PEDS test 1

Ill and hospitalized children may ____ to a lower level of communication than their typical communication; baby talk

Regress

What is the regulated temperature for a bath?

120 degrees or less

What is the regular circumfurance for an infant?

33-35 cm

Where should the carseat be for an infant?

In the back middle seat, facing backwards

What might school age children do when they want to postpone an intervention?

Bargain

What is the only immunization that you can use after birht?

Hepatitis B Immunization

What immunization would you need to get for measle, mumps, and rubella?

MMR

What is this communicable disease in PEDS?

Commonly affects children 5-15 years of age

S/S: Lacy rasher x several weeks after initial infection. Erythema of the cheeks giving the appearance of “slapped cheeks” and lacy pattern rash on the trunk and extremities

Droplet precautions

Fifth Disease (Erythema Infectiosum)

What is this communicable disease in PEDS?

LEss than 10 years of age. Resolve within 10 days

Difficulty with eating and playing d/t painful lesions to hands, feet, and mouth

Hand, foot, and mouth disease

What is this communicable disease in PEDS?

Disease causing inflammation and decreased liver function

The common source is contaminated food or water; most will recover within 2 weeks

S/S: Fever, malaise, poor appetite nausea, jaundice, abdomen pain, and dark urine

Need blood test to diagnose, contact isolation, strick hand hygiene

Hepatitis A

What is this communicable disease in PEDS?

Can cause short or long-term liver dysfunction

Transmitted through blood or body fluids

S/S: aching, malaise, joint pain, jaundice, dark urine, loss of appetite, mild right upper quadrant abdomen pain

Blood test to diagnose

Educate no sharing of toothbrushes or razors. If allergic to YEAST risk for anaphylactic reaction

Hepatitis B

What is this communicable disease in PEDS?

Common in adolescents transmitted through SALIVA viral infection caused by the Epstein-Barr virus

S/S: Fever, sore throat, malaise, enlarged posterior cervical lymph nodes

Dx: positive mono test

Intervention: Fever management, hydration, rest

Educate on NO CONTACT sports for 6-8 weeks if spleen is enlarged

Mononucleosis (Epstein-Barr Virus)

What is this communicable disease in PEDS?

A virus that causes inflammation of the salivary glands below and in front of the ears (parotid swelling)

Droplet precautions

S/S: Swelling of parotid salivary glands, headache, fever, earache, muscle aches. Boys may have painful swelling of the testicles. Girls may have ovarian involvement with abdominal pain and breast pain

Interventions: Bland soft food, keep hydrated, fever management, ice pakcs or warm compresses to neck for comfort.

Mumps (Parotitis)

What is the most common procedure or first line for a first trimester abortion (9 weeks)?

Surgical (Vacuum) Aspiration

What medications can be used for a medical abortion (Up to 9 weeks)?

Methotrexate, Misoprostol, and mifepristone

What is used for a second trimester abortion (14-27 weeks)?

Dilation and evacuation. May use laminaria

What is this communicable disease in PEDS?

Spread with direct contact

Droplet (airborne)

Incubation 14 to 21 days

Infectious 7 days before to 5 days after the rash appears

Prevention is MMR immunization

Rubella (German Measles)

What is this communicable disease in PEDS?

Spread with direct contact- Very small raised bumps, flat red, coplet sports

Droplet precatuoons

Incubation 10-20 days

Infectious 4 days before 5 days after the rash appears

Rubeola (Measles)

What is this communicable disease in PEDS?

Direct contact/droplet

Manifestations 1 to 2 days prior to rash: fever, fatigue, loss of appetite, headache

Rash that starts in the center of trunk spreading to the proximal extremities. Scabs in 1 week.

Younger needs their finger nails trimmed, hydrated, nourished

Oatmeal baths help to decrease the itching

Varicella Zoster (Chickenpox)

What is this communicable disease in PEDS?

Direct contact

Pink or red color in the sclera of the eyes; yellow green, purulent drainage discharge from the eyes

Swelling of the conjuctiva, excessive tearing

Discourage sharing towels

Wipe from the inside out

If bacterial antibiotic drops or ointment

Conjunctivitis

What is this communicable disease in PEDS?

