Peds unit 3
What is a hydrocele and what education would be given to the parents?
- Hydrocele= fluid found in the sacral sac - i.e: A boy with hydrocele will have an enlarged scrotum that may decrease in size when he is lying down Education - Usually benign and self-limiting - Noted early in infancy and often resolves spontaneously by 1 year of age - If doesn't resolve on its own, refer the child to a urologist, as surgery may be indicated - Not associated with the development of infertility
What are the 4 techniques used to assess abdomen? What is the correct order?
1. Inspection: Inspect the abdomen for size, shape, and symmetry. The abdomen in the infant and toddler is rounded and protuberant until the abdominal musculature becomes well developed. Though rounded, the abdomen should not be distended (at any age). By adolescence, the stature is more erect and the abdomen begins to appear flat when standing and concave when supine. The thin skin of a young child may allow the visualization of superficial venous circulation across the abdomen. Inspect the abdomen for movement. At eye level with the abdomen, note abdomen and thorax movement occurring simultaneously. Visible peristaltic waves are abnormal and should be reported immediately. Inspect the newborn's umbilicus for color, bleeding, odor, and drainage. The umbilical stump should slowly dry, become black and hard, and fall away from the cutaneous navel by the end of the second week of life. Note drainage or granulation at the umbilical site indicating delayed drying of the umbilical stump. Inspect the umbilicus in older infants and young children for the presence of umbilical hernia. Because the umbilicus divides the rectus abdominis muscle, it is not uncommon to see an umbilical hernia protrude through and become larger when the infant or toddler strains or cries. This is a benign finding and will usually disappear as the abdomen becomes stronger. Adolescents may have jewelry piercing the umbilicus 2. Auscultation Auscultate the abdomen using the diaphragm or the bell of the stethoscope pressed firmly against the abdomen. Count the bowel sounds in each of the four quadrants for a full minute. Bowel sounds should be present by a few hours after birth and should remain active throughout life. Note whether bowel sounds are normally active, hyperactive, hypoactive, or absent. Normal bowel sounds can be described as growls, gurgles, and clicking sounds. Hypoactive bowel sounds may occur postoperatively. Hyperactive bowels sounds are common with diarrhea. Classify bowel sounds as absent after listening for 5 full minutes in each area. Absent bowel sounds may indicate ileus or peritonitis. 3. Percussion Indirectly percuss all areas of the abdomen. Normal findings include dullness along the costal margins and tympany over the remainder of the abdomen. A full bladder may yield dullness to percussion. 4. Palpation Palpate the abdomen with the child in a supine position. If the child's legs are small enough, the knees may be brought up with the nondominant hand to flex the hips and relax the abdomen. Palpate all four quadrants of the abdomen in a systematic fashion, first lightly and then deeply. Apply light pressure with the fingertips to perform light palpation, assessing for tenderness and muscle tone. Note skin turgor by gently elevating a piece of skin and allowing it to fall back into place. Perform deep palpation to assess the organs and any masses. Place one hand on top of the other and palpate from the lower quadrants to the upper. The edge of the liver may be felt at the right costal margin, and the tip of the spleen can be felt at the left costal margin. The descending colon may be felt in the left lower quadrant as a small column and the bladder as a soft balloon below the umbilicus. The kidneys are rarely palpable. The abdomen should be soft and nontender to palpation. Report firmness, tenderness, or masses. Palpate the inguinal area for the presence of hernia or enlarged lymph nodes.
Freud Latency
A time of tranquility between the Oedipal phase of early childhood and adolescence—focuses on activities that develop social and cognitive skills Develops social skills in relating to same-sex friends through joining clubs like Brownies, Girl Scouts, Boy Scouts
Priority focus for parents and nurses to provide adolescents to facilitate healthy lifestyles.
Adolescence is a time of rapid growth with dramatic changes in body size and proportions. The magnitude of these changes is second only to the growth in infancy. During this time sexual characteristics develop and reproductive maturity is achieved. The age of onset and the duration of the physiologic changes vary from individual to individual. Generally, girls enter puberty earlier (at 9 to 10 years of age) than boys (at 10 to 11 years). Adolescents will represent varying levels of identity formation and will offer unique challenges to the nurses.
Kohlberg (Conventional) Stage 3 Interpersonal conforming "good child, bad child" AGE 7-10
An act is wrong because it brings punishment Behavior is completely wrong or right Does not understand the reason behind rules
Food that are considered a good source of Iron.
Beef, chicken, fish Liver Peanut butter Nuts and seeds Green peas, lima beans Eggs Dark leafy vegetables such as spinach Strawberries Tomato juice Whole-grain bread Raisins Watermelon
Pre-operative plan of care for an infant with bladder exstrophy
Bladder exstrophy requires surgical repair. In the preoperative period, care is focused on protecting the exstrophied bladder and preventing infection. Keep the infant in a supine position; keep the bladder moist and cover it with a sterile plastic bag. Change soiled diapers immediately to prevent contamination of the bladder with feces. Sponge-bathe the infant rather than immersing him or her in water to prevent pathogens in the bath water from entering the bladder. Prevent breakdown of the surrounding abdominal skin by applying protective barrier creams. In some instances it may be necessary to consult the ostomy nurse for advice on dealing with the abdominal skin excoriation. If an orthopedic surgeon is involved due to the malformed pubic arch, follow through with recommended positioning or bracing to prevent further separation of the pubic arch.
