peds exam 2

Children who are severely immunocompromised should not receive ___ ___.

live vaccines

Lead

Remains a preventable health threat Still many children between 1-5 have issues with lead poisoning

Despair

Is withdrawn and quiet without crying; displays apathy, depression, lack of interest, overall feelings of sadness

Ice to water measuring

1 cup of iced water = 1/2 cup water

The Maternal Child Health Bureau defines children with special health care needs as

"those who have or are at risk for a chronic physical, developmental, behavioral, or emotional condition and who has required health and related services of a type or amount beyond that required by children generally". -Children who have a terminal illness or are otherwise *dying, also require additional care.

*Nutritional Support -Enteral

*Orogastric, nasogastric, nasojejunal, or nasoduodenal (tubes inserted along existing anatomy) Gastrostomy, or jejunostomy (tubes inserted directly into the GI tract through a surgical opening in the abdomen) Indicated in patients with a functioning GI tract but cannot consume enough calories orally

Role of the Nurse in Family-Centered Care

-Assess the learning needs and identify knowledge deficits -Provide education that is appropriate to the educational and developmental levels of the child and family -Empower children and their families through education and advocacy -Encourage the family to participate in the child's care

Disadvantages of Home Health Care

-Can be an intrusion to family privacy; scheduling can be problematic -Care can be overwhelming; there may be multiple caregivers to educate -Financial issues can be a burden -Care can be more costly; home care may not be covered by health insurance -Having a caregiver at home can contribute to financial strain through loss of paycheck

Children who have (or at risk for) conditions beyond the usual need:

-Chronic physical -Developmental -Behavioral -Emotional (USDHHS, HRSA, MCHB, n.d.) Children with a terminal illness, or are dying

Role of Nurses in Home Health Care

-Direct providers of care -Provide education for child and family -Child and family advocates -Coordination of care among other healthcare providers

Health History Data Related to Pain Assessment

-Location, quality, severity, and onset of the pain, as well as the circumstances in which the child experiences the pain -Conditions, if any, that preceded the onset of pain and conditions that followed the onset of pain -Any associated symptoms, such as weight loss, fever, vomiting, or diarrhea, that may indicate a current illness -Any recent trauma, including any interventions that were used in an attempt to relieve the pain

Examples of Care in Home Health Care

-Provide education about the diagnosis and its management in the home -Review any special techniques and request return demonstration to assess a caregiver's mastery in the home -Providing written schedules of interventions or medications that are consistent with family schedule -Identify and remove any barriers in the home or community that might limit the child reaching full potential

Three Components of Health Supervision

1. *Developmental surveillance and screening 2. Injury and disease prevention 3. Health promotion

Community Health Nursing

1. Aimed at disease prevention and improvement of health of both populations and communities. 2. Population refers to "all" of the people occupying the area or those who share one or more characteristic. 3. Community is defined as a collection of people who interact with one another with common interests/ sense of unity. 4. Healthy People 2030 ensures that health care professionals look at the individual as well as the community. Reasons for Early Transitions of Care From Hospitals to Communities Strained health care funding Shorter hospital stays Cost containment Acute care not good environment for children - remember developmental delays occur when child isn't in own environment Successful discharge planning begins upon the child's admission to the facility.

Preventing medication error

3 times higher in peds Confirm that the child's weight is accurate Always weigh children in KG Double check medication calculation If dose seems unusually small or large - verify Always report medication errors or near-misses

*** ___ mL per kg of body weight for the first ___ kg ___ mL per kg of body weight for the next ___ kg ___ mL per kg of body weight for the remainder of body weight in kilograms

100 mL per kg of body weight for the first 10 kg 50 mL per kg of body weight for the next 10 kg 20 mL per kg of body weight for the remainder of body weight in kilograms

_____ body fat Liver immaturity, altering first-pass elimination

Decreased

*Child Life Specialist

A child life specialist or CLS is an individual who is specifically trained in the developmental impact of illness, injury, and trauma of a child and his/her family. Member of a multidisciplinary team and works in conjunction with other HCP and parents to foster an atmosphere that promotes the child's well-being.

Components of *Transition Planning - pg 343

A written plan for transition to adult care should be initiated in midadolescence. Puberty is often affected by chronic illness (either delayed or earlier). Multidisciplinary care coordination including community resources Acknowledgment of the changing roles Fostering of the youth's self-determination skills - including getting them into groups to help with complying with illness needs Importance of a medical home

The nurse is caring for a special needs infant. Which intervention will be most important in helping the child reach his or her maximum developmental potential? A)Directing her parents to an early intervention program B)Monitoring her progress in elementary school C)Serving on an individualized education program committee D)Preparing a plan for her to transition to college

A)Directing her parents to an early intervention program

When providing care to a dying child and his family, which would be most important? A)Focusing on the family as the unit of care B)Teaching the family appropriate care measures C)Offering the child support and encouragement D)Assisting the parents in decision making

A)Focusing on the family as the unit of care

The nurse is caring for a 7-year-old girl hospitalized in isolation. The nurse notices that she has begun sucking her thumb and changing her speech patterns to those of a toddler. What condition is the girl manifesting? A)Regression B)Suppression C)Repression D)Denial

A)Regression

Specific Types of Screenings Performed -hearing

AAP recommends screening on all infants Hearing loss is a common condition in newborns Even mild hearing loss can cause serious delays in social and emotional development, Language acquisition and cognitive function

Immunity

Ability to destroy and remove a specific antigen from the body

Active immunity

Acquired when a person's own immune system generates the immune response

Nutritional Support -Parenteral

Additional fluids via peripheral IV Total parenteral nutrition (TPN) via central line May be used in the absence of a functioning GI tract

Nurse's Role in Pharmacologic Pain Management

Adhering to the rights of medication administration Knowledge about the drug's pharmacokinetics and pharmacodynamics Assessment is crucial and ongoing Monitor physiologic parameters -level of consciousness -vital signs -oxygen saturation levels -urinary output -monitor for signs of adverse effects (respiratory depression) Assess the child's and parents' emotional status Teach the child and parent's about the drug

Specific Learning Principles Related to Parents

Adults are self-directed Adults are problem focused and task oriented Adults want an immediate need satisfied Adults value past experiences and beliefs

Factors Influencing Pain

Age - birth to grave Gender - unsure in children if sex plays a part - no real data Cognitive level - key factor affecting perception and response Temperament - plays an important role (difficult temperament = greater pain response) Previous pain experiences Family and cultural background Situational factors

Factors Affecting a Child's Response to Illness and Hospitalization; box 11.4 - page 306

Age, developmental and cognitive level Child's perception of the situation Amount of separation from parent/caregiver Previous experiences with illness Type and amount of preparation prior to admission Recent life stressors and changes to self or family Coping skills (innate or acquired) Availability of support systems Cultural background and traditions Parental reactions to illness and hospitalization

A nurse is providing teaching to the mother of an adolescent girl about how to manage menstrual pain non-pharmacologically. Which statement by the mother indicates a need for further teaching? A)"I need to help her learn techniques to distract her; card games, for example." B)"I need to be able to identify the subtle ways she shows pain." C)"I need to follow these instructions exactly for them to work properly." D)"I need to encourage her to practice and utilize these techniques."

Answer C - "I need to follow these instructions exactly for them to work properly." The mother does not need to follow the instructions exactly; she needs to review the methods and modify them in a way that works best for her daughter. The other statements are correct.

