My Peds Exam 1 Notes hghgh ghghghghghg PDF

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Lecture 1: Role of the nurse Provider: for patient and family (family centered care), meet the needs of the child depending on developmental level, culture, age, family involvement. Educator: teach the child on their level and the parent. DO NOT teach during trauma because it won’t stick, assess how they learn best so you can provide it to them, so they have the best chance of understanding what they’re teaching. Establish rapport and encourage participation. Don’t be in a hurry to interrupt them Advocate: be aware of the patient and family needs and give them info needed to make the decision for care of child (respect decision even if you don’t agree). Be active on comities that promote health. Ensure needs are being met and that care plan meets the needs, cultures, and beliefs of patient and family. Case Manager: have the best outcome while having continuity of care and keeping cost down. Matching health care resources to patients condition and links child and fam Healthy People o Goals and objectives with 10-year targets striving to improve the health of all of us Healthcare financing o CHIP: program administered by the states but follows federal guidelines (funded by both) 10 million children enrolled. (3.6children in CHIP/Medicaid in FL)  Medicaid is largest form of insurance in US  PT. Protection/ ACA: eligible for health ins (low co pay based on income)  WIC: federal grants given to states for nutrition education, food, referrals for pregnant women, breastfeeding, children at age 5 to be at nutritional risk Health screening, nutrition, breast feed counsel, (ex: infant cereal, peanut butter, whole wheat bread, diary, fruit/veggies) Practice act, accountable for our actions so we have to do CEU’s Legal Issues o Informed consent: need to be signed for child. If one parent has custody; either sign unless its stipulated on the custody to only one, then they can only give consent o Child participation: can sign consent if pregnant, emancipated, mature minor (14-18) o Child vs Parent: ex: blood transfusion o Confidentiality: HIPAA Ethic issues o Beneficence: obligation to promote well-being of child/family o Autonomy: right to self-determination and respect their refusal/consent o Non-maleficence: reduce risk of harm o Justice: treat all w same respect (like VIP vs poverty child) o Ethics committee can get involved if parents and HCP can’t decide on treatment, even court can become involved.  Organ transplant concern: requires that team recognized issues between children and adults.

CHAPTER 2: PFCC  Patient family centered care: mutually beneficial partnership develops between family, nurse and other health care professionals (includes respect and trust, open collaboration, being on the same page with everyone, consider different cultures, beliefs, and backgrounds) -Anxiety is decreased when parent is present during procedures -Parents are now recognized as part of children care  Promoting PFCC: use words like “working together, guidelines, welcome” INSTEAD OF “policies, allowed, not permitted”. Maintain mutual respect and trust -take CULTURAL BELIEFS into consideration -ASSESS the parent’s strength in managing ongoing responsibilities before adding more. -Parental roles o Assisting in the design and evaluation of programs and systems o Assessing a healthcare setting for its family-centered policies and care practices, as well as its cultural appropriateness o Participating in the renovation or construction of healthcare facilities o Recommending changes that will ultimately improve the quality of care o Educating health professionals about working effectively with families as partners in the child’s care  Family Composition o Nuclear family: child lives w both biological parents o Blended family: two parents w biological children from a previous marriage who marry or cohabit (step people) o Extended family: one parent/couple shares expenses as well as household/child responsibilities with grandparents, sibling of parent, or other relatives (live w grandma)  FMLA: eligible employee takes unpaid job protected leave for 12weeks in a 12month period w job protected and benefits/insurances still active o Can be used in adoption and foster homes, newborns, illness of self, spouse, or child  Head start: program that will meet all children’s needs from birth-5 years of age and must be culturally responsive to communities they serve o Early leaning (readiness for school), health (developmental screens, oral and mental health support), family well-being (to support housing, education, and financial security) o Early head start program (until 3 years of age- “Zero to Three”) o Provides services to more than 1 million children per year. Chapter 3: Culture  Culture is based on values and beliefs which you learn as you grow up.  Giger: (transcultural nursing) transcultural assessment model where the client is the center of care and culturally unique. o Based on six phenomena: communication, space, social organization, time, environmental control, biological variation o Creating right environment to support healing (providing space, giving time to respond, eye contact patterns) o GIGER THE GUIDER  Leininger: nurse will know and understand diff cultures and provide meaningful care to CHILD while valuing their culture beliefs

