Exam 1 Study Guide
In working with the toddler, which of the following statements would be most appropriate to say to the toddler to decrease the behavior known as negativism? a) "You love having the same food every day, do you want apples again with lunch? "b) "It is time for lunch, I am going to put your bib on." c) "Do you want help getting into your chair so we can have lunch?" d) "Are you getting hungry and ready for lunch?"
"b) "It is time for lunch, I am going to put your bib on." STATEMENT NOT QUESTION! Decrease opportunity for negative answers
Understand abuse in a child, what to look for, how do they react, etc.
ASK THE PARENTS WHAT CAUSED THE BRUISES A child who shrinks at the approach of adults in addition to having bruises and burns may be a victim of abuse. Withdrawal, aggression, lack of emotional response/reaction, fear of parents, lack of social smile (infants) Inconsistency between nature of injury and developmental level of the child Inconsistency between caregiver's report and the injuries Frequent injuries, delay in seeking health care, dull affect Other injuries discovered that are not related to the original client concern; multiple fractures or bruises/welts at different stages of healing
What should be expected in a toddler regarding developmental tasks
Autonomy versus shame and doubt Independence is paramount task for toddlers, who are attempting to do everything for themselves (use negativism or negative responses as they begin to express this independence) Ritualism, or maintaining routines and reliability provide a sense of comfort to toddler
Know what a teens biggest concern is when they have abdominal surgery
Being different from their peers; body-image
Know about teaching personnel to measure a newborn's respiratory rate.
Count for a complete minute because newborns are irregular breathers (30-60 BPM normal range)
What is the screening tool mostly used to assess development in children.
Denver II Screening Tool
4 year old to assess their gross motor skills
can Hop on one foot, so ASSESS this
What pain scale could be used on a 5-year-old?
FLACC (2 months to 7 years) FACES (3 years and older) - MOST COMMON FOR PRESCHOOLERS (3-6) OUCHER (3-13 years) NUMERIC (5 years and older) --assessment for readiness: which # is larger? 5 or 9, which # is smaller 7 or 4; place blocks in order from biggest to smallest NON-COMMUNICATING CHILDREN'S PAIN CHECKLIST (3 years and older)
Understand the developmental assessment and interventions would the nurse need to know for a 5-year-old boy who is terminally ill with Cystic Fibrosis.
Give opportunity to make decisions about their care (autonomy), assure them they did nothing wrong to deserve this, reassure the child that his parents can be with him
Understand Moro reflex
Moro reflex (Birth to 4 months) -Elicited by allowing the head and trunk of an infant in a semi-sitting position to fall backward to an angle of at least 30 degrees -The infant's arms and legs symmetrically extend, then abduct while fingers spread to form a c shape -Startle response
Understand what to tell the mom when a preschooler has a soft BM every other day.
Normal
Understand what is correct regarding modifying procedures for children's appropriate developmental level.
Want to be explained procedures when school age; provide factual information
A nurse is assessing an infant. Which of the following are manifestations of pain in an infant? (Select all that apply.) a. Pursed lips b. Loud cry c. Lowered eyebrows d. Rigid body e. Pushes away stimulus
b. Loud cry c. Lowered eyebrows d. Rigid body
Understand what statements can be made to a 6-year-old who is hospitalized for dehydration or any problem.
Accept and acknowledge what they say; subjectively define whatever the child/patient says
A nurse is caring for a 3-year-old client whose parents report that she has an intense fear of painful procedures, such as injections. Which of the following strategies should the nurse recommend including in the the child's plan of care? (Select all the apply.) A. Have a parent stay with the child during procedures b. Cluster invasive procedures when possible C. Perform procedures as quickly as possible D. Allow the child to keep a toy from home with her E. Use mummy restraints during painful procedures
A. Have the parent stay with the child during the procedures. D. Allow the child to keep a toy from home with her. C. Perform procedures as quickly as possible Also, provide a distraction for the child and limit the number of visitors in the room during the procedure Rationale: -Maintaining parent-child contact is one of the most supportive interventions for toddlers and preschoolers undergoing painful procedures. - Do not Cluster invasive procedures when possible; Clustering creates an unnecessarily lengthy and painful period for the client, which is likely to increase fear. - Moving quickly through the steps of a painful procedure is a supportive intervention for children undergoing painful procedures. -Having familiar and cherished objects nearby is therapeutic for children during their hospitalization. - Mummy restraints help to immobilize very young children and keep them safe during procedures, but it is likely to increase fear in toddlers and preschoolers so do NOT USE
In discussing their 2-year-old's behavior with the nurse, which of the parents' statements suggests the child may be ready for toilet teaching? A. The child hides behind her bedroom door when defecating. B. The toddler walks with a wide, swaying gait. C. The child frequently repeats words parents just said. D. The child often removes her shoes and socks.
A. The child hides behind her bedroom door when defecating.
Toddler wellness check up - what can they do that would be normal?
By 15 months: Walk without help; uses cup well; builds a tower of two blocks; creeps up stairs 18 months - runs clumsily; falls often, throws a ball overhand; jumps in place with both feet; pulls and pushes toys; builds towers 3-6 blocks; turns pages 2-3 at a time; manages spoon without rotation by 2 years, walk up and down stairs by placing both feet on each step; build a tower of 6-7 blocks; turn pages of book one page at a time; kick a ball; unscrew lids By 2.5 years, stands on one foot momentarily; draws circles and has good hand-finger coordination; jumps across the floor and off a chair or step using both feet
A 16-year-old male is hospitalized for cystic fibrosis. He will be an inpatient for 2 weeks while he receives IV antibiotics. As the nurse caring for this patient, what action can you take that will most enhance his psychosocial development? A. Fax the teen's teacher, and have her send in his homework. B. Encourage the teen's friends to visit him in the hospital. C. Encourage the teen's grandparents to visit frequently. D. Tell the teen he is free to use his phone to call friends
B. Encourage friends to visit him in the hospital Teens are most concerned about being like their peers. Having the teen's friends visit will help him feel he is still part of the school and social environment.
