Peds ATI Nursing Care of Children 2019 study guide for proctored exam PDF

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Study guide for proctored ATI "RN Nursing Care of Children 2019"...

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Care of the Child ATI Chapter 1 Parenting styles: §

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Dictatorial or authoritarian o Super strict parents, it’s their way or the highway o Parents try to control their child’s behaviors through unquestioned rules or expectations o Ex. the child is never allowed to watch tv on a school night Permissive o Very laid back, allow children to set their rules o Parents exert very little control over their child’s behaviors; consult the child when making decisions o Ex. the child assists in deciding whether or not they can watch tv on a school night Democratic or authoritative o Right in the middle, not too strict but also not too permissive o Parents direct the child’s behaviors by setting rules and explain the reason behind them o Parents negatively reinforce deviations from the rules and may do so by taking privileges away o Ex. the child can watch tv for 1 hour on school nights as long as their homework is done Passive parents o Do not care what is going on, don’t even consult with the children. Uninvolved, indifferent or emotionally removed

Chapter 2 Physical Assessment Findings § § § § § §

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Pediatric vital signs differ from an adult’s, except for blood pressure. Temperature of a one year old is 99.9 degrees Not until 5 years old when they begin to have a normal temperature of 98.6 Pulse rate for an infant is 80-180 with respirations of 30-35 Infant bp systolic is between 65-80 and their diastolic is between 40 & 50 The fontanels* o Should be flat and soft o Posterior: closes between 6 & 8 weeks o Anterior closes between 12 & 18 months Infant can have 6-8 teeth by one year of age There will be 20 deciduous teeth and 32 permeant teeth

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Reflexes* o Moro reflex: present from birth to four months. Allowing the head and trunk of the infant to fall backwards. The arms and legs symmetrically extend and abduct, and fingers form a C shape. o Rooting: stroking the infant’s cheek or edge of mouth causes the infant to turn their head to that side and suck. Birth to 4 months. o Palmar grasp: placing an object in the infant’s palm and the infant grasps the object. Birth to 3 months. o Plantar: by touching the sole of the infant’s foot the toes curl downward. Birth to 8 months. o Startle: by making a loud noise the infant abducts arms and hands remained clenched. Birth to 4 months. o Tonic neck: by turning the infants head to one side the infant will extend the arm and leg on that side and flex the opposite side. Birth to 3-4 months. o Babinski: by stroking the outer edge of the sole up toward the toes the infant will fan its toes upward and out. Birth to 1 year. o Stepping: by holding the infant upright with its feet touching the surface the infant will make stepping movements. Birth to 4 weeks. Cranial nerves o 1 is olfactory o 2 is optic o 3 oculomotor o 4 trochlear: ability of eye to look down and in o 5 trigeminal: have child close eye and they will detect you touching their face o 6 abducens: the ability to look laterally with the eyes o 7 facial: symmetry facial movements o 8 vestibulocochlear/acoustic: checking hearing o 9 glossopharyngeal: checking for intact gag reflex o 10 vagus: checking for swallowing o 11 spinal accessory: can move shoulders symmetrically o 12 hypoglossal: tongue is midline and can move in all directions

Ooh ooh ooh to touch and feel very good velvet such heaven Some say marry money but my brother says big brains matter most

Chapter 3 Physical Development: §

Doubles by 6 months; triples by 1 year*

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2.5 cm (1 in) per month for the first 6 months Length increases by 50% by 12 months of age First teeth erupt between 6-10 months

Age 1 month 2 months

Gross motor Demonstrates head lag Lifts head up when prone

3 months

Raises head and shoulders when prone, slight head lag

4 months 5 months 6 months 7 months

Rolls from back to side Rolls from front to back Rolls from back to front Bears full weight on feet. Sits leaning forward on both hands Sits unsupported Pulls to standing position. Creeps on hands and knees

8 months 9 months

10 months 11 months

12 months

Changes from prone to sitting position Cruises or walks while holding on to something. Walks with one hand held. Sits down from a standing position without assistance

Fine motor Strong grasp Holds hands in an open position, grasp reflex fading No longer has a grasp reflex, keeps hands open loosely. Grasps with both hands Uses palmar grasp Holds bottle Moves objects from hand to hand Begins using pincer grip Has crude pincer grip. Dominant hand preference evident Grasps rattle by its hand Places objects into a container. Neat pincer grasp. Tries to build a two-block tower w/o success. Can turn pages in a book.

