Peds Exam 2 Study Guide
When does the secondary circular reactions stage occur during the sensorimotor phase of Piaget's Cognitive Development and what does it consist of?
4-8 months; Imitation, play, affect
Which developmental characteristic is an 8-month-old infant demonstrating if the child clings to the parent, cries, and turns away from a new babysitter?
stranger fear
Laryngotracheal foreign body aspiration signs
stridor, hoarseness, worsening= cyanosis
What characterizes oral allergy syndrome?
swelling and itching of lips, tongue, throat
Which condition would the nurse suspect when a 6-month old infant demonstrates increased drooling, finger sucking and biting on objects
teething
When does the coordination of secondary schema stage occur during the sensorimotor phase of Piaget's Cognitive Development and what does it consist of?
8-12 months; Beginning of intellectual reasoning
When are finger foods introduced?
9 months
What are the approximate caloric requirements for a preschool aged child?
90 kcal/kg
What is an expected fine motor skill for a 12 month old infant?
the ability to turn pages in a book
Which system maturation is associated with school-age children?
the heart grows more slowly and is smaller in relation to the rest of the body
Which developmental factor increases the risk for infection in infants and young children?
the relatively short and open eustachian tubes of young children give pathogens easy access to the middle ear
Which characteristic may be observed in latchkey children?
they feel more lonely or isolated
Which recommendation would the nurse make for the family of a 9-month old infant who is worried about a baby's thumb sucking?
thumb sucking should be discouraged when permanent teeth begin to erupt
Infant Development of Body Image
Concept of object permanence By end of first year child recognizes that he/she is distinct from parents Increased interest in image As motor skills develop, the child learns that the body is useful
Cognitive development of school-aged children according to Piaget
Concrete operations
Common fears in preschoolers
Dark Being left alone Animals (e.g., snakes, large dogs) Ghosts Objects or persons associated with pain (Technique of desensitization used to overcome fears)
What is Failure to Thrive?
Deceleration of growth in both height and weight Less than 5th percentile Crosses 2+ growth curve lines down on chart
What tool is used to assess speech problems
Denver Articulation Screening Examination (DASE)
What psychosocial stage are preschoolers in according to Erikson?
Developing a sense of initiative
Psychosocial development of school-aged children according to Erikson
Developing sense of industry (purpose)
Which response would the nurse provide the parents of a 6-month old infant who are concerned that their baby pushes the spoonful of baby food away whenever it is near the mouth?
Just keep offering the spoon to him even though he pushes it away
Rickettsialpox is caused by:
Rickettsia akari
Scabies is caused by what?
Sarcoptes scabiei
Cutaneous symptoms of a food allergy:
hives, red rash, flushing
Which type of dressing is appropriate when describing the application of an alginate dressing to a patient's wound?
hydrophilic
Psychosocial development of teens according to Erikson
identity development (group identity, individual identity, sex-role identity)
Which developmental finding in a 5 month old warrants further investigation by the nurse?
inability to hold the head erect and steady when sitting
Which Failure to Thrive (FTT) classification would the nurse use for a 1-month-old infant with FTT secondary to congenital heart disease?
increased metabolism
Why are upper respiratory tract infections, otitis media and tonsillitis more common in toddlers?
inner ear structures are short and straight tonsils are large
Which gross motor skill is developmentally appropriate for an 18-month old toddler?
jumps in place with both feet
Colic is most common in what age of infants?
less than 3 mo
Which clinical findings are suggestive of marasmus?
loose, wrinkled skin and generalized wasting of body tissues
What is a macromineral?
minerals with daily requirements greater than 100 mg (ex. calcium)
Kwashiorkor is of _________________ origin.
multifactorial
Which clinical manifestation would the nurse expect to note when a pneumothorax occurs in a neonate who is undergoing mechanical ventilation?
nasal flaring, retractions and grunting
Signs of immediate GI hypersensitivity to food:
nausea, cyclic vomiting, diarrhea, abdominal cramping
Which is considered the most common allergenic food?
