Exam 1 Flashcards

Question

Interventions for autism (7)

Answer 1

- Early screening and intervention to maximize their social skills - Behavior Modification i.e. Limit setting - Decreasing environmental stimuli - Introduce new situations slowly - Involve parents b-c warm up to new people slowly - Promote consistency in caregiving - Ensure safety (May have poorer safety cues)

Answer 2

Weight - Regain birth weight by 2 weeks (up to 10% loss) - Double birth weight by age 6 months - Triple birth weight by age 1 year Length - measured until 24-36 months - length should increase by 50% by 1 year - faster growth in first 6 months vs 2nd 6 months

Answer 3

Head Circumference - increase by 33% by 1 yr - important determinant of brain growth (microcephaly indicates neurological insult and macrocephaly can indicate increased ICP) - measured above eyes and ears until 36 months - equals chest circumference by 1 yr Fontanels - anterior closes b/w 12-18 months - posterior closes b/w 6-8 weeks

Answer 4

Hematopoietic - physiologic anemia 3-6 months due to fetal Hgb disappearing before adult hgb compensates Digestion - drooling around 3m due to poorly coordinated swallowing reflex - Enzymes specific for breaking down milk till 5-6m (amylase and lipase develop then) Renal system -immature so meds stay in system longer till age 3 yrs Immunity - lack IgA (in colostrum) - has vernix caseosa (white oily substance in creases w/ protective properties

Answer 5

- nesting toys - teething rings - rattles - mobile - high contrast (0-6m)

Answer 6

Head control-2-3 months Rolling over- as early as 2 months - Age 5 months: abdomen to back - Age 6 months: back to abdomen Sitting: supported by hands at 7m and unsupported by 8m

Answer 7

Crawls (on belly) then creeps (on hands) 8 months Move from prone to sitting position: age 10 months Cruises around furniture -11months Sits from standing- 12 months- some walking Bear weight on feet- 7 months

Answer 8

Grasping object: ages 2 to 3 months Palmar grasp 5 months Holds bottle: age 6 months Transferring object between hands: age 7 months Pincer grasp: crude begins at 8 months and neat by 11 months

Answer 9

Removing objects from container: age 11m Building tower of two blocks but fails: age 1 year Pick up dropped objects: 6m Develops dominant hand preference: 9m

Answer 10

5, 3, 4, 6, 7, 2,1,8 Grasp reflex strong Holds rattle Look for objects dropped Transfer items from 1 hand to another Rake food Use crude pincer grasp Nesting objects Turns many pages at a time

Answer 11

Trust - Feeding - Stimulation and Comfort (quality care) Mistrust - when gratification of needs is delayed - when needs met before infant asks (does not learn delayed gratification) Social modifications - Grasping (pleasurable tactile) - Biting (first conflict is biting w/ breastfeeding)

Answer 12

1. Primitive Reflexes (birth- 1m) 2. Voluntary Acts (1-4 m) - reaching and grasping for a wanted toy - realize causality i.e. primary circular reactions) 3. Imitation of sounds and gestures (play) -- 4-8 m 4. Repetition - Apply to a new situ ation-drop the toy, someone will pick it up - recognize others also control environment 5. Affects- Wave “bye bye” mom goes to work (reason for separation anxiety) 6. Object permanence (6 months w/ peek a boo; 8-12 Advanced object permanence, separation anxiety)

Answer 13

- separation anxiety b/w 4-8 months (insecure attachment disorders form here if failure to learn object permanence and discriminate parent from others) - stranger fear b/w 6-8 months (nurse should be soft, eye-level, stay safe distance and avoid sudden invasive gestures; child may refuse to play with strangers)

Answer 14

- Pronounces vowels by 2 months - Verbalizes consonants by 5-6 months - understands simple commands and gives meaning to words by 9-10 months - Understand words such as “no, mama, dada” by 10 months - Speaks 3-5 words with meaning - 12 months (besides dada, mama)

Answer 15

15 hrs each day (9-11 at night by 4m) SIDS prevention - back to sleep - sleep in crib w/ firm mattress - no loose objects, crib bumpers, soft toys, and bedding out of baby's sleep area - avoid letting baby overheat at night - breastfeed first 6 months

Answer 16

Primary nutrition - breastfeed exclusively w/ iron supplements for first 6m - iron fortified formula okay alt (do not microwave) Supplements - Vitamin D in first few days of life - iron supplements or iron-fortified formula - fluoride supplements if at risk for caries Food introduction - solids okay around 6m (teeth appear, extrusion reflex gone, head control) - one new food a week (q4-7 days) - start w/ cereal then veggies, fruit, meat

Answer 17

Things to avoid - avoid cow milk, honey, citrus, eggs, strawberries early - do not mix food in bottle and feed through large nipple - do not give add'l fluids in first 4 months - avoid propping bottle, milk in bed, and fruit juices to prevent caries Weaning from bottle/breast - replace one feed at a time - night feed is last to go - usually done around 2 yrs

Answer 18

- first dental visit at 6 month - wipe teeth with moist cloth till teeth/6m - brush with water till 2 yrs - pea size of toothpaste at 2 yrs Teeth -Age of child in months- 6 = # of teeth - relieve teething w/ cold or acetaminophen

Answer 19

ASPIRATION- check for small objects, feed sitting up, small food bites, avoid pits and bones SUFFOCATION- “Back to sleep”, avoid extra blankets and pillow, avoid unsafe sleep, crib slats, 6cm apart, no crib bumpers, remove bibs, avoid bags, balloons, and buckets DROWNING- supervise baths, fence pools, keep bathroom doors closed, keep appliances shut; teach toddlers and up how to swim and not go in water too deep FALLS-crib rails, car seats, supervise when on furniture, avoid scatter rugs, fence the stairs, keep furniture away from the window. BODILY DAMAGE-Secure furniture, supervise with animals, keep away sharp items, walk w/ scissors down

Answer 20

- check paint for furniture and toys- no lead - All toxic substances on high shelf - Keep plants out of reach - Child safe caps and all meds stored out of reach (SAFETY LOCK FOR TODDLERS) - Know poison control number (1-800-222-1222) - Give medications as a drug, do not call it “candy” - Carbon monoxide detector in home

