Test 2

A mother tells the nurse that she will visit her 2-year-old son tomorrow about noon. During the child's bath, he asks for Mommy. What is the nurse's best reply? "Mommy will be here after lunch." "Mommy always comes back to see you." "Your Mommy told me yesterday that she would be here today about noon." "Mommy had to go home for a while, but she will be here today."

"Mommy will be here after lunch." Because toddlers have a limited concept of time, the nurse should translate the mother's statement about being back around noon to a familiar activity that takes place at that time. Telling the child that his mother always comes back to see him does not give the child any meaningful information about when his mother will visit. Twelve noon is a meaningless concept for a toddler. Stating that his mother had to go home but will be back today does not provide the child with any meaningful information related to when she will actually visit.

A parent tells the nurse, "I am worried about my 13-year-old son. He hasn't started puberty, and my daughter did when she was 11 years of age." The most appropriate explanation by the nurse is "This is unusual and requires further evaluation of your son." "This is unusual because the onset of pubescence is usually the same in siblings." "This is normal because the onset of pubescence is usually earlier in girls than it is in boys." "This is abnormal because the onset of pubescence is usually earlier in boys than it is in girls."

"This is normal because the onset of pubescence is usually earlier in girls than it is in boys." Girls begin puberty on average approximately 2 years before boys. Puberty usually begins no earlier than age 12 years in boys, with an average age of onset of 14 years; therefore, no further evaluation is necessary at this time. The age of pubescence is gender related, with the average age of puberty onset being 12 years for girls and 14 years for boys. Puberty usually begins no earlier than age 12 years in boys, with an average age of onset of 14 years; therefore, her son is not having an abnormal onset of puberty.

estrogen

"feminizing hormone"

psychological factors of enuresis

"sleep more soundly than other children" emotional factors familial tendency

stage 1

(9.5-14 yr) testicular enlargement and sparse pubic hair

Causes of burns

- heat - chemicals - electricity - solar radiation cold

WHat happens at development of a 8-9year old ?

-Height grows 2 inches per year -More graceful -Can count backward -Reads for pleasure -Uses common tools, chores -Dramatizes -Social groups -Dresses self, modesty

What are causes of stress on the child ?

-Identify with peers -Domestic violence-50% likely to be abused -Academic competition -Athletic competition -Over-programmed with activities -High divorce rates •50% divorce rate -Bullying

What happens at the development of a 6 year old?

-Loses first tooth -Constant activity -Vision reaches maturity -Knows rt and lt -Reads from memory, -Will cheat to win as they learn rules -Occasional tantrums

anticipatory guidance- care of families

-Parents need support and guidance -Information needs regarding developmental changes and process of gaining independence -Help "letting go" and promoting independence

what are examples of approach behaviors?

-asks for information regarding diagnosis -seeks help and support from others -anticipates future problems -endows the chronic illness or complex condition with meaning -shares burden of disorder with others -plans realistically for the future -acknowledges and accepts child's awareness of diagnosis and prognosis. -expresses feelings -verbalizes possible loss of child

if you think child sexually abused within last 72 to 96 hours

-beyond our scope needs to be done by trained personel abused children at risk for conduct disorders poor academic performance

Pulmonary edema due to burn

-can happen if fluid overload -acute respiratory distress syndrome because of leaking fluid into interstitial spaces of lung

what are coping patterns used by children with special needs?

-competence and optimism -feels different and withdraws -is irritable, moody, and acts out -complies with treatment -seeks support.

Sunburn treatment

-cool tap water -immersion in tepid bath -moisturizer -tylenol for discomfort

Sepsis due to infection after burn

-critical problem with burns -taken away big defense which is our skin -if they cut out dying tissue (eschar) it can reduce chances -graft and removing eschar can reduce incidence of sepsiss

human bites

-dental plaque and gingiva -risk for infection -may need tetanus shot

physical neglect

-depriving of food, clothing, shelter, supervision, medical care, education

what happens during adolescent development?

-develop personal and sexual identitiy -achieve independence from family -form heterosexual relationships -learn through abstract thinking

what happens during infant development?

-development of sense of trust -bonding or attachment to parent -learning through sensorimotor experiences -sent of separateness from parent

what are anticipated parental stress points?

-diagnosis of condition -developmental milestones -start of schooling -reaching the ultimate attainment (tasks such as walking or reading may be impossible) -adolescence -future placement -death of child

chelation therapy for lead toxicity

-does not counteract effects that already took place -may have multiple treatments ot reduce it -important to hydrate during chelation therapy -very hard on kidneys

scar tissue and burns

-doesn't stretch or contract like normal skin -deformities, contractures -itch, peel, may need benadryl, hydroxyzine because patient can't scratch their burn scars -may not have sweat glands -can get hyperthermia during times of hot weather

what are examples of avoidance behaviors?

-fails to recognize seriousness of childs condition refuses to agree to treatment -intellectualizes about illness but in areas unrelated to child's condition -avoids staff, family members, or child.

Brown recluse

-fiddle shaped mark on head -cases blerb or blister -changes to purple star area -eventually necrosis: can lose a big chunk of flesh from brown recluse bite

Management and rehab for a burn

-focus on preventing infection -closing burning quickly -providing comfort for patient because it is very painful -very important for visitors -hand washing procedures -use of PPE -caution with disease coming into burn units

Poison Ivy, Oak, Sumac

-full blow reaction after 2 days -blisters, oozing spots, streaks -heals on its own -itching goes away 10-14 days -calamine lotion, aveeno bath, topical steroids -benadryl is a good go to -if severe then oral steroids ***Immediately after contact flush the area with cold water, lesions don't spread by contact, so they can't spread to anyone else

Things to look for after someone has had a burn

-functional impairment -skin does not stretch and move -prevent joint mobility and expansion of chest with breathing -ROM is a big thing to evaluate with scars

Inhalation injury from burn

-heat damage below vocal cords rare -may see burns around face & lips -singed nasal hairs -could have laryngeal edema : hoarseness, rales, crackles, wheezing, increased secretions, endotracheal intubation may be necessary

lead poisoning problems

-hyperactivity -aggression -cognitive and behavioral problems

nursing priorities with lead poisiong

-identify source -good record of I & O -monitor renal function during chelation therapy

contact dermatitis

-inflammatory reaction, they came into contact with something that has caused hypersensitivity reaction -sharp demarcated edges between inflamed and normal skin -constant itching

how does lead poisoning occur?

-inhalation, ingestion, lead based pain because the chips are sweet, water or food sources, pottery or dishes, use of cosmetics

what happens during preschool age development?

-initiative and purpose -master self care skills -begin to develop peer relationships -develops sense of body image and sexual identifications -learns through preoperational thinking

High alert in burns

-maintenance of body temp -chief dangers: >infection >wound infection >bacterial pneumonia >sepsis >careful to try to prevent contracture (maintain body alignment, posturing, splinting extremities in an extension position, provide active and passive physical therapy, encourage children to have spontaneous movement when they can)

Problems with burns

-make capillaries more permeable -allows plasma proteins, fluids, electrolytes to be lost -after large burn: hypovolemia -another response is anemia: RBC are injures or destroyed by heat -increase in metabolism to maintain body heat: increased energy consumption, nutrition and calories are a big deal in burn victim

mercury thermometer

-mercury volatile at room temp -enters blood stream when inhaled -when mercury breaks you need a hazmat team to clean up -mercury poisoning --- painful extremities

Minor burn comfort measures

-moisturizer without alcohol or fragrance

what are the four types of parental response to the disorder?

-overprotection -rejection -denial -gradual acceptance

Psychosocial component to burns

-parents feel helpless, loss of contorl -kids need to know treatments are not injury -parents may be overwhelmed with guilt -some grieving on child and parents part on normal appearance loss -need to have home therapy program set up

Chronic lead poisoning problems

-physical growth -issues with reproduction later on

What are examples of shock and denial?

-physician shopping -attributing symptoms to a minor condition -refusing to beliebe tests -acting happy and optimistic despite revealed diagnosis.

what are key factors in developing a successful parent/professional partnership?

-promote primary nursing -acknowledge parents overall competence and their unique expertise with their child -respect parents time as having value equal to that of other members of the child's healthcare team -explain or define any medical terms -include family in team meetings about the child or relay the information.

Big cause of fatality after a burn

-pulmonary infection -not a lot of respiratory movement -usually in bed a long time

Lead poisoning common symptoms

-rarely have symptoms -anticipatory guidance -screen for children at risk -need screen by blood at 1-2 years old -any child with risk factors may need to be screened more often

prevention of infection after a burn

-removal of tissue that is not alive anymore -closure of burn -sometimes with debridement they can use hydrotherapy -cleans the burn but also cleans entire body -hydrotherapy or a shower also gives the patient some good practice with range of motion -water makes it easier to move their joints

what are characteristics of parental overprotection?

-sacrifices self and rest of family for child -continually helps the child even when they are capable -inconsistent with discipline -offers suggestions and calls attention to every activity with praise -protects the child from every discomfort.

what happens during school age development?

-sense of accomplishment -peer relationships -learn through concrete operations

lead properties in poisoning

-settles in bones and teeth -competes with molecules of calcium in bones and teeth -not good for bones and teeth -children who are iron deficient absorb lead more easily -interferes with binding of iron on heme molecule -can affect kidney

Grafts with burns options

-skin taken from cadaver which would be a temporary solution -synthetic skin substitutes -permanent skin coverings : dermatomes, take a piece of skin from a donor site, may be tricky because pt may not have a good donor site Dermal replacements but they are expensive

nurse's role in sex education

-treat as normal part of growth and development -*encourage use of correct terms* -differentiate sex vs. *sexuality - orientation and having emotions for another person* -questions and answers -values, problem solving skills -open for communication with parents

what are mechanisms to promote healthy sibling relationships?

-value each child individually and avoid comparison. Remind each child of his or her positive qualities and attributions. -help siblings see differences and similarities between themselves and the child with special needs. -teach siblings ways to interact with the child -seek to be fair in terms of discipline, attention, and resources. -let siblings settle their own differences. -legitimize reasonable anger. even children with special needs behave badly sometimes. -respect a siblings reluctance to be with or to include the child with special needs in activities.

wild animal bite or pet bite

-worried about rabies -rinse wound as much as possible -consider danger of rabies or tetanus shot or booster -puncture wound: prophylactic antibiotic, sometimes suturing needs to be done

postpubescence

1 to 2 years after puberty where skeletal growth is complete and reproductive functions become established

postpubescence

1-2 years after puberty; skeletal growth is complete and reproductive functions become established

what are the adaptive tasks of parents having children with chronic conditions?

1. accept the childs condition 2. manage the childs condition on a day-to-day basis 3. meet the childs normal developmental needs 4. meet the developmental needs of other family members 5. cope with ongoing stress and periodic crises 6. assist family members to manage their feelings 7. educate others about the childs condition 8. establish a support system

how do you facilitate shared decision making?

1. continually assess the impacts of the child's illness and treatment on the family 2. provide honest, accurate information regarding the trajectory of the disease, anticipated complications, prognostic information. 3. discuss what the family desires for the child's quality of life. 4. avoid personal opinion or judgement of the families questions and decisions 5. beware of nurses personal and cultural assumptions and the ways these assumptions impact communication, decision making, and judgement.

what are the goals of home care?

1. normalize the life of the child 2.minimize the disruptive impact of the childs condition on the family 3. foster the childs maximum growth and development

carbon monoxide poisoning treatment

100% oxygen

If a child ingests something

1st: call poision control center 2nd: assess VS, mental status, respiratory support, circulatory support if needed Main thing after CAB assessment is to terminate exposure, so get those pills out of the childs mouth, flush body surface exposed, identify the poison, call poison control center

prepubescence

2 years preceding puberty (varying ages from 9-12 (but girls about 2 years before boys))

what percent of total height is achieved during puberty?

20-25%; usually occurs within a 24-36 month period

what percentage of children are obese?

25-30%

height increases by ___ inches per year, and weight increases by ___ kg per year

2inches, 2-3 kg

Partial thickness burn

2nd degree >blister, variable amount of scarring >does not include sweat glands or hair follicles >can be extensive scarring

in females, estrogen increase until about ___ after menarche; estrogen then remains at this max level throughout reproductive life

3 years

normal bladder capacity in child

300-350 ml sufficient to hold nighttime urine

normal bladder capacity in children

300-350mL is sufficient to hold a night's urine

Full Thickness burn

3rd degree burn >extends into subcutaneous >nerve endings, sweat glands, hair follicles >lack of sensation >requires surgery: usually grafting 4th degree burn >full thickneses >include muscle, fascia, bone >very significant

Which action would indicate a priority for the nurse in terms of health promotion safety? 8-year-old child uses helmet protection while riding a bicycle. 4-year-old child wears protective equipment while on a skateboard. School-age child uses car seat restraint system. Protective equipment is used while the 9-year-old child is riding a scooter.

4-year-old child wears protective equipment while on a skateboard. Skateboard use is not recommended for children aged 5 and younger regardless if they are wearing protective equipment. All of the other options indicate that attention has been placed on safety concerns and that the children are developmentally appropriate to handle the physical skill activity.

What is the difference in sports between ages 5-8 and 8-10?

5-8: not focussed on winning 8-10: like competition, encourage a variety of sports to try, prone to injuries bc of competition

At which age, is a strong preference exhibited for members of the same sex to engage in play activities rather than play with mixed groups? 7 6 8 9

7 At age 7, boys prefer to play with boys and girls prefer to play with girls. At age 6, play is considered to be more independent but showing some degree of socialization. Between the ages of 8 and 9, there is more interest in body-girl relationships and beginning to mix group play.

androgens are secreted in small and gradually increasing amounts up to ___ to ___ years, then a rapid increase in BOTH SEXES UNTIL 15 YEARS

7-9 years

what ages may resist going to bed?

8-11 years

thelarche

8-13 years; breast buds

adrenarche

8-13; pubic hair growth

prepubescence age

9-12; typically 2 years before boys for girls

the average amount of sleep a night is ___ hours in school aged children, but it is highly individualized

9.5

manifestations of kjlinefelter syndrome

> may not be diagnosed until patient is seen for infertility > azoospermia; small testes >defective development of secondary sex characteristics >cognitive impairment of varying degrees' behavioral problems; possibly gross motor difficulties

primary amenorrhea

> no secondary sex characteristics and no menarche by age 14 and 15 OR >secondary sex characteristics are present but menarche has not occurred by age 16 to 16 1/2 years >no uterine bleeding after attaining SMR 5 for 1 year or after breast development for 4 years

Sleep problems in toddlers and preschoolers

>have trouble going to sleep >wake up at night Causes: increased autonomy trying to exert control by resisting bedtime negative sleep associations fears parents don't set limits no bedtime routines

Greg, age 2½ years, was admitted to the pediatric unit yesterday. His parents are making plans to visit as often as possible during his hospitalization. Greg's parents complain to the nurse that the child "cries, screams, and throws himself" whenever they leave the hospital to eat. The nurse should do which of the following? A) Explain that his behavior is a normal response to hospitalization. B) Explain that this behavior will diminish in a few days. C) Encourage the parents not to leave the child's room. D) Encourage the parents to leave when the child is asleep.

A

A (This school-age child is attempting to maintain control. The nurse should provide the girl with structured choices about when the IV will be inserted. This can be characteristic behavior when an individual needs to maintain some control over a situation. The child is trying to have some control in the hospital experience.)

A 10-year-old girl needs to have another intravenous (IV) line started. She keeps telling the nurse, "Wait a minute," and, "I'm not ready." The nurse should recognize that: a. This is normal behavior for a school-age child. b. This behavior is usually not seen past the preschool years. c. The child thinks the nurse is punishing her. d. The child has successfully manipulated the nurse in the past.

C (A 15-year-old boy admitted with a vaso-occlusive sickle cell crisis.)

A 14-year-old boy is being admitted to the hospital for an appendectomy. Which roommate should the nurse assign with this patient? a. A 4-year-old boy who is first day post-appendectomy surgery b. A 6-year-old boy with pneumonia c. A 15-year-old boy admitted with a vaso-occlusive sickle cell crisis d. A 12-year-old boy with cellulitis

95th

A BMI greater than or equal to the _____________ percentile is considered obese

A (Children often undergo separation anxiety when they are separated from their parents. This separation anxiety manifests in different stages such as protest, despair, and detachment. Protest is the first stage of separation anxiety, during which the child screams, cries, or hits the other person for separating him or her from the parents. After this stage, the child enters the stage of despair, where the child begins to withdraw from others and stay depressed. During this stage, the child starts wetting the bed and sucking the thumb because of fear and anxiety. After the stage of despair, the child enters the stage of detachment. The child starts interacting with strangers and takes an increased interest in the surroundings or sits in a corner and plays with a toy.)

A child has recently been admitted to the hospital. The child's parents have not yet arrived at the hospital. What behavior is the child exhibiting that leads the nurse to believe the child is exhibiting the stage of protest? The child: A. Screams and hits the nurse. B. Is withdrawn from others. C. Has the habit of bed-wetting. D. Sits in a corner with a toy.

D (Hospitalized children undergo depression when they are separated from their parents. As they go through the stages of separation anxiety, children eventually detach from their parents and develop new and shallow relationships. Children interact with others and develop new relationships as a result of resignation, not contentment. Children who are detached begin to show increased interest in their surroundings. They are also not developing their social interaction skills. Children try not to think about the separation; hence, they start developing new interactions.)

A child is hospitalized for a chronic illness. Initially, the child showed symptoms of depression but later started interacting with others. What does the nurse infer from the patient's behavior? The child is: A. Content with the care provided. B. Showing improved social skills. C. Getting used to the surroundings. D. Detached from both parents.

A (The child's behavior indicates that the child is in the protest stage of separation anxiety. The child is less able to cope with separation because of stress from the illness and wants to stay with the parents. The child expresses anger indirectly by showing behavioral changes. These behavioral changes are observed in the protest stage of separation anxiety. In the despair stage, the child appears less active, depressed, and uninterested in play and refuses to eat food. The denial stage is also called the detachment stage. In this stage the child is interested in the surroundings, plays with others, and forms new but superficial relationships with others.)

A child is hospitalized for treatment of the flu. Once the child's parents leave, the child starts crying, looks for parents, attempts to leave, refuses to take medicine, hits other children, and breaks toys. What should the nurse conclude from the child's behavior? The child is in the: A. Protest stage. B. Despair stage. C. Denial stage. D. Detachment stage.

C (The playroom is a safe haven for children, free from medical or nursing procedures. The child can be returned to his or her room for the blood pressure and then escorted back to the playroom. The exam room is reserved for painful procedures that should not be performed in the child's hospital bed. Documenting that the blood pressure was not obtained because the child was in the playroom is inappropriate.)

A child is playing in the playroom. The nurse needs to take a blood pressure on the child. Which is the appropriate procedure for obtaining the blood pressure? a. Take the blood pressure in the playroom. b. Ask the child to come to the exam room to obtain the blood pressure. c. Ask the child to return to his or her room for the blood pressure, then escort the child back to the playroom. d. Document that the blood pressure was not obtained because the child was in the playroom.

A (The child does not have enough knowledge about the tonsillectomy. Therefore the child may have fear about the surgery. The nurse should explain to the child that once the tonsils are removed, they do not need "fixing" again. It helps relieve the child's fear about the operation, and the child may feel comfortable. Once the tonsillectomy has been done in the child, a second operation is not required after another throat infection. There will actually not be a need for repeating the operation at any age. The child needs to be instructed that there may be other sore throats in the future. However, the child needs to be reassured that future sore throats will not require surgery.)

A child is scheduled for a tonsillectomy and is afraid of the surgery. The child asks the nurse, "Will I need another operation when I have a sore throat again?" Which response should the nurse give to the child? A. "Once your tonsils are taken out, you will not need the surgery again." B. "You will need to repeat the surgery when you have another infection." C. "You will need to have another surgery when you turn 14 years old." D. "Once your tonsils are fixed, you will not have any more sore throats."

C (Children who undergo orofacial surgery should not use a straw for drinking fluids because it can damage the surgical site. Therefore the parents should not use cup with a lid and a straw for giving fluids to the child. The parents should bring a blanket and pillow for the child in the car so that the child can sit or sleep properly. Parents should bring a plastic bag, which will be helpful if the child becomes nauseated or vomits. The parents should give prescribed pain medication to the child before leaving the facility for relieving pain.)

A child who has undergone orofacial surgery is getting discharged. The nurse teaches the parents about how to safely transport the child on the way home. Which statement made by the parents indicates a need for additional teaching? "We should: A. Have a blanket and pillow for our child for the car ride home." B. Have a plastic bag for our child in case of nausea and vomiting." C. Use a cup with a lid and a straw for giving fluids to our child." D. Make sure our child has pain medication before discharge."

concept of illness, intellectual maturity

A child's ______ is MORE IMPORTANT than _______ in predicting anxiety. This is impacted by temperament, parental relationships, age, male gender, intelligence, compounding stressors.

An 8-year-old girl tells the nurse that she has cancer because God is punishing her for being bad. What should the nurse interpret this as?

A common belief at this age

Overuse syndrome

A common feature of this is repetitive microtrauma that results in inflammation, pain, tenderness, swelling, and disability

A parent asks about whether a 7-year-old child is able to care for a dog. Based on the childs age, what does the nurse suggest

A dog can help the child develop confidence and emotional health.

A, C, E (The parents should use a basin or plastic bag for managing vomiting in the child. A blanket and pillow should be kept in the car to provide comfort. Pain medication can be administered before leaving to provide a pain-free journey home. The use of a car safety restraint system should be encouraged for the child's safety. Also, the use of a straw for drinking fluids should be encouraged except for children with oral facial surgeries.)

A hospitalized child is being released for home health care. What suggestions should the nurse provide to prepare the family for transporting the child home? Select all that apply. A. Take a basin in case of vomiting B. Avoid using the restraint system C. Keep a blanket and pillow in the car D. Discourage the use of a straw for drinking fluids E. Administer prescribed pain medication before leaving

A (Because toddlers have a limited concept of time, the nurse should translate the mother's statement about being back around noon by linking the arrival time to a familiar activity that takes place at that time. Saying that the child's mother will always return does not give the child any information about when his mother will visit. Twelve noon is a meaningless concept for a toddler. Saying generally that the child's mother will visit does not give the child specific information about when his mother will visit.)

A mother tells the nurse that she will visit her 2-year-old son tomorrow about noon. During the child's bath, he asks for mommy. The nurse's best reply is: A. "Mommy will be here after lunch." B. "Mommy always comes back to see you." C. "Your mommy told me yesterday that she would be here today about noon." D. "Mommy had to go home for a while, but she will be here today."

B (Allow the child to hold the digital thermometer while taking the child's blood pressure.)

A nurse in the emergency department is assessing a 5-year-old child with symptoms of pneumonia and a fever of 102° F. Which intervention can the nurse implement to promote a sense of control for the child? a. None, this is an emergency and the child should not participate in care. b. Allow the child to hold the digital thermometer while taking the child's blood pressure. c. Ask the child if it is OK to take a temperature in the ear. d. Have parents wait in the waiting room.

B, C, D (b. Administration of chamomile tea at bedtime c. Hypnotherapy for relief of pain d. Acupressure to relieve headaches)

A nurse is interviewing the parents of a toddler about use of complementary or alternative medical practices. The parents share several practices they use in their household. Which should the nurse document as complementary or alternative medical practices (select all that apply)? a. Use of acetaminophen (Tylenol) for fever b. Administration of chamomile tea at bedtime c. Hypnotherapy for relief of pain d. Acupressure to relieve headaches e. Cool mist vaporizer at the bedside for "stuffiness"

C (Perform the exam while the child is on the parent's lap.)

A nurse is preparing to complete an admission assessment on a 2-year-old child. The child is sitting on the parent's lap. Which technique should the nurse implement to complete the physical exam? a. Ask the parent to place the child in the hospital crib. b. Take the child and parent to the exam room. c. Perform the exam while the child is on the parent's lap. d. Ask the child to stand by the parent while completing the exam.

B, C, D (Allows the child to express feelings)

A nurse plans therapeutic play time for a hospitalized child. Which are the benefits of therapeutic play (select all that apply)? a. Serves as method to assist disturbed children b. Allows the child to express feelings c. The nurse can gain insight into the child's feelings d. The child can deal with concerns and feelings e. Gives the child a structured play environment

The nurse is providing support to parents at the time their child is diagnosed with chronic disabilities. The nurse notices that the parents keep asking the same questions. What is the nurses best intervention? a. Patiently continue to answer questions. b. Kindly refer them to someone else for answering their questions. c. Recognize that some parents cannot understand explanations. d. Suggest that they ask their questions when they are not upset.

ANS: A Diagnosis is one of the anticipated stress points for parents. The parents may not hear or remember all that is said to them. The nurse should continue to provide the kind of information they desire. This is a particularly stressful time for the parents; the nurse can play a key role in providing necessary information. Parents should be provided with oral and written information. The nurse needs to work with the family to ensure understanding of the information. The parents require information at the time of diagnosis. Other questions will arise as they adjust to the information.

The parents of a child born with disabilities ask the nurse for advice about discipline. The nurses response should be based on knowledge that discipline is: a. essential for the child. b. too difficult to implement with a special-needs child. c. not needed unless child becomes problematic. d. best achieved with punishment for misbehavior.

ANS: A Discipline is essential for the child. It provides boundaries on which to test out their behavior and teaches them socially acceptable behaviors. The nurse should teach the parents ways to manage the childs behavior before it becomes problematic. Punishment is not effective in managing behavior.

The nurse is providing support to a family who is experiencing anticipatory grief related to their childs imminent death. Which of the following is an appropriate nursing intervention? a. Be available to family. b. Attempt to lighten the mood. c. Suggest activities to cheer up the family. d. Discourage crying until actual time of death.

ANS: A One of the most important nursing interventions of death is the availability of the nurse for the family.

A common parental reaction to a child with special needs is parental overprotection. Parental behavior suggestive of this includes: a. giving inconsistent discipline. b. providing consistent, strict discipline. c. forcing child to help self, even when not capable. d. encouraging social and educational activities not appropriate to childs level of capability.

ANS: A Parental overprotection is manifested by the parents fear of letting the child achieve any new skill; they allow the child to avoid all discipline and cater to every desire to prevent frustration. Overprotective parents: do not set limits and or institute discipline; prefer to remain in the role of total caregiver; do not allow the child to perform self-care; and do not encourage the child to participate in social and educational activities.

The nurse is caring for a child who has just died. The parents ask to be left alone so that they can rock their child one more time. The nurses most appropriate response is to: a. grant their request. b. assess why they feel this is necessary. c. discourage this because it will only prolong their grief. d. kindly explain that they need to say good-bye to their child now and leave.

ANS: A The parents should be allowed to remain with their child after the death. The nurse can remove all the tubes and equipment and offer the parents the option of preparing the body.

