PHP ticket to class (exam 2)

late adolescence

(ages 18-21). This stage is a time of important personal and vocational decisions and refined abilities to reason logically and solve problems.

young child (early childhood)

(ages 3-4). Young children are increasingly competent at self-feeding, but they still prefer eating with their hands rather than using utensils. They are becoming more interested in trying new foods and participating in family meals.

late infancy

(ages 9-12 months). During this stage growth slows, but infants' maturation and purposeful activity allow them to eat a wider variety of foods.

what is an mTBI?

-acute brain injury resulting from mechanical direct or transmitted energy to the head from external physical forces

characteristics of injury

-ask how head injury happened, where -type of location and force documented, minor forces can lead to significant symptoms, rotational force may increase injury severity

on field exam should include

1 abc 2 neurological assessment 3. determine initial disposition

The nurse reviews the CDC growth chart below of a 9 month old patient. What is the best action by the nurse? a. Tell the parent the infant is underweight. b. Tell the parent the infant is normal weight. c. Plot the measurements on a WHO growth chart before making an interpretation. d.Plot the measurements on a BMI for age growth chart before making an interpretation.

Plot the measurements on a WHO growth chart before making an interpretation.

Mindy is here for her 14 year old check up. The nurse reviews Mindy's growth chart below. How would the nurse classify Mindy's BMI for age when she was 3 years old?(picture included) a, underweight b. normal weight c. overweight d. obese

b normal weight

Which parent statement about milk would indicate the nurse should clarify misconceptions? a. "I should not start my child on cow's milk before 12 months of age." b. "It is preferred that children without risk factors drink whole milk from age 1 to 2." c. "I can give my 1 year old 2% milk since we have a strong family history of heart disease." d. "After the age of 2, it is best to give my child 2% milk."

d

initial physical examination covers:

mental status, cognition, balance, strength, scalp or skull abnormalities, any signs of deteriorating neurological function

activity for children

•Discourage television viewing •Encourage interactive activities (talking and reading together).

adolescence: other topics

•Positive body image -Discourage dieting -Encourage healthy eating •Follow same guidelines for oral health and physical activity as middle childhood

take away points

-Breastfeeding is preferred infant feeding method -No cow's milk before age 1; after age 2 it should be low fat or fat free -Water from a fluoridated community source is the preferred drink -Healthy eating is about balance, parents set the example -Screening with BMI for age starts at age 2. Normal weight is ≥5th percentile ≤85th percentile - Screen time should not exceed 2 hours a day

why is there a concern about mTBI among children?

-a developing brain- less white to make them more suseptible to metabolic change, axons in childs brain are not as myelineated -a developing body, less developed muscularture, decreased ability to absorb mechanical energy, thinner cranial bone -developing curiosity, risk taking behavior and many benefits can put them at an increased risk

mTBI physiology

-brain to accelerate and deaccelerate, rotate etc that can leed to one side force , energy passes through brain tissue injuring it, cascade of metabolic or physical events, acute clinical symptoms

what is a clinical nurse specialist

-concpetualized as core competencies in 3 interacting spheres actualized in speciality practice, and guided by speciality knowledge and standards

mTBI can lead to one or more of the following symptoms:

-confusion, disorientation, loss of consciousness for 30 min or less, post traumatic amnesia for less than 24 hours, neuorlogical abnormalities like focal signs, symptoms or seizure -glasgow coma sclae score of 13-15 30 min post injury

signs of neurologic deterioration

-indication of cervical spine injury, any focal neurological deficit, decreasing level of consciousness, severe or worsening symptoms -any suspiciion of neurologica deterioration needs to goto emergency and monitoring, unclear if can be observed at hoem

validated decision rules combin factors that might indicate higher risk of intracranial injury

-less than 2 years old, vomiting, loss of consciousness, severe injury, severe or worsening headache, amnesia, glasgow coma score <15

CTE

-neurodegenerative disease, believed to be caused in part by exposure to : repetitive head impacts, including concussions, subconcussive head impacts(do not cause symptoms of concussion)

SCAT sports concussion assessment tool

-number of symptoms, severity of symptoms -evaluate orientation, memory, concentration and balance

prolonged recovery of mTBI is associated with:

-older age, female sex, hispanic ethnicity, lower socioeconomic status, lower cognitive ability, learning difficulties

At what age should the nurse tell a family a child should typically eat adult food serving sizes? (write whole number only)

4

The nurse provides information to a family about physical activity. Which client statement reflects the need for more teaching? a. "We should not let our child have a TV in her room." b. "We need to limit screen time to no more than 2 hours a day." c. "Our 8 year-old can begin lifting weights." d. "Children and adolescents should get at least 60 minutes of physical activity a day."

