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Pediatrics Flashcards

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1
Q

1 Month

A

Gross motor: head lag (poor head control
Fine motor: grasp 0-3 months
Babinski reflex: 0-12 months
Rooting reflex: 0-4 months
Tonic neck reflex: 0-4 months

Language: responds to touch and voices, sensory motor communication

Social/Cognitive: Finds safety with caregiver and looks at face

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2
Q

Developmental Milestones
2-3 months

A

Gross motor: Kick legs
Raises head when prone
Less head lag

FIne motor: Grasp reflex finishes

Language: responds to sounds, able to make sounds with mouth

Social/cognitive: smiles and coos when seeing a familiar face

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3
Q

Developmental Milestones
4-5 months

A

Gross motor: no more head lag
(report head lag is found after 4 months)
“infants head stays behind the shoulders when raised from supine to sitting position”
At 5 months can roll from front to back

Fine motor: grabs object voluntarily
Diminished moro reflex and other reflexes

Language: mimics sounds heard, sable to change cry tone for different needs

Social/cognitive: soothed by caregivers voices
Copies expressions
Cries when doesn’t get their way

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4
Q

Developmental Milestones
6-9 months

A

Gross motor: birth weight doubles at 6 months
Rolls from back to front
Can sit up unsupported
Can pull self up
Avoid having toys from crib

Fine motor:
Holds a big bottle
7 months: transfers objects from 1 hand to the other

language: babbling words “mama, dadda” responds to name
Not babbling 9 months - MUST REPORT IT

Social/cognitive:
Identify faces and strangers, separation anxiety begins at 6 months

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5
Q

Developmental Milestones 10-12 months

A

Gross motor:
Prone to sitting position

Fine motor:
10 months
Pincer grasp “pick up small finger foods”
11 months: neat pincer grasp (thumb and pointer)
Grasps a rattle or doll by the arm
Transfer objects from hand to had

Language:
Able to make a variety of sounds
Mimics gestures
Understand simple works: yes or no

Social/cognitive: Vocalization and speech (talking toys and books are best)
Purposeful play - build, sort, stack, make

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6
Q

Developmental Milestones 12 months

A

Gross motor
Birth weight triples
Sit down from standing
Crawl upstairs
Walks 1 step while holding hand

Fine motor:
fully developed 2 finger pincer grasp
Tries to build 2 block tower unsuccessfully
Attempts to turn book pages

Language: 3-4 words, nonverbal gestures (waving, head nodding)

Social/cognitive
Shy: stranger danger
Can follow short simple directions
Search for hidden objects (object permanence)

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7
Q

Developmental Milestones 18 months

A

Gross motor: walk up/down stairs while holding a hand
Throws ball
Jump in place with both feet

Fine motor: turns 2 pages in a book at a time (Uncoordinated)
Holds cup and spoon
Build tower of 4 blocks
Scribble with crayons
No finger dexterity (no scissors, no colouring pencils)

language: 10+ word vocabulary
Follow commands
Use gestures to show what they want

Social/Cognitive:
Angry baby
Temper and ownership “mine”
Parallel play 1-3 years
Okay next to each but not direct interaction with others

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8
Q

18 month old what finding should the nurse report too the provider for follow up development screening

A

Uses 4 words
Cannot hold a spoon or cup
Unable to sit down from sanding position
Finds it difficult to pick up small food items with dumb and index finger

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9
Q

Developmental Milestones 2 years old

A

Gross motor:
walks without help
run and kick ball
Walks up and down stairs independently 1 step at a time
Toilet trained by two

Fine motor:
builds a tower pf 7 blocks
Draws vertical lines
Able to turn 1 page at a time
Opens doors by turning door knobs

Language: says own name
300+ words
2-3 woord sentences
Identifies pictures with named

Social/cognitive imitates adult behaviour
Gaining independence

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10
Q

Developmental Milestones
3 Years

A

Gross motor:
Tricycle and jumps forward
Learning balance
Walks up stairs with alternating feet

FIne motor:
Draws circles
Spoon feeds self
Undress self
Holds crayons with gingers instead of first
Can use scissors
Zips up zipper

Language:
3-4 word sentences
Asks “why” a lot
Knows age
Follows more complex instructs

Social/Cognitive
Associative play 3-6 years
Unorganized play without goals or rules encourage imagination play

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11
Q

Developmental Milestones
4 years old

A

Gross motor
Skips, hops on 1 foot
Catches a ball 50% of the time
Climbs and jumps

Fine motor: draw 4 sides shapes like a square/rectangle
Can pour drinks and make food

Language: able to tell stories, can memorize alphabet and numbers

Social/cognitive
Imaginary play, dress up and tea party
Play with older children rather than alone

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12
Q

Fine motor skills of a 2 year old

A

Draws a vertical line

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13
Q

Gross motor skill at 18 months of age

A

Jumps in place with both feet

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14
Q

4 month old (full term) the nurse is most concerned with which finding?

