Salicylates Study Guide EXAM 3 PDF

Study guide EXAM 3 Salicylates 1. Uses of Salicylates: Common uses include pain relief, reducing fever, and anti- inflammatory effects. 2. Aspirin is a type of Salicylate 3. How Salicylates Lower Body Temperature: They inhibit prostaglandin synthesis, reducing the hypothalamic re...

Study guide EXAM 3 Salicylates 1. Uses of Salicylates: Common uses include pain relief, reducing fever, and anti- inflammatory effects. 2. Aspirin is a type of Salicylate 3. How Salicylates Lower Body Temperature: They inhibit prostaglandin synthesis, reducing the hypothalamic response to pyrogens, thereby lowering body temperature. 4. Prostaglandins and Pain: Prostaglandins are chemicals that promote inflammation, pain, and fever. Salicylates reduce pain by inhibiting prostaglandin synthesis. 5. Prostaglandins and Anti-Inflammatory Effects: By blocking prostaglandin synthesis, salicylates reduce inflammation and associated pain. 6. Aspirin and Bleeding: Aspirin inhibits platelet aggregation by irreversibly blocking the enzyme COX-1 in platelets, reducing clot formation. This effect lasts the lifespan of the platelet (7–10 days). 7. Six Uses of Aspirin Therapy: Pain relief, fever reduction, anti-inflammatory, heart attack prevention, stroke prevention, and treatment of rheumatoid arthritis. 8. GI Adverse Reactions to Aspirin: Common reactions include nausea, stomach pain, and gastrointestinal bleeding. 9. Signs of Allergic Reaction to Salicylates: Symptoms may include rash, hives, breathing difficulties, or anaphylaxis. 10. Contraindications of Aspirin Therapy: Includes peptic ulcer disease, bleeding disorders, hypersensitivity to NSAIDs, children with viral infections (risk of Reye's syndrome), and third-trimester pregnancy. 11. Salicylism: This is a condition caused by aspirin toxicity, which can present with symptoms like tinnitus, dizziness, nausea, and vomiting. Treatment may involve stopping the drug and supportive care. 12. Foods Containing Salicylates: Foods like berries, tomatoes, and almonds contain salicylates, which may increase the risk of salicylism if consumed excessively. 13. Effect of Taking Aspirin with an Anticoagulant: It increases the risk of bleeding. 14. Effect of Taking Aspirin with NSAIDs: Can increase the risk of GI bleeding and ulceration.  15. Effect of Taking Aspirin with Antacids: Antacids may decrease the absorption and effectiveness of aspirin. Nonsalicylates – Acetaminophen (Tylenol) 1. Primary Nonsalicylate Analgesic: Acetaminophen. 2. Reasons to Choose Acetaminophen over Aspirin: It doesn’t cause GI bleeding, it’s safe for patients with bleeding disorders, and it’s less likely to cause allergic reactions. 3. Actions of Acetaminophen: Pain relief (analgesic) and fever reduction (antipyretic). 4. Effectiveness for Inflammatory Conditions: Acetaminophen is not effective for inflammation because it has minimal anti-inflammatory effects. 5. Use in Patients with Bleeding Tendencies: Acetaminophen is safer than aspirin as it doesn’t affect platelets or increase bleeding risk. 6. Three Uses of Acetaminophen: Pain relief, fever reduction, and in combination with other drugs for pain management. 7. Significance of Hepatotoxicity: Overdosing on acetaminophen can cause severe liver damage, especially in those with pre-existing liver conditions or who consume alcohol. 8. Acetaminophen in Diabetic Patients: Diabetic patients may need to avoid excessive doses due to potential liver strain, especially if they have other complications. 9. Signs of Acetaminophen Toxicity: Early signs include nausea, vomiting, and right upper quadrant pain. Early recognition is critical to prevent liver failure. 10. Treatment for Acetaminophen Toxicity: N-acetylcysteine (NAC) is administered, often intravenously, as an antidote. NSAIK Naproxen Salicylate acid (Aspirin) Acetylsalicylic acid (Aspirin) Ibuprofen and Indomethacin Ketorolac (Toradol) NSAIDs 1. Three Actions of NSAIDs: Anti-inflammatory, analgesic (pain relief), and antipyretic (fever reduction). 2. Analgesic and Antipyretic Mechanism: NSAIDs inhibit cyclooxygenase enzymes (COX-1 and COX-2), reducing prostaglandin production. 