Exam 1 Pediatric and Hospice Nursing Review

Hospice Care and Eligibility

• Client Management: Utilize the hospice team for managing shortness of breath in lung cancer patients.
• Eligibility Criteria: Restricted to terminally ill clients, such as those with breast cancer and $3\text{ months}$ to live, terminal lung cancer patients who have stopped treatment, or end-stage kidney disease patients who have ceased dialysis.

Newborn and Infant Assessment

• PKU (Phenylketonuria): Include a low protein diet in the Plan of Care (POC).
• Autism Spectrum: Characterized by repetitive movements.
• Pain Indicators: A furrowed brow in a $6\text{ month old}$ infant suggests pain.
• Fontanels: The anterior fontanel closes at $18\text{ months}$; the posterior fontanel closes at $2\text{ months}$.
• Ear Assessment: The light reflex is found at the $7\text{ o'clock}$ position.
• Reflexes:   - Doll's eye: Disappears as the neurological system matures.   - Crawl: Disappears around $6\text{ weeks}$.   - Babinski: Positive sign when the big toe goes up and others fan outward.
• Weight: Birth weight should triple by $12\text{ months}$.

Vital Signs and Physical Care

• Newborn RR: $30$ to $60\text{ breaths per minute}$. Report apnea lasting over $20\text{ seconds}$, retractions, grunting, or nasal flaring.
• Infant Vitals:   - Temp: $97.7$ to $99.3^{\circ}F$ (Fever evaluation required over $100.4^{\circ}F$).   - HR: $109$ to $164\text{ bpm}$.   - BP: Approximately $64/41\text{ mmHg}$.   - O2: $95$ to $100\%$.
• Spina Bifida: Requires a latex-free environment.
• Jaundice Prevention: Frequent feeding within the first $4\text{ hours}$ after birth.
• Assessment Sequence: Use a modified head-to-toe approach; do least invasive procedures first, leaving ENT, BP, and painful areas for last.

Immunizations and Medical Procedures

• Injection Technique: Administer Penicillin IM at a $90\text{ degree}$ angle for adults.
• Pediatric Vaccination: For preschoolers, use a $1.8\text{ mm} / 0.5\text{ inch}$ needle in the deltoid muscle.
• MMR Vaccine: Contraindicated for $15\text{ month old}$ infants who are immunocompromised.
• Vaccine Schedule:   - $11\text{ year old}$: Tdap.   - $4\text{ year old}$: Tdap, IPV, MMR, and Varicella.   - College Students: Meningitis vaccine.
• Medication Administration: Offer juice or water to help a resistant $4\text{ year old}$ take medicine.

Developmental Milestones and Psychosocial Stages

• $3\text{ months}$: Lifts head, coos, social smile.
• $6\text{ months}$: Rolls over, sits with support.
• $12\text{ months}$: Walks with support, speaks $1$ to $3\text{ words}$.
• $15\text{ months}$: Walks independently, stacks $2\text{ objects}$.
• $2\text{ years}$: Runs, kicks a ball, $2\text{ word sentences}$.
• $3\text{ years}$: Rides tricycle, put on clothes independently, $3\text{ word sentences}$.
• Erik Erikson (Toddler $1$ to $3\text{ years}$): Autonomy vs. Shame and Doubt (desire for independence; "me do it"). Use choice-offering strategies (e.g., "red cup or blue cup?").
• Pain Scales: Use the FLACC scale (Face, Legs, Activity, Cry, Consolability) for infants and the FACES scale for older children.

Safety, Nutrition, and Orthopedics

• Car Seat Safety: Rear-facing until age $2$; straps must be snug and flat with the buckle at armpit level; avoid bulky clothing.
• SIDS Prevention: Sleep on back, firm mattress, no pillows, blankets, or stuffed animals, and no smoke exposure.
• Nutrition:   - Infants: Breast milk or formula for the first year; solids introduced at $6\text{ months}$; intake of $24$ to $32\text{ oz}$ per day.   - Toddlers: Provide finger foods and small portions of quality foods.
• Spinal Curvature:   - Scoliosis: Sideways curve.   - Lordosis: Inward lumbar curve.