Answer 21

- Smoke detectors - Check temperature of all formula and bath waters - Water heater set under 120 degrees - Avoid cigarettes/ashes near child - Flame retardant clothes - Store all candles, matches, lighters in high place - Caution with sun exposure, use sunscreen - Safe cooking (microwave and pot handles turned inward) - Do practice fire drills

Answer 22

Weight- quadruple birth weight by 30 months Heights - grow 3 in a year - measured starting at age 2 yrs - growth via leg elongation Stature- potbelly and wide legged (under after 2 yrs)

Answer 23

Neuro - all brain cells present by 1 yr - myelination of spinal cord complete Elimination - voluntary control around 18-24 m - hold urine 2 hrs by 14-18m

Answer 24

15 months - Uses a cup well - Builds a tower of 2 blocks - play fetch 18 months - Manages a spoon - Turns pages in book 2-3 at a time - Throws ball overhand w/o losing balance 2 years - Builds a tower of 6-7 blocks 2.5 years - Draws circles - Has good hand-finger coordination

Answer 25

15 months - Walks without help w/ wide stance - Creeps up stairs 18 months - Assumes a standing position - tries to run but falls 2 years - Walks up and down stairs 2.5 years - Jumps in place with both feet - Stands on one foot momentarily

Answer 26

- sensorimotor stage (until 2 years) - preoperational stage (2-7) - Cannot distinguish safe from unsafe (so must physically remove from danger) - object's appearance dictates its functions based on child's memory of what that object does - Domestic mimicry (playing house, role play) - Beginning sense of time (“Wait a minute”)-- spatial relations - object permanence advances

Answer 27

- Punishment and obedience orientation (2-4 yrs): action is good or bad based on rewards or punishments - Naïve instrumental orientation (4-7 yrs): actions directed toward satisfying their need and less so the needs of others; concrete sense of justice and fairness based on what others say - School age- morality of the rule and situation determine the children reaction - Adolescent- moral standards are subjective so they question everything and decide for themselves

Answer 28

- by 1, say one-word sentences or holophrases - by 2, can use multiword sentences and string 2-3 words together - by 3, can use simple sentences, grammatical rules and know age Tips - use adult-child conversations (reading, storytelling, interaction) - avoid screen use for under 18 m - child usually understands more than they can say

Answer 29

- body image by 1 yr - recognize gender differences by 2 - gender identity by 3 yrs (may fondle genitalia, "play doctor") - Notice body size in comparison to others by 5 yrs Sex education tips - Find out what child knows and thinks - Be honest (most info is forgotten but correct info can be repeated till child comprehends

Answer 30

- Independence (differentiate self from others; accept separation from others, control bodily functions) - Negativism (negative responses; so reduce opportunities to say no) - Ritualism (provides them comfort) - Transitional objects - Animism - Centration- focus on one thing

Answer 31

- Blocks - Books - Push/pull toys - Balls - Large piece puzzles - Finger paints/thick crayons - Imagination (Boxes, kitchen pots/spoons)

Answer 32

- relief of stress, energy, tension (a way to cope) - intellectual and social development Infants- sensory affective and solitary play Toddlers - parallel play (usually do not share) Preschool- associative play (group play w/o rigidity) School age- cooperative and competitive

Answer 33

Factors needed - Voluntary sphincter control begins 18-24 months train at 22-30 months - child feels urge to urinate or defecate and communicates the need - child can stay dry 2 hours Tips - Nighttime develops last- should master before 6 years - Limit practice sessions to 5-8 minutes - stay with child, give clear directions, rewards

Answer 34

- Reasoning (appropriate for older children esp related to morals; may involve contracting) - Behavior modification (positive reinforcement and rewards)- Call out the behavior not the child; suggest appropriate alternatives - Ignoring (useful b-c Child may experience “response burst” i.e. increase negative behavior at the start of parental ignoring to test limits - Time-out ( 1 minute per year of age in non stimulating environment; withholding privileges) - Corporal punishment (short-term decrease in behavior but teaches children that violence is acceptable and can harm them)-- not recommended - verbal ( stern voice, sustained eye contact) for young children

Answer 35

Temper Tantrums (kicking, screaming, holding breath) - manage w/ consistent expectations, ignore noninjurious behavior, time outs - normal part of development (problem if > 15 mins, > 5x per day, or after 5 yrs Sibling rivalry (upset by dethronement; preschoolers may act out) - manage by preparing child before the birth Regression (during stress or discomfort) - manage w/ ignoring and praising appropriate behavior

Answer 36

11-12 hours a day w/ one nap a day Tips - move to bed at 35 inches - establish bedtime ritual (same hr, snack, stuffed animal or blanket) - may be resistant or have night wakings

Answer 37

Serving size - 1 tbsp/year of age Limits - 24-30 oz/day of milk (can be lowfat at 2 yrs) - 4-6 oz/day of juice Concerns - physiologic anorexia (18m) due to picky eating and food fads (one food over others) - tactile learners so play with food

Answer 38

- all children in rear seat until 13 yrs - rear-facing carseat until 2 yrs - front-facing carseat until 4 yrs/ 40 pounds - booster seat until 80 pounds or 4 ft 9 in - keep trunk closed - do not leave child unattended in car - seat belt use - no phone, alc, or drugs while driving (for adolescents) - do not add extra padding to car seats

Answer 39

Weight: 2-3 kg per yr Height - 6.5-9 cm per yr - elongation of legs vs trunk Posture: graceful, slender and sturdy

Answer 40

3 years - Rides tricycle - Jumps off bottom step and broad jumps - Stands on one foot for a few seconds - tiptoe 4 years - Skips and hops on one foot - Throws a ball overhead 5 years - Jumps rope, skates, swims - Walks backward heel to toe - Throws and catches ball easily - skips on alternate feet

Answer 41

3 years - Copies circle and cross - Tower of 9-10 cubes 4 years - Uses scissors - Laces shoes but can’t tie bow - dress self 5 years - Ties shoes but may need help - Uses scissors and pencil well

Answer 42

- guilt due to consequences of misbehavior Tasks - develop consciousness - magical thinking (b-c I thought it, it happened)

Answer 43

- fear of bodily harm (dark, animals, procedure; think broken skin = insides will come out) until 5-6 yrs - Aggression due to frustration (thwart self-satisfaction), modeling (parent aggressive), and reinforcement (get attention)-- usually normal

Answer 44

Pre-conceptual thought (2-4 yrs) - problem solving based on what is seen vs memory - concerned w/ why and how of things Intuitive thought (later preoperational phase) - Classify information, aware of cause/effect - Understand time w/ regard to daily events (mom will come after lunch)) - begin to consider others POV (may give brief explanations and expect others to fully understand (transductive reasoning)) - very literal thinking

Answer 45

Sentences - telegraphic speech (3-4 word sentences w/ essential info) at 3-4 yrs - 4-5 word sentences w/ adjectives, verbs, prepositions by 4-5 yrs Speech Problems: stuttering or stammering around 2-5 yrs - Manage w/ speaking slow, not interrupting, not completing child's sentences, and listening

Answer 46

- Completion of separation-individuation (began in infancy)-- aware of their position and role in family - why replaces toddler's no - able to understand warnings of danger - develops imaginary friends (usually rid at school entry)

Answer 47

- Tricycles, wagons, sports equipment - alphabet or number flash cards AND books - Electronic games and educational TV for learning - Paints, crayons - musical toys - Imaginative or dramatic play such as dress up clothes, dolls, housekeeping, puppets, Construction sets

Answer 48

12 hrs a day (some may nap) Tips - do not let sleep w/ parents - use night light for fears of dark, nightmares, terrors which are common

Answer 49

* Read with their children daily * Rhyme, play, and cuddle with their children daily; maintain family * Routines for meals, playtime, and sleeping * Reward their children with praise for successes * Establish strong, nurturing relationships with their children.

Answer 50

Serving size - half serving size of as adults Difficulties - picky eating improves by age 5 Health Promotion - choose low fat over high fat (fat < 30% of diet) - ensure calcium and vitamin D - ensure 1-2 hrs/day of activity

Answer 51

Weight- 2-3 kg/yr Height- 5cm/yr Physical appearance - doubled strength - refined coordination

Answer 52

- prepubescent around age 9 (2 yrs prior to puberty) - last deciduous tooth shed at beginning and final permanent teeth added at the end

Answer 53

- self-concept (concious awareness of self and ideals) develops and is influenced by others - peer pressure (need to conform and belong; may need to bullying) - clubs (groups w/ rigid rules) - dyadic relationships w/ same-sex i.e. best friends

Answer 54

Industry - sense of accomplishment (competitions, meaningful work) - extrinsic motivation (rule follower, like to win, rewards) Inferiority - fear ridicule by peers - unable to excel in areas (all children must learn that they can not master everything)

Answer 55

- Masters concept of conservation (numbers, substance, weight, volume/displacement) - Can see other POV (understands emotions) - Understand relational concepts (Tells time, understands size and color gradients) - Classifications (into groups based on attributes or logical order) - Learn to read (Understands rules of grammar and that a word can have many meanings) - conceptual thinking (judge what they reason)

Answer 56

- Teams (Clubs and peer groups; organized sports) - Hopscotch, jump rope - Ride bicycles - Quiet activities (Building models, Crafts, board games) - Collections (rocks, stamps, cards, coins, stuffed animals)

Answer 57

- see teacher as mentor - may be latchkey (need activities and safety guidance) - may have stress (teach coping skills )

Answer 58

- Lying (most know it is wrong but still may do it to escape punishment ( young child) or to meet expectations of others (older child) - Stealing (Limited sense of property rights b/w 5-8 yrs so take what they are attracted) - Cheating ( 5-6 yrs, may not recognize it is wrong and do it automatically)

Answer 59

Avg amount: 9-11 hrs a night (no naps) - younger (6-7) have fewer bedtime problems) - middle (8-11) may need reminders and be resistant so have routine - Older (12) may listen to music or read prior to bed

Answer 60

Difficulties - Don’t know what kids eat when away (even if parent packs lunch - Junk food and fast foods common Tips - Provide nutritious snacks - Role model healthy eating - eat less than preschoolers and adolescents - do not need to eat as promptly as preschoolers

Answer 61

- Wear helmets when riding bike, motorcycle, ATV, skateboards, scooters - Learn rules of road (Ride with direction of traffic away from parked cars, use hand signals) - Walk bike if busy area - Use lights and reflectors, light clothes at night - Don’t ride double unless equipped

Answer 62

- protective equipment during sports - locked firearms - window guards to prevent falls - teach address, phone, and stranger safety - no trampoline in under 6 yr olds

Answer 63

Girl Height- stop growing 2-2.5 years after menarche/puberty, grow 2-8 inches Girl Weight- gain 7-25 kg (15 - 55 pounds) Boy height- stop growing at age 18-20 years, grow 4-12 inches Boys weight- 7-30 kg (15.5-66 pounds) Growth pattern: lanky b-c extremities and neck grow prior to rest of body

Answer 64

- Appearance of breast buds (thelarche)-- 9-10 yrs (delay if not by 13 yrs) - Growth of pubic hair (Adrenarche)-follows thelarche in 2-6 months - Axillary hair growth - Onset of menstruation (menarche)-- 10-15 yrs (delay after 15 yrs)

Answer 65

- Testicular enlargement (delay if not by 14 yrs) - gynecomastia (transient for 2 yrs) - Appearance of pubic hair - Growth of genitalia - Growth of axillary hair - Facial hair growth (2 yrs after pubic hair) - Change in voice

Answer 66

- Abstract thinking/ imaginative - use analytical thinking to make decisions - Able to think through more than 2 variables concurrently - Evaluate own thinking and others (Able to understand how actions/factors influence others) - Idealistic

Answer 67

Identities - Personal sense of identity (coherent picture of past, present, future; autonomy from parents) - Group identity with peer group (best friends, rejection of adult group; very important) - sexual identity (Increased interest in romantic relationships, may experiment, body image)) Concepts - View themselves as invincible

Answer 68

- Non-violent video games and music - Social Media - Sports - pets - Career training programs - Reading - Social events- dances, movies, football games