A nurse is preparing a 4-year-old boy for surgery. Which nursing action is appropriate for preoperative teaching based on Erikson's developmental stages? A. Allowing the child to make a project related to the surgery B. Having the child put a surgical mask on a doll C. Asking the child how he feels about surgery D. Allowing the child to listen to music without further instructions
B. Having the child put a surgical mask on a doll *Imitative and imaginative play
Understand nutritional factors in a toddler
Begin developing taste preferences and are generally picky eaters who repeatedly request their favorite foods Physiologic anorexia occurs (decreased appetite) 24-28 oz o milk per day and may switch from drinking whole milk to low-fat milk after 2 years of age Juice: limit to 4-6 oz per day Avoid trans fatty acids and saturated fats 1 cup of fruit daily Serving size: 1 tablespoon for each year of age or 1/4 to 1/3 of an adult portion Increasing autonomy means they prefer finger foods Regular meal times and nutritious snacks best meet needs Avoid snacks/desserts high in sugar, fat, or sodium Avoid choking hazard foods (nuts, grapes, hot dogs, peanut butter, raw carrots, dried beans, tough meats, popcorn) Cut food into small, bite-size pieces Should not be allowed to engage in drinking or eating during play activities or while lying down
How can the nurse best facilitate the trust relationship between infant and parents while the infant is hospitalized? The nurse should: 1. Encourage the parents to remain at their child's bedside as much as possible. 2. Keep parents informed about all aspects of their child's condition. 3. Encourage the parents to hold their child as much as possible. 4. Advise the parents to participate actively in their child's care.
3. Encourage the parents to hold their child as much as possible.
A nurse is caring for a 6-month old infant. Which of the following findings indicate to the nurse that the infant may be experiencing pain? A. Dry palms and feet B. Decreased muscle tone C. Furrowed brow D. Eyes wide open
C. Furrowed brow and/or increasing crying Rationale: A furrowed brow may indicate that the infant is in pain or distress -Pain indicators include diaphoresis, increased muscle tone, and shut eyes with open mouth
A nurse is assessing the psychosocial development of a toddler. The nurse should recognize that this stage is characterized by which of the following? A. Imaginary playmates B. Erikson's stage of initiative vs. guilt C. Demonstrations of sexual curiosity D. Negative behaviors characterized by the need for autonomy
D. Negative behaviors characterized by the need for autonomy
During a well-child visit, the nurse observes the child saying "no" to her mother quite frequently. The mother asks the nurse, "How do I deal with her saying no all the time?" What would be appropriate for the nurse to suggest? Select all that apply. A. "Make a statement instead of asking a question." B. "Use time-out every other time she tells you no." C. "Limit the number of questions you ask of her." D. "Offer her two options from which to choose." D. "Offer her something she would like, such as ice cream, to distract her."
A. "Make a statement instead of asking a question." C. "Limit the number of questions you ask of her." D. "Offer her two options from which to choose."
A nurse is caring for a 2-year-old who is hospitalized and throws a tantrum when his parents leave. Which of the following toys should the nurse provide to alleviate the child's stress? a) Set of building blocks b) Toy hammer and pounding board c) Picture book about hospitals d) stuffed animal
B) Toy hammer and pounding board. All toys are age appropriate, but a toy hammer and pounding board helps the child to express the anger and frustration he feels about the parent leaving but lacks the verbal ability to express.
A toddler's mother tells you that no matter what she asks of her child, he says, "No." A suggestion you might make to help her handle this problem is for her to A) give him secondary, not primary, choices. B) ask no further questions of him. C) pretend she does not hear him. D) tell him never to say, "No" again.
A) give him secondary, not primary, choices.
Understand a 2-year-old child's developmental factors.
Autonomy vs. shame and doubt -negativism and ritualism -Independence is paramount Preoperational stage of cognitive development Using multiword sentences by combining two to three words Egocentric: unable to see things from the perspective of others, can only view things from their personal points of view Good behavior is rewarded, and bad behavior is punished Parallel play
A 5-year-old child is hospitalized with a fractured femur. Which tool should the nurse use to assess this child's pain? 1. CRIES Scale 2. Faces Pain Rating Scale 3. SUN Scale 4. PIPP Scale
2. FACES Rationale: 1. The CRIES Scale was developed for preterm and full-term neonates. 3. The SUN Scale was developed for use in newborns. 4. The PIPP Scale was developed for premature infants.
Which assessment findings indicate delayed development in a preschooler? Select all that apply. 1 The preschooler is afraid of the dark. 2 The preschooler is unable to hop or jump. 3 The preschooler has difficulty making friends. 4 The preschooler has gained 1 pound in a year. 5 The preschooler has an imaginary playmate.
2 The preschooler is unable to hop (by age four) or jump (jump rope by age five) 3 The preschooler has difficulty making friends. 4 The preschooler has gained 1 pound in a year.
A 3 1/2 year-old child is found masturbating in the family living room. Which response by the parent would best address this behavior? A. "We do not touch ourselves in public. Please go to your room if you want to continue this behavior." B. "Your penis is very interesting, isn't it? But you can injure it by touching it so much." C. "You need to quit that right now. It's not nice to touch your privates." D. "I will ask your father to talk to you about this since he is a boy too."
A. "We do not touch ourselves in public. Please go to your room if you want to continue this behavior." Rationale: Although masturbation in this age group is not an uncommon behavior, the child must be told in a matter-of-fact manner that this is not appropriate activity in public. The parent needs to remain calm and not get angry or embarrassed. Usually, masturbation is just part of a young child's curiosity about his or her body.
The nurse is assessing a 4-year-old for gross motor skill development. Which would the nurse expect this preschooler to have accomplished? A. Hopping on one foot B. Standing on one foot for 10 seconds C. Skipping D. Swimming
A. Hopping on one foot 4 year old can stand on one foot for 5 seconds; at 5, can stand on on one foot for 10 seconds and may learn to swim
Know infant's vital signs. What location is to assess a heart rate?
Apical pulse is most accurate for infant heart rate (apex of the heart; tip of right and left ventricle on the patient's left side) Infant (1 month to 12 months) Vital Signs: TEMP: 3-6 months: 37.5 degrees C (99.5 F) 12 months: 37.7 degrees C (99.9 F) Recommended Routes: Axillary; rectal if exact measurement is necessary HR: 90-160 BPM RR: 25-30/min BP: Average: 85/50 Age, height, and sex all influence BP
A nurse is assessing a preschooler. Which of the following findings should indicate to the nurse a need for speech therapy? (Select all that apply) A. The preschooler stutters when speaking B. The preschooler mispronounces words C. The preschooler speaks in three word sentences D. The preschooler talks to himself when reading E. The preschooler speaks in a nasally tone F. Seeing letters in reverse (dyslexia)
B. The preschooler mispronounces words D. The preschooler speaks in a nasally tone F. Seeing letters in reverse (dyslexia) Rationale: -Mispronouncing words is expected in a toddler but should be evaluated as a preschooler. Mispronounced vowels and consonants occur between the ages of 24 - 36 months; -Dyslexia is a learning problem that causes the child to see words or letters in reverse. It is noticeable during preschool development when language, vocabulary, and speech are quickly developing. Signs of dyslexia include being slow to learn words, having difficulty rhyming, confusing small words (at, it, of, to), reversing letters, and writing words in reverse - A child who speaks in a nasally tone of voice may have a neurogenic speech disorder that is caused by weakened muscles of the tongue, soft palate and face. These children should be evaluated by a speech therapist for therapy. -Many preschoolers stutter as thinking races ahead of their ability to articulate ideas. Most of this stuttering, when not made an issue, will resolve on its own. Calling attention to the dysfluency often exacerbates it.
Steps to use time-out as a disciplinary measure for a 4-year old
Parent knows the misbehavior was intentional. Warn the child there will be a time-out if the behavior does not stop. Move the preschooler to a boring spot. Set a timer for no more than 4 minutes. If the child gets up, return the child to the time-out location and restart the time.
What does Erikson suggest about a 10 year old who has been hospitalized for a length of time regarding their assignments/school work?
School-age children (6-12 years): Provide factual information Encourage the child to express feelings Try to maintain a normal routine for long hospitalizations, including time for school work Encourage contact with peer groups
Know about the child development of a preschooler.
PARTICIPATE IN IMAGINARY PLAY Preschooler: 3-6 years Physical development: Weight: should gain 2-3 kg (4.5 to 6.5 lb) per year Height: Should grow 6.2-9 cm (2.4 to 3.5 in) per year -Bodies evolve away from the unsteady wide stances and protruding abdomens of toddlers into a more graceful, postural erect, and sturdy physicality Find and Gross Motor Skills: -Should show improvement in fine motor skills (copying figures on paper and dressing independently) Gross motor: -3 year old: rides a tricycle; jumps off bottom step, stands on one foot for a few seconds -4 year old: Skips and hops on one foot; throws ball overhead; catches ball reliably -5-year old: Jumps rope, walks backward with heel to toe; throws and catches a ball with ease Cognitive development: -Piaget's preoperational phase: The preconceptual thought transitions to the phase of intuitive thought around the age of 4 years and lasts until the age of 7 years -Moves from totally egocentric thoughts to social awareness and the ability to consider the viewpoints of others -Make judgements based on visual appearances Variations in thinking during this age include: - Magical thinking (thoughts are all powerful and can cause events to occur) - Animism (Ascribing lifelike qualities to inanimate objects); - Centration (focus on one aspect instead of considering all possible alternatives) - Time (begin to understand the sequence of daily events; time best explained to them in relation to an event). By end of the preschool years, children have a better comprehension of time-oriented words. Language Development: -Increases to more than 2,100 words by the end of the 5th year -Speak in sentences of three to four words at the ages of 3-4; and four to five words at the age of 4-5 -Enjoys talking, and language becomes their primary method of communication Psychosocial: -Eirkson's Initiative Vs. Guilt: become energetic learners, despite not having all the physical abilities necessary to be successful at everything -Guilt can occur when they believe they have misbehaved or when they are unable to accomplish a task -Guiding preschoolers to attempt actives within their capabilities while setting limits is appropriate Kohlberg's Moral Development: Early preschoolers: continue in the good-bad orientation of the toddler years (actions are taken based on whether or not it will result in a reward or punishment) Older preschoolers: primarily take actions based on satisfying personal needs, yet are beginning to understand the concepts of justice and fairness Self-Concept Development: -Feel good about themselves with regard to mastering skills that allow independence (dressing, feeding) -during stress, insecurity, or illness, they can regress to previous immature behaviors or develop habits (nose-picking, bed-wetting, thumb sucking) -Begin to recognize differences in appearances and identify what is considered acceptable and unacceptable -By age of 5, preschoolers begin comparing themselves to peers -Poor understanding of anatomy makes intrusive experiences (injections or cuts) frightening to preschoolers; believe it is important to use bandages after an injury Social Development: -Generally do not exhibit stranger anxiety and have less separation anxiety -Changes in daily routine are tolerated but they can develop more imaginary fears -Prolonged separation (during hospitalization) can provoke anxiety; fave toys and appropriate play should be used to help easy fears -Pretend play is healthy and allows preschoolers to determine the differences between reality and fantasy