nuts, eggs, milk, shellfish, fish, soy, wheat
Bronchial foreign body aspiration signs:
paroxysmal cough, wheezing, asymmetric breath sounds, decreased air entry
The nurse understands that which guidelines are followed for administering the tuberculin skin test?
periodic administration for children at high risk
Nasal foreign body aspiration signs:
persistent unilateral discharge
Which intervention lowers the risk for sudden infant death syndrome (SIDS)?
placing the infant in the supine position to sleep
What is an expected fine motor skill for an 8 to 9 month old infant?
crude pincer grasp
Which symptoms are associated with gingivitis in school-aged children?
deposition of plaque inflammation of gums
For which condition would the nurse evaluate when caring for a 12-month-old infant who is unable to pull up to a standing position?
developmental dysplasia of the hip
Anaphylaxis in infants
difficulty with inhalation, facial or throat swelling of any kind, urticaria, wheeze or noisy breathing, croupy cough, difficulty swallowing, excessive drool, dizziness
Which supply is appropriate when removing a tick embedded in the skin?
disinfectant, forceps, sterile needle
Which condition is associated with prolonged bottle feeding?
early childhood caries
Benefits of breast milk
excellent nutritional balance transfers immunologic defenses promotes GI motility/function lowers short and long term risk of some conditions for mother and baby
Which recommendation would the nurse provide the mother of an 8-month old infant who wishes to discontinue breastfeeding?
feed commercial iron-fortified formula
Which characteristic reflects the psychosocial development of school-age children?
feelings of inferiority may emerge if unable to assume responsibilities
Which secondary teeth usually erupt when the child is 6 years old?
first molar
Which recommendation would the nurse provide the parent of an infant experiencing teething pain?
give the child a cold teething ring to relieve inflammation
Obesity
greater than 95th percentile for BMI; larger amount of fatty tissue than lean muscle mass
In which way would the nurse describe growth during the first year of life?
growth is especially rapid during the first 6 months of the first year of life
Concerns related to normal growth and development of toddlers
Toilet training Sibling rivalry Temper tantrums Negativism Regressive behavior
Which clinical manifestation would the nurse expect when caring for a child with dyssomnias?
Trouble falling asleep at night
Potential contributing findings for ASD
Unusual body movements Atypical emotional regulation Reduced motor control
Which best describes the origin of a cow's milk allergy (CMA)?
a multifaceted disorder causing systemic and local reactions
Which type of diet do children with CF require?
a well-balanced, high protein, high calorie diet
Toddlers run by:
18 months
At what age do toddlers gain sphincter control for elimination?
18-24 months
Age range for young adults
18-25
Which nursing advice is appropriate for the parents of a child with cat scratch disease when discussing the timeframe it resolves?
4-6 weeks
Why is a humidified atmosphere recommended for a young child with an upper respiratory tract infection?
It is soothing to inflamed mucous membrane
Which vitamin supplement would the nurse recommend for all pregnant women to prevent neural tube defects in infants?
0.4 mg of folic acid
When does the primary circular reactions stage occur during the sensorimotor phase of Piaget's Cognitive Development?
1-4 months
Which location is appropriate when looking for evidence of nits when inspecting a child for head lice?
1/4 inch (6 mm) from the scalp
At what age would the nurse expect an infant to be able to say "mama" and "dada" with meaning?
10 months
At what age does puberty generally begin for boys and girls?
10 years for girls, 12 years for boys
What is the approximate fluid requirement for preschool aged children (dependent on activity and climate too)?
100ml/kg
Age range for teens
11 or 12 to 17 years
At what age does the second molars erupt in a school-aged child?
11-13 years
Bedtime resistance is common until about age _____.
12
Toddlers walk by:
12 months
What is prepubescence?
2 year period that precedes puberty
Toddlers can use two or three word phases by what age?
2 years
Toddlers climb stairs by:
2 years
Toddlers usually have a comprehension of 300 words by how old?
2 years
Behavioral signs or Autism or ASD can be detected in what year of life?