Answer 69

- May omit meals (esp breakfast) - Common deficiencies: vitamins (folic, b6, A) and mineral (iron, calcium, zinc) - Excess in sugar, fat, cholesterol, and sodium - Eating disorders (Anorexia and bulimia) - Obesity - hyperlipidemia (screen 9 yrs and up) - hypertension (screen 3 yrs and up) - doubled nutrition requirements

Answer 70

- Emotional well-being (coping, mood regulation, mental health, sexuality, Suicidal ideation) - Physical growth and development (physical and dental health, body image, healthy nutrition, physical activity) - Social and academic competence (relationships with peers and family, school performance, interpersonal relationships) - Risk reduction (tobacco, alcohol, other drugs, pregnancy, STIs)-- important in adolescence b-c risk taking behavior - Violence and injury prevention (safety belt and helmet use, substance abuse and riding in a vehicle, interpersonal violence, bullying)-- encourage safe driving

Answer 71

- Poor school performance - Lack of interest/ Social isolation - Sleep or appetite disturbances (should get 9 hrs) - Expression of suicidal thoughts (suicide 3rd leading cause of death; screen ALL)

Answer 72

- discourage tanning (suggest lotions and SPF sunscreen) - encourage sterilized equipment for body art (tattoos and piercings) esp if diabetic, asthmatic, or skin disorders - if working, do not do more than 20 hrs a week

Answer 73

- school age need concrete answers - Ask about sex in nonjudgmental way (do not assume sexual orientation) - do not try to force adolescents to disclose things to family w/o safety plan - Address questions in “matter of fact” way using proper terminology - Protect adolescents to access of unrealistic expectations through media devices

Answer 74

Equation: √((ht (cm) x wt (kg))/3600)) Units: m2

Answer 75

- Based on child weight i.e. 100 (first 10 kg)+ 50 (2nd 10kg) + 20 (remaining kg) Output - q2h - subtract weight of dry diaper from wet diaper (unable to distinguish stool from urine) - minimum 1 mL/kg/hr (30 mL/hr if > 30 kg)

Answer 76

3mo-2 yrs Resting (awake): 80-150 beats/min Resting (sleeping): 70-120 beats/min 2yrs-10 yrs Resting (awake): 70-110 beats/min Resting (sleeping): 60-90 beats/min 10 yrs+ - 60-100 beats/min

Answer 77

1-11 mo: 30-60 breaths/min 2-6 yrs: 21-25 breaths/min 8-10 yrs: 19-21 breaths/min

Answer 78

1-2 yrs: 90/56 mm hg (measured starting at 3 routinely OR for critical care) 5 yrs: 95/56 mm Hg 10 yrs: 102/62 mm Hg 14 yrs: 110/65 mm Hg Discrepancy: Coarctation of the Aorta

Answer 79

- Warm, child-friendly room - Include time to play and become acquainted - auscultate heart, abdomen lungs early before child disturbed (infants- toddlers) - Perform distressing procedures near the end of the exam (ears and mouth; areas of pain; temp and BP) - offer choices if they exist - be quick and efficient but do not rush - record in head to toe but perform in developmentally appropriate sequence

Answer 80

- able to participate by age 7 yrs - most of information is obtained from adult present (dont assume person is mom or dad)

Answer 81

- perform with child on parent's lap (or hold confidently - assess mouth while crying - talk in quiet, unhurried, nonthreatening voice (may need high-pitched voice and smiling)

Answer 82

- Allow to sit on parent’s lap or stand near parent - Use play- count fingers, tickle toes, who can i see in here today (ears) - Introduce equipment slowly (let them play with it first; hide scary equipment) - Have parent remove outer clothing, leave underwear on until needed to remove - Explain things concretely and short sentences - Praise for cooperative behavior and use rewards

Answer 83

- Prefer parent’s closeness (Can be standing and/or sitting) - If cooperative (usually like to please), can examine head to toe - Request self-undressing. Leave underpants. - Demonstrate and let child examine equipment - Paper doll technique (demonstrate first on doll then child)

Answer 84

- Examine head to toe, genitalia last - Self-undressing, keep on underwear, provide a gown - Explain exam and findings to the child (include long-term benefits for adolescents) - Teach about body functions and care (esp sexual development) - Respect need for privacy/modesty (May or may not want parent present) - encourage them to share feelings and ask questions

Answer 85

Sleep problems Headaches Stomach aches Increased crying Clingy Bed wetting Baby talk Developing new fears

Answer 86

Poor coping skills (withdrawal) Behavior and learning difficulties Mood swings (aggressive or stubborn) Sleep issues Regression (bedwetting, thumbsucking) Compulsive behaviors Change in eating habits (overeating)

Answer 87

Stepping-0-4 weeks, Sucking/rooting, palmar grasp, Moro (startle), tonic neck (fencing), 3-4 months Plantar grasp-0-8 months Babinski- 0-1 year (fanning of toes) If they do not disappear, sign of CNS impairment

Answer 88

Normal: feel soft and flat Bulging w/ crying, vomiting, increased ICP sunken w/ dehydration

Answer 89

Expected Findings - cerumen in ear - newborn blinks to sound - infant turn to sounds Unexpected Findings - foreign bodies in ear - ear infections (more common than in adults b-c close proximity Procedure - pinna down and back if under 3 (up and back if older than 3) - examine hearing in children with speech delays - use whisper test up until preschool

Answer 90

Expected - depth perception around 7-9 months (mature around 2-3 yrs) - binocularity around 6 wks (esp by 4 months) - visual acuity 20/40 in toddlers Procedures - visual screening for 3 and up (non-letter alternative to snellen for young children) - corneal light reflex test AND cover-unconver test for strabismus - check for red reflex - hold head for H test in young children

Answer 91

Expected - small, non-tender, mobile lymph nodes - short neck w/ skin folds until 3-4 yrs Unexpected - tender, enlarged, warm lymph nodes = infection - webbing of neck (extra skin fold= turners syndrome)

Answer 92

Expected Findings - enlarged tonsils - 6-8 teeth by age 1 for infants Tips - examine while crying in infant - avoid tongue blade

Answer 93

Expected Findings - sinus arrhythmia (HR increases w/ inspiration, sleep, waking) - S2 split on inspiration - apical pulse at 4th ICS for under 7 yrs, 5th ICS for over 7 yrs Unexpected Findings - weak lower pulses (COA) - murmurs (range from innocent (no problem) to organic (physiological conditions)) Tips - evaluate while sitting and lying down - always use apical HR for 60 seconds if < 2 yrs (best while sleep for infants) - radial pulse okay after 2 yrs

Answer 94

Expected Findings - obligatory nose breathers (up till 4 months) - diaphragmatic breathing (children under 6-7 yrs) - irregular rhythm in infants - 1:2 AP to lateral ratio by 6 yrs (barrel and 1:1 in infancy) - Hiccups Unexpected Findings - s/s of respiratory distress - allergic salute in allergy season Tips - take RR for 60 seconds - hold feeds if newborn > 60 breaths/min - take RR at end of each cry if crying b-c takes deep breath

Answer 95

Expected Findings - protuberant abdomen (large liver= fast metabolism/drug usage in toddlers) - umbilical hernia in infants Unexpected findings - sunken abdomen may be dehydration or malnutrition Tips - ticklish so place your hand over theres at first - flex knees to relax abdomen

Answer 96

-CN exam--make it a game! (“Give me a big frown”; “See how tight you can close your eyes”) - Cerebellar function tests (Finger to Nose, Romberg, balance, tandum walk) should be same as adult by school age ( “Walk like a duck”, “Walk on your tippy toes” - Sensation- use cotton or tickling, don’t use a pin; not tested in infants - Memory (ask about birthdays, recent events in toddlers and up -DTRs in child over 5 yrs

Answer 97

Expected Findings - genu varum (bow legged) in infancy till 18 months - genu valgum (knock kneed) around 2-7 yrs Unexpected Findings - scoliosis (screening school age and beyond via leaning forward w/ knees straight) - hip dysplasia ( seen in infants via ortolani sign and barlow signs) Procedures - For leg discrepancy, compare level of malleoli OR child trendelenburg sign (place hands on illiac crest from behind and should be level) - Romberg test (child close eyes and remains standing straight for 20 sec) for coordination

Answer 98

Expected - bruising on legs when learning to walk - cyanotic extremities in newborn for first few hrs - thin skin in young children (use tape w/ caution) Unexpected - bruising on padded areas (abdomen) - diaper rash Tips - turgor on above clavicle for school age - turgor on abdomen for infants-preschool

Answer 99

- smaller and shorter airway - short straight eustachian tube - increased infections from 3-6 m when maternal antibodies leave and waiting for infant antibodies

Answer 100

- Retractions - Irregular sounds: wheezes (high pitched), stridor - Head bopping - Nasal flaring (unable to breath w/ an occluded nostril) - Mucus-y poops - Gargled speech - excessive crying - nonproductive cough

Answer 101

- Inflammatory response -> airway remodeling - Accumulation of secretions -> hypoxemia - Bronchoconstriction (Spasm of bronchi and bronchioles) -> respiratory acidosis

Answer 102

- Hacking, paroxysmal, irritative and nonproductive Cough (especially at night or early morning due to bronchial edema) - Frothy, clear, gelatinous sputum (as secretions increase) - Coarse and loud breath sounds (sonorous crackles, rhonchi, wheezing) - Prodromal itching at front of neck or upper back (seen in some children) - absent air movement and air hunger (no breath sounds, chest tightness)- medical emergency b-c sign of ventilatory failure - limited speech (unable to say more than 5 words) and anxiety - barrel chest (if repeated)

Answer 103

- frequent assessment (esp pulse ox, lung sounds, breathing) - give oxygen (nasal cannula, face mask, blow by) - Calm environment and reassurance - encourage deep breathing (via games like blow out candles or big bad wolf) - give medications (bronchodilators then steroids; use spacer for better coordination) - suction as needed (mouth then nose)

Answer 104

- Intermittent <= 2 days a week - Mild persistent: > 2 days a week, but not daily - Moderate persistent: daily, night-time symptoms 3-4 times a week - Severe persistent: several times a day, continual symptoms, night-time symptoms more than once a week less than 5 or nightly greater than 5; Use beta agonist several times a day

Answer 105

- Chest x-ray (may show hyperinflation or infiltrates)) - Pulmonary Function Test (includes spirometry (5 yrs +), bronchoprovocation (direct exposure to antigens), exercise tolerance) - Allergy Testing (skin, Eosinophilia levels, IgE levels) - ABG

Answer 106

- Peak flow meter (used in 5+ to manage asthma by measuring max flow of air forcefully exhaled in 1 second) Levels Green– keep doing regular acitivities Yellow- may need extra treatment Red- call provider or EMS

Answer 107

- Avoid triggers ( house and outdoor allergens, smoke, temp extremes) - Adherence to preventive medications (anti-inflammatories and LABA) - Exercise (best is swimming) - Hyposensitization/ allergen immunotherapy - Breathing exercises - Peak Flow Meters - use dehumidifiers or air conditioners

Answer 108

Cromolyn sodium - maintenance for 2+ Glucocorticoids (Prednisolone, Methylprednisolone) - first line for 5 yr + - usually inhaled for maintenance; systemic for acute exacerbation - may cause thrush or stunt growth Anti-leukotrienes (montelukast sodium) - for moderate persistent asthma in 12m _ Monoclonal antibodies (omalizumab) - for moderate to severe persistent in 12 yr + - black box warning for anaphylaxis so monitor for 2 hrs

Answer 109

EIB: airway obstruction during or after vigorous exercise - Peaks 5-10 minutes after stopping activity (usually during endurance activity) - Stops 20-30 minutes after activity Treatment: prophylaxis with SABAs or cromolyn sodium before exercise

Answer 110

Status Asthmatics: an episode of severe asthma that does not respond to normal treatment. S/s: profuse sweating, sitting upright and refuses to lie down Treatment - same as asthma (cardiorespiratory and pulse oximetry monitoring, humidified oxygen, Inhaled SABA, systemic corticosteroid, anticholinergic) - IV magnesium sulfate (Muscle relaxant to decrease inflammation and improve pulmonary function) - Heliox (helium and oxygen)- decreases airway resistance and work of breathing via nonrebreathing face mask - Ketamine (Dissociative anesthetic causes smooth muscle relaxation)

