ATI Pediatrics Proctored Exam Graded A 2025

1. Parenting styles • Dictatorial or authoritarian: nursing care o Parents try to control the child’s behaviors and attitudes through unquestioned rules and expectations ▪ Ex: The child is never allowed to watch television on school nights • Permissive: o Parents exert little or no control over the child’s behaviors, and consult the child when making decisions ▪ Ex: The child assists with deciding whether he will watch television • Democratic or authoritative: o Parents direct the child’s behavior by setting rules and explaining the reason for each rule setting ▪ Ex: The child can watch television for 1 hr on school nights after completing all of his homework and chores o Parents negatively reinforce deviations form the rules ▪ Ex: The privilege is taken away but later reinstated based on new guidelines Chapter 2: Physical assessment findings 1. Vital signs -Usually vital signs are all high except for BP -Temperature: -3 – 6 months 99.5 -1 year 99.9 -3 year 99.0 -5 years 98.6 -7 years 98.2 -9 – 11 years 98.1 -13 years 97.9 -Pulse: -Newborn 80 – 180/min -1 weeks – 3 months 80 – 220/min -3 months – 2 years 70 – 150/min -2 – 10 years 60 – 110/min -10 years and older 50 – 90/min -Respirations: -Newborn – 1year 30 – 35/min -1 – 2 years 25 – 30/min -2 – 6 years 21 – 25/min -6 – 12 years 19 – 21/min -12 years and older 16 – 19/min -Blood pressure: -Low as a baby but increases the older they get -Infants: Systolic: 65-78/ Diastolic: 41-52 2. Head: Fontanels should be flat • Anterior fontanel: o Closes by 12-18 months • Posterior fontanel: o Closes by 6-8 weeks 3. Teeth -Infants should have 6-8 teeth by 1 year old -Children and adolescents should have teeth that are white and smooth, and begin replacing the 20 deciduous teeth with 32 permanent teeth 4. Infant Reflexes Stepping Birth to 4 weeks Palmar Grasp Birth to 3 months Tonic Neck Reflex (Fencer Position) Birth to 3 – 4 months Sucking and Rooting Reflex Birth to 4 months Moro Reflex (Fall backward) Birth to 4 months Startle Reflex (Loud Noise) Plantar Reflex Babinski Reflex Birth to 4 months Birth to 8 months Birth to 1 year 1. Physical Development • Weight: Chapter 3: Health promotion of infants (2 days to 1 year) o Doubled by 5 months o Tripled by 12 months o Quartered by 30 months • Height: o 2.5 cm (1 in) per month for the first 6 months • Length: o Increases by 50% by 12 months • Dentition: o First teeth erupt between 6-10 months 2. Motor skill development • 1 Month o Head lag o Strong grasp reflex • 2 Months o Lifts head when prone o Holds hand in open position | Grasp reflex fades • 3 Months o Raises head and shoulders when prone | Slight head lag o No grasp reflex | Keeps hands loosely open • 4 Months o Rolls from back to side o Grasp objects with both hands • 5 Months o Rolls from front to back o Palmar grasp dominantly • 6 Months o Rolls from back to front o Holds bottle • 7 Months o Bears full weight on feet | Sits, leaning forward on both hands o Moves objects from hand to hand • 8 Months o Sits unsupported o Pincer grasp • 9 Months o Pulls to a standing position | Creeps on hands and knees instead of crawling o Crude pincer grasp | Dominant hand is evident • 10 Months o Prone to sitting position o Grasps rattle by its handle • 11 Months o Walks while holding onto something | Walks with one hand held o Places objects into a container | Neat pincer grasp • 12 Months o Stands without support briefly | Sits from standing position without assistance o Tries to build a two-block tower w/o success | Can turn pages in a book 3. Cognitive development • Piaget: sensorimotor (birth to 24 months) • Object Permanence: objects still exists when it is out of view o Occurs at 9-10 months 4. Language development: 3-5 words by the age of 1 year 5. Psychosocial development • Erikson: Trust vs. Mistrust: -Learn delayed gratification -Trust is developed by meeting comfort, feeding, simulation, and caring needs -Mistrust develops if needs are inadequately or inconsistently met