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Summary NSG 4421 PEDS FINAL STUDY GUIDE
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NSG 4421 PEDS FINAL STUDY GUIDE
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NSG 4421 PEDS FINAL STUDY GUIDEChapter 1:
1. Top leading causes of death/age group
a. Infants= not safe in any environment. Crawling= putting objects in mouth= poisoning or
aspiration
b. Toddler= mobile. Run/climb= r/f falls, burns & collisions
c. 5-9 yrs= bike accident (no helmet) = head injuries. Accidental poisoning r/t meds
d. Adolescents= MVCs, drug/alcohol abuse/suicide= intentional poisoning
e. Others: drowning/burns/firearms
2. Family-centered care
a. Planning, delivery & evaluation of HC grounded in mutually beneficial partnership of HCP, pts
& fams
b. Consider the need of ALL fam members
c. Key elements= realize fam is constant in child’s life, facilitating fam professional collaboration,
exchanging unbiased info, honor culture preferences, encourage fam to fam support, appreciate
fam & child
d. 2 basic concepts for nurses:
i. Enabling= creating opportunities& means for fam to display abilities to meet the needs of
child
ii. Empowerment= help fam acquire sense of control over fam life; helping behaviors that
foster their own strengths, abilities & actions
3. Atraumatic Care test question: don’t say a needle stick. Practice on a bear
a. Care to eliminate or minimize psych & physical distress of child & fam w/in the health system
b. Ex. Teddy bear in room- sit them down & explain procedure, foster parent-child relationship,
prepare child for unfamiliar procedure, dec pain, allow play time/ expressing fear, privacy,
respect culture, provide choices
c. Psych stress= anxiety, fear, stress, anger, disappointment, sadness
d. Physical= sleepiness, pain, temp immobile
e. 3 principles=
i. prevent or minimize child separation from fam
ii. promote a sense of control
iii. prevent body harm
f. Setting: anywhere, personnel: anyone
Chapter 2:
1. Family theories:
a. Describes fam unit & how they respond to events
b. Fam SYSTEM theory= affects all fam (circular casualty). Too little change & not enough to hurt
the fam balance btwn the two can initiate change & react to it. Focus on fam as a whole (not
individually) FOUCUS ON INTERATIONS!!!!
c. Fam STRESS theory= how fam responds to a stressful event. Predictable (parenthood) &
unpredictable (illness, divorce, unemployment). Multiple stressors in 1 yr can = breakdown.
Promote adaptation & structural change. Focus on +: cope, resources & social support FOCUS
ON ADJUSTMENT AND ADAPTATION
d. Developmental theory= address fam change overtime, usually use 1st child as maturational
marker, fam changes in individual ways but similar, must all achieve individual time specific
changes as part of the cycle TRANSITIONS HAVE DISEQULIBRIUM. STAGES.
2. Family Structures:
, a. Nuclear= 2 parents & children (step, biologic, foster, adopted) & parents don’t have to be
married
b. Traditional nuclear = 2 parents and their children
c. Traditional blended= 2 parents & at least 1 step
d. Traditional extended= at least 1 parent, 1 child, 1 relative (grandparents)
e. Binuclear (single-parent) = assuming parent role but eliminating spouse role, divorced but joint
parenting- joint custody
f. Polygamous (single-parent) = multiple wives/ husbands. Sororal: vies are sisters, nonsororal
g. Communal=community
h. LGBT
3. Parenting Styles
a. Authoritarian (parent rules) = “bc I said so”. Control the child behavior & attitude
unquestionable. Rules & regulation are expected to be followed. Children are polite, dependable,
honest & can be defiant & antisocial THE KID WILL BE SHY SENSITIVE AND SELF
CONSCIOUS
b. Permissive (child rules) = little to no control. Allow child to make own decisions. Parent is a
resource, not a role model. Rarely punish child (inconsistent)
c. Authoritative (combo of the two)= direct the child by giving them a reason as to why, respect the
child as a person & allow child to voice objections, control focus on issue & not withdrawal from
lover or fear of punishment. Inner directness (control behaviors based on guilt or shame).
