1
Q
pediatric continuum of health
A
community, culture, and family triangle
health maintenance and promotion
2
Q
ecology of human development
A
Urie Bronfenbrenner- mutual interaction between child and settings (contexts)
like nature vs nurture
3
Q
review screenings for different ages in ppt*** also review developmental stages for kids!!! in textbook
A
yass, most missed on exam #1
4
Q
do toddlers need to try new foods before they like them??
A
yesssss
5
Q
microsystems
A
child interacts directly
fam, friends
6
Q
mesosystem
A
interactions between microsystems
parent, teacher, student
7
Q
exosystem
A
settings that influence children even though child doesn’t consistently or directly interact with that system
neighborhood, economy
8
Q
macrosystem
A
beliefs, values, and behaviors conveyed in a child’s environment
US Congress, mass media, christianity
9
Q
chronosystem
A
time period in history which a child grows up - impacts directly and indirectly
10
Q
1 threat to child health??
A
poverty
early intervention is best way for improvement in children
worst in infants!! and toddlers***
11
Q
most common cause of child death after 1 yr?
A
injury
12
Q
newborn**
A
up to 1 month
Eat, sleep, eliminate
Reflexes vs motor skills
Helpless/vulnerable - Developing trust
Communicate with crying, cooing…
13
Q
infant**
A
1 month to 1 yr
Motor skills – head control, roll, sit, stand/cruise, walk??
Self-regulation – sleep, eating
Developing trust, exploring
Communicate with crying, babbling, gestures, receptive>expressive, one word by one year
Nutrition expands – soft foods and beyond
14
Q
toddler**
A
1-3 years
Motor skills – walk, run (“top heavy”), scribbling, throwing
Self-regulation – toileting
Developing autonomy, tantrums
Communicate – language “explosion” – 2 words together by 2 yo, 3 word sentence by 3 yo, parallel play
Nutrition expands – family foods, develop preferences
15
Q
preschooler**
A
3-6 years
Motor skills – jump, skip 1 foot, trike, drawing, use scissors
Developing independence, self-care, imagination, cooperative play
Communicate with speech 100% understandable to strangers, follow rules in simple game
16
Q
school-aged**
A
6-12 years
Motor skills – increasingly coordinated - engage in hobbies
Self-regulation – hygiene, responsibility, chores, emotional expression through words
Developing competence, self-esteem, problem-solving skills
Makes friends
17
Q
adolescent**
A
12+
Self-regulation – increasing independence, managing stress, conflict
Developing decision-making skills, identity, compassion, empathy
Positive engagement in community
Peers of great importance
18
Q
vitals difference
A
apical pulse on infants and toddlers! 1 full min HR and RR
19
Q
don’t ask for permission or eye contact if taking vitals asleep, always to most painful thing last - BP measure last
A
i guess heehe
20
Q
healthy weight percentile for growth chart??**
A
5-85%
21
Q
DEFG?
A
Don’t ever forget glucose! check without order if child looks bad
standing orders for peds
22
Q
family-centered care
A
fam is more involved to make child comfortable
23
Q
healthcare/medical home
A
consistent doctor/nurse
24
Q
resiliency wheel (6)
A
1) prosocial bonding
2) clear and consistent boundaries
3) develop needed life skills
4) opportunities for meaningful participation/contribution to others
5) caring and support
6) high expectations
also: faith
25
growth assessment
chart of height weight, head circumference, BMI, etc.
26
most common chronic disease of childhood?
dental caries (cavities)
27
5 s's calming stuffs
swaddle
sway
shush
side/or stomach
suck
don't EVER shake baby!!! shaken baby syndrome :(
28
fevers/febrile kids**
don't be too scared, it's a good indication their body is working well to fight whatever is going on
they really don't cause brain damage but can very rarely
29
antipyretics**
be careful to not overdose. a 3 day fever is normal, but longer is not
30
where check baby temp
axillary - or oral, maybe rectal
31
light coverings and one blanket if shivering, shivering--> raises fever,
otherwise one layer of clothing and no blankets for babies
yaaa
32
serious signs in peds fever (5)**
Not serious?? (3)**
1) reduced consciousness
2) seizures
3) cyanosis
4) rapid breathing
5) slow capillary refill
but NOT: diarrhea, vomiting, and rashes (unless they are petechiae or purple rashes)
RR >60 at any age is always a concern***
33
child CPR - should you start compressions if pt not breathing well but has a pulse <60 and rescue breaths alone aren't helping??
