-
Over 2 yo max calories from fat....
30%
-
How much juice a day is ok....
up to age 6
7+
-
How much fish, meat, beans should kids eat/day?
2-3 yo
4-8 yo
-
How much whole grains should be in your diet?
- 2-3 yo = 3 oz
- 4-8 yo = 4-5 oz
-
Don't cook with this oil?
How much oil a day?
NO HYDROGENATED OILS
3-4 tsp
-
Make sure this is in your bread and cereals...
whole grains
-
Safe Zones
patients beds and play rooms
don't do any procedures here.
-
Goals for a family with a child with chronic medical problems
- family remains intact
- achieve and maintain normalization
- maximize function throughout the illness
-
Challenges for a nurse caring for a child
- recognition of childs communication technique
- evaluation for pain and discomfort
- total patient care
- listening to parental concerns
-
At what age is it appropriate to give a child meds crushed and with a mixed chaser?
9 months
-
What age child will have stranger and separation anxiety?
Toddler
-
When communicating with a toddler about interventions try to....
keep it fun, short and simple, honest and give choices
-
Which age groups will regress?
All
-
Best approach for giving meds to children
Ask the parents for help or ideas of how to give
Go in with all of your supplies ready
-
Preferred site for IM injection
Vastus Lateralis
-
Needle information for IM Vastus Lateralis injection
- 5/8-1 inch needle
- 22-25 gauge
- 0.5-3 mL syringe
-
When doing a PA what is the key....
Least invasive (respirations, HR) to most invasive (groin/genatalia inspection, ears and mouth)
infants and toddlers wont mind groin, but older kids will
-
Height is measure
head to heels
- under 2 laying down
- 2+ standing
-
How do you weigh a kid?
- <2 naked
- >2 with diaper or as few clothes as possible
-
What do I plot on a growth chart?
- height
- weight
- head circumfrence
-
Which vital signs do I measure for 1 minute?
Respirations and HR
-
Look at this for measuring respirations...
Infant
Toddler and older
-
Temperature taking.....
Infant have it done by...
What age do you start oral?
-
Blood Pressure tricks
- 2/3 of arm length
- put it on arm/leg, bundle then come back when settled
- call it an arm hug
- let child play with before
-
Best to take the RR when
baby is sleeping or child is calm
-
Best position for taking breath sounds
sitting
-
For all procedures it is a good idea to....
let them hold or play with things prior to me using them
-
When should an eye test be done?
no later than 3 yo
-
When do we start to screen for scoliosis
9-15
-
Who is at greatest risk for injury?
infants and toddlers
-
SIDS occurs most often at this age? But till this age?
-
Intrinsic Factors predisposing a child to SIDS
- genetics
- males
- premie
- prenatal exposure to cigarette smoke or alcohol
-
Extrinisic factors predisposing a child to SIDS
- prone sleeping position
- bed sharing
- soft mattress
- exposure to cigarette smoke
-
What puts a baby most at risk for SIDS
prone sleeping + bed sharing
-
Most consistent cue to determine if an infant or child is in pain
facial expression
-
Who cries longer when in pain? Infant or toddler?
Toddler
-
When can a child use words to tell you they are in pain?
18 mo
-
Who feels pain most intensely?
INFANTS
-
What is the preferred route for admin of analgesics?
PO
-
Maximum opioid amount?
Maximum is determined by it being titrated till the person doesn't feel pain and is experiencing few side effects
-
If a child is on an IV opioid they must be on...
cardiac and apnea monitor and pulse ox
-
Ask the parents this question when doing a pain history.....then....
what words do they use to tell you they are in pain.
use those words consistently regarding their pain
-
FLACC
- 1-10 (2 pts. each level max)
- Facial
- Legs
- Activity
- Cry
- Consolable
-
Oucher assessment
select the face that matches how you feel
3-12 yo
-
Poker Chip Tool for pain assessment
4 poker chips...each rep. pain
4-12
-
Visual Analog Scale for pain
1-10 ranking of pain for self
older school age and adolescents
-
Descriptive pain assessment
-
How can you tell an infants in pain?
- FLACC
- high pitched cry
- grimacing
- VS change (tachy, htn, decreased O2 sat)
- thrashing/shaking
- not sleeping/or sleeping a lot
- not eating
- rub painful area or guard the area
-
How can you tell a toddlers in pain?