3. COX-1 and COX-2: COX-1 is found in most tissues and is responsible for maintaining the stomach lining, while COX-2 is primarily involved in inflammation and pain. 4. Ibuprofen/Naproxen Adverse Reactions: These drugs can cause GI bleeding, ulcers, and kidney issues. They work by inhibiting COX-1 and COX-2. 5. Benefit of Celecoxib over Ibuprofen: Celecoxib is more selective for COX-2, potentially causing fewer GI side effects than ibuprofen. 6. Four Uses of NSAIDs: Treatment of arthritis, musculoskeletal pain, fever, and menstrual cramps. 7. Common Adverse Reactions: Includes stomach pain, nausea, GI bleeding, kidney issues, and increased risk of cardiovascular events. 8. Five Contraindications of NSAIDs: Include peptic ulcer disease, renal impairment, heart failure, recent MI, and allergy to NSAIDs. Opioid Analgesics 1. WHO Pain Relief Ladder: The ladder suggests starting with non-opioids, adding weaker opioids for moderate pain, and using stronger opioids for severe pain. 2. Agonist: A drug that binds to a receptor and produces a full response. 3. Partial Agonist: Binds to receptors but produces a lesser response than a full agonist.  4. Agonist-Antagonist: Can activate some receptors while blocking others, offering pain relief with lower risk of certain side effects. 5. Secondary Effects of Opioids: Can include respiratory depression, constipation, nausea, and sedation. 6. Ten Uses of Opioids: Pain relief, cough suppression, severe diarrhea, post-surgical pain, chronic pain management, cancer pain, trauma, end-of-life comfort, regional anesthesia, and palliative care. 7. Contraindications for Asthma and Head Injury: Opioids can depress breathing (asthma risk) and increase intracranial pressure (dangerous in head injuries). 8. Nursing Assessments for Opioids: Monitor respiratory rate, pain levels, and signs of sedation. 9. Nursing Interventions: a. Breathing Pattern: Encourage deep breathing exercises, monitor respiratory rate, and oxygen saturation. b. Risk for Injury: Assess for sedation, fall risk, and ensure patient safety. c. Constipation: Provide dietary fiber, encourage fluid intake, and consider stool softeners if needed. Opioid Antagonists 1. Opioid Antagonist: A drug that blocks opioid receptors, reversing the effects of opioids. 2. Naloxone Action Speed: It can reverse respiratory depression within minutes of administration. 3. Three Uses of Opioid Antagonists: Treat opioid overdose, reverse respiratory depression in opioid use, and address post-surgical opioid-induced sedation. 4. Adverse Reactions of Naloxone: Can cause nausea, vomiting, sweating, increased heart rate, and rapid withdrawal symptoms in opioid-dependent individuals. 1. Legal and Ethical Responsibilities in Medication Administration Nursing Practice Acts: These laws vary by state but generally define the scope of nursing practice and responsibilities in medication administration. Nurses must be aware of these guidelines to operate within their legal scope and understand their duty to the patient and the institution.  Clarification and Refusal: Nurses hold the legal responsibility to question and verify any prescription that seems unclear or incorrect. If there is a potential safety risk, they have the right—and duty—to refuse medication administration until clarification is obtained. 2. Core Pharmacokinetic Processes Absorption: Focuses on how drugs enter the bloodstream. Absorption varies by the route of administration (e.g., IV provides immediate absorption, while oral meds must pass through the digestive system). Other factors include drug solubility and body pH, affecting how quickly a drug reaches therapeutic levels. Distribution: After absorption, drugs are transported to target tissues. Distribution depends on factors like blood flow, cell membrane permeability, and protein binding. Metabolism: Primarily occurs in the liver, where drugs are transformed into active or inactive metabolites. The First-Pass Effect refers to the liver's role in breaking down drugs after oral administration, which can reduce the drug's efficacy if not considered in dosing. Excretion: The process of eliminating drugs from the body, mainly via the kidneys. Poor kidney function can lead to drug buildup and toxicity, so kidney health is essential in dosing. 