PEDS Exam 1 (Xavier ABSN) Questions and Answers 2023/24

PEDS Exam 1 (Xavier ABSN) questions and answers 2023/24 cephalocaudal development - proceeds from the head downward through the body and toward the feet. proximodistal development - proceeds from the center of the body outward toward the extremities trust vs. mistrust - Erikson's first stage during the first year of life, infants learn to trust when they are cared for in a consistent warm manner autonomy vs. shame/doubt - Erikson's stage in which a toddler learns to exercise will and to do things independently; failure to do so causes shame and doubt initiative vs. guilt - Erikson's third stage in which the child finds independence in planning, playing and other activities industry vs. inferiority - Erikson's stage between 6 and 11 years, when the child learns to be productive identity vs. role confusion - Erikson's stage during which teenagers and young adults search for and become their true selves appropriate growth for infants (birth-1 mo) - -gains 5-7oz per week -grows 1.5 cm in first month -head circumference increases 1.5 cm per month birth-1 mo fine motor milestones - -hold hand in fist -draws arms and legs into body while crying birth-1 mo gross motor milestones - -inborn reflexes (startling, rooting) are predominant -may lift head briefly when prone -alerts to high-pitched noises -comforts w/ touch 2-4 mo fine motor milestones - -holds rattle and other objects when placed in hand -looks at and plays with own fingers -brings hands to midline 2-4 mo gross motor milestones - -moro reflex fades in strength -can turn from side to back and then return -decrease in head lad when pulled to sitting position; sits with head held in midline with some bobbing -hold head and supports weigh on forearms when prone appropriate growth for infants (2-4 mo) - -gains 5-7 oz/week -grows 1.5 cm/month -head circumference grows 1.5 cm/month -posterior fontanelle closes -ingests 120 mL/kg/24 h 6-8 mo fine motor milestones - -bangs objects held in hands -transfers objects from one hand to the other -beginning pincer grasp at times 6-8 mo gross motor milestones - -most inborn reflexes extinguished -sits alone steadily without support by 6 mo -likes to bounce on legs when in standing position appropriate growth for infants (6-8 mo) - -gains 3-5 oz/week -grows 1 cm/month -teeth erupt 8-10 mo fine motor milestones - -picks up small objects -uses pincer grasp well 8-10 mo gross motor milestones - -crawls/pulls whole body alone floor with arms -creep by using hands and keep trunk off floor -pulls self by standing and sitting by 10 mo -recovers balance when sitting appropriate growth for infants (8-10 mo) - -gains 3-5 oz/week -grows 1 cm/month 10-12 mo fine motor milestones - -may hold crayon/pencil -places objects into containers through holes 10-12 mo gross motor milestones - -stands alone -walks holding onto furniture -sits down from standing appropriate growth for infants (10-12 mo) - -gains 3-5 oz/week -grows 1 cm/month -head circumference equals chest circumference -triples birth weight by 1 year solitary play - appropriate for infants, plays by themselves parallel play - appropriate for toddlers, playing with similar objects side by side, occasionally trading toys and words associative play - appropriate for preschoolers, play side by side with friends, each engaging in their own activities but also engaging friends cooperative play - appropriate for school-age children, characterized as cooperation with others and the ability to play as part of a unified whole tools for infant fine motor skills - -rattle -bottle -small objects (pincer grasp) -crayon/pencil -containers with holes/objects 4-6 mo fine motor milestones - -grasps rattle and other objects at will -mouths objects -hold bottle -hold feet and pulls to mouth -grasps with whole hand -manipulates objects 4-6 mo gross motor milestones - -head held steady while sitting -no head lag when pulled to sitting -turns from abdomen to back by 4 months and then back to abdomen by 6 months -supports weight when standing appropriate growth for infants (4-6 mo) - -gains 5-7 oz/week -doubles birth weight -grows 1.5 cm/month -head circumferences increases 1.5 cm -teeth may begin erupting -ingests 100 mL/kg/24 hr tools for toddler fine motor skills - -blocks -paper/crayons -ball -dress up -pitchers (pouring) tools for preschooler fine motor skills - -scissors -paper/crayons -pasting, beads, clay -clothes with buttons -toothbrush -spoons, knives, forks tools for school-age fine motor skills - -crafts -cards -board games developing trust w/ an infant - -encourage parental presence -adhere to infant's home routine as much as possible -utilize topical anesthetics or preprocedural sedation -promote quiet environment developing trust w/ toddler - -encourage parental presence -allow parents to hold child in lap for examinations and procedures when possible -allow choices when possible -utilize topical anesthetics or preprocedural sedation -explain procedures using