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NURS 373 > Pediatric Assessment > Flashcards

Pediatric Assessment Flashcards

(75 cards)

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1
Q

Pediatric differences in neuro system (many)

A

big changes in brain growth in early years

CNS immature, nerve fibres poorly developed

numerous reflexes present initially

BBB not mature until 2 years

myelinization over the first year of life

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2
Q

What does an immature BBB increase the risk of?

A

infection, especially meningitis

baby with fever - treat as though they have meningitis until you find out what they have

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3
Q

Fontanelle definition

A

fontanelles are formed at the intersection of sutures, separations of bones in skull that haven’t joined

covered by tough membranous tissue that protects the brain

allow brain growth

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4
Q

Posterior fontanelle closes by…

A

2 to 3 months

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5
Q

Anterior fontanelle closes by…

A

18 months

larger than posterior

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6
Q

Fontanelle - sign of dehydration

A

sunken

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7
Q

Fontanelle - sign of increased intercranial pressure

A

bulging

pulsating

tented

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8
Q

Neuro assessment components (many)

A

reflexes

fontanelles

GCS

PERRLA

behaviour appropriate to situation, age, development

strength and coordination of limbs
-hypertonic, hypotonic
-infants - strength of suck

cry

orientation - modified (age, teacher, pets etc)

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9
Q

Constant irritability cry

A

bad, high-pitched crying

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10
Q

Increased inter cranial pressure cry

A

screaming cat cry

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11
Q

What system exhibits some of the biggest differences between children and adults?

A

respiratory

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12
Q

Pediatric differences in upper airway

A

shorter neck and trachea

larynx and glottis high in neck

tongue is large relative to small nasal and oral airway passages

nose breathing

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13
Q

What does a shorter and narrower trachea increase the risk of?

A

obstruction

safety concern - putting things in mouth

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14
Q

What type of breathers are newborns?

A

nose breathers

will NOT automatically open mouth if nose is obstructed

nasal patency is critical**

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15
Q

What does the larynx and glottis being high in neck increased the risk of?

A

aspiration

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16
Q

If a code blue is called for a child, what type of issue is it usually due to?

A

resp!

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17
Q

Pediatric differences in lower airway

A

less alveoli, more underdeveloped
-increased by age 8

less lung volume
-decreased ability to take deep breaths

diaphragmatic breathe (til age 6)

CO2 is not effectively expired when child is distressed

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18
Q

What do smaller alveoli predispose infants to?

A

alveolar collapse

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19
Q

What does ineffective expiration of CO2 increase the risk of?

A

metabolic acidosis

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20
Q

Airway resistance

A

children have smaller, narrower airways

greater airway resistance

with edema or swelling the airway is further narrowed

increased WOB

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21
Q

Components of a respiratory assessment (many)

A

Auscultation of lungs

WOB

Skin colour

Observation - symmetry

Coughing

O2 sat

Rate, rhythm

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22
Q

T or F: Adventitious sounds are less obvious in children.

