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scc pediatrics
pediatrics
| Question | Answer |
|---|---|
| anterior fonatanel closes at_______& posterior fonatanel closes at _______ | anterior 12-18 months posterior 6-8 weeks |
| INFANT/TODDLER age range | BIRTH TO ONE YEAR ONE TO THREE YEARS |
| PRESCHOOLER/SCHOOL-AGE AGE RANGE | THREE TO FIVE YEARS SIX TO 12 YEARS |
| ADOLESCENT AGE RANGE | 12-18 YEARS |
| Freud stage? birth -1yr ; sucking biting, exploring the world | Oral |
| freud stage? age 1-3 yrs- toilet training | Anal |
| freud stage? age 3-6yrs-discovers difference between boys and girls; loves the opp sex parent | Phallic |
| freud, immediate gratificaton | Freud- Id |
| freud,conscious rational,sensors the id | Ego- |
| freud, conscience and ideals-constant battle with the id | Superego- |
| freud Latency | Freud; child expands on traits- no particular body part 6-12 |
| freud Genital | Freud; incr sex maturation- capacity for love and maturity 12-18 |
| Children tend to _____ report their pain. | under |
| Erickson's birth–1 year | Trust vs. mistrust: develops trust as caregiver meets child's needs |
| Erickson's 1-3 years | Autonomy vs. shame and doubt Child learns to control body functions, increasing independent; toilet training |
| Erickson's 3-6 years | Initiative vs. guilt Learns about the world thru play; develops conscience; dresses self; makes choices |
| Erickson's 6-12 years | Industry vs. inferiority Works on projects & competes with others; follows rules; school age |
| Erickson's 12-18 | yearsIdentity vs. role confusion Trying to establish own identity |
| Piaget Preoperational Stage | 2-7 yrs, egocentrism, imitation,exploration, questions,concrete thinking, intuitive reasoning,observation, Magical thinking, symbols & language Transductive reasoning- (items that share characteristics are the same) |
| Piaget Sensorimotor Stage | Birth-2 yrs,object permanence,Develop sense of self,language explosion,Explore environment w/mouth,Causality,Spatial relationship(square peg/ round hole) |
| Piaget Concrete Operational Stage | 7-11 yrs,more logical & coherent,Concept of time, Inductive reasoning(uses past experiences for new conclusions)ordering,& classifying facts for problem solving,Less self centered,sports,Concept of conservation and reversibility are mastered |
| Piaget Formal Operational Stage | 12 yrs to Adulthood incr abstract, logical, analytical,creative,complex thinking Alternative solutions for problems, inductive/deductive reasoning;Primary task= develop philosophy of life// |
| Infant weight/height | Doubles by 6 mos/triples by 1 yr. Best for nutritional status Grows about 1 in/mo ( 1st/6mo’s)/ then ½ (next 6mo’s)Best to indicate growth |
| Infant rest | 13- 16hrs/day including frequent naps |
| 0 - 3 mo's milestone | palmar/Reflexive grasp only Rooting and sucking Recognizes familiar faces/objects |
| 4-6 mo's milestone | Good head control Sit w/ support, can roll voluntary grasp Smiles at mirror image |
| 7-9 mo's milestone | Sits independently,Crawls, stands with assist, pulls to stand Rakes with fingers/Crude pincer grasp Chewing movements Increasing fear of strangers,Imitates |
| 10-12 mo's milestone | Stands alone,Walks w/& w/o support self-feed,neat pincer grasp Imitates expressions;“object permanence |
| 9-12 mo's language | 4 words mama, papa, etc |
| Infant play | solitary |
| toddler play | parallel |
| toddler Weight gains/grows | 4-6lbs a year 2 to 2.5 inches a year |
| toddler's rest | 10hrs/day wean down to 1 nap a day; 0 naps needed by 3yo |
| toddlers eating habits are related to _______ _______, growth_____ and they need _____ food & become _______eaters | physiologic anorexia; slows;less;picky |
| Toddlers are ready to start potty training when 3 things occur: | 1. periods of dryness for at least 2 hr 2. walking 3. can take off clothes |
| toddlers motor skills include: | Walks alone, runs,Kicks ball Open/close hand, fine grasp, scribble,Turns knob |
| language skills at 2 yrs | 200 words; |
| language skills by end of 3 yo | 1000 words/short sentences |
| hospitalzied toddler experiences 3 periods of adjustment;1____;2_____;3_____ | 1.protest;2.despair;3. denial |
| Nursing consideration for the hospitalized toddler include: | preserve child’s trust,Reassure of parents return,leave personal item, Maintain routines and rituals |
| preschoolers weight gains preschoolers height grows | 4-5 lbs/yr 2-3 inches/yr |
| preschooler rest needs are: | 9-10 hrs, no naps |
| preschooler motor skills include: | Runs, climbs, throws ball overhead, stand on one foot, hop and stand on tiptoe Dresses self,Buttons,Draws stick figures Brushes teeth |
| preschooler play include | Associative play(more interactions w/ each other)Imagination; Drama play |
| school age grows school age gains | 2 inches/yr 5 lbs/yr |
| school age play | cooperative play, sports, win approval |
| preschooler hospitalization fears R/T | mutilation( magical thinkers); viewed as punishment |
| school age hospitalization fears R/T | death, lack of control, better able to cope |
| adolescent females grow_____ and gain_____ | 3- 6” in height & gain 20-25 lbs |
| adolescent males grow_____ and gain_____ | 3-5” in height & gain 15-20 lbs |
| Adolescent rest | at least 8hrs |
| adolescent hospitalization fears R/T | Altered achievement of identity,Disruptions of plans,Decreased access to friends;fragility of life |
| Infant & Toddlers view of death & dying | Lack understanding |
| Preschoolers view of death & dying | Temporary & reversible |
| School age view of death & dying | Irreversible; not necessarily inevitable |
| Adolescents view of death & dying | Irreversible, universal & inevitable |
| Physiologic Measures of Pain | Increased-HR,RR,BP O2-decreases |
| Behavioral Pain Signs | Vocalization,Facial Expression,Body movement, altered sleep, irritability |
| Young Infants Response to Pain | rigidity thrashing,Loud crying,Facial expression; No understanding between stimuli and pain |
| Older Infant Response to Pain | Withdrawal from painful stimuli Loud crying;Facial grimace;Physical resistance |
| Young Child’s Response to Pain | Loud crying screaming, Verbalizations; Thrashing limbs; Attempts to push away stimulus |
| School-Age Child’s Response to Pain | Stalling behavior; Muscle rigidity; May use all behaviors of young child |
| Adolescent’s Response to Pain | Less vocal protest less motor activity; Increased muscle tension and body control; More verbalization |
| Toddlers are _____ thinkers and May view pain as __________ and only report to ______ _____ | magical; punishment; their parents |
| preschoolers have trouble with _____vs________; are ________ thinkers;and need _____ that pain will end, but they have an ability to use_____ ____ | reality vs fantasy; concrete; proof; coping skills |
| School Age children response to pain may _______ and may________ emotionally and can _______ their pain | exagerate;withdraw; verbalize |
| Adolescents ____ or ____ ___ be honest about their pain,may have an _______ ______, be ____-________ & have a ______ of pain | may or may not;imaginary audience;self-focused; fear |
| pharmacological pain management include | Ibuprofen: (5-10mg/kg/dose Q 8 hrs) Keterolac:(Toradol)(0.25mg to 1mg/kg/dose Q 6 hrs)(Not to exceed 5 days of treatment) Morphine(opiod of choice) Dilaudid Fentanyl |
| mild cognitive impairment IQ | IQ: 50-55 to 70-75 |
| moderate cognitive impairment IQ | 35/40 - 50/55 |
| severe cognitive impairment IQ | 20/25 - 35/40 |
| Profound cognitive impairment IQ | below 20-25 |
| DOWN SYNDROME signs IN INFANT | UPWARD SLANT TO EYES LARGE SPACING BETWEEN EYES PROTRUDING THICK TONGUE SHORT BROAD NECK MOTTLED SKIN HYPOTONIA |
| etiology of visual deficiencies | Refractive/Nonrefractive Perinatal Infections- (TORCH) Retinopathy of Prematurity Trauma Postnatal Infections |
| etiology of conjuctivitis in newborns | chlamydia, gonorrhea, herpes |
| etiology of conjuctivitis in infants | tear duct obstruction |
| etiology of conjuctivitis in children | bacterial(#1), viral, allergy, foreign body |
| retinoblastoma- definition, sign, tx | Congenital malignant intraocular tumor,Cat’s eye Reflex- (white reflection in eye, white glow)tx-surgery, laser, cryotherapy, chemotherapy |
| infants/ children increased risk of otitis media due to | poor eustachian tube function, shorter no slant ear canal L/T decr drainage, incr chance of infection, less antibodies |
| Kernig's sign | neuro test for meningitis flex leg @ knee & hip then straighten (pos if painful) |
| Brudzinski’s sign | neuro test for meningitis lie supine raise head up (pos if painful) |
| glasgow coma scale measure what 3 areas? max score/meaning? low score/meaning? | eyes, verbal response, motor response max=15 unaltered LOC min= 3 extremely decr LOC |
| Clinical Manifestations of Increased ICP in Infants | Irritability, poor feeding High pitched cry, difficult to soothe Fontanelles: tense, bulging Cranial sutures: separated Eyes: setting-sun sign Scalp veins: distended |
| Clinical Manifestations of Increased ICP in Children | Headache Vomiting: with or without nausea Seizures Diplopia, blurred vision |
| Behavioral Signs of Increasing ICP | Irritability, restlessness Drowsiness, indifference, decrease in physical activity and motor skills C/O fatigue, somnolence Inability to follow commands, memory loss Weight loss |
| Late Signs of Increasing ICP | Decreased LOC Decreased motor response to command Decreased sensory response to painful stimuli Alterations in pupil size and reactivity Papilledema Decerebrate or decorticate posturing Cheyne-Stokes respirations |
| Indications for ICP monitoring | Glasgow coma scale <7 Glasgow coma scale <8 with respiratory distress |
| ICP non-pharm Tx | Neuro position: HOB up 10 to 20 degrees Head and neck neutral Temperature: Normothermia w/o cooling devices or meds Encourage presence of family Uninterrupted periods of sleep and rest |
| ICP pharm Tx | Medication: Mannitol, Lasix IV drip of midasolam (Versed) Pain meds Pavulon to decrease muscle response to stimuli Anticonvulsants Steroids w/neoplasms |
| ICP Assessment | LOC Pupillary reaction Vital signs assessment frequency Q15-q2hrs |
| Meningitis Sx: Child/Adolescents: | abrupt fever, chills, HA, vomiting, sz, Kernig and Brudzinski signs, nuchal rigidity |
| Meningitis Sx: Infants and Neonates | poor feeding, poor tone with lack of mvt, poor cry, hypothermia or fever, full, tense, bulging fontanel may not be present til late |
| Meningitis Dx: | LP with elevated WBC, decreased glucose, increased protein, increased pressure |
| Meningitis management | IVF, Isolation, analgesics, anitbiotics, antipyretics, monitor respirations, dexamethasone for ICP (short term) |
| meningitis causes | viral/bacterial strep most common |
| encephalitis causes | herpes most common |
| encephalitis sx | cerebral edema and ICP,: HA, malaise, fever, dizziness, apathy, nuchal rigidity, n&v, tremors, hyperactivity, speech difficulties |
| encephalitis severe sx | High fever, stupor, seizures, disorientation, spasticity, coma, death |
| encephalitis management | acyclovir, antibiotics, Neuro checks, LOC, ICP monitor |
| encephalitis dx | LP- normal to cloudy, WBC sl elevated w/ increased lymphs, Protein normal to sl elevated, IgM for type 1 herpes simplex decr neuro signs |
| Hydrocephalus | syndrome resulting from disturbances in fluid balance of CSF caused by impaired absorption or obstruction of flow thru ventricular system. |
| Hydrocephalus sx in infancy | head grows abnormally, ant. fontanel tense, bulging, dilated scalp veins, bones of skull become thin, frontal protrusion “bossing”, setting sun sign. |
| Hydrocephalus sx in children/adults | sutures closed so s/s match ICP-Headache Vomiting: with or without nausea Seizures Diplopia, blurred vision |
| Hydrocephalus dx & tx | Dx-MRI/CT Tx-VP shunt |
| S/S of shunt malfunction | incr ICP Decr neuros/LOC |
