NSG222 Family Nursing (Pediatrics Section) Exam 1 | 82 HESI A2 EXAM | 146 Expert curated questions and answers | verified for accuracy | 100% accuracy | Pass Guarantee

Principles of Atraumatic Care

Prevent or minumize physical stressors, including, pain, discomfot, immobility, sleep deprivation, inability to eat or drink, and changes in elimination

Prevent or minimize parent- child separation

Promote family centered care, treating the family as the patient

Promote a sense of control

Atraumatic Care

therapeutic care that minimizes or eliminates the psychological and physical distress experienced by children and their families in the health care system

Techniques For Providing Atraumatic Care

•Therapeutic communication (Goal directed, Focused and purposeful)

•Therapeutic play (Provides emotional outlet or coping devices)

•Child education (Helps child understand the reason for the hospitalization/procedures)

•Parental education (engages parents as active participants in health care team

Role of Child Life Specialists In Atraumatic Care

Provide programs to prepare children for hospitalization and painful procedures

Provide support during medical procedures

Therapeutic play and activities to support normal growth and development

Sibling support; advocacy for the child and family (allow siblings to be with them)

Grief and bereavement support

How To Minimize Physical Stressors Of The Child During Hospitalization/During Procedure

Engage the child in identifying what would make him or her comfortable

Use positions that are comfortable to the child (sitting on parents lap)

Therapeutic hugging

Use distraction methods (music, conversation)

Specific Learning Principles Related To Children

•Establishing rapport with the child is the first step

•The age and developmental level of the child will determine the amount, format, and timing of the information given

•Create a teaching plan that addresses the developmental stage of the child

•Adolescents are particularly sensitive about maintaining body image and feelings of control and autonomy

Health supervision

The process of health promotion services, growth and development monitoring, and disease and injury prevention throughout the child's life.

Three Components Of Health Supervision

1. Developmental surveillance and screening

2. Injury and disease prevention

3. Health promotion

Components of Developmental Surveillance

Noting and addressing parental concerns

Obtaining a developmental history (obtain developmental questionnaire from parent)

Perform a physical assessment (recognize normal growth and development)

Making accurate observations (observe the child, communicate with the child)

Consulting with relevant professionals

Developmental Surveillance

is an ongoing collection of skilled observations made over time during health care visits.

Setting Where Health Supervision Is Observed

Private physician offices

Freestanding clinics in retail stores

Community health department clinics

Non profit community-based clinics with sliding scale payments

Daycare centers

Schools

What Should Be Done During Health Supervision Visit?

History and physical assessment

Developmental/behavioral assessment

Sensory screening (vision and hearing)

Appropriate at risk screening

Immunizations

Health Promotion

*** nurse will examine child and do physical exam, have patient fill out questionnaire, different screening include metabolic screening, monitor vs, check lab values, provide immunizations based on age.

***educate parents on preventing drowning, poisoning, and eating (weight, foot intake, dental care)

Vaccination Schedule From Newborn

Birth: Hep B

1-2: Hep B

2-4: RV, DTaP, Hib, PCV13, IPV

6: Hep B

Anticipatory Guidance

Patient/family counseling which includes information, advice, and suggestions about expected health-related life occurrences, health maintenance, and preventive plans.

Topics for Anticipatory Guidance

•Promoting oral health care

•Promoting healthy weight

•Promoting healthy activity

•Promoting personal hygiene

•Promoting safe sun exposure

Steps of the Admission Process

•Introduce self and smile; explain the different roles of the nurse.

•Let the child and family know what will happen and what is expected of them.

•Communicate at age-appropriate levels.

•Orient child and family to hospital unit.

•Allow time for questions or concerns.

•Perform nursing interview.

*** Try to figure out the needs of the child to address the concerns

What Is The Role Of The School Nurse?

