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Pedi Comp Final
Review for Comp Final - Nursing
| Term | Definition |
|---|---|
| anticipatory guidance | process of understanding upcoming developmental needs & then teaching caregivers to meet those needs |
| cephalocaudal development | process by which development proceeds from head down through body towards feet |
| chronological age | age in years |
| critical periods | times when an individual is especially responsive to certain environmental effects, sometimes call sensitive periods |
| development | an increase in capability or function; more complex concept that is a continuous, orderly series of conditions that lead to activities, new motives for activities; and eventual patterns of behavior |
| developmental age | age based on functional behavior and ability to adapt to environment; does not necessarily correspond to chronological age |
| differentation | development from simple operations to more complex activities and functions |
| egocentrism | an inability to put oneself in another's place; unable to see things from any other perspective other than own; cannot see another's pov or any reason to do so |
| growth | an increase in physical size |
| growth spurt | brief periods of rapid increase in growth rate |
| object permanence | knowledge that an object or person continues to exist when not seen, heard, or felt |
| proximodistal development | process by which development proceeds from the center of body outward to extremities, symmetrically |
| regression | use of behavior that is more appropriate to an earlier stage of development, often used to cope with stress or anxiety |
| ritualism | toddler's need to maintain sameness and reliability; provides a sense of comfort |
| separation anxiety | distress behavior observed in young children separated from familiar caregivers |
| therapeutic play | planned play techniques that provide opportunity for children to deal with their fears and concerns rel to illness or hospitalization |
| Adjusted age | for preterm infants: # of weeks premature subtracted from chronological age to determine infant's dev age or level. Not used after age 2. |
| Prenatal Period | Germinal: conception to 2 weeks Embryonic: 2 wks to 8 wks Fetal: 8 to 40 wks |
| Infancy | Neonatal: birth to 28 days Infancy: 1 to 12 months |
| Early Childhood | Toddler: 1 to 3 years Preschooler: 3 to 6 years |
| School age | 6 to 12 years |
| Later Childhood | Prepubertal: 10 to 13 years Adolescence: 13 to 18 years |
| Reflexes present at birth | Moro, Tonic Neck, Protective (gag, cough, blink, pupillary), Grasp, Rooting, Babinski |
| Moro reflex | "Startle reflex" elicited by loud noise or sudden position change. DISAPPEARS BY 6 MOS |
| Tonic neck | Elicited when infant lies supine and head is turned to one side; infant will assume a "fencing position". DISAPPEARS BY 6 MOS |
| Grasp | infant's hands and feet will grasp when stimulated. DISAPPEARS BY 3-4 MOS |
| Rooting | Elicited when side of mouth is touched, causing infant to turn to side being touched. DISAPPEARS BY 4 MOS |
| Babinski | fanning of toes when sole of foot is stroked upwards. DISAPPEARS BETWEEN 12-18 MOS - usu when infant begins to walk |
| Reflexes appearing in infancy | Parachute, Landau, Labrynth righting, Body righting |
| Gains head control | by 4 months |
| Rolls from back to side | by 4 months |
| Rolls from abdomen to back | by 5 months |
| Rolls from back to abdomen | by 6 months |
| Sits alone unsupported | by 8 months |
| Stands holding furniture | by 9 months |
| Crawls with abdomen on floor | 10 months |
| Creeps with abdomen off of floor | 11 months |
| Cruises holding furniture | 10-12 months |
| Can sit down from upright pos | 10-12 months |
| Walks | 12 months |
| Holds bottle | around 6 months |
| Transfers obj from one hand to other | around 7 months |
| Pincer grasp | by 10 months |
| Turns head to locate sounds | by 2 months |
| smiles | 2-3 months |
| taste preferences | by 6 months |
| responds to name | by 7 months |
| follows moving obj, visual acuity 20/50 or better | by 12 months |
| Amblyopia | unilateral or bilateral decrease of best corrected vision in an otherwise healthy eye |
| Solid foods | introduce no earlier than 6 months to avoid exposure to allergens |
| First food given | Iron-fortified rice cereal -- low allergenic potential |
| deciduous teeth start coming in... | by age 5-6 months |
| Max formula to be given per day | 28-30 ounces - to avoid iron-deficiency anemia |
| Nutrition req (1-6 mos) | 108 kcal/kg/day; protein 9.1 g/day |
| Nutrition req (6-12 mos) | 98 kcal/kg/day; protein 11 g/day |
| Car seats | keep toddler-facing rear until 2 years or highest wt/ht allowed by seat mfg; after use forward-facing rear seat until max ht/wt allowed by mfg then use booster seat |
| Infants car seats | MUST be in rear-facing safety seat in middle of the back seat until 20 lbs and 1 year of age. BOTH req's must be met |
| Injury Prevention Teaching (infants) | Aspiration; Suffocation; Falls; Poisonings; Burns; Car Seat |
| Infant play | Solitary |
| Heb B vaccinations | 1 - at birth; 2 - 1-4 months; 3 - 6-18 months |
| Rotavirus | 1 - 2 months; 2 - 4 months; 3 - 6 months |
| Diptheria-tetanus-acellular pertussis (DTaP) | 1ST - 2 months; 2nd - 4 mos; 3rd - 6 mos; 4th - 15-18 mos; 5th - 4 - 6 years |
| H. influenzae type B (Hib) | 1 - 2 mos; 2 - 4 mos; 3 - 6 mos; 4 - 12-18 mos |
| Inactivated poliovirus (IPV) | 2 mos; 4 mos; 6-18 mos; 4-6 years |
| Pneumococcal vaccine (PCV) | 2 mos; 4 mos; 6 mos; 12-15 mos; PCV13 - older child |
| Measels-mumps-rubella (MMR) | 12-15 mos; 4-6 years |
| Varicella | 12-15 mos; 4-6 years |
| Flu | Annually: age 6 mos |
| Hep A | 12-23 mos; then at least 6 mos later |
| Toddler growth (height) | at 2 years 50% of adult height |
| Anterior fontanel | closes by 18 mos |
| Deciduous teeth all present | by 2.5-3 years old |
| How many deciduous teeth | approx 20 |
| Nutrition req (toddler 1-3 years) | 102 kcal/kg/day and 11 grams of protein per day |
| Toddler Play | Parallel - imaginative and make-believe play; may imitate adult in play |
| Toddlers enjoy repetitive stories and short songs with rhyme | |
| negativism | behavior peculiarity marked by not performing suggested actions (passive negativism) occurs in toddlers to test boundaries & because they hear no a lot |
| habituation | rapid development of decreased sensitivity to specific common postbirth stimuli, such as env noise, light, heelsticks. This adaptive response protects the nb from overstimulation. |
| Piaget | Cognitive development theorist |
| Sensorimotor | birth to 2 yrs: infant learns through senses and motor activity; progresses from reflex through simple repetitive behaviors to imitate behaviors; develops "cause and effect"; curiosity, experimentation, exploration for learning; obj perm fully dev |
| Preoperational | 2-7 yrs: forms symbolic thought; egocentrism; unable to grasp conservation; increase language ability; play becomes more socialized; can concentrate on only one characteristic of an obj at a time |
| Centration | only able to concentrate on one characteristic of an object at a time |
| Concrete Operational | 7-11 yrs: thoughts becoming logical and coherent; able to shift attention ; concrete thinking (black/white, right/wrong); can classify and sort facts, problem solving; acquires conservation skills |
| Formal Operations | 11 years +: can logically manipulate abstract and unobservable concepts; adaptable and flexible; can deal with contradictions; uses scientific approach to prob solving; has concept of the future |
| Erikson | Psychosocial development |
| Trust vs. Mistrust | birth to 1 year: est trust in caregivers Mistrust dev if basic needs are inconsistently or inadequately met |
| Autonomy vs. Shame and Doubt | 1-3 years: Increased ability to control self and env; practices and attains new phys skills, developing autonomy; symbolic independence by controlling bowels/bladder; saying "no" Success: self-confidence/willpower Unsuccessful: shame and doubt |
| Initiative vs. Guilt | 3 to 6 yrs: explores phys world with senses; initiates new activities & considers new ideas; demos initiative by form/carrying out plan; develops conscience |
| Industry vs. Inferiority | 6 to 12 yrs: School-age; dev new interests and involvement in activities; learns to follow rules; reading, writing, math, and social skills |
| Identity vs. Role Confusion | 12 to 18 yrs: rapid and marked physical changes; preoccupied with phys appearance; examines and redefines roles; experimental; peer group VIP |
