NURS 299 - EXAM IV

Explain actions to effectively deal with stress

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- effective coping: finding a balance between acceptance and action, between letting go and taking control

- stress management techniques: differentiate between acceptance and action, counter harmful effects of stress

- stress management interventions - self awareness

- recognize signs of stress (muscle tension resulting in backache, headache)

- attend to cues to reduce negative mood states or symptoms

Define stress

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- a state of threatened homeostasis that triggers an adaptive response

- "a state of threatened homeostasis that triggers and array of adaptive physiological, behavioral, and even social responses in an effort to reestablish homeostasis or relative balance to avoid chaos"

Describe affirmations and benefits

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- affirmations: positive thought

- repeating affirmation throughout the day enhances self- esteem and reduces stress

Explain the approach to create a better diet plan for a client who is stressed

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- create a goal with the patient, make the goal together

- always create the goal with the patient; never for them because they will be less likely to follow it

- healthy diets have a positive influence on health, physical performance, state of mind, and improves functioning

Explain the benefits and limitations of alternative therapies (as a whole)

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- acupuncture: ancient chinese technique

- fine needles are placed at specific meridian points on the body; used to reduce pain & prevent/ manage stress disorders

- hypnosis: narrows consciousness; elicits relaxation, inertia, passivity

- useful for smoking cessation, anxiety, and pain

- reiki: japanese "universal spirit"

- uses life force energy fields to affect health

Define cognitive restructuring

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- modifies negative and exaggerated thinking to reduce stress

- evaluates challenges and thoughts; replaces with more rational responses

- STOP, break the cycle, take a breath and relax. choose a more rational response

List the benefits of regular exercise

enhances well being while decreasing stress, good mood, health improvement

Describe the preschool children's fears about their body

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- fear of mutilation, fear of death

- upset over minor injuries: pain/illness viewed as punishment

List the genetic disease that may be diagnosed during preschool

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Can Dumb Frogs Walk Away

Cystic fibrosis, Duchenne muscular dystrophy, fragile X syndrome, William syndrome, autism

Summarize the nutritional needs in this age group

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- attention to iron, calcium intake

- limit fat and sugar

- variable hunger and appetite levels

List the allergies commonly associated in preschoolers

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- milk

- eggs

- peanuts

Recall the hygiene tasks preschoolers are developing

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- learning utensil use

- oral care

- potty trained

- washing hands, flushing toilet

- changing their own clothes when soiling themselves (handle gently and encouragingly)

Describe the characteristics of preschool play

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- doll or puppet play

- at this age, they are balancing on one foot, jumping and running

Characteristics of social play

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- important role social/ psychological development

- mimic others (adults)

- play reveals child's reality and perceptions

- toys chosen for age- appropriateness

Characteristics of imitation play

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- window into social competency

- fantasy (imaginary companion, imaginary scenario)

List the activities that interfere with adequate exercise

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- television/ screen time

- less active lifestyle

Explain bedtime rituals

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- prolonged bedtime routines (saying goodnight to 20 stuffed animals)

- honor reasonable rituals

- be firm and consistent

Explain sleep disturbances

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- night terrors vs nightmares (anxiety dreams\

- helping a child understand "real" vs "pretend" stories/ ideas lessen nightmares

Identify the Piaget task of irreversibility

filling two different sized glasses with the same amount of water

child will not understand that the "tall" glass and "short" glass have the same amount of water

*the video played in class

Identify vision problems of the preschool period

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- amblyopia: lazy eye, cover strong eye with patch

- refractive errors: myopia- near sighted (elongated eyeball), glasses always indicated

- strabismus: cross eyed

- color blindness

Provide examples of Erikson's task for preschool

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- initiative vs guilt

- sense of initiative: vigorous activity and active imagination

- as adults/ caregivers: want to encourage behaviors to promote a positive self concept; this helps child feel confident and secure in their abilities