3. Pharmacodynamics: How Drugs Affect the Body Agonists vs. Antagonists: Agonists activate receptors to produce a physiological response, while antagonists block these receptors to inhibit an action. Synergistic Effects: When two drugs are combined, they can enhance each other's effects, requiring dosage adjustments to avoid potential adverse reactions. Therapeutic Effect vs. Toxicity: Therapeutic effects are the intended results of the drug. Toxicity occurs from overdose or accumulation, leading to harmful side effects. 4. Medication Administration Routes and Techniques Oral Administration: Convenient but affected by digestive factors (e.g., acidity). Drugs with high first-pass metabolism may be less effective orally.  Topical & Transdermal: These drugs provide local or systemic effects via skin absorption. For transdermal patches, it’s important to rotate sites to avoid skin irritation and ensure consistent absorption. Parenteral Routes (Injections): o Intramuscular (IM): Faster absorption than subcutaneous due to greater blood flow in muscles; used for vaccines and certain long-acting drugs. o Subcutaneous (Sub-Q): Suitable for slow-release medications like insulin, with rotation of injection sites to avoid tissue damage. o Intravenous (IV): Provides immediate therapeutic effects and is preferred in emergencies. 5. Key Considerations for Medication Dosage Calculations Half-Life: Understanding the half-life of drugs is essential for timing doses correctly to maintain therapeutic levels without causing toxicity. Metric Conversions: Nurses often convert between metric and household systems. For example, converting milligrams to grams or vice versa is crucial for accurate dosing. Pediatric and Geriatric Dosing: Dosage must be carefully calculated based on weight, body surface area (BSA), and organ function. For instance, the elderly may need lower doses due to decreased kidney function. 6. High-Risk Medication and Patient Safety Practices Rights of Medication Administration: The “Rights” (right patient, drug, dose, time, route, documentation, and right to refuse) form the basis of safe medication administration. Double-Checking High-Risk Drugs: High-alert drugs like anticoagulants and insulin require double-checking due to their potential for serious adverse effects if administered incorrectly. Use of MAR (Medication Administration Record): Documenting medication administration is mandatory to reduce errors and ensure continuity of care across healthcare providers. 7. Drug Effects and Misuse Adverse and Side Effects: Unintended drug responses vary in severity. Nurses must monitor for these effects and be prepared to manage any adverse reactions.  Drug Tolerance and Dependence: Chronic use may lead to tolerance (requiring higher doses for effect) or dependence (where stopping leads to withdrawal). Drug Misuse and Abuse: Includes improper use of medications (e.g., taking higher doses) and can lead to toxicity, requiring careful monitoring and education on safe use. 8. Educating Patients for Safe Medication Use Discharge Planning and Education: Patients should leave with a clear understanding of their medications, including dosing, timing, potential side effects, and what to avoid (e.g., alcohol). Medication Adherence Tools: For patients managing multiple medications, tools like pill organizers or linking medications with daily routines can improve adherence. Disposal of Medications: Expired or unused medications should be disposed of safely, especially narcotics, to prevent misuse. 9. Medication Errors and Reporting Definition and Types: A medication error includes any preventable event that may lead to inappropriate use or harm, including wrong dose, wrong patient, or wrong drug errors. Error Reporting Protocol: Nurses have an ethical responsibility to report errors immediately. This includes notifying a physician, documenting in the patient’s record, and completing an incident report to prevent future errors. Analgesics Overview 1. Definition: Analgesics are drugs that relieve pain without causing loss of consciousness. 