Direct contact, droplet

Common cold manifestations, runny nose and congestion, sneezing, mild fever, mild cough

Sever cough starts 1 to 2 weeks; violent and rapid coughing

Loud “Whooping” sound upon inspiration

Pertussis (Whooping cough)

What is this communicable disease in PEDS?

Caused by group A beta-hemolytic strepoccocus

Droplet spread, direct contact with secretions

No longer contagious after 24 hr on antibiotics

S/S: sore throat, fever, headache, enlarged and tender tonsillar lymph nodes

Complication of glomerulonephritis and rheumatic fever if left untreated

Replace tooth brush

Streop throat (Scarlet fever)

What cognitive development stage of Piaget’s is this?

Birth to 2 years

Child progresses from reflex activity to imitative behaviors. The concept to be mastered is object permanence which is the understanding that objects still exist when they can’t be seen, heard, or touched directly

Sensorimotor stage

What cognitive development stage of Piaget’s is this?

ages 2 to 7 yrs

Egocentric (child can’t comprehend a point of view different from his or her own. Magical thinking and increased ability to use language.

Preoperational stage

What cognitive development stage of Piaget’s is this?

Ages 7 to 11 yrs

Thought processes are more logical and less self-centered. Concepts to be mastered in sorting, ordering, and classifying facts to use in problem solving.

Concrete operational stage

What cognitive development stage of Piaget’s is this?

11 to 20 yrs

Adaping and flexibility

Adolescents can think abstractly (Skill that is essential to think critically and solve problems)

Formal operational thought stage

What are some strategies for effective communication?

1. Encourage parents to talk openly regarding their concerns

2. Use open-ended questions

3. Active listening

4. Clarity or provide teaching points to decrease misunderstandings

5. Include the child (incorporate play into nursing assessments/education

What age group is this for communication?

Trust vs mistrust

They give nonverbal cues such as smilling

Tend to cry when hungry, sleepy, or pain/discomfort/lonely, or need diapers changed

Coo when content and happy

Respond to sound, touch, and tone of voice

Infants

What age group is this for communication?

Nurse would use statements such as “good job”

Medical play may be useful in demonstrating how a procedure will take place

May practice on a doll or stuffed animal having a procedure done

Allow to handle equipment such as stethoscope

Bleeding may be percieved as ‘Insides leaking out” often comforted with bandage

Toddlers

What age group is this for communication?

Direct communication is equally as important as communicating with parents. Children at this age group want answers to their questions

They want to know why or how things happen

May bargain to postpone an intervention

School age children

What age group is this for communication?

Trust is extremely important in relationships and influences the extent of communication

Use open-ended questions, encourage them to express his or her feelings and concerns, provide privacy, and active listening and respect

Adolescents

What is this for the development of infants?

Posterior part closes by 2-3 months of age

The soft spot in the back of the head

Posterior Fontanel

What is this for development of infants?

Anterior part closes 12-18 months of age

The soft spot in the front of the infants head

Anterior Fontanel

Where do we listen at for an infants heart rate?

4th intercostal space (apex of the heart)

How long do we count an infants respiratory rate?

1 full minute due to irregular rate and rhythm

What is the correlation to an infants size over time?

Birth weight will double at 6 months, triple at 12 months

Birth length increases by 50% by age of 12 months

When does this infant develop this milestone?

Moves head side to side, smiles, coos, hold head up when lying on stomach

2 months

When does this infant develop this milestone?

babbling (mimic noises), holds and reaches for toys (rattles), rolls over (stop swaddling at the point when they roll over)

4 months

When does this infant develop this milestone?

Sits with support, stranger anxiety, recognizes their name, enjoys mirrors to see self

6 months

When does this infant develop this milestone?

Sits without support crawling, stands with holding onto object, pincer grasp, moves objects hand to hand. Object permanence.

8-9 months

When does this infant develop this milestone?

Simple words such as dada, mama, separation anxiety, bangs objects together, and puts objects in container; begins walking

10-12 months

When do infants start to walk on their own?

15 months

When do infants teeth start to come in?

Around 6-8 teeth by the end of the first year of life: Usually 6-10 months of age (average 8 months)

What is the language development for infants?

Crying is the first form of verbal communication

Makes single vowels by 2 months

Laughs at 4 months

Says 3-5 words by age of one

What is the health promotion for infants?

