PEDS Exam 1

How many children will experience some sort of abuse in their life?

25%

What children are at increased risk of being abuse or neglected?

special needs children

What age are children at the greatest risk of being abused? and what age of children are more at risk for being a victim?

Ages 1 and 4

What is the most common form of abuse and what does it cause?

Child neglect is 80% of all abuse cases

• failure to thrive d/t decreased intake of calories

• hygiene needs

• housing

• safety needs and adequate supervision

What are signs of physical abuse?

• abusive head trauma

• Munchausen syndrome by proxy

• bruises in usual places at various stages of healing

• bruises and welts caused by belts, cords, etc

• burns (cigarette, iron), immersion burns (symmetrical in shape)

• whiplash injuries caused by shaken baby

• bald patches with hair pulled out

• fractures in various stages of healing

What is child sexual abuse?

it refers to the involvement of a child in sexual acitivity that violates the laws of social taboos of society that they:

• do not fully comprehend

• do not consent to

• are not developmentally prepared for

about 1 in 4 girls and 1 in 13 boys experience child sexual abuse

91% of sexual abuse is perpetrated by someone the child or the family knows

What is interprofessional care of the maltreated child?

• caregiver-child interaction

• history and interview

• physical assessment

• care management

  • abused children have a hard time establishing trust

  • you only want one nurse to care for an abused child so they have one consistent caregiver

What is included in the nursing assessment of the abused child?

• injuries not congruent with the child’s age, skills, or correlated with the causes

• delay in medical care

• failure to thrive

• torn, stained, bloody under clothes

• lacerations of external genitalia, bedwetting or soiling, child with STDs

• child frightened or withdrawn in presence of parent or adults

Nursing plans and interventions of child abuse

• you are legally required to report all cases of suspected abuse

• take color photograph of all injuries

• document factual, objective statements about child’s physical condition and interactions with family

• establish trust, and care for physical problems of child

• recognize own feelings of anger towards the parents

What is growth?

an increased in physical size or whole of any of its parts or an increase in the number and size of cells

• can be measured easily and accurately

What is development?

a continuous, orderly series of conditions that leads to activities, new motives for activities, and patterns of behavior

• you can’t measure development the same as growth because every child develops differently BUT you want them within 3 months of expected development

• changes in development could be affected by:

  • trauma

  • hands off parents

  • missing different developmental stages

  • culture

  • environment

What are the parameters of growth?

• weight, length, and height

• head circumference indicates brain growth

• eruption of teeth follows a sequential pattern

• growth spurts

What are the stages of growth and development?

• newborn; birth - 1 month

• infancy; 1 month - 1 year

• toddlerhood; 1 - 3 years

• preschool; 3-6 years

• school age; 6-11 or 12

• adolescents; 12 - 18 (puberty)

What are the different patterns of growth and development?

• simple to complex

• proximal to distal (proximodistal)

• head to lower extremities (cephalocaudal)

• there are wide variations within normal limits

What can influence development?

• genetics

• environment

• culture

• nutrition

• health status

• family structure

• parent attitudes

• child-rearing philosophies (Facebook groups are a problem!!!)

What can you expect in physical growth in newborns?

5-7 oz weight gain per week for the first 6 months

When does the posterior fontanel close?

after 2-3 months

When does the anterior fontanel close?

after 12-18 months

What can you expect in physical growth in an infant 6 months old?

the birth weight DOUBLES

height increases by 1 inch per month for the first 6 months

What can you expect in physical growth in an infant 12 months old?

the birth weight TRIPLES
birth length increases by 50%

What are differences in physical growth at specific ages?

1 - 2 yrs - weight gain slows

2 - 5 yrs - increased by 5 lbs per year

6 - 9 yrs - weight increases by 2-3 kg/yr weight almost doubles during this time

around 10 years old girls can start puberty and finish growing at 15, during this time secondary sex characteristics develop, boys catch up around age 14 and finish at 17

Gross Motor development stages

Newborn - tummy time

6 months - tripod/sitting

12 months - walking

What gross motor skills should develop from ages 1-3 months?

1 - lift head

2 - lift shoulders

3 - up on elbows, lift chest

What gross motor skills should develop from ages 4-5 months?

4 - up on wrists and roll over

5 - rolling back to front

What gross motor skills should develop from ages 6- 10 months?

