NUR230 Galen Exam 3 (Peds Exam 1) With 100% correct answers 2025-2026 already graded A+

Enabling

Families are given the opportunity to display their caring abilities and gain new ones

Empowerment

Families are given the ability to maintain or acquire sense of control and make positive changes

Principles of Atraumatic Care

- Prevent separation

- Promote sense of control

- Minimize bodily injury

Role of the Pediatric Nurse

- Therapeutic relationship

- Family advocacy (speak up for and listen to family)

- Health promotion and teaching

- Injury prevention

- Family support

- Mediator

Example of Atraumatic Care

- Preform invasive procedures only in the treatment room

Social Roles:

Primary vs. Secondary

-Primary: Patients peers/family

-Secondary: Sports, church

Self esteem & Culture

Some cultures promote more pride and independence than others

Communities

-The more external and internal assets; the less risky behavior

-Increases secondary social groups

Peer groups

- Risk taking behaviors

- Peer pressure

Cultural & Religious Health Beliefs & Practices

Some practices may be considered abusive in the dominate culture and are reportable while others are tolerated

Growth

- Increase in number and size of cells as they divide and synthesize new proteins

- Physiological changes (Height, weight, bone length, etc.)

- Physical changes

Development

- Advancement from lower to more advanced stage of complexity; increased capacity through growth, maturation, and learning

- Acquisition of skills and functioning

Sequential trends

- Based on the concept that each child will normally pass through each stage of growth and development in a predictable sequence

- Universal and basic to all human beings

- Accomplishes these in a manner and time unique to that individual

- Crawl, walk, run

Directional growth: Cephalocaudal

Head to toe direction

Directional growth: Proximodistal

- Near to far

- Midline to peripheral concept

Growth internally and externally

- Dramatic growth from birth to 4 years old and again at 12 years old during puberty

- Severe illness and malnutrition will affect the rate of growth and development

Neurologic maturation; most occurs before birth

- Rapid neurological growth between 15-29 weeks gestation

- Rapid growth from birth to 1 year and through early childhood

- More gradual rate through childhood into adolescence

Erikson (Psychosocial)

- Trust vs. Mistrust

(birth to 1 year): basic needs must be met by a loving person; outcome is faith and optimism.

Erikson (Psychosocial)

- Initiative vs Guilt

(3-6 years): develops a conscience with an inner voice that warns and threatens; if activities are in direct conflict with parents, can be made to feel guilty. Outcome is direction and purpose.

Erikson (Psychosocial)

- Autonomy vs. Shame and Doubtful

(1-3 years): centered on toddlers ability to control body, self, and environment; outcome is self-control and willpower.

Erikson (Psychosocial)

- Industry vs. Inferiority

(6-12 years): children are ready to be workers and producers, engage in tasks that can carry throughout completion, learn to compete and cooperate. Outcome is competence.

Erikson (Psychosocial)

- Identity vs. Role Confusion

(12-18 years): period of rapid body changes, peers are important, need to integrate concepts and values with those of society and to come to a decision about an occupation. Outcome is devotion and fidelity to others and to values and ideologies. Core conflict is role confusion.

Piaget (Cognitive)

- Sensorimotor

(Birth - 2 years):

-Simple learning; behavior imitation

- Problem solves through trial and error

Piaget (Cognitive)

- Preoperational

(2-7 years):

- Egocentric

- Able to make simple associations; thought is concrete and tangible

- Taking information and applying to other concepts

- Transudative reasoning; ex: women with big bellies are pregnant

Piaget (Cognitive)

- Concrete operations

(7-11 years):

- Thoughts becoming logical and coherent; able to classify and sort

- Problem solving is concrete and systemic

- Less self-centered

- Understands others point of view

Piaget (Cognitive)

- Formal operations

(11-15 years):

- Adaptable and flexible

- Able to think in abstract terms; form hypothesis

Functions of Play

1) Sensorimotor development (music toys)

2) Intellectual development (blocks and shapes)

3) Creativity (drawing a picture)

4) Self-awareness (sharing; interacting with others)

5) Therapeutic value

6) Moral value

Types of Play

- Unoccupied play (infant)

Child is not mobile and has random movements with no purpose

Ex: Crib mobile

Types of Play

- Solitary play (infant/toddler)

Play alone with their interest centered on their own activity

Ex: Playing alone

Types of Play

- Onlooker play (infant/toddler)

Watch what other children are doing but do not make any attempt to enter the play activity

Ex: Observing others

Types of Play

- Parallel play (toddler)

Children play independently but with other children

Ex: Playing alone; same room as other children

Types of Play

- Associative play (preschooler)

Children play together but with no group goal

Ex: Sharing toys, but each child has their own goal

Types of Play

- Cooperative play (school age)

Play is organized and children play in a group with other children working to complete a goal