A

The infants head lags when pulled from laying to sitting position

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15
Q

5 month old, the nurse expects to make which observation

A

The infant rolls to back (supine) from prone position

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16
Q

Child walks up and down steps, has steady gait and can use short sentences, how many months?

A

24 months

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17
Q

9 month old, need for further investigation?

A

Child is not babbling

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18
Q

6 month old expected finding

A

Rolls over in both directions

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19
Q

3 year old developmental delay

A

Unable to use a spoon to feed himself

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20
Q

3 year old age appropriate development

A

Copies a circle
Rides a tricycle
Undresses without help

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21
Q

Expected growth and development by 12 months

A

Walks while holding onto someones hand

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22
Q

24 month old child Highest level developmental milestone

A

The child opens a door. by turning the doorknob

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23
Q

Language and communication

A

New borns 0-1:
Noverbal communication
reports to touch and voices, sensory motor communication

Infants 1-12 months:
At around 10 months say “mama and dada”
Over 12 months says up to 3-5 words

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24
Q

expected growth and development at 9 months

A

Should be able to say mama and dada
Will pull up and stand for several seconds holding on to furniture
Will be able to pick up small pieces of food

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25
An infant client is able to stand holding on to objects, plays peek a boo and is starting to say mama and dada which age?
9 months
26
Toddlers and preschool 1-5 years
Priority finding: 2 year does not talk to respond while being assessed
27
Assessing speech development refer to further examination
An 18 month old who only says no
28
Speech impairment
a 5 year old who only answers with single words
29
School age 6-12 years
Uses logic
30
Adolescence 12-18
Abstract thinking Privacy - ask certain questions without the parents present Encourage peer contact - risk for social isolation may lead to depression and anxiety - have friends come to visit at the hospital, meeting other teens who are receiving similar treatment
31
16 year old refusing classmates visit. Which concern will the nurse plant o address first
Social isolation
32
a 16 year old admitted to the hospital which nursing intervention is most appropriate
Allow the client to interact with others in his or her same age group
33
14 year old girl, hospitalized and has been places in traction. Which nursing action would be appropriate to meet the Childs needs?
Let the child wear her own clothing when friends visit
34
Piaget theory 0-2
Sensorimotor: thinks in the present moment through the senses (not the past or future) Object permanence (objects are still there even if you can see it) Teaching: teach in the present moment Teach them you are going while you are doing
35
Piaget theory 3-6
Preschool preroperational thinking: imaginative, symbolic thought Magical thinking (do not understand cause and effect) Scraped knee was caused by earlier misbehaviour Thinks being sick is their fault or being adopted is their fault Teaching: Teach shortly before a procedure Day of The morning of or a few hours before What you’re going to do “I’m going to insert a Foley catheter"
36
Piaget theory 7-11
Skill learning Concert operational Logical thought, flows rules, rigid thinking Only 1 way to do something Teaching: teach day before include kills like insulin injections Demonstration and reading Tomorrow we will You will do this everyday Teach bandage placement skills at 7 years old
37
Piaget theory 12-15
Adolecents Adult learning Formal operational Developing abstract thought Causes and effect thinking (example: love, hate mortality) Teach like an adult Med sure + style Manage their own care tech them to: report these findings... if you see this, follow up with your provider Which child can manage their own care? 14 year old with DM type 1 Risk taking behaviour = very non compliance
38
14 year old with type 1 diabetes ammiited to the ICU with a blood glucose 500mg/dl what is contributing to the no compliant behaviour
Clients psychosocial developmental stage
39
Which of the following children would be classified as being in the concrete operational stage, as defined by Piaget
An 8 year old third grade student
40
Which phase of cognitive development are infants
Sensorimotor
41
What description characterizes normal cognition during the period of early adolescence (11-14)
