HESI PN PEDIATRICS PROCTORED EXAM

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HESI PN PEDIATRICS PROCTORED EXAM

VERSION 9

Chapter 1: Family centered nursing care

• Parenting styles

-Dictatorial or authoritarian:

-Parents try to control the child’s behaviors and attitudes through unquestioned rules and expectations

-Ex: The child is never allowed to watch television on school nights

-Permissive:

-Parents exert little or no control over the child’s behaviors, and consult the child when making decisions

-Ex: The child assists with deciding whether he will watch television

-Democratic or authoritative:

-Parents direct the child’s behavior by setting rules and explaining the reason for each rule setting

-Ex: The child can watch television for 1 hr on school nights after

completing all of his homework and chores -Parents negatively reinforce deviations form the rules

-Ex: The privilege is taken away but later reinstated based on new

guidelines

Chapter 2: Physical assessment findings

• Vital signs

-Usually vital signs are all high except for BP

-Temperature:

-3 – 6 months 99.5 -1 year 99.9 -3 year 99.0 -5 years 98.6 -7 years 98.2 -9 – 11 years 98.1 -13 years 97.9

-Pulse:

-Newborn 80 – 180/min -1 weeks – 3 months 80 – 220/min -3 months – 2 years 70 – 150/min -2 – 10 years 60 – 110/min -10 years and older 50 – 90/min

-Respirations:

-Newborn – 1year 30 – 35/min -1 – 2 years 25 – 30/min -2 – 6 years 21 – 25/min -6 – 12 years 19 – 21/min -12 years and older 16 – 19/min

-Blood pressure: 1 / 4

1 -Low as a baby but increases the older they get

-Infants:

-Systolic: 65-78

-Diastolic: 41-52

• Head

-Fontanels should be flat

-Posterior fontanel:

-Closes by 6-8 weeks

-Anterior fontanel:

-Closes by 12-18 months

• Teeth

-Infants should have 6-8 teeth by 1 year old -Children and adolescents should have teeth that are white and smooth, and begin replacing the 20 deciduous teeth with 32 permanent teeth

• Infant Reflexes

Stepping Birth to 4 weeks Palmar Grasp Birth to 3 months Tonic Neck Reflex (Fencer Position) Birth to 3 – 4 months Sucking and Rooting Reflex Birth to 4 months Moro Reflex (Fall backward) Birth to 4 months Startle Reflex (Loud Noise) Birth to 4 months Plantar Reflex Birth to 8 months Babinski Reflex Birth to 1 year

Chapter 3: Health promotion of infants (2 days to 1 year)

• Physical Development

-Weight:

-Doubled by 5 months -Tripled by 12 months -Quartered by 30 months

-Height:

-2.5 cm (1 in) per month for the first 6 months

-Length:

-Increases by 50% by 12 months

-Dentition:

-First teeth erupt between 6-10 months

• Motor skill development

 1 Month

• Head lag
• Strong grasp reflex

 2 Months

• Lifts head when prone
• Holds hand in open position | Grasp reflex fades

 3 Months

• Raises head and shoulders when prone | Slight head lag
• No grasp reflex | Keeps hands loosely open

 4 Months

• Rolls from back to side
• Grasp objects with both hands 2 / 4

1  5 Months

• Rolls from front to back
• Palmar grasp dominantly

 6 Months

• Rolls from back to front
• Holds bottle

 7 Months

• Bears full weight on feet | Sits, leaning forward on both hands
• Moves objects from hand to hand

 8 Months

• Sits unsupported
• Pincer grasp

 9 Months

• Pulls to a standing position | Creeps on hands and knees instead of crawling
• Crude pincer grasp | Dominant hand is evident

 10 Months

• Prone to sitting position
• Grasps rattle by its handle

 11 Months

• Walks while holding onto something | Walks with one hand held
• Places objects into a container | Neat pincer grasp

 12 Months

• Stands without support briefly | Sits from standing position without assistance
• Tries to build a two-block tower w/o success | Can turn pages in a book
• Cognitive development

-Piaget: sensorimotor (birth to 24 months)

-Object Permanence: objects still exists when it is out of view

-Occurs at 9-10 months

• Language development

-3-5 words by the age of 1 year

• Psychosocial development

-Erikson: Trust vs. Mistrust:

• Learn delayed gratification

-Trust is developed by meeting comfort, feeding, simulation, and caring needs -Mistrust develops if needs are inadequately or inconsistently met or if needs are continuously met before being vocalized by the infant

• Social development

-Separation Anxiety: protest when separated from parents

-Begins around 4-8 months

-Stranger Fear: ability to discriminate between familiar and unfamiliar people

-Begins 6-8 months

• Age appropriate activities

-Rattles -Playing pat-a cake -Brightly colored toys -Playing with blocks

• Nutrition

-Breastfeeding provides a complete diet for infants during the first 6 months -Solids are introduced around 4-6 months -Iron-fortified cereal is the first to be introduced -New foods should be introduced one at a time, over a 5-7 day period to observe for allergy reactions 3 / 4

1 -Juice and water usually not needed for 1 st year

-Appropriate finger foods:

-Ripe bananas -Toast strips -Graham crackers -Cheese cubes -Noodles -Firmly cooked vegetables -Raw pieces of fruit (except grapes)

• Injury prevention

-Avoid small objects (grapes, coins, and candy) -Handles of pots and pans should be kept turned to the back of the stove -Sunscreen should be used when infants are exposed to the sun -Infants and toddlers remain in a rear-facing car seat until age 2 -Crib slats should be no farther apart than 6 months -Pillows should be kept out of the crib -Infants should be placed on their backs for sleep

Chapter 4: Health Promotion of Toddlers (1 to 3 years)

• Physical development

-Weight:

-30 months: 4 times the birth weight

-Height:

-Toddlers grow 7.5 cm (3 in) per year

-Head circumference and chest circumference:

-Usually equal by 1 to 2 years of age

• Cognitive development

-Piaget: sensorimotor stage transitions to preoperational stage 19 – 24 months

-Object Permanence: fully developed

• Language development

-1 year: using one-word sentences

-2 years: 300 words, multiword sentences by combining 2-3 words

• Psychosocial Development

-Autonomy vs. Shame and Doubt -Independence is paramount for toddlers who are attempting to do everything for themselves -Use negativism or negative responses to express their independence -Ritualism, or maintaining routines and reliability, provides a sense of comfort for toddlers as they begin to explore the environment beyond those most familiar to them

• Age appropriate activities

-Parallel play: Toddlers observe other children and then might engage in activities nearby

-Appropriate activities:

-Playing with blocks -Push-pull toys -Large-piece puzzles -Thick crayons -Toilet training can begin when toddlers have the sensation of needing to urinate or defecate

• Motor skill development

 15 Months

• Walks without help | Creeps up stairs
• Uses a cup well | Builds 2 tower blocks

 18 Months

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