Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Fall - Pediatrics > Class three > Flashcards

Class three Flashcards

(103 cards)

Start Studying
1
Q

What should be assessed first? Why?

A

Heart first
As the exam goes, they fuss which leads to an increase in the HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where do you listen for heart rate on a child? How long do you listen to each site for?

A

Apical pulse for 1 minute

Upper left sternal border
Right sternal border (listen long enough to hear any irregular sounds)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Why are murmurs common in children?

A

Children have a really high HR so they have turbulent blood flow –> benign murmur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What should be assessed second? How long should you listen and why?

A

Respirations

Listen for one minute because their respirations are fast and irregular so you need to listen for a full minute to get an accurate count

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are two skin colors that are not concerning

A

Mottling: bad at auto regulation especially temperature
Acrocyansosis: warm and cyanotic/purple feet and hands d/t poor regulation of vascular stability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What skin coloring is concerning?

A

Cicroralcyanosis
Around the mouth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What else can you look for while just looking at the patient?

A

Assess for color
Neuro: sleeping, awake, arousable, reflexes
S/S of distress: pain?
General growth: malnourished, dehydrated, proportionate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What should you check third? Where and why?

A

Pulses
Femoral (diaper line) or brachial (inside of inner arm)
Cant use radial/pedal because vasculature is not well developed so weak

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are fontanelles and suture lines? What is the purpose for them?

A

Spot spots and openings in the cranium

Squish for delivery and allow for brain growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When do fontanelles and sutures close? What do you measure to check these and for how long do you measure them?

A

Anterior: closes at 9-18 months
Posterior: 2 month
Sutures: 18-24 months

Measure head circumference until 2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do you do an assessment on a pediatric patient?

A

Quiet/least invasive parts of the exam first

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What will be examined last in a pediatric assessment and why?

A

Head

Most invasive so should be last

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the doorway assessment?

A

Things that you can look at by just looking at the patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are some general appearance things to look at?

A

Overall health and age
Activity/behavior
Development
Nourishment
Statue
Head to toe
Growth charts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What can you learn form just a cry?

A

Respiratory status
Cardiac
Neuro/development
Emotional status
Communication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What does a cry tell you about respiratory status?

A

Patent airway
Stridor, wheezing, absent could mean obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does crying tell you about cardiac?

A

Cyanotic with crying

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What does crying tell you about neuro/development?

A

High pitched: underlying neuro symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does crying tell you about communication?

A

Pain
Afraid
Stranger anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How does a cry tell you how sick the patient is?

A

How they are reacting to painful things - should cry with pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are some differences in pediatric assessment data?

A

Higher baseline metabolic needs
Poor auto regulation
Primitive reflexes
Soft spots
Disproportionate head: body
Disproportionate facial features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is poorly regulated in pediatrics?

A

RR and HR
Higher water content
Increased insensible water losses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the concern about having a higher water content?

A

Increase risk of fluid and electrolyte shifts –> electrolyte imbalances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the concern about poor auto regulation r/t HR?

A

children decompensated quickly so when HR is not longer sustained –> cardiopulmonary arrest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the difference between sensible and insensible water loss?
Sensible: can be seen like sweating, urine, vomit, bleeding, diarrhea Insensible: can't be seen like normal respirations, evaporation from skin, fever (infants have increase RR and skin doesn't have a lot of fat to hold water)
26
What is PEWS and what is the purpose of it?
Tool created by clinical staff to support clinical judgment and give nurses power and objective data to decrease pediatric codes Help to detect early decompensation, improves response time/early intervention, improves team communication, and improves outcomes
27
How early does PEWS detect prior to cardiac arrest?
12-24 hours before
28
What 3 domains are assess in the PEWS score?
Behavior Respiratory Cardiovascular
29
A PEWS score above what requires action?
score above 2
30
What is a a good PEWS score?
0-2
31
What should occur with a PEWS score of 0-1?
Continue monitoring and document as usual
32
What should occur with a PEWS score of 2?
Continue monitoring and document as usual Review patient with more experience healthcare provider Escalate if deemed further consolation required OR resources do not allow to meet care needs
33
What should occur for a PEWS score of 3?
Moved to yellow Review patient with more experience healthcare provider Escalate if deemed further consolation required OR resources do not allow to meet care needs Increase frequency of assessments and document per plan form consult with more experienced care provider
34
What should occur for a PEWS score of 4?
Review patient with more experience healthcare provider Escalate if deemed further consolation required OR resources do not allow to meet care needs Notify most responsible physician (MRP) or delegate MRP or delegate communicate plan of care to mitigate contributing factors of deterioration Increase assessment frequency and document Reassess adequacy of resources available and escalate to meet deficits Consider internal or external transfer to higher level of care
35
What should occur for a PEWS score of 5?
Review patient with more experience healthcare provider Escalate if deemed further consolation required OR resources do not allow to meet care needs Notify most responsible physician (MRP) or delegate MRP or delegate MRP assess patient immediately and if can't attend call STAT for physician review per MRP's direction Appropriate "sensor" review MRP or delegate communicate plan of care to mitigate contributing factors of deterioration Increase assessment frequency and document Increase nursing to 1:1 Reassess care location to higher level of care
36
What is a change in neuro status consistent with?
End organ damage Neuro decompensation can tell us the effects off loss of circulation to other parts of the body like kidneys
37
How do you assess orientation in children? Infants?
Responsive? Ask who mom and dad is if they are in the room Ask parents if child has had an changes in their baseline behavior like losing milestones Infant: sternal rub/foot flick
38
What are the interaction that are included in behavior parameters?
Restless Irritable
39
What is the activity included in the behavior parameters?
Sleeping Playing
40
What are behaviors parameters that are assessed in PEWS?
Orientation Interactions/behavior Activity
41
What are the cardiac perfusion parameters for PEWS?
Pulse Cap refill Color and temp (central and peripheral)
42
Where should you check cap refill on an infant?
Circulatory system is immature so fingers and toes might not be reliable so assess for cap refill somewhere central like ears and belly
43
Why are BP and UOP not used for PEWS?
Both are not immediate/late assessment findings so may not change for hours or days BP can compensate for changes in BP especially by increase HR
44
What are the respiratory distress parameters for PEWS?
Resp rate Work of breathing Oxygen requirement Continuous nebs
45
Why isn't SpO2 a parameter for Respiratory distress?
Because circulation system is immature so fingers and toes might not be reliable
46
How do you determine if if a benign murmur?
Murmur decreases in intensity with standing
47
Due to instability b/t skin and internal, where should you get the temperature of a child?
Rectal temps are more accurate
48
What are signs of difficulty warming yourself up in infants?
Acrocyanosis and mottling
49
What occurs because of poor auto regulation?
Temp instability between skin and internal Overheat easily because can't sweat Skin turgor/fat helps w. temp stability High water content b/c fat holds onto water Difficulty warming self up
50
What overstimulates infants?What does this lead to?
Infants are easily overstimulated by changes in environment Leads to an increase in metabolic demand
51
What are cues of distress in an infant?
Subtle (increase in HR) Hiccup (could mean over fed or over stimulated) Looking away Mottling Changes in resp. effort
52
What age are abdominal breathers?
under 7 years old
53
What are some common chest wall variations?
Chest wall has same diameter as head Barrel shape b/c alveoli are immature so they stay inflated Infant ribcage is flexible so retractions are common
54
What is in a general pediatric nervous system assessment?
Developmental milestones appropriate for age Reflexes and tone (strength assessment for neuro issues) Measurement of head circumference for fontanels, sutures and ICP
55
What is the muscle and tone for a patient with muscular dystrophy?
Flaccid and weak
56
What is the muscle and tone for a patient with cerebral palsy?
Spasticity
57
What are infant reflexes?
1. Sucking 2. Rooting 3. Moro 4. Parachute 5. Fencing 6. Babinski 7. Stair stepping
58
When should primitive reflexes disappear?
6 - 9 months
59
What is the rooting reflex?
Stroke cheek and infant suckles
60
What is the moro reflex?
Hands open, arms go out and head throws back Usually because startled
61
What it the parachute reflex?
Lift feet
62
What is the point of infant reflexes?
Helps to keep baby alive and helps neuro system develop
