NUR 335 - Peds Exam 1 Study Guide.

Peds Exam 1 Study Guide
50 questions total

Chapter 4; Age specific- Chapter 9, 11, 12, 14, 15




 There will be a few medication questions on this exam, more specifically dosage
calculations. Please be sure to remember how to convert lbs to kg




 Pain scale scoring types/which is appropriate to use at what age (FLACC, FACES,
Numbers, etc)
- FLACC: Face Legs Activity Cry Consolability  used for 2months-3years old ;
0=no pain; 10=worst pain
- FACES/Wong-Baker: uses facial expressions to indicate pain; ask child to identify
which facial expression they most associate with; used for children as young as 3
years old
- Numeric pain scale: explain to child that 0 is least amount of pain experienced
and 10 is greatest amount of pain felt; used for children aged 4-17 years old
- CRIES: Crying, Requires oxygenation, Increased VS, Expression, Sleepless; used
for 32 weeks to 20 week post term infants; 0=no pain; 10=worst pain
o Crying (0-2)
o Requires increased oxygen (0-2)
o Increased vital signs (0-2)
o Expression (0-2)
o Sleepless (0-2)
- NIPS: Neonatal Infant Pain Scale; used for average gestational age 33.5 weeks;
0=no pain; 7=worst pain
o Facial expression (0-1)
o Arms (0-1)

, o Cry (0-2)
o Legs (0-1)
o Breathing patterns (0-1)
o State of arousal (0-1)




 Developmentally appropriate growth and development for each age category
(newborn, infant, toddler, preschool, school age, and adolescent)

Infant
 Age: 2 days-1year
 Specifics of physical assessment: Head circumference averages between 33 and 35 cm;
crown to rump length is 31-35cm, approximately equal to head circumference; posterior
fontanel closed between 6-8 weeks of age
 Height and weight changes: average weight at birth is 2,700 g to 4,000 g (6-9lbs);
newborns lose up to 10% of their birth weight by 3-4 days of age due to fluid shifts,
meconium loss, and limited intake; birth weight is typically regained by 10th-14th day of
life
- 1st 6 months: infants gain 150-210 g (5-7 oz) weekly; at 6 months weight has
doubled
- Average weight for 6 months old: 7.3 kg
- Average weight at 1 year: 9.75 kg; triple that of birth weight
- Height: increases by 2.5 cm (1in) a month during the 1st 6 months of life and
slows during the 2nd 6 months
- Average height: 65 cm at 6 months; 74cm at 12 months
- Chest assumes more adult contour with lateral diameter becoming larger than
anteroposterior diameter
 Nutrition/Elimination patterns: 1st 6 months human milk is most desirable complete diet
for infants; supplemental fluoride may be required in exclusively breastfed children;
honey should be avoided b/c of risk of botulism; 2nd 6 months addition of solid foods to
infants diet is important

, - Meconium: should occur w/in 24-48hrs after birth; description when you chart;
green-black color
- Transitional stools: usually appear by DOL 3; transition from meconium to milk;
green-yellow in color
- Milk stools: usually appear by DOL 4; differences in breast milk and formula
stools
- Breast milk exclusive 1st 6 months
- Supplements: vit D, Iron, fluoride
- Solids begin @ 4-6 months and progress 6-12 months
- Formula types 20kcal/oz w/ iron
- No cows milk or honey <12 months age
- Feeding and elimination patterns
- Oral health
- Food allergy: family history increases risk
- BMI begins at age 2
 Reflexes/fine motor/gross motor/locomotion and timing:
- Reflexes: primitive reflexes
- rooting, suck, palmar grasp, tonic neck “fencer”: birth-3-4 months
- plantar grasp: birth to 8 months
- moro “startle”: birth to 4 months
- positive Babinski reflex: birth to 1 year
- Fine motor development: 2-3 months- prehension (grasp) of objects
- 6 months: increased manipulative skill; grasp bottles, feet, and pull into their
mouths
- Transfer object between hands at 7 months
- 8-9 months: gradually turns into pincer grasp
- Pincer grasp at 10 months old
- Remove objects from container at 11 months
- Build tower of 2 blocks at 12 months

, - Gross Motor Development: head control- stable head control is evident at 4
months old
- Head lag in 1st 2 months
- Head control at 4 months
- Parachute reflex by 7 months
- Rolling over: ability to willfully turn from abdomen to the back occurs around 5
months old and ability to turn from back to abdomen occurs at approximately 6
months old
- Sitting: by 7 months, infants can sit alone; by 10 months they can maneuver from
a prone to a sitting position
- Locomotion: involves ability to bear weight; propel forward on all 4 extremities;
stand upright with support; cruise by holding on to furniture and walk alone
- Cephalocaudal direction of development
- Increased coordination of extremities at 4 months
- Crawling at 6-7 months (usually backwards)
- Creeping at 9 months
- Walk with assistance at 11 months
- Walk alone at 12 months
 Erikson: concerned with acquiring a sense of trust while overcoming a sense of mistrust;
trust vs mistrust; importance of caregiver-child relationship; and importance of
consistency of care
 Piaget: cognition or the ability to know; sensorimotor phase with 6 stages, birth to 24
months
- Stage 1: Reflex stage birth to 1 month
- Stage 2: Primary circular reactions: 1-4 months; includes voluntary acts
- Secondary circular reactions: 4-8 months; imitation, play, affect
- Coordination of secondary schema: 8-12 months
- Stage 4: Beginning of intellectual reasoning; infants use previous behavioral
achievements primarily as foundation for adding new intellectual skills to
expanding repertoire