NSG 3600 PEDS Exam 1 Questions and Answers

NSG 3600 PEDS Exam 1 Questions and Answers 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! 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! Three principles that help achieve atraumatic care Prevent separation Promote sense of control Minimize bodily injury Physical Restraint for child 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 mouths) 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. Newborn/Infant Anticipatory Guidance Teach parents what to expect with growth and development. Example sleep-wake patterns. Nutrition should be just formula/breast milk until around 4 to 6 months then add rice cereal. Being adding pureed food at 6 months. NO COWS MILK until 12 months of age. Safety at at this age is when the outlets needs to be covered, making sure bottles are not too hot, and not leaving chocking hazards around. Toddler Physical Development Slower growth child will gain around 3-5 pounds a year. During this time the child is able to walk so we need to worry about safety. Mobility allows exploration. Toddler Gross Motor Here they learn to ride a tricycle/kick ball Toddler Fine Motor Learn how to copy circle, turn book pages, learns how to use a spoon. Toddler Language Development Single words are going to be used. Learn short phrases that will be used to fulfill needs. Toddler Communication Strategies (verbal/nonverbal) Use small words and earn the trust with caregiver first. Toddler Tantrums Normal for age and normal for them to happen at the hospital. They normally occur when they are tired/hungry/over-whelmed. Never leave the child alone while this is happening. We need to let the child have the tantrum but try to calm them down with distraction. Toddler Anticipatory Guidance Childproofing everything to keep the child safe. They need to wear a helmet while riding a bike. Making sure that when the child is in time out that it is in the same room. Both parents in the child life need to show consistency and be on the same page. Pre-school Physical Development Here the child will gain around 5 pounds a year and gain stronger abdominal muscles. Here their posture will improve along with their balance and agility. Pre-School Gross Motor Here the child will dress themselves, learn to skip and hop on one foot, and learn how to catch and throw a ball. We want them to take the initiative to do things themselves. Pre-School Fine Motor Skills Learn to draw stick figure with 6 parts, learn to tie their shoes, and use a fork, knife, and spoon. Pre-School Language Development Will have word vocabulary. A stutter is common in this age. They can recognize letters and use sentences. LOVE ASKING WHY (stage where it is all about them) Pre-School Communication Strategies (Verbal/nonverbal) Adults and others need to watch that they are saying around child due to child repeats everything. Child has magical thinking and will have imaginary friends. Pre-School Anticipatory Guidance Praise accomplishments (dressing self correctly or putting on shoes). Need to teach playground safety, stranger danger, and must wear a helmet when on scooter. With nutrition try different types of foods during snacks. In having magical thinking the child will begin to have dreams and nightmares. School-Age Physical Development Gain around 4-6 pounds per year, begin to loss that baby fat and start to have refined facial features along with having axillary sweating. We need to teach each child that they are going to have body changes. Girls: Hips broaden, pelvis widens, pubic hair grows, menarche possible before age 12. Boys: muscular bodies, pubic hair growth, testes and scrotum changes (drop), gynecomastia due to hormone changes. School-Age Gross Motor Have a good sense of strength/coordination and will begin to play team sports. Have a good sense of balance and can climb. School-Age Fine Motor Developed hand eye coordination and have hobbies such as drawing playing musical instruments. School-Age Language Development 8000-15,000 words in vocabulary. Will being to have long conversations about understands jokes. Here the child may experiment with profanity. School-Age Communication Strategies (Verbal/nonverbal) We need to very honest with the child to gain their trust. When u they ask a question use the statement "well what can you tell me/ what do you know about....." Watch the words you use such as stick because they might think a read wooden stick. School-Age Anticipatory Guidance Making sure they know about the physical changes in their body, teaching them safety like wearing a helmet when riding a bike and in the older school age kids no smoking. When it comes to exercise we need to start working on those good habits and eating right. Adolescence Physical Development Puberty is rapid and acne may occur. Adolescence Language Development Can communicate and debate alternative points of view and the vocabulary continually developing . They have abstract thinking. Adolescence Communication Strategies (Verbal/nonverbal) Be up front and honest. We need to make sure this group has a voice when it comes to making choices and decisions when it comes to their care. Making sure the patient has privacy and confidentiality. Adolescence Anticipatory Guidance Use open communication and talk about peer pressure and safety such has drinking and driving, drugs, and sex. Physical changes will continue and issues with their body will occur. Nutrition Based on Growth and Development Milestones: Infants Breast milk or formula, intro solids (rice cereal) at 4-6 months, encourage self-feeding finger foods, wean to a sippy cup at 9-12 months, WHOLE MILK CAN BE GIVEN AFTER 12 MONTHS IF GIVEN EARLIER IT CAN CAUSE THE BABY TO GET ANEMIA. Nutrition Based on Growth and Development Milestones: Toddler Allow self-feed and is able to use cups, eating finger foods, 2-3 healthy snacks per day, do not force eating because they are grazers, allow a few choices put to 2 or 3. Nutrition Based Growth and Development Milestones: Preschooler 3 meals and 2 snacks per day, allow choices and introduce NEW FOODS. Nutrition Based on Growth and Development Milestone: School Age 3 meals and 2-3 snacks per take, teach to make nutritious choices, avoid high fat, processed, and fast food, manage weight through exercise and healthy choices (Good for this group to go to the food market with parents) Nutrition Based on Growth and Development Milestones: Adolescents Provide teaching to make nutritious choices, avoid high fat, processed, and fast food, manage weight through exercise and healthy choices, eat 3 meals a day along with 2-3 snacks per day (healthy) When it comes to meals for all ages what is important? To have family sit down meals to help build communication and bond with the family. FLACC Scale Observation scale for nonverbal children used for >2months to 3 years old. This scale can also be used for children who has some type of developmental issue such as being nonverbal. Has 5 category (face, legs, activity, cry, consolability) Range from 0-10 (high score is bad) Wong-Baker Face Scale Used for preschool/school age kids. Goes from 0 to 10 and the kids will point to pictures of how they feel. High score is hurt worst and is bad. Numeric Pain Scale Used for children above the age of 12 due to understanding the numeral scale. Scale from 0-10. Pain Management Strategies for Infant/Toddler Parents should be there comfort. Distract and comfort after procedure, swaddling, use a pacifier. Here we want the parents to stay with the child while they are in the hospital. Pain Management Strategies for Preschooler We do medical play/participation, tell the child what they are going to see/hear/feel during the procedure. Give them praise and reward after the procedure. (Let them play with the stethoscope) Pain Management Strategies for School age Distraction is key! Use deep breathing, trivia, talking, holding hands, parental presence, explanation in simple terms, allow to play with equipment, allow participation and praise and reward. Pain Management Strategies for Teens Distract with imagery, tablet, deep breathing, talking jokes, ask patient permission for parental involvement, allow participation, explain procedures, give choices, praise and reward. (Make them feel independent) When should we use treatment rooms? For procedures that are invasive. Let the kids take a toy or blanket to give them a sense of security. This also keeps their room their safe space. Reactions to Hospitalization: Infant Separation and stranger anxiety will start at 6 months. We need to communicate with parents to stay and education them on care. Here the child needs to be held/cuddle/swaddle. Child need parents for consistency. Reactions to Hospitalization Toddler Will have separation anxiety. Will have regression such as talking like a baby and bed wetting and wetting their pants. We will see lot of tantrums. The child should go back to normal when the child is back at home. Reactions to Hospitalization Preschooler Views hospitalization as punishment (reason they are there due to hitting a sibling). This can be due to having magical thinking and we need to tell them that they are not in trouble. Encourage child to ask questions and allow choices (2-3). Reactions to Hospitalization: School age Increase need for attention, fears bodily mutilation, give simple explanations and choices, we need to respect privacy, encourage verbalization of fears. Use open-end questions with this group. This group understand cause and effect so fear is big. Encourage verbalization of fears and have open conversations. Alleviate fears about the changes in body image when possible.