NCLEX-RN Flashcards: Pediatric Nursing, Growth and Development, Immunizations

Erikson's stages for childhood are trust versus mistrust from birth to 18 months, where consistent caregiving builds trust; autonomy versus shame and doubt from 18 months to 3 years, where toddlers develop independence through choices; initiative versus guilt from 3 to 6 years, where preschoolers explore and learn through play; and industry versus inferiority from 6 to 12 years, where school-age children develop competence through achievement. Adolescents face identity versus role confusion from 12 to 18 years, developing a sense of self.

The childhood vaccination schedule includes hepatitis B starting at birth, rotavirus at 2 and 4 months, diphtheria-tetanus-pertussis or DTaP at 2, 4, 6, and 15 to 18 months with a booster at 4 to 6 years, Haemophilus influenzae type b or Hib at 2, 4, and 12 to 15 months, pneumococcal conjugate at 2, 4, 6, and 12 to 15 months, inactivated poliovirus at 2, 4, 6 to 18 months, and 4 to 6 years, measles-mumps-rubella or MMR at 12 to 15 months and 4 to 6 years, and varicella at 12 to 15 months and 4 to 6 years. Live vaccines like MMR and varicella are contraindicated in immunocompromised children.

Signs of dehydration in infants include sunken fontanels, decreased or absent tears when crying, dry mucous membranes, decreased urine output with fewer than six wet diapers per day, concentrated dark urine, tachycardia, lethargy, and poor skin turgor with tenting. Severe dehydration adds sunken eyes, mottled cool skin, capillary refill greater than three seconds, and altered consciousness. Infants are at higher risk than adults because they have a higher body surface area to weight ratio, higher metabolic rate, and immature kidneys.

Epiglottitis is a rapidly progressive bacterial infection, most commonly from Haemophilus influenzae type b, causing severe swelling of the epiglottis that can completely obstruct the airway within hours. The classic presentation is a child with sudden high fever, sore throat, drooling, dysphagia, muffled voice, and the tripod position where the child sits upright leaning forward with the jaw thrust out to maximize the airway opening. The nurse must never examine the throat or place anything in the mouth because stimulation can trigger complete airway spasm.

Fever in children is defined as a temperature above 100.4 degrees Fahrenheit or 38 degrees Celsius. The nurse should assess the child's overall appearance, activity level, and hydration status rather than treating the number alone. Antipyretics include acetaminophen and ibuprofen dosed by weight, not age. Aspirin is contraindicated in children under 19 with viral illness due to Reye syndrome risk. Encourage fluid intake. Use lightweight clothing and a comfortable ambient temperature. Tepid sponge baths may help but should not cause shivering, which increases metabolic heat production.

Intussusception is a medical emergency where one segment of intestine telescopes into an adjacent segment, causing obstruction, inflammation, and potential necrosis. It is the most common cause of intestinal obstruction in children aged 3 months to 6 years. Classic signs include sudden intermittent episodes of severe colicky abdominal pain causing the child to draw up the knees and cry inconsolably, followed by periods of calm. "Currant jelly" stools containing blood and mucus are a late sign. A sausage-shaped abdominal mass may be palpable. Diagnosis is confirmed by ultrasound. ---