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Summary NRSG 328 Final Exam Study Guide

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Final exam study guide for NRSG 328. *Essential!! *For you,at a price that's fair enough!!

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Spring 2018 Final Exam Blueprint

Chapter 4- Communication, Physical, and Developmental Assessment

1. Perform a complete age-specific head-to-toe assessment
 FIRST SUPINE POSITION: to examine heart, lungs, abdomen, & hips
 NEXT PRONE POSITION: to examine spine, back, and sacrum
 Auscultate, percuss, and palpate while quiet
 Minimal physical contact first to establish that you’re not scary. Distract with play
 In older children/adolescents: assess genitalia last

2. Identify birthmarks (e.g., café au lait, Mongolian spot) and implications.
 Mongolian spot: bluish- bruise like spot on the back
 Café au lait: note size and number. 5+ could mean neurofibromatosis

Chapter 5- Pain Assessment and Management in Children

1. Review responses and effects of pain (e.g., see slide harmful effects of pain in Pediatric client).

Harmful Effects of Unrelieved Pain
• Physiologic stress responses
– Increased ICP, HR, RR, BP
– Decreased SaO2
• Behavioral changes (particularly neonates)
– Muscle rigidity, facial expression, crying,
withdrawal, and sleeplessness
• Chronic pain syndromes




2. Understand how to appropriately assess pain in children
 HOW? Use OLDCARTS! (onset, location, duration, characteristics, aggravating &
relieving factors, timing, severity). Assess of treatment is effective
 WHEN? 15-30 minutes after intervention

Chapter 22- Family Centered Care of the Child During Illness and Hospitalization

1. Understand the effects of hospitalization on the child and the family
 ON INFANT/CHILD: goes through separation anxiety consisting of the following
stages:
 Stage of protest: crying and screaming for parent
 State of despair: depression, crying stops, withdrawals, less active
 Detachment/denial: NOT COPING MECHANISM, but child accepts that parents are
gone & gets used to new environment
 ADOLESCENTS

,  Loneliness & isolation
 Fear of treatment, losing self-determination, and choices
 Anger, sad, stress, regression
 Special needs: more emotional consequences possible
 FAMILIES
 Parents feel loss of control and helplessness
 Fam-centered care must also include siblings too
 Siblings may feel hospitalization is their fault (siblings need support too and
parents may forget that)
 Jealousy & anger may result

2. Identify ways to minimize loss of control in the pediatric client during hospitalization

Minimizing Loss of Control
• Importance of consulting Child Life
• Promote freedom of movement
• Preserve parent-child contact
• Truth and Reassurance
• Maintaining routine and independence
– Provide information
– Provide resources




Chapter 10- Health Promotion of the Infant and Family

1. Major physical and developmental milestones expected in the first year as discussed in class
(e.g., head control, sitting, walking, pincer grasp, etc.)
 Fine/motor skills (before age 1)
o 2-3 mo: grasps object
o 7 mo: transfers object btwn hands
o 10 mo: pincer grasp
o 11 mo: removes object from container
o 12 mo: builds tower of 2 blocks
 Gross motor skills
o 4-6 mo: head control improves
o 5-6 mo: rolls over
o 7 mo: sits alone

 Locomotion:

, o 6-7 mo: crawling
o 9 mo: creeping
o 11 mo: walk w/ assist
o 12 mo: walk alone

2. Review feeding in the first year of life (i.e., what can they eat/drink and when).

Chapter 11- Health Promotion of the Infant

1. Identify the management of serious food allergy
 Common allergies: eggs, cow’s milk, peanuts. ATOPY = allergy w/ heredity
 Management:
 Epipen
 Benadryl (diphenhydramine)
 Medicalert bracelet
 Emergency plan (giving epipen vs. calling 911?)
 Caution of biphasic response (when allergy feels better but suddenly gets
worse)

2. Review the topic of Apnea in Infancy including definition and management
 Definition: respiratory pause lasting 15-20 sec +, or less than 15-20 sec w/ pallor,
cyanosis, bradycardia, hypotension
 Management: use apnes monitor, stimulation, parent education, medications




Chapter 12- Health Promotion of the Toddler and Family

1. Identify the Erikson stage of psychosocial development and how is one achieved versus the
result of not achieving this stage
 Autonomy: developing independence (negativism: “I’ll do it”, no)
 Shame: parents shame child for trying to do things themselves.

Chapter 13- Health Promotion of the Preschooler and Family

1. Identify expected play in preschoolers.


Chapter 14- Health Problems of Early Childhood

1. Identify the different types of neglect and abuse including presentation and symptoms.
 Physical neglect: deprivation of food, clothing, shelter, supervision, medcal care,
education. Most common form of maltreatment
 Emotional neglect: lack of affection, attention, emotional nurturance

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