Pedes Unit 2 Test: Comprehensive Guide | Updated Edition

Pedes Unit 2 Test: Comprehensive Guide | Updated Edition T/F nutrition for a 2 year old who was born preterm should be set for their adjusted age T What is failure to thrive Weight below 5th percentile What is the greatest contributing factor for FTT? Poverty What should we use as an indicator for FTT? weight for length Nursing interventions for FTT? -Observe parent-child interactions, especially during feedings. -Develop an appropriate feeding schedule. -Provide feedings as prescribed (usually 120 kcal/kg/day is needed to demonstrate proper weight gain). -Weigh the child daily and maintain strict records of intake and output. -Educate parents about proper feeding techniques and volumes. -Provide extensive support to alleviate parental anxiety related to the child's inability to gain weight. How to assess a child with FTT? -How often are you feeding baby -What size bottle are you using -How do you make formula at home -Assess parent child interactions -Daily weights -strict I/O -Weigh diapers How many calories per day are needed for weight gain in FTT? 120 kcal/kg/day What are resources for special needs children and family -Early intervention programs (mandated by law for those under 3 years) -The Individuals with Disabilities Education Act of 2004 (3-21 yrs; quiet room for testing; least restrictive environment) -Supplemental Security Incomes (SSI) -Respite -Complimentary therapies (homeopathic, hippotherapy, massage, pet therapy) What is the leading cause of death from disease in children >1 year? Cancer Palliative care -goal: alleviate suffering -comfort care that can occur at any time Hospice care for children -They are allowed to continue to recieve potentially curable treatment while in hospice unlike with adults -life <6 months -Bereavement counseling continues for family after death What is the goal of hospice care? pain control and comfort, integrative care Types of grief Normal, anticipatory, complicated, parental grief, sibling grief Anticipatory grief Occurs at initial dx of terminal illness Complicated grief Unable to heal after grief Acute grief the intense physical and emotional expression of grief occurring as the awareness increases of a loss of someone or something significant Parental grief Focus on hopes and dreams that are lost Sibling grief -Survivors guilt -anger, denial Infant, toddler, preschool developmental needs in dying Infant: No understanding of death Toddler: -little to no understanding -max time with parents Preschool: -May see death as a punishment -death is temporary (magical thinking) -correct their misunderstanding and be honest School-age and adolescent developmental needs in dying School-age: -may have more fear of disease and death -Be honest -concrete understanding of death at age 8 or 9 years -help them establish sense of control Adolescents: -more adult understanding -difficulty w/acceptance -feel alienated from peers -Give DETAILED explanation S/S of death -sensation of warmth despite body feeling cold -loss of bladder and bowel control -Cheyne-stokes RR (lasts about 30 sec to 2 min) -Decreased appetite/thirst -Bradycardia, hypotension -dysphagia -loss of senses -confusion -loss of consciousness End of life care for family -allow family to assist with preparation of the body -encourage family to hold child if needed -allow as much time the family desires with the body -provide memory keepsakes -allow time to share stories/talk about the child -Units have nurses who assist with family care in pediatric death What are nationally notifiable diseases? -Botulism -Chlamydia/gonorrhea/syphillis -ehrlichiosis (tick borne) -Lyme disease (tick) -Malaria (mosquito) -RMSF (tick) -Rabies -Hep A, B, and C -Flu -Measels -Meningococcus -mumps -pertussis -polio -Q fever -Rubella -Varicella (morbidity only) -Strep group A -Tetanus -diptheria -TB Infectious process -When the organism enters the body and multiplies causing damage to tissues. -INITIAL vasoconstriction thennn dilation -Cellular response is the arrival of WBCs to the area Neutrophils (granulocyte) FIRST line of defense (for bacteria, fungus, cell debris, foreign substances) Eosinophils (Granulocyte) Allergic disorders or parasitic infection Basophils (granulocytes) Respond to allergic disorders and hypersensitive reactions; used to study