or if needs are continuously met before being vocalized by the infant 6. Social development • Separation Anxiety: protest when separated from parents o Begins around 4-8 months • Stranger Fear: ability to discriminate between familiar and unfamiliar people o Begins 6-8 months 7. Age appropriate activities -Rattles -Playing pat-a cake -Brightly colored toys -Playing with blocks 8. Nutrition • Breastfeeding provides a complete diet for infants during the first 6 months • Solids are introduced around 4-6 months o Iron-fortified cereal is the first to be introduced o New foods should be introduced one at a time, over a 5-7 day period to observe for allergy reactions • Juice and water usually not needed for 1st year • Appropriate finger foods: o Ripe bananas o Toast strips o Graham crackers o Cheese cubes o Noodles o Firmly cooked vegetables o Raw pieces of fruit (except grapes) 9. Injury prevention -Avoid small objects (grapes, coins, and candy) -Handles of pots and pans should be kept turned to the back of the stove -Sunscreen should be used when infants are exposed to the sun -Infants and toddlers remain in a rear-facing car seat until age 2 -Crib slats should be no farther apart than 6 months -Pillows should be kept out of the crib -Infants should be placed on their backs for sleep Chapter 4: Health Promotion of Toddlers (1 to 3 years) 1. Physical development • Weight: 30 months: 4 times the birth weight • Height: Toddlers grow 7.5 cm (3 in) per year • Head circumference and chest circumference: Usually equal by 1 to 2 years of age 2. Cognitive development o Piaget: sensorimotor stage transitions to preoperational stage 19 – 24 months • Object Permanence: fully developed 3. Language development -1 year: using one-word sentences -2 years: 300 words, multiword sentences by combining 2-3 words 4. Psychosocial Development • Autonomy vs. Shame and Doubt -Independence is paramount for toddlers who are attempting to do everything for themselves -Use negativism or negative responses to express their independence -Ritualism, or maintaining routines and reliability, provides a sense of comfort for toddlers as they begin to explore the environment beyond those most familiar to them 5. Age appropriate activities • Parallel play: Toddlers observe other children and then might engage in activities nearby • Appropriate activities: -Playing with blocks -Push-pull toys -Large-piece puzzles -Thick crayons -Toilet training can begin when toddlers have the sensation of needing to urinate/defecate 6. Motor skill development ▪ 15 Months o Walks without help | Creeps up stairs o Uses a cup well | Builds 2 tower blocks ▪ 18 Months o Runs clumsily | Throws overhand | Jumps in place w/ both feet | Pulls/Pushes toys o Manages a spoon w/o rotation | Turns pages 2-3 pages /time | Builds 3-4 blocks | Uses crayon to scribble spontaneously | Feeds self ▪ 24 Months (2 years) o Walks backwards | Walks up/down stairs w/ 2 feet on each step o Builds 6-7 blocks | Turns pages 1 @ a time ▪ 30 Months (2.5 years) o Balances on 1 leg | Jumps across floor / off chair w/ both feet | Walks tiptoe o Draws circles | has good hand-finger coordination 7. Nutrition • Whole milk at 1 year old • Can start drinking low-fat milk after 2 years of age • Juice consumption should be limited to 4-6 oz. per day -Foods that are potential choking hazards: -Nuts -Grapes -Hot dogs -Peanut butter -Raw carrots -Tough meats -Popcorn Chapter 5: Health Promotion of Preschoolers (3-6 years) 1. Physical development • Weight: Gain 2-3 kg (4.5-6.5 lb) per year • Height: Should grow 6.9-9 cm per year 2. Fine and gross motor skills ▪ 3 Years o Toe and heel walks o Tricycle o Jumps off bottom step o Stands on one foot for a few seconds ▪ 4 Years o Hops on one foot | Skips o Throws ball overhead o Catches ball reliably ▪ 5 Years o Jumps rope o Walks backward o Throws and catches a ball 3. Cognitive development • Piaget: preoperational stage o Moves from totally egocentric thoughts to social awareness and the ability to consider the