Peds Exam #1
what is the startle reflex known as? when does this occur?
moro reflex, occurs at 2 months
how does an adolescent present when in pain
muscle tension with body control, verbal expressions of pain
what allows for control of bowel and bladder in a toddler? about when does this happen?
myelination of spinal cord (2 years old)
nutrition in adolescents
needs additional calcium, iron, protein, and zinc to make up for rapid growth period
when a child is learning independence and they say "no" a lot, what is this called?
negativism
how do you have older children rate pain?
numeric scale; they can describe pain and are aware of their body functions
when a child is overhang others play, such as an infant watching a child, what is this known as
onlooker
what common newborn reflex occurs at 5-6 months where baby grabs hands, fingers, etc. ?
palmar grasping
when a child is playing independently but amongst other children what is this known as?
parallel play
what is munchausens by Proxy? (MSBP)
parent/caretaker persistently fabricates symptoms on behalf of another, causing that person to be regarded as ill
parenting style where parent does not really care what child does
passive (uninvolved)
parenting style that has no control over child, is very laid back
permissive
what occurs with babies head development after during 2-3 months?
posterior fontanel closes
what are common in toddlers until after 2nd year?
pot belly and bow legs
when a toddlers knowledge is based on their perspective, not logical, this is called
preoperational thinking
Erickson: initiative vs guilt what does this stage involve?
preschoolers are energetic learners but lack physical abilities to be successful at everything moral development: rewards or punishment - understand bad and good - 1min of time out per age social development: imaginary friends
what is one of the main goals during hospitalization?
preserve childs trust (trust vs mistrust)
what gross motor skills should a 4 month old be able to do?
rolls from back to side
what is the reflex called where baby starts sucking when cheek is stroked at 4 months?
rooting reflex
what should the nurse be concerned about if there is bruising present in a child under 6 months old?
shaken baby syndrome
what can cause an improvement or complete resolution of the symptoms of infant colic?
simethicone (mylicon drops)
infants spend much of their time engaging in _________ play
solitary
when a child is playing alone, what is this known as?
solitary play
how does a school aged child present when in pain
stalling behavior, muscle rigidity, toddler behavior when in pain
when a baby is placed in a standing position and makes marching movements what is this called
stepping reflex
when children play in groups this is known as what?
team play
preschooler thoughts on death/unintentional injuries
that they are temporary/if someone dies they will be back
what is assent?
the agreement of someone not legally able to give consent * allows respect for child and their developing autonomy
magical thinking in a preschooler - what can they think (negative)
they think they make death happen ex. "I wont get better because i was bad"
what common newborn reflex occurs at 5-7 months where the baby is able to turn head and reposition?
tonic neck (fencer)
what fine motor skills should a 7 month old be able to do?
transfer objects from hand to hand
what gross motor skill should a 7 month old be able to do?
tripod sit
true or false you dont wake a baby to eat unless they are under weight
true
at what age can a toddler turn several pages at once? at what age should they be turning one page at a time?
turns several pages until 18 months, by 2 years can turn 1 page at a time
what does FLACC stand for? who is it used for?
used for infants, delayed and special needs children Face Legs Activity Cry Consolabiltiy
age appropriate activities birth to 3 months - what do they prefer?
visual stimuli
at 12 months old what gross motor skill should a baby have?
walks with hand held and sits from a standing position
school aged child: average weight and height gain
weight gain: 2-3kgs per year height: grows 5cm/year
what is physiological anorexia?
when a toddler grows really fast from 1-2 and almost comes to a halt by 3 and they are not as hungry as usual/cut back on eating
if a procedure cannot wait, can a minor give consent?
yes
signs of neglect
- absent from school - isnt taken to doctor when sick/parent does not comply with giving medication
who created the oral stage of psychosexual development? what age range is it? what is it?
- created by freud - age range birth to 1 year - infant develops pleasure largely from the mouth when sucking and eating as primary desires
who created the sensorimotor stage of cognitive development? age range? what is it?