2nd
At what age do the primitive reflexes begin to fade?
3 months (fading starting at 5 months of age would be considered a delay)
Toddlers can use simple sentences and acquire 5-6 new words a day by what age?
3 years
The preschool period lasts from _____ to ______ years.
3-5
By age 12 months, infants should say....
3-5 words besides "mama" and "dada"
By which age does the moro reflex disappear in an infant?
4 months
At which age do children begin staring at their own mirror image?
5 months
Until which age is fetal hemoglobin (HgbF) still present in the body?
5 months
What is the age range of a "school-aged" child?
5-12 years (onset of puberty)
When does the posterior fontanel close?
6-8 weeks
Approximately how many kg would the nurse expect a 6-month old infant to weigh if the infant weighed 3.5 kg at birth?
7 kg
At what age is transferring objects from one hand to the other an expected fine motor skill?
7 months
Because the absorption of fat soluble vitamins is decreased in cystic fibrosis which vitamin supplementation is necessary?
A, D, E, K
What does treatment involve for FTT?
Address underlying cause High caloric density feedings Vitamin and mineral supplements Work with family/education
The nurse finds that a 2-month-old infant is not gaining weight despite receiving expressed breast milk. The mother works for 8 hours and expresses milk once during this time. Which recommendation would the nurse make to the mother?
Advise the mother to express milk at least every 3 to 4 hours (to maintain adequate milk supply)
Types of play in preschool aged children
Associative play Imitative play Imaginative play/playmates Dramatic play
At what age would the nurse expect an infant's anterior fontanel to close?
Between 12-18 mo (average of 14 mo)
When does the reflex stage occur during the sensorimotor phase of Piaget's Cognitive Development?
Birth-1 month
Principles of emergency treatment in cases of poisoning:
Call poison control center first before doing anything Assessment Gastric Decontamination (induce vomiting, absorb toxin, gastric lavage) Prevention of reoccurence
Rocky Mountain Spotted Fever
Caused by Rickettsia
Treatment for Lyme Disease?
Doxycycline
Health concerns of adolescents
Emotional well-being Intentional and unintentional injury Dietary habits, eating disorders and obesity Physical fitness Sexual behavior, STIs, and unintended pregnancy LGBT+ considerations Mental health and suicide School and learning problems Hypertension Hyperlipidemia Immunizations Body art Tanning Sleep deprivation and insomnia
Early stages of Lyme Disease (3-30 days)
Erythema migrans (specific rash from bite), fever, chills, headache, fatigue, muscle and joint aches, swollen lymph nodes
What is Colic?
Excessive crying (rule of 3s: 3 hours for 3 days for 3 weeks+) thought to be caused by abdominal pain
Which type of injury is common in 2-month old infants?
Falls, aspiration, suffocation, MVA
What are physical changes of school-aged children?
Fat distribution changes Increased muscle tissue
Psychosocial development highlights in preschoolers
Feelings of guilt, anxiety and fear may result from thoughts that differ from expected behavior Development of superego (conscience) Moral development (learning right from wrong)
Cognitive development of teens according to Piaget
Formal operations
Preschool age development of sexuality
Forms a strong attachment to the opposite-sex parent while identifying with the same-sex parent Becomes concerned with modesty Sex role limitation; "dressing up like Mommy or Daddy" Sexual exploration is more pronounced Questions arise about sexual reproduction
What conditions to assess for when an ALTE occurs?
GERD, arrhythmias, seizure disorder, sepsis, other infections
Fine motor development in infants
Grasping object at 2-3 months Palmar grasp at 6 months Transfer object between hands at 7 months Pincer grasp at 10 months Remove objects from container at 11 months Build tower of 2 blocks at 12 months
Growth and development of preschoolers
Growth slows and stabilizes Average weight gain remains about 5 pounds per year Average height increases 2.5-3 in per year Body systems mature and stabilize; can adjust to moderate stress and change Gross motor skills well established (walking, running, jumping, climbing) Readiness for school
Many methods to control hypothermia
HATS Appropriate clothing Bathing away from cold sources Covering exposed skin Holding, including kangaroo care Isolette
Gross motor development in infants
Head lag in first 2 months Head control at 4 months Rolling over (from abdomen to back) at 5-6 months Parachute reflex by seven months Sit alone by 7 months Move from prone to sitting position by 10 months
For which reason is low-fat milk not recommended for an infant less than 6 months old? (select all that apply)
High in sodium Inadequate essential fatty acids
The addition of vitamins to commercially prepared infant foods increases the risk for which disorder?