viewpoint of others • Magical thinking: Thoughts are all-powerful and can cause events to occur • Animism: Ascribing life-like qualities to inanimate objects 4. Psychosocial development • Erikson: Initiative vs. guilt: -Preschoolers become energetic learners, despite not having all of the physical abilities necessary to be successful at everything -Guilt can occur when preschoolers believe they have misbehaved or when they are unable to accomplish a task -During stress, insecurity, or illness, preschoolers can regress to previous immature behaviors or develop habits (nose picking, bed-wetting, thumb sucking) 5. Age appropriate activities -Preschooler’s transition to associative play -Play is not highly organized, but cooperation does exist between children -Appropriate activities: -Playing ball -Putting puzzles together -Riding tricycles -Playing pretend dress up activities -Role-playing 6. Sleep and rest -On average, preschoolers need about 12 hours of sleep -Keep a consistent bedtime routine -Avoid allowing preschoolers to sleep with their parents Chapter 6: Health promotion of School-Age children (6-12 years) 1. Physical development -Weight: Gain 2-3 kg (4.4-6.6 lb.) per year -Height: Grows 5 cm (2 in.) per year 2. Cognitive development • Piaget: Concrete operations ---Able to see the perspective of others 3. Psychosocial development • Erikson: Industry vs. Inferiority -A sense of industry is achieved through the development of skills and knowledge that allows the child to provide meaningful contributions to society -A sense of accomplishment is gained through the ability to cooperate and compete with others -Peer groups play an important part in social development 4. Age appropriate activities -Competitive and cooperative play is predominant -Play simple board and number games -Play hopscotch -Jump rope -Ride bicycles -Join organized sports (for skill building) 5. Sleep and rest: Need 9 hrs of sleep at age 11 6. Dental health : The first permanent teeth erupt around 6 years of age Chapter 7: Health promotion of Adolescents (12 to 20 years) 1. Physical development -Girls stop growing at about 2-2.5 years after the onset of menarche -In girls, sexual maturation occurs in the following order: -Breast development -Pubic hair growth -Axillary hair growth -Menstruation -In boys, sexual maturation occurs in the following order: -Testicular enlargement -Pubic hair growth -Penile enlargement -Growth of axillary hair -Facial hair growth -Vocal changes 2. Cognitive development • Piaget: Formal operations -Increasingly capable of using formal logic to make decisions 3. Psychosocial development • Erikson: Identity vs. role confusion -Adolescents develop a sense of personal identity and to come to view themselves as unique individuals 4. Age-appropriate activities -Nonviolent videogames -Nonviolent music -Sports -Caring for a pet -Reading Chapter 8: Safe Medication Administration 1. Oral -This route of medication administration is preferred for children -Avoid mixing medication with formula or putting it in a bottle of formula because the infant might not take the entire feeding, and the medication can alter the taste of the formula -Use the smallest measuring liquid medication for doses of liquid medication -Avoid measuring liquid medication in a tsp. or tbsp. -Administer the medication in the side of the mouth in small amounts -Stroke the infant under the chin to promote swallowing while holding the cheeks together 2. Otic -Children younger than years: Pull the pinna downward and straight back -Children older than 3 years: Pull the pinna upward and back 3. Intramuscular -Use a 22-25 gauge, 1/2-1 inch needle -Vastus lateralis is the recommended site in infants and small children -Other sites: Ventrogluteal and deltoid 4. Intravenous -Avoid terminology such as “bee sting” or “stick” -Apply EMLA to the site for 60 minutes prior to attempt (helps numb) -Keep equipment out of site until procedure begins -Perform procedure in a treatment room (don’t do it in their