Which is most descriptive of a school-age childs reaction to death? a. Is very interested in funerals and burials b. Has little understanding of words such as forever c. Imagines the deceased person to be still alive d. Has an idealistic view of world and criticizes funerals as barbaric

ANS: A The school-age child is interested in post-death services and may be inquisitive about what happens to the body.

Which is the most appropriate nursing intervention to promote normalization in a school-age child with a chronic illness? a. Give child as much control as possible. b. Ask childs peer to make child feel normal. c. Convince child that nothing is wrong with him or her. d. Explain to parents that family rules for the child do not need to be the same as for healthy siblings.

ANS: A The school-age child who is ill may be forced into a period of dependency. To foster normalcy, the child should be given as much control as possible. It is unrealistic to expect one individual to make the child feel normal. The child has a chronic illness. It would be unacceptable to convince the child that nothing is wrong. The family rules should be similar for each of the children in a family. Resentment and hostility can arise if different standards are applied to each child.

The nurse is talking with the parents of a child who died 6 months ago. They sometimes still hear the childs voice and have trouble sleeping. They describe feeling empty and depressed. The nurse should recognize that: a. these are normal grief responses. b. the pain of the loss is usually less by this time. c. these grief responses are more typical of the early stages of grief. d. this grieving is essential until the pain is gone and the child is gradually forgotten.

ANS: A These are normal grief responses. The process of grief work is lengthy.

Which is an appropriate nursing intervention when providing comfort and support for a child when death is imminent? a. Limit care to essentials. b. Avoid playing music near child. c. Explain to child need for constant measurement of vital signs. d. Whisper to child instead of using normal voice.

ANS: A When death is imminent, care should be limited to interventions for palliative care.

A cure is no longer possible for a young child with cancer. The nursing staff recognizes that the goal of treatment must shift from cure to palliation. Which is an important consideration at this time? a. The family is included in the decision to shift the goals of treatment. b. The decision must be made by the health professionals involved in the childs care. c. The family needs to understand that palliative care takes place in the home. d. The decision should not be communicated to the family because it will encourage a sense of hopelessness.

ANS: A When the child reaches the terminal stage, the nurse and physician should explore the familys wishes. The family should help decide what interventions will occur as they plan for their childs death.

Which are appropriate statements the nurse should make to parents after the death of their child? (Select all that apply.) a. We feel so sorry that we couldnt save your child. b. Your child isnt suffering anymore. c. I know how you feel. d. Youre feeling all the pain of losing a child. e. You are still young enough to have another baby.

ANS: A, D By saying, We feel so sorry that we couldnt save your child, the nurse is expressing personal feeling of loss or frustration, which is therapeutic. Stating, Youre feeling all the pain of losing a child, focuses on a feeling, which is therapeutic. The statement, Your child isnt suffering anymore, is a judgmental statement, which is nontherapeutic. I know how you feel and Youre still young enough to have another baby are statements that give artificial consolation and are nontherapeutic.

Which describes avoidance behaviors parents may exhibit when learning that their child has a chronic condition? (Select all that apply.) a. Refuses to agree to treatment b. Shares burden of disorder with others c. Verbalizes possible loss of child d. Withdraws from outside world e. Punishes self because of guilt and shame

ANS: A, D, E A parent who refuses to agree to treatment, withdraws from the outside world, and punishes self because of guilt and shame is exhibiting avoidance coping behaviors. A parent who shares the burden of disorder with others and verbalizes possible loss of child is exhibiting approach coping behaviors.

At the time of a childs death, the nurse tells his mother, We will miss him so much. The best interpretation of this is that the nurse is: a. pretending to be experiencing grief. b. expressing personal feelings of loss. c. denying the mothers sense of loss. d. talking when listening would be better.

ANS: B A patients death is one of the most stressful aspects of critical care or oncology nursing. Nurses experience reactions similar to those of family members because of their involvement with the child and family during the illness. Nurses often have feelings of personal loss when a patient dies.

Parents are asking about an early intervention program for their child who has special needs. The nurse relates that this program is for which age of child? a. Birth to 1 year of age b. Birth to 3 years of age c. Ages 1 to 4 d. Ages 4 and 5

ANS: B A variety of supplemental programs have been designed in the school system to accommodate special needs, both at school age and younger, through early intervention, which consists of any sustained and systematic effort to assist children from birth to age 3 years with disabilities and those who are developmentally vulnerable.

Kelly, an 8-year-old girl, will soon be able to return to school after an injury that resulted in several severe, chronic disabilities. Which is the most appropriate action by the school nurse? a. Recommend that the childs parents attend school at first to prevent teasing. b. Prepare the childs classmates and teachers for changes they can expect. c. Refer the child to a school where the children have chronic disabilities similar to hers. d. Discuss with the child and her parents the fact that her classmates will not accept her as they did before.

ANS: B Attendance at school is an important part of normalization for Kelly. The school nurse should prepare teachers and classmates about her condition, abilities, and special needs. A visit by the parents can be helpful, but unless the classmates are prepared for the changes, it alone will not prevent teasing. Kellys school experience should be normalized as much as possible. Children need the opportunity to interact with healthy peers, as well as to engage in activities with groups or clubs composed of similarly affected persons. Children with special needs are encouraged to maintain and reestablish relationships with peers and to participate according to their capabilities.

Which best describes how preschoolers react to the death of a loved one? a. Preschooler is too young to have a concept of death. b. Preschooler may feel guilty and responsible for the death. c. Grief is acute but does not last long at this age. d. Grief is usually expressed in the same way in which the adults in the preschoolers life are expressing grief.

ANS: B Because of egocentricity, the preschooler may feel guilty and responsible for the death.

Which intervention will encourage a sense of autonomy in a toddler with disabilities? a. Avoid separation from family during hospitalizations. b. Encourage independence in as many areas as possible. c. Expose child to pleasurable experiences as much as possible. d. Help parents learn special care needs of their child.

ANS: B Encouraging the toddler to be independent encourages a sense of autonomy. The child can be given choices about feeding, dressing, and diversional activities, which will provide a sense of control. Avoiding separation from family during hospitalizations, and helping parents learn special care needs of their child should be practiced as part of family-centered care. It does not necessarily foster autonomy. Exposing the child to pleasurable experiences, especially sensory ones, is a supportive intervention. It does not promote autonomy.

Families progress through various stages of reactions when a child is diagnosed with a chronic illness or disability. After the shock phase, a period of adjustment usually follows. This is often characterized by which of the following responses? a. Denial b. Guilt and anger c. Social reintegration d. Acceptance of childs limitations

ANS: B For most families, the adjustment phase is accompanied by several responses. Guilt, self-accusation, bitterness, and anger are common reactions. The initial diagnosis of a chronic illness or disability often is met with intense emotion, characterized by shock and denial. Social reintegration and acceptance of the childs limitations are the culmination of the adjustment process.

Which represents a common best practice in the provision of services to children with special needs? a. Care is now being focused on the childs chronologic age. b. Children with special needs are being integrated into regular classrooms. c. Children with special needs no longer have to be cared for by their families. d. Children with special needs are being separated into residential treatment facilities.

ANS: B Normalization refers to behaviors and interventions for the disabled to integrate into society by living life as persons without a disability would. For children, normalization includes attending school and being integrated into regular classrooms. This affords the child the advantages of learning with a wide group of peers. Care is necessarily focused on the childs developmental age. Home care by the family is considered best practice. The nurse can assist families by assessing social support systems, coping strategies, family cohesiveness, and family and community resources.

The nurse and a new nurse are caring for a child who will require palliative care. Which statement made by the new nurse would indicate a correct understanding of palliative care? a. Palliative care serves to hasten death and make the process easier for the family. b. Palliative care provides pain and symptom management for the child. c. The goal of palliative care is to place the child in a hospice setting at the end of life. d. The goal of palliative care is to act as the liaison between the family, child, and other health care professionals.

ANS: B One of the goals of palliative care is to provide pain and symptom management.

A nurse is planning palliative care for a child with severe pain. Which should the nurse expect to be prescribed for pain relief? a. Opioids as needed b. Opioids on a regular schedule c. Distraction and relaxation techniques d. Nonsteroidal anti-inflammatory drugs

ANS: B Pain medications, for children in palliative care, should be given on a regular schedule, and extra doses for breakthrough pain should be available to maintain comfort. Opioid drugs such as morphine should be given for severe pain, and the dose should be increased as necessary to maintain optimal pain relief. Techniques such as distraction, relaxation techniques, and guided imagery should be combined with drug therapy to provide the child and family strategies to control pain. Nonsteroidal anti-inflammatory drugs are not sufficient to manage severe pain for children in palliative care.

The nurse comes into the room of a child who was just diagnosed with a chronic disability. The childs parents begin to yell at the nurse about a variety of concerns. Which is the nurses best response? a. What is really wrong? b. Being angry is only natural. c. Yelling at me will not change things. d. I will come back when you settle down.

ANS: B Parental anger after the diagnosis of a child with a chronic disability is a common response. One of the most common targets for parental anger is members of the staff. The nurse should recognize the common response of anger to the diagnosis and allow the family to ventilate. What is really wrong?/Yelling at me will not change things/I will come back when you settle down will place the parents on the defensive and not facilitate communication.

Lindsey, age 5 years, will be starting kindergarten next month. She has cerebral palsy, and it has been determined that she needs to be in a special education classroom. Her parents are tearful when telling the nurse about this and state that they did not realize her disability was so severe. The best interpretation of this situation is that: a. this is a sign parents are in denial. b. this is a normal anticipated time of parental stress. c. the parents need to learn more about cerebral palsy. d. the parents are used to having expectations that are too high.

ANS: B Parenting a child with a chronic illness can be stressful for parents. There are anticipated times that parental stress increases. One of these identified times is when the child begins school. Nurses can help parents recognize and plan interventions to work through these stressful periods. The parents are not in denial; they are responding to the childs placement in school. The parents are not exhibiting signs of a knowledge deficit; this is their first interaction with the school system with this child.

The feeling of guilt that the child caused the disability or illness is especially critical in which child? a. Toddler b. Preschooler c. School-age child d. Adolescent

ANS: B Preschoolers are most likely to be affected by feelings of guilt that they caused the illness or disability or are being punished for wrongdoings. Toddlers are focused on establishing their autonomy. The illness will foster dependence. The school-age child will have limited opportunities for achievement and may not be able to understand limitations. Adolescents face the task of incorporating their disabilities into their changing self-concept.

Approach behaviors are those coping mechanisms that result in a familys movement toward adjustment and resolution of the crisis of having a child with a chronic illness or disability. Which is considered an approach behavior? a. Is unable to adjust to a progression of the disease or condition b. Anticipates future problems and seeks guidance and answers c. Looks for new cures without a perspective toward possible benefit d. Fails to recognize seriousness of childs condition despite physical evidence

ANS: B The parents who anticipate future problems and seek guidance and answers are demonstrating approach behaviors. They are demonstrating positive actions in caring for their child. Being unable to adjust to a progression of the disease or condition, looking for new cures without a perspective toward possible benefit, and failing to recognize seriousness of childs condition despite physical evidence are avoidance behaviors. The parents are moving away from adjustment (and toward maladaptation) in the crisis of a child with chronic illness or disability.

A nurse is caring for a child who is near death. Which physical signs indicate the child is approaching death? (Select all that apply.) a. Body feels warm b. Tactile sensation decreasing c. Speech becomes rapid d. Change in respiratory pattern e. Difficulty swallowing

ANS: B, D, E Physical signs of approaching death include: tactile sensation beginning to decrease, a change in respiratory pattern, and difficulty swallowing. Even though there is a sensation of heat the body feels cool, not warm, and speech becomes slurred, not rapid.

The nurse case manager is planning a care conference about a young child who has complex health care needs and will soon be discharged home. Who should the nurse invite to the conference? a. Family and nursing staff b. Social worker, nursing staff, and primary care physician c. Family and key health professionals involved in childs care d. Primary care physician and key health professionals involved in the childs care

ANS: C A multidisciplinary conference is necessary for coordination of care for children with complex health needs. The family is included, along with key health professionals who are involved in the childs care. The nursing staff can address the childs nursing care needs with the family, but other involved disciplines must be included. The family must be included in the discharge conferences, which allows them to determine what education they will require and the resources needed at home. A member of the nursing staff must be included to review the childs nursing needs.

At what age do most children have an adult concept of death as being inevitable, universal, and irreversible? a. 4 to 5 years b. 6 to 8 years c. 9 to 11 years d. 12 to 16 years

ANS: C By age 9 to 11 years, children have an adult concept of death. They realize that it is inevitable, universal, and irreversible.

Which nursing intervention is especially helpful in assessing parental guilt when a disability or chronic illness is diagnosed? a. Ask the parents if they feel guilty. b. Discuss guilt only after the parents mention it. c. Discuss the meaning of the parents religious and cultural background. d. Observe for signs of overprotectiveness.

ANS: C Guilt may be associated with cultural or religious beliefs. Some parents are convinced that they are being punished for some previous misdeed. Others may see the disorder as a sacrifice sent by God to test their religious beliefs. The nurse can help the parents explore their religious beliefs. The parents may not be able to identify the feelings of guilt. It would be appropriate for the nurse to explore their adjustment responses. Overprotectiveness is a parental response during the adjustment phase. The parents fear letting the child achieve any new skill and avoid all discipline.

A 16-year-old boy with a chronic illness has recently become rebellious and is taking risks such as missing doses of his medication. The nurse should explain to his parents that: a. he needs more discipline. b. he needs more socialization with peers. c. this is part of normal adolescence. d. this is how he is asking for more parental control.

ANS: C Risk taking, rebelliousness, and lack of cooperation are normal parts of adolescence.

A school-age child is diagnosed with a life-threatening illness. The parents want to protect their child from knowing the seriousness of the illness. The nurse should explain that: a. this will help the child cope effectively by denial. b. this attitude is helpful to give parents time to cope. c. terminally ill children know when they are seriously ill. d. terminally ill children usually choose not to discuss the seriousness of their illness.

ANS: C The child needs honest and accurate information about the illness, treatments, and prognosis. Children, even at a young age, realize that something is seriously wrong and that it involves them. The nurse should help the parents understand the importance of honesty.

A 9-year-old boy has several physical disabilities. His father explains to the nurse that his son concentrates on what he can, rather than cannot, do and is as independent as possible. The nurses best interpretation of this is that the: a. father is experiencing denial. b. father is expressing his own views. c. child is using an adaptive coping style. d. child is using a maladaptive coping style.

ANS: C The father is describing a well-adapted child who has learned to accept physical limitations. These children function well at home, at school, and with peers. They have an understanding of their disorder that allows them to accept their limitations, assume responsibility for care, and assist in treatment and rehabilitation. The father is describing his childs behavior. He is not denying the childs limitations. The father is exhibiting an adaptive coping style.

The nurse observes that a seriously ill child passively accepts all painful procedures. The nurse should recognize that this is most likely an indication that the child is experiencing a: a. sense of hopefulness. b. sense of chronic sorrow. c. belief that procedures are a deserved punishment. d. belief that procedures are an important part of care.

ANS: C The nurse should be particularly alert to the child who passively accepts all painful procedures. This child may believe that such acts are inflicted as deserved punishment. The child who is hopeful is mobilized into goal-directed actions. This child would actively participate in care. Chronic sorrow is the feeling of sorrow and loss that recurs in waves over time. It is usually evident in the parents, not in the child. A child who believes that procedures are an important part of care would actively participate in care. Nursing interventions should be used to minimize the pain.

Which are adaptive coping patterns used by children with special needs? (Select all that apply.) a. Feels different and withdraws b. Is irritable, moody, and acts out c. Seeks support d. Develops optimism

ANS: C, D Adaptive coping patterns used by children with special needs include seeking support and developing optimism. Maladaptive behaviors are seeing themselves as different and withdrawing and becoming irritable, moody, and beginning to act out.

At what developmental period do children have the most difficulty coping with death, particularly if it is their own? a. Toddlerhood b. Preschool c. School-age d. Adolescence

ANS: D Adolescents, because of their mature understanding of death, remnants of guilt and shame, and issues with deviations from normal, have the most difficulty coping with death.

Most parents of children with special needs tend to experience chronic sorrow. This is characterized by: a. lack of acceptance of childs limitation. b. lack of available support to prevent sorrow. c. periods of intensified sorrow when experiencing anger and guilt. d. periods of intensified sorrow and loss that occur in waves over time.

ANS: D Chronic sorrow is manifested by feelings of sorrow and loss that recur in waves over time. The sorrow is in response to the recognition of the childs limitations. The family should be assessed in an ongoing manner to provide appropriate support as the needs of the family change. The sorrow is not preventable. The chronic sorrow occurs during the reintegration and acknowledgment stage.

A preschooler is found digging up a pet bird that was recently buried after it died. The best explanation for this behavior is that: a. he has a morbid preoccupation with death. b. he is looking to see whether a ghost took it away. c. the loss is not yet resolved, and professional counseling is needed. d. reassurance is needed that the pet has not gone somewhere else.

ANS: D The preschooler can recognize that the pet has died but has difficulties with the permanence. Digging up the bird gives reassurance that the bird is still present.

Nursing interventions to help the siblings of a child with special needs cope include: a. explaining to the siblings that embarrassment is unhealthy. b. encouraging the parents not to expect siblings to help them care for the child with special needs. c. providing information to the siblings about the childs condition only as they request it. d. suggesting to the parents ways of showing gratitude to the siblings who help care for the child with special needs.

ANS: D The presence of a child with special needs in a family will change the family dynamic. Siblings may be asked to take on additional responsibilities to help the parents to care for the child. The parents should show gratitude, such as an increase in allowance, special privileges, and verbal praise. Embarrassment may be associated with having a sibling with a chronic illness or disability. Parents must be able to respond in an appropriate manner without punishing the sibling. The parents may need assistance with the care of the child. Most siblings are positive about the extra responsibilities. The siblings need to be informed about the childs condition before a nonfamily member does so. The parents do not want the siblings to fantasize about what is wrong with the child.

The nurse is talking with the parent of a child newly diagnosed with a chronic illness. The parent is upset and tearful. The nurse asks, Whom do you talk to when something is worrying you? This should be interpreted as: a. inappropriate, because the parent is so upset. b. a diversion of the present crisis to similar situations with which the parent has dealt. c. an intervention to find someone to help the parent. d. part of assessing the parents available support system.

ANS: D These are important data for the nurse to obtain. This question will provide information about the marital relationship (whether the parent speaks to the spouse), alternate support systems, and ability to communicate. By assessing these areas, the nurse can facilitate the identification and use of community resources as needed. It is an important part of assessment information to determine the parents support network. The nurse is obtaining information to help support the parent through the diagnosis. The parent is not in need of additional parenting help at this time.

Which term best describes a multidisciplinary approach to the management of a terminal illness that focuses on symptom control and support? a. Dying care b. Curative care c. Restorative care d. Palliative care

ANS: D This is one of the definitions of palliative care. The goal of palliative care is the achievement of the highest possible quality of life for patients and their families.

Turner syndrome

Absence of one of the X chromosomes (45,X)

Acetaminophen antidote

Acetylcysteine Acute symptoms: N/V, sweating, may get pale

Aspirin poisoning

Activated charcoal -can make them acidotic, give sodium bicarb to counteract that, may have to cool patient because of hyperpyrexia, if causes bleeding may need to give vitamin K -acute signs >tinnitus

What is the most important nursing consideration in the management of cellulitis? Application of Burow solution compresses Administration of oral or parenteral antibiotics Topical application of an antibiotic Incision and drainage of severe lesions

Administration of oral or parenteral antibiotics Oral or parenteral antibiotics are indicated depending on the extent of the cellulitis. Warm water compresses may be indicated for limited cellulitis. Antibiotics need to be administered systemically (orally or parenterally), not topically. If incision and drainage are implemented, there is a risk of spreading infection or making the lesion worse.

The school nurse is teaching a class on injury prevention. What should be included when discussing firearms? Adolescents are too young to use a gun properly for hunting. Gun carrying among adolescents is on the rise, primarily among inner-city youth. Nonpowder guns (air rifles, BB guns) are a relatively safe alternative to powder guns. Adolescence is the peak age for being either a victim or an offender in an injury involving a firearm.

Adolescence is the peak age for being either a victim or an offender in an injury involving a firearm. Gun carrying among adolescents is on the rise. The increase in gun availability is linked to increased gun injuries and deaths among children. Adolescents can be taught to safely use and store guns for hunting. Gun carrying is on the rise in adolescents and is not limited to stereotypical inner-city youth. Nonpowder guns, such as air rifles and BB guns, cause almost as many injuries as powder guns.

What is an important consideration for the school nurse planning a class on injury prevention for adolescents? Adolescents generally are not risk takers. Adolescents can anticipate the long-term consequences of serious injuries. Adolescents need to discharge energy, often at the expense of logical thinking. During adolescence, participation in sports should be limited to prevent permanent injuries.

Adolescents need to discharge energy, often at the expense of logical thinking. The physical, sensory, and psychomotor development of adolescents provides a sense of strength and confidence. There is also an increase in energy coupled with risk taking that puts them at risk, because they often ignore logical thinking. Adolescents tend to be risk takers because of their feelings of indestructibility. The feelings of indestructibility that accompany adolescence interfere with understanding the consequences of their behavior, thus increasing their potential for injuries. Sports can be a useful way to discharge energy and should not be limited. Care must be taken to avoid overuse injuries and to use appropriate protective equipment.

B, D, E (Detachment is the third stage of separation anxiety. It is also referred to as the denial stage. In this stage the child begins to take an interest in the surroundings. The child also forms new but superficial relationships with others and becomes more interested in interacting with strangers or familiar caregivers. The child's behavior indicates that the child has finally adjusted to the loss of the parents. This is a serious stage because reversal of the potential adverse effects is less likely to occur after detachment. Refusing to eat, drink, and get out of bed are characteristics of the despair stage of separation anxiety. Attempting to leave the hospital to find the parents is observed in protest stage of separation anxiety.)

After assessment, the nurse notices that a child is in the detachment stage of separation anxiety. Which behavioral changes would the nurse observe in the child? Select all that apply. A. Refuses to eat, drink, or get out of the bed B. Shows an increased interest in the surroundings C. Tries to leave the hospital to find the parents D. Begins to form new relationships with others E. Interacts with strangers or familiar caregivers

A nurse working with adolescents is aware of common drugs of abuse. Which of the following drugs is the most common drug of abuse in the adolescent population? Alcohol Morphine Cocaine Oxycontin

Alcohol Alcohol is the drug most often used and abused by the adolescent population. The ease of access and the low cost make alcohol the drug of choice for many teenagers. Morphine is not the most common drug of abuse in the adolescent population. Cocaine and oxycontin are not the most common drugs of abuse in the adolescent population.

An adolescent is accompanied by their mother for an annual physical examination. Based on the nurse's knowledge of this age group, the nurse should avoid questions on which topics? Select all that apply. Alcohol use Sexual activity Cigarette smoking School performance Use of car seat belts

Alcohol use Sexual activity Cigarette smoking The nurse must maintain confidentiality, which is between the nurse and adolescent. Therefore, while the mother is in the room, the nurse should not ask personal questions. The nurse can ask general questions about academic performance and use of car seat belts without breaching confidentiality.

A toddler is hospitalized for an upcoming surgical procedure. Which method might provide the best way to inform the child about the surgery? By using anatomical drawings as illustrations and allowing the child to color them with markers. Allowing the child to dress up using surgical gown and mask. Having the child sign his name with an "X" on an actual surgical consent form. Taking the child to the operating theater to view a surgery.

Allowing the child to dress up using surgical gown and mask. The concept of dramatic play is used to provide information to children who are having complex health issues or who have to undergo surgical procedures or therapies. It allows for children to be able to respond and interact with the possibility of puzzling or frightening experiences related to the unknown. The use of anatomical drawings may be too realistic for the toddler even though markers would be allowed for coloring. Having the child sign an "X" on an actual surgical consent would not be understood this developmental level. Taking the child to view a surgery at this age may cause more anxiety.

B (Siblings experience loneliness, fear, worry, anger, resentment, jealousy, and guilt. The siblings experience stress equal to that of the hospitalized child. These are not uncommon responses by normal siblings. There is no evidence that the family has maladaptive coping or that the siblings lack understanding.)

Amy, age 6 years, needs to be hospitalized again because of a chronic illness. The clinic nurse overhears her school-age siblings tell her, "We are sick of Mom always sitting with you in the hospital and playing with you. It isn't fair that you get everything and we have to stay with the neighbors." The nurse's best assessment of this situation is that: a. The siblings are immature and probably spoiled. b. Jealousy and resentment are common reactions to the illness or hospitalization of a sibling. c. The family has ineffective coping mechanisms to deal with chronic illness. d. The siblings need to better understand their sister's illness and needs.

B (A toddler experiences separation anxiety secondary to being separated from the parents. To avoid this, the parents should be encouraged to room in as much as possible. Maintaining routines and ensuring privacy are helpful interventions, but they would not substitute for the parents. Contact with same-aged children would not substitute for having the parents present.)

An appropriate nursing intervention to minimize separation anxiety in a hospitalized toddler is to: a. Provide for privacy. b. Encourage parents to room in. c. Explain procedures and routines. d. Encourage contact with children the same age.

7 to 9 years 15 years

Androgens are secreted in small, gradually increased amounts up to ____________ years old, then there is a rapid increase in both sexes, especially boys until_____________

adolescents females

Anorexia is primarily seen in _____________ and young adult____________________

A child with a serious chronic illness will soon be discharged home. The case manager requests that the family provide total care for the child for a couple of days while the child is still hospitalized. Based on the principles of family-centered care, which statement addresses this principle? Appropriate because families are usually eager to get involved. Appropriate because it can be beneficial to the transition from hospital to home. Inappropriate because of legal issues when parents care for their children on hospital property. Inappropriate because the family will have to assume the care soon enough and this may increase their stress unnecessarily.

Appropriate because it can be beneficial to the transition from hospital to home. This is appropriate. At least two family members should be comfortable caring for the child before discharge. Caring for the child with the nurse available to answer questions and provide support and guidance will make the transition home for the parents and child easier. The family needs to learn the skills necessary to care for the child at home. Their eagerness is important, but it is not the reason to provide total care for their child while still hospitalized. The family members will be able to learn to care for their child with the supervision of nursing staff. Legal issues related to caring for their child in the hospital setting are not relevant. Learning to care for their child before discharge is essential to properly prepare the family to assume the care and minimize their stress level as much as possible.

Working with parents in preparation for discharge of a hospitalized child who will need to have wet to dry dressing changes performed at home will require that the nurse include which element in the plan of care? Arrange for home health nurse to change dressings as the parents may not understand the complexity of the task. Arrange for a step by step training sequence for wet to dry dressing changes with the parents of the child with return demonstration to evaluate understanding. Provide the parents with a detailed instruction sheet regarding the dressing change procedure as the method of instruction. Arrange for follow up with the child's pediatrician prior to the next scheduled dressing change so that the parents can receive further instruction.