- created by piaget - birth to 24 months - infants progress from reflexive to simple repetitive to imitative activities
when does trust vs mistrust occur? who founded this psychosocial stage?
- erikson - trust is developed when basic needs are met
when a toddler or preschool aged child is in pain, how would they present?
- noncooperative - pushes away stimuli - verbal expressions of pain - clings to caregiver - anticipates pain
examples of appropriate toys for an infant
- rattles - big plastic rings - mirrors - teether toys - listening to someone read - peekaboo - patty cake
common preschool issues
night terrors - turn over in bed before 2 hour mark of sleeping to reduce trauma to teeth - if baby tooth turns gray needs to be pulled obesity - do not constantly reward with sweet treats
school aged children hospitalization: things to keep in mind
1) use music therapy 2) stressed by being dependent on another adult 3) fear of loss of bodily function 4) fear of body mutilation 5) encourage questions 6) allow videos and posters for teaching 7) give factual information
what are methods of pain management for pediatrics?
1) use treatment room for care 2) play therapy 3) music/aroma therapy 4) EMLA cream - used to numb area (thick layer, wrap with waterproof bandage)
school aged children important aspects
1) uses cooperative play 2) need positive reinforcement 3) children are at risk for bullying, especially those with disabilities, speech impairments, different physical characteristics, academic difficulties, and those with different sexual orientation
why do you have to wait until after 2 years old to give a toddler low fat milk?
1) vitamins and nutrients 2) whole milk has fat that helps myelin sheath grow for bladder control
how much fruit should a toddler have per day?
1 cup (8 oz)
what is the leading cause of death in infants ? age range?
1 month- 1 year, peaks 2-4 months
at what age should a baby stop using a pacifier?
1 year, start substituting it with other things at 9 months
3 pain scales used in pediatrics
1) NIPS 2) FLACC 3) Wong-Baker faces
how to prevent SIDS
1) back to sleep 2) avoid cosleeping 3) prevent overheating 4) offer pacifiers at times of sleep
characteristics of MSBP
1) bleeding 2) fevers 3) biochemical chaos 4) rashes 5) neurological symptoms 6) fabricated symptoms
signs of physical neglect
1) clothes that are not suitable for weather 2) lack of hygiene 3) failure to thrive 4) body odor
characteristics of a healthy family
1) communication 2) enjoys eachothers company 3) has traditions and rituals 4) polite and respectful
warning signs of child abuse/maltreatment
1) delay in seeking medical help 2) story and injuries do not line up 3) injuries that are extremely unlikely given childs development 4) childs appearance/interactions with their parents are innapropriate
what assessment is done in pediatric hospital care?
1) developmental level 2) coping skills 3) what do children and parents know about the illness
what is play therapy used for?
1) ensures comfortable and familiar environment of home 2) way to learn socially acceptable behavior 3) protection from everyday stressors
signs of sexual abuse to look for
1) forcing a child to engage in a sexual act 2) STIs 3) hard time sitting from pain 4) bed wetting/regression
warning signs of MSBP
1) illness that is unexplained, prolonged, and so extraordinary 2) symptoms only when caregiver is present 3) parents that will not leave ill child alone 4) seizures that do not respond to carefully administered anticonvulsants
how to diagnose shaken baby syndrome
1) look for subdural hematoma upon MRI 2) look for retinal hemorrhage 3) bulging fontanels
what is important with discipline of a toddler?
