Assessments for Children in Acute Care
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Questions and Answers

In an acute care setting, besides matching parent wristbands, where else might a child's identification band be located on an infant?

  • Upper arm
  • Lower leg (correct)
  • On the forehead
  • Around the ankle
  • Prior to performing any physical assessment on a child, the nurse would begin with which action?

  • Asking the child questions first
  • Performing the most invasive tasks
  • Explaining the procedure
  • Performing the least invasive tasks (correct)
  • When offered choices, what should the nurse remember when allowing a child to choose where to take their temperature?

  • Offer a wide range of options
  • Offer any way the child may want to take temperature
  • Offer multiple ways to take the temperature
  • Offer only a couple of options (correct)
  • Which of these is an example of how a nurse might actively include a child in their physical assessment?

    <p>Have the child guess their height and weight (B)</p> Signup and view all the answers

    When caring for a transgender adolescent, which of these is most important for the nurse to acknowledge first?

    <p>Their patient's preferred pronouns (C)</p> Signup and view all the answers

    What is the priority when communicating with a child's parents/guardians, before providing care?

    <p>Communicate with the child first (A)</p> Signup and view all the answers

    During any interaction with a patient, the nurse must always do which action first?

    <p>Introduce themselves (A)</p> Signup and view all the answers

    When taking a child's temperature, what is the alternative to a rectal reading?

    <p>Forehead or armpit (B)</p> Signup and view all the answers

    What is the typical first substance that adolescents experiment with?

    <p>Cigarettes (D)</p> Signup and view all the answers

    What occurs during the Babinski reflex?

    <p>The big toe moves upward and other toes fan out (D)</p> Signup and view all the answers

    At what age does the Babinski reflex typically disappear?

    <p>Up to 2 years (C)</p> Signup and view all the answers

    What should be a concern for an adolescent regarding the use of birth control and smoking?

    <p>Higher likelihood of blood clots (C)</p> Signup and view all the answers

    What key action should be taken when addressing adolescents' concerns?

    <p>Listen to their concerns seriously (A)</p> Signup and view all the answers

    Which symptom is NOT associated with galactosemia?

    <p>Severe headache (B)</p> Signup and view all the answers

    Which is a development milestone for speech/language in a 6-month-old?

    <p>Babble with vowel sounds (D)</p> Signup and view all the answers

    What is a key milestone for hearing/understanding in a 12-month-old?

    <p>Understands simple phrases (D)</p> Signup and view all the answers

    Which development milestone is expected in a 9-month-old related to hearing?

    <p>Looks at objects when talked about (D)</p> Signup and view all the answers

    What is the speech/language milestone for a 3-month-old?

    <p>Coo sounds (C)</p> Signup and view all the answers

    At what age is a child expected to begin using 1-2 words as a speech milestone?

    <p>12 months (C)</p> Signup and view all the answers

    Which is an expected hearing milestone for a 3-month-old?

    <p>May stay quiet/smile when spoken to (C)</p> Signup and view all the answers

    Which symptom is commonly linked to failure to thrive in infants with galactosemia?

    <p>Diarrhea (D)</p> Signup and view all the answers

    What is the speech/language milestone for an 18-month-old child?

    <p>Points to pictures in a book (C)</p> Signup and view all the answers

    At what age do children typically use 2 word phrases in speech?

    <p>2 years (C)</p> Signup and view all the answers

    What is a typical hearing and understanding milestone for a 2-year-old?

    <p>Follows 2-step directions (B)</p> Signup and view all the answers

    How can a nurse respect a client's culture?

    <p>By scheduling care based on the client's preferences and practices. (B)</p> Signup and view all the answers

    What speech/language skill is expected of a 3-year-old?

    <p>Creates 3 word phrases (A)</p> Signup and view all the answers

    What understanding skill is typical for a 4-year-old?

    <p>Understands colors (D)</p> Signup and view all the answers

    When a child is dying, which supportive individuals may the family see?

    <p>Social worker, chaplain, child life specialist, and outside support groups. (C)</p> Signup and view all the answers

    What is one opportunity that parents may desire when their child is dying?