| Stages of Separation Anxiety | 1) Protest: sad, agitated, angry, inconsolable 2) Despair: sad, hopeless, withdrawn, acts ambivalent when parents present 3) Detachment: happy, interested in env; attaches to others; may ignore parents |
| Infant pain response | inc in BP and HR and decrease in O2 sat; harsh, tense, or loud crying; facial grimacing, flinching, thrashing; gen restlessness, uncooperative, clings to caregiver |
| Preschoolers Major fears | Mutilation and intrusive procedures |
| School-age fears | Pain and bodily injury; loss of control; fears rel to school, peers, and family |
| Adolescent fears | Loss of independence; loss of identity; body image disturbance; rejection by peers |
| cerumen | waxy sub secreted in outer third of ear canal; aka earwax |
| facies | expression and appearance of face |
| fremitus | vibrations of voice transmitted through chest wall of a person speaking; can be palpated with hands on chest or back or auscultated with a steth |
| genogram | family map of three or more generations that records relationships, deaths, occupations, and health and illness hist |
| lordosis | anterior convex curvature of lumbar spine |
| Mongolian spots | bluish-colored area usu located in sacral region of newborn Asian, Native American, and African-American infants; usu disappears in childhood |
| objective data | info obtained through physical assessment techniques and diagnostic studies |
| scoliosis | lateral curvature of the spine |
| strabismus | lack of eye muscle coordination caused by one muscle being weaker than the other |
| subjective data | info obtained from child and family using interview techniques |
| Parts of a Nursing Diagnosis | Problem statement (r/t) etiology (aeb) signs and symptoms |
| PA approaches for Infant | -child lying supine or held by caregiver -use distraction -Assess heart, pulse, lungs, resp, and fontanels while quiet--then head-to-toe -Eyes, ears, and mouth near end -check reflexes as body parts are examined -Moro reflex -Painful parts last |
| PA approaches for Toddler | -Minimal contact initially -Allow to inspect equipment -Assess heart and lungs while quiet, then head-to-toe -Eyes, ears, and mouth last |
| PA approaches for Preschool | -Allow to handle equipment -Head-to-toe if cooperative -Same as toddler if uncooperative |
| PA approaches for School-age | -Respect privacy -Explain procedures -Head-to-toe -Genitalia last |
| PA approaches for Adolescent | -Explain findings -Proceed as for school-age child |
| conjunctivitis | inflammation of conjunctiva |
| corneal light reflex (Hirschberg test) | a screening for strabismus and symmetrical alignment of eyes |
| cover-uncover test | a screening test for "lazy eye" |
| epistaxis | nosebleed |
| otitis media | inflammation of middle ear |
| pharyngitis | inflammation of pharynx |
| sensory impairment | a general term that indicates sensory disability that may range in severity from mild to profound; includes hearing and visual impairments |
| tonsillitis | inflammation of tonsils, resulting in tonsillar enlargement, frequently occurs with pharyngitis |
| Pharyngitis - Etiology and Patho | -common d/o in children 4-7 years -rare in infancy -approx 80% is viral --symptomatic care -Bacterial MCC by group A beta-hemolytic strep |
| Pharyngitis - s/s's | Sore throat, difficulty swallowing, drooling, inflammation of pharynx and enlarged tonsils (with or without exudate), fever, vomiting, cough, lymphadenopathy, headache, hoarseness or change in voice |
| Pharyngitis - diagnostics | throat culture to est. etiology; rapid strep test (bacterial) |
| Pharyngitis - txt | Viral - symptomatic - diet easy to swallow; salt water gargles, throat lozenges, anesthetic spray; analgesic (acetaminophen); bacterial - antibiotic as ordered |
| Pharyngitis - teach | Importance of finishing full course of antibiotics; ***untreated or inadequately txt can lead to rheumatic fever, glomerulonephritis or other serious sequelae |
| Tonsillitis Mgmt | Same as pharyngitis s/s incl mouth-breathing |
| Tonsillectomy | surgical removal of tonsils to prevent recurrent tonsillitis; one of the most common childhood procedures - usu done in conjunction to adenoidectomy |
| Indications for tonsillectomy | recurrent tonsillitis, peritonsillar abscess, or resp compromise due to airway obstruction |
