Hammad- ATI (Pt 3)

Health promotion of toddlers (1 to 3 years)

Characteristics of Healthy Families

Good Communication & Listening, Affirmation & Support, Clear Set of Rules-Beliefs-Values, Respect, Sense of Trust, Play & Share Humor Together

Traditional Nuclear Family

Married Couple & Their Biologic Children

Nuclear Family

Two Parents & Their Children

Single-Parent Family

One Parent & One or More Children

Blended Family (Reconstituted Family)

At Least One Stepparent, Stepsibling, or Half-Sibling

Extended Family

At Least One Parent, One or More Children & Other Individuals

LGBT Family

Two Members of the Same Sex Who Have Children & a Legal or Common-Law Tie

Foster Family

A Child or Children Who Have Been Placed in an Approved Living Environment Away From the Family of Origin, Usually With One or Two Parents

Binuclear Family

Parents Who Have Terminated Spousal Roles but Continue Their Parenting Roles

Communal Family

Individuals Who Share Common Ownership of Property & Goods, & Exchange Services Without Money Consideration

Authoritarian Parenting

Parents Try to Control the Child's Behavior & Attitudes Through Unquestioned Rules & Expectations

Permissive Parenting

Parents Exert Little or No Control Over the Child's Behaviors, & Consult the Child When Making Decisions

Authoritative Parenting

Parents Direct the Child's Behavior by Setting Rules & Explaining the Reason for Each Rule Setting; Parents Negatively Reinforce Deviations From the Rules

Guidelines for Promoting Acceptable Behavior in Children

Set Clear & Realistic Limits & Expectations
Validate the Child's Feelings Offer Sympathetic Explanations
Provide Role Modeling & Reinforcement for Appropriate Behavior
Focus on the Child's Behavior When Discipling the Child

Expected Temperature for 3 Months

37.5 C (99.5 F)

Expected Temperature for 6 Months

37.7 C (99.9 F)

Expected Temperature for 1 Year

37.2 C (99.0 F)

Expected Temperature for 3 Years

37.2 C (99.0 F)

Expected Temperature for 5 Years

37.0 C (98.6 F)

Expected Temperature for 7 Years

36.8 C (98.2 F)

Expected Temperature for 9 - 11 Years

36.7 C (98.1 F)

Expected Temperature for 13 Years

36.6 C (97.9 F)

Recommended Routes for Temperature 3 Months- 1 Year

Axillary & Rectal

Recommended Routes for Temperature 3 - 5 Years

Axillary, Tympanic, Oral Rectal

Recommended Routes for Temperature 7 - 13 Years

Oral, Axillary, Tympanic

Expected Pulse Rate for Newborn

110-160/Min

Expected Pulse Rate for Infant

90-160/Min

Expected Pulse Rate for Toddler

80-140/Min

Expected Pulse Rate for Preschooler

70-120/Min

Expected Pulse Rate for School-Aged

60-110/Min

Expected Pulse Rate for Adolescent

50-100/Min

Expected Respirations for Newborn

30-60/Min

Expected Respirations for Infant

25-30/Min

Expected Respirations for Toddler

25-30/Min

Expected Respirations for Preschooler

20-25/Min

Expected Respirations for School-Aged

20-25/Min

Expected Respirations for Adolescent

16-20/Min

General Appearance

Undistressed, Clean, Well-Kept, & Without Body Odors; Eye Contact When Addressed; Follow Simple Commands; Uses Speech, Language, & Motor Skills Spontaneously

Expected Findings for the Skin

Smooth & Slightly Dry; Brisk Elasticity, Symmetric Skin Folds; Warm or Slightly Cool to the Touch

Expected Findings for the Hair & Scalp

Hair Should be Distributed, Smooth, & Strong; Scalp is Clean & Absent of Scaliness, Infestations, & Trauma

Expected Findings for the Nails

Pink Over the Nail Bed & White at the Tips; Smooth & Firm

Expected Findings for the Lymph Nodes

Should be Nonpalpable; If Found in children They Should be Small, Palpable, Nontender, & Mobile

