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Flashcards in Pedi ATI Deck (76):


birth-1auxillary: 97.9-98.9
1-12 oral: 98.1-99.9
12+ oral: 97.8-98.0



Up to 1 week : 100-160 (fluctuations with activity)
1wk-3months: 100-220
3 months - 2 yrs: 80-150
2-12: 70-110
12+: 50-90



Newborn: 30-60 with periods of apnea < 15 sec
upto 1 yr: 30
1-2: 25-30
2-6: 21-24
6-12: 19-21
12+: 16-18


Blood Pressure

Influenced by age, height, and gentder. Compare to national measures
infants: 60-80 systolic, 40-50 diastolic
1: 97-107/53-60
3: 100-110/61-68
6: 104-114/67-75
10: 112-122/73-80
16: 122-132/79-86



Posterior: 2-3 months
Anterior 12-18 months



Suck-root: birth to 4 months
Palmar grasp: birth - 6 months
Plantar grasp: birth to 8 months
Moro (startle): birth to 4 months
tonic neck (fencer) birth to 3-4 months
Babinski: birth to 1 year
stepping: birth to 4 weeks


Cranial Nerves

I Olfactory: smell
II Optic: intact visual acuity, peripheral and color vision (can track and object)
III Oculuomotor: PERRLA, no nystagmus, blinks
IV Trochlear: Look down and in
V Trigeminal: clench teeth, detects facial touch, root and suck reflex
VI Abducens: See laterally, follows your face
VII Facial: salt vs sweet, symmetrical face movements,
VIII Acoustic: no vertigo, intact hearing, tracks sound, blinks to loud
IX Glossopharyngeal: intact gag reflex, sour taste on back tongue
X Vagus: clear speech, no difficulty swallowing
XI Spinal Accessory: moves shoulders symmetrically with equal strength
XII Hypoglossal: midline tongue, moves in all directions, for and infant open mouth when nares occluded, no difficulty swallow


First year gross and fine motor skills

Months old; gross; fine
1; head lag; grasp reflex
2; lifts head off mattress; holds hands in open position
3; raises head and shoulders; no grasp, keeps hands loosely open
4; rolls from back to side; places objects in mouth
5; rolls front to back; uses palmar grasp
6; rolls back to front; holds bottle
7; bears full wt on feet; objects from hand to hand
8; sits unsupported; pincer grasp
9; pulls to standing; crude pincer grasp
10; prone to sitting; grasps rattle by handle
11; walks holding on; places objects in container
12; sit down from standing without help; TRIES to build 2 block tower


Piaget birth-24 months

Sensorimotor :
object permanence (9 months)
mental representation (recognition of symbols)


Pyschosocial first year

Erickson: trust vs mistrust
Attachment: infant bonds with parents
Separation anxiety 4-8 months



1-3 yrs
30 months wt is 4 x birth wt
grow 3 inches per year

15 months; walks without help, creeps up stairs; uses cup, 2 blocks
18 months; standing position; spoon, turn pages
2 yrs; walks up and down stairs; 6-7 blocks
2.5 yrs; jumps, stands one foot; draw circle, hand finger coordination

400 words, 2-3 word phrases


Piaget cognitive toddler

sensorimotor- preoperational
object permanence
mimicry-playing house
imitates others


Psychosocial toddler Erickson

autonomy vs shame and doubt
independence, separation anxiety
moral development
self concept - see separate from parents
body image changes, gender identity at 3



3: rides tricycle, jumps off step, stand on one foot for few sec
4: skips and hops on one foot, throws ball overhead
5: jump ropes, walks backward, stairs easily
dress independent, copy things on paper

Understand time past present future
Sentences, know colors


Piaget preschool cognitive

preconceptual thought 2-4: visual judgements, inanimate objects alive, immennent justice
intuitive thought 4-7: classify info, cause effect relationship


Psychosocial Erickson Preschool

initiative vs guilt
moral development
self concept of development (may regress if unable or stressed)
Body image, fear dark
Less separation anxiety, little stranger anxiety
Pretend play
12 hrs sleep


School age

6-12 years old
Puberty begins
Vision to 20-20
Coordination improves
understands grammar and multiple meanings of words


