Flashcards in peds Deck (41)
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1
growth and developemnt
growth = increase in physical
development = increase in capability or function
***development does not always follow growth and chronological age
2
cephalaocaudal development
moes from head downward through body and towards feet
3
proximodistal development
moves from center of body outward to extremities
4
play and toys
play is the "work" of children
when born they have involuntary grasp reflex
5
general peds info
anterior fontanel close 12-18months
posterior fontanel close 2-3months
foods are introduced r/t allergies & immature GI tract
peanuts are dangerous to aspirate because when wet they swell and crumble
when giving IM injections the ventrogluteal muscle is contraindicated in children who have not been walking
pull earlobe down and back
they are not ready if they fail at toileting
should drink 2-3 cups of milk if 15mon
best friend stage occurs at 9-10 yo
suffocation and drowning are common deaths
teach stranger safety
growth rate decreases between 6-12yo
school age child requires 2400 cal/day
6
VS/assessment
begin with observation
use distraction
talk with parents first
VS:
least invasive first
observe before touching or talking to them
progression of obtaining:
RR
HR
BP
Temp
infants and toddlers can RR and HR for one full minute
Temps:
rectal:
most reliable
DO NOT give newborns, diarrhea, rectal lesions, chemo, immunosuppressed
axillary:
all ages when oral is not possible
oral:
5-6yo
tympanic:
all ages
O2:
obtain a picture of the blood oxygen level through the skin
check perfusion, skin temp, edema to determine the best location for the sensor probe
finger and toe
7
communication w/ newborn
nonverbal
express through crying
respond to human voice and presence
touch has a positive effect
enough parent to touch infant
8
communication w/ infant (1-12months)
primarily nonverbal
begin verbal with repeating cosinents
communicate through crying and facial expressions
attentive to human voice and presence
minimal comprehension of words
responds to touch through patting, rocking, and stroking
speak in gentle toned voice
cuddle
pat
rub to calm
encourage the presence of parents
9
communication w/ toddlers and preschoolers (1-5yo)
verbal skills
3-4 form 3-4 word sentences called telegraphic speech
concrete thinking
vocabulary depends on development and family's use
may ask a lot of questions
short attention span
limited memory
cognitive development:
egocentric
magical thinking
animism
object performance
nonverbal communication:
dramatic play
drawing
play is the work of the child
10
communication with school age children (6-12yo)
cognitive development:
able to use logic
understand other point of view
understand cause and effect
understand body functions
verbal communication:
big vocabulary
receptive and expressive language is balanced
misinterpretation of phrases is still common
nonverbal:
interpret nonverbal messages
expression of thoughts and feelings
11
communication w/ adolescents (13-18yo)
abstract thinking without full adult comprehension
interpretation of medical terminology is limited
independence
trust and understanding build rapport
privacy
strategies:
straightforward
talk in private
part of interview without parents present
12
communication w/ children w/ physical and or developmental disabilities
may feel hopeless, fear, and anxiety if cannot communicate
family may experience fear and anxiety
strategies:
use gestures
picture boards
writing tablets
head nods
eye blinks
13
observable signs of respiratory distress in children
use of accessory muscles
nasal flaring
sternal retractions
grunting with respirations
any illness than affect O2 and CO2
ex: pneumonia, atelectasis, pneumothorax, pleural effusion
14
laryngotracheobronchititis
aka croup
viral infection that causes slight/severe dyspnea, barking cough, brassy cough, high temp
viral organisms that cause this:
parinfluenza
adenovirus
RSV
treatment:
steam from hot showers
cool temp therapy (constricts the swollen blood vessels in the trachea that are swelling)
nebulizer epinephrine (fast, improvement 10-15minutes, watch for relapse and return of symptoms) or corticosteroids
15
epiglottis
obstructive inflammatory process
absence of cough
presence of dysphagia
drooling
rapid progression to severe respiratory distress
primary organism cause: H flu
prevention: Hib vaccine
caused by infection of the epiglottis
can lead to occluded airway
medical emergency
** the less noise they may the worse the airway is obstructed
don't visualize throat with tongue depressor
16
RSV
respiratory syncytial virus
leading cause of lower respiratory tract illness in children less than 2yo
caused by acute viral infection that affects the bronchioles
RF:
prematurity
congenital disorders
smoke
s/s
begins with simple URI
nasal discharge
fever
wheezing
nonproductive paroxysmal cough
tachypnea with flaring nares
dyspnea and retractions
know the onset of s/s because RSV will worse at 2-3 days
treatment:
mild: antipyretics
severe:
IV fluids
albuterol sulfate
antipyretics
suction
O2
17
pneumonia
inflammation of the lungs
causes:
bacterial
viral
fungal
aspiration of foreign substance
s/s
fine crackles
rhonchi w/ cough
decreased/absent breath sounds
chest pain
back/abdominal pain
fever
treatment:
depends on type
ABCs
O2
fluids
antibiotics for bacteria pneumonia
supportive care for viral (hydration, antipyretics, nebulizers)
18
cleft palate/cleft lip
orofacial defect that affects the oropharynx and increases the risk of malnutrition and aspiration
treatment:
preop:
fed with an elongated nipple or medicine dropper
burp frequently because they swallow lots of air (risk for abdominal distension)
correct cleft lip first because it helps with feeding and promotes parents bonding
post op:
protect the suture line
position supine or side lying
DONT place them prone
avoid putting hard/rough food or utensils down their mouth
soft diet
should be repaired before speech deevlops
19
GERD
backwash or reflux of gastric contents into the esophagus
risk for aspiration of gastric contents into the lungs which can lead to pneumonia
treatment:
upright position with feeding and 30minutes after
upright postion
frequent burping
thickened formula may be tolerated better
20
pyloric stenosis
projectile vomiting during/after feeding
s/s
feel an olive shaped mass in the epigastric region near the umbilicus
lots of pressure behind the vomitus
diagnosis:
abdominal ultrasounds
treatment:
hydrate
electrolytes
i and o
monitor urine specific gravity
daily weight
surgery
21
intususception
piece of the bowel telescopes in on itself forming an obstruction
s/s
sudden onset
cramping
abdominal pain
drawing up of knees
inconsolability
pain
****currant jelly stools
monitor stools closely
22
Hirschsprung's
congenital anomaly
agaglionic mega colon
mechanical obstruction
affects sigmoid colon
s/s
constipation
no nerves
no peristalsis
abdominal distension
ribbon like stools that have foul smell
treