiative versus guilt. Which nursing example is the appropriate task and instruction?
Praise the child when demonstrating correct dressing, eating, and toileting independently.
Superior segments of lower lobes
Prone lying on a bed with two pillows under the pelvis
The nurse is developing a plan of care for a 10 month old with a respiratory infection. Which interventions are appropriate to include?
Providing a consistent routine with touching, rocking, and cuddling throughout hospitalization.
Parents of a toddler describe how they handled their child's temper tantrum in a shopping mall. What action of the parents indicates need for additional teaching?
Reason with the child to stop behavior
The nurse is assessing a toddler's language development. What finding would the nurse interpret as reflecting expected development for a 2-year-old?
Speaks in two-word sentences using a noun and a verb
Communication and Speech of Toddlers #1
Receptive language develops quicker than expressive language. Can understand directions before giving directions Echolalia (pronounced ecko lay' lee uh): -Repetition of words and phrases without understanding meaning Telegraphic speech: -Two- to three-word sentences. -Only contain enough words to get the point across. Encourage caregivers to read to their children.
Diaper Dermatitis
Red, moist, maculopapular patch with poorly defined borders in diaper area, extending along inguinal and gluteal folds. History of infrequent diaper changes or occlusive coverings. Inflammatory disease caused by skin irritation from ammonia, heat, moisture, occlusive diapers.
Billy's mother is with him at a visit for a sore throat. During the interview she states that she does not know what to do with him. "He's taking two or three showers a day and it was not that long ago that I could barely get him to take a bath at all." Which response by the nurse would be most appropriate?
Reinforce the family rules but also allow him to develop his own routine."
The mother of a 9-month-old child reports her child's eyes are often crossed. The nurse confirms this during the examination. What action is indicated?
Report the findings to the physician
Which activity will the nurse encourage new parents to complete in order to assist their infant in accomplishing Erikson's developmental task for the first year of life?
Respond promptly when the infant cries.
A nurse is educating a client being discharged with her newborn baby. What is the highest priority item that must be included in the teaching plan?
Restrain the baby in a car seat
A 6-month-old boy is brought to the doctor's office with a high fever. The physician diagnoses the child as having a viral infection of some kind and recommends acetaminophen to reduce the fever. After 3 days, the mother returns with the child. The fever is gone, but a rash of discrete, rose-pink macules approximately 2 to 3 mm and flat with the skin surface appears. Which condition should the nurse suspect?
Roseola
18 months gross motor
Runs clumsily, falls often Throws a ball overhand Jumps in place with both feet Pulls and pushes toys
Myopia (nearsightedness)
Sees close objects clearly, but not objects in the distance headaches and vertigo eye rubbing difficulty reading clumsiness poor school performance
A 2-year-old toddler holds his breath until passing out when he wants something the parent does not want him to have. The nurse would decide whether these temper tantrums are a form of seizure based on the fact that:
Seizures are not provoked; temper tantrums are.
Which children are not able to communicate pain verbally, the nurse can use a behavioral assessment. The nurse knows that this assessment will likely include;
Sleep patterns
Early signs of hypoxemia
Tachypnea, tachycardia Restlessness, anxiety, confusion Pale skin, mucous membranes Elevated blood pressure Use of accessory muscles, nasal flaring Tracheal tugging Adventitious lung sounds
To obtain an accurate heart rate in an infant, what would be most important for the nurse to do?
Take the apical pulse
A nurse is teaching the parent of an infant who has Down syndrome. Which of the following statements by the parent indicates an understanding of the teaching?
Teach the parent that Down syndrome increases the risk for respiratory infections
Acrocyanosis
Temporary cyanotic condition, usually in newborns resulting in a bluish color around the lips, hands and fingernails, feet and toenails. May last for a few hours and disappear with warming.
The nurse is interacting with several families with children during their health visits. Which child would the nurse prioritize to receive a hearing screening?
The 3-week-old infant who was discharged without a hearing screening
The nurse is observing a 24 month old boy in a daycare center, Which finding suggests delayed motor development/
The child is unable to push a toy lawn mower.
The nurse is assessing a healthy 2-year-old client. Which assessment finding most concerns the nurse?
The child speaks in one-word sentences
A 12-month-old seen at a walk-in clinic weighed 8 pounds 4 ounces (3750 g) at birth. Weight now is 20 pounds 8 ounces (9300g). The nurse determines:
The child weighs less than expected for age.
The nurse is assessing a toddler's fine motor skills. Which finding of the nurse could be a safety concern?
Turn Door Knobs
Temper tantrums in toddlers
Typical until they learn how to deal with frustration by engaging in different actions and verbalizing their feelings -Discipline for a toddler consists of consistency, timing, commitment, and age-appropriate approach -Structured firmness for meeting reasonable expectations, ignoring temper tantrums, praising accomplishments, and a brief explanation as to why a behavior is unacceptable. you cannot reason with a toddler
A new parent asks the nurse, "About how many wet diapers should my infant have in a day?" Which response by the nurse would be most appropriate?
Typically, an infant has 6 to 8 wet diapers a day."
The nurse is caring for a 2 year old child who has had surgery. When assessing this child's pain, which of the following developmental characteristics would the nurse keep in mind?
Uses words for pain as owie, boo-boo, or hurt
A nurse is presenting a class on toilet training to a group of parents of toddlers .Which information would the nurse include in the class? Select all that apply.