Rear-facing car seat in back seats, immunizations, no cows milk until 1 year of age, Solids introduced at 6 months, One food at a time over a 5-7 day period to detect allergy, no honey until age 1

How do we prevent SIDS (sudden infant death syndrome)?

Sleep position on back

Remove items from the crib

Don’t overdress the baby or have too many blankets

Don’t sleep in the same bed as an infant, CAN share a room but not bed

Avoid tobacco smoke

What stage of Erickson’s is this for development?

Toddlers are becoming independent and are trying to do everything for themselves

Discovering they are an individual which is separate from their caregiver

Trying new things such as potty training

When in hospital: Provide opportunities for independence and give choice. Praise when accomplishments but no punishment if don’t do a task right

They like to say no (Negativism)

Autonomy vs shame and doubt

What stage of anxiety is this for a toddler?

Wanting parent to stay, toddler will cry, scream, cling to parent

Protest stage

What stage of anxiety is this for a toddler?

Inactive and withdrawing, Toddler may regress to old past behaviors. May refuse to eat, drink, or move

Despair stage

What stage of anxiety is this for a toddler?

Holding together until parent returns, Toddler will show increased interest in surroundings, will interact with others, appear happy

Detachment stage

What is the language development of a toddler?

Increased language of 50-300 words by age of 2

3 years of age combines several words to create simple sentences using correct grammar

What stage of Erickson’s is this for development?

A sense of industry is achieved though the development of skills and knowledge that allows the child to make meaningfu contributions to society

A sense of accomplishment is gained through the ability to cooperate and compete with others

Can go through a part of discourageent

Industry vs inferiority

Wha is decreased separation of mom/baby called?

Golden Hour

What is the best thing to do for infants?

Prenantal Care

What are the weeks for each trimester?

First: Weeks 1-13

Second: Weeks 14-26

Third: Weeks 27-40

What is this related to pregnancy?

The number of pregnancies in which the fetus has reached 20 weeks; the point of viability; twins are one; includes stillbirth if they reach viability of 20 weeks

Para

When does the Human Chorionic Gonadotropin (HcG) begin?

Day of implantation

What can an increase or higher than normal level of HcG mean?

Can indicate molar pregnancy, Down Syndrome, ectopic pregnancy or multiple gestation

What can a decrease in HcG indicate?

Miscarriage

What type of signs of pregnancy is this?

Amenorrhea

Breast changes

Fatigue, N/V

Quickening (First fetal movement that the women feels)

Urinary frequency

Presumptive Signs (changes felt by women)

What type of signs of pregnancy is this?

Goodell’s Sign, Chadwick’s sign, Hegar’s sign, POSITIVE PREGNANCY TEST, Ballottement, Braxton Hicks Contractions (false labor contractions), Abdominal enlargement, Skin hyperpigmentation (Melasma, Linea Nigra)

Probable Signs (changes observed by examiner)

Where would the uterus be palpated at 12 weeks?

Symphysis Pubis

Where would the uterus be palpated at 20 weeks?

Umbilicus

Where would the uterus be palpated at 36 weeks?

Xiphoid Process

What type of signs of pregnancy is this?
Can hear the heartbeat of the infant

Can see the infant on an ultrasound

Doctor can feel the infants movements

Positive signs of pregnancy

A blood product that keeps Rh- mom from producing antibodies against Rh+ blood from baby..

Rhogam

What are the three times a women might get Rhogam?

1. Is 28 weeks prophylaxis to any women that is -

2. After an invasive procedure or miscarriage

3. After delivery if the baby is +

What are the danger signals to report if your pregnant?

Vaginal bleeding with/with out discomfort, Rupture of membranes, Swelling of the fingers/ puffy eyes or face, Continuous pounding headache, Visual disturbances, Persistent or severe abdominal pain/epigastric pain, Chills or fever, painful urination, Persistent vomiting, Change in frequancy or strength of fetal movement, and contractions between 20-37 weeks.

Why do pregnant women get prescribed folic acid?

Helps prevent neural tube defects

When the the development of the embryonic period end?

8 weeks

What does prolactin do for the reproductive system?

Stimulate milk production

What is the hormone that causes the milk to come out/baby to come out?