What is a testicular torsion and what do you do if you suspected one?
In testicular torsion, a testicle is abnormally attached to the scrotum and twisted. It requires immediate attention because ischemia can result if the torsion is left untreated, leading to infertility. Testicular torsion may occur at any age but most commonly occurs in boys aged 12 to 18 years. Surgical correction is necessary immediately. Administer pain medication prior to surgery. Reassure the child and family that surgery will alleviate the problem and is performed to restore adequate blood flow to the testicle. After surgical repair, provide routine postoperative care.
What are signs of dehydration?
Mental status: comatos Fontanels: Mild- soft and flat, moderate/severe- sunken Eye: Sunken orbits Oral mucosa: dry Skin turgor: Decreased elasticity, tenting HR: INC Extremities: Cool, mottled, delayed cap refill Urine output: < 1 mL/kg/hr
Preparing a child for renal ultrasound what would you do as a nurse
No fasting is required prior to the procedure. Does not require contrast material. The child should feel no discomfort during the ultrasound. The only thing the nurse should due is apply a urine bag as follows: Cleanse the perineal area well and pat dry. If a culture is to be obtained, cleanse the genital area with povidone-iodine (Betadine) or per institutional protocol. Apply benzoin around the scrotum or the vulvar area to aid with urine bag adhesion. Allow the benzoin to dry. Apply the urine bag. For boys: Ensure that the penis is fully inside the bag; a portion of the scrotum may or may not be inside the bag, depending on scrotal size. For girls: Apply the narrow portion of the bag on the perineal space between the anal and vulvar areas first for best adhesion, and then spread the remaining adhesive section. Tuck the bag downward inside the diaper to discourage leaking. Check the bag frequently for urine
Cleft palate- can a mother breastfeed before and after surgery?
Postoperatively, some surgeons allow breastfeeding to be resumed almost immediately. However, the nurse needs to advise the mother to check with the surgeon to determine when breastfeeding can resume.
Tell about the benefits of circumcision.
The benefits of circumcision include: a decreased incidence of UTI decrease incidence of sexually transmitted diseases, AIDS, and penile cancer and in female partners a decreased occurrence of cervical cancer Whether to circumcise or not is a personal decision and often based on religious beliefs or social or cultural customs. Nurses should support and educate the parents in either case.
Teaching plan for an over-weight 7-year-old?
The school-age child's calorie needs vary based on age, gender, and activity level. In general, children with higher activity levels and male gender have higher calorie needs. Boys and girls 4 to 8 years old who are moderately active will need about 1,400 to 1,600 calories a day, Of these calories, 45% to 65% should come from carbohydrates, 10% to 30% from protein, and 25% to 35% from fat. The 4- to 8-year-old child needs 800 to 1,000 mg of calcium. Calcium is needed for the development of strong bones and teeth. Milk, yogurt, and cheese provide protein, vitamins, and minerals and are an excellent source of calcium. Meats, poultry, fish, and eggs provide protein, vitamins, and minerals.
List most common adolescent injuries.
Unintentional injuries are the leading causes of death in adolescents. Motor vehicle accidents are the leading cause of injury death followed by poisoning, which includes prescription drug overdose. Males are more likely than females to die of any type of injury. (refers more to death...) The largest numbers of adolescent injuries are due to motor vehicle crashes.
Education for parents who have to work and the 12 year child has to be home alone?
With the increasing incidence of both parents in the workforce and many children living with just one parent, often times, children return home alone without adult supervision for a number of hours. Most young children are not capable of handling stress or making decisions on their own before 11 or 12 years of age. However, some school-age children are more mature and can be left alone by 8 to 10 years of age; maturity is the key, not the age. Parents not only need to consider their child's maturity and readiness to be home alone but also must comply with legal requirements if present. Many States offer guidelines of when it is ok to leave a child at home alone and a few States have laws with a minimum age but these vary by State; therefore, the nurse needs to be familiar with the State and local laws in order to assist parents in making decisions about when it is appropriate for their child to be home alone. The AAP recommends that a school-age child come home to a parent or another responsible adult. Despite the level of maturity, children who are unsupervised are more likely to participate in risky behaviors such as smoking, drinking, and doing drugs. In addition, latchkey children may feel anxiety, stress, fear, boredom, loneliness, they miss more days of school, and have lower academic scores . If children come home to no supervision, they should know the names, addresses, and phone numbers of parents and a neighbor, as well as emergency numbers. They should be given rules about answering the door and the phone. They should tell anyone who comes to the door or who calls that mom is home but busy at this time. Directions as to the handling of the house key and fire safety should be taught and demonstrated
Education for Parents about Ostomy Surgery for their Child
"Arrange for the family to consult with a wound care nurse to help them deal with the anxieties and care of newly placed stomas." "Provide information about the diagnosis and the stages of surgical procedures the child will undergo. Provide postoperative teaching to educate parents on proper stoma care as well as medication management"
What are potential contributors to renal failure?
