Exam 1 (NUR 440)

external internal

Community Impact on Family: -The community can impact the family in terms of child health. Examples: poor families may live in houses with asbestos or lead paint. Also, in terms of safe play areas for the children. -May need to do community assessment to look at the resources including timing of services and availability. -Youth need to receive both e______ (support, empowerment, boundaries, and constructive use of time) and i_____ assets (commitment to learning, values, social competency, and identity) from the community to help develop their sense of self.

Negativism

Concerns R/T Normal G & D: N_____= This is the increase in saying "no". -Nursing can help the parent see it is a positive step as the toddler recognizes he/she is a separate individual. It is a normal and the stage does end and is important to achieving autonomy -Three important questions to ask the parent are: a. Are you giving him/her too many choices? Limiting the choice to two or avoid asking a question with the primary answer of yes or no may help. b. Are you asking him too many things when he's/she's tired? c. Are you asking him to do things beyond his/her ability?

play regressive

Concerns R/T Normal G & D: Stress -Parents may not realize that young children can experience stress and some may be beneficial as it helps the child to develop coping skills. -Observing child p___ can be useful in identifying stress. -Prevention is key in anticipating stressful situation but recognize regression can occur. -It is important to ignore r_____ behavior and praise developmentally appropriate behavior.

sole

Concerns R/T Normal Growth and Development: Sibling Rivalry -Usually occurs with birth of baby but can happen in beginning of blended family. It occurs due to the disruption in routine and for first born it is the loss of s___ parental attention. -Parent need to help the child prepare for the change slowly recognizing developmental level. The parent also needs to set realistic idea and the new baby is not an immediate playmate. -Child may act out overtly, verbalize that want baby to go away or regress in behavior. Important for parent to supervise interaction between the siblings. -Need to supervise the interaction between siblings no matter how well the older child is behaving.

consistency

Concerns R/T Normal Growth and Development: Temper Tantrums -Natural consequence of development because they know what they want but lack the vocabulary to express their feelings in another manner. Tantrums that include breath holding are not harmful. -*Key is c_____ in the rules and to teach parents to recognize when they may occur and prevent them. This can be done by giving the child an option and praise child for choosing positive behaviors.* -Teach parents if it does occur, assure child is safe, otherwise do not call attention to behavior as this may reinforce it. It is important to provide comfort once they are able to gain control.

time out

Concerns related to normal Growth and Development: Limit setting and discipline -It is important for parent to begin to set limits as the infant is becoming mobile (as they do not understand cause and effect). For discipline, it is recommended that the parent begins by using a negative voice or stern eye contact. -As the parents need to increase measures; giving the child a t___ o___ is appropriate (1 minute for every year of age) in an appropriate setting (for infants this could be a playpen with no toys for an older child this could be a small chair).

Separation

Concerns related to normal Growth and Development: s_____ anxiety and stranger fear -This is influenced by gender, age and size of stranger, stranger's approach, and child's proximity to parents. -This is a normal stage as it represents a healthy parent-child bond. -In clinical, it is important if a parent is present to have the parent hold the child. Also, approach the infant at eye level and talk softly. It is key to allow the older infant to warm-up to you.

records safety

Concerns: Child care -There are different types of care it can be in the family home or another facility. Child center-based care may be licensed facility. -Nursing may be needed to help the parents select an appropriate facility. If it is a licensed facility; the parents can review their r____. -Some other considerations are: fees, teacher qualifications, and student-to-staff ratios. -Additionally, it is important to discuss the facility s____, infection control, and health care practices. Finally, encourage the parent to arrange an on-site observation.

6-10 teething 3

Concerns: Teething -This is a difficult period for both the infant and parent due the discomfort experienced during tooth eruption. -Begin at _-__ months with lower central incisors the pattern varies with each child. -Common signs are drooling and biting on hard objects. Some infants are irritable, mild temperature elevation, ear rubbing and decrease appetite for solids. Other findings need to be evaluated for the potential for another illness. -For pain management, cold is soothing and a frozen t_____ ring can help. Topical anesthetic ointments (Baby Orajel) should be used with care as the absorption rates do vary in infants. -For persistent irritability, the parents can use acetaminophen or ibuprofen but should not do so for more than _ days.

18 to 20 4 Otitis

Concerns: Thumb sucking and pacifiers -Infants naturally have a need to nonnutritive sucking as a means of pleasure. If unable, you may see infant suck on their tongue. As the infant gets older this may be the result of the child feeling tired, hungry or insecure. Parents need to be informed about this need. -Parents are concerned related to prolonged thumb sucking; but studies show it peaks at age 1_ to 2_ months and is not harmful unless it persists past the age of _ or when permanent teeth are erupting. -There is conflicting information in the literature related to benefits and risks for pacifier use. Several studies demonstrated an increased risk of O_____ Media with its use. While, the The American Academy of Pediatrics (AAP) recommends the use of pacifiers for the benefit of pain management and decrease risk of Sudden Infant Death Syndrome (SIDS). -The AAP currently recommends pacifier use for the first 6 months then wean over the next 6 months.

24 girls, boys 6

Concerns: Toilet Training -Major task of toddlerhood. It occurs due to the voluntary control is achieved with the urethral and anal sphincter (at ~ __ mos.). -It is important to assess child readiness of bowel, bladder, cognitive, motor and psychological. It also includes parent readiness (Nursing Care Guidelines). Remind parents there is no right age after ~ 22 mos. to begin or end and ___ are often ready earlier than b___. -There is a lag of nighttime control after daytime training. If it has not occurred by age __, then further evaluation is needed. -Bowel training especially in conjunction with well-balanced diet can be easier to obtain due to the predictability of bowel patterns. -Clothes should be easy to remove and remind parents that accidents can occur during initial use of underwear. -Parent should discuss and reinforce steps including good handwashing.

developmental, obesity mortality

Consequences of poverty: -Poor nutrition with lack of readily available healthy foods --> nutritional deficiencies, d______ lag, and pediatric o_____. -Poor sanitation or crowded living conditions. -Lack of medical insurance, lack of access to care, and lack of preventative services --> overall poor health, increased rate of diseases and increased infant m______.

narrowing

Croup= obstruction and n_______ results from the edema of croup.

accommodate primary

Cultural Influences: -Goal is to *a______ cultural beliefs* as much as possible to assure compliance of treatment and patient and family satisfaction. -Cultural belief is NOT usually used as a p_____ therapy.

Skill, Encounters

Cultural Influences: -Nursing needs to consider the cultural influences when providing health care (Remembering not to generalize/stereotype but to consider the Camphina-Bacote ASKED model- Awareness, S___, Knowledge, E______, and Desire). -In addition, culture is more than race and ethnicity. It can be male/female, generational, life experiences, upbringing, etc. It can be visible or invisible. -See Box 2-8 (Exploring a Family's Culture, Illness, and Care) -National Center for Cultural Competency

alternative

Cultural Influences: Health Beliefs/Practices: -Health Practices is also culturally driven in terms of prevention and treatment of illnesses. -See Box 2-9 of cultural practices that could be considered abusive. -It is important to explain that these may be considered harmful and the need to explore a______ measures.

Natural Supernatural imbalance

Cultural Influences: Health Beliefs/Practices: -With health beliefs, it is the integration of the cause of illness and maintenance of health and often have strong cultural influences: a. N_____ forces can include the body is not protected from cold air or the air is impure and leads to illness. b. S_______ forces which are forces beyond comprehension. In some cultures like Mediterranean it is the concept of the "evil eye." c. Illness is the i______ of forces and goal is to maintain balance or equilibrium.

humidified vest pancreatic bronchodilator

Cystic Fibrosis Nursing Interventions: -Monitor respiratory rate and depth, VS, LOC and O2 saturation -Supplemental, h______ O2 -Position of comfort -Assist with v___ treatments and percussion/postural drainage -Suction nares and oropharnyx -Maintain hydration and nutrition -Medications (antibiotics, p______ enzymes, b_______) -Assess and address anxiety level of the patient/parent

CFTR, chloride autosomal recessive Exocrine and epithelial sweat

Cystic Fibrosis: -Caused by a mutation in the C____ gene (mutant gene does not move c______ ions, causing sticky mucus to build up on the outside of the cell) -Autosomal _______ -E______ and e_____ cells have a defective chloride ion transport and a decrease in the amount of water that can flow across the cell membrane -Diagnosed with s____ test

Drowning

D= D_____: can occur in as little as an 1 to 2 inches of water; as the result, an infant needs to be supervised around any water source. AAP cautions parents that swim programs at this age does not prevent drowning.

volume diameter alveoli

Development of the Lower Airway: -Increase in lung v_____ across development -Increased d_____ of lower airway structures -Proliferation of a____ across development

family

Development: Spiritual -It is strongly related to cognitive development and is strongly influenced by f_____. -Recent studies have looked at the influence of spirituality on health, illness and well-being. -Toddlers learn about God through words and action of others but do not fully understand the meanings due to the inability to clearly distinguish between fantasy and reality. -Toddlers begin to assimilate the rituals associated with the divine (such as folding hand to pray for meals and bed) and may find comfort in the routines. -Fowler's Faith Development

manipulative

Developmental Milestones: Fine Motor Skills The infant's m_______ skills increase beginning at 6 months with holding a bottle or playing with their feet. This progresses to hand to hand transfer at 7 months and continues to improve.

pincer

Developmental Milestones: Fine Motor Skills The p____ grasp occurs as the Palmer grasp is replaced at 8-9 months allowing the infant to pick up objects with thumb and forefinger. It is well established by the 10th month.

prehension

Developmental Milestones: Fine Motor Skills The p________ grasp starts at ~ 2-3 months as a reflex but becomes more voluntary and at 5 months to enable the infant to grasp objects.

crawl creeping

Developmental Milestones: Gross Motor Skills At 9 months, the infant can c____ (going forward with belly on the floor) and this progresses to c_____ (going forward on hands and knees).

standing

Developmental Milestones: Gross Motor Skills At 9 to 10 months, they may be able to pull to s_____ position but only maneuver back down with falling.

toy

Developmental Milestones: Gross Motor Skills By 11 months, they may walk with t___, holding on to furniture or with holding two hands.

one

Developmental Milestones: Gross Motor Skills By one year, they can walk with o___ hand or are starting with independent steps.

Head

Developmental Milestones: Gross Motor Skills H____ control established at 4-6 months with head lag noted prior to this time.

Rolling

Developmental Milestones: Gross Motor Skills R_____ over at 5-6 months, it occurs first at 5 months with abdomen to back and back to abdomen at 6 months.

Sitting

Developmental Milestones: Gross Motor Skills S_____ alone occurs at 7 months in the tripod fashion and at 8 months this progress to sitting unsupported. Development of head and trunk control allows the infant to sit.