Arrange for a step by step training sequence for wet to dry dressing changes with the parents of the child with return demonstration to evaluate understanding. Arranging for step-by-step sequenced instructions along with return demonstration should be included in the plan of care for the discharge of this child who requires wet to dry dressing changes. Arranging for home health to provide this service may not be possible in terms of insurance coverage. Providing the parents with a detailed instruction sheet should be given but it not the sole method of instruction as it is important to assess and implement tasks so as to make sure that the parents have a thorough understanding of the process. And while follow up with the pediatrician is part of the discharge process, it is the hospital's responsibility to provide thorough discharge instructions and training.

What would we tell a parent that asks if the 6 year old sibling should attend her sister's funeral?

Ask if they would like to join

What should you teach regarding bullying?

Assess for signs Discussion groups Training to teachers, school nurse

What is importnt to do for religious and spiritual support?

Assess religious and spiritual needs Religious organizations, hospital hospice chaplain

The nurse is developing a teaching pamphlet for parents of school-age children. What anticipatory guidelines should the nurse include in the pamphlet?

At age 12 years, parents should be certain that the childs sex education is adequate with accurate information.

7 to 12 years old

At what age can children identify their own physiologic responses to stress

8 -11 years old

At what ages do school-age kids resist going to bed?

What are topics to discuss at time of death?

Autopsy Funeral arrangements Organ or tissue donation

What is the average age of puberty in boys and girls?

Average age of puberty is 12 in girls and 14 in boys (prepubescence is about 2 years prior)

axillary, tympanic, temporal

B/c toddlers and young preschoolers are traumatized by invasive procedures, what are the (3) best routes for obtaining a temperature?

D (When a child is hospitalized, the altered family role, physical disability, loss of peer acceptance, lack of productivity, and inability to cope with stress usurp individual power and identity. This is especially detrimental to school-age children, who are striving for independence and productivity and are now experiencing events that lessen their control and power. Infants, toddlers, and preschoolers, although affected by loss of power, are not as significantly affected as are school-age children.)

Because of their striving for independence and productivity, which age-group of children is particularly vulnerable to events that may lessen their feeling of control and power? a. Infants b. Toddlers c. Preschoolers d. School-age children

egocentric, magical (preoperational)

Because preschoolers display this type of thinking, they may view illness/hospitalization as a punishment for misdeeds and think that what is happening to them is the same as someone else they knew (dramatization, concrete thinking)?

Which is most descriptive of the spiritual development of the older adolescent? Beliefs become more abstract. Rituals and practices become increasingly important. Strict observance of religious customs is common. Emphasis is placed on external manifestations, such as whether a person goes to church.

Beliefs become more abstract. Because of their abstract thinking abilities, adolescents are able to interpret analogies and symbols related to their spiritual development. Rituals and practices become less important as the adolescent questions values and ideals of families. Strict observation of religious customs becomes less important as the adolescent questions values and ideals of families. Adolescents question external manifestations when not supported by adherence to supportive behaviors. The adolescent's spiritual development is more internally driven.

What is preschool child understanding of and reactions to Dying?

Believe thoughts may cause events See death as departure or sleep May see death as temporary or reversible Words like "forever" may not be understood Fear of separation from parent Take words literally (avoid saying the person has "gone to sleep") because they may now fear sleep

What is school age child understanding of and reactions to Dying?

Better sense of causality Less egocentric than preschoolers but may still associate misdeeds with death Higher cognitive abilities but still prone to incorrect definitions Clarify meanings and as them to repeat back By age 7-9 children have a more adult concept of death

6 months - 5 yrs

Between what ages is dealing with hospitalization extremely difficult b/c they have minimal understanding of what is going on around them & no abstract thinking?

What accurately describes physical development during the school-age years?

Boys and girls double strength and physical capabilities.

gynecomastia

Boys can temporarily have ____________ which usually disappears within 2 years

pubertal delay 14

Boys may be considered to have a _______________ if enlargement of the testes or scrotal changes have not occurred by____________ years old

Which of the following statements best describes the relationship school-age children have with their families? A) children desire to spend equal time with family and peers B) children are prepared to reject parental controls C) children need and want restrictions placed on their behavior by the family D) the peer group replaces the family as the primary influence in setting standards of behavior and rules

C

What is important to remember when discussing organ and tissue donation?

Can be stressful for nursing and staff Should be done in privacy "Are you an organ donor family?" "Have you ever considered organ donation?" Does not mutilate the body, still able to have open casket Will not delay funeral

It is important to remember that a child's understanding of death may be vague because they....

Can only perceive in their frame of reference May repeat what is said, "Grandpa died and went to heaven."

When teaching injury prevention during the school-age years, what should the nurse include?

Caution children against engaging in competitive sports.

A 10-year-old child is riding a bicycle on the grounds of the school. Which finding if observed by the school nurse would require intervention? Child is seen walking the bicycle through the crosswalk. Child is riding close to the curb. Child's shoes are ill fitting. Child is riding single file.

Child's shoes are ill fitting. Shoes that are ill fitting can result in potential injury as they can get caught up in gears and affect the ability of the child to navigate. All of the other observed behaviors are consistent with safe practice.

What is characteristic of children with posttraumatic stress disorder (PTSD)? Denial as a defense mechanism is unusual. Traumatic effects cannot remain indefinitely. Previous coping strategies and defense mechanisms are not useful. Children often play out the situation over and over again in an attempt to come to terms with their fear.

Children often play out the situation over and over again in an attempt to come to terms with their fear. This is an expected response by a child to a traumatic event. Play is often the safest means of communication for children and should be encouraged as a means of expression with a child experiencing PTSD. Denial is a defense mechanism commonly used by children and adolescents. Professional help is indicated if the stages of response are prolonged. Coping strategies and defense mechanisms that have been effective previously may be effective for PTSD.

Which behavior would most likely be manifested in a young child experiencing the protest phase of separation anxiety? Inactivity Clinging to the parent Depression and sadness Forming superficial relationships

Clinging to the parent In the protest phase of separation anxiety, the child aggressively responds to separation from a parent by clinging and holding onto the parent and screaming for the parent. Inactivity is a sign of despair in a young child, not protest. A depressed, sad child indicates despair, not the protest phase. The formation of superficial relationships indicates that a young child is in the phase of detachment, not protest.

What should the nurse include when giving parents guidelines about helping their children in school? Help children as much as possible with their homework. Punish children who fail to perform adequately. Communicate with teachers if there appears to be a problem. Accept responsibility for children's successes and failures.

Communicate with teachers if there appears to be a problem. Parents should communicate with teachers if there is a problem and not wait for a scheduled conference. Parent involvement is one factor in children's success in school. Children need to do their own homework. This cultivates responsibility. Discipline should be used to help children control behaviors that might be affecting school performance, but failure to perform adequately should not be punished itself. Communicating with the child is a better solution to getting to the "root" of the school performance problem. School-age children need to develop responsibility. Keeping promises and meeting deadlines lays a successful foundation for adulthood and adult responsibilities.

A middle age child understands that with regards to a mathematical equation that 7 can be composed of 4+3 as well as 2+5. Based on this finding, the nurse documents that the development level of the child reflects? Concrete operations Verification of latency period Conservation Accomplished industry versus inferiority

Conservation Piaget's cognitive theory development describes conservation as the ability of the child to understand that the same concept may exist as identified by a different method. Numerical relationships are understood before substance conservation. Concrete operations is the term Piaget applies to the entire stage whereby children are able to use thought processes to experience events and actions. The latency period is described by Freud as the ability of the child to go from peer relationships to heterosexual relationships. Industry versus inferiority refers to Erikson's overview of this time frame whereby children if successful master the challenges between industry and inferiority.

What is the most important goal when caring for an individual with anorexia nervosa? Encourage weight gain Correct malnutrition Limit fluid intake Provide effective oral care

Correct malnutrition Correct malnutrition is the priority goal of treatment. The individual with anorexia nervosa would probably not be receptive to encouragement of weight gain because of the complex etiology of the disorder. Anorexics often have low self-esteem and have a need for control, which they meet by controlling their eating. Fluids are often restricted by the individual with anorexia. It is important to correct fluid and electrolyte imbalances if present and not restrict fluid intake. Oral and dental care is more of an issue with the bulimia nervosa patient secondary to the excessive purging or vomiting episodes.

reasons for sexual experimentation

Curiosity Pleasure Conquest Peer pressure to conform

adolescent sexuality

Dating Sexual orientation Sexual experimentation—wide range

The nurse is collecting history on a 16-year-old admitted for treatment of anorexia nervosa. The patient limits the answers to yes or no. What is the primary nursing goal for this patient at this time? Ask about favorite foods to provide for them to eat. Return to ask further questions when the patient wants to talk. Discuss the treatment plan and expected stay in the hospital. Develop a positive rapport with the patient.

Develop a positive rapport with the patient. The nurse would focus on development and establishing a positive rapport with the patient at the early stage. Eating disorders in children often stem from low self-esteem. Children with eating disorders may have low self-esteem and a lack of trust in others. It is important to establish a trusting relationship with the patient. Asking the patient about favorite foods is not a question that will build rapport with the patient. Returning to ask further questions when the patient wants to talk is not the primary nursing goal at this time. Discussing the treatment plan and expected stay in the hospital is not an appropriate goal because the patient is not open to discussion at this time.

How do you promote normal Development and Family Support in adolesence?

Developing independence/autonomy through activities

kohlberg: moral development

Development of conscience and moral standards in a child age 6 to 7 years, reward and punishment guide choices older school-age child is able to judge an act by the intentions that prompted it rules and judgments become more founded on the needs and desires of others

What do chronic illnesses do to the child with a chronic illness or disability?

Developmental aspects Coping mechanisms Responses to parental behavior Type of illness or disability ADA: Americans with Disabilities Act

What is important to note for sibling support?

Developmental stage and level of maturity will be an influence on feelings and behaviors Siblings may feel isolated and displaced Have parents involve siblings in care if appropriate

What happens when a parent doesn't want you to tell the child about illness or death?

Difficult for health care providers Children are very perceptive Help parents understand that honesty and shared decision making is important to the child's emotional health and family health Truth provides answers for future questions and fosters trust Helping the child set their own limits: " Do you want us to tell you everything, even if the news is not good?"

voluntary

Drug abuse, misuse and addiction are culturally defined and are ________________behaviors

C (From this assessment, the nurse interprets that the child is in the despair stage. This is the second stage of separation anxiety. In the despair stage, the child appears less active, depressed, and uninterested in play or food. In this stage the child's physical condition may deteriorate from refusing to eat, drink, or get out of bed. The denial stage is the third stage of separation anxiety. In the denial stage, the child is more interested in the surroundings, plays with others, and forms new but superficial relationships with others. In the protest stage, the child reacts aggressively, cries, screams, and searches for the parents with the eyes. Detachment is the third stage of separation anxiety. It is also called denial.)

During the assessment of a child, the nurse finds that the child is inactive, depressed, sad, and uncommunicative; refuses to eat; and generally lacks interest in everything around her. What should the nurse interpret from this assessment? The child is in the: A. Denial stage. B. Protest stage. C. Despair stage. D. Detachment stage

C (He may be experiencing detachment, which is the third stage of separation anxiety.)

During the first 4 days of hospitalization, Eric, age 18 months, cried inconsolably when his parents left him, and he refused the staff's attention. Now the nurse observes that Eric appears to be "settled in" and unconcerned about seeing his parents. The nurse should interpret this as which of the following? a. He has successfully adjusted to the hospital environment. b. He has transferred his trust to the nursing staff. c. He may be experiencing detachment, which is the third stage of separation anxiety. d. Because he is "at home" in the hospital now, seeing his mother frequently will only start the cycle again.

In working with a teenager who has symptomatic acne. Which dietary measure would the nurse suggest in order to prevent potential flare ups of clinical symptoms? Increase intake of dairy products. Eat foods that have a low glycemic index. Limit fluid intake. Drink whole milk instead of skimmed milk.

Eat foods that have a low glycemic index. Research has shown there is an increased likelihood of acne breakout with ingestion of dairy products and foods that have a high glycemic index. Restriction of fluid intake and substitution of whole milk instead of skimmed milk does not afford any reduction in acne breakouts.

Anorexia nervosa

Eating disorder characterized by a refusal to maintain a minimally normal body weight and by severe weight loss in the absence of obvious physical cause

How to assess family strengths and adjustments?

Elicit information to assess the family adjustment (See Table 19-2) Coping Health Inventory for Parents (CHIPTS) Assessment is a continual process

C (Parents should bring favorite items from home to be with the child. Young children associate inanimate objects with significant people; they gain comfort and reassurance from these items. New toys will not serve the purpose of familiar toys and objects from home. The parents may experience some guilt as a response to the hospitalization, but there is no evidence that it is maladaptive.)

Emma, age 3 years, is being admitted for about 1 week of hospitalization. Her parents tell the nurse that they are going to buy her "a lot of new toys because she will be in the hospital." The nurse's reply should be based on an understanding that: a. New toys make hospitalization easier. b. New toys are usually better than older ones for children of this age. c. At this age children often need the comfort and reassurance of familiar toys from home. d. Buying new toys for a hospitalized child is a maladaptive way to cope with parental guilt.

Which action would improve dental health in the school-age child? Limiting brushing of teeth to three times a day following meals. Encouraging the child to floss. Have the parent brush the child's teeth in order to make sure it is done properly. Have the child consume fruit juice rather than soda.

Encouraging the child to floss. Flossing is a critical activity that has been shown to improve dental health. Brushing teeth following meals as well as following snacks has also been shown to improve dental health. At this age, the child should be able to brush their own teeth. Whereas soda should be avoided, the use of fruit juice may contribute to dental caries as it is considered to be a sugar source and example of a fermentable carbohydrate. Water as a drink should be promoted to improve dental health.

Industry vs. Inferiority

Erickson's stage of development from 6 to 12 YEARS

Identity vs. Role Confusion

Erikson's stage of development from 12 to 18 YEARS

What may cause a child to lie?

Escape punishment Meet other expectations Cant separate fact and fantasy No property rights

3 years

Estrogen levels increase in females until about ________ years after menarche and stay at this level throughout her reproductive life

Nurse's Role in Sports for Children and Adolescents

Evaluation for activities, prevention of injuries, treatment of injuries, rehab, instruction to student and parents

neglect

Failure of parent or other person legally responsible for child's welfare to provide for the child's basic needs and an adequate level of care

What are barriers to pediatric palliative care?

Failure to accept realities of life-limiting disease Access to palliative care services and hospice Communication with the family Child's understanding of death

Which is characteristic of the psychosocial development of school-age children? A developing sense of initiative is important. Peer approval is not yet a motivating factor. Motivation comes from extrinsic rather than intrinsic sources. Feelings of inferiority or lack of worth can be derived from children themselves or from the environment.

Feelings of inferiority or lack of worth can be derived from children themselves or from the environment. The school-age child is eager to develop skills and participate in activities. All children are not able to do all tasks well, and the child must be prepared to accept some feelings of inferiority, as highlighted in Erikson's stage for this age-group of industry versus inferiority. Initiative versus guilt is the stage characteristic of preschoolers. Peer group formation is one of the major characteristics of school-age children. School-age children gain satisfaction from independent behaviors that are internally driven and accomplished.

trust; consistent loving caregivers

For infants, the loss of control can be avoided by forming _______. How?

independence, productivity (they fear death, abandonment, permanent injury, boredom); involve them in care, provide explanations

For school-age children, the loss of control during hospitalization can be avoided by instilling a sense of _______ & _______. How?

autonomy; daily routines and rituals

For toddlers, the loss of control can be avoided by instilling a sense of _______. How?

<5 yrs, particularly <30 months

For what age groups is the primary nursing goal to minimize separation anxiety by involving the parent in everything?

How are the children developing their relationships?

Friends and sustaining relationships important Ability to form complex relationships Communication, share feelings Increasing independence from parents necessary

2 - 2 1/2 year 18 - 20 years old

Growth in height typically ceases ______________ years after menarche in girls and _____________ years old in boys

Adolescents, unless previously immunized, should receive three doses of what vaccine? A) Hep A B) MMR C) HPV D) DPT

HPV

The most appropriate question to ask a rape victim prior to the start of the physical examination is Has she showered or bathed since the attack? Does she think rape is a violent crime? How many items did the attacker take? When the attack occurred, could she have prevented it?

Has she showered or bathed since the attack? The nurse needs to document if the patient has bathed or showered prior to collecting evidence from the rape. Cleaning the body could remove trace body secretions, such as saliva, semen, or blood, left by the perpetrator, which would be important to collect if possible. It is not appropriate to ask the patient if she thinks rape is a violent crime. It is not a priority to ask how many items the attacker took from her. It is not appropriate to ask the patient if she could have prevented the attack.

7 years old

If a child has a strong family history of high cholesterol, at what age should they be screened?

What is the problems if parents discourage self sexual exploration?

If parents avoid this curiosity the information will come from they will do their own self sexual exploration with inaccurate info

How does the onset of the pubertal growth spurt compare in girls and boys? In girls, it occurs about 2 years before it appears in boys. In girls, it occurs about 3 years before it appears in boys. In boys, it occurs about 1 year before it appears in girls. It is about the same in both boys and girls.

In girls, it occurs about 2 years before it appears in boys. The average age of onset for puberty is 12 years in girls and 14 years in boys. Although this may be true for an individual, the average difference is approximately 2 years. Usually, girls begin puberty and their growth spurt earlier than boys.

smokeless tobacco

Increasing popularity Serious hazards Carcinogenic Periodontal disease, tooth erosion, soft tissue damage

Which behavior is most characteristic of the concrete operations stage of cognitive development? Progression from reflex activity to imitative behavior Inability to put oneself in another's place Increasingly logical and coherent thought processes Ability to think in abstract terms and draw logical conclusions

Increasingly logical and coherent thought processes Increasingly logical and coherent thought processes are characteristic of concrete operations. Children in this stage are able to classify objects. Progression from reflex activity to imitative behavior is characteristic of the sensorimotor stage, which occurs from birth to 2 years of age. Inability to put oneself in another's place is characteristic of the preoperational stage, ages 2 to 7 years. Adolescents, in the formal operations stage, have the ability to think in abstract terms and draw logical conclusions.

A child is brought into the hospital following a fire at his home. The child appears to be sleeping on the stretcher bed. No observable burn injuries are noted based on preliminary survey. However, the nurse would place a priortiy observation on the possiblity of the child having? Inhalation Injury Thermal burns Decreased metabolism leading to hypovolemic shock Chemical burns

Inhalation Injury Inhalation injury in the form of carbon monoxide poisoning or smoke inhalation should be considered in this situation. It is critical for the nurse to make these observations in order to prevent further complications. Thermal and chemical burns would cause evident tissue destruction which would be foun on preliminary survery. In burn states, incresaed metabolism would occur.

kohlberg- moral development

Internalized set of moral principles Questioning of existing moral values and relevance to society Understand duty and obligation, reciprocal rights of others Concepts of justice, reparation

drug tolerance and physical dependence

Involuntary physiologic responses to the pharmacologic characteristics of drugs

What is important to note about play?

Involves physical skill, intellectual ability, and fantasy Children form groups, cliques, clubs, secret societies Rules and rituals See need for rules in games they play

How should the nurse interact with a school age child?

Involving them in the care because they are -Eager to develop skills and participate in meaningful and socially useful work -Acquire sense of personal and interpersonal competence -Growing sense of independence -they want to be approved by peers -they feel inferior when they mess up or cannot accomplish something so provide activities they can accomplish

The parents of 9-year-old twin children tell the nurse, They have filled up their bedroom with collections of rocks, shells, stamps, and bird nests. The nurse should recognize that this is which?

It is a characteristic of cognitive development at this age

A nurse is working with teenagers and their parents in a school drug prevention program. Several of the parents ask how they can determine if their child has a problem with drugs. The most appropriate response by the nurse is: There is no way to know until they tell you. At some point, the child will develop depression and attempt suicide; then you can put them in rehab. It is common for them to withdraw and not achieve normal developmental tasks. You should then consult a professional. You should make your child take a home test for drugs. You can buy those at the drug store.

It is common for them to withdraw and not achieve normal developmental tasks. You should then consult a professional. Children and teenagers who begin using drugs may often stop participating in routine activities and not continue to achieve the normal milestones of the adolescent period. If the parent ever has a question, they should seek information from a health care provider. Waiting for the child to tell the parent is not a way to determine if the child has a problem with drugs. It is a very passive approach to parenting. Waiting for the child to develop depression and attempt suicide is not a preventive approach to handling drug use. Taking a home test for drugs is not a measure that should be taken unless the child has been caught engaging in drug use.

A 12-year-old child is admitted for an emergency appendectomy and rushed into surgery. The parents tell the nurse that they also have a 4-year-old son at home and wonder if they should tell him about his older brother being in the hospital. The best response by the nurse to this query would be to? Tell the parents to refrain from telling the 4-year-old as he will not be able to understand the concepts of hospitalization and surgery. Have the parents go home and bring their 4-year-old back to the hospital so he can be present throughout this family stress experience. It is important to tell their 4-year-old son about his older brother using words and terms that he can understand at his age. Have the parents bring their son in during visiting hours and arrange for a tour of the hospital unit.

It is important to tell their 4-year-old son about his older brother using words and terms that he can understand at his age. It is important to share a hospitalization experience with siblings, however being mindful of their developmental and cognitive level. And while the 4-year-old can be taken into the hospital setting and even receive a tour of the hospital unit, the experience should not be tied into a "show and tell" event. The 4-year-old child does not have to present throughout the entire hospitalization experience as that may produce unnecessary stress in altering his environment and daily routine.

60 minutes 3 days

It is recommended that adolescents need to engage in a minimum of ______________ of physical activity daily and muscle strengthening activity for at least __________ days per week

60 minutes

It is recommended that school-aged children should participate in a minimum of _______________ of moderate to vigorous physical activity daily

The school nurse is teaching a class on safety. Which activities require protective athletic gear? Select all that apply. Lacrosse Football Swimming Gymnastics Skateboarding

Lacrosse Football Skateboarding Any sport that involves body contact such as lacrosse, football, and skateboarding requires a child to wear protective equipment. Swimming does not involve body contact and requires no protective equipment. Gymnastics does not require protective equipment.

A (School-age children need to have control of their environment. The nurse should offer explanations or prepare the child for experiences that are unavoidable. The nurse should refer to the child by the preferred name. Telling the child about all of the limitations of visiting does not help her adjust to the hospital. At the age of 8 years, the child and parents should be oriented to the environment.)

Latasha, age 8 years, is being admitted to the hospital from the emergency department with an injury from falling off her bicycle. What will help her most in her adjustment to the hospital? a. Explain hospital schedules such as mealtimes. b. Use terms such as "honey" and "dear" to show a caring attitude. c. Explain when parents can visit and why siblings cannot come to see her. d. Orient her parents, because she is young, to her room and hospital facility.

Which action should be included in a plan of care for an adolescent who is being treated for depression with tricyclic antidepressants? Restriction of fluids is needed to prevent fluid overload. Recording of daily weight. Make sure that dental hygiene is being performed on a routine basis. Increase in caloric intake to maintain weight.

Make sure that dental hygiene is being performed on a routine basis. The use of tricyclic antidepressants exerts a significant effect on dentition ranging to increased incidence of dental caries and decreased amount of saliva. Therefore, a dental hygiene program should be included as part of therapeutic management in order to avoid potential complications. Fluid intake should be encouraged and there is no need for documented daily weights or increase in caloric intake to maintain weight.

What sex does the Klinefelter Syndrome affect?

Males (1 in 850)

Examination of a child's mouth reveals that teeth do not line up properly upon attempts to have the child bite down. This finding is noted as? Malocclusion Gingivitis Evidence of dental caries Dental injury

Malocclusion Malocclusion occurs when upper and lower teeth do not approximate when a child bites down. Gingivitis refers to inflammation of the gums. Evidence of dental caries would refer to the presence of a cavity. Dental injury refers to evidence of chipping or dislocation as a result of trauma.

How are they to help develop their personality?

Manage parental expectations Help the child be successful Enhance positive developmental outcomes Anticipate high-risk situations Allow children to succeed in ways appropriate to their unique temperaments Where do I "fit" in with family, school environment and relationships with peers

Manifestation of Klinefelter syndrome

May not be diagnosed until a patient is seen for infertility •Azoospermia; small testes •Defective development of secondary sex characteristics •Cognitive impairment of varying degrees; behavioral problems; possibly, gross motor difficulties

Klinefelter syndrome

Most common chromosomal abnormality characterized by the presence of one or more additional X chromosomes (47,XXY) that occurs in males

Klinefelter syndrome

Most common of all chromosomal abnormalities Presence of one or more additional X chromosomes (complement of 47,XXY is most common) Rarely seen before puberty Adolescent virilization fails

The most likely source of injury, whether intentional or unintentional in adolescents is associated with? Motor vehicle accidents Poisoning Drowning Homicide

Motor vehicle accidents Motor vehicle accidents are the most common cause of injury and death in adolescents. Homicide is the second leading cause.

What other activities may they take part in?

Need time for play longer intention span Ability to read Musical instruments Collecting and organizing Media

Primary amenorrhea

No secondary sect characteristics and no menarche by 14-15 years OR secondary sex characteristics are present but menarche has not occurred by age 16-16.5 No uterine bleeding after attaining SMR 5 for 1 year or after breast development for 4 years

Primary amenorrhea

No secondary sect characteristics and no menarche by 14-15 years OR secondary sex characteristics are present but menarche has not occurred by age 16-16.5 No uterine bleeding for 5 years after breast development

What is care at time of death?

Nurses help in parents recognizing changes in child that signal death is near Draw pictures, messages, visions, family gather at bedside Allow time for good-byes Cultural sensitivity Mementos, personal items Post mortem care referral to family support

A (Children in this age-group still fear that their insides may leak out at the injection site, even if the bleeding has stopped. Provide the Band-Aid. No explanation should be required.)

Olivia, age 5 years, tells the nurse that she "needs a Band-Aid" where she had an injection. The best nursing action is to: a. Apply a Band-Aid. b. Ask her why she wants a Band-Aid. c. Explain why a Band-Aid is not needed. d. Show her that the bleeding has already stopped.

Which benchmark serves as the ending period for the middle year period of development? Beginning school Onset of puberty Wisdom teeth appearing Loss of deciduous teeth

Onset of puberty The onset of puberty signals the end of the middle year period. Beginning school and loss of deciduous teeth are associated with the beginning of the middle year period. Appearance of wisdom teeth occurs later on in life.