- ex. puzzles, helping with chores, organizing

- self concept is refined through task- oriented and societally oriented experiences

Describe the coping mechanism used by preschool children and how to deal with problems

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- similar coping mechanisms to toddler

- maturing coping skills: fewer tantrums

- more problem solving abilities

- use of projection/ fantasy

- controlling behavior

- want to be gentle, consistent, and adult direction

List the immunizations in this age group (2)

DTap, MMR

Describe how to support the preschooler during a health visit

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- explain actions in age appropriate terminology

- expect child to cooperate for visit

- let child play with stethoscope

- include preschooler in history-taking

- direct questions about diet and health

- ex. tooth brushing, favorite activities, and friends

- needs parents close during injections

Explain enuresis

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- wetting self

- nocturnal vs diurnal enuresis

- begin with urine culture related to infection

- behavior management strategies; drug therapy

List the primary, secondary, and tertiary strategies for child abuse

primary: preventing chi8ld abuse before it occurs

secondary: parent education classes targeted for high-risk families, home-visiting, etc

tertiary: focusing on the treatment of child after child abuse has occured

Recall when kidneys reach full maturity

by the end of infancy and early toddler years

- can a 5 year old child receive renally excreted medication? yes

Concrete thinking

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- reasoning based on what you see, hear, feel, and experience

- "raining cats and dogs" literally thinking it is raining cats and dogs

Abstract thinking

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- true, logical thought

- ex. solving problems, understanding concepts, analyzing situations, able to understand deeper meaning of something

Recall most common accidents

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- injuries: leading cause of death

- motor vehicle accidents; prevention: car seats, riding in the back seat

- household furniture/ tools/ equipment

- firearm safety; prevention: lock away all firearms

- burns

- drowning

Identify prevention strategies

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- ride in back seat

- lock up firearms

- teach danger of matches, open flames, hot objects

- don't leave cigarettes and matches on the kitchen counter

- supervise around water

- wear helmets

- teach proper street-crossing techniques

Define celiac disease and list foods to avoid

celiac disease is an immune reaction to eating gluten

avoid wheat, barley, and rye

Summarize dental caries in school-age children

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- school age children have a potential for dental caries, periodontal disease, malocclusion

- school sealant programs reduce caries by 60% (program for children who are at greater risk for developing cavities)

Describe the State Children's Health Insurance Program (CHIP)

support comprehensive care to children who do not meet Medicaid criteria but live in families too poor to afford private insurance

Contrast active & passive teaching strategies

- active:

- passive:

- active: getting student involved in the material such as discussions, projects, activities, applying knowledge, helps stimulate understanding

- passive: listening to a lecture, reading a book, independent study followed by tests, one way communication between teacher and student

List the leading causes of fatalities

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- motor vehicle accidents is #1

- bicycles

- firearms

- sports

- drowning

- burns

Identify the prevention strategies

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- wear seat belts, ride in back seat of car, follow street safety

- wear a helmet & other protective gear

- keep firearms locked and secured

- swimming lessons, always supervise children around water

- smoke detectors at home, don't play with fire

Identify causes of weight gain and how to manage obesity

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- prepuberty weight gain (body is preparing for growth spurt)

- encourage staying in touch with internal cues of hunger (eat when hungry, stop eating when full)

- well balanced diet: 1200-1800 calories/day

- nutritional education

- educate healthy lifestyle behaviors

- school programs and dietary guidelines

Factors of obesity

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- environmental: using food as reward, lack of physical activity

- genetics

- increased rates in African American & Hispanic

- increased risk for muscle pain, joint pain, fractures, high BP, diabetes, sleep apnea, being bullied

Management for obesity

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- multimodal intervention

- reasonable caloric restriction

- physical exercise

- peer counseling

- habit changes: focus on healthy lifestyle behaviors NOT weight loss

List common nutritional deficiencies and causes

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- common deficiencies: calcium, iron, vit C

- iron deficiency anemia associated with poverty & malnutrition. most common in african, hispanic, native american