simple language -provide nightlight developing trust w/ preschooler - -encourage parental presence -allow choices when possible -utilize topical anesthetics or preprocedural sedation -explain procedures using simple language -provide nightlight developing trust w/ school-age child - encourage parental presence -allow choices when possible -utilize topical anesthetics or preprocedural sedation -explain all procedures and provide reassurance -encourage peer interaction developing trust w/ adolescent - -include adolescent in plan of care -encourage discussion of fears/anxieties -explain all procedures -ask adolescent about desire for parental involvement -encourage peer interaction concepts of family-centered care - -agreed upon partnerships between families of children, nurses and providers, in which the families and children benefit -understanding growth/development needs of children and their families -treating children and their families as clients -working with all types of families -collaborating with families regarding hospitalization, home and community resources -allowing families to serve as experts regarding their children's health conditions, usual behaviors in different situations and routine needs -respecting cultural diversity and incorporating cultural views in the plan of care FLACC - used for ages 2mo-7yrs or those unable to communicate pain 0-10 scale -face -legs -activity -cry -consolability FACES - used for age 3 or older 0-5 scale using faces diagram oucher - 3 yr to 13 years 6 photos of children faces showing "no hurt" to "biggest hurt you could ever have" numeric scale - age 5-10 scale 0-10, 10 is the worst pain you've ever had non-communicating child pain scale - observe and rate: -vocal -social -facial -activity -body and limbs -physiological pain in children - -children feel a similar amount of pain to adults -infants express pain through behavioral/physiological cues -children remember painful episodes and fear future procedures -parents know their child and can identify behaviors associated with pain -children use distraction to cope w/ pain by soon become exhausted and fall asleep -children who have experience with pain respond more vigorously to pain -may be too young to express pain or afraid to tell anyone other than a parents about pain -heal quickly from surgery but have the same amount of tissue damage -cause of pain cannot always be determined -may develop physical dependence/tolerance to opioids infant pain expression - -cries -chin quivering -grimacing -disturbed sleep -restlessness -irritability toddler pain expression - -cried, wails -uses common words for pain like 'owie' or 'boo boo' -demonstrates fear of pain -may resist with entire body -aggressive behavior -disturbed sleep preschooler pain expression - -physical resistance -aggressive behavior -easily frustrated -can express pain on sensory level -can identify location and intensity of pain school-age pain expression - -passive resistance -clenches fists -emotional withdrawal -plea bargaining -pretend comfort to project bravery -regress w/ stress and anxiety -can specify location/intensity adolescent pain expression - -wants to behave in socially acceptable manner -may immerse self in an activity as a pain distraction -may not complain about pain -gives more sophisticated descriptions of pain primary prevention - activities the decrease opportunity for injury/illness, ex. giving immunizations secondary prevention - early identification of health problems through screening and the prevention of complications and adverse consequences of illness, ex. developmental screening tertiary prevention - reduction in the consequences of a disease or condition with aim of restoring optimal function, ex. rehabilitation following car accident examples of health promotion - -enhance good nutrition at each developmental stage -integrate physical activity into child's daily events -provide adequate housing -promote oral health -foster positive personality development example of health maintenance - -immunizations -teaching abut car safety -developmental screening -hearing/vision screening -rehabilitation discipline techniques - -limit rules to those that are essential -provide safe environment to explore w/o need for constant caution -spend time interacting with child each day -use distraction as first approach and praise child for selecting new activity -tell child once that behavior is unsatisfactory -separate child from setting where unsatisfactory behavior occurs -explain it is not ok to hurt others -separate child from violent situation in "time out" -ensure child has adequate food/sleep, opportunities for active play and has positive attention -encourage child to use words rather than violence communication with adolescents - -greet warmly -ask about questions/concerns -ask for opinions/reactions throughout visit -explain procedures -introduce personnel supplements for breastfed babies - Fluoride, Vitamin D, iron, Vitamin B12 infant dental care - -avoid