PEDIATRICS Flashcards
(216 cards)
1
Q
-Measurable: Inch, Kg, lbs, cm,
-Observable
A
Quantitative: GROWTH
2
Q
-Observable
-Maturation: Predictable
-behavioral Changes
A
Qualitative: Development
3
Q
Best indicator of development
A
Behavioral Changes
4
Q
start of Growth and Development
A
Start: Conception/Fertilization
5
Q
1st human cell
A
Zygote
6
Q
8-16 Cells that Stays 3 days in fallopian tube
A
Morula
7
Q
8 weeks or 2 months
A
Embryo:
8
Q
1st human cells to embryonic cell
A
O-Z-M-B-E
Ovum-Zygote- Morula- Blastocyst-Embryo
9
Q
a complete cessation of cardiopulmonary & circulatory system and the entire brain, including the brainstem.
A
Death
10
Q
Non-modifiable factors
-Genetics
-The study of how your behaviors and environment can cause changes that affect the way your genes work.
A
Epignetic Factor
11
Q
Modifiable Factors
-food, air,water,
-Shelter, home
A
Mileau/ Environment:
12
Q
Learning by doing
A
Enactive learning
13
Q
Learning by observing
A
Vicarious learning:
14
Q
Time: toilet training
A
18 months
15
Q
early to achieve T.T. would lead to…?
A
Delayed Child
16
Q
Readiness for toilet training:
A
Physiological: walk, sit, stand, squat (W-S-S-S)
Psychological: verbalize the need to T.T.
Psychosocial: Not shy & afraid
17
Q
most important changes in readiness for toilet training:
A
Physiological:
18
Q
Age: Bowel training: Anal phase
A
18 months- 30 months
*Bowel precedes Bladder
19
Q
age: Bladder training: Day time bladder training
A
30 mons- 36 mons
20
Q
age: bladder training: Night time B.T.
A
36 mons-48 mons
21
Q
age: bladder training: Night time B.T.
A
36 mons-48 mons
22
Q
Bed wetting
A
Enuresis:
*Should be resolved before school age
23
Q
Bed pooping
A
Encopresis
*Should be resolved before school age
24
Q
Discipline during Toilet Training
A
FIRM & CONSISTENT
Problem:
-Strict/rigid parents: OCPD
-Lenient/ laxity: Disorganized
25
Cheek: head will turn to side of stimulation---> sucking
Rooting Reflex:
26
Lips: vacuum lips
Sucking reflex
27
Anterior tongue (protective hindrance to complementary feeding)
Spitting/ Extrusion reflex:
28
Posterior tongue
Swallowing reflex
29
introduction of solid foods
-increase iron demand
(physiologic anemia
COMPLEMENTARY FEEDING
30
Best time COMPLEMENTARY FEEDING
6 mons
31
Earliest time: COMPLEMENTARY FEEDING
4 mons
32
FOODS: COMPLEMENTARY FEEDING
1.Cereals, Am (rice water): With iron
2.Vegetables: soft, mashed
Avoid: Chunk,Hard vegetables
3.Fruits: One at a time
4.Soft meat: well cooked (fish)
Avoid: chunky
5.Egg yolk
33
FOODS TO AVOID: COMPLEMENTARY FEEDING
1.Grapes, corn, popcorn, etc.,
:Aspiration
2.Egg white: Allergy
3. Honey: Botulism/ Poisoning
*Skin of fruits has latex content= high allergy
1st: Vegetable
2nd: Fruits
34
-Process of gradual decrease of breastmilk and increasr of semi-solid food.
Weaning
35
Best time: Weaning
6 months
36
Earliest: Weaning
4 months
37
feeling sensation
-supine w/ head slighlty elevated--->
-Elevated & down---.>
-Embracing
Startle:
Moro:
38
Nagulat/ shookt
-loud noise, jarring of crib
-quick extension of extremities
Startle
39
Disappearance: Moro/startle
4-6 months
40
Permanent & Absent startle/moro
Permanent: CNS lesions/scars
Brain cancer
Absent: Brain damage
Cerebral palsy
PKU (phenylketonuria)
Spinal Cord Injury
***PKU low IQ/Blue eyes
41
Disappearance: Tonic-Neck/Boxing/ Fencing
4 months
42
Baby can turn to side:
Tonic-Neck/Boxing/ Fencing
4 months
43
Absent: Dancing/Stepping reflex
sciatic nerve injury
EINC:Right leg: Hepa b inject.
