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STUDY GUIDE EXAM 1 ( 20 Questions; Ch 1-5) WEEK 4 Key Terms/Definitions: ● Regression - When a child reverts to an earlier developmental stage in response to stress, illness, or a significant change. ⇢ Ie. A potty-trained child having accidents, an older child reverting back to thumb-sucking when facing a stressful event like hospitalization or a family issue. ● Egocentrism - A child’s inability to see things from perspectives other than their own. Normal part of early childhood development especially seen in the preoperational stage in ages 2-7. ● Ritualism - The need for repetitive action or routines, often seen in children as a way to provide comfort/stability. Common in early childhood, particularly toddlers. ⇢ ie. Rome needing lamby to go to sleep ● Autonomy - Ability for a child to make independent decisions and take control over one’s actions. Promote autonomy by encouraging young children to make their own decisions to help develop a sense of independence and self-confidence. Important aspect of growth during toddlerhood (1-3) as they begin to explore their ability to do things on their own ⇢ ie. Feed themselves Sleep Patterns necessary for Health Growth and Development p. 17 Newborns 1-4 weeks 15-16 hrs/day; No recognizable sleep patterns established yet Infants < 1 year 14-15 hrs/day; 4-6 hrs at a time, 2-3 naps Toddlers 1-3 years 12-14 hrs/day; 9-10 at night, 1 long nap Preschoolers 3-6 years 10-12 hrs/day; At night, no nap by age 5 School Age 6-12 years 10-1 1 hrs/day; Occasional Nap Adolescents 13-19 years 8-10 hrs/day
Types and Different Families we have today Week 1 p.6- ● Nuclear - Traditional; consists of parents & their children (biological or adopted) ↳ Disadvantages: no extra support available during crisis ● Binuclear Family - Parents remarry and share custody of care of children; each parent and NEW spouses share custody of raising child in separate households ↳ Disadvantages: child may learn two sets of rules which can be challenging (ie. “At mom’s house I’m allowed to be on my phone at dinner time” aka Riley) ● Blended - Parents with a child/children from previous relationships who marry and live together aka “step family”. A blended family could provide emotional support & shared roles in household providing opportunities for family members to learn how to work together and find new ways to accomplish tasks (ie. A widow with a son remarries another person, a single parent remarries) ↳ Disadvantages: Financial responsibilities can be shared but also produce strain if support must be provided to previous spouse/children of either adult, or both ● Cohabitation - Two adults and child/children live together as a nuclear family while adults remain unmarried. Can provide emotional & financial support to members ↳ Disadvantage: Individual may feel uncomfortable with partner’s real or perceived lack of commitment ● Extended - “multigenerational”. Includes at least one parent; a child/children any combination of grandparents, aunts, uncles or cousins. The group provides support to the child. ↳ Disadvantage: Conflicts may arise about the roles; confusion on which adult makes the decisions for the child (ie. Alex & Kana’i) ● Single-Parent - Single parent living at home with child/children. On the rise due to divorce. Parent & child are each other’s source of support; can create close bonds. ↳ Disadvantages: Can strain/overwhelm the parent without support, financial constraints and childcare challenges, may lead to low self-esteem in parent ● Communal - Adults & their children choose to live with a group of people (not relatives) who become the extended family. Parent gives up the paternal role, and the leader of the group makes decisions for the child. Usually one of religious beliefs/social values. ↳ Disadvantage: tendency to provide medical care within group rather than seeking professional help
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Types of assessment tools and how they are used and what they tell you Pharmacokinetics Movement and action of drugs through body ⇢ie. PO tylenol: mouth→stomach→bloodstream→liver Pharmacodynamics Changes that the drug causes to the body. The pathophysiology of drugs ⇢ie. Tylenol; antipyretic to reduce fever & pain/inflammation *Note: Properties of medications (5) include: (p. 41 & slide 70; Wk2 concepts PPT)
- Absorption: how drug is absorbed and moved through bloodstream
- Distribution: How drug is distributed/transferred to other sites within body
- Protein binding capacity: measure of drug’s efficiency
- Metabolism: process of converting drug into a useful form
- Elimination: getting rid of drug from body APPT adolescents^ location^ intensity^ quality Eas
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● IM (ie. immunizations) 23g-25g ½ - 1” length needle
- Insert @90 degrees
- Don’t inject the gluteus muscle until the child learns to walk! (9-18mos) ● S.C/ SQ Route (ie. insulin) 25g-29g ½ -1” length needle (^3) 8 5 8
Sites: abdomen, lateral or posterior area of upper arm/thigh, upper ventrolateral dorsal area
- Grasp SC tissue with thumb & forefinger
- Insert @45 degree angle **Piaget’s Cognitive Development and Play Age Stage Intellectual Acts Birth to 2 Sensorimotor - Reflex activity thru simple, repetitive behaviors, to imitative behaviors:
- object permanence (develops 4- mo solidified at 8 mos; things are there even if you can’t see them),
- causality (cause & effect),
