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Exam 2

Terms in this set (210)

toddler age range
12 mo - 3 yr
lordosis
lumbar curvature
toddlers are potbellied
what age should you not restrict fat?
<2 years
gross motor skill: walking up stairs
2 years
gross motor skill: hopping on one foot
3 years
fine motor skill: feeding self
15 months
fine motor skill: holding crayon w/ fingers
3 years
developmental theorists & main concept
Erikson - psychosocial
Freud - psychosexual
Piaget - cognitive
Kohlberg - moral
Erikson stages
autonomy vs shame & doubt
initiative vs guilt
industry vs inferiority
identity vs role confusion
Erikson: toddler
autonomy vs shame & doubt

ambivalence, negativism, temper tantrums
Erikson: preschool
initiative vs guilt

3-6 yr
praise & positive reinforcement
Erikson: school age
industry vs inferiority

6-12 yr
jealousy
Erikson: adolescence
identity vs role confusion

12-18 yr
rebellion, peer pressure, ambivalence
Freud stages
anal
phallic
latent
genital
Freud: toddler
anal stage

"food jags"
toilet training
bedtime rituals
nighttime fears
Freud: preschool
phallic stage

masturbation
gender identification
Oedipal/Electra complex
Freud: school age
latent stage

same sex peer relationships
privacy & modesty
Freud: adolescence
genital stage

intimacy
safe sex
Piaget stages
preoperational
preoperational
concrete operational
formal operational
Piaget: toddler
preoperational

object permanence
egocentrism/difficulty sharing
poor concept of time
poor body boundaries
imaginary playmates
Piaget: preschool
preoperational

lack conservation & reversibility
share better
symbolic play
magical thinking, animisim
Piaget: school age
concrete operational

starting to understand conservation
cause/effect & safety
sorting into multiple categories
collections
Piaget: adolescence
formal operational

formal reasoning
abstract thinking
imaginary audience
egocentrism/personal fable
Kohlberg stages
doesn't apply to toddlers
preconventional
conventional
conventional & post conventional
Kohlberg: toddler
moral doesn't apply to toddlers
Kohlberg: preschool
preconventional

conscience: right vs wrong
role models
story telling
Kohlberg: school age
conventional

societal expectations
follow rules
bullying
Kohlberg: adolescence
80% conventional & 20% post conventional

making own decisions
spiritual awareness
play styles per age group
toddler: parallel
preschool: co-op/associative
school age: team play
adolescent: competitive
bladder or bowel continence comes first?
bowel
when should child be potty trained?
1 yr after starts to walk
when should bladder training be accomplished?
by 3.5 yr
when should nighttime training be accomplished?
by 5 yr
how do you combat negativism?
give positive direction for what toddler can do
dawdling teaching
teach parents to allow more time to enjoy the beauty in life
time out teaching
immediate
short duration
discuss alternate solutions
when should you not reason with a toddler?
during a temper tantrum
separation anxiety
starts 6 mo
peaks preschool years
lasts up to 8 yr

relate time to events
object permanence age & toys
acquired ~8 mo
jack in box, nesting, sorting, peekaboo
critical time for self esteem development
1.5 - 3 yr
language contraction & expansion
toddler "me do it"
parent "you will do it"
toddler 3 developmental challenges
toilet training
meal time
bedtime
toddler play type & toys
parallel play
push/pull, fill/dump
imaginary friend
2.5 - 5 yr
higher IQ
normal & ok for parents to foster
child must take responsibility for wrongdoings
common toddler injuries
MVA
burns
ingesting poisons
choking
drowning
preschool age range
3-5 yr
gross motor skill: riding tricycle
3 yr
fine motor skill: using scissors
4 yr
fine motor skill: tying shoelaces
some 5 yr can, some need help
young masturbation age & teaching
preschool

use correct terms
matter of fact
done in private
avoid instilling guilt
animism
preschool

lifelike qualities to inanimate objects
turn beeping monitors around
centration
can only focus on 1 concept at a time

preschool
lack of conservation & reversibility
preschool
Oedipal/Electra complex & age
phallic stage/preschool
Oedipal: boys desire mom, but fear dad's punishment
Electra: girls desire dad, but fear mom's punishment
what do preschoolers need in their breakfast, & why?
protein
for growth
preschool play types & toys
co-op/associative
dramatic/dress up
symbolic/learn roles