The nurse is teaching the student nurse the factors that affect the pharmacodynamics of the medications being administered. What is a factor affecting this property of medication in children? A)Immature body systems B)Weight C)Body surface D)Body composition

Answer is A - Immature body systems - slide 5 Although a drug's mechanism of action is the same in any individual, the physiologic immaturity of some body systems in a child can affect a drug's pharmacodynamics (behavior of the medication at the cellular level). The child's age, weight, body surface area, and body composition also can affect the drug's pharmacokinetics (movement of drugs throughout the body via absorption, distribution, metabolism, and excretion).

The nurse is caring for a child who is recovering from an appendectomy. What is the appropriate term for the pain this child is experiencing? A)Nociceptive pain B)Neuropathic pain C)Chronic pain D)Superficial somatic pain

Answer is A -Nociceptive pain Nociceptive pain reflects pain due to noxious stimuli that damages normal tissues or has the potential to do so if the pain is prolonged. Nociceptive pain ranges from sharp or burning; to dull, aching, or cramping; to deep aching or sharp stabbing. Examples of conditions that result in nociceptive pain include chemical burns, sunburn, cuts, appendicitis, and bladder distention. Neuropathic pain is pain due to malfunctioning of the peripheral or central nervous system. Chronic pain is defined as pain that continues past the expected point of healing for injured tissue. Superficial somatic pain, often called cutaneous pain, involves stimulation of nociceptors in the skin, subcutaneous tissue, or mucous membranes.

The nurse tells a joke to a 12-year-old to distract him from a painful procedure. What pain management technique is the nurse using? A)Relaxation B)Distraction C)Imagery D)Thought stopping

Answer is B - Distraction Distraction involves having the child focus on another stimulus, thereby attempting to shield him from pain. Humor has been demonstrated to be an effective distracting technique for pain management.

The nurse is preparing to administer oral ampicillin to a child who weighs 40 kg. The safe dose for children is 50 to 100 mg/kg/day divided in doses administered every 6 hours. What would be the low single safe dose and high single safe dose per day for this child? A)50 to 100 mg per dose B)100 to 500 mg per dose C)500 to 1,000 mg per dose D)1,000 to 5,000 mg per dose

Answer is C: 500 to 1,000 mg per dose To calculate the dosage, the nurse would set up a proportion to calculate the low dose as follows: 50 mg/1 kg = x mg/40 kg; solve for x by cross-multiplying: 1 × x = 50 × 40; x = 2,000 mg divided by 4 doses per day = 500 mg. Then calculate the high safe dose range using the following proportion: 100 mg/1 kg = x mg/40 kg; solve for x by cross-multiplying: 1 × x = 100 × 40; x = 4,000 mg divided by 4 doses per day = 1,000 mg.

The nurse is conducting an assessment of a high school track athlete. The client tells the nurse he is experiencing pain along his outer thigh. He describes it as tight, achy, and tender, particularly after he runs. The nurse understands that he is most likely experiencing what kind of pain? A)Cutaneous B)Neuropathic C)Visceral D)Deep somatic

Answer is D - Deep Somatic Deep somatic pain typically involves the muscles, tendons, joints, fasciae, and bones. It can be localized or diffuse and is usually described as dull, aching, or cramping with tenderness. It can also be due to overuse injuries commonly experienced by athletes. Cutaneous pain usually involves the skin and is described as sharp or burning. Neuropathic pain is due to a malfunctioning of the peripheral nervous system and is described as burning or tingling. Visceral pain is pain that develops within organs.

The nurse caring for a 6-year-old client enters the room to administer an oral medication in the form of a pill. The dad at the bedside looks at the pill and tells the nurse that his daughter has a hard time swallowing pills. What is the best response by the nurse? A)Ask the child to try swallowing the pill and offer a choice of drinks to take with it. B)Crush the pill and add it to applesauce. C)Request that the healthcare provider prescribe the medication in liquid form. D)Call the pharmacy and ask if the pill can be crushed.

Answer is D -Call the pharmacy and ask if the pill can be crushed. The father is the best source of knowledge on medication administration for the child. The pharmacy should be called to determine if the pill might be crushed. Asking the child to try swallowing the pill disregards the information the father has just given. Requesting that the healthcare provider order the medication in liquid form is not necessary at this point.

Psychological Effects of Hospitalization on Children

Anxiety and fear related to the overall process, Potential for bodily injury, physical harm, and pain Separation from home, family, friends, etc. Loss of control Anger and guilt Acting out *Regression - return to a previous state of development Other types of defense mechanisms

Positive Outcomes of Family-Centered Care for Children

Anxiety is decreased Children are calmer and pain management is enhanced Recovery times are shortened Families' confidence and problem-solving skills are improved Communication between the health care team and the family is also improved A decrease in health care costs is seen Health care resources are used more effectively They want to be heard

Families - Box 12.1, page 337

Are a constant in the child's life Need to access to information and training Deserve to receive culturally competent care Know their strengths, limitations, and fears Merit mutual respect and responsibility for outcomes

*Live attenuated vaccines

Are modified living organisms that are weakened. Organism can produce an immune response but does not produce the complications of the illness Examples: MMR - one most commonly used in childhood immunizations. Can be given same day with other live vaccines Varicella vaccine - (Chickenpox) all children between 12- 15 months who have not had chickenpox should be vaccinated. Rotavirus Vaccine - disease causes severe, watery stools, cramping and can quickly lead to dehydration in the infected child. Given orally, some contraindications

Components of Learning Needs Assessment

Assessment must include child and family Follows nursing process: assess, plan implementation, evaluate, and document teaching Identify learning styles and preferences, and potential barriers to learning Consider cultural factors that may impact learning Assess health literacy

Hyperlipidemia

Atherosclerosis has been seen in children Screen between 9-11 years old and again between 18-21.

The nurse is caring for a 2-year-old in the hospital, and the mother expresses concern that the toddler will be scared. Which response by the nurse would be most appropriate? A. "Don't worry; we practice family-centered and atraumatic care here" B. "We will do our best to minimize the stress that your child experiences" C. "It will probably be upsetting for you as well, so you should stay home" D. "Our practice of atraumatic care will eliminate all pain and stress for your child"

B

When caring for children, how does the nurse best incorporate the concept of family-centered care? A. Encourages the family to allow the physician to make health care decisions for the child B. Uses the concepts of respect, family strengths, diversity, and collaboration with the family C. Advises the family to choose a pediatric provider who is on the child's health care plan D. Recognizes that families undergoing stress related to the child's illness cannot make good decisions

B

When planning the education for a child and parents regarding a procedure, what is the first step the nurse should take? A. Decide which procedure and medications the child will be discharged on. B. Determine the child's and family's learning needs and styles. C. Ask the family if they have ever performed this type of procedure before. D. Tell the child and family what the goals of the teaching session are.

