NUR 158 Exam 4
How would you describe an x-ray to a preschooler?
"the x-ray department has big machines that won't hurt you; it's a little cold there too" "It's a picture or big camera to take pictures of the inside of your body" tell them how long they'll be gone "you will be in the xray dept till lunchtime"
Intravenous Administration
* Only effective way for administering medications
Identify the risk factors for suicide in adolescents.
- Depression or other mental illness • Mental health changes • Family history of suicide • History of previous suicide attempt • Poor school performance • Family disorganization • Substance abuse • LGBTQ • Giving away valued possessions • Being a loner/having no close friends • Changes in behavior • Incarceration
Recognize therapeutic communication for children and families dealing with acute and chronic medical conditions
- use of open-ended questions, reflection, paraphrasing, acknowledgment of emotions, and active listening. - goal-directed, focused, purposeful communication), therapeutic play (type of play that provides an emotional outlet or improves the child's ability to cope with the stress of illness and hospitalization), and education to help the child and family understand the reason for the hospitalization and the necessary tests and procedure
What would be the expected gross motor skills for preschoolers?
-agile while standing, walking, running, and jumping -can go up and down stairs and walk forward and backward easily. -Standing on tiptoes or on one foot still requires extra concentration. -in constant motion. - uses the body to understand new concepts (such as using the arms in a "chug-chug" motion when describing how the train wheels work). 3 years: • Climbs well • Pedals tricycle • Runs easily • Walks up and down stairs with alternate feet • Bends over easily without fallin 4 years: • Throws ball overhand • Kicks ball forward • Catches bounced ball • Hops on one foot • Stands on one foot up to 5 seconds • Alternates feet going up and down steps • Moves backward and forward with agility 5 years: • Stands on one foot 10 seconds or longer • Swings and climbs well • May skip • Somersaults • May learn to skate and swim
List foods that could promote calcium intact for adolescents.
fortified ready to eat cereals cheese yogurt almond milk white beans broccoli
Which muscle would the nurse give a newborn a hepatitis B vaccine? Which size needle would be used?
vastus lateralis (anterolateral) length 5/8-1 inch 22-25 G
Distribution of Medication in Children Affected By:
§Higher percentage of body water than adults §More rapid extracellular fluid exchange §Decreased body fat §Liver immaturity, altering first-pass elimination §Decreased amounts of plasma proteins available for drug binding §Immature blood-brain barrier, especially in neonates, allowing permeation by certain medications
Subcutaneous & Intradermal Administration
•Distributes medications in the fatty layers of body •Used primarily for: •Insulin •Heparin •Certain immunizations
Rectal Administration
•Suppositories •Lubricate with water-soluble lubricant •Not preferred route in children because •Invasive •Absorption erratic & unpredictable
Ophthalmic Administration
•Typically in form of drops or ointment •Place child in supine position •Applying Eye Medications •Wash & Dry Hands Thoroughly •Cleanse the eye. Move from nose side of eye outward. Use clean area of cloth each time, different cloth for each eye, and warm water. •Allow drops or ointment to come to room temperature
If an adolescent does not want a parent present for a physical exam, what would the appropriate response be?
respect adolescents wishes and ensure privacy
How can we prevent medication errors in children?
right med right pt (2 identifiers) right time right route of admin right dose (get pt's weight) right approach Confirming the child's identity and double-checking the dosage before administration of any medication Confirm that the children's weight is accurate. Always weigh children in kilograms. Double-check medication calculations; utilize another health care provider when possible, especially for high-risk medications. If a dose seems unusually small or large, verify the order. Utilize medication ordering and dispensing systems, if available. Always report medication errors or near-miss errors to help prevent future mistakes. Utilize the Joint Commission's official "Do Not Use" list *ensure proper dosing
What health screening are appropriate at this age?
screenings for vision, hearing, touch/smell, and screen for development of being overweight.
What advise would the nurse give to parents dealing with toddler tantrums?
suggest that the parent should be especially diligent about maintaining structure/routine as well as avoiding tantrum triggers(fatigue and hunger). Explain to parents that they may need to exercise additional patience with new activities to which the slow-to-warm-up toddler may need extra time becoming accustomed. -normal toddler behavior
When caring for a school-aged surgical patient, what would be the nurse's priority?
the RN must use knowledge of normal growth and development to recognize potential delays, promote continued appropriate growth and development, and interact successfully with the school-age child. *Provide opportunities for the school-age child to maintain independence, gain control, and increase self-esteem.
