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Pedi Comp Final

Review for Comp Final - Nursing

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),
Created by: JaeLaw23