Limited abstract thoughts
42
Bhevauour is characterized of the formal operational stage
The child has the ability to think abstractly
43
6 year old does not recognize the objects exist when the objects are outside the visual filed which action should the nurse take
Report it to the paediatrician
44
Pain assessment 0-6 months
CRIES Scale Crying Requires oxygen Increased vital signs Expression Sleepless
45
FLACC Scale 2 months - 7 years
Face Legs Activity Cry Consolability
46
Faces Scale 3 years and up
View pain as magical thinking Pusnishment or blame someone or pain
47
4 year old child when experiencing pain the nurse anticipates
Views pain as punishment Blames someone else for the pain believes pain will disappear magically
48
Numeric Scale 5 years and up
Rate pain on scale of 1-10
49
Pedicatric physical exam
Interact with parents 1st and child 2nd Encourage the parent to be involved with the child Communicate with age appropriate simple language Keep medical equipment out of sight Invasive procedures always LAST Ear exam and BP cuff
50
Physical examination of a toddler appropriate nursing interventions
keep the medical equipment out of the toddlers sight until its needed
51
While preparing a physical assessment on 22 month old child the nurse should complete the following actions in which order?
Least invasive to most invasive Interact with the parent first use a toy to play with the child Take the child weight and height Listen to heart and lung sounds Obtain vitals
52
Pedicatric physical exam 0-12 months
Height: 1 inch per month 50% increase at 12 months Weight: doubles ta 6 months Triples at 12 months Anything under bench marks must be reported to HCP
53
Which assessment finding should the nurse report to the health care provider?
6 month old with birth weight of 8lbs 5oz who now weights 14lbs 4oz
54
8 month of client possible delay in growth and development
my child has almost doubled the birth weight
55
Nutrition 0-12 months
Breast milk for iron fortified formula (no cows milk) Solids begin at 4-6 months Only 1 new food per week to assess unknown allergies
56
Infant assessment
Head circumference should be slightly bigger than the chest equals in size around 12-19 months Newborns have two fontanels = soft spots, should be flat and only slightly pulsate when the baby cries, coughs or lies flat
57
Head Fontanelles
Bulging at rest = meningitis, increased ICP Sunken fontanells = dehydration, fluid volume defect Report both to HCP immediately Closure of fontanelles Posterior = 2 months anterior = 2-18 months
58
Infant respiratory distress
Nasal flaring Accessory muscle use Abdominal breathing Nonproductive cough Excessive crying: “cry all the time” 1-3 hours per day is normal Assess infants pattern frequency and quality of crying High pitched = increased ICP or brain damage
59
Infant Teeth
First tooth 6-10 months (lower central incisor) Signs of teething: drooling and irritability Intervention: teeth care with washcloth
60
Infant reflexes
babinski reflex: 0-12 months Toes fan out when stroking sole or bottom foot Rooting (sucking) reflex: 0-4 months, sucking motion when stroking the side of the cheek or mouth Tonic neck reflex: 0-4 months, when placed on the back the head turns to one side and infant flex the arm of the opposite side Moro reflex: 0-4 months Startle reflex: in response to loud noise or sudden movement infant stretches out arms and legs like they’re startled then immediately pulls back into body Stepping reflex 1 month + Baby steps in air when helped up palmer grasp 0-3 months: grabs on to any object placed in their plan plantar grasp: 0-8 months, placing object under toe, infants will curl their toes attempting to grab it
61
9 month old the nurse expects which reflex?
Babinski
62
What is the reflex assessed by stroking the outer sole of the foot
Babinski
63
How will the nurse assess the rooting reflex
By stroking the cheeks of the newborn
64
2 month old infant placed on their back and head turned to one side, The infant responds by flexing arm on the opposite side and extending the arm that is pointing the same direction she is facing. Which of the following bets describes this reflex?
65
3 month old monitoring for signs of increased intracranial pressure, anterior fontanel is soft and flat, most appropriate action?
Document the finding
66
infant GI assessment
Small amount of bloody mucous inside stool Yellow brownish stool Continue to monitor the colour, amount and consistency if continues could mean something is wrong
67
What colour stool would the nurse explain to expect on the their day of life
Yellowish brown coloured stools
68
Toddlers 1-3 Growth assessment
Height: 3 inches per year Weight: average yearly gain of 4-6 lbs 30 months (2.5 years) weight should be 4 times greater than birth weight
69
a 39month of child. Which finding requires immediate follow up with the primary care provider