The nurse is providing injury prevention anticipatory guidance to parents of a 3-year-old child should include which items of information? Select all that apply. a) the use of child-resistant containers and cupboard safety closure b) the routine use of syrup of ipecac for accidental poisoning c) drug and alcohol education d) the proper use of sports equipment e) keeping the poison control center's number close to the phone
a) the use of child-resistant containers and cupboard safety closure e) keeping the poison control center's number close to the phone
A nurse is teaching an assistive personnel to measure a newborn's respiratory rate. Which of the following statements indicates an understanding of why the respiratory rate should be counted for a complete minute? a. Newborns are abdominal breathers b. Newborns do not expand their lungs fully with each respiration c. Activity will increase the respiratory rate. d. The rate and rhythm of breath are irregular in newborns
d. The rate and rhythm of breath are irregular in newborns Rationale: Newborns have an irregular respiratory rate and rhythm. Therefore, counting the respiratory rate for a complete minute is recommended to obtain an accurate rate -Other options are correct; however, they have no impact on obtaining a respiratory rate
Understand what behaviors could be expected from a newborn from a substance abuser mom.
Abstinence syndrome (withdrawal): -Increased wakefulness; jittery -High-pitched cry -Incessant crying; inability to console -Irritability -Tremors -Hyperactive with an increased moro reflex -Increased deep tendon reflexes -Increased muscle tone (hypertonicity) -Convulsions -Nasal congestion with flaring; tachypnea -Frequent yawning -Sweating -Poor feeding; projectile vomiting, diarrhea -Excessive, uncoordinated, and constant sucking -Too much stimuli is overwhelming; poor tolerance to changes in routine (don't make eye contact when feeding them)
The father of a 2-year-old girl tells the nurse that he and his wife would like to begin toilet training their daughter soon. He asks when the right time is to begin this process. What should the nurse say in response? A. "She's well past the age to begin toilet training; most children are ready by age 1, when they have developed the needed nervous system control." B. "When she starts tugging on a wet or dirty diaper, she is letting you know she's ready." C. "It is best to wait a little longer, until she is 3; only then will she be socially developed enough to understand what you are asking her to do." D. "The best time to start toilet training is as soon as the child begins walking."
B. "When she starts tugging on a wet or dirty diaper, she is letting you know she's ready."
A nurse is caring for a 12-month-old toddler who is hospitalized and confined to a room with contact precautions in place. Which of the following toys should the nurse recommend in order to meet the developmental needs of the client? A. Large building blocks B. Hanging crib toys C. Modeling clay D. Crayons and a coloring book
A. Large building blocks
Understand what kind of props could be used when starting an IV on a 6-year-old.
Show the child the equipment to be used before the procedure. "Pick your favorite Band-Aid and show me which arm to use." (offer choices) Play therapy: Demonstrate on a doll or stuffed animal
The parent of a 4-year-old Preschooler tells the nurse about being frustrated because all the parent seems to do lately is fight with the Preschooler over what the Preschooler wants to eat and wear. The parent notes sometimes wanting to spank the Preschooler for always disagreeing. What would be the best suggestion for the nurse to make to this parent?
Use the time-out technique for discipline: 4 minute time out
Understand how to make a nursing assignment when a 3-month-old child is hospitalized for two weeks.
Place infants who parents are not in attendance close to nurse's stations so that their needs can be quickly met Provide consistency in assigning caregivers
A 2-year-old child is treated in the emergency room for a burn to the chest and abdomen. The child sustained the burn by grabbing a cup of hot coffee that was left on the kitchen counter. The nurse reviews safety principles with the parents before discharge. Which statement by the parents indicates an understanding of measures to provide safety in the home? A. "We will be sure not to leave hot liquids unattended." B. "I guess my children need to understand what the word HOT means." C. "We will be sure that the children stay in their rooms when we work in the kitchen." d. "We will install a safety gate as soon as we get home so the children cannot get into the kitchen."
A. "We will be sure not to leave hot liquids unattended."
Understand what are some questions that can be asked to a 17-year-old to identify risky behaviors.
Ask adolescents about risky sexual behaviors and discuss the need for mutual consent prior to sexual contact Ask about alcohol, tobacco, and marijuana use (and frequency) during screenings ASK if they would like to have their parents stay while they are examined or if they would like to have them wait outside until the examination/assessment is done - A nurse can discuss confidential matters with a teen client if he or she does not want parents to know. The nurse must keep the client's information confidential, unless it indicates that the law has been broken, or it is dangerous or life threatening. - The nurse can give the client a choice about whether the parents remain in the room during the exam. In this way, the client is able to start making more choices for his or her own healthcare and the parents are still told that he or she may spend time alone with the nurse. This keeps all family members informed, so that the parents do not feel as if the nurse is trying to be secretive with their child.
