Summary
Final Exam Objectives Summary
- Course
- NRSG 328
- Institution
- Emory University
Pediatric Nursing course objectives for the cumulative final. *Essential!! *For you, at a price that's fair enough!!
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Spring 2018 Final Exam BlueprintChapter 4- Communication, Physical, and Developmental Assessment
1. Perform a complete age-specific head-to-toe assessment
a. infants
i. sequence: examine heart, lungs, abdomen, hips→ spine, back, sacrum (traumatic procedures last)
ii. prep: undress to diaper, distraction techniques
b. toddler
i. sequence: minimal physical contact initially, play, auscultate, percuss, palpate while quiet
ii. prep: parent removes clothing, allow them to inspect equipment, praise the child
c. preschool
i. sequence: perform head to toe if cooperative
ii. prep: children undress, brief demonstration of equipment, describe the process
iii. count respirations first (before disturbing the child)
iv. count apical heart rate second
v. measure BP third
vi. measure temp. last
d. Understand the importance of atraumatic care
i. avoid invasive procedures when possible, choose words carefully
e. Understand the key components of the individual systems during a physiologic assessment (i.e., what are we looking
for?) ati ch. 2
i. growth measurements, growth charts
ii. temp: method based on facility, age, development, illness severity
1. axillary for infants, tympanic/ axillary/ oral for toddlers and older
iii. pulse: <2 years→ measure apical for 1 minute
1. compare radial and femoral pulses in infancy
2. HR decreases as they get older
iv. respirations: count; decreases as they get older
v. BP: use correct cuff size; compare upper and lower extremities
1. increases with age
vi. SaO2: should be >92% (ideally near 100%)
vii. skin: birthmarks, palms, abuse, lesions/ rashes, color, texture, temp. HSN
1. cafe au lait (not size and #; implicated neurofibromatosis)
2. mongolian spot: present at birth and fades
3. palm creases: Simian crease (transverse palmar crease)--> Down Syndrome
4. palpable lymph nodes; are they painful, red, moveable
viii. head and neck: shape, symmetry, head control/ range of motion, facial symmetry/ movement/
appearance, fontanels (anterior→ 12-18 months; posterior→ 2-3 months)
ix. ears:
1. external structures alignment, pits/ tags/ sinuses/ discharge
2. internal: assess canal/ tympanic membrane→ pull pinna down and back
x. nose: internal turbinates, septum, smell
xi. mouth/ throat: lip color/ moisture, tongue movement/ appearance, buccal mucosa, thrush, dentition, tonsils/
uvula/ oropharynx
xii. chest: size, shape, symmetry, movement, breast development
xiii. lungs: breathing effort, rate/ rhythm, depth, quality, retractions, sounds
xiv. heart: apical pulse, rate, rhythm, sound (murmur 1-5), heaves, thrills, lifts
xv. abdomen: 4 quadrants, inspection (umbilicus stump falls at 2 weeks), hernias), auscultation (sounds),
palpation
xvi. genitalia: tanner staging, signs of abuse (tears, bruising, discharge)
xvii. spine and extremities: curvature, tuft of hair/ dimples (spina bifida), ROM, joints, muscles (strength, ROM,
gait, posture), deformities
xviii. neuro: physical, behavioral, emotional, cerebellar function, reflexes (primitive reflexes, DTRs), cranial
nerves
1. babinski reflex gone by 1 year (fanning of toes)
xix. developmental: denver ii, ages/stages, autism
2. Identify birthmarks (e.g., café au lait, Mongolian spot) and implications.
a. neurofibromatosis
i. clinical manifestations: presence of multiple care au lait birthmarks (>= 6 spots of at least 5mm in
diameter)
ii. freckling of axillary and groin
, iii. growth of tumors along nerves in the skin, brain, and other parts of the body
b. mongolian spot: present at birth and fades
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).
a. dangers of unrelieved pain: longterm consequences, physiologic stress: increased ICP, HR, RR, BP, decreased SaO2,
behavioral changes (muscle rigidity, facial expression, crying, withdrawal, sleeplessness, chronic pain syndromes
2. Understand how to appropriately assess pain in children
a. behavioral (infants to age 4 years)
i. observational→ vocalization, facial expression, body movements, crying, rigidity/ sudden movements
ii. FLACC scale (2m-7y): facial expression, leg movement, activity, cry, consolability
iii. CRIES (neonates)- observational; crying, requires O2, increased BP/HR, expression, sleepless
b. self report (> 4 years)
i. faces scale, numeric rating scale (8y and older)
c. children with communication/ cognitive impairment
i. high risk for inadequate treatment of pain
ii. Non-Communicating Children’s Pain Checklist (NCCPC): vocal, social, facial activity, body and limbs
iii. Pain Indicator for Communicatively Impaired Children
d. Children with chronic and complex pain
i. difficult to isolate pain symptom from other symptom (children with cancer)
ii. rating pain does not always accurately convey how they really feel
e. Assessment components: OLDCARTS (onset, location, duration, characteristics, aggravating factors, relieving,
severity), is current treatment effective
Chapter 22- Family Centered Care of the Child During Illness and Hospitalization
1. Understand the effects of hospitalization on the child and the family
a. alters the parental role: helpless, questioning staff skills, need info to be explained in simple language, fear,
uncertainty
b. siblings: loneliness, fear, jealousy, guilt
c. infants and preschool: separation anxiety, stage of protest (inconsolable, refusing attention), stage of despair
(depression, withdrawn, distraction, inactive), denial/ detachment (resigned from the fact that the mother is gone)
d. early childhood: separation anxiety is greatest
e. late childhood to adolescence: loneliness/ isolation, fear of treatment, anger, sadness, stress, regression
2. Identify ways to minimize loss of control in the pediatric client during hospitalization
a. consulting child life
b. promote freedom of movement, minimize/ preventing fear of bodily injury, maintain routine and independence
(provide info/ 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.)