2. Types: a. Opioid Analgesics: Often used for moderate to severe pain. b. Non-opioid Analgesics: Includes NSAIDs and acetaminophen, commonly used for mild to moderate pain. II. Opioid Analgesics 1. Examples: Codeine, morphine, fentanyl, oxycodone, hydromorphone, methadone, and Demerol. 2. Mechanism of Action: Bind to opioid receptors in the brain, spinal cord, and other parts of the body, reducing the perception of pain. 3. Indications: a. Pain relief for acute and chronic pain. b. Additional uses include cough suppression and diarrhea management. 4. Contraindications: a. Known hypersensitivity, respiratory depression, and certain gastrointestinal conditions. 5. Adverse Effects: a. CNS Depression: Can lead to respiratory depression (most serious). b. Other Side Effects: Nausea, vomiting, urinary retention, constipation, pupil constriction (miosis), and potential for addiction. 6. Tolerance and Dependence: a. Tolerance: Need for higher doses to achieve the same effect. b. Physical Dependence: Leads to withdrawal symptoms if the drug is abruptly discontinued. c. Psychological Dependence: Craving for the drug beyond physical pain relief. 7. Toxicity and Overdose Management: a. Naloxone (Narcan) and Naltrexone (Revia) are opioid antagonists used to reverse opioid overdose symptoms, especially respiratory depression. III. Non-opioid Analgesics 1. NSAIDs (Nonsteroidal Anti-inflammatory Drugs): a. Mechanism of Action: Inhibit cyclooxygenase (COX) enzymes, which are involved in inflammation and pain. b. Common Types: Ibuprofen, naproxen, diclofenac, meloxicam, and aspirin. c. Uses: Pain relief, anti-inflammatory, and antipyretic effects, often used in conditions with inflammation like arthritis. d. Adverse Effects: i. Gastrointestinal: Nausea, ulcers, bleeding. ii. Central Nervous System: Dizziness, headache.  iii. Cardiovascular: Increased risk of heart attack and stroke. iv. Severe Reactions: Rare but severe reactions include Steven-Johnson syndrome and toxic epidermal necrolysis. e. Contraindications: Hypersensitivity, liver/kidney disease, and concurrent use with anticoagulants (increased bleeding risk). 2. Salicylates (e.g., Aspirin): a. Mechanism: Similar to NSAIDs, also inhibits COX enzymes. b. Precautions: i. Avoid in children with viral infections due to the risk of Reye’s syndrome. ii. Avoid in patients with bleeding disorders or those with gastrointestinal irritation. 3. Acetaminophen: a. Mechanism: Acts centrally to reduce pain and fever but lacks anti- inflammatory properties. b. Dosage Limits: i. Max daily dose for adults is 3,250 mg. ii. Reduced to 2,000 mg in the elderly or those with liver conditions. c. Adverse Effects: i. Liver toxicity, especially if combined with alcohol or in overdose. ii. Monitoring required for patients with liver dysfunction. IV. Nursing Implications and Pain Management 1. Assessment: a. Conduct a thorough pain assessment; treat pain as the “fifth vital sign.” b. Use pain scales (0-10 or other scales) to evaluate pain intensity and efficacy of treatment. 2. Monitoring: a. Monitor for adverse effects such as respiratory depression with opioids and gastrointestinal issues with NSAIDs. b. Observe for signs of toxicity, especially with high-risk drugs (e.g., acetaminophen and liver damage). 3. Administration Best Practices: a. Follow the “rights” of medication administration (right patient, drug, dose, route, time, and documentation). b. For opioids, start with the lowest effective dose and titrate up if necessary.  c. Educate patients on not crushing extended-release tablets and on the risks of combining multiple medications with similar ingredients. 4. Patient Education: a. Inform patients about potential side effects and signs of toxicity. b. Explain the importance of adherence to dosing schedules and the dangers of mixing medications, particularly acetaminophen and alcohol. 