Remove or minimize health barriers to learning by providing direct healthcare to students, screenings, referrals for health conditions

Nursing Management Of Children With Special Needs

Case management and advocacy

Screening and ongoing assessment of the child

Provision of appropriate home care

Care of the technology-dependent child

Education and support of the child and family

Referral for resources

*** these children will meet developmental milestones later than normal

Long Term Risks For The Premature Infant

Cognitive delays

Visual impairment, chronic lung disease

Cerebral palsy

Attention deficit disorder

Learning disabilities

Difficulties with socialization

Vulnerable child syndrome

Alterations in muscle tone

Transporting Infants and Children

Within unit transport infants may be carried for short distances (dependent on institutions guidelines)

Infants and children should be securely transported in suitable conveyance for transports outside of the unit

Guidelines for safety: age, developmental level, physical condition, destination

Various methods: Carrying (infants), strollers, wagons, rolling beds

Rights of pediatric medication administration

Right medication

Right patient

Right time

Right route of administration

Right dose

Right approach

Right documentation

How Should The Nurse Administer Pediatric Medications To Child

Be open and honest with patient about what you're giving them

Do not put medication in food essential for diet or favorite food could cause food aversions

Patient may suck on ice or popsicle before administration to numb tongue to bitter or sour taste of medication

Factors Affecting Absorption Of Medications In Children Versus Adults

Oral medications: increased gastric motility

IM: decreased absorption

Subcutaneous: decreased absorption

Topical: increased absorption due to greater body surface are and greater permeability of infants skin

What Should You Monitor In Patients Less Than 2 Receiving Medications?

Monitor kidney function

How To Explain Medications To Child

Explain what you are giving (age appropriately)

What the child will experience

What is expected if the child

How the parents can participate and support their child

*** do not put any medications in child's food/formula without explaining what is going on

How Should The Nurse Care For A Child With An Enternal Tube

Check placement (check ph is less than 5.5, check residual)

Measure tube

(abdominal xray will be done during initial insertion)

Do not use plunger to just push feeding in

What Are S/S Of Misplaced Enternal Tube?

Vomiting

S/S of respiratory distress

What Are Pain Phases? (In order)

Transduction: nociceptors (specialized nerve cell endings) are activated when exposed to noxious stimuli

Transmission: stimuli are relayed to brain

Perception: Impulse is interpreted as pain

Modulation: Neuromodulators modulate the pain sensation

Factors Influencing Pain

Age

Gender

Cognitive level

Temperament

Previous pain experiences

Family and cultural background

Situational factors

Faces Pain Rating Scale

ages 3+, emoticon-like faces (most commonly used)

Oucher Pain Rating Scale

ages 3+, actual photos of children, must know number values

Poker Chip Tool

ages 3+, uses 1-4 poker chips to describe pain

Visual Analog Scale (VAS)

ages 5+, scales 0-10

Adolescent Pediatric Pain Tool

ages 8 to 15, measures pain location, intensity and quality

Non Verbal Signs Of Pain In Infant

eyes tightly closed, furrowed brows

Non Verbal Signs Of Pain In Toddlers

quietness, pointing to where it hurts, teeth clenching

Non Verbal Signs Of Pain In Preschoolers

may become quiet withdrawn, may hold the area that hurts

Non Verbal Signs Of Pain In School Age Children

May withdraw by staring at TV, clenched fists, stiff body, closing eyes, wrinkling forehead, gritting teeth

Non Verbal Signs Of Pain In Adolescents

May attempt to remain stoic and not exhibit any emotion, increased muscle tension, clenched fists and teeth, rapid breathing, guarding the affected body part. Lack of interest in everyday activities or a decreased ability to concentrate

Medications Used For Pain Management

Analgesics

nonopioid/ opioid

Anesthetics

Adjunct

What Is The Ceiling Effect?

After a certain dose, no matter how much the dose is increased the medication no longer provides analgesic effects

Non pharmacological Pain Management

distraction therapies, heat, ice, accupuncture, massage, imagining something that makes them happy.

may be used in combination with pharmacological pain management

teach these to parent

Nurse's Role in Pharmacologic Pain Management

Monitor V/S

Monitor respiratory depression

Know where medication is excreted in body and how it will affect them based on age

Know absorption and distribution of drug

Monitor for adverse effects

Educate child and parent about what the drug will do or any side effects

What Are Primitive Reflexes?

Neonates are born with primitive reflexes. They are the Moro reflex, root, suck, asymmetric tonic neck, plantar, Palmer grasp, step and babinski. The babinski reflex disappears at age 1 year, the other reflexes diminish over the first few months of life.

What Are Protective Reflexes?

