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Flashcards in Pedi ATI Deck (76)
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0

Temperature

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

1

Pulse

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

2

Respirations

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

3

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
GIRLS

4

Fontanels

Posterior: 2-3 months
Anterior 12-18 months

5

Reflexes

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

6

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

7

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

8

Piaget birth-24 months

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

9

Pyschosocial first year

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

10

Toddler

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

11

Piaget cognitive toddler

sensorimotor- preoperational
object permanence
mimicry-playing house
imitates others

12

Psychosocial toddler Erickson

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

13

Preschool

3-6
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

14

Piaget preschool cognitive

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

15

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

16

School age

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

17

Piaget cognitive school age

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

18

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

19

Adolescent

12-20 years
acne
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

20

Piaget cognitive adolescents

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

21

Erickson psychosocial adolescents

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

Vocational work habits and future plans
Sexuality
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

22

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

23

Meningitis

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

24

CSF collection

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

25

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
CSF

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

26

Seizure types

Generalized
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

Partial:
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

27

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

28

Cushings reflex

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

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

29

Glascow coma scale

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