Culture care diversity and universality and its components include values, beliefs, political, legal, economic, educational, religious and philosophical factors. o “Sunrise enabler” is a guide that can be used to examine a variety of influences on care. o LENINGER THE ENABLER  Purnell: 12 concepts to assess pt so you can promote culturally centered care o Model for cultural competence important components of the individual, family, and community o PURNELL 12  Specter: health is balance of physical, mental, and spiritual aspects in outside world o Illness occurs because of imbalance of one or all parts of the person (mind, body, spirit) o “HEALTH traditions model” reflects balance of the person and is predicated on the concept of holistic health/describes practices used to maintain, protect, and restore health. o SPECTOR THE SKEPTIC  Race, ethnicity, stereotyping, prejudice, and bias o Assimilation: adopting/incorporating characteristics of the new culture within one’s practices o Acculturation: modifying one’s culture to fit within the new or dominant culture  Culturally sensitive practices o Family roles: who has authority in the house, who is patriarch/matriarch dependent on cultural influence o Communication: verbal (spoken/written), nonverbal, health literacy (no medical jargon) o Time: diff culture diff value on time  Cultures in the past begin care w lengthy descriptions of health care treatment with little interest in learning methods of adapting  Cultures in the present focus on NOW and usually don’t engage in preventative care methods  Cultures in the future are hard to meet goals with/ it’s hard to take it one day at a time o Nutrition: the way they cook food, religion falls into it  Health beliefs o Magico-religious paradigm: health/illness determined by god, magic (tell child its not their fault) o Holistic paradigm: illness results when natural value/harmony is distributed (biofeedback) o Scientific/biomed paradigm: physiological explain illness  Western medicine/surgical procedures Chapter 6: Communication  Verbal: spoken or written word  Nonverbal: facial expressions, body language, eye contact, touch, physical appearance  Factors that block communication o Medical Jargon: don’t use words like “dye” o Gender: some may respond more to those who give most care (mom=female) o

o Health status: if in trauma, short and concise communication o Nurse attitude: be caring, show empathy, develop trust in parent/child  Developmental concern o Newborn: all nonverbal, crying, touch, swaddling o Infant: nonverbal but respond to toys, singing, cooing, leg kick, trash arms (if pain) o Toddler/preschool: verbal communication comes to play so allow them choices like do you want a shot in the right or left leg (helps promote independence), be careful with choice of words o School age: using a doll can be a good way to explain things o Adolescent: be careful w medical jargon and respect them  Cognitive Concern o Special needs: remain calm, use pt name, use pictures to explain, white board to write o Visual impairment: announce entrance, reorient them to room, speak slow and calm, explain procedure before you touch them, let them handle some equipment o Hearing impairment: enter slow, face them when speaking, find out best method of communication (ask parent) o Language barriers: use visual aids, interpreter service available (DON’T USE FAMILY MEMBERS because what if they aren’t telling them everything you said ???)  Nursing management o Establish trust: make sure to be truthful (yes this may hurt a little) o Confidentiality: share on need to know basis, offer adolescent privacy from parent o Convey respect: always knock, use child’s name, use mr/ms with parent, consider culture  Communication Strategies o Play: promotes G&D, use toys o Expressive play: drawing to better express themselves o Journaling: older child better express in writing o Story telling: use for school age children, have them fill in blanks in story o Humor: must be used appropriately and can help child relax  Ineffective Techniques: o Advising: don’t tell child what to do, guide them o Challenging: invalidates their thoughts o False reassurance: say “dr. so and so is the best”, “we’ll do everything we can” o Pressure: pressure them? will think nurse feels there’s a secret so they will shut down o Disagree: help guide them don’t just disagree because invalidates their thoughts o PAGE 163, TABLE 6.5 (MORE INEFFECTIVE TECHNIQUES) Chapter 4: Genetics  Genetic basics o All human cells except RBC contain DNA o Genetic diseases are inherited diseases that result from a dysfunction of a single gene  Human genome o Entire DNA in a human cell and is the inheritance of everyone  Cell Division o Basic unit of life *are specialized (pancreatic cells differ from nerve cells)