-Obstructive uropathy, recurrent UTI, renal insufficiency, and progressive damage to the kidney. -Hydronephrosis -Vesicoureteral Reflux ACQUIRED DISORDERS RESULTING IN ALTERED RENAL FUNCTION. -Nephrotic Syndrome - Acute post-streptococcal glomerulonephritis (APSGN) -Hemolytic-uremic syndrome (HUS) -Acute Renal Failure. has it's own heading and discussion, "In children, acute renal failure most commonly occurs as a result of decreased renal perfusion, as occurs in hypovolemic or septic shock. It may also occur in children with hemolytic anemia or as a result of nephrotoxicity from medications." However, I included the list above from. because those conditions specifically state that they can lead to renal failure
Teaching plan for parents on a 9 year old on socialization
Continuous peer relationships provide the most important social interaction for school-age children. Peer and peer-group identification are most essential to the socialization of the school-age child.
What questions could you ask of an 8-year-old when assessing gross motor skills?
Do you know how to ride a bicycle, skate, and/or swim? Can you jump rope without losing your balance? Can you catch a small ball using hands only? Can you hop on one foot?
What are the physical characteristics of a 15 year old boy?
Height for adolescent boys who are between the 50th and 95th percentile ranges from 132 cm (52½ inches) to 176.8 cm (69½ inches). Weight of boys in these percentiles ranges from 35.3 kg (77¼ lb) to 95.76 kg (211 lb). On average, boys will gain 10 to 30 cm (4 to 12 inches) in height and 7 to 30 kg (15 to 65 lb) in weight.
Education prior to endoscopy?
Lower endoscopy (colonoscopy): Explain the following: The child must undergo a bowel cleansing prior to the examination. Encourage fluids to prevent dehydration. Conscious sedation or anesthesia care; monitor for possible complications of perforation, bleeding, and increased abdominal pain. Upper endoscopy (EGD): Explain the following: Conscious sedation or anesthesia care; monitor for complications of perforation/bleeding.
How would you expect a 7 year old to act in a regular check up?
School-age children fear being kidnapped or undergoing surgery. They fear death and are fascinated by death and dying. The school-age child needs reassurance that his or her fears are normal for this age. Teach the child coping strategies such as positive self-statements such as "I can do this" and relaxation techniques such as deep breathing and visualization. They are interested at this age about how things are made and work. They love to achieve things. They should be improving in coordination, balance, and rhythm; they enjoy activities like biking, skating, and swimming. Should have 20/20 visual acuity. They tend to imitate parents, teachers, and others
Kohlberg's conventional stage of moral development what motivation for school-age children to follow rules?
moral development places the older toddler in the preconventional level. The toddler is only just beginning to learn right from wrong and does not understand the larger concept of morality. The toddler will base his or her actions on the avoidance of punishment and the attainment of pleasure. Older toddlers begin to feel empathy for others.
What are peer groups and how can they effect children? List positive and negative
A child's friends can have a major influence, positive or negative, on his or her growth and development. Peer group relationships often begin early and are a large part of the child's world, particularly with school-age children and adolescents. This influence starts in playgroups in preschool or elementary school. The child is confronted with a variety of values and belief systems from interactions with his or her friends. To be accepted, the child must conform to the specific values and beliefs of the group. When these values and beliefs differ from those of the adults in the child's world, conflicts can occur, possibly separating children from the adults and strengthening their sense of belonging to the peer group. When the child's friends are successful in school or other activities, the growth and development of the child continues in a healthy and positive way. When these groups demonstrate healthy behaviors, the influence is very positive; but peer groups can also exert negative influences on the child. Thus, it is vital to identify the important peer groups in a child's life and the positive or negative behaviors connected with these groups.
Risk factors for acute post-streptococcal glomerulonephritis
Acute post-streptococcal glomerulonephritis (APSGN) is a condition in which immune processes injure the glomeruli. Immune mechanisms cause inflammation, which results in altered glomerular structure and function in both kidneys. It often occurs following an infection, usually an upper respiratory or skin infection. APSGN is caused by an antibody-antigen reaction secondary to an infection with a nephritogenic strain of group A β-hemolytic streptococcus. APSGN occurs more frequently in males than females and more frequently between the ages of 5 and 12 years. Assess the child's current and past medical history for risk factors such as a recent episode of pharyngitis or other streptococcal infection, age older than 2 years, or male sex.
What would you assess with Acute Poststreptococcal Glomerulonephritis?
Acute post-streptococcal glomerulonephritis (APSGN) is a condition in which immune processes injure the glomeruli. Immune mechanisms cause inflammation, which results in altered glomerular structure and function in both kidneys. It often occurs following an infection, usually an upper respiratory or skin infection. APSGN is caused by an antibody-antigen reaction secondary to an infection with a nephritogenic strain of group A β-hemolytic streptococcus. APSGN occurs more frequently in males than females and more frequently between the ages of 5 and 12 years. The most serious complication is progression to uremia and renal failure (either acute or chronic). There is no specific medical treatment for APSGN. Treatment is aimed at maintaining fluid volume and managing hypertension. If there is evidence of a current streptococcal infection, antibiotic therapy will be necessary. NURSING ASSESSMENT For a full description of the assessment phase of the nursing process, refer to the Assessment section of the Nursing Process Overview earlier in the chapter. Assessment findings pertinent to acute glomerulonephritis are discussed below. Health History. Elicit a description of the present illness and chief complaint. Common signs and symptoms reported during the health history might include: Fever Lethargy Headache Decreased urine output Abdominal pain Vomiting Anorexia Assess the child's current and past medical history for risk factors such as a recent episode of pharyngitis or other streptococcal infection, age older than 2 years, or male sex. Physical Examination and Laboratory and Diagnostic Tests. Assess the child's blood pressure for elevation, which is common. Note the presence of mild edema. Observe for signs of cardiopulmonary congestion such as increased work of breathing or cough. Auscultate the lungs for crackles and the heart for gallop. The urine dipstick test will reveal proteinuria as well as hematuria. Inspect the urine for gross hematuria, which will cause the urine to appear tea colored, cola colored, or even a dirty green color. Serum creatinine and BUN may be normal or elevated, the serum complement level is depressed, and the erythrocyte sedimentation rate is elevated. Laboratory findings specific to streptococcus include an elevated antistreptolysin O (ASO) titer and an elevated DNAase B antigen titer.