Weight is 6 times greater than birth weight (should only be 4x greater) Family and meal habits need to be discussed
70
Toddlers 1-3 Head assessment
Head circumferences increase by 1 inches by the 2nd year then slows by half until age 5 Taller more slender appearance
71
Toddlers nutrition
Limit Milk: 16 to 24 oz per day (2-3 cups) Juice 2-6oz per day Encourage more solid foods
72
Safety teaching toddlers 1-3
Safety teaching Choking hazard Cut food into bite side pieces Sit child up when eating Avoid round food (popcorn, raisins, grapes, celery, candy) airway is small Burns: cover allertical outlets and face handel inward = stove top pots and pans Apply sunscreens pf 15 for greater before going outside and apply every 2-3 hours Drowning: Close bathrooms doors, never alone during body of water (bathtub, toilet, pools) Crib safety: Infant on back to prevent SIDS Never on stomach/ prone position unattended = SIDS dont put the infant to bed with a bottle = dental caries Nothing in crib Remove crib musical mobiles at 4-5 months Car seat: rear facing in back seat at 45 degree snuggle Never place the car seat in front seat Never place padding under or behind an infant or child in a carseat (it can eject the child during a car crash) Used until 30 lbs Booster eat 8-12 years 4’9inches 35-80lbs
73
Physical exam 3-6 preschool/kindergarten
Growth: height 2-3 inches per year Weight gain 4.5 - 6.5lbs per year Nutrition 50% less calories than adults Activity and sleep 1 hour of activity 12 hours of sleep (at around 7:00pm) Avoid sleeping with parents
74
4 year old beliefs
Believe that an injury is the result of misbehaving Feels responsible for being placed for adoption
75
4 year old child when experiencing pain the nurse anticipates
Veins pain as punishment Blames someone else for the pain Believes pain will disappear magically
76
Ear assessment
Less than 3 years pull down and back Over 3 years: pull up and back
77
Position the pinna to visualize the eardrum of a 4 year old child
Pull up and back
78
Direction to pull the pinna of an infant during an ear exam
Down and back
79
School age 6-12 physical exam
Growth: Height: 2 inches per day Weight: yearly gain of 4.5-6.5 Activity and sleep: competitive and team play 9 hours of sleep per night Safety Use car seat until 4 feet 9 inches never in/near pool alone treat them like mini adults Same head to toe assessment Same pain scale assessment Same subjective assessment Explain results of the exam to the child Respect privacy
80
11 year old client with abdominal discomfort what are the best actions during a physical exam
Complete a full head to toe assessment in the same way as an adult Explain the result of the examination to both parent and child Ask the child to describe their primary symptoms Respect the request to be examined without guardian present
81
Adolescents 12-18 physical exam
Boys stop growing 18-20 years old girls from growing 2.5 years old after first period Activity Priority intervention Encourage meeting with friends and peers No socialization: Immediate post op Immunocompromised (chemo, radiation) Contagious infectious disease
82
Growth different between girls and boys
growth in height ceases 2 to 2.5 Years after menarche in girls
83
General puberty age for girls and boys
10 years for girls 12 years for boys
84
16 year old girl who has not started menstruation
refer the adolescent for an evaluation
85
Which of the following should the nurse asses first on a well-child exam in a 6 week old infant who is sleeping?
Auscultation off lung and heart sounds
86
Paediatric vital signs Heart rate
Neonate 0-28 days 110-180 Infant 0-12 months: 110-160 Toddler 1-3: 80-110
87
Paediatric vital signs Respiratory rate
neonate 1-28 days: 30-60 Infant 0-12 months: 30-60 Toddler (1-3): 24-40
88
Pediatric vital signs Blood pressure
Neonate 1-28 days: 60-90/20-60 Infant 0-12months: 70-105/35-55 Toddler 1-3: 85-105/40-65
89
10 month old, crying and committing with abdominal distention for the past 6 hours. The infant is now quietly resting with a pulse 220min and blood pressure of 85/45 What should the nurse report to the HCP
Client is now lethargic with tachycardia
90
Assessing the heart rate of a 1 year old
Listen to apical pulse for a full minute
91
12 month old with respiratory infections, respiratory rate of 36
Document the findings
92
Blood pressure 2 year old 92/60, this blood pressure would be:
Normal
93
Temperature
Oral stem 5-6 year olds Axillary all ages Rectal: infants (most common) risk for perforation of the bowel, to used for immunosuppressed clients and those on chemotherapy and radiation Not for clients with cardiac conditions Not for clients with diarrhea/fecal inaction
94
Child has oxygen saturation of 88% most appropriate initial action
Verify the position off the pulse oximerty probe

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