Children have ^ self-esteem, resilience & interactive, assertive & content
4. Discipline Styles
a. Limit setting= help kids channel undesirable feelings, protect them from danger, learn socially
acceptable behavior, test limit of control, children NEED & WANT limits, help test environment
& know others are there to protect them *******make sure limits are made CLEAR!!
b. Reasoning= explain why action is wrong, young may not understand, kids may be used to getting
attention (act up= lengthy discussion). Think bad attention is better than no attention – This
works for the older child but not necessarily for toddler/preschool
c. Scolding= combo w/ reasoning. Child may take “you are a bad kid” seriously
d. + and – reinforcement= if its rewarded, going to repeat behavior. No reward= no repeat.
Token/stickers= must explain desired action & reward, verbal approval always
~~~~~~ there was a test question abt how tokens/stickers go with the +/- reinforcements
e. Ignoring= eventually stop or minimize act, use when child does wrong for attention, watch for
response burst= ^ action to test parent
f. Consequence= natural- w/o intervention, no friend until room is clean. Logical- r/t problem,
can’t play w/ toy until others are cleaned up. Unrelated- time out. Must be planned & it will
happen. Public= time out when we get home. ~~~~ time out lasts 1 min per age in years of child
g. Corporal/physical punishment (spanking)- teaches kids violence is acceptable. Harms te child,
may become used to pain, child may misbehave when parent isn’t around due to behaving well
for their own sake
Chapter 10:
Biologic/Physical Growth
Infants
Weight= gain 5-7 oz q week. 1.5 lbs/qwk for first 5 mo. Double by 6 mo. Triple by 1 yr.
Height= ^^ 1 in/mo for 6 mo. Grow in spurts & more in trunk. 6 mo= 65 cm. 1 yr= 74 cm
Head circumference= demonstrates growth of brain. 6 mo= 43 cm. 1 yr= 46 cm.
Chest circumference= closure of fontanelles at 6-8 wks and 18 mo. Equal to head at 1 yr
Heart- doubles in size by 1 yr (slower).
, Sensory changes.
o Visual preferences- 6 mo= distinguish btwn fam and strangers (separation anxiety begins)
o Binocular fixation- begins 6 wks, est @ 4 months. Fixation of two images to one. Strabismus
present= permanent blindness
o Depth perception= 7-9 mo.
o Parachute reflex @ 7 mo.= hands out to catch themselves
o Turn head towards noise @ 2-3 months
Neuro= biggest change. ^ age=^ reflex
Resp= abd movement. ^ r/f disease (dec mucus). ^ ear infection (short tube). Small airway easily
obstructed by edema or object. ^ volume of dead space=breathing twice as fast for more O2
Immune= no IgA in mucus lining=dec mucus= less protection against infection. BF=^IgA. Probiotic
factors help GI tract grow good bacteria to fight infections
Cardiac= ^HR (slows w/ age). Systolic @ 2 mo ^^. Diastolic @ 3 mo dec
Hematopoietic= HgbF present for 5 mo. & mixed w/ adult hgb= dec. RBC from HgbF depressing
production of erythropoietin= physiologic jaundice (3-6 mo). Maternal derived iron stores for first 5-6
mo.
Digestive= gastric digestion dependent on HCl and rennin (acts on casein in milk= formation of curds-
allow milk to stay longer for digestion). Digestion happens in duodenum. Carbs digested around 4-6 mo.
@ 1 yr- can tolerate 3 meals/day w/ evening bottle, 2 BM/day, vulnerable to V/D and dehydration.
Complete sucking (BF), swallowing (not food), & breathing movements @ 9 mo. Santmyer swallow-
blow in face & allow swallowing reflex
Thermoregulation= vernix caseosa (oily white substance in creases that protects breakdown and
infection. Ability to contract and shiver ^ w/ age. Shivering= muscle contract= metabolic heat= BAD. ^
adipose tissue in 6 mo.
Renal= ^ r/f dehydration. Fully developed @ 2 yrs.
Toddler (12-36 mo. Or 1-3 yrs.)
Growth= “step like” not linear
Weight= 4-6 lbs/yr (slow). BW quadrupled by 2.5 yrs.
Height= 3 in/yr. Adult ht= twice child’s @ 2
Head circumference= ^ 1 in during 2nd yr & slow until 5. Anterior fontanel close @ 12-18 mo.