Piaget cognitive school age

Concrete operations
wt and volume unchanging
simple analogies
understands time
classifies complex info
understands emotions
solves problems


Erickson school age psychosocial

industry vs inferiority: learn things, motivated by tasks that increase self worth, fears of peer ridicule

Moral development: justice, law and order
Self respect, encourage where they can excel
Body image changes, sexual curiosity, privacy
Social: peer pressure, friendships, conformity



12-20 years
girls stop growing 2 yrs after menarche
boys stop around 18-20
Girls order: breasts, pubic hair, menstruation
Boys order: Increase in testes and scrotum, pubic hair, rapid growth genitalia, axillary hair, lip hair, voice change


Piaget cognitive adolescents

Formal operations: think like adult, abstract, longer attention, imaginative and idealistic, logical decisions, future oriented, deductive reasoning, actions influence others


Erickson psychosocial adolescents

Identity vs role confusion: influenced by family expectations, group identity influences behavior

Vocational work habits and future plans
Invincible to health outcomes of risky behavior
Law and order-rules adjusted, not absolute
Self concept: friends, activities help
Body image: how the world views them


Pain scales

CRIES postop scale: 32 wks gestation to 20 wks old, cry, vitals, expression, sleep
FLACC: 2 months - 7 yrs; faces, legs, activity, cry, consolable,
FACES: 3 yrs and up; happy sad faces
VAS Visual analog: 7 and up (maybe as young as 4.5); 0-10, child points to # that best describes
Numeric: 5 and up
Word graphic: 4 and up
Oucher 3 and up
Noncommunicating check list: 3-18 yrs; 0-18 scale, vocal, social, facial, activity level, movement, physiologic changes



Viral (MMR) or bacterial (URI, bacteria, immunosupressed, crowded living, CSF access)

photophobia, headache, drowsy, irritable, N&V, seizures, nuchal rigidity, Brudzinskis sign (flex extremeties with flex neck), Kernig sign (pain when extending knee when hip flexed), fever and chills, petechia or pupura (immediate medical attention),

isolation droplet when suspected, decrease stimuli, low lights, cool room, lay without pillow, head slightly elevated, seizure precautions

ABX, corticosteroids, anticonvulsants, analgesics-nonopiods,

complications: increased ICP > brain damage

CBC, culture, CSF

PVC and Hib vaccinations help protect


CSF collection

empty bladder, fetal position or sitting if older, sedatives, EMLA cream L3-5, monitor for hematoma, lie flat for 4-8 hrs


Reye Syndrome

Liver dysfunction and Cerebral edema
hypoglycemia, shock

No Asprin for viral illness

Stage 1: lethargy, vomit, anorexia, liver dysfunction, brisk pupil rxn, can follow commands
Stage 2: confusion, combative, hyperventilate, hyperreflex, sluggish pupil, responds to pain
Stage 3: coma, seizures, flexion rigidity,
Stage 4: deeper coma, extension rigidity, fixed large pupil, brainstem dysfunction, minimal liver dysfunction
Stage 5: hypotonia, seizures, resp arrest, no liver dysfunction

Increased Liver, ammonia
Low hgb, hct, platelets

Liver biopsy (check clotting prior), NPO prior, hemorrhage and vitals post

Fluids with I&O, position (avoid flextion and extension, head midline, elevate 30), vitamin K if bleeding, NG tube, intubation, seizure precaution, diuretic (mannitol), insulin

Complications: neurological speech, hearing, CP, paralysis, developmental delays; death


Seizure types

Tonic-clonic (grand mal): aura, tonic episode, loss of conscious, clonic pisone, breathing may stop, cyanosis, biting, incontinence, confusion and sleepy

Tonic: only tonic phase, does not loose conscious, few seconds

Clonic: only clonic, no fatigue,

Absence: common in children, lasts seconds, blank stare, function resumes after

Myoclonic: brief jerk or stiffening, 1 or 2 sides, seconds

Atonic-kinetic: muscle tone lost, confusion after, falling

Complex: automatisms lip smack, loss of conscious, amnesia before and after

Simple: no loss of conscious, unusual sensations, dejavu, autonomic abnormalities change in vitals, one sided movement, bad smell