CHRONIC inflammation Lymphocytes (B, T, and NK) -Main source of producing an immune response -respond to viral infections (measels, rubella, chickenpox, infectious mono, tumors) B cells: Produce specific antibodies Monocytes 2nd line of defense, responds to larger and more severe infections than neutrophils by phagocytosis -Leukemias and lymphomas -CHRONIC inflammation What is considered a fever? (rectal and oral) Rectal: >100.4 F Oral: >100 F What part of the brain regulates temperature? Hypothalamus What vitals changes are r/t an elevated temperature? Increased HR, RR, metabolic rate -Vasodilation occurs causing skin flushes, warmth What is the purpose of a fever? -Slows growth of bacteria/virus Hyperthermia Seen when there is a disorder w/in the CNS (body is no longer able Causes: disease, drugs, heat stroke Cryogen Prevents body temp from rising too high (should never be more than 105 F) Pryogen a substance, typically produced by a bacterium, that produces fever when introduced or released into the blood. Stages of infection -Incubation -Prodrome -illenss -convalescense Incubation Time from entrance to appearance of 1st s/s (Prodrome stage) Pathogens grow and multiply -Asymptomatic Prodrome Onset of NON-SPECIFIC s/s to more specific s/s (illness stage) (Fever, malaise) Illness Develop SPECIFIC S/S (ex: vessicles indicates chicken pox) Convalescence Acute s/s of illness disappear What is a susceptible host? -Someone who cannot resist an infection and is more prone to morbidity of infection (ex: mom is not susceptible host of pertussis but baby is) Assessment of children -Pertinent health Hx (mothers preg) -Family hx (recent infections) -Immunization hx -immunocompromised -History of Present Illness (HPI) -Pertinent objective findings -Lab and Dx testing How to assess HPI? -Known exposure to infectious/communicable disease -fever -sore throat -poor feeding -n/d/v -cough -rash (pain with rash?) Examples of objective findings in assessment of a sick child? -Toxic appearance (hypo/hyper RR, pale, cyanotic, inconsolable) -Irritable -Lethargy -cough -nasale d/c -sunken eyes -rash -swollen lymph nodes -sunken fontaneles -tachycardia What nursing principle is atraumatic care based on? Non-maleficence (do no harm) What are the 3 goals of atraumatic care 1. Prevent/minimize physical/psychological stressors 2. Prevent/minimize parent-child separation 3. Promote a sense of control Atraumatic care: preventing/minimizing physical harm -distraction (sing, count, blow bubbles, squeeze hand, point to pictures, blow a pinwheel) -playing games -therapeutic hugging/comfort holds -Pain meds -Decrease noise -therapeutic communication -Age appropriate education Atraumatic care: Prevent/minimize parent-child separation -Provide accomodations for family to stay with child -Allow family to stay for invasive procedures -Treat the family like the patient -Educate family on what is happening Atraumatic care: Promote sense of control -Allow for family involvement in care -Encourage communication -Collaborate w/family's needs (schedules) -Ellicit family's knowledge in the child's normal and hx Infants: Age-appropriate communication -Quickly respond to crying -allow infant time to warm up to you -Use soothing tone when talking to infant -communicate thru play if older -watch for s/s of overstimulation (closing eyes, turning head away, yawning, irritable) Toddlers: Age-appropriate communication -Approach carefully -Use the toddlers preferred words for objects or actions so they can better understand you -Stories, dolls, books -Prepare toddlers for procedures just before they are about to occur -parallel play to help initiate communication Preschoolers: Age-appropriate communication -Use play, puppets, storytelling -Speak honestly -Use simple, concrete terms -Ask specific questions -participate in imaginative play to help open communication -prepare preschoolers about 1 hr prior to a procedure School-age: Age-appropriate communication -Use diagrams, illustrations, books, videos -Allow child to honestly express feelings -say "some children feel anxious about..." (invoke 3rd party) - allow questions -prepare them a few days in advance for procedures Adolescents: Age-appropriate communication -always respect privacy -ensure confidentiality -remain nonjudgmental -listen attentively and speak respectfully -use appropriate medical terminology (defining words as needed) Child life specialist -Member of care team: they are trained on the developmental impact of illness, injury, and trauma on children and families -Their Goal: reduce stress experienced by children and families r/t hospitalization Interventions: teach coping strategies through play, prep, edu. Help make a healthy environment. Grief and bereavement support Infant behavior in the hospital -Fearful (stanger anxiety from 6-18 months) -cannot follow directions/understand -may not sleep well -facial expression are the most consistent indicator of pain Safety for infants in the hospital -Close supervision (at least 1 adult caregiver in the room w/you at all times) -keep one hand on infant when crib rails are down -No small objects left near them -safe toys -room close to nurse station -encourage family to stay Interventions for infants in the hospital -Encourage home routines -Minimize painful procedures -consistency of caregivers (same nurse is best) -smile/talk during interactions -smooth, continuous movements -provide comfort after procedures -use pacy between feedings Toddler behavior in hospital -Limited ability to: describe illness, understand need for procedures, ability to follow directions -separation anxiety/fear (first protest, despair, then detachment!) -May have intense reactions -Regression Toddler safety in hospital -Crib rails up/overhead crib protection -Should not be alone unless secured in a crib -Bed only when adult present at all times -no small objects/safe, appropriate toys -out of reach of cords, outlets -adult present when ambulating Toddler interventions -Encourage parent to stay -Give choices -Encourage play -Plan for regression -maintain home routines -simple directions Preschooler behavior in hospital -Magical thinking (think illness=punnishment) -Limited ability to describe s/s -limited understanding of illness but knows what illness feels like -separation anxiety -allow questions Preschooler safety -Bed in lowest position, side rails up -Tell child to call before getting out of bed -Keep harmful objects out of reach Preschooler interventions -Simple language to explain procedures -encourage them to help -Use play to work through fears -handle medical equipment if safe -maintain home routines School-age behavior in hospital -Better at describing their pain, more aware of body function -ask why a lot (simple explanations) -Like to have control -attached to parents -like peers and regular routines -can tell when they are not being told the truth Safety for school-age in hospital -keep in bed w/side rails up when in bed Interventions for school-age in hospital -Allow to make choices -encourage school work -allow feeling expression -keep home routines -allow visits from friends Adolescents behavior in hospital -Increasing awareness of cause/effect -concerned w/body image changes -may or may not express fears -need privacy -May feel isolated from peers -Worry about school absences/activities -May not adhere to treatments/meds due to peer influence Safety of adolescents in hospital Be aware of whereabouts (set clear boundaries) Interventions for adolescents in hospital When to go to the "treatment room" and procedures for kids -anytime there is a procedure that may be painful -older child may opt to stay in hospital room -always praise/reward the child no matter how they responded after the procedure Types of Comfort holds -Chest to chest -Back to chest -Side sitting -swaddle Atraumatic care for kids -Perform ALL blood draws in treatment room -Topical anesthetics -avoid traditional restraint or "holding down" the child. Use alternative positioning like "therapeutic hugging" -Insert a saline lock if the child requires multiple doses of parenteral medication. -advocate for minimal lab blood draws/Injections -refrigerant spray prior to venipuncture -Oral sucrose -Nonnutritive sucking in infants -allow family choice to stay for an invasive procedure -Maintain the child's home routine r/t activities of daily living -Ask permission from parents to approach child to appear non-threatening -Encourage the child to have access to security item -make the environment comfortable and inviting. Atraumatic care pre-procedure -Provide description and reason (the dr will look at your blood to see if you're sick) -Describe where the procedure