Chest circumference= ^ & exceed abd. More growth in legs= taller appearance. Still potbellied
Sensory changes
o Visual acuity= 20/40. Full binocular vision.
o Hear, smell, taste, and touch develop & use to explor. Descending development of spinal tract= ^
sensation of lower extremities= pleasant tactile to sooth
Most physiologic systems are mature at end of toddlerhood
Brain= myelination of SC complete by 2= gross motor skills. 75% developed. Broca area developed
(speech). Cortical areas developed= control of legs, arms, and sphincters. @ 2-3 yrs= coordination &
consolidation develop (pay attention and listen longer)
Resp= ear & throat are short. Tonsils are big= r/f infections. Abd resp.
GI= stomach capacity ^= tolerate 3 meals/ day. @18-24 mo= more control over sphincters. Bladder can
be controlled & hold urine for 2 hrs or longer
Skin= more tightly bound= less infection & fluid loss. Sebum production dec= dry skin (don’t sweat as
much). Learn control body temp (put on jacket)
Hematopoietic= passive immunity disappears. Antibodies well est.
, Preschooler (3-5 yrs)
Weight= gain 4.5-6.3 lbs/yr
Height= 2-3 in/yr
Muscles= development and bone growth cont. more graceful. Most are potty trained
Most organ systems develop & able to adjust to moderate stress and change. Bone and muscles still
immature.
School-aged (6-12yrs)
Begins @ shedding of baby teeth. End @ puberty w/ grown permanent teeth
Growth= 2 in/yr
Weight= double (4.4-6 lbs/yr)
@ 6yrs= 46 in. & 46.3 lbs
@ 12 yrs= 59 in. & 88.2 lbs
Posture improves, fat gradually diminishes (thinner appearance), strength ^ ( no heavy lifting, muscles
immature), dec head circumference (brain grow slower), dec waist circumference, ^ leg length, facial
proportions change (skull & brain grow very slow)
GI= fewer upset stomach, maintained of BS, retention of food longer, caloric needs less, ^ bladder
capacity
VS= HR & RR slow, BP ^
Immune system= ^, may be more sick during first 1-2 yrs of school bc of more exposure
Bones= growing. Watch shoes (can prevent growth). Chairs and desk= feet need to reach floor.
Prepubescence= 2 yrs before puberty. First sign @ 9 yrs (evident 11-12). Preadolescence begin @ end of
middle childhood & end @ 13 bday
Puberty= avg age: F @ 12, M @ 14.
Teens
Transition btwn child & adult. Time of profound changes probs more so than at any other time.
Stages: Early= F ht peak @ 12, M @ 14. Middle= growth dec for F, ^ for M. Late= physically mater
structure & reproductive
Puberty hits= F= 9-14 yrs. M= 10-16yrs (earlier for girls)
Girls= muscles mass growth peaks @ menarche & slows, peak linerar ht velocity (PHV)= 12 yrs. Ht @
menarche= indicator of adult ht. growth stops usually after 2 yrs of menarche. Wt peak= 6 mo after
PHV. Average gained during teens= 2-8 in & 15-55 lbs. ^ sys BP & pulse HR. basal body temp reaches
adult @ 12.
Boys= muscle mass cont through puberty PHV @ 14. Ht stops at 18-20 yrs. Ht peaks after testicles form
and pubic hair is present. Outgrow shoes first, then pants, then shirt. Av gain during teens= 4-12 in &
15-66 lbs. lower sys BP ^^ blood vol, hct, RBC, iron, etc, lung growth due to ^ & shoulder size &
metabolic rate. Basal body temp reaches adult temp later.
Brain= support cells= better neurons. Not fully developed. May not reach full size until 20 yrs. Myelin
sheath ^= faster neuron processing
Puberty
o Girls= early- estrogen in little amnts, not enough for ovulation. Midpuberty- ^ estrogen= build-
up of endometrial lining=period. Estrogen- growth on vagina & breast. Low levels= stimulate
skeletal growth, ^ levels inhibit growth. Fertile after first period. Androgen= ^ pubic & body hair,
acne, odor, etc.
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