When the primitive reflexes diminish, the infant develops protective or postural response reflexes. They help with motor development and remain for life once established. They are the righting and parachute reactions.

What Are Righting Reactions?

These develop in response to the new environment of gravity. Distinguishable at 10-12 months and remain active throughout life

What Is The Neck Righting Reflex?

It is when the baby immediately rotated the body in the direction to which the head is turned (typical at 6-10 months)

***By 4 months the baby should be able to hold its head independently

Development Expected In Infants That Are 3 mo Old

Lifts head and neck when on abdomen

Grasps objects

Turns head side to side

Reflexes still present but palmer and plantar grasps disappearing (3-4 months)

Development Expected Of 6 mo Old

Moro reflex disappears around 6 months, startle at 4 months, tonic neck 4-6 months.

Birth weight double by 6 months

Rolls front to back around 5 months, back to front around 6 months

Reaches for and grasps object, puts them in mouth

Chews/teething, babbles

Sits when propped, can support some weight if held in standing position

Recognizes familiar objects, expresses displeasure if removed, developing object permanence

Development Expected Of 9 mo Old

Sits unsupported by 8 months, pulls to standing

8-9 months and craws, responds to name

Transfers objects hand to hand, points to and

picks them up, uses pincer grasp

Likes mirrors

Develops separation anxiety between 8-9 months, around 9 months also develops stranger anxiety

Development Expected Of 1 year Old

Birth weight tripled

Has 6-8 teeth

Knows name

Cruises or walks when 1 hand held

Places object in container

May have security object

Drink from cup and use spoon but prefers fingers

What Toys Appropriate For Infants?

Age 1-4 months: mobile, mirrors, rattles, music/singing, high-contrast

patterns in books

4-7 months: fabric/board books, music, toys that do things and are easy

to hold, toys that float or squirt water, soft dills/animals

6-12 months: plastic cups, bowls or buckets, mirror, blocks, stacking toys,

busy boxes, balls, dolls, toy phone, push-pull toys, board books with

pictures

What Factors Are Important For Infant Nutrition? What Is Safety Related To Infant Care?

• Nutrition:

• Infants should have breast milk or formula until age 6 months.

• Solid foods can be introduced at 4- 6 months, introducing 1 new food a

week.

• Continue breast milk or formula until age 1 year.

• Then the infant can be switched to whole milk.

• Safety: Keep small objects or hard foods out of reach. Cover outlets,

protect from falls, prevent poisoning from medications or household

chemicals. Never leave unattended by water. Car seat should be rear

facing throughout infancy and in the back seat. Crib should have firm

mattress that fits snugly in crib

What Are Some Developmental Concerns Related To Growth/Development In The Infant Period And How Should They Be Addressed?

• Colic: inconsolable crying that lasts 3 hours or more. It happens more often in

the evening and usually resolves around 3 months of age. Parents should

develop stepwise approach to make sure the basic needs are met. When

needs are met, they attempt to soothe by reducing stimulation, carrying,

swings/vibration, pacifier (try 1 intervention at a time).

• Spitting up: normal after feedings. Encourage to burp frequently and keep

upright (not in a seat) for 30 minutes after feeding.

• Thumb sucking/security: thumb sucking is a healthy, self-comforting activity.

Pacifiers work but can be linked to increased incidence of otitis. If use pacifier,

wean by age 2-3 or can negatively affect teeth. If have security object, wean

after infancy.

• Teething pain: application of cold can be soothing, over-the-counter topical

aesthetics may be helpful

What Do Theorists Believe About Infant Development?

• Piaget: Psychosocial dvlp: sensorimotor, uses senses to explore the

world. Discusses separation anxiety, object permanence, ability to use

symbols

• Erikson: Cognitive dulp.: Trust vs mistrust, infant develops trust when

basic needs met. Caregivers learn infant signals and responds to them

to meet needs, signals include crying, cooing and facial expressions

• Freud: oral stage, sexual urges gratified through mouth

What Type Of Discipline Is Appropriate In Infants?

• Setting limits for safety

• Reward good behavior (Positive reinforcement)

• Do not reward bad behavior

• Be consistent

• Maintain routines

What Are Expectations Related To Growth In Toddlers? 1-3yr

• Weight: gain 3-5 pounds a year

• Height: grow about 3 inches per year, reach half of adult height by age

2.