1) needs to be consistent with well defined boundaries 2) limit setting
4 kinds of maltreatment
1) physical 2) sexual 3) emotional 4) neglect
characteristics of an environment that can influence maltreatment of a child
1) poverty/unemployment 2) lack of social support 3) violent communities 4) inadequate housing 5) crowded living arrangements 6) drugs and/or alcohol 7) divorce 8) chronic stress 9) social isolation
what can minors seek care for without a parents permission
1) pregnancy 2) STD 3) alcohol/drug use 4) abuse
nursing interventions when suspecting child abuse/maltreatment
1) promote self-esteem 2) assess and protect child from danger 3) assist with grieving 4) team work/appropriate referrals for social services
3 stages of separation anxiety in peds during hospitalization
1) protest - scream and cry 2) despair - sad 3) detachment
phases of separation anxiety (6-30months)
1) protest phase - screaming/crying, clinging to parent 2) despair phase - crying stops, evidence of depression 3) detachment phase - resignation, not contentment
nursing interventions in peds hospitalization
1) provide developmentally appropriate activities 2) teach what to expect with illness/treatment 3) encourage independence and choices
what 3 tasks need to be accomplished in the sensorimotor stage?
1) separation 2) object permanence (9 months) 3) mental representation (9 months)
2 types of fractures common in child abuse
1) spiral fractures 2) greenstick fractures
how are toddlers different from children of other age groups?
1) they grow more rapidly than infants do 2) they need more calories than infants do 3) toddlers have fewer febrile seizures than preschoolers
children at risk for maltreatment
1) unwanted children 2) crying/irritable child 3) hyperactive child 4) low birth weight child 5) premature/failure to bond 6) child/children with physical or mental disabilities
when does colic begin?
1-2 weeks old
what age range is toddler
1-3 years
how much sleep does a toddler need?
11-12 hours of sleep with nap time being eliminated after age 2
sleep needs for preschool aged child
12 hours
nutritional needs for preschool aged child
1200-1400 kcal/day 12-19g of protein
a child should be able to use a cup and spoon without rotation by how many months?
15 months
at what age should a child be going up/downs stairs on all 4s and walking without help?
15 months
when should a toddler be able to throw a ball overhand?
18 months
how much does baby head increase from 4-6 months?
1cm
at what age does cooing occur as language development?
3-4 months
when are consonants added to a baby language development?
3-4 months
what age is preschool
3-6 years
single vowel sounds should be started by what age? (language development)
2 months
at what age range is the FLACC scale used?
2 months- 7 years
preschool children: average weight gain?
2-3 kgs per year
at what age should a toddler have learned to draw circles?
2.5 years old
motor skills: at what age can a child balance on 1 foot?
3
motor skills: at what age can a child copy a circle?
3
at what age should a baby be turning their head to the sound of a rattle (language development)
3 months
at what age can a child reliably use pain scales? what scale is most commonly used now?
3 or 4; wong-baker faces pains cale
motor skills: at what age can a child catch a ball?
4
motor skills: at what age can a child use scissors?
4
who came up with the idea that peoperational thinking leads to intuitive thoughts? what are some of these thoughts?
Piaget came up with this idea 1) magical thinking 2) animism - thinking inanimate objects are alive 3) centration - focus on one thing and disregard everything else 4) time - understands sequence of events but not time (ex. after lunch mommy will be here) 5) language skills advancing
at what age should a baby be laughing and squealing? (language development)
4 months
when does the sucking reflex stop?
4 months
when should a toddler outgrow temper tantrums
4 yrs old
at what age should a baby be sitting up in a highchair?
4-6 months
how many servings of fruits and veggies does a preschooler need daily?
5 servings
night time toilet training does not need to occur until what age?
5 years old
motor skills: at what age can a child jump rope?
5-6
motor skills: at what age can a child draw 5-7 body parts on a stick figure?
5-6
how much does birth length increase by end of 12 months?
50%
when do first teeth show in a baby?
6-10 months
at how many months can an infant be introduced to fruits and vegetables?
6-8 months
how many teeth should a child have by 1 year old?
6-8 teeth
preschool children: average height increase ?
6.2-9 cm per year
at what age do babies squire the fine motor skill of beginning the pincer grasp?
8 months
what age does prepubescence start at?
9
average sleep needed for school aged child (6-12yrs old)
9 hours
at what age can a sippy cup be introduced?
9 months
at what age should a baby comprehend the word "no"?