Hypervitaminosis (10 or more times the recommended dietary allowance)
What can cold stress in infants cause?
Hypoxia Metabolic acidosis Hypoglycemia
What is a food sensitivity and example?
Immunoglobulin E (IgE)-mediated immune response Ex. cow's milk
Highly replicated findings for ASD in 12-18 months
Impaired social attention Impaired social communication Atypical object use (tapping and spinning) Abnormal visual attention
Fine motor development of toddlers
Improved manual dexterity at 12-15 months Throws a ball by 18 months Draws circles by age 3
What are classifications of Failure to Thrive?
Inadequate caloric intake Inadequate absorption Increased metabolism Defective utilization
Preschool age development of body image
Increasing comprehension of "desirable" appearances Aware of racial identity, differences in appearances, and biases Poorly defined body boundaries (I.e. Fear that if the skin is "broken," all one's blood and "insides" can leak out, Frightened by intrusive experiences)
Preschool age social development
Individuation-separation process is completed Overcomes stranger anxiety and fear of separation from the parents Still needs parental security and guidance Security from familiar objects Play therapy is beneficial for working through fears, anxieties, and fantasies Minimal help with toileting, eating, or dressing Is willing to please Has internalized values and standards of family and culture May begin to challenge parental values
Apparent Life Threatening Event (ALTE)
Infants exhibit a combination of: Apnea Change in color or muscle tone Choking, gagging, or coughing Usually involves significant intervention
When formula is best for an infant
Infections such as HIV Immunodeficiencies Maternal medications contraindicating breastfeeding Disorders of inborn metabolism
Proper introduction of solid foods after 6 months of age
Introduce foods at intervals of 4-7 days to allow for identification of food allergies May need fluoride supplements Rice or oatmeal cereal starting at 4-6 mo (iron rich) Then, move to veggies and fruit (roughly 6-8 mo) One new food every few days If NKA or high risk for allergy, introduce peanuts, eggs in 4-6 mo Meat, fish, poultry start at 8-10 mo
Which action would the nurse take when the parents of a 12-month old express concern that their infant is still sucking the thumb and ask how to stop this "annoying" behavior?
Investigate the parents' feelings regarding their child's behavior
When caring for an infant with protein-energy malnutrition, which nutritional supplement would the nurse withhold until the infant is able to tolerate a steady food source?
Iron
Which anticipatory guidance would the nurse provide the family of a 6-month-old infant being seen for a well-baby check up?
Keep the crib rails raised to full height at all times
For which condition is an infant at risk if the diet has limited protein-based food sources?
Kwashiorkor
Heavy metal poisoning
Lead ingestion most common (can be inhaled or ingested) Mercury toxicity occurs less frequently
Which disease is suspected after reviewing a lab report stating that a child tested positive for borrelia borgdorferi?
Lyme disease
Treatment of the hospitalized child with ASD:
Maintain consistency in their structured routine Decrease simulation Individual assessment and approach, use family to guide HCP interuptions to a minimum
Which region is endemic for Cryptococcosis?
Mississippi and Ohio River Valleys
Larynx foreign body aspiration signs:
No breathing or speaking
What is a food intolerance and example?