Using training pants that slide down easily and quickly Praising the child when they urinate and defecate Putting the child on the potty at regular intervals during the day
24 month gross motor skills
Walks down stairs holding rail with both feet on each step, kicks ball without demonstration, throws overhand
A parent brings a 6-month-old infant to the pediatric clinic for her well-child examination. Her birthweight was 8 pounds(3600g),and was 20inches (50.8cm)in length . The nurse weighing the infant today would expect her weight and length to be at least:
Weight of 16lbs(7300g) and length of 26 inches
A nurse is planning to perform a peripheral vison test on a child. Which of the following actions should the nurse take?
When performing a peripheral vison test, the nurse ask the child to focus on an object while bringing a pencil into the child's peripheral vision.
The parents of a 2 year old toddler are frustrated by the frequent confrontations they have with their toddler. Which is the best anticipating guidance the nurse can offer to prevent confrontations?
You need to adhere to a serious routine
A 3-year-old child is hospitalized. The parents are concerned because the child is now refusing to use the potty and is wetting the bed, even though the child has achieved toilet training. Which response by the nurse is most appropriate?
Your child is experiencing regression as a result of stress."
strabismus
abnormal deviation of the eye (cross eyed) common until 6 months
parallel play
activity in which children play side by side without interacting
Signs of respiratory distress
agitation, anxiety, restlessness stridor, wheezing accessory muscle use tachypnea mild tachycardia nasal flaring, seesaw breathing, head bobbing
Erikson's Theory
autonomy vs shame and doubt -Give proper direction and space to explore and develop independence.
BRUE
brief resolved unexplained event
A nurse is caring for a child who is receiving oxygen therapy and is on continuous oxygen saturation monitor that is reading 89%. Which of the following is a priority action for the nurse to take a. Increase the oxygen flow rate b. In Courage the child to take deep breaths c. Ensure proper placement of the sensor probe D. Place a child in Fowler's position
c. Ensure proper placement of sensor probe
The nurse is measuring an infant's head circumference and charts it to be at the 40th percentile. When completing which other measurement does the nurse anticipate a correlating result?
child's length will be at the 40th percentile.
Late signs of hypoxemia
confusion and stupor, cyanosis, bradypnea, bradycardia hypotension, cardiac dysrhythmias
The nurse is assessing for pain in a 2-month-old infant. Which behavior indicates that this baby is experiencing pain?
continued crying after diaper change and being fed
seborrhea
cradle cap
hypoxemia
deficient amount of oxygen in the blood
Kolhberg's theory of moral development
describe the approaches of individuals to resolving moral dilemmas. Kolhberg believed we progress through 6 stages divided into 3 main phases: pre-conventional, conventional, post-conventional -Avoidance of punishment as motivation for obedience -Not focused on right and wrong
Acute Otitis Media (AOM)
effusion in the middle ear that occurs suddenly and is associated with other signs of illness -Toddler is at risk for speech delay if frequent or untreated. Risk factors: --exposure to tobacco smoke -Exposure to other children -Congenital anomalies Protective factors: -Breastfeeding -Pneumococcal vaccination -Treat with antibiotics and comfort measures. -Myringotomy if recurrent AOM.
colic
excessive, inconsolable crying by a young infant for no apparent reason -Peaks at 6 weeks of age and resolves by 3 to 6 months of age. -Is often worse in the evening time. -No treatment, but caregivers require psychological and emotional support. -Encourage caregivers to lay the infant in the crib when frustrated.
Impact of hospitalization of Toddler
limited communication poor body image limited comprehension has separation anxiety intense reactions regression
Types of vaccinations
live, attenuated vaccines inactivated/killed vaccines toxoid vaccines conjugate
A staff nurse is talking about Piaget's theory with a nursing student. Infants are in the sensorimotor stage of cognitive development during which object permanence is mastered. An example of an infant displaying this ability is
looking for a toy in her crib at the last place she saw it
15 months gross motor
marks with a crayon puts objects in and out of cup
A nurse is assessing a toddler for possible hearing loss. Which of the following findings are indications of hearing impairment?
monotone speech speaks loudly appears shy
Pediatric Face Mask
pediatric‑size mask that covers the nose and mouth ● Used for short‑term therapy ● Used at a flow rate of 5 to 10 l/min to minimize carbon dioxide rebreathing. ● Face masks require a snug fit and might not be tolerated. ● Used for supplying high oxygen flow rate or for children who are mouth breathers.
primitive reflexes
reflexes, controlled by "primitive" parts of the brain, that disappear during the first year of life. -Includes: sucking, rooting, Babinski, Moro (startle), stepping, palmar grasp, plantar grasp, tonic neck (fencer).
oral suctioning
removal of secretions from the mouth
The mother of a 4-month-old refuses for her baby to be "stuck" when immunized. What immunization will the nurse administer under these restrictions?
rotavirus
Discipline for toddlers
should be immediate detail what was wrong consistent
posterior sections of upper lobes
sitting position with child leaning forward curled over pillows
SIDS
sudden infant death syndrome, or crib death; cause unknown. Associated failure of synapse of nerves to activate the diaphragm
anterior segments of both upper lobes
supine and rotated slightly away from side being drained
tracheotomy
surgical operation of cutting into the trachea (windpipe)
Snellen letter chart
test for acuity of distance vision
Freud's Psychosexual Stages
the childhood stages of development (oral, anal, phallic, latency, genital) during which, according to Freud, the id's pleasure-seeking energies focus on distinct erogenous zones Anal in toddlers
Infancy
the period from birth to age 1 year, is a time of many changes. During the first year of life, the infant progresses from a neonate, totally dependent on the world
The nurse is observing a 36-month-old boy during a well-child visit. Which motor skill has he most recently acquired?
undress himself
Astigmatism
uneven refractive curvatures in vision in which only parts of letters on a page can be seen headache and vertigo Appearance of normal vision because tilting the head enables all letters to be seen