YES! Start compressions even if not at asystole yet
if not perfusing well start CPR regardless
34
respiratory differences peds***
babies are obligate nose breathers for first year of life
swollen tonsils risk for air obstruction
greater risk of obstructed airway
tracheal cartilage is more malleable so it's more difficult to intubate child than an adult****
lower airway is more bony and causes greater work of breathing-->intercostal retractions, substernal, subcostal
fewer underdeveloped alveoli and bronchioles
35
respiratory score chart
on desktop, add up pts for each section
36
circulation/perfusion
cap refill 2 seconds or less is normal
central cyanosis is late sign
37
paradoxical breathing
chest expands during inhalation and the abdomen is drawn inwards and then during exhalation the abdomen is pushed outwards
38
airway management for choking in different ages
1 year old: back blows upside down
kids over 1: back slaps and heimlick maneuver
if stridor, keep them calm!! Prevent partial-->complete obstruction, need bronchoscopy*****
39
sudden infant death syndrome (SIDS)**
number 1 cause of death under age 1, especially 2-3 months
abnormality in brainstem that interferes w protective responses, added stressors can make it worse
40
risk factors for babies
tummy time so head isn't misshapen, only have clothes on and no blanket typically
41
croup (laryngotracheobronchitis/LTB)
and
stridor***
stridor- partial airway obstruction
croup- a disease that causes swelling in the airways and problems breathing. Children with croup often have a high-pitched “creaking” and stridor
42
croup treatment
caused by virus
sit in steamy bathroom, sit outside at night, fluids, corticosteroids, beta agonists
give norepinephrine and albuterol, humidified O2 also****
43
epiglottitis**
age 2-8 years more common, less common than croup, bacterial
keep kid calm!! #1 priority
happens more often now bc anti-vaxxers
44
4 D's of epiglottitis**
dysphonia (difficulty speaking)
dysphagia
drooling
distressed respiratory effort
45
lower airway disease/reactive airway diseases
bronchiolitis- below trachea, juicy noisy mess**
46
bronchiolitis**
Respiratory syncytial virus (RSV)*** most common cause (77%)
One of the most common hospital admissions in winter for high risk infants
Common lower resp tract pathogen of infants/small children
In older children and adults RSV causes URI involving nose, throat, & sinuses
47
clinical manifestations brionchiolitis
Fever
Inspiratory and expiratory wheeze
Deep cough
Increased work of breathing
Copious thick, clear mucus
Poor feeding, irritability, lethargy
*RSV: contagious 8 days droplet
Bronchiolitis develops 2nd to 3rd day after exposure
Symptoms peak 3-5 days and then resolve over the week
May have lasting cough for 2-4 weeks.
48
treat RSV**
Nasal Suction
Fluids (OG, NG, IV last resort babies)***
Antipyretics
Cuddles
humidified O2 if needed***
if RR >70, don't take food orally, place NG to place fluids
49
O2 sat goal peds
>90%
50
RSV, don't:
Routine Bronchodilators
Corticosteroids
Singulair
Chest Physiotherapy
Antibiotics
Epinephrine
51
RSV complications
Dehydration
Aspiration
Secondary infections
Apnea in very young infants
Respiratory failure
52
excercise lungs how?
"blow" out my pen light, or blow bubbles!
53
synagis
RSV vaccine used for premie babies and children w significant cardiac or respiratory conditions, given once a month during 5 winter months, $5-,000 - 9,000 per year
54
asthma
chronic airway inflammation
Airway inflammation
Airflow obstruction
Airway hyper-responsiveness
anti-inflammatory and bronchodilators for treatment
triggers: bugs, pets, mold/mildew, weeds/grass, dust mites, cleaners, stress, perfume
55
protective factors
factors that build a child's immune response through nonallergic pathway
large family size
later birth order
child care attendance
dog
living on a farm
breastfeeding??
asthma episodes are most significant when nothing is heard
56
asthma - peak flow monitoring
GREEN 80-100%
YELLOW 50-80%
RED <50%
57
severe peds asthma attack do what first?
humidified oxygen, then bronchodilator, opposite to adults order
Treat hypoxia
Saturate with inhaled bronchodilators
Add ipratropium to mitigate excess mucus
Address swelling with systemic corticosteroids
Additional drugs: Theophylline (CNS stimulant- stimulate breathing), epinephrine, terbutaline (SABA) and magnesium (relax)
58
asthma controller meds (6 categories)
Beta agonists
Methylxanthines
Mast cell inhibitors
Corticosteroids
Leukotriene modifiers
Hyposensitization
use spacer with metered-dose inhaler!! (MDI)
59
beta agonists
SABA- proair/albuterol
LABA- Severent/salmeterol
60
methylxanthines
Methylxanthines- theophylline (less common)
61
mast cell inhibitors
inhaled anti-inflammatories like cromolyn
62
corticosteroids
inhaled have less systemic effects, wash mouth out, pulmicort
presnisone PO
63
leukotrine modifiers
singulair/montellukast
64
cystic fibrosis (CF)**
mostly caucasians, child with cystic fibrosis could expect to live about 5 years. Individuals with cystic fibrosis born in 2017 have a life expectancy of 45 years or more.
affects everything
65
manifestations CF
Stasis of mucous
Wheezing and rhonchi
Cough
Dyspnea
Atelectasis/ Chronic obstruction
Cyanosis
Barrel chest
Clubbing- chronic hypoxia
Multiple respiratory infections
66
CF- pancreas/GI
Pancreas- Poorly digested food R/T inability to secrete digestive enzymes
Deficiency in fat soluble vitamins
Failure to thrive/delayed growth
Cystic fibrosis can --> related diabetes
GI- Meconium ileus at birth
Steatorrhea
Abdominal distension
Constipation/obstruction
Rectal prolapse
Liver cirrhosis
67
CF - monitoring
Growth and nutritional status monitored every 3 months
Annual pubertal assessment
Especially important times for monitoring
First 12 months after diagnosis
Birth to 12 months for those diagnosed prenatally or by GDS
Peripubertal growth period
68
CF - nutrition
Arrange for nutritional consult
May need 1.5 x daily caloric requirement
Multivitamins recommended
Moderate fat intake and no need to restrict salt intake (low Na in CF)
Diet must support GI function of each child
need to take enzymes to digest fat!
stool softeners or laxatives, treat GERD, enemas
69
number 1 comorbidity with CF
diabetes mellitus- need insulin
70
CF - social distance??
6 ft apart at all times with other CF pts or anyone else who is sick
71
why decreased BP in kids
so many changes in development, don't think 120/80!
72
look at heart rate chart
don't need to memorize, but familiarize, lots of normal variation
73
respiratory>cardiac
ABC's still, respiratory compromise-->hypoxia-->bradycardia (after tachycardia)**
74
cardiac output (CO) - what is main determinant?
main determinant of CO in kids is heart rate!
consider preload, contractility, afterload
75
HR red flags for infant and child***
***Red Flag: HR < 80 or >220 infant, < 60 or >180 child **Intervene with respiratory intervention first
76
cardiac differences peds***
Infants- minimal cardiac reserve, higher risk for heart failure, susceptible to pressure or volume overload
Increased O2 requirements from birth - 2 mos.
Higher metabolic rates
Heart muscle not fully developed (~5 years of age) = Limited ability to alter stroke volume
77
changes in BP?
a very late sign when sick
78
child congestive heart failure (CHF)**
timing of interventions is vital:
intervention cardiac cath
palliative surgery
corrective surgery
79
CHF peds meds**
diuretics
ACE inhibitors
antiarrhythmics
anticoagulants
BP meds
Digoxin- administer according to orders, monitor HR, can cause bradycardia, monitor dig levels, monitor K, can cause hyperkalemia
on the other hand:
hypokalemia + dig = overdose/toxicity, always with diuretic like spironolactone
80
peds arrhythmias**
kids with congenital heart defects at risk- surgical repair, cardiac abnormalities, decreased ventricular function
81
most common cause of bradycardia in kids?**
hypoxemia**
82
most common peds coronary heart disease (CHD)
ventricular septal defect (VSD) -->sending more blood to lungs-->pulmonary edema, fluid overload
also ASD is atrial septal defect
83
increased pulmonary blood flow = ?**
congestive heart failure, heart will beat faster to compensate
84
s/s Congestive Heart Failure (CHF)
increased pulmonary blood flow/CHF:
tachypnea, tachycardia, heart murmur, poor weight gain (poor feeding, fussiness), diaphoresis (sweating), edema--periorbital,
frequent respiratory infections
85
decreased pulmonary blood flow
cyanosis,
tachycardia,
loud murmur,
dyspnea,
SOB,
fatigue with exertion (hypoxemia),
delayed developmental milestones,
polycythemia (elevated HCT/RBC, attempt to increase oxygenation),
clubbing
86
tetrology of fallot (4)****
1) pulmonic valve stenosis
2) leads to R ventricle hypertrophy and thickening
3) ventricular septal defect
4) overriding aorta
O2 goals are NOT 95-100**** more like 75-85%***
87
cyanosis**
Hypoxemia – Deoxygenated arterial hgb
Pulse oximetry – Non-invasive measure of percutaneous arterial O2 saturation, early sign of hypoxemia–
Normal 95%-98%
Cyanosis – 85%
Early intervention required with low O2 saturation
May be impacted by other conditions - anemia
Screening of infants to r/o congenital defect
88
hypercyanotic episodes
Hypercyanotic Lesions – Early repair prevents
Bodies response to increase O2
Tachypnea- early
Tachycardia
Cyanosis, pallor, poor perfusion
Diaphoresis
Irritability, Fussiness
Seizures/LOC
Bradycardia- late
Unrepaired lesions – children "squat" to increase pulmonary blood flow
89
coarctation of the aorta**
narrowing of the aorta after the 3 great arteries/ on the subclavian artery, causes variation in BP upper vs lower, take both, palpate pulses in lower extremities because lower BP in those areas
90
shock peds**
inability to get O2 and nutrients to tissues for whatever reason
hypovolemic- most common, from dehydration, blood loss r/t trauma, BP drop is late sign, treatment is O2, fluids identify cause of fluid loss, and fluid replacement
91
types of shock (4)**
hypovolemic, cardiogenic, distributive, obstructive
92
cardiogenic shock peds**
heart muscle not working, fluids don't help, underlying cause
93
distributive shock peds**
ex: anaphylaxis, sepsis
Blood volume OK – Distribution of blood not OK, body/vessels are confused
Emergent treatment of underlying cause
94
obstructive shock peds**
Blood flow to and from the heart obstructed=emergent intervention!!
Common:
Pneumothorax - Breath sounds equal b/l?
Cardiac Tamponade – Muffled heart sounds
95
cardiomyopathy/sudden cardiac arrest
Screening – Fainted, passed out, exercise related chest pain/SOB, fam history heart or sudden death or pacemaker < age 50
Improved Survival– Lay rescuer CPR, Improved quality, AED availability and use
Most common arrythmia w SCA = VT
Cardiomyopathy – anatomically normal heart with abnormal myocardial structure or function
Affect systolic or diastolic function
Potential for life threatening arrythmias
Family history/genetic
Presentation age varies
96
kawasaki disease
Leading cause of acquired heart disease in kids
Acute febrile systemic vascular inflammation d/t virus
Occurrence < 5 years of age, 50% < 2 years of age
Hallmark – HIGH fever > 5 days, cherry red lips, swollen hands and feet
Rx – IVIG (immune globulin/antibodies), aspirin (only situation give aspirin to kids)**, convalescent phase
Complication– coronary artery aneurysm
97
acquired pediatric heart conditions (2)
1) acute rheumatic fever
2) MIS-C
98
acute rheumatic fever
Autoimmune inflammatory response to pharyngeal group A strep
Prevention is key=adequate treatment of Strep throat!! Caregiver education r/t strep?
Symptoms – history of sore throat, new heart murmur = carditis, joint pain, rash, nodules, chest pain
99
MIS-C - multisystem inflammatory syndrome in kids
Linked to COVID-19, post exposure
Fever, multisystem level involvement
Cardiac Symptoms – 80% of MIS-C kids; myocarditis, coronary artery aneurysm, arrythmias, conduction abnormalities
N414
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