Electrical

E= E_____, Electrical Burns, and other Burns: Electrical burns (prevent with covering all outlets and be aware of frayed wiring) Other burns are primarily scald burns (prevention water heater set at ≤ 120° F, watch child in kitchen, do not heat formula in microwave and turn pot handles inward); sunburns (prevent by reducing sun exposure and assure appropriate clothing-some pediatricians do not recommend sunscreen use in infants, and any heat producing element which includes fireplace or curling irons (prevention assure that barriers are in place)

laryngospasms tracheostomy or endotracheal Neubulized oral Antibiotics

Epiglottitis: -Do not put anything in the mouth - Examination of the throat can result in l________ and airway collapse -Allow child to determine position of comfort -Plan for emergency respiratory care -t______ or e______ intubation -N________ medication & supplemental oxygen -IV fluids - NO o____ fluids -A______

8 hours Intense Dysphagia Tripod Inspiratory distress

Epiglottitis: EMERGENCY! Clinical Manifestations: -2-_ years -Onset is rapid, h____ -High fever -i_____ sore throat -D______ -Drooling -Prefers upright sitting position (t_____ position, with mouth open) -i______ Stridor -Severe respiratory d_____

identity

Erikson: Psychosocial Development "A sense of i______ provides the ability to experience one's self as something that has continuity and sameness, and to act accordingly."

Rhythm Quality

Evaluation of Respirations: 1. Rate 2. R______ 3. Depth 4. Q_____

coordination

Example of sensorimotor stage progression: primary circular, the baby has a rattle and shakes it and it makes a sound it will shake it again. If you hide the rattle they will not look for it. In secondary circular they may start to look around and if they see the rattle will pick it up and shake it. in c_____, they will look for that favorite rattle even if it is hidden as they know now that objects exists even when the do not see them.

Fall

F is F___ prevention: never leave an infant unattended on a raised surface. Risk from falls increase with increased mobility. For parent education, discourage use of infant walkers and infant should not be mobile and unsupervised. Gates should be used at any stairway. In the hospital, always check the crib rail height.

semi-closed oldest

Family *Development* Theory: Is the work of *Duvall* & Miller (1977): -The purpose is to discuss the developmental tasks of the family (see Box 2-1). This is done in terms of structure, function, and roles. (SFR) -Supposition: family is considered a s___-closed system that interacts with larger systems. -In addition to the family tasks at every stage; the individual family members must achieve their own developmental goals. -The age of the _____ child is the marker for stage transition

adjustment responses disorganization manageable

Family *Stress* Theory (cont.): -Need to list family's strengths and coping abilities. As well as challenges to plan care. Some strengths may assets, resilience, motivation and capabilities -Once exposed to the crisis it is the a_______ phase characterized by disorganization and unsuccessful attempts to meet crisis. -The focus is on family r______ to stressful life situations and what facilitates successful adaptation. -The course of family adjustment following a crisis includes: 1. Period of d________ 2. Angle of recovery 3. Reorganization and new level of family functioning -Functional families are able to see events as m_______ and understandable and it is easier to use existing measures of coping than developing new ones. -With crisis prone families more likely to see A with > frequency & > severity and tend to id C as a crisis more frequently

maladaption

Family *Stress* Theory: -This theory is used to explain how families react to predictable and unpredictable stressors that it may encounter (i.e. hospitalization of a member, unemployment, death, etc.) -These stressors may also occur simultaneously and may overwhelm the family; therefore, putting the family's ability to cope and place it at risk for m________. -McCubbin and McCubbin (1994) built on this model to include resiliency that allows family to perform better after a crisis.

interactions feedback

Family *Systems* Theory: -Family is viewed as a whole and a dynamic system with interaction within members between the system and the environment. -This family unit is surrounded by the larger systems of extended family, then community and at the periphery to society. -The emphasis is on the interaction and any problem or dysfunction does not lie in one member but the type of i_______ used by the family. Too much or too little change can lead to dysfunction. Due to this concept, the family becomes the patient and the focus of care. -Bowen (1966) looks at health families as being adaptable (in considerations of the boundaries in terms of openness and closure) and using f_____ to look at strengths and goal attainment.

large authoritarian

Family Size and Configuration: -Common to ____ families is the ability to adapt to change and cope with crisis. -Group goals and considerations take precedence over the individual. -Depending on the size there may be issue related to amount of resources. -The family is more a______ with older siblings providing discipline. Children may seek support from other family members (leading to more security) and may adopt a role to gain family recognition. -The adolescents may be more peer-oriented then family-oriented.

small

Family Size and Configuration: -Family size affects parenting practices. -Common to ____ families is the emphasis of individual development compared to same-age neighborhood children or social class. Adolescents may identify more strongly with the parents.

culture, coping skills

Family: Nursing Process: 1. Assessment= Family type, c____, religion, c_____ skills and resources 2. Nursing diagnosis= a. Compromised family coping r/t multiple stressors b. Interrupted family process r/t a child with a significant illness requiring alteration in family function. c. Risk for caregiver role strain r/t child with a chronic illness or other stressors d. Impaired social interaction (parents and child) r/t lack of family or respite support

resiliency integrity Parenting Coping, Support

Family: Nursing Process: 3. Interventions a. EBP Coping | r______ promotion: Counsel family members about additional effective coping skills for their own use. b. EBP Family i_____ promotion: Monitor current family relationships. Facilitate open communication among family members and provide visitation. c. P_____ promotion: Discuss family goals for managing child's care. Consider family strengths and coping abilities may need to make referrals. Consider ethnic or religious background in care planning. d. C____ enhancement or Caregiver S_____

often consistently

Family: Nursing Process: 4. Evaluation|Family Functioning (2602), Integrity (2603), Participation (2605), and Coping (1302): Family is functioning optimally and can care for the child with available resources. This should be at level of 4 (o____ demonstrated) to 5 (c______ demonstrated) with specific examples.

patency bronchoscopy

Foreign Body Aspiration Nursing Interventions: -Assess p_____ of airway and adequacy of ventilation -Cardiorespiratory and pulse ox monitor -Supplemental oxygen -Anticipate b_______ or other procedure to remove object -Child safety education

Neglect

Forms of abuse: N_____, subtle form just as damaging. It is the failure to provide for the child's basic needs and an adequate level of care. It may be due to need for guidance for the parents. It can be from a number of causes include lack of knowledge or lack of resources. It can be physical with lack of the basics of food, clothing, shelter. Observe how the child is dressed can be a key assessment. It also can be emotional with the failure to meet the child's needs for affection and nurturance.

Psychological

Forms of abuse: P_____ can be belittling threatening, isolating or exploiting child. It is the most difficult to detect and effects can be severe. One key is the parent only uses negative terms r/t child.

GBTL fertilization

Gay, Lesbian, Bisexual and Transgendered families (_____)= This is a family in which there is a legal or common-law link between 2 persons of the same sex who have children. Children come from previous relationships, foster, adoption, use of artificial f______ or use of surrogate.

pronoun 3

Gender Identity: -Toddlers continue with body exploration for pleasure. Parental reactions can influence the child's own attitudes toward sex. This includes learning the vocabulary surrounding the anatomy using the correct names. -By age 2, they recognize gender differences and refer by appropriate p_____. The sense of maleness or femaleness (gender identity) is formed by age _ and includes the child's feelings toward their gender.

Malformations

Genetic Influences : Congenital Anomalies: M_______= which occur often before the 12th week of gestation resulting in abnormal formation of body parts (Cleft lip and palate).

Associations

Genetic Influences : Congenital Anomalies: Those with a genetic or environmental component include: A______= are a nonrandom pattern of malformations from an undetermined cause (VACTERL-vertebral, anal atresia, cardiac defect, tracheoesophageal fistula, renal, and limb defects).

Sequences

Genetic Influences : Congenital Anomalies: Those with a genetic or environmental component include: S_______= occur when a single anomaly leads to a cascade of additional anomalies (Pierre Robin sequence).

Syndromes

Genetic Influences : Congenital Anomalies: Those with a genetic or environmental component include: S_________= which occur from a specific cause and result in a recognizable pattern (chromosomal abnormality Trisomy 21 in Down Syndrome).

chromosomal gene mitochondrial

Genetic Influences : Genetic Disorders: -Genetic Disorders occur because of c________ abnormalities (Downs Syndrome), single g____ mutations (sickle cell anemia), combination of genetic and environmental factors, and m_________ DNA mutations. -Lists can be found in Tables 3-2 and 3-4. We will talk about many specific diseases during the semester.

Dominant

Genetic Influences : Patterns of Inheritance: -Autosomal _______= Single copy of mutant allele is sufficient for phenotype (disease) to be expressed (See Box 3-2)

Recessive

Genetic Influences : Patterns of Inheritance: -Autosomal _______= always homozygous for trait as need a copy from each parent for phenotype (disease) to be expressed (See Box 3-3)

Penetrance

Genetic Influences : Patterns of Inheritance: -Complete (100%) P_______= means the gene(s) for a trait are expressed in all the population who have them.

X-linked Dominant

Genetic Influences : Patterns of Inheritance: -X-linked _______= This is rare but both males and females can be effected but the disease less severe in females. (See Figure 3-16)

X-Linked Recessive

Genetic Influences : Patterns of Inheritance: -X-linked _______= males have a 50% chance of being affected, while females are carriers as allele is on X-chromosome (See Box-3-4)

reproductive

Genetic Influences : Screening: -Benefits of carrier screening include genetic counseling, r______ planning, and providing information to at-risk family members. -Nursing needs to educate families on why the screening is being done, what the results mean, and what is the impact of false-positive or false negative results. Box 3-8 discusses the essential nursing competencies related to genetics and genomics.

sensitivity specificity

Genetic Influences : Screening: -Screening is one method to help determine actual risks. One example is the newborn screen. This varies by state. -Concerns are that tests need to be able to determine who actually has the risk/disease (s_______) and those who do not (s______). Additionally, concerns for the child/adolescent who carries the "faulty" gene may have issues with self-esteem and can have additional cultural impacts.

history, congenital isolation, consequence

Genetic Influences on Family Health: -In pediatrics, genetics has a large influence on health. The Human Genome Project is a national program looking at this. -The American College of Medical Genetics has guidelines for genetics consultations. It includes a family h_____ of hereditary diseases (familial trait or child with a genetic disease or disorder), a major c______ anomaly, a parent request and other considerations. (See Box 3-7 for Assessment Clues) -2%-4% of all live- born children are born with congenital anomalies or birth defects. These can occur in i_____ like congenital heart defects. They can also be a normal variation with no serious c______ like a café-au-lait spot (hyperpigmented skin).

air Nystatin

Health Problem of Infancy: Diaper Dermatitis -It is the result of prolonged and repetitive contact with an irritant, principally urine, feces, soaps, detergents, ointments, and friction. It is also the continuous moisture that allows the breakdown to occur. It may involve a secondary yeast infection. -Prevention is the key. This can be accomplished through timely diaper changes, allowing skin to dry through a__ exposure, avoid frequent washing of the area and commercial diaper wipes. Newer diapers are constructed to help reduce the incidence. -Treatment includes the use of occlusive ointments. N_____ cream may be required to if Candida is present. Butt paste is effective but can be expensive. If a barrier paste is used it is recommended to leave the paste intact removing only soiled area and reapplying. This is effective EBP that shows good healing in 24-48 hours.

reproductive STDs

Health Problems of Adolescence: -General health concerns of adolescents -Health problems of the r_______ system -S__s

Endometriosis Vaginitis

Health Problems of the Female Reproductive System: -Amenorrhea -Dysmenorrhea -E_______ -PMS -V______

Priapism Varicocele Gynecomastia

Health Problems of the Male Reproductive System: -P_____ -Testicular Tumors -V______ -Epididymitis -Testicular Torsion -G_______

12

Health Promotion for Preschoolers • Activity - Naturally active and benefit from free play and exposure to a variety of physical activities • Sleep - 1_ hours per at night with infrequent naps during day - Quiet activities in evening prior to bath and bed - Routines and rituals still important

MVI

Health Promotion for Preschoolers • Injury Prevention - Due to improved mobility falls are less of concern and they understand and avoid danger. - M__ are concern due to running out in the street or riding tricycles.

90, 1800

Health Promotion for Preschoolers • Nutrition - _0 kcals/kg or 1_00 calories/day there is a MyPyramid for Preschoolers. AAP also has guidelines. - Family eating habits & routines help to establish healthy behaviors and limit potential for obesity and metabolic syndrome. - Child's growth pattern is a way to frame eating discussions as food habits that may persist from toddlerhood.

habits

Health Promotion for Preschoolers: Dental Health - Dental care imperative to teach good dental h____. - Dental caries very common in childhood, so need supervision/assistance with brushing with parents flossing. - Need dental screens by PCP and care by dentist.

Infants

I_____ (Birth to 12 mos.)

Stress Developmental

Illness/Disability Prevention: Childhood Injuries: Childhood Risk Factors (Box 1-2) -Sex of child (males > females) -Temperament -S____ and lack of self-protection -Alcohol and Drug Use -Injury History -D______ Level -Cognitive Ability -Anatomic Characteristics of the Child -Environmental and Family Factors

MVA Firearms

Illness/Disability Prevention: Childhood Injuries: Other unintentional injuries: -M__s -Drowning -Fire/Burns -F______ -Choking -Falls -Head injuries

Cyanosis

Imminent Respiratory Arrest: -Bradypnea -Bradycardia -C______ -Stupor -Coma

age changes

Impact on Child: -Affected by child's a___ at the onset of the illness or disability -Varies and c_____ across development

Financial respite Sibling

Impact on Family: -Change in parental role -Complicated home routines -F______ stress -Fear for the child -Community reaction -Limited r____ -Practical considerations -S_____ needs

33% Posterior, anterior

Infants: Physical Growth -Head Circumference- at the end of 1st year the head has increased in size by _3%. -Important for brain growth and development. -Fontanels a. _____ fontanel first to close at about 6 to 8 weeks of age and the ______ is the last and closes about 12-18 mo. Plot on growth chart child < 3 yo. - Overall, infant growth is influenced by genetic, metabolic, environment and nutritional factors.

hepatic

Ingestions: Concerns • Acetaminophen-leads to h____ failure, most common both accidental and intentional, with an antidote N-acetylcysteine

bleeding edema hyperpyrexia

Ingestions: Concerns • Aspirin (Acetylsalicylic Acid)-leads to abnormal b______, pulmonary e____, convulsions, hyperp_____ (extreme fever).

esophageal, perforation vomiting

Ingestions: Concerns • Corrosives (strong acids & alkalis)-leads to e_____ strictures &/or gastrointestinal p______ especially liquid preparations. DO NOT induce v____.

pneumonia

Ingestions: Concerns • Hydrocarbons-leads to chemical p______ due to aspiration. DO NOT induce vomiting.

liver

Ingestions: Concerns • Iron-can lead to l____ failure and death often concern is the look like candy and come in packages of large quantities.

benzodiazepines

Ingestions: Concerns • Medicine cabinets have lots of drugs concern with opioids and b______ but they do have antidotes

side-lying charcoal 1

Ingestions: Emergency Treatment - Prevent further absorption - • Place child in ____-lying, sitting, or kneeling position to avoid aspiration. • Gastric Decontamination- no longer routinely used (see EBP) - If recommended done with activated c_____ with/without sorbitol (1 g/kg). - gastric lavage (only done within _ hour of ingestion, ingestion of sustained release material, or massive amount of poison) • Syrup of Ipecac (an emetic) is not recommended for routine poison treatment by the AAP. - Prevent reoccurrence through home safety education and use of child-resistant containers (Applying Evidence)

First

Ingestions: Emergency Treatment • Parents advised to call Poison Control Center(PCC) 1-800-222-1222 as the ____ step - most poisonings are managed at home. - Assessment of child • V.S., LOC, respiratory effort, and color • If needed initiate CPR. - Terminate exposure to material • Empty mouth, flush eyes or skin, remove contaminated clothing, and with inhalation move to fresh air - Identify the Agent • Question victim or witnesses, look for empty containers and save all evidence (including vomitus, urine, etc).

asymptomatic

Ingestions: Lead Poisoning • Causes: - Ingestion/inhalation of micro-particles primarily from lead- based paint or contaminated soil in the yard (Box 14-3 and culture competence box) - Young children most vulnerable (0.8% had BLLs > 10 mcg/ dL) - Children are often a________ even at higher levels. • Damage to: - Developing soft tissue (brain) resulting in decreased synaptic activity low dose leads to mild deficits but high can lead to encephalopathy. - Ultimately settles in bones and teeth in inert form and makes up the greatest portion of body burden. - Erythrocytes resulting anemia especially if iron-deficient they will absorb lead more readily.

5 Chelation, bone Prevention

Ingestions: Lead Poisoning • Diagnosis: - Obtain venous blood level concerned with an BLL > _ mcg/dl. - Routine Screening as a secondary prevention. It is recommended for all Medicaid will pay for 2 (1 & 2 yo). If risk identified can perform as young as 6 months (American Academy of Pediatrics, 2008). • Treatment: BLL level (Table 140-2) - C______ Therapy (calcium EDTA-IV)- removal of lead from circulating blood but may not remove from b____ and require multiple treatments. Excreted by kidney (need hydration). May begin will 20 mcg/dL. • NursingManagement: - P______ most effective - May require environmental scan to look at sources of lead - Need good I/O documentation due to renal toxic effects.

6 oral home

Ingestions: Mainly a problem of children under the age of _ years. - What are the Developmental Characteristics leading to accidental poisoning? • Infants and Toddlers explore world with o___ experimentation and taste is not discriminating, so may ingest unpalatable substance. • Toddlers and Preschoolers are curious, noncompliant, and like to imitate behaviors. - What are the Environmental Characteristics leading to accidental poisoning? • Easy access to substances & poisonous plants, Periods left alone to explore, unlocked cabinets. • Lead-based paint in home and lead-contaminated soil in yard. • *90% of poisonings occur in the ____.*

Food lawn mowers

Injury Prevention: Aspiration and Suffocation -F___ and small objects continue to be the greatest risks. Bodily Harm -Concerns are that of the infant with the addition of l___ m____ and fire arms as children are curious. Children should be away from areas being mowed and should never ride on a lawn mower.

choices independence fear

Interventions to Minimize Stressors: -Minimize number of caregivers -Maintain child's normal routines -Provide c_____ -Encourage i_________ -Involve family in child's care -Provide clear, developmentally appropriate explanations -Listen to and acknowledge f___ -Provide developmentally appropriate activities and opportunity for play -Complete developmentally appropriate pain assessment -Provide adequate pain management

commands 100 expressive

Language Development: -At 9-10 mos., they understands works like "no" and can respond to simple c_______. -At 1 yr., the vocabulary is at ~ _00 words and can say 3 to 5 words with meaning. -It is important for infants to be exposed to e_____ speech and any delay in achieving language milestones are evaluated for potential hearing loss.

Crying gurgle meaning

Language Development: -C_____ is the first means of communication. Through out the first year, the parents learn to differentiate the cry. -At 3-4 mos., the baby can coo, g____ and laugh. -At 6 mos., the infant can combine syllables like " mama or dada" but do not ascribe m_____ to the word.

300 understandability Books

Language Development: -Vocabulary expands to about _00 words by age 2. -Bilingual children can achieve the milestones in each language. -By age 2, the toddler is using 2-3 word sentences and this increases to simple sentences. Speech also gains in u______ (about 65%) during this time. -By 30 mos., the child knows his/her name, age, gender, can to 3. -B___ and increased adult-child conversations may aid in language development; while prolonged television viewing may lead to language delays.

Pertussis

Lower Airway Conditions: -Bronchiolitis -P______

Munchausen female

M______ by Proxy- also know as medical child abuse this is a form of medical child abuse as the parent brings child in for care as an attention seeking behavior. -The 2 classic findings are the problem is not seen on exam just from the history and problem disappears when abuser is no longer providing care. -Typically, the perpetrator is _____ with some medical knowledge. -Good documentation of parent-child interactions is essential with video proof is required to prosecute.

Morbidity Respiratory

M______= Defined as illness with symptoms severe enough to limit activity or reason to seek medical attention. -R_____ accounts for 50% -Increased in children in poverty, low birth weight, and chronic illnesses.

Congenital, SIDS Accidents, cancer

Mortality: Infant: -C_______ Anomalies -Preterm/Low birth weight -S___ Child/Adolescent -A______ for all > 1 year -For 1-4: anomalies/homicide next -For 5-14: c_____ is next -For > 14: suicide is next

rigidity

Musculoskeletal Development: -Increased r____ of rib cage -Changing position of ribs to spine across development

Poisoning

NCP: Ingestions • Risk for p_____ (Ackley&Ladwig, 2014) • Interventions: - Complete assessment including ABC if needed - Call PCC - Initiate any ordered treatment - Evaluate lead exposure - Educate parents related to age-related safety measures. - Educate lead prevention • Outcome: Knowledge: Child Physical safety level 5(extensive know >90% of material) with appropriate actives for child development and strategies to prevent exposure to toxic chemical or substance.

transmission

Nasopharyngitis/Pharyngitis Goals: -Comfort -Maintain adequate fluid and nutritional intake -Decrease risk of t_______ to others

Feeding Restlessness Diarrhea congestion

Nasopharyngitis/Pharyngitis S/Sx: -Throat pain -F_____ poorly or poor appetite -Lethargy -Irritability -R_______ -Fever -Vomiting -D______ -Upper airway c______

Inflammation

Nasopharyngitis/Pharyngitis= i_______ of the nose and throat -Multiple viral or bacterial organisms

nasal Cool fluids hand

Nasopharyngitis/Pharyngitis Nursing Management: -Saline drops with n____ suction prior to feedings -C____-mist, room humidifier -Quiet play and rest -Encourage f_____ -Teach family good h___ hygiene

further

Nursing Process: Abuse Goals of Nursing care are to: 1. Protect child from f____ abuse 2. Support child 3. Support family 4. Plan for discharge 5. Prevent abuse from occurring

caregiver

Nursing Process: Abuse Assessment Need a complete patient history with an interview. -It is important to establish a rapport with the child and ask and record questions and answers verbatim. They should be developmentally appropriate and non-leading. -You may need to separate child from c_____. -You need to be suspicious anytime the story does not match the physical findings.