• Head circumference: grows 1 inch between ages 1 and 2, then half an

inch per year until age 5

• Anterior fontanel should be closed by age 18 months

What Are Developmental Expectations Of Toddler?

• Walks alone by 15 months, creeps up stairs, begins to run, uses cup,

builds tower of 2 blocks

• By 18 months: kicks a ball, jumps in place with both feet, uses push-pull

toys (toys they can manipulate), builds tower of 3-4 blocks

• By age 2: climbs on furniture, walks up and down stairs, builds tower of

4 or more blocks, runs and jumps

• By age 3: builds tower of >6 blocks, plays on riding toys, takes steps on

tiptoe, stands on one foot, draws circles, dresses and undresses self

with assistance, scribbles, shows hand preference, has most of baby

teeth

How Do Toddlers Play? What Toys Are Appropriate For Toddlers?

• Toddlers exhibit parallel play, they like to imitate others, also like make

believe

• Appropriate toys are:

• Blocks

• Books

• Push-pull toys

• Balls

• Finger paints

• Puzzles with large pieces

• Thick crayons

• Containers they can fill and empty

What Do Theorists Say About Toddler Years?

• Erikson: autonomy versus shame and doubt, seek autonomy by gaining

more control over toileting and food preferences, success leads to self-

confidence and self control, if not successful leads to shame and doubt

• Piaget: in preoperational stage, displays magical thinking-think their

thoughts impact the real world, play make believe, imitate others, are

egocentric, can't see things from other's perspective

• Freud: anal stage, derive pleasure from controlling bowel movements

• Kohlberg: preconventional stage starts at age 2, follow rules for fear of

punishment

What Do Parents Need To Do To Promote Growth And Development?

• Frustration leads to temper tantrums, parents need to provide

consistent, age-appropriate expectations to assist with this. When

tantrums happen, ignore the behavior and make sure the child is safe.

Parents need to model self-control.

• Maintain routines, this provides comfort

• Discipline should be consistent with well-defined boundaries to develop

appropriate behaviors

• Nutrition: Should be weaning from bottle by 12-15 months, Dairy

products are primary source of calcium. Milk should be limited to 16

ounces a day to prevent iron-deficiency anemia. Include iron-fortified

cereals in diet. Cut all foods into bite-sized pieces to prevent choking.

What Is Important Related To Safety For Toddlers?

Car seat: use appropriate size/style for weight and age. Should be rear-facing

until age 2, or they outgrow the height and weight restrictions for the seat, then

may be forward facing.

Home: avoid exposure to tobacco smoke, use safety gates, lock doors that may

have dangerous contents, cover outlets and try to hide electrical cords, lock

firearms, wear helmet when on bike. Begin teaching about crossing streets and

avoiding animals they do not know. Lock cabinets containing chemicals

Water safety: Supervise in and around water at all times

What Should The Parent Know About Time Outs Related To Toddlers?

• A timer should be set to

start...WHEN THE CHILD IS

QUIET!

• Use one minute for each year of

age

• Place the toddler in a safe area

• Explain the reason for the time

out and the rules and behavior

expected during the time out

What Are Milestones For Preschool Development? 3-5yrs

• They will grow about 2.5-3 inches a year and gain 4-5 pounds a year

• Age 3: climbs well, runs easily, walks up and down stairs with alternate feet,

undresses self, builds tower of 9-10 blocks, screws/unscrews lids, turns book

pages

• Age 4: hop and stand on one foot, throws overhand, catches a bounced ball,

kicks ball, uses scissors, draws circles and squares, laces shoes, draws a person

with 2-4 body parts

• Speak so strangers can understand by 5, brushes teeth and uses toilet and

dresses without assistance, can skip, swim and ride a bike, jumps rope, walks

backward heel to toe, prints some letters, ties shoes, uses utensils well

What Are Considerations For Play In The Preschool Period?

• Preschoolers exhibit associative play, it is not organized but they can cooperate with

others

Appropriate activities:

• Playing ball

• Puzzles, simple sewing, electronic games

• Plays make believe and dress-up

• Role play, sand boxes, skating, wading pools

• Painting

• Puppets

• BookS

• Musical toys/instruments

What Do Theorists Say About The Preschool Age?