- LOUD crying
- verbalize it-ouch, hurt, boo boo
- restlesness
- guard the site
- touch painful area
- run from nurse or delay procedures
-
How can you tell a pre school aged kids in pain?
- cry and struggle with you
- regression
- withdrawal
-
Weird things pre schoolers think about pain....
- they caused it....its a punishment
- deny having pain so don't have to get things done
-
How can you tell a school aged child is in pain
- **They will verbalize it**
- stiff body posture
- withdrawal
- procrastinate/bargain to delay the procedure
-
How can you tell an adolescent is in pain?
- **Verbalizes it**
- muscle tension
- withdrawal
- depression
- decreased motor actuvity
- sore, ache, pounding
-
Non pharmacological approaches
- quiet and calm environment
- repositioning, holding, touching, massage, compresses, breathing tech., distractions, guided imagery, muscle relaxation
kangaroo care
-
What's better to calm a patient rubbing/stroking or patting the back and buttocks?
patting
-
How can you help a child that is in pain and not breathing well?
remind them to breathe....party blowers, bubble soap blow wands
-
Describe fluid boluses
isotonic solutions - normal saline or LR
20mL/kg over 15-30 min
-
What age loves band aids and stickers?
Pre Schoolers
-
Toddlers and pre schoolers will have their meds mixed....what is key when choosing foods?
- don't blend with their favorite foods
- use a small amount of pudding, apple sauce
-
Good way to auscultate the heart, lungs and abdomen of a baby?
while they are sleeping or being held by their parent
-
2 Primitive Reflexes
- Palmar Grasp
- Stepping reflex
-
Moro Reflex
infants head and trunk are allowed to drop back 30 degrees ....baby gets "startled" with legs and fingers stretching out
-
What age does it become difficult to do a PA because of stranger anxiety?
How do I handle it?
- 6-12 months
- distract with toys/objects
- have them sit on their parents lap
- leave ears/oral for last
-
Who is the most challenging patient because they are least likely to cooperate?
Toddlers
**Resistance and CRYING are normal responses to exams**
-
Pre Schoolers and the PA...how do they respond?
- they want their parents close by
- BUT they want to show they can get undressed and can cooperate
- praise them for cooperating
-
School aged kids and the PA
- ESTABLISH TRUST FIRST
- Ask questions about them/school/friends
- Let them be modest
- Teach child about their body
-
Adolescents and the PA
- Straightforward approach
- Parent should be present
- Parent should be given opportunity to discuss questions/concerns
- Genitals examined in MIDDLE of exam
-
What approach helps the parents/kids feel that they are having some control?
tell them in advance what they can and should do during the procedure....to help
"I need to draw blood, can you help me by holding still?"
-
What age is it ok for a child to be in a seatbelt?
9...but not by an airbag
-
At what age doe kids understand they can die too?
10
-
View of death by age...
Pre School
School Age
Adolescent
- Pre school-temporary/reversible/punishment
- School Age-Irreversible/sad
- Adolescent-inevitable/irreversible/but a distant event
-
Goals of Healthy People
- Increase access to care
- keep people healthy
- achieve a healthy quality of life
-
Primary, Secondary and Tertiary Interventions for health promotion
- Primary-Prevent Disease
- Secondary-Early Recognition and Treatment
- Tertiary-Restore health to highest level possible and prevent further complications
-
2020 Healthy People objectives
- Increase proportion of children to who have access to medical home
- Make sure all have the finances to receive adequate health care
- Screen early and often
-
What age do babies roll....
back to belly
belly to back
- back to belly- 6 months
- belly to back- 2-3 months
-
At 7 months babies start to
- play social games like peek a boo
- begin to creep or crawl, moving one limb at a time
-
When can a baby hold their own cup for drinking?
12-13 months
-
When can a baby walk backwards?
15 months
-
What age do kids start to play interactive games like hid and seek?
24 months
-
Most important thing to a teen is
Privacy
-
When do you introduce foods to a baby?
- 6 months and start with iron fortified cereals
- introduce a sippy cup
-
When do you introduce soft foods, chopped table foods to a baby?
9 months
-
Eating and the 12 month old
- 2-3 cups daily of whole milk
- variety of table foods from all food groups
- use utensils
- eat 3 meals plus snacks
-
Main task for an infant is
eating
-
Main task for an 18 month to 3 yo is
toilet training
-
If a child gains autonomy they will
- have self control
- will say no, but will still do what's asked
- cope with problems
- have patience
- manifest pride
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