Jane doe

Infant: Play and toys

- Solitary play- likes to play alone, like to grasp and manipulate objects, enjoys sensory and tactile stimuli
- Mobiles, rattles/noise making objects, mirrors, teething toys, large blocks, musical toys, stuffed toys, nesting/pull-apart toys, push-pull toys

Toddlers: Play and toys

1-3 years

- Parallel play- still likes to play alone but near someone. Enjoys toys that use motor and coordination abilities. Enjoys repetition (short songs with rhythm)
- Blocks, wheel toys, puzzles, crayons, books, push-pull toys, filling and emptying containers

Preschool: Play and toys

3-6 years

- Associative play- will play with peers (often imaginative). Enjoys plat that imitates adult behavior (cooking, tools, nurse, police officer, teacher)
- Enjoys toys that continue to develop motor and coordination such as tricycles, clay, drawing, paint, swings, song and dance

School-age/Adolescents: Play and toys

Younger school-age toys
Older school-age toys

- Cooperative play- enjoys rules, rituals, team play, activities
- Constructive toys such as puzzles, crafts, erector sets (younger age)
- Video games, competitive activities, board and card games, books, music (older age)

What age does a child get separation anxiety?
What would it look like in the hospital?
What should the nurse say to the parent about their child's behavior?

- Age 4-8 months
- Worry and fear
- They cry, protest, get anxious

Erikson's Developmental Stage: Infant

Trust vs. Mistrust

- Based on the caregiver-infant relationship and the care received by the infant
- Ensure that the parent is with the infant in the hospital as much as possible and rooming in/performing all care that they can

Erikson's Developmental Stage: Toddler

Autonomy vs. Shame and Doubt

Independence --> dressing oneself, performing self-care, toilet training, offering symbol choices related to the body

Erikson's Developmental Stage: Preschool

Initiative vs. Guilt

Exploring their environment and take initiative to plan activities --> where child will enjoy mimicking cooking in the kitchen or helping with chores around the house

Erikson's Developmental Stage: School-age

Industry vs. Inferiority

Related to being competitive/cooperative --> achieved in school whereas a hospitalized child is missing that. Nurse will make up for that in the playroom, playing cards/boardgames/video games making sure they maintain their school work

Erikson's Developmental Stage: Adolescent

Identity vs. Role Confusion

Difficult to achieve but the primary person to help form the adolescent's identity is the *peer group*. In hospital's it's important to make sure the adolescent has visits with their friends or connecting through social media

Order of Erikson's Developmental Stages

Trust vs. Mistrust
Autonomy vs. Shame and Doubt
Initiative vs. Guilt
Industry vs. Inferiority
Identity vs. Role Confusion

Nutrition: Infant

- Breastfeeding or iron-fortified formula for the first 12 months of life
- No forms of milk or milk products (almond, goat, etc)
- Iron-fortified cereal at age 4-6 months old
- Fruits, fruit juice, and vegetables at 6-8 months old
- Finger foods at 8-9 months old (no eggs or meat)
- Chopped, cooked table food at 12 months old (may give eggs and meat but no honey yet)

Nutrition: Toddlers

- Caloric needs are less than infancy
- Picky eater is common
- Finger foods are preferred
- Offer high protein
- Serving size 1 tbsp per year of age
- May consume cow's milk but no more than 24-28 oz/day

Nutrition: Preschool

- Consume half of adult portions (1800 kcal/day)
- Continues to be picky but more willing to try new foods as they age
- Continue to offer protein snacks

Nutrition: School-age

Eats adult portions by end of school-age years

Nutrition: Adolescents

- Calcium and iron are more important nutrients in addition to protein
- Need for increase calories to support growth spurt

Death: Infants/Toddlers/Preschoolers

Drowning

Death: School-age

MVA or transportation injury (pedestrian vs. car, bicycle, skateboard)

Death: Adolescents

Unintentional injury due to poor judgement and risky behavior followed by homicide

Physical Development: Infant

- Weight doubles in 6 months and triples in 1 year
- Height increases by 50% by year 1
- Head growth is rapid

Language Development: Infant

- Coos/babbles at 3 months
- Laughs at 4 months
- Understand "no" at 9 months
- Vowels consonants
- Can say ma ma and da da
- Progresses to four more words by 1 year