C

no routine imagiing of pediatric patients with mTBI include using of:

CT, MRI, SPECT, skull x ray -use validated clinical decision rules determine if imaging is warranted

Which parent statement about bottle-feeding reflects the need for more teaching? a. "It is recommedned that I wean my child from the bottle by 2 years of age." b. "I should not heat bottles in the microwave." c. "It is best to mix formula with tap water from a community source because it is fluoridated." d. "Putting a baby to bed with a propped bottle can lead to choking and tooth decay."

a

Which recommendation about weight management should the nurse make? a. A medically supervised weight loss of no more than 2 lbs per week may be appropriate for children with a BMI greater than the 99th percentile. b. Gradual weight loss of no more than 1 lb per week may be appropriate for children with a BMI between the 95th-99th percentiles. c. Gradual weight loss of no more than 1 lb per month may be appropriate for children with BMIs between the 85th and 94th percentiles. d. A medically supervised weight loss of no more than 1 lb per week may be appropriate for children with BMI's between the 85th and 99th percentiles.

a

The nurse explains how parents influence healthy eating habits in children. Which information should the nurse include in the discussion? Select all that apply. a. The family is the predominant influence on infants', children's, and adolescents' attitudes toward food. b. Parents provide the majority of food for younger childern so have control over their intake of junk food. c. It is important for parents to model healthy eating because children adopt their parents food preferences. d. Try to have occaisonal family meals. e. Families should engage children in helping prepare food.

a b c e

A 14 year old girl was hit in the head with a ball at a soccer game does she need: a. a CT or MRI b. Does she just need rest c. can she resume daily activities

a if she receives a glasgow coma scale of 13-15?

review management of recovery

a short rest period of 2-3 days, a patient should not leave the er with permission to return to sports that day

Which client should be screened for iron deficiency anemia? Select all that apply. a. All childern between 12 and 18 months. b. Any child who routinely drinks more than 24 ounces of milk per day. c. Mexican-American children ages 9-12 months. d. preterm infants e. Females ages 12 to 21 with known risk factors for iron-deficiency anemia.

all are correct

case study: a 17 year old football player hits his head on the ground following a tackle, the athlete is slow to get up and as the team healthcare provider you are called onto the field to assess the injured athlete What is your next coarse of action?

assess for adequeate airway breathing, conduct neurological assessment to examine status, determine initial disposition all of the above

steps back after mTIB

back to regular activities - light aerobic exercise - sports specific exercise - non contact training drills - full contact practice - return to sports -if symptoms return stop activity, minimum of 24 hours with no symptoms at athlete can starts again at previous step

Mindy is here for her 14 year old check up. The nurse reviews the growth chart below. At age 4, what percentile was Mindy's BMI for age? a 50th b 75th c 85th d 90th

c. 85th

At Mindy's 14 year old check up, her BMI is 22. Using the growth chart, where does the nurse plot Mindy's BMI? a. above 90th percentile b. above 85th percentile c. above 75th percentile d. above 50th percentile

c. above 75th percentile

assess patinet for mTBI

characteristics of injury, symptom and severity, risk factors

A parent wants to know when a child can brush their teeth independently. What is the nurse's best response? a. Kindergartners can brush their teeth independently. b. Children who can eat without assistance have the skills to brush their teeth alone. c. four-year-old knows how to spit excessive toothpaste, so is ready to brush their teeth on their own. d. It takes until age 7 or 8 for children to be able to do a thorough job independently.

d

What recommendation should the nurse give a family about appropriate beverages? a. Juice should be limited to no more than 8mL per day. b. Bottled water is the preferred fluid for children. c. Sports drinks are ideal ways to provide hydration during physical activity. d. Sugary drinks are a major contributor to childhood obesity.

