NSG 3600 PEDS Exam 1 Questions and Answers

NSG 3600 PEDS Exam 1 Questions and Answers Chapter 20 Caring for the Developing Child what is Family Center Care? Family is recognized as the constant in a child's life. We support, respect, encourage, and enhance the strength the competence of the family. The needs of ALL family members must be ADDRESSED! Name the 5 Newborn reflexes ? 1.Rooting 2.Sucking 3.Moro 4.Plantar 5.Babinski what is the Newborn reflexes Rooting Infant's head turns, and he begins to suck when his cheek or lower lip is stroked. what is the Newborn reflex Sucking Sucking motion of lips, mouth, and tongue allows the infant to take in sustenance. what is the Newborn reflex Moro/ startle reflex Startle response with sudden jarring causes extension of the head. The arms abduct and move upward. The hands form a "C". what is the Newborn Reflex Plantar This is noted when the palms of the hands or soles of the feet are stroked causing fingers or toes to curl inward what is the Newborn Reflex Babinski This is the turning in of the foot and fanning out of the toes when the sole of the foot is stroked. What are the Physical Growth patterns of the infant birth-1 month -Height -Weight -Head circumference -Chest Circumference -Height is 19-21 inches. -Weight 7.5 lbs. -Head circumference is 13-14 inches. -Chest circumference is 12-13 inches. Need 17-20 hours of sleep What are Gross Motor Skills Growth patterns of the infant birth-1 month Reflexes are present. Absence of head control. Head lag when pulled from lying to sitting position. Assumes a flexed position. Kicks legs and waves arms. Rounded back when sitting. See Denver Developmental Tool What are Fine Motor Skills Growth patterns of the infant birth-1 month Hand predominately closed. Strong palmar and plantar grasp reflexes what are the Psychosocial & Play Growth patterns of the infant birth-1 month Learns to relieve anxiety through oral sensations (breastfeeding, sucking on fist). Begins to learn to trust caregivers. Play: Interaction with parents and caregivers. Mobiles. What are the Physical Growth patterns of the infant 1-2 months -Height -Weight -Head circumference -Chest Circumference Height increases 1 inch per month. Weight increases 1.5 pounds per month. Head circumference increases 0.5 inches per month what are the Gross Motor Skills Growth patterns of the infant 1-2 months Less head lag when pulled to a sitting position. When prone, can slightly lift head off floor. Improved head control turns and lifts head from side to side when prone. Some head control when upright. what are Fine Motor Skills Growth patterns of the infant 1-2 months Holds hands open. Grasp reflex is absent. Can pull at clothes and blankets, bats at objects. what are the Cognitive, Sensory & Language Growth patterns of the infant 1-2 months When supine follows dangling toys. Visually searches for sounds. When crying, can be consoled easily by being held or spoken to. Turns head to sound. Language: Coos, has social smile. what are the Psychosocial & Play Growth patterns of the infant 1-2 months · Same as infant to 1 month ; learns to calm self. -Play: solitary play. -Stimulates sensorimotor development with simple imitative games. Interaction with parents and caregivers through games such as Patty-cake and Peek-a-boo. what are the Physical Growth patterns of the infant 9-12 months -Height -Weight -Head circumference -Chest Circumference Height-increases by 1 inch per month. Weight-triples the birth weight by 1 year. Head and chest circumference are at the same at 1 year of age. what are the Gross Motor Skills Growth patterns of the infant 9-12 months -Creep on hands and knees. -Pulls self to standing position. -Stands while holding onto furniture and begins to cruise. -Changes from prone to sitting position. -Can reach backwards while sitting. -Can sit down from standing position alone. -Begins to walk holding hand and then independently, takes first step what are the Cognitive, Sensory & Language Growth patterns of the infant 9-12 months increasing depth perception. Moves toward sound. Thoroughly explores and experiences objects. Points to simple objects. Language: Says "mama," "dada," and "uh-oh." Understands a few words. Responds to own name. Exhibits stranger anxiety. Begins to distinguish colors. Increasing ability to see things in distance. what are the Psychosocial & Play Growth patterns of the infant 9-12 months Completes Erikson's stage of Trust vs Mistrust; able to calm self. Play: Solitary play. Like games like Patty-Cake, Peek-a-boo, Songs, Finger painting, and ball rolling. what is Atraumatic Care? Therapeutic care is provided using interventions to eliminate or minimize psychological and physical distress of the child and the family. The GOAL of providing this type of care is to FIRST DO NO HARM! what is the role of the Pediatric nurse ? -Incorporate knowledge of Growth and development -Recognizes the physiological differences between children and adults -Provide care in a developmentally appropriate manner -Recognize famiy as integral -Practice culturally sensitive health care -Implement models of care specified for the pediatric population what are Three principles that help achieve atraumatic care Prevent separation Promote sense of control Minimize bodily injury What should be checked when Physical Restraint for child is being used Extremity has to be check every 15 minutes for 1 hour after initial application and then every 1-2 hours after. Pharmacological Restraint for child Sedation of child tp allow safe completion of procedure. Chloral hydrate (Aquachloral) What