    <p>To create legacy work such as handprints or recording their voice. (B)</p> Signup and view all the answers

    Which of the following is an example of gross motor skills in infants aged 2-3 months?

    <p>Lifts head and chest while lying on stomach (D)</p> Signup and view all the answers

    What differentiates fine motor skills from gross motor skills?

    <p>Gross motor skills use larger muscle groups (A)</p> Signup and view all the answers

    What should a nurse do if the parents want to hold their baby after it has passed?

    <p>Swaddle the baby in a warm blanket before handing them over. (B)</p> Signup and view all the answers

    What is important for a nurse to do when a child is withdrawing from care in the ICU?

    <p>Provide a calm and peaceful environment by reducing unnecessary equipment. (A)</p> Signup and view all the answers

    Which of the following is NOT a fine motor skill expected from a 2-3 month old child?

    <p>Supports upper body with arms (D)</p> Signup and view all the answers

    What might families want during the process of their child dying?

    <p>To hold or lay in bed with their dying child. (A)</p> Signup and view all the answers

    Why is it beneficial for a nurse to ask clients and their families about culture?

    <p>To have a better understanding and provide tailored care. (A)</p> Signup and view all the answers

    What should be avoided to prevent further stress to parents in a grieving situation?

    <p>Handing the parents the baby immediately without preparation. (B)</p> Signup and view all the answers

    What is an important approach for a nurse when dealing with a frightened child?

    <p>Getting down with the child at eye level (C)</p> Signup and view all the answers

    Which factor is critical when communicating with parents of hospitalized children?

    <p>Providing them with updates on condition and care plans (A)</p> Signup and view all the answers

    What is the best way to obtain information from a client during an assessment?

    <p>Use open-ended questions to gather detailed information (B)</p> Signup and view all the answers

    When assessing an adolescent in the presence of their parent, what should the nurse do first?

    <p>Ask the adolescent if they want their parent in the room (A)</p> Signup and view all the answers

    What is a key aspect of practicing cultural sensitivity in nursing?

    <p>Being open to the beliefs of other cultures (A)</p> Signup and view all the answers

    What should a nurse remember about parents in the context of family-centered care?

    <p>They often feel empowered by being involved (A)</p> Signup and view all the answers

    When caring for clients, which question strategy should be avoided?

    <p>Using closed-ended questions (B)</p> Signup and view all the answers

    How can a nurse gain a better understanding of a client’s cultural background?

    <p>Being aware of personal biases and asking open-ended questions (A)</p> Signup and view all the answers

    Flashcards

    What is the Babinski reflex?

    A reflex present in infants up to 2 years old. When the sole of the foot is stroked, the big toe moves upward and the other toes fan out.

    What substance do adolescents usually experiment with first?

    Adolescents typically experiment with smoking first.

    How should you approach substance abuse counseling with adolescents?

    When providing guidance on substance abuse to adolescents, it's crucial to acknowledge and address their concerns.

    How do adolescents who are sexually inactive view STIs?

    Adolescents who are sexually inactive may not be concerned about sexually transmitted infections (STIs).

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    What is important to discuss when educating adolescents about smoking?

    It's important to educate adolescents about the risks of smoking, particularly when combined with birth control.

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    Respecting Cultural Practices in Healthcare

    Asking about a client's prayer time and working their schedule around it can show respect for their cultural practices.

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    Importance of Cultural Sensitivity

    True. Respecting cultural differences is crucial in providing care.

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    Support for Families Facing Child's Death

    Social workers, child life specialists, chaplains, and support groups outside of the hospital staff can provide crucial support to families facing a child's terminal illness.

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    End-of-Life Legacy Work

    Legacy work, such as recording the child's voice or making hand and foot prints, allows parents to create lasting memories of their child.

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    Parental Wishes in End-of-Life Care (1)

    Parents might seek time to hold their child, share a final goodbye, or lay with their child.

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    Handling a Deceased Baby

    Nurses can swaddle the baby in a warm blanket to provide comfort and minimize stress for the parents.

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    End-of-Life Care in the ICU

    Nurses should create a calm and peaceful environment by removing unnecessary equipment to support the child's comfort and provide emotional space for the family.