Mitosis (somatic/tissue cells) that end up with 2 daughter cells and are responsible for rapid human growth o Meiosis (reproductive) result in formation of sperm/oocyte but amount of genetic material is cut in half. *Crossing over happens here Chromosomal alterations o Occur during cell division *are either altered in number of chromosomes, or structural o Alterations in numbers  Aneuploidy: happens from error during cell division (nondisjunction in meiosis)  When paired chromosomes don’t separate before migrating into sperm/egg, gamete is created with either 2/0 copies of a chromosome  Leads to a monosomic zygote that Is missing a chromosome o (turner syndrome)  Trisomic zygote that has 3 chromosomes instead of the usual 2 o Patau syndrome, down syndrome, Edwards syndrome  Mosaicism: nondisjunction in mitosis resulting in 2 or more cell lines with different chromosomal make up *earlier error occurs, the more abnormal o Structural  Deletion: portion of the chromosome is missing  Duplication: portion of the chromosome has been duplicated that results in extra genetic material  Translocations: a part of one chromosome is transferred to another chromosome - two types: balanced (correct amount/different arrangement) or unbalanced (extra or missing piece like in down syndrome)  Inversion: chromosome broken off, turned upside down and reattached causing genetic material to be inverted. *cause hemophilia A Genes o Segment of chromosome identified w a function (commonly: protein production) o Humans have same genes but different numbers (controls physical trait/health) o Genes are altered/mutated when= change taken place in nucleotide  Genes are expressed when its actively making proteins. (alteration may or may not cause the protein product to be defective) o Alleles: forms of same gene that have small differences in their sequence of DNA which contribute to each individuals’ unique physical features *(1 from mom/1 from dad)  Homozygous: identical alleles (2 alleles for gene that causes brown eyes)  Heterozygous: two alleles interact with each other expressing a trait Mendelian Disorder o Genetic disorder caused by changes or alterations in a single gene that follow an either autosomal dominant, autosomal recessive, X-Linked, or Y-linked pattern.  Single gene disorders are characterized how they are passed down in family Dominant Inheritance (disorder) o Abnormal gene from one parent causes the disorder even when the matching gene from the other parent is normal Autosomal Dominant o When abnormal gene is only from one parent? AUTOSOMAL DOMINANT o

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There is 50% chance the parent who is affected will pass the altered gene to child  Dwarfism, Marfan syndrome, Huntington disease  Recessive Inheritance (disorder) o Two mutated or altered genes are inherited, one from each parent  Autosomal Recessive o When there are two copies of altered/abnormal gene? AUTOSOMAL RECESSIVE o 25% chance of inheriting abnormal gene from both parents and developing disorder o 50% chance of inheriting one mutated/abnormal gene *which makes them a carrier  Phenylalanine, sickle cell anemia, cystic fibrosis  X-linked o Refers to genes on X chromosome (sex chromosome)  Female: XX  Male: X(mom) Y (dad) o Females who carry an X-linked disorder have 50% chance of passing it to child, so DAUGHTERS who inherit altered gene will most likely be a carrier and SONS will inherit condition from their carrier mother and pass the altered gene to their daughters who WILL become carriers  Hemophilia A, Duchenne muscular dystrophy  Y-linked o Transmitted only from father to son and linked with infertility  Multifactorial inheritance o Caused by interaction of multiple genetic and environmental factors o A combination of genes from both parents along with environmental factors compromise the disorder  Spina bifida, congenital heart defects, cleft lip/palate, autism  Genetic Testing o Identify changes in chromosomes, genes, or proteins to confirm or rule out a suspected genetic condition. *Help determine persons chance of developing or passing on a genetic disorder. (over 1000 genetic test being utilized) Type of Test Description Diagnostic Establish a diagnosis of a genetic disorder in an individual who is symptomatic or testing has had a positive screening test Prenatal testing Identify a fetus with a genetic disease or condition. Test initiated due to family history or maternal factors. Newborn Test a newborn to identify the presence of a condition that requires immediate initiation of treatment to prevent death/ disability. screening Preimplantation Following in vitro fertilization, testing is performed on embryos to identify testing embryos with a particular genetic condition. Carrier testing Testing asymptomatic individual to identify carrier status for a genetic condition. Predictive testing Offered to asymptomatic individuals to detect genetic conditions that occur later Presymptomatic: in life. Predisposition: detects mutations that will eventually cause symptoms (Huntington disease). detects mutations that increase the likelihood that symptoms will develop (BRCA) o Screening test are for populations vs. Diagnostic tests specific o

For every + screen test you must do a diagnostic test Lecture 2 Chapter 5: Growth and Development o

What is growth?