| S/S of shunt infection | fever infalmmation of tract abdominal pain shift to the left |
| Reye Syndrome (RS) | damaged hepatic mitochondria (from ASA)disrupts the urea cycle L/T hi ammonia, low bs, , incr serum short chain fatty acids.Fatty infilitration occurs in renal, neuronal, myocardial,muscle tissue which L/T encephalopathy, heart & kidney damage |
| Reyes Syndrome Stages | 1. Initial viral infection-(URI) 2.Brief recovery period 3.few day later vomiting w/ lethargy, changed mental status- (agitation, confusion)rising BP,RR,HR & hyperactive reflexes 4. coma 5. coma deepens, sz’s, decr. tendon reflexes, respiratory failu |
| Reye Syndrome (RS)- dx/tx | dx-evaluation-LOC; liver biopsy/enzymes, ammonnia levels(high), BS(low), PTT-prolonged tx-IV fluid, Insulin, Corticosteroids, Diuretics,ICP monitoring, |
| Neuroblastoma | malignant tumor developed from nerve tissue, usually occurs in infants & children. First symptoms are usually fever, malaise, pain |
| Sz etiolgy/signs in infants | birth injury, congenital effects, infection(meningitis)(febrile), metabolic dx, toxic substances- bicycling, lip smacking |
| Sz etiolgy children | alcohol/drugs, trauma, infection, congenital conditions, genetic factors, brain tumor, neurological problems |
| Sz dx & assessment | Diagnosis- ECG (determines type of Sz); LP, BS, CBC- to rule out Assessment- record Sz activity, neuro status, VS |
| Sz management/types | Management- anticonvulsants, ketogenic diet, afebrile Types- partial (specific area in brain) or generalized (complex) (multiple areas of the brain) |
| Craniosynostosis | congenital defect that causes one or more sutures on a baby's head to close earlier than normal. The early closing of a suture leads to an abnormally shaped head. Etiology- Associated with inherited syndromes |
| Craniosynostosis management | Management- Relieve any pressure on the brain, Make sure there is enough room in the skull to allow the brain to properly grow; surgery |
| near drowning categories | Category A- awake minimal injury, fully conscious,hypothermia, ABG abn Category B- mod injury, stuporous, hypothermia,resp distress, aBG’s abn Category C- severe comatose, severe anoxia, posturing or flacid |
| near drowning complications | Hypoxia Aspiration Hypothermia |
| neural tube defects? types? | Neural Tube Defects-failure of the neural tube to close after 28 days conception Anencephaly, spina bifida |
| types of spina Bifida | SB Occulta: a defect not visible externally SB Cystica: a visible defect -meningocele &myleomenigocele |
| spina Bifida dx | Elevated alpha-fetoprotein (AFP), ultrasound, xrays, ct |
| spina Bifida Tx | prevention R/t Supplementation—0.4 mg/ day if hx 4.0 mg/day |
| Spina Bifida Occulta complication | Altered gait Bowel/bladder problems Foot deformities |
| Myelomeningocele s/s | contains meninges, spinal fluid, & nerves neural deficit of varying degrees : Flaccid or spastic paralysis, bowel/bladder incontinence, clubfoot, knee contractures, hydrocephalus, mental retardation, Arnold chiari malformation, curvature of the spine |
| Cerebral Palsy | Nonprogressive neuromuscular ds w/ varying degrees of damage or developmental defects in the part of the brain that controls motor functions, may be partially paralyzed, have normal intelligence |
| Etiology of CP | Intrauterine hypoxia/asphyxia, preterm, LBW mat infection, mat drugs, radiation, anoxia, toxemia, mat diabetes, malnutrition, isoimmunization |
| spastic cp s/s | Incr DTR’s, hypertonia, incr. flexion, contractures, muscle spasms, underdevelopment of affected limbs, walks on toes w/ scissor gait, crossing one foot in front other |
| Athetoid/dyskinetic CP s/s | Athetoid- chorea( involuntary, irregular jerking movements) slow, wormlike, writhing mvmts when voluntary mvmt is attempted Dystonic- slow twisting mvmts of the trunk/extremeties |
| Ataxic CP s/s | , non spastic; wide based gait, poor balance and muscle coordination, rapid repetitive movements |
