1307 Test 2 BP
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| admission questions | use focused questions and allow time for answering; conducted asap after admission; ID bracelet placed on child
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| leading statements | use open-ended questions
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| subjected vs. objective data | subjective - said by the child or family; objective - information you observe directly; baseline measurements of child's height, weight, temp, pulse, respiration, and BP
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| chief complaint | reason for the child's visit to the health care setting; caregivers primary concern is his or her rason for seeking health care for the child
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| therapeutic play vs. play therapy | play therapy - psychoanalysis that clincians use to uncover a disturbed child's underlying thoughts, feelings, and motivations to help understand them better; therapeutic play - to help child understand what will happen to them in specific situations
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| safety during exams | always use standard precautions
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| abnormal assessment findings | bruises in soft tissue, bruises with a clear outline of an object, or unexplained injuries might indicate child abuse
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| Glasgow coma scale | neurologic assessment tool used to monitor a child's neurologic status after the initial neurologic exam; compares results from one time to another and from one examiner to another; monitors various aspects of the child's neurological functioning
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| answering children's questions | be honest and simple
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| security about hospitalization |
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| siderails and safety | always raise when you leave pt unattended
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| physical and emotional safety |
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| discharge conference | discharge preparations begin when admitted
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| SIDS prevention | position infants on their backs or supported on their sides for sleeping
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| procedure teaching for different age groups | should be done according to the child's developmental level (CHECK)
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| pre-op teaching - anything need to note or special documentation | patient teaching about procedure, skin preparation, preparation of gastrointestinal and urinary systems, preop medication
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| pre-op medication - when to give medications | sedative about 1.5 to 2 hours before surgery; analgesic-atropine mixture mya be given immediately before pt leaves for OR - dim lights and minimize noise; administer meds carefully and quickly due to child's anxiety
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| anuria - when is it dangerous | if it persists for more than 6 hours
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| care of chronically ill child |
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| how to deal with the separation of children and parents | rooming-in; have parent give something of theirs to the child so the child knows they are coming back; be friendly; surroundings should be warm and inviting
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| help children overcome fear | friendly, warm surroundings; safe, attractive age-appropriate furniture; colorful staff uniforms; let children wear their own clothes; separate room for procedures; playroom and rooming-in; meals to include child's favorite foods
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| feelings of guilt about hospitalization | child may feel guilt;family may feel guilt about illness, past experiences of illness & hospitalization, disruption in family life, threat to child's long-term health, cultural or religious influences, coping methods, financial impact, how family responds
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| teach about hospitalization | consider child's developmental level; child-life program can make hospitalization less threatening for children and parents; works with nurses, physicians, and other health team members to help meet developmental, emotional, and intellectual needs
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| helping family with anxiety | allow family to help; encourage them to take breaks for meals and rest; give a personal possession to the child to help reassure them the caregiver will return
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| normal responses to hospital | anxiety and stress
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| siblings adjusting to hospital | allow siblings to visit; may be at home imagining a much more serious illness than is actually the case; must not have a cold or other contagious illness and must have up-to-date immunizations
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| apical pulse in infants | preferred method to determine pulse in infant or young child; try to take while child is asleep; count pulse before child is disturbed for other procedures; place stethoscope between left nipple and sternum
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| head circumference | place paper or plastic measuring tape arount the most prominent part of the back of the head; record and plot on a growth chart to monitor the growth of the child's head; chest will exceed head circumfrence
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| rectal temperatures | may be taken in children but usually only if another method cannot be used; in newborns - danger of irritation to the rectal mucosa or in children who have had rectal surgery or who have diarrhea; lubricate end of thermometer with lubricant;
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| monitoring changes in vital signs | closely monitor temp by checking frequently; document baseline temp and additional temps
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| care of a child with temperature, febrile seizures | Febrile seizures are usually a generalized seizure early in the course of fever; often one of the initial symptoms of an acute infection somewhere in the body
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| use of different testing equipment - cardiac monitors |
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| use of different testing equipment - O2 saturation |
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| physical signs of pain, how family responds to pain | changes in behavior like rigidity, thrashing, facial expressions, loud crying or screaming, flexion of knees, restlessness, irritability; increased pulse rate and BP, sweating palms, dilated pupils, flushed or moist skin, loss of appetite
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| patient-controlled analgesia | can be used with children 7 and up
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| moist heat, why heat? | moist heat produces faster results, usually applied in the form of a warm compress or soak; heat increases circulation by vasodilation, promotes muscle relaxation, relieving pain and congestion; speeds the formation of drainage of superficial abscesses
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| ileostomy care | requires emmaculate care, especially when diapering
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| urine specimen - potty trained and not | urine collection bag used if not potty trained - must be placedon clean, dry skin; offer fluids 15-20 minutes before specimen is needed; genetalia are exposed; clean and dry; place collection bag; replace diaper. Trained - clean catch, catheterization
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| LP position | restrain child in position that will enlarge the intervertebral spaces; strict asepsis used; position to curve spine
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| tube placements and tube feedings |
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| oxygen tents |
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| nasal drainage sample |
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| restraints |
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| diluting elixir meds | can dilute with water or juice if not contraindicated
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| IM sites | infants - preferred site is vastus lateralis
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| PRN meds and safety |
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| PO meds to infants |
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| teens adjusting to hospital and chronic illness |
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| family adjusting with chronic illness | siblings may feel left out from being cared for; financial stress, marital problems, etc.
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| respite program | care of ill child so caregivers can have a period of rest and refreshment
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| dying child | unrealistic comprehension of death; help sibling talk about death
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| how each age group feels when another child dies or has chronic illness | preschool - egocentric; 6-7 - magical thinking; 8-9 - death is universal and irreversible; school-age - sad, vocal, aggression; adolescents - mad, creates crisis, needs opportunities to talk
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| hearing and death | hearing is the last sense to go
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| pattern of death |
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| child abuse s/s | bruises in soft tissue, bruises with a clear outline of an object, or unexplained injuries might indicate child abuse; signs could also be seen in the genitalia and rectal area
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| spiral fractures | not a commonly seen fracture in long bones; suspect child abuse if story doesn't add up
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| sexual abuse | the employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or simulation of such conduct
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| Munchausen | Munchausen by proxy - one person either fabricates or induces illness in another to get attention; caregiver frequently reports symbptoms of illness when child is well; mother is most often the person with syndrome
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| possible abuse cases | must be reported
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| feeding tube | verify placement
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| sexual abuse(continued) | rape, interfamilial relationships, statutory rape, molestation, prostitution, or other form of sexual exploitation of children or inces with children
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