Status Epilepticus

lasts longer than 30 min, no postictal phase

Maintain airway, O2, IV access, ECG monitor, pulse ox, ABGs, loading dose of diazepam or lorazepam, continuous infusion of dilantin or cerebyx


Cushings reflex

hypertension with a widened pulse pressure (systolic-diastolic) and bradycardia

sign of increased ICP (normal is 10-15 mmhg)


Glascow coma scale

8- severe head injury and coma
9-12 moderate head injury
13 up minor head trauma



normal is 10 - 15 mm hg
to decrease it elevate head 30 degrees, avoid flexion extension and rotation of head, keep head midline, keep body in alignment, minimize suctioning, avoid cough or blowing, no straining,

monitor for fluid overload to not increase it

Corticosteroids decrease cerebral edema
Diuretic (mannitol)
Dilantin to prevent seizures
Morphine or fentanyl citrate for pain



Myopia-nearsighted: cant see distance; biconcave lens
hyperopia-farsighted: cant see close, normal until age 7; convex
astigmatism: tilting head may help, uneven vision
strabismus: misaligned, cant see print clearly, keeping one eye closed helps, crosseyed; patch strong eye
amblyopia-lazy eye: reduced acuity in one eye



shortness of breath, anxiety, tachypneea, tachycardia, restless, pallor, cyanosis, adventitious breath sounds, confusion
elevated BP, resp distress nasal flaring and accessory muscles.



elevated CO2
restless, hypertension, headache


oxygen toxicity

nonproductive cough, hypoventilation, nasal stuffiness, substernal pan, N&V, fatigue, headache, sore throat



common cold
virus for 7-10 days,
inflammation, rhinirrhea, cough, dry throat, sneeze, nasal voice, fever, decreased appetite, irritable



strep throat
GAHBS-hemolytic streptococci
inflamed throat with exudate
headache, fever, abdominal pain
cervical lymphadenopathy
truncal, axillary, perineal rash



tracheobronchitis, With URI, self limiting, provide symptom relief

persistant cough from inflammation



RSV, bronchi and bronchioles,

rhinorhea, pharyngitis, fever, cough, wheeze, increased resp rate, nasal flare, retractions, cyanosis



Medical emergency
haemophilus influenza
sit with chin pointed out, mouth open, tongue out
anxiety with resp distress
no cough
dysphonia (difficult speaking)
stridor on inspiration
sore throat, high fever, restless


Acute laryngitis

viral, self limiting


Asthma meds

Bronchodilators albuterol, terbutaline for rapid relief; causes tachycardia and tremors; take 5 min before antiinflamatory inhaler

cholinergic antagonists, ipratropium, acute bronchospasms; causes dry mouth

corticosteroids; fluticasone, prednisone (take with food)
leukotreine modifiers (singulair), mast cell stabilizers (intal), and monoclonal antibodies (xolair)


Status asthmaticus

life threatening, unresponsive to other trtmnt,

wheeze, labored breathing, accesory muscle, distended neck veins, risk for cardiac and resp arrest

Intubation, humidified O2, 3 nebulizer trtmts 20-30 mins apart; beta2-agonist and ipatropium, iv access, ABGs and electrolytes, corticosteroids, magnesium sulfate to relax smooth muscle, ketamine, nonrebreather mask


Cystic fibrosis

autosomal recessive-both parents carriers
absence pancreatic enzymes
fatty stools
chloride sweat > 60 meq
CPT before meals
pancreatic enzymes with all food
adequate fluid and sodium intake
hypoglycemic agents
dornase alfa: thins mucus, nubulizer once day
GI complications: meconium ileus, pancreatic fibrosis, obstruction
High calorie and high protein
ADEK vitamins (water soluable forms)
stool softners and laxatives


Left to right shunt



Tetralogy of fallot

pulmonary stenosis
Overriding aorta
R ventricular hypertrophy

squatting position



myocardial contractility
hold if infants pulse <70
toxicity: bradycardia, dysrhythmias, N&V, anorexia
monitor levels
q 12 hrs, do not miss, do not give again if vomits, rinse after oral,



potassium wasting diuretic, rids excess sodium and water
monitor I&O
hypokalemia: muscle weakness, irritable, drowsy, abnormal HR,
eat potassium foods: bran, potato, tomato, bananna, melon, oranges
weigh daily


Rheumatic fever

GABHS infection of throat, within 2-6 wks
URI hx, fever, fatigue, sore throat, activity intolerance, poor appetite, tachycardia, new murmur, chest pain, large joints, rash on trunk and inner extremeties (erythema marginatum), CNS involvement - chorea, irritable

rising ASO titer

Two major criteria or one major and two minor for dx
Major: carditis, subcutaneous nodules, polyarthritis, erythema marginatum, chorea
Minor: fever, arthralgia

Pcn V or Erythromycin for 10-14 days
prophylactic trtmnt: Pcn 200000U bid, a monthly PCN G injection, sulfadiazine 1g po daily for a minimum of 5 yrs



give with vitamin C
not with milk or antacids
diarrhea, constipation, nausea, tarry stools normal
empty stomach if tolerable
give with straw and rinse to prevent teeth staining
Increase fiber


Sickle Cell

Africans, autosomal recessive, may pass down if just trait
hemoglobin electrophoresis definitive test
transcranial doppler done annually for risk for CVA
Fluids, pain meds, oxygen, blood products, rest and nutrition,


Types of dehydration

Isotonic: water and sodium lost equally, reduced circulating fluid, hypovolemic shock may result, serum sodium in normal limits 130-150

Hypotonic: electrolyte loss is greater than water loss, ECF to ICF, Smaller fluid loss but more severe physical manifestations, sodium less than 130

Hypertonic: water loss greater than electrolyte, ICF to ECF, Shock is not likely, neurological changes may occur, sodium greater than 150


Levels of dehydration

Mild: weight loss is 5% in infants, 3 to 4% in children. Capillary refill greater than two seconds, slight thirst, specific gravity greater than 1.02

Moderate: weight loss is 10% in infants, 6 to 8% in children. capillary refill 2 to 4 seconds, thirsty, irritable, slight increase in pulse, orthostatic blood-pressure, dry mucous membranes and tears, decreased skin turgor, specific gravity >1.020

Severe: weight loss 15% in infants, 10% in children. Capillary refill greater than four seconds, tachycardia, orthostatic blood pressure, shock, extreme thirst, dry membranes and tented skin, anterior fontanelle sunken, oliguria or anuria



pee pants 2x week for 3 months, at least 5 yrs old
rule out other causes
Antidiuretic desmopressin at bedtime, avoid fluids after dinner,
Tricyclic antidepressants tofranil 1 hr before bed
Anticholinergic ditropan reduces bladder contractions
Bladder stretching by holding fluid


Acute glomerulonephrities

most common is from streptococcal infection APSGN
6-7 yrs old,
renal manifestations 10-21 days after strep infection
decreased glomerular filtration rate>decreased urine
anorexia, pallor, pain, dyspnea, orthopnea, crackles, distended neck veins, edema, HTN,

eliminate sodium in the diet, possible potassium, possible fluid restriction, monitor BP and weight daily

ABX, diuretics, antihypertensives


Nephrotic syndrome

albumin passes to urine
hyperlipidemia, proteinuria, hypoalbuminemia, edema
3 types: minimal change is from 2-7 yrs old, unknown cause; secondary is from glomerular damage; congenital is inherited

Wt gain, anorexia, N&V, diarrhea, decreased activity, irritable, edema worse in morning, ascites, dark frothy little or no urine, elevated BP

24 hr urine - 3 or 4 plus protein, increased specific gravity
biopsy if unresponsive to steroid therapy

daily wt, measure abdomen daily, limit salt and fluids, increase protein in diet, rest

Corticosteroids 7-21 days then taper down (prone to infection)
Lasix (eat K foods)
25% albumin (watch for anaphylaxis)
Cyclophosphamide if steroids are not tolerated


Cerebral Palsy

most common permanent physical disability in kids
manifestions from mild to sever
nonprogressive impairment of motor function, muscle control, coordination, and posture.

RF include brain anomalies, cerebral infection, head trauma, brain anoxia, premature or multiple births, low birth wt, perinatal asphyxia, kenicterus from hyperbilirubenemia,

poor head control or no smiling at 3 months,
arch back and stiff extremetires, floppy limbs,
cant sit by 8 months
uses only one side of body
feeding difficulty,
muscle spasms
persistent reflexes such as moro or tonic neck

MRI for dx
encourage development and self care
suction available for increased secretions, keep head elevated

Baclofen: decrease muscle spasm, oral or intrathecally, (monitor for muscle weakness, fatigue, diaphoresis, and constipation)
Valium for spasticity


Types of cerebral palsy

Spastic: hypertonicity, ^deep tendon reflex, clonus, poor muscle control; one up to all extremities can be effected; scoliosis; tip toe, scissor walk, contractures

dyskinetic: movements increase with stress, absent during sleep, normal reflexes, no clonus, speech impairment

Athetoid: involuntary jerking of trunk face neck and tounge

Dystonic: slow twisting of trunk and extremeties

Ataxic: wide gait, poor coordination, cant do repetitive mvmnts, difficulty with quick or precise movements, jerky speech


Spina Bifida

neural tube defect, degree of dysfunction depends on level of defect
Spina bifida occulta: defect not visible to eye, no manifestions, look for dimple
Spina bifida cystic:
meningocele: sac protrusion present with spinal fluid and meninges, no problems once repaired
myelomeningocele: sac meninges, spinal fluid, and nerves
slightly decreased sensation to complete paralysis possible, joint deformities, incontinence, develop delays, hydrocephalus (may need shunt placement), ^latex allergy

Neural tube closes during 3-5 wks gestation, due to insufficient folic acid
AFP may detect it (16-18 wks)
RAST: detects latex allergy

Assess sac every 2 hrs, place in prone position, moist (NACL) nonadherent dressing, passive ROM exercises,
Ditropan for bladder incontinence


Down Syndrome

hypotonicity, heart defects, thyroid dysfunction, dysfunctional immune system, high risk for leukemia
> over 35 yrs old, multifactorial
small head, flat forehead, low ears, slant eyes, protrude tongue, flat nose, transverse palmar crease, space between toe

AFP is low
Common respiratory infections, poor mucus drainage, dry mouth from mouth breathing-rinse it frequently


Juvenile Idiopathic Arthritis

systemic, oligoarthritis, polyarthritis, with possible rheumatoid factor
before 16, lasts 6 wks or longer with no cause, peaks 1-3 yrs

NSAIDS: GI discomfort of bleeding
methotrexate slows degeneration, monitor liver and CBC, avoid alcohol, birth control
Enbrel immunosupressive, 1-2 weekly subQ
Corticosteroids: used for severe life threatening cases, eye solution, oral, or IV, joint injection, wt gain common, alters growth
Use of heat and splints, especially at night


Muscular Dystrophy

inherited with progressive deterioration
loss of muscular strength
Duchenne: most common, xlink recessive, 3-7 yrs onset, live to early adult

usually cant walk by age 12, mild cognitive delays, wt loss, fatigue, orthopnea

DNA test or muscle biopsy, CK is elevated,

maintain resp function, use incentive spirometer,

Prednisone: increases muscle strength, infection prone
Discuss end of life care such as feeding tubes and ventilation


Acne meds

Retin-A may irritate skin, use pea size at night, avoid sun

Benolyl peroxide: antibacterial, bleaches clothes but not skin

Topical antibacterials: inhibits growth, avoid sun and use suncreen

Accutane: prescribed by dermatologists, dry skin and mucus membranes, dry eyes, decreased night vision, headaches, photosensitive, elevated cholesterol & triglycerides, depression, suicide, monitor behavioral changes, teratogenic


Lab tests for burns

First 24 hrs

Hgb & hct are elevated due to loss and 3rd spacing
Sodium decreased due to 3rd spacing
Potassium increased due to cell destruction

After 48-72 hrs, fluid mobilization
Hgb Hct decreased due to fluid shift back
sodium decreased renal and wound loss
potassiumm decreased renal loss and movement into cells
WBC increased and then left shift
Blood glucose elevated from stress
ABGs hypoxic, metabolic acidosis
Protein and albumin low

NS or LR first 24 hrs, colloid with albumin or plasma expanders after 24 hrs; urine output of 1-2 ml-kg-hr, 30 ml-hr if over 66 lbs