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    Providing Support to Grieving Parents

    Nurses should allow time and privacy for the parents to grieve, while reminding them that assistance is available if needed.

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    Communicating with a scared child

    Building trust is crucial when communicating with a scared child. Lower yourself to their level to create a sense of comfort and safety.

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    Communicating with parents of a hospitalized child

    Effective communication is key for informing parents about their child's condition and plan of care. Prioritize family-centered care by involving parents in decision-making. Remember, parents are under immense stress when their child is hospitalized.

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    Asking open-ended questions

    When asking questions, aim for open-ended inquiries to gather comprehensive information. Begin with 'Tell me more about...' to encourage detailed responses.

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    Assessing an adolescent with parents

    Respect the adolescent's autonomy by asking if they want their parent present during the assessment. This helps build trust and empower them.

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    Cultural sensitivity in healthcare

    Recognize and acknowledge the unique beliefs and practices of different cultures. Be aware of your own biases and avoid letting them influence your care. Ask open-ended questions to gain a deeper understanding and support the client's preferences.

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    Effective communication in healthcare

    When communicating with a patient, ensure clear verbal and nonverbal communication. Convey empathy and understanding through your tone, body language, and active listening skills.

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    Importance of medical history

    The patient's medical history, medications, allergies, and current symptoms are crucial for making informed decisions and providing safe care.

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    Respecting patient autonomy

    Respecting patients' wishes and values aligns with ethical caregiving. Ensure you understand their preferences and involve them in decision-making.

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    Child Identification in Acute Care

    In an acute care setting, identifying a child can be done using wristbands, which are typically found on the lower leg for babies, and parents often wear matching bands.

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    Child Assessment: Start Least Invasive

    When assessing a child, start with the least invasive tasks first. If appropriate, involve the child in more invasive tasks, such as putting on a BP cuff, and explain what you are doing.

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    Child Temperature Assessment

    Temperature can be taken in two ways: in the armpit or using the forehead. Remember, letting the child choose where to take their temperature gives them control.

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    Child Choice: Avoid Overwhelm

    When offering choices to children, give them a limited number of options to avoid confusion. For example, ask them where they prefer to take their temperature, but avoid overwhelming them with too many options.

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    Active Child Participation in Assessment

    Actively involve children in their physical assessment. For example, make it a game by starting with their height and weight, and asking them to guess how tall or heavy they are.

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    Transgender Adolescent Care: Respect

    When caring for a transgender adolescent, always demonstrate respect. Ask for their preferred name and pronouns, and address them accordingly.

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    Communication with Parents First

    When communicating with parents or guardians about their child, it's crucial to communicate with them directly first. This builds trust and ensures their involvement in the care plan.

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    Introduce Yourself First

    Always introduce yourself before interacting with anyone, especially patients. This establishes a professional and welcoming environment.

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    What is a typical speech/language milestone for a 2-year-old?

    A 2-year-old child can typically use two-word phrases, such as "want juice" or "go outside".

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    What is a typical speech/language milestone for a 3-year-old?

    A 3-year-old child can generally use three-word phrases, like "I want cookie" or "go play outside".

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    What is a typical speech/language milestone for a 4-year-old?

    A 4-year-old child can often put together four or more words into sentences, such as "I want to play with the ball" or "Can we go to the park?"

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    What is the difference between fine and gross motor skills?

    Gross motor skills involve large muscle movements, like walking, running, or crawling. Fine motor skills involve smaller muscle movements, like grasping, drawing, or writing.

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    What are some examples of fine motor skills in a 2-3 month old child?

    A 2-3 month old child can demonstrate fine motor skills such as grasping toys, opening and closing their hands, and following an object with their eyes.

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    What are some examples of gross motor skills in a 2-3 month old child?

    A 2-3 month old child can demonstrate gross motor skills such as raising their head and chest, supporting their upper body with their arms while lying on their stomach, and kicking their legs.

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    What is Galactosemia?

    A rare genetic disorder where the body cannot break down galactose, a type of sugar found in milk. It can cause serious health problems if not treated.

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    What kind of Formula is suitable for babies with Galactosemia?