| Mixed/dystonic | combination spactic & dyskinetic; poor eating/sucking; no specific motor pattern delay |
| Possible Signs of CP | Poor head control after age 3 mos Stiff limbs Arching back/pushing away Floppy tone Unable to sit w/o support at 8 mos Clenched fists after 3 mos irritability No smiling by 3 mos Feeding difficulties tongue thrusting gagging/choking w/ feeds |
| which dx has a high incidence of latex allergies | cp |
| Muscular Dystrophies | Absence of muscle protein dystrophin, (helps support structure of muscle fibers) results in degeneration of muscles. Fat & connective tissue replace the degenerating muscle fibers.progressive wasting of skeletal muscles, genetic |
| Characteristics of DMD | Calf muscles hypertrophy,Waddling gait, frequent falls, Gowers sign (only able to get up from a prone position with the use of upper arms) Lordosis,Progressive generalized weakness |
| DMD dx | Suspected based on clinical appearance EMG, muscle biopsy,CPK and AST |
| Management of DMD | No effective treatment maintain function in unaffected muscles as long as possible,Genetic counseling for family |
| Respiratory Distress Syndrome | Pulmonary immaturity, together with surfactant deficiency, leads to alveolar collapse.Lungs collapse between breaths, making the infant work harder |
| Bronchopulmonary Dysplasia | Chronic disease in premature infants treated w/ vents, from early lung injury chronic respiratory distress, hypoxemia, reduced lung compliance, increased airway resistance, and expiratory flow limitation |
| Respiratory Distress Syndrome | Pulmonary immaturity, together with surfactant deficiency, leads to alveolar collapse Lungs collapse between breaths, making the infant work harder |
| S/S uri in children | Fever Anorexia, vomiting, diarrhea, abdominal pain Cough, sore throat, nasal blockage or discharge adventagious Respiratory sounds |
| Tonsillitis | infection of the tonsils R/T pharyngitis; viral or bacterial Inflammed lymphoid tissue |
| Tonsillitis dx & tx | dx:clinical eval & rapid strep test tx: tonsillectomy. ABT, opiods, antipyretics, analgesics, humidifier, soft liquid diet, salt water gargles |
| s/s Influenza in children & Tx | 3-4 days; chills fever, lethargy, rhinitis,Fatigue, lethargy, non-productive cough Tamaflu (only for type A)w/in24-48hrs |
| otitis media- definition & dx | inflammation of the Eustachian tube Diagnostics- evaluation of tympanic membrane |
| otitis media s/s | s/s- ear pain(pulling),poor feeding, fever, irritability, low appetite, purulent drainage, nasal congestion/cough, vomiting/diarrhea |
| otitis media tx | Pharmacologic- ABT Surgical-myringoectomy- surgical incision of the eardrum w/tympanostomy (tube) |
| croup | Inflammatory mucosal edema, secretions, muscle spasm lead to airway obstruction Inflammation of the larynx LTB = Laryngotracheobronchitis Most common of the croup syndromes |
| s/s croup | Characterized by hoarseness, “barking” cough, inspiratory stridor, and varying degrees of respiratory distress Can progress to respiratory acidosis, respiratory failure and death |
| croup tx | Airway management Maintain hydration—PO or IV High humidity with cool mist Nebulizer treatments Epinephrine Steroids- methylprednisone iv |
| s/s Acute Epiglottitis | Sore throat, pain, tripod positioning, retractions “cherry red” epiglottis = diagnostic Inspiratory stridor, mild hypoxia, distress High fever (102 of >) Immediate hospitalization required |
| epiglottitis tx/prevention | prevent respiratory obstruction (intubation) Hib vaccine |
| Bacterial Tracheitis | Inspiratory stridor Suprasternal retractions Barking or “seal-like” cough Increasing respiratory distress and hypoxia Can progress to respiratory acidosis, respiratory failure and death Thick, purulent secretions result in respiratory distress |
| Bacterial Tracheitis tx | Humidified oxygen Antipyretics Antibiotics May require intubation Bronchodilators |
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