Exam 1 N173

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Exam 1 N173
2014-01-25 19:04:09
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Lecture #1
Lecture #1 Study Guide
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  1. Over 2 yo max calories from fat....
  2. How much juice a day is ok....
    up to age 6
    • 6 oz
    • 12 oz
  3. How much fish, meat, beans should kids eat/day?
    2-3 yo
    4-8 yo
    • 2 oz
    • 3-5 oz
  4. How much whole grains should be in your diet?
    • 2-3 yo = 3 oz
    • 4-8 yo = 4-5 oz
  5. Don't cook with this oil?

    How much oil a day?

    3-4 tsp
  6. Make sure this is in your bread and cereals...
    whole grains
  7. Safe Zones
    patients beds and play rooms

    don't do any procedures here.
  8. Goals for a family with a child with chronic medical problems
    • family remains intact
    • achieve and maintain normalization
    • maximize function throughout the illness
  9. Challenges for a nurse caring for a child
    • recognition of childs communication technique
    • evaluation for pain and discomfort
    • total patient care
    • listening to parental concerns
  10. At what age is it appropriate to give a child meds crushed and with a mixed chaser?
    9 months
  11. What age child will have stranger and separation anxiety?
  12. When communicating with a toddler about interventions try to....
    keep it fun, short and simple, honest and give choices
  13. Which age groups will regress?
  14. Best approach for giving meds to children
    Ask the parents for help or ideas of how to give

    Go in with all of your supplies ready
  15. Preferred site for IM injection
    Vastus Lateralis
  16. Needle information for IM Vastus Lateralis injection
    • 5/8-1 inch needle
    • 22-25 gauge
    • 0.5-3 mL syringe
  17. When doing a PA what is the key....
    Least invasive (respirations, HR) to most invasive (groin/genatalia inspection, ears and mouth)

    infants and toddlers wont mind groin, but older kids will
  18. Height is measure
    head to heels

    • under 2 laying down
    • 2+ standing
  19. How do you weigh a kid?
    • <2 naked
    • >2 with diaper or as few clothes as possible
  20. What do I plot on a growth chart?
    • height
    • weight
    • head circumfrence
  21. Which vital signs do I measure for 1 minute?
    Respirations and HR
  22. Look at this for measuring respirations...
    Toddler and older
    • abdomen
    • thoracic area
  23. Temperature taking.....
    Infant have it done by...
    What age do you start oral?
    • axillary
    • 5-6 yo
  24. Blood Pressure tricks
    • 2/3 of arm length
    • put it on arm/leg, bundle then come back when settled
    • call it an arm hug
    • let child play with before
  25. Best to take the RR when
    baby is sleeping or child is calm
  26. Best position for taking breath sounds
  27. For all procedures it is a good idea to....
    let them hold or play with things prior to me using them
  28. When should an eye test be done?
    no later than 3 yo
  29. When do we start to screen for scoliosis
  30. Who is at greatest risk for injury?
    infants and toddlers
  31. SIDS occurs most often at this age?  But till this age?
    • 2-4 mo
    • 1 yo
  32. Intrinsic Factors predisposing a child to SIDS
    • genetics
    • males
    • premie
    • prenatal exposure to cigarette smoke or alcohol
  33. Extrinisic factors predisposing a child to SIDS
    • prone sleeping position
    • bed sharing
    • soft mattress
    • exposure to cigarette smoke
  34. What puts a baby most at risk for SIDS
    prone sleeping + bed sharing
  35. Most consistent cue to determine if an infant or child is in pain
    facial expression
  36. Who cries longer when in pain?  Infant or toddler?
  37. When can a child use words to tell you they are in pain?
    18 mo
  38. Who feels pain most intensely?
  39. What is the preferred route for admin of analgesics?
  40. Maximum opioid amount?
    Maximum is determined by it being titrated till the person doesn't feel pain and is experiencing few side effects
  41. If a child is on an IV opioid they must be on...
    cardiac and apnea monitor and pulse ox
  42. Ask the parents this question when doing a pain history.....then....
    what words do they use to tell you they are in pain.

    use those words consistently regarding their pain
  43. FLACC
    • 1-10 (2 pts. each level max)
    • Facial
    • Legs
    • Activity
    • Cry
    • Consolable
  44. Oucher assessment
    select the face that matches how you feel

    3-12 yo
  45. Poker Chip Tool for pain assessment
    4 poker chips...each rep. pain

  46. Visual Analog Scale for pain
    1-10 ranking of pain for self

    older school age and adolescents
  47. Descriptive pain assessment
    • sharp
    • dull
    • burning