    Soy-based formula is a suitable option as it does not contain galactose. It is typically used for infants with galactosemia.

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    What symptoms are typical in babies with Galactosemia?

    Galactosemia can manifest with symptoms like loss of appetite, vomiting, diarrhea, and jaundice. These symptoms often lead to failure to thrive if left untreated.

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    What is a typical speech/language milestone at 3 months old?

    At 3 months old, babies typically "coo" as a form of vocalization. This is a milestone in their speech development.

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    What is a typical hearing/understanding milestone at 3 months old?

    At 3 months old, babies are developing their ability to understand and recognize sounds. They will likely respond to your voice and may stay calm or smile when you speak to them.

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    What is a typical speech/language milestone at 6 months old?

    At 6 months old, babies begin to "babble", experimenting with sounds and syllables. This is a precursor to actual words.

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    What is a typical hearing/understanding milestone at 6 months old?

    At 6 months old, babies notice a wider range of sounds, including music and changes in voice tone. They also start to turn their heads towards the source of a sound.

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    What is a typical hearing/understanding milestone at 9 months old?

    Around 9 months old, babies begin to imitate actions and gestures. They also look at objects when they are named.

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    Study Notes

    Assessments for Children

    • Some examples of identification of a child in an acute care setting include wristbands (especially for babies, sometimes on the lower leg) and matching bands for parents.

    Assessment for Children:

    • Start with the least invasive tasks.
    • Next, if appropriate, have the child assist with more involved tasks, like putting a blood pressure cuff on. Explain each step and what the machines are doing.
    • Be aware of any impairments and adjust the assessment accordingly.

    Assessment for Children: Temperature

    • Two examples of areas to take a child's temperature are the forehead and armpit.
    • Give the child control over decisions, such as asking them where to have their temperature taken.

    Assessment for Children: Decisions

    • When giving a child choices, only give a couple of options rather than a long list to avoid confusion.

    Assessment for Children: Physical Assessment

    • Actively include the child in their physical assessment by starting with their height and weight; have them guess their size and weight.
    • If caring for a transgender adolescent, be respectful, and ask how they prefer to be addressed (e.g., pronouns).

    Assessment for Children: Communication with Parents/Guardians

    • Communicate with the parents/guardians first.
    • Introduce yourself.
    • Get down to eye level with the client and build rapport.

    Communication: Child Afraid

    • Get down to eye level and begin to build trust.

    Communication: Parents of Client

    • Keep parents updated on the child's condition and treatment plan.
    • Family-centered care is vital. Parents should have input in their child's care.
    • Parents are often stressed when their child is hospitalized.

    Communication: Asking Questions

    • Ask open-ended questions to obtain good information.

    Cultural Diversity: Important Factors:

    • Be open to the beliefs of other cultures.
    • Be aware of your own beliefs and don't let them interfere with the assessment.
    • Ask open-ended questions to understand the client's culture better, and ask how you can be supportive.

    Cultural Diversity: Example

    • The nurse should ask when the client's prayer time is and arrange the schedule accordingly.

    Cultural Diversity: Respect

    • Providing the most respect for different cultures is beneficial.

    End-of-Life: Opportunities for Parents

    • Parents may want time to hold their baby.
    • Parents/family may want to lay in the bed with the child.
    • Parents may want to do activities (locks of hair, records of voice, molds of hand/feet).

    End-of-Life: ICU Care:

    • Provide a calm, peaceful environment.
    • Remove unnecessary equipment (e.g., beeping pumps, alarms).
    • Position the child comfortably.
    • Allow parents/family to be present and offer any support needed.

    End-of-Life: Traumatic Death of a Child

    • Support groups (spiritual guidance).
    • Chaplin.
    • Social workers.
    • Counselors.
    • Legacy work with a child life specialist.
    • Organ donation notification (likely hospital policy, such as tissue).

    Pain Scales

    • The FLACC Scale is used for infants.

    Pain Scales for Preschoolers (and up)

    • The Wong-Baker FACES pain scale is used for preschoolers (and up).

    Pain Scale: Factors to Discuss with a 10 Year Old Client

    • Talk to the client about the pain scale used.
    • Who they will meet after surgery.
    • Describe how to manage the pain.