63
When does sucking and rooting generally go away?
Gone by 4 months
64
Where do you measure head circumference?
Right above eyebrows and ears around the broadest part of head
65
How do you determine if an infants large head is benign or worrisome?
By looking at developmentally normal or delay/losing milestones
66
What is hydrocephaly?
Big head Worrisome if prominent veins or eye gaze like crosseyed
67
What is microcephaly?
Small head Cognition various but generally delays
68
What is plagiocephaly? How do you fix it? What can it cause?
Flat head usually from sleeping on back Fixed with a helmet Can cause facial asymmetry if not corrected
69
When should the eyes be lined up by?
6 months Aka: intermitente eso/exotropia normal until 6 months
70
When is 20/20 vision obtained?
early childhood
71
What is suborbital shiners? What is this common in?
Dark circles under the eyes Common in allergies
72
What could low set ears indicate?
Development/neuro delay
73
What could an ear tag/disformed ears indicate?
Renal abnormality
74
What should you assess for the nose, mouth and throat?
Tongue protruding and size? Palate high and intact? Tonsils - hypertrophy to adolescence Sinuses are not fully developed until school age Shoddy lymph nodes
75
When do you lose baby teeth? When do adult teeth come in?
Baby teeth lost at 6-12 years Adult teeth come in at 6-18 years
76
When should the belly begin to thin out?
By school age
77
What occurs in an infant's skin?
More water More fat Lanugo Downy hair Rashes
78
What kind of rashes do infants get? Is this worrisome?
Sensitive skin Milia and infant acne Cradle cap Diaper dermatitis Most go away on own
79
Why is there a caution of IVs with infants? What should you look for?
There is more fat so it can be hard to determine if the IV has infiltrated To determine this, look at temp, compare with other side, redness/pale, irritability, assess IV every hour
80
What is the general rule for bruises?
If a baby isn't causing, there should be no bruising
81
Where are bruises usually found?
On bony prominences like Forehead, elbows, knees, ankles, heels
82
Where are is bruising rare/abnormal?
Soft tissue injuries like the face, trunk, abdomen, buttocks, armpits, genitals, neck, inner legs, upper and lower back
83
Why is it important to be aware of patterns regarding burns?
To know accidental vs. intentional HISTORY HISTORY HISTORY
84
What is the degree of a burn a factor of?
Skin thickness (full thickness is intentional) Temp of the solid/liquid or gas Length of contact with solid/liquid or gas
85
Where are the most common areas of trauma regarding burns?
Perineum and extremities
86
What are some suspicious burn patterns?
"dip" burns Back/buttock in infant/toddler Burn on dorsum of hand (kids will touch with their palms so back of hands/feet is not normal) Deep contact burn with pattern of contact surface
87
What are some misconceptions reading pain in children?
Infants don't feel pain Children and adolescents will become addicted if treated with opioids Children who are playing, sleeping or can be distracted are not in pain Children can tolerate pain better than adults Children cannot tell you where it hurts Children always tell the truth about pain Children become accustomed to painful procedures
88
What are some signs of pain in young infant?
Generalized response of body trashing Loud crying Facial expressions of pain like brows lowered and drawn, eyes closed tightly, mouth open
89
What are some signs of pain in an older infant?
Localized body response with deliberate withdrawal of stimulated area Loud crying Facial expressions of pain or anger Pushing the stimulus away after it is applied
90
What are some signs of pain in a young child like toddler and school age?
Loud screaming and crying "ow", "ouch" "that hurts" Thrashing of arms and legs Pushes away before stimulus applied Clings to parents May become restless and irritable Stalling behavior like "wait" Muscle rigidity, clenched fists, white knuckles, contracted limbs, stiffness, closed eyes, wrinkles forehead
91
What are some signs of pain in an adolescent?
Less vocal protest More motor activity More verbal expression like it hurt or you're hurting me Increased muscle tension/boy control
92
When is it appropriate to use the FLACC scale?
Newborns to 7 years old
93
What does FLACC stand for? What type of scale is this?
Face, Legs, Activity, Cry, Consolability Oberserver-rating scale
94
What does the CRIES pain scale stand for?
Crying Requires O2 for 95% sat Increase VS Expression Sleepless
95
What does a cries score less than 4 mean? More than 4?
Less than 4: non-charm measures More than 4: pharm and non pharm measures
96
When is it appropriate to use the Wong-baker faces
3 years and older
97
When is it okay to use the numeric pain scale?
Over the age of 9
98
What is the individualized numeric rating scale?
Parents come up with a scale that is specific to their child's behavior and how their child usually acts/behaves based on no pain to severe pain
99
What are non-pharmacologic methods for pain control?
Distraction Relaxation Guided imagery Positive self-talk Containment Nonnutritive sucking Sucrose Kangaroo care Complementary and alternative medicine Heat and cold Music therapy Play therapy Pet therapy Consult child life specialist
100
What is the 2 step approach to pharm methods of pain relief in children?
Older than 3 months in mild pain first consider nonopioid like Tylenol and NSAIDS Second step for child with moderate-severe pain is administer opioid like morphine
101
What is the goals for pain relief win children?
Optimal dosing of meds to control pain w/o severe side effects Select least traumatic route Combine non pharm and pharm Evaluate effectiveness on intervention
102
What are a couple pharm options for pain control in children
1. Eutectic mixture of local anesthetics (EMLA) 2. Lipsomal lidocaine 4-5% (LMX4 or LMX5) 3. PCA
103
How long at administration of an IV pain med should you recheck pain? PO pain med?
IV: 15 minutes PO: 60 minutes

Fall - Pediatrics (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions