NURS 550 Final Exam (Q & A, Latest-2023) / nurs 550 Final Exam / NURS550 Final Exam / nurs550 Final Exam: |Verified Q & A, Complete Document for EXAM|

NURS 550 Final Exam (Q & A, Latest-2023) / nurs 550 Final Exam / NURS550 Final Exam / nurs550 Final Exam: |Verified Q & A, Complete Document for EXAM| NURS550: Advanced Health Assessment and Diagnostic Reasoning Winter 2016 PEDIATRIC PATIENT 1. Identify differences in vital signs (BP, HR, RR) for the pediatric patient when compared to the adult patient BP: challenging to obtain, important for high-risk infants and routine after age 3 Infants: Doppler method Normal SBP: 70mmHg at birth 85mmHg at 1 month 90mmHg at 6 months Pulse: palpate in femoral or brachial arteries, or auscultate heart -more sensitive to effects of illness, exercise, and emotion than adults Birth-1mo = 90-190 (140 avg) 1-6mo = 80-180 (130 avg) 6-12mo = 75-155 (115 avg) 1-2 yrs = 70-150 (avg 110) 2-6 yrs = 68-138 (avg 103) 6-10 yrs = 65-125 (avg 95) Resp. Rate: Newborn: 30-60 bpm 2-12 months: 50 is tachypneic Early childhood (1 to 4 years): 20-40 Late childhood: 15-25 Age 15 reaches adult level 2. Describe difference in physical examination findings and examination procedures for the pediatric patient when compared to the adult patient **See page 797, 822, 823, 834, 835, 839, 845 a. Breathing pattern and rate: -greater range and responsiveness to illness, exercise, and emotion than that of adults -can vary considerably moment to moment from rapid to slow -sleeping respiratory rate is most reliable -observe for a full minute b. Assessing the mouth and throat Inspection and palpation with tongue blade and flashlight -Newborn: mouth is edentulous, alveolar mucosa smooth with finely serrated borders; -occasionally pearl-like retention cysts (Epstein’s pearls) along Downloaded by Thomas Mboya () lOMoARcPSD| alveolar ridges (posterior midline of hard palate), tiny, white or yellow, rounded (disappear within 1-2months); -petechiae commonly found on soft palate after birth -Saliva production: little saliva during first 3 months, older infants produce a lot of saliva, drool frequently -Tongue: possible whitish covering from milk, easily scraped away -Pharynx: best visualized when baby is crying, likely not able to visualize tonsils (infants do not have prominent lymphoid tissue, increase in size as children grow) -Peak tonsillar growth is 8-16yrs, grade on 1+ to 4+ Some are old enough/cooperative enough to say “ahhh” -Crying: listen to quality, should be lusty and strong -Tooth eruption: rule of thumb- one tooth for each month of age between 6 and 26 months, up to 20 primary teeth -Teeth should be examined for caries -look for abnormal positioning -look for malocclusion, maxillary protrustion (overbite), mandibular protrusion (underbite), submucosal cleft palate c. Assessing a painful area Infants: relies mostly on behavior observation, look for facial expressions (grimace, eyes squeezed shut, mouth stretched open), arm/leg movement, cries (high-pitched, tense, harsh) Toddlers/Preschool: often able to indicate location; may guard or protect the painful area, or tug (such as the ear) Younger School Age: use of a self-reporting pain scale 3. Describe the presentation of a pediatric child who is in respiratory distress Infant: nasal flaring, grunting, audible wheezing, stridor, retractions of supraclavicular, intercostal, or subcostal areas, pallor or cyanotic Young/School-aged: may assume tripod position 4. Describe the presentation of a pediatric patient who is febrile -Infants and children have a less constant temperature than adults -Avg rectal temp is 99F until age 3 -Temp fluctuations of 3F in a day is normal (up to 101F), particularly with vigorous activity, anxiety, excessive bundling -Fever in infants can raise RR up to 10/min for each degree centigrade -Tachypnea and increased resp. effort are seen with lower respiratory disease such as bronchiolitis and pneumonia -Fever 38C or 100.4F in infants 2-3mo may be a sign of serious infection or disease Downloaded by Thomas Mboya () lOMoARcPSD| 5. Describe the presentation of a pediatric patient who is experiencing pain See 2c 6. Identify ways to gain trust and rapport with a pediatric patient -let the child remain dressed -engage in age-appropriate conversation with simple questions about their illness or toys -compliment their appearance, behavior -tell a story or play a game; let them participate in the exam -if the child is shy, turn attention to the parent to give the child time to warm up -the exam can be performed on the floor or in the parent’s lap -explain each step and continue conversing to provide distraction -older children: address by name, meet at their level with eye contact, discuss their interests 7. Identify developmental milestones based on the Denver Developmental Screening Test -The DDST detects developmental delays in 4 domains of development from birth through 6 years: 1. Personal-social 2. Fine motor-adaptive 3. Language 4. Gross motor (see the DDST attachment in course handouts) 8. Describe the APGAR scoring system -assessment of the newborn immediately after birth -5 components to classify neurologic recovery from birth, 3-point scale for each component (0-2) -Scoring continues every 5 minutes until score is 7 Clinical Sign 0 1 2 Heart rate Absent 100 100 Resp. effort Absent Slow and irregular Good; strong Muscle tone Flaccid Some flexion of arms and legs Active movement Reflex irritability No responses Grimace Crying vigorously, sneeze, or cough Color Blue, pale Pink body, blue extremities Pink all over 1-Min. Apgar Score 5-Min. Apgar Score 8-10 Normal 8-10 Normal 5-7 Some nervous system 0-7 High risk for