Based on the nurse's knowledge of wounds and wound healing, what are factors that can delay or cause dysfunctional wound healing? Select all that apply. Overweight Hypoxemia Hypervolemia Prolonged infection Corticosteroid therapy

Overweight Corticosteroid therapy Poor nutrition without proper protein and calorie intake affects healing more than being overweight itself. Corticosteroid therapy or other immunocompromising therapy prevents macrophages from migrating to the site of injury, thus suppressing epithelialization. Hypovolemia, not hypervolemia, inhibits wound healing due to low circulating blood volume and oxygenation of tissues. Hypoxemia makes tissues more susceptible to infection due to insufficient oxygenation. Prolonged infection affects the healing process and causes increased scarring.

secondary dysmenorrhea

Painful menstruation related to pelvic pathology (fibrioids, endometriosis, PID) Can occur any time in the menstrual cycle

treatment room; bed, area of comfort

Painful procedures should occur in a _______ and never ________ or else they will associate these locations with painful situations.

anticipatory guidance: care of families

Parents adjust to child's increasing independence Parents provide support as unobtrusively as possible Child moves from narrow family relationships to broader world of relationships

What does it mean by theFamily becoming the "sounding board"?

Parents are encouraging their kids to be more independent and reducing their micromanagement roles parents are listening and consulting with their kids more

Childs relationship with family

Parents are primary influence in shaping child's personality, behavior, and value system Increasing independence from parents is primary goal of middle childhood Children not ready to abandon parental control

How to discuss death with children?

Parents want to protect the child from the impact of the diagnosis Children have an awareness of the seriousness of their diagnosis even when protected from the truth Children need accurate and honest info Gradual process Open communication Literature about the disease, illness and death Timing, timing, timing- everyone is different

Who can support the child with chronic illness/disability?

Parents- relationships, finance, coping mechanism Siblings Extended family and friends- respite care, support

hormones anterior pituitary hypothalamus

Physical changes of puberty are primarily the result of _____________________ and are controlled by the ________________________ gland in response to a stimulus by the ______________________________

When the nurse uses a standard nursing care plan as a guide in planning care for a hospitalized child, which should be eliminated? Expected outcome or goal Dependent nursing functions Problems not pertinent to the child and family Potential health problems of the child and family

Problems not pertinent to the child and family To create an individualized care plan, the nurse eliminates the irrelevant material and specific information not pertinent to the child and family in question. Consideration of an expected outcome or goal is an essential component of an individualized nursing care plan. Consideration of dependent nursing functions, or those interventions requiring an order, is an essential component of an individualized nursing care plan. Consideration of potential health problems of the child and family is an essential component of an individualized nursing care plan.

A child has sustained an injury and lost a primary tooth. Which priority action should be taken by the nurse at this time? Provide comfort measures and assess for bleeding. Referral to the dentist for immediate consultation. Recover the tooth and prepare for reimplantation. If the tooth is dirty, rinse it off and cover in gauze until needed for reimplantation.

Provide comfort measures and assess for bleeding. Avulsed primary teeth are usually not reimplanted. Therefore the nurse should focus on assessment of the site and comfort measures. All of the other options would be indicated if an avulsed tooth were to be reimplanted.

A child has been stung by a bee and the parents call the walk in clinic asking for instructions on what to do as they make their way to the clinic. The nurse responds by stating? Tell the parents to remove all of the child's clothing and apply warm water to the affected area. Remove the stinger from the site. Encourage the child to take slow deep breaths to minimize associuated anxiety that has occured due to the event. Have the parents offer the child water.

Remove the stinger from the site. First action is to remove the stinger, then cleanse the area with soap and water and apply a cool compress. There is no need to remove the child's clothing or provide fluid hydration. There is no indication tha the child is experiencing any evidence of anxiety provided by the parent's communication.

The nurse is caring for a 12-year-old who sustained major burns when putting charcoal lighter on a campfire. The nurse observes that the child is "very brave" and appears to accept pain with little or no response. What is the most appropriate nursing action related to this? Request a psychological consultation. Ask the child why the child does not have pain. Praise the child for the ability to withstand pain. Encourage continued bravery as a coping strategy.

Request a psychological consultation. A psychological consultation will assist the child in verbalizing fears. This age group is very concerned with physical appearance. The psychologist can help integrate the issues the child is facing. It is likely that the child is having pain but not acknowledging the pain. Speaking with a psychologist might assist the child in relaying his or her fears and pain. If the child is feeling pain, the nurse should not praise the child for hiding the pain. The nurse should encourage the child to speak up during painful episodes so that the pain can be managed appropriately. Bravery may not be an effective coping strategy if the child is in severe pain.

WHat are measures to allow a natural death?

Requesting a do-not-resuscitate (DNR) status or allow for natural death (AFND) Antibiotics? Only if it relieves pain like a UTI Blood transfusions? Suction? Yes Slow or delayed codes are not legal Parenteral or NG fluids?yes Deciding whether death will occur at home or in the acute care setting

A nurse is assessing a patient diagnosed with attention deficit hyperactive disorder (ADHD). What behavior would the nurse anticipate the patient to demonstrate? Ability to complete school work during class Requires reminders to keep focused and on task Is defiant with parents and refuses to complete chores at home Is aggressive with peers when asked to participate in team sports

Requires reminders to keep focused and on task Children with ADHD are often not able to remain focused and require frequent reminders to remain focused and complete an assigned task. They generally are not able to complete work at school and require extra time to complete assignments. The ability to complete school work during class is not something the nurse would anticipate this patient to demonstrate. Defiance with parents and refusal to complete chores at home are not behaviors the nurse would anticipate this patient to demonstrate. Aggression with peers when asked to participate in team sports is not typical of ADHD behavior.

A nurse has been assigned as the home health nurse for a technologically dependent child. The nurse recognizes that the background of this family differs widely from the nurse's own. The nurse views some of their lifestyle choices as less than ideal. What is the most appropriate nursing intervention? Assign the nurse a different family to follow. Respect the differences Assess why the family is different Determine whether the family is dysfunctional

Respect the differences The nurse must respect the family's culture and background. The family is the constant in the child's life, and cultural awareness and sensitivity are critical to a nurse's care of a child and family. The nurse may have some influence on care necessary for the child, but it is inappropriate to assign the nurse to a different family. Nurses must be able to work with families from all cultural groups and respect the differences between the families' cultural norms and those of the nurse's own culture. The nurse will assess the differences, but respecting these differences is what is important. Cultural differences do not make a family dysfunctional, unless the cultural practices are putting the child at risk.

What are the core principles of palliative care?

Respecting patient goals, preferences, and choices Providing comprehensive care Using the strength of interdisciplinary resources Acknowledging and addressing caregiver concerns Building systems that support responsible palliative care policies and regulations

school health

Responsibilities of parents, schools, and health departments ongoing assessment, screening, and referrals, routine services, emergency care, safety and infection control instruction increase knowledge of health and health habits

Therapeutic management of stress fractures

Rest to alleviate repetitive stress that initiated the symptoms Training with alternative exercise regimens Physical therapy, cryotherapy, cold whirlpools

What may cause a child to cheat?

Revenge Supplement income Attention or love Poor role models Don't know any better

relationships with parents

Roles change from protection/dependency to mutual affection/equality Process involves turmoil and ambiguity Teenager struggles between privileges and responsibility Emancipation from parents may begin with rejection of parents by teenager

A, C, E (Unfamiliar environment Strange smells Inadequate knowledge of condition and routine)

Ryan has just been unexpectedly admitted to the intensive care unit after abdominal surgery. The nursing staff has completed the admission process, and Ryan's condition is beginning to stabilize. When speaking with the parents, the nurses should expect which stressors to be evident (select all that apply)? a. Unfamiliar environment b. Usual day-night routine c. Strange smells d. Provision of privacy e. Inadequate knowledge of condition and routine

Are Slow or delayed codes are legal?

Slow or delayed codes are NOT legal

Which symptoms are commonly seen in a child with depression? Select all that apply. Focus on violence Excessive laughing Somatic complaints Increased motor activity Poor school performance

Somatic complaints Poor school performance Children with depression will complain of nonspecific complaints such as not feeling well. Children with depression will show a lack of interest in doing homework or achieving in school and getting lower grades than usual. Focus on violence can be associated with depression in the adolescent. A child with depression exhibits predominantly sad facial expression with absence or diminished range of affective response. Children with depression will have diminished motor activity and complain of being too tired.

symptoms of normal grief

Somatic distress Preoccupation with the image of the deceased Denial Guilt Anger and hostility Loss of usual patterns of conduct

What is an important consideration related to childhood stress? Children should be protected from stress. Children do not have coping strategies. Parents cannot prepare children for stress. Some children are more vulnerable to stress than others.

Some children are more vulnerable to stress than others. Children's age, temperament, life situation, and state of health affect their vulnerability, reactions, and ability to handle stress. It is not feasible to protect children from all stress. Children can be taught coping strategies. Supportive interpersonal relationships are essential to the psychological well-being of children. Adults need to recognize signs of stress before they become overwhelming. Providing children with interpersonal security helps them develop coping strategies for dealing with stress.

spiritual development

Some may question the values and beliefs of the family Capable of understanding abstract concepts and interpreting analogies and symbols May fear that others will not understand their feelings Tendency for introspection and emotional intensity

Why is it that a 9 year old can have menses but still is not emotionally or psychosocially mature?

Some younger children are advanced in their tanner stages, but still at their normal emotional developmental level Physical maturity not necessarily correlated with emotional and social maturity

The school nurse is discussing after-school sports participation with parents of children age 10 years. The nurses presentation includes which important consideration

Sports participation is encouraged if the type of sport is appropriate to the childs abilities.

What are standards for hospice?

Standards dictate the care given Interdisciplinary team to work with a patient and family Supports the patient and family physically, emotionally, and spiritually by promoting a "living until you die" philosophy Care continues to support the family through the bereavement

What are red flags of stress?

Stomach pains or headaches Sleep problems Bed-wetting Changes in eating habits Aggressive behaviors Reluctance to participate Regression to earlier behaviors (thumb sucking)

Which observation if noted by the school nurse would pose a priority concern? Teenager is using her mobile phone while walking in the hallway to class. Student is using the computer in a classroom to post a picture of herself taken in class on Facebook. Student is looking at a risqué image of another student on her phone while seated at the cafeteria table. Student is texting her parents that she will be home later than expected.

Student is looking at a risqué image of another student on her phone while seated at the cafeteria table. This observation would be an example of sexting which is illegal and associated with risky sexual actions according to recent evidenced based practice. The use of social media within the school setting to post a picture of a student taken in class while not the best practice would not cause a concern unless the image was provocative or offensive. Texting information to advise parents that a student would be late would be considered to be appropriate. Use of mobile phones in the school setting may not pose a problem unless that activity is restricted by school policy.

An adolescent teen has confided to the school nurse that he is bisexual and asks the school nurse for advice in "coming out" top his peers. What would be the best response to the student's request? Call the parents of the child directly and tell them before the child "comes out" to his peers. Suggest that the individual have form a safety plan first before disclosing information. Suggest to the student that he tell his parents first before he tells anyone else. Let the student know that you are supportive but that he is the only person that knows when the time is right to "come out."

Suggest that the individual have form a safety plan first before disclosing information. It is important to have a safety plan in place first before "coming out" as individuals may not be able to cope with the information and as such the adolescent teen maybe exposed to potential rejection, violence or misunderstanding. The nurse has no legal authority to violate confidentiality by notifying the teen's parents without his consent. And although it may be best to tell one's parents first, the priority is to have a safety plan in place prior to disclosure of this type of information. Similarly, the teen is the best person to determine when the time is right but safety and support are a priority.

In planning sex education and contraceptive teaching for adolescents, what should the nurse consider? Most teenagers today are knowledgeable about reproductive anatomy and physiology. Both sexual activity and contraception require planning. Most teenagers who become pregnant do so as an act of hostility, especially toward the parents. Teenagers need contraception education in both oral and written form.

Teenagers need contraception education in both oral and written form. Sex education and contraceptive information need to be concrete and concise. Oral explanations with demonstrations and written explanations with diagrams should be provided. Sex education and contraceptive teaching are independent of adolescents' knowledge of reproductive anatomy and physiology. Contraception requires planning. Most adolescents are sexually active for 6 months to 1 year before seeking contraceptive information. Most adolescent sexual activity is unplanned. There are no data to support that most teenage pregnancies occur as acts of hostility toward parents.

A child is brought to the emergency department after falling down the basement stairs. On assessment, what findings may cause the nurse to suspect child abuse? Select all that apply. The child's bruises are located only on the right arm and leg. The child is brought to the emergency department by an unrelated adult. The child has a history of a broken arm last year from falling off a swing. The child's caregiver is anxious that the child get immediate medical attention. The child has red, green, and yellow bruises on more than one plane of the body.

The child is brought to the emergency department by an unrelated adult. The child has red, green, and yellow bruises on more than one plane of the body. A child brought to a health care provider for a trauma or suspicious injury by an unrelated adult or if the primary care provider is totally unavailable is a warning sign of abuse. Varying degrees of healing of bruises in more than one plane of the body is a warning of abuse. Falling down stairs can be an unintentional injury. A child with an isolated documented injury is not a warning sign of abuse. Multiple fractures of differing ages are a warning sign of abuse. An anxious caregiver is a normal response for an injured child. A delay in seeking care is a warning sign of abuse.

Prior to returning to school, an individualized home care plan (IHCP) needs to be developed for which child? The child recently identified with a penicillin allergy. The child being treated for pediculosis capitis (head lice). The child out of school for two week due to mononucleosis. The child recently diagnosed with insulin-dependent diabetes mellitus.

The child recently diagnosed with insulin-dependent diabetes mellitus. An IHCP is needed for the insulin-dependent child to ensure appropriate management of health care needs is in place. The child allergic to penicillin will not receive this medication anymore and a medication alert ID is necessary. An IHCP is not needed. The child treated for pediculosis capitis (head lice) can return to school and does not need an IHCP. The child who missed two weeks of school will need arrangements made for make-up work and an IHCP is not needed.

menarche

The first menstrual period is called _____________

6 years old

The first permanent (secondary) teeth erupt at what age?

13 years old 10 -25 years old

The mean age of onset for anorexia is _______________but can range from ___________________

10 1/2 to 15 years old

The normal age for menarche is usually ______________ years

C (The child has fear of sleeping alone in the room. This information is usually noted under the self-perception—self-concept pattern of the nursing history. The nurse tries to comfort the child's fear of sleeping alone by being present until the child falls asleep. Nightmares can be managed by comforting the child and preventing specific fears. Nightmares and disturbed sleep may be brought on by hospitalization and may improve once the child adapts himself or herself to the new environment. Bed-wetting is common in younger children but needs further evaluation in older children.)

The nurse develops a plan of care based on the information documented in a child's admission assessment. The nurse instructs the health care team that they should not leave the room until the child falls asleep. What information documented under the self-perception-self-concept pattern would necessitate this nursing intervention? The child has: A. Nightmares. B. Disturbed sleep patterns. C. A fear of sleeping alone. D. The habit of bed-wetting.

C (The painting materials made from wallpaper paste may contain wheat. If the paint comes in contact with the child's skin, it can cause an allergic reaction. Therefore the nurse changes the activity. The child who is on a salt-restricted diet need not worry about salt being in the paint. A patient is placed on salt restriction to prevent water retention, not because of an allergy. The child who is lactose intolerant cannot ingest dairy products. Beetroot is used as natural dyes in paintings; however, the wallpaper paste does not contain beetroot extract.)

The nurse gets out finger painting materials made from wallpaper paste for a child. After reviewing the child's medical record, the nurse decides to get out crayons and a coloring book instead. What information did the nurse find in the nursing history? The child: A. Is on a salt-restricted diet. B. Has lactose intolerance. C. Has an allergy to wheat. D. Is allergic to beetroot.

B (It is impossible to evaluate the improvement in the respiratory function of the child without having any baseline data. The child's feedback provides only subjective assessment. Evaluation of respiratory system function requires formal knowledge of the respiratory system assessment. Therefore, parent opinion is not reliable for improvement in the child's respiratory function. Evaluation of the improvement in the respiratory function requires objective assessment. Obtaining the primary health care provider's opinion is a type of subjective assessment.)

The nurse has been assigned to the pediatric respiratory unit. What is the preliminary requirement for the nurse to evaluate improvement in the respiratory function of the child with treatment? A. The child's feedback B. The baseline data C. The parents' opinion D. The primary health care provider's opinion

B (The self-care scale can be used for rating the functional self-care abilities of the child. The score ranges from 0 to IV. If the child is scored a II, this implies that the child requires assistance or supervision from another person. A child who is independent with activities of daily living would receive a 0. A score of I implies that the child requires equipment or a device for self-care. A score of III implies that the child requires assistance or supervision from another person and equipment or a device. A score of IV implies that the child is totally dependent and does not participate.)

The nurse is assessing a child's level of self-care. The nurse documents a rating of II for dressing and grooming. What can be inferred from this rating? The child: A. Is independent on all aspects of personal care. B. Depends on the supervision of another person. C. Needs to use equipment or another adaptive device. D. Requires direction from a person and uses equipment.

C (The nurse should rate the child as a II (two) because the child requires assistance of a caregiver for general hygiene and dressing. A grading of 0 (zero) is given to the child who is capable of taking full self-care. A grading of a I (one) is given to the child who requires the use of equipment or a device for self-care. A child who is totally dependent and does not participate in self-care would be rated a IV (four).)

The nurse is assessing the functional self-care level of a child and determines that the child requires the assistance of a caregiver for general hygiene and dressing. How would the nurse rate the child? A. 0 B. I C. II D. IV

C (The nurse should use a telephone to maintain contact between the child and parents so that the child can feel comfortable. It helps relieve the child's anxiety. The nurse should maintain eye contact and gently touch the child to establish rapport. The nurse should talk with the child about the parents and family to prevent detachment of the child from the parents. The nurse should not use a laptop to contact the child and parents. The laptop may not be compatible with medical equipment, and use may be restricted in certain areas.)

The nurse is caring for a child with an influenza viral infection. The child is anxious because the parents are unable to stay with the child. What should the nurse do to relieve the child's anxiety? The nurse should: A. Not maintain any eye contact with the child. B. Not speak with the child about missing the parents. C. Use the phone to let the child talk with the parents. D. Use a laptop to allow the child and parents to talk

C (The nurse should ask the child's parents about how the child usually handles disappointment. This can help the nurse understand the coping-stress tolerance pattern of the child. It is also helpful for identifying stressors in the child. It is important to know how discipline problems are managed in the child. This helps to know about the child and parent role-relationship pattern. When the nurse asks about the child's friends, it is to assess the child's role and relationship patterns outside the home. The nurse can understand the role and relationship pattern between the parents and child after knowing who will stay in the hospital with the child.)

The nurse is caring for a child with cancer. What should the nurse ask the child's parents about in order to obtain information about the child's coping-stress tolerance pattern? A. "How do you both handle discipline problems at home?" B. "Have you ever noticed if your child has many friends?" C. "How does your child usually handle disappointment?" D. "Who will be staying with your child at the hospital?"

C (Loss of peer-group contact may pose a severe emotional threat to an adolescent because of loss of group status; friends visiting is an important aspect of hospitalization for an adolescent and would be very reassuring. Adolescents may welcome the opportunity to be away from their parents. The separation from siblings may produce reactions from difficulty coping to a welcome relief.)

The nurse is caring for an adolescent who had an external fixator placed after suffering a fracture of the wrist during a bicycle accident. Which statement by the adolescent would be expected about separation anxiety? a. "I wish my parents could spend the night with me while I am in the hospital." b. "I think I would like for my siblings to visit me but not my friends." c. "I hope my friends don't forget about visiting me." d. "I will be embarrassed if my friends come to the hospital to visit."

A, C, E (Young children's posthospital behaviors include: They show initial aloofness toward parents; this may last from a few minutes (most common) to a few days. This is frequently followed by dependency behaviors: tendency to cling to parents; demands for parents' attention; vigorous opposition to any separation (e.g., staying at preschool or with a babysitter). Other negative behaviors include: new fears (e.g., nightmares); resistance to going to bed, night waking; withdrawal and shyness; hyperactivity; temper tantrums; food peculiarities; attachment to blanket or toy; regression in newly learned skills (e.g., self-toileting). Posthospital behaviors for older children include negative behaviors: emotional coldness followed by intense, demanding dependence on parents; anger toward parents; jealousy toward others (e.g., siblings).)

The nurse is discharging a young child from the hospital. The nurse should instruct the parents to look for which posthospital child behaviors? Select all the apply. A. Tendency to cling to parents B. Jealousy toward others C. Demands for parents' attention D. Anger toward parents E. New fears such as nightmares

B, C, E (Ambulatory care is associated with an increased cost-saving as compared to hospital admissions, since there are no admission-related costs. Ambulatory care is associated with lesser chances of acquiring infections due to limited exposure to health care facilities. Ambulatory care is devoid of the stressors of hospitalization. There is deficient care due to the absence of qualified medical person for supervision. Ambulatory care is more challenging when compared to hospitalization as the child and the parents need to rely mostly on themselves for providing care to the child.)

The nurse is educating a group of parents and children in the pediatric ward about the benefits of ambulatory care. What benefits does the nurse discuss with the group? Select all that apply. A. Improved care B. Increased cost-saving C. Reduced chances of infection D. Ambulatory care is lesser challenging E. Minimum stressors of hospitalization

B, C, D (The bill of rights emphasizes the quality of health care to the children and explains that children and teens should be treated with respect and dignity. The bill also states that children have the right to make choices and decisions in their health care. Children have right to get emotional support from the health care professionals. Children cannot always expect economic assistance from the hospital. The nurse need not explain complicated information such as pathologic process of the disease to the child since the child will not be able to understand. Such information should be provided to the caregivers of the child.)

The nurse is explaining the health care bill of rights for children to parents and children in a pediatric ward. What key information does the nurse discuss with the group? Select all that apply. A. Quality health care B. Economic assistance C. Respect and personal dignity D. Making choices and decisions E. Complex information

A (The nurse records the admission history of the patient in terms of different functional health patterns. This helps in documenting all the required information about the patient. The patient requires help inserting his or her contact lenses. This implies that the patient needs support to perform an activity. The nurse should record this information under the activity-exercise pattern. The cognitive-perceptual pattern recognizes the cognitive development in the child and includes information such as defects in vision, hearing, or grading in the school. The nutrition-metabolic pattern is used in the assessment of nutrition in the patient, food allergies, and food intake habits. The health perception-health management pattern reports the medication and the health history of the child.)

The nurse is obtaining the admission history of a recently admitted adolescent. The nurse notes the patient requires help inserting contact lenses. Under which functional health pattern should the nurse record this observation? A. Activity-exercise pattern B. Cognitive-perceptual pattern C. Nutrition-metabolic pattern D. Health perception-health management pattern

A (The child is refusing to take vaccination because of fear of bleeding and pain. The nurse should ask the child to select the color of the bandage to be used. This reassures the child and will make him or her feel better. Even if the nurse tells the child that the bleeding will stop when the needle is removed, it does little to help relieve the child's fear. The nurse should not scold the child in a firm tone because the child may get frightened. Giving a favorite toy to the child for playing is not helpful for relieving the fear. A favorite toy may help the child sleep at night. Requesting a staff member sit beside the child may not be helpful for relieving the child's fear. It may be needed to help hold the child still during a procedure.)

The nurse is preparing to administer a vaccine to a child. The child is refusing to take the vaccination because of fear of bleeding. What should the nurse do in this situation? A. Tell the child he or she can pick the bandage color. B. Tell the child bleeding will stop in a few seconds. C. Request a staff member sit beside the child. D. Give a favorite toy to the child for distraction.

B (Play is one of the most important aspects of a child's life and one of the most effective tools for managing stress. It is helpful for the child to relieve stress. It is also essential for the child's mental, emotional, and social well-being. Play does not make the child anxious in an unfamiliar environment. It helps the child feel more secure in a strange environment. Play lessens the stress of separation from the family because the child is busy. During play, the child communicates with others, which helps develop a positive attitude toward others. It also stimulates thinking in the child by allowing the child to express creative ideas.)

The nurse is teaching the nursing students about functions of play in the hospital. Which statement made by the nursing student indicates the need for further teaching? "Play: A. Can lessen the stress of separation from the family." B. Makes the child nervous in a strange environment." C. Helps the child develop a positive attitude for others." D. Provides an expressive outlet for the child's creative ideas."

B (Intravenous antibiotics are a priority action for the nurse. A short delay may be possible to allow the child some choice, but a prolonged delay only serves to increase the anxiety. The nurse should start the IV line, recognizing that the child is attempting to gain control. If the timing of the IV line start was not essential for the start of IV antibiotics, postponing might be acceptable. The child may never be ready. The anxiety is likely to increase with prolonged delay.)

The nurse needs to start an intravenous (IV) line on an 8-year-old child to begin administering intravenous antibiotics. The child starts to cry and tells the nurse, "Do it later, O.K.?" The nurse should: A. start the IV line because allowing the child to manipulate the nurse is bad. B. start the IV line because unlimited procrastination results in heightened anxiety. C. postpone starting the IV line until the child is ready so that the child experiences a sense of control. D. postpone starting the IV line until the child is ready so that the child's anxiety is reduced.

A, B, E (For assessing the role-relationship pattern in the child, the nurse should ask the parents about any security objects the child may have at home that provide comfort, discipline problems of the child, and family changes. From this information, the nurse can understand the relationship between the parents and the child. Information about sweating gives an idea about the elimination pattern in the child. Information about the disappointment handling potential of the child gives an idea about the child's coping-stress tolerance pattern.)

The nurse plans to assess the role-relationship pattern in a child. Which questions should the nurse ask the parents? Select all that apply. A. "Does the child have any security objects at home?" B. "How do you handle discipline problems at home?" C. "Have you ever noticed that your child sweats a lot?" D. "How does your child usually handle disappointments?" E. "Have any major changes in the family occurred lately?"

B, C, E (The nurse should assess the child's usual health habits at home to promote a more normal environment in the hospital. This includes the child's sleep-rest, nutritional-metabolic, and activity-exercise patterns. The nurse would assess the sleep-rest pattern by asking when the child goes to sleep at night. Assessing the nutritional-metabolic pattern would include asking about food preferences. The nurse should also ask what toy the child plays with at home as part of the activity-exercise pattern. These will help the nurse plan individualized care for the child. History about herbal and complementary therapy helps in preventing drug-drug interaction and severe adverse effects.)

The nursing student is caring for a child admitted to the hospital. The nursing student asks the nurse instructor, "How can we keep the child's routine habits while he is in the hospital?" What would be the best response by the nurse instructor? Select all that apply. "Ask the parents: A. "About the use of any herbal therapies." B. "When the child goes to sleep at night." C. "What foods the child prefers to eat." D. "How the child's grades are in school." E. "Which toy the child plays with at home."