puzzles & books
school age age range
6-12 yr
deciduous teeth loss age
6-7 yr
when do children want modesty & privacy?
6-12 yr/school age
when are same sex peers common?
school age
when do children like doing tasks to completion?
school age
how much screen time is ok?
limit to 1-2 hr/day
when do children achieve conservation of mass/volume?
school age
when do children understand reversibility?
school age
when do children understand causation (cause/effect)?
school age
when do children understand seriation, classification, & collections?
school age
debug bullying
D - decide to ignore
E - exit, walk away
B - be friendly
U - use firm talk
G - get adult help
what time should discipline be avoided?
meal time
6 yr old requires how much sleep?
12 hrs
11 yr old requires how much sleep?
10 hrs
toddler/preschooler view of death
preoperational
views as reversible
magical thinking
school age view of death
concrete operational
death is permanent but punishment
adolescent/young adult view of death
formal operational
views as universal
accepting of death
infectious mononucleosis
AKA Epstein-Barr virus
herpes-like
spread: saliva & intimacy
infectious mono/EBV clinical manifestations
lethargy
fatigue
miss a lot of school
splenomegaly
swollen lymph nodes
sore throat
abdomen palpation in mono/EBV
carefully; avoid rupture
esp during 2nd week of illness
mono/EBV tests
↑ WBC w/ >10% atypical lymphocyte count
throat cultures to r/o strep
when should mono/EBV seek medical attention?
pain in abdomen
trouble breathing or drinking fluids
sepsis
systemic overresponse to bacterial, fungal, viral, or parasite infection
sepsis AKA
septicemia
SIRS systemic inflammatory response syndrome
who is more susceptible to sepsis? why?
neonates
lack of IgM function (bacterial protection)
neonatal sepsis s/s
hypothermia
hypotension (septic shock)
apnea
bradycardia
nonspecific (lethargy, feeding intolerance)
child sepsis s/s
hypotension (septic shock)
fever
tachypnea
tachycardia
what order for septic neonate?
NPO to prevent NEC
sepsis abx
ampicillin
aminoglycosides (-mycin)
IgA is for what?
viral
IgE is for what?
allergy
parasites
IgG is for what?
bacterial
IgM is for what?
bacterial
SCID
severe combined immunodeficiency disease

absence of humoral & cell mediated immunity
Swiss-type lymphopenic agammaglobulinemia
autosomal recessive
X-linked lymphopenic agammaglobulinemia
X-linked recessive
SCID, Swiss-type, & XLA s/s
after prenatal immunity is exhausted:

chronic opportunistic infections
leads to organic FTT
SCID, Swiss-type, & XLA lab findings
no T or B cell function
no natural killer (NK) cell immunity
immunoglobulin deficiency
SCID, Swiss-type, & XLA precautions
reverse barrier (protective) isolation
CMV neg, lymphocyte removed, irradiated blood
T lymphocytes in blood products can cause what in SCID?
fatal graft vs host disease (GVHD)
SCID therapeutic management
hematopoietic stem cell transplant
must be human leukocyte antigen compatible (HLA)
GVHD s/s
maculopapular rash
begins on hands & soles of feet
HIV/AIDS patho
↓ CD4 T-cells
poor functioning B-cells
non fuctioning immunoglobulins
AIDS defining opportunistic infections lab value
T4 lymphocyte below 200 cells
HIV tests
DNA polymerase chain reaction (PCR)
RNA assay (viral load)
AIDS defining opportunistic infections
Pneumocystis jiroveci pneumonia
Candidiasis
Cryptococcosis
Mycobacterium avium complex (MAC)
Pneumocystis jiroveci pneumonia
AIDS defining OI
fungal
Bactrim
doesn't respond to anti fungals
Candidiasis
AIDS defining OI
most common (9/10 pts w/ HIV)
Tx: antifungals
Cryptococcosis
AIDS defining OI
most life-threatening
from bird shit
Bactrim things to know
Pneumocystis jiroveci pneumonia

Sulfa-Trimetho
sulfa allergy
sunlight
SJS
fluids to ↓ crystalluria
MAC
AIDS defining OI
Mycobacterium avium complex
oral ingestion, inhalation
anemia common
most common bacterial infection
Rifabutin for life
Kaposi sarcoma
purplish lesion
AIDS hallmark
AIDS defining diagnoses
Kaposi's sarcoma
Non-Hodgkin's lymphoma
invasive cervical cancer
liomyosarcoma
lymphocytic interstitial pneumonia (LIP)
conditions unique to AIDS
HIV encephalopathy AKA AIDS dementia
HIV wasting syndrome
HIV wasting syndrome Tx
↑ protein
↑ calories
what can help AIDS pt to eat?
viscous lidocaine or Myle's Magic
↓ oral sore pain to ↑ eating
highly active antiretroviral therapy (HAART)
2 nucleoside analogs + 1 protease inhib
nucleoside analog reverse transcriptase inhibitors (NRTI)
target viral replication at reverse transcriptase phase
zidovudine (AZT)
given to HIV+ mothers after 14 wk gestation & newborns
reduces transmission to below 50%
protease inhibitors
blocks viral replication necessary enzyme
Kaletra-Lopinavir/Ritonavir combo
approved for children under 2 yr
what increases HIV quality of life?
protease inhibitors
non-nucleoside reverse transcriptase inhibitors (NNRTI)
efavirenz (Sustiva)
immediately notify if rash
HIV alternate
1 NRTI & 1 NNRTI
(zidovudine/AZT & efavirenz/Sustiva)
fusion inhibitor
entry inhibitor