Physical Development: Preschool

- Weight growth is slow but steady gaining 4-5 lbs per year
- Height increases 2-3 inches per year
- By end of school age girls gain more height and weight than boys

Physical Development: Adolescents

- Rapid period of growth
- Can grow 15-65 lbs by the age of 18
- Rapid growth in height. Slows after menarche and stops at age 16 for girls and late teens for boys

Physical Development: School-age

By end of school age girls gain more height and weight than boys

Physical Development: Toddlers

- Weight growth slows
- Weight is 4x the birth weight at 2.5 years old
- At 2 years old, height is approximately 50% of adult weight

Language Development: Toddlers

Multiword, 4-5 simple sentences by 3 years old

Language Development: Preschool

Huge increase in vocabulary (2,100 words), enjoys talking, uses grammar in sentences

Language Development: Adolescents

Mastered language and conversation

Fine and Gross Motor Development: Infant

Gross --> posture, head balance, sitting, creeping, standing, walking
Fine --> use of hands and fingers to grasp objects

3 months- desire to grasp
4 months- head control
5 months- two handed grasp
6 months- rolls back to abdomen, holds bottle
8 months- sits alone
9 months- stands alone onto furniture
10 months- crawls, pincer grasp
11 months- creeps and then cruises
12 months- walks with one hand held

Fine and Gross Motor Development: Toddlers

Still clumsy. Motor coordination advances to walking, jumping, running, stair climbing

15 months- walks independently, uses a cup, builds tower of blocks
18 months- jumps, throws ball, turns pages in book
24 months- walks up the stairs (two feet on each stair), runs
36 months- stands on tiptoe, draws a circle

Fine and Gross Motor Development: Preschool

Well-coordinated, rides tricycles, skips, hops, balances on alternate feet

3 years old- rides tricycle
4 years old- skips, hops on one foot
5 years old- throws and catches a ball

Fine and Gross Motor Development: School-age

Movements become more limber, graceful, and coordinated

Fine and Gross Motor Development: Adolescents

Movements become more limber, graceful, and coordinated

Aerosol

- Use a mask especially for younger children
- Allow guardian to hold child during treatment and use a distraction

Oral

Hold child in what position?
Use medication through what?
Syringe use?
Do not mix what?
Can mix what?

- Upright position
- Allow infant to suck medication through nipple, syringe, or dropper
- Syringe use- place to side in buccal pouch to avoid aspiration
- Do not mix liquid medication in formula or juice unless medication needs to be crushed
- Can mix with small amount of applesauce for older children

Optic

Position?
How to apply medication?
Best time to administer ointment?

- Supine or sitting position. Ask child to look up
- Pull down lower eye lid and apply medication
- Before nap or bedtime

Otic

Position?
How to apply medication for children younger than 3?
How to apply medication for children 3+?

- Prone or supine position with affected ear up
- Pull pinna down and back
- Pull pinna up and back

Rectal

Insert quickly and hold buttocks together for 5 minutes. Distract child with book or TV

Nasal

Position for infant?
Position for child?
How to administer medication?

- Hold infant in football position
- Position child with head extended
- Insert tip vertically and then angle prior to administration

Intradermal

Administer inside surface of forearm

Will need to restrain younger child in parents/nurses lap or swaddle. Parent/nurse needs to hug and coddle immediately after injection

Subcutaneous

Where to administer for infants?
Where to administer for young children?

- Anterior thigh for infant
- Upper lateral arm for young children in cooperative

Will need to restrain younger child in parents/nurses lap or swaddle. Parent/nurse needs to hug and coddle immediately after injection

Intramuscular

When to administer?
Where to administer for infants?
Where to administer for young children?

- Apply Emla cream to site 60 minutes before injection
- Vastus lateralis for infant
- Deltoid for young children if cooperative

Will need to restrain younger child in parents/nurses lap or swaddle. Parent/nurse needs to hug and coddle immediately after injection

Intravenous

When to administer?
Avoid what?