What are characteristics of Crohn disease?
Age at onset10-20 yearsIncidence4-6 per 100,000Area of bowel affectedOropharynx, esophagus, and stomach, rare: small bowel only, 25-30%; colon and anus only, 25%; ileocolitis, 40%; diffuse disease, 5%DistributionSegmental; disease-free skip areas commonPathologyFull-thickness, acute, and chronic inflammation; noncaseating granulomas (50%), extraintestinal fistulas, abscesses, stricture, and fibrosis may be presentRadiography findingsSegmental lesions; thickened, circular folds; cobblestone appearance of bowel wall secondary to longitudinal ulcers and transverse fissures; fixation and separation of loops; narrowed lumen; "sting sign"; fistulasIntestinal symptomsAbdominal pain, diarrhea (usually loose with blood if colon involved), perianal disease, enteroenteric or enterocutaneous fistula, abscess, anorexiaLaboratory findingsHigh erythrocyte sedimentation rate; microcytic anemia; low serum iron and total iron-binding capacity; increased fecal protein loss; low serum albumin; antineutrophil cytoplasmic antibodies present in 10-20%; Saccharomyces cerevisiae antibodies positive in 60%
What is IBS plus signs/symptoms
All of the following occur least once per week minimum for at least 2 months before diagnosis: Abdominal pain relieved 25% of the time by defecation Onset of discomfort associated with a change in frequency of stool Onset of discomfort associated with a change in appearance of the stool No structural, neoplastic, inflammatory, or metabolic explanation for this abdominal pain.
What is amblyopia?
Amblyopia refers to poor visual development in the otherwise structurally normal eye. It develops within the first decade of life and, if left untreated, is the most common cause of vision loss in children and young adults. Amblyopia occurs in about 1% to 4% of children. The vision in one eye is reduced because the eye and the brain are not working together properly. While the eyes are fighting to focus differently because of their differences in visual acuity, one eye is stronger than the other. This is why amblyopia is often referred to as "lazy eye." Amblyopia may be caused by any disorder that affects normal visual development, including strabismus and differences in visual acuity or astigmatism between the two eyes. It may also result from eye trauma, ptosis, or cataract. If untreated, children with amblyopia will have worsening acuity of the poorer eye and strain in the better eye, which may also lead to worsening of acuity in that eye. Eventually blindness will result in one or both eyes. Therapeutic management of amblyopia focuses on strengthening the weaker eye. This may be achieved through patching for several hours per day, using atropine drops in the better eye (once daily), vision therapy, or eye muscle surgery if the cause is strabismus.
Developmental concerns of bullying
Bullying, which is inflicting unwanted, repeated verbal, emotional, or physical abuse upon others, is on the rise. Utilizing email, text messages, social networking, and instant messaging, often referred to as cyberbullying, is a growing concern. Bullies often look for victims who appear shy, weak, and defenseless. Children with health issues, such as disabilities, obesity, and food allergies, are at an increased risk of being bullied. Bullying in School Children Children who bully most often have low self-esteem, poor grades, and poor interpersonal skills. Both boys and girls are bullied but boys tend to bully other boys and more often show force when bullying. In general, about 10% of all children attending school are frightened and afraid most of the day. About 25% of children have been bullied. Most of the bullying occurs at school. Both boys and girls are bullied and can bully others; however, boys are twice as likely to be bullies and victims of bullying. Being bullied can have negative results on children throughout life. These children often have increased episodes of headaches, stomachaches, sleep problems, anxiety, loneliness, depression, and suicidal tendencies. After the problem of either being bullied or being the bully has been identified, parents must work with the child, the school, and the physician or nurse practitioner to solve the problem
What labs would you expect for pancreatitis?
Common laboratory studies ordered for the assessment and monitoring of pancreatitis include: Serum amylase and/or lipase: levels three times the normal values are extremely indicative of pancreatitis Liver profile: often done to check for increased liver functions and/or bilirubin levels Blood work: leukocytosis is common with acute pancreatitis. Hyperglycemia and hypocalcemia may also be noted. C-reactive protein: levels may be elevated
Most important aspect of social interaction for school age children? Page
Continuous peer relationships provide the most important social interaction for school-age children. Valuable lessons are learned from interactions with children of their own age. Children learn to respect differing points of view that are represented in their groups. Peer groups establish norms and standards that signify acceptance or rejection. Children may modify behavior to gain acceptance. A characteristic of school-age children is their formation of groups with rules and values. Peer and peer-group identification are important to the socialization of the school-age child.
What assessment of the stool would you find with a patient with intussusception?
Diarrhea, currant-jelly stools, gross blood, or hemoccult-positive stools.
Education for parents about 10-year-old stealing.
