CPN Flashcards
(293 cards)
1
Q
Cephalocaudally
A
Head to toe
2
Q
Proximodistally
A
Trunk to tips of extremities
3
Q
Length is measured at what month range
A
0-36 months
4
Q
Height is measured at what age
A
2
5
Q
Weight at 6 months
A
Doubled birth weight
6
Q
Weight at 1 year
A
Tripled birth weight
7
Q
Overweight BMI and percentile
A
Percentile: 85% to 95%
BMI: 25 to 29.9
8
Q
Average birth length
A
20 inches
9
Q
Average increase in height at 1 year
A
10in
10
Q
Average height increase in 2nd year
A
5in
11
Q
Average height increase per year after age 3
A
2.5 in
12
Q
How does height at 4yrs compare to birth length
A
Doubles at 4 yes
13
Q
Social smile
A
3 months
14
Q
Laugh
A
4 months
15
Q
Stranger anxiety emerges
A
4-6months
16
Q
Peek a boo, look in mirror
A
7-9 months
17
Q
Claps and waves bye bye
A
10-12 months
18
Q
Babble
A
3 months
19
Q
Turns towards rattling noise
A
3 months
20
Q
Understands cause and effect
A
7- 9months
21
Q
Able to say 5 words
A
10-12 months
22
Q
Able to lift head
A
2 months
23
Q
Posterior fontanel closed
A
2 months
24
Q
Eyes track in all fields of gaze
A
3 months
25
Rakes objects
4 months
26
Grasps rattle
4 months
27
Rolls from front to back
4 months
28
Rolls from back to front
5-6 months
29
Transfer objects from hand to hand
5 months
30
Sits with support
5 months
31
Sits without support
8 months
32
Pincer grasp
9 months
33
Crawls
9 months
34
Pulls self to a stand
10-12 months
35
Toddler age range
1-2
36
When does separation anxiety develop
Toddler (1-2)
37
Formula for # of words in a phrase for ages 2-5
Age + 1 = words in a phrase
38
Number of words a 12 month old knows
5
39
Number of words an 18 month old knows
50
40
Number of words a 24 month old knows
400
41
When does the anterior fontanel close
12-18 months
42
Age able to climb stairs
21 months
43
Preschool ages
3-5
44
When is the conscience begin to develop
Preschool age (3-5)
45
When does modesty develop
Preschool age (3-5)
46
Builds tower of more than 6 blocks
3 years
47
Throws ball overhead
4 years
48
What’s ages are school age
6-12years
49
When does morality begin to develop
6-9 sense of right and wrong
| 10-13 more shades of grey
50
Breast development
10years
51
Pubic hair in females
11
52
Height spurt in females
12
53
Menarche
13
54
Testicular enlargement age
11
55
Pubic hair in males
12 years
56
Height spurt in males
13-14
57
Psychosocial focus for infant 0-12months
Trust
58
Psychosocial focus for toddler (1-2 year old)
Autonomy ( new tasks)
59
Psychosocial focus of preschooler (3-5years)
Initiative (dressing self, helping with take, push buttons)
60
Psychosocial focus of school age child (6- 12)
Achievement
61
Psychosocial focus of an adolescent
Identity development
62
Cognitive development of infant (0-12months)
Learns through interaction with the environment
63
Cognitive development of toddler (1-2)
Egocentric focus
64
Cognitive development of a preschooler (3-5)
Thinking is non logical, non linear
65
Cognitive development of school age child (6-12)
Thinking is logical, linear
66
Cognitive development of adolescent
Adaptable, flexible, abstract
67
Communication considerations for toddlers (1-2)
Avoid separation from parents. Allow for autonomy
68
Communication considerations for preschoolers (3-5)
Give choices, DEMONSTRATION (equipment, on dolls)
69
What supplement is important for breastfed infants