will occur -Introduce strange equipment -ID normal sensations -Inform child if pain is involved -tell them it's okay to cry/yell -Give ways to distract pt (you can sing, count, etc) Atraumatic care intra-procedure -allow child to express feelings but tell them they must stay still Physical stressors for kids -Restraints -Pain -inability to eat/drink Psychological stressors for kids -Stranger anxiety -fear of harm Types of play and benefits in the hospital -Unstructured play: play at their will -nursing care play: get the kid to "blow bubbles" while you listen to their lungs -therapeutic play: act out fears (giving a doll a shot) Benefits -Emotional outlet -opportunity for teaching/learning Hospital discharge -F/U appointment -Nurse MUST assess family's knowledge and resources -guidelines when to contact provider -return to school instructions (When can they go back? excuses) -referral agencies (home health, DME) -diet/activity Community-Based nursing care -Cost effective way to provide care -allows chronically ill children to recieve home care (outpatient, health department, schools, medically fragile daycares, home health care) Individualized Health Plan (IHP) -Nurse helps develop IHP for students with complex health needs -Must include directions for care while child is still at school -Ex: WBC differential measure of the percentage of different types of white blood cells present in the blood Erythrocyte Sedimentation Rate (ESR) -Detect presence of inflammation, infection Blood culture and sensitivity -Detect presence of bacteria or yeast that may have spread to blood stream -Determines abx the bacteria is sensitive to -2 cultures from 2 different sites -ideally BEFORE abx use Why do we start prophylactic broad spectrum abx before we get lab results? -Cannot wait for culture Stool culture Detects parasites -ova w/diarrhea, fever, abd pain -often a min of 3 samples on 3 days FUO Fever of unknown origin What are indications for a urine culture in pediatrics? -FUO -Dysuria -Urgency -abnormal UA How to obtain a urine culture in children if the child is NOT potty trained? In and out catheter Wound culture -May need to irrigate first if heavy drainage -Clean first then take culture -do not take culture from exudate or eschar What is the most reliable detector of Strep group A pharyngitis? -Throat culture How to perform a nasal swab? -Insert swab into nose until reaching nasopharynx; insert straight back NOT up, leave for several seconds -Detects pertussis, diptheria, flu, RSV T/F antipyretics provide symptomatic relief but don't change course of infection T What are benefits of treating fever in children? -Reduce workload on heart (decreases Tachypnea and tachycardia) What rectal temp should be seen by a provider ASAP if less than 3 months? >100.4 F (bc they could have sepsis and this is harder to dx in kids) Home management of fever -Diurnal variation may allow temp changes during day (peaks: evening) -Antipyretics may be used if child demonstrates discomfort -always check correct dose before admin -NEVER give aspirin-containing products to kids under 19 years with a fever due to Reyes syndrome -push fluids -no cold baths, sponging (we don't want child to shiver bc it will increase body temp more) Reyes syndrome Commonly seen in kids who recently had flu or chicken pox -Avoid in people Less than 19 years When should caregivers call MD/NP? -Child is < 3 months old with temp >100.4 F -Febrile seizure (cause is mostly due to how quickly their temp gets elevated not how high) -Child is lethargic/listless -fever >3-5 days -Fever >105 F -immunocompromised with illness -inconsolable crying -unable to swallow When should kids stay home from school? Temp 100.4 or higher GI: -Vomiting w/in the last 24 hours -Diarrhea within the past 24 hr Skin/hair: -Body rash with itching -Lice Eyes: -Eye infection Etc: -Hospital stay/ER visit (medical release to return to school must be provided) When can kids go back to school after an illness? -Fever: none for 24 hr w/o use of antipyretics -Diarrhea: No diarrhea for 24 hr -Vomiting: Free from vomiting for at least 2 solid meals -Rash/itch: No rash/itching/fever -Lice: Treated with lice at home w/proof -Notes: Have a note to return to school from MD/NP or a Medical release When can kids go back to school after a fever? Fever free for 24 hr w/o anti-pyretics