Pain play

Nursing Process: Abuse Interventions Prevent further injury as well as teaching and family interventions mentioned previously. Other topics include: -Coping Enhancement for Child and Family -Environmental Management: Violence prevention -P___ management -Abuse protection support: child -Therapeutic p__ -Skin surveillance -Developmental Care -Art therapy -Nutritional Management -Crisis Intervention -Education of discharge needs and abuse prevention

developmental hand 6

Nursing Process: Infant Interventions Environmental Management: safety a. Identify safety needs based on d_____ level. b. Identify and remove safety hazards in the environment and may require a home visit. Infection protection a. Teach parents to monitor for fever and physical signs of infection and dehydration. Emphasize good h___ washing to prevent spread of illness. Immunization and vaccination management a. Passive immunity wanes at ~ _ mo. Need to immunize baby on schedule. Letting parent know what to expect at next visit and answer questions. For education, you can give the brochures and dispel any myths. b. Infants should not be around people with colds in winter to reduce RSV infections. Smoking Cessation Assistance for the parent if needed.

vision and hearing

Nursing Process: Infant Interventions: Parent Education: Infant -This is a comprehensive list on parent teaching. Includes diet and diaper rash prevention. a. Health Education- Nursing needs to do current and anticipatory teaching. EBP that is effective. b. Use a variety of strategies and intervention points in the educational program. c. Develop collaborative multidisciplinary partnerships. e. Family Centered Care-Guidance during the first year -Health Screening -Normal screenings: v____ and h_____ checked. If there is a family history of chronic illness may have child screened so that early intervention may occur. -Health System Guidance-Parents have contact numbers to get questions answered or if the infant needs to be seen by PMD

normalization hopefulness goal

Nursing Strategies to Promote Child Coping: -Identify and teach coping mechanisms -Promote n______ -Support h________ -Assist with g____ setting and planning

strengths anticipatory siblings

Nursing Strategies to Promote Family Coping: -Identify family s_____ -Provide ongoing information -Provide a______ guidance -Facilitate goal setting and planning -Involve s_____ -Encourage use of support system

proteins calories cereals

Nutritional Concern: Vegetarian Diets -Children and adolescents on vegetarian diets have the potential for lifelong health diets and eating habits. -Good nutrition assessment is key to see the exact food consumption. In addition, a physical assessment may be needed to look for deficiencies or excesses. -Concern with the stricter vegan diet is the lack of adequate complete p_____ for growth and development; inadequate c_____ for energy; poor digestibility of bulky, natural and unprocessed foods; and deficiencies of vitamin B6, B12, niacin, riboflavin, vitamin D, iron, and calcium. These children require a multivitamin-mineral supplement. -Need to evaluate for Iron deficiency anemia and Vitamin D with strict vegetarian as unrefined c____ impair iron, calcium, and zinc absorption. -Education may be required there are vegetarian food pyramids. This includes ensuring that child is receiving complete proteins by combining sources like grains, seeds, and legumes or grains and milk products at the same meal.

sunlight 400 seizures

Nutritional Concern: Vitamin D -There is a growing incidence of Vitamin D deficiency estimated at 21-23%. -Results from exclusive breastfeeding and low exposure to s_____. -In older children, it is the result of diet low in Vitamin D and calcium or dairy products lack Vitamin D fortification. -AAP recommends _00-1000 IU of Vitamin D for any baby who is exclusively breastfed or consuming less than 1 L/day of Vitamin D fortified formula/milk. For older child it is 600-1000 IU. -Clinical manifestations of deficiency include: abdominal pain, s_____, limb pain, and weakness.

Moral Sexuality

Other domains of adolescent development: -Occupational -M____ -Spiritual -S_______ -Body Image

Poisonings Auto

P= P_____/Ingestion will be covered in preschool lecture. A= A____ safety once mobile with backing up, also car or truck in hot weather and the infant is left unattended death by hyperthermia can occur in hours and it is a criminal offense. Also concern with Air bags as it needs to be deactivated.

Parental role

P____ R____= These are the socially sanctioned roles of mother and father but are changing as society has changed with increased opportunities for women and fathers becoming more active in childrearing. Role conflicts may arise due to the culture lag of the persisting traditional role definitions.

Prophylactic Nasogastric Nasogastric Vaccination

Pertussis Treatment and Prevention: -Antibiotics (azithromycin, clarithromycin, erythromycin, or trimethoprim-sulfamethoxasole) -P_______ treatment of close contacts -Airway management, supplemental oxygen -N______ feeding -N______ or IV fluids -V_______ -Family education, hand hygiene

bacterial Immunization eradicated

Pertussis: -Highly contagious acute _______ infection of the upper and lower respiratory tract -Most severely affects infants and young children -i_______ provides protection against the disease, maternal immunization recommended -Disease nearly e_______, now on the rise

formal

Piaget: concrete thinking --> _____ operations

parallel

Play: -Play continues to be influenced by development. -Play is considered p_____ during this period in which they like to play next to another child but not with the other child. -The toddler likes imitative play like dress-up. -An education toy is best when it fosters adult child interaction and fosters creative thinking, i.e. blocks, doll and clay. -Toddlers like to bang hammer on toys, talk on the phone, climbing in and out and up and down, manipulate objects, and coloring with a pen. -Toy safety needs to be evaluated.

solitary

Play: -Play in the 1st year is considered s_____ and is important as it is a major socializing agent. -Additionally, it provides the stimulation needed to learn from interactions with the environment. (See Table 10-2 for clinical keys) -Additionally, involves the sensorimotor skills. -Simulation is important and infants need to be played with. The nurse can help parents with education related to milestones and need for play

Associative girls Play

Play: Preschoolers • "Work of Children" as it allows them to understand and work out life's experiences. • A_______ Play-group play without the rules and rigid organizational structure. There is also a focus on imitative or dramatic play in which they mimic adult roles. • Activities should continue to aid development of gross and fine motor skills. Electronic games can help to learn basic skills. • Imaginary Playmates are common more with _____. But occur as result of the blur between reality and fantasy • *The best way to effectively communicate with a preschooler is through p____. It can strengthen the parent/child relationship*

slows

Preschool Children 3-5 y.o. • Rate of growth s___/stabilizes - Weight gain at ~ 2-3 kg/yr. - Height increases at ~6.5-9 cm/yr. - Proportions changing. Now more graceful, sturdy, agile, and posturally erect

Aggression

Preschooler: Concerns with Growth and Development A_____= Behavior that attempts to hurt a person/destroy property. - May start at this time and may be the result of frustration, parental disapproval, or humiliation. - One of the tasks is to learn social acceptable behaviors by controlling aggression and redirecting the anger. - Parents need to model appropriate behavior because it is a powerful influence.

prevention

Preschooler: Concerns with Growth and Development: Stress and Fears Fear is a product of their developmental stage. - Best addressed through p______. - Teach coping skills of talking about the issue or image a fun place. - Fear can be addressed by desensitization with exposing child to feared object in a safe situation.

school and parent

Preschooler: School Concerns • Preschool is helpful with social development in terms of group cooperation, coping with frustration and anger, and provides peer-group experiences. • Preschool also provides extensive stimulation for language and physical development. Otherwise, school may be overwhelming and sensory overload impedes learning. • School readiness should be established by the s____ and p_____. The school needs to be able to address all types of learning needs. For the parent, it is promote a positive attitude toward learning. The nurse can help the parent assess the readiness. • Preparing the child is essential and parents need to provide the school with information about the child to help ease the transition

symbolic shapes, facial, pencil picture, recognizable complex, numbers, letters

Preschoolers: *Fine Motor skills* • See increasing skillful manipulation necessary for developing s____ language. • Age 3: builds large tower, able to draw multiple s____, does a circle and adds f____ features and holds p____ with fingers. • Age 4: copies basic figures and increased p____ ability with designs that are somewhat r______. • Age 5: c______ pictures that are more recognizable, can use all geometric shapes including triangle/ diamond, and printing n_____, and l_____.

tip toe, climbs Skips, descends jumps rope, skate, and swim

Preschoolers: *Gross Motor skills* • Age 3: Rides tricycle, jumps, walks on t__ t__, can balance on one foot, and c____ stairs with alternate foot pattern. • Age 4: s___ and hops on one foot, throws ball effectively, d_____ stairs with alternate foot pattern. • Age 5: Skips on alternate, j____ r____, and can begins to s___ and s___.

mutilation

Preschoolers: Body Image • Begin to understand differences in appearance and may verbalize this. • Lack defined body boundaries that lead to fear of m_____/annihilation with intrusive experiences and disruptions to the integrity of the skin or loss of body parts.

Initiative appropriately right from wrong

Preschoolers: Psychosocial Development Erikson • Developmental Task Sense of i______ (energetic learning). • If not mastered- this will lead to sense of guilt due to the child overstepping the limits of their ability or not behaving a_________. • A major task is the development of a conscience, in regarding to learning r____ from w____.

Preconceptual Intuitive

Preschoolers: Psychosocial Development Piaget • Preoperational Phase (2-7 years) - Pre______ Phase (2-4 yrs.) - I_______ Thought Phase (4-7 yrs.) - moving toward less egocentricity to more social awareness

Magical Irreversibility time Egocentricity Centrism Animism conserve

Preschoolers: Psychosocial Development Piaget (cont.) -M_____ thinking-thoughts are all powerful and key to their vulnerability. -i______ thinking - inability to undo or reverse the actions initiated phyisically - No concept of t____- they use their own frame of reference of life -E_______-Self-reference -Understanding is limited to what has been described by others -C______-Only one idea at a time -A______ - project lifelike qualities onto inanimate objects -Inability to c______- no understanding that mass can be changed.

opposite, same redirect

Preschoolers: Sexual Development/Education •It is an important phase of overall sexual identity as they form attachment to the ______ sex parent and identify with the ____ sex parent. This is seen with role imitation. •They are aware of being either male or female and have better language and cognitive skills as what this means. •Exploring genitalia may be more pronounced as well as curiosity about the other sex (by playing doctor). It is important for parents to neither condone or condemn the behavior, to ask question to parent, and r______ play. •For education, it is finding out what they know and think. It is important to give short, simple, honest and matter-of-fact answers.

stuttering

Preschoolers: Social and Language Development • Crucial time for speech development is the 2-4 year old range. • Have the ability to be bilingual. • Developmental s______ is common and as the result of trying to say the words they are thinking about as they are thinking faster than the ability to produce the words. • The best therapy for speech problems is early detection and treatment.

stable diminish 2100

Preschoolers: Social and Language Development •The separation process is complete with less anxiety but prolonged separation with hospitalization is difficult and need concrete explanations due to more imaginary fears and find comfort in familiar objects. •Temperament remain s____ during this time. The ritualism and negativism d______. Concern with adjustment to group situations. •Much more social and willing to please. •Language is now more sophisticated with a vocabulary of more than _100 words by age 5 and increased sentence structure with speech.

concrete short Development

Preschoolers: Spiritual Development • Faith and Religious concepts continue to come from significant others. • They have a c______ conception of God with physical characteristics like an imaginary friend. • Can memorize s____ prayers. • Limited understanding of rituals. • D________ of conscience is linked to spiritual development.