5. Managing Overdose: a. Be prepared to administer reversal agents (e.g., naloxone for opioids). b. Provide supportive care, such as ensuring airway patency and monitoring vital signs, until further medical assistance arrives. 6. Promoting Safety and Optimal Therapy: a. Ensure patients understand which medications to avoid (e.g., NSAIDs in kidney disease, salicylates in children with viral infections). b. Promote safe practices for at-home pain management, including the use of assistive devices for medication organization and instructions on proper disposal of unused medications. Reye’s Syndrome is a rare, potentially fatal condition causing liver and brain swelling, often affecting children and teenagers recovering from viral infections like the flu or chickenpox. It is strongly linked to aspirin use in young patients with viral illnesses. Key Points: Symptoms: Initial symptoms include vomiting and lethargy, which can progress to confusion, seizures, and even coma. Prevention: Avoid aspirin in individuals under 18, especially during viral infections; acetaminophen or ibuprofen are safer alternatives. Diagnosis and Treatment: Requires immediate hospitalization, supportive care, and treatment to reduce brain swelling. Nursing Role: Educate parents on the risks of aspirin in children, recognize symptoms early, and suggest safe alternatives for pain and fever management. Esophagogastroduodenoscopy (EGD):  o Purpose: Uses a flexible endoscope to inspect the esophagus, stomach, and duodenum for issues like ulcers, inflammation, or tumors, and can collect biopsies. o Nurse’s Role: Prepare the patient, monitor vital signs during the procedure, and provide post-procedure instructions and care. Urine Collection Methods: o Midstream Clean-Catch: Instruct on sterile collection to avoid contamination, label, and transport immediately. o 24-Hour Collection: Guide on discarding the first morning void, collecting all urine for 24 hours, and ensuring proper storage before prompt lab transport. Occult Blood Testing: o Pre-Test: Educate on dietary and medication restrictions that could affect results. o Post-Test: Discuss results and possible next steps if positive; provide instructions if repeat testing is needed. Ostomy Care: o Types include colostomy, ileostomy, and ureterostomy. − Colostomy An opening is created in the large intestine (colon) and attached to the outside of the abdomen. This allows stool to bypass a damaged or diseased part of the colon. − Ileostomy An opening is created in the small intestine (ileum) and attached to the outside of the abdomen. This bypasses the colon, rectum, and anus. − Urostomy The ureters, which are the tubes that carry urine from the kidneys to the bladder, are attached to the outside of the abdomen. This bypasses the bladder. o Care Tips: Empty and change pouches regularly, check for leaks, protect the stoma, and monitor for signs of complications like skin irritation. A healthy stoma should be red and moist. Urinary Catheterization: o Purpose: For urine drainage, output monitoring, or relieving urinary retention. o Nursing Actions: Follow strict sterile technique during insertion, prevent tubing kinks, secure the catheter, maintain hygiene, and monitor for CAUTIs  (common healthcare-associated infections caused by improper insertion or care). Infection Control Precautions 1. Standard Precautions: Basic practices for all patient care to prevent exposure to body fluids; includes hand hygiene, gowns, gloves, and masks. 2. Contact Precautions: For infections like MRSA or VRE spread by direct/indirect contact; requires gown and gloves. 3. Droplet Precautions: Used for illnesses spread by respiratory droplets (e.g., influenza); requires a mask when close to the patient. 4. Airborne Precautions: For diseases like tuberculosis spread by airborne particles; requires N95 respirators and a negative pressure room. 5. Protective Environment: For immunocompromised patients to shield them from environmental exposures. Sterile Technique Essentials 1. Principles: a. Ensure a sterile field with sterile drapes and equipment. b. Maintain sterility by only introducing sterile items into the field, avoiding contamination, and recognizing breaks in technique. c. Discard any contaminated items and re-establish the sterile field as needed. 