putting child to bed with bottle -wipe teeth off daily with gauze or infant toothbrush -see dentist at end of infancy 1 year old - age at which honey can be introduced birth-1 mo eating pattern - -eats every 2-3 h -2-3 oz per feeding 2-4 mo eating pattern - -has coordinated suck/swallow -eats every 3-4 h -3-4 oz per feeding 4-6 mo eating pattern - -begins baby food, usually rice cereal -consumes breast milk/formula 4x day -4-5 oz per feeding 6-8 mo eating pattern - -eats baby food (rice cereal, fruits, vegetables) -consumes breast milk/formula 4x day -6-8 oz per feeding 8-10 mo eating pattern - -enjoys soft finger food TID -consumes breast milk/formula 4x day -6 oz per feeding -uses cup with lid 10-12 mo eating pattern - -eats most soft table food with family TID -uses cup w/ or w/o lid -attempts to feed self with soon though spills often -consumes breast milk/formula 4x day -6-8 oz per feeding toddler eating pattern - -physiologic anorexia -offer variety of nutritious food several times daily -should drink 16-24 oz of whole milk (then 2%) -provide opportunities to self-feed preschooler eating pattern - -food jags -enjoy helping with food preparation -do not give food other than designated snack and meal time school-age eating pattern - -responsible for preparing snacks -encourage education about healthy options adolescence eating pattern - -need over 2000 calories to support growth spurt nursing dx for changes in growth curve - -imbalanced nutrition -obesity -self esteem -readiness for enhanced coping -activity intolerance s/s anorexia nervosea - -extreme weight loss -excessive compulsive exercising -crying spells -isolation -suicidal thoughts -cold intolerance -dizziness -constipation -amenorrhea -osteoporosis -fluid/electrolyte imbalances s/s bulimia nervosa - -preoccupied with body weight -dehydration -electrolyte disturbance -dental caries -gum recession -esophageal tears alternatives to breastfeeding - iron fortified formula nutrients needed for adolescents - calcium, iron, protein and zinc pediatric upper airway differences - -shorter -narrower -increased airway resistance -infants: obligatory nose breathers pediatric lower airway differences - -constantly growing -bronchi/bronchioles underdeveloped in newborns -use diaphragm to breathe -consume more oxygen due to higher metabolic rate -fewer glycogen reserves pediatric respiratory assessment - -children 15-30 breaths -infants 25-50 -O2 -breath sounds nursing interventions for epiglottitis - -maintain patent airway (discourage crying) -meet fluid/nutrition needs (cool, non carbonated drinks) -administer medications (oral dexamethasone/nebulized epinephrine) r/f RSV - -immunosuppression -low birth weight -lung disease -severe neuromuscular disease -congenital heart defects pathophysiology cystic fibrosis - defective cl- channel - secretion of abnormally thick mucus that plugs lungs, pancreas, and liver - recurrent pulm infections (Pseudomonas spp, S. aureus), chronic bronchitis, bronchiectasis, pancreatic insufficiency (malabsorption and steattorhea), nasal polyps, and meconium ileus in newborns. Mutation often causes abnormal protein folding resulting in degradation of channel before reaching cell surface. pancreatic enzymes - pancreatic ducts may be blocked by mucus and unable to release these substances needed for digestion nursing care following cardiac cath - -place pressure on site for 15 min then apply pressure dressing -bed rest 4-6h w/ legs straight -avoid elevating HOB -provide quiet activities -encourage child to drink small amounts of clear liquids -provide adequate fluids (maintain fluid balance) s/s of increased pulmonary blood flow - -poor weight gain -dyspnea -tachypnea -intercostal retractions -periorbital edema circulation in VSD - blood is shunted from the ventricular septum directly across the open septum into the pulmonary artery s/s VSD - -poor growth -exercise intolerance -increase in pulmonary infections -pulmonary hypertension education for parents post-op (open heart) - -potential behavior problems following hospitalization -reassure child of safety -allow child to live normal, active life admission orders PDA - -chest radiograph -ECG s/s chronic hypoxemia - -fatigue -clubbing of fingers/toes -exertional dyspnea -delayed developmental milestones tetralogy of fallot - congenital malformation involving: -stenosis of pulmonary valve -right ventricular hypertrophy -ventricular septal defect -overriding of the aorta s/s tetralogy of fallot - -hypoxia -cyanosis -tachypnea -polycythemia -metabolic acidosis -poor growth -clubbing -exercise intolerance -instinctive squatting (toddlers) nursing interventions r/t pulmonary stenosis - -place child in knees to chest position -reduce stimuli -provide O2 -postpone unpleasant procedures circulation in transposition of great arteries - pulmonary artery is outflow for left ventricle, aorta is outflow for right ventricle= parallel circulations tx transposition of great arteries - -prostaglandin E1 -diuretics -digoxin -surgery