    Home Health Pediatric Services

    • Private duty nursing.
    • Case management.
    • Child life specialist.
    • Physicians.
    • Physical therapy (PT).
    • Occupational therapy (OT).
    • Speech therapy (ST).
    • Pharmacists.
    • Dietitians.

    Importance of Community Resources

    • Family resources, or lack thereof, significantly impact a child's health.

    PKU

    • Phenylketonuria is an autosomal recessive deficiency of the enzyme phenylalanine. In short, it is a lack of an enzyme.

    PKU Testing and Conduct

    • Guthrie test is the name of the test.
    • Testing is done within 24-72 hours after birth.
    • Doctors use Guthrie cards to collect capillary blood from the infant's heel. The cards are saved for later testing.

    PKU Diet

    • A low-phenylalanine, low-protein diet is used throughout the child's life.
    • Specialized formulas may be needed, given the cost.

    Galactosemia

    • Lack of an enzyme to breakdown galactose to glucose.
    • A common enzyme deficiency.
    • Galactose is a major nutrient in newborns, used for energy production, fuel storage, and regulating carbohydrate assimilation.
    • The most common symptom is loss of appetite.

    Developmental Milestones: 3 Months: Speech/Language

    • "Cooing"

    Developmental Milestones: 3 Months: Hearing/Understanding

    • Recognizes voice.

    Developmental Milestones: 6 Months: Speech/Language

    • "Babbling"

    Developmental Milestones: 6 Months: Hearing/Understanding

    • Notice sounds,music, changes in tone.
    • Move eyes towards sound

    Developmental Milestones: 12 Months: Speech/Language

    • 1-2 words

    Developmental Milestones: 12 Months: Hearing/Understanding

    • Understand simple phrases.
    • Recognizes words for common objects.

    Developmental Milestones: 18 Months: Speech/Language

    • 18 words

    Developmental Milestones: 18 Months: Hearing/Understanding

    • Follows simple commands or questions.
    • Points to images.
    • 2 word phrases

    Developmental Milestones: 2 Years: Speech/Language

    • Follows 2 step directions.
    • Uses gestures during pretend play.
    • 3 word phrases.

    Developmental Milestones: 2 Years: Hearing/Understanding

    • Uses gestures during pretend play.

    Developmental Milestones: 3 Years: Speech/Language

    • Understands spatial/time concepts.

    Developmental Milestones: 3 Years: Hearing/Understanding

    • Understands pronouns/plurals.

    Developmental Milestones: 4 Years: Speech/Language

    • 4 or more word sentences.

    Developmental Milestones: 4 Years: Hearing/Understanding

    • Understands concepts like why or how.
    • Groups objects.
    • Identifies colors.

    Developmental Milestones Differences: Fine and Gross Motor Skills

    • Fine motor skills involve smaller muscles, such as grasping, object manipulation, or drawing.
    • Gross motor skills use larger muscles and include activities like sitting, crawling, walking, or running.

    Developmental Milestones: 2-3 Month Child: Fine Motor Skills

    • Grasps toys.
    • Opens and closes hands.
    • Eyes follow an object to midline.

    Developmental Milestones: 2-3 Month Child: Gross Motor Skills

    • Raises head and chest when lying on stomach.
    • Supports upper body with arms when lying on stomach,
    • Stretches legs out and kicks when lying on stomach or back.

    Developmental Milestones: 6-8 Month Child: Fine Motor Skills

    • Bangs objects on table.
    • Can transfer objects from hand to hand.

    Developmental Milestones: 6-8 Month Child: Gross Motor Skills

    • Can roll from side to side.
    • Sits unsupported by 7 or 8 months; and supports whole weight on legs.

    Developmental Milestones: 1 Year Old Child: Fine Motor Skills

    • Can hold crayon; marks on paper.
    • Begins to use objects correctly.

    Developmental Milestones: 1 Year Old Child: Gross Motor Skills

    • Pulls self up to stand.
    • Walks holding on to furniture; may walk 2 or 3 steps independently.