Answer 111

SABAs (Albuterol, Terbutaline) - for acute relief or prevent EIB LABAs (Salmeterol) - never monotherapy, use w/ corticosteroid Anticholinergics (ipratropium, atropine) - anticholinergic effects (dry mouth, no secretions, blurry vision) - for acute relief

Answer 112

Cause: viral Key s/s: open mouth breathing (up to 3 yrs), chilling sensations The Do's - supportive care b-c no cure (raise HOB, suctioning, vaporization, acetaminophen) - reassure family colds are common till age 5 - monitor for complications (fever, dehydration, ear infection) - rule out strep The Don'ts - OTC cough suppressants (dextromethorphan w/ caution in 6 yrs and up) - Expectorants, antibiotics, antihistamines are not used

Answer 113

Patho: small airways become obstructed -> emphysema and patchy atelectasis at bronchiolar level Key s/s: - rhinorrhea - apnea (first sign in infants under 1 months besides lethargy and irritability) - low fever Prevention-palivizumab (monoclonal antibody) once a month IM (given in NICU) The Dont's of treatment - avoid Routine chest percussion and drainage - Fluids by mouth may be contraindicated - Bronchodilators rarely beneficial - no antibiotics b-c viral

Answer 114

The Do's of Treatment - Contact or droplet Isolation- lives 1 hr on hands - Ribavirin-antiviral agent- inhalations (VERY DANGEROUS so limited use) - Heated high-flow nasal cannula (HHFNC)- extra humidity with oxygen administration and CPAP - CPAP, BiPAP, or intubation required if respiratory acidosis present) - Suctioning (Nasal aspiration with aspirator to remove secretions; best treatment) - IV fluids for acute phase - Nebulized Hypertonic (3%) saline for those hospitalized more than 3 days to help w/ mucociliary clearance

Answer 115

Causative Agent: GABS S/s - pharyngitis (inflamed tonsils) - cervical lymphadenopathy - scarlet fever (erythematous sandpaper-like rash) Main risks - rheumatic fever (inflammatory of heart, CNS, joints)-- within 18 days - acute glomerulonephritis-- within 10 days

Answer 116

Diagnostics: rapid test to screen for strep and do throat culture if screen negative Treatments - Warm saline gargles - Penicillin or macrolide antibiotic (infectious for 24 post initiation of antibiotic; no longer contagious after 24 hrs so can return to school) - unless viral - cool drinks and foods (ice cream, ice chips) - chloraseptic or acetaminophen or ibuprofen, for pain (liquid or chewable)

Answer 117

Causative Agent: viral or bacterial, often w/ pharyngitis S/s - edematous tonsils (difficult breathing, swallowing, hearing (if adenoids)) - snoring and mouth breathing (noctural dyspnea) - foul mouth odor - persistent cough Treatments - Saline gargles, lozenges, non opioid pain meds - soft to liquid diet - If severe and not resolved by other methods, tonsillectomy or adenoidectomy

Answer 118

Contraindications: bleeding disorders, cleft palate, acute infection, under 3-4 yrs (b-c hypertrophy of lymphoid tissue possible) Post-op care - Pain management-meds (always give PO meds before IV meds run out) and ice collar - Observe for complications (s/s of hemorrhage)- such as frequent swallowing, tachycardia, pallor, bright red emesis - position for fluid drainage (prone, side lying) - expect dark brown emesis (bright red is active bleeding) - full recovery in 1-2 weeks

Answer 119

The Dont's Post-op - Avoid fluids until child alert and can swallow - Citrus juice can cause discomfort - Milk, ice cream and pudding not offered until clear tolerated because can cause child to clear throat - Avoid gargle, coughing, suctioning, straws, nose blowing - No red products or red dyes in fluids

Answer 120

Causative Agent: EBV, viral Key S/s: - Sore throat (Exudative pharyngitis w/ petechiae) - Lymphadenopathy - Hepatosplenomegaly Main risks: neurological (meningitis, seizures), Severe S/s to report to HCP - severe sore throat (unable to eat or drink) - severe abdominal pain - difficulty breathing - respiratory stridor

Answer 121

Diagnostics - heterophil antibody test (positive up to 6m post exposure in 4 yrs and up) - mono spot test (earlier diagnosis) - increased WBC (atypical leukocytes) Treatments - symptomatic (mild elixir analgesic, gargles, troches, warm drinks) - corticosteroids - avoid strenuous activities (contact sports until splenomegaly resolved) - contagious (just don’t share hygiene products and drinks) - viral so no antibiotics

Answer 122

Key S/s: coarse, dry, hacking cough worse at night Diagnostics: previous URI Treatments - symptomatic (rest, analgesics, antipyretics, humidity) - antibiotics if bacterial - cough suppressants (allow rest at night but interfere w/ secretion clearance)

Answer 123

Basic pathophysiology: thick, sticky mucus due to exocrine gland dysfunction Etiology: autonomic recessive (1 in 4 chance each pregnancy if both parents are carriers)

Answer 124

- chronic pneumonia (thick sputum) - emphysema (barrel chest, clubbed fingers) - recurrent URI due to bronchial obstruction Severe - pneumothorax and atelectasis - hemoptysis (from recurrent infection, emergency if > 250 ml/24 hr) - nasal polyposis (due to chronic inflammation, may need irrigation or corticosteroids)

Answer 125

- meconium ileus (intestinal obstruction) or constipation -- need stool softeners - malabsorption syndrome in pancreas (leads to steatorrhea (bulky frothy stools) and azotorrhea (foul smelling stools w/ putrefied protein)) - Reduced digestive enzymes - Cystic-fibrosis Diabetes (common and need insulin) - Portal hypertension in bile and liver (due to biliary cirrhosis) - rectal prolapse - simple use lubricated finger to put back - Chronic GERD - use H2 antagonist and GI motility