Left leg: Vit. k
44
Dissapearance:
Dancing/Stepping reflex
4 months
45
Darwin/ palmar grasp: Start to assess
2 mons (Open hand)
1 mon (Fisted hand)
46
Disappearance: Darwin/ palmar grasp
4-5 months
47
Touch the sole= curling of toes
Plantar Grasp:
48
Disappreance: plantar Grasp:
8-10 months
49
stroke the sole inverted “j” = fanning of toes.
Babinski
50
Disappearance: babinski
0-12 months
51
-Test for Spinal Cord Injury
Galant Reflex
52
Disappearance:Galant Reflex
9-10 months
53
Foot; motor coordination
Cross-extension reflex
54
Disappearance:Cross-extension reflex
12 months
55
-Prone
-Falling sensation--> opening/extension of extrimities
Parachute reflex
56
Disappearance: OF PARACHUTE REFLEX
18 months
57
Aka “superman reflex
Landau reflex
58
Disappearance: OF LANDAU REFLEX
2 years old
59
what is the most important neuro relfex?
MORO/STARTLE REFLEX
60
PERMANENT/ PROTECTIVE REFLEXES
aspiration
-touch uvula (posterior position)
Gag reflex
61
PERMANENT/ PROTECTIVE REFLEXES
-protection: Pneumonia
Coughing & sneezing
62
PERMANENT/ PROTECTIVE REFLEXES: Protection: Hypoxia
Yawning
63
Controlled CNS (trigimenalPERMANENT/ PROTECTIVE REFLEXES)
Blinking
64
Inflammation of corneal:
keratitis
65
new EINC
ENC
66
WHO GOAL FOR ENC
↓ NMR ( 28 days) & ↓ MMR
67
Before ENC/EINC:
increase number of neonatal death in the first 7 hours.
68
2009: EINC IN PH
Adopted by the DOH: EINC/Unang Yakap
69
TIME BOUND INTERVENTIONS:
Birth-90 Mins: (1.5 hours)
30 seconds
1.Dry the baby
Immediate: 30 seconds
Thorough: Face, Head, Body, Extremity
70
Purpose: Dry the baby
-Stimulation: crying
-Prevents hypothermia: Evaporation
71
TIME BOUND INTERVENTIONS:
Birth-90 Mins: (1.5 hours)
next 30 secs; within 1 minute
SKIN-TO-SKIN CONTACT
-Prone with head turned to side to the mother’s chest/abdomen.
72
Crawling of the baby to breast.
Nudging:
73
produces oil: pheromones in mother's breast
Montgomery’s:
74
delays crede’s prophylaxis until baby finds breast >1hr.
Vision (10 in)
75
Purpose: of skin to skin
-promotes bonding, B.F., Baby’s sucking reflex.
-Prevents hypothermia, hypoglycemia, infection
76
TIME BOUND INTERVENTIONS:
Birth-90 Mins: (1.5 hours)
Time: 1-3 minutes
DELAYED/PROPERLY TIMED CORD CLAMPING & CUTTING
77
Best time: DELAYED/PROPERLY TIMED CORD CLAMPING & CUTTING
when the pulsation stops
-Prevents ANEMIA
Observe aseptic technique.