2. Dressing Changes: a. Use clean technique for simple dressings and sterile technique for complex wounds. b. Gather supplies, perform hand hygiene, don sterile gloves, and use sterile instruments. Apply the new dressing carefully to avoid contamination and discard soiled materials properly. Medications and Immunity 1. Antibiotics:  a. Types include penicillin's, cephalosporins, and fluoroquinolones for treating various infections. b. Nursing Considerations: Monitor for allergies, gastrointestinal effects, and educate on completing the full course. 2. Antivirals: a. Treat viruses like herpes and influenza. b. Monitoring: Watch for common side effects like nausea and fatigue. 3. Antifungals: a. Used for fungal infections such as candidiasis. b. Monitoring: Monitor for hepatotoxicity and gastrointestinal effects. 4. Types of Immunity: a. Active Immunity: Acquired through exposure or vaccination, stimulates long-term antibody production. b. Passive Immunity: Temporary immunity through transferred antibodies (e.g., immune globulins). Nutrients: Essential components such as carbohydrates, fats, proteins, vitamins, minerals, and water, supporting body systems and influenced by factors like age, sex, growth, and health. Nutritional Assessment & Physical Exam Assessments: Include weight, height, BMI, skinfold thickness, basal metabolic rate, and waist circumference. Common Tools: o 24-hour recall and food diary for tracking dietary intake. o Lab tests such as serum albumin, hemoglobin, hematocrit, and creatinine levels. Macronutrients 1. Proteins: a. Building blocks for body structures, classified as complete (animal-based) and incomplete (plant-based). b. RDA: 0.8g/kg body weight; 10-35% of daily calories. 2. Carbohydrates:  a. Simple (sugars like glucose and fructose) and complex (starches, fibers). b. Functions: Provide energy, support glycogen storage, and maintain blood glucose. 3. Fats: a. Categories: Saturated (solid, animal-based) and unsaturated (liquid, plant- based). b. Functions: Energy source, insulation, carrier for fat-soluble vitamins (A, D, E, K). c. Recommended: Less than 20-35% of daily calories. Vitamins & Minerals Water-Soluble Vitamins: o Vitamin C (ascorbic acid) aids in iron absorption. o B complex vitamins support metabolism and RBC production. Fat-Soluble Vitamins: o Vitamin A (vision), D (calcium absorption), E (antioxidant), K (blood clotting). Minerals: o Calcium and Phosphorus: Bone and tooth formation. o Iron: Hemoglobin formation. o Zinc: Wound healing and immune function. Special Nutritional Needs Dietary Adjustments by Population: o Older adults: Limited income, decreased taste/smell, risk of malnutrition. o Pregnant teenagers, elderly, substance abusers: Require monitoring for nutrient deficiencies. Therapeutic Diets 1. Diabetic/CHO Consistent: Focus on regulated carbohydrate intake. 2. Low-Residue (Fiber): Reduces bowel movement frequency for digestive issues. 3. Cardiac: Low-fat, high-fiber to reduce cholesterol. 4. High-Protein, High-Calorie: Needed for conditions like cancer, HIV/AIDS, and burn recovery.  Electrolytes Key Electrolytes: o Sodium: Fluid balance, nerve transmission. o Potassium: Muscle and nerve function. o Calcium: Bone health, muscle contraction. o Magnesium: Enzyme function, muscle relaxation. Hydration & Water Intake Importance of Water: Aids in digestion, absorption, and excretion. Water Sources: Dietary intake and internal metabolic processes. Assessment & Interventions for Special Populations Older Adults: Look for swallowing issues, weight loss, and vitamin deficiencies. Dysphagia: Modify textures, assist with feeding, ensure patient safety to prevent aspiration. Nasogastric (NG) tube A thin, flexible plastic tube that's inserted through the nose into the stomach. NG tubes are typically used for short-term purposes, such as providing extra calories or removing stomach contents. Gastrostomy tube (G-tube or PEG-tube) A tube that's inserted through a small