Iron, begin at 4 months
70
How many ounces per day is an infant expected to eat
20oz
71
What is the upper limit for oz of BM/ formula that indicates a switch to purées is appropriate
30oz
72
What is the benefit of whole milk
Fats that provide myelination of the brain
73
What age should purées be introduced
4 months
74
What food should be used in moderation
Rice due to arsenic levels
75
When should a transition to table food be initiated
6-12 months
76
When does teething begin
3-4 months
77
When does the first tooth appear
6 months
78
How many baby(deciduous) teeth are there are 3 years
20
79
When does a child loose their first tooth
6
80
What is the #1 cause of mortality in adolescents
Motor vehicle accidents
81
What are the names of the vision tests used for preschoolers (3-5)
LEA symbols
| Allen figures
82
What is the name of the vision test used for school aged kids (6-12)
Sloan letters chart
83
In a toddler what can be an indicator of hearing deficiency
Babbling
84
Live vaccines (4)
MMR
Varicella
Rotavirus
Nasal Influenza
85
When do the side effects of a live vaccine typically occur
2-4 weeks after admin
86
What is unique about the rash that can occur after the varicella vaccine
It can be contagious
87
How long does Rita virus vaccine shed in the stool after vacccine
14 days
88
Until what age should IM injections be given in the Vastus lateralis
3 years
89
How many doses of MMR are there
1st dose: 12-15 months
| 2nd dose: 4-6 years
90
What is a unique feature of the MMR vaccine
A child less than 12 months can get it if there is a local measles outbreak
91
How many doses of the HPV vaccine are they
2
92
How is pertussis treated
Antibiotics
93
What is the communicability of varicella
Contagious 2 days before the rash even appears and until the scabs crust
94
What are the three stages of lesions in varicella
Papule
Vesicles
Crusts
95
What is the course of treatment of an immunocompromised child after exposure to varicella
Give varicella-zoster immune globulin ASAP up to 10 days post exposure
96
How is mononucleosis transmitted
Oropharyngeal secretions
97
How many weeks of activity restriction should be implemented for kids with mono after the acute phase
3 weeks
98
Classic symptom of TB
Night sweats
99
TB infection means
Prior infection
100
TB disease
Active infection with positive culture and X-ray
101
Fifth disease is caused by what virus
Parvovirus
102
What is a hallmark sign of goth disease
Red facial rash (slapped face)
103
What virus causes hand-foot-mouth
Enterovirus
104
Symptoms of hand foot mouth
Malaise
Ulcer in mouth
Rash on palms of hands and feet (sometimes knees elbows and genitalia)
105
What is the treatment for Lyme disease
Antibiotics
106
Describe juvenile idiopathic arthritis
Autoimmune disease of connective tissues
107
What routine exam is important for kids with JIA
Slit lamp eye exams to look for uveitis
108
What is the main method of transmission for children with HIV
Born to HIV positive mothers
109
What is a symptom of HIV
Recurrent oral candidiasis and yeast in diaper area
110
Is HIV diagnosed by antibodies or by virologic diagnostic test in babies
Virologic test
111
How does vitiligo testing for HIV in babies work
Done over time with multiple tests. Hopefully known by 6months
112
How are babies born to HIV positive moms treated.