6 - sitting/tripod

7-8 - crawling

9-10 - pull to stand

What gross motor skills should develop from ages 10 - 12 months?

10 - 11 - cruising

12 - walking

What gross motor skills should develop from ages 2-5?

2 - climbing stairs

3 - ride a tricycle

4- hop on one foot

5- skipping

What are the fine motor development skills from newborn to 3 months?

newborn - eyes are fixed and fists are clenches

1 month -e yes move from side to side

2-3 months - eyes move up and down, eyes move in a circle, hands should be open

What are the fine motor skills that should be developed from ages 4-9 months?

4 months - bring hands to midline, put hands in mouth; reaching and batting

6 months - grasping by raking (raking grasp) - they “rake” things towards them

9 months- immature pincer grasp (grab with whole hand), pointing

What are the fine motor skills that should be developed from ages 12 - 18 months?

12 months - mature pincer grasp (can use fingers to pick things up)

12 - 15 months - improved manual dexterity

18 months - throwing a ball

What are the fine motor skills that should be developed from ages 3-5 years?

• hand-eye coordination is refined

• muscle coordination

• dressing and drawing

• using scissors at 4 years

• tying shoes at 5 years

What are the fine motor skills that should be developed from ages 6-12 years?

• painting and drawing

• using tools (hammer, screwdriver)

• riding a bike

• jumping rope

• dressing and grooming alone

What are the different stages of language development from newborn to 12 months?

• newborns - cry, alert to sound

• 2 months - cooing “ahhh, oohh”, matching parents pitch

• 4 months - a-gooing “ahh-goo”, babbling, laughing

• 6 months - play with sounds, repeats sounds to self, can identify mother/father’s voices, squealing

• 9 months - “Mamamama” “Dadada” not specific

• 12 months - “mama” “dada” becomes specific

What are the different stages of language development from 1 - 4 years?

• 1 year “mama” & “dada” plus 1 other word

• 2 years - 2 word combos; vocabulary of 300 words and 50% intelligible to a stranger

• 3 years - 3 or 4 words together; small sentences and phrases; 75% intelligible to strangers; mimicking

• 4 years - past tense; 100% intelligible to a stranger; has a sense of grammar

What are the social development skills from 0-6 months?

• look at faces; social smiles

• recognize and prefer parents; can distinguish between strangers

• laughing; object permanence; knows parents exist even if they can’t see them

What are the social development skills from 6 - 12 months?

• stranger anxiety

• social skills are linked; social referencing (9-10 months)

• want to explore everything during this time; thrive for independence

• walking at 12 months

what is included in the psychosocial and cognitive development of an infant?

• develops the foundation of personality

• establish basic trust

• parent/infant attachment

• stranger anxiety

• basic needs need to be met

what is included in the psychosocial and cognitive development of a child in early childhood?

• consumed with curiosity and boundless energy

• object permanence is firmly established

• displays deferred imitation

• period of rapid learning

• this is the TODDLER AGE - they want to get into everything and learn

what is included in the psychosocial and cognitive development of a school age child?

• gradually move away from home as the primary source of support and enter the world of their peers

• able to understand and obey rules

• develop a conscience and internalize cultural and social values

what is included in the psychosocial and cognitive development of an adolescent?

• intense feeling of body image

• egocentric

• move from obedience to rebellion

• audience conscious

• believe bad things only happen to others

What are the development considerations for the hospitalized child of infant age (birth - 1 year)?

• parents

• set schedule

• preparation and teaching

• consoling

What are the development considerations for the hospitalized child of toddler age (1-3 years)?

• simple and brief

• parents

• security objects

• regression

• bodies

• autonomy

What are the development considerations for the hospitalized child of preschool age (3-5 years)?

• egocentricity

• painful procedures

• questions

• simple words

• medical play

• fear of mutilation (BANDAIDS ARE BIG IN FIXING THIS FEAR)

What are the development considerations for the hospitalized child of school age (6 - 12 years)?

• parents

• school and peers

• explanations

• privacy and modesty

• participate in care

What are the development considerations for the hospitalized child of adolescent age (12-18)?

• school and peers

• body image

• teaching should include time without parents

• maintain identity

What is the nurses role in promoting optimal growth and development?