Expected Findings for the Head

Symmetric, Fontanels Should be Flat

Expected Findings for the Face

Symmetric Appearance & Movement, Proportional Features

Expected Findings for the Neck

Short in Infants, No Palpable Masses, Midline Trachea, Full ROM Present Whether Elicited Actively or Passively

Expected Findings for the Eyes

Eyebrows Should be Symmetric & Evenly Distributed from the Inner to the outer Canthus
Eyelids Should be Closed Completely & Open to Allow the Border & Most of the Upper Portion of the Iris to be Seen
Eyelashes Should Curve Outward & Evenly Distributed
Conjunctiva Should be Pink & Transparent
Lacrimal Apparatus is Without Excessive Tearing, Redness, or Discharge
Sclera Should be White
Cornea Should be Clear
Pupils Should be Round, Equal in Size, Reactive to Light, & Accommodating
Irises Should be Round with Permanent Color Manifesting Around 6-12 Months of Age

Expected Findings for Vision

Peripheral Visual Fields Should be: Upward 50%, Downward 70%, Nasally 60%, Temporally 90%
Extraocular Movements: Corneal Light Reflex Should be Symmetric, Cover/Uncover Test Should Demonstrate Equal Movement of the Eyes, Absent of Nystagmus
Color Vison: Child Should be Able to Correctly Identify Shapes, Symbols, or Numbers
Internal Exam: Red Reflex Should be Present

Expected Findings of the Ears

Alignment: Top of the Auricles Should Meet in an Imaginary Horizontal Line that Extends From the Outer Canthus of the Eye
External Ear Should be Free of Foreign Bodies & Lesions; Cerumen is Normal
Internal Ears: Membranes Should be Pearly Pink, or Gray; Light Reflex Should be Visible
Hearing: Intact Acoustic Blink Reflexes, Infants Should Turn to Sounds

Expected Findings for the Nose

Position Should be Midline, Patency Should be Present for Each Nostril
Internal Structure: Septum is Midline & Intact, Mucosa is Pink in Light-Skinned Clients & in Various Brown or Gray Colors in Dark-Skinned

Expected Findings for the Nose & Throat

Lips: Darker Pigmentation Than Facial Skin; Smooth, Soft
Gums: Coral Pink
Teeth: 20 Teeth by 1 Year of Age & 32 Deciduous Teeth by Adolescence
Hard & Soft Palates: Intact, Firm, & Concave
Uvula: Intact & Moves with Vocalization
Tonsils: Infants May Not be Able to Visualize; Children are Barely Visible to Prominent, Same Color as Surrounding Mucosa
Voice: Infant- Strong Cry, Children & Adolescents are Clear & Articulate

Expected Findings for the Thorax & Lungs

Chest Shape: Infants is Almost Circular with Anteroposterior Diameter Equaling the Transverse or Lateral Diameter; Children & Adolescents the Transverse Diameter to Anteroposterior Diameter Changes to 2:1
Ribs & Sternum: More Soft & Flexible in Infants, Symmetric & Smooth with No Protrusions or Bulges
Movement: Symmetric, No Retractions; Infants- Irregular Rhythms are Common
Breath Sounds: Inspiration is Longer & Louder than Expiration; Vesicular, or Soft, Swishing Sounds are Heard Over the Lungs
Breasts: Newborns- Enlarged for the First Few Days; Children & Adolescents- Nipples & Areolas are Darker Pigmented & Symmetric

Expected Findings for the Circulatory System

Heart Sounds: S1 & S2 Should be Clear & Crisp
Pulses: Brachial, Temporal, & Femoral Should be Palpable, Full, & Localized
Abdomen: Is Without Tenderness, No Guarding, Peristaltic Waves Should be Visible in Thinner Children; Symmetric Without Protrusions