- Apply Emla cream to site 60 minutes before injection
- Avoid using child's dominant hand

Assessment of Pain: Infant/Toddlers and Nonverbal Children to 7 years

FLACC score (faces, legs, activity, cry, consolability)

Assessment of Pain: Preschool

FACES scale

Assessment of Pain: School-age

FACES scale and numeric scale for 5 and older

Assessment of Pain: Adolescents

Numeric scale

Immunizations

Birth- Hep B
1 month- Hep B
2 months- RV, DTaP, Hib, PCV, IPV
4 months- Rv, DTaP, Hib, PCV, IPV
6 months- Hep B, RV, DTaP, Hib, PCV, IPV, Influenza yearly
12 months- DTaP, Hib, PCV
15 months- MMR, Varicella influenza
4-6 years- DTaP, IPV, Influenza, MMR, Varicella

Precautions, Contraindications, Administration of: Hep B

Age of vaccine
Administration
Precautions
Contraindications
Side effects
Adverse effects

- Birth, 1 month, 6 months
- IM administration
- Low birth weight
- Anaphylactic allergy to yeast
- Injection site reactions (pain, soreness, redness, swelling), low grade fever
- Allergic reaction, dizziness, vision changes

Precautions, Contraindications, Administration of:
DTaP

Age of vaccine
Administration
Precautions
Contraindications
Side effects
Adverse effects

- 2 months, 4 months, 6 months, 15-18 months, 4-6 years
- IM administration
- Seizures
- Encephalopathy (brain disease that alters brain function)
- Injection site reactions, low grade fever
- Fever 105 or higher

Precautions, Contraindications, Administration of: HiB

Age of vaccine
Administration
Precautions
Contraindications
Side effects
Adverse effects

- 2 months, 4 months, 6 months, 12-15 months
- IM administration
- No precautions
- No contraindications
- Injection site reactions, low grade fever
- Fever 101 or higher. Vomiting, diarrhea, irritability

Precautions, Contraindications, Administration of: PCV

Age of vaccine
Administration
Precautions
Contraindications
Side effects
Adverse effects

- 2 months, 4 months, 6 months, 12-15 months
- IM administration
- No precautions
- Anaphylactic reaction to vaccines
- Injection site reactions, low grade fever
- Anorexia, irritability

Precautions, Contraindications, Administration of: IPV

Age of vaccine
Administration
Precautions
Contraindications
Side effects
Adverse effects

- 2 months, 4 months, 6 months, 4-6 years
- IM administration
- Pregnancy
- Anaphylactic reaction to neomycin, streptomycin, or polymyxin
- Injection site reactions, low grade fever
- No adverse effects

Precautions, Contraindications, Administration of: MMR

Age of vaccine
Administration
Precautions
Contraindications
Side effects
Adverse effects

- 12-15 months, 4-6 years
- SQ administration (store in freezer)
- Anaphylactic reaction to eggs, gelatin, or neomycin
- Pregnancy
- Injection site reactions, low grade fever
- Thrombocytopenia, seizures, joint pain

Precautions, Contraindications, Administration of: Varicella

Age of vaccine
Administration
Precautions
Contraindications
Side effects
Adverse effects

- 12-15 months, 4-6 years
- SQ administration (store in freezer)
- Corticosteroid or antiviral use
- Pregnancy, anaphylactic shock to gelatin or neomycin
- Injection site reactions, low grade fever, rash
- Encephalitis (inflammation to the brain due to infection). RARE

Erythema Infectiosum: "Fifth's Disease"

Precautions
Assessment
Incubation

- Contact and droplet
- Upper respiratory issues before rash starts- runny nose, dry cough, stuffy nose, and then a rash will appear. First appears on face aka "slapped face" then followed by body rash. Rash fades and skin is itchy
- 4-21 days

Pertussis: "Whooping Cough"

Precautions
Assessment
Incubation

- Contact and droplet
- Low grade fever, sneezing, watery eyes. Severe coughing (gets worse at night), coughing fits, violent and rapid coughing, loud "whooping" sound upon inspiration. Protruding tongue
- 6-20 days

Rubella: "German Measles"

Precautions
Assessment
Incubation

- Contact and droplet
- Low grade fever, coryza, cough. Rash starts on face then spreads down to the rest of the body lasting 2-3 days
- 14-21 days

Rubeola: "Measles"

Precautions
Assessment
Incubation

- Contact and airborne
- Fever, malaise, three "C's" (cough, coryza, conjunctivitis with photophobia) followed by Koplik (tiny white spots) appear in mouth 2 days before rash. Red/reddish-brown rash begins on face spreading downward
- 10-20 days

