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Pediatrics Nursing Exam 1 Galen College of Nursing

Terms in this set (97)

Family Centered care involves
the family as a whole
A nurse should recognize the family without
judgement
Enabling
family is given opportunities
Empowering
family has a sense of control
Family is the ______________ in the child's life.
constant
Support personnel ______________ in the child's life.
fluctuate
While empowering a family a nurse should:
recognize and honor cultural diversity
encourage family to family support and networking
ensure health care is flexible, accessible and comprehensive
exchange complete and unbiased information
Reasoning
explaining to a child why something is wrong using age appropriate language
Preoperative stage
toddlers and preschoolers aren't able to distinguish between their point of view and those of others. (they may do something knowing it is wrong, but do it anyway knowing they will get attention, even if it is "bad" attention)
Scolding
often takes the form of shame or criticism, kids take this seriously and really think they ARE bad.
When disciplining a child focus on the ______________, NOT the child.
Misbehavior
Should you use "I" or "You" when disciplining?
"I"
Behavior Modification Theory
behavior that is rewarded will be repeated
Ignoring behavior will eventually ...
extinguish or minimize the act.
Do not ____________ to the child.
give in
Response burst
the child's bad behavior increases to test the parents and see if they are serious about the plan
Consequences in discipline
allowing children to experience the results of their behavior, 3 types.
3 types of consequences in discipline
Natural, logical and unrelated
Natural consequence of discipline
occur without intervention, such as being late and missing dinner
Logical consequence of discipline
directly related to the rule, such as not being allowed to play with a toy until all of the other ones are put away
Unrelated consequence of discipline
imposed deliberately, such as not playing until homework is completed or the use of "time out"
What consequence of discipline works best?
Natural or Logical
"time-out"
child is placed in an isolated and unstimulating place and becomes bored, wanting to behave to reenter the family group.
Time limit for "time-out"
1 minute per year of age
Corporal or physical punishment
spanking, this inflicts pain and a short term decrease in behavior
Flaws in corporal punishment:
teaches violence
may physically harm the child
children become accustomed to it and may need more severe punishment each time
interferes with effective parent-child interaction
may affect moral reasoning
What is atraumatic care?
"do no harm"
How does a nurse implement atraumatic care?
eliminating or minimizing the psychological and physical distress experienced by child and their family in the health care system, making sure that their primary concern is the concern of the welfare of the child and family
Ways for a nurse to implement atraumatic care:
prevent the child's separation from the parent
promote a sense of control (parent/child)
prevent bodily injury
foster parent-child relationships
prepare child for unknown procedure
control pain
provide play activities
provide choices
respect culture
Therapeutic relationship
relate to children and their families, yet remain separate enough to distinguish own feelings and needs
______________ promote family's control over child's health care (empowerment).
Boundaries
What does therapeutic care result in?
The family is empowered to self-care
A nurse needs to care but ___________ emotions to practice accurate therapeutic care.
detach
Health beliefs
related to the cause of illness and the maintenance of health are an integral part of the cultural heritage of families
Natural forces
cold air entering the body and impurities in the air (chinese believe cold weather, rain and wind are responsible for "cold" conditions.
Supernatural forces
evil influences such as voodoo, witchcraft or evil spirits (ex.: evil eye)
Imbalances of forces
Hot and cold - unrelated to temperature, cold weather, rain or cold wind are treated with "hot" foods, herbs or drugs, whereas menstruation is a "hot" condition treated with whole milk or non hot foods.
Anaclitic depression
A pattern of depressed behavior found among very young children that is caused by separation from one's mother, separation anxiety. Hits middle infancy-preschool aged children especially hard.
Protest phase of separation anxiety Infancy
crying, screaming, searching for parents with eyes, clinging to parent, avoiding and rejecting contact with strangers
Protest phase of separation anxiety Toddlers
verbally attacking strangers (Go away!), physically attacking strangers, attempting to escape to find parents
Protest phase of separation anxiety
behaviors may last from hours to days, protests may become continuous, ceasing only with physical exhaustion, approach of stranger may precipitate increased protest
Despair phase of separation anxiety
being inactive, withdrawing from others, depression, sadness, lacking interest in environment, being uncommunicative, regressing to earlier behavior, refusal to eat, drink
Detachment (denial) phase of separation anxiety
showing increased interest in surroundings, interacting with strangers or familiar caregivers, forming new but superficial relationships, appearing happy, rarely seen in hospitalized children, represent a superficial adjustment to loss
Separation anxiety School age children
Parents don't play as big a role as they do for infant/preschoolers although when asked separation is their biggest fear, hospitalization will increase their need for parental security and guidance
Separation anxiety Older School age children
reluctant to ask for help from other adults because they are seeking independence and don't want to appear weak, may get irritable with parents, withdrawal from hospital personnel, inability to relate to peers, rejection of siblings or subsequent behavioral problems at school
Separation anxiety Adolescents
Emotions range from difficulty coping, welcoming the event, loss of peer group contact could have a severe emotional threat
Trust vs. Mistrust
Infants - provide trust, consistent loving caregivers, daily routines based on child's needs (as close to home routine as possible)
Autonomy vs. Shame
Toddlers - daily routine and rituals, provide sense of control (tv shows, eating, sleeping, bathing, etc.)
During Autonomy vs. Shame stage a loss of control may lead to:
regression of behavior, negativity, temper tantrums (ignore this reaction)
Egocentric magical thinking
Preschoolers - imaginary friends, child may feel like they can control more than they really can (illness), may view illness or hospitalization as a punishment
Preoperational stage preschoolers
Understand explanations in terms of real events, will take things literally. (Ex: you will feel a stick when injecting a needle, child will literally think a stick is being used)
Independence and productivity
School age - strive for independence, most vulnerable to losing control because of hospitalization, give structured choices to provide control. Fears of death, abandonment, permanent injury. Boredom.
How to prepare an infant for a procedure?
trust and sensorimotor thought
involve parent in procedure
keep parent in childs line of vision
give child familiar object if parent can't stay
limit strangers
use sensory soothing measures
Sensory soothing measures
stroking skin, talking softly
How to prepare a toddler for a procedure?
explain what child will see, taste, feel, smell
emphasize aspects of a procedure that will require cooperation
tell child it is okay to cry, yell, etc.
use few, simple terms familiar to child
give one direction at a time
keep teaching sessions short
allow child to handle equipment
use play to demonstrate (not on favorite doll)
How to prepare a preschool aged child for a procedure?
explain in simple terms in relation to how it affects child
demonstrate use of equipment
use neutral words to describe procedure
state clearly that this is not a punishment
How to prepare a school age child for a procedure?
explain using correct scientific or medical terms
explain using simple diagrams
plan for longer teaching sessions
gain childs cooperation
tell child what is expected
allow responsibility for simple tasks
How to prepare an adolescent for a procedure?
explain long term consequences of procedures
provide privacy
encourage questioning
realize they may fear death or other risks
impose as few restrictions as possible
Pain scale for 3+ years old child:
Faces pain scale
Oucher scale
Pain scale for 4+ years old child:
Faces pain scale
Oucher scale
Poker chip tool
Word-graph rating scale
Pain scale for 4+ years old child
Faces pain scale
Oucher scale
Poker chip tool
Word-graph rating scale
Numeric scale
Pain scale for 7 yr + perferably
Visual analog scale
FLACC scale
Facial expressions, Legs (what they are doing), Activity (quiet, squirming, arched), Cry, Consolability
Best indicator for pain in young infant
Rigidity or thrashing, loud crying, facial expression (brows lowered and drawn together, eyes-tightly closed, mouth open and squarish), no association between approaching stimulus and subsequent pain
Best indicator for pain in older infant
deliberate withdrawal of stimulated area, loud crying, facial expressions of pain or anger, physical resistance, especially pushing stimulus away after it is applied
Best indicator for pain in young child
loud crying, screaming, verbal expression "ow", "ouch", "it hurts", thrashing of arms and legs, attempts to push stimulus away, requests termination of procedure, clinging to parent, nurse, request for emotional support (hugs), becoming restless or irritable with continuing pain, behaviors occurring before actual painful procedure
Best indicator for pain in school aged child
see all behaviors of young child especially during actual procedure, stalling behavior (wait a minute, i'm not ready), muscular rigidity (clenched fists, white knuckles, gritted teeth, contracted limbs, body stiffness, closed eyes, wrinkled foreheat)
Best indicator for pain in adolescents
less vocal protest, less motor activity, more verbal expressions, increased muscle tension and body control
Non pharmacological management of pain for children
distraction, relaxation, guided imagery, cutaneous stimulation, swaddling, sugar pacifier, rocking, holding, topical anethetics, sedatives
ELMA (numby stuff)
takes 30 minutes before it works
How are communicable diseases prevented?
immunizations, antibiotics and antitoxins
What is the role of nursing with communicable diseases?
prevent spreading and cross contamination, hand washing (nurse and teaching parents/children how), transmission precaution enforcement, know s/s of diseases and known possible complications, extra precautions for immunocompromised patients
What kind of precautions for measles?
droplet
What is the incubation period for measles?
10-20 days
What are Koplik's spots?
small irregular spots with bluish center in buccol mucosa, will appear 2 days before the measles rash will appear
What comfort measures should be taken for measles?
cool baths, lotions
What is the incubation period for mumps and rubella?
14-21 days
What are the signs and symptoms for mumps?
fever, malaise followed by parotisis and carotid inflammation
Treatment for mumps and Rubella?
antipyretic/analgesics
Complications of mumps?
orchitis, meningoencephalitis
Orchitis
testicular inflammation, treated with warmth and support
Meningoencephalitis
inflammation of the brain
What kind of precautions for pertussis, chicken pox, rubella, mumps?
droplet/direct contact precautions
What is the incubation period for pertussis (whooping cough)?
6-20 days
What are the signs and symptoms of pertussis?
short, rapid coughs followed by crowing of "whoop" sound
What is the treatment for pertussis?
oxygen, antibiotics if needed
What is a serious complication of pertussis?
pneumonia (usual cause of death)
What is the greatest danger or complication of Rubella?
teratogenic effect for fetus
What is the incubation period for Chicken Pox?
2-3 weeks (usually 14-16 days)
When is chicken pox contagious?
1 day before, 6 days after eruption of lesions
What is the treatment for Chicken pox?
keep child home, skin care (lotion, keep nails trimmed)
What should be avoided with chicken pox?
aspirins
Acyclovir (Zorvirax) is for what?
Chicken pox, lesions severeity # lesions, # days fever
Contraindication for DTP or DTaP immunization?
Encephalopathy within 7 days of administration of previous dose
Precautions for DTP or DTaP immunization?
fever of 105 within 48 hours after prior administration
collapse or shocklike state within 48 hours of previous administration
seizure within 3 days of receiving previous dose
persistant, inconsoluable crying lasting greater than 3 hours with in 48 hours of previous dose administration
Contraindication of inactive poliovirus vaccine (IPV)?
anaphylactic reaction to neomycin or streptomycin
Precaution for IPV?
pregnancy
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