Expected Findings for the Genitalia

Anus: Surrounding the Skin Should be Intact with Sphincter Tightening Noted When Anus is Touched
Male: Hair Distribution is Diamond Shaped After Puberty; Penis- Straight, Urethral Meatus is At the Tip of Penis, Foreskin May Not be Retractable. Scrotum- Hangs Separately From the Penis, Skin has Rugose Appearance & is Loose, Inguinal Canal Should be Absent of Swelling
Female: Hair is Distributed Over the Mons Pubis & Should be Documented in Amount & Location, Appear as Inverted Triangle; Labia- Symmetric, Moist on Inner Aspects. Clitoris- Small, Without Bruising or Edema. Urethral Meatus- Slit-Like in Appearance With No Discharge. Vaginal Orifice: Hymen May be Absent or Either Completely or Partially Covered Over the Vaginal Opening Prior to Sexual Intercourse

Expected Findings for the Musculoskeletal System

Joints: Stable & Symmetric with Full ROM & No Crepitus or Redness
Spine: Infants- Without Dimples or Tufts of Hair, Midline with an Overall C-Shaped Lateral Curve. Toddlers- Appear Squat With Short Legs & Protuberant Abdomens. Preschoolers- Appear More Erect Than Toddlers. Children- Develop the Cervical, Thoracic, & Lumbar Curvatures Like that of Adults. Adolescents: Should Remain Midline
Gait: Toddlers & Young Children- Bowlegged or Knock-Knee Appearance, Feet Should Face Forward While Walking. Older Children & Adolescents- Steady Gait Should be Noted With Even Wear on the Soles of Shoes

What Reflexes Should Appear From Birth to 4 Months?

Sucking & Rooting Reflexes, Palmar Grasp, Tonic Neck Reflex (Fencer Position)

What Reflexes Should Appear From 8 to 10 Months?

Pincer Grasp

What Reflexes Should Appear From Birth to 8 Months?

Plantar Grasp

What Reflexes Should Appear From Birth to 6 Months?

Moro Reflex

What Reflexes Should Appear From Birth to 1 Year?

Babinski Reflex

What Reflexes Should Appear From Birth to 4 Weeks?

Stepping

Expected Finding for Olfactory Nerve

Infants: Difficult to Test
Children & Adolescents: Identifies Smells Through Each Nostril Individually

Expected Finding for Optic Nerve

Infant: Looks at Face & Tracks with Eyes
Children & Adolescents: Has Intact Visual Acuity, Peripheral Vision, & Color Vision

Expected Finding for Oculomotor Nerve

Infant: Blinks in Response to Light, Has Pupils that are Reactive to Light.
Children & Adolescents: Has No Nystagmus & PERRLA is Intact

Expected Finding for Trochlear Nerve

Infant: Looks at Face & Tracks with Eyes
Children & Adolescents: Has to Ability to Look Down & In With Eyes

Expected Finding for Trigeminal Nerve

Infant: Has Rooting & Sucking Reflexes
Children & Adolescents: Is Able to Clench Teeth Together, Detects Touch on Face With Eyes Closed

Expected Finding for Abducens Nerve

Infants: Looks at Face & Tracks with Eyes
Children & Adolescents: Is Able to Move Eyes Laterally Toward Temples

Expected Finding for Facial Nerve

Infant: Has Symmetric Facial Movements
Children & Adolescents: Ability to Differentiate Between Salty & Sweet on the Tongue, Symmetric Facial Movements

Expected Finding for Acoustic Nerve

Infant: Tracks a Sound, Blinks in Response to a Loud Noise
Children & Adolescents: Does Not Experience Vertigo, Has Intact Hearing

Expected Finding for Glossopharyngeal Nerve

Infant: Has an Intact Gag Reflex
Children & Adolescents: Intact Gag Reflex, Able to Taste Sour Sensations on Back of the Tongue

Expected Finding for Vagus Nerve

Infant: No Difficulties Swallowing
Children & Adolescents: Speech Clear, No Difficulties Swallowing, Uvula is Midline

Expected Finding for Spinal Accessory

Infant: Moves Shoulders Symmetrically
Children & Adolescents: Has Equal Strength of Shoulder Shrug Against Examiners Hands

Expected Finding for Hypoglossal

Infant: No Difficulties Swallowing, Opens Mouth When Nares are Occluded
Children & Adolescents: Has Tongue that is Midline, Able to Move Tongue in All Directions with equal Strength Against Tongue Blade Resistance