room) -Allow parents to stay if they prefer -Swaddle infants -Offer nutritive sucking to infants before, during, and after the procedure Chapter 9: Pain management 1. Atraumatic measures: -Use play therapy to explain procedures, allowing the child to perform the procedure on a doll/toy 2. Pharmacological measures -Give medications routinely, vs. PRN, to manage pain that is expected to last for an extended period of time 3. Pain assessment tool -Flacc: 2 months- 7 years -Faces: 3 years and older -Oucher: 3-13 years -Numeric scale: 5 years and older Chapter 10: Hospitalization, illness, and play 1. Infant -Experiences stranger anxiety between 6-18 months -Displays physical behaviors as expressions of discomfort due to inability to verbalize 2. Toddler -Limited ability to describe illness -Limited ability to follow directions -Experiences separation anxiety -Can exhibit an intense reaction to any type of procedure -Behavior can regress 3. Preschooler -Fears related to magical thinking -Can experience separation anxiety -Might believe illness and hospitalization are a punishment -Explain procedures using simple, clear language -Avoid medical jargon -Give choices when possible, such as, “Do you want your medicine in a cup or spoon?” 4. School-age child -Ability to describe pain -Increasing ability to understand cause and effect -Provide factual information -Encourage contact with peer group 5. Adolescent -Perceptions of illness severity are based on the degree of body images -Develops body image disturbance -Experiences feelings of isolation from peers -Provide factual information -Encourage contact with peer group Chapter 11: Death and Dying 1. Grief and mourning -Anticipatory grief: When death is expected or a possible outcome -Complicated grief: Extends for more than 1 year following the loss 2. Current stages of development -Infants/toddlers (birth-3 years): -Have little to no concept of death -Mirror parental emotions -Can regress to an earlier stage of behavior -Preschool (3-6): -Magical thinking allows for the belief that thoughts can cause an event such as death resulting in feeling guilt and shame -Interpret separation from parents as punishment for bad behavior -View dying as temporary -School-age (6-12): -Begin to have adult concept of death -Fear often displayed through uncooperative behavior -Adolescent (12-20): -Can have adult-like concept of death -Can have difficulty accepting death -Rely more on peers than the influence of parents -Can become increasingly stressed by changes in physical appearance 3. Physical manifestations of death -Sensation of heat when the body feels cool -Decreased sensation and movement in lower extremities -Swallowing difficulties -Bradycardia/hypotension -Cheyne-strokes respirations 4. After death -Allow family to stay with the body as long as they desire -Allow family to rock the infant/toddler -Remove tubes and equipment -Offer to allow family to assist with preparation of the body Chapter 12: Acute Neurological disorders 1. Meningitis -Viral (aseptic) Meningitis: supportive care for recovery -Bacterial (septic) Meningitis: contagious infection -Hib and PCV vaccines decrease the incidence -Newborns: -Poor Muscle Tone -Weak Cry -Poor Suck | Refuses Feedings -Vomiting/Diarrhea -Bulging Fontanels (late sign) -3 Months – 2 Years: -Seizures with a High-Pitched Cry -Bulging Fontanels -Poor Feedings | Vomiting -Possible nuchal rigidity -Brudzinki’s sign and Kernig’s sign not reliable for diagnosis -2 Years – Adolescence: -Seizures (often initial sign) -Nuchal rigidity -Fever/chills -Headache/vomiting -Irritability/restlessness that can progress to drowsiness/stupor -Petechiae or purpuric type rash (with meningococcal infection) -+ Brudzinski Sign: flexion of extremities with deliberate flexion of the neck -+ Kernig’s Sign: resistance to extension of the leg from a flexed position -Laboratory Tests -Blood Cultures | CBC | CSF Analysis -Viral CSF -Clear Color | Slightly Elevated WBC & Protein | Normal Glucose | -Gram -Bacterial CSF -Cloudy Color | Elevated WBC | Elevated Protein | Decreased Glucose | +Gram -Diagnostic Procedures -Lumbar Puncture (Definitive Diagnostic Test) -Empty Bladder -EMLA Cream 45min – 1-hour prior -Side-lying Position, Head Flexed, Knees Drawn up to Chest -Remain in Flat Position to prevent Leakage and Spinal HA -Nursing care: -Droplet precautions -Maintain NPO status if the client has decreased LOC -Decrease environmental stimuli -Medications: -IV antibiotics for bacterial infections -Complications: -ICP: -Newborns and Infants -Bulging or Tense Fontanels -Increased Head Circumference -High-Pitched Cry | Irritability -Distended Scalp Veins -Bradycardia | Respiratory Changes -Children -Headache -N/V -Diplopia -Seizures -Bradycardia | Respiratory Changes 2. Reye Syndrome -Affects the liver (liver dysfunction) and brain (cerebral edema) -Follows a viral illness (Influenza | Gastroenteritis | Varicella) -Giving Aspirin for treating fevers -Laboratory tests: -Elevated liver enzymes (ALT and AST) -Elevated serum ammonia -Diagnostic procedures: -Liver biopsy/CSF analysis Chapter 13: Seizures 1. Risk factors -Febrile Episode -Cerebral Edema -Intracranial Infection / Hemorrhage -Brain Tumors / Cyst -Toxins or Drugs -Lead Poisoning -Hypoglycemia -Electrolyte imbalances 2. Generalized seizures • Tonic-clonic seizures: -Also known as Grand mal o Tonic Phase (10-30 seconds) Loss of Consciousness | Loss of Swallowing Reflex | Apnea leading to Cyanosis Tonic Contraction of entire body: arms and legs flexed, head and neck extended o Clonic Phase (30-50 seconds): Violent jerking movements of the body o Postictal State (30 minutes) -Remains semiconscious but arouses with difficulty and confused -No recollection of the seizure • Absence seizure: petit mal or lapses o Onset between ages 5 – 8 years and ceases by the teenage years -Loss of Consciousness lasting 5 – 10 seconds -Minimal or no change in behavior -Resembles daydreaming or Inattentiveness -Can drop items being held, but the child seldom falls -Lip Smacking | Twitching of Eyelids or Face | Slight Hand Movements • Myoclonic seizure: -Brief contraction of muscle or groups of muscle -No postictal state • Atonic or akinetic seizure: Muscle tone is lost for a few seconds 3. Diagnostic procedures • EEG: -Abstain from caffeine for several hours prior to the procedure -Wash hair (no oils or sprays) before and after the procedure to remove electrode gel 4. Nursing care • Initiate Seizure Precautions: -Pad side rails of Bed | Crib | Wheelchair -Keep bed free of objects that could cause Injury -Have Suction and Oxygen Equipment available • During a Seizure: -Protect from Injury (move furniture away, hold head in lap) -Maintain a position to provide a patent airway -Suction Oral Secretions -Side-lying Position (decreases risk of aspiration) -Loosen restrictive clothing -Do NOT restrain the child -Do NOT put anything in the child’s mouth -Do NOT open the jaw or insert an airway during seizure -This can damage teeth, lips, or tongue -Remain with the child -Note onset, time, and characteristics of seizure -Allow seizure to end spontaneously • Post-Seizure: -Side-lying position to prevent aspiration and facilitate drainage of secretions -Check for breathing, V/S and position of head -NPO until swallowing reflex has returned 5. Medications: Antiepileptic Drugs (AEDs): -Diazepam (Valium) | Phenytoin | Carbamazepine | Valporic Acid | 6. Therapeutic procedures -Focal Resection: of an area of the brain to remove epileptogenic zone -Corpus Callostomy: separation of two hemispheres in the brain -Vagal Nerve Stimulator 7. Complications • Status Epilepticus: -Prolonged Seizure Activity that Lasts >30 minutes or Continuous seizure activity in which the client does not enter a Postictal Phase -Maintain Airway, Administer oxygen, IV access Chapter 14: Head injury 1. Physical assessment findings • Minor injury: -Vomiting -Pallor -Irritability -Lethargy/drowsiness • Severe injury: Increased ICP -Infants: -Bulging fontanel -Irritability (usually 1st