Ex: Sharing toys, has common goal; competition

Communicating with Infants

- Respond to non-verbal ques, such as tone and touch

- Cannot understand verbal ques

- Cooing and crying are main form of communication

Communicating with Early Childhood

- Egocentric

- Respond best to when you discuss how THEY will be effected

- Experience of others has no interest to them

- Describe what they are going to feel

Communicating with School Age

- Wants explanations and reasons for everything; need to know the "why"

- The "why" stage

Communicating with Adolescence

- Confidentiality is important

- Needs privacy; they might be scared to tell parents things

- ALWAYS have to report any type of abuse

Physical Assessment

- Length: 24-36 months, then use height

- Weight: naked preferred if using infant scale

- Head circumference

- Temperature

- Pulse & Respiration rate: trends down with age

-Blood pressure: trends up with age

*** Changing percentile by 1 or 2 is concerning

*** Failure to thrive - less than 5%

*** Head circumference = neuro problems

Pain Scales

- NIPS: facial expression, cry, breathing pattern, arms, legs, state of arousal; neonates less than 2 months

- FLACC: face, legs, activity, cry, consolablity; infants older than 2 months

- Faces: 3-4 years old; must be able to identify emotions

- Numeric Scale (0-10): 8 years and older, may be used early as 5 years old; must know how to count and know the value of numbers

Non-pharmacological Pain Management (Infant)

Containment (blanket rolls to provide a "nest"), positioning (swaddling), sucking (providing pacifier), and kangaroo care (skin to skin contact with parent)

Non-pharmacological Pain Management (Toddler and Child)

- Distraction

- Relaxation

- Music, pet/art therapy

Pharmacological Pain Management: Mild to Moderate

- Acetaminophen

- NSAIDs (ex: ibuprofen)

Pharmacological Pain Management: Moderate to Severe

- Opioids (ex: morphine, dilaudid, fentanyl)

Pharmacological Pain Management: Adjuvant

- Antianxiety: Diazepam (Valium) & Midazolam (Versed)

- Tricyclic antidepressants: Amitriptyline

- Antiepileptics: Gabapentin and Clonazepam

- Stool softeners/laxatives

- Antiemetics

- Diphenhydramine

- Steroids

Developmental milestones: 1 month

- Flexed position

- Can turn head side to side when prone

Developmental milestones: 2 months

- Vocalizes distinct from crying

- Social smile

Developmental milestones: 3 months

- Holds objects but will not reach for them

- Turns head to follow sounds

- Coos, squeals to show pleasure

Developmental milestones: 4 months

- Moro, tonic neck and rooting reflex gone

- Almost no head lag

- Rolls from back to side

- Plays with hands

- Laughs aloud

Developmental milestones: 5 months

- Rolls from abdomen to back

- Grasps objects voluntarily

Developmental milestones: 6 months

- Teething, two lower incisors

- Imitates sounds, actions

- Babbles one syllable

- Briefly searches for dropped object

Developmental milestones: 7 months

- Sits, leaning forward on hands

- Transfers objects from one hand to another

- Increasing stranger danger

Developmental milestones: 8 months

- Sits steadily unsupported

Developmental milestones: 9 months

- Pulls self to standing position, creeps along furniture

- Crude pincer grasps

Developmental milestones: 10 months

- Develops object permanence

Developmental milestones: 11 months

- Cruises or walks with both hands held

Developmental milestones: 12 months

- Birth weight tripled

- Birth length increased by 50%

- Walks with one hand held

- Says 3-5 words besides mama and dada

Developmental milestones: 15 months

- Creeps up stairs

- Says 4 -6 words

Developmental milestones: 18 months

- Anterior fontanel closed

- Says 10 or more words

- Awareness of ownership

Developmental milestones: 24 months

- Weight gain of 4-6 lbs/yr, height 4-5 in

- Talks increasingly - 300 words

- Parallel play

Developmental milestones: 30 months

- Jumps with both feet

- Knows first and last name

- May be potty trained

Developmental milestones: 3 years

- May have achieved night time bowel/bladder control

- Walks upstairs with alternating feet

- Vocab 900 words, 3-4 word sentences

- Play is parallel and associative

- Attempts to please parents

Developmental milestones: 4 years

- Vocab 1500 words; 4-5 word sentences

- Play is associative

- Rebels if parents expectations are high

Developmental milestones: 5 years

- Handedness is established

- Eruption of permanent teeth may begin

- Vocab 2100 words, 6-8 word sentences

Developmental miles stones: School age

- 6 - 12 years

- Height increase of 2 inches per year; weight increase 2-6 lbs per year

- Self concept and body image begins

- Active age

- Lots of maturity occurs at 8 - 9 years old

- Puberty may begin at 10 - years of age

Developmental milestones: Early adolescence

(11- 14):

- Secondary sex characteristics appear

- Decline in self esteem increase in "best friend"

- Wide mood swings, moodiness, temper, outbursts

Developmental milestone: Middle adolescence

(15-17):

- Growth decelerating in females

- Modifies body image

- Self - centered

- Major conflicts over independence/control

- Withdraws when upset/feelings are hurt

Developmental milestones: Late adolescence

(18-20):