Discuss ways to teach concept of ownership and property rights Handle situation openly Assist child in developing and enacting a plan to return what was stolen Make sure the punishment is appropriate for the action By the age of 9, the child should respect others' possessions and property and understand that stealing is wrong. The school-age child may steal because he or she desires the item, feels peer pressure and is trying to impress his or her peers, or has a sense of low self-esteem Stealing becomes a concern if the child steals and does not have remorse or steals continuously, or if stealing is accompanied by other behavior problems. In dealing with children who exhibit stealing, lying, or cheating behaviors, parents must first realize the importance of their own behaviors in those areas. Secondly, parents must directly confront any stealing, lying, or cheating behaviors and discuss (and follow through consistently with) the consequences of such behaviors .
Teaching plan to help avoid UTIs
Drink enough fluid (to keep urine flushed through bladder). Drink cranberry juice to acidify the urine. Avoid colas and caffeine, which irritate the bladder. Urinate frequently and do not "hold" urine (to discourage urinary stasis). Avoid bubble baths (they contribute to vulvar and perineal irritation). Wipe from front to back after voiding (to avoid contaminating the urethra with rectal material). Wear cotton underwear (to decrease the incidence of perineal irritation). Avoid wearing tight jeans or pants. Wash the perineal area daily with soap and water. While menstruating, change sanitary pads frequently to discourage bacterial growth. Void immediately after sexual intercourse.
Assessment of 17 year old girl, what would alert the nurse of developmental delay?
Early Adolescence (10-13 years)Pubic hair begins to curl and spread over mons pubis; Genitalia pigmentation increasesBreast bud and areola continue to enlarge; No separation of breastsFirst menstrual period (average 12 years, normal range 9-16 years) Middle Adolescence (14-16 years)Pubic hair becomes coarse in texture and continues to curl; amount of hair increasesAreola and papilla separate from the contour of the breast to form a secondary mound Late Adolescence (17-20 years)Mature pubic hair distribution and coarseness Height and weight.Height for girls who are between the 50th and 95th percentile ranges from 144.8 cm (57 inches) to 173.6 cm (68½ inches)Weight ranging from 27.24 kg (60 lb) to 82.47 kg (181 lb)On average, girls will gain 5 to 20 cm (2 to 8 inches) in height and 7 to 25 kg (15 to 55 lb) in weight during adolescence
Appearance of 10 year old you document breast buds what stage is she at?
Early adolescence Early adolescence spans age 10-13 years. In females this involves: Pubic hair begins to curl and spread over mons pubis; genitalia pigmentation increases Breast bud and areola continue to enlarge; no separation of breasts First menstrual period (average 12 years, normal range 9-16 years)
14-16 sexual and birth control education what will help influence this age group the most:
Encourage adolescents to postpone sexual intercourse for as long as possible, but explain the need to use barrier methods, such as male and female condoms, if they choose to have sexual intercourse. For teens who have already had sexual intercourse, encourage abstinence at this point. Also encourage them to minimize their lifetime number of sexual partners, to use barrier methods consistently and correctly, and to be aware of the connection between drug and alcohol use and sexual activity.
Explain and give example of Erikson's stage industry versus inferiority.
Erikson describes the task of the school-age years to be a sense of industry versus inferiority. During this time, the child is developing his or her sense of self-worth by becoming involved in multiple activities at home, at school, and in the community, which develops his or her cognitive and social skills. The child is very interested in learning how things are made and work. The school-age child's satisfaction from achieving success in developing new skills leads him or her to an increased sense of self-worth and level of competence. It is the role of the parents, teachers, coaches, and nurses of the school-age child to identify areas of competency and to build on the child's successful experiences to promote mastery, success, and self-esteem. If the expectations of adults are set too high, the child will develop a sense of inferiority and incompetence that can affect all aspects of his or her life. Example of industry: The child was praised for getting a A+ on a math test that he worked hard studying for. Example of inferiority: The parents scolded their child because he got a B+ on a math test instead of getting an A.
Erickson's development theory for adolescent what is it and give example of each
He believed that teenagers achieve a sense of identity. During the task of developing his or her own sense of identity, the adolescent revisits each of the previous stages of development. Examples: The sense of trust is encountered as the adolescent strives to find out whom and what ideals he or she can have faith in. In revisiting the stage of autonomy, the adolescent is seeking out ways to express his or her individuality in an effective manner. The adolescent would avoid behaviors that would "shame" or ridicule him or her in front of his or her peers. The sense of initiative is revisited as the adolescent develops his or her vision for what he or she might become. And the sense of industry is again encountered as the adolescent makes his or her choice to participate in different activities at school, in the community, at church, and in the workforce. The ability of the adolescent to successfully form a sense of self is dependent upon how well the adolescent successfully completed the former stages of development. Erikson (1963) believed that if the adolescent has been successful, he or she can develop resources during adolescence to overcome any gaps in previous developmental stages. If the adolescent believes that he or she cannot express himself or herself in any manner due to societal restrictions, he or she will develop role confusion.
Kohlberg Stage 4: "Law and order" AGE 10-12
If child and adult differ in opinions, the adult is right Can put self in another person's position Begins to exercise the "golden rule" Acts are judged in terms of intention, not just punishment
A 4 year old is ordered to do incentive spirometry after surgery. What other things could you have the child do if unable to use the IS?
In a child who's not developmentally able to use an incentive spirometer: Play games to encourage deep breathing (blow out penlight, blow cotton ball across bedside table with straw, etc.): children are more likely to cooperate with interventions if play is involved. Demonstrate/encourage use of pillow splinting with coughing to decrease abdominal pain and stress on incision. Also use early ambulation and leg exercises.
Physical Exam on a 11 year old girl what would you expect to find?
In later school-age years, most girls begin to surpass boys in both height and weight (pg. 154) She will be between 60-130 lbs, 52-62 inches tall, BMI 14.4-24.
Need a urine sample from a 4 year old how do you go about getting one.
Infants and toddlers who are not toilet trained may require a urine bag for urine collection. A sterile urine bag is required for a urine culture, a clean bag for routine urinalysis. A 24-hour urine collection bag is also available. Applying The Urine Bag Cleanse the perineal area well and pat dry. If a culture is to be obtained, cleanse the genital area with povidone-iodine (Betadine) or per institutional protocol. Apply benzoin around the scrotum or the vulvar area to aid with urine bag adhesion. Allow the benzoin to dry. Apply the urine bag.For boys: Ensure that the penis is fully inside the bag; a portion of the scrotum may or may not be inside the bag, depending on scrotal size.For girls: Apply the narrow portion of the bag on the perineal space between the anal and vulvar areas first for best adhesion, and then spread the remaining adhesive section. Tuck the bag downward inside the diaper to discourage leaking. Check the bag frequently for urine
Drug and alcohol education for school age children
Inquire about tobacco and alcohol use Discuss the physical and social dangers of tobacco and alcohol use Urge parents to be good role models Limit reading and media materials about alcohol and tobacco use Discuss the influences of tobacco and alcohol use by peers Educate the child on spit tobacco. Let them know it is just as dangerous as smoking tobacco Advocate for a smoke-free environment in the home and other places frequented Avoid having tobacco and alcohol products readily available in the home What alcohol and drugs are like and how they harm you Differences in medical use versus illegal use of drugs How to think critically to interpret messages seen in advertising, media, sports, and entertainment personalities
What is the education provided to parents/child for a barium swallow/upper GI:
Instruct the patient to fast after midnight the night before the test. Describe the milkshake consistency and chalky taste of the barium preparation and that it may be unpleasant to swallow. Explain that the patient will be placed in various positions on a tilting X-ray table and that X-rays will be taken. The test visualizes the form, position, mucosal folds, peristaltic activity, and motility of the esophagus, stomach, and upper GI tract Females of reproductive age must be screened for pregnancy. Infants may need to be given barium via syringe.
What teen would a nurse anticipate screening for hypertension
It is important for the nurse to recognize the ethnic background of each adolescent. Research has shown that certain ethnic groups are at higher risk for certain diseases. For example, adolescent African Americans are at higher risk for developing hypertension. The prevalence of obesity is highest in Hispanic males and African American females between the ages of 12 and 19 years. This increase in obesity in adolescents has led to increases in hypertension, heart disease, and type 2 diabetes.
What are the major barriers to health of adolescents?
It is important for the nurse to recognize the ethnic background of each adolescent. Research has shown that certain ethnic groups are at higher risk for certain diseases. For example, adolescent African Americans are at higher risk for developing hypertension. But the major barrier to the adolescent's health and successful achievement of the tasks of adolescence is socioeconomic status. Adolescents at a lower socioeconomic level are at higher risk for developing health care problems and risk-taking behaviors; this may be due to their inability to access health care and to obtain needed services. In caring for adolescents, recognize the influence of their culture, ethnicity, and socioeconomic level upon them.
What information can you give a parent who's child is afraid of going to school?
It is important to investigate specific causes of school refusal/school phobia and take appropriate actions. Many times, school phobia is a symptom of deeper problems. The physician or nurse practitioner should conduct a physical examination of the child to rule out any physical illness. After these measures are taken, the parent, teacher, school counselor, and school administrator may devise a plan to assist the student to overcome a specific fear. In uncomplicated cases, parents must return the child to school as soon as possible. There may be altered schedules (partial days or decreased hours) to help promote a successful transition back to school. Another idea to help desensitize the child may be to have him or her spend part of the day in the counselor's or school nurse's office.
How does media affect school age children?
Limit total screen time, which includes television watching, video game playing, and internet-connected devices to 1 to 2 hours per day. Children 8 to 10 years of age in the United States spend about 4 hours a day either watching TV or playing video games. During that time, a child by the age of 18 will see 200,000 violent acts.Although a school-age child can determine what is real from what is fantasy, research has shown that this amount of time in front of a screen—watching it or playing video games—can lead to aggressive behavior, less physical activity, and obesity Parents should set limits on how much screen time the child can have. The AAP recommends 2 hours or less of screen time per day.
What interventions can you provide a one year old that has rotavirus and is dehydrated?
Maintain IV line and administer IV fluid as ordered to maintain fluid volume. Offer small amounts of oral rehydration solution frequently to maintain fluid volume. Small amounts are usually well tolerated by children with diarrhea and vomiting. When symptoms have lessened or resolved, reintroduce regular diet to reduce number of stools, provide adequate nutrition, and shorten duration of effects of illness. Avoid high-carbohydrate fluids such as Kool-aid and fruit juice, as they are low in electrolytes, and increased simple carbohydrate consumption can decrease stool transit time. Assess hydration status (skin turgor, oral mucosa, presence of tears) every 4 to 8 hours to evaluate maintenance of adequate fluid volume. Assess adequacy of urine output to assess end-organ perfusion. Maintain strict intake and output record and weigh child daily to evaluate effectiveness of rehydration. Weigh child daily: accurate weight is one of the best indicators of fluid volume status in children. Discourage milk products and fluids that contain high levels of sugar during the acute phase of illness, as these products may worsen diarrhea.