Collaboration Empowerment

Principles of Family Centered Care: a. Formal and Informal Support b. Information Sharing c. C_______ d. E_________ e. Flexibility in practice, policy, and procedure

damp water 6 months 3 y.o.

Promote Optimal Health: Dental health -Begin early dental care: initially clean teeth and gums with d____ cloth. The infant may need distraction during this care. Once the process is established and more teeth are present; the parent may switch to a small, soft toothbrush using w____ only. -Initial dental screen should be at _ months with a dental home established by 1 year. -Fluoride supplements (0.25 mg daily) need to be initiated beginning at 6 mos. if water does not have adequate fluoride content (< 0.3 ppm). This may last until the child is _ y.o. -Parental education is important in terms of avoid propping any bottle; giving milk or fruit juices in bed (which bathes the teeth) to prevent early dental caries.

crackers grapes cow's

Promote Optimal Health: Nutrition 2nd 6 months: Breast milk or formula continues to be the primary source of nutrition. -Solids are primarily for taste and chewing experiences. -At 6 months, c_____ can be used for finger/teething food. -8-9 months junior foods, and nutritious finger foods (cooked vegetables, raw pieces of fruit except g____, or cheese) Serving size is ½ to max of 1 tablespoon. -1 year they can move to well-cooked table food. -No ____'s milk until > 1 y.o. to prevent iron deficiency anemia.

Human breast 4th extrusion

Promote Optimal Health: Nutrition -It is important for nursing to be proactive in teaching parents about proper infant nutrition and nutritional habits to promote healthy living. 1st 6 months: -H____ b___ milk is the preferred diet during this time, otherwise use Iron fortified formula. -Prior to the _th month, the infant does not require any increased fluids with the use of water or juice all intake should be formula. -Introduction of solids should not start until 4 to 6 months due to the presence of the e______ reflex and the immaturity of the GI tract. Rice cereal is usually the first food. Then it can progress to vegetables, fruits, and then meats. Allow 5-7 days between initiation to look for reaction to the food. -Iron supplementation may not be needed if the child is consuming iron fortified cereal after this age.

honey vit C 4-6 oz

Promote Optimal Health: Nutrition: -No h____ to decrease risk of botulism. -No fat restriction due to the need of essential fatty acids for growth and development. -After 6 months mixing cereal with fruit juice may increase the absorption of iron due to the presence of vitamin _. Before this it should be expressed breast milk or formula. -Fruit juices should be 100% juice. No more than 4-_ oz./day.

11 Breast

Promote Optimal Health: Sleep and Activity -Sleep pattern and needs vary among infants. This includes the need for naps. -By 3-4 months the infant will have a nocturnal pattern of 9-__ hours. -Naps are common and usually are 1-2 by the end of the first year. -_____ feed babies demonstrate shorter sleeping periods. -Sleep concerns are common in the infancy period; mostly in terms of the infant's need for additional sleep. If a problem is suspected, careful assessment is needed and includes actual times and the perceived problem to be able to plan effective interventions. -For activity, most infants are naturally active and problems only arise when the infant is confined to playpens, swings or other devices. This limits the child's innate curiosity and the development of the necessary gross motor skills.

jags anorexia Ritualistic

Promoting Optimal Health: Nutrition -Dr. Horodynski initially began her research with toddlers. -Current studies showing food j___ (wanting same food repeatedly or little varying of intake) are prevalent but it is important to have a balanced diet. This again will help with growth and development and the establishment of healthy routines. -There is no huge growth spurt so the toddler may have small appetite (physiological a____). -Appropriate portion sizes ( 1 Tablespoon/year) are key as well as giving them finger foods due to the preference of eating with fingers. Meal times need to be short. R_____ needs same cup/plate -See the food pyramid for children for teaching tips and activities. -Culture ask what foods are prevalent in the culture to assure balance.

decreases

Promoting Optimal Health: Sleep and Activity -Total sleep time __creases during this period. -They usually only nap once a day and at the end of toddlerhood this may be a challenge. -They may resist going to be at night and express fears (this may be due to fear of separation or stresses felt during the day). Bedtime routines and a favorite blanket or animal may help the problem. -Children are naturally active but again there is concern over increased screen time and lack of areas for safe play will lead to increasing rates of obesity.

scant 6 deciduous

Providing Optimal Health: Dental Health -Dental health important to establish healthy patterns and avoid early childhood caries (cavities in child 18 mo- 3 yrs.) -These children more likely to have continuing dental problems that can influence speech, cause pain and delay development. No putting down with a bottle of milk or juice. -Between meal snacks should be healthy; so limit high sugar to prevent caries, and encourage high calcium to build strong teeth. -Child should have their own toothbrush and use water or a s___ amount of toothpaste (pea-sized). Initially, child will need for the parent to brush teeth but as they become more independent; the activity should be supervised. If child is resistant, rinsing the mouth out with water 3-4 times is helpful. -Dental visits to a Pediatric dentist is preferred and should occur every _ months. First visit should be non traumatic just about seeing equipment and meet the dentist. -By 2 ½ has all 20 d_____ teeth, so fluoride still needed.

Divorce

Psychosocial Development: Erikson (1963) continued: -This trust will provide the foundation for all succeeding phases. -Failure can occur with parent's inability to read and respond to cues appropriately and lead to mistrust and fear. May appear later such as beginning school. D____ can also reactivate trust issues. -CLINICAL- It is important to provide for security (i.e. holding patient) and to meet all needs in a timely manner. It may also include providing distractions and comfort after painful procedure. Mistrust can occur in the hospital setting if needs are met inconsistently or with the use of multiple caregivers.

timely safe and dependable

Psychosocial Development: Erikson (1963): Development of Trust with failure is Mistrust (birth to 1 y.o.) *Learn Hope* -It can be achieved when infants needs are met in a t_____ manner. -This is further dependent on the quality of the relationship with the parent (caregiver) and child. With success, the infant will view world as s____ and people are d______. -With advance in skills will use other means to communicate need other than cry.

shame regression

Psychosocial Developmental: Erikson (1963): Stage: Development of Autonomy or learning Will -Builds with the increase in motor and mental abilities of the child. Additionally, it involves the need to exert their own will and control. If a parent is impatient or does everything for child s____/doubt can occur. -CLINICAL: They want to do everything themselves. This can be take temp, eject cover, feeding etc. Important to recognize child abilities and let them do tasks they are capable of i.e. dressing and bathing -Accept r______ in hospital. Important to give the child choices like what toy to play with.

oxygen carbon dioxide

Purpose of the Respiratory System: -Supply sufficient o_____ to meet the metabolic demands of the body -Remove c____ d_____ from the body

Spirituality interferes open

Religious Influences: -Religion will dictate the families code of mortality as well as, influencing attitudes toward education, roles, and their ultimate destiny and for some like the Amish it can be difficult to distinguish from culture. -S________ is the deepest level that provides meaning for life. -Integrating care is important (see Box 2-6). See Fowler's Stages of Faith -Among some religious groups illness and death are punishment for sin and illness is the "will of God." Others see it as a test of faith. The nurse should respect the practices unless it i_____ with the child's health. In the face of disagreement, it is important to have o___ and respectful communication.

Lethargy Coma

Respiratory Acidosis S/Sx: (down) -Confusion -L______ -Headache -Increased ICP -C____

Dizziness Muscle

Respiratory Alkalosis S/Sx: (up) -Confusion -D_____ -Neuromuscular irritability -M_____ cramping/spasms

Anxiety Irritability

Respiratory Decompensation: -A____ -i______ -Decreased level of consciousness -Confusion -Hyper/hypotension

Retractions flaring Head stridor

Respiratory Distress Signs: -Tachypnea -R______ -Nasal F_____ -Restlessness -Color changes -H____ bobbing -Grunting, s____, audible wheezing

60 50

Respiratory Failure= Inadequate gas exchange leading to hypoxemia and/or hypercapnia ABG= 1. PaO2 <_0 mmHg 2. PaCO2 >_0 mmHg

ASPIRATION

Respiratory System Nursing Outcomes: -AIRWAY PATENCY - Resp Rate, Pulse Oximetry Readings, Airway clearance -A______ PREVENTION - coughing, pulse oximetry readings, change in respiratory status -GAS EXCHANGE - pulse oximetry reading, arterial blood gases (ABG's), RR, skin color -VENTILATION - normal RR and HR for age, skin color, pulse oximetry readings -ANXIETY REDUCTION - irritability, ability to sleep/rest -COPING - age appropriate behavior -HYDRATION - urine output, daily body weight, skin turgor -FLUID BALANCE- daily fluid maintenance, urine output

location

Retractions: Described in terms of severity and l______ -Intercostal -Subcostal -Suprasternal -Substernal -Supraclavicular

Education Activities Safety Suicidality

Risk Assessment: Bright Futures (HEEADSSS) -Home -E______ -Eating -A_______ -Drugs -S_____ -Sex -S______

socialization

Role learning -Roles are learned through s______ and practiced through play. This may be influenced by how it is reinforced and any cultural influences.

Concrete reasoning

S.A.: Cognitive Development (Piaget) 7 yrs-11 yrs. • This is the stage of C_____ Operational thought • Increased r_____ ability. Can think and articulate the process of thinking. This allows them to understand math, time, history, and most important learning to read. • Better able to view a situation from another's point of view, varying perspectives.

Conservation Serialization

S.A.: Cognitive Development (Piaget) 7 yrs-11 yrs. (cont.): • Key concepts: -C______ - physical properties & space - Classifications - including collecting objects. - S_______ - arrangement of objects - Reversibility - Anticipate results and/or consequences

27% 50%

STIs: Youth bear disproportionate share of STIs -Americans ages 15-24 make up just 2_% of the sexually active population. -But account for 5_% of the 20 million new STIs in the U.S. each year.