  48. How can you tell an infants in pain?
    • FLACC
    • high pitched cry
    • grimacing
    • VS change (tachy, htn, decreased O2 sat)
    • thrashing/shaking
    • not sleeping/or sleeping a lot
    • not eating
    • rub painful area or guard the area
  49. How can you tell a toddlers in pain?
    • LOUD crying
    • verbalize it-ouch, hurt, boo boo
    • restlesness
    • guard the site
    • touch painful area
    • run from nurse or delay procedures
  50. How can you tell a pre school aged kids in pain?
    • cry and struggle with you
    • regression
    • withdrawal
  51. Weird things pre schoolers think about pain....
    • they caused it....its a punishment
    • deny having pain so don't have to get things done
  52. How can you tell a school aged child is in pain
    • **They will verbalize it**
    • stiff body posture
    • withdrawal
    • procrastinate/bargain to delay the procedure
  53. How can you tell an adolescent is in pain?
    • **Verbalizes it**
    • muscle tension
    • withdrawal
    • depression
    • decreased motor actuvity
    • sore, ache, pounding
  54. Non pharmacological approaches
    • quiet and calm environment
    • repositioning, holding, touching, massage, compresses, breathing tech., distractions, guided imagery, muscle relaxation

    kangaroo care
  55. What's better to calm a patient rubbing/stroking or patting the back and buttocks?
  56. How can you help a child that is in pain and not breathing well?
    remind them to breathe....party blowers, bubble soap blow wands
  57. Describe fluid boluses
    isotonic solutions - normal saline or LR

    20mL/kg over 15-30 min
  58. What age loves band aids and stickers?
    Pre Schoolers
  59. Toddlers and pre schoolers will have their meds mixed....what is key when choosing foods?
    • don't blend with their favorite foods
    • use a small amount of pudding, apple sauce
  60. Good way to auscultate the heart, lungs and abdomen of a baby?
    while they are sleeping or being held by their parent
  61. 2 Primitive Reflexes
    • Palmar Grasp
    • Stepping reflex
  62. Moro Reflex
    infants head and trunk are allowed to drop back 30 degrees ....baby gets "startled" with legs and fingers stretching out
  63. What age does it become difficult to do a PA because of stranger anxiety?
    How do I handle it?
    • 6-12 months
    • distract with toys/objects
    • have them sit on their parents lap
    • leave ears/oral for last
  64. Who is the most challenging patient because they are least likely to cooperate?

    **Resistance and CRYING are normal responses to exams**
  65. Pre Schoolers and the PA...how do they respond?
    • they want their parents close by
    • BUT they  want to show they can get undressed and can cooperate
    • praise them for cooperating
  66. School aged kids and the PA
    • Ask questions about them/school/friends
    • Let them be modest
    • Teach child about their body
  67. Adolescents and the PA
    • Straightforward approach
    • Parent should be present
    • Parent should be given opportunity to discuss questions/concerns
    • Genitals examined in MIDDLE of exam
  68. What approach helps the parents/kids feel that they are having some control?
    tell them in advance what they can and should do during the procedure....to help

    "I need to draw blood, can you help me by holding still?"
  69. What age is it ok for a child to be in a seatbelt?
    9...but not by an airbag
  70. At what age doe kids understand they can die too?
  71. View of death by age...
    Pre School
    School Age
    • Pre school-temporary/reversible/punishment
    • School Age-Irreversible/sad
    • Adolescent-inevitable/irreversible/but a distant event
  72. Goals of Healthy People
    • Increase access to care
    • keep people healthy
    • achieve a healthy quality of life
  73. Primary, Secondary and Tertiary Interventions for health promotion
    • Primary-Prevent Disease
    • Secondary-Early Recognition and Treatment
    • Tertiary-Restore health to highest level possible and prevent further complications
  74. 2020 Healthy People objectives
    • Increase proportion of children to who have access to medical home
    • Make sure all have the finances to receive adequate health care
    • Screen early and often
  75. What age do babies roll....
    back to belly
    belly to back
    • back to belly- 6 months
    • belly to back- 2-3 months
  76. At 7 months babies start to
    • play social games like peek a boo
    • begin to creep or crawl, moving one limb at a time
  77. When can a baby hold their own cup for drinking?
    12-13 months
  78. When can a baby walk backwards?
    15 months
  79. What age do kids start to play interactive games like hid and seek?
    24 months
  80. Most important thing to a teen is
  81. When do you introduce foods to a baby?
    • 6 months and start with iron fortified cereals
    • introduce a sippy cup
  82. When do you introduce soft foods, chopped table foods to a baby?
    9 months
  83. Eating and the 12 month old
    • 2-3 cups daily of whole milk
    • variety of table foods from all food groups
    • use utensils
    • eat 3 meals plus snacks
  84. Main task for an infant is
  85. Main task for an 18 month to 3 yo is
    toilet training
  86. If a child gains autonomy they will
    • have self control
    • will say no, but will still do what's asked
    • cope with problems
    • have patience
    • manifest pride