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4th Quarter : 4
Units 12 - 16
| Question | Answer |
|---|---|
| OU | Both eyes |
| OS | Left eye |
| OD | Right eye |
| How much formula should a child under the age of 1 be getting each day? | 26 - 32 oz. |
| Why don't we introduce foods until around 6 months? | Babies don't have the necessary enzymes needed to digest foods until that time. |
| When do we introduce meat? | About 6 months. |
| How do we measure height in children under 36 months? | Lying down. |
| How long do we measure head circumference? | Up to 36 months. |
| Infant HR | 120 - 160 |
| Child HR | 80 - 100 |
| Adult HR | 60 - 80 |
| What could a very high BP on a child indicate? | Renal HTN |
| You cannot hear a BP on a child under the age of __. | 4 |
| Amblyopia | Lazy eye. |
| What vision gets a referral in a preschooler? | 20/50 |
| What vision gets a referral in a school age child? | 20/40 |
| What causes the red reflex of the eye? | Light shining where the optic nerve meets the back of the eye. |
| What is the Hirschberg's test? | A shined light in eyes will show equally in pupils. |
| Exotropia | Deviation to outside. |
| Esotropia | Deviation to inside. |
| What level do you need to pass the hearing test? | 25 |
| What do dB test for? | Loudness |
| What do Hz test for? | Pitch |
| What is a normal deviation for scoliosis? | Less than 5 degrees on either side. |
| What invasive areas should be saved for last? | Pubic area & ears. |
| When does the posterior fontanel close? | 6 - 8 weeks. |
| When does the anterior fontanel close? | 12 - 24 months. |
| Ear exam under 2 | Pull down & back. |
| Ear exam over 2 | Pull up & back. |
| What is circumoral cyanosis? | Blue around mouth. |
| Why are 3 month olds drooling? | Not a good coordination of swallowing yet. |
| Torticollis | Contracted neck muscles cause a twisted, unnatural position. |
| What may be used if a skin tag remains once the umbilical cord has fallen off? | Silver nitrate. |
| When is an umbilical hernia cause for concern? | If it cannot be pushed back in. |
| Pilonidal cyst | Occurs in cleft between buttocks. |
| Murmur scale | I - mild, VI - loud, blowing. |
| Cap refill | Should be less than 2 seconds. |
| How long is a bowlegged appearance normal? | To the age of 2. |
| When does stranger anxiety occur? | 7 - 18 months. |
| When do children respond to simple commands? | 9 months |
| When does separation anxiety occur? | 13 months - 2 years. |
| At what age do children fear bodily harm? | 3 - 5 years. |
| When do children see a relationship between cause & effect? | 5 - 12 years. |
| Cranial nerve V | Trigeminal - bite, touch sensation, corneal reflex. |
| Cranial nerve VII | Facial - expression, taste. |
| Cranial nerve XI | Accessory - sternocleidomastoid & trapezius muscle of shoulder. |
| Cranial nerve II | Optic - light perception, visual acuity, peripheral & color vision, optic disc. |
| Cranial nerve III | Oculomotor - extraocular movements, PERRLA, eyelid closing. |
| Cranial nerve IV | Trochlear - superior oblique muscle. |
| Cranial nerve VI | Abducens - lateral rectus muscle. |
| Cranial nerve VIII | Auditory - hearing, equilibrium. |
| Cranial nerve I | Olfactory - odor identification. |
| Cranial nerve IX | Glossopharyngeal - gag. |
| Cranial nerve X | Vagus - voice quality, swallow. |
| Cranial nerve XII | Hypoglossal - tongue movement |
| Communication - Under 5 | Egocentric. Don't use other child's experiences, focus on them only. They are direct and concrete. Don't smile if you are doing something that may hurt them. |
| Communication - School age | Rely on what they know, not what they see. Want explanation and reason, no verification beyond that. Want to know about functions of things. |
| Communication - Adolescence | Fluctuate from adult to child thinking & behavior. Accepting of anyone who displays genuine interest. |
| Parts of a pediatric health history: | Identifying info, CC, PI, PH, ROS, family medical hx, psychosocial hx, sexual hx, family hx, nutritional assessment. |