When can a child go back to school after vomiting? -Free from vomiting for at least 2 solid meals When can a child go back to school after diarrhea? free from diarrhea for at least 24 hrs Tylenol dose for kids 10-15 mg/kg/dose -no more than q4hr -no more than 5 doses in a 24 hr period Ibuprofen dose for kids (motrin, advil) 4-10 mg/kg/dose -ONLY in kids >6 months old -no more than 4 doses in 24 hrs Acetaminophen overdose S/S: n/v, sweating, hepatic s.s (RUQ pain, jaundice, confusion), death or gradual recovery Treatment of acetaminophen overdose N-Acetylcysteine given orally (Mucomyst) -Activated charcoal WITHIN 1 hr of ingestion What children are at greatest risk for sepsis? -Infant < 3months -kids with indwelling venous catheter What is the most common cause of sepsis in infants? -GBS type A -Staph aurius -Meningitis What is immunity ability to destroy and remove a antigen from the body Are vaccines passive or active immunity? active immunity Herd immunity The resistance of a group to an attack by a disease to which a large proportion of the members of the group are immune What is immunization? Process when someone becomes protected from a disease (can be induced by a disease or vax) Live attenuated vaccine Living organisms that are weakened and produce a immune response but not the illness. -Types: MMR, Varicella, and rotavirus, some flu vax Killed vaccines Contain whole dead organisms; cannot reproduce Ex: Toxoid vaccines Contain protein products (toxins) produced by bacteria Conjugate vaccines Results from chemically linking the bacterial cell wall polysaccharide portions with proteins Recombinant DNA vaccines Use GMOs mRNA vaccines RNA instructions to make "spike proteins" that the immune system recognizes and creates antibodies for. What are common side effects of vaccines -Low-grade fever -swelling at site -fussiness -redness/tender What education should the nurse distribute PRIOR to vax administration? Vaccine Information Statements (VIS) What gauge needle/length is needed for SubQ injections? 23-25 G Length: 5/8 inch What gauge needle/length is needed for IM injections? 22-25 G Length: 1" (if older than newborn), 5/8" for newborn What injection site is used for SubQ injections (pedes) Infant (1-12 months) [fatty tissue of vastus lateralis] Children 12 months or older, adolescents [fatty tissue over vastus lateralis or over triceps] IM injection sites for pedes Newborns (vastus lateralis) infants (vastus lateralis) Children >3 yrs (vastus lateralis or deltoid) What should the nurse ask prior to giving vaccines? -Previous immunization reactions -screen for precautions/contraindications -provide VIS -Sign consents -Give copy of immunization record -Vaccine Adverse Event Reporting System (VAERS) Contraindications to live vaccines? -Severely immunocompromised -Pregnant In what cases should vaccines be temporarily postponed? -Immunosuppression -Moderate to severe illness -Pregnancy -Recently recieved blood products If a pt has a allergic reaction to a vaccine component, will they be allowed to get it again? No. Permanently contraindicated. What should be documented for vax administration? -Date administered -Name of vax -Lot # and expiration date of vax -site and route administered -edition date of VIS given to parents -Name and address of facility -Name of person giving the vax Diptheria Cause: Corynebacterium diptheria S/S: tonsillar and pharyngeal infections (Tx: ABX, antitoxin, airway management) -pseudomembrane forms over pharynx, uvula, tonsils, and soft palate (causes airway obstruction and suffocation) -Neck edema and lymphadenopathy -risk factors: unimmunized or underimmunized Scarlet fever -Cause: Group A strep -S/s: fever >101, Sand-paper rash, strawberry tongue, tonsil enlargement/exudate, rash on face/trunk/extremity, body aches, pharyngitis -Common ages: 5-12 yrs -Tx: penicillin V -Mngt: cold, soft food -Rare complications: rheumatic fever, glomerulonephritis, skin infections, pneumonia Tetanus Neurological disease caused by toxins of clostridium tetani -Increasing muscle spasm and tone that is descending -Entry: through burns, wounds, IV street drugs -Found in animal feces, soil, dust -Fatality: 10% of cases are fatal Tx: supporting cardiopulmonary function, control muscle spasms, tetanus immunoglobulin and vaccine, wound debridement, IV abx Prevention: booster