stops HIV from entering or binding
integrase inhibitor
raltegravir (Isentress)

blocks HIV enzyme from splicing itself into human DNA
4 things to do with HIV infected mothers
1.) HAART prevents perinatal transmission
2.) oral AZT after 14th wk gestation
3.) IV AZT during L&D
4.) no breastfeeding
latex allergy foods to avoid
BLACK
banana
latex
avocado
chestnut
kiwi
when do you introduce gluten to infant?
gradually from 4+ months
during ongoing breastfeeding
how do you introduce new foods to babies?
one at a time
at least one week apart
what happens during anaphylaxis?
antigen enters
vasoactive (hist)amines
vasodilation & bronchoconstriction
↑ capillary permeability
vascular collapse & cardiac arrest
anaphylaxis Tx
restore circulation:
CPR
IVF
epinephrine/EpiPen
corticosteroids & antihistamines
EpiPen things to know
should have at least 2 Tx
follow up w/ med care
can inject through clothes
maintain in skin at least 10 sec
diaper dermatitis barrier/protective sealants
A+D
zinc oxide
calmoseptine paste
Desitin
what can't corticosteroids be used on? why?
diaper dermatitis
face

diaper = no air exposure
causes ↑ levels, ↑ side effects
diaper dermatitis/rash causes
infrequent diaper changes
soaps
bubble baths
lotions
laundry detergents
diaper dermatitis/rash recommended diaper changes
infants: every hr
older: every 2 hr
how do you clean diaper dermatitis/rash skin?
mild soap & water
rinse well
candida rash description
red pin point satellite lesions
oral candidiasis AKA
thrush
moniliasis
candida Txs
oral: Mycostatin suspension 4x/day
swish & swallow

perineal: Nystatin cream 4x/day, Calmoseptine

vaginal: suppositories or creams
seborrheic dermatitis
Malassezia furfur

infant cradle cap
yellow scales
massage emollient/oil & let sit 20 min

adolescent dandruff
impetigo
Staphylococcus aureus

fluid filled vesicles/pustules that rupture, forming honey colored crust
highly contagious until healed
pruritis
impetigo Tx
wash lesions 3x/day warm antiseptic soapy water

cool compress BID or Burrow solution
topical bactericidal: Bactroban
what pts are at risk for impetigo?
pts w/ eczema
failure to respond to impetigo Tx
may indicate MRSA infection
abx Clindamycin
cellulitis
bacterial infection of SQ & dermis
lymphangitis streaking & lymph node involvement
Cellulitis teaching
shadowing/draw line around to check if worsening

potential complications to watch out for:
osteomyelitis/bone pain
fever
sepsis s/s
Tinea
ringworm
fungi: dermatophytes

Tinea capitis (head)
Tinea corporis (body)
Tinea pedis (feet)
ringworm Tx
topical alone ineffective
oral & topical antifungal griseofulvin
continue Tx 1-2 wks post lesions clearing
SJS
severe form of erythema multiforme
lesions of skin & MM, fever, & multiple systemic symptoms
what can cause SJS?
medication hypersensitivity
infectious disease reaction, ex: Mycoplasma
what skin conditions are commonly mistaken?
SJS thought to be chicken pox
bullae
fluid filled blisters
SJS lesion description
irregular borders
bullae may rupture, causing fluid loss
SJS s/s
fever & malaise first
rash except scalp & MM
SJS Tx rationale
reverse iso
↑ protein (wound healing)
↑ fluids
viscous lidocaine
good oral hygiene
daily ophthal exam (conjuctivitis/corneal ulcers)
abx, corticosteroids
atopic dermatitis
AKA eczema
epidermis superficial inflammation
erythemic, oozing, itchy vesicles that crust
mutation in filaggrin gene
can develop impetigo
xerosis
dry skin
eczema immune response
IgE & T cell mediated
eczema clinical therapy
hydrate skin: lotion 5 min after bath
relieve pruritis
↓ inflammation w/ corticosteroid cream
prevent/control secondary infection
acne vulgaris
hair follicle obstruction & inflammation
causes comedones, papules, pustules, nodules, & cysts
severe acne vulgaris Tx
isotretinoin (Accutane)
teratogenic
lice
AKA pediculosis
parasitic insects