B

A large portion of the nurse's efforts is dedicated to health supervision for children who use the facility as their primary medical contact. At which facility does the nurse work? A)An urgent care center B)A pediatric practice C)A mobile outreach immunization program D)A dermatology practice

B)A pediatric practice

Teaching Points During *Transition of Adolescent to Adult Care

Begin at age 12-14 for successful transition Diagnosis and medical history to date Treatment rationale Symptoms of worsening condition Danger signs When to seek help from a professional (and from whom) Medical insurance process Detailed written plan of care Consultation with transition services coordinator

*Pharmacodynamics

Behavior of medication at the cellular level Affected by the physiologic immaturity of some body systems in a child compared to adults; response may vary based on genetic makeup

Medications Used for Pain Management -Adjuvant

Benzodiazepines Anticonvulsants

*Inactivated vaccines

Contain whole dead organisms; incapable of reproducing, but can produce an immune response Examples DTaP vs TdaP Polio - IPV, the only one recommended - poses no threat of vaccine-acquired disease Hepatitis A Vaccine - close contact or eating/drinking contamination water/food

The nurse is teaching a group of parents with premature infants about the various medical and developmental problems that may occur. The nurse determines that additional teaching is needed when the group identifies what as a problem? A)Sudden infant death syndrome B)Hydrocephalus C)Peptic ulcer D)Broncho-pulmonary dysplasia

C Gastroesophageal reflux disease, not peptic ulcer, is a medical problem that commonly affects premature infants. Myriad problems may occur, including sudden infant death syndrome, hydrocephalus, bronchopulmonary dysplasia, cardiac changes, growth retardation, nutrient deficiencies, bradycardia, rickets, inguinal or umbilical hernias, visual problems, hearing deficits, delayed dentition, and growth delays.

Immature blood-brain barrier, especially neonates, allowing movement of certain medications into the _____.

CSF

Nursing Management of Children With Special Needs

Case management and advocacy Screening and ongoing assessment of the child Provision of appropriate home care Care of the technology-dependent child Education and support of the child and family Referral for resources

Indicators of Pain in Infants -Physiologic

Changes in heart rate, respiratory rate, oxygen saturation levels, vagal tone, plantar or palmar sweating

Topical

Creams, ointments, lotions, drops Transdermal patches

Health Supervision in Chronic Illness

Children with chronic illnesses may need specialized health supervision needs and more frequent visits Critical need for coordination of services from multiple specialties through medical home Families with a member with a chronic illness may need additional supports Coordination of community resources to support family's needs Ongoing assessments of family needs

Developmental Level

Children's responses to the stressors of fear, separation anxiety, and loss of control vary depending on their age and developmental level. Younger children, with their limited life experience and immature intellectual capacities, have a more difficult time comprehending what is happening to them Separation anxiety - typically begins once a child has developed object permanence - usually around 4-8 months Loss of control Anxiety and fear

Over the long term, former premature infants are at a higher risk than typical infants of developing:

Cognitive delays Cerebral palsy Attention deficit disorders Learning disabilities Difficulties with socialization Vulnerable child syndrome

Long-Term Risks for the Premature Infant

Cognitive delays Visual impairment, chronic lung disease Cerebral palsy Attention deficit disorder Learning disabilities Difficulties with socialization Vulnerable child syndrome Alterations in muscle tone

*** ProQuad: MMR and varicella Kinrix/Quadracel: DtaP-IPV Pediarix: DTAP-Hep B - IVP Pentacel: DTaP-IPV/Bib

Combination vaccines

Common Adverse Events Associated With Use of Opioid Medications

Constipation Pruritus Nausea and vomiting

*Toxoid vaccines

Contain protein products produced by bacteria called toxins Heat-treated to weaken its effect, but can produce an immune response

Special issues in health supervision

Cultural influences Community influences Health supervision and the chronically ill child Health supervision and the internationally adopted child

The nurse is providing home care for a 1-year-old girl who is technologically dependent. Which intervention will best support the family process? A)Finding an integrated health program for the family B)Teaching modifications of the medical regimen for vacation C)Assessing family expectations for the special needs child D)Creating schedules for therapies and interventions

D Coordinating care with the schedules and capabilities of the parents provides the greatest support for the family. It gives them a sense of order and control. Integrated health care programs may not be available in the family's area. Teaching therapy modifications for travel and assessing family expectations are not supportive interventions.

When providing atraumatic care to a child, which action would be the most appropriate? A. Applying restraints for any procedure that would be uncomfortable B. Keeping the lights on in the child's room throughout the day and night C. Limiting the use of topical anesthetics for painful injections D. Allowing parents and children an informed choice about being together

D. Allowing parents and children an informed choice about being together

____ amounts of plasma proteins available for drug binding

Decreased

Methods to Promote Coping in Children

Deep breathing techniques Distraction techniques Imagery Providing opportunities for therapeutic play Music Provide age-appropriate education before events occur Provide support to siblings and other family members

Techniques to Reduce Stress in Children During Invasive Procedures

Demonstrate common activities in nursing care on stuffed animals or dolls first Avoid the use of medical terms; use developmentally appropriate language Allow the child to handle some equipment Teach the child the steps of the procedure; encourage questions Show the child the room where he or she will be staying Introduce the child to other health care personnel Explain the unfamiliar sounds the child may hear

*Intradermal (ID) administration

Deposits medication just under the epidermis Used for TB screening and allergy testing

Physiologic Factors Affecting Metabolism of Medications in Children

Differences in hepatic enzyme production or renal clearance Increased metabolic rate Biotransformation -Is affected by the same variations affecting distribution in children -Immaturity of the kidneys until the age of 1 to 2 years affects renal blood flow, glomerular filtration, and active tubular secretion >Results in a longer half-life and increases the potential for toxicity of drugs primarily excreted by the kidneys

Red Flags Indicating Poor Literacy Skills

Difficulty filling out forms Frequently missed appointments Noncompliance and lack of follow-up with treatment regimens History of medication errors Responses such as "I forgot my glasses" or "I'll read this when I get home" Inability to answer questions about treatment or medicines Avoiding asking questions for fear of looking stupid

Types of Vaccines

Diphtheria, tetanus, and pertussis (DTaP, TdaP) Haemophilus influenzae type B (Hib) Polio, measles, mumps, and rubella (IPV, MMR) Hepatitis A and B (HepA, HepB) Varicella (Var) Pneumococcal (PCV, PPSV) and influenza (IIV, LAIV) Rotavirus Human papillomavirus (HPV2, HPV4) Meningococcal

Educational opportunities mandated by law:

Early intervention from birth to age 2 and preschool for 3‐ to 5‐year‐olds IDEA (2004) - The Individuals with Disabilities Education Improvement Act of 2004. Mandates government-funded care coordination and special education for children up to 3 years of age. Local school system - IEP; Individualized education program - written plan designed to meet the preschool, primary, or secondary school student's individual needs.

Guidelines for Organ Donation

Discussion is separate from impending death or brain death notification Written consent is necessary All expenses are borne by recipient's family State that the child's appearance will not be marred Donating child will not suffer Family culture and spiritual beliefs must be considered

Protest

Displays crying, agitation, rejection of others, anger, inconsolable grief

*Subcutaneous (SQ) administration

Distributes medication into the fatty layers of the body Used for insulin administration, heparin, and certain immunizations

*Restraint Policy

Document reason for the restraint in record based upon child assessment parameters Use of at least one alternative method for restriction before using a restraint Use of the least restrictive type of restraint for the purpose Need for a written order by a licensed independent practitioner (LIP) within 1 hour of application of the restraint Need for face-to-face evaluation by LIP within 15 minutes of application of the restraint; then hourly Attach to crib or bed frame - not side rails Remove every 2 hours for ROM and bathroom opportunities Review reasons for restraints and effectiveness

Types of Screening -Selective screening

Done when a risk assessment indicates the child has one or more risk factors for a disorder

Factors Affecting the Choice of Pharmacologic Interventions for Pain

Drug being administered The child's status The type, intensity, and location of the pain Any factors that may be influencing the child's pain

Promoting Home Care for the Technology-Dependent Child

Early discharge planning Direct care and care coordination for the child at home Identify potential problems in home environment In addition for the former premature infant Provide ongoing follow-up Routine well-child care Assess growth and development based upon calculated age

Resources for the Child With Special Needs

Educational opportunities - page 341; the law guarantees that eligible children will obtain access to services that will enhance their development. Financial resources - pg 342 - SSI - is a cash assistance program with monthly benefits. SSI qualifies the child for Medicaid - these benefits vary depending on the state of residence. *Respite care - pg 342 - provides an opportunity for families to take a break from the daily intensive care giving responsibilities *Complementary therapies - pg 342 - adjunct therapies

Enhanced Communication - page 209

Effective communication with children and their parents is critical to providing *atraumatic quality nursing care. Enhances good outcomes Provides for a satisfaction with nursing care We as nurses are in an ideal position to improve communication in the health care environment As a pediatric nurse, or a nurse caring for a pediatric patient (two completely different fields of nursing) - we have an obligation to listen, hear, and to feel the voices of the children in our care. They want to be respected, listened to and understood. Remember communication is not only a two way street - it has many ways to be communicated: verbal and non-verbal.