Please list the steps in enema administration.
Make sure you have all of the items that you will need. Place them on a clean surface nearby.Enema solutionEnema bag and tubeWater-based lubricant like KY JellyA tissue or cloth Check the drug.Read the label to make sure that you have the correct drug.Make sure you have the right dose. Check the amount of drug against what the doctor ordered.Check the expiration date. Do not use it if it is expired. Get the drug ready to give.Some enema solutions come in a pre-filled container.For others, the doctor will ask you to make the solution at home. Then you will need to fill the enema bag with the right amount of solution for your age. Wash your hands with warm, soapy water before you begin. Some people prefer to use a glove, plastic wrap, or finger cot to protect their fingers when giving an enema. What happens during the procedure? Lie down on your side.If you are right handed, lie on your left side.If you are left handed, lie on your right side. Raise your top knee toward your chin. Pre Filled enema bottle Coat the tip of the bottle with the lubricating jelly. Gently push the end of the enema bottle into your rectum. For children, this is about 11/2 to 2 inches (3.75 to 5 cm). For adults, this is about 2 to 3 inches (5 to 7.5 cm). Gently squeeze the contents of the bottle into the rectum. Remove the enema bottle. If possible, wait to have a bowel movement until you have a strong feeling of needing to go. Try to wait at least 5 to 10 minutes. Enema bag and tube Coat the tip of the tube with the lubricating jelly. Gently push the end of the tube into your rectum. For children, this is about 11/2 to 2 inches (3.75 to 5 cm). For adults, this is about 2 to 3 inches (5 to 7.5 cm). Open the clamp and let the fluid flow by gravity into your rectum. Keep the bag 1 to 2 feet (0.3 to 0.6 meters) above your hips. If you start to have cramps in your stomach, lower the bag a little. The enema fluid should flow into your rectum over about 5 to 10 minutes. Remove the enema tube. If possible, wait to have a bowel movement until you have a strong feeling of needing to go. Try to wait at least 5 to 10 minutes. What happens after the procedure? If the enema bottle is disposable, throw it away. If it is reusable, wash with hot soapy water. You may want to also boil the tubing to sterilize it. Wash your hands to remove any drug that may be on them
What would you expect to find on a 10 year old for concrete thinking?
Piaget's stage of cognitive development for the 7- to 11-year-old is the period of concrete operational thoughts. In developing concrete operations, the child is able to assimilate and coordinate information about his or her world from different dimensions. The child is able to see things from another person's point of view and think through an action, anticipating its consequences and the possibility of having to rethink the action. He or she is able to use stored memories of past experiences to evaluate and interpret present situations. The school-age child also develops the ability to classify or divide things into different sets and to identify their relationships to each other. The school-age child is able to classify members of four generations on a family tree vertically and horizontally, and at the same time see that one person can be a father, son, uncle, and grandson. It is at this time that the school-age child develops an interest in collecting objects. The child starts out collecting multiple objects and becomes more selective as he or she gets older. Also, during concrete operational thinking, the school-age child develops an understanding of the principle of conservation—that matter does not change when its form changes. For example, if the child pours a half cup of water into a short, wide glass and into a tall, thin glass, she still only has a half cup of water despite the fact that it looks like the tall, thin glass has more She learns about conserving matter in a sequence ranging from the simplest to the more complex. further information about cognitive development of school-age children. Piaget Concrete operational Learns by manipulating concrete objects Lacks ability to think abstractly Learns that certain characteristics of objects remain constant Understands concepts of time Engages in serial ordering, addition, subtraction Classifies or groups objects by their common elements Understands relationships among objects Starts collections of items Can reverse thought process
Post-surgical care for hypospadias repair
Postoperatively, assess urinary drainage from the urethral stent or drainage tube, which allows for discharge of urine without stress along the surgical site. Ensure that the urinary drainage tube remains carefully taped with the penis in an upright position to prevent stress on the urethral incision. The penile dressing is usually a compression type, used to decrease edema and bruising. Administer antibiotics if prescribed. Assess for pain, which is usually not extensive, and administer analgesics or antispasmodics (oral oxybutynin or B & O suppository) as needed for bladder spasms. Bladder spasms may also be managed effectively through the use of epidural analgesia. If the child is to be discharged with the urinary catheter in place (which is common), teach the parents how to care for the catheter and drainage system. Have parents demonstrate their ability to irrigate the catheter should a mucus plug occur. Tub baths are generally prohibited until it is time to remove the penile dressing. Roughhousing, ride-on toys, or any activity involving straddling is not allowed for 2 to 3 weeks.
Pt had renal transplant and is on cyclosporine what complication should the nurse teach parents to watch out for?