Pediculosis capitis (head)
Pediculosis corporis (body)
Pediculosis pubis (pubic area)
pediculosis Tx
permethrin 1% (Nix) shampoo

lindane (Kwell) shampoo no longer recommended. neurotoxic. causes seizures
how long can lice survive off host?
48 hr
hatch in 7-10 days

retreatment may be req
scabies
parasitic mites
intense itching 1-2 mo after initial contact
scabies Tx
warm soap & water
topical scabicide (Elimite) left on 8-48 hr

oral antihistamines: ↓ itching to ↓ secondary infection from itching open wound
common causes of burns
#1 hot water
#1 grease

scald & contact are highest risk of burn injuries in children <10 yr
water temp should be set to?
<120 °F
superficial partial thickness burns
1st °
sun or brief scald
heals 5-10 days w/o scar
partial thickness burns
2nd °
epidermis & some dermis
heal by re-epithelialization
heals 14 days
variable scarring
may become full thickness if gets infected
full thickness burns
3rd °: epidermis, dermis, & SQ
4th °: muscle/fascia/bone exposed
nerve ends destroyed
pain returns as nerves regenerate
regeneration cannot occur
grafting always required
rule of 9's: child
18% head
18% front trunk
18% back trunk
9% L arm
9% R arm
13.5% L leg
13.5% R leg
1% genitals
rule of 9's: adult
9% head
18% front trunk
18% back trunk
9% L arm
9% R arm
18% L leg
18% R leg
1% genitals
rule of palms
child's palm + fingers = 1% body surface area
BSA calculation
√[cm x kg / 3600]

answer in ㎡
Parkland burn fluid replacement formula
4 ml x TBSA x weight in kg
1st half given in 1st 8 hr
2nd half given in 16 hr left

ex: 25 kg child, 10% burn
4 x 10 x 25 = 1,000 ml
500 ml given in 1st 8 hr
500 ml given in 16 hr left
fluids for burn replacement
LR or NS

w/ dextrose for children
when replacing fluid in burn pt, watch for?
FO when capillaries can seal again

maintain urine output of 1 ml/kg/hr
moderate to severe burn: what are infants at risk for? children?
infants at risk for hypoglycemia
children at risk for hyperglycemia
Curling's stress ulcer
duodenal ulcer in severe burn pts

↓BP from shock caused ↓ blood supply, which causes ischemia
thing to know about giving abx to burn pts
given at low therapeutic range to make sure kidneys are functioning
what precaution are burn pts on?
seizure

from ECF loss and Na+ imbalance
where does greatest damage from electrical burns occur?
entry & exit points

watch for AKI
hydrotherapy purposes
overall hygiene
debride wound
ROM
dressing changes
1x/day baths
why must dead skin be debrided?
not capable of regeration
autograft
skin graft from pt's own body
allograft (homograft)
skin graft from human cadaver
xenograft (heterograft)
skin graft from another species, usually pig
elastic/pressure garments & face shields
minimize scarring in burn pts
splints
prevent flexure contractions in burn pts
vaccine fridge temp
36-48°F
2-8°C
vaccine freezer temp
-58 to 5°F
-50 to -15°C
vaccines that must be in freezer
Var (chicken pox)
MMRV
ZVL (shingles)
vaccine that can go in fridge or freezer
MMR
6 step vaccine process
1. assess immunization record
2. check current schedule
3. ask screening Qs
4. educate parent/client
5. administer vaccine
6. document
how many vaccines required for immunity?
inactivated: 3-5
live attenuated: 1-2
where did first "vaccine" come from?
small pox 1,000+ yrs ago
if baby spits up Rotavirus vaccine, what do you do?
do not repeat dose
when can child receive measles vaccine?
12-15 mo
again at 4-6 yr
measles herd immunity percent
95%
polio herd immunity percent
85%
because less contagious
VAERS
Vaccine Adverse Event Reporting System

reporting errors & reactions
pneumococcal vaccine thing to know
do not give PCV13 & PPSV23 at same visit
DTaP vs Tdap
DTaP: 6wk-6yr. do not use in 7+ yr
Tdap: adults & booster
HPV vaccine
11/12-26 yr
ok in 9yr w/ Hx of SA
how is MMR given?
SQ
12-15 mo & 4-6 yr
preferred herpes zoster/shingles vaccine?
RZV (Shingrix)
influenza vaccine recommendation
all people 6 months & older, every year
why do you screen at every vaccine visit?
immunosuppression status
allergies change
what do you have to give every vaccine pt?
vaccine information statement (VIS)
federally required

cannot come from CDC because it lacks MCIR language
preferred vaccine site 12 mo - 2 yr
anterolateral thigh
preferred vaccine site 3+ yr
deltoid

can still use anterolateral thigh
sycope/fainting after vaccine occurs when?
within 15 min of vaccine
adolescents & young adults
6 required vaccine documentation elements
1. date vaccine given
2. date VIS given
3. VIS publication date
4. vaccine manufacturer
5. lot #
6. signature & title of vaccine giver
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