- spatial relationships (recognizing shapes & relation) 2 to 7 yrs. Preoperational - Egocentric (one point of view); Magical thinking;
- representational language (symbolic play; one thing can stand for something else),
- transductive reasoning (tendency to see connection between unrelated things ie. no nap = not afternoon yet) 7 to 11 yrs. Concrete operational
- More logical and coherent;
- Inductive reasoning (gather facts to come to conclusion)
- less self-centered; sort, order, classify
- No abstract thinking yet 12 to 20 yrs Formal operational
- Adaptable, flexible;
- thinks abstractly,
- forms logical conclusions,
- test hypotheses**
School-age 6 -12 yrs. Adolescence 13 – 19 yrs. Industry versus inferiority – ”I am what I learn” Identity vs Role Confusion “I know who I am” *Follows rules, group work; projects; peers; conservation. Obsessed with his looks; puberty; expectations of peers; social life Sexual Maturity in Females and Males (Tanner/Stages)p. 134- GIRLS - Stage 1: Only papilla (nipple) elevates, no pubic hair present Stage 2: When breast buds develop on females, straight hair on labia Stage 3: Entire breast enlarges (nipple doesn’t protrude), darker/curled/dense hair Stage 4: Breast enlarges, nipple & papilla protrude as secondary mound, pubic hair more adult in distribution Stage 5: The areola no longer appears separate from the breast, fully developed. Pubic hair may extend to the medial part of thighs
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*BOYS -
Stage 1: No pubic hair present Stage 2: Downy hair develops laterally, scrotum more textured, penis/testes may enlarge Stage 3: Hair extends across pubis, penis enlarges in length Stage 4: Hair more abundant and curls, scrotum darkens Stage 5: adult quality and pattern, hair extends to inner borders of thigh
- Tanner staging is the development of secondary sex characteristics occuring in an anticipated sequence and is divided into distinct stages (I-V) for both sexes.
- The timing is different for each individual, the sequence remains the same (breast buds then pubic hair/underarms, and menarche (11-14 yrs old). The ovaries present at birth remain inactive until puberty ● What is the first visible sign of sexual maturity in girls? Breast buds → body hair → pubic hair → underarms →menarche ● Boys? Genital development & pubic hair growth
- Hypothalamus produces gonadotropin-releasing hormone → triggers pituitary gland to produce follicle-stimulating hormone (FSH) & luteinizing hormone (LH) initiating the ovulation cycle for girls and testicular maturation and sperm production in boys (12-15yrs old)
Week 1 Ch.1 Introduction to Pediatric Nursing Empowering: allowing parents to maintain sense of control over their childs care Ie. Routine (bath care, etc). Enablement: Practices that help family members acquire skills necessary to meet needs of child Ie. Educating and having parents demonstrate technique for inhaler administration in asthmatic child 3 Organizations that outlines the scope & standards of pediatric nursing practice: ● ANA ● NAPNAP ● SPN Components of effective communication ● Touch ● Environment ● Physical proximity ● Listening ● Visual communication ● Tone of voice ● Body language ● Timing Morbidity: Number of people in population faced with a specific health problem at a particular point in time Ie. Children are most healthy in middle childhood d/t immune system (develop habits that influence health later in life). ➔ morbidity rates dropping for poliomyelitis & measles due to vaccines ➔ Most common cause of morbidity among children & adolescents (1-19yrs) is unintentional injury (drowning, MVA, firearms, poisoning) ➔ Most common cause of morbidity in Infants (<1yr) is congenital anomaly ( micronesian betel nut addiction, DM) Mortality: Number of deaths from a specific cause in a given year ➔ Accidents are the leading cause of death in ALL age groups (>1yrs) in the U.S. Parenting Styles:
Authoritarian or Dictatorial: Parents try to control child’s behaviors and attitudes through unquestioned rules and expectations Ie. “Do not run near the street because I said so!” Authoritative or Democratic: Parent’s direct child’s behavior by setting rules and explain reason for each rule Ie. “Do not run by the street because it is dangerous, there are cars driving and you may get hurt” Permissive or Laissez Faire: Parents exert little or no control Ie. *let’s child play near the street while calling out “be careful!” Guidelines for promoting healthy behavior in children: ❖ Set clear & realistic limits and expectations ❖ Validate child’s feelings & offer sympathetic explanations ❖ Provide role modeling & reinforcement for appropriate behavior ❖ Focus on behavior when disciplining Ch.1 Post Quiz:
- The phrase infant mortality rates refers to the: A. Number of children faced with any given health problem B. Number of infant deaths in any given year C. Nutritional health of population of infants D. Socioeconomic status of a population of infants
- A child is admitted for surgery. On your admission assessment, the mother tells you that her family is composed of herself, the patient (her daughter), her new husband, and her stepson. What type of family is this? A. Nuclear family B. Cohabitation family C. Blended family D. Foster family