Sexual male believed Megan's

S_____ abuse- is the most devastating and involves acts in which children do not understand, cannot give consent or violate social taboos. -The perpetrator is usually an adult ___ known to the child but it may also be another child or adolescent. -It may be familial which may lead to prolonged abuse with fear of victim that they will not be b____. -For males who are abused, the findings may be subtle and it often goes unreported. Adults should look for any child who is showing above average knowledge or behaviors. -The victim will need a lot of support for exam. M____'s Law make sex offenders report location. Be aware that adolescent victims may themselves be offenders to someone younger and will be generational unless it is stopped.

matches Sunburns

Safety Precautions: Burns -The concerns are all the same as infants but increased in risks due to increased mobility. Additionally, there is concern with children playing with m_____. Flame burns are the most fatal types. -S______ are more prevalent due to increased time outdoors. It is important to use appropriate sunscreen and protective clothing.

skid

Safety Precautions: Falls -They remain an issue due to increase in falling down stairs, off a chair or on a play ground. Another risk is falling out of a window in the summer as screens are not designed to prevent falls. -Falls occurring in the hospital from children running in the hallways and in the rooms is currently under investigation. Assure that children are wearing shoes or s___ proof socks and do not allow them to run.

Touch

Safety Promotion and injury prevention: Drowning -Toddlers continue to be a high risk because of increased mobility and innate curiosity. Their head remains a heavy part of the body and may make it difficult for the child to maintain balance or extricate themselves. -T____ Supervision of toddlers around water sources is essential -Again teaching swimming or water safety is helpful but not sufficient protection.

struck

Safety Promotion and injury prevention: Motor Vehicle injuries -The appropriate use of car seats remains the major issue. See Family-Centered Care car seat guidelines. Need appropriate toddler or booster seat. -Additionally, now they can run and are unaware of danger; so they are at increased risk to be s____ by a moving car. -Finally, educate parents about leaving a child unattended in the car can lead to hyperthermia and death.

Errors Falls

Safety Risks for Hospitalized Children: 1. Medical E______ 2. Hospital Acquired Infection 3. Environmental/Situational 4. F____

grammar metalinguistic

School Age: Language Development • During this time they learn complex g_____ rules. Written language skills also involve correct sentence structure. • Their understanding of words increases and narrative skills also improve i.e. can provide directions and understand know, think, and believe. • They also develop a m___linguistic awareness that allows them to appreciate jokes, riddles, and puns.

Industry others esteem intrinsic Extrinsic

School Age: Psychosocial Development (Erikson) • Stage of accomplishments in which a Sense of i_____ is the major task. - No violent inner upheavals leads to new mastery. - Involves the ability to cooperate, compete with others, and cope effective with others. Learn value of working with o____ as they need and want real achievement. - Self-concept-->Self-worth-->Self-e______ - Learns the value of work and increased competence (i_____ motivations). - E______ motivations- grades, rewards, and additional privileges. - What is the danger - *Inferiority [feeling inadequate]*

society Bullying

School Age: Social Development • Family is still central to the child and parents are the primary influence on the child. • Begin to identify with peers as daily relationships with this group is the most important social interactions. It allows for a broader concept of the world and understanding of social norms. It also begins the formation of the "best friend" relationships. • It is also when they become active members in clubs that requires the child to follow a set of rigid rules. It allows the child to find a place in s_____ and a feeling of security as conformity is the core of group structure. • They do not want to appear to be different. B______ may start at this time.

human Family

School Age: Spiritual Development • Children have a great desire to learn about their God. There is a fascination with the ideas of heaven and hell. • They view God as h____. • They expect to be punished for misbehavior and may continue to view illness and injury as punishment. • F_____ is still central and need concrete explanations of religious concepts. • Rituals are a comfort and a part of the daily routines. • They are able to discuss their faith.

violence dying criticism

School age: Concerns • Coping with stress - Children today experience more stress. Examples: school with fear of failure/criticism, need to fit in, and over commitment with activities lead to a cumulative and overwhelming effect. - Exposure to v_____ still a problem. - Important to recognize and develop coping mechanisms to deal with it rather than internalizing which may cause the start of physical symptoms or externalize with aggression • Fears - Still persist and now include d____ as they are fascinated by all aspects of death and dying, including loss or something bad happening to a parent. - Fear of failure and c_____. - Now may include school fears and bullying. - Children need to know their concerns are heard and understood.

privileges Lying Cheating

School age: Concerns • Discipline - Is important as it helps the child to stop inappropriate behavior, be aware of acceptable behavior for future situations, help the child understand the reasons behind the acceptable vs. not accepted behaviors, and empathize with the victim of a misdeed. - Due to their cognitive skills discipline can advance from time outs to with holding p_____ or imposing penalties. - This may be in response to dishonest behavior in terms of lying, stealing, or cheating. • L____ may be a way to escape punishment (example for stealing) or exaggerate a story to impress others. • C______ is in the young school age as they do not want to lose at a game.

stress isolation

School age: Concerns • Latchkey Children - There are an increasing number of these children and many have chronic illnesses. - May increase s____ for the child and lead to more risk taking behaviors. - Suffer from i_____ and fear and to cope will hide or play the TV loud to drown out other sounds.

positive

School age: Concerns • School Experience - This is an essential experience as it allows to demonstrate success, transmits societal values, acts as a setting for peer relationships, and allows for structure in a child's world. • Role of the teacher - It is primary to guide the intellectual development and can affect the student as they are a significant person and students seek their approval. Demonstrating p____ regard helps a student to create a positive self-concept and acceptance by other classmates. • Role of the Parents - Like the preschooler parents have a strong influence on the school experience. They need to assure that homework is done and help as needed.

peers formal

School age: Sexual Development • Body image during this time comes from evaluating themselves vs. their p___. They may conceal perceived shortcomings of their body and may not express these concerns to family. • They may experiment with some form of sex play due to curiosity and attitudes are acquired based on how parents respond to sexual exploration. • Sexual Education should occur in a f_____ setting at this time. It should be framed as the natural order of things and a basis for cultural survival. Most other information will come from peers. • Nurses can help parents and children as a normal part of growth and development. It can include practicing safe sex. adolescents need concrete information that allow to deal with what happens as they mature.

health individual

School-Age Health Promotion • School Health - Due to time spent in school concerned with the environment of the school. This includes school safety. - This can include h____ education providing the fundamentals of healthy behaviors. • School Nursing Services - School nurse is the manager of the school health program. They are a holistic health care provider. They must develop, implement, and evaluate i______ health plans (IHPs). - Some are School-Based Health Centers with PNPs to provide primary care. - Not always present in every school which is a concern with the increasing number of chronically ill and disable children in the system.

independence

School-Age: Anticipatory Guidance • It is important for nursing to help the parent as they begin to share more of the child's interests and time with a peer group . • The peer group will help the child in achieving a sense of industry and increased i_______ to help them move toward adolescence.

positive Grazing 9

School-Age: Health Promotion • *Goal by end of age period the child has acquired p_____ heath behaviors*. • Nutrition: - Mealtime Rituals with Family • G_____ need good nutrition education because eating meals at school. • National School Breakfast and Lunch programs assist especially those at poverty level. • *Sleep needs decline during this time and recommend at least _ hours. Need time to wind down. Sleep problems may persist to sleep walking and talking*.

60 deciduous fluoride

School-Age: Health Promotion • Physical Activity - Children still require _0 minutes of activity every day. There needs to be a limit on screen time. - Continue to encourage sports and participation especially if it is appropriate for their abilities. Sports not only help with physical fitness but socialization and self-esteem. • Dental Health - This is the time where they are loosing their d______ teeth and secondary teeth are now present. - Good dental care is essential to avoid caries. Children can do the skill independently but may need reminders from parents. - Regular dental care, continued use of f_____ are essential to maintain healthy teeth.

care

School-Age: NCP • Care plans continue • Knowledge deficit related to self c___ - They can begin to do their own cares related to a chronic illness. • Outcomes: Child Development: Middle Childhood (0108). - This covers ages 6-11 years old.

Bike

School-Age: injury Prevention • Concern is risk-taking behavior to improve status or acceptance by peers. Because they are transitioning in thinking they may not always understand the consequence. • MVIs are still a concern as either pedestrian or passenger. Important to review traffic safety and reinforce appropriate car seat and seat belt use. • B____ injury are a problem due to lack of knowledge in traffic situations. To reduce this, review bike safety, correct size bike, and helmet use should be strongly encouraged.

sledding

School-Age: injury Prevention • Skateboards and In-Line Skates are popular and important to teach safety and wear all protective safety gear • There are safety considerations for lawn mowers and snowmobiles and limits should be placed during this time. Other potential source of injury is s_____. • Nursing role are advocating for prevention through education of risks and should include the child and parent with discussion surrounding child's ability and developmental level.

immune muscle 13th

School-age Children • Organ systems are maturing and resembling more adult physiology. The i_____ system is more competent. • While bones increase in ossification and lengthening m_____ mass although increased is not quite as fast. Leading to injury concerns. • Prepubescence is the the 2 year period that ends with the 1_th birthday. It precedes puberty, which is the development of the secondary sex characteristics. It may occur as early as 9 y.o. in girls. Early appearance of puberty is also a concern that may lead to low self-esteem and risk taking behaviors.

double girls, boys

School-age Children (6-12 YO) • Weight gain continues to be 2-3 kg/year and will be almost d_____ by the end of the period. • Height is about 5 cm/year for a total of 30-60 cm for the period. • ____ usually surpass ___ in height and weight during this time. • Body proportions continue to change with longer legs and a lower center of gravity as it occurs in spurts not continuous.

Cooperative Rules belonging

School-age Children: C______ Play • Skill acquisition - builds confidence. • Physical activity - builds muscle development, balance and coordination. • Builds social groups and relationships. • Learn and follow r____- giving them a sense of belonging although the rules are rigid - team play, clubs, etc. Knowing the rules gives a sense of b______.

30,000 18%

Scope of Need: - > _0,000 families receive CSHCS in the State of MI - 1_% children in the US require special healthcare services

reflexive

Social Development: -Infants development first r_____ but attachment to the parent occurs with the development of object permanence. -Caregiver now the standard term for primary provider and important that they display signs of love and affection both verbal and physical to aid the bonding process. -Failure puts the infant at risk to mistrust the world especially with emotional deprivation. -Infant will move through the following attachment process: differential cry, smile, or laugh, visual orientation to the person, crying when they leave the room, approach thru locomotion (creep, crawl, or walk) when re-enter, cling, to finally being able to explore from safe base. -Considered critical to optimum child development.

resources

Social Influences : Poverty: -Poverty is a subculture related to but different from social class and is defined as a condition in which families live without adequate r_____. These rates are increasing in the US.

public perception

Social Influences: Health Inequities: -Robert Wood Johnson said "Our goal is to eliminate health disparities by improving the health of all but for some to improve it faster." -The work of Lillian Wald the first p____ health nurse. She is the founder of the Children's Bureau in Washington D.C. -Study by Renee Canady of the Ingham Co Health Department looked at focus groups and their care and common theme was that showing their Medicaid card changed the p______ of the family by the staff and they felt affected their care

heritage

Special Family Considerations: Adoption: -Cross-racial and international adoptions may provide additional challenges. -Need to preserve the adopted child's racial h_____. -Additional difficulties because child does not look like other family members. -For the international child, medical information may be incomplete and delays may be present due to poor nutrition and lack of social interactions.