• interview parents

• assess child’s ability to think through situations

• assess child’s verbal ability

• carefully observe child

What is included in health promotion for the infant?

• household preparation (nesting phase is prepping the house for the baby)

• safe sleep

• crib safety

• nutrition, breastfeeding, formula - it is preferred that all women breastfeed; if a baby is solely breastfed, they will need vitamin D supplements; all infants need iron fortified formula up to 1 year of age, introduce baby food at 6 months, DO NOT give babies water until 1 year of age because you can deplete their sodium and cause seizures; be cautious of peanut butter and DO NOT give honey because of botulism

• safety - the developmental stage the child is in will determine parent education about safety

• dental care - be careful giving bottles with fruit juices, NEVER prop the bottle because it can cause bottle rot and cavities

What is included in the safe infant sleep checklist?

• share room NOT bed - room share for 3-4 months

• properly follow the manufacturer’s instructions to assemble the crib, submit the product registration card to hear about recalls or updates

• place babies on their backs for naps and sleep until 1yrs old on a firm flat surface

• have firm mattress and fitted sheets - remove blankets, pillows, toys, bumper pads

• dress baby in wearable blanket or onesie - it is recommended a sleep sack over a swaddle because it is easy for babies to wiggle out

What are some concerns during infancy?

• crying - signs of need

• hygiene - prevent cradle cap

• failure to thrive - ensure proper feeding and formula mixing

• colic - care must be individualized for each pt

What are the different stages of health promotion during early childhood?

• play - play is a child’s work

• safety - car safety, prevent falls, water safety, prevent poisoning

• toilet training - assess readiness (they will tell you when they go, take off diapers, doing the potty dance)

• nutrition - food jags (shape of food, sugar, and fast food), obesity risk

• dental care - 20 deciduous teeth by age 3, proper cleaning, age in months MINUS 6 is how you determine how many teeth a child should have

• sleep and rest - 10-14 hrs of sleep per day, bedtime ritual

What should you know about car safety?

• toddlers restrained upright forward facing car seat until they outgrow height or weight recommendations

• kids younger than 13 should eb in the backseat

• booster seat for children older than 4 until they outgrow or are old enough to wear a seat lap and shoulder belt (8-12 years, 4 ft 9in)

What are some selected issues related to the toddler?

toilet training - readiness cues

temper tantrums - a response to anger and frustration

sibling rivalry - regression

toddlers have negativism because they hear “no” all the time

What are some selected issues related to the preschooler?

• stuttering - speech and language therapy

• preschool and daycare - expand social and play skills

• prepping the child for school - chronological and developmental maturity should be evaluated

Toddler vs Preschooler

TODDLER

• terrible twos

• 12-36 months they are egocentric and demanding behaviors

PRESCHOOLER

• become increasingly independent

• age 3-5 years they are imaginative, creative, and curious

What are the healthy people 2030 goals for toddlers and preschoolers?

• inc positive parenting

• achieve and maintain vaccination coverage

• prevent increase in poisoning deaths

• increase age-appropriate vehicle restraint system use

• prevent increase of fall related deaths

• reduce drowning deaths

• prevent inappropriate weight grain in kids 2-5 yrs

• reduce secondhand smoke exposure for ages 3-11

What is health promotion in the school-aged child?

• dental care - baby teeth are lost, this begins around age 6

• nutrition - inc appetite due to inc energy

• sleep and rest - set bedtime, limit tv before bed

• safety - unintentional injury is leading cause of death

• stress - becomes prominent in this age group; bullying

What is health promotion in an adolescent?

• nutrition - fast food and junk food; eating disorder; nutritional guidance

• violence - a lot of adolescents are involved in gang related activity

• sports - ensure safety; hands on sports can stop growth

• hygiene - acne; cavities decrease; wisdom teeth erupt

• sleep - staying up late

• safety - car accidents are the leading cause of death (still unintentional), tanning, vaping, sexual activities, STDs

What happens during puberty?

• dramatic changes in size and appearance - rapid growth

• secondary sexual characteristics

  • girls get breasts, pubic hair

  • boys experience testicular and penile enlargement as well as voice changes and facial hair

• growth is faster in girls than boys

• sexual maturity ratings

  • SMRs

  • Tanner stages

What is involved in the neonatal stages of development?