| Preop Mgmt | client and family preop teaching, baseline labs, incl bleeding and clotting times |
| Postop Mgmt | -Provide pain control -Monitor for excessive bleeding/hemorrhage: continual swallowing, vomiting bright red blood, VS changes -Clear, chilled fluids when awake and oriented; avoid red-colored fluids -teach child/parents that sore throat is expected 1 |
| Discharge teach | -s/s complications -analgesic med admin -adequate fluids necessary; soft diet as tolerated -avoid strenuous activity for 7-10 days -return to school in 10 days |
| alveoli | small, saclike dilataions of terminal bronchioles where O2-CO2 gas exchange takes place |
| atelectasis | incomplete expansion or collapse of lung caused by obstruction of airway from secretions or a foreign body |
| barrel chest | anteroposterior diameter of chest is increased to give chest a rounded appearance; caused by air trapping and hyperinflation of alveoli, resulting in skeletal changes |
| bronchopulmonary dysplasia (BPD) | chronic obstructive pulm disease occurring in infants after prolonged exposure to mechanical ventilation and O2 therapy |
| digital clubbing | increased rounding of nails of fingers and toes with a loss of normal angle at base of nail; indication of long term hypoxia |
| dyspnea | difficulty breathing |
| epiglottis | structure that covers larynx during swallowing to prevent food from entering trachea |
| hypercapnia | excessive carbon dioxide in the blood |
| hypoxemia | deficiency of oxygen in the blood |
| laryngotracheobrochitis | a viral infection causing inflammation, edema, and narrowing of larynx, trachea, and bronchi |
| peak expiratory flow rate | maximum amt of air that can be forcibly exhaled |
| surfactant | phospholipid produced by alveoli that reduces surface tension of fluids and aids in lung expansion |
| sweat test | measures sweat sodium and chloride concentrations; sample is collected from child's forearm on absorbent material; a level greater than 60 mEq/L is diagnostic for CF |
| Tachypnea | rapid respirations |
| trigger | initiator of an asthmatic episode |
| Cystic Fibrosis (CF) | multisystem d/o of exocrine glands, leading to increased production of thick mucus in bronchioles, small intestines, and pancreatic and bile ducts |
| CF continued | Lung problems most serious threat to life - secretions pool in bronchioles, cause atelectasis and serve as a medium for bacterial growth -Pancreatic ducts become clogged and prevent enzyme release -Malabsorbtion of fats and proteins lead to growth probs |
| CF - etiology and patho | Inherited - autosomal recessive trait - chromosome 7 CFTR defect; usu diag in infancy |
| acyanotic heart defect | heart condition that does not cause deoxygenation, or low oxygen levels; color of skin and mucous membranes are usu normal pink |
| cardiac catheterization | a test that examines heart by placing a catheter into a vein or artery and advancing it to heart in order to sample O2 levels and take pressure meas in heart chambers |
| cyanotic heart defect | a heart condition that causes blood to contain less oxygen than body needs; skin and mucous mem color is usu pale to blue |
| echocardiogram | a graphic record of walls, valves, and vessels of heart produced by ultrasound |
| Jones Criteria | guidelines for diagnosis of initial attack of rheumatic fever developed in 1992 |
| left to right shunt | movement of blood from left side of heart to right side through an abnormal opening |
| lymphadenopathy | a condition that causes swollen glads and can be caused by infection or cancer |
| murmur | a heart sound resembling running water through a tight space; usu indicates a malfunctioning valve or an abnormal opening in cardiac septum |
| polycythemia | a condition of more red blood cells than normal; often indicates hypoxemia and body's compensatory response |
| prostaglandin E1 | a hormone that reopens Ductus Arteriosus; it is used in cases where blood in not oxygenating properly and patent ductus arteriosus allows for mixing of saturated and unsaturated blood |
| right to left shunt | movement of blood from right side of heart to left side of heart through an abnormal opening in septum; this results in deoxygenated blood because systemic blood bypasses lungs and is ejected into aorta |
| vasculitis | inflammation of tunica intima (inner linning) of arteries and veins |