q10 yrs Pertussis "whooping cough" -Cause: Bordetella pertussis bacteria -What: Starts w/cold symptoms 7-10 days followed by paroxysmal cough and copious secretions for 1-4 weeks. -Who: children <1 year -Tx: Macrolide abx, treat close contacts, humidifier, frequent suctioning, encourage fluids, observe for airway obstruction, droplet precautions! What precaution is used for pertussis? Droplet precautions Viral exanthem -What: Skin rash or eruption caused by a virus -Tx supportive (home care usually): antipyretics, hydration, skin care Mumps "think lumps" -Cause: paramyxovirus -S/S: fever, parotitis, orchitis (inflammation of testicles in 50% of post-pubertal boys) -Precautions: droplet -Tx: supportive (not contagious 9 days after onset of parotitis), pain mngt, antipyretics Rubella (German measeles) -Cause: rubella virus -S/S: maculopapular descending rash begins on face, spreads to feet and ends in this way as well; low-grade fever, malaise -Precautions: Droplet -Tx: supportive (antipyretics) -Contagious: no longer contagious after 7 days from rash onset Rubeola (measels) -Cause: measels virus -Transmission: blood, droplet, urine -S/s: koplik spots (early sign), eryhtematous maculopapular rash, conjunctivitis, cough, fever -Precautions: airborne precautions until after 4 days after rash onset. -Contagious: HIGHLY contagious until 4 days AFTER onset -Tx: supportive Varicella (Chicken Pox) -Cause: varicella zoster virus, HHV 3 -Transmission: HIGHLY contagious, contact, airborne, placental -S/S: lesions form from papules to vesicles; HA in prodrome; fever/malaise; intensely pruritic. The vescicles will erupt, scab, and crust. -Tx: supportive but may recieve immune globulin in high risk (oatmeal baths) -Long-term effect: Lifelong latent infection (shingles) -Contangious: not contagious until after lesions have crusted over. Erythema infectiosum (fifth disease) -Cause: human parvovirus B19 -Transmission: droplet, blood, placental (VERY dangerous can cause miscarriage in 1st trimester) -S/s: pain or swelling in joints, "slapped cheek" appearance with circumoral pallor --> spreads to trunk (often itchy) -Contagious: Most children no longer infected when rash appears -Tx: supportive Hand, foot, and mouth disease -Cause: coxsackie A virus -Transmission: fecal oral -S/s: high fever first, followed by vesicles on tongue, oral mucosa, hands and feet -Tx: supportive Covid-19 Incubation period: 2-14 days Tx: supportive, isolation Vax: vaccine if >6 months Rare: MIS-C (autoimmune multi-system inflammatory syndrome in child) that causes organ swelling -Tx: IgG immunoglobulin Lyme disease -Cause: spirochete borrelia burgdorferi -S/s: rash after bite that looks like a bulls-eye, fever, HA, fatigue, arthralgias -Tx: Doxycycline (if older than 8 yr due to teeth staining), amoxicillin if younger). Tx lasts for 14-28 days -Prevention: Prompt removal of ticks RMSF -2nd most common vector-borne disease after Lyme -Cause: Rickettsia -Vectors: american dog tick and mountain wood tick -S/S: anorexia, HIGH fever, rash 2-5 days AFTER fever onset, muscle pain, malaise -Fatality: can be fatal w/o prompt tx -Tx: ABX therapy (doxycycline is preferred tx at any age) usually 7-14 days Tick removal -Dont twist/jerk -pull tick directly up -clean site -save tick -protect fingers with glove/paper towel Pediculosis capitis (head lice) -Transmitted by direct contact with hair of infected person -Eggs hatch in 6-10 days, adult lice in 2-3 wks -Tx: wash hair with pediculocide (permetherin, malathion, ivermectin) Scabies -Cause: sarcoptes scabei -Transmission: prolonged, close personal contact -S/S: intense itching at night, erythematous papular rash w/excoriations (rash more present on palms, soles, fingers) -Tx: scabicide (permetherin, lindane to entire body below the head overnight), treat anyone in household and sexual contacts prophylactically; wash bedding/clothing in hot water; -Precautions: Contact Pinworms -Cause: enterobius vermicularis -S/s: anal itching at night (pruritus ani) -Transmission: fecal-oral route, contaminated hands, toys, bedding, clothing, toilet seats -Dx: worms visualized with scotch tape test (put tape on rectum at night) -Tx: single dose of albendazole (repeat in 2 weeks) -Precautions: treat family members, -Contangious: can be reinfected easily How to check for identifiers when providing care? -Mom