A

FALSE

more obvious

can’t clear aiways

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23
Q

Fine Crackles

A

high pitched crackling or popping sound heard on INSPIRATION

not cleared by coughing

inhaled air collides with previously deflated airways which will pop open

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24
Q

Course Crackles

A

low pitched bubbling and gurgling sounds, like velcro

start in early inspiration and may be present in expiration

inhaled air collides with secretions in trachea or large bronchi

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25
Wheezes
constricted airways musical high pitched squeaking sounds often heard mid to late EXPIRATION air is squeezed or compressed through passageways narrowed almost to closure though collapsing airways, swelling, secretions high OR low pitched
26
Stridor
high pitched crowing sound originated in larynx or trachea obstruction from swollen inflamed tissues or lodged foreign body e.g. Croup**, post-intubation
27
Transmitted sounds
may seem to originate in the lungs but is referred from the upper airway i.e. mucous in the throat or nose MOST COMMON*****
28
Signs of increased WOB
subcostal, intercostal indrawing supra and substernal accessory muscle use tracheal tug nasal flaring head bobbing grunting esp in infants at the end of every breath**
29
Where can O2 sat be taken on a child? (4)
1) foot 2) toe 3) earlobe 4) wrist
30
What would shallow breaths indicate?
pain especially in the stomach
31
Pediatric differences in cardio system (many)
CO is rate dependent heart is labile (easily changed) increased HR, moreso than adults lower BP (underdeveloped left ventricle) radial pulse NOT palpable lower absolute blood volume – vulnerable to fluid and electrolyte imbalances
32
Biggest cardiac differences between children and adults
child: CO is rate dependent adult: CO is SV dependent
33
Components of a cardiovascular assessment (many)
cap refill HR and rhythm skin colour edema heart sounds temperature hydration status - I&O, fontanelle, weight, skin turgor, cap refill peripheral pulses
34
Cap refill should be less than...
3 seconds
35
How long to assess HR for?
FULL MINUTE
36
T or F: Sinus arrhythmias are normal in children.
TRUE
37
Edema in children is more present in the...
face, periorbital area
38
Reasons infant may be cyanotic
1) cardiac 2) pulmonary
39
Cyanosis that WORSENS with crying
most likely associated with cardiac********
40
Cyanosis that IMPROVES with crying
pulmonary
41
Acrocyanosis (cyanosis of extremities)
NORMAL in newborn blue hands and feet in first couple of days
42
Peripheral cyanosis
extremities, perioral may represent hypothermia or decreased flow
43
Central cyanosis
inside mucous membranes reduced hemoglobin saturation
44
Pediatric differences in GI
saliva production begins at 4 months sucking is present until 3 – 4 months (reflex - will suck on finger, bottle etc.) stomach capacity increases from 30 – 300 mls in the first year of life (need less fluid) 1 – 3 years - intestinal flora becomes more adult like, stomach acidity increases myelination of nerves to the anal sphincter allows physiologic control of bowel function around 2 years lower esophageal sphincter muscle tone not fully developed until 1 month – babies regurg infant small intestine is 250 cm, adult is 600 cm bigger but immature liver slow development of glycogen storage capacity more body water abdomen susceptible to trauma gastric digestion is less functional
45
When babies spit up, does this cause heart burn?
no no acidic like in adults
46
What does having a small intestine increase the risk of?
necrotizing enterocolitis (NEC) in infants if removing bowel, can result in short bowel syndrome
47
What does a slow development of glycogen storage capacity increase the risk of?
hypoglycemia in infants
48
Components of a GI assessment (many)
auscultation of 4 quadrants BMs palpate abdomen observe - symmetry, elevation, tubes, drains, belly button healing properly, distention appetite N/V diet/feeding colostomy/ileostomy
49
How do we want the abdomen to feel?
soft
50
T or F: Big bellies in infants and toddlers is normal
YES gets flatter with age want to know their normal though
51
Pediatric differences of the genitourinary system
kidney weight doubles in first month of life infants - can't concentrate urine as well smaller bladder capacity kidney is relatively large, susceptible to trauma urethra is shorter in females, closer to rectum in infants under 2 - poor bladder control due to insufficient nerve development
52
What is the bladder capacity of infants?
15 to 20 mls
53
Components of genitourinary assessment
input and output urine characteristics
54
Way to measure output in infants
weight diaper 1 mg = 1 ml
55
What we want output to be per hour
more than 1 - 2ml/kilo
56
Differences in output between children and adult
child: weight dependent adult: 30 mL/hour
57
Why are catheters not often used in children?
increased risk of UTIs
58
If NPO, IV should be run at.....
maintenance rate (or maintenance and a half)
59
Conditions that INCREASE fluid requirements
fever vomiting diarrhea diabetes insipidus burns tachypnea chemo
60
Conditions that DECREASE fluid requirements
meningitis (dont' increase intercranial pressure) HF renal failure SIADH
61
Pediatric differences in MSK
higher % of cartilage in ribs, more flexible and compliant softer bones, more easily bent and fractured bones heal faster muscles lack tone, power, and coordination during infancy lower muscle mass compared to adults (25% vs 40%)
62
Components of an MSK assessment (many)
movement, strength signs of pain reflexes ROM resistance against gravity TONE age appropriate movements balance, gait
63
Signs of MSK pain in children
compensating*** don’t want to be touched irritable
64
Pediatric differences in the endocrine/metabolic system
higher metabolic rate, oxygen needs, caloric needs thermoregulation is immature in infant temperature lability present – temp can increase to very high levels even in minor infections ratio of temperature elevation is 4:1 (4 extra breaths for every 1 degree F above N) larger skin surface area
65
What does immature thermoregulation in infants increase the risk of?
hypothermia
66
For which symptoms is it most important to get the doctor for? (2)
1) dehydration 2) respiratory distress
67
Pediatric differences in the immune system
immune system immature, slow response to infection infants: 6 - 9 resp infections/year by age 6: 4 - 5 resp infections/year GI infections common allergies common (ask re fam history, be careful with meds) immunization schedule – keep up to date
68
Pediatric pain assessment - physiologic signs of pain
resp distress increased HR, BP sweating red in face
69
Pediatric pain scales (4)
1) Numeric 2) Faces 3) FLACC 4) NIPS
70
Numeric pain scale
better for older children important to put it into context
71
Faces pain scale
5 faces with expressions not the Wong Baker scale
72
FLACC pain scale
Faces, Legs, Activity, Crying, Consolability behavioural scale
73
NIPS pain scale
Neonatal Infant Pain Scale behavioural scale
74
Pharmacological pain management
Tylenol, Advil morphine hydromorphone - not as common
75
Non-pharmacological pain management
ice, heat distraction, play parent, toy skin-to-skin sucrose* - more so for infants breastfeeding

NURS 373 (12 decks)

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