| Analyzing pain | Type, location, severity, duration, influencing factor. |
| By what age should infants have good head control? | 4 months |
| Acute Viral Nasopharyngitis | Common cold, URI. |
| When does URI peak? | 3 - 5 days. |
| When does URI resolve? | 7 - 14 days. |
| How many colds do kids average each year? | 6 - 10 |
| How many colds do adults average each year? | 2 - 4 |
| Acute Streptococcal Pharyngitis | Strep throat. |
| What causes strep throat? | Group A b-hemolytic strep. |
| How is strep throat transmitted? | Person to person contact with saliva or nasal secretions. |
| How many sore throats can be attributed to viruses? | 80 - 90% |
| How soon after taking antibiotics, for strep, is a child considered non-contagious? | 24 - 48 hours. |
| Tonsilitis often occurs along with: | Pharyngitis |
| Tonsilitis is caused by? | Viruses & bacteria. |
| A child that is mouthbreathing may have? | Swollen adenoids. |
| How long does it take for an oral steroid to begin working? | 8 hours |
| How long does it take for an IV steroid to begin working? | 4 hours |
| Otitis media | Middle ear infection. |
| By the age of 3, how many children have had OM? | 70% |
| Is there a higher incidence of OM with boys or girls? | Boys |
| What is a major contributing factor to OM? | Short eustachian tubes. |
| When do symptoms of OM often present? | In the middle of the night. |
| Myringotomy | Perforation of ear drum to place tubes. |
| Epiglottitis should be treated as: | A medical emergency. |
| What has decreased the incidence of epiglottitis? | The introduction of the Hib vaccine. |
| What causes epiglottitis? | H-flu, mono. |
| Symptoms of epiglottitis: | Sudden onset, F, orthopneic position, appear ill, stridor, anxious, drooling. |
| Treatment for epiglottitis: | KEEP AIRWAY OPEN. Antibiotics. Vaccine for prevention. |
| Respiratory Syncytial Virus | RSV, Bronchiolitis. |
| Who gets RSV? | Children under 2, preemies. |
| How is RSV spread? | By contact and droplets. |
| What happens with RSV? | Inflammation, airway obstruction d/t shed epithelial cells. |
| RSV symptoms: | Sat <95, wet breath sounds, retractions, circumoral cyanosis, F, irritable, 3 - 4 sec. cap refill, cough. |
| How is RSV diagnosed? | Nasal swab test. |
| RSV treatment: | Symptomatic. Mist tent, Ribavirin, IV fluids. |
| RSV prevention: | Synagis, Respigam. Aid in developing immunity. Only for high risk kids. |
| Pertussis | Whooping cough. |
| Pertussis is, is not contagious. | Is. |
| Incubation period for pertussis: | 5 - 21 days. |
| Pertussis most often occurs in children under the age of: | 4 years |
| Symptoms of pertussis: | Such forceful coughing, ofthen have trouble catching breath. Can squeal on inspiration. |
| Treatment of pertussis: | Antibiotics, oxygen. |
| How long will pertussis take to run it's course? | 4 - 6 weeks. |
| What immunization is used to prevent pertussis? | dTap |
| Measles | Rubeola |
| Incubation period of measles: | 10 - 20 days. |
| When is measles contagious? | 4 days before rash, to 5 days after rash. Most contagious before. |
| Symptoms of measles: | Look miserable, F, malaise, flu-like symptoms, Koplik spots, maculopapular rash, lymphadenopathy. |
| What is the defining characteristic of measles? | Koplik spots (small white spots inside mouth). |
| Complication of measles: | Pneumonia, ear infections, bronchitis/iolitis, encephalitis, laryngitis - to point of obstruction. |
| Treatment of measles: | Supportive. Antibiotics with high risk kids. |
| Cause of mumps: | Virus |
| Cause of measles: | Virus |
| Incubation period of mumps: | 5 - 21 days. |
| What affect can mumps have on men? | It can cause sterility in males. |
| Symptoms of mumps: | Great swelling in the parotid glands, orchitis, anorexia. |
| Orchitis | Inflammation of the testicles. |
| Complications of mumps: | Orchitis, deafness, myocarditis, encephalitis, hepatitis, arthritis. |
| Rubella | German measles |
| Rubella is caused by: | A virus. |
| What is the greatest cause for concern with rubella? | It is a 1st trimester teratogen. |
| Where is the rubella virus found? | In nasopharynx secretions. |
| What is the incubation period of rubella? | 14 - 21 days. |
| When is rubella contagious? | 7 days before rash to 5 days after. |
| Where does the rash occur with rubella? | First on face, then spreads down. |
| Varicella | Chicken pox |
| What causes chicken pox? | Varicella zoster. |
| What is the incubation period for chicken pox? | 14 - 21 days. |
| Where do the lesions of chicken pox begin? | On abdomen, then spread out. |
| How long is a child with chicken pox contagious? | Until the last lesion has scabbed over. |
| Classic chicken pox symptom: | Vesicular lesions. |
| How has vaccine affected chicken pox? | It presents differently, more mildly. 2 doses of vaccine are now required. |
| Complication of chicken pox | Shingles |
| Where can chicken pox lesions occur? | Outside and inside body. Eyes, ears. |
| Impetigo | Red, macule-vesicular, honey-crust. |
| What causes impetigo? | Staph or strep. |
| Tinea capitis | On head. |
| Tinea corporis | On body. |
| Treatment of tinea: | Oral/topical Griseofulvin, clortrimazole. |
| Treatment for candida: | Nystatin, amphotericin B. |
| How are scabies treated? | Permethrin cream. |
| How long can an adult louse live, away from a human host? | Not longer than 48 hours. |
| What is the most common cause of emergency surgery during childhood? | Appendicitis |
| Appendicitis patho: | Obstructed appendix. Increased pressure. Compressed vessels. Ischemia/necrosis. Perforation. Peritonitis. |
| Symptoms of appendicitis: | Pain aggravated by movement, anorexia, n/v, pallor, irritable, tachycardia, shallow RR, chills, F, high WBC w/ increased % of bands. LRQ tenderness. |
| Diagnosis of appendicitis: | H & P, pain location, McBurney's point, UA, UHCG (female), CBC, CT, US. |
| Diarrhea can be caused by: | Rotavirus |
| Diarrhea causes: | Metabolic acidosis |
| BRAT diet | Bananas, rice, applesauce, toast. |
| Eneuresis | Bed wetting |
| Bed wetting is usually gone by: | 6 - 8 years. |
| Encopresis | Leaking stool |
| Treatment for encopresis: | Treat constipation. |
| What causes a febrile seizure? | A sudden spike in T. |
| Why do we not use ice baths, or alcohol to treat high F? | Shivering can make F go up. |
| What is the most frequent cause of cardiact arrest in a child? | Respiratory arrest. |
| What are 3 issues of hospitalization for a child? | Separation anxiety. Loss of control. Fear of bodily injury/pain. |
| What are the 3 stages of separation anxiety? | Protest. Despair. Detachment. |
| Protest | Throws fit. |
| Despair | May not look at person entering room. |
| Detachment | Appears ok, but will ignore parent when comes in room. |
| Loss of control: Infant | R/t trust. Mom should stay with child, if possible. |
| Loss of control: Toddler | R/t autonomy. Keep rituals, like would at home. |
| Loss of control: Preschooler | R/t magical thinking. Choose words carefully. |
| Loss of control: School age | R/t industrious. If it's possible, let child up and out to play. |
| Loss of control: Adolescent | R/t identity & independence. Give choices. |
| Things that increase vulnerability | Difficult temperment, bad parent/child relation, 6m - 4y, male, low intelligence, multiple stresses (hospitalizations). |
| How do nurses promote a safe/trusting environment? | Assess child & family. Look at stages of separation. Communicate. Provide therapeutic care. |
| When is fear of bodily injury/pain the greatest? | 7 - 10 years. |
| Asthma is associated with: | Allergies, GERD, sinusitis. |
| Triple whammy of asthma | Airway inflammation, bronchoconstriction/spasm, increased mucous production. |
| What is the the most sensitive indicator of how bad an asthma attack is? | Heart rate. (Less than 100 is mild) |
| What medications are used with Status Asthmaticus? | Epinephrine, MgSO4, IV prednisone. |