What site do we use to take a temperature of a 9-month-old?
Axillary Rectal if exact measurement is necessary
A nurse is planning care for an infant. Which if the following would be the most appropriate site to assess a pulse? A. Carotid artery B. Apex of the heart C. Brachial artery D. Temporal artery
B. Apex of the heart (apical pulse) -The most effective way to asses an infant's heart rate is by auscultating the apex of the heart. -From birth to age 3 years the apex beat is located in the 4th intercostal space; patient's left side and with increasing age gradually moves into the 5th space in most children. -Apical pulse should be assessed by listening between the sternum and the left nipple
Understand Babinski reflex
Babinski reflex (birth to 1 year) -Elicited by stroking the outer edge of the sole of an infant's foot up toward the toes -The infant's toes fan upward and out
Which of these manifestations, if identified in a 6-year-old patient, should the nurse associate with a possible developmental delay based on Piaget's theory? A. The child speaks in complete sentences but often talks only about himself. B. The child still plays with a favorite doll that he has had since he was a toddler. C. The child continues to suck his thumb. D. The child describes an event from his own perspective, even though the entire family was present.
C. The child continues to suck his thumb.
Understand from where a child's gross motor skills develop from.
Cephalocaudal - head to toe Cognitive development Large muscles (arms, legs, and trunk) develop first, so kids master gross motor skills such as walking first. Small (fine) motor skills, which require control and dexterity in the hands and fingers, come later. As babies grow, they first develop control in their neck (head control) and trunk (sitting balance) and then they learn to control their shoulders, then elbows, wrists, and finally, their fingers Proximodstal fashion (from center to the periphery) - gross skills first, then fine motor skills
Understand nursing management of a dying child
Focus on managing pain and discomfort; avoiding dehydration; meeting with caregivers to discuss organ donation key role is to be an advocate, manage pain and discomfort, provide nutrition/hydration, develop a holistic connection, be present emotionally, assist family through the grief process The nurse must FIRST come to terms with her own views/perceptions toward death and dying
Know what nursing intervention to promote for a 16-year-old's psychosocial development who has been hospitalized for 2 weeks.
Erikson's identify Vs. role confusion state -Adolescents often try different roles and experiences to develop a sense of personal identify, and come to view themselves as unique individuals -Adolescents become part of a peer group that greatly influences behavior *Allow the child to interact with others in his or her same age group.
Understand the motor skill development in a 10-month-old
Gross motor skills: Changes from a prone to a sitting position Fine motor skills: Grasps rattle by its handle Should already be able to pull to a standing position (9 months) and creep on hands and knees (9 months); use pincer grasp and crude pincer grasp (9 months); neat pincer grasp, placing objects into a container, and cruising or walking while holding onto something shouldn't be evident until 11 months
Understand the assessment in a healthy 4-year-old regarding motor skill development
Improvement in fine motor skills (copying figures on paper and dressing independently) Gross Motor skills of a 4 year old: -Skips and hops on one foot -Throws ball overhead -Catches ball reliably
Understand what kind of toys a 12-month-old toddler can have if the toddler is in contact precautions.
Large blocks, toys that pop apart, push and pull toys (all age-appropriate toys for a 12 month old)
Understand what to tell a 3 ½ year old when they began to touch their private areas.
Normal part of preschool development Calmly (without anger or embarrassment) and in a matter-of-fact manner, explain that it is not appropriate activity in public; request they go to their room if they would like to continue the behavior If the parent overreacts to this behavior, then it may occur more frequently.
Understand the development of a school age boy regarding growth spurts/when do they occur
Onset of physiologic changes begins around the age of 9 (Particularly in girls) Stop growing at around 18-20 years Rapid growth in height and weight occurs; permanent teeth erupt; differences in the rate of growth and maturation between boys and girls becomes apparent Visible sexual maturation is minimal in boys 4.4-6.6 lb per year 2 inches per yea
Understand suicidal signs in an adolescent
Poor school performance; changes in mood Lack of interest in things that were of interest to the adolescent in the past Social isolation Disturbances in sleep or appetite Expression of suicidal thoughts
Know what nursing interventions would best fit the developmental stage as described by Erickson for a 4-year old who has been hospitalized.
Preschooler of 4 years old: Initiative vs. Guilt -Guide them to attempt activities within their capabilities while setting limits Nursing Interventions: Explain procedures using simple, clear language (avoid medical jargon and terms that can be misinterpreted) Encourage independence by letting the child provide self-care Encourage expression of feelings Validate the child's fears and concerns Provide toys that allow for emotional expression (a pounding board to release feelings of protest) Provide consistency in assigning caregivers Give choices when possible (do you want your medicine in a cup or spoon?) Allow younger children to handle equipment if it is safe Provide play activities (drawing, painting) Educational and child-appropriate shows and videos; demonstrate a procedure before it is performed. using dolls or stuffed animals Maintain routine as much as possible Begin with least invasive parts of a physical exam then move to more intrusive areas.
What are some discipline measures that can be used on a 4-year-old.