d

3 stages of infancy

early infancy, middle infancy, late infancy -•Infancy is divided into 3 stages. Physical growth, developmental achievements, nutrition needs, and feeding patterns vary significantly in each.

most common cause of mTBI

falls in young children -use stair gates, supervised at all times

8 danger zones of teen driving

inexperience, other teens, nightitme, no seatbelt, distracted, drowsy, reckless, impaired

mtbi prevention tips should focus on

motor vehicles, recreational activities, fall prevention, sports injury

Mindy is here for her 14 year old check up. The nurse reviews Mindy's growth chart below. Last year her BMI for age would have been classified as which? a. underweight b. normal weight c. overweight d. obese

obese

when should you return to sports

once back to regular activites -the younger the athlete, the more conservative the approach -could take place over days, weeks, months, involves monitoring symptoms, supervision throughout process

The nurse reviews the growth chart of a 6-year-old female (see exhibit). How does the nurse classify the BMI?(picture on quiz) a. underweight b. normal weight c. overweight d. obese

overweight

returning to school

patients can usually being school within 2-3 days, cusomized to their symptoms -monitor for increased problem with attention span, increased times need to complete tasks, increased symptoms presentation, changes in academic performans -might need shorter days, rest breaks, reduced workload, allowed extended time to complete work

4 categories of mTBI signs and symptoms

somatic, cognitive, affective, sleep

childs return to activity based on

symptoms or level of severity -non strenuous activities beginning within a few days -when symptoms are gone or mild,patient should return to regular schedule and not until then should they go back into sports

toddler (early childhood)

•(ages 1-2). Toddlers are characterized by a growing sense of independence and sometimes by struggles over food and refusing to eat certain foods. They are developing fine motor skills, so eating is often messy.

early adolescence

•(ages 11-14). Adolescents are characterized by pubertal changes and a growing capacity for abstract thought, although concrete and oriented toward the present.

middle adolescence

•(ages 15-17). Adolescents are characterized by independence, experimentation, future-oriented thinking, and problem-solving abilities.

middle infancy

•(ages 6-9 months). During this stage growth slows but is still rapid.

early infancy

•(birth-age 6 months). The most rapid changes occur during this stage.

3 principles of bright future

•1. Nutrition must be integrated into the lives of infants, children, adolescents, and families. •2. Good nutrition requires balance. •3. An element of joy enhances nutrition, health, and well-being.

adolescencts: growth and development

•Adolescents achieve the final 15% to 20% of their adult height and gain 50% of their adult weight. •Adolescents accumulate up to 40% of their skeletal mass. •Nutrient needs are greatest during peak periods of growth (sexual maturity rating [SMR] 2-3 in females, 3-4 in males). •Females complete most physical growth about 2 years after (mean age of menarche is 12.5 years) •Males begin puberty about 2 years later than females. •Males experience major growth spurts and increases in muscle mass during middle adolescence.

bmi for age and weight loss middle childhood

•BMI < 5th percentile is underweight •BMI 85th - 94th percentiles, the child is considered overweight and needs further screening. •BMI >95th percentile, the child is considered obese and needs in-depth medical assessment •Weight loss -should not occur in children with BMI below the 95th percentile. Prefer to grow into weight -gradual weight loss of no more than 1 lb per month may be appropriate for children with BMI 95th -99th percentiles. -A weight loss of no more than 2 lbs per week may be appropriate for children with BMI > the 99th percentile

oral health infancy

•Brush infant's teeth with a small, soft toothbrush and a smear of fluoridated toothpaste twice a day •Hold infants while feeding; never prop a bottle •Avoiding habits harmful to their infant's teeth -putting the infant to sleep with a bottle or sippy cup - allowing frequent and prolonged bottle-feedings or use of a sippy cup containing beverages high in sugar. •Maintaining personal oral health

oral health children middle childhood

•Brush teeth with fluoridated toothpaste twice a day •Drinking water when thirsty. •Use community fluoridated water as a safe, effective way to reduce dental caries. -If bottled water is preferred, recommend a brand with fluoride added at a concentration of approximately 0.8-1.0 mg/L [ppm]. •Limit foods (candy, cookies) and beverages (juice, juice drinks, soft drinks) high in sugar.