-Breech: Tetanus Neonatorum
No milking of the cord
-Can cause intracerebral hemorrhage
Observe: A-V-A
-Lacking: complication
-Heart defects
-Renal agenesis: Dysfunctional kidneys
-Down syndrome: Trisomy 21 (translocation)
78
Distance of Clamp in cutting of cord
Umbilicus --2cm---C1--3cm--C2
-5cm from umbilicus to c2
-cut near clamp 1
79
After cord clamping & cutting
-give 10 u of oxytocin (IM)
-To stimulate uterine contraction
80
TIME BOUND INTERVENTIONS:
Birth-90 Mins: (1.5 hours)
90 mins (1 1/2 hrs)
Nonseparation:
81
TIME BOUND INTERVENTIONS:
Birth-90 Mins: (1.5 hours)
start within 60 minutes
Breastfeeding:
82
duration of breastfeeding
Duration: 20 minutes;
10 mins & 10 mins
1st :10 minutes: nourishment
2nd: 10 minutes: sucking pleasure
***5 mins per breast
Interval: B.F. per demand/ 2-4 hrs
83
Feeding cues:
-Opening mouth -Licking
-Rooting -tonguing
-Crying: late sign of hunger.
84
late sign of hunger of newborn
crying
85
EYE OINTMENT: DELAYED IN 1 HOUR
CREDE’S PROPHYLAXIS
DRUG: Antibiotic (erythromycin)
86
Manner of applying crede's prophylaxis
1-2 cm; inner to outer canthus
87
crede's prophylaxis prevents:
Opthalmia Neonatorum
Chlamydial conjuctivitis
Gonorrheal conjuctivitis
Newborn Blindness.
88
Causes of opthalmia Neonatorum:
-Gonorrhea: Neisseira Gonorrhea
-Chlamydia:Treponema Pallidum
89
TIME BOUND INTERVENTIONS:
Birth-90 Mins: (1.5 hours)
90 MINUTES- 6 HOURS
vaccine administration
2 Vaccines: BCG & HEP B
and Vit. k
90
BCG:
ID; Right deltoid; 0.05 ml; TB
91
HEP B:
IM; Right Vasus Lateralis muscle (outer middle aspect of thigh); 0.5ml
92
VIT K.
(Phytomenadione/ Aquamephyton): Left Vastus Lateralis; MI; 0.1ml
93
ANTHROPOMETRICS:
Height
Normal:
18-22 inches; Ave: 20 in
45-55cm/ ave: 50cm
94
Height gain:
1 mon-6 mon: 1inch/month
6mon-12mon: 1.5 inch/month
95
ANTHROPOMETRICS:
Weight
Normal:
2,500-4,000 grams
2.5-4 kg; 5.5-8.8 lbs
96
weight loss newborn
*1st 10 days/ within 10 days
Weight loss (10% max wt loss)
Physiologic weight loss: extrauterine life
After 10 days- Progressive weight gain
97
weight gain of baby
Doubles (2x) 6 months
Triples (3x) 12 months
Quadruople (4x) 24 months
98
Head Circumference
13-14 inches; 33-35 cm
99
Chest circumference
12-13 inches; 31-33 cm
100
Abdominal Circumference
12-13 inches/ 31-33 cm
101
circumference: if HC is < CC
Abnormal microcephaly (Low IQ, M.R.)
Cause:
-Hereditry
-Viral infection: Zika, Rubella (Forchheimer’s spot)
102
ENC: 6 HOURS AFTER
Bathe the baby
-Bathe 1 part at a time
-test & feel temperature of water (use elbow)
-never remove vernix caseosa
-For insulation & Infection
Prevention
-Craddle cap/Seborrhea
-Remove by bathing
WOF: hypothermia
103
PREVENT HEAT LOSS
-Contact with Cold object/Surface.
-Touching wall, Weigh scale w/o cloth
Conduction
104
PREVENT HEAT LOSS:
-proximity/near cold object;
-Near wall
Radiation:
105
PREVENT HEAT LOSS: Wet body parts
Evaporation:
106
PREVENT HEAT LOSS:
-Room air drafts (Window doors)
-Thermostat
Ideal room tempt: 25-28 C
Convection:
107
WITHIN 24-72 HOURS (1-3 DAYS
NEWBORN SCREENING
-Heel prick blood
-Med tech: Collect specimen
Trained RN
-diagnose metabolic congenital diseases
Basic Newborn screening
-6 diseases
Expanded/ Advance N.S.
