Chapter 30 – Basic Pediatric Nursing Care – Flashcards
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What is the WIC Program?
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Women, Infants and Children program. Offers assistance with food and nutrition counseling for low-income, pregnant, breastfeeding, non-breastfeeding postpartum women and infants and children under the age of five years.
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American Nurses Association Definition of Nursing:
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The prevention of illness, the alleviation of suffering, protection, promotion, and restoration of health in the care
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Birth defects
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Congenital anomalies. Any abnormality present at birth, particularly a structural one, that is possible to inherit genetically, acquire during gestation, or acquire during parturition.
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Children with special needs
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Infants and children with congenital abnormalities, malignancies, GI diseases, and CNS abnormalities.
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Family-centered care
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The philosophy of care that recognizes the family as the constant in the child's life and holds that systems and personnel are called on to support, respect, encourage, and enhance the strengths and competence of the family.
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Infants' Concepts of Illness
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Perceive illness as generalized discomfort and pain.
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Preschoolers' Concepts of Illness
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Conceive illness as a punishment for bad thoughts or behavior. Believe that adults have the power to magically cure the illness if they wish to.
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School-Age Concepts of Illness
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Sometimes perceive illness as a result of bad behavior or indiscreet behavior; sometimes have an accurate awareness of the location of body parts and beginning understanding of body processes and functions.
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Adolescents Concepts of Illness
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Focus on discrete symptoms rather than overall effect of illness; often intellectually question and deal with information about illness; will at times use denial of illness or overcompensate in areas not affected
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Healthy Traits for an Infant
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Double weight by 6 months; triple weight by 1 year. Vision at birth is 20/3000; by 12 months is 20/1000. Likes toys that can bang, shake or be pulled; enjoys playing "peek-a-boo".
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Anticipatory Guidance
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Psychological preparation of a patient for an event expected to be stressful...
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Discuss measuring body temperature
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Detect abnormally high or low values. The main concern is the brain, because very high temperatures can cause neural damage, and that represents the central or core heat.
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How to use an otoscope
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You have to get the sensor and detect heat from the eardrum not the cooler canals. You have the straighten the ear canal, pull the ear down and probe tip pointing at the midpoint between the eyebrow and the sideburn on the opposite side of the face.
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How to calculate normal blood pressure
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SYSTOLIC: 1-7 years: Age in years + 90 8-18 years: 2 X age in years + 83 DIASTOLIC: 1-5 years: 56 6-8 years: age in years + 52
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Correct Blood Pressure Cuff Size
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In choosing cuffs, use an appropriately sized one. Cuff of proper size will cover 2/3 of the length of the upper arm or leg. It's better to use an oversized cuff rather than an undersized one.
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Are newborns obligate breathers?
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Newborns are obligate nasal breathers in which they breathe only through their noses.
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Guidelines for auscultation of lungs
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Make sure the child is relaxed. Check the room if comfortable and quiet. Warm the stethoscope before placing it against the skin. Put firm pressure on chestpiece but not enough to prevent vibrations and transmission of sound. Don't put it over hair or clothing. Use a symmetric and orderly approach. The child should blow.
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Guidelines for the back
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The back of a newborn is C-shaped. When the child begins to grow, the S-shape can start to show up.
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Weaning
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Gradually eliminating breastfeeding or bottle feeding and instituting cup and table feedings
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Do not use corn syrup or honey because...
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the risk of botulism.
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Describe Dr. Abraham Jacobi
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The father of pediatrics. He established milk stations.
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Describe Lilian Ward.
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Founded the Henry Street Settlement in NYC, which provided nursing service, social work, and an organized program of social, cultural, and educational activities.
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Social Policy Task Force of the American Nurses Association states that nursing is...
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nursing is the prevention of illness, the alleviation of suffering, and the protection, promotion, and restoration of health in care of the individuals, families, groups, communities, and populations
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3 key components of family-centered care
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respect, collaboration, and support
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2 basic concepts of family-centered care
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enabling and empowerment
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What is empowerment?
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The interaction of professionals with families to bring about or cement families' sense of control over their lives.