9-10 months
difference between normal and suspicious bruising
normal: knees, shine, elbows, forehead suspicious: face, head, neck, chest, back, thighs, genitalia, buttocks ** ALL IN DIFFERENT STAGES OF BRUISING
Piaget - Cognitive Development what is formal operations? important development during this?
individuals thoughts start taking more of an abstract form and egocentric thoughts decrease develops abstract thinking
aspects of physical abuse
intentional use of force on someone
true or false: magical thinking is always good
FALSE; can be bad at times
school aged child: average HR, RR, BP
HR = 60-110 RR = 20-25 BP = 91/54-129/98
preschool children: average HR RR BP
HR = 70-120 RR = 20-25 BP = 86/75
normal toddler: HR? BP? RR?
HR = 80-140 BP = 80/39 - 80/67 RR = 25-30
during maturation of a toddler ____ and ____ slow, while _____ increases
HR and RR slow, BP increases
family composition that has a mom, dad, and kids but they are not biological
nuclear family
how much does head circumference increase in a baby per month?
about 2cm
what are fine motor skills?
activities done to produce a purposeful result
difference between ear exam for adults vs younger children
adults: up and back younger children: down and out
at what age can a baby have berries?
after 1 yr old
at what age should a baby be saying 3-5 words?
age 1
by what age does a child eat adult food portions?
age 12
at what age do children begin to have an adult concept of death? important info to know?
age 9-12 - will respond to factual information - fear the disease processed each process, and loss of control
emancipation can occur at what age/and for what reasons?
ages 14-16 can be requested, or occurs if in active duty, married, living apart from family and supporting oneself
what occurs with babies head development from 12-18 months?
anterior fontanel closes
when children play together but without organization what is this known as?
associative play
giving care with the least amount of pain as possible is known as
atraumatic care
after 1-2 weeks of life what is babies weight?
back to birth weight
when is hearing screening done for a baby?
before coming home from hospital
family composition where parents are divorced but both still have parental rights
binuclear
traditional family composition is called
biological
if child is being breast fed, what is important to know?
it lacks vitamin D, child will need vitamin d supplement
what does Erickson mean when he says the toddler stage is autonomy vs shame and doubt?
child needs independent opportunities to make their own decisions (such as dressing themselves) if they see others doing it and they cant, they will feel ashamed
people who share a home and act as if they are married are known as
communal family
the understanding that something stays the same quantity even though its appearance changes is known as
conservation
what helps improve a childs stay in the hospital?
consistent nursing care
what is the 1st form of verbal communication?
crying
what is the family system theory ?
it views the family as a whole not just as individuals
age appropriate activities for 6-9 year old?
jumping, skate, biking
what type of milk is given to 3-6 year olds?
low fat milk
how do you measure a toddler?
lying down until they are 3 years old
age appropriate activities for 9-12 year old?
master gross motor skills, card games, board games
parenting style that sets limits and enforces consequences
democrative (authoritative)
parenting style that is very hard on child, "because I said so"
dictatorial (authoritarian)
what does it mean when toddlers model what the parents or caregiver does?
domestic mimicry
physical growth and development birth weight ______ by 6 months, and _____ by end of 1st year
doubles by 6 months, triples by end of first year
piaget concrete operations: early school aged children thing in __________ thinking, while the older child begins to think in ____________ thinking
early school aged child = perceptional thinking older child = conceptional thinking
if teeth dont occur within a year what do you do?
get X-ray done
when do girls stop growing? boys?
girls stop growing about 2 years after first period boys stop growing at 18-20 years old
what fine motor skills should a 4 month old be able to do ?
grasp objects with both hands
priority nursing interventions for maltreatment of child
having child removed from abusive situation
what is the importance of Eriksons stage of industry vs inferiority?
if a child fails to develop a sense of industry, they will feel a sense of inferiority to their peers who have mastered this task
what to do when a toddler is having a temper tantrum
ignore behavior as long as they are safe, be patient
When is final height achieved?
in puberty
what does it mean if bulging in fontanel occurs? what do you do?
indicates increased ICP, call HCP immediately