is Chloral hydrate (Aquachloral) This medication is used to calm the body down. It is a hypnotics family. Side effects include drowsiness and trouble waking up in the morning, nausea, vomiting, stomach pain, diarrhea, and headache may occur. Stomach problems can be reduced by taking meds with a full glass of water. For long term watch for serious stomach issues and kidney problems. Can be addictive Joint Commission Requires the nurse to assess what while the child is in restraints? Signs of injury associated with application of restraint. Nutrition/hydration. Circulation and ROM. Vital signs, hygiene and elimination. Physical and psychological status and comfort and readiness for discontinuation. Distraction Provide a toy to divert the child's attention Time-out Give child a cool-off place where they can calm down Removal of privileges Withhold a favorite toy until behavior is appropriate. For older kids an example would be grounding. Verbal reprimands Given spoken warnings or disapprovals without berating child Corporal Punishment (not recommended) Spanking When can a child under the age of 18 give informed consent on their own Depends on the state law for each: Reproductive health (birth control, counseling). Help for substance abuse. When they are self-supporting (emancipated) In many states "pregnancy" automatically considers the person emancipated. Examples of atraumatic care Eliminate or minimize distress experienced by a child in a healthcare setting and perform invasive procedure only in treatment room. What is a appropriate use of play as communication technique in children? Play sessions serve as assessment tools for determining children's awareness and perception of illness. What is the formal operational thinking that occurs between the ages of 11 and 14 years old? Thought process includes thinking in abstract terms, possibilities, and hypotheses. What test on a child would Chloral hydrate be appropriate for a child to take? MRI test because the medication helps sedate the child to stay still. During a time out what should the adult never do? Never play a child in time out where they would be alone in a room. We need to always have our eyes on the child. What is a way to prevent tantrums? Making sure the child has a regular nap and snack schedule. Sensorimotor Development- Jean Piaget Cognitive Theory 1st stage. Takes place from birth to age 2. During this time, the primary means of cognition is through the SENSES. The child takes in and processes information strictly on a physiological or emotional level. (LEARN COLORS, SHAPES, PUT WORDS TO OBJECTS) They use their senses to learn everything and they do a lot with trial and error and imitate everything. Preoperational Stage-Jean Piaget Cognitive Theory 2nd stage. Occurs in ages 2-7. Takes into account the development of motor skills and is divided into two substages: preconceptual and intuitive. The child is still not capable of logical thinking, but because of the increased ability to use words to connect cognitively with the world. Imagination and intuition are strong this is when conservation is developed. Takes into account the development of motor skills. They cannot put themselves in other people's shoes and every focus on themselves. Make simple associations such as thinking my momma has a big belly because she is pregnant so that means everyone with big bellies is pregnant. Concrete Operational Stage- Jean Piaget Cognitive Theory 3rd stage. At this stage the 7-11 year old child is able to organize thoughts in a logical order. The child is able to categorize and label objects. Concepts attached to concrete situations. Time, space, and quantity are understood and can be applied but NOT AS INDEPENDENT CONCEPTS. Can begin to problem solve but not doe have the ability to do abstract thinking. Can see things in logical order. Formal Operational Stage- Jean Piaget Cognitive Theory 4th stage. Occurs in ages 11-15 when the child uses abstract reasoning to handle difficult concepts and can analyze both sides of the issue. The child has theoretical, hypothetical, and counterfactual thinking. Strategy and planning become possible. (Can form a hypothesis and have abstract thinking. Uses abstract thinking to handle difficult concepts) Age Appropriate Play for Infant Solitary play (plays alone): loves bright colors and toys that make noises. Examples are books, blocks, musical toys, mobiles, finger/hand games. Age Appropriate Play Toddler Use parallel play where they are around one another but may not play with each other. Examples of toys include push-pull toys, books/movies, coloring books/large crayons, matching games, ride on toys, imitative toys such as dishes, playhouse, blowing bubbles. Age Appropriate Play Preschooler Use associative play which is where the children will play with other children but they do not meet a common goal or use teamwork. They do role play, simple board games, alphabet or color games, simple computer games. Age Appropriate Play School Age Use cooperative play where the children will play together as a team to meet a common goal and get more active. Examples of toys are music, books, crafts, team sports, bike, skateboard, card or board games, video movie or games, puzzles. Age Appropriate Play Adolescent Uses cooperative play where they like to compete against their peers. Examples of this would be team sports, video/computer games , card or board games, art concerts, "hanging out", social events with friends. Growth Increases in number and size of cells as they divide and synthesize new proteins. Physiological size (height, weight, bone