Health Promotion
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What is the primary focus of Erikson's stage of industry vs inferiority?
Independence, making life choices, privacy begins to become important/confidentiality
How can caregivers help prevent their child from getting sunburned?
UV-blocking clothing, apply sunscreen 30 minutes prior to outdoor activity, outdoor activities later in the day when sun is lower, SPF 30+
What are some ways comfort can be provided to a toddler-aged child?
Parent separation is huge: allow for caregivers to be present as much as possible, temper tantrums are common: use distraction, teach and support, tell calmly what needs to do, praise; positive discipline
What are some items of high importance when caring for a premature infant in the NICU?
Thermoregulation, remember normal abnormals (VS often dip at times then return to baseline--but always be cautious about fluctuations in temperature)
Describe pain management protocols if a hospitalized child has pain that is unrelieved by the medication that is ordered AND describe an ideal pediatric candidate for pain-control utilizing a PCA pump
Notify MD; try nonpharmacological pain-relieving measures
Cognitively aware, developmentally appropriate based upon age; typically minimum of 5-6 years
What is the primary focus of Erikson's trust vs mistrust stage AND the primary focus of autonomy vs shame and doubt?
Trust vs mistrust: safety with caregiver (reliability, care, affection)/be involved in baby's care, talk calmly, smile and soothe baby
Autonomy vs shame and doubt: independence from parents (sit on table or with parent, let handle equipment, close to parent, give choices, security objects, give praise)
What education should nurses provide to new parents regarding SIDS?
Sleeping on the back fully opens the airway; as a rule of thumb: focus teaching efforts on what we want to accomplish/focus on the positives
What are some important oral care educational items to give to parents?
Bed without a bottle, no juice, wipe gums 1-2 x/day with washcloth to clean, 2 front teeth by 6 months, teething comfort measures, fluoride drops might be recommended based on water supply, no lidocaine/benzocaine; schedule first dentist appt. by 1 year; important for speech, positive self-image and to prevent systemic illnesses
Describe NG tube insertion technique AND what is a common treatment for apnea of prematurity?
No vaseline needed, auscultate tube placement with air bolus, might feed via PO them OG or NG, discuss how to measure (nare to tip of ear then down to area between xiphoid process and umbilicus)
Caffeine and watch carefully for apnea/bradycardia/desaturation episodes
Discuss common ways of administering medications to a young child (around 3-4 years of age) AND describe 2 ways to ensure safety when administering medications to a hospitalized 5-year-old child
If crushed, dissolve in only 5-10 mL of liquid; young children will not be able to swallow
Check armband. If parent is present, can confirm identity by parent reading child's name and DOB aloud; scan armband and medication/read armband and information in electronic chart
Discuss site-specific details for IM injections in children
Vastus lateralis: infant
Deltoid: older children (maybe 5+)
Ventrogluteal/dorsogluteal: not ideal due to proximity to sciatic nerve/not recommended
Might need to restrain, parents can help; EMLA to help numb the area; 5/8 inch needle up to 28 days of age (and 0.5 mL of liquid) then 1 inch needle; 1 mL of fluid in ventrogluteal and vastus lateralis/0.5 mL for deltoid; older children might need 1-1.5 inch needle and up to 3 mL of fluid
What are some developmentally appropriate skills for a 2-3 year old?
*Jumps, *kicks a ball, *draws a circle and other shapes by age 3, *undresses self first, *uses short sentences, *learns to pour, *dresses and undresses self by age 3, 500-900 words and uses short sentences
Slightly later: rides bike, ties shoes, climbs well, buttons clothes
Discuss confidentiality and privacy in a school setting. What are some important items to keep in mind?
Allow students to voice concerns in a judgment-free manner; can speak confidentially unless there is risk of harm to self or others
How do nurses help to foster adequate growth and development of preterm babies in the NICU AND are parents able to hold their hospitalized children? What if they have IV fluids running?