All treated with prophylactic antiretrovirals
113
Is it safe for an HIV positive mother to breastfeed
No
114
What two live vaccines CAN be given to HIV positive kids
MMR and varicella
115
What can be a cause of hypotonic dehydration
Water intoxication
116
Sodium low or high in hypotonic dehydration
Low
117
What is a complication of hypotonic dehydration
Cerebral edema and seizures
118
Best way to treat mild to moderate dehydration
Oral rehydration with pedialyte
| 5-10mls every 5min
119
What do hypertonic IV solutions contain
Dextrose! What we give all the time
120
What is the main organism that causes UTI
E. Coli
121
When do the testes descend from the abdomen to the scrotum
3rd trimester
122
What are assessment findings of nephrotic syndrome
Proteinuria
Hypoalbuminemia
Third spacing
123
What treatment is used for nephrotic syndrome
Corticosteroids
124
What causes nephrotic syndrome
Autoimmune process
125
What causes glomerulonephritis
Occurs 1-2 weeks after group A beta hemolytic strep
Antibodies are made that attack the glomerulus
126
What assessment findings do you see with glomerulonephritis
Hematuria
Elevated BP
Edema
127
What is the treatment for glomerulonephritis
Antibiotics (for strep)
| Anti-hypertensives
128
Cause of impetigo
Staph or strep
129
Assessment finding of impetigo
Honey colored crusts
130
Treatment for impetigo
Oral or topical antibiotics
131
What is the treatment for scabies
Scabicide below the neck, leave on 8-12 hours and wash, repeat 1 week later
132
What is ringworm (Tinea) caused by
Fungus
133
Types of ring worm/ tinea
Jock itch
| Athletes foot
134
Treatment of ring worm/ tinea
Selenium sulfide shampoo
Oral or topical anti fungal
Antifungal powder
135
What causes head lice (pediculosis capitis)
Parasites
136
How do you treat head lice
Nix (cream rinse)
Pyrethrum (RID)
Manually remove bits with comb
137
Do children need to stay out of school when there is active lice outbreaks
No
138
How does a child get Stevens-Johnson syndrome (erythema multiforme exudativum)
It is usually a drug reaction to antibiotics or ant seizure meds
139
Symptoms of stevens Johnson syndrome
Body rash
Intense sloughing of skin
Ulceration
140
What are treatments for Steven Johnson’s syndrome
```
Skin care
Magic mouthwash
NG feedings if indicated
Pain management
** lubricants to prevent corneal damage
```
141
Definition of anemia
Decrease in serum hemoglobin
142
Normal hemoglobin range
11.5 - 14.5
143
Symptoms of acute anemia
Muscle weakness, fatigue, pallor , HA, light headed, increased HR
144
How do you treat anemia
Treat underlying cause
Iron supplements
Blood transfusion
145
What population is at risk for iron deficient anemia
Premature infants
146
What is a risk factor for becoming iron deficient
Only drinking whole milk with no real food after 12 months
147
Why do red blood cells sickle
Dehydration
| Hypoxia
148
Treatment for Vado occlusive crisis
Hydration
Oxygen (as needed)
Pain management
149
Why are children with sickle cell disease more like to be more affected by illness
Do not have a fully functioning spleen
150
If a child with sickle cell disease has a fever what are next steps
Think sepsis!
CBC
Blood cultures
IV abx
151
What important teaching point must be included to families with sickle cell disease.
They must have a thermometer, know how to use it, and how to know what a fever it.
152
Describe immune/idiopathic thrombocytopenic purpura
Hemorrhagic disorder that results in autoimmune destruction of the platelets in the spleen
153
Normal platelet
150,000 -400,000
154
What is a main symptom of immune/idiopathic thrombocytopenia purpura
Petechiae
Bruises
Bleeding in urine or gums
155
What is the treatment for immune/idiopathic thrombocytopenia purpura
IVIG to increase platelet count
156
Important teaching point for kids with immune/idiopathic thrombocytopenic purpura
No contact sports!
Avoid trauma, injections
No ibuprofen
157
What is hemophilia
A deficiency in one of the factors necessary for blood coagulation
158
How is hemophilia treated
By giving “factor”
159
What causes disseminated intravascular coagulation
Trauma
Transfusion reaction
Cancer
160
Largo of DIC
Consumption of clotting factors that leads to massive bleeding
161
How do you treat DIC
FFP
| Plasma
162
Describe leukemia
Abnormal proliferation of WBC invading the bone marrow
163
Symptoms of leukemia
Bone pain
Anemia
Lymphadenopathy
Immunosuppression
164
Two type of leukemia
ALL - Acute lymphoid leukemia
| AML - Acute myelogenous leukemia
165
What are signs of a brain tumor
Headache upon waking
Seizures
Increased ICP
Neuro abnormalities (gait, speech, etc.)