incision in the abdomen and is used for longer-term enteral nutrition. Percutaneous endoscopic gastrostomy (PEG) A type of gastrostomy tube that's generally used when enteral nutrition is needed for a longer period of time. PEG tubes are often used for patients with swallowing disorders. CAN NOT LOWER HEAD OF BED. Nasointestinal feeding tube A type of feeding tube that can be weighted or non-weighted, and with or without a stylet. Hyponatremia Too much water relative to sodium. This condition can be caused by drinking too much water, certain health conditions, or taking certain medications. Symptoms include nausea, vomiting, headache, confusion, and muscle weakness. Hypernatremia Too little water relative to sodium. This condition can be caused by dehydration, diarrhea or vomiting, taking diuretics, or high fever. Symptoms include excessive thirst, lethargy, confusion, and muscle twitching. FRIED- Fever + flushed skin Restless Increased fluid retention + blood pressure Edema – peripheral and pitting Decreased urine output, oliguria(no urine output), dry mouth PPN A less concentrated solution delivered through a peripheral vein, usually in the arm. PPN is used for short-term nutritional support when someone can't eat or digest food properly, but their condition doesn't require TPN. PPN is less invasive than TPN, but it's not recommended for long-term use. TPN A complete nutritional solution delivered through a central vein, such as a PICC line. TPN is used when someone can't use their digestive system at all, or when they need to avoid using it so it can heal. TPN is administered through a central vein because the solution has a high osmolarity that can irritate peripheral veins. Introduction to Pediatric Nursing Pediatric Nursing: Focuses on a parent-nurse partnership, promoting a therapeutic relationship between guardians and the child.  Key Concepts: Pediatric patients differ significantly from adults, requiring specialized care, particularly with unique anatomical and physiological characteristics (e.g., airway differences, immature immune system, high glucose needs). Stages of Growth and Development 1. Neonate: First 28-30 days 2. Infancy: Birth to 1 year 3. Toddler: 1 to 3 years 4. Preschooler: 3 to 5 years 5. School-ager: 6 to 10 years 6. Prepubertal: 10 to 13 years 7. Adolescent: 13 to 18+ years Principles of Growth Directional Trends: o Cephalocaudal (head-to-toe) and Proximal-distal (center-to-extremities) Pace: Unique to individuals; rapid growth in infancy and puberty, slower during other stages. Sensitive Periods: Times when development is particularly responsive to environmental factors, like trust building in the first year. Developmental Theories 1. Erikson’s Psychosocial Stages: Key stages include Trust vs. Mistrust (birth-1 year), Autonomy vs. Shame/Doubt (1-3 years), and Identity vs. Role Confusion (12-18 years). 2. Piaget’s Cognitive Development: Sensorimotor (birth-2 years), Preoperational (2-7 years), Concrete Operational (7-11 years), and Formal Operational (11+ years). 3. Kohlberg’s Moral Development: Covers stages of moral reasoning from obedience-driven to principled conscience-driven. Communication with Pediatric Patients Strategies by Age: o Infants: Soothing voice, cuddling.  o Toddlers: Allow choices, use simple words. o Preschoolers: Explain procedures in sensory terms. o School-age: Answer "how" and "why" questions, reassure about body integrity. o Adolescents: Maintain privacy, use correct terminology. Types of Play Purpose of Play: Supports motor, intellectual, social, and creative development. Types: Solitary, parallel, associative, cooperative, onlooker, and virtual play. Physical and Developmental Assessments Growth Measurements: Track height, weight, and head circumference for children under two years. Age-Specific Exam Approaches: o Infants: Begin with least intrusive steps. o Toddlers: Allow play before inspection. o School-age and Adolescents: Respect privacy and perform genital exams last. Pediatric Vital Signs by Age Newborn: HR 120-160 bpm, RR 30-60 breaths/min. Toddler: HR 80-130 bpm, RR 20-30 breaths/min. Preschooler: HR 80-120 bpm, RR 20-25 breaths/min. School-age: HR 70-110 bpm, RR 16-22 breaths/min. Adolescents: HR 60-100 bpm, RR 12-20 breaths/min. Nutrition Across Stages Infancy: Breastmilk or formula until 6 months; introduce solids at 6 months. Toddlerhood: Balanced diet with focus on autonomy; picky eating may begin. School Age: Teach healthy choices; nutrient-dense foods are key. Adolescence: High caloric and protein needs due to growth spurts.  