Minimize physical distress during procedures

Engage the child in identifying what would make him or her comfortable Use positions that are comfortable to the child *Therapeutic hugging Use distraction methods (music, conversation)

Parental education

Engages parents as active participants in health care team

Specific Learning Principles Related to Children

Establishing rapport with the child is the first step The age and developmental level of the child will determine the amount, format, and timing of the information given Create a teaching plan that addresses the developmental stage of the child Adolescents are particularly sensitive about maintaining body image and feelings of control and autonomy

Is the following statement true or false? The nurse crushing a tablet to administer it to a child should mix the medication with the child's formula.

False. The nurse crushing a tablet to administer it to a child should not mix the medication with the child's formula. Rationale: The crushed tablet or inside of a capsule may taste bitter, so it should never be mixed with formula or other essential foods. Otherwise, the child may associate the bitter taste with the food and later refuse to eat it. It could be mixed with a small amount of apple sauce or other nonessential food.

Is the following statement true or false? The nurse accurately explains to a child's parents that the point at which a person feels the highest intensity of a painful stimulus is termed the pain threshold.

False. The point at which a person feels the lowest intensity of a painful stimulus is termed the pain threshold. Rationale: In addition to sending a message to the cerebral cortex, the thalamus also sends a message to the limbic system, where the sensation is interpreted emotionally, and to the brain stem centers, where autonomic nervous system responses begin.

working with an interpreter

Express the information in two or three different ways if needed. Use metaphors to illustrate points Use a trained interpreter to help ensure the family can read and understand translated written materials Avoid side conversations during sessions Remember that just because someone speaks another language, it doesn't mean he or she will be a good interpreter Do not use children as interpreters

Pediatric Pain Assessment Tools

FACES pain rating scale Oucher pain rating scale Poker chip tool Word-graphic rating scale Visual analog and numeric scales Adolescent pediatric pain tool

Indicators of Pain in Infants -Behavioral

Facial expressions (most common), body movements, crying, increased irritability, refusal to move injured body part, interrupted sleep

T/F Hepatitis B, MMR, Varicella and Hib vaccines are all administered via the subcutaneous route

False -hep B is IM

Is the following statement true or false? The nurse is preparing a child with varicella for admission to an isolation room. This child will be at risk for sensory overload.

False. A child in an isolation room will be at risk for sensory deprivation. Rationale: Children in this setting may experience sensory deprivation due to the limited contact with others and the use of personal protective equipment such as gloves, masks, and gowns.

Is the following statement true or false? The nurse observes that a hospitalized 5-year-old child shows signs of distress when her mother leaves to get a cup of coffee. This change in the child's behavioral state is known as regression.

False. The child showing signs of distress when her mother leaves to get a cup of coffee is experiencing the condition known as separation anxiety. Rationale: Separation of children from their homes, families, friends, and what is familiar to them may result in separation anxiety. Regression refers to a return to a previous stage of development due to anxiety.

Is the following statement true or false? The nurse initiates transition planning for adulthood when the patient reaches 21.

False. Transition planning is complex and requires education for the parent and child and coordination of services long before the age of majority (18 years of age in most states). Rationale: Both parents and adolescent patient need education about how to obtain resources and services when the adolescence transitions to adulthood. Families often establish long-term relationships with providers and may find transitioning to another provider stressful. Comprehensive planning can often reduce these stressors.

Discharge Instruction Information

Follow-up appointment information Guidelines for when to contact physician or nurse practitioner Dietary recommendations/restrictions Activity level allowed and specify time intervals for any restrictions Medications including any common over-the-counter meds Additional treatments the child requires at home or school Specific dates for the child to return to school or day care Referral information

*IV therapy

Gather equipment before approaching child Select room other than patient's room for procedure Select hand rather than wrist or upper arm veins Ensure adequate pain relief Allow anesthetic-prepared site to dry Prepare the site using aseptic techniques using terms the child can understand Use a barrier to avoid pinching the skin If needed, use a device to transilluminate the vein. Make only two attempts to gain access. Seek additional help if unsuccessful Encourage parental participation to hold and comfort child Coordinate care with other departments Secure line with minimal amount of tape Protect the site from accidental bumping Assess the insertion site at regular intervals IV maintenance fluid calculation Preventing complications Infiltration Inflammation Discontinuing the IV device - page 371 review

Roles of the Nurse

General Inpatient Unit Emergency Departments Pediatric Intensive care units Rehabilitation Units/Facilities Outpatient facilities Physician's Office or Clinic, Health Departments, and Urgent Care Centers Medically Fragile Day care centers Schools - box 11.1, page 302 Home Health Care Other community settings Nurses provide well care, episodic ill care, and chronic care

Providing Basic Care for the Hospitalized Child

General hygiene measures Bathing - never leave a child alone in a bathtub. Use gentle, pH-balanced soap with moisturizer. A good time for assessment - especially for skin alterations Hair care - based on the child's condition Multiple products available Be aware of cultural differences General hygiene measures - continue Oral hygiene - part of basic care; wipe infants gums with wet cloth; assist children in brushing and flossing; soft toothbrushes after each meal Nutritional care - relieve pain and nausea before meals are served Importance of Play Types of play Unstructured play, part of nursing care and therapeutic play.

Types of Admissions

General or specialty inpatient unit Direct admission to surgery Psychiatric inpatient unit Emergency and urgent care department Pediatric intensive care unit Outpatient or special procedures unit Rehabilitation unit or hospital

*Recombinant vaccines

Genetically engineered organism Examples: Hepatitis B

Health Literacy

Is the ability to obtain, read, process, understand, and use health care information to make appropriate health care decisions It's more than ability to read, they must analyze it, make decisions based on what they know, and relate it back to their family. Low health literacy affects people of all ages, races, and educational/income levels.

Therapeutic communication

Goal directed Focused and purposeful

Home Health Care -goal -focus

Goal: Promoting, restoring, and maintaining the health of the child Focus: Minimizing the effects of the illness or disability and providing the child or family with the means to care for the illness or disability at home

*Complementary Therapies Used by Families With Special Needs Children

Homeopathic and herbal medicine Pet therapy *Hippotherapy - use of equine movement - purposeful movement of the horse, with child as a rider. Music - induce positive behavioral changes, reduce pain or stress, or various other positive effects. Massage - Used to reduce pain, promote relaxation, or demonstrate a specific positive effect related to the child's particular medical condition Culture-specific therapies

*Distraction Methods - Box 8.2, pg 205

Have the child point toes inward and wiggle them Ask the child to squeeze your hand Encourage the child to count aloud Sing a song and have the child sing along Point out the pictures on the ceiling Have the child blow bubbles Play music appealing to the child

Issues Covered in Psychosocial Assessments

Health insurance coverage Transportation to health care facilities Financial stressors Family coping (parents, siblings, extended family) School's response to the child with a chronic illness

Stressors of Daily Life for Families of Children With Special Needs

Housing situation may change Technical care incorporated into daily life May be affected: Sleep Carrying out basic activities of living Family identity Employment Caregiver health Holiday's and vacations Siblings may feel neglected and act out

Child education

Helps child understand the reason for the hospitalization/procedures in developmentally appropriate ways

___ percentage of body water than adults (amount of water relative to the amount of body fat)

Higher

Pain in pediatric patients

Highly individualized Defined as "an unpleasant sensory and emotional experience that is associated with actual or potential tissue damage or described in terms of such damage" Assessing pain in children can sometimes be difficult If left unmanaged, pain in children can lead to serious physical and emotional consequences.

Health Supervision Visit

History and physical assessment Developmental/behavioral assessment Sensory screening (vision and hearing) Appropriate at-risk screening Immunizations Health promotion

Goals of Child and Family Education

Improve the child and family's health literacy Encourage communication with physicians or nurse practitioners Improve health outcomes and promote healthy lifestyles Encourage involvement of child and family in care and decision making about care Improve compliance with care and treatment plan Promote a sense of autonomy and control

Early Hearing Risk Assessment

In the preverbal child (newborns and older): Auditory skill monitoring by assessing reaction to sounds—does the child react to parent voice or loud noise appropriately? Developmental surveillance—does the child try to vocalize? Parental concerns—do the parents have concerns about the child hearing? Any changes in hearing?

Causes of Failure to Thrive

Inability to suck and/or swallow correctly Malabsorption Inadequate preparation of food Diarrhea Vomiting Alterations in metabolism or caloric/nutrient needs associated with chronic illness Disrupted relationship with maternal figure

Types of Screening -Risk assessment

Includes objective and subjective data to determine the likelihood that the child will develop a condition

Pain Management Guide for Children

Individualize interventions based on the amount of pain experienced and the child's characteristics, such as developmental level, temperament, previous pain experience, and coping strategies Use nonpharmacologic and pharmacologic approaches to ease or eliminate the pain

*Transition Times in Care of Special Needs Child

Initial diagnosis or change in prognosis Increased symptoms When the child moves to a new setting (hospital, school) During a parent's absence During periods of developmental change Arrival of new family members

FTT

Inorganic causes of FTT include neglect, abuse, behavioral problems, lack of appropriate maternal interaction, poor feeding techniques, lack of parental knowledge, or parental mental illness. A baby that does not make eye contact and is less active than the other infants would display body language that should show the nurse that this child is a FTT child. Feedings are prescribed usually at 120kcal/kg/day vs. the normal 80 kcal/kg/day Have parents perform a detailed dietary dairy history for 3-days

Steps of the Admission Process

Introduce self and smile; explain the different roles of the nurse Let the child and family know what will happen and what is expected of them Communicate at age-appropriate levels Orient child and family to hospital unit Allow time for questions or concerns Perform nursing interview and admission assessment

Phases of Nursing Care for Hospitalized Children

Introduction Building a trusting relationship Decision-making phase Providing comfort and reassurance All phases are interconnected!

LEARN Framework

L: Listen empathetically and with understanding to the family's perception of the situation. E: Explain your perception of the situation. A: Acknowledge and discuss the similarities as well as differences between the two perceptions. R: Recommend interventions. N: Negotiate and agree on the interventions.

Iron-deficiency anemia

Leading nutritional deficiency in the US Cognitive and motor deficits = developmental delays and behavioral disturbances

Orders Related to End-of-Life Care

Limitations of Care: Parents and patients (when able) may specify their wishes for care at the end-of-life "Do not resuscitate (DNR)" Withhold cardiopulmonary resuscitation if child's heart stops beating May have special limitations as part of order (oxygen and comfort care but no compressions) "Allow Natural Death (AND): In some institutions DNR is being replaced by AND "allow natural death"

Forms of Oral Medications

Liquids Elixirs Syrups Suspensions Powders Tablets Capsules

Focus of Palliative Care

Managing pain and discomfort Providing nutrition Providing emotional support to the *dying child and family Assisting the family through the grief process

Impact on the Family

May experience: Multitude of emotions and life changes Overwhelm Burdened with care Fear, anger, sadness, guilt, frustration, or resentment Financial burdens Altered family activities Siblings may feel cheated of parental time and affection

Impact on the Child: delayed development -infant

May fail to develop a sense of trust and bonding

Impact on the Child: delayed development -School-age child

May have difficulty achieving industry

Impact on the Child: delayed development -Preschooler

May have difficulty achieving sense of initiative

Impact on the Child: delayed development -Toddler

May have difficulty developing autonomy

Impact on the Child: delayed development -Adolescent

May have difficulty forming a sense of self-identity relative to peers

Guidelines to Determine BSA

Measure the child's height Determine the child's weight Using the nomogram, draw a line to connect the height measurement in the left column and the weight measurement in the right column Determine the point where this line intersects the line in the surface area column. This is the BSA, expressed in meters squared (m2)

Required Interventions When a Child Is Receiving Moderate (Conscious) Sedation

Moderate sedation is a medically controlled state of depressed consciousness Ensuring that emergency equipment is readily available Maintaining a patent airway Monitoring the child's level of consciousness and responsiveness Assessing the child's vital signs (especially pulse rate, heart rate, *blood pressure, and respiratory rate) Monitoring oxygen saturation levels

Pain Transmission in the Nervous System -Modulation

Neuromodulators modulate the pain sensation Naturally occurring examples include serotonin, endorphins, enkephalins, and dynorphins Pharmacologic treatments can interrupt or modulate the perception of pain Pain sensation can be modified peripherally (at the site) or centrally (in the brain)

*Measures to Reduce Complications With TPN

Monitor the child's vital signs closely for changes. Adhere to strict aseptic technique; monitor insertion site. Ensure that the system remains a closed system at all times. Use occlusive dressings; monitor insertion site at dressing change. Adhere to agency policy for flushing of the catheter and maintaining catheter patency. Assess intake and output frequently. Monitor blood glucose levels and obtain laboratory tests as ordered to evaluate for changes in fluid and electrolytes.

Future based

Most health promotion and disease prevention in the US have a future based orientation View the child as an active and controlling agent in the own health.

*Pharmacokinetics

Movement of drugs over time throughout the body via absorption, distribution, metabolism, and excretion Affected by the child's age, weight, body surface area, body composition, and diseases affecting related organs (liver, kidney), i.e. immature body system

*Combination vaccines

Multiple of these - most notable is: Influenza Vaccine Three types: inactive (IIV); recombinant (RIV) and live attenuated (LAIV) These vaccines are officered as trivalent or quadrivalent depending on the number of virus strains we are trying to vaccinate against. LAIV is given intranasally and not given to anyone immunocompromised. Contraindicated in children 2-4 years diagnosed with asthma Quadrivalent is offered to those over 65 and considered "high dose"

Pain Transmission in the Nervous System -Perception

Nerve fibers divide in the dorsal horn of the spinal cord, cross to the opposite side, and rise upward to the thalamus Thalamus quickly sends a message to somatosensory cortex of the brain where impulse is interpreted as pain A-delta fibers lead to sharp, stabbing, local pain C fibers lead to diffuse, dull, burning or aching pain Pain threshold is the point where a person feels the lowest intensity of painful stimulus Remember, pain is what the patient says it is

Myths and Misconceptions About Children and Pain

Newborns don't feel pain Exposure to pain at an early age has little or no effect later Infants and small children have little memory of pain Intensity of the child's reaction to pain indicates intensity of pain A child who is sleeping or playing is not in pain Children are truthful when asked if they are in pain Children learn to adapt to pain and painful procedures Children experience more adverse effects of narcotic analgesics than adults do Children are more prone to addiction to narcotic analgesics Not true!

*Vision

Newborns with ocular structural abnormalities are at a high risk for vision impairment. Vision screening should be done at all scheduled health visits The "tumbling E" chart is appropriate for 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. The Snellen eye chart may be used for children age 6 or older who know the alphabet. Make the chart at child's eye level Make sure there is sufficient lighting Place a mark on the floor approximately 10-20 feet from the chart - depending on what tool is used Align the child's heels on the mark Have the child read each line with one eye covered and then with other eye covered Have the child read with both eyes

Pain Transmission in the Nervous System -Transduction

Nociceptors (specialized nerve cell endings) are activated when exposed to noxious stimuli Mechanical, chemical, or thermal

Biophysical Interventions for Pain Management

Nonnutritive sucking with sucrose (infants or toddlers) Heat and cold applications Massage and pressure

Medications Used for Pain Management -Analgesics

Nonopioid and opioids

Hypertension -what is the #1 factor?

Obesity is number one factor

Role of the Community-Based Nurse

Physical care - more autonomous role Education and communication Discharge planning and case management Advocacy and resource management

Later Hearing Risk Assessment

Older than 4 years old Assessment of parental concerns Difficulty hearing on the telephone Difficulty hearing people in a noisy background Frequent asking of others to repeat themselves Turning the television up too loudly

*Developmental Surveillance and Screening

Ongoing collection of skilled observations made over time -Noting and addressing parental concerns -Obtaining a developmental history -Making accurate observations -Consulting with relevant professionals Are brief assessment that identify children who warrant more attention Development is a longitudinal process

Topics for Anticipatory Guidance

Promoting oral health care - most common chronic illness Promoting healthy weight - a growing problem Promoting healthy activity Promoting personal hygiene - handwashing! Promoting safe sun exposure - teaching guidelines 9.3, pg 251

Medications Used for Pain Management -Preferred routes

Oral, rectal, intravenous, topical, or local nerve block routes Epidural administration and moderate sedation also can be used

Present based care

Other cultures are more concerned about what is happening now Health promotion activities are more short term wigh goals and out comes more useful

*Barriers to Immunizations

Parental concerns about vaccine safety and side effects Vaccines do not work My child is not at risk Natural immunity is better More than one physician More children in the family, the less likely to be immunized - "forgets"

Factors Influencing Family's Reaction to Illness/Hospitalization

Parenting style: authoritarian, authoritative, permissive and neglecting Quality of family-child relationship Family members' coping skills and available support system Cultural, ethnic, and religious variations Values and practices related to illness General response to stress Attitudes about the care of a sick child

*Nursing Care of the Child With an Enteral Tube

Placement must be confirmed prior to adding anything Nonradiologic methods to check include (if not high risk for aspiration): -Checking color and pH of aspirate -Checking external markings on the tube and verifying external tube length Always assessing for signs indicative of feeding tube misplacement -Unexplained gagging, vomiting, or coughing -Signs and symptoms of respiratory distress Be aware of developmental needs that may be inhibited by tube feedings

Inhaled

Powders Aerosols

Resources and Services Needed

Prescription medication or durable medical equipment Medical care (including transportation to care) Mental health and education services Physical, occupational, or speech therapy Treatment for emotional, developmental, or behavioral problems Financial assistance Family support

Risk Factors for Vulnerable Child Syndrome

Preterm birth Congenital anomaly Newborn jaundice Handicapping condition An accident or illness that the child was not expected to recover from Crying or feeding problems in the first 5 years of life

Principles of Atraumatic Care

Prevent or minimize physical stressors, including pain, discomfort, immobility, sleep deprivation, inability to eat or drink, and changes in elimination Prevent or minimize parent-child separation Promote family-centered care, treating the family as the patient Promote a sense of control

Settings for Health Supervision - where are they?

Private physician offices Freestanding clinics in retail stores Community health department clinics Nonprofit community-based clinics with sliding scale payments Daycare centers Schools

Passive immunity

Produced when the immunoglobulins of one person are transferred to another

School work

Promote schoolwork while the child is in the hospital. This connection to the child's school helps maintain normalcy for the child and minimizes the disruption of everyday life

Nurse's Role in Managing Chronic Pain

Similar to that for the child experiencing acute pain or procedure-related pain Assessment of the child's pain is key Onset, duration, intensity, and location of pain Alleviating or exacerbating factors Impact on child's daily life Effect on child and family's stress level Methods used to alleviate pain (including home remedies or alternative therapies) Physical examination Multiple nonpharmacologic and pharmacologic strategies combined to provide pain relief

Nursing Management of the *Dying Child

Provide pain medication around the clock rather than on an "as needed" basis to prevent recurrence or escalation of pain. Change the child's position frequently but gently to minimize discomfort Nurses must work through their own feelings about *dying to stay fully present with the child and family. Be still and silent for a time to really listen to the child and family

*Role of Child Life Specialists in Atraumatic Care

Provide programs to prepare children for hospitalization and painful procedures Provide support during medical procedures *Therapeutic play and activities to support normal growth and development Educate child and family about health conditions Teach and support coping and pain management strategies Sibling support; advocacy for the child and family Grief and bereavement support

Educating and preventing medication errors -Educating the child and parents

Provide thorough instruction, including frequency of administration,when the next dose is due, and length of time the medication is to be given. Stress the importance of completing the prescribed dose Provide tips for medication administration

Characteristics of a *Medical Home - box 9.1, pg 223

Provider has a long-term, trusting and comprehensive relationship with patient and family from infancy through adolescence Family-centered care; providers are respectful of family's customs and beliefs Care is accessible, affordable, and comprehensive Delivery of specialty care is coordinated in the medical home Provider is accessible for and responsive to questions

Therapeutic play

Provides emotional outlet or coping devices

Preparation for surgery or hospitalization

Provides reassurance and comfort to the child and allows him or her to know what will happen and what is expected of him Must be geared to the child's age and developmental level

Principles of Health Supervision

Providing services proactively Optimizing child's level of functioning Ensuring child is growing and developing appropriately Promoting best possible health of child Preventing injury and illness through child teaching Providing care developed from the national guidelines

*Key Principles of Pain Assessment (*QUESTT)

Question the child Use a reliable and valid pain scale Evaluate the child's behavior and physiologic changes to establish a baseline and determine the effectiveness of the intervention Secure the parent's involvement Take the cause of pain into account when intervening Take action

Behavioral-Cognitive Pain Management Strategies

Relaxation Distraction Imagery Biofeedback Thought stopping Positive self-talk

Palliative Care Principles

Respect for the child's goals, preferences, and choices Acknowledgment and addressing of caregiver's concerns Provision of a comprehensive, interdisciplinary continuum of care in the community Competent and ethical care Goal is to provide the best quality of life possible at the end of life while alleviating physical, psychological, emotional and spiritual suffering.

*Conjugate vaccines

Result of chemically linking the bacterial cell wall polysaccharide with proteins. Increases the immune response. Examples: Haemophilus influenzae B (Hib) Meningococcal Vaccine Disease can cause meningitis, epiglottitis and septic arthritis

Rights of Pediatric Medication

Right medication Right patient Right time Right route of administration Right dose Right Approach - why is this important in pediatrics? Right documentation, Right to be educated, Right to refuse, Right form

Types of Screening -Universal screening

Screening of an entire population regardless of the child's individual risk

Teaching Adolescents

Sensitive to maintaining body image Feelings of control and autonomy

advantages of home health care

Shorter hospital stays with decreased overall health care costs. Psychological comfort for child and family to have care delivered in a familiar setting. Potential for decreased stress on the family.

Techniques to Improve Learning - Table 8.4, page 216

Slow down and repeat information often Speak in conversational style using plain language; consider using metaphors to illustrate complex points "Chunk" information and teach in small bites Prioritize information and teach "survival skills" first Use visuals Teach using an interactive, "hands‐on" approach Teach using demonstration , return demonstration, and teach back, tell back

Specific Types of Screenings Performed -Metabolic

State law determines which metabolic screening tests are mandatory in that state March of Dimes would like to see all states provide newborn screenings for 34 health conditions.

Pain Transmission in the Nervous System -Transmission

Stimuli are converted to electrical impulses and relayed to spinal cord and brain by afferent nerve fibers and unmyelinated small C fibers Neurotransmitters facilitate transmission process to the brain

Rectal

Suppositories - not preferred route due to erratic absorption/invasive

Evaluating Learning

The child or family demonstrates a skill The child or family repeats back or teaches back the information in own words The child or family answers open-ended questions The child or family responds to a pretend scenario in their home

Assessing Growth and Development

The corrected or adjusted age should be used for evaluating progression in growth as well as development. A 6-month old infant was born at 28 weeks' gestation (12 weeks or 3 months early), his growth and development expectations are those of a 3 month old (corrected age) Continue to use "corrected or adjusted age" until the child is 3 years old.

Documentation of Child and Family Teaching

The learning needs assessment Information on the child's medical condition and plan of care Goals of child education; date goal is met Teaching method used and how received by child and family Medications, including drug-drug and drug-food interactions Modified diets and nutritional needs Safe use of medical equipment Follow-up care and community resources discussed

Medically Fragile

The medically fragile child (child with medical complexity) - a child with substantial health care needs, one or more chronic conditions, functional limitations - technology assistance and health care use.

*Factors Affecting the Choice of Equipment for IV Therapy

The type of solution or medication to be administered The duration of the therapy The age and developmental level of the child The child's status The condition of the child's veins Rule of thumb: select the smallest gauge for the shortest length of time necessary to minimize trauma to the veins

Using Age-Appropriate Language to Assess Pain in Older Children

Toddlers are likely to understand words such as "owie" or "boo-boo" Preschoolers may need to be coaxed to discuss their pain as they feel it is something to be expected; may withdraw or hide School-age children can usually report type, location, and severity because of their well-developed language skills Teens concern about body image and fear of losing control may result in denying pain or refusing medication

Is the following statement true or false? The nurse assessing pain in children is correct in stating that the school-age child is usually able to communicate the type, location, and severity of pain.

True. The school-age child is usually able to communicate the type, location, and severity of pain. Rationale: Children older than the age of 8 years can use specific words, such as sharp as a knife, burning, or pulling, to describe their pain. However, they may deny pain in an attempt to appear brave or to avoid further pain related to a procedure or intervention. Please review Table 14.1, page 390

Factors Affecting Children's Responses to Pain

Type of pain Extent of pain Age/developmental level Cultural/family norms surrounding expression of pain

Teaching School age Children:

Unless extremely ill - they want to participate in their care Need to cooperate and achieve (Industry vs. shame) Teach together with the parents

Pain Management Guide for Children

Use nonpharmacologic and pharmacologic approaches to ease or eliminate the pain Teach the child and family about pain-relief interventions and techniques and discuss with the child and family expectations of pain management

Verbal Communication Page 210

Use open-ended questions that do not restrict the child's or the parents' answers Redirect the conversation to maintain focus Use reflection to clarify Paraphrase the child's or parent's feelings to demonstrate empathy Acknowledge emotions Active listening Don't use big "fancy" words to make you look "all knowing"

Nurse's Role in Managing Procedure-Related Pain

Use topical anesthetic at site of a skin or vessel puncture Use nonpharmacologic strategies for pain relief Prepare child/family ahead of time about the procedure Use therapeutic hugging to secure the child Use the smallest-gauge needle possible Use intermittent infusion device or PICC for multiple samples Opt for venipuncture in newborns instead of heel sticks if large amount needed Use kangaroo care for newborns before and after heel stick Provide nonnutritive sucking before the procedure

*Providing Atraumatic Care When Administering Medications

Using comforting positions Encourage child to participate in care Give child developmentally appropriate options Using topical anesthetic prior to injections

Guidelines for Administering Medications via Gastrostomy or Jejunostomy Tubes

Verify placement of tube - how is that done Give liquid medications directly via syringe along with small amount of air Mix powdered medication with warm water; crush pills as finely as possible and mix with water prior to adding to tube Open up capsules and mix with water to dissolve contents Flush tube with water after administering medications

Determining Pediatric Doses by Body Weight

Weigh the child If the child's weight is in pounds, convert it to kilograms (divide the child's weight in pounds by 2.2) Check a drug reference for the safe dose range (e.g., 10 to 20 mg/kg of body weight) Calculate the low safe dose Calculate the high safe dose Determine if the dose ordered is within this range

Questions Appropriate to Ask When Performing a Cultural Assessment

Who is the person caring for the child at home? Who is the authority figure in the family? What is the social support structure? Are there any special dietary needs and concerns? Are any traditional health practices used? Are any special clothes or other items used to help maintain health? What religious beliefs, ceremonies, and spiritual practices are important on a daily basis or as they relate to health?

Developmentally Appropriate Explanations for Medications for Children

Why the drug is needed What the child will experience What is expected of the child How the parents can participate and support their child

Pain is what _____

a child says it is - a perception

The nurse is aware that the community affects the health of its members. Which statements accurately reflect a community influence of health care? Select all that apply. A)A community can be a contributor to a child's health or be the cause of his or her illnesses. B)The child's health should be separated from the health of the surrounding community. C)Community support and resources are necessary for children with significant problems. D)Poverty has not been linked to an increase in health problems in communities. E)The breakdown of community and family support systems can lead to depression and violence. F)Ideally, the child's medical home is located outside the community.

a, c, e ?

The nurse is administering amoxicillin orally to an infant with a bacterial infection. Which of the following physical factors might affect the absorption of this medication? a. Slower gastric emptying b. Vasomotor instability c. Decreased perfusion d. Lower percentage of body water

a. Slower gastric emptying. -Slower gastric emptying might affect the absorption of amoxicillin. Rationale: Slower gastric emptying might affect the absorption of amoxicillin since it is being given orally. Vasomotor instability might affect intramuscular absorption of medication but unlikely with an oral solution. Decreased perfusion alters subcutaneous administration of medication and may decrease absorption. Infants have a higher percentage of body water (body water/body weight) than adults.

__________ ___________is acquired when a person's own immune system generates the immune response.

active immunity

Factors Affecting Absorption of Medications in Children versus Adults -Subcutaneous absorption

any decreased perfusion = decreased absorption

In which of the following phases of hospital care would the nurse seek to learn about the child's favorite toys in order to establish rapport? a. Introduction b. Building a trusting relationship c. Decision-making phase d. Providing comfort and reassurance

b. Building a trusting relationship. The nurse would learn about the child's favorite toys to understand the toys' significance to the child as a way to establish rapport. This helps to build a trusting relationship between the nurse and the child. Rationale: The initial phase involves collecting information to form the basis of the trusting relationship. The decision-making phase involves allowing the children to help make decisions about their health care plan. Providing comfort and reassurance refers to using techniques to reinforce the trusting relationship, such as praising the child.

Developmental level -Preschoolers

better verbal and developmental skills; interpret words literally and have an active imagination; egocentric

The nurse is caring for a school-age child with cerebral palsy. Which of the following developmental tasks, appropriate for this age, may be delayed? a. Attachment to family b. Sense of independence c. Achieving industry d. Forming a sense of identity

c. Achieving industry. This developmental task may be delayed if the child cannot participate in school activities. Rationale: Extended hospitalization can disrupt developmental milestones. Developing a sense of attachment to family may be delayed in an infant. Developing a sense of independence may be delayed in the toddler, and having a sense of individual self in relation to peers may be delayed in the adolescent.

The numbers of children with ____ ____ are increasing.

chronic illness (a long-lasting or recurrent illness)

Health is defined by the influence of the _____.

culture

The safe dose of a medication is 10 to 20 mg/kg. What would the nurse calculate as the low safe dose for a child who weighs 40 kg? a. 100 mg b. 200 mg c. 300 mg d. 400 mg

d. 400 mg. 400 mg is the low safe dose for a child who weighs 40 kg if the safe dose of a medication is 10 to 20 mg/kg. Rationale: to calculate the low safe dose use the following proportion: 10 mg/1 kg = x mg/40 kg Solve for x by cross-multiplying 1 × x = 10 × 40 x = 400 mg

The nurse is assessing the pain of a 3-year-old child. Which of the following pain assessment scales would be most appropriate? a. Visual analog scale b. Visual numeric scale c. Word-graphic rating scale d. FACES pain rating scale

d. FACES pain rating scale. The FACES pain rating scale would be most appropriate for a 3-year-old. Rationale: The FACES pain rating scale is a self-report tool that can be used by children as young as 3 or 4 years of age. The word-graphic rating scale is useful for children between 4 and 17 years old. The visual analog scale can be used with children 7 years or older. The numeric scale can be used with children 8 years or older.

The nurse is providing atraumatic care to a child hospitalized for cardiac surgery. Which of the following is a recommended guideline when communicating with the child's parents? a. Do not cause undue stress by providing details of the surgery b. Direct the focus of the parent from providing routine care of the child to preparing for the surgery c. Direct the parents to the physician if they have questions about the surgery d. Treat the parents as equal partners in the care of their child by allowing them to perform as much care as possible

d. Treat the parents as equal partners in the care of their child by allowing them to perform as much care as possible

Factors Affecting Absorption of Medications in Children versus Adults -Intramuscular absorption

decreased due to smaller muscle mass, muscle tone; other individual factors are perfusion and vasomotor instability

Detachment

denial Uses coping mechanisms, displays resignation but not contentment, may have developmental delays

Developmental level -infants

dependent on others for all things; trust is developed when their needs are met

Is the following statement true or false? The nurse assessing the veins of a 5-month-old infant for peripheral IV therapy correctly chooses the baby's foot.

false -foot is last option due to pain

Etiology -Neuropathic

due to malfunctioning of the peripheral or central nervous system; continuous or intermittent - burning, tingling, shooting, squeezing or spasm-like pain

Is the following statement true or false? The nurse preparing discharge teaching for the parents of a hospitalized child should base this teaching on the fact that adults are present focused and do not value past experiences.

false Adults value independence and want to learn on their own. Adults learn best when they perceive there is a gap in their knowledge base an want information and skills to fill the gap. Adults bring an accumulated wealth of experience to each health care encounter; this provides a rich base for new learning.

t/f Universal screening is performed when a risk assessment indicates there is one or more risk factors present.

false, selective screening

Is the following statement true or false? The nurse is providing atraumatic care to a child who is undergoing surgery and the child's family. The focus of this type of care is solely on meeting the physical needs of the child.

false

Developmental level -Adolescents

fear injury and pain; loss of control is a key factor; anger withdrawal, or general lack of cooperation may occur

Developmental level -School-Age

generally hospitalized because of long-term illnesses or trauma; more realistic understanding for reason for illness;

Duration -Chronic

great than 6 months; past the expected point of healing for tissue damage; continuous or intermittent with periods of exacerbation or remission. Interferes with life.

Atraumatic care defined as

therapeutic care that minimizes or eliminates the psychological and physical distress experience by children and their families in the health care system. Concept is based on the underlying premise of "do no harm"

Vulnerable child syndrome definition

is a clinical state in which the parent's reactions to a serious illness or event in the child's past continue to have long-term psychologically harmful effects on the child and parents for many years.

Factors Affecting Absorption of Medications in Children versus Adults -Topical absorption of medications

increased due to greater body surface area and greater permeability of infant's skin

Developmental level -Toddlers

mastering accomplishments; shame vs. doubt; resurgence in separation anxiety

Source/location -Visceral

pain that develops within organs such as the heart, lungs, gastrointestinal tract, pancreas, liver, gallbladder, kidneys or bladder. Often product of disease; deep ache, or sharp stabbing sensation; referred pain

Three Stages of Separation Anxiety - pg 305

protest despair detachment

~*scenario used in class*~ A child does not want to take pain meds for burn debridement what do you do?

provide distraction -play music -put on tv

More ___ extracellular fluid exchange

rapid

Duration -acute

rapid onset of varying intensity; tissue damage resolves with healing

Etiology -Nociceptive

reflects pain due to noxious stimuli that damages normal tissue or may do so if pain is prolonged; nervous system is intact

Factors Affecting Absorption of Medications in Children versus Adults -Oral medications

slower gastric emptying increased intestinal motility -a proportionately larger small intestine surface area higher gastric pH decreased lipase and amylase secretion compared with adults

Source/location -Somatic

superficial; develops in the tissue; can be deep as well. Localized and described as sharp, pricking, or burning sensation. Tenderness commonly is present Deep somatic pain - described as dull, aching, or cramping. Usually from a strain or overuse, maybe from direct injury and inflammation.

Teaching Preschool Children:

the nurse and the family assume all responsibility for what is learned, how it is learned and when it is learned. Begin with their developmental learning age Play out the parts Repeat what they say they know

Is the following statement true or false? The community can be a contributor to a child's health, or it can be the cause of his or her illnesses.

true

The focus of pediatric health supervision is on _____.

wellness -Visit provides the opportunity to maximize health promotion for the child. -Part of the continuum of care - not isolated tasks and check marks

Otic administration for: -younger than three yo? -older than three yo?

younger than 3 yo = down and back older than 3 yo = pull up and out for

*Hepatitis B vaccine

~recombinant vaccine -recommended at birth >1st: newborn >2nd: 12 hrs >3rd: 1-2 months >4th: 6-18 months (4 total) Hep B can result in serious infection that affects the liver -sexually transmitted -spreads through contact with blood and body fluids -spread from infected mother to newborn at birth

*Orogastric tubes

•inserted via the mouth into the stomach •Indication: -short-term external feeding, usually limited to young infants only •Nursing Implications: -long-term use or repeated insertion causes irritation and discomfort -silicone and polyurethane ver flexible and more comfortable; require a stylet or guide wire for insertion -length of long-term use varies according to the type of tube used and the institution protocol -maintaining orogastric pressure placement between feedings can be difficult due to oral secretions >instilling air into the tube and then auscultating for the sound is no longer considered a viable method for checking tube placement as it has consistently proven to be unreliable