• Piaget: preoperational phase, have some ability to consider the

viewpoint of others. Focus on one aspect, understand sequences, have

magical thinking, give lifelike qualities to inanimate objects.

• Erikson; initiative versus guilt, feel guilty if they cannot accomplish a

task independently or think they misbehaved. Encourage child to

perform simple tasks (that can be accomplished independently)

• Kohlberg: preconventional, early preschool same as toddlers, older

preschoolers can begin to understand justice and fairness.

• Freud: phallic stage 3-6 years old, preoccupied with genitals, curious

about anatomic differences

What Are Signs That The Preschooler Is Ready For Kindergarten?

Can tolerate being in school 5 days a

week

Start new routines early to help them

transition

Plan ahead for immunizations required

by school or obtain appropriate waivers

What Are Important Safety Measures For Preschoolers?

Car seat: use forward facing seat with top

tether until age 4, after reaching car seat

height restrictions can use booster that uses

lap and shoulder belt

Home: prevent tobacco exposure, safety by

streets/on bikes, prevent poisoning by

keeping medication and chemicals

locked/out of reach

Water safety: good time for swim lessons

but still too young to be left unattended

What Is Important Regarding Promoting Nutrition In Preschoolers?

• Continue to learn healthy eating habits

• Limit sweets and fast foods

• May be picky eaters, may not try new things or eat only a

small variety of foods. If they are growing well, is not a

concern. Avoid coaxing or threatening behaviors as they may

create negative relationships related to mealtime-SO KEEP

MEALTIME POSITIVE

• Maintain a matter-of-fact approach to eating, offer the meal

or snack and allow them to decide how much of the food if

any they eat

Other Considerations Regarding Preschoolers

Other considerations regarding preschoolers:

-may believe in monsters or be afraid of the dark

-lying may be common due to fear of getting in trouble or because

of their imagination

-body integrity is important

-uses future tense

-knows same and different

-Asks why

What Is Expected Growth And Development In The School Age Years?

es 6-12, grow about 2.5 inches a year and gain about 7 pounds a year

will slow for boys between ages 10-12, which may lead to obesity. Girls may

idly and they will have changes in their body that will soften their body lines.

imary or deciduous teeth are lost and will be replaced by 28 permanent teeth

ird molars or wisdom teeth will not be in).

What Are Expected Activities In The School Age Period?

• School age children engage in cooperative play, they can complete

complex tasks due to improved coordination, balance and fine motor

skills

• 6-9 years: ride bikes, jump rope, play hopscotch, have collections, play

simple board and number games, build simple models, join organized

sports

• 9-12 years: make crafts, build models, start hobbies, collect things,

solve jigsaw puzzles, play board and card games, involved in organized

competitive sports; it important to note the American Academy of

Pediatrics say parents should set limits on how much screen time is

given to school-age children, 2hrs or less is recommended

Screen Time For School Age Children

• Television watching, internet activity, or video gaming should not be used as a reward.

• Parents should set limits on how much screen time the child can have.

• The AAP recommends 2 hours or less of screen time per day.

• There should be no TV during dinner and no TV or internet-connected devices in the child's room.

• The parents should be aware of what the child is watching and doing online.

Thit sapbr unto no libas3 the sub,eand child cent Watchinfprograms together and parents using

What Is Important For Safety Related To The School Age Child?

Increased independence may lead to

increased self-confidence and

decressed tears, which contributes vo

accidental injuries

Car safety: when child is Aft gin or

taller, may sit in car without booster

using shoulder and lap belt. Should

not be in front seat with airbas before

age 13

Pedestrian safety: children under age

10 should not walk alone

Bicycle/sport: use of helmets for

bicycles and skating

Fire: supervise matches, cooking and

ironing

Water: supervise to prevent water-

related accidents

TV/internet: Limit TV watching,

internet activity and video game

activity and do not use these activities

as rewards.

What Is Important Related To Nutrition For School Age Children?

Diet preferences

continue

Influence: Outside activities,

family, media and

peers can influence

eating habits.