• sense organs develop early in gestation

  • eyes at 22 days

  • ears during 3rd week, critical period 4-6 weeks

• VERY sensitive to teratogens

• any interference in development can result in later sensory alterations

What is involved in the development of speech?

• the fetus can hear during the 2nd trimester

• can hear mom’s heartbeat and voices

• hearing is essential for development of speech

• babbling begins at 4-6 months, if not developed test their hearing

• babbling is followed by receptive and expressive language development

What is in the vision screening for a child at birth?

• structural abnormalities

• red reflex

• ability to fixate

What is in the vision screening for a child 3 years and older?

• HOTV cards

• lea symbols

• tumbling E

When do children develop 20/20 vision? What is also common at this age?

they develop 20/20 vision at 5 years old

• hyperopia is common (see distant objects clearly but nearby objects are blurry)

What should we know about visual impairments?

• 5-10% of all preschoolers

• they are identified through vision screening programs

• suspect visual impairment of any child whose pupils do not react to light

• partially sighted

  • acuity of 20/70 to 20/20, education usually in public school system

• legally blind

  • acuity of 20/200 or poorer, legal and medical term

What are examples of traumatic eye injuries?

• corneal abrasion

  • scraping or tearing the cornea by foreign bodies, contact lenses, paper or fingernails

• subconjunctival hemorrhage

  • red areas under the conjunctiva

  • resolve spontaneously

• hyphema

  • hemorrhage from blow or penetration to eye

• chemical splashing

  • hot or corrosive liquid splashes

How do you take care of a child who has a visual impairment and is hospitalized?

• orient child to hospital environment by emphasizing spatial relations; use familiar terms and avoid mention of color; frequently orient them to time and place

• never touch child without identifying yourself and explaining; provide detailed explanations

• use parents for best source of communication

• identify noises for the child

• keep things in the same location and order

• allow as much control as possible

• supervise the child and counsel parents to supervise as needed

What is conductive hearing loss?

• outer or middle ear affected by damage, inflammation, or obstruction

• constant ear infections - babies will pull at ears

• caused by excessive cerumen, foreign bodies, perforated tympanic membrane, otitis media

• temporary and reversible

What is sensorineural hearing loss?

• result of damage or malformation of the inner ear

• caused by heredity, environment (infection like meningitis, exposure to loud music, ototoxic meds, prematurity)

• usually permanent hearing loss

What is mixed hearing loss?

a mix of conductive and sensorineural

What is central hearing loss?

• result of damage to the conduction system between the auditory nervous system and the cerebral cortex

• result from trauma, neurovascular changes, brain tumors

• difficulty in differentiation of sounds, auditory memory

What is considered slight to moderately severe hearing impairment?

• residual hearing with the use of an aid

• failure to hear higher than 65 decibels

What are the manifestations in infancy of hearing impairments?

• lack of startle reflex

• absence of reaction to auditory stimuli

• absence of well-formed syllables by age 11 months

• general indifference to sound

• lack of response to spoken word

What is the care management of hearing impairments?

• encourage hearing aid use

  • make sure child has hearing aid in before speaking

  • no background noise

• lipreading

  • look directly at child’s face

  • have child’s full attention

  • speak clearly but not loudly or slowly

• cued speech

• sign language

  • use basic or interpreter when necessary

• speech-language therapy

• use visual aids

• socialization

• support child and family

What are preventative measures for hearing impairments?

• treatment and management of recurrent otitis media

• prenatal preventative measures

  • genetic testing

  • avoid ototoxic drugs

  • rule out syphilis, rubella, blood incompatibility

  • avoid exposure to noise pollution

What is the sequence of the human genome?

• increased understanding of human traits, skills and disabilities

• human genome is the full set of DNA instructions

• genotypes - small variations

• phenotypes - visible difference

• mutations - deletions, additions, or recopying

What are cognitive impairments?

• general term to encompass any type of mental difficulty or deficiency

• “intellectual disability”

• diagnosis is made after a period of suspicion by family or health professionals or at birth (like down syndrome)

What classifies an intellectual disability?