sign) -High-pitched cry -Poor feeding -Children: -Nausea/headache -Forceful vomiting -Blurred vision -Seizures -Late signs: -Alterations in pupillary response -Posturing (flexion and extension) -Decreased motor response -Decreased response to painful stimuli -Cheyne-stokes respirations -Seizures -Flexion: severe dysfunction of the cerebral cortex -Extension: Severe dysfunction at the level of the midbrain 2. Nursing care • Ensure the spine is stabilized until a spinal cord injury is ruled out • Implement actions to decrease ICP: o Keep the head midline with the bed elevated 30 degrees, which will also promote venous draining o Avoid extreme flexion, extension, or rotation of the head and maintain in midline neutral position o Keep the client’s body in alignment, avoiding hip flexion/extension o Minimize oral suctioning o Nasal suctioning is contraindicated o Instruct the client to avoid coughing and blowing the nose • Insert and maintain indwelling catheter • Administer stool softeners to avoid straining 3. Medications o Mannitol: Osmotic diuretic used to treat cerebral edema o Antiepileptic: Used to prevent or treat seizures o Corticosteroid ( dexamethasone ): To help decrease edema 4. Therapeutic procedures -Craniotomy: to help relieve pressure 5. Complications • Epidural hematoma: Bleeding between the dura and the skull • Subdural hemorrhage: Bleeding between the dura and the arachnoid membrane • Brain herniation: Downward shift of brain tissue Chapter 15: Cognitive and sensory impairments 1. Visual impairments • Myopia: Nearsightedness o -Sees close objects clearly, but not objects in the distance • Hyperopia: Farsightedness o -Sees distant objects clearly, but not objects that re close • Strabismus: -Esotropia: inward deviation of the eye -Exotropia: outward deviation of the eye -Occlusion therapy: Patch stronger eye to make weaker eye stronger 2. Visual screening • Snellen letter, tumbling E, or picture chart -Place the client 10 feet from the chart with heels on the 10-foot mark Chapter 16: Oxygen and Inhalation therapy 1. Metered-dose Inhaler -Shake the inhaler 5-6 times -Attach the spacer -Helps facilitate proper inhalation -Take a deep breath and then exhale -Tilt the head back slightly, and press the inhaler -While pressing the inhaler, begin a slow, deep breath that lasts for 3-5 seconds -Hold the breath for 5-10 seconds 2. Dry powder inhaler: DO NOT shake 3. Chest physiotherapy -Is a set of techniques that includes manual or mechanical percussion, vibration, cough, forceful expiration (or huffing), and breathing exercises -Helps loosen respiratory secretions -Schedule treatments before meals or at least 1 hr after meals and at bedtime -Administer bronchodilator medication or nebulizer treatment prior 4 4. Hypoxemia -Early signs: -Tachypnea -Tachycardia -Restlessness -Use of accessory muscles -Nasal flaring 5. Oxygen toxicity -Can result from high concentrations of oxygen, long duration of oxygen therapy, and the child’s degree of lung disease -Hypoventilation and increased PaCO2 levels allow for rapid progression into unconscious state Chapter 17: Acute and infectious respiratory illnesses 1. Tonsillitis -Physical assessment findings: -Report of sore throat with difficulty swallowing -Mouth odor/mouth breathing -Fever -Tonsil inflammation with redness and edema -Laboratory tests: -Throat culture: -For GABHS -Medications: -Antipyretics/analgesics: acetaminophen -Antibiotics: for Tx of GABHS -Tonsillectomy: for recurring tonsillitis -Side-lying position after then elevate HOB when child is awake -Assess for evidence of bleeding: -Frequent swallowing/clearing the throat -Avoid red-colored liquids, citrus juice, and milk-based foods -Discourage coughing, throat clearing, and nose blowing in order to protect the surgical site -Avoid straws: can damage surgical site -Alert parents that there can be clots or blood-tinged mucus in vomitus -Limit activity to decrease the potential for bleeding -Fully recovery usually occurs in 14 days 2. Croup syndromes