Growth is an increase in
physical size
Development
is an increase in capability or function
-development does not always follow growth and
... [Show More] chronological age
-chronological age and developmental age are two different things
Cephalocaudal development is development that moves from the...
head downward through the body and towards the feet
Proximodistal development is development that moves from the...
center of the body outward to the extremities
Define play...
play is the "work" of children
-it is how they learn new things. socialize and learn to use coping skills
-in addition to growth and developmental level, you must also think about the client's disease when choosing toys
-for children with a heart defect, you would not give them something to do that will excite and increase their heart rate because that would increase the workload on the heart and we NEVER want to increase the workload on the heart of a client with heart disease
You are taking care of a 5 month old baby. What toy is most appropriate for an infant?
rattle- working on grasp reflex
When a baby is born, they have... grasp reflex
involuntary
You are caring for an 11 year old boy in the hospital. What would be an appropriate activity for him?
-playing video games in the room
-coin collecting
-watching TV
-reading his favorite book
When does the anterior fontanel close?
12 to 18 months
When does the posterior fontanel close?
2 to 3 months
Why are new foods introduced to infants one at a time?
allergies, and they also have immature GI tracts
Why are peanuts so dangerous when aspirated?
when peanuts are wet, they will swell and crumble
-dangerous for airway, hard to remove and allergy risk
When giving an IM injection why is the ventrogluteal muscle contraindicated in children who have not been walking for at least a year?
the ventrogluteal muscle is not developed well enough
When viewing the auditory canal in the young child how is the earlobe positioned?
down and back
-bigger they are, harder you pull
What are the most common reason for failed toilet training?
they are not ready
-never make toilet training punishable
-takes boys longer
How many cups of milk should a 15- month old toddler consume daily?
2 to 3 cups
At what age does the best friend stage occur?
9 to 10 years
What are the leading causes of death from accidental injury in infants up to 1 year of age?
suffocation, motor vehicle related injuries, and drowning (bathtub or small amount of water)
-falls are leading cause of ER visits
Car seat safety: general guidelines
-do not place car seat in the front passenger side of the car because of airbags
-place infants <20 pounds in the middle of the back seat in the rear-facing, semi-reclined car seat; this provides the best protection for their heavy head and weak neck
-in children 12 to 23 months of age, a convertible car seat for age and weight is recommended and can be positioned facing forward
-car seats should be used, regardless of age, until the child weighs at least 30 pounds
-never place padding under or behind an infant or child in a car seat (during car crash padding can become compressed leading to slack in the harness)
-booster seats can be used for children 4 to 8 years
Hyperthermia and car seat safety
-can occur from being left in a vehicle in hot weather (greater than 80 degrees)
-develops rapidly because infants are not able to regulate their body temperature
-forgetting to get infants out of the car has been related to busy schedules, distractions such as cell phones and other mental preoccupations
Between ages 6 and 12, what is the major cause of severe accidental injury?
motor vehicle accidents
-helmet safety
Teach stranger safety...
including not talking or texting to anyone they don't know on the internet, social media sites, or phone
What happens to the growth rate between 6 and 12 years?
decreases
A school age child requires, on average, how many calories per day?
2400 calories
How much earlier do girls experience the onset of adolescence than boys?
about 1 to 2 years
What is the first step in collecting vital signs or an assessment?
always begin with observation
Distraction techniques
-used to make sure we are getting most accurate set of vital signs (pen lights, age appropriate toys, stickers)
-don't forget to talk to the parents, even before you talk to the child. You need a trusting relationship with them
Order to obtain vital signs
-least invasive first
-observe before touching or even talking to them
-progression of obtaining vital signs: respiration, heart rate (done at same time), blood pressure, temperature
-in infants and toddlers, always count RR and HR for one full minute because of irregularities due to their immature nervous system regulation
-if vital signs cannot be taken without disturbing the child, then record the behavior with the measurements
Rectal temperature
considered the most reliable route for measurements in infants and children
-do not get rectal temperatures on newborns, it is too risk to perforate the anus
-contraindicated in any child who has diarrhea, rectal lesions, is receiving chemotherapy, is immuno-suppressed, or has no rectum
No rectum known as?
imperforated anus or anorectal malformation
Axillary temperature
may be done in all ages when an oral route is not possible
Oral temperature
start at age 5 to 6 years, child is more likely to cooperate at this age
Tympanic temperature
all ages, less sensitive for children less than 3 years of age
Testing Tip
always note when the temperature was taken
DO NOT add or subtract a degree
Oxygen saturation
used to obtain a "picture" of the blood oxygen level through the skin
-check perfusion, skin temperature, and edema to determine best location for the sensor probe; also consider the child's activity level
-common sites are fingers and toes
-the oxygen saturation on the oximeter display should correlate with the child's radial pulse
Communication for newborns (birth to 1 month)
-primary mode of communication is nonverbal
-they express themselves through crying
-respond to human voice and presence
-touch has a positive effect
-nursing strategy: encourage parent to touch infant
Communication for infants (1 month to 12 months)
-communication is still primarily nonverbal
-begin verbal communication with vocalizations, starting with repeating consonants
-communicate through crying and facial expressions
-attentive to human voice and presence, but minimal comprehension of words
-responds to touch through patting, rocking and stroking
-nursing strategy: speak in gentle-toned voice, cuddle, pat, rub to calm, and encourage the presence of parents
Communication for toddlers and preschoolers (1 to 5 years)
-evolving verbal skills
-use of language to express thoughts
-children ages 3 to 4, form 3-4 word sentences, called telegraphic speech
-concrete and literal thinking; may misinterpret phrases
-vocabulary depends on development and family's use
-may ask a lot of questions (preschooler); ask "why" to everything
-short attention span
-limited memory
-cognitive development: egocentric, magical thinking, animism (thoughts of toys behaving like humans), object permanence (objects still exist when child can't see them)
-nonverbal communication: express themselves through dramatic play and drawing, play is work of the child
Communication of the school-age child (6 to 12 years)
-cognitive development: able to use logic, begin to understand others points of view, begin to understand cause and effect, developing and understanding of body function
-verbal communication: big vocabulary, receptive and expressive language is more balanced, misinterpretation of phrases is still common
-nonverbal communication: can interpret nonverbal messages, expression of thoughts and feelings
Communication of adolescents (13-18 years)
-abstract thinking without full adult comprehension
-interpretation of medical terminology is limited
-strive for independence
-trust and understanding build rapport
-need privacy
-nursing strategies: straightforward approach; talk in private area, conduct at least part of the interview without parent present
Communication with children with physical or developmental disabilities
-if unable to communicate, may feel helplessness, fear, or anxiety
-family may experience fear and anxiety
-nursing strategy: use gestures, picture boards, writing tablets, use a system of head nods, eye blinks
What are observable signs of respiratory distress in children?
-use of accessory muscles
-nasal flaring
-sternal retractions
-grunting with respiration
-any illness that affects the lungs ability to get oxygen in and carbon dioxide out will cause respiratory distress
-illnesses that can cause respiratory distress include pneumonia, atelectasis, pneumothorax, and plural effusion
-the amount of respiratory distress depends on the degree of airway disease
What is laryngotracheobronchitis?
-a viral infection that can result in: slight to severe dyspnea, barking or brassy cough, and elevated temperature
-commonly known ans croup
-viral organisms responsible for croup include: parainfluenza, adenovirus, and RSV
-sound like a barking seal
Treatment for LTB:
-manage children at home with mild croup; at home most episodes can be treated with:
---steam from hot showers
---cool temperature therapy: cold air outside, open freezer --> helps constrict the swollen blood vessels in the trachea that are causing swelling (opens up airways)
-if symptoms worsen or there is no improvement:
---nebulized epi or corticosteriods may be prescribed by the primary healthcare provider or administered in the emergency department
-nebulized epi has a rapid onset; generally see improvement in 10 to 15 minutes; always watch for a relapse and return of symptoms when epi wears off
What is epiglottis?
-a serious obstructive inflammatory process: there is absence of a cough, presence of dysphagia, drooling, and rapid progression to severe respiratory distress
-primary organism cause: H-flu
-prevention: Hib vaccine
-caused by infection of the epiglottis, can lead to partial or full occlusion of the airway
-considered a medical emergency
-look worse than they sound, the less noise they make, the worse they airway obstruction
-never try to visualize the throat or tongue with a tongue depressor
-help children remain comfortable
What is RSV?
-leading cause of lower respiratory tract illness in children less than 2 years of age, caused by an acute viral infection that affects the bronchioles
-can be life threatening in infants
Risk factors for RSV
-prematurity
-congenital disorders; like congenital heart defects
-smoke, in any form
-in premature infants and those with congential disorder, the focus is on prevention; this includes avoiding sick contacts and immunization with the RSV vaccine (Synagis, RespiGam)
Signs and symptoms of RSV
-begin with simple URI
-nasal discharge
-mild fever
-wheezing
-nonproductive paroxysmal cough
-tachypnea with flaring nares
-dyspnea and retractions
-know the onset of signs/symptoms, because RSV will become worse at days 2 to 3 and can progress to life threatening respiratory distress
HINT
signs and symptoms can range from mild to severe; can progress from a simple cough and runny nose to copious amounts and mucous, to severe respiratory distress [Show Less]