Cognitive Development: Piaget § §

From birth to 24 months they are in the sensorimotor stage Object permanence occurs around 9 months of age.

Language Development: §

Should be able to say 3-5 words by age 1 and they know the concept of no.

Erickson: § § § §

From birth to 1 year is trust vs. mistrust. Is the caretaker meeting the needs of the infant? Separations anxiety occurs around 4-8 months of age Stranger fear occurs around 6-8 months of age

Toys: © Rattles, blocks, brightly colored toys, playing patty cake, reading books, mirrors,

and playing with balls. Immunizations: © Birth: hep B © 2 months: 2nd hep B, IPV (inactivated polio), RV (rotavirus), PCV (pneumococcal),

DTaP, Hib (haemophilus influenza type B) © 4 months: all of the above minus the hep B © 6 months: all including hep B © Should also get flu between 6 months and 1 year

Nutrition: § § § §

Breastmilk for the first 6 months No solids until 4 to 6 months, iron fortified rice cereal Do not need juice or water during first year of life** Introduce new foods one at a time over a 4 to 7 day period to observe for allergies

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Never leave unattended in bathtub Stay in rear facing cars seat until two years of age Crib slats should be no more than 6 cm apart, keep pillows out of crib On back to sleep*

Chapter 4: © Quadruple weight by 30 months of age © Grow 3 inches per year © Head and chest circumference should be equal around 2 years of age

Age 15 months 18 months

Gross Motor Walks without help. Creeps up stairs Runs clumsily, falls often, throws ball overhead, jumps in place with both feet. Pushes and pulls toys

Fine Motor Uses a cup. Builds a tower of 2 blocks Manages a spoon. Turns pages in a book two or three at a time, build a tower of 3-4 blocks

2 years

2.5 years

Walks up and down stairs by placing both feet on each step Jumps across flow and off a chair using both feet. Stands on one foot for a moment. Takes a few steps on tip toe

Builds tower of 6-7 blocks and turns pages of books one at a time. Draws circles. Has good hand-finger coordination

© At one year, they are using one-word sentences or hollow phrases. At two years

they use multi word sentences, 2-3 words. Erickson: § § §

Autonomy vs. shame Independence, trying to do stuff for themselves; Expressed by saying “no” a lot. Thrive on ritualism

Toys: © Playing with blocks, push pull toys, large piece puzzles and thick crayons. Finger

paints and looking at books. Toilet training: © Depends on age and when the child can recognize the sensation to go.

Immunizations: © © © ©

12-15 months: IPV and PCV, MMR and varicella, Hib 12-23 months: hep A (at least 6 months apart) 15-18 months: DTaP Annual flu

Nutrition: © © © © ©

Breast milk or formula through 1 year 1-2 years they receive full fat milk At 2 can transition to low fat milk Juice consumption should be limited to 4-6 oz per day Nuts, grapes, hot dogs, peanut butter, raw carrots, tough meats, and popcorn should all be avoided.

Injury prevention: © Prevent burns, drowning, and aspiration

Chapter 5: © They should gain about 4.5 to 6 pounds per year. © Should grow about 2.5-3.5 inches per year.

3 years old Rides tricycle Jumps off bottom step Stands on one foot for a few seconds

4 years old Skips and hops on one foot. Throws ball overhead Catches ball reliably

5 years old Jumps rope Walks backwards with heel to toe Throws and catches ball

Piaget: § § §

Phase of intuitive thought around age 4 Have magical thinking Animism is also present

Erickson: § §

Initiative vs. guilt May regress if a new child is brought home, this is normal for any stress or insecurity

Toys: © Playing ball, puzzles, tricycles, dress up and role playing.

Immunizations: © 4-6 years: DTaP, MMR and IPV © 3-6 years: seasonal flu

Sleep: © Need about 12 hours of sleep © Consistent bedtime routine and avoid letting them sleep with you

Dental: © Eruption of primary teeth is finalized by the beginning of the preschool years. © Wear protective gear such as helmets and pads

Chapter 6: School-Age Children © Will gain about 4.5-6.6 pounds a year © They will grow about 2 inches per year © Permanent teeth begin to come in

Piaget: § §

Concrete operations See perspective of others instead of having an egocentric type of view

Erickson: § § §

Industry vs. inferiority Child is trying to make meaningful contributions to society Cooperate and compete with others

Socialization: § §

Peer groups are very important Competitive and cooperative play occurs

Activities: §

Board games, hopscotch, jump rope, bicycles and organized sports.