- diets are high in fat and sodium

Explain enuresis causes and management

involuntary passing of urine

- begin with urine culture to rule out UTI

- behavior management strategies; drug therapy

Explain encopresis causes and management

involuntary passing of stool after age 4

- common complication of chronic constipation

- psychosocial component

- stress or emotional disturbances could be triggers

- bowel management program & counseling is recommended

Sleep walking & sleep talking

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- normal due to immature nervous system

- when cns matures, they'll likely outgrow it

- management: consider safety, relaxation techniques, sleep preparation consistency

Identify factors that influence school- age child's nutrition

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- access to food: lack of nutritious food, make own snacks

- mass media influence: billboards, TV, tiktok

- contemporary busy lifestyles

- skip meals, eating out

- nutritional education

- school programs and dietary guidelines

Appropriate toy/ gift - consider development

beads to make jewelry

Describe smoking in school-age children

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- average age to begin: 11 yrs/old

- 1,600 kids try smoking everyday

Clarify areas to be screened during a well- child visit (2)

elevated blood pressure, vision

Describe major biological changes during school age child

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- growing a slower, steadier pace

- growth spurts

- transitioning from baby teeth to permanent teeth

- stronger immune system

- tonsils (lymphoid tissue) are larger in children than adults (normal)

Describe play and activity of healthy school age child

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- little league baseball, soccer

- gymnastics, ballet

- bike riding, rollerblading

Recognize examples of Piaget concrete operations

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- reasoning that's based on what you can see, hear, feel, and experience

- learn by manipulating concrete objects

- less egocentric- start considering other's views

- expanded conceptual understanding

Recall problems detected by vision and hearing screening

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- myopia: nearsightedness

- astigmatism: uneven focusing

- hearing deficit: can be cause by chronic serious otitis media

List typical cognitive gains

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- language: rapid development, complex sentences, reading, letter & sound recognition, combinations to form words, handwriting skills

- hand-eye coordination, motor control, perceptual abilities

- memory - improved ability, organizing, classifying, labeling facilitates retention

Describe the nurse's role for children with ADHD (6)

Detection, referral, collaboration on plan, counseling, liaison with family

Recognize examples of Erikson task for school age child

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- industry vs inferiority

- mastery of whatever child is doing

- children succeed at age specific tasks; increases their sense of self worth

- children need encouragement from people that are important to them

List parental advice

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- help the child be more responsible (pets, chores, allowances)

- help the child develop socially acceptable behaviors/ self worth

- nonviolent resolutions for conflict

- behavioral contracts

- when correcting a child, explain how one feels instead of labeling the child as "bad"

Recognize Kohlberg's stage of moral development

- preconventional (2)

- conventional (5)

- younger school age: preconventional

- moral behavior based on self- interest

- the child continues to do many things to avoid getting trouble and does not understand the reason for rules, but performs actions that will benefit themselves (not getting in trouble)

- older school age: conventional

- concerned about group interests/ values

- moral behavior problems (lying, stealing, cheating)

- common developmental behaviors

- guidance needed during this stage

- consequences should be congruent with developmental understanding of the event

Describe developmental changes in teens

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- accelerated growth spurt

- secondary sexual characteristics

Risk taking behaviors

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- negative health choices/ outcomes

- sense of invincibility

- adolescent experimentation

Signs and symptoms that require further evaluation

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- late onset of puberty

- if greater than 15 degree of spine, S shaped curve (scoliosis)

List the leading causes of death

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- motor vehicle accidents

- depression, leading to suicide

- unintentional injury

List the leading injuries

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- motor vehicle accidents

- sports injuries

- violence

- unintentional injury

List the common infections and poisonings

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- infectious mononucleosis

- meningococcal

- STIs

- HPV is precursor to cervical cancer, genital warts

- poisonings: drugs, alcohol

Describe occurrence and complications of teen pregnancy

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- birthrate for girls 15-19 yrs/old; 18.8 per 1000