-28 diseases
-results are available in 1 week
108
NO in ENC
-Bathing within 6 hours
-no foot printing
-slapping, spanking, turning upside down,
-application of anything in cord stump
109
Frequence of APGAR scoring
-Conduct twice
1st: within 1 minute
-Determine the need for resuscitation
2nd: 5 minutes
-check for the adaptation to extrauterine life
-Basis for FDAR
110
APGAR SCORE: SEVERLY DEPRESSED
SEVERELY DEPRESSED: 0-3
Management:
-Cpr
-Intubation
-Mechanical Ventilator
-Manual ventilation (ambubag)
-Treat the cause
111
APGAR SCORE: FAIR/GUARDED
4-6
Management:
-Suction: withdrawal; 10 secs max
-Hyperoxygenation before & after intermittent
-Gentle and rotating motion
O2: high flow
WOF: Retrolental Fibroplasia
-Blindness caused by ↑ o2
-Drop light
EXTENDED SKIN-TO-SKIN CONTACT:
KMC (Kangaroo-mother-care)
-can be done by father, grandmother, relatives.
112
APGAR SCORE: GOOD
7-10: GOOD
-Routine Newborn care
113
HR:
120-160 bpm
114
RR:
30-60 cpm
115
BP:
Sytole: 60-80 mmhg
Diastole: 40-50 mmhg
116
Temperature:
36-5- 37.2 C
-1st rectal: imperforated anus
-2nd axillary
117
SaO2:
>95%
118
HEAD/FONTANELS
B-A-D
Bregma-Anterior-Diamond
Size: 3x4
Closure: 12-18 months
119
HEAD/FONTANELS
L-P-T
Lambda-Posterior-Traingle
Size: 1x1
Closure: 2-3 months
120
Swelling made of fluids
CAPPUT SUCCEEDANEUM
121
Well outlined swelling
:doesn’t cross the suture line
CEPHALHEMATOMA
122
Swelling made of blood
CEPHALHEMATOMA
123
Vaguely outlined
:crosses suture line
CAPPUT SUCCEEDANEUM
124
Disappearance CAPPUT SUCCEEDANEUM
1 week
125
Disappears: CEPHALHEMATOMA
weeks- months
126
Causes Jaundice
CEPHALHEMATOMA
127
Both are normal
CAPPUT SUCCEEDANEUM
CEPHALHEMATOMA
128
Sunken/Depressed
-Dehydration (↑BP,↓ HR& ↓RR)
129
Bulging/Swelling
-↑ ICP
-Narrow pulse pressure <30 mmhg
-Cushing Triad (Hyper, Brady, Brady)
130
normal ICP pressure
(N: 0-15 mmhg)
131
-protusion of sac in occipital area that contains CSF & Meninge
-1-10 weeks of life: occurrence
ENECEPHALOCELE (back)
132
-Absence of cranial bone
-Brain is visible = death
-breech presentation : ↓ head
weight= cannot move
ANENCEPHALY
133
-Abnormal early closure of suture line= can’t moulding
CRANIOSYNOSTOSIS
134
-closure of nasal passage
Both nostrils: Immediate cyanosis after birth
Choanal Atresia
135
how to assess Choanal Atresia
Alternately Pinching/occluding each nostrils that leads to cyanosis
136
Mngmnt: of choanal atresia
Surgery
137
Flat nasal bridge
Down syndrome (Trisomy 21)
138
EAR: ABNORMAL
Hearing loss:
No startle Reflex
139
EAR: ABNORMAL
Low set ears:
Down syndrome
140
NECK: ABNORMAL
Short neck:
down syndrome
141
NECK: ABNORMAL
-Overstreched fascia