Immunizations §

11-12 years: DTaP and HPV

Sleep §

At least 9 hours

Chapter 7: Adolescents © Girls will stop growing about 2 to 2.5 years after they stop their period. © Boys stop growing around 18 to 20 years of age.

Girls © © © ©

Breast development Pubic hair growth Axillae hair growth Menstruation

Boys © © © © © ©

Testicular enlargement Pubic hair growth Penile enlargement Axillae hair growth Facial hair growth Vocal changes

Piaget: §

formal operations

Erickson: § §

identity vs. role confusion figuring out who they want to be

Activities: §

video games, music, sports, pets, reading and social events.

Immunizations: §

16-18: meningitis

Safety § § §

Protective gear Wearing seat belts, no drinking and driving, discourage cell phone use while driving. Talk about substance abuse

Chapter 8: § § § §

Oral route is always preferred if possible Use the smallest measuring device possible Do not mix into formula because they may not finish the whole bottle Insert medication into side of mouth; hold cheeks together then stroke chin to get them to swallow more effectively

Ear drops: - If the child is less than 3 years old, pull the pinna down and straight back - Child over 3 years old - pull pinna upward and back

Injections: § § § §

Vastus lateralis is preferred site for IM injections Ventral gluteal or deltoid would be the second recommended site 22-25 gauge with a 0.5-1-inch needle Subcutaneous injections: 26-30-gauge needle

When inserting an IV, take the child away from their bed and into a procedure room. You don’t want to mix up their associations between their safe places and unsafe places. Use emla cream to numb the area. Avoid terminology such as a bee sting or a stick. Keep equipment out of sight until you are ready to perform the procedure. Offer nonnutritive sucking to infants before, during, and after procedure. Chapter 9: Pain management - Self-report is only appropriate if the child is 4 years or older. FLACC §

From 2 months to 7 years

FACES §

3 years old and above

OUCHER §

3 to 13 years old

Numeric scale §

5 years old and older

Nursing interventions: § § § §

Use play therapy to explain procedures Given medications on schedule instead of when needed Combine opioid and non-opioid for greater effect EMLA o Apply 60 min prior to puncture o 2.5 hours prior to a deep puncture o Place occlusive dressing over that, and then clean the skin

Chapter 10:

Infant § Does not know what is going on; unable to describe their illness or how they are feeling § May have stranger anxiety § May express physical behaviors due to the inability to express themselves verbally Toddler § Limited ability to describe illness or follow directions § Behavior may regress during hospitalization § Separation anxiety § Intense reactions to any kind of procedures Preschooler § Magical thinking § Still experience separation anxiety School-age child § Able to describe pain and can understand cause and effect Adolescent § Body image is a key concern § May feel isolated from peers** Interventions: § § §

Preschoolers - explain the procedure in very simple clear language, give a choice if they can (do you want to take your medicine in a cup or a spoon) School age - give factual information, tell the truth, encourage contact with peer group and to express their feelings Adolescents - give factual information, encourage contact with peers

Play: § §

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Parallel play: one child playing next to another (not with); toddler Associative play: o Preschoolers o Play together without much organization Cooperative play: o School age o Play in groups and is more organized

Chapter 11:

Death and dying Anticipatory grief: when death is expected; outcomes identified Complicated grief: lasts longer than a year

Infants & Toddlers § No concept of death § Mirror parents’ emotions § Regress in behavior Preschooler § Magical thinking § Feel guilt or shame because they think they did something that caused death to occur § See dying as temporary School age § Adult concept of death § Express fear through uncooperative behavior Adolescents § Adult concept of death § Rely on peers than family § Stressed out by changes in physical appearance Physical manifestations §

Sensation of heat when the body feels cool, decreased sensation, loss of senses, decreased LOC, swallowing difficulties, bradycardia, hypotension, Cheyenne stokes respirations.