- incidence highest in hispanics

- high risk in maternal/ infant outcomes (low birth weight), education and economic effects

- anticipatory guidance: support & services for pregnant adolescents to facilitate positive outcomes

List the primary prevention for Type 2 diabetes (3)

be active, eat a balanced diet, maintain normal weight

Describe Erikson's theory of psychosocial development: identity vs role confusion

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- need to develop a sense of self and personal identity

- restaging of each previous stage development

- threats to identity can result in delinquent behavior and mental health issues

- trying to figure out who they are

- risk taking & consequences

- caring about what they wear

Contrast the physical growth (puberty) differences between males and females

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- girls are approximately 2 years ahead of boys

- girls get growth spurt earlier than boys

- secondary sexual characteristics

- girls: breast development

- boys: increase in testicle and penis size

Primary sexual characteristics

essential for reproduction

- females: ovaries, uterus, vagina

- males: testicles and penis growth

Secondary sexual characteristics

nonessential for reproduction

- female: breast development, wider hips, menstrual cycle, pubic hair

- male: pubic hair, deepened voice, facial hair

Describe approaches to acne and scoliosis

- acne:

- scoliosis:

- acne: soap/ water; topical medications; stress management

- scoliosis: screening, referral for evaluation

Describe sleep for teenages and complications of sleep deprivation

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- need at least 9 hours of sleep

- sleep deprivation

- multiple activities and responsibilities

- "too much on their plate"

- stay up late and wake up early for school

- texting after bedtime major problem

- nursing role: help cope with, and balance responsbilities

Identify Piaget's stage of formal operations

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- lays groundwork for abstract thinking

- adolescent behaviors and characteristics: introspection (think about their thinking) and egocentrism; intolerance of "staus quo"

Recall the risks/ complications for tattoos and body piercings

health risks for infection and bleeding

Bulimia nervosa

eating normally then purging, mild to moderate erosion of tooth enamel

Anorexia nervosa

distorted body image, excessive exercise, self starvation, does not purge, laxatives

Binge eating disorder

eating large amount of food and can't control it

Describe the factors that influence nutrition in adolescents

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- ideal body image

- fast foods, soda, sweets, alcohol

- peer pressure

- activities requiring weight restriction

- increased needs with growth spurt

Nutritional needs of males

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- 2300-2900 kcal

- 45-59g of protein

- 1300 mg calcium

Nutritional needs of females

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- 2200 kcal

- 45g of protein

- 1300 mg of calcium, may need more in girls who play sports

Explain the benefits of sports

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- opportunity for healthy teaching

- promote healthy lifestyles

- physical activity

- teamwork

Identify factors that influence body image and self esteem in adolescents

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- acne

- body art

- peer pressure

- societal norms and expectations

Describe characteristics of positive relationships between parents and their teens

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- parents try to learn to "let go"

- willingness to listen, ongoing affection for and acceptance of teen, negotiation limits

Explain how nurses influence adolescent health

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- health education

- physical changes with puberty

- prevention of STI

- prevention of pregnancy

- breast self exam

- testicular self exam

- substance abuse education

Recognize Kohlberg's stage of moral development in this age group

begin transition to post-conventional stage

- idea of justice, universal principles

- expanded understanding of good/ bad

Recall the recommendations to ensure children receive adequate nutrients

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- respond with what you want them to do, not respond with what you want them to reduce

- ex. "increase your fruits and vegetables and fiber" not "stop eating ..."

List the risk factors for Type 2 diabetes

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- obesity

- excessive food intake

- excessive dietary fat intake

- sedentary lifestyle

List the calcium needs for teens and who is at greatest risk for deficiency

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- 1300 mg

- greatest risk for deficiency: adolescent girls who play sports

List the risk factors for iron-deficiency anemia

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- inadequate kcal intake

- poverty

- malnutrition

- most common in african american, hispanic, native american