Non-IgE-mediated immune response Ex. Lactose intolerance
High Risk Late Preterm Infant
Respiratory distress Hypoglycemia Temperature instability Poor feeding Jaundice Adverse neurodevelopmental outcome Infection
4 types of conjunctivitis
Opthalmia Neonatorum (chemical) Bacterial Viral Allergic
Toddler play
Parallel play Imitation Little emphasis on gender-stereotyped toys Increased locomotive skills Educational toys and books Tactile play Appropriate safety in relation to size, shape, risk for toxins, and sturdiness of toys
Which technique is the recommended approach to warming frozen breast milk for an infant?
Place the container with frozen milk in a lukewarm water bath to warm it
Which would be expected, in regard to the healing process, for the immunocompromised child who sustained a skin injury after falling?
Poor inflammatory response
What cognitive development stage are preschoolers in according to Piaget?
Preoperational phase spans 2-7 years Divided into 2 phases: Preconceptual phase at 2-4 Intuitive thought phase at 4-7
Which factors are associated with an increased occurrence of SIDS?
Preterm infant, Low APGAR, Bronchopulmonary dysplasia
Lead poisoning diagnosis
Rarely symptomatic but affects renal, neurologic, and hematologic systems (bone marrow) (Diagnosis involves anemia, venous blood sample lead level of 10 or higher)
Toddler development of body image
Refers to body parts by name Avoid negative labels about physical appearance Recognizes differences between male and female by age 2 Gender roles understood Gender identity by age 3
Cognitive development highlights of the preschooler
Shifts from egocentric thought to social awareness Able to consider other viewpoints Egocentricity is still evident Language continues to develop Concept of causality is beginning to develop Concept of time is incompletely understood Uses magical thinking frequently
Piaget's sensorimotor stage is characterized by:
Six stages, Birth to 24 months Reflex stage, Primary circular reactions, secondary circular reactions, coordination of secondary schema (details in another flashcard)
Common concerns for preschool aged children
Sleep problems (terrors, nightmares, etc) Skin disorders (contact dermatitis, human bites, burns) Ingestion of Injurious Agents (children younger than 6) Foreign Body Aspiration Conjunctivitis Ear infections Lyme Disease Poison Ivy Insect bites and stings Neurodevelopmental concerns (Autism and Autism Spectrum Disorders)
Sleep and activity of preschool aged children
Sleeps for 12 hours per night; infrequent naps Free play is encouraged Emphasis is on fun and safety
Which response would the nurse provide the parent of a 10 month old who is worried that the baby cries and screams whenever being left with the grandparents?
Stranger anxiety is common for an infant this age
Oral Readiness Assessment
Strong suck Coordination of suck, swallow, breathe Intact gag reflex Rooting Waking around feedings
Safety acronym: SAFE PAD
Suffocation Aspiration, asphyxia, animal bites Falls Electrical and other burns Poisoning and Ingestions Automobile safety Drowning
Which antibiotic is appropriate when treating a child who has been diagnosed with MRSA?
Sulfamethoxazole/trimethoprim, vancomycin
Piaget's sensorimotor stages in toddlers
Tertiary circular reactions at 13-18 months Invention of new means through mental combinations at 19-24 months
Which statement characterizes the eating behavior of toddlers?
They become fussy eaters (around 18 months)
Which evaluation would the nurse make when observing a 5-month old who has no head lag when pulled to a sitting position?
This is an expected finding
What is the rationale for the nurse recommending that the parent of a 7-month old infant reduce pacifier use?
To prevent otitis media (a middle ear infection)
Which vitamin supplement would the nurse anticipate being prescribed for a 13-month-old infant diagnosed with measles?
Vitamin A
Which vitamin would the nurse anticipate being prescribed for an exclusively breastfed 4-month old infant?
Vitamin D
Assessing Readiness for Toilet Training
Voluntary sphincter control Ability to stay dry for 2 hours Fine motor skills to remove clothing Willingness to please parents Curiosity about adult's or sibling's toilet habits Impatience with wet or soiled diapers
Proportional changes in infants
Weight gain is 5 to 7 ounces per week Double the birth weight by age six months Triple the birth weight by age 1 year Growth occurs In spurts rather than gradually
Biologic development of toddlers (ages 12 mo-36 mo)
Weight gain slows to 4-6 pounds per year Birth weight should be quadrupled by 2.5 years Height increases about 3 in per year Growth is steplike rather than linear Adult height is 2 times the height at age 2 years Anterior fontanel closes by 12 months
Which dietary supplement is appropriate to facilitate healing when educating the parents of a child who was burned?