After death § § §

Allow family to stay with body as long as they like Assist in preparation of body Let them be involved

Chapter 12: Neurological Disorders Meningitis

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Viral or bacterial o Viral resolves with supportive care for recovery o Bacterial is more dangerous & is contagious (two vaccines - PCV and HIB) Symptoms o Photophobia, n/v, irritability, headache, o In newborn: poor muscle tone, weak cry, poor suck, refusal to eat, v/d, bulging fontanels is a late sign o For 3 months to 2 years: seizures, high pitch cry, fever, irritability, nuchal rigidity, poor feeding and vomiting. o 2 years to adolescents: seizures, nuchal rigidity, positive Brudzinski sign & Kernig, fever, chills, vomiting, irritability headache and petechiae. § Those signs not reliable in diagnosis for those 3 months to 2 years Labs o Analysis of cerebral spinal fluid through lumbar puncture o If it is bacterial the CSF will be cloudy, elevated WBC count, elevated protein count, and decreased glucose content. Positive gram stain. o If it viral it will be clear instead of cloudy. A slightly elevated WBC count, a normal or slightly elevated protein, normal glucose content, and a negative gram stain. Lumbar puncture o Have child empty their bladder before the procedure o Use emla cream on the area to be punctured o Side lying position o After they need to remain in bed for 4 to 8 hours in a flat position If this disease is suspected, they need to be on droplet precautions**** If they have a decreased LOC related to the disease, they need to be NPO Provide a quiet, dimmed environment PT needs to be on seizure precautions If it is bacterial, they are going to need an IV antibiotic Monitor for increased cranial pressure o Infants: bulging fontanels, increased head circumference, high pitched cry, irritability, bradycardia and respiratory changes. o Children: irritability, headache, n/v, seizures, bradycardia, and respiratory changes.

Reye’s Syndrome: § §

Can cause liver dysfunction and cerebral edema Associated with giving aspirin to children with a fever

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Follows a viral illness like the flu, gastroenteritis, or varicella. Labs o Liver enzymes will be elevated o Ammonia will be elevated Do a liver biopsy and CSF analysis to diagnose Symptoms o Lethargy, irritability, confusion, delirium, vomiting and loss of consciousness

Chapter 13: Seizures § §

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Can have an unknown etiology Risk factors o Cerebral edema, fever, trauma or hemorrhaging, brain tumor, toxins in the body, lead poisoning, hypoglycemia, electrolyte imbalance and infection. Types o Tonic clonic § Tonic: arms and legs flex up; head and neck extend. Loss of consciousness § Clonic: jerking of muscles in your body. § Postictal phase: awake confused, slow to arouse, and have no recollection of the seizure. o Absence § With school age children, 4-12 yrs § Loss of consciousness for 5-10 sec, looks as if the child is daydreaming. § Lip-smacking or twitching of the eyelids or face o Myoclonic § Brief contraction of a muscle or muscle group but there is no postictal phase o Atonic § Lose tone and fall Diagnosis o EEG § No caffeine and wash hair prior to Seizure precautions o Pad the side rails of the bed, suction and oxygen readily available o Gently place on side, make sure airway is patent, loosen any restrictive clothes, move any furniture or obstacles out of the way.

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o Post seizure: keep in side lying position, take vital signs, neuro check, no food or liquid until gag reflex is back. Meds o Antiepileptic meds § Carbamazepine, valproic acid § Phenytoin & diazepam Surgical o Focal resection of certain areas of the brain o Vagal nerve stimulator Complication o Status epilepticus: lasting more than 30 minutes, medical emergency § IV access

Chapter 14: Head injury Minor §

Confusion, vomiting, pallor, irritability, drowsiness,

Major §

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ICP first sign is irritability o Infant: Bulging fontanels, high pitched cry, poor feeding o Chile: Nausea, headache, vomiting, blurred vision, and seizures o Late signs: delayed or impaired pupillary responses, posturing (decorticate = toward the cord) § Decorticate means that there is a problem with the cerebral cortex. § Decerebrate means an issue with the brain stem Nursing care o Stabilize spin until it is checked, VS, Glasgow coma scale Ways to decrease ICP o Keep HOB at 30 degrees, maintain head in midline or neutral position, minimize oral or endotracheal suctioning, avoid coughing or blowing nose, insert foley catheter, and give stool softeners to avoid straining. o Implement seizure precautions o Meds § Corticosteroids • Dexamethasone • Mannitol § Antiepileptics

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o Surgery § Craniotomy • Relieve pressure Complications o Epidural hemorrhage, subdural hemorrhage o Brain herniation § Loss of blinking, loss of gag reflex, nonreactive pupils, and coma

Chapter 15: Cognitive and Sensory Impairments § §

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