oral health for toddlers/young children

•Brush the child's teeth with a small, soft toothbrush twice a day (after breakfast and before bed). -1-2 use a smear of fluoridated tooth paste -> 2 use a pea-sized amount of fluoridated toothpaste •Young children cannot clean their teeth without help. -(After children acquire fine motor skills [ability to tie their shoelaces], typically by age 7 or 8, they can brush their teeth effectively.) •Drink water when thirsty. •Use community fluoridated water to reduce dental caries •Limiting foods high in sugar

middle childhood

•Children in middle childhood gain an average of 7 lbs •in weight and 2½ inches in height per year. •Growth spurts, accompanied by increased appetite and food intake, are common. -Expected accelerated growth (for girls at ages 9-11, for boys at about age 12). -Variation in onset of puberty among children. •Body composition& body shape remains relatively constant. •Children's food intake is strongly associated with what their parents eat.

body image middle childhood

•Children may become overly concerned about their •Physical appearance. -Girls may be especially worried about being overweight and may begin to eat less or diet. •Boys may be concerned about their stature and muscle size and strength. •During middle childhood, muscle-building activities (weight lifting) do not build muscle mass and can be harmful; muscle strength can be improved with appropriate physical activities.

early childhood trends

•Children quadruple their birth weight by age 2. •Between ages 2 and 5, children gain an average of 4.5 to 6.5 lbs and grow 2.5 to 3.5 inches per year. •As growth rates decline during early childhood, children's appetites decrease, and the amount of food they consume may become unpredictable. •As toddlers' eating skills develop, they progress from eating soft pieces of food to eating foods with more texture. •Toddlers are unpredictable and tend to be leery of new foods and may refuse to eat them •By age 3 or 4, children are able to use their fingers to push food onto a spoon, pick up food with a fork, and drink from a cup.

adolescence: discuss substance abuse

•Consuming excessive quantities of caffeinated beverages (soft drinks, coffee, energy drinks). •Dangers of using alcohol, tobacco, and other drugs. •Dangers of using performance-enhancing products(protein supplements, anabolic steroids).

for breastfeeding mothers

•Continue breastfeeding for 12 months or as long as the mother and child wish to continue. •Feed infant on demand to stimulate the lactation. •Allow infant to finish feeding at one breast before offering the other breast •Feed infant when he/she is hungry, typically - 10to 12 times per day during the initial weeks of life - 8 to12 times per day for the next several months - 6 to 12 times per day thereafter. •Feed infant more often during periods of rapid growth.

middle childhood: begin talking about substance abuse

•Dangers of using alcohol, tobacco, and other drugs. •Dangers of using performance-enhancing products (protein supplements, anabolic steroids).

adolescents: common concerns

•Decrease in consumption of dairy products. •Increase in consumption sugary drinks •Insufficient intake of fruits and vegetables. •High consumption foods high in fat and sodium. •Rise in overweight and obesity. •Low levels of physical activity. •Increase in eating disorders, body image concerns, dieting, and unsafe weight-loss methods. •Prevalence of iron-deficiency anemia (in females). •Prevalence of hyperlipidemia. •Food insecurity among adolescents from families with low incomes.

diet while breastfeeding

•Eat a variety of healthy foods •Drink beverages such as milk or juice when thirsty -drink a glass of water at each feeding. •Limit the consumption of beverages containing caffeine (coffee, tea, soft drinks) to 2 servings per day. • Avoid alcoholic beverages 2 hours before breastfeeding. -If the mother drinks alcoholic beverages, no more than 8 oz wine, 12 oz beer, or 2 oz hard liquor should be consumed per day [less for small women].