Mumps

Precautions
Assessment
Incubation

- Contact and airborne
- Fever, headache, earache, painful and swollen parotid glands, can lead to deafness, meningitis
- 14-21 days

Varicella: "Chicken Pox"

Precautions
Assessment
Incubation

- Contact and airborne
- Fever, malaise, crust to all parts of the body irritability
- 2-3 weeks

Phenylketonuria (PKU)

Definition
Interventions
Treatment

- When you don't have enough enzymes to digest proteins
- Diet, positive PKU newborn screening, able to breastfeed, monitor for cognitive impairment
- Strict diet with limited protein

Myelomeningocele (Spina Bifida)

Definition
Interventions
Treatment

- Folic acid deficiency
- Protect the sac from injury (use sterile moist dressing), no diapers or clothing (will need radiant warmer), prone or side-lying position, surgery within 24-72 hours
- Protect infection and skin integrity

Necrotizing Enterocolitis

Definition
Interventions

- A serious gastrointestinal problem that mostly affects premature babies
- Surgery to remove necrotized bowel

Respiratory Distress Syndrome (RDS)

Definition
Interventions

- Lung disease that affects newborns and prevents normal breathing
- Prone position (increases chest expansion), oxygen, NPO if RR is >60 and TPN, beractant (helps lungs function normally), prophylactic antibiotics, may require mechanical ventilation

Congenital Hypothyroidism

Definition
Interventions

- Absent or non-functioning thyroid gland
- Levothyroxine (needs lifelong), administer in morning 30 min prior to feeding

Hyperbilirubinemia

Definition
Interventions/Treatments

- Too much bilirubin in your baby's blood
- Breastfeeding, phototherapy (expose as much skin as possible), protect eyes, monitor temperature, immunoglobulin if RH incompatibility, transfusion of severely high bilirubin

Iron Toxicity

Interventions
Assessments

*Interventions:*
- Gastric lavage
- IV chelation
- Parental education

*Assessments:*
- Hematemesis (vomiting blood)
- Hepatoxicity (ALT >40, AST >56)
- Can lead to metabolic acidosis, hypoglycemia, shock, death

Lead Toxicity

Interventions
Assessments

*Interventions:*
- IV chelation therapy
- Parental education
- Social services
- Individualized plan

*Assessments:*
- Hyperactivity, impulsive, inattention, intellectual mild impairment, cognitive delay
- Can progress to severe cognitive impairment, paralysis, nephrotoxicity, seizures, death
- Lead level

Acetaminophen Toxicity

Interventions
Assessments

*Interventions:*
- Administer antidote (n-acetylcysteine PO)
- Teach parents dosage limits

*Assessments:*
- Nausea, vomiting
- RUQ pain, jaundice, hepatoxicity, hypercoagulation
- Can progress to death

Acetylsalicylic Acid (Aspirin) Poisoning:

Interventions
Assessments

*Interventions:*
- Gastric lavage with activated charcoal
- Sodium bicarb
- O2, mechanical ventilation
- Vitamin K for hemorrhage
- Teach parents to avoid all products containing ASA

*Assessments:*
- Nausea, vomiting, GI bleed, dehydration, hemorrhage
- Confusion, seizures
- Can lead to Reyes Syndrome and death

Depression

What medication is prescribed?
Non-pharmacological intervention?

- SSRI's. Medications ending in -etine or -opram (fluoxetine, citalopram)

- Therapeutic plan/individual and family counseling

PTSD

What medication is prescribed?
Non-pharmacological intervention?

- SNRI's (serotonin and norepinephrine reuptake inhibitors)

- Psychotherapy

ADHD

What medication is prescribed?
Non-pharmacological intervention?

- Methylphenidate

- Behavioral modification, academic support, social skills, therapy

Autism

What medication is prescribed?
Non-pharmacological intervention?

- No medication

- Specialized treatment, behavioral modification, decrease environment stimuli, introduce new situations slowly, reward system

Cognitive Impairment

What medication is prescribed?
Non-pharmacological intervention?