Pediatric Pain Management Pain Assessment: Use age-appropriate scales like FLACC for infants, face scales for older children. Interventions: o Pharmacological: Appropriate analgesics based on age. o Non-pharmacological: Distraction, imagery, relaxation. Atraumatic Care Minimize Distress: Techniques to reduce anxiety, such as preparing the child and using comfort items. Parental Involvement: Essential to enhance security and coping in children. Hospitalization Stressors Separation Anxiety: Peaks in toddlers; characterized by protest, despair, and detachment. Loss of Control: Maintain routines to mitigate stress. Pain and Injury Fear: Use comfort strategies and explain procedures at an age- appropriate level. Nursing Interventions by Developmental Stage Infants: Gentle voice, soft touches, describe procedures. Toddlers: Brief explanations, offer choices. School Age: Use visuals and involve them in care decisions. Adolescents: Respect privacy, allow autonomy. Chvostek's sign- CHEEK A facial muscle twitch that occurs when the facial nerve is tapped lightly in front of the ear. This sign is caused by increased neuromuscular excitability. Trousseau's sign A carpopedal spasm, or contraction of the hand and wrist muscles, that occurs when a blood pressure cuff is inflated above systolic pressure for a few minutes. This sign is caused by ischemia, or reduced blood flow, to the hand and wrist Normal ranges: Sodium (RDA 1,300-1,500 mg) Maintains fluid balance Cell membrane permeability and absorption of glucose Cardiac function Acid-base balance Regulation of neuromuscular function Normal -136-145 mEq/L o Hyponatremia: A condition where there is too much sodium and not enough water in the body. It's diagnosed when the level of sodium in the blood is higher than 145 milliequivalents per liter (mEq/l). o Hypernatremia: A condition where there is too much water and not enough sodium in the body. It's diagnosed when the level of sodium in the blood is lower than 135 mEq/l. Chloride (RDA 2,000-2,300 mg - Normal - 98-106 mEq/L Potassium (RDA 4,700 mg) - Muscle contraction Cardiac function Protein synthesis Nerve impulse transmissions Carbohydrate metabolism Acid-base balance Intracellular cation Normal -3.5-5 mEq/L Hypokalemia- too low  Hyperkalemia- too much Calcium (RDA 1,000-1,200 mg) - Phosphorus (RDA- 700 mg) - Nerve and muscle activity Vitamin utilization Kidney function Metabolism of carbohydrates, proteins, fats Cell growth and repair Myocardial contraction Energy production Bone and tooth formation Acid-base balance Red blood cell function Normal -3-4.5 mg/dL Hyperphosphatemia- TOO MUCH Hypophosphatemia- TOO LITTLE Magnesium (RDA 310-420 mg) Parathyroid hormone regulation Acid-base balance Enzyme activation Smooth muscle regulation Metabolism of carbohydrates and protein Cell growth and reproduction Normal - 1.3-2.1 mEq/L Hypermagnesemia- TOO MUCH Hypomagnesemia- TOO LITTLE GLUCOSE- Energy source for metabolic and biologic functions o brain Normal -70-100 o Hypoglycemia- COLD AND CLAMMY NEEDS SOME CANDY o Hyperglycemia Chromium (AI 20-35 mcg) -  Hemoglobin synthesis Cellular oxidation Transportation of oxygen Normal- 70-140 mcg/dL Copper (RDA 900 mcg) - Hemoglobin synthesis Cellular oxidation Transportation of oxygen Normal- 70-140 mcg/dL Iodine (RDA 150 mcg) - Thyroid hormone synthesis Normal -15-20 mg Sources- supplements, iodized salt, seafood Iron (RDA 8-18 mg) - Zinc (RDA 8-11 mg) - Cellular metabolism Maintenance of taste and smell Burn and wound healing Gonadal function Maintenance of serum vitamin A concentration Acid-base balance Protein digestion Promotion of growth Normal -8 mg women, 11 mg men