What is development? Cephalocaudal development

Proximodistal development

What is the Denver II?

Nurses in G&D

Erikson (Psychosocial) P.114

An increase in physical size. It represents quantitative changes such as height, weight, blood pressure, and number of words in the child’s vocabulary. A qualitative increase in capability or function. Refers to how your brain is functioning. Proceeds from the head downward through the body toward the feet. Head to toe. For example, infants learn to hold up their heads before sitting, and to sit before standing. Proceeds from the center of the body outward towards the extremities (periphery). For example, infants are first able to control the trunk then the arms. Later, fine movements of the fingers are achieved. The Denver II is a tool to assess development. It is a screening procedure which looks at everything then decides if the child is progressing (meeting milestones). The purpose is to identify delays in children unable to perform at age-appropriate level. Used from birth to 6 years. Assesses development in 4 areas: personal-social, gross motor, fine motor, and language. ~ Personal-social – the ability to get along with people such as playing peek-a-boo and patty-cake. ~ Gross motor – large muscle development such as standing alone and walking well. ~ Fine motor – the ability to see and use hands such as grasping a rattle. ~ Language – the child’s ability to speak such as saying words other than “mama” or “dada”. Nurse’s knowledge in growth and development allows: 1. To give anticipatory guidance to parents 2. Provide age-appropriate care 3. Intervene to promote wellness For each stage, Erikson identified a crisis. If needs are not met, an unhealthy outcome occurs. If needs are met, the consequence is healthy, and the child moves on to future stages with strengths. Stages (1) TRUST vs. MISTRUST (birth – 1 year) The task of the first year of life is to establish basic trust. Trust is fostered by consistent, loving care by a mothering person and by provision of food, clean clothing, touch, and comfort. If needs are not met, the infant will eventually learn to mistrust others.

(2) AUTONOMY vs. SHAME & DOUBT (1 – 3 years) The toddler shows independence by controlling excretions (potty-training), saying no when asked to do something, and directing motor activity and play. Children who are criticized will develop a sense of shame and doubt in their abilities. “Say “NO” all the time (3) INITIATIVE vs. GUILT (3 – 6 years) The preschooler initiates new activities and new ideas. Begin to assert power and control over the world. Need to try things on their own. Constant criticism leads to feelings of guilt (fear of trying new things) and a lack of purpose. (4) INDUSTRY vs. INFERIORITY (6 – 12 years) School-age childhood is characterized by development of new interests and by involvement in activities. The child takes pride in accomplishments in sports, school, home, and community. If the child cannot accomplish what is expected, a sense of inferiority will occur. Develop sense of competent if successful. Important for success? Unconditional love and security from parents Must be a good balance bc if you overpraise them= arrogance

Freud (Psychosexual)

(5) IDENTITY vs. ROLE CONFUSION (12 – 18 years) In adolescence, a new sense of identity or self, is established. The adolescent who is unable to establish a meaningful definition of self will experience confusion. Can be rebellious Believes that early childhood experiences form the unconscious motivation for actions later in life. He believed that sexual energy is centered in specific parts of the body at certain ages. Id – basic sexual energy that is present at birth (unconscious mind) and drives the individual to seek pleasure. Ex: hungry baby cries till fed Ego – realistic part of the person, serves the reality principle (conscious mind). Develops during infancy as they search for acceptable methods of meeting impulses. Ex: Child ask mom for permission to borrow necklace Superego – moral/ethical system which develops in childhood and contains a set of values and a conscience. Ex: John couldn’t join friends bc they were bullying him Stages (1) Oral (birth – 1 year) The infant derives pleasure largely from the mouth with

sucking and eating as primary desires. (2) Anal (1 – 3 years) The toddler’s pleasure is centered in the anal area being able to withhold and expel fecal material. (Potty trained) (3) Phallic (3 – 6 years) In the preschool child, the genitalia become an interesting and sensitive area/ Recognizes sex differences. (4) Latency (6 – 12 years) Sexual energy...