Which statement by a student nurse indicates that additional instruction is needed regarding topical agents being used to treat burns? They eliminate bacterial growth but do not remove the bacteria from the skin They are not considered to be toxic substances They are associated with electrolyte derangement of surronding tissues They are able to penetrate through eschar levels to reach the wound

They are associated with electrolyte derangement of surrounding tissues Topical agents used in the treatment of burns should provide minimal electrolyte derangement. The other options stated are all consistent with the expceted actions of topical agents uised in the treatment of burns.

Which statement is correct about young children who report sexual abuse by one of their parents? They may exhibit various behavioral manifestations. In most cases, the child has fabricated the story. Their stories are not believed unless other evidence is apparent. They should be able to retell the story the same way to another person.

They may exhibit various behavioral manifestations. There is no diagnostic profile of the child who is being sexually abused. Many different behavioral manifestations may be exhibited, from outward sexual behaviors with others to withdrawal and introversion. It is never appropriate to assume that a child has fabricated the story of sexual abuse. Adults are reluctant to believe children, and sexual abuse often goes unreported. Physical examination is normal in approximately 80% of abused children. The child will usually try to protect their parents and may accept responsibility for the act.

Parents of a 10-year-old child are concerned that their child has been recently showing signs of low self-esteem. Which should the nurse consider when discussing this issue with the parents? Changing self-esteem is difficult after about age 5 years. Self-esteem is the objective judgment of one's worthiness. Transitory periods of lowered self-esteem are expected developmentally. High self-esteem develops when parents show adequate love for the child.

Transitory periods of lowered self-esteem are expected developmentally. Self-esteem changes with development. Transient declines are expected and, with positive encouragement and support, are only temporary. Self-esteem is influenced throughout adolescence. One aspect of self-esteem is a subjective judgment of one's worthiness. Self-esteem is based on several factors, including competence, sense of control, moral worth, and worthiness of love and acceptance.

The school nurse is presenting sexual information to a group of school-age girls. What approach should the nurse take when presenting the information?

Treat sex as a normal part of growth and development.

true

True/False: if suicide was attempted in the past, the risk for future attempts increases

true

True/False: school- age children's larger, stronger muscles and increased stamina means they can they can engage in more physical activity but they still may not be ready for strenuous competitive athletics

How do you promote normal Development and Family Support in early childhood?

Understanding basic trust, separation from parents, and beginning independence and including it in activities

smoking hazards

Undisputed damage related to tobacco use. Decreased lung function. Addiction/dependence on nicotine. Earlier age of smoking—more difficult to quit later in life.

A parent calls the health clinic stating that her child was just exposed to poison ivy and asks what she should do to prevent further complications? Have the parent contact the Health Department so they will be aware of a possible outbreak of this event. Quarnetine the child until the rash disappears as the child is considered to be contagious. Wash the exposed area of contact with cold water to neutralize effects of oil exposure. Suggest to the parent that a tetanus booster is necessary to prevent further complications from this puncture exposure.

Wash the exposed area of contact with cold water to neutralize effects of oil exposure. Best practice if this is a recent exposure is to wash the affected area with cold running water to minimize the effects by neutralizing the oil and possible bonding to skin areas. The Health Deparment does not have to be contacted as this is not considredd to be a public health issues. The child does not have to be quarentined as posion ivy can only be spread by direct contact of oils assocaited with the plant. Tetanus booster is not required as this is associated with contact and not puncture.

The school nurse is teaching bicycle safety to a group of school-age children. What should the nurse include in the session?

Watch for and yield to pedestrians Ride bicycles with traffic away from parked cars. Keep both hands on the handlebars except when signaling.

toddlers, preschoolers

What age groups benefit largely from using bandages (the larger the bandage, the more importance is attached to the wound so good for children to be able to watch their wound bandages become smaller and smaller)?

recovery, increased coping skills, feeling competent by mastering stress, socialization experiences that broaden interpersonal relationships

What are (4) major beneficial effects of hospitalization?

normalies environment, reduces interference with child's ongoing development, helps distance them from illness, provides sense of control

What are (4) major reasons why providing opportunity for play is extremely important in hospitalized/ill children?

drain, toilet cleaners, detergent, batteries

What are common corrosives?

gasoline, kerosene, lighter fluid, paint thinner

What are common hydrocarbons?

sharp, persistent, progressive or deep, dull ache located over bone most important is pain over the involved bony surface

What are common symptoms of stress fractures?

Acute early: N&V, tinnitus, hyperventilation Acute late: hyperactivity, fever, confusion, seizures, renal failure

What are signs and symptoms of Aspirin poisoning?

severe burning pain in mouth, throat and stomach, white swollen mucous membranes, edema of lips, tongue, coughing, hemoptysis, drooling, shock

What are signs and symptoms of a corrosive poisoning?

gagging, choking, coughing, burning throat and stomach, altered sensorium, lethargy, weakness, Respiratory symptoms like tachypnea, cyanosis, retractions, grunting

What are signs and symptoms of hydrocarbon poisoning?

severe weight loss, amenorrhea, bradycardia, hypotension, cold intolerance, dry skin, brittle nails, thinning hair, evidence of muscle wasting

What are some clinical manifestations of Anorexia?

lack of contact with reality, in their own world language disturbances, impaired interpersonal relationships, inappropriate affect

What are some common manifestations of childhood schizophrenia?

Newborn - chlamydia, gonorrhea, herpes simplex virus Infant- tear duct obstruction Child- bacterial, viral, allergic, or foreign body

What are the causes of conjunctivitis in newborns? Infants? Children?

weight may normal tooth erosion, esophageal damage, and other GI concerns psychological issues: self deprecating thoughts, depressed mood

What are the clinical manifestations of bulimia?

antipsychotic drugs dizziness, drowsiness, tachycardia, hypotension, extrapyramidal effects

What are the common drug prescribed to children with schizophrenia? What are their side effects?

Stimulants: methylphenidate (Ritalin), dextroamphetamine (Adderall) SE: loss of appetite, weight loss, abd pain, headache, insomnia, hypertension

What are the common medications prescribed to children with ADHD? What are some of their side effects?

effects on the central nervous system

What are the most serious consequences of lead exposure?

0-24 hr: N&V, sweating,pallor 24-72 hr: improvement, upper quadrant pain 72-96 hr: pain upper R quad, jaundice, N&V confusion, coagulation abnormalities More then 5 days: hepatotoxicity resolves, Or organ failure

What are the stages of Acetaminophen poisoning?

protest --> despair --> detachment (denial)

What are the stages that occur during separation anxiety?

A, B, D (The nurse has to follow a few guidelines while admitting the child to the hospital. The nurse should apply an identification band on the child's wrist. This helps in providing appropriate care to the child. The nurse should take the nursing admission history in order to help to identify needs of the child. The nurse should explain to the parents as well as the child about the inpatient facilities. This would make them comfortable within the hospital. Specimens should be collected and may even be ordered for other specimens upon admission. The nurse should orient the parents and the child about the hospital regulations and schedules like visiting hours and food timings.)

What are the various guidelines that the nurse has to follow for the admission of a child into the hospital? Select all that apply. A. Apply an identification band on the child's wrist. B. Obtain the nursing admission history of the child. C. Specimens for lab tests should not be taken. D. Orient the parents about the inpatient facilities. E. Hospital regulations should not be disclosed.

human parovirus

What infectious agent causes Erythema Infectiosum (Fifth disease)?

human herpes virus type 6 5 to 15 days

What infectious agent causes Roseola? How long is incubation period?

paramyxovirus droplet or direct contact

What infectious agent causes mumps? How is it transmitted?

tape test (put tape over anal cavity and worms stick to tape)

What is a common diagnostic test for pinworms?

aquafor

What is a common treatment for vaginitis?

can cause severe anemia in the fetus

What is a concern if a child with Fifth Disease has been around a pregnant woman?

A, B, E (Encourage parents to bring in homework and schedule study times. Allow the adolescent to wear street clothes. Encourage parents to bring in favorite foods.)

What is an age-appropriate nursing intervention to facilitate psychologic adjustment for an adolescent expected to have a prolonged hospitalization (select all that apply)? a. Encourage parents to bring in homework and schedule study times. b. Allow the adolescent to wear street clothes. c. Involve the parents in care. d. Follow home routines. e. Encourage parents to bring in favorite foods.

reasoning

What is an effective disciplinary technique for school aged children?

separation (rather than loss of control)

What is the MAJOR stressor for infants?

6 -12 years old

What is the age range for a school-age child?

13 - 19 years old

What is the age range for adolescence?

9 1/2 hours

What is the average amount of sleep a school- age child gets at night?

C (Let the child decide which color arm board to use with the IV.)

What is the best action for the nurse to take when a 5-year-old child who requires another 2 days of intravenous (IV) antibiotics cries, screams, and resists having the IV restarted? a. Exit the room and leave the child alone until he stops crying. b. Tell the child big boys and girls "don't cry." c. Let the child decide which color arm board to use with the IV. d. Administer a narcotic analgesic for pain to quiet the child.

honestly, matter of fact, at their level of understanding tell them what they need to know and what will happen to them as they become sexually mature

What is the best way to answer a school-aged child's questions about sex?

short rapid coughs followed by crowing or whoop sound pneumonia Zithromax

What is the clinical presentation of Pertussis (whooping cough)? What are complications? Treatment?

koplik spots ( small red spots w/ bluish center)

What is the clinical presentation of Rubeola (measles)?

strep throat with a rash; beefy red tonsils, petechiae carditis, peritonsillar abscess, glomerulonephritis

What is the clinical presentation of Scarlet fever? Complication?

loss of identity

What is the major conflict that affects adolescents during hospitalization?

separation anxiety

What is the major conflict that affects infants and toddlers during hospitalization?

bodily injury and pain

What is the major conflict that affects preschoolers during hospitalization?

loss of control

What is the major conflict that affects school-age children during hospitalization?

separation anxiety; 6-30 months

What is the major stress for middle infancy to preschool years; what specific ages make this up?

pregnancy

What is the most common cause of secondary amenorrhea?

motor vehicle accidents

What is the most common cause of severe injury in school-aged children?

C (Lack of physical connection to the hospital)

What is the primary disadvantage associated with outpatient and day facility care? a. Increased cost b. Increased risk of infection c. Lack of physical connection to the hospital d. Longer separation of the child from family

minimize separation anxiety; involve parent in everything (as much as they feel comfortable)

What is the primary nursing goal of those <5 yrs, specifically <30 months? How can you do this?

motor vehicle crashes

What is the single greatest cause of unintentional injury and death in adolescents?

presence of an active psychiatric disorder (depression, bipolar disorder, psychosis, substance abuse, or conduct behavior)

What is the single most important factor that causes suicidal attempts or suicide?

blood lead level (BLL) test with venous blood sample

What is the test used to screen and diagnose lead levels?

suicide

What is the third leading cause of death in teens?

mucomyst (N-acetlycystine)

What is the treatment for Acetaminophen poisoning?

testosterone administration to enhance masculine characteristics

What is the treatment for Klinefelter syndrome?

chelation therapy

What is the treatment for high blood lead level?

postconventional autonomous

What level in kohlberg are adolescents in?

A (The major stress for children from infancy through the preschool years is separation anxiety, also called anaclitic depression. This is a major stressor of hospitalization. Loss of control, fear of bodily injury, and fear of pain are all stressors associated with hospitalization. However, separation from family is a primary stressor in this age-group.)

What represents the major stressor of hospitalization for children from middle infancy throughout the preschool years? a. Separation anxiety b. Loss of control c. Fear of bodily injury d. Fear of pain

fluid and electrolyte alterations and observation for signs of cardiac complications

What should be monitored in anorexia and bulimia patients?

renal function

What should be monitored when a patient is receiving chelation therapy?

call poison control before initiating any interventions

What should parents do first if they suspect their child has been poisoned?

identity vs role confusion

What stage in erikson are adolescents in?

EDTA given IV or IM

What type of chelation therapy is needed for severe lead poisoning of > 70 mcg/dl? How is it given?

airborne precautions, strict isolation

What type of precaution is needed for chicken pox?

A (If a toddler is not prepared for hospitalization, a typical preschooler fantasy is to attribute the hospitalization to punishment for real or imagined misdeeds. Threat to child's self-image and loss of companionship with friends are reactions typical of school-age children. Regression is a response characteristic of toddlers when threatened with loss of control.)

When a preschool child is hospitalized without adequate preparation, the nurse should recognize that the child may likely see hospitalization as: a. Punishment. b. Threat to child's self-image. c. An opportunity for regression. d. Loss of companionship with friends.

replant tooth and have child bite down on gauze then transport to dentist OR can place tooth in cold milk for transport

When a tooth is knocked out (avulsed) what can be should be done with the tooth?

B, C, D, E (Risk factors for increased stress level of a child to illness or hospitalization: "Difficult" temperament; Lack of fit between child and parent; Age (especially between 6 months and 5 years old); Male gender; Below-average intelligence; Multiple and continuing stresses (e.g., frequent hospitalizations).)

When admitting a child to the inpatient pediatric unit, the nurse should assess for which risk factors that can increase the child's stress level associated with hospitalization? Select all that apply. A. Mild temperament B. Lack of fit between parent and child C. Below-average intelligence D. Age E. Gender

providing somewhat different and less negative account of disease, offering explanation that is characteristic of next stage of cognitive dev

When children are upset about illness, perception can be changed by what (2) methods?

when lesions have crusted over

When is a child with chicken pox no longer contagious?

before the rash appears

When is the child contagious with Fifth disease?

after meals, after snack, at bedtime

When should teeth be brushed?

rear seat

Where is the safest vehicle seat for a child under 13?

adolescent

Which age group has: loss of peer group contact ay pose a severe emotional threat b/c of loss of group status, inability to exert group control or leadership, and loss of group acceptance?

B (In the protest phase, the child aggressively responds to separation from parents (such as clinging to a parent). Inactivity is characteristic of despair. Depression and sadness are characteristics of despair. Regression to earlier behavior is characteristic of despair.)

Which behavior would most likely be manifested in a young child experiencing the protest phase of separation anxiety? A. Inactivity B. Clings to parent C. Depressed, sad D. Regression to earlier behavior

B (Emergency hospitalization)

Which situation poses the greatest challenge to the nurse working with a child and family? a. Twenty-four-hour observation b. Emergency hospitalization c. Outpatient admission d. Rehabilitation admission

C (If the parents cannot stay with the child in the hospital, the nurse may ask the parents to leave an article such as a blanket or toy from home. This is because young children associate such inanimate objects with significant people, and they gain comfort and reassurance from these possessions. When a child is frightened, the nurse should provide physical contact to ease the child. If the child is allergic to the linens at the hospital, it would be the hospital's responsibility to find alternative bedding. There are plenty of blankets available in the hospital, so the parents would not bring the blanket to keep the child warm.)

Why does the nurse ask the parents of a hospitalized child to bring the child's blanket from home? A. To alleviate any fears in the child B. To decrease any allergic reactions C. To provide comfort for the child D. To keep the child warm at night

WHat happens at development of a 9-12 year old ?

Writes brief stories Reads for enjoyment, care of pets Cooks Leaves home for short periods "best friend" Consider death irreversible Gain independence within family

self-concept

a conscious awareness of a variety of self-perceptions

how is moral developed in the older school age?

able to judge an act by the intentions that prompted it

menarche

about 2 years after thelarch, menstruation begins

turner syndrome

absence of X chromosome (45, X) -females -incidence is 1 in 2500 female births Manifestations: >sterile >short stature >no secondary sex characteristics >webbed neck, shield shaped chest, widely spaced nipples, low posterior line

Secondary amenorrhea

absence of menses after menstruation was previously established for at least 6 months in a women with regular periods or for at least 12 months in a women with irregular periods

secondary amenorrhea

absence of menses for 6 months or absence of three cycles after menstruation was previously est. most common cause is pregnancy other causes are eating disorders, stress, and other causes of severe weight loss

A ventilator-dependent child is being discharged home from the hospital. Prior to discharge, the home health care nurse discusses the development of an emergency plan with the family. The most essential component of the plan is acquisition of a backup generator. designation of an emergency shelter. notifying the power company that the child is on life support. provision for alternate heating and cooling source if power is lost. notifying emergency medical services that child is on life support.

acquisition of a backup generator. It is essential that the family have a backup generator in place prior to discharge so that the child's life support is not interrupted should power be lost. Designation of an emergency shelter, notifying the power company that the child is on life support, provision for alternate hearing and cooling source if power is lost and notifying the emergency medical services that the child is on life support are important concerns but are not considered to be the most essential component of the discharge plan.

health problems related to sports participation

acute overload injuries, overuse syndrome

rape trauma syndrome

acute phase of disorganization long term reorganization process nightmares, fears, phobias, panic reactions feelings of helplessness, powerless victim recovery

mourning takes a long time

acute phase v resolving periods of grief can relapse

Nursing care and management of a burn

acute: -assess pulmonary status -treat burn shock by.. >monitoring VS >output and fluid infusion >respiratory >monitor for signs of adequate hydration >might see electrolyte imbalances >changes in respiratory function >risk of hypothermia extremity that is burned >monitor pulse in extremity frequently

Name some concepts related to isolation.

added stressor of hospitalization child may have limited understanding dealing with child's fears potential for sensory deprivation

The children should know..

address and parent phone number

What to teach about cellphone safety?

address and phone number fire department

what is the principle of double effect?

an action that has one good (intended) and one bad (unintended but forseeable affect) is permissible if the following actions are met) 1. action itself must be good 2. the good effect must not be produced by the bad effect 3.there must be a compelling or proportionate reason for permitting the bad effect.

How might adolescents respond to a loss of control?

anger/frustration

what is early intervention?

any sustained and systematic effort to assist developmentally vulnerable or disabled children from birth to 3 years old.

sex differences in general growth patterns

appear to be the result of hormonal effects during puberty skeletal growth voice changes lean or not lean body mass skin, glands, and hair

in a pt with bulimia, there will be how many cycles per day?

around 8+

How might preschoolers view hospitalization or illness?

as punishment for misdeeds

factors to promote optimum health during adolescence

assumption of responsibility for health assess for risk factors immunizations nutrition eating habits and behaviors healthy lifestyle habits sleep and rest exercise and activity dental health personal care stress reduction sexuality education and guidance

8-11

at what age will a child most likely resist bedtimes

What are two things that toddlers need?

autonomy, daily routines and rituals

14

avg age of puberty in boys

12

avg age of puberty in girls

What to teach about water safety?

avoid drowning by teaching children to swim gated pool Encourage parents to have 1 adult life guarding

early childhood

basic trust, separation from parents, beginning independence

enuresis

bed wetting more common in boys usually ceases between 6-8 years

Enuresis

bed wetting more common in boys usually ceases at 6-8 years

nocturnal enuresis

bed wetting; more likely in males; can last up to 15 years old

children of 12 years and older are general less resistant to

bedtimes

maturation of systems

bladder capacity increases; heart smaller in relation to the rest of the body; immune system increasingly effective; bones increase in ossification; physical maturity not necessarily correlated with emotional and social maturity

The psychosexual conflicts of preschool children make them extremely vulnerable to separation anxiety. loss of control. bodily injury and pain. loss of identity.

bodily injury and pain. Intrusive procedures, whether or not they are perceived as painful, are threatening to the preschooler because of the poorly developed concept of body integrity. Separation anxiety is more of a characteristic of infancy. Loss of control is a characteristic fear of school-age children. Loss of identity is a concern of adolescents because illnesses are conceptualized as the effect on the individual.

The school nurse is asked to speak with the parents of a 10-year-old boy who has been bullying other children. The nurse's response should be based on knowledge that bullying at this age is considered normal. children who bully others usually join gangs. bullying is a short-term problem that is generally outgrown by the end of the school-age years. bullying often manifests itself in children who are different or have poor academic or social skills.

bullying often manifests itself in children who are different or have poor academic or social skills. Poor relationships with peers and a lack of group identification, such as looking different or having poor academic or social skills, contribute to bullying behavior. Bullying is a maladaptive response to poor relationships with peers and lack of group identification; therefore, it is not considered normal behavior. Children who chronically bully tend to be impulsive, easily frustrated, and at increased risk for dropping out of school, but there is no direct correlation between bullies and joining gangs. Children who bully may be at risk for long-term psychological disturbances and psychiatric symptoms. Future problems for bullies may include violence, substance abuse, and criminal convictions, which often occur in adulthood.

adrenal cortex

causes small amount of secretion before puberty

Secondary sex characteristics

changes of the body that result from hormonal changes but play no direct part in reproduction (facial hair, pubic hair, voice changes, fat deposits)

factors that predispose for physical abuse

characteristics of parents characteristics of child environmental conditions young parents, single parents, parents with unrelated partners in the house abusive families often socially isolated low income low education level substance abuse parent who are abusive have low self esteem little knowledge of parenting skills highest risk from birth to 1 year unwanted hyperactive, physically disabled, brain damage , high risk for abuse sometimes one child is singled out and if they are removed then other child at risk for being singled out chronic stress : unemployment, poverty, divorce, alcohol, substance addiction

lead poisoning treatment

chelation therapy, chemical combines with metal for rapid excretion from the body

this stage is about the transition between

childhood and adulthood

A 4-year-old child is scheduled for cardiac surgery in a week. The child's parents call the hospital to ask how to prepare the child for the upcoming hospitalization and surgical procedure. The nurse's reply should be based on the knowledge that preparation at this age will only increase the child's stress. preparation needs to be at least 2 to 3 weeks before hospitalization to be effective. children who are prepared experience less fear and stress during hospitalization. children who are prepared experience overwhelming fear by the time hospitalization occurs.

children who are prepared experience less fear and stress during hospitalization. Preparing the child for the hospitalization will reduce the number of unknown elements. Taking tours, handling some of the equipment, or being told stories about what to expect will increase the familiar items. Timing of the preparation must also be considered. Four- to 7-year-olds can be prepared up to 1 week in advance of the hospitalization. Preparation of a 4-year-old will reduce stress by having the child incorporate and assimilate the information more slowly. Children between the ages of 4 and 7 years should be prepared about 1 week before hospitalization. A reduction in fear is usually observed when children are prepared appropriately for hospitalization.

Diagnosis of enuresis

chornological or developmental age over 5 years -2 times per week or more for 3 months may have urgency and frequency

dx of enuresis

chronologic or developmental age over 5 years two times per week or more for three months may have urgency or frequency

The nurse is discussing health behaviors with a 14-year-old who recently began smoking cigarettes. An appropriate tactic for the nurse to use when discussing this lifestyle choice is cigarette smoking is only "cool" in high school and is not accepted in college. cigarette smoking can cause permanent damage to the lungs and can cause cancer as an adult. cigarettes are expensive, and a 14-year-old will not be able to afford them, so he should stop smoking. cigarettes contain nicotine, and this will cause addiction to other drugs.

cigarette smoking can cause permanent damage to the lungs and can cause cancer as an adult. Cigarette smoking can cause permanent damage to the lungs and can cause cancer as an adult. At 14, the child only thinks of the present. The nurse would need to include and explain, and even use pictures to illustrate, what might happen to the body if the child continues to smoke. Saying cigarette smoking is only cool in high school and is not accepted in college is not a useful tactic the nurse should use when discussing smoking cigarettes. Suggesting that cigarettes are not affordable and the 14-year-old should therefore stop smoking is not a healthy approach to teaching adolescents to stop smoking. Cigarettes contain nicotine, and this will cause addiction to other drugs. Adolescents are not often concerned with whether cigarette smoking will lead to other addictions.

The parents of 9-year-old twins tell the nurse, "They have filled up their bedroom with collections of rocks, shells, stamps, and cars." The nurse should recognize that this behavior is characteristic of giftedness. typical "twin" behavior. cognitive development at this age. psychosocial development at this age.

cognitive development at this age. Classification skills are developed during the school-age years. This age-group enjoys sorting objects according to shared characteristics. Giftedness is not measured simply by a school-age child's ability to classify objects, which is an expected cognitive skill for this age-group. Giftedness signs include specific academic aptitudes, advanced memory skills, creative thinking, ability in the visual or performing arts, and psychomotor ability, either individually or in combination. The development of classification skills is characteristic of the school-age child and is not related to the behavior of twins. Psychosocial development of the school-age child is focused on accomplishment or industry, not the cognitive skills of classification that are described.

What treatments can be done in DNR?

comfort measures and care oxygen, IVF, pain meds, IVs

What is more important in predicting anxiety in children: concept of illness or intellectual maturity?

concept of illness

What happens in the protest phase of separation anxiety?

crying and screaming, clinging to the parent

What happens during the despair phase of separation anxiety?

crying stops, evidence of depression

responses to puberty differ depending on the stage of development

curiosity in early adolescence, concerns with normalcy, concerns for late maturing teens, concept of perfect bod achievement

Prepubescence

defined as the two years preceding puberty; typically occurs during preadolescence

emotional abuse OR psychosocial maltreatment

deliberate attempt to destroy or significantly impair a child's self-esteem or competence

physical abuse

deliberate infliction of physical injury on a child

physical abuse

deliberate infliction of physical injury on a child Shaken baby syndrome

Munchausen syndrome by proxy (MSBP)

deliberately exaggerates or fabricates histories and symptoms or induces symptoms; may include physical, emotional, and psychological abuse for the gratification of the caregiver

What is another name for the detachment phase of separation anxiety?

denial phase

peers form a transitional world between ___ and ___

dependence, autonomy

Name the five responses to stressors of hospitalization that parents experience:

desbelief/anger/guilt- especially if the illness has a sudden onset fear/anxiety- related to the child's pain and the seriousness of the illness frustration- especially related to the need for info depression

Nurses counseling parents regarding the home care of the child with a cardiac defect before corrective surgery should stress the importance of reducing caloric intake to decrease cardiac demands. importance of relaxing discipline and limit-setting to prevent crying. need to be extremely concerned about cyanotic spells. desirability of promoting normalcy within the limits of the child's condition.

desirability of promoting normalcy within the limits of the child's condition. The child needs to have social interactions, discipline, and appropriate limit setting. Parents need to be encouraged to promote as normal a life as possible for their child. The child needs increased caloric intake after cardiac surgery. The child needs discipline and appropriate limit setting, as would be done with any other child his or her age. Because cyanotic spells will occur in children with some defects, the parents need to be taught how to assess for and manage them appropriately, thereby decreasing their anxiety and concern.

adolescence

developing independence and autonimy

PTSD

development of characteristic symptoms following exposure to an extremely traumatic experience or catastrophic event person may function adequately but have foreboding regarding the future

Focusing on the childs ________________ rather than chronologic age or diagnosis emphasized the child's abilities and strengths rather than disabilities.

developmental level

Attention-deficit/hyperactivity disorder (ADHD)

developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity

postconventional autonomous

develops a personal, functional value system independent of authority figures and peers

stimulant medications for ADHD

dextroamphetamine (dexedrine), amphetamine and dextroamphetamine (Adderall), methylphenidate (Ritalin)

Name some individual risk factors that increase vulnerability to stressors of hospitalization.

difficult temperament lack of fit between a child and parent age- 6mo-5 years especially male gender below average intelligence multiple and continuing stressors, like frequent hospitalization

boys are more likely to bully using the ___ method

direct (physical)

2 types of bullying

direct and indirect

What is one of the most stressful aspects of communication between families and healthcare professionals?

disclosure of serious chronic or complex condition of a child

what is DNaR?

do not attempt resuscitation.