- A five-year old is in the hospital after having an appendectomy. A full liquid diet is ordered for the child. A carbonated soda, chicken broth, milk, and ice cream are on the food tray. The mother states the child isn’t permitted to have these foods because she doesn’t allow sugar. Which action is the nurse’s best response? A. Explain that these are the only foods allowed after surgery B. Respect the mother’s wishes and remove the food C. Discuss the nutritional value of these foods are surgery D. Review with the mother what foods are allowed and include her in the menu selection
Theories of Development: ❖ Erikson’s Psychosocial Theory ❖ Freud Psychosexual (oral, anal, phallic, latency, genitalia) ❖ Piaget Cognitive Development (sensory, preoperational, concrete operational, formal operational) ❖ Kohlberg moral development ❖ Dewey “hands on approach” Ch. 2 Post Quiz:
- A 2-year-old can be expected to sleep A. 12-14 hrs/day, with most of it during the night and one long nap during the day B. 14-15 hrs/day, usually 4-6 hours at a time & 2-3 naps during the day C. 10-12 hours a day with no naps D. 8-10 hrs/day with one nap during the day
- According to Erikson’s theory of psychosocial development, a 7-year-old who enjoys working with others and helping his or her parents on weekend projects is in what stage? A. Autonomy vs. shame and doubt B. Initiative vs. guilt C. Industry vs. Inferiority D. Identity vs. role confusion
- The nurse is caring for a 5-year-old who is terminally ill. She recognizes at this age, the child: A. Has no concept of death whatsoever B. Knows the words “dead/death” but the concept of forever has no value C. Understands the universality and irreversibility of death D. has a an adult perception of death but is focused on the here and now Answers: (^2 )
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- A. A toddler can be expected to sleep 8-10 hrs/day mostly at night with a long nap during the day to equal 12-14 hrs
- C. Industry vs inferiority occurs from 6-12 yrs old. During this time the child enjoys being helpful and relationships become more important. Autonomy versus shame and doubt occurs through toddlerhood. Initiative vs guilt happens in 3-6 year olds, and identity vs. role confusion occurs during adolescence.
- At 5 years old they can’t grasp the concept of forever but do know words relating to death. As they mature, more concrete concepts of death occur. It isn’t until adolescence that the child has an adult perception of death yet they remain focused on the present Physical Assessment of Child ★ Start from least invasive to most (observation → checking ears) Observe: ● How is the child dressed? ● Personal hygiene? ● Is the child more frightened/fearful than expected? ● Are there body image concerns? ● What is the child’s psychological state? Eyes: Corneal light reflex & cover-uncover for strabismus and pseudostrabismus Cardiac Exam: Perform when child is calm
- Innocent heart murmurs are common (40% have them in childhood; often with fever, changes with positions, often disappearing when supine). Refer to doctor if heard.
- S1, S2 should be clear & crisp Respiratory: Perform when the child is calm, warm stethoscope before placement. Allow child to participate in exam and try it out Abdominal: Use distractions, or hand-over-hand technique. Infants & toddlers have protuberant stomachs. Older children is flat; celiac dx or cystic fibrosis can cause abdomen to be protuberant Musculoskeletal: observe with toys (blocks/crayons for fine motor, climbing, check for scoliosis esp during pre adolescent growth spurt (accentuated) Genitalia: Undescended testes = infertility problems (descends by one year or sooner) hypospadias = surgery. Clitoris enlarged/bruised = congenital adrenal hyperplasia or abuse. Hymen may or may not be intact dependant on sexual activity Ears:
Week 3 Ch. 3 Infancy ● Myelinization of neurons occur in cephalocaudal (head-to-toe) direction taking about 2 years (head control) All disappear^ by 6ms except
Babinski 12
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● Until 2 years old, height is measured in supine position from top of head to bottom of heel. By 1 year length will increase by 50% (1”/mo for the first 6mos, then ½”/mo for the next 6 mos) occurring in the trunk rather than legs ● Average infant will double their birth weight by 5mos, and triple it by 1 year ● Head circumference is measured as well. ● Be sure to assess both anterior (2x2e side while the opposite leg flecm closing at about 18 months) and posterior (1x1cm closing by 2 months) fontanel’s - it should be soft and flat. If it is bulging or tense indicates ↑ICP, while a sunken fontanelle indicates dehydration Ch. 3 Post Quiz:
- A social milestone that infants should acquire by ages 2-3 months is A. Grasping at objects B. Smiling C. Stranger anxiety D. Vocalizing “mama”
- Which finger food is appropriate for an 8-month-old infant? A. Cheerios B. Grapes C. Mixed nuts D. Raw carrot slice
- The best assessment of whether an infant is receiving enough formula or breast milk is if: A. Burps well B. Doesn’t cry after feeding C. Has six or more wet diapers a day D. Sleeps all night
- Which of these interventions decreases the risks of SIDS? A. Feeding infant in upright position B. Not giving a bottle in bed at night C. Putting an infant on their back to sleep D. Raising the head of crib Answers:
- B. Smiling is a social communication milestone that can be reached by 2-3 months
- A. Infants are developmentally ready to eat solids by age 6 months, when they can maintain their posture in an upright position to decrease risk of choking; cheerios are a good option