-missing x chromosomes (23rd)
Webbed neck/Turner Syndrome:
142
NECK: ABNORMAL
-weakness of SCM
-Breasfeeding baby should lean on affected side; to exercise
Torticollis (Wry neck)
143
↑Estrogen & ↑Prolactin :Normal
Witch milk:
144
Abnormal
-Protusion & displacement of sternum
-Seen in pt with Marfan syndrome
Pigeon’s chest:
145
-See-saw respiration (in-in)
-Sign of respiratory distress
Chest indrawing/ Chest retraction
146
-necrotizing enterocolitis: inflammed large & small intestines
↑abdominal diameter
147
closure of membrane
7-10 weeks:
148
Management: for (-) sac : raw intestine
Complications: Gastroschisis
NPO, No BF, IV, Moist Pnss
149
(+) sac:
Small <4cm
Large >4cm
150
Small <4cm
Umbilical hernia
Management:
-allow breastfeeding
-Moist: PNSS
151
Large >4cm
-Stomach, liver, intestines
-Omphalocele
MANAGEMENT:
-NPO
-No breastfeeding
-Moist: PNSS
152
divided spine
Spina Bifida
153
“dumpling”; lumbar sacral
-common in 1 out of 20
Occulta
154
-protusion: sac of
Meninges + CSF
Meningocele
155
-Protusion: sac of
Meninges +CSF+ Spinal cord
-Incontinence & paralysis
-Position: Side lying
Myelomeningocele
156
absence of extremity
Amelia:
157
Incomplete extremity
Phocomelia:
158
Small extremity
Micromelia:
159
what medication during pregnancy can cause incomplete/absence of extremity
halidomide (thalomid)
160
fusion of digits
Syndactyly:
161
Excess digits
Polydactyly:
162
Talipes Disorders: abnormal flexion of foot (plantar flexion)
Clubfoot
163
Turned inward: Talipes Disorders: Foot
Varus deviation:
164
Turned outward: Talipes Disorders: Foot
Valgus deviation:
165
Talipes Disorders: Forefoot (toes) lower than the heel
Equinus/horse foot:
166
Talipes Disorders: Heel first
Calcaneus:
167
Management: Talipes Disorders: Foot
Casting
Corrective Boots
Danger:
-Always check toes
-Neurovascular compromised
168
-Exposure to maternal hormones
-↑ Estrogen & Progesterone
Pseudomenstruation: Normal
Pseudohermaphroditism: Abnormal
169
-Undescended testis
-Expected in premature baby
Cryptorchidism
170
DOC:Cryptorchidism
HCG Hormone
171
unretracted foreskin/prepuce
Phimosis
172
Mngmnt: phimosis
Circumcision at birth
173
Urethral opening : Upper/Dorsal aspect
EpPerDor
Epispadias
***doesnt necessarily need surgery: angle when urination
174
Urethral opening: Lower/Ventral aspect
HyVenLow
Hypospadias
175
MNGMNT: hypospadias
Hooding (Surgery)
176
NEWBORN SCREENING
G-O-C-C-P-M
177
-Glucose 6 phosphate dehydrogenase
-RBC health/life
Problem:Hemolytic Anemia: Oddly shaped RBC
G6PD Deficiency
178
Triggers:G6PD Deficiency
Hemolytic Anemia
Drugs: Aspirin, Chloramphenicol, quinine, quinidine, chloroquine, sulfa drugs, cotrimoxazole.