166
Two types of lymphomas
Hodgkins (reed-stern berg cells)
Non hodgkins (proliferation of B or T lymphocytes
167
Classic symptom of Hodgkin’s lymphoma
Night sweats
168
Symptoms of non Hodgkin’s lymphoma
Swelling in abdomen or neck
| Also has night sweats
169
What is a Wilma tumor (nephroblastoma)
Cancer of the kidney
170
Symptoms of Wilma tumors (nephroblastoma)
Hypertension
Hematuria
Anemia
Constipation
171
What is an important consideration with Wilms tumors
Do not palpate the abdomen
172
What is tumor lysis syndrome
Occurs within 72 hours after chemo
| Included elevated iron acid, potassium
173
What are the implications of tumor lysis syndrome
Cardiac dysthymias
Renal impairment
Seizures
174
If you know a child will soon be receiving chemo, what is important not to give
Potassium contains IV fluids
175
What are you very likely to see with leukemia
Bruising
176
What’s the most likely cause of diarrhea
Rotavirus
177
What acid/base change can diarrhea cause
Metabolic alkalosis
178
What acid/base disorder can vomiting cause
Metabolic alkalosis
179
What does bile tinge vomit indicate
Bloackage
180
What is a hallmark sign of pyloric stenosis
Projectile vomiting
181
After outpatient management of GER what are the next types of studies that are done
Barium swallow
Upper GI
pH probe
182
What acid/base change can diarrhea cause
Metabolic alkalosis
183
What acid/base disorder can vomiting cause
Metabolic alkalosis
184
What does bile tinge vomit indicate
Bloackage
185
What is a hallmark sign of pyloric stenosis
Projectile vomiting
186
After outpatient management of GER what are the next types of studies that are done
Barium swallow
Upper GI
pH probe
187
What are the interventions for GER
Thickened formula
Upright 30 min after feed
Antacids and proton pump inhibitors
188
What is necrotizing enterocolitis
When bowel mucosa becomes necrotic because blood flow to GI tract is compromised.
189
What assessment finding are common with necrotizing enterocolitis
Abdominal distention
Increased gastric residuals
Vomiting
Bradycardia/hypotension (later sign)
190
What are treatments a for necrotizing enterocolitis
Bowel rest
NG tube to low suction
Antibiotics
*cluster cares reduce stress
191
When is a cleft lip repair done
1-4 months of age
192
When can a cleft palate repair be done
When the infant is weened from breast or bottle. 6-12months.
Must be able to drink from cup.
No sucking
193
Nursing care after cleft lip/palate
Monitor for bleeding
Elbow restraints
No belly sleeping
Nothing inside mouth
194
What is esophageal atresia
When the esaphagus ends in a blind pouch
195
What is tracheoesophageal fistula
Connection between esaphagus and trachea
196
What is a sign of Esophageal atresia and tracheoeshapageal fistula
Excessive drooling
197
Treatment for esophageal atresia and tracheoesophagel fistula
G-tube until other surgical repair can be done
198
What equipment is necessary to be set up for esophageal atresia and tracheoesophageal fistula
Suction
199
Three possible treatments for appendicitis
1. Immediate removal
2. IV abx, outpatient PO abx, return for scheduled surgery
3. Scheduled appendectomy no abx
200
What is a sign of hirshprungs
Ribbon like liquid stool
201
Treatment for hirschprungs
Surgical removal of aganglionic areas
| Possible colostomy
202
What is intussusception
Portion of intestine telescopes back on itself for unknown reason
203
What is a sign of intussusception
Currant jelly stools
Inconsolable
Knees to chest
Bilious vomiting
204
What is the best way to diagnose intussusception
Barium enema
205
Treatment for intussusception
Enemas
| Might need surgical resection of parts of intestine if gangrenous
206
What is encoparesis
Fecal soiling of underwear in child over 4 years
Liquid stool leaks around ball of stool
Usually because of stool holding
207
What parts of the GI tract are affected by ulcerative colitis
Colon and rectum
208
What parts of the GI tract are affected by Crohn’s disease
Any part
209
What are symptoms of UV or Crohns
bloody diarrhea
Abdominal pain and cramps
Weight loss
Growth retardation
210
Treatment for crohns and UC
```
Analgesics
Corticosteroids
Immunomodulators
Biological like Remicade
High protein high calorie
May need total colectomy
```
211
What are important side effects of remicade
```
Chills
Dizziness
Fatigue
Chest pain
Stomach pain
Infection (TB and fungal)
Development of rare cancers
```
212
What is biliary atresia
Congenital condition involving obstruction or destruction of extrhepatic biliary structures
213
What are symptoms of biliary atresia
```
Jaundice (not helped by phototherapy)
Itching and irritability
Pale stools
FTT
Hepatomegaly
```
214
What vitamins have decreased absorption in biliary atresia
Fat soluble ( A,D, E, K)
215
What’s the treatment for biliary atresia
Fat soluble vitamins
Kasai procedure (temporary fix)
Liver transplant
216
What is the dosing for acetaminophen
10-15mg/kg per dose Q4
217
Why is codeine no longer given to children
Codeine normally converts to morphine in the body.