Nesting, clustering care, portholes closed; we don't always draw labs and they often don't have many, if any, medications
Parents and children alike will feel comforted by being present; offer to show how to safely hold with tubes, etc. in place
Describe the appearance of chickenpox AND describe care of a patient with parotitis (mumps) AND discuss the PPE required when caring for a patient with pertussis AND give two possible complications of untreated strep
Various stages of healing, rash begins on trunk/scalp/face; macule to papule to vesicle then crusts over; 1-5 days of eruptions is very itchy; oral lesions; crusts can last 1-3 weeks
Soft foods, monitor for testicular swelling, cool or warm compress on neck if needed
Mask, gloves, eye wear, gown; scarlet fever and rheumatic fever
What are three developmentally appropriate skills for a 5-year-old?
For 3-6 years: scissors, draws circle/square/cross, *buttons clothes, uses spoon/fork/knife, brushes teeth, toilet without assistance by 5 years of age, *climbs well, throws ball overhand by age 4, *rides bicycle, *ties shoes, 2000 words/talks endlessly
What is the primary focus of Erikson's initiative vs guilt stage AND what is the primary focus of the identity vs role confusion stage?
Initiative vs guilt: allow to handle equipment, intrusive procedures at end, parent nearby
Identity vs role confusion: provide teaching/more complex descriptions, engage them, head-to-toe assessments are usually possible due to this age group being more cooperative
Give developmentally appropriate skills for a 1 to 2 year old
Walks with ease, scribbles, *throws a ball (can throw before able to kick), undresses self, push-pull toys, 4-6 words then by 18 months: 15-20 words, run and jump by age 2, tower of 4 blocks by age 2
If a school-age child cries and tells you, "I'm bad!" discuss what your response to them would be. Then discuss what your response to a preschool-aged child would be in the same situation.
Ask them to describe their feelings/thoughts more, i.e. "tell me more about how you're feeling..."
"You are here because..." (speak to a child in a way that helps them better understand the circumstances without placing blame or saying something that might make them feel like you are in agreement with their negative assessment. Do not be dismissive.
Give two behavioral indicators of pain AND two reasons managing pain in children can be challenging AND discuss the risk of immunizations vs natural infection with a communicable disease
Sleeplessness, restlessness, flat affect, aggressive behavior, withdrawal, moaning, whimpering, uncooperative, irritability
Children cannot always communicate their pain and often have pain and fear which can be more difficult for them to manage; pain in children is often undertreated when compared with same procedures performed on adults
Natural infection could result in serious complications; immunization benefits outweigh the risks
When teaching parents of young children (infancy through school-age), list educational items of high importance AND tell them what to expect regarding their child's weight at 6 months and 12 months
Accident prevention, sunscreen, immunizations, nutrition, exercise, oral health, routine well-visits, no smoking, lead poisoning, seat belts, burns, drowning, falls, safe street crossing AND weight doubles by 6 months and triples by 12 months
List specific roles of a school nurse AND provide 2 items that school nurses would not be responsible for
Provide teaching for illnesses/injuries/chronic medical conditions; wellness teaching (this can look different in each school); vision/hearing/BMI/ht/wt; checking for immunization compliance; checking for head lice AND prescribing medications, diagnosing medical conditions
What are some important teaching items for parents of school-age children specifically?
Accident prevention (safe swimming, cooking safety); stranger safety, who to call/summon in an emergency, emergency phone numbers
Discuss ways of helping to ease stress of hospitalization for a toddler-aged child then provide the same for a preschool-aged child
Toddler: Does not need new toys, family members present as much as possible
Preschooler: offer choices, allow to handle equipment, routines are helpful, parents participating in care, honesty if parents must leave
Describe CRIES pain scale vs FLACC vs FACES
CRIES: both physiological and behavioral signs/subjective and objective; crying, requires oxygen, increased VS, expression, sleeplessness; used for newborns and is the neonatal postoperative pain scale
FLACC: used from 2 months-7 years and sometimes older than 7; can be used if a child does not speak or has a low IQ/developmental delay; face, legs, activity, cry, consolability; used often; mostly behavioral indicators of pain; must use if child cannot communication (i.e. postop); if cannot self-report pain, this is the scale that is used
FACES:3 years through adolescence; child chooses face that shows how they are feeling; it is a self-report, not nurse report; number correlates with description (six-line drawings of faces with expressions from happy to neutral to crying: each face is associated with a number)