length) Development Advancement from to more advanced stage of complexity, increased capacity through growth, maturation, and learning. Ongoing process, acquisition of skills and functioning. Sequential Trends Are based on the concept that each child will normally pass through each stage of growth and development in a predictable sequence. These patterns, or trends, are universal and basic to all human beings, but each human being accomplishes these in a manner and time unique to that individual. Examples of Sequential Trends Everyone goes through the same stages but may not be at the same time. Such as child walking at 9 months or a child waling at 12 months. Erik Erikson Development Theories: Trust vs. Mistrust (Newborn to 1 year)- recognize that there are people that will meet their basic needs. The infant's struggle becomes evidence in the recognition that not everyone or every situation is "safe". Through trust, the infant learns to have confidence in personal worth and well-being along with connectedness to others. Result: faith & optimism. Failure to master this stage leaves a sense of hopelessness and disconnectedness. (Example of this disconnect can be seen in infants with failure to thrive or with attachment disorder. Can be seen in adults later on in life who have issues with maintaining significant relationship). Erik Erikson Development Theories: Autonomy vs Shame & Doubt (1 year to 3 years) Balance independence and self-sufficiency against sense of uncertainty. It is the time for the child to establish willpower, determination, and a can-do attitude about self. An example of this stage happens when the toddler wants to choose clothing and dress independently. The struggle happens when the parents allow the child to make personal choices yet expect the choices to be socially acceptable. The child is able to do many new things and wants to explore everything. This newfound independence is accompanied by new rules that may cause internal conflict. The child must develop personal abilities while struggling with both fears and wishes. The child has self-doubt later in life this stage is no successfully met. The goal or result we want the child to have is Self-control and power. Erik Erikson Development Theories: Initiative vs Guilt (3 years to 6 years old) Develop the resourcefulness to achieve and learn new things without receiving self-reproach. It is difficult for a young child to resolve the conflict between wanting to be independent and needing to stay attached to parents. The child's learning of new songs, games, or jokes are good examples of initiative. The child feels confident to try new ideas. It is important that parents and teachers encourage this initiative to help the child develop a sense of purpose. If initiative is discourage or ignored, the child may feel guilt or lack of resourcefulness. (Here the child is exploring the world with all of their senses and where they build their inner voice. If they mess up such as missing a belt loop or put their shirt on backwards tell the child they did a great job but that you would like to help). Erik Erikson Development Theories: Industry vs Inferiority (6 years to 12 years) Develop a sense of confidence through mastery of task. This sense of accomplishment can be counterbalanced by a sense of inadequacy or inferiority that comes from not succeeding. The realization that the child is competent is one of the important building blocks in the development of self-esteem. Industry is evident when the child is able to do homework independently and regulate social behavior. Performing the prescribed tasks at school or home also shows industry, If the child cannot accomplish realistic expected tasks, the feeling of inferiority may result. (Here the children love to ask questions and want to know how their body works. We should include them in their care!) The result is Competence. Erik Erikson Development Theories: Identity vs Role Confusion (12 years to 18 years old) Acquiring a clear sense of self and purpose. This is a time of forging ahead and acquiring a clear sense of self as an individual in the face of new and at time conflicting demands or desires. During this stage the adolescent wants to define, "what to be when I grow up". During this time the child concentrates on goals and life plans separate from those of peers and family. At this point the child has the ability to think about self as well as others and proceeds accordingly. An adolescents who is unable to make decisions about possible career choices, personal belief and value systems, and sexual orientation, for example may develop a weak sense of self and be incapable of committing to an identity. This indecision leads to role confusion. (They are just trying to find a place in the world. Their body image is a big issue and they will see a lot of peer pressure and we need to make sure they are safe) Results if everything is met are fidelity to others and individual values. Newborn/Infant Fine Motor Transfer objects between hands, scribble, stack large objects age 6-12 months, uses the pincer grasp (taking their index and thumb to pick up stuff- 9 to 12 months) Newborn/Infant Language Development Very important to make different sounds and talk to the infant to help develop social interaction. Crying, babbling, imitation, influenced by social interactions. Being to social smile at 2 months. Being using words like mama/dada at 9-12 months. what subjects should be addressed when teaching a Infant/Newborn Parent about Anticipatory guidence Nutrition Health promotion Focus on safety Sleep wake