Quick

Special Family Considerations: Adoption: -Historically, the biological mother alone made the decision but now there is consideration of the biological father's rights. -Nursing may help as adoptive parents may have less support and preparation. This can be done through information, support, and referral to support groups. Child response: -____ placement may facilitate parent-child attachment. -Older infant and young child need to break connection to previous caregiver and then bond to new adoptive parent. -Siblings may need to be included to assure they are not being replaced.

formation

Special Family Considerations: Adoption: -Telling the child regarding the adoption can be a source of anxiety and needs to be done for identity f_____ and an important parental role. Ideally, done so they child does not remember a time in which they did not know. -The parents should anticipate some behavior changes due to this new knowledge. -Additionally, there may be issues with feelings of abandonment and the need to find out information to aid identity formation.

trust

Special Family Considerations: Foster Care: -Different in that it takes place away from the family of origin. Length of stay varies and each state has its own rules and regulations including medical decision-making. -Children may struggle with t____ issues surrounding how many placements and a sense of isolation or confusion. -Nursing need to be aware that children have a higher incidence of acute and chronic health problems. This requires the need for additional assessment and case management skills to achieve higher quality care.

guardianship

Special Family Considerations: Foster Care: -Parent receives money for care. Children raised in foster care may have constant insecurity and potential emotional difficulties depending why they were removed. Need to know medical guardianship (may be state). Most follow health care instructions conscientiously. This is important as there is a high prevalence of chronic and complex health conditions. -Legal g_______ is a permanent placement that is an alternative to adoption. Parental rights are not terminated.

guilt

Special Family considerations: Divorce: -Issues arise due to the parent being preoccupied with their own feelings and decreased coping leads to g____ of not being able to support their children through the process. -As the household is being re-established; there is often disorder with loss of routine and reduced parental competence. -Impact of the divorce on children is age dependent (see Box 3-7).

developmental fault

Special Family considerations: Divorce: -Telling the children is also d_______ dependent but should be done with individual discussion with each child. -It is important to discuss reason for the divorce and provide reassurance that it is not the f____ of the children. Child should be able to communicate feelings and ask questions. (See Box 2-5) -Custody may vary and it is important to understand who has medical-making powers and who needs to be taught information related to care.

12 13 20

Stages of Adolescence: Early= ages 9-__ Middle= ages __-16 Late= 17-__

30 well-child care

Stages of Duvall's Developmental Theory Stage 2: The early child-bearing family or Family with Infant (Infant thru _0 mo.): -Nursing impact: family needs information on w___-child care. May also need assistance into moving to the role of caring for an ill child. You can assess this by asking how parent has tried to solve the problem in an appropriate/therapeutic manner.

6 y/o safety

Stages of Duvall's Developmental Theory Stage 3: The family w/ preschool children (2.5-__ y.o.): -Nursing impact: child s____ is huge concern and if accidental injury occurs nursing may have to deal with parent guilt and provide safety education.

13 education peer

Stages of Duvall's Developmental Theory Stage 4: The family w/ Schoolchildren(6-__ y.o.): -Nursing impact: e______ similar to preschool with addition of good school experience. Children need to develop p___ relations.

20 communication

Stages of Duvall's Developmental Theory Stage 5: The family w/adolescent children (13-_0 y.o.): -Nursing impact: counseling regarding safe behavior, dangers of chemical abuse, nurse may assist family with c_______ during this stage as letting go or conversely not allowing autonomy may cause conflict.

Control

Stressor - Loss of C______

history anxiety

Stressor - Pain: A child's pain experience is influenced by: 1. Source 2. Age/Cognitive development 3. Pain h______ 4. A______ (child & parent) 5. Culture

Protest Detachment

Stressor - Separation Anxiety: Three Phases 1. P_____ 2. Despair 3. D_______

1 viral male

Sudden Unexpected Infant Death (SUIDS): -Leading cause of death after _ month -Cause of death unknown, despite autopsy Risk factors -low Apgar scores -____ infections -siblings with SIDS -____ gender -Native American, African American Protective interventions -Safe sleep practices -Pacifier use -Caregiver smoking cessation

Toddlers

T_____ (age 12 mos. to 36 mos.)

negativistic

Temperament: -Temperament is retained from infancy. -Parents often perceive toddlers as being more challenging due to the increase in n______ traits hence the "terrible twos". This may be exacerbated with the easy infant becoming a challenge in toddlerhood. -Important to help them realize that behaviors can change but temperament doesn't.

environmental depression adaptation

Temperament: -Infants are born with a tendency to respond to its environment. They will have varying degrees of regularity in activities of eating, sleeping, and playing. -There may be a disconnect with infant's temperament and the parent's perception or response to the behaviors. -Research believes temperament to include both a biologic and e_____ component. Some researchers believe there is a connection with infant temperament and maternal d______. -As nurses, we may need to help the parents identify the infant's personality. This will help the parent to see the uniqueness of the infant and design appropriate childrearing techniques. -Parents can also learn to modify the environment to promote a______. I.e. if child is distracted easily with eating; they can feed the child in quiet place to minimize distraction and encourage the focus on eating.

Promotion Prevention Normal disparities

The Goals of Pediatric Nursing: 1. Improve the quality of life and health for children and their families (Health P______) 2. Prevent future health problems as children grow and develop (Illness/Disability P_____/Management) 3. Lessen the impact of chronic illness and disability. (N_____ Development Promotion) 4. Eliminate health d______. (Health Promotion, Illness Prevention, & Normal Development Promotion)

Safety Stressors

The Hospitalized Child: Objectives 1. Family Centered Care 2. S____ 3. S______

Family Atraumatic

The Philosophy of Pediatric Nursing Care: -F_____-centered care= Partnership/ Therapeutic relationship -A_____ care -Safety focus -Society of Pediatric Nurses -SPN Bill of Rights

education 8

The Philosophy of Pediatric Nursing Care: -Family Advocacy and Caring= Role of health e______ -Ethical Decision-Making= Role of assent starting at about age __. Use of Clinical Reasoning and Evidence-Based Care to achieve quality outcomes (Box 1-5)

blended nuclear

The b_____ family (reconstituted)= -This includes at least one stepparent, stepsibling, or half-sibling. The stepparent is the spouse of a child's biologic parent. -This category exists at the beginning of the family formation. Overtime, the family will become a _____ family. -Special Consideration: The family has to negotiate the new customs and cooperative parenting is key to reduce power conflicts and stress. Open communication, flexibility, and mutual support are critical for successful relationships.

binuclear

The b_____ family= This family occurs with the children post-divorce can be members of 2 separate households with joint custody and co-parenting by mother and father.

extended

The e_______ family= Multigenerational family with parent-child and sibling relationships may be biologic, step, adoptive or foster. -Culture plays a role in the respect/seeking of advice from elder members and whether family is male/female lead. -Grandparent as primary caregiver -additional challenges of worry about child, decreased finances and own health concerns.

nuclear

The n______ family= This is two parents and their children with ties being biological, step, half, foster, or adoptive. This is built over time.

polygamous

The p______ family= It is not legal in the U.S. but does exist and is widespread through out the world. It is a family in which the conjugal unit is extended through the addition of spouses in polygamous matings. They may live in the same household or in separate ones.

single-parent girls home

The s____-p____ family= Emerging as more common due to the establishment of separate households as the result of divorce, death, desertion, or single parenthood. Special Considerations: -Managing shortages of money, time and energy is a concern especially for the single mother. This may lead to issues with inadequate housing or safety concerns. -If the single parent is a teenager; then studies show adverse effects on child's health and well-being. -Single fathers may be challenged by coping with emotional needs of children, especially g___. They also may lack h____-making skills and managing the household alone. -These families need increased support from the community that are more flexible in their hours. Stress is increased with childcare concerns and with a sick child.

traditional nuclear

The t____ n____ family= This is a family of married couple and biological children only.

Erikson and Piaget Duvall's

Theories Guiding Pediatric Nursing: -Child Psychosocial and Sensorimotor Developmental Theories (E____ & P____) -Family System, Stress & Family Life Cycle Theories (Resilience Models & D_____'s Stage of Family Development)

Suffocation

Think SAFE PAD S is S_______/Sleep position: can occur from sources such as refrigerator entrapment or deflated latex balloons as a choking hazard. The bed or crib can is an additional source. -Back to sleep with no soft mattress, pillows, excessive covers or bumper pads. Although can lift head at 2 mo; it is still not safe enough to prevent suffocation. -Additionally, sleeping with the parent should be discouraged. There is an article by AAP about an educational intervention. Crib slats and corner post extensions can be a source for strangulation.

15 18 24

Toddler Developmental Milestones: Fine Motor -By __ mos., they can put a round peg in a round whole even when the board is changed and scribble with a pencil or crayon. -By __ mos., they can throw a ball overhand and maintain balance and build a tower with 3-4 blocks. -By __ mos., they can build a tower of 6-7 blocks and they can imitate a circle and vertical line when drawing.

run stairs jump

Toddler Developmental Milestones: Gross Motor -By 18 mos., they can r__ but fall easily and coordination is improved by age 2-3. -By 24 mos., they can walk up and down s____. -By age 2 ½, they can j___ with both feet.

6 3

Toddlers: Weight Gains 5-_ lbs. per year. Height Gains _ inches per year. It is mainly elongation of the legs. Head Circumference Increases about an 1 inch in 2nd year and 0.5 in/year after that

antibiotics 3

Tonsillitis and Adenoiditis (pharyngeal tonsils): Treatment: -Medical Management with a_______ -Surgical Management with removal of the tonsils and adenoids usually not until after age _ years.

5-7 aspirin or ibuprofen

Tonsillitis and Adenoiditis: Post-operative nursing care: -Assessment of vital signs -Pain Management -Assess for post-operative hemorrhage, frequent swallowing (can occur up to _-7 days post-op) Discharge planning -No a_____ or i_______ for pain or fever control -Assessment of swallowing

minorities

US Children's Health Statistics from CDC: -Obtains data from the Department of Health and Human Services and evaluates the burden of the disease in the US. -Discusses how m_____ and low-income children are consistently those who suffer from poor health. -It also highlights asthma, allergies and ADHD; and the number of school days missed due to all illness.