Expected Finding for Neurological System

Infant Reflexes
Cranial Nerves
Deep Tendon Reflexes: Partial Flexion of the Lower Arm at the Biceps Tendon, Partial Extension of the Lower Arm at the Triceps Tendon, Partial Extension of the Lower Leg at the Patellar Tendon, Plantar Flexion of the Foot at the Achilles Tendon
Cerebellar Function (Children & Adolescents): Finger to Nose Test- Rapid Coordinated Movements; Heel to Shin Test- Able to Run the Heel of One Foot Down the shin of the Other Leg While Standing; Romberg Test- Able to Stand with Slight Swaying While Eyes Are Closed

Safe Administration of Oral Medication

Determine Ability to Swallow, Use Smallest Measuring Device for Doses of Liquid Medication, Avoid Using Teaspoons & Tablespoon, Use Rigid Cups for Dispensing & Not Paper Cups, Avoid Mixing Medication, Hold Infant in Semi-Reclining Position, Hold Small Child in Upright Position, Administer in the Side f the Moth in Small Amounts, Only Use the Droppers that Come with the Medication for Measurement, Stroke Infant Under the Chin to Promote Swallowing, Reinforce Teaching to Children to Swallow Tablets When Not Available in Other Forms

Safe Administration of Optic Medication

Place the Child in Supine or Sitting Position, Extend the Child's Head & Ask the Child to Look Up, Pull the Lower Eye Lid Downward & Apply Medication in the Conjunctiva, Administer Ointments From the Inner Canthus of the Eye Preferably Before Nap or Bedtime

Safe Administration of Otic Medication

Place the Child in a Prone or Supine Position with the Affected Ear Upward

Safe Administration of Nasal Medication

Remove Mucus Prior to Administration, Position the Child with the Head Hyperextended, Use a Football Hold Position for Infants

Safe Administration of Aerosol Medication

Use a Mask for Younger children

Safe Administration of Rectal Medication

Provide Lubrication to the Medication by Using Warm Water or Other Lubricant, Insert Beyond Both Rectal Sphincters, Hold the Buttocks Gently Together for 5-10 Min, If Necessary to Half the Dose, Cut the Medication Lengthwise

Safe Administration of Transdermal/Topical Medication

Ensure the skin is Dry & Intact, Apply to the Body or Major Muscle. Monitor Skin Site of Administration Regularly, Rotate Sites Frequently

Safe Administration of Injections

Change Needle if it Pierced a Rubber Stopper on a Vial, Secure the Infant or Child Prior to Injections, Determine the Need for Assistance, Avoid Tracking of Medication, When Selecting Sites Consider: Medication Amount, Viscosity, & Type; Muscle Mass, Condition, Access of Site, & Potential for Contamination; Treatment Course & Number of Injections; Age & Size of Child

Safe Administration of Intradermal Injections

Administer on the Inside of the Foreman, Use a TB Syringe with 26- to 30- Gauge Needle With an Intradermal Bevel, Insert at 15 Degree Angle, Do Not Aspirate

Safe Administration of Subcutaneous Injections

Common Sites are the Lateral Aspect of the Upper Arm, Abdomen, & Anterior Thigh, Inject Volumes Less than 0.5 mL, Use a 1 mL Syringe With a 26- to 30- Gauge Needle, Insert at a 90 Degree Angle for Children Who are Thin, Check Policy for Aspiration Practices

Safe Administration of Intramuscular Injections

Use a 22- to 25- Gauge With 1/2- to 1- Inch Needle
Vastus Lateralis: Recommended Site in Infants & Small Children, Position the Child Supine, Side-Lying, or Sitting, Inject Up to 0.5 mL for Infants, Inject Up to 2 mL for Children.
Ventrogluteal: Position the Child Supine, Side-Lying, or Prone; Inject 0.5 to 1 mL for Infants, Inject Up to 2 mL for Children.
Deltoid: Explain the Procedure to the Child & Guardians, Position the Child Sitting or Standing, Inject Up to 1 mL