| When do we refer for scoliosis? | When angle is 5 - 10 degrees. |
| When is surgery necessary with scoliosis? | With curve greater than 40 degrees. |
| What is the largest group of muscle diseases of childhood? | Muscular dystrophy. |
| What happens in muscular dystrophy? | Muscle fibers waste away. |
| Muscular dystrophy diagnosis: | High CPK, family Hx, EMG, muscle biopsy, DNA analysis. |
| Duchenne's (Pseudohypertrophic) | Most severe form of muscular dystrophy. |
| Pseudohypertrophic | Enlarged muscles d/t fatty tissue infiltration. |
| Onset of Duchenne's | 3 - 5 years. |
| What symptoms are first noted with Duchenne's? | Trouble walking, climbing, running. |
| At what age is a child with Duchenne's usually in a wheelchair? | 12 years. |
| What is affected with Duchenne's? | Muscle wasting, weakness. Later; facial, oropharyngeal, respiratory muscles. |
| When does death usually occur with Duchenne's? | 15 - 25 years. |
| What is the COD with Duchenne's? | Respiratory or cardiac failure. |
| Muscular dystrophy signs & symptoms: | Waddling gait, GOWER's SIGN, lordosis, frequent falls, enlarged muscles (calves), facial enlargement r/t fatty infiltrations, mental deficiency. |
| Complication of muscular dystrophy: | Contractures, lung infection, cardiac. |
| What is the most common form of childhood cancer? | Leukemia |
| When is leukemia most common? | 2 - 6 years. |
| Which has a better survival rate, A.L.L. or A.M.L.? | A.L.L. |
| Leukemia | Describes a group of malignant diseases of the bone marrow and lymph system. |
| Which is most common, A.L.L. or A.M.L.? | A.L.L. |
| Leukemia patho: | Proliferation of immature WBCs |
| How is leukemia staged? | Initial WBC count, age, sex, and type. |
| Signs & symptoms of leukemia | Anemia, infection, bleeding, fatigue, pallor, low grade F, anorexia, bone/joint pain, petechiae, liver/spleen/gland swelling, CNS symptoms. |
| What is the definitive diagnosis for leukemia? | Bone marrow aspiration or biopsy. |
| What is a lumbar puncture used for, with leukemia? | To confirm CNS involvement. |
| How is leukemia managed? | Chemo |
| What is the cure rate for A.L.L.? | 85 - 95% |
| How many children go into remission within the 1st year, with leukemia and treatment? | > 95% |
| When is relapse most common with leukemia? | In the first year, 16%. |
| What is the 3rd most common group of leukemia? | Lymphomas |
| What are the two main classifications of lymphoma? | Hodgkins and Non-Hodgkins. |
| Where does lymphoma occur? | Begins in lymph nodes, metastasizes to: spleen, liver, lungs, bone marrow, thymus. |
| What is the prognosis with lymphoma? | Early detection, > 90%. Late detection, 65 - 75%. |
| Signs and symptoms of Hodgkins: | Enlarged, painless lymph nodes. F, pruritus, wt. loss, nausea, night sweats, anorexia. |
| Hodgkins: | B cells. Definitive stages. |
| Non-Hodgkins: | T cells. Difficult to classify. Occurs more often than Hodgkins. |
| What is the most common chronic disease of childhood? | Asthma |
| When keeping a journal r/t to asthma, how soon can one tell an asthma attack is coming? | Up to 2 days before. |
| Cystic Fibrosis | Inherited, autosomal recessive. |
| What is the most common lethal disease among white children, adolescents and young adults? | Cystic fibrosis. |
| How is cystic fibrosis diagnosed? | Sweat test. |
| How soon are most children with cystic fibrosis diagnosed? | By the age of 3. |
| What sort of stools may be seen with cystic fibrosis? | White, bulky. |
| Cystic fibrosis causes abnormal mucus secretion and obstruction, where? | Bronchi, small intestine, pancreatic ducts, bile ducts. |
| IDDM peaks at what age? | 10 - 15 years |
| What is the most common endocrine disorder in kids? | IDDM |
| BMI | (weight / height x height) x 703 |
| BMI ranges | Normal: 18 - 24.9 Overweight: 25 - 29.9 Obese: 30 or > |
| When does gynecomastia usually resolve? | Within a year. |
| Who attempts suicide more often? | Girls |
