Lifespan Flashcards
(44 cards)
1
Q
Paediatric Assessment Triangle:
A
- Appearance: tone, interactiveness, consolability, look/gaze, speech/cry
- Work of breathing: abnormal breathing sounds, abnormal positioning, retractions, nasal flaring
- Circulation to the skin: pallor, mottling, cyanosis
2
Q
Airway differences for paeds:
A
- large head
- short neck
- small face and mandible
- large tongue
- epiglottis is horseshoe shaped and projects posteriorly at 45 degrees
- larynx is higher and anterior, more flexible
- trachea is short and soft
- narrow airway
- nasal breathers
- smaller lung capacity
- poorly developed intercostal muscles
3
Q
Breathing differences for paeds:
A
- lungs are relatively immature at birth
- both the upper and lower airways are small
- infants rely primarily on diaphragmatic breathing
- ribs lie more horizontally
- increases RR to compensate for respiratory difficulty
4
Q
Heart and circulation differences for paeds:
A
- anatomically same heart as adult
- heart increases SV by strengthening by increasing HR
- low compliance
- HR important
5
Q
Estimating a child’s weight:
A
<10yrs: weight = (age+4)x2kg
> 10yrs: weight = 3xage kg
6
Q
Endotracheal size of paeds:
A
(age/4) + 4
7
Q
Mason-Likar lead placement
A
- if a child is squirming and wriggly for an ECG, place limb leads on shoulders and lower torso
8
Q
ECG paeds:
A
- V3R and V4R (mirror images of V3 and V4 but on right side) may be requested because newborns have comparatively stronger and bigger right ventricles than left.
- reverses in first few months of life
9
Q
Physical assessment (paeds):
A
- Appearance: skin (bruises, rashes, eczema), hygiene, teeth, clothing, behaviour
- general behaviour: communication, recognition of familiar people/objects
10
Q
Paeds history:
A
- Ante/post natal history: C-section, vaginal, easy, complications
- Immunisations
- parents concerns and beliefs
- legal orders (parents divorced/custody)
- parents
- adolescents may not want parents
- eating habits
- toileting
- daily routine
- sleep patterns
- emotional state, comforters
11
Q
Development of the neonate and infant:
A
- Average weight = 2.7-3.8kg
- Average height = 50cm
- Average head circumference = 35cm
- height and weight of infant is affected by genetics and ethnicity
- vision
- hearing
- smell and taste
- touch
- motor development
12
Q
Fontanelle:
A
- soft spot on head where the skull has not fused together yet
13
Q
Young children’s health risks:
A
- Child abuse (physical, neglect, emotional, sexual)
- Respiratory tract infection
- Gastroenteritis
- Respiratory distress
- other (eg. injuries, poisonings, drownings)
14
Q
Lower airway (paeds)
A
- asthma
- caused by contraction of smooth muscle and airway inflammation
- bronchial airway becomes obstructed and expiration of air is prolonged
- rate and depth of inspiration increases leading to hyperinflation of lungs
- bronchiolitis
- acute inflammatory disease in lower respiratory tract
- bronchioles obstructed due to mucous production
- decreased lung compliance, hyperventilation, ventilation perfusion mismatch
- symptoms: runny nose, cough, fever, expiratory wheeze
15
Q
Upper airway infections (paeds)
A
- croup
- viral infection
- vocal cords, subglottic tissue and trachea inflamed and oedematous
- stridor
- signs of worsening: hypoxia, fatigue, decreased conscious state, increasing WOB
16
Q
Signs of respiratory distress (paeds)
A
- accessory muscle use
- subcostal and substernal recession
- nasal flaring
- tracheal tug
- SOB
- increased WOB
- fatigue
- cyanosis
- head bobbing
- tachypnoea
17
Q
Respiratory assessment (paeds)
A
- Look (level of activity, mental/conscious state, colour, RR, respiratory effort)
- Listen (stridor, wheeze, grunting, speech)
- Feel (skin?)
- use of accessory muscles (intercostal, subcostal, abdominal, nasal flaring)
18
Q
cardiovascular assessment (paeds)
A
- look (colour, skin, degree of activity, mental status, respiratory effort, perspiration, oedema)
- listen (heart sounds, heart rate, rhythm)
- feel (skin - cool, clammy, hot to touch)
19
Q
Circulation assessment:
A
- HR
- BP
- bradycardia and hypotension are late and pre-terminal signs
- intake
- urinary output
- pulse volume
- capillary refill (2secs)
- skin
- mental status
20
Q
Red flags in paediatric assessment:
A
- RR >60
- significant bleeding
- respiratory distress
- nasal flaring
- altered mental state
- noisy breathing
- seizures
- cyanosis
- fever with a rash
- HR>180
- HR<60
21
Q
Stages of adolescence: early
A
- 11-14 years
- physical growth reaches peak velocity
- menstruation
- normality = critical aspect
- peer groups important
- negotiating with parents
- mood swings
22
Q
Stages of adolescence: middle
A
- 14-16 years
- abstract thinking and social conscience
- increased conflict with parents
- strong fear of rejection
- breast development
- pubic and body hair growth
23
Q
Stages of adolescence: late
A
- 16-18 years
- physically mature
- abstract thought processes well developed
- fairly independent
- beginning of intimate relationships
24
Q
Adolescent health risks:
A
- Consequences of risky behaviour
- STI
- pregnancy
- eating disorders
- mental health
- substance use
25
Main areas of focus in the elderly:
- cognition (dementia, delirium, depression)
- continence
- falls, mobility, self-care
- frailty
- medication
- nutrition & swallowing
- pain
- palliative approach
- pressure injuries & skin tears
26
Why do we have an ageing population?