Oxytocin

What is the pregnancy maintaining hormone?

Progesterone

Periodic uterine bleeding, approx 14 days after ovulation

Menstrual cycle

What phase of the endometrial cycle is this?

Shedding of 2/3 of the endometrium

Menstrual phase

What phase of the endometrial cycle is this?

Rapid growth, day 5-14 Estrogen increase

Proliferative phase

What phase of the endometrial cycle is this?

From ovulation until 3 days before next menstrual period -Increase in progesterone; days 14-25

Secretary phase

What phase of the endometrial cycle is this?

Estrogen and progesterone rapidly decrease - necrosis develops

Ischemic phase

What part of the menstrual cycle is this?

Follicular phase - Primary follicle matures

Estrogen levels peak - release of egg = ovulation - day 14

Following ovulation, estrogen levels drop, lutueal phase - Corpus Luteum High levels of Progesterone

Ovarian Cycle

What part of the menstrual cycle is this?

Low levels of estrogen and progesterone at the end of the menstrual cycle

Hypothalamus secrete GnRH

Anterior pituitary - FSH (beggining of mesntrual cycle) and LH (End of menstrual cycle)

Hypothalmic - Pituitary cycle

When is a first trimester abortion?

After 9 weeks

What is the follow up care for abortions?

Avoid strenuous activity for few days, Bleeding / cramping possible 1-2 weeks, No tampons/douching/intercourse 1-3 weeks, WATCH for excessive bleeding

What type of infertility is this?

This happens when they were never able to get pregnant

Primary infertility

What type of infertility is this?

Happens when they were able to get pregnant in the past and cannot get pregnant now

Secondary Infertility

What is this reproductive alternative?

Going to bypass the fallopian tubes and go straight to the uterus. Going to instill the fertilized egg into uterus

IVF-ET

What is this reproductive alternative?

Going into the fallopian tubes making implantation more natural. Injects gametes.

GIFT

What is this reproductive alternative?

Straight into the fallopian tube to make implantation more natural. The zygote goes into the fallopian tube straight into the uterus

ZIFT

What is this in pregnancy?

“Bag of water” - Contains embryo and amniotic fluid. Fluid should be clear

Function: Constant temperature, Cushion, freedom of movement and allows for symmetrical growth

Could have Polyhydramnios (Too much fluid over 1500-2000mL) or Oligohydramnias (Too little fluid less than 500 mL)

Amniotic sac

What is this in pregnancy?

Contains two arteries (Carry blood from embryo - Deoxygenated) and one vein (Carries oxygenated blood/ nutrients to baby)

Should be thick unless mother doing drugs, alcohol, or smoking

Umbilical cord

What is this in pregnancy?

Fully functional 8-10 weeks

Function: Metabolic exchange in the intervillious spaces - maternal supplies oxygen and nutrients, take away carbon dioxide and waste product

Hormon production - hCG, estrogen and Progesterone

Placenta

What is this sign of pregnancy?

Softening of the cervical tip (Can be seen 6-8 weeks). It is good that the cervix is soft

Goodell’s Sign

What is this sign of pregnancy?

bluish color of cervix (Increased Vascularity) 6-8 weeks

Chadwick’s Sign

What is this sign of pregnancy?

Isthmus (Lower uterine segment) becomes compressible and soft. 6-8 weeks

Causes uterus to press on the bladder

Hegar’s sign

What is this sign of pregnancy?

Passive movement of unengaged fetus. Felt around 18 weeks

Fetal head rebounds with gentle, upward tapping through the vagina

Ballottement

What is this sign of pregnancy?

First fetal movement that the women feels (16-20 weeks)

Described as a “flutter”

Quickening

At 38-40 weeks what can occur?

Lightening will occur (Fundal height decreased)

Increased vaginal discharge (white/mucous discharge, no blood or foul odor)

Leukorrhea

What is this?

Sebaceous glandsbecome more prominent or enlarged and secretes susbtance which lubricates nipples

Montgomery tubicles

What is this in pregnancy?

Cheeks, nose, and forehead botchy, brownish hyperpigmentation

Cholasma (Melasma)

What is this?

Pigmented line from the symphysis pubis to the top of the fundus midline

Linea nigra