    Developmental Milestones: 2-3 Year Old Child: Fine Motor Skills

    • Learns to dress self.
    • Can draw simple shapes (e.g., circle).

    Developmental Milestones: 2-3 Year Old Child: Gross Motor Skills

    • Jumps.
    • Kicks a ball.
    • Learns to ride a tricycle.

    Developmental Milestones: 4-5 Year Old Child: Fine Motor Skills

    • Use scissors.
    • Learning to tie shoes.
    • Brushes teeth.

    Developmental Milestones: 4-5 Year Old Child: Gross Motor Skills

    • Goes up and down stairs independently.
    • Throws a ball overhead.
    • Hops on one foot.

    Developmental Milestones: 10 Month Old Assessment

    • Pinch and grasp skills (e.g., with cereal).
    • The ability to walk a few steps without assistance.

    Developmental Toys For Toddlers:

    • Stuffed animals.
    • Building blocks.
    • Books.
    • Play dough.
    • Tricycles.
    • Small cars and trains.
    • Pretend toys for play
    • Pots, pans, spoons, and cups.

    Fontanels

    • Fontanels are soft spots on a baby's head.
    • Anterior and posterior fontanels are located on the top of a baby's head.
    • The anterior fontanel closes between 12 and 18 months old.
    • The posterior fontanel closes between 2 and 3 months old.

    Erikson's Stages: Infancy (Birth to 1 year)

    • Trust vs. Mistrust.

    Erikson's Stages: Early Childhood (1-3 years)

    • Autonomy vs. Shame and Doubt.

    Erikson's Stages: Preschool (3-6 years)

    • Initiative vs. Guilt.

    Erikson's Stages: School Age (6-12 years)

    • Industry vs. Inferiority.

    Erikson's Stages: Adolescent (12-19 years)

    • Identity vs. Role Confusion.

    Erikson's Stages: Young Adulthood

    • Intimacy vs. Isolation.

    Erikson's Stages: Middle Adulthood

    • Generativity vs. Stagnation.

    Erikson's Stages: Maturity

    • Integrity vs. Despair.

    Educating Family Members Regarding Infant Sleeping

    • Place infants on their backs.
    • Remove all blankets/pillows.
    • Make sure the infant's crib is away from windows.

    SIDS

    • Sudden infant death syndrome.

    Peak Age for SIDS

    • 2-4 months.

    Methods to Prevent SIDS

    • Pacifiers.

    Appearance of Newborns/Color Tone

    • Acrocyanosis (bluish hands and feet) is normal in newborns.

    Why Babies Have Bluish Hands and Feet

    • Blood flow is prioritized to vital organs (brain, heart, lungs).

    Vulnerable Adolescents

    • Peer pressure, body image, bullying, sex trafficking, suicidal ideation,

    Normal Urine Output for Newborn/Infant (0-1 year)

    • 2 mL/kg/hour

    Normal Urine Output for Toddler

    • 1.5 mL/kg/hour

    Calculating Urine Output in a Child

    • Divide the volume of urine by the time (in hours) divided by the weight of the child in kilograms.

    Iron Deficiency Anemia

    • Iron deficiency anemia is a common microcytic anemia characterized by small, pale red blood cells and depleted iron stores, leading to erythropoiesis issues.

    Iron Deficiency Anemia Caregiver Education

    • Use iron-fortified formula.
    • Avoid cow's milk in infants until they are 1 year old.
    • Breastfeed infants, or provide an iron supplement if breastfeeding is not possible.
    • Encourage iron-rich foods.

    Adolescents and Sexual Activity

    • A 15-year-old discussing having multiple partners is considered normal as long as condoms are used.

    Adolescents and Substance Use: Initial Drug of Choice

    • Smoking.

    Babinski Sign/Reflex

    • Stroking the sole of a baby's foot causes the big toe to move upwards and other toes to fan out.
    • It is normal in children up to 2 years old and disappears as they get older.

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    Description

    This quiz explores the best practices for conducting assessments on children in an acute care setting. Emphasis is placed on child involvement, temperature measurement techniques, and adapting assessments to children's unique needs. Discover how to effectively communicate and perform assessments while ensuring comfort and understanding.

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