Peds ATI Nursing Care of Children Study Guide Part 1

Care of the Child ATI Chapter 1 Parenting styles: § § § § Dictatorial or authoritarian o Super strict parents, it’s their way or the highway o Parents try to control their child’s behaviors through unquestioned rules or expectations o Ex. the child is never allowed to watch tv on a school night Permissive o Very laid back, allow children to set their rules o Parents exert very little control over their child’s behaviors; consult the child when making decisions o Ex. the child assists in deciding whether or not they can watch tv on a school night Democratic or authoritative o Right in the middle, not too strict but also not too permissive o Parents direct the child’s behaviors by setting rules and explain the reason behind them o Parents negatively reinforce deviations from the rules and may do so by taking privileges away o Ex. the child can watch tv for 1 hour on school nights as long as their homework is done Passive parents o Do not care what is going on, don’t even consult with the children. Uninvolved, indifferent or emotionally removed Chapter 2 Physical Assessment Findings § § § § § § § § Pediatric vital signs differ from an adult’s, except for blood pressure. Temperature of a one year old is 99.9 degrees Not until 5 years old when they begin to have a normal temperature of 98.6 Pulse rate for an infant is 80-180 with respirations of 30-35 Infant bp systolic is between 65-80 and their diastolic is between 40 & 50 The fontanels* o Should be flat and soft o Posterior: closes between 6 & 8 weeks o Anterior closes between 12 & 18 months Infant can have 6-8 teeth by one year of age There will be 20 deciduous teeth and 32 permeant teeth § § Reflexes* o Moro reflex: present from birth to four months. Allowing the head and trunk of the infant to fall backwards. The arms and legs symmetrically extend and abduct, and fingers form a C shape. o Rooting: stroking the infant’s cheek or edge of mouth causes the infant to turn their head to that side and suck. Birth to 4 months. o Palmar grasp: placing an object in the infant’s palm and the infant grasps the object. Birth to 3 months. o Plantar: by touching the sole of the infant’s foot the toes curl downward. Birth to 8 months. o Startle: by making a loud noise the infant abducts arms and hands remained clenched. Birth to 4 months. o Tonic neck: by turning the infants head to one side the infant will extend the arm and leg on that side and flex the opposite side. Birth to 3-4 months. o Babinski: by stroking the outer edge of the sole up toward the toes the infant will fan its toes upward and out. Birth to 1 year. o Stepping: by holding the infant upright with its feet touching the surface the infant will make stepping movements. Birth to 4 weeks. Cranial nerves o 1 is olfactory o 2 is optic o 3 oculomotor o 4 trochlear: ability of eye to look down and in o 5 trigeminal: have child close eye and they will detect you touching their face o 6 abducens: the ability to look laterally with the eyes o 7 facial: symmetry facial movements o 8 vestibulocochlear/acoustic: checking hearing o 9 glossopharyngeal: checking for intact gag reflex o 10 vagus: checking for swallowing o 11 spinal accessory: can move shoulders symmetrically o 12 hypoglossal: tongue is midline and can move in all directions Ooh ooh ooh to touch and feel very good velvet such heaven Some say marry money but my brother says big brains matter most Chapter 3 Physical Development: § Doubles by 6 months; triples by 1 year* § § § 2.5 cm (1 in) per month for the first 6 months Length increases by 50% by 12 months of age First teeth erupt between 6-10 months Age 1 month 2 months Gross motor Demonstrates head lag Lifts head up when prone 3 months Raises head and shoulders when prone, slight head lag 4 months 5 months 6 months 7 months Rolls from back to side Rolls from front to back Rolls from back to front Bears full weight on feet. Sits leaning forward on both hands Sits unsupported Pulls to standing position. Creeps on hands and knees 8 months 9 months 10 months 11 months 12 months Changes from prone to sitting position Cruises or walks while holding on to something. Walks with one hand held. Sits down from a standing position without assistance Fine motor Strong grasp Holds hands in an open position, grasp reflex fading No longer has a grasp reflex, keeps hands open loosely. Grasps with both hands Uses palmar grasp Holds bottle Moves objects from hand to hand Begins using pincer grip Has crude pincer grip. Dominant hand preference evident Grasps rattle by its hand Places objects into a container. Neat pincer grasp. Tries to build a two-block tower w/o success. Can turn pages in a book. Cognitive Development: Piaget § § From birth to 24 months they are in the sensorimotor stage Object permanence occurs around 9 months of age. Language Development: § Should be able to say 3-5 words by age 1 and they know the concept of no. Erickson: § § § § From birth to 1 year is trust vs. mistrust. Is the caretaker meeting the needs of the infant? Separations anxiety occurs around 4-8 months of age Stranger fear occurs around 6-8 months of age Toys: © Rattles, blocks, brightly colored toys, playing patty cake, reading books, mirrors, and playing with balls. Immunizations: © Birth: hep B © 2 months: 2nd hep B, IPV (inactivated polio), RV (rotavirus), PCV (pneumococcal), DTaP, Hib (haemophilus influenza type B) © 4 months: all of the above minus the hep B © 6 months: all including hep B © Should also get flu between 6 months and 1 year Nutrition: § § § § Breastmilk for the first 6 months No solids until 4 to 6 months, iron fortified rice cereal Do not need juice or water during first year of life** Introduce new foods one at a time over a 4 to 7 day period to observe for allergies © © © © Never leave unattended in bathtub Stay in rear facing cars seat until two years of age Crib slats should be no more than 6 cm apart, keep pillows out of crib On back to sleep* Chapter 4: © Quadruple weight by 30 months of age © Grow 3 inches per year © Head and chest circumference should be equal around 2 years of age Age 15 months 18 months Gross Motor Walks without help. Creeps up stairs Runs clumsily, falls often, throws ball overhead, jumps in place with both feet. Pushes and pulls toys Fine Motor Uses a cup. Builds a tower of 2 blocks Manages a spoon. Turns pages in a book two or three at a time, build a tower of 3-4 blocks 2 years 2.5 years Walks up and down stairs by placing both feet on each step Jumps across flow and off a chair using both feet. Stands on one foot for a moment. Takes a few steps on tip toe Builds tower of 6-7 blocks and turns pages of books one at a time. Draws circles. Has good hand-finger coordination © At one year, they are using one-word sentences or hollow phrases. At two years they use multi word sentences, 2-3 words. Erickson: § § § Autonomy vs. shame Independence, trying to do stuff for themselves; Expressed by saying “no” a lot. Thrive on ritualism Toys: © Playing with blocks, push pull toys, large piece puzzles and thick crayons. Finger paints and looking at books. Toilet training: © Depends on age and when the child can recognize the sensation to go. Immunizations: © © © © 12-15 months: IPV and PCV, MMR and varicella, Hib 12-23 months: hep A (at least 6 months apart) 15-18 months: DTaP Annual flu Nutrition: © © © © © Breast milk or formula through 1 year 1-2 years they receive full fat milk At 2 can transition to low fat milk Juice consumption should be limited to 4-6 oz per day Nuts, grapes, hot dogs, peanut butter, raw carrots, tough meats, and popcorn should all be avoided. Injury prevention: © Prevent burns, drowning, and aspiration Chapter 5: © They should gain about 4.5 to 6 pounds per year. © Should grow about 2.5-3.5 inches per year. 3 years old Rides tricycle Jumps off bottom step Stands on one foot for a few seconds 4 years old Skips and hops on one foot. Throws ball overhead Catches ball reliably 5 years old Jumps rope Walks backwards with heel to toe Throws and catches ball Piaget: § § § Phase of intuitive thought around age 4 Have magical thinking Animism is also present Erickson: § § Initiative vs. guilt May regress if a new child is brought home, this is normal for any stress or insecurity Toys: © Playing ball, puzzles, tricycles, dress up and role playing. Immunizations: © 4-6 years: DTaP, MMR and IPV © 3-6 years: seasonal flu Sleep: © Need about 12 hours of sleep © Consistent bedtime routine and avoid letting them sleep with you Dental: © Eruption of primary teeth is finalized by the beginning of the preschool years. © Wear protective gear such as helmets and pads Chapter 6: School-Age Children © Will gain about 4.5-6.6 pounds a year © They will grow about 2 inches per year © Permanent teeth begin to come in Piaget: § § Concrete operations See perspective of others instead of having an egocentric type of view Erickson: § § § Industry vs. inferiority Child is trying to make meaningful contributions to society Cooperate and compete with others Socialization: § § Peer groups are very important Competitive and cooperative play occurs Activities: § Board games, hopscotch, jump rope, bicycles and organized sports. Immunizations § 11-12 years: DTaP and HPV Sleep § At least 9 hours Chapter 7: Adolescents © Girls will stop growing about 2 to 2.5 years after they stop their period. © Boys stop growing around 18 to 20 years of age. Girls © © © © Breast development Pubic hair growth Axillae hair growth Menstruation Boys © © © © © © Testicular enlargement Pubic hair growth Penile enlargement Axillae hair growth Facial hair growth Vocal changes Piaget: § formal operations Erickson: § § identity vs. role confusion figuring out who they want to be Activities: § video games, music, sports, pets, reading and social events. Immunizations: § 16-18: meningitis Safety Protective gear Wearing seat belts, no drinking and driving, discourage cell phone use while driving. § Talk about substance abuse § § Chapter 8: § § § § Oral route is always preferred if possible Use the smallest measuring device possible Do not mix into formula because they may not finish the whole bottle Insert medication into side of mouth; hold cheeks together then stroke chin to get them to swallow more effectively Ear drops: - If the child is less than 3 years old, pull the pinna down and straight back - Child over 3 years old - pull pinna upward and back Injections: § § § § Vastus lateralis is preferred site for IM injections Ventral gluteal or deltoid would be the second recommended site 22-25 gauge with a 0.5-1-inch needle Subcutaneous injections: 26-30-gauge needle When inserting an IV, take the child away from their bed and into a procedure room. You don’t want to mix up their associations between their safe places and unsafe places. Use emla cream to numb the area. Avoid terminology such as a bee sting or a stick. Keep equipment out of sight until you are ready to perform the procedure. Offer nonnutritive sucking to infants before, during, and after procedure. Chapter 9: Pain management - Self-report is only appropriate if the child is 4 years or older. FLACC § From 2 months to 7 years FACES § 3 years old and above OUCHER § 3 to 13 years old Numeric scale § 5 years old and older Nursing interventions: § § § § Use play therapy to explain procedures Given medications on schedule instead of when needed Combine opioid and non-opioid for greater effect EMLA o Apply 60 min prior to puncture o 2.5 hours prior to a deep puncture o Place occlusive dressing over that, and then clean the skin Chapter 10: Infant § Does not know what is going on; unable to describe their illness or how they are feeling § May have stranger anxiety § May express physical behaviors due to the inability to express themselves verbally Toddler § Limited ability to describe illness or follow directions § Behavior may regress during hospitalization § Separation anxiety § Intense reactions to any kind of procedures Preschooler § Magical thinking § Still experience separation anxiety School-age child § Able to describe pain and can understand cause and effect Adolescent § Body image is a key concern § May feel isolated from peers** Interventions: Preschoolers - explain the procedure in very simple clear language, give a choice if they can (do you want to take your medicine in a cup or a spoon) § School age - give factual information, tell the truth, encourage contact with peer group and to express their feelings § Adolescents - give factual information, encourage contact with peers § Play: § § § Parallel play: one child playing next to another (not with); toddler Associative play: o Preschoolers o Play together without much organization Cooperative play: o School age o Play in groups and is more organized