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Infant weight
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Doubles weight by 6 months; triples weight by 1 year
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Infant vision
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20/300 at birth. 20/100 by 1 year.
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Toddler weight
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Weight gain fro 1 to 3 years is about 5 lbs per year
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Infant concept of illness
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Generalized discomfort and pain
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Preschoolers concept of illness
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Conceive illness as a punishment for bad thoughts or behavior; believe that adults have the power to magically cure the illness if they want to
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Measuring a child's head circumference
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You must measure the head circumference of children up to 36 months. The area you measure is usually above the eyebrows and pinna of the ears and around the occipital promience at the back of the skull.
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What is measuring length?
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Length refers to measuremnts taken when the child is supine. Until the kid is 2 years old you should measure recumbent height.
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How to measure triceps skinfold thickness
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With child's right arm flexed 90 degrees at elbow, mark midpoint between acromion and olecranon on posterior aspect of arm. With arm hanging freely, grasp a fold of skin between thumb and forefinger 1 cm above midpoint. Pull the fold away from underlying muscle and continue to hold though the remainng steps until measurement is completed. Apply pressure with thumb. Follow directions for using other calipers. Estimate reading to nearest millimeter.
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In febrile patients, the main concern is temperature of the ...
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brain, because very high temperatures can cause neural damage
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Oral temperatures are okay for children ..
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6 years of age and older
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True core temperature is with the ...
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auditory (ear temperature) because it's so close to the hypothalamus
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Counting a newborn's respirations
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Newborns are obligate nasal breathers, which means they breathe only through their noses; they will not breathe through the mouth until they reach 3 or 4 weeks of age; infants's respirations are mainly diaphragmatic; use the abdominal movements you observe for your count
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Calculating normal systolic blood pressure
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1-7 years: Age in years + 90 8-18 years: (2 X age in years) + 83
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Calculating normal diastolic blood pressure
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1-5 years: 56 6-8 years: Age in years + 52
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En face position
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Position in which the adult's face and the infant's face are approximately 8 inches apart and on the same plane, as when the mother holds the infant up in front of her face or when she nurses the infant
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When do newborns get the ability to follow bright, colorful objects?
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By the 2nd or 3rd week of life
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Accommodation
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Changes in ciliary muscles and the lens in bringing light rays from various distances to focus on the retina
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Refraction
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The production by the normal eye of the proper image of the object on the retina
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How to clean the ears
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Clean the ears with a washcloth. If they use a swab, gently wipe only the outer portion of the external canal. They can soften any hard cerumen by putting in 2 or 3 drops of mineral oil into the ear for a few days and then rinsing the external canal with an ear syringe.
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When inspecting the tongue, what does the protrusion of the tongue mean?
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It means the child probably has a cognitive impairment.
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What does asymmetry of the chest probably mean?
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The possibility of a serious underlying problem such as cardiac enlargement or pulmonary dysfunction.
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What does a barrel-shaped chest mean?
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Chronic obstructive pulmonary disease such as cystic fibrosis or asthma
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When inspecting the abdomen, what is the most important sound to hear?
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Peristalsis.
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Describe peristalsis.
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You will probably hear it every 10 to 30 seconds. Normal peristalsis sounds like metallic clicks and gurgles. Loud grumbling noises usually mean hunger. Report absence of bowel sounds or hyperperistalsis because it usually denotes an abdominal disorder
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How to inspect the abdomen
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It is done while the child is erect and supine. Normally in infants and young children, the abdomen is cylindric. In the supine position, it is flat.
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Why are infants more prone to fluid volume excess and dehydration?
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Because glomerular filtration and absorption are low due to immature kidney function
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If a child complains of perianal itching...
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Test for pinworms
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Describe a child's metabolism
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55% for maintenance of body functions. 25% for physical activity. 8% for fecal loss. 12% for growth.
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What is the most desirable complete diet for a baby for the 1st 6 months of life?
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Human milk
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Why give finger foods?
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It helps infants develop a hand-to-mouth cycle which is essential for feeding themselves.
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Signs of allergic reaction
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Rash, wheezing, diarrhea
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What is weaning?