What is the priority learning activity for a 6-month old infant?
the infant begins to distinguish emotions based on the tone of voice. Squealing and yelling /laughing begin around 6 months of age; these may be used to express joy or displeasure.
Describe therapeutic play. How does this help with procedures?
type of play that provides an emotional outlet or improves the child's ability to cope with the stress of illness and hospitalization-helps child cope with feelings and fears it allows for expression of feelings and fears and promote energy expenditure and to help them adapt to the effects of illness and hospitalization. It provides an emotional outlet, opportunities for teaching and learning, and the ability to become familiar with a situation and improve physiologic abilities (using a doll for needle play to help with feelings)
What is the major cause of injuries for adolescents?
unintentional injuries: #1 motor vehicle crashes #2 poisoning likely due to overdose on opioids
Intramuscular Administration
•Distributes meds in muscle layers •Preferred site for infants less than 7 months of age is vastus lateralis •Preferred route for infants & children greater than 7 months is the ventrogluteal site •Dorseogluteal site not recommended in children less than 5 years of age •Deltoid used in children over 3 years of age
Oral Administration
•Supplied in many forms (liquids, powders, tablets, and capsules •Children less than 5-6 years of age generally at increased risk of aspiration
Otic Medication
•Typically Ear Drops •Administering Pediatric Ear Drops: •Pull pinna down and back if child is younger than 3 years of age •Pull pinna up and back if child is 4 years of age and older
Nasal Administration
•Typically drops and sprays •May need additional assistance •Position child upright with head tilted slightly back
Describe health promotion for preschoolers.
◦Promote growth through play ◦Promote early learning ◦Promote language development ◦Choosing a preschool/starting kindergarten ◦Promote safety ◦Promote nutrition ◦Promote healthy sleep & rest ◦Promote appropriate discipline
Remember which screening charts for visual acuity are used for each age group.
-Snellen letters or numbers: school age, child must know his or her letters or numbers for the test to be valid. - "Tumbling E": preschool, child points in the direction that the "E" is facing. - LEA symbols or Allen figures: preschool, child should first identify the pictures with both eyes at a comfortable distance prior to monocular testing to ensure validity of the test. - Ishihara: school-age, Screens for color discrimination (numbers composed of dots, hidden within other dots) - Color Vision Testing Made Easy (CVTME): preschool, uses dot pictures like the Ishihara, but instead of numbers has easily identified shapes imbedded in the dots - "tumbling E" chart: children who do not yet know the alphabet but who can follow instructions to indicate the direction that the arms of the "E" are pointing - A picture chart similar to the Allen object recognition chart is appropriate for vision screening in the preschool-age child. - Snellen eye chart: may be used for children age 6 or older who know the alphabet (traditional chart for vision screening 5-6yrs)
What are Erikson's Stages?
1) trust v mistrust (birth-1yr) 2) autonomy v shame and doubt (toddlers) 3) initiative v guilt (3-6yrs) 4) industry v inferiority (school-age) 5) identity v role confusion or diffusion (adolescent 10-20yrs)
Dose Determination by Body Weight
1.Weigh child 2.If weight in pounds convert to kilograms - divide weight in pounds by 2.2 3.Check for safe dose range 4.Calculate low safe dose 5.Calculate high safe dose Determine if the dose ordered is within safe dose ra
National Patient Safety Goal (NPSG) - Goal 1
Improve the Accuracy of Patient Identification
Describe the primitive reflex palmar grasp.
Infant reflexively grasps when palm is touched. It appears at birth and disappears 4-6 months
Describe ways to assist a child adapting to an extended hospital admission.
Maintain the child's home routine related to activities of daily living. • In the hospital, use primary nursing. • Encourage the child to have a security item present, if desired. • Involve the child and family in planning care from the moment of the first encounter. • Empower the family and child by providing knowledge. • Allow the child and family choices when they are available. • Make the environment more inviting and less intimidating.
Medication Distribution
Movement of a drug from the blood to interstitial spaces and then into cells
What is acrocyanosis?