No plants or flowers cuz of psuedomonas infections, increase calories and protein,

Silver nitrate, silvadene, mafenide acetate, bacitracin


Diabetes mellitus

15 g carbs equal to 1 carbohydrate exchange
When sick monitor glucose every 3-4 hrs, stay hydrated, test for ketones, rest, call in BG >240, fever >102 and tylenol doesnt help

hypoglycemia: shaky, sweaty, anxiety, irritable, nervous, chills, nausea, headache, weak, confusion. 15-20g carbs, recheck BG in 15 min, if 250, test ketones. Can be caused by infection and stress



Rapid; lispro humalog; 15, 30-60; 3-4
Short; Humulin R; 30-6-; 2-3; 5-7
Intermediate; NPH Humulin N; 1-2, 4-12, 18-24
Long; lantus glargine; 1, none, 10-24 Do not mix


diabetic ketoacidosis

>300, breakdown fat and accumulation of ketones. Rapid onset, mortality high

insufficient insulin, acute stress trauma or surgery, poor management of illness

N&V, abdominal pain, 3Ps, confusion, dehydration, kussmaul resp rapid and deep fruity smell,

provide rapid NS, followed by hypotonic .45%NS, when glucose is down to 250 add glucose to IV to reduce cerebral edema from drastic changes; IV bolus insulin 0.1 unit-kg followed by continuous regular insulin at 0.1unit-kg-hr; monitor BG hourly

montor K levels, initally elevated, when insulin given they are low, make sure urine output is good when giving K

ph<7 acidosis, give sodium bicarb slow IV


Otitis Media

AOM acute infection, yellow or red TM, purulent drainage,

OME effusion, no infection, orange TM, rhinitis, cough, diarrhea
Either one could cause long term speech delays
Amoxicillin, Augmentin, zithromax for 10-14 days
Benzocaine ear drops

Myringotomy or tympanoplasty; avoid water


HAART therapy


uses 3-4 meds

enfuvirtide helps decrease the virus and limit spread
Nucleoside reverse transcriptase inhibitors NRTIs- retrovir
NonNRTIs NNRTIs rescriptor and sustiva
Protease inhibitors Norvir, Agenerase, Viracept

Monitor labs, CBC, WBC, liver, hDL, cholesterol and triglycerides

Antibiotics Trimethoprim sulfamethoxazole - prophylactic trtmnt for PCP in newborns
Zovirax for herpes
Amphotericin B for fungal


Pancytopenia drugs

bone marrow supression with anemia, neutropenia, thrombocytopenia

often side effect of chemo
bleeding precautions

Filgrastim (neupogen) stimulates WBCs, subQ daily
epoetin alfa (procrit) stimulates RBCs, subQ 2-3x week
oprelvekin (interleukin 11, nuemega) stimulates platelets, subQdaily



ALL acute lymphoid (most common in kids)
AML acute myelogenous or nonlymphoid leukemia

bone marrow dysfunction>anemia, neutropenia, increased production of immature WBCs

most common childhood cancer, bone marrow biopsy needed, CSF with lumbar puncture to determine CNS involvement, sonograms, liver and kidney functions

Chemo in four phases: induction, CNS prophylactic, intensification, maintenance

HCST transplant, bone marrow or stem cells, protective isolation, mask glove gown, no flowers,

bleeding and infection precautions


Lead poisoning

from paint or remodeling dust

low dose exposure: distracted, impulsive, hyperactive, hearing impaired, mild intelectual difficulty

high dose: mental retardation, blindness, paralysis, coma, seizures, death

Other manfestations: renal impairment, impaired calcium function, anemia

Trtmnt: chelation therapy using calcium EDTA


Potassium foods

bran cereal


Iron Foods

dried fruit
red meat
green leafy veggies
iron fortified bread and flour
give with empty stomach and vitamin C
do not take with milk


Latex foods




Name, norm, abnormal

Sweat chloride 60 indicates CF
sodium 130-150
hypoglycemia 250
fasting BG >126
HbA1c 4-6%, >8% is not good, target is <7%

hgb hct
2 months 9-14; 28-42
6-12 yrs 11.5-15.5; 35-45
12-18 male 13-16; 37-49
12-18 female 12-16; 36-46