| Cardiac Cath - preop | age-appropriate teaching; family support; NPO after midnight; Oral sedation; baseline VS, Hgb, Hct, and pedal pulses |
| Cardiac Cath - POSTop | Monitor for bleeding: maintain direct pressure to insertion site for 15 mins and a pressure dressing for 6 hrs; Obtain VS q15 m 1st hr and q 30 until stable; Bedrest - 6 hrs |
| PostOp Cardiac Cath Contd | Monitor for dysrhythmias, infection; assess distal extremity to insertion site; diuresis of dye |
| Cardiac Cath - D/C teach | s/s of complications; clam, quiet play for 1st 24 hrs; increase fluids to maintain hydration & offset diuretic effect of contrast dye |
| Atrial Septal Defect (ASD) | loc between atria; septal wall defect allowing blood to flow from l. atrium to r. atrium (left-to-right shunt) |
| ASD - etiology and patho | Opening between atria; Foramen ovale fails to close; can be large part of septum absent; increased pulmonary blood flow |
| ASD Assessment | dyspnea, fatigue, poor growth, Soft systolic murmur (pulm area - splitting S2); echo reveals r. vent. overload and shunt; CHF, Cardiac cath - visualize defect |
| Brudzinski's sign | noted when pt's head is flexed while in supine position, resulting in involuntary flexion of knees or hips; positive sign is common in meningitis |
| coma | level of unconsciousness in which pt cannot be aroused with painful stimuli |
| Cushing's triad | a late sign of ICP characterized by a widening pulse pressure (rising systolic/stable diastolic), bradycardia, and irregular respirations |
| Epidural hematoma | bleeding between the dura and cranium |
| intracranial pressure (ICP) | force exerted by brain tissue, CSF, and blood within cranial vault; normal ICP is 4 to 12 mm Hg and is dependent on age |
| Kernig's sign | demonstrated when pt's led is raised with knee flexed and any resistance or pain is felt; common in meningitis |
| Level of consciousness (LOC) | measure of degree of responsiveness of mind to sensory stimuli; lower levels ind decreased neurologic fx; levels can be categorized as confusion, delirium, obtunded, stupor, and coma |
| Full consciousness | awake and alert, oriented to time, place, and person, behavior appropriate for age |
| Confusion | Impaired decision making |
| Disorientation | Confusion regarding time, place; decreased LOC |
| Lethargy | Limited spontaneous movement, sluggish speech, drowsy, falling asleep quickly |
| Obtundation | Only arousable with stimulation |
| Stupor | Remaining in a deep sleep, slow response to vigorous and repeated stimulation or moaning responses to stimuli |
| Coma | No motor or verbal response or extension posturing to noxious stimuli |
| Persistent vegetative state | Perm lost fx of the cerebral cortex. Eyes follow objects only by reflex or when attracted to direction of loud sound. all four limbs are spastic but can w/draw from painful stimuli, hands show reflexive grasping, face can grimace |
| meninges | fibrous membrane that covers brain and lines vertebral canal; consists of three layers - dura, arachnoid, and pia mater |
| myelin | sheath of fat covering axon process of neuron or nerve fibers, increases speed and accuracy of nerve impulses; myelination not complete at birth, proceeds cephalocaudaly during childhood |
| neurogenic | lack of innervation to an organ |
| nuchal rigidity | stiffness of neck or resistance to neck flexion, often seen in infections of CNS |
| Opisthotonus | pt positions self with hyperextension of head and neck; seen in meningitis and felt to relieve some discomfort from meningeal irritation. |
| photophobia | sensitivity to light, seen in pts with migraine headaches or viral infections such as measles, meningitis, and encephalitis |
| pulse pressure | difference in systolic and diastolic blood pressure |
| subdural hematoma | bleeding between the dura and cerebrum |
| spasticity | tenderness of muscles, uncoordinated, stiff movements; can be seen as scissoring or crossing of legs; exaggerated reflex reactions |
| tonic-clonic | term frequently used to describe characteristics of certain seizures; tonic indicates continuous muscle contraction; clonic indicates alternating contraction and relaxation of muscles |
| Anti seizure meds | Phenobarbital, carbamazepine (Tegretol), |
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