- No medication

- Individualized plan, encourage growth and development, socialization, self care, protect from injury

Symptoms of PTSD

Psychosis initially followed by numbness and calmness. After 2-3 months and beyond there are flashbacks, somatic conversation, anxiety, phobia, obsessions, and depression

Signs and Symptoms of AOM (Acute Otitis Media)

- Rubbing or pulling on the ear
- Crying
- Lethargy
- Rhinorrhea, vomiting, diarrhea
- Bulging yellow or red tympanic membrane
- Purulent material in middle of ear or drainage from external canal
- Decreased or no tympanic movement with pneumatic otoscope

Difference of AOM in an infant and school-age child

- Most commonly found in the ages of 6-24 months
- Lower incidence with breastfed babies
- Higher incidence in babies that have bottle propped up, sleep with a bottle, in house with a smoker, cleft lip palate, down syndrome

What is a spacer? Why is it used?

A device that attaches to the end of your inhaler. Helps by getting the medication straight to where its needed in the lungs

Post-op instructions for a child who had a Tonsillectomy?

Signs of incision hemorrhage?

- Analgesic drugs PO or IV
- Elevate HOB to facilitate drainage
- Ice chips, cool liquids, ice pops (not red)
- Ice collar
- Avoid vigorous tooth brushing, spicy, citrus, dairy foods, gargling

Client Education:
- Avoid coughing, throat clearing, nose blowing
- Avoid straws
- Notify provider if bright-red bleeding occurs
- Rest as much as possible

- Frequent swallowing, tachycardia, hypotension

Medication to administer for asthma exacerbation

What medication is used for chronic maintenance of asthma?

- Beta 2 Adrenergic Agents (medications ending in -erol --> can be oral, inhaled, or nebulizer)

- Albuterol- short acting
- Formoterol- long acting

- Montelukast

Side effects for asthma exacerbation

- Mouth irritation
- Tachycardia
- Palpitation
- Tremors
- Seizures

Interventions if asthma exacerbation occurs

What are the interventions for Cystic Fibrosis? Why?

Reduces the risk for respiratory infectionsT

- Hand washing
- Airway clearance
- Fluids to loosen secretions
- Bronchodilators
- O2
- IV antibiotics
- High calorie protein diet
- Pancreatic enzymes with meals
- ADEK vitamins

Tinea Capitis

Ringworm of the scalp

"Lice", scaly, itchy lesions with alopecia to the scalp

Tinea Coporis

Ringworm of the body

Round erythema, itchy scaling patches with cleared center to body

Tinea Cruis

Jock itch

Round erythema, itchy patches with scales to thigh and groin folds

Tinea Pedis

Athlete's foot

Erythema and cracking lesions between the toes and feet

Interventions for Pediculosis Capitis (Lice)

- OTC permethrin shampoo
- Removal of nits after shampooing with cream rinse
- Wash linens and towels in hot water and hot dryer
- Seal non-washable items in a plastic bag for two weeks

Interventions for a partial-thickness burn?

- Pain management
- Prevention of infection- silver sulfadiazine and bacitracin
- Hydration
- Nutritional support

Candida Diaper Dermatitis Interventions (5)

- Air dry (no diaper) as much as possible
- Change soiled diapers ASAP
- Clean gently
- Apply anti-fungal Nystatin cream
- If severe- oral nystatin liquid swish and swallow in addition to cream

Contact Diaper Dermatitis Interventions (4)

- Air dry (no diaper) as much as possible
- Change soiled diapers ASAP
- Clean gently- avoid allergic agents
- Apply skin barrier. Do not wash off with diaper change

Treatment for Seborrheic Dermatitis (3)

- Gently remove scales with wash cloth and comb through hair
- Apply mineral oil to scalp
- Use OTC anti-seborrheic shampoo

Treatment for Scabies (4)

- Rx 5% Permethrin cream
- Wash cream off body in 8-14 hours
- Wash linens and towels in hot water and hot dryer
- Seal non-washable items in plastic bag for two weeks

Peak Time: NPH

4-14 hours (long intermediate-acting)

Peak Time: Regular Insulin

1-5 hours (short-acting)

Peak Time: Rapid Acting Insulin (Lispro)

0.5-2.5 hours

Hypoglycemia

Definition
Signs and symptoms

Blood glucose

Hyperglycemia

Definition
Signs and symtoms

Blood glucose >250

Thirst/polyuria, lethargic, nausea/vomiting, confusion, can lead to DKA