physical activity middle childhood

•Engage in 60 or more minutes of physical activity/day. •Wear appropriate safety equipment (helmets, pads, mouth guards, goggles) when physically active. •Drink water when physically active •Reduce sedentary behaviors -Limit total entertainment media time (watching television, playing computer or video games) to no more than 1 to 2 hours of quality programming a day. -No television in the child's bedroom

feeding practices parents need to know

•Exclusive breastfeeding [only breast milk] is recommended for a minimum of 4 months, but preferably for 6 months. •Until age 12 months avoiding low-iron milk (cow's, goat's, soy), even in infant cereal. •Feed infants until they are full. •For younger infant (up to age 3 months), signs of hunger include putting the hand to the mouth, sucking, rooting, pre-cry facial grimaces, and fussing. •For older infant (ages 4-6 months), signs of hunger include moving the head forward to reach the spoon and swiping food toward the mouth. •Spitting up a little breast milk or formula at each feeding is normal.

food safety in infancy

•Follow food safety practices for storage of expressed breast milk or formula. •Avoid warming bottles or food in containers or jars in the microwave. •Test warmed fluids to make sure that they aren't too warm by sprinkling drops on the wrist . •Avoid foods that may cause choking •Follow food safety practices to reduce infant's risk of food-borne illness.

supplements infancy

•Give breastfed and partially breastfed infants a vitamin D supplement beginning during the first few days of life. -Supplementation should continue unless the infant is weaned and is consuming at least 1 L per day or 1 qt per day of vitamin D-fortified formula •Give infants ingesting less than 1 L per day or 1 qt per day of vitamin D-fortified formula a vitamin D supplement beginning during the first few days of life. •Give breastfed infants vitamin B12 before age 6 months if the mother is vitamin B12 deficient -(vegan [eats no animal products], is undernourished, does not take vitamin B12 supplements).

for formula fed babies

•Hold infant close when feeding, in a semi-upright position. •Feed infant when he is hungry, typically every 3 to 4 hours (6-8/ in 24 hours) until solids added. •Prepare and offer more formula as their infant's appetite increases. •Offer infants water on hot days between feedings -infants don't usually need water. •Use fluoridated water to make formula •Do not enlarge the hole in the bottle nipple to make infant formula come out faster. •Seek consultation with a HCP if their infant is not feeding enough or seems hungry all the time.

bright fututre visions and goals

•Improve the nutrition status of infants, children, & adolescents. •Identify desired health and nutrition outcomes that result from positive nutrition status. •Set guidelines to help health professionals promote the nutrition status of infants, children,& adolescents. •Encourage partnerships among health professionals, families, and communities to promote the nutrition status of infants, children, & adolescents. •Describe the roles of health professionals in delivering nutrition services within the community. •Identify opportunities for coordination & collaboration between health professionals and the community.

eating behaviors middle childhood

•Increase the variety of foods the child eats and finding ways to incorporate new foods into the child's diet. •Making healthy foods choices based on Dietary Guidelines for Americans . •Children ages 2 to 8 need to drink 2 cups of low-fat or fat-free milk per day or consume the equivalent dairy. -Children ages 9 and older need to drink 3 cups •Supplement 400 units vitamin D if low intake. •Eating 3 meals and 1 to 2 snacks per day. •Making family mealtimes a priority •Limit high fat/high calorie/high sugar/low nutrient foods and drinks •Consider need for school lunch program

growth patterns in infants

•Infants usually regain their birth weight by 7 days after birth, double their birth weight by age 4 to 6 months, and triple their birth weight by age 1. •Infants usually increase their length by 50% in the first year, but the rate of increase slows during the second half of the year. •Growth rates of exclusively breastfed infants and formula fed infants differ. -Breastfed infants grow more rapidly during the first half of the year but less rapidly during the second half.

adolescence: eating

•Make healthy foods choices based on Dietary Guidelines for Americans •Drink 3 cups of low-fat (1%) or fat-free (skim) milk •Take a vitamin D supplement of 400 IU per day if low intake •Eat 3 meals and snacks, as needed, per day. •Limit foods high in fat or sugar •Enroll adolescent in school breakfast and lunch programs, if needed.