Answer 126

Musculoskeletal - Failure to Thrive due to malnutrition - bone health concerns due to pancreatic insufficiency and steroid use -- may need growth hormones Reproduction - most males are sterile - mucus blocks cervix in females but pregnancy possible (higher risk for complications)

Answer 127

- newborn screen w/ sweat chloride > 60 mEq/L (normal is 40) - absence of pancreatic enzyme - stool fat analysis (72 hr) - family history

Answer 128

- usually BID - chest physical therapy (percussion, postural drainage, flutter/handheld percussor) - Positive expiratory therapy (PEP) - Breathing against resistance to keep airway open and get around mucus so it can be expectorated) - High-frequency chest compressions (HFCC)--vibration vest assists mucus breakdown and clearance) - Exercises (stimulate mucus excretion, muscle development, pulmonary vital capacity, and sense of well-being)- encourage sports - breathing exercises (deep breathing, bubbles)

Answer 129

Mucolytics (Dornase alfa) - decreases mucus viscosity - side effects are laryngitis and minor voice alts Antibiotics - long course so need PICC or implanted port - IV vancomycin, inhaled tobramycin Bronchodilators - give before Airway clearance therapy Oxygen - w/ caution b-c often have CO2 retention

Answer 130

Pancreatic Enzymes (Pancrease) - enteric-coated given at every meal and snack (powder form in applesauce for infants) - increase dose if fatty stools Nebulized hypertonic saline - only for 6 yrs + and severe b-c may cause bronchospasms - increases mucus clearance and airway hydration CFTR Modulator (cystic fibrosis transmembrane conductance regulator)-- Ivacaftor - for 2 yrs and up w/ specific mutation - reduces likelihood of sticky mucus development

Answer 131

- high-protein, high-caloric diet - decreased fat - increased sodium - needs replacement of fat soluble vitamins - may need gastric feedings at night (growth failure despite PN may = deterioration) - remain upright post-feed to prevent Gerd

Answer 132

Causative Agent: bacterial (abrupt onset) Key S/s: - Absence of cough - Drool (painful swallowing) - Agitation - Tripod position (sitting upright and leaning forward w/ mouth open, chin out, and tongue protruding) - stridor Main risks: severe respiratory distress Diagnostics: cherry red epiglottis

Answer 133

Treatments - maintain airway (prep for intubation) - keep calm (in parent's lap) - give IV cephalosporins (Ceftriaxone/cefotaxime or vancomycin ) - do not examine throat if suspected (need provider and resuscitation equipment prior to throat exam) - Humidified oxygen via mask or blow-by to reduce agitation - Corticosteroids (can reduce edema early) - Droplet precautions 24 hrs after initiation of antibiotics Prevention: Hib vaccine

Answer 134

Causative Agent: most common croup, viral Key S/s - barky, brassy cough and horseness (worse at night and w/ crying) - stridor - prior URI - Dyspnea (due to narrow airway from inflamed mucosal lining) Main risks: respiratory acidosis -> respiratory failure

Answer 135

Treatments - Cool mist (or cool car ride if no stridor at rest) - Racemic Epinephrine Tx (short-term relief for moderate or severe croup—rapid onset but short duration) - Frequent assessment - Corticosteroids (dexamethasone PO)—standard treatment - Heliox (helium with oxygen): moderate to severe croup - Avoid aggravating child b-c can worsen respiratory distress

Answer 136

Causative Agent: viral w/ allergic component Key S/s - recurrent paroxysmal nocturnal attacks of laryngeal obstruction (awakes in middle of night w/ barking cough that subsides the next day) - hoarseness may remain next day - no fever Treatments - humidity or cool night air - epinephrine for severe

Answer 137

Causative Agent: bacterial of trachea Key S/s - large, thick secretions - stridor in every position - no response to LTB therapy - no drooling Treatments - intubation - suctioning (endoscopy w/ HCP) - antibiotics (erythromycins) - antipyretics

Answer 138

- Shot, bee sting --- say poke - Deaden - Take your blood pressure - Stool - Test

Answer 139

- Infants less than a year - Any child losing fluid through NG, stomas, sweat, drainage tubes - Children on IV therapy - Children who just had a recent surgery. - Children with medical diagnoses such as that are affected by fluid fluctuations ( Respiratory, Cardiac, Endocrine)

Answer 140

Mild - oral fluids (water, juice, pedialyte) - meds (acetaminophen or ibuprofen) Severe - IV rehydration - call provider if > 40-40.6

Answer 141

- have clear liquids >2 hours - breast milk >4 hours and infant formula >6 hours before procedure (keep eye out for dehydration) - serve liquid in small container to give illusion of a lot - keep mouth moist w/ atomizer or ice chips - keep close eye on older children who may try to sneak liquids - do not leave fluids at bedside

Answer 142

Structural - Gastroschisis (born with GI outside of skin - Short gut (lack of perfusion to guts in premature infants leads to gut death and surgical removal of dead parts) - TEF- (malformations of trachea and esophagus) Functional - FTT-Failure to Thrive - GERD-Gastroesophageal Reflux Disease Malabsorption - CF, Anorexia

Answer 143

- give by gravity - check placement w/ x-ray, pH, measure mark - use 5 or 8 french tip - do in quiet calm environment - use nonnutritive sucking to improve digestion

Answer 144

1. Do not give a child a choice of the medication. 2. Allow choices the child can have some control over 3. Do not lie, saying it won’t hurt or taste bad 4. Give worst meds last (prednisone = bad taste) 5. Give brief explanations 6. Tell the child is ok to be scared. 7. Always include the child and parent when talking during med administration. 8. Be confident and positive when approaching the child (Do not use baby talk, you can just change your intonation) 9. The younger the child the shorter time between explanations and administration. Involve the parent.