• intellectual functioning -IQ of 70-75 or below

• functional strengths and weaknesses - impairment in 2 of 10 adaptive skills to make diagnosis

• younger than age 18 at time of diagnosis

85% of the population with CIs are mildly impaired meaning that they can be:

educable - can teach them and they can retain and understand

• this can also lead to mental health issues because they know they are different

10% of the population with CIs are moderately impaired meaning that they can be:

trainable - you can show them what to do but they don’t understand the need for it

What are problems related to a mild intellectual disability?

• self esteem issues related to the presence or absence of physical features, largely determined by the cause of the intellectual disability

• social isolation and loneliness

• depression

What are problems related to a severe intellectual disability?

• self injury

• fecal smearing

• temper tantrums, tearing personal items, disrobing

What are the causes of intellectual disabilities?

• genetics (down syndrome)

• alterations occurring during pregnancy (drugs, alcohol, injury)

• neonatal alterations (lack of oxygen, being dropped)

• acquired childhood conditions or diseases (encephalitis)

• environmental problems

• unknown causes

What is the nursing care for cognitive impairments?

• educate the child and family - early interventions

• teach self-care skills

• promote optimal development - inc time spent in regular school setting

• encourage play and exercise with other kids

• provide means of communication

• establish discipline

• get appropriate care ASAP to catch up with milestones

What is the cause of Down Syndrome?

• occurs when cell division is abnormal

• nonfamilial trisomy 21

  • extra chromosome 21 in 95% of cases

• Maternal age

  • age 35 - risk is 1 per 350 births

  • age 40 - risk is 1 per 100 births

What are the clinical manifestations of down syndrome?

• square head with upward slant to eyes

• flat nasal bridge, protruding tongue which leads to respiratory and feeding issues

• hypotonia - floppy limbs

What are the physical problems caused by down syndrome?

• cardiac defects

• respiratory infection

• feeding difficulties

• delayed developmental skills

• skeletal defects altered immune function

• hypothyroidism, diabetic muscular infarction

What is the therapeutic management of down syndrome?

• surgery to correct congenital anomalies

• evaluate hearing and sight

• periodic thyroid function test

What is the care management of down syndrome?

• supporting child’s family at time of diagnosis

• prevent physical problems

• assist in prenatal diagnosis and genetic counseling

• nursing goal is to help child reach their optimal level of functioning

What is fragile X syndrome?

it is usually in boys and is caused by abnormal gene on the lower end of the long arm of the X chromosome

What are the clinical manifestations of Fragile X Syndrome?

• large head circumference

• prognathism - long face with prominent jaw

• large protruding ears

• postpubertal: large testes

• manifestations variable in females carries of gene

What are the classical behavior features of Fragile X Syndrome?

• mild to severe cognitive impairment

• delayed speech and language

• hyperactivity

• hypersensitivity to taste, sound, touch

• autistic like behavior

• aggressive behavior

• gaze avoidance

• hand flapping

like ADHD / Autism

Therapeutic management, prognosis, and care management of Fragile X syndrome

• tegretol/prozac for behavior

• stimulants for hyperactivity

• referral to early intervention program

• normal life span

• genetic counseling - it is likely if one kid has it, other kids will have it as well

What is Rett Syndrome?

It is exclusively linked to females and has mutations on the X chromosome

What are symptoms of Rett Syndrome?

they emerge between ages of 6-18 months

• social and intellectual development stops

• stereotypical hand and gait disturbances

• seizures

• breathing impairments

• flapping and clasping hands

What is fetal alcohol disorder and what does it cause?

the most severe form experienced by the infant exposed to alcohol in utero

• persistent symmetric growth retardation

• malformations of face and skull

• skeletal and cardiac malformations

• CNS deficits

• intellectual and developmental disabilities

What is autism?

• deficits in social interactions, communication and behavior

• sometimes it can be improved or overcome

What are clinical manifestations in autism?

• peculiar and bizarre primarily in specific areas

  • socialization

  • communication

  • behavior

  • difficulty with eye and body contact

  • language delay

How do you diagnose autism?

• often delayed until 2-3 because this is when social interactions start

• symptoms are typically noticeable at 3 but can be as early as 1

Miscellaneous about autism

• there is NO cure

• you can improve language skills with therapy

• recognize early, attempt to modify behavior, provide a structed routine, decrease unacceptable behavior

• stress family counseling

What is Asperger Syndrome?

• high functioning autism

• the symptoms are social and emotional

• rigidity regarding schedules, motor clumsiness, and organizational skill problems