a. rapid growth during 1st year (2x birth weight by 6 months, 3x birth weight by 1 year)
i. will lose up to 10% of birth weight by 3-4 days and regained after 10th-14th day
ii. gain about 1.5 lbs per month during first 5 months
b. avg. height is 74 cm by 1 year, birth length has increased by almost 50%
i. grown about 2.5 cm per month in first 6 months
c. head growth is rapid (46 cm by 12 months)--> avg. head circumferance btw 33-35 cm
i. posterior fontanel fuses by 6-8 weeks
ii. anterior fontanel fuses by 12-18 months
d. teeth: 6-8 teeth by 1 year
e. parachute reflex appears by 7 months
f. moro reflex disappears by 3 months
g. fine motor development
i. grasps objects→ 2-3 months
ii. transfers objects between hands→ age 7 months
iii. crude pincer grasp (<8 months)
iv. pincer grasp (thumb and index finger)→ age 10 months
v. removes objects from containers→ age 11 months
vi. builds tower of two blocks → 12 months
h. Gross motor development
i. head control and tummy time
, 1. improved by 4-6 months
ii. rolls over→ 5-6 months
iii. sits alone→ 7 months
iv. locomotion:
1. crawling→ age 6-7 months
a. moving forward with belly on the floor
2. creeping→ 9 months
a. moving forward on hands and knees with belly off the floor
3. cruising→ 11 months
a. walking while holding onto something
4. walk alone→ 12 months (up to 15 months)
2. Review feeding in the first year of life (i.e., what can they eat/drink and when).
a. nutrition: breast milk for first 6 months of life [ iron fortified milk is a safe alternative; vitamin D supplements]
b. solid food (4-6 months)s: introduce at intervals of 4-7 days to allow for ID of food allergies; start with iron
fortified cereal, then fruits/ veggies, then meat
i. citrus fruits, meat, eggs (after 6 months)
c. NO COWS MILK before 12 MONTHS
Chapter 11- Health Promotion of the Infant
1. Identify the management of serious food allergy
a. most common allergens in children: eggs, cow’s milk, peanuts
b. atopy: allergy w/ hereditary tendency
c. manifestations of food hypersensitivity
i. systemic: anaphylaxis, growth failure
ii. GI: abdominal pain, vomiting, diarrhea
iii. respiratory: cough, wheezing, rhinitis
iv. cutaneous: urticaria, rash, atopic dermatitis
d. management
i. check airway, epipen, benadryl (diphenhydramine), medicalert bracelet, emergency plan, caution for
biphasic reaction
2. Review the topic of Apnea in Infancy including definition and management
a. unexplained respiratory pause lasting 15-20 seconds or more OR less than 15-20 seconds accompanied by pallor,
cyanosis, bradycardia, or hypotension (term infant)
b. apnea monitoring (proper placement, proper settings), stimulation, parent education, medications (caffeine PO/IV)
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
a. developing autonomy vs shame and doubt→ independence is paramount
i. toddler wants to do things themselves but parent may shame the child for this
ii. negativism: responding to things negatively: “no” and “i do it”--> assertion of control
1. offer 2 choices, stay calm
iii. ritualization provides sense of comfort
b. effect of hospitalization→ affects rituals and freedom
c. temper tantrums
i. kicking, screaming, breath holding
ii. increase when child is ill, hungry, tired
iii. management: consistency/ developmentally appropriate expectations, stay calm, ensure safety
Chapter 13- Health Promotion of the Preschooler and Family
1. Identify expected play in preschoolers.
a. associative play: play beside each other but dont have rules
b. imitation, imaginary playmates, mutual play with parents
Chapter 14- Health Problems of Early Childhood
1. Identify the different types of neglect and abuse including presentation and symptoms.
a. physical neglect
i. deprivation of food, clothing, shelter, supervision, medical care, education
ii. most common form of maltreatment
iii. children <4 (80% of neglect cases)
b. emotional neglect
i. lack of affection, attention, emotional nurturance
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