Foods: Ampalaya, Soya, Nuts, Beans, Mints
Substance: Mentol, Naphthalene (moth balls)
***Put in a medic ALERT DRUGS
179
MANAGEMENT: during hemolysis G6PD
RBC transfusion: Chronic
Risk for: Iron Toxicity
-First sign: Iron fist Sign or Pain on knuckles
-Liver Damage (LFT check)
7-56 u/l : SGPT (ALT)
10-50 u/l : SGOT (AST)
-Abdominal pain
180
S/sx: G6PD
V-A-N-D-A
181
Antidote: G6PD
Chelation Therapy: removal of excess minerals
182
Agent/Management: G6PD
-Deferoxamine (Desferral)
-Urination
-CI: kidney failure
-Agent:Deferasirox
-feces
-Last resort: Surgery (Spleenectomy)
183
-Lactose intolerance
-Dissacharide (glucose +galactose)
GALACTOSEMIA
184
Problem:GALACTOSEMIA
GI symptoms
-Diarrhea & vomiting
-Liver damage
***cataract: only seen on pt with galactasemia
185
MANAGEMENT: GALACTOSEMIA
No breastfeeding
Formula milk ---> Lactose free
NEUTRAMIGEN
186
Milk for galactosemia
NEUTRAMIGEN
187
Problem:
Reflective Adrenal Cortex
↓Sugar(Cortisol)
↓Aldosterone (Hypovolemia)
N: Testosterone
CAH : CONGENITAL ADRENAL HYPERPLASIA
188
APG: ↑ ACTH
(Adrenocorticotropic Hormones)
↓
Stimulates Adrenal Cortex =Hyperplasia
↓
↑sex
CAH : CONGENITAL ADRENAL HYPERPLASIA
189
CAH Mortality
Increase mortality in first 7 hours because of ;
1st: shock,
2nd: Hypoglycemia,
3rd: Hypovolemia.
190
S/sx: CAH (MALE)
-early puberty
-enlarged penis, masculine voice, pubic hair
-4ft .
191
S/sx: CAH (FEMALE)
-no menarche
-virilisation (loss of feminity)
-deep voice
-hirsutism
-flat chested
-enlarged clitoris
192
MANAGEMENT: CAH
Hydrocortisone: synthetic cortisol
Medication is effective when:
-↑ Breastfeeding time
-↓ engorgement breast of mother
Fuducortisone: Synthetic aldosterone
-Effective: Weight Gain
193
Etiology:
Mother has Hyperthyroidism
-Common In girls
CONGENITAL HYPOTHYROIDISM
194
Birth
-Hypothermia/Hypoglycemia
-Bradycardia, Apnea
-WOF: SIDS
CONGENITAL HYPOTHYROIDISM
195
child with CONGENITAL HYPOTHYROIDISM
Cretinism (Child)
-physically & mentally challenged
196
MANAGEMENT: congenital hypothyroidism
Within 10 days give Levothyroxine (synthroid, levothroid)
Mix with milk
197
inability to metabolize protein
Phenylalamine
↓
Precursor: Melanin (skin
Thyroxine (heat; t4)
Epinephrine (Fight-Flight)
Toxic: Brain= brain damage
(Pround) M.R.
PKU (Phenylketonuria)
198
Phenylalanine Free milk for PKU
LOFENALAC
199
Management for PKU:
Phenylalanine Free milk:
LOFENALAC
Diet: low animal protein
↑fruits & Vegetables
200
-inability to metabolize protein
-Valine
-isoleucia
-leucin
MSUD (Maple Syrup Urine Disease)
201
Complications: MSUD
Brain damage & Kidney failure
Hallmark sign: Maple syrup urine odor
202
MANAGEMENT: MSUD
↓ animal protein
B-complex (IM)(IV)
203
First 12 weeks pus in BCG what will the nurse do?
do not report; MOTHER SHOULD WIPE
204
Antidote of warfarin
Vitamin K or Aquamephyton:
205
90 mins- 6 hour: Before Separation make sure you put ID band that contains?
-Hospital number
-Complete mother’s name
-Date & time of birth
206
Newborns are obligatory_____breathers
nose
207
Manner of suctioning
MoSe: 1st MOUTH & 2nd NOSE:
208
All fontanels will close at what time:
18 months
209
B9/folic acid dose:
400mcg/day
210
B9/folic acid source:
Green leafy vegetables
211
B12 source:
meat
212
s/e loss of extremities during pregnancy to newborn.
Thalidomide/Anti-emetic
213
LITHIUM TOXICITY: s/sx
V-A-N-D-A
214
Autosomal Recessive disease
G6PD, O, Galactosemia:
215
Not Autosomal recessive
Congenital hypothyroidism:
216
management for Sep-Anx:
-Temper tantrums
-Give security object
-give promise
-1 firm goodbye