- Physically mature

- Established abstract thought

- Increase in self esteem

- Emotional/physical separation from parents complete

- Anger more apt to be concealed

Reactions to Hospitalization: Infant

- Reliant on parent

- Assign primary nurse, stick to routine

Reactions to Hospitalization: Toddlers

- Hospitalization disrupts autonomy, may cause regression

- Follow daily routine

Reactions to Hospitalization: Preschoolers

-Egocentric; may view hospitalization as punishment, fear body mutilation

- Needs reassurance

Reactions to Hospitalization: School age

- Strive for independence, fear abandonment, injury, and death

- Needs reassurance

Reactions to Hospitalization: Adolescence

- Struggle for independence, hospitalization may cause anger

- Benefit from contact with peers

Obesity:

- Overweight: BMI between 85th - 95th percentile

- Obesity: BMI greater than or equal to 95th percentile

Failure to Thrive:

- Weight and height (sometimes) below the 5th percentile

- Risk factors & causes:

* Organic: Preemie, IUGR, CHD

* Nonorganic: Poverty, neglect, knowledge deficit

- Treatment: reverse the cause

Clinical Manifestations of Respiratory Dysfunction

- Respiratory distress: grunting, nasal flaring, retractions, cyanosis, tachypnea

- Fever: may be absent in newborn

- Anorexia: very common because baby can eat and breath at the same time

- Vomiting: small children vomit readily with illness

- Nasal blockage/drainage

Nursing Management of Respiratory Dysfunction

- Ease respiratory efforts (bulb syringe, steam room, increase fluids, pat back, humidifier, set child upright)

- Promote rest and comfort

- Prevent spread of infection

- Reduce temperature (take of socks and/or hat)

- Promote hydration and nutrition

- Provide family support

Cause of Nasopharyngitis

- Numerous viruses

- RSV, rhinovirus, influenza and parainfluenza

- URI

Clinical Manifestations of Nasopharyngitis

- Varies with age

- Fever, nasal mucus, sneezing

Therapeutic Management of Nasopharyngitis

- No cure

Nursing management of Nasopharyngitis

- Fluids, rest, elevation of HOB, suction, prevention is key

- Education on cough and sneeze etiquette

- Viral infection = no antibiotics

Cause of Pharyngitis

- Viral or Group A Beta Hemolytic Streptococcus (strep throat)

Clinical Manifestations of Pharyngitis

- Sore throat, headache, fever, possible rash, abdominal pain

Diagnostic Evaluation of Pharyngitis

- Throat culture and rapid strep test

Therapeutic Management of Pharyngitis

- Penicillin, if strep

- No antibiotics if viral

Nursing Interventions of Pharyngitis

- No school/daycare for 24 hours (time begins when first dose of antibiotics is taken)

- Acetaminophen/Ibuprofen for pain

- Finish for course of antibiotics

Cause of Tonsilitis

- Often occurs with pharyngitis

- Can be viral or bacterial

Clinical Manifestations of Tonsilitis

- Edema/enlargement of tonsils

- Difficulty swallowing

- Mouth breathing

Therapeutic management of Tonsillitis

- Antibiotics if bacterial

- Tonsillectomy if criteria met

Nursing Management of Tonsillitis

- Pain management

Tonsillectomy and Adenoidectomy (T&A)

- Removed due to often strep throat or airway obstruction

Post-Op care of Tonsillectomy and Adenoidectomy

- Cool, clear fluids (no red liquids, carbonation may cause pain)

- No milk or dairy (thickens secretions)

- Frequent swallowing, coughing, or clearing throat can cause bleeding

- Vomiting bright red blood CALL DOCTOR

- Scheduled pain medications

- No straws; can pull clots

Otitis media (OM)

- Presence of inflammation and fluid in the middle ear

- Along with acute symptoms of illness (fever, drainage, pain)

Otitis Media Effusion (OME)

- Presence of fluid in middle ear

- Without symptoms of illness

Cause of Otitis Media

- Bacterial OM often proceeded by viral respiratory infection

- RSV, flu

- Non-infectious: blockage in eustachian tubes

Clinical Manifestations of Otitis Media

- Acute ear pain

- Fever

Clinical Manifestations of Otitis Media Effusion

- Rhinitis

- Cough

Therapeutic Management of Otitis Media

- Antibiotics used judiciously (not every case)

- Possible tympanostomy tube placement

Nursing Management of Otitis Media

- Relieve pain

- Prevent recurrence

- Educate family on breastfeeding

- NO bottle propping

- Avoid secondhand smoke

- Immunize

Croup Syndromes

- Characterized by hoarseness, "barking" cough, inspiratory stridor, and varying degrees of respiratory distress

- Affect larynx, trachea, and bronchi

Cause of Acute Epiglottitis

- Obstruction inflammatory process (MEDICAL EMERGENCY)

- H. influenzae