Exam 1 N173
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. What would you like to do?
Over 2 yo max calories from fat....
How much juice a day is ok....
up to age 6
How much fish, meat, beans should kids eat/day?
How much whole grains should be in your diet?
- 2-3 yo = 3 oz
- 4-8 yo = 4-5 oz
Don't cook with this oil?
How much oil a day?
NO HYDROGENATED OILS
Make sure this is in your bread and cereals...
patients beds and play rooms
don't do any procedures here.
Goals for a family with a child with chronic medical problems
- family remains intact
- achieve and maintain normalization
- maximize function throughout the illness
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
At what age is it appropriate to give a child meds crushed and with a mixed chaser?
What age child will have stranger and separation anxiety?
When communicating with a toddler about interventions try to....
keep it fun, short and simple, honest and give choices
Which age groups will regress?
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
Preferred site for IM injection
Needle information for IM Vastus Lateralis injection
- 5/8-1 inch needle
- 22-25 gauge
- 0.5-3 mL syringe
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
Height is measure
head to heels
- under 2 laying down
- 2+ standing
How do you weigh a kid?
- <2 naked
- >2 with diaper or as few clothes as possible
What do I plot on a growth chart?
- head circumfrence
Which vital signs do I measure for 1 minute?
Respirations and HR
Look at this for measuring respirations...
Toddler and older
Infant have it done by...
What age do you start oral?
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
Best to take the RR when
baby is sleeping or child is calm
Best position for taking breath sounds
For all procedures it is a good idea to....
let them hold or play with things prior to me using them
When should an eye test be done?
no later than 3 yo
When do we start to screen for scoliosis
Who is at greatest risk for injury?
infants and toddlers
SIDS occurs most often at this age? But till this age?
Intrinsic Factors predisposing a child to SIDS
- prenatal exposure to cigarette smoke or alcohol
Extrinisic factors predisposing a child to SIDS
- prone sleeping position
- bed sharing
- soft mattress
- exposure to cigarette smoke
What puts a baby most at risk for SIDS
prone sleeping + bed sharing
Most consistent cue to determine if an infant or child is in pain
Who cries longer when in pain? Infant or toddler?
When can a child use words to tell you they are in pain?
Who feels pain most intensely?
What is the preferred route for admin of analgesics?
Maximum opioid amount?
Maximum is determined by it being titrated till the person doesn't feel pain and is experiencing few side effects
If a child is on an IV opioid they must be on...
cardiac and apnea monitor and pulse ox
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
- 1-10 (2 pts. each level max)
select the face that matches how you feel
Poker Chip Tool for pain assessment
4 poker chips...each rep. pain
Visual Analog Scale for pain
1-10 ranking of pain for self
older school age and adolescents
Descriptive pain assessment
How can you tell an infants in pain?
- high pitched cry
- VS change (tachy, htn, decreased O2 sat)
- not sleeping/or sleeping a lot
- not eating
- rub painful area or guard the area
How can you tell a toddlers in pain?
- LOUD crying
- verbalize it-ouch, hurt, boo boo
- guard the site
- touch painful area
- run from nurse or delay procedures
How can you tell a pre school aged kids in pain?
- cry and struggle with you
Weird things pre schoolers think about pain....
- they caused it....its a punishment
- deny having pain so don't have to get things done
How can you tell a school aged child is in pain
- **They will verbalize it**
- stiff body posture
- procrastinate/bargain to delay the procedure
How can you tell an adolescent is in pain?
- **Verbalizes it**
- muscle tension
- decreased motor actuvity
- sore, ache, pounding
Non pharmacological approaches
- quiet and calm environment
- repositioning, holding, touching, massage, compresses, breathing tech., distractions, guided imagery, muscle relaxation
What's better to calm a patient rubbing/stroking or patting the back and buttocks?
How can you help a child that is in pain and not breathing well?
remind them to breathe....party blowers, bubble soap blow wands
Describe fluid boluses
isotonic solutions - normal saline or LR
20mL/kg over 15-30 min
What age loves band aids and stickers?
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
Good way to auscultate the heart, lungs and abdomen of a baby?
while they are sleeping or being held by their parent
2 Primitive Reflexes
- Palmar Grasp
- Stepping reflex
infants head and trunk are allowed to drop back 30 degrees ....baby gets "startled" with legs and fingers stretching out
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
Who is the most challenging patient because they are least likely to cooperate?
**Resistance and CRYING are normal responses to exams**
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
School aged kids and the PA
- ESTABLISH TRUST FIRST
- Ask questions about them/school/friends
- Let them be modest
- Teach child about their body
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
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?"
What age is it ok for a child to be in a seatbelt?
9...but not by an airbag
At what age doe kids understand they can die too?
View of death by age...
- Pre school-temporary/reversible/punishment
- School Age-Irreversible/sad
- Adolescent-inevitable/irreversible/but a distant event
Goals of Healthy People
- Increase access to care
- keep people healthy
- achieve a healthy quality of life
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
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
What age do babies roll....
back to belly
belly to back
- back to belly- 6 months
- belly to back- 2-3 months
At 7 months babies start to
- play social games like peek a boo
- begin to creep or crawl, moving one limb at a time
When can a baby hold their own cup for drinking?
When can a baby walk backwards?
What age do kids start to play interactive games like hid and seek?
Most important thing to a teen is
When do you introduce foods to a baby?
- 6 months and start with iron fortified cereals
- introduce a sippy cup
When do you introduce soft foods, chopped table foods to a baby?
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
Main task for an infant is
Main task for an 18 month to 3 yo is
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
What would you like to do?
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