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Gradually eliminating breastfeeding or bottle feeding and instituting cup and table feedings
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When do you bathe a child?
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Before a feeding to avoid stimulating regurgitation or vomiting by doing so afterward.
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How do you clean an umbilical cord?
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With alcohol.
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How do you sponge bathe a baby at crib side?
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Place the baby across the width of the bed facing you. This practice allows greater control of any movement of the baby and decreases the likelihood of the baby rolling out of the crib.
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How to wash male baby genitalia?
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Wash the penis and scrotum of a circumcised male. In an uncircumcised male, external washing and rinsing is necessary. DON'T retract the foreskin because it is almost always attached to the glans.
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What is an anterior fontanelle?
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A space, roughly diamond shaped covered by tough membranes between the bones of an infant's cranium; the posterior fontanelle is triangular
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How to hold a bottle feeding
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The formula should fill the nipple wholly to decrease the amount of air that the baby will swallow.
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Strategy to burp an infant #1
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Place the infant in sitting position. With one hand over the infant's chin and chest supporting the body as the infant leans forward, use the other to gently pat or rub the baby's back from waist to shoulders.
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How to position a baby after a feeding
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Right side. This permits the feeding to flow toward the lower end of the stomach and allows any swallowed air to rise above the fluid and through the esophagus.
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What is a gavage feeding?
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Passing a feeding tube through the nose or mouth, down to the esophagus, into the stomach.
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How to measure a gavage tube feeding
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Measure from the nose to the distal area of the earlobe and then to the end of the xiphoid process. Or measure from the nose to the earlobe and then to a point midway between the xiphoid process and the umbilicus
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Why do you tape an indwelling tube to a person's cheek and not forehead?
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To prevent possible structural and cosmetic damage
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How to check tube placement
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-Aspirating for stomach contents -Injecting a small amount of air through the syringe while simultaneously listening with a stethoscope over the area for sounds of gurgling and growling
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How to do a gavage feeding
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To prevent nausea and vomiting, use rates of no more than 5mL every 5 to 10 minutes in very small/premature infants. Use rates of no more than 10mL in older infants and small children.
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What to do after a feeding
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Flush the tube with sterile water (1-2 mL for small tubes and 5mL for large tubes). Clamp or cap indwelling tubes after feeding. Let the child be positioned on the right side for at least 1 hour to keep the possibility of the regurgitation and aspiration to a minimum.
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Who is a gastronomy tube for?
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It is used in children when passing a gastric tube is contraindicated or in children who require tube feeding over an extended period.
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How does a gastronomy tube work?
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The practitioner inserts the tube through the abdominal wall into the stomach and secures it with a pure-string suture and anchors the stomach to the peritoneum at the operative site
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Are safety reminder devices a last resort?
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Yes.
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What calls for an elbow safety reminder device?
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They allow a baby to move the upper extremities but prevent them from touching the head and neck area; protect a repaired cleft lip or scalp infusion site.
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What calls for a mummy safety reminder device?
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It is used when it is necessary to immobilize head, neck, trunk and upper/lower extremities.
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What is a clove hitch safety reminder device?
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It is for all extremities of a child.
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Suprapubic bladder aspirations
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Place the infant in a froglike position for the procedure. A doctor prepares the skin above the bladder and puts in a 20-21-gauge needle into the bladder and removes several milliliters of urine. Do this 30-60 minutes after voiding.
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How to do plastic urine collection bags
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When the bad is in place, cut a slit into the disposable diaper before it is placed on the child. Then you can pull the urine bag through to the outside so you can monitor. When the child voids, remove the bad so there is less chance of losing the urine specimen.
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What to add to a catheterization
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When a baby is being catheterized, you apply a 2% lidocaine lubricant with applicator to the meatus. It's to reduce the discomfort.
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For venipuncture with a jugular vein, how should the baby's head be turned?
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45 degrees
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What is EMLA?
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Eutenic mixutre of local anesthetics for a lumbar puncture at least 1 hour before the procedure.