| Who successfully commits suicide most often? | Boys |
| What is precocious puberty? | Onset before age 9. |
| What is the first major sign of puberty with a girl? | Breast bud development. |
| What is the first major sign of puberty with a boy? | Testicular enlargement. |
| When does the first ovulation occur? | 6 - 14 months after menarche. |
| What happens with Osgood Schlater? | Bones grow faster than muscle. |
| What is a reason for poor posture during puberty? | The rapid growth. |
| At what age, by law, are children entitled to the right of privacy with medical professionals? | 14 years |
| What is the leading COD in adolescence? | Injury |
| When does acne peak? | 16 - 18 years. |
| Acne is more common in: | Boys |
| What is a side effect of Retin-A and accutane? | Photosensitivity |
| What may be used to treat acne? | Retin-A, accutane, benzoyl peroxide, antibiotics, OCPs. |
| Which acne medication has teratogenic effects? | Accutane (retinoic acid). |
| What has the highest mortality rate of any mental illness? | Anorexia Nervosa |
| Anorexia | Weight < 85% of normal, absence of 3 consecutive menstrual cycles. |
| Elevated cortisol | Body conserves fat. |
| Anorexia s/sx | Amenorrhea, constipation, HA, wt. loss. |
| Bulimia | Weight WNL, laxative use, episodic. |
| Which is more common, anorexia or bulimia? | Bulimia |
| When is testicular cancer common? | 15 - 25 years. |
| Primary prevention | Prevent problem before it occurs. |
| Secondary prevention | Early detection or intervention of illness. |
| Tertiary prevention | Preventing further damage. |
| 80% of mental disorders in children are r/t what? | Life experience. |
| Attachment theory | Socioemotional bond with primary caregiver. |
| Family systems theory | Health is dependent upon the family function. |
| Behavior theory | Abnormal behavior a problem to daily life. Rule out chem/brain disorders. Reinforcement. |
| Cognitive theory | How information is processed. Use of metaphors. |
| What is a child evaluated for, with ADHD? | Inattention, hyperactivity, impulsity, distractability. |
| Autism | Characterized by a peculiar emotional and cognitive isolation and detachment. |
| When is autism diagnosed? | Before the age of 3. |
| What are signs of autism, in infancy? | Not good eye contact, not a cuddler, no smiling back. |
| Autistic children are insensitive to: | Pain |
| Behavioral signs of autism | Toe walk, lines things up, does things over and over, oversensitive to sounds/textures, odd pattern of movement. |
| Indication for further evaluation of autism: | No babble at 12 mo. No gesture at 12 mo. No single words at 16 mo. No two word phrases by 24 mo. |
| Tic | Sudden, repetitive movement, gesture or utterance. |
| Transient tics | Last less than 12 months. |
| Chronic multiple tic disorder | More than 12 mo, motor/phonic, onset 6 - 10 yr, most severe in early-mid childhood, subsides in adolescence. |
| Copralia | Uttering obscene words. |
| Copropraxia | Self abusive behavior. |
| What is most commonly used to treat tics? | Risperdal |
| Sensorimotor | 0 - 2 years. Physical interaction with environment. Object permanence. |
| Preoperational | 2 - 7 years. Concepts are concrete. Egocentric. |
| Concrete Operations | 7 - 11 years. Concrete experiences increase. Some abstract thinking. |
| Formal Operations | 11 - 15 years. Thinking like an adult. Abstract thinking. |
| Trust vs. Mistrust | 0 - 12 months. |
| Autonomy vs. Shame & Doubt | 1 - 3 years. Can I do it myself? Fantasy play. Determined to exercise free choice. |
| Initiative vs. Guilt | 3 - 5 years. Am I good or bad? Still egocentric. Sex rold identification. |
| Industry vs. Inferiority | 6 - 10 years. Enjoys achievement. Develops friendships. |
| Identity vs. Role Confusion | 11 - 18 years. Who am I? Looks important. |
| Asthma manifestations | Mucosal edema, bronchoconstriction, excessive secretion production. |
Created by:
NataschAnn
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