Safe Administration of Intravenous

Monitor Venipuncture Site per Facility Protocol & prior to Administration of Medications
Peripheral Venous Access Devices: Use a 24- to 22- Gauge Catheter, Use for a Continuous & Intermittent IV Medication Administration, Short-Term IV Therapy can be Completed at Home with the Assistance of a Home Health Nurse
Central Venous Access Devices: Short Term- Non-Tunneled Catheter or PICC Line Require an X-Ray to Verify Placement Prior to Use; Long Term- Tunneled Catheter or Implanted Infusion Ports

Expected Findings for Young Infant Dealing With Pain

Loud Cry, Rigid Body Thrashing, Local Reflex Withdrawal From Pain Stimulus, Expressions of Pain, Lack of Association Between Stimulus & Pain

Expected Findings for Older Infants Dealing With Pain

Loud Cry, Deliberate Withdrawal From Pain, Facial Expression of Pain

Expected Findings for Toddler Dealing With Pain

Loud Cry or Screaming, Verbal Expressions of Pain, Thrashing of Extremities, Attempt to Push Away or Avoid Stimulus, Noncooperation, Clinging to a Significant Person, Behaviors Occur in Anticipation of Painful stimulus, Request Physical Comfort

Expected Findings for School-Aged Child Dealing With Pain

Stalling Behavior, Muscular Rigidity, Any Toddler Behavior But Less Intense in the Anticipatory Phase & More Intense With Painful Stimulus.

Expected Findings for Adolescents Dealing With Pain

More Verbal Expressions of Pain With Less Protest, Muscle Tension With Body Control

Pain Management (Nursing Care)

Recheck Child's Level of Pain Frequently, Use Nonpharmacological or Pharmacological or Both, Ask Parent or Caregiver to Monitor Their Child's Pain Level, Ask Parent or Caregiver of Their Satisfaction of the Pain Management, Monitor Child for Adverse Reactions, Review Laboratory Reports, Monitor the Child's Physical Functioning Following Pain Management Intervention, Monitor for Negative Effects or Distress the Child Might Experience Related to Pain

Pain Management (Atraumatic Measures)

Use Treatment Room for Painful Procedures, Avoid Procedures in "Safe Places", Use Developmentally Appropriate Terminology When Explaining Procedures, Offer Choices to the Child, Allow Parents to Stay With the Child During Painful Procedures, Use Play Therapy to Explain Procedures, allowing the Child to Perform the Procedure on a Doll or Toy

Appropriate Routes for Medication Administration

Oral, Lidocaine & Prilocaine, Fentanyl PATCH, IV Bolus, IV PCA, Family-Controlled Analgesia

Pain Management (Nonpharmacological Measures)

Distraction, Relaxation, Guided imagery, Positive Self-Talk, Behavioral Contracting, Containment, Nonnutritive Sucking, Kangaroo Care, Complementary & Alternative Medicine

Pain Management (Complications)

Opioid Adverse Effects

Hospitalization & Illness

Separation Anxiety Manifests in Three Behavioral Responses: Protest- Screaming, Clinging to Parents, Verbal & Physical Aggression Toward Strangers. Despair- Withdrawal From Others, Depression, Decreased Communication, Developmental Regression. Detachment- Interacting with strangers, Forming New Relationships, Happy Appearance

Impact of Hospitalization (Infant)

Experiences Stranger Anxiety Between 6 to 8 Months of Age, Displays Physical Behaviors as Expressions, Can Experience sleep Deprivation Due to Strange Noises, Monitoring Devices, & Procedures

Impact of Hospitalization (Toddler)

Experiences Separation Anxiety, Can Exhibit an Intense Reaction to Any Type of Procedure Due to the Intrusion of Boundaries, Behavior Can Regress

Impact of Hospitalization (Preschooler)

Can Experience Separation Anxiety, Can Harbor Fears of Bodily Harm, Might Believe illness & Hospitalization Are a Punishment

Impact of Hospitalization (School-Aged Child)

Fear Loss of Control, Seeks Information as a Way to Maintain a Sense of Control, Can Sense When Not Being Told the Truth, Can Experience Stress Related to Separation From Peers & Regular Routine