Zinc, Vitamins C and D
Which category of medication is the first line therapy for inflammation in children with asthma?
corticosteroids
Which characteristic best describes the fine motor skills of a 5-month old infant?
able to grasp an object voluntarily
There is NO need for what during the first four months of infancy when it comes to nutrition?
additional fluids besides breastmilk or fortified formula
When to wean from breast or bottle to cup?
after 1 year
When to introduce solid foods to an infant?
after 6 months
Which therapeutic management would the nurse expect the primary health care provider to prescribe for an infant with nasopharyngitis?
antipyretic
Dyslalia
articulation problems in speech
What psychosocial development stage are toddlers in according to Erikson?
autonomy vs. shame and doubt
Challenges of formula feeding
cost, storage and prep concerns
Prevention of Lyme Disease:
cover skin, light color clothing, promethin treated clothing, DEET
Which symptom would the nurse expect to find in a child with acute laryngotracheobronchitis?
barky, brassy cough
Why should NO honey be given to infants in their first year of life?
botulism
Infant nutrition for the first 6 months of life
breastmilk or fortified formula
Which is the MOST effective means of preventing dental caries in school-age children?
brushing teeth after meals, after snacks, and at bedtime
For which condition are infants with acute marasmus at risk if food is reintroduced too quickly?
cardiac failure
Which diet alternative would the nurse recommend to a 3-month-old infant who is allergic to cow's milk?
casein hydrolysate milk formula
Which is an important consideration related to stress in school-age children?
children are capable of identifying stress responses
Achievement of which cognitive task occurs during the school years?
conservation
Which is the most important factor in determining the degree of fit between an infant's temperament and the interactions between the child and parents?
harmony between the parent's expectations and the child's actual temperament
The parent of a child with cystic fibrosis calls the clinic nurse to report that the child is experiencing tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse would tell the parent to bring the child to the clinic because these symptoms are indicative of what?
pneumothorax
Which postoperative nursing care must be provided for the child who had a tonsillectomy?
provide analgesics rectally or intravenously
The nurse observes a toddler playign with other children, then coming to the parent to be held, then returning to play with others. Which developmental task would the nurse recognize this toddler to be demonstrating?
rapprochement
Encopresis and constipation in the child
repeated inappropriate stooling in a child who has reached an age (4 yrs) where bowel control is expected
Enuresis in the child
repeated inappropriate voiding in a child who has reached an age (5 yrs) where bladder control is expected
Colic is self limiting meaning it...
resolves on its own by 12-16 weeks
Which recommendation would the nurse provide to the parent of a 6-month-old infant about the introduction of solid foods?
rice cereal is a good first food because it is easily digested and low in allergenic potential
Which developmental achievement is characteristic of the motor skills of a 24-month-old?
runs well with a wide stance
Which new gross motor skill would the nurse expect a 7-month old infant to perform?
sitting erect momentarily
Late stages of Lyme Disease (weeks to months)
stiff neck, swelling and arthritis in joints, facial palsy, arrhythmia
Which is the purpose of the peak expiratory flow rate (PEFR) test for a child with asthma undergoing pulmonary function tests?
to assess the severity of asthma
When an infant with congenital heart disease is given palivizumab, which is the purpose?
to prevent RSV
Which are clinical manifestations of failure to thrive?
undernutrition, developmental delays, avoidance of eye contact, apathy, withdrawn behavior, feeding or eating disorders
For how long do infants have iron stores from the prenatal period?
up to 6 months
Which gross motor developmental milestone would the nurse expect to observe in a 15-month-old?
walking alone, using a wide stance
Which is the MOST appropriate nursing intervention for a child after a tonsillectomy?
watching for continuous swallowing (early sign of bleeding)