Preventing Rejection and Promoting Renal Function. Administer immunosuppressants accurately and in a timely fashion. Obtain and monitor serum levels of these medications per protocol. Immediately report significant alterations in vital signs or edema at the surgical site, as they may indicate transplant rejection. Maintain strict documentation of intake and output. Once adequate urine output is established, intake is usually liberalized. Educating the Child and Family. Develop a schedule to cluster care so that the child may receive the rest needed for recovery despite the many and frequent assessments and interventions. With the family, develop a medication schedule that will be compatible with the family's life at home as well as the restrictions related to some medications. Begin teaching with the family as soon as the child's condition is stable. Accurate medication administration and home monitoring are necessary to prevent rejection. The child may return to school when discharged from the hospital, but the family will need to communicate closely with the school nurse about the child's immunosuppressed status. The American Nephrology Nurses Association has developed a renal transplant fact sheet that can be shared with the school nurse. A link to the association's website is located on . Take Note! Tell the parents to inform their child's physician or nurse practitioner about the child's long-term corticosteroid use and/or immunosuppressed status, as the child should not receive any live vaccines.
Teaching plan for celiac disease
Providing child and family education is the key nursing role in managing children with celiac disease. The child must adhere to a strict gluten-free diet for his or her entire life. This is often very challenging, because gluten is found in most wheat products, rye, barley, and possibly oats. Encourage the parents and child to maintain this gluten-free diet. Often, families consult a dietitian to learn about the gluten-free diet. Provide educational materials and resources to the parents. Many resources are available today about celiac disease because it is becoming more commonly diagnosed. Links to several resources are located on . These resources can offer information on all aspects of celiac disease, including dietary guidelines and resources for food shopping and eating in restaurants.
What are the physical characteristics of a 15 year old girl?
Pubic hair becomes coarse in texture and continues to curl; amount of hair increases. Areola and papilla separate from the contour of the breast to form a secondary mound.
13 year old male what physical qualities would you expect?
Pubic hair spreads laterally, begins to curl; pigmentation increases Growth and enlargement of testes in scrotum (scrotum reddish in color) and continued lengthening of penis Leggy look due to extremities growing faster than the trunk Testosterone increases Height for adolescent boys who are between the 50th and 95th percentile ranges from 132 cm (52½ inches) to 176.8 cm (69½ inches). Weight of boys in these percentiles ranges from 35.3 kg (77¼ lb) to 95.76 kg (211 lb). On average, boys will gain 10 to 30 cm (4 to 12 inches) in height and 7 to 30 kg (15 to 65 lb) in weight.
What is self concept and self-esteem? Which is more important to a teenager?
Self-concept and self-esteem are often tied to body image. Adolescents who perceive their body as being different than peers or as less than ideal may view themselves negatively. Adolescent girls often are influenced by peers and the media and want to weigh less and have smaller hips, waist, or thighs. Boys tend to view themselves as being too thin or not muscular enough. Sexual characteristics are important to the adolescent's self-concept and body image. Boys are concerned about the size of their penis and facial hair while girls are concerned about breast size and the onset of menstruation. Larger breasts are considered more feminine and menstruation is considered the right of passage into adulthood. All of these body changes are important to the adolescent's self-concept.
How do you prevent vulvovaginitis?
Teach appropriate hygiene (daily and toileting). Girls (or their parents) should wash the genital area thoroughly on a daily basis with mild soap and water. Rinse the area well. Encourage girls to wipe after urinating and after bowel movements to wipe in a front-to-back motion. The girl should wear cotton underwear and should change it at least once a day.
Promoting reading at home for an 8 year old
The school-age child learns to read and reading efficiency improves language skills. Reading skills are improved with increased reading exposure. School-age children begin to use more complex grammatical forms such as plurals and pronouns.
Why are girls at a higher risk for UTI then boys?
UTI occurs most often as a result of bacteria ascending to the bladder via the urethra. About 8% of girls and 2% of boys will experience at least one UTI during childhood. One explanation for the more common occurrence in females is that the female's shorter urethra allows bacteria to have easier access to the bladder. The urethra is also located quite close to the vagina and anus in females, allowing spread of bacteria from those areas. The sexually active female adolescent is at risk for the development of UTI, as bacteria may be forced into the urethra by pressure from intercourse. The adolescent male may be somewhat protected from UTI by the antibacterial properties of prostate secretions.
Factors for adolescent injuries?
Unintentional injuries are the leading causes of death in adolescents. Motor vehicle accidents are the leading cause of injury death followed by poisoning, which includes prescription drug overdose. Males are more likely than females to die of any type of injury. Influencing factors related to the prevalence of adolescent injuries include increased physical growth, insufficient psychomotor coordination for the task, abundance of energy, impulsivity, peer pressure, and inexperience. Impulsivity, inexperience, and peer pressure may place the teen in a vulnerable situation between knowing what is right and wanting to impress peers. On the other hand, teens have a feeling of invulnerability, which may contribute to negative outcomes. Alcohol and other drugs are contributing factors in automobile and firearm accidents among adolescents.
End-stage renal disease why is erythropoietin given?
Uremic toxins deplete erythrocytes and the failing kidneys cannot produce erythropoietin and causes severe anemia. Erythropoietin injections are given to stimulate red blood cell growth.
Lab results for a patient with nephrotic syndrome:
Urine dipstick will reveal marked proteinuria. Infrequently, mild hematuria is also present. Serum protein and albumin levels will be low (often markedly so). Serum cholesterol and triglyceride levels are elevated. With continued nephrotic syndrome, creatinine and BUN may become elevated.
