NUR 2513 Maternal Child Nursing Exam 3

Hospitalization causes many issues - Stress is the Big one. This can be positive and negative Answer- Positive - Child begins to expand their world when parents are absent. Healthcare providers can see the child adapt. If parents are gone too long........abandonment can set in. **Stress helps them learn how to cope. Negative - Long term stress (not good), however display itself in physical manifestation. What are 3 things children are most afraid of? Answer- -losing control or independence -fear of pain or punishment -fear of bodily harm or change How can we minimize the stress of hospitalization? Answer- Parent rooming in w/ patient, bring an object/toy from home, draw pictures to hang in room, offer choices of watching movie or picking a game, therapeutic play, child life specialist, guided imagery How do we communicate with children? Answer- Children in general - Get to their level physically. Use simple words. Eye contact. Play to demonstrate. Be approachable. DO NOT LIE TO THEM! Communication: Hearing deficit Answer- Sign language, pictures, computerized electronics, eye contact, touch, turn light on. Gain their attention before speaking, face child when speaking, speak slowly and loudly. Communication:Visual deficit Answer- Announce yourself, let them know that you are there. Keep routine in the room the same. Make sure they have their glasses on. Bright lights. Communication: Cognitive issues Answer- Be gentle and kind, very short directives. Praise. Hold boundaries. Separation comfort care Answer- -with favorite items or activity, distraction, parents room in or go with child to procedures. -Child will protest separation due to anxiety, [prep with tours and explanation, use transitional objects] reinforce when they will see parent again. -Despair follows due to grief of separation, detachment due to ongoing anger/coping skills. Alleviate stress and fears: Answer- -explain procedure -distraction -ask parent to stay and participate in care -explain what's going on What is the benefit of play? Answer- ● Allows children to express feelings and fears. ● Facilitates mastery of developmental stages and assists in the development of problem solving abilities. ● Allows children to learn socially acceptable behaviors. ● Activities should be specific to each child's stage of development. ● Can be used to teach children. ● A means of protection from everyday stressors. Solitary play Answer- The child plays alone, without regard for those around him. Characteristic of infants. Onlooker play Answer- The child observes the other children around him as he plays alone; may alter own play activities based on what he sees the others doing or may be content to continue in his play while simply talking with the other children; play activities are different (e.g., one child may be bouncing a ball while another is playing with jacks). Characteristic of toddlers. **RED FLAG for continuing in this phase of play, which is usually indicative of autism Parallel play Answer- Children play independently among other children but they do not yet play together, which is characteristic of toddlers. Associative play Answer- Children playing together without organization, which is characteristic of preschoolers Cooperative play Answer- Organized playing in groups. Children assume designated roles in the games, have goals for the games, and rely on one another for the game to continue and progress. This is characteristic of school-age children and adolescents. Nutrition is: Answer- the single most important factor in the growth and development of children. Are food fads that different children encounter harmful? Answer- -No, and are usually self-limiting. -Adolescents have many different needs for greater caloric intake and more concentrated iron, folic acid, and protein. Toddlers: At risk for? Answer- Physiological anemia -Because of too much calcium in milk impedes iron absorption Physiological anorexia -Toddlers begin developing taste preferences and are generally picky eaters who repeatedly request their favorite foods. Physiologic anorexia occurs, resulting in toddlers becoming fussy eaters because of a decreased appetite. Risks with inadequate nutrition: Answer- • Cardiac and organic failure, electrolytic imbalance, cardiac dysrhythmia, tooth enamel erosion, esophageal damage. Kids are obsessive picky eaters. • Older kids become obsessive and restrictive. • Over-eaters think about meals before all else. • In little kids they can become constipated, unhealthy. • Anemia can be an issue. Food fads are not uncommon and if the child has a daily food intake that is overall balanced, the parent should be comforted and instructed to continue to track the