Child Health Nursing. Pediatric ATI Notes

John Pediatric ATI Notes Child Health Nursing Pediatric ATI Notes Chapter 1: Intro • Parenting styles o Authoritarian: my way or the highway o Democratic/authoritative: “v” very good parent o Permissive: stay u ...

John Pediatric ATI Notes Child Health Nursing Pediatric ATI Notes Chapter 1: Intro • Parenting styles o Authoritarian: my way or the highway o Democratic/authoritative: “v” very good parent o Permissive: stay up! Do whatever you want o Passive: not paying attention, uninvolved, indifferent Chapter 2: Changes in vitals and development • Vitals o Everything higher, except for BP o Temp of 1 y/o: 37.7, 99.9 (low grade fever in adult, but normal for child), normal for child, not until 5 y/o until temp normalizes o RR: 30-35 – newborn to 1 yr o HR: 80-180 o BP: SBP: 65-80, DBP: 40-50 – infant o Which of the following are cause for concern? Find the one out of range. o Posterior: 6-8 weeks, anterior: 12 – 18 months  Fontanels should be flat and soft • Teeth o 6-8 teeth by 1 y/o o End up having 20 deciduous teeth, 32 permanent teeth • Reflexes o Moro: present from birth to 4 months, semi-sitting and let them fall back, arms and legs extend out o Tonic neck: birth to 3-4 months, turn head to one side, extend arm and leg on that side, flex opposite o Babinski: stroke outer edge of foot – toes up & out – in place for first year of birth • Cranial Nerves o 1: olfactory, smell o 2: optic, visual acuity o 3: oculomotor, pupils reactive to light o 4: trochlear, eyes to look down and in o 5: trigeminal, test close eyes and detect you touching their face o 6: abducens, track laterally with eyes o 7: facial, symmetrical facial movement o 8: acoustic – hearing o 9: gag reflex – glossopharyngeal o 10: vagus, swallowing o 11: spinal accessory, shoulders o 12: hypoglossal, move tongue & midline Chapter 3: Infant • Weight: doubled by 6 months, triple by 12 months • Height: 1 inch per month for first 6 months • Length: by 12 months, length increase by 50% • First teeth erupt b/t 6-10 months • Gross and fine motor o By 3 months old, baby should only have slight head lag  Head lag at 6-7 months is not common finding o 4 months, roll back to side o 5 months, front to back o 6 months, back to front, hold a bottle o 7 months, move object one hand to other o 8 months, sit unsupported o 9 months, crude pincer grasp o 10 months, grasp rattle, move from prone to sitting o 11 months, object into container, neat pincer grasp o 12 months, build block tower with 2 blocks, won’t succeed  should not be able to build tower by 1 • Paiget o Birth to 12 months: sensorimotor, object permeance (object exists even when cant see it) by 9 months • Language o 3-5 words by 1 year old, concept of no • Eriksen o Trust vs. mistrust: caretaker meeting needs of infant?????? • Separation anxiety o 4-8 months of age o Stranger anxiety, 6-8 months of age • Play o Pat-a-cake, blocks, mirrors, rattles • Immunizations o Birth, 1 vaccine: Hep B o 2 month visit, 2nd Hep B, IPV, RV, PCV, DTaP, HIP o 4 month, all of those, minus Hep B o 6 month, Hep B back, plus all of those o Flu shot: 6 mo to 1 yr • Nutrition o Breastmilk, first solid iron fortified rice cereal at 4-6 months o No juice or water in first year o New foods one at a time over four to seven-day period • Safety o Grapes, coins, candy o Avoid sun o Avoid handles hanging out o Cover outlets o No baby near water sources alone! o Rear facing car seat until 2 years of age o Crib slats no more than 2 cm apart Chapter 4: Toddler • Weight: quadruple weight by 30 months (2 ½ y/o) • Grow 3 in (5cm) per year • Head circ, chest circ: equal • Height • Gross and fine o 15 months child should walk without help o 15 months build tower with 2 blocks o 18 months ball over hand o 2 years up and down stairs, both feet each step o 2 years tower with 6-8 blocks o 2 ½ draw circles o 2 ½ jump • Language o 1 year one-word sentence (holophrases) o 2-year multi