screenings in early children

•Measure weight length & OFC to age 2 •Start using BMI for age staring at 2 years •Screen all children at 12-18months for Iron-Deficiency Anemia •Consider screening older children drinking >24 ounces milk/ day •Screen children at high risk or those with known risk factors at ages 9 to 12 months and again 6 months later including -Children from families with low incomes -Children who are eligible for (WIC) -Children who are migrants or recently arrived refugees -Children who are Mexican-American -Preterm infants

concerns in early children

•Obesity prevalence has risen from 5% to more than 12% among children ages 2 to 5. •Children who are obese often remain obese into adulthood •Obesity is associated with many chronic health conditions, •Iron deficiency anemia is common in children, especially children from families with low incomes. And may have adverse effects on growth and development. •Children with special health care needs may have nutrition concerns, including poor growth, poor eating skills, inadequate or excessive food intake, developmental delays, elimination problems, and metabolic disorders.

teaching young children about food

•Offer a variety of healthy foods. •Offer foods from other cultures. •Teach child how foods are grown (planting a vegetable garden) and where foods come from (visiting a dairy farm). •Read books and singing songs about foods. Involve their child in food shopping and preparation

food safety for toddlers

•Precautions to prevent toddlers from choking: -Staying with their child while eating. -Having their child sit while eating. -Not allowing their child to eat in the car. -Keeping mealtimes and snack times calm. -Avoiding foods that may cause their toddler to choke •Modify foods for young child to make them safer: -cutting hot dogs in quarters lengthwise and then into small pieces, cutting whole grapes in half lengthwise, chopping nuts finely, chopping raw carrots finely or into thin strips, spreading peanut butter thinly on crackers or bread

food safety infancy

•Prepare formula as instructed, and following sanitary procedures -washing hands before preparing formula -cleaning area where formula is prepared -cleaning and disinfecting reusable bottles, caps, and nipples before each use -washing and drying top of formula container before opening. •Do not add cereal or other foods to infant formula. •Discarding infant formula left in the bottle •Cover and refrigerating open containers of ready-to feed or concentrated formula. •Store powdered formula at room temperature.

physical activity toddlers/young children

•Promote both structured (following the leader) and free (child moves in any way he likes) play. •Play with child and being physically active. •Plan family physical activities each week -Let their child decide which physical activities to do •Taking part in community projects as a family •Encouraging interactive activities (playing, singing, and reading together). •Limiting their child's total entertainment media time(watching television, playing computer or video games) to no more than 1 to 2 hours of quality programming a day.

screening for anemia middle childhood

•Screen children consuming a strict vegetarian diet without iron supplementation. •Screen children with known risk factors for iron-deficiency anemia (low iron intake, special health care needs, previous diagnosis of iron-deficiency anemia). -Remember high dairy intake is a risk for anemia

adolescence: anemia

•Screen females ages 12 to 21 during routine physical exams. -Screen females ages 12 to 21 with known risk factors for iron-deficiency anemia •Screen males ages 12 to 18 during their peak growth period during routine physical examinations. -Screen males ages 12 to 18 with known risk factors for iron-deficiency anemia

more healthy eating for young early childhood

•Serve variety of healthy food •Provide a vitamin D supplement of 400 IU per day for children who do not obtain through diet •Serve children ages 4 and older portion sizes similar to those eaten by older family members -Provide children ages 2 to 3 with the same number of servings as children ages 4 and older, but with smaller portions(about two-thirds of a serving). •Maintain child's appetite for healthy foods by limiting foods (candy, cookies) and beverages (fruit drinks, soft drinks) high in sugar. -Limit juice consumption to 4 to 6 oz per day -Encourage drinking water throughout day.

family influencing eating behaviors

•The family is the predominant influence on infants', children's, and adolescents' attitudes toward food and their adoption of healthy eating behaviors. The family exerts this influence by: -Providing food -Transmitting attitudes, preferences, and values about food, which affect lifetime eating behaviors -Establishing the social environment in which food is shared

healthy eating in early childhood

•ean child from the bottle by age 12 to 14 months. •Modify foods to make them easier for child to eat. •Help children ages 2 to 5 gradually decrease fat intake. •Milk -Serve children ages 1 to 2 whole milk (serve reduced 2% milk if obesity is of concern or if there is a family history of obesity, dyslipidemia, or cardiovascular disease). -Serve children > age 2 low-fat (1%) or fat-free milk. -Serve children ages 2 and older 2 servings of milk (two 8-oz cups) per day.