Need: Need calcium from

milk, yogurt and

cheese for

development of

strong bones and

teeth. Need lean

meats, poultry, fish

and eggs to provide

protein, vitamins

and minerals

Promote: Promote balanced

diet, avoiding fatty

meats, high-fat dairy

products, eggs.

Encourage: Encourage exercise

and limit sedentary

activities to prevent

obesity

What Do Theorists Say About School Age Children?

• Piaget: concrete operations stage, tell time, classify complex information, can

solve problems and see the perspective of others, can think abstractly, can

master math and reading skills, understands cause and effect

• Erikson: industry versus inferiority, sense of accomplishment gained through

ability to cooperate and compete with others, have sense of inferiority if

unable to master tasks, wants to form relationships.

• Kohlberg: preconventional to age 7, then conventional stage of morality, they

seek conformity and loyalty, follow rules and want to maintain social order,

like to do activities with a friend, forms clubs with rules

• Freud: latency stage, focuses on peer relationships, wants privacy and to

understand body

What Is Expected For Development Of Adolescence? How Is Development Different Between Boys And Girls? (13yr-19yr)

Girls reach physical maturity before boys, the first menstrual

period begins between age of 9 and 15 (average 12.8 years).

Height increases rapidly before menarche and ends 2-2.5

years after menarche.

Boys growth spurt is later (between ages of 10.5 and 16

years) and ends between ages 13.5 and 17.5 years. Muscle

mass increase in boys.

Coordination may be an issue due to uneven growth spurts;

there may be a decrease in coordination

Handwriting is neat, have precise hand-eye coordination and

finger dexterity

How Do We Promote Healthy Weight In An Adolescence?

Assess the knowledge of the parents an adolescent on

healthy eating

• Encourage the adolescent to keep a detailed food and

exercise dairy for 1 week to determine patterns of eating

and exercise; or have them do a recall nutritional history

• Analyze data with adolescent and recommend changes

• Have adolescent create meal and plans and help with

grocery shopping to give them a sense of control and

decision-making

• Assist with adding exercise to daily routine to

decrease/avoid obesity

What Do The Theorists Believe About Adolescent Development?

According to Piaget, 10 and 11 year olds are still in the concrete operations

stage. At age 12 they transition to the formal operations stge. They develop

analytic and abstract thinking, show concern for politics and social issues, they

are able to think long term and set goals, they compare themselves with their

peers, start to have an awareness of personal limitations, they are able to

predict outcomes and consequences.

• According to Freud, they are in latency stage until 12, then they are in the

genital stage. During this stage, they struggle with sexuality, their body

changes and fluctuating hormones brings back sexual desire, their social

relationships are changing, they struggle with dependence versus

independence from their parents, they are learning to form loving

relationships, they must manage sexual urges in socially acceptable ways.

What Do The Theorists Believe About Adolescent Development? (continued)

• Adolescents are in the identity versus role confusion stage according to

Erikson. They are preoccupied with how they are seen in the eyes of

others and are working to establish their own identity. They try out

new roles to see what is best for them. If they cannot find a meaningful

definition of self they are at risk for role confusion in one or more roles

in their life. Some confusion is good and can result in self-reflection and

self-examination.

• Kohlberg believes that they are in the postconventional stage of

development. They construct a personal and functional value system

that is independent of their authority figures and peers.

Kolberg Theory

• Infant: No moral development

• Toddler (1 ½ to 3 yrs): No moral development

• Preschooler (3-6 yrs): Preconventional morality is a matter of good or

bad on a system of punishments

• Middle Childhood (7-11): Conventional Level-tries to be good, treats

others the way they want to be treated

• Adolescence (12-18): Postconventional Level-moral standards beyond

authority figure (religion, social)

Car Seat Safety

• parents follow the American Academy of Pediatrics (AAP) guidelines.

• Toddlers should remain in a rear facing seat until the child outgrows the

height and weight restrictions for the seat

• Children should use a booster seat until the seat belt crosses the shoulder

and chest in the right place

• A forward-facing car seat should be used until the child outgrows the

height and weight restrictions of the seat and then use a belt-positioning

booster seat until the lap and shoulder seat belt fits properly across the

shoulder and chest.

• Children 13 years and older can sit in the front seat, but the airbag should

not be turned off