intake. Nutritional needs Answer- -Infant- breast feed up to 1 year, no milk prior -Solid foods - around 6 mo., slowly new food every 3-4 days -Toddlers - picky eaters, physiological anorexia, grazers; no food fads are detrimental unless purposely not eating. -Growth problems if not receiving proper amount of proteins: Ask what they like (if don't like milk find another option for calcium) **Too much milk can cause anemia [Ca impedes iron absorption] Adolescent nutrition requires Answer- Rapid growth and high metabolism require increases in quality nutrients, and make adolescents unable to tolerate caloric restrictions. **During times of rapid growth, additional calcium, iron, protein, folic acid, and zinc are needed. Rate of growth Answer- Greatest growth in infants, and then again in adolescents which puts them at risk for anemia due to menstruation and muscle mass increase. Restraints Answer- Are used for procedures to keep children safe!! *2 common types of restraints- mummy (papoose) and elbow restraints. • Elbow prevents elbow flex - can't reach things to pull/touch. • Mummy (papoose) is swaddling and whole body stabilization. Used for procedures and medication administration. **During a procedure you don't need an order for a restraint. If you want to KEEP THEM ON you need an order. **Restraints 411: Answer- -Must be removed every 2 hours. -Parent teaching and return demonstrations must be validated. -Chemical restraints are sedation. Can be used to reduce anxiety pre-op or post-op **Airway MUST BE MANAGED at all times. Child must be under direct surveillance at all times. Reasons for Restraints Answer- Restraining a child may be a necessary intervention to ensure a child's safety during a procedure or to prevent injury to an operative site. Consents - for invasive procedures Answer- *Need signature consent for invasive procedures; from parent, guardian or emancipated; pregnant, military, court order -If a child is of age, they don't need their parent's signature. -If emancipated they can sign as well. If not the parent must sign. -In emergencies physician can approve if parents are not available. -Religious beliefs can be overturned by courts in some cases. *Consents are Voluntary, understanding of procedure [cognitive/language barriers; interpreter if needed], attempt to contacts [document] telephone attempt; life or limb. Discipline is for: Answer- -Safety and education with positive reinforcement; to make good choices, aggressiveness with toddlers because they don't remember Discipline strategies Answer- Distraction: Provide a toy to divert the child's attention. Time-Out: Move the child to a "cooling-off" place where the child can calm down. Removal of Privileges: Withhold a favorite toy until the child's behavior is appropriate. Verbal Reprimands: Give spoken warnings or disapprovals without berating the child or judging the child as "bad." Corporal Punishment (e.g., spanking, swatting, and grabbing): Not recommended. Harmful disciplines Answer- -Corporal punishment [okay to hit, slap or harm] -Isolation (in some cases) -Demoralizing; screaming/verbal abuse -Neglect - passive aggression. Types: Authoritarian- dictator & Authoritative/democratic (is most effective) *Parent can go in and out of different style modes sometimes Beneficial discipline Answer- Time out [without isolation], redirection, distraction, positive reinforcement, modeling preferred /desired behavior, removal of privileges, natural consequences of actions. FLACC assessment tool Answer- Ages 2 months to 7 years Pain rated on a 0 to 10 scale by assessing the behaviors of the child FACES assessment tool (Wong-Baker) Answer- 3 years and older Pain rated on a scale of 0 to 5 using a diagram of six faces. Substitute 0, 2, 4, 6, 8, 10 for 0 to 5 to convert to the 0 to 10 scale. Explain each face to the child; ask the child to choose a face that best describes how they are feeling: 0: No hurt 1: Hurts a bit 2: Hurts a little more 3: Hurts even more 4: Hurts a whole lot 5: Hurts worst OUCHER assessment tool Answer- 3 to 13 years old Pain rated on a scale of 0 to 5 using six photographs. Substitute 0, 2, 4, 6, 8, 10 for 0 to 5 to convert to the 0 to 10 scale. Have the child organize the photographs in order of no pain to the worst pain; ask the child to choose a picture that best describes how they are feeling: 0: No hurt 1: Hurts a bit 2: Hurts a little more 3: Hurts even more 4: Hurts a whole lot 5: Hurts worst Numeric pain assessment tool Answer- 5 years and older Pain rated on a scale of 0 to 10. Explain to the child that 0 means "no pain" and 10 means "worst pain." Have the child verbally report a number or point to their level of pain on a visual scale. Non-communicating child's pain assessment tool Answer- 3 years and older Behaviors are observed for 10 min. Six subcategories are each scored on a scale 0 to 3. 