word sentences • Eriksen o Autonomy vs. shame and doubt: independence, “I do self” o Express themselves by saying no o Thrive on ritualism • Activities o Blocks, large puzzles, thick crayons • Toileting o Toddlers recognize sensation, stay dry through the night • Immunizations o 12-15 month: IPV, PCV, HIV, MMR, Varicella o 12-23: Hep A, 2 does, 6 months apart o 15-18: DTaP, annual flu vaccine • Nutrition o Breast milk or formula o 1-2: full fat (whole) milk o At 2, transition to low fat milk o Limited or no juice consumption, 4-6 oz per day o Prevent choking hazards: nuts, grapes, hot dogs, PB, raw carrots, tough meats, popcorn • Safety o Prevent burns, drowning, aspiration, crib slats Chapter 5: Preschooler • Weight: gain 4.4-6.6 lbs per year • Height: grow 2.5-3.5 in per year • Gross and fine o Ride a tricycle at age 3, jump off bottom step o 4; skip and hop, throw ball overhead o 5; jump rope • Piaget o Preconceptual to intuitive thought at age 4  Magical thinking, something they did can control something else from happening  Animism, inanimate objective has feelings • Eriksen o Initiative vs. guilt o Regression with new baby • Activities o Balls, puzzles, trikes (age 3) • Immunizations o 4-6 years: DTaP, MMR, IPV o Annual flu shot • Sleep o 12 hours of sleep o Consistent bedtime routine • Teeth o Eruption by beginning of preschool years • Safety o Helmet! Chapter 6: School Age • Height: 2 in in height per year • Weight: gain 4.4-6.6 lbs per year • Piaget o Concrete-operations, see perspective of others vs. having egocentric POV • Eriksen o Industry vs. inferiority, make meaningful contributions to society, cooperate and compete o Peer groups, no more parallel play from toddlerhood – competitive & cooperative play • Activities o Board games, hopscotch, jump ropes, bikes, organized sports • Immunizations o 11-12, DTaP, HPV (3 shot series) • Sleep o 9 hours @ age 12 • Safety o Helmet, protective gear Chapter 7: Adolescents • Girls stop growing 2-2 ½ years post period • Boys stop around 18-20 years • Girls o Breasts, pubes, axilla hair, period – order it happens • Boys o Big testicles, pubes, facial hair, voice changing – order it happens • Piaget o Formal operations • Eriksen o Identity vs. role confusion, trying to figure out their identity, do you wanna be a goth? • Activities o Video games, music, sports, pets • Immunization o 16-18, meningitis – typically before college d/t crowded dorm o Flu vaccine • Injury Prevention o Helmet use o Driving, seatbelts, no drinking, discourage cellphone use while driving o Substance abuse Chapter 8: Medication Administration • Oral o Route always preferred, smallest measuring device, do not mix with formula because they will not get all of the formula o Hold cheeks together, stroke chin, admin in side of mouth • Ear drops o Less than 3 years old, downward and back o Over 3 years, upward and back • Injections o IM: vastus lateralis preferred, can give in ventrogluteal or deltoid  Gauge: 22-25, ½ inch to 1 inch o Subq  Gauge: 26-30, 1 mL syringe, insert 90 degrees o IV  Take kid away from bed, to procedure room, EMLA cream, avoid terminology such as bee sting, or stick, keep equipment out of sight, parents can stay, swaddling for infant, non-nutritive sucking (sucrose) Chapter 9: Pain Management • Self-report on pain is only appropriate for children 4 y/o+ • FLAX: 2 mo to 7 years • FACES: 2 years above • OUCHER: 3-13 years • Numeric: 5 years and older • Play therapy about procedures you’re about to perform • Admin medicine on a schedule, not PRN • Combine non-opioid and opioid medications • Apply EMLA 60 mins prior to superficial puncture, 2.5 hours prior to deep Chapter 10: Hospitalization Implications • Infant: don’t know what is going on, stranger anxiety, 6-18 months, express physical behaviors b/c cant express verbally ::::::::::::::::::::::::::::::::::::::::CONTENT CONTINUED IN THE ATTACHMENT:::::::::::::::::::::::::::::::::::::::::::::::::::