- Disease control
- Health advances and technology
- Improved sanitation
- Better living conditions
- Vaccination
27
Factors affecting ageing:
- genetic makeup
- inherit predetermined illness
- wear and tear
- less efficient function
- stress = illness - immune process influenced
- radiation exposure
- nutrients/balanced diet
- environment
- pollution
- smoking
- asbestos
28
Physical changes with ageing:
- elongated ears
- grey, thin hair
- thicker hair in ears and nose
- darkening/wrinkles - skin & around eyes
- deepening - hallows axilla, intercostal space & supraclavicular space
- narrower gait (women), wider gait (men)
- decreased height
- reduced muscle mass
- reduced skin fold thickness
- growth of facial hair in women, reduction in leg hair
29
Cardiac (elderly)
- more prominent arteries (head, neck, extremities)
- aorta (dilated, elongated)
- cardiac output decreased
- increased resistance (peripheral blood flow)
- BP increase (to help with reduced peripheral blood flow
- less elasticity of vessels
- less O2 use
- SV decrease
30
Skin (elderly)
- more prone to tears
- thin
- requires additional care
31
Respiratory (elderly)
- Loss of elasticity, increased rigidity
- blunting - cough and laryngeal reflexes
- 50% reduction in normal capacity by 90yrs
- fewer but larger alveoli
- more rigid thoracic muscles
- lack of basilar inflation
- forced expiratory volume reduced
- decreased ciliary action
32
GIT (elderly)
- atrophy of gastric mucosa
- stomach motility, hunger, contractions, empty time reduced
- less production of pancreatic and hydrochloric acid
- less cells and surface to absorb in intestine
- slower peristalsis
- reduced intestinal blood flow
- liver smaller
- less saliva
- reduction in sensation of taste
- reduced oesophageal motility
- more dilated oesophagus
33
Renal (elderly)
- decreased tubular function
- loss of nephrons
- renal blood flow reduced
- weaker bladder muscles
- decreased bladder capacity
34
Skeletal system (elderly)
- slight kyphosis (spine curvature)
- thinner discs, shortening vertebrae
- slight hip/knee flexion
- wrist flexion
- impaired flexion and extension movements
- decrease in bone mass and minerals
35
Neurological (elderly)
- decreased conduction (slower response/reaction time)
36
Pain (elderly)
- stressor to physical, emotional, spiritual wellbeing
- poor positioning, posture, inactivity, emotional issues and adverse drug effects could cause
- frustration, anger, anxiety could contribute
37
Sensory
- more opaque lens
- decreased pupil size
- increased amount cerumen (earwax)
- tympanic membrane (atrophy)
- impaired olfactory
- atrophy of hair
38
Cognitive function (elderly)
- personality (not normal to change)
- memory (short loss common, retrieval from long term slower)
- intelligence (reduced if unwell, basic level maintained)
- learning (no change when well, motor skills may reduce ability)
39
Dementia
- Gradual loss of intellectual abilities
- memory, reasoning, judgement, abstract thinking
- causes: nutritional deficiencies (eg. vitamin B12), long term polypharmacy, excessive alcohol intake
40
Alzheimer's progression:
1st phase: 0-4 years, foggy, less responsive, flat
2nd phase: 4-10 years, recent memory gone, lucid moments, speech difficulty
3rd phase: 3-5 years, total disorientation, catastrophic reaction (violence), movement limited
4th phase: 1-2 years, terminal, totally confused, incontinent, totally dependent, death (due to physiological complications)
41
Delirium
- acute state = sudden onset
- global cognitive impairment
- reversible with early intervention
- causes: hypoxia, infection, withdrawal of alcohol, trauma, sleep deprivation, faecal impaction, dehydration
42
Why are the elderly more susceptible to exploitation and abuse:
- limited financial power
- weakness
- incapacity
- cognitive alterations
43
Define elder abuse:
Any act which causes harm to an older person and is carried out by someone they know and trust.
44
What is the most common type of elder abuse and who commits this?
- Financial abuse, closely followed by emotional
| - children tend to be the main abusers