Preschoolers have definite opinions, which may bring them into opposition with parents - Guide the Preschooler through without discouraging his or her right to an opinion. -Time-out is a good technique that allows parents to discipline without using physical punishment. - Time-out should last for 1 minute for every year of age (4 min timeout for a 4 year old). - Spanking is never encouraged and is totally discouraged by the American Academy of Pediatrics. - Taking the Preschooler's toys away does not accomplish the same as time-out. After taking away the toy the Preschooler just goes and gets another without understanding the meaning behind the punishment. - It is easy for the parent to get frustrated, especially if the Preschooler is very willful. This can best be avoided by being consistent with rules - Parents are encouraged to express their disapproval when child uses naughty language; calmly tell the Preschooler not to say those words again. Ignoring the behavior will not correct it and punishment is not necessary.
Understand how an 18-month-old toddler who has been hospitalized for 10 days may act (the behaviors or developmental reactions that are exhibited)
Separation anxiety during hospitalization manifests in three behavior responses: -Protest: screaming, clinging to parents, verbal and physical regression toward strangers -Despair: Withdrawal from others, depression, decreased communication, developmental regression -Detachment: interacting with strangers, forming new relationships, happy appearance Impact of hospitalization on toddlers: -Experiences separation anxiety -Can exhibit an intense reaction to any type of procedure due to the intrusion of boundaries -Behavior can regress
Know some behaviors for a 6-year-old that might be noted as a possible psychosocial developmental delay
Signs of developmental delay in preschool-aged children include not playing with other children, not being able to build a block tower of six to eight blocks, not engaging in fantasy play, and not separating from the parent without major protest
The pediatric nurse is teaching a new nurse how to recognize signs that a toddler is ready for toilet training. The nurse includes which indicators as signs of readiness for toilet training?
The child shows an interest in toilets and potty chairs. -It is a sign of readiness when the toddler shows an interest in the toilet and how it works. This shows that the child may be ready to learn about the process and practice of using the toilet or potty chair The child is able to pull up and remove his or her pants. This demonstrates physical maturation and is one sign of readiness for toilet training. The child is eager to please the parents with a dry diaper. -This scenario reflects readiness for toilet training, since the child is showing signs of psychological maturation as well as the physical ability to hold their urine for a while. The child notices his or her own wet diaper and may try to remove it. -This reflects readiness for toilet training because the child understands the difference between being wet and dry and shows a preference for being clean and dry.
Know the psychosocial development of a toddler
Toddler: 1 -3 years Erikson Psychosocial development: Autonomy versus shame and doubt -Independence is paramount for toddlers, who are attempting to do everything for themselves -Often use negativism, or negative responses, as they begin to express their independence -Ritualism, or maintaining routines and reliability, provides a sense of comfort for toddlers as they begin to explore the environment beyond those most familiar to them
Understand how to promote sleep for a toddler
Toddlers average 11-12 hours of sleep per day, including one nap Naps often are eliminated in older toddlerhood Resistance to bedtime and expression of fears are common in this age group Maintain a regular bedtime and bedtime routine to help promote sleep
What could be encouraged with parent to facilitate the trust relationship between the infant and foster parents.
Trust is developed by meeting comfort, feeding, stimulation, and caring needs Encourage foster parents to hold the infant as much as possible The infant should learn delayed gratification (needs should be vocalized by the infant)
Understand how to tell if an infant is experiencing pain.
Younger infant: Loud cry Rigid body or thrashing Local reflex withdrawal from pain stimulus Expressions of pain (eyes tightly closed, mouth open in a squares shape, eyebrows lowered and drawn together) Lack of association between stimulus and pain Older Infant: Loud cry Deliberate withdrawal from pain Facial expression of pain *USE FLACC scale starting at 2 months, CRIES for neonates
A nurse is caring for an 18 month old toddler who has been hospitalized for 10 days. after the toddler's mother leaves the room, the nurse observes the toddler sitting quietly in the corner of the crib, sucking her thumb. When the nurse approaches the crib, the toddler turns away from the nurse. the nurse should understand that these behaviors indicate which of the following developmental reactions? a. anxiety reaction to the stress of hospitalization b. regression c. resentment toward the mother d. developing autonomy
A. An anxiety reaction to the stress of hospitalization
A nurse is caring for a 10 year old child who will need to be hospitalized for an extended period of time. Which of the following actions should the nurse include in the nursing plan to meet the client's psychosocial needs according to Erikson? A. Arrange for the hospital teacher to do lesson plans B. Allow the client to select his own food off the menu C. Encourage visits from the client's friends D. Provide a daily session with a play therapist
A. Arrange for the hospital teacher to do lesson plans -Encourage the client to complete school work Industry vs. Inferiority stage of development. By keeping up with school work through a normal routine, the child will feel less inferior to his classmates due to the missed school.
A 4-year old child diagnosed with leukemia is hospitalized for chemotherapy. The child is fearful of the hospitalization. Which nursing intervention would be most appropriate to alleviate the child's fears? A. Encourage the child's parents to stay with the child B. Encourage play with other children of the same age C. Advise the family to visit only during the scheduled visiting hours D. Provide a private room, allowing the child to bring favorite toys from home
A. Encourage the child's parents to stay with the child
A nurse is preparing to assist with applying a cast to a preschooler's arm. Which of the following actions should the nurse take? A. Wrap the arm of the child's doll or toy prior to the procedure B. Tell the child, "This will make your arm feel better" C. Place a heated fan at the bedside to facilitate drying D. Support the casted arm with a firm grasp
A. Wrap the arm of the child's doll or toy prior to the procedure Rationale: This action shows the child that it does not hurt the doll or stuffed animal, and, in turn, will not hurt the child
What are some safety concerns for anticipatory guidance of a 2-year-old.
Anticipatory guidance: process of understanding upcoming developmental needs and then teaching caregivers to meet those needs Anticipatory Guidance for a 2 year old: -avoid struggles about feeding -cover electrical outlets/ cords. - Lock toxic substances. - Use car seat (rear facing until the age of 2 or until toddler exceeds the height recco; forward facing when over the age of 2) in backseat of car - Encourage books, bedtime routines and discourage TV - Mention toilet training (90% trained by 3 years) and tooth brushing. Speech dysfluency common. -Expression of bedtime fears is common. -Expect behaviors associated with negativism and ritualism. Safety Guideline for toddlers (1-3 year olds): -small objects (grapes, coins, colored beads, candy) should be avoided -Toys with small parts should be kept out of reach; age-appropriate toys should be provided -Clothing should be checked for safety hazards (loose buttons) -Balloons should be kept away -Known emergency procedures for choking -lock firearms; sharp objects out of reach -Do not leave unattended with any animals present -Teach stranger safety -Check bath water temp -Thermostats on hot water heaters should be turned down to LESS THAN 49 C (120 F) -Working smoke detectors in the house -Pot handles should be turned toward the back of the stove -Electrical outlets covered -Wear sunscreen when outdoors -Do not leave unattended in bathtubs -Keep toilet lids closed -Closely supervised near pools or bodies of water -Toddlers should be taught to swim -Lock doors and windows -Crib mattress is LOWEST POSITION with the rails all the way up -Safety gates should be used across the top and bottom of stairs - lead paint should be avoided -Safety locks on cabinets that contain cleaners and other chemicals -Poison control number should be kept near phone -Meds in childproof cabinets away from reach of toddlers -Working carbon monoxide detector in the home -Plastic bags should be avoided -Crib mattresses fit tightly -Crib slats should be no farther apart that 6 cm (2.375 in) -Pillows should be kept out of the crib -Drawstrings should be removed from jackets and other clothing
Understand what to do or teach regarding temper tantrums.
Its normal, how they express themselves regarding independence; expressing they want to be in control -toddlers attempt to gain control of the situation Result when toddlers are frustrated with restrictions on independence Provide consistent, age-appropriate expectations to help toddlers work through frustration Ignoring is an appropriate response -Ignoring a negative behavior is a basic concept in behavior modification. - The parent should be instructed to make sure that the child is safe, and then appear to ignore the child or walk away. - Without an audience, the behavior is more likely to extinguish itself quickly. - NO restraints (can cause behavior to intensify) - It is not developmentally appropriate to tell the child it's not acceptable. -Temper tantrums occur due to an age-appropriate lack of self-control, which is gradually gained as the child matures -DO NOT offer the opportunity to play a game because that provides positive reinforcement for an unacceptable behavior) Once temper tantrums have started, which intervention is appropriate? move objects out of the way of child to prevent injury.
Understand how a 4-year-old views being in the dark
Make judgements based on visual appearances (dark & not being able to see = scary) Encourage the parent to allow a small night light and reassure them there are no monsters; provide a fave toy Consistent bedtime routine Fears are normal in the preschool-aged child. Some Preschooler's are afraid of the dark. The parents should be advised to show patience with their Preschooler as he works through this fear. Refusing a night light will further increase the stress of the Preschooler. Parents should not give credibility to the fear by checking under the bed for monsters. Parents should not use the television to soothe the Preschooler, rather develop a routine that relaxing such as one-on-time with the Preschooler. Parents should not disrupt the usual bedtime routine by allowing the Preschooler to sleep with them; reassure (provide with a favorite toy. Imagine thinkers)
Understand nutrition of pre-school age children
Mildly active preschoolers require 1200-1400 kcal/day; average intake should by 1, or 800 calories a day Finicky eating can remain a behavior in preschoolers, but often by 5 years of age they become more willing to sample different foods Quality more important than quantity Need 13-19 g/day of protein (2 to 4 oz equivalents) in addition to adequate intake of calcium, iron, folate and vitamins A and C -500-800 mg calcium and 10 mg iron daily Saturated fats should be less than 10% of their total caloric intake, and total fat over several days should be 20 to 30% of total caloric intake To combat obesity: 5 servings of fruits and vegetables per day 2 hr or les of screen time 0 servings of sugar-sweetened beverages 1 hr of physical activity per day
Understand alternative therapies to calm a pediatric patient.
Pet therapy, music, imaginary friend, distractions Distraction -Use play, radio, a computer game, or movie -Tell jokes or a story to the child Relaxation -Hold or rock the infant or young child -Assist older children into a comfortable position -Assist with breathing techniques Guided imagery -Assist the child in an imaginary experience -Have the child describe the details Positive Self Talk -Have the child say positive things during a procedure or painful episode Behavioral contracting -Use stickers or tokens as rewards -Give time limits for the child to cooperate -Reinforce cooperation with a reward Containment -Swaddle the infant -Place rolled blankets around the child -Maintain proper positioning Nonnutritive sucking -Offer pacifier with sucrose before, during, and after painful procedures -Offer nonnutritive sucking during episodes of pain Kangaroo care -Skin to skin contact between infants and parents Complementary and alternative medicine -Offer foods, vitamins, or supplements -Offer massage or chiropractic options -Review energy-based treatments (magnets) -Discuss mind-body techniques (hypnosis, homeopathy, or naturopathy)
Know when a 2-year-old is ready for toilet training.
Signs of readiness: Child remains dry for a minimum of 2 hours during the day or is dry after naps Bowel movements are regular and predictable Facial expressions, posture, or words reveal that the child needs to have a bowel movement or urinate. Child follows simple verbal instructions Child imitates his or her parents' behavior Child can walk to the bathroom and undress with minimal to no assistance Child is uncomfortable with soiled diapers and asks to be changed Child asks to use the toilet or toilet chair Child asks to wear grown-up underwear The child must recognize the urge to let go and hold on and be able to communicate that to the parent Parents should begin the readiness phase of toilet training by teaching the child about how the body functions in relation to voiding and having a BM Discussions to assess a child's readiness for toilet training can begin at the 15-month visit and continue at future visits depending on the parent's needs. Optimal age: 18-30 months (Children typically show signs of readiness to potty train between the ages of 2 and 3.) -Myelination of spinal cord (12-18 mo.) is needed so they can voluntarily control bowel and bladder sphincters. Usually not ready until 18-24 mo.
Know what to do when a child constantly says "no", and you are trying to assess the child.
Sit them on daddy's lap Saying no is the child's way of trying to exert his independence and is expected. A toddler's "no" (or negativism) can best be eliminated by making a statement instead of asking a question Limit the number of questions you ask Offer two choices from which to choose
Understand the developmental skills of a 3-year-old
Speak in sentences of 3-4 words at the ages of 3 and 4 At 3 years: combine several words to create simple sentences using grammatical rules Preconceptual thought; object permanence becomes fully developed; memories of events that relate to them; imitation Erikson's autonomy vs. shame and doubt (tail end; begins transitions to initiative vs. guilt of preschool aged children) Gross Motor development skills: Rides a tricycle Jumps off bottom step Stand one one foot for a few seconds Can draw circles and have good hand-finger coordination which continues to improve
Know what reflexes are most essential during the first three months of life.
Sucking and Rooting Reflexes (birth or 4 months) - MOST IMPORTANT -Elicited by stroking an infant's cheek or the edge of an infant's mouth -Infant turns their head toward the side that is touched and starts to suck Palmar grasp (birth to 4 months) -Elicited by placing an object in an infant's palm -The infant grasps that object Plantar grasp (birth to 8 months) -Elicited by touching the sole of an infant's foot -The infant's toes curl downward Moro reflex (Birth to 4 months) -Elicited by allowing the head and trunk of an infant in a semi-sitting position to fall backward to an angle of at least 30 degrees -The infant's arms and legs symmetrically extend, then abduct while fingers spread to form a c shape Tonic neck reflex (fencer position) (Birth to 3-4 months) -Elicited by turning an infant's head to nose side -The infant extends the arm and leg on that side and flexes the arm and leg on the opposite side Stepping (birth to 4 weeks) -Elicited by holding an infant upright with his feet touching a flat surface -The infant makes stepping movements Babinski reflex (birth to 1 year) -Elicited by stroking the outer edge of the sole of an infant's foot up toward the toes -The infant's toes fan upward and out
Know what strategies the nurse should add to a 3-year-old child's plan of care
WANT THE PARENT TO STAY; when doing procedures do so safely and quickly; keep a toy with him to distract him Toddler (3-6 year olds) Nursing interventions: Explain procedures using simple, clear language (avoid medical jargon and terms that can be misinterpreted) Encourage independence by letting the child provide self-care Encourage expression of feelings Validate the child's fears and concerns Provide toys that allow for emotional expression (a pounding board to release feelings of protest) Provide consistency in assigning caregivers Give choices when possible (do you want your medicine in a cup or spoon?) Allow younger children to handle equipment if it is safe Provide play activities (drawing, painting) Educational and child-appropriate shows and videos; demonstrate a procedure before it is performed. using dolls or stuffed animals Maintain routine as much as possible Begin with least invasive parts of a physical exam then move to more intrusive areas.
Understand how to assess an 18-month child's independent gait.
WATCH THEM Gross Motor Skills at 18 months: -Runs clumsily; falls often -Can crawl/creep up stairs but needs assistance when climbing stairs upright -Throws a ball overhand -Jumps in place with both feet -Pulls and pushes toys By 15 months, they should be able to walk without help and creep up stairs (can crawl up stairs but needs assistance when climbing the stairs upright) Toddlers and young children: A bowlegged or knock-knee appearance is a common finding; feet should face forward while walking
Know how a 6-month-old infant expresses pain
Younger infant: Loud cry - increase their cry Rigid body or thrashing Local reflex withdrawal from pain stimulus Expressions of pain (eyes tightly closed, mouth open in a squares shape, eyebrows lowered and drawn together) Lack of association between stimulus and pain Older Infant: Loud cry Deliberate withdrawal from pain Facial expression of pain
A nurse in a pediatric clinic is talking with the mother of a preschool-age child. The mother tells the nurse that her son is a "picky eater." Which of the following instructions should the nurse include in the teaching? a) Have the child remain at the table after meals to increase food intake. b) Add fruit juice to the child's diet to increase vitamin intake. c) Emphasize the quantity, rather than the quality, of food consumed. d) Expect that food consumption might not decrease significantly.
d) Expect that food consumption might not decrease significantly. Food consumption varies and most preschool-age children consume an adequate quantity of food despite their fads and preferences.(Avoid prolonging time at table, which promotes overeating & poor nutrition habits; Fruit juice consumption should be limited; quality is more important than quantity)