Gastric lavage

do this within 1 hour of ingestion -protected airway so patient must be intubated possible sedation needs to be done at an emergency facility

ANA code of ethics

does not support the active intent on the part of the nurse to end a persons life

substance abuse

drug abuse, misuse, and addiction: voluntary behaviors, culturally defined, use of drugs for other than an acceptable medical purpose drug tolerance and physical dependence

treatment for enuresis

drugs- imipramine (tofranil), oxybutynin, DDVAP bladder training fluid restriction in evenings interruption of sleep to void conditioned reflex response device

treatment of enuresis

drugs: imipramine (tofranil), oxybutynin, desmopressin (ddavp) bladder training fluid restriction in evenings after 4pm interruption of sleep to void conditioned reflex response device (bedwetting alarms)

monosymptomatic enuresis (most common)

dry during the day

eriksons stage meaning

eager to develop skills and participate in meaningful and socially useful work; acquires a sense of personal and interpersonal competence; growing sense of independence; peer approval is a strong motivator

most anomalies in the male reproductive system are identified in ___

early childhood

bullima

eating disorder characterized by binge eating may be followed by purging behaviors (laxative abuse, self induced vomiting, diuretic abuse, rigorous exercise regimens)

Bulimia

eating disorder characterized by repeated episodes of binge eating following by inappropriate compensatory behaviors (purging)

anorexia nervosa

eating disorder involving refusal to maintain a normal body weight primarily in adolescent and young adult females mean age of onset is 13.75 years, 10-25 years old

therapeutic play

effective, nondirective modality for helping children deal with concerns & fears, as well as help nurses gain insights into child's needs & feelings

Long term prognosis for lead poisoning

effects on CNS permanent brain damage behavior changes paralysis seizures

What type of thinking is normal in preschoolers?

egocentric and magical thinking

single parents

enormous burden try to keep everything going; both parental roles

emotional and sexual abuse

enuresis may wet bed, could have a sleep disorder

Gastric decontamination

epicac no longer recommended -if actual antidote use that

In helping a child to adapt to a hospitalization experience, the best approach would be to allow the child to bring in all of his favorite toys to the hospital so as to represent a more familiar environment. let the parents bring in food from home that the child is used to eating for all meals. establish a daily routine and schedule with the child and parent to help maintain consistency. allow the child to select his room on the unit.

establish a daily routine and schedule with the child and parent to help maintain consistency. By providing a daily routine and schedule, the nurse helps to support consistency. It is not realistic for the child to bring in all of his favorite toys or allow the child to make a room selection on the unit. Bringing food in from home for all meals is not realistic and may not be advised based on therapeutic treatment.

sexual abuse

evidence diminishes pretty good within 24 hours no scarring if suspected needs to be investigated quickly

child's age +2 years is the

expected bladder capacity in ounces

primary sex characteristics

external genitalia and reproductive organs; primarily internal

physical abuse s/s

failure to grow, malnutrition, poor personal hygiene

emotional neglect

failure to meet the child's needs for affection, attention, and motional nurturance

The nurse working in an outpatient surgery center for children should understand that children's anxiety is minimal in such a center. waiting is not stressful for parents in such a center. accurate and complete discharge teaching is the responsibility of the surgeon. families need to be prepared for what to expect after discharge.

families need to be prepared for what to expect after discharge. Discharge instructions should be provided in both written and oral form and in the primary language of the patient and family. Instructions need to include normal responses to the procedure and when to notify the practitioner if untoward reactions occur. Although anxiety may be reduced because of the lack of an overnight stay, the child will still experience the stress associated with a medical procedure. The waiting period while the child is having the procedure is a stressful time for families in both outpatient and inpatient settings. Discharge instructions are a responsibility of both the surgeon and the nursing staff.

secondary encopresis

fecal incontinence after period of established fecal continence after age of 4

Erikson: Inferiority

feelings may derive from self or social environment; may occur if incapable or unprepared to assume the responsibilities associated with developing a sense of accomplishment; all children feel some degree of inferiority regarding skills they cannot master

piaget- cognitive development

formal operation period abstract thinking

Girls experience an increase in weight and fat deposition during puberty. Nursing considerations related to this include giving reassurance that these changes are normal. suggesting dietary measures to control weight gain. recommending increased exercise to control weight gain. encouraging a low-fat diet to prevent fat deposition.

giving reassurance that these changes are normal. A certain amount of fat is increased along with lean body mass to fill the characteristic contours of the child's gender. A healthy balance must be achieved between expected healthy weight gain and obesity as related to these normal and expected physical changes. This should not be done unless weight gain is excessive. Eating disorders can develop in this group, and diet management should be considered only under a health care practitioner's care. Exercise is an important component in weight management but should never be done or encouraged in increased amounts or in excess to control weight gain that occurs normally during puberty. Some fat deposition is essential for normal hormonal regulation. Menarche is delayed in girls with body fat contents that are too low; therefore, a low-fat diet is not a recommended intervention.

maturation of ___ produces biological changes of puberty

gonads

growth and development at this stage is, and they will have progress with physical and emotional maturity

gradual

vaginitis

gray-white vaginal discharge with odor and itching of the vulva and vagina could be signs of

stage 3

hair darker, coarser, and curly and spread sparsely over entire pubis in the typical female triangle

9.5

how many hours of sleep, on avg, does a school-age child get

2

how many inches per year does height increase by in a school-age child

2-3

how many kg per year does the weight increase in a school-age child

88 lbs

how much does the average 12 year old weigh

nursing care for abused child

identify ASAP thorough physical exam SID, osteogenesis or bleeding disorders that can be misinterpreted as abuse

childs age +2 = expected bladder capacity in ounces

if child is 5 then we expect they can hold 7 oz of urine

why do kids smoke?

imitation of adult behavior peer pressure perceived popularity of smokers less likely to smoke if parents and family do not less likely to smoke with high performance sports activities

what is included in the concept of functional burden?

impacts of the child with special needs family resources and ability to cope

social development

importance of the peer group identification with peers is a strong influence in a child gaining independence from parents sex roles are strongly influenced by peer relationships

smoking stats

in 2002, 28.2% of hs students reported tobacco use more students are using smokeless tobacco or cigars although numbers have declined, it is considered the chief avoidable cause of death

The management of adolescent obesity should include planning a low-calorie, low-protein diet. incorporating favorite foods into the diet. encouraging diversional activities during mealtimes. using nutritious foods as a method of reward.

incorporating favorite foods into the diet. Incorporating small amounts of the adolescent's favorite foods will increase adherence to the nutritional plan. A food plan high in nutrients with calories and fats at a healthy level is recommended. Adolescents need calories and protein in appropriate amounts to allow continued physical growth during a growth spurt and puberty. Diversional activities such as television watching may contribute to overeating and should be discouraged. Food should never be used as a reward.

Bones ______ in ossification

increase

obesity

increase in body weight due to the accumulation of excessive body fat relative to lean body mass

what does childhood obesity impact?

increase in risk for DM II risk of adult obesity HTN hyperlipidemia CVD social isolation low self esteem depression

What do adolescents struggle for?

independence and liberation

What do school age children strive for?

independence and productivity

girls are more likely to bully ___

indirectly (gossip)

school age

industry and activity

What is the erickson stage for school aged children?

industry vs inferiority

increased awareness of differences may influence feelings of:

inferiority

epididymitis

inflammation of the epididymis that is frequently caused by the spread of infection from the urethra or the bladder

What do adolescents need when they are ill or hospitalized?

information about their condition

side effects of stimulants for ADHD

insomnia, anorexia, and weight loss HTN may suppress growth if used over time

PTSD: Initial response

intense arousal- lasts 1-2 hrs fight or flight response

physical neglect

involves the deprivation of necessities such as food, clothes, shelter, supervision, medical care, and education

An adolescent boy tells the school nurse that he is gay. The nurse's response should be based on knowledge that he is too young to have had enough sexual activity to determine his sexual orientation at this time. it is important to provide a nonthreatening environment for him to discuss his feelings. the nurse should feel open in discussing his or her own beliefs about homosexuality. homosexual adolescents do not have concerns that differ from those of heterosexual adolescents.

it is important to provide a nonthreatening environment for him to discuss his feelings. The nurse needs to be open and nonjudgmental in interactions with adolescents who have questions about their sexual orientation. This will allow a safe environment for the adolescents to speak and receive guidance from a health care professional as warranted. Adolescence is when sexual identity develops; therefore, questions about sexual orientation often surface at this time. The nurse's own beliefs should not bias the interaction with this student and, therefore, are irrelevant. Homosexual adolescents have different challenges to growing up and their sexual identity than heterosexual adolescents, often related to societal, cultural, religious, and spiritual influences.

What makes a child a target for bullying :( ?

lack esteem, insecurities

emotional neglect

lack of affection, attention, and emotional nurturance

PTSD: Second Phase

lasts approx 2 weeks denial period of quiescence`

Heavy metal poisoning what are we talking about?

lead, mercury

Childrens who played were ______ likely to commit violence as adults

least

generally, children like their physical selves ___ as they grow older

less

what age group has the least significance of the concept of death?

less than 6 months

A home health nurse is assigned to an adolescent with recently acquired tetraplegia. The adolescent's mother tells the nurse, "I'm sick of providing all the care while my husband does whatever he wants and whenever he wants." Based on the nurse's knowledge of family-centered care, the most appropriate nursing intervention is to listen and reflect the mother's feelings. refer the mother for psychological counseling. suggest ways the mother can get the husband to help with care. meet with the adolescent's father in private and ask why he does not help.

listen and reflect the mother's feelings. It is appropriate for the nurse to reflect with the mother about her feelings and explore avenues for additional home health assistance and provide respite care for the mother. A support group for caregivers is more appropriate at this time, not counseling. It is inappropriate for the nurse to agree with the mother that the husband is not helping enough. The nurse is making a judgment that is beyond the role of the nurse in addition to undermining the family relationship. It is inappropriate to meet with the father privately because the meeting is based on the mother's assumption of the father's minimal involvement with the adolescent's care. The father may be working two jobs to support the family's additional expenses.

How might siblings react to a brother or sister being hospitalized?

lonliness, fear, worry resentment, anger, jealousy guilt

what are physical signs of approaching death?

loss of sensation and movement in lower extremities sensation of heat although the body feels cold loss of senses confusion, loss of consciousness, slurred speech muscle weakness changes in respiratory pattern CHEYNE-STOKES respirations. DEATH RATTLE. weak, slow, pulse. decreased blood pressure.

What are dishonest behaviors child face?

lying, stealing, cheating

sexual abuse

man who victim lives with below poverty level parents of highschool education more likely than college employed or volunteer in teaching and coaching

androgens

masculinizing hormones

puberty

maturational, hormonal, and growth process that occurs when reproductive organs begin to function and secondary sex characteristics develop; point at which secondary maturity is achieved (menses for girls and what ever the hell happens to boys)

stage 5

mature configuration: projection of papilla only caused by recession of areola into general contour

school-age

may indicate fear of bodily pain by communicating with precise verbalization of pain, passive requests for support or help, or use of procrastination techniques

adolescents

may indicate fear of bodily pain by exhibiting self-control and using limited movement

preschoolers

may indicate fear of bodily pain through aggression, verbal expression, or dependency

infants

may indicate fear of bodily pain through facial expressions and body movements showing discomfort

toddlers

may indicate fear of bodily pain through intense emotional upset or physical resistance

gynecomastia

may occur with normal achievement of male puberty and resolves within 1 year can be caused by anabolic steroid use or endocrine disorders testosterone supplementation may aggravate gynecomastia plastic surgery

gynecomastia

may occur with normal achievement of male puberty and resolves within 1 year >can be caused by anabolic steroid use or endocrine disorders >testosterone supplementation may aggravate gynecomastia >plastic surgery?

what is another term for euthanasia?

mercy killing or assisted suicide.

what is the ideal time for formal sex education?

middle childhood Lifespan approach; info on sexual maturity and the process of reproduction; effective communication with parents

What is Kohlberg's theory?

moral development Development of conscience and moral standards Rules and judgments become more founded on needs and desires of others

encopresis risk factors

more common in boys may follow psychological stress may be secondary to constipation or impaction

sex chromosome abnormalities

most are caused by an altered number of sex chromosomes

monosymptomatic enuresis

most common form of enuresis, dry during the day

child neglect

most common form of maltreatment

In reviewing information about a school-age child, the nurse notes that the child goes to after school activities each day as the parents do not get home until considerably later in the day. Based on this description, the nurse would document concern for the growth and development due to lack of parental influence. no further action is needed. referral to a social worker for evaluation of the family unit. notation of being a latchkey child.

no further action is needed. Many children have working parents and do not exhibit any adverse outcomes if they attend after school activities each day following release from school. There is no need for referral to a social worker. A latchkey child by definition is one that has no parental or supervision contact following the school day and are responsible for their own care until the parent comes home.

stage 1

no pubic hair; essentially the same as during childhood; no distinction between hair on pubis and hair over abdomen

Under 6 months sun exposure

no sunscreen if under 6 months -shade or clothing protection

While caring for hospitalized adolescents, the nurse observes that sometimes they are skeptical of their parents' religious beliefs and practices. The nurse should recognize that this is normal in spiritual development. abnormal in spiritual development. related to illness and occurs only at times of crisis. related to the parents' inability to adequately explain their beliefs and practices.

normal in spiritual development. The behavior described occurs in stage 4 in spiritual development. Adolescents attempt to determine which of their parents' standards and beliefs to incorporate into their own. The behavior described is not abnormal. The behavior described is not applicable only during times of crisis. The behavior described is not related to the parents' inability to explain their beliefs and practices.

An adolescent girl is brought to the hospital emergency department by her parents after being raped. The girl is calm and controlled throughout the interview and examination. The nurse should recognize that this behavior is one of a variety of behaviors normally seen in rape victims. indicative of a higher-than-usual level of maturity in the adolescent. suggestive that a rape has not actually occurred. suggestive that the adolescent had severe emotional problems before the rape occurred.

one of a variety of behaviors normally seen in rape victims. Rape victims display a wide range of behaviors. A controlled manner may be an attempt to maintain composure and control while hiding inner turmoil. The responses described are indicative of those often assessed in rape victims. There are no data to support that a rape has not occurred. Physical assessment will provide valuable information. There are no data to support that the adolescent had prior emotional problems.

Enteral feedings are ordered for a young child with burns covering 40% of the total body surface area. The nurse should know that oral feedings are contraindicated. enteral feedings must be stopped during painful procedures. paralytic ileus precludes use of enteral feedings. the feedings will be high in carbohydrate and low in protein.

paralytic ileus precludes use of enteral feedings. Enteral feedings can begin when the paralytic ileus resolves. Oral feedings are not contraindicated. Oral feedings are encouraged. Most children with burns are unable to consume sufficient calories by mouth, but every possible effort is made to encourage oral feeding. Enteral feedings can continue during procedures. A high-protein, high-calorie diet is recommended to compensate for the increased basal metabolic rate that occurs after a burn injury.

overprotection

parent's fear of child achieving any new skill, avoid all discipline, cater to every need/desire

who is the primary influence in shaping a child's personality, behavior, and value system?

parents

rejection

parents detach themselves emotionally from the child by providing adequate physical care. May constantly nag child.

When caring for the suicidal adolescent, the most important nursing intervention is emphasizing that a suicide attempt is an immature way of dealing with stress. paying particular attention to children who are withdrawn and are giving away their personal belongings. ignoring threats of suicide because they are usually bids for attention. recognizing a suicide attempt as an impulsive act resulting from a temporary crisis.

paying particular attention to children who are withdrawn and are giving away their personal belongings. It is imperative that the nurse recognize warning signs of a potential suicide. For the depressed youngster, suicide may appear to be the only way out, and telling a child that he or she is immature in feelings or behavior will exacerbate an already crisis-laden situation. All threats of suicide must be taken seriously and should never be ignored. Even if the crisis is temporary, the child's perception may be that suicide is the only way out of it.

stage 3: (males)

penile enlargement, voice changes, early facial hair

stage 5

penile growth, first ejaculation, axillary, groin, and facial hair, final voice change

play in school age children involves

physical skill, intellectual ability, fantasy form groups, cliques, clubs, secret societies rules and rituals see the need for rules in the game team play quiet games and activities ego mastery

in the adolescent stage, there is rapid ___,___,___,___ maturation

physical, cognitive, social, and emotional

What should you teach parents with sports?

pick sports matching their physica ldevelopment

When conducting a class on sex and sexual activities with adolescents, the most appropriate approach by the nurse is to use dolls to teach the content. present normal body functions in a straightforward manner. refer the adolescents to their parents for sexual information. delay giving information about pregnancy unless the adolescents are sexually active.

present normal body functions in a straightforward manner. The nurse should provide accurate and complete information using correct terminology that is understandable to the adolescent. Dolls are appropriate for teaching a younger age-group of children. Using the correct terminology is more appropriate for a group of adolescents. Parents are important for conveying the morals and values surrounding sexual activities, but nurses may provide adolescents with accurate, complete information. Adolescents should have information before they become sexually active about the potential consequences of sex, including the practice of safe sex to prevent pregnancy and the transmission of sexually transmitted diseases.

stage 4

projection of areola and papilla to form a secondary mound (may not occur in all girls)

main goal in treatment of sunb urn

protection from sunburn: -SPF lotion -sunblock (zinc) -PABA - very allergenic so must be PABA free for someone that is allergic

An adolescent is admitted to the hospital for a fractured femur. The most appropriate nursing intervention(s) in caring for this adolescent is/are to Select all that apply. provide written material about the hospital. provide an opportunity for the adolescent to try on surgical attire. explain the upcoming surgery to the adolescent using anatomically correct models. provide an opportunity for the adolescent to talk with peers who have had a similar experience. provide education for the parents of what to teach so they can share with their adolescent.

provide written material about the hospital. explain the upcoming surgery to the adolescent using anatomically correct models. provide an opportunity for the adolescent to talk with peers who have had a similar experience. Adolescents benefit from written material about hospitalization. This material offers information and services provided in the hospital that the adolescent can access that gives a sense of control. The use of anatomically correct models to explain surgical procedures offers the adolescent opportunities to ask questions and decrease fear and anxiety. The opportunity for the adolescent to talk with peers who have had a similar experience to facilitate communication on their level. Dressing up in surgical attire is appropriate for the younger child, not the adolescent. The adolescent should be taught firsthand about the hospitalization and what to expect.

play

provides diversion and brings about relaxation, helps child feel more secure in strange environment, lessens stress of separation and feelings of homesickness, provides means for release of tension and expression of feelings

play therapy

psychological technique reserved for use by a trained and qualified therapist as interpretative method w/ emotionally disturbed children

10 in girls and 12 in boys

puberty begins at ____________ in girls and ___________ in boys

When does school-age end?

puberty with acquisition of final permanent teeth

stage 4

pubic hair denser, curled and adult distribution but less abundant and restricted to pubic area

androgens are responsible for:

rapid growth of the early teenager

A case manager is assigned to coordinate the care of a child with a complex medical condition. The family is told that one of the goals is to control costs. This goal should be recognized as unsafe. realistic. impossible. inappropriate.

realistic. Management of costs is one part of case management. With a case manager providing coordination and continuity across care settings and facilitating access to needed medical services, cost control is a realistic outcome. Cost management will only be unsafe if treatment and equipment necessary for the child's care are denied. Cost management is a realistic goal for the case manager, not an impossible one. Cost management is not an inappropriate one, unless treatment or equipment necessary for the child's care is denied.

Name four things that hospitalization is beneficial to

recovery from illness increase coping skills mastering of stress and feelings of being competent in coping new socialization experiences

A 16-year-old girl tells the school nurse that she has not started to menstruate. The most appropriate nursing intervention is to explain that this is not unusual. refer the adolescent for an evaluation. assume that the adolescent is pregnant. suggest the adolescent stop exercising until menarche occurs.

refer the adolescent for an evaluation. This meets the definition of primary amenorrhea and should be evaluated. Menstruation usually begins approximately 2 years after the beginning of secondary sex characteristics. Although pregnancy is a possibility, the nurse should not assume that the girl is pregnant until further assessment is performed. There is no indication that the adolescent is exercising excessively.

encopresis

repeated voluntary or involuntary passage of feces of normal or near normal consistency into places not appropriate for that purpose (not caused by any physiologic effect, e.g. laxative or medical problem)

overuse syndrome

repetitive microtrauma inflammation of the involved structure complaints of pain, tenderness, swelling, disability ex-tennis elbow

What happens during the detachment (denial) phase of separation anxiety?

resignation but not contentment; superficial adjustment may seriously affect attachment to the parent after separation

secondary sex characteristics

result of hormonal changes (voice, hair growth)

secondary sex characteristics

result of hormonal changes: voice change, hair growth, breast enlargement, fat deposits no direct role in reproduction

Signs and symptoms that are associated with stress in a school-age child that require intervention are Select all that apply. child not wanted to go to sleep occasionally at the usual bedtime. reverting to a previous behavioral pattern exhibited several years ago. bedwetting. doesn't want to eat a certain food although the child has ate it before. doesn't want to go outside and prefers to remain in his bedroom each day after school but previously had been extremely sociable.

reverting to a previous behavioral pattern exhibited several years ago. bedwetting. doesn't want to go outside and prefers to remain in his bedroom each day after school but previously had been extremely sociable. Reverting to a previous behavior indicative of regression, evidence of bedwetting and change in socialization pattern as signs and symptoms of stress should be investigated as they are signal areas of concern. Occasional reluctance to go to sleep at the regularly scheduled bedtime may be an isolated event which is self-limiting. Refusal to eat a food even if the child ate the food before is not by itself indicative of a significant stress event.

how is moral developed in the age of 6-7?

reward and punishment guide choices

The school nurse is seeing a child who brought poison ivy to school in a leaf collection. The child says that only hands touched it. The most appropriate nursing action is to apply Burow solution compresses immediately. soak hands in warm water. rinse hands in cold, running water. scrub hands thoroughly with antibacterial soap.

rinse hands in cold, running water. Washing the child's hands in cold running water is the recommended first action. Once contact has been made, it is desirable to flush the skin with cold running water within 15 minutes of exposure to neutralize the effect. Applying Burrow solution is effective for soothing the skin lesions once the dermatitis has begun. Antibacterial soap is not recommended as it removes protective skin oils, and may allow spread of contact.

Physical abuse areas that we assess

scalp, behind ears, frenulum, exterior genitalia document findings on body diagram get photos for legal purposes pay attention to weight, nutritional status, height hygiene and age appropriate status can show neglect or emotional abuse

what is second to the family as a socializing agent?

school experience

dramatic increase in growth accompanies

sexual maturation

The parents of an 8-year-old girl tell the nurse that their daughter wants to join a soccer team. Based on the nurse's knowledge of this age-group, the most appropriate recommendation is organized sports, such as soccer, are not appropriate at this age. competition is detrimental to the establishment of a positive self-image. sports participation is encouraged if the sport is appropriate to the child's abilities. girls should compete only against girls because at this age boys are larger and have more muscle mass.

sports participation is encouraged if the sport is appropriate to the child's abilities. The parents should help the child select a sport that is suitable to her capabilities and interests. Team sports contribute to the school-age child's social, intellectual, and skill growth. Organized sports for school-age children can provide safe, appropriate activities with supportive parents and coaches. The desire to participate in competitive team sports develops out of a need for peer interaction for the school-age child. A sport should be selected that meets the child's capabilities and interests. The physical changes in boys described take place during puberty, later in the school-age years; therefore, there is no reason for boys and girls to compete separately at age 8 years.

detachment (denial)

stage of separation anxiety where the child shows increased interest in surrounding, interacts w/ strangers or familiar caregivers, forms new but superficial relationships, appears happy

detachment (denial)

stage of separation anxiety where the child superficially appears to have adjusted to the loss as they become more interested in surroundings, playing w/ others, and forming new relationships but this is due to resignation & not a sign of contentment

despair

stage of separation anxiety where the child's physical condition may deteriorate to refusal to eat, drink, or even move

varicocele tx

surgery

How to promote nutrition in school-age children ?

taking family centered approach cooking together

The onset of puberty in boys is characterized by voice changes. testicular enlargement. growth of dark pubic hair. increased size of the penis.

testicular enlargement. This is the first change that signals puberty in boys during Tanner stage 2 of sexual development. Voice changes occur between Tanner stages 3 and 4 of sexual development. Fine pubic hair may occur at the base of the penis early in puberty, but darker hair occurs during Tanner stage 3 of sexual development. The penis enlarges during Tanner stage 3 of sexual development.

What is normalization?

the efforts of family members make to create a normal family life, their perceptions of the consequences of these efforts, and the meanings they attribute to their management efforts.

scrotal varicocele

the elongation, dilation, and tortuosity of the veins of the spermatic cord superior to the testicle; wormlike mass above testicle upon palpation

Prior to accepting an assignment as a home health nurse, the nurse must realize that the family is in charge. all decisions are made by the health care provider. the family will adapt their lifestyle to the needs of the nurse. independent decisions regarding emergency care of the child are made by the nurse.

the family is in charge. The nurse must realize that the family is in charge. The family is in charge and the health care providers must realize this matter. The nurse must be flexible and adaptable to the family's lifestyle. Informed consent must be provided by the family for emergency care-any care.

menarche

the first appearance of menstruation occurring 2 years after the appearance of prepubescent changes

adrenarche

the growth of pubic hair 2 -6 months after thelarche

gradual acceptance

the parent place necessary and realistic restrictions, encourage self care, and promote reasonable physical and social abilities

Adolescents might feel separated from:

the peer group

sexual abuse

the use, persuasion, or coercion of any child to engage in sexually explicit conduct or simulation of such conduct for producing visual depiction of such conduct, or rape, molestation, prostitution, or incest with children

A child is being treated for burns in the emergency room. The parents have provided information relative to the origin of the burn event but the patterns of injury are not consistent with their description. The nurse would suspect that the parents are too upset to provide information at this time, so additional questions can be answered later. the child may have not told the parents the truth about the event. there may be a potential for abuse and as such requires follow up. there is no real concern as the burn injuries are minimal and non life threatenning.

there may be a potential for abuse and as such requires follow up. Anytime burn pattern injuries do not correlate with the provided information of the event, there is a potential for suspecting abuse. As such the nurse should be cognizant of this fact and follow up accordingly. Being upset would be a reasonable parent response but the physical evidence should coincide with the provided description. Suspecting that the child (victim) is not telling the truth would not be a concern unless additional evidence would be presented that would support that conclusion. Even if the burn injuries are not considered to be life-threatenning, health care providers take the issue of suspected abuse very seriously and it must be reported and followed through as part of professional practice guidelines.

how do preschoolers react to death?

they believe that it is a consequences of thoughts or actions. they may feel guilty and responsible for the death of a sibling. greatest fear associated with death is separation from parents.

what can happen to children on long-term opioid pain management?

they can become tolerant. NOT ADDICTED.

Why can school-age children become obese?

they have more food choices and can opt to vending machines

how do adolescents react to death?

they have the most difficulty coping with death. least likely to accept cessation of life, particularly if its their own.

how do school-age children react to death?

they may have fears such as the reason for the illness, communicability of the disease, consequences of the disease, and the process of dying. fear of unknown is greatest. interested in post death services. inquisitive about what happens to the dead body.

when child taken away from family

they mourn loss of parent need to understand not a punishment child gets to go home with parent by home visits need to learn coping mechanisms for prolonged crying - community resources and self help

A parent is concerned as her 6-year-old child "cheats" when playing games with other children. The parent is concerned that this behavior will affect future behaviors as the child gets older. The nurse understands the parent's anxiety about the described behavior and provides the following assurance this type of behavior occurs around this age period and is due to the child not being able to understand what it means to lose. this is a prompted behavior that occurs intermittently at this age. you are right to be concerned about this type of behavior. it is best to ignore the behavior as it will stop eventually.

this type of behavior occurs around this age period and is due to the child not being able to understand what it means to lose. Cheating as a behavior occurs primarily between the ages of 5 and 6. It is almost at times displayed as an automatic behavior as the child does not understand about winning and losing. The behavior typically goes away as the child matures. Ignoring the behavior without some direction is not advised as it is best to address the situation and help the child to begin understanding of the concept.

How to promote exercise?

through sports

adolescence

time of growing into psychological, social, and physical maturation

what can happen to the body because of bulimia?

tooth erosion, esophageal damage, GI concerns

What are three things that infants need?

trust, consistent loving caregivers, daily routines

Testicular torsion

tunica vaginalis, which encases the testicle, fails to do so and the testis hangs free from vascular structures which can result in partial or complete venous occlusion with rotation around vascular axis

prepubescence

two years before the onset of puberty

How can you assist family members in managing their feelings ?

understand they are facing shock and denial adjustment reintegration and acknowledgment establishing a support system

How do you promote normal Development and Family Support in school age?

understanding industry/activity and including it in activities

name some male reproductive disorders

urethritis, hematuria, phimosis, trauma, carcinoma, scrotal varicocele, testicular torsion

An example of indirect bullying would be if telling an individual that you don't like them because you were hurt by their actions. raising one's hand to prevent another person from hitting you. taking a toy away from someone because you want it to see it. using social media to make offensive comments about an individual.

using social media to make offensive comments about an individual. Indirect bullying are actions that are taken that are meant to cause harm to an individual or group. The use of social media to make offensive comments about an individual is not the place for professing feelings. One must take into account that offensive comments by definition are offensive. Telling an individual that you don't like them as a result of their exhibited behavior is an example of direct communication. Taking a toy away from someone because you want to see it may not be the best approach but it does involve direct action.

physical evidence collecting for SANEs

vaginal secretions for evidence of sperm, blood, DNA genital culture to rule out a preexisting condition testing for HIV and other STDs initially and at appropriate intervals

the school experience helps with the transmission of ___ of the society, and peer relationships become increasingly important

values

A finding that is consistent with prepubescence is variation in physical appearance between boys and girls. age of onset of physical signs is the same for both boys and girls. does not occur during the preadolescence period. appearance of secondary sex characteristics is the same for both boys and girls.

variation in physical appearance between boys and girls. During the period of prepubescence there is a variation in physical appearance between boys and girls. The age of onset of these appearances also varies with girls exhibiting changes earlier than their male counterparts. The changes occur during the preadolescence period. Secondary sex characteristics also present at different times for boys and girls.

injuries

vehicles, firearms and other weapons, sports injuries, water safety, poisoning, tobacco, alcohol, other drugs

Prevention of burns!

water heater setting no higher than 120 degrees F

injury prevention

wear helmets when riding bikes, appropriate safety equipment for all sports

6-12

what age is school-age defined as

12-18

what age is the adolescent child

achieve sense of self-confidence

what is the major developmental task in erikson's industry vs inferiority stage

preconventional

what level in kohlberg is the school-age child in?

formal operations

what stage in piaget are adolescents in?

concrete operation

what stage of piaget is the school-age child in

17

when do boys finish growing on avg

15

when do girls finish growing on avg

15

when does adult-like thinking begin? (problem-solving & abstract thinking)

Do school age children often become bored?

yes

is anorexia nervosa life threatening?

yes

will males and females differ in size during the school age period?

yes

how do you find out parents cultural influences on health belief?

you ask them: what is your perception of this illness? what is your understanding of what the illness did to your child? How severe you believe this illness or disability is? how long are you expecting the illness to last What tx do you want to be used? What results do you expect from tx? What worries or concerns you?

Black widow bite

-black widows avoid light -s/s >dizziness >weakness >abdominal pain >delirium >seizures Tx: antivenom

contributing factors for neglect

-caregiver lack of knowledge -not having resources -substance abuse issues -insufficient funds

psychological factors on enuresis

"Sleeps more soundly than other children" Emotional factors Familial tendency

androgens

"masculinizing hormones"

thelarche

(8-13 yr) breast buds

Adrenarche

(8-13 yr) pubic hair growth

causes of childhood obesity

-5% due to underlying disease (hypothyroidism, other metabolic disease, CNS disorders) -Role of heredity -Inactivity -Patterns of eating behaviors

Nutrition and lead poisoning

-adequate intake of calcium and iron to reduce absorption of lead -regular meals -avoid mexican candy -avoid folk remedies -shouldn't store food in open cans -only use cold water for consumption

Complications of burns

-airway compromise -burn shock >blood volume decreases rapidly >CO reduced -infection local and systemic >sepsis

Epididymitis treatment

-antibiotics, scrotal elevation, scrotal ice packs -can result in sterility if treatment is delayed

What to teach about emergency prepardness?

-Smoke detecters -Poison control -Matches -Guns locked -Don't open door -Fire department number Kids : address and phone number

tanner stages of sexual maturity

-Stages of development of secondary sex characteristics and genital development -Defined as a guide for estimating sexual maturity

dental health

-Eruption of permanent teeth -Good dental hygiene -Prevention of dental caries -Periodontal disease -Malocclusion -Dental injury -Dental avulsion: replacement/reattachment- Knocked out tooth—place in cold milk or under child's tongue (or parent's) until it can be replaced.

Sunburns in toddlers and preschoolers exposure

-peak exposure time is between 10 am and 3pm -fresh snow, water at pools, and sand reflects UV rays so burn quicker and more intense

Care of someone with a burn

-surveillance culture -sedation -analgesia >morphine >versed >fentanyl >short acting anesthetics - propofol, nitrous oxide for dressing changes or procedures

how do infants and toddlers react to death?

-they may still act if the person is alive -as they grow they are more willing to let go of the dead person -reacts poorly to change in routine and parental anxiety

boys have a more rapid increase of androgen until about ___ years

15

Superficial burn

1st degree >minor, no blistering

prepubescence

2 year period the precedes puberty, typically occurs in preadolescence

When is dishonest behavior common ?

5-6 y/o

School age is generally defined as age _____

6-12 years

A, C, E (a. Discuss dietary restrictions. c. Send a pain scale home with the family. e. Discuss complications that may occur.)

A child is being discharged from an ambulatory care center after an inguinal hernia repair. Which discharge interventions should the nurse implement (select all that apply)? a. Discuss dietary restrictions. b. Hold any analgesic medications until the child is home. c. Send a pain scale home with the family. d. Suggest the parents fill the prescriptions on the way home. e. Discuss complications that may occur.

Stress fracture

A consequence of repetitive, excessive stress on the bone that causes microfractures within the bone

A (Regression is seen during hospitalization.)

A previously "potty-trained" 30-month-old child has reverted to wearing diapers while hospitalized. The nurse should reassure the parents that this is normal because: a. Regression is seen during hospitalization. b. Developmental delays occur because of the hospitalization. c. The child is experiencing urinary urgency because of hospitalization. d. The child was too young to be "potty-trained."

C (Create a schedule similar to the one the child follows at home.)

A school-age child, admitted for intravenous antibiotic therapy for osteomyelitis, reports difficulty in going to sleep at night. Which intervention should the nurse implement to assist the child in going to sleep at bedtime? a. Request a prescription for a sleeping pill. b. Allow the child to stay up late and sleep late in the morning. c. Create a schedule similar to the one the child follows at home. d. Plan passive activities in the morning and interactive activities right before bedtime.

Turner syndrome

A syndrome characterized by the absence of one X chromosome (45,X) that affects females

prepubescence

About 2 years before puberty, heralding physical changes

Which statement is not accurate regarding the roles and responsibilities of a school nurse? They are responsible for development and implementation of plans of care for all children within the designated school. All school nurses are registered nurses. They are responsible for medical needs of the children within the designated school. They evaluate implementation of care delivered to children within the designated school setting.

All school nurses are registered nurses. Not all schools have a school nurse but may have unlicensed assistive personnel that work within the school setting that have received training to provide routine standardized care under the supervision of a school nurse. The other options are all within the roles and responsibilities of a school nurse.

How much do parents want to be involved?

Bathing and dressing the body Offer opportunities to hold

57 inches tall

Booster seats should be used until the child is_________

With regard to separation anxiety displayed in a child who is hospitalized, which behavior would indicates the stage of despair? Child clings to parents for comfort. Child tells nurses and staff to "go away." Child is constantly crying and sobbing. Child demonstrates regressive behavior.

Child demonstrates regressive behavior. Demonstrating regressive behavior is a characteristic of the stage of despair. All of the other options indicate a stage of protest.

Which is descriptive of the social development of school-age children? Identification with peers is minimal Children frequently have "best friends" Boys and girls play equally with each other Peer approval is not yet an influence toward conformity

Children frequently have "best friends" Same-sex peers form relationships that encourage sharing of secrets and jokes and coming to each other's aid. Identification with the peer group is an important milestone for the school-age child to move toward independence from families. During the school-age years, same-sex peer groups are more prevalent; therefore, there is less interaction between boys and girls. Conforming to the rules is an essential part of group membership and, therefore, an important skill for the school-age child to learn in terms of peer relationships.

How is spiritual development for a school age child?

Children think in very concrete terms Children expect punishment for misbehavior May view illness or injury as punishment for a real or imagined misdeed

how do we communicate bad news to families?

Clear words, sit them down, assess baseline knowledge, what have you been told, childs understanding of death, fear of pain, dying alone, living alone

At what Piaget stage is the school age child in?

Concrete operations -They use thought processes to experience events and actions -they can develop understanding of relationships between things and ideas -Able to make judgments based on reason ("conceptual thinking") -Conservation—physical matter does not appear and disappear by magic

Piaget Cognitive Development

Concrete operations * Use thought processes to experience events and actions * Develop an understanding of relationships between things and ideas * Able to make judgments based on reason (conceptual thinking)

What can the nurse's reaction be to caring a child with alife threatening illness?

Denial Anger or depression Guilt

At what age would orthodontic treatment be considered to have the most potential for successful outcome? When the adolescent growth period has stopped. Early referral if malocclusion presents regardless of age. Treatment differs based on gender due to difference in growth and development. When all primary teeth are present.

Early referral if malocclusion presents regardless of age. If malocclusion is present, best practice would be to have early referral for evaluation and treatment. Orthodontic treatment should be started prior to the growth period stopping. Orthodontic treatment is based on individual presentation and not gender based variables. Orthodontic treatment is typically not started when all primary teeth are still present.

The school nurse is discussing dental health with some children in first grade. Which should be included? Teach how to floss teeth properly. Recommend a toothbrush with hard nylon bristles to get in between the teeth. Emphasize the importance of brushing before bedtime. Recommend nonfluoridated toothpaste.

Emphasize the importance of brushing before bedtime. Children should be taught to brush their teeth after meals and snacks and before bedtime to prevent dental caries. Parents should help with flossing until children develop the dexterity required, when they are in about the third grade. A toothbrush with soft nylon bristles is recommended to prevent damage to the gums. The American Dental Association recommends fluoridated toothpaste for this age-group.

testosterone

FSH and LH act on testicular cells to stimulate the production of ______________ and sperm

secondary encopresis

Fecal incontinence after period of prior established fecal continence after age 4

development of self concept and body image

Feelings of confusion in early adolescence Acute awareness of appearance, comparison of appearance with others Blemishes and defects are magnified out of proportion Matures to self-concept based on uniqueness and individuality

Turners Syndrome effects which sex?

Females (1 in 2500)

estrogen

Feminizing hormone

peer group (often do not want peers to come visit them b/c they do not want to be viewed differently)

For adolescents, the loss of control during hospitalization is mostly r/t lack of separation from ______.

pubertal delay 13

Girls may be considered to have a ______________________ if breast development has not occurred by ______ years old

What can develop do to sibling grief?

Grieves in their own way Grieve for a long time and changes with cognitive development Regression

What is an important consideration for the school nurse who is planning a class on bicycle safety?

Head injuries are the major causes of bicycle-related fatalities. Helmets, helmets, helmets

Who is at more risk of child abuse ?

Homes with domestic violence are 50% llikely to abuse children

usually less than a year spontaneously subsides with the achievement of male development

How long does gynecomastia last in males during puberty?

2 inches

How much does a school- aged child's height increase in a year?

2-3 kg (4.4 -6.6 lbs)

How much does a school- aged child's weight increase in a year?

testing for LD and ADHD

IQ hand-eye visual and auditory perception comprehension memory

symptoms must be present in more then one environment rule out psychiatric disorders, medical problems, traumatic experiences behavioral checklist and adaptive scales completed by caregivers and educators

In order to diagnose a child with ADHD, what are some things that need to occur?

sexual immaturity sexual maturity

In the Tanner stages of development, stage one means____________ and stage five means____________

How will you establish a support system?

Intrafamilial resources Social support systems Parent-to-parent support Parent-professional partnerships Community resources

During the adolescence period, what role does the school environment take on? It is the only site for their continuing education. It forms the basis for their social life. It provides a consistent structure based on peer group assignment. It allows for development of autonomy as a transition from only being in the home environment.

It forms the basis for their social life. The school environment becomes the focus of the adolescent's social life. While the school environment provides a site for education, the adolescent may also be receiving instruction at other areas or venues. The school environment is not based on peer group assignment and peer groups provide the transitional structure for adolescent's emerging autonomy.

What are latchkey children?

Kids home w/o parents and have the key to home and can go in without adult supervision teach not to answer door

nurses response to caring for dying children

LISTEN (avoid judging or offering advice) Acknowledge coping strategies used by families Normal responses Self-care Follow-up support

What are conditions requiring palliative care?

Life-threatening conditions in which treatment failed Conditions in which premature death is expected but long-term treatments are expected to prolong life Progressive conditions extending over many years with no curative treatment Conditions with severe disability in which premature death is likely Terminal neonatal conditions

The nurse is teaching a class on the dangers of "huffing." What information is included as a major side effect of "huffing?" Cardiac arrest Loss of vision Delay of growth Loss of consciousness

Loss of consciousness Skin discoloration is not a side effect of huffing. Cardiac arrest is not typically a major side effect of huffing. Loss of consciousness and respiratory arrest are major side effects of huffing. Delay of growth is not a side effect of huffing.

What can develop due to parental grief?

Loss of hopes and dreams for their child Loss of the family unit Stress on marriage or relationship

What is being used to develop school lunches?

MY Plate

androgens

Masculinizing hormone

What is adolescent understanding of and reactions to Dying?

Mature understanding of death May still feel guilt and shame Own death is a threat to identity- "Who am I?" May feel alienated from peers Body changes Foster self-control, privacy, answer questions honestly, respect

What signs may seriously ill toddlers demonstrate?

May show immobilization, regression, separation anxiety Perceive sadness from parents/family Encourage parents to stay as much as possible Holding and rocking toddler and infant

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puberty delay

No thelarche by age 13 years

Sex chromosome abnormalities

Occur with relatively high frequency Most caused by altered number of sex chromosomes

primary enuresis

Onset of wetting in children who have never been dry for extended periods of time

What are nonpharm interventions for pain for a child?

PLAY massage Relaxation technique Accupuncture Pet therapy Ice/hot packs

An adolescent patient is being treated for a Trichomonas infection with the appropriate antibiotic. Which instruction should be included in the plan of care? Only the person needs to be treated and not any sexual partners. Patient should refrain from drinking beer during treatment. Antibiotic must be administered via parenteral route. Topical medication in the form of an antifungal is also included in the treatment plan.

Patient should refrain from drinking beer during treatment. Treatment of Trichomonas is accomplished through use of Flagyl which is an ant infective agent. Alcohol should be avoided during the treatment phase and for a 48-hour period following treatment. Sexual partners should be treated as this is considered to be a sexually transmitted disease. Medication can be administered orally as well parenterally. Topical medication is not prescribed for treatment.

What are the goals of organized athletics for preadolescent children?

Physical fitness Basic motor skills A positive self-image

A child has a long standing history of abuse which has triggered many emotional problems. Which type of therapy would be indicated to possibly help the child explore these emotional problems? Dramatic play Therapeutic play Play therapy Creative expression

Play therapy Play therapy is used for patients who have psychological problems facilitated by trained professionals to encourage expression of feelings. Dramatic play is used as a method of communication and interaction whereby children play with puppets and/or objects to gain understanding. Therapeutic play helps the child to learn to deal with fears and apprehension but is nondirective in nature. Creative expression is a method whereby children can use other media such as drawing and painting to express their feelings.

ovulatory cycles pathologic condition

Primary dysmenorrhea is associated with _____________ while secondary dysmenorrhea is associated with a _______________________

What kind of things do you need to do for the family?

Provide support at time of diagnosis Assess family strengths Assess family's adjustment Accept family's emotional reactions: Denial, guilt, anger Support family's coping methods Advocate for empowerment Educate about the disorder and general health care

WHat are stress reduction techniques for children?

Relaxation techniques Deep-breathing exercises Progressive relaxation of muscle groups Positive imagery Physical activity

What are perspectives on the care of children with special needs?

Scope of the problem Trends in care Developmental focus Family-centered care "Normalization" Home care Mainstreaming Early intervention •Managed care

What to teach about car safety?

Seatbelts Booster seats till 12

How can the nurse cope with stress

Separate work and personal life Exercise Hobbies

What should you teach the child about sexuality?

Sex educations in schools Open lines of communication Terminology Normal curiosity of childhood

The school nurse has been asked to begin teaching sex education in the fifth grade. What should the nurse recognize?

Sexuality is presented as a normal part of growth and development

physiologic changes

Size and strength of heart, blood volume, and systolic blood pressure increase Pulse rate and basal heat production decrease Adult values for all formed elements of blood Respiratory volume and vital capacity increase Increased performance capabilities

Tanner stages

Stages of development of secondary sex characteristics and genital development

When teaching injury prevention during the school-age years, what should the nurse include?

Teach basic rules of water safety.

The nurse is teaching parents about safety for their latchkey children. What should the nurse include in the teaching session?

Teach the child weather-related safety Emphasize fire safety rules and conduct practice fire drills

Which finding if found in a male adolescent would indicate a medical priority for treatment? Epididymitis Varicocele Testicular torsion Gynecomastia

Testicular torsion Testicular torsion if found in a male patient (regardless of age) would be considered to be a medical emergency and as such would require immediate intervention. Epididymitis is an infectious process that requires appropriate antibiotic therapy. Depending on the presentation of a varicocele with associated symptoms, intervention may be required. Gynecomastia requires investigational work up to identify the etiology but in some cases it is idiopathic and self-limiting.

Treatment of Klinefelter Syndrome

Testosterone administration to enhance masculine characteristics

adolescent growth spurt 24 to 36 month

The ___________________ is where growth of skeletal muscles and internal organs occurs during a ________________ month period

What characterizes moral development in the older school-age child?

The child is able to judge an act by the intentions that prompted it rather than just by the consequences.

B (Hospitalization is a stressor in children and so they may react differently to it. Certain children are more susceptible to the stressful effects of hospitalization than others. Children who have difficult temperament may not readily adjust with the unfamiliar environment of the hospital. These children may experience adverse effects of hospitalization. Female children are able to withhold stress more when compared to male children and thus are less likely to experience stressors. Children with average intelligence may be able to understand their condition and the importance of hospitalization and thus may be more adaptable. Children with lower IQ would not understand the purpose of hospital admission and thus would be extremely stressed due to hospitalization. Children who are older than 6 years of age have developed the maturity to understand their condition and the purpose of hospitalization. Thus, they would be more adaptable to their condition, and experience less stress related to hospitalization.)

The nurse works in a pediatric unit. Which child would have an increased vulnerability to the stresses of hospitalization? A. A female child B. A child with a difficult temperament C. A child with an average intelligence D. A child older than 6 years of age

FSH

The ovaries are stimulated to produce estrogen by what hormone?

mutual affection and equality

The relationship between parents and adolescents changes from one of protection/dependency to one of _____________________

3 samples from 3 diapers

To diagnose an intestinal parasitic disease, you need to obtain and test _________ different stool samples from __________ different diapers

False, you treat the whole family

True/False: If a child has pinworms, you need to treat just the child

true

True/False: anorexia is characterized by the relentless pursuit of thinness and the fear of fatness

true

True/False: before puberty, there is no essential size or strength difference between girls and boys

bandages

Using ______ in toddlers and preschoolers is important to reassure them that the bleeding will stop.

preschoolers

What age group needs to be educated b/c of their magical thinking where they will fantasize the worst of every situation?

sterile, short stature, webbed neck, shield-shaped chest, wide paced nipples, low posterior hairline, masculine looking girl Treatment includes growth hormone therapy

What are the manifestations of Turner syndrome? What is the treatment?

severe acute pain of testes, may be swollen, red, warm, edematous, or appear fixed treatment is emergency surgery to preserve teste

What are the manifestations of testicular torsion? How is it treated?

influenza, meningococcal, Tdap, HPV

What immunizations are needed at ages 11-12 years old?

physical restriction

What is the MAJOR stressor for toddlers?

fever, headache, malaise, followed by parotitis orchitis and meningoencephalitis

What is the clinical presentation of mumps? What can it possibly cause?

persistent fever for 3 to 4 days but appears well when fever subsides rash appears on trunk then face then extremities

What is the common clinical presentation of Roseola?

Flagyl (metronidazole)

What is the common treatment of Giardiasis?

HPV (human papillomavirus vaccine) (Gardasil) 3 dose series given at 11- 12 years of age to both girls and boys

What is the immunization the protects against cervical cancer? When is it given?

bordetella pertussis 6 to 20 days

What is the infectious agent that causes Pertussis (whooping cough)? What is the incubation period?

group A B-hemolytic streptocci droplet or direct contact 1 to 7 days

What is the infectious agent that causes Scarlet fever? How is it transmitted? Incubation period?

10 mcg/dl or greater

What is the lead level at which chelation therapy is needed?

call poison control, gastric decontamination questionable, symptomatic treatment of pneumonia

What is the treatment for hydrocarbon poisoning?

Rest, alternative exercise regimens, physical therapy, NSAIDs

What is the treatment for overuse syndromes?

magical thinking

Why do preschoolers, in particular, need to be educated/promote understanding?

self concept

a conscience awareness of self-perception, such as one's physical characteristics, abilities, values, self-ideals, and expectancy and the idea of self in relation to others

testicular torsion

a sharp pain in the scrotum caused by twisting of the vas deferens and blood vessels leading into the testicle

symptoms of conversion reactions

abd pain, fainting, pseudoseizures, paralysis, headaches, visual field restriction (rule out true seizures with EEG)

conversion reactions

also known as hysteria, hysterical conversion reaction,a dhcildhood hysteria sudden onset; traced to a precipitating event

What can happen to the sibling relationship when a sibling is sick or hospitalized?

anger or jealousy

PTSD: Third Phase

appears to get worse; lasts 2-3 months

emotional abuse

attacking childs self esteem

preadolescence

begins toward the end of middle childhood and ends at 13th birthday

peers provide a sense of

belonging and a feeling of strength and power

peers assume an increasingly significant role in adolescence, called the

best friend

gynecomastia

bilateral or unilateral breast enlargement in males that frequently occurs during puberty

munchansen syndrome by proxy

biological mom, healthcare knowledge -if suspected remove child and see if child gets better

stage 2 (pubertal)

breast bud stage - small area of elevation around papilla; enlargement of areolar diameter

what is it called when a person who has bulimia has a low weight?

bulimorexia

Charts that show total body area of burn are designed by what?

by age

PTSD symptoms

depression, anxiety, conversion reactions phobic symptoms, repetitive actions flashbacks inquiry about what has happened

therapeutic management of encopresis

determine the cause dietary intervention management of constipation psychotherapeutic interventions

therapeutic management of encopresis

determine the cause dietary intervention management of constipation psychotherapeutic interventions

Nursing interventions to promote health during middle childhood should include stressing the need for increased calorie intake to meet the increased demands on the body. instructing parents to defer questions about sex until the child reaches adolescence. educating the child and parents about the need for effective dental hygiene because these are the years in which permanent teeth erupt. advising parents that the child will need decreasing amounts of rest toward the end of this period.

educating the child and parents about the need for effective dental hygiene because these are the years in which permanent teeth erupt. Because the permanent teeth are present, it is important for the child to learn how to care for these teeth. Caloric needs are diminished in relation to body size during the middle years; however, a balanced diet is important to prepare for the adolescent growth spurt. Parents should approach sex education with a life span approach and answer questions appropriate to the child's age. School-age children often need to be reminded to go to sleep.

Evidence-based research shows that the most successful strategy for preventing smoking in teenagers is emphasis on immediate effects of smoking. emphasis on long-term effects of smoking. large-scale public information campaigns. threatening the social norms of groups most likely to smoke.

emphasis on immediate effects of smoking. An emphasis on immediate effects of smoking has proven to be one of the most effective strategies for preventing smoking. Information focuses on tobacco smell and other aesthetic issues. Because this age-group is neither future oriented nor consequence oriented, emphasis on the long-term effects of smoking does not work as well as focusing on the immediate effects. Public campaigns can be effective when focused on the immediate effects of smoking, but they often focus on the more long-term effects of smoking. Threatening social norms in adolescents is not an effective strategy for the prevention of smoking.

How is nursing care provided to the family?

encourage parent participation in planning and care family assessment

vericocele

enlarged, dilated veins near the testicle

What needs to happen with ambulatory or outpatient care?

explicit discharge and follow up instructions

primary sex characteristics

external and internal organs necessary for reproduction

Primary sex characteristics

external and internal organs necessary for reproduction (uterus, ovaries, penis, breasts)

primary encopresis

fecal incontinence after age 4

what is chronic sorrow?

feelings of sorrow and loss that recur in waves over time.

estrogen

feminizing hormone; low production during childhood in males, there is gradual production throughout maturation

menarche

first period

Older children common cause of burn

flame related burns

principles of pallative care

focus on symptom control and support psychological, social, and spiritual approach can be provided in a hospital, community, or home

Prevention of occurence of posioning

get on childs eye level and look around for possible access child resistant closures or locks

Electrical injury by household current

greatest incident in young children

Spiral fracture

green stick fracture, sign of physical abuse, lack of reaction to frightening events aggressivee behavior can sometimes be a red flag too

what is complicated grief?

grief that occurs less than one tear after the loss. includes symptoms such as intrusive thoughts, severe emotion, unusual sleep disturbances.

once the girl starts her first period, she will probably not

grow much more

what are the most common feelings experienced during the adjustment phase?

guild and self accusation.

stage 5

hair adult in quantity, type and pattern with spread to inner aspect of thighs

vaginitis: education

health teaching

divorce

highly common in families in this situation usually 1 partner is at home managing all other family responsibilities while the other is caring for the child resentment can occur with either parents

Common cause of burns in toddlers

hot water scald

46 lbs

how much does the average 6 year old weigh

20-25%

how much of total height is achieved during puberty?

Major Burn treatment options

if respiratory involvement >100% oxygen if fluid shifts >fluid replacement therapy evaporative loss >have issue of low volume or fluid loss nutrition >more calories and enough protein >hypoglycemia - due to stress of burn >if can't get adequate by mouth may need enteral feeding >epithelial cells need Vitamin's A, C, Zinc to promote skin healing

nutrition

importance of balanced diet to promote growth quality of the diet related to the family's pattern of eating quality of dietary choices in the school caf fast food concerns

ADHD

inattention, hyperactivity, impulsivity typical onset is before 7

What can happen to a family involved in the ICU?

increased stress for the child and family, perception of security resulting from constant monitoring and individualized care

Immune system ______ effectiveness

increases

How much is the bladder capacity at this age?

increases to about 300 cc

estrogen

increases until about 3 years after menarche

what is the primary goal of middle childhood?

increasing independence from parents

Non accidental burns

indicate abuse

Erikson stage

industry v. inferiority (6-12)

repetitive microtrauma

injuries that result in performing the same motion repeatedly

nutritional therapy for anorexia nervosa

intravenous and tube feedings monitor cardiovascular status

what is euthanasia?

involves action carried out by a person other than the patient to end life of the patient suffering from a terminal condition.

Sexual orientation as a concept related to the adolescent period is not aligned with sexual identity. refers to patterns of arousal of feelings only between heterosexual couples. is different for each individual based on their own preferences. can be measured by hormones levels.

is different for each individual based on their own preferences. Sexual orientation is the pattern of sexual arousal or romantic attraction between individuals regardless of whether it is based on heterosexual, same sex of transgender identification. It is not measured by hormone levels and is correlated with sexual identity.

freud stage

latency period of psychosexual period

parent role

learn and do complex technical care, symptom management, advocate for child, and seek and coordinate health and social services for their child

How can a nurse normalize the hospital environment?

maintain the child's routine as much as possible time structuring self care schoolwork friends and visitors

dads

may think their role as protector is challenged because they do not know how to help; may feel depressed, angry, weak, guilty, powerless, isolated, embarrassed

body mass index (BMI)

measurement that is most accurate in screening children and adolescence for obesity

things that influence sexuality

media, knowledge from peers, TV, movies, magazines need factual info, presentation based on developmental maturity and ability to ask questions ROLE MODELING

What else are parents/caregivers concerned about?

medication addiction

What is malocclusion?

misalignment of teeth and people get braces

klinefelter syndrome

most common of all chromosomal abnormalities (1 in 850 males) >presence of one or more additional X chromosomes (complement of 47, XXY is most common) -occurs in males -rarely seen before puberty -adolescent virilization fails

An important consideration in preventing injuries during middle childhood is that peer pressure is not strong enough to affect risk-taking behavior. most injuries occur in or near school or home. injuries from burns are the highest at this age because of fascination with fire. lack of muscular coordination and control results in an increased incidence of injuries.

most injuries occur in or near school or home. Most children in the middle years spend the majority of their time in and around school or home; therefore, the risk for injuries is increased in and around these areas. Peer pressure as an impetus for risk-taking behavior begins in the school-age years but is more significant in adolescence. Burn injuries are higher in the toddler years, when children are curious and mobile. They may expose themselves to objects capable of burning them (e.g., hot pots of water in the kitchen). Automobile accidents, either as a pedestrian or passenger, account for the majority of severe accidents in the middle years. School-age children have more refined muscle development, which results in an overall decrease in the number of accidents. Lack of muscular coordination and control leading to injuries occurs in younger children.

what is the greatest cause of serious or fatal injuries in teens?

motor vehicle crashes

the most common cause of severe injury and death in school aged children is:

motor vehicle crashes, pedestrian and passenger bike injuries

Activated charcoal

needs to be given within 1 hour may require NG tube if you can't get the child to drink complications: -vomiting -potential aspiration -can cause constipation and obstruction -mix with something sweet, give it in a cup with a straw that is not see through because it looks like mud, mix it with cola

are children ready to abandon parental control?

no

does pharmacologic therapy tend to help patients with anorexia nervosa?

no

in bulimia, weight may be

normal, slightly above normal, low

developmentally warning signs for abuse

not developmentally possible for injury due to stage of development delayed treatment of injury different wound and fracture, levels of feeling

stress fractures

occur as a result of repeated muscle contraction seen most often in repetitive weight bearing sports

secondary enuresis

occurs in a child who has had at least 6 months of nighttime dryness, onset after established continence

secondary enuresis

onset of wetting after est. urinary continence

Sex hormones are secreted by

ovaries, testes, adrenal glands

What pattern will parents follow when a child is ill?

overprotection and indulgent attention

6 - 14 months

ovulation and regular menstrual periods occur ___________ months after menarche

dysmenorrhea

pain during or shortly before menstruation

primary dysmenorrhea

painful menstruation associated with prostaglandin release in ovulatory cycles

denial

parents act as if disorder does not exist; attempt child to overcompensate for it

stage 3

penile enlargement, voice changes, early facial hair GYNECOMASTIA occurs in 1/3 of males in midpuberty

stage 5 in males

penile growth, first ejaculation, axillary groin, facial hair, final voice change

Burns are categorized by

percentage of total body surface area burned -for children school age and younger 10% body burn can be life threatening

euthanasia

person other than the patient carries out the action to end the patients life.

Warning signs for abuse

physical evidence history of injury that is incompatible might see patient affect inappropraite - have crazy painful injury and affect is not reflecting that

vaginitis: cause

physical, chemical, or infectious

suicidal ideation

preoccupation with thoughts about committing suicide and may be a precursor to suicide

What thought are preschoolers in?

preoperational

Goal of tx of contact dermatitis

prevent further exposure -try to limit specific areas such as eyes -if we see contact dermatitis in a specific area we know that there was specific contact -if generalized then cause is probably soap, bubble bath, detergent

What are the priorities identified in preventing or minimizing separation?

primary nursing goal (especially if 5 or less) family centered care parents are not visitors familiar items from home

malocclusions

problems in upper and lower dental arch position and tooth relationships

what are the three phases of separation anxiety?

protest phase, despair phase, detachment phase

What might happen when a toddler experiences loss of control? Name three.

regression of behavior, negativity, temper tantrums

psychosocial development

relationships center around same sex peers

Bee sting

remove the stinger as quickly as possible

encopresis

repeated voluntary or involuntary passage of feces of normal or near normal consistency into places not appropriate for that purpose not caused by any physiologic effect more common in males may follow psychological stress may be secondary to constipation or impaction

What is home care?

represents the return to a system and set of priorities in which family values are as important in the care of a child with a chronic health problem as they are in the care of other children.

what are avoidance behaviors?

result in movement away from adjustment and represent maladaptation to the crisis.

neuroendocrine events of puberty

role of anterior pituitary and hypothalamus hormones stimulate gonads gonads produce and release gametes, secrete sex-appropriate hormones

A child is becoming increasingly anxious over attending school with increasing frequency as the school year has gone on. Now the child is also presenting with physical symptoms which subside when the child remains at home. Based on this finding, the nurse would suspect that the child has school phobia. passive aggressive disorder. psychosomatic complaints. general anxiety disorder.

school phobia. School phobia (school refusal and school avoidance) refers to expression of fear or increasing anxiety related to the attendance of school. Physical symptoms may accompany this presentation and resolve when the child is not in attendance at school. The described behavior does not indicate passive aggressive disorder or general anxiety disorder. And while the child manifests psychosomatic complaints, these are correlated directly with the school environment as a trigger.

chemical burns

seen in pediatrics >chance that you can have systemic toxicity >can be exposed to eyes or ingested or inhaled

positive self concept leads to feelings of:

self respect, self confidence, happiness

what are some psychological issues associated with bulimia?

self-deprecating thoughts depressed mood hx of unsuccessful dieting overweight in childhood low impulse control

psychosocial development

sense of identity (erikson) early adolescence- group identity v alienation development of personal identity v role diffusion sex role identity emotionality

puberty

sexual maturation

common symptoms of stress fractures

sharp, persistent, progressive or deep, dull ache pain over the involved bony surface

When does school-age begin?

shedding of first deciduous teeth

the dental health stage begins with the

shedding of the first deciduous teeth

What did a study show about video games?

show pathologic play poor grades cannot solve conflicts peacefully violent

the ill child is obligated to play what role?

sick role

body image ins influenced by

significant others

therapeutic management of bulimia

similar to that of anorexia hospitalization to treat potassium depletion and esophageal damage cardiac monitoring is indicated behavioral management

dx for childhood obesity

skinfold measurements BMI calculations body fat measurements dx test to rule out metabolic and endocrine disorders

Heart ________ in relation to the rest of bod

smaller

what affects relationships with peers that did not used to exist?

social media and advanced technology

assisted suicide

someone provides patient with means to end their life

stage 2

sparse growth of long, straight, downy, and slightly pigmented hair extending along labia; between stages 2-3 begins to appear on pubis

protest

stage of separation anxiety that can last hours to days, ceasing only w/ physical exhaustion

detachment (denial)

stage of separation anxiety that is the most serious; reversal of potential adverse effects less likely

detachment (denial)

stage of separation anxiety that occurs after prolonged separation, rarely seen in hospitalized kids; may seriously affect attachment to parent

protest

stage of separation anxiety where the child cries, screams for parents & refuses attention of anyone else

despair

stage of separation anxiety where the child is inactive, withdrawn, sad, uninterested in env, uncommunicative, regresses to early behaviors of thumb sucking, bedwetting, pacifier use, bottle use

protest

stage of separation anxiety where the child is inconsolable in their grief & may cry, scream, search for parent w/ eyes, cling to parent, avoid & reject contact w/ strangers

protest

stage of separation anxiety where the child may verbally attack a stranger, physical attack a stranger, attempt to escape to find parent, attempt to physically force parent to stay

protest

stage of separation anxiety where the child reacts aggressively to separation from the parent

detachment (denial)

stage of separation anxiety where the child separates from the parent in effort to escape emotional pain of desiring the parent's presence & copes by forming shallow relationships w/ others, becoming increasingly self-centered, attaching primary importance to material objects

despair

stage of separation anxiety where the child's crying stops and depression is evident as the child is much less active, uninterested in play or food, withdraws from others

HOw do we manage pain?

step-ladder approach

shaken baby syndrome

subdural or subarachnoid hematoma >retinal hemorrhage - giveaway that something has happened >flu like symptoms >vomiting >irritability >poor feeding >listlessness >seizures >posturing >changes in LOC >apnea >bradycardia >Death

testicular torsion treatment

surgery

concerns related to normal growth and development

teachers, parents, latch key children, limit setting ans discipline, dishonest behavior, stress and fear

gynecomastia

temporary breast enlargement in male

gynecomastia

temporary breast enlargement; occurs in 1/3 of males in midpuberty

childhood depression

temporary depression is acute precipitated by a traumatic event chronic- may accompany chronic illness or disability, familial circumstances

stage 1: 9.5-14 years

testicular enlargement and sparse pubic hair

the testes secrete

testosterone levels will increase to a max level at maturity

Treatment of klinefelter syndrome

testosterone administration to enhance masculine characteristics

Primary amenorrhea

the absence of secondary sex characteristics and no uterine bleeding by 13 years old OR absence of uterine bleeding with secondary sex characteristics by 16.5 years old

thelarche

the appearance of breast buds

suicide

the deliberate act of self injury with the intent that the injury results in death

What is a functional burden?

the issues related to caring for and living with the child in relation to the families resources and ability to cope.

what is mainstreaming?

the process of paralleling normalization and home care. ex: child still attending school while seeking treatment.

2

there is approximately a _______ year difference between girls and boys in the onset of prepubescence

abstract thinking

think beyond present mental manipulation of multiple variables concerned about others' thoughts and needs

suicide

third leading cause of death in teens

How is the step ladder done?

this how doctors will include on the MAR: a non-opioid: Tylenol opioid for mild/mod pain: NOrco opioid from mod to severe: Morphine

Preverbal views on death is _______.

unknown

abusive parents

unwilling or unable to comfort may blame child for being clumsy and stupid may become hostile child unresponsive or excessive clinging to parent or intolerant to separation may be passive and accept discomfort and accept pain uncooperative and fearful avoid eye contact

moms

usually primary caregiver and most likely to give up their job; have a greater need for social support and positive appraisal of the situation than fathers

personal care

vision, hearing, posture, body art, suntanning (UV damage)

long term outcomes of shaken baby syndrome

visual impairment developmental delay hearing loss cerebral palsey

What to teach about sun safety?

wear sunscreen

industry vs inferiority

what stage of Erikson is a school-age child in?

when is guilt the greatest?

when the disorder can be directly traced to the parents. Ex: genetics

What decision does the family have to make regarding death?

will it occur at home or in the acute care setting

dx of LD and ADHD

wuality of motor action developmentally inappropriate inattention, impulsivity, and hyperactivity wide variation of severity dx criteria have been developed by the american psychiatric association

Are blood transfusions and suction used in a pt with a DNR or AFND?

yes

Should siblings' attend funeral services?

yes May have regrets if they do not attend Should not be forced to attend

Are parenteral or NG fluids used in DNR?

yes DNR doesn't mean do not treat

Are antibiotics used in a pt with a DNR or AFND?

yes ONLY IF it relieves pain like a UTI

WHat happens at development of a 7 year old ?

-Learns time -Brushes teeth and hair with minimal help -May steal but developing a conscience -Group play, team play Prefers to play with own gender

Emergency care of a burn

-Main thing is to stop the burn >remove burned clothing >apply cool water >don't use ice >don't apply anything to the burn at all Major burn: >put pt in horizontal position >remove clothing >keep victim warm >because of hypothermia Chemical Burn: >continuous flushing with large amounts of water before transfer to ED Burn itself: >cover it with a clean dry cloth >air contact is painful >also preventing hypothermia by covering it

When preparing a child for ambulatory or outpatient care, the preparation of the child can be:

challenging

how do you encourage expression of emotion in children?

-describe the behavior -give evidence of understanding -give evidence of caring -help focus on feelings

what happens during toddlerhood development?

-develop autonomy -master locomotor and language skills -learning throuhg sensorimotos experience, begins preoperational thought

some risk factors for lead poisoning

-poverty -younger than 6 -urban area -older home where lead contamination was never removed

how do you promote normalization?

-preparation-prepare child in advance for changes -participation-include child in as many decisions as possible -sharing -control -expectation-same rules to every child in the family

Ingestion of injurious agents

6 years old and younger >cosmetics >medications >household cleaning products >gasoline >other misc substances children love to explore imitate what other people are doing such as taking meds

What is considered school-age ?

6-12 years

spiritual development

children think in concrete terms expect punishment for misbehavior may view illness or injury as punishment for a real of imagined misdeed

stage 3

further enlargement of breast and areola with no separation of their contours

Sexal abuse red flag

if child can give you details of sexual acts that are very detailed or performed sexual acts on others when talking to child make sure you include all words verbatim

dx of LD and ADHD

quality of motor action developmentally inappropriate inattention, impulsive, and hyperactivity wide variation of severity dx criteria have been developed by the american psychiatric association

no longer looking for care at the end of life. It is ___

quality over quantity

WHat signs do you teach parents about psychosomatic complaints of bullying?

A Healthy kid c/o HA, stomach ache, problems sleeping, anxiety, low self esteem

therapeutic management for primary and secondary dysmenorrhea

NSAIDs estrogen therapy oral contraceptives dietary changes exercise comfort measures

Drugs for stress fractures

NSAIDs for discomfort

What are side effects of opiods?

Nausea, vomiting, constipation, sedation, respiratory depression and pruitis.

childhood schizophrenia

severe deviation in ego functioning psychotic disorders that appear after age 4-5 characterized by a gradual onset of neurotic symptoms lack of contact with reality; child is in a world of his or her own

childhood schiizophrenia

severe deviations in ego functioning and is generally reserved for psychotic disorders that appear in children younger than 15 years old

clinical manifestations of anorexia nervosa

severe weight loss amenorrhea bradycardia, decrease BP hypothermia, cold intolerance dry skin, brittle hair and nails lanugo

produced in varying amounts by both sexes throughout the lifespan

sex hormones

what is a normal curiosity during preadolescence?

sex play

SANEs

sexual assault nurse examiner dx evaluation: be sensitive to the victims emotional status; obtain account of incident; collect physical evidence

puberty

sexual maturity is achieved

Manifestations of turners syndrome

Sterile, short stature, no secondary sex characteristics, webbed neck, shield shaped chest, widely spaced nipples, low posterior hairline

sterile rarely seen before puberty small testes can have cognitive impairment or mental delays defective development of secondary sex characteristics

What are some manifestations of Klinefelter syndrome?

NSAIDs oral contraceptives exercise or comfort measures

What are some treatments for dysmenorrhea?

loss of control, fear of injury/pain, separation anxiety

What are the 3 major stressors of children during illness and hospitalization?

testicular enlargement, thinning, reddening and increases looseness of scrotum

What are the first pubescent changes that occur in boys?

1. "slapped face" appearance disappears between 1 -4 days 2. maculopapular rash on extremities lasting for 7 days or more 3. rash subsides but skin reappears as irritated or traumatized by heat, cold or friction

What are the three stages to a Fifth Disease rash?

car restraint systems door-lock mechanisms appropriate passenger seating locations

What are three automobile safety measures proven to reduce motor vehicle injury in children?

Dtap, IPV, influenza, MMR, VAR

What immunizations are needed at the kindergarten check up? (ages 4 to 6)

virus 10 to 20 days droplet transmission

What infectious agent cause Rubeola (measles)? How long is the incubation period? Source of transmission?

contact poison control, maintain airway, analgesics

What is the treatment for corrosive poisoning?

activated charcoal

What is the treatment of Aspirin poisoning?

What are the components of a health visit?

Yearly health visits: -Blood pressure screening -Vision and hearing screening -Assessment for height, weight, and body mass indices that would signify childhood obesity -Scoliosis screening -Assessment of developmental milestones -Permanent teeth eruption

A female school-age child asks the school nurse, How many pounds should I expect to gain in a year? The nurse should give which response?

You will gain about 4.4 to 6.6 lb per year.

A male school-age student asks the school nurse, How much with my height increase in a year? The nurse should give which response?

Your height will increase on average 2 inches a year.

secondary amenorrhea

absence of menses for 6 months or absence of three cycles after mensturation was previously established >most common cause is pregnancy (even with primary amenorrhea) >other causes are eating disorders, stress, and other causes of severe weight loss

secondary amenorrhea

absence of menses for 6 or 12 months or absence of three cycles after menstruation was previously est. most common cause is pregnancy other causes are eating disorders, stress, and other causes of severe weight loss

what is palliative care?

active total care of patients whose disease is not responsive to curative treatment.

types of drugs abused

alcohol narcotics CNS depressants and stimulants cocaine hallucinogens inhalants xanthines and theobromines (chocolate, coffee, tea, colas- not usually considered drugs by society)

diagnosis of stress fractures

based on clinical observation and bone scan

When might you see effects of hospitalization on children?

before admission, during hospitalization, or after discharge

puberty

beginning of development of secondary sex characteristics

adolescence

beginning with the onset of puberty and ending with the cessation of body growth at 18-20 years

incestuous sexual abuse

begins later usually eldest daughter male victims less likely to report lots of grooming

name some male reproductive disorders

trauma, carcinoma, scrotal varicocele, testicular torsion, Epididymitis

Minor burns treatment

use mild soap and water >cover with antimicrobial ointment >dressings - removal of dressings is a way to debride burn -tetanus shot -analgesics -antipyretic > tylenol to help alleviate symptoms of heat

average age of puberty

12 in girls 14 in boys

postpubescence

1 to 2 years after puberty; skeletal growth is complete and reproductive functions become established

testicular cancer

painless nodule cancer of the testicle, usually occurring in men 15 to 35 years of age

by 1 year

What age should a child be screened for lead?

self concept

a conscious awareness of a variety of self perceptions (ex- abilities, values, appearances) importance of significant adults in shaping this

learning disability (LD)

a heterogeneous group of disorders with difficulties in acquisition and use of listening, speaking, reading, writing, reasoning, math and/or social skills

LD: Learning disability

a heterogeneous group of disorders with difficulties in acquisition and use of listening, speaking, reading, writing, reasoning, mathematical, and/or social skills

A 13-year-old boy is concerned about bilateral breast enlargement. The most appropriate explanation by the nurse is based on knowing that this is a sign of too much body fat. a sign of hormonal imbalance. a normal occurrence during puberty. an indication of precocious puberty.

a normal occurrence during puberty. Gynecomastia, or enlargement of the breast tissue, is common during midpuberty in about one third of boys. For most boys, the breast enlargement disappears within 2 years. Although overweight boys may have excess body weight in the breast area, in boys of normal body weight, gynecomastia is a normal occurrence during puberty. If gynecomastia persists beyond 2 years, then a hormonal cause may need to be investigated. Precocious puberty is the early onset of puberty, before age 9 years in boys, and is not related to the gynecomastia.

A home health nurse is caring for a 2-week-old infant and notes on assessment that the infant has a string tied around the wrist. The nurse checks for adequate circulation. The most appropriate nursing intervention by the nurse is to ask the parents to remove the string. report the parents to Social Services for child endangerment. remove the string and inform the parents that the string is dangerous. ask the parents the meaning of the string and leave the string in place.

ask the parents the meaning of the string and leave the string in place. Families of various cultural backgrounds have specific beliefs about health care. These beliefs may differ from the nurse's beliefs and the nurse needs to honor the practices and seek clarification of the cultural practice. The nurse should honor the practices of the family. For the nurse to do otherwise would lead to loss of trust from the family. The nurse needs to provide education to the family that includes safety principles as the infant grows.

What are the steps in preparing for hospitalization?

assessment, nursing dx, planning, implementation, evaluation

The nurse is teaching a community health promotion class to parents and school-age children related to bicycle safety. Issues to cover in the sessions include bicycle helmets need to be worn only if the child is planning to ride in traffic. reflectors should be installed only on bicycles that are to be ridden at night. bicycles should be ridden against the traffic so that the rider can see the cars. bicycles should be walked through busy intersections.

bicycles should be walked through busy intersections. Bicycles should be walked through busy intersections to allow the child to have full view of the traffic and be able to react accordingly, with safety the number one priority. Bicycle helmets should be worn at all times to prevent head injuries. Reflectors should be installed on all bicycles, whether they are ridden during the daytime or at night only. Bicycles should always be ridden with the traffic, not against the traffic. This will assist in preventing accidents.

A 15-year-old female is in a free clinic seeking information on birth control. The girl tells the nurse that she is sexually active with multiple partners. She states that she does not want to have to remember to take a pill every day. The most appropriate birth control option for this patient is an intrauterine device. abstinence. diaphragm. condom.

condom. Condom use is recommended for birth control in teens who are sexually active with multiple partners. An intrauterine device is not a method of birth control that protects from sexually transmitted diseases. Abstinence is not an effective approach to birth control for a teen who is sexually active with multiple partners. A diaphragm is not a method of birth control that protects from sexually transmitted diseases.

A sexually active adolescent asks the school nurse about prevention of sexually transmitted diseases (STDs). The most appropriate recommendation by the nurse is the use of condoms. prophylactic antibiotics. any type of contraception method. withdrawal method of contraception.

condoms. Condoms provide a barrier to the organisms that cause STDs. Prophylactic antibiotics are not recommended to prevent STDs. Antibiotics are only effective against bacteria, not viruses. Only condoms create a physical barrier that prevents contact with the organisms that cause STDs.

vaginitis: diagnosis

confirmed by vaginal exam and microscopic evaluation of vaginal secretions

Treatment for sleep issues

consistent bedtime ritual ignore any attention seeking behavior night light transitional objects rituals: bath time, story

sports

controversy regarding early participation in competitive sports concerns with physical and emotional maturity in competitive environment acquisition of skills general like competition

what are approach behaviors?

coping mechanisms that result in movement toward adjustment and resolution of the crisis.

Consequences of sleep issues

day time tiredness difficulty concentrating hyperactivity

polysymptomatic enuresis

daytime urgency

What do school age children fear?

death, abandonment, permanent injury

During the rehabilitative phase of care, pressure dressings are primarily applied to burned areas to relieve pain. decrease blood supply to scar. limit motion during the healing process. encourage healing through scar formation.

decrease blood supply to scar. Uniform pressure to the scar decreases the blood supply. The use of pressure garments serves to decrease the blood supply to the hypertrophic tissue. This is done to prevent scarring and contractures. The goal of the pressure dressing is to improve the appearance of scars by decreasing the blood supply to the area. Motion is encouraged because it prevents contractures. Movement should take place to the point of pain, but no further. The goal of the pressure dressing is to minimize the development of scar tissue.

the goal of social development in adolescence is to

define one's identity independently from parental authority much ambivalence intense sociability intense loneliness acceptance by peers

obesity

defined as an increase in body weight due to accumulation of excessive body fat relative to a lean body mass obesity is generally considered when weight is more than the 95th percentile for age, gender, and height overweight is generally considered when weight is more than the 90th percentile

obesity

defined as an increase in body weight due to accumulation of exessive body fat relative to a lean body mass obesity is generally considered when weight is more than the 95th percentile for age, gender, and height overweight is generally considered when weight is more than the 90th percentile

school phobia

defined as extreme reluctance to attend school for a sustained period as a result of severe anxiety or fear of school related experiences also called school refusal and school avoidance treatment depends on the cause phyical symptoms that do not appear when staying home or weekends/holidays