may give 2 identifiers -Check wristband Fluoroquinolones -floxacin -Do not give until 16 yr old -Can cause ruptured tendons esp if they are still growing Tetracycline -do not give to pregnant women or children before age 8 or damage to tooth enamel occurs Tylenol Must be at least 2 months old Iburprofen Must be at least 6 months old Diphenhydramine DO NOT give to children <2 yr (will not be able to determine if the illness has worsened or not) Promethazine Avoid in kids due to sedation effect When can a child have the adult dose? When they weigh about 40-50 Kg What age should NOT swallow pills? <5-6 yr Why do we never mix a medication with a essential food like breast milk? -They will associate the milk with medication -You instead should use applesauce Opthalmic meds -Administer ointments prior to bedtime/nap Otic meds -Make sure drops are at room temp -<3 yr pinna down and back ->3 yr pinna up and back -Remain in same position for several minutes, massage tragus, cotton ball PRN Infants IM injections -Site: vastus lateralis ONLY -volume: NEVER more than 0.5 mL in inj. -Needle length: 5/8th inch needle -Gauge: 22-25 G School-age/toddler IM injections -Site: vastus lateralis, ventrogluteal, deltoid -Guage: 22-25 G -Needle length: 1-1.5" When can we use the deltoid site for an IM injection? > 3yr old SubQ injection sites -Anterior thigh, abdomen, lateral aspect of upper arm Intradermal injections Use TB syringe Gauge: 26-30 G 15 degree angle Site: inside surface of forearm IV 24-20 G -dont change unless indicated -Avoid placing IV in dominant/sucking hand -DONT use clip connectors (use luer lock) What is the goal of health supervision? Catch disabilities and diseases early on to make sure a child develops properly and is well. What is developmental surveillance? -Occurs at every visit -Uses a screening tool -Recommended at 9, 18, 24, and 30 months What are types of developmental surveillance screening tools? Ages and stages questionnaire (ASQ) Parent's evaluation of developmental status (PEDS) Child development inventory (CDI) Denver II How is the "tumbling E" test performed? -Passing: Get 50% correct -Procedure: stand 10 ft away and cover 1 eye -Age: preschool What is the procedure for using the Snellen Chart? -Stand 20ft away -cover one eye (May wear glasses) Passing: 50% correct Ages: >6 years old What is the ishihara test? color blindness test using NUMBERS! Age: school age (need to know their numbers) What is the CVTME? Color blindness test (uses SHAPES) Age: preschool age What children are at risk for iron deficiency anemia? -High consumption of cow's milk -lead exposure -Low income, migrants -blood loss -LBW, preemie -Rapidly growing When is a Hgb/HCT first performed in kids? 12 months old What is the procedure for a metabolic screening for newborns? -Required in all states -Done at 24-48 hr of age -Must be confirmed at first WC -Tests for: PKU, sickle cell, thalassemia, Galactosemia, CF, SCID, and Congenital hypothyroidism How is vision screened in a neonate? Baby should fixate on an object 10-12 inches from their face, then follow to midline How is vision screened in a 2 month+? Should fixate and follow object 180 degrees How is vision screened in a preschooler? Tumbling E or Allen Figures How is vision screened in a school-age child and up? Snellen chart What is an elevated lead level? >3.5 mcg/dL (mcg=ug) When does HTN screening start in kids? 3 years old then annually When is autism screening performed? 18 months and 24 months (2 years) -Use M-CHAT-R questionnaire When does depression screening begin? 12-20 yr then annually What children are at risk for a developmental delay? -Gestational age <33 weeks -LBW -Maternal drug use -Hypertonia/hypotonia -severe kernicterus -congenital malformations -Lead levels >5 mcg/dL -Sibling or parent w/developmental disability/delay -Single parent w/less than a high school edu -Single parent What ages are wellness checks performed? 1st or 2nd week -2 months -4 months -6 months -9 months -12 months -15 months -18 months -24 months -30 months -yearly until age 21 FLACC scale -Faces -Legs -Activity -Cry -Consolability For infants 2 months to 7 years who are unable to validate the presence of or quantify the severity of the pain What age group should the nurse use the FLACC scale for pain? 2 months to 7 years (anyone who cannot quantify pain)