Blueness of the hands and feet, normal in babies up to several days of age and results from an immature circulatory system completing the switch from fetal to extrauterine life
Remember normal finding for a 12-month old at a well-child visit.
?The 12-month-old will explore objects in different ways, such as throwing, banging, dropping, and shaking. He or she may imitate gestures and know how to use certain objects correctly (e.g., puts phone to ear, turns up cup to drink, attempts to comb hair) The average 12-month-old has four to eight teeth. Blood pressure steadily increases over the first 12 months of life, from an average of 60/40 in the newborn to 100/50 in the 12-month-old. RR slows birthweight triples length increases by 50% Head circumference increases about 10 cm from birth to 1 year of age sits from standing position/walks independently eat with fingers/assist with getting dressed
What factors should the nurse incorporate when caring for a dying child?
Caring for the dying child is a family-centered, multidisciplinary process. Nurses must respond to the child's and family's physiologic, emotional, and spiritual needs during this difficult time - examine one's own values related to dying - organ donation •Managing Pain & Discomfort •Providing Nutrition •Providing Emotional Support to Dying Child & Their Family •Assisting Family Through Grief Process - end of life decisions - hospice/palliative care
What observations would the nurse observe to confirm attachment between a postpartum mother and her infant?
eye contact parental response to infant cues parental verbalization of caring for infant infant response to parent's caretaking behavior
Describe alternative positioning and when it would be beneficial.
During painful or invasive procedures, avoid traditional restraint or "holding down" of the child. *Use alternative positioning such as "therapeutic hugging* (a holding position that promotes close physical contact between the child and a parent or caregiver) - If the above-mentioned positions are not an option, have the parent stand near the child's head to provide comfort.
What is priority for the nurse admitting a medically fragile patient?
Family-centered care minimizes the impact of chronic illness and maximizes the child's developmental potential. To provide the best nursing care for these children and their families, the nurse must first develop a trusting relationship with the family
Review administration of gastrostomy tube feedings. How much residual would be required to hold a feed for a school-aged child?
For g-tube feeds, it is a general guidline to *hold feeds for any residual greater than 100 mL.* Therefore, if you have a 15 mL residual for a school-aged child, you will replace the residual and continue with the scheduled feeding. -opening into stomach -Measure the length of the tube daily from the exit site on the stomach to the end of the tube.
Why would the nurse use an orogastric tube in a neonate instead of a nasogastric tube?
For infants, who are obligate nose breathers, insertion via the mouth may be appropriate. Oral insertion also promotes sucking in the infant.
When does discharge planning begin?
Successful discharge planning begins *upon the child's admission to the facility*
When assessing an infant, what is the best way to listen for respirations?
The most accurate respiratory rate is obtained before disturbing the infant or child. This can often be done easily when the parent/caregiver is holding the child before any clothing is removed. Count the respiratory rate for a full minute to ensure accuracy. Infants' respirations are primarily diaphragmatic, so count the abdominal movements.
Before placing an IV in a child, would the nurse check for lab orders before sticking the child? Why?
Yes because it is best to not have to stick the child more than necessary
What are some ways to encourage a school-aged child to cough and deep breath?
blow bubbles blow a whistle blow cotton ball up into the air
What would be appropriate nutrition for a toddler?
calcium (dairy, broccoli, oranges, sweet potatoes, tofu, legumes) iron (iron fortified cereals, other iron rich foods, Vit C) fiber (19 g) Don't restrict fats encourage water intake 3 full meals, 2 snacks daily (1/4 the size of adult portion)
What gross motor skills would the nurse expect a school-aged child to be able to perform?
coordination, balance, and rhythm improve, facilitating the opportunity to ride a two-wheeled bike, jump rope, dance, and participate in a variety of other sports 6-8 yrs: enjoy bicycling, skating, and swimming 8-10 yrs: are less restless, but their energy level continues to be high with activities more subdued and directed. These children exhibit greater rhythm and gracefulness of muscular movements, allowing them to participate in physical activities that require longer and more concentrated attention and effort, such as baseball or soccer. 10-12 yrs: (the pubescent years for girls), energy levels remain high but are more controlled and focused. Physical skills in this age group are similar to those of adults, with strength and endurance increasing during adolescence.