| Some children have genetic difference that causes too much morphine creation and they die of morphine OD
218
Normal pH range
7.35-7.45
219
Normal CO2
35-45
220
Normal HCO3 (bicarbonate)
22-26
221
Possible cause of respiratory acidosis
Respiratory distress
222
Possible cause of metabolic acidosis
```
Diarrhea
Kidney failure (not making bicarbonate)
```
223
Cause of respiratory alkalosis
Hyperventilation
224
Cause of metabolic alkalosis
Vomiting
225
How do you asses or put drop in children’s ears from 0-3
Down and back
226
How do you asses or put drops in ears for kids greater than 3
Up and back
227
What things can help prevent otitis media
Breastfeeding
Feeding in upright position
Discontinue pacifier use after 6months
228
What are some defining symptoms of asthma
Inflammation
Mucous
Narrowing of airways (bronchospasm)
229
Which vaccine should be avoided in asthmatics
Live influenza
230
Use of metered dose inhaler
Use spacer and mask
| Once older puff, inhale, hold about 8 seconds
231
Teaching point for inhaler use
Rinse mouth after use
232
Bronchilolitis is an infection of which part of the respiratory tract?
Lower, affects bronchioles
233
What can severe RSV prior in the first year of life out them at risk for
Asthma
234
How long is bronchiolitis contagious
Up to 14 days after start of symptoms
235
Is albuterol or decencies Eli used in bronchiolotis
No
236
What is the patho of CO poisoning
RBCs pick up CO molecule quicker and easier than O2
237
Symptoms of CO poisoning
Full headache
Dizziness
Fatigue
Eventually LOC
Confusion
238
Explain bronchopulmonary dysplasia
Chronic lung disease maybe caused by injury to premature lung
239
What is symptom that differentiates itself from other repsiratory problems
Unable to wean from supplemental O2
240
Some interventions for bronchopulmonary displaysia
```
O2
Positive airway pressure (if needed)
Small frequent feedings
Lose volume, but higher calorie feeds
Corticosteroids
Bronchodilators
Diuretics
```
241
Laryngotrqcheobronchitis / croup
| Cause
Viral inflammation of larynx, trachea, bronchi
Usually caused by parainfluenza virus
242
Treatments for layengetracheobronchitis
Keep child calm
IVF
Racemic Epi (evaluate response after 6hrs)
Corticosteroids
243
What is epiglottis
Life threatening bacterial infection (h. Influenza) to the epiglottis
244
What are signs of epiglottis
Difficulty swallowing
Drooling
Tongue protrusion
245
What shouldn’t you do with epiglottitis
Manually assess airway
246
How is epiglottitis diagnosed
Lateral neck film
247
Treatment for epiglottitis
IV corticosteroids
IV abx
Always have tracheostomy supplies and intubation equipment ready
248
What is a unique fact about epiglottitis
It is rarely seen because we vaccine against Hib in childhood
249
What is the pathogen most responsible for tonsillitis
Beta hemolytic strep
250
What are assessment findings with tonsillitis
Red swollen tonsils with exudate
Foul smelling breath
Snoring
Sleep apnea
251
What is the most important assessment post op tonsillectomy
Monitoring for bleeding
Pt side lying
Monitor for frequent swallowing
Vomiting bright red blood
252
Important teaching for tonsillectomies
Watch for bleeding 24hrs post op
| Watch for bleeding 7 days after (scans fall off)
253
What is cystic fibrosis
Autosomal recessive disorder of exocrine (mucous producing) glands
254
How do young patients with CF present
Fatty stools
Frequent resp infections in infancy
FTT
255
How is CF diagnosed
On newborn screen
| Sweat chloride test
256
Respiratory manifestations of CF
Chronic wet cough
Dyspnea
Barrel chest
Easily gets respiratory infections (increased mucous loves bacteria)
257
Treatment of respiratory symptoms in CF
Chest percussion
| Aerosol used pulozyme
258
What is a GI sign of CF in newborns
Not passing meconium stool and having meconium ileus
259
More GI implications of CF
Blocked pancreatic ducts (no pancreatic enzymes for digestion)
Impaired nutrient absorption
260
GI management of CF
Take pancreatic enzymes with meals and snacks.
| * take in applesauce before meal*
261
Implication on reproductive system with CF
Females: delayed puberty, difficulty getting pregnant
Males: often sterile
262
How do you determine the length of a Cather needed to suction a trach
Should be 0.5 cm beyond the end of the trach.
263
Why should sterile saline not be used in trachs
Removes normal flora and protea airway colonization and nosocomial pneumonia
264
Where is lead deposited in the body
In the brain and bone
265
After surgical repair of a meningocele what is important to assess
Assess for neurogenic bladder (post void volumes greater than 20ml
266
Kids with meningoceles will often had what allergy
Latex
Banana
Avocado
267
Clinical manifestation of lead poisoning
Pallor fatigue tachy
Behavior changes
Anemic
268
Treatment for lead level greater than or equal to 45
Oral or IV chelation therapy
269
Treatment for lead poisoning greater than or equal to 70
Chelation therapy
| Hospitalization to monitor fluid status and kidney function
270
What are some symptoms associated with congenital hypothyroidism
Intellectual disability
Enlarged tongue
Hoarse cry
*promot treatment can avoid these
271
Symptoms of thyroid storm
Rapid heart rate
High BP
Increased body temp
272
Treatment for thyroid storm
Anti thyroid drug
273
Symptoms of Cushing syndrome
Central obesity
Moon face
Susceptibility to infection
Osteoporosis
274
How to remember diabetes insipidus
Hi and dry
| High sodium and dehydrated
275
Treatment of diabetes insipidus
DDAVP
| Exogenous vasopressin
276
Way to remember syndrome of inappropriate anti diuretic hormone
Low and too much h2o
| Low sodium fluid overload
277
What are negative outcomes of syndrome of inappropriate anti diuretic hormone
Cerebral edema
| Seizures
278
How does exercise affect BG and insulin
Decrease blood sugar and decreased insulin needs
279
Oral medication for DM II
Metformon (glucophage)
280
When does opioid withdraw and need to wean occur
After 5 days of use
281
What happens with tetralogy of fallot
Oxygenated and deoxygenated blood mixes.
| Not enough oxygen systemically
282
What is the issue with ventricular septal defects
Heart “pumping” affected. Not enough blood being pumped out
283
How are VSDs treated
Use of digoxin and diuretics
| May close spontaneously or need surgery
284
Signs of digoxin toxicity
Bradycardia, dysrhthmias, nausea and vomiting.
285
Classic symptoms of coarctation of the aorta
Bounding UE pulses, weak or absent in LE.
| Repaired by surgery
286
What causes rheumatic fever
Untreated strep infections.
| Antibodies attack heart valves
287
Symptoms of rheumatic fever
Recent strep infection
Joint redness and swelling
Fever
Fatigue
288
Treatment for rheumatic fever
Anti-inflammatory meds
| Must be on penecillin prophylaxis for 10 years or until 25. Whichever is greater
289
What is Kawasaki’s disease
Systemic vasculitis
| Coronary arteries most at risk
290
Symptoms of Kawasaki’s disease
| Acute phase
High fever unresponsive to antipyretic
Inflammation of mouth lips tongue
Strawberry tongue
Swollen/red hands feet
291
Symptoms of Kawasaki’s disease subacute phase
Resolution of fever
| Hands and feet peel
292
Symptoms of Kawasaki’s disease convalescent phase
Clinical signs have resolved
| ESR, CRP normalize
293
Treatment for Kawasaki’s disease
IVIG
| High dose aspirin (regardless of age)