0: Not at all 1: Just a little 2: Fairly often 3: Very often SUBCATEGORIES Vocal Social Facial Activity Body and limbs Physiological CUTOFF SCORES 11 or higher indicates moderate to severe pain. 6 to 10 indicates mild pain. Non-Pharm methods to allievate pain Answer- Distraction ● Use play, radio, a computer game, or a movie. ● Tell jokes or a story to the child. Relaxation ● Hold or rock the infant or young child. ● Assist older children into a comfortable position. ● Assist with breathing techniques. Guided imagery ● Assist the child in an imaginary experience. ● Have the child describe the details. Positive selftalk: Have the child say positive things during a procedure or painful episode. Behavioral contracting ● Use stickers or tokens as rewards. ● Give time limits for the child to cooperate. ● Reinforce cooperation with a reward. Containment ● Swaddle the infant. ● Place rolled blankets around the child. ● Maintain proper positioning. Nonnutritive sucking ● Offer pacifier with sucrose before, during, and after painful procedures. ● Offer nonnutritive sucking during episodes of pain. Kangaroo care: skintoskin contact between infants and parents Myths about pain management in children Answer- • Children do not feel pain with the same intensity as adults. • Children cannot tell where they hurt. • Children will tell you if they are really having pain. • Children become accustomed to pain. • Narcotic analgesics are dangerous for children because they become addicted or go into respiratory distress. • If children can be distracted, they are not in pain. • If children say they are in pain, but do not look in pain, they do not need to be medicated. • Being in pain for only a little while is not that bad. • After children have undergone surgery, they should not be given analgesia until they can vocalize pain because they received enough anesthetic to "cover" their pain. • The best way to give analgesics is intramuscularly. • Children with neurological impairments do not feel pain as much as other children. • Children, especially boys, should learn to tolerate pain; they will make better, stronger adults. What drug is most frequently used for severe or postoperative pain in children? Answer- **Most common medication used post-op pain is *MORPHINE* - Biggest risk is respiratory depression. • Titrate meds VERY carefully until 110 lbs (50 kg), at that point they will get the adult dose • When using adult dose you CANNOT continue to use age and weight for dosing (=OVERDOSE) • Be aware of possible respiratory depression, liver and kidney function, keep them well hydrated, possibility of addiction Infant reflexes - Stepping Answer- Birth to 4 weeks Elicited by holding an infant upright with his feet touching a flat surface, the infant will make stepping movements. Infant reflexes - Palmar grasp Answer- Birth to 3 months Elicited by placing an object in an infant's palm. The infant grasps the object. Infant reflexes - Sucking and rooting reflexes Answer- Birth to 4 months Elicited by stroking an infant's cheek or the edge of an infant's mouth. The infant turns her head toward the side that is touched and starts to suck. Infant reflexes - Moro reflex Answer- Birth to 4 months Elicited by allowing the head and trunk of an infant in a semisitting position to fall backward to an angle of at least 30° The infant's arms and legs symmetrically extend, then abduct while fingers spread to form C shape. Infant reflexes - Startle reflex Answer- Birth to 4 months Elicited by clapping hands or by a loud noise The newborn abducts arms at the elbows, and the hands remain clenched. Infant reflexes - Tonic neck reflex (fencer position) Answer- Birth to 4 months Elicited by turning an infant's head to one side The infant extends the arm and leg on that side and flexes the arm and leg on the opposite side. Infant reflexes - Plantar grasp Answer- Birth to 8 months Elicited by touching the sole of an infant's foot The infant's toes curl downward Infant reflexes - Babinski reflex Answer- Birth to 1 year Elicited by stroking the outer edge of the sole of an infant's foot up toward the toes The infant's toes fan upward and out. Size milestones of infants to toddlers Answer- *Infancy- greatest rate for growth at 6 mo. (7 lb.) Double birth weight @ 6 months (14), and triple weight by 1 year old (21lbs). *Posterior fontanelles close at 6-8 weeks old, anterior fontanelles close 12-18 months *Children; grow from head to tail, middle to distal, simple to complex, grow at the same steps but not the same rates. Motor skill milestones for the first year of life Answer- • Raises head and shoulders at 3 months