Answer 145

- orange tips = oral syringe - use nipple for infants to suck - chewables are good for preschoolers - give capsules w/ small amount of food or liquid - never mix in bottle b-c may not drink it all or not want to drink if nasty - place syringe on side of mouth (spraying at back can cause aspiration) - chase bad tasting w/ water, juice, ice pop (nondairy) - small puff in face can cause swallow reflex

Answer 146

Gauge: 22-25 Vastus lateralis and ventrogluteal Size: 5/8 - 1 inch Max volume: 0.5 for infant, 2 ml small child Deltoid Size: 1/2 - 1 inch Max volume: 0.5-1 ml

Answer 147

- assess site q1-2 hrs - use 22-24 gauge for small veins - usually by IV pump ( if bolus, 20 ml/kg okay) - children 5 and up can use PCA pump (family version available too) - Use superficial hand, wrist, forearm, foot, or ankle veins in small infants - Avoid foot veins in children learning to walk or walking - Use scalp veins in infants up to 9 months after other sites have failed

Answer 148

Enema - done if NPO due to vomiting or mental status - contraindicated in immunosuppressed or thrombocytopenia - max volumes (120-240 for infant, 240-360 small child) - No soapsuds Intraosseous - done in pediatric resuscitation if IV not possible after 3 attempts or 90 seconds

Answer 149

Optic - put pressure on lacrimal duct after administration for 1 minute to wash tear duct and prevent medicine from draining into body - ointment goes inner to outer canthus - give drops prior to ointment (3 mins apart) - if eyes clenched, put in nasal corner and it will go in once eyes open Otic - warm to room temp to prevent vertigo Nasal - hyperextend head to prevent strangling sensation from trickling

Answer 150

- Axillary preferred in infant to 2 years - Rectal temps if accuracy needed (age over 1 month) - 2-5 years axillary or TM - Can take orally when child can hold under tongue (5+)

Answer 151

* NIPS- Neonatal Infant Pain Scale-birth -1 month * FLACC Pain Scale- 2 month -7 years - Face Legs Arms/Activitiy Crying Consolability - For non-verbal child * Oucher Scale 0-5 scale; have child place faces in order then choose * Faces Pain Scale- 3 years and older *Numeric Pain Scale- Children 5 -7 years and older

Answer 152

Infants - Pre-verbal (physiologic response, crying, difficulty sleeping, feeding, relaxing) - Facial expression most reliable - Older infant may push or pull away Toddlers - loud cry - words that indicate pain - stay very still

Answer 153

- verbal report as young as 3 yrs for pain, location, and degree - Views pain as a punishment for thoughts/behavior - Regression to earlier behaviors (bed wetting, thumb sucking, crying, kicking) - Denies pain – fear of pain relieving measures “shots” - Avoid telling child to be “brave” or good boy or girl after procedure - Fears body mutilation (Need all their parts; Band-aids are important, magical thinking)

Answer 154

School-age - Describes pain and can quantify intensity (if scale is explained in simple terms) - Awareness of death - Bargains or tries to “make a deal” (I’ll let you change my dressing after this tv show) Adolescent - understands cause and effect - quantifies and describes pain

Answer 155

- Ice - Vapocoolant Sprays (may cause some constriction or may not be liked) - TENS units (stimulate nerves above location) - EMLA (eutectic mixture of lidocaine) cream- or Lidocaine- apply 60 minutes before poke) - Shot Blocker or buzzy (yellow thing which blocks some of the nerves or (distracts nerves) - sedation for infants or young children sometimes - change needle if pierced rubber stopper - apply pressure 10 sec before

Answer 156

Infants - Nonnutritive sucking (pacifier, Sweet ease) - touch, holding, rocking Toddlers and preschoolers - distraction (books, videos, music, bubbles--use child life) School-age and Adolescents - guided imagery - breathing exercises

Answer 157

- Phrase requests for appropriate behavior positively, such as “Put the book down” rather than “Don’t touch the book.” - Give advance notice or “friendly reminders,” such as “When the TV program is over, it is time for dinner” or “I’ll give you to the count of three, and then we have to go.” - Be consistent and commit to discipline - Praise good behavior - offer options when possible - role model good behavior esp honesty

Answer 158

- Moisturized air (useful with hoarseness or laryngeal involvement) for 10-15 minutes - Steamed vaporizers, kettles, and boiling water are discouraged - Steam in shower is good method - Use nasal aspiratory or bulb syringe for young infants before feeding and sleeping - Saline nose drops (1/2 tsp salt, 1 cup water) useful - Topical vapor rub for 2 yrs and older ( never give orally or under the nose)

Answer 159

- Dehydration possible if febrile, anorexic, vomiting, or has diarrhea (esp if infant) - Parents should encourage small amounts of fluids (clear if vomiting) frequently (Infalyte and Pedialyte, water, or low-carb drinks) - Avoid drinks with caffeine that may act as diuretic - Do not force fluids or foods (IV fluids or NG tube may be needed if child dehydrated and not drinking) - Hydration is more important than food in acute illness

Answer 160

Increase - Decreased perfusion (shock) - Elevated temperature - Pain - Medications (atropine, morphine, epinephrine) - Hypoxia Decrease *bradycardia more concern than tachycardia* - Vagal stimulation - Increased ICP - Medications (neostigmine [Prostigmin])

Answer 161

Increase - Respiratory distress - Excess fluid volume - Hypothermia - Elevated temperature Decrease - Anesthetics - Opioids ( compensated for w/ hyperpnea)

Answer 162

Increase - Excess intravascular volume (severe in preterm b-c hemorrhage possible) - Increased ICP - CO2 retention - Pain Decrease - Vasodilating anesthetic agents (halothane, isoflurane, enflurane) - Opioids (e.g., morphine) - shock (late sign due to elasticity and constriction of vessels to maintain cardiac output)

Answer 163

Increase - Shock (late sign) - Infection - Environmental causes (warm room, excess coverings) Decrease - Vasodilating anesthetic agents (halothane, isoflurane, enflurane) - Muscle relaxants - Environmental causes (cool room) esp infants - Infusion of cool fluids or blood

Answer 164

Infants - parent may collect at home (diaper collection can alter results) - Special urine collection bag often used for urine dipstick or urinalysis but not culture - UTI confirmed with catheterization or suprapubic aspiration - wipe abdomen with alcohol pad and fan dry for voiding in 2 minutes - apply pressure over suprapubic area for Perez reflex (can cause urination)

Answer 165

Preschoolers and toddlers - may not void on request so give a liquid and wait 30 minutes - May be anxious about voiding in unfamiliar place School age - cooperative but curious Adolescents - may paper bag to disguise (ask about menses)