Adenoiditis

Upper Airway Conditions: 1. Foreign Body Obstruction 2. Nasopharyngitis/Pharyngitis 3. Tonsillitis & A_______ 4. Croup 5. Epiglottitis

Asthma nutrition

(FYI) Global health Statistics from World Health Organization: -A_____ is the most common chronic disease among children with most asthma-related deaths occurring in low- and lower-middle income countries. -Every year, more than 200 million children under five years old fail to reach their full cognitive and social potential. This is primary linked to poor n_____. Undernutrition is associated with 35% of the disease burden in children < 5 y.o. -Compare this to the fact that almost 43 million children < 5 y.o. were overweight in 2010. -Total spending in US related to health is >8,895 US /year, which is the highest. This is compared to lowest in the country of Democratic Republic of the Congo is $ 15 US/year.

image Gender

-Body i_____ parallels sensorimotor development. The infant's mouth is the principle area of pleasurable sensations with hands, fingers, and feet as primary objects to play with. As motor abilities increase; the hands can be used to bring object to the mouth and legs are used to be able to move around. -G_____ identity begins as parents act a certain way with the infant due to the gender. The infant enjoys skin-to-skin contact and can explore their own body for pleasure.

Aspiration

A is A______ prevention: aspiration of foreign objects can be food or nonfood items. Examples are small objects/toys, hot dogs, grapes, or pacifiers. These objects can obstruct small airways. Once the child is mobile, the floor needs to be kept clean of all small articles.

Acne Retinoids accutane Slow

A___= Infectious disease of sebaceous glands and hair folicles -Psychologic distress does not correlate with disease severity Tx: -Topical: R_____, benzoyl peroxide, salicylic acid, antibiotics -Oral: antibiotics, a_____ -S___ resolution -Scarring

Head Retinal

Abusive H____ Trauma- is a serious form of abuse caused by the violent shaking of an infant or young child and results in head trauma due to the large head and weaker neck muscles which causes the brain to shift in the skull that tears blood vessels and neurons. Classic signs include: -Intracranial bleeding (subdural or subarchnoid) -R_____ hemorrhages -Fractures of ribs and long bones may also occur. -Children may present with previous injuries and either mild symptoms that may be confused with common pediatric illnesses (vomiting, irritability, or poor-feeding) or life-threatening signs (seizures, apnea, loss of consciousness, bradycardia or death). -The long term consequences may be detrimental for the child if they survive and prevention is a key with teaching parents how to deal with crying especially if it is inconsolable.

2 resuscitation 50%

Acute Life Threatening Event(ALTE): -Most often occurs in infants under _-months of age -Event may occur during feeding, sleep, or while awake -Emergency r______ may be required -Therapy focused on finding and treating underlying cause -Cause of the event is identified in approximately _0% of cases

age Reinforce

Adolescent Health Promotion: 1. Identify Concern: concerns vary by a__ 2. Develop Plan For Intervention: a. development b. context 3. Implement and Evaluate Intervention: Revise and R______

PO2 SaO2

Arterial Blood Gas (ABG): pH 7.35-7.45  PCO2 35-45 HCO3 22-26 ___ 80-100 ____ 93-100

beta corticosteroids

Asthma Management: 1. Rescue bronchodilators (b___-agonist) 2. Systemic and inhaled c______ 3. Asthma action plan for home management

small

Asthma: -Broncial Asthama= thick mucus, mucosal edema, and smooth muscle spasm causing obstruction of s____ airways; breathing becomes labored and expiration is difficult.

secretions constriction Inflammation

Asthma= Defined as a chronic disorder of the airways that involves all of the following: 1) Airway obstruction/s_____ 2) Airway c______ 3) Airway i______

6 environmental head-to-toe

Basic Growth & Developmental Principles: -Body systems normally progress in an orderly process and undergo progressive maturation. -Growth is rapid during the 1st year of life, particularly the first _ months of life. -Development of skills respond to e______ influences as well as genetic influences. -Fine and gross motor skills progress from h___-to-t___ and center-to-periphery (cephalocaudal-proximodistal) sequence.

puberty

Biologic Development: "It is really important to keep in mind that p_____ is the biology of change and adolescence is the socio-cultural reflection of that..." -Abigail Baird

18

Bodily harm: can occur from multiple sources for example, any pointed object. Forks should be avoided until 1_ mos. High noise levels can result in hearing loss. Animal attacks may be an unrecognized danger to infants. Nursing role: Education is the key with growth and development a prime focus. There is a child safety home checklist under Family-Centered care.

six

Body Image (Self-Concept): "While the onset of puberty can vary by as much as s___ years, every adolescent wants to be right on the 50-yard line, right in the ...middle of the field. One is always too tall, too short, too thin, too fat, too hairy, too clear-skinned, too early, too late. Understandably, problems of self-image are rampant." -Joan Lipsitz

positive threatening

Body Image: Toddlers -They are learning the names for body parts. -They may have inaccuracies in their thinking, i.e. all fat people are pregnant. So, it is important for nursing to encourage parents to foster a p_____ body image. -There is a lack of clarity with body boundaries and intrusion into personal space is considered t_____ even if it not painful, i.e. taking an axillary temperature, examining ears or mouth.

Palivizumab <32 weeks smoke Breast

Bronchiolitis 2014 AAP Prevention Guidelines: -P______ a. Monthly doses during respiratory season in first year of life b. Use for Infants with significant heart or lung disease OR Infants born at <3_ weeks, who required supplemental oxygen for more than 28 days -Hand hygiene -Reduce/eliminate exposure to second hand s___ -b_____ feeding -Family education

Nasogastric suctioning bacterial albuterol or epinephrine

Bronchiolitis 2014 AAP Treatment Guidelines: -N______ or IV fluids -Nasal s______ -Supplemental oxygen with pulse ox monitoring -No CPT, corticosteroids, or antibiotics (unless b_______ infection is also present), -Nebulized 3% hypertonic saline (no a_____ or e______)

viral cold Respiratory Syncytial Virus

Bronchiolitis: -Common v____ infection of the lower respiratory tract -Common c___ in adults -More severe disease in young infants -Multiple organisms, most common R___ S___ V___ (RSV)

Child Family

CHRONIC ILLNESS, DEVELOPMENTAL DELAY, AND DISABILITY: Objectives 1. Scope of Need 2. Impact on C____ 3. Impact on F_______

lap 2

Car safety: Most deaths come from infant on another's l___ -Do not assume parents know how to put in the car seat. Many towns/cities have a resource to assure proper car seat installation. -Infants need to be in an appropriate car seat that is rear-facing and in the middle of the seat. This has been proven to help prevent head, neck and other injuries. -Once the child has reached the height maximum or as close as _ years as possible it is permissible to have them face forward. -Premature infants need a car seat study with oxygen saturation monitoring prior to discharge.

obstruction neuro-trauma

Causes of Respiratory Acidosis (low pH, high PCO2)= Hypoventilation (airway o______, n____-trauma)

hypoxia fever

Causes of Respiratory Alkalosis (high pH, low PCO2)= Hyperventilation (h____, anxiety, f____)

prevented

Childhood Global Mortality (WHO): -6.6 million children under the age of five died in 2012. -More than half of these early child deaths are due to conditions that could be p_______ or treated with access to simple, affordable interventions including medications. a. Lack of HiB vaccine over 300,000 children die from the illness. b. Lack of Meningitis vaccine (primarily Group A meningococcus) belt of sub-Saharan Africa, stretching from Senegal in the west to Ethiopia in the east, has the highest rates of the disease.

obesity >95th 5

Childhood Health Problems: -Childhood o____ as the most common nutritional problem reaching epidemic a. BMI is > 9_th percentile for age and gender b. Causes? (electronics, sedentary lifestyles etc.) -Injury -Mental Health as emerging concern (1 in _ adolescents) especially on general care unit

Cystic Fibrosis

Chronic Respiratory Conditions: -Asthma -C_____ F_____

160 165

Clubbing in Cystic Fibrosis: -Normal= 153 degrees -Mild= 16_ degrees -Moderate= 16_ degrees -Severe= 175 degrees

Preoperational

Cognitive Development: Piaget P______ Thought (2-7 y.o.) will discuss in preschool. Box 12-1 has list of characteristics that are important to assess in clinical.

trial and error further cause and effect

Cognitive Development: Piaget Sensorimotor 5th stage: Tertiary Circular Reaction (12-18 mos.)= Child experiments to learn new things about objects/events. Does this by t___ and e____. -There is increased differentiation of self from objects (so they can venture f_____ from parents). -They begin to understand c____ and e____ (light comes on by switch and exploring the same object in a new place) but can not transfer the knowledge to a new situation; so they will reinvestigate the situation. -Clinical: allow toddler to explore the environment and provide variety with toys.

time imitation

Cognitive Development: Piaget Sensorimotor 6th stage: Invention of New Means through Mental Combinations (18-24 mos.)= This is the transitional phase to preoperational thought. Beginning sense of t___. -Object permanence is complete. Child can search for hidden object any where. This allows them to infer the cause when only experiencing the effect. -Child can solve basic problems through memory and imitation, i.e. how to open a box. -Can infer a cause when only seeing the effect -There is greater symbolism to i_____, i.e. waving good-bye and mimic activities of the house hold.

Neonatal

Cognitive Development: Piaget (1952): 1st stage: N_____ Reflex (birth to 1 mo.)= All behavior is reflexive (sucking, swallowing, rooting, grasping and crying) at this time. As they progress, they start to perceive patterns that provide a foundation for future stages.

memory object permanence

Cognitive Development: Piaget (1952): 3rd stage: Secondary Circular Reaction (4 to 8 mos.)= In this stage, activities separate from a child's body with m____ starting to be present. Infants will initiate, recognize and repeat pleasurable experiences. I.e. the like looking in a mirror, play peek a boo, and will react when parent picks up. -They also learn o_____ p_______, this skill begins at about 6 to 8 mos. This leads to the issues when the infant is left by parent because the infant realizes that the parent still exists even though they are out of sight. Parents may need help recognizing and dealing with this behavior. In clinical, it may help the infant to have the parent to stay within patient sight during exams and procedures.

Coordination inanimate reasoning goal barrier

Cognitive Development: Piaget (1952): 4th stage: C______ of secondary schemas (8-12 mo.)= Increasing motor ability allows for great exploration of the environment. -Object permanence continues to develop with i_____ objects. This marks the beginning of intellectual r______. -Infant can plan activity have g___-directed behavior such as hitting mobile to make it move and will initiate activity to cause activity of object which is separate from body activity. -They also will actively attempt to remove b_____ to a desired or undesired action. I.e. if a large toys is in the way of creeping they will attempt to climb over or push it away.

Sensorimotor

Cognitive Development: Piaget (1952): S_______ phase (birth to 24 months) i.e. first four stages= Deals with practical intelligence. As infant relate to the world through their senses. As they move through, they learn basic concept that people are entities separate from objects. Move from reflexive to simple repetitive to imitate activity.

Circular intentional

Cognitive Development: Piaget (1952): 2nd stage: Primary C_____ Reaction (1 to 4 mos.)= The infant begins to look at objects and starts to *separates self from the object*. They also *begin i_____ behaviors* and recognize the orderly sequence of the stimuli and their responses. Additionally, this influenced by the motor ability that is present.