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How to do a lumbar puncture
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The child should sit on the bed and face the nurse. Gently flex the neck and legs. This angle increases the spinal curvature and help the physician gain entry into the subarachnoid space of the lumbar spinal canal.
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When using oxygenation, how long do you check oxygen levels?
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Every 2 hours
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Describe a closed incubator.
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Imperfectly fitted lids, uncovered vents and portholes that must be opened.
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Advantages of oxygen masks
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Various sizes available. Ability to provide a predictable concentration of oxygen whether child breathes through the nose or mouth.
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Disadvantages of oxygen masks
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Skin irritation. Fear of suffocation. Accumulation of moisture on face. Possibility of aspiration of vomitus. Difficulty in controlling O2 concentrations.
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Advantages of nasal cannula
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Provision of constant oxygen flow even while child eats or talks. Possibility of more complete observation of child because nose and mouth remain unobstructed.
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Disadvantages of nasal cannula
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Discomfrt. Possibility of causing abdominal distention and discomfort/vomiting. Difficulty of controlling O2 concentrations if child breathes through mouth. Inability to provide mist if desired.
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Advantages of oxygen tent
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Achievement of lower O2 concentrations. Child receives higher inspired O2 concentration even while eating.
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Disadvantages of oxygen tent
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Necessity for right fit around bed to prevent leakage of O2. Cool/wet tent environment. Poor access to patient.
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Describe mist tents.
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The purpose of using a mist tent is to improve a child's respiratory status by liquefying pulmonary secretions.
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How do you maintain humidity levels in a mist tent?
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You can tuck the tent under the mattress of a crib to maintain humidity levels.
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Suctioning
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Signs that a child needs suctioning includes pallor, restlessness, anxiety, increased pulse, respiration, temperature, dypsnea, bubbling, rattling, nasal flaring, grunting,gasping, cyanosis, erythema
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When to do suctioning
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Do suctioning when secretions are audible in the airway or when signs of airway obstruction or oxygen deficit are present.
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Suctioning levels for a child
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50-95 mm Hg for an infant. 95 to 110 mm Hg for a child.
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Suctioning depth for a tracheostomy and endotracheal tube
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1/4 to 1/2 inch beyond the tip of the artificial airway. Determine placement by placing an appropriately sized suction catheter into an artificial airway of the same size.
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Timing for tracheostomy and endotracheal tube
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No more than 5 seconds
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Frequency for suctioning
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Allow 30 second between suctioning attempts
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Is milk a clear liquid?
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No, because it becomes curd when it comes in contact with stomach lining.
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How to measure the voiding of a baby who isn't toilet-trained?
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Measure the wet diapers (minus the weight of a dry diaper)
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6 rights
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right medication. right time. right person. right amount. right route. right documentation.
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Estimated child's dose
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BSA of child/BSA of adult X Adult Dose
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Intradermal Injections
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3/8-1/2 inch 25 to 27 inch Short Bevel. Primary: Ventral forearm
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Subcutaneous Injections
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3/4-5/8 inch 23 to 26 gauge. Medium Bevel. Primary: Upper arm, lower abdomen, anterior thigh
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Intramural Injections
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5/8-1 inch. 20-25 gauge. Medium Bevel. Where: vastus lateralis, ventrogluteal
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Why not use a single site repeatedly?
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Fibrosis of the muscle. Subsequent muscle contractures.
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Needle length for IM injections
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Grasp the vastus lateralis muscle or deltoid and choose a needle length that is approximately half the distance between your thumb and index fingers.
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Should you use the dorsogluteal muscle?
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The dorsogluteal muscle is insufficiently developed to be safe site for infants and small children. NO.
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Rectal administration of medication
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Lubricate the suppository with water-soluble jelly or warm water and insert it quickly and gently into the rectum beyond the rectal sphincters. Then hold the buttocks together firmly to relieve pressure on the anal sphincter until the urge to expel the suppository has passed.
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Enema
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Use an isotonic solution. Don't use plain water, because it can cause rapid fluid shift and overload.
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How far apart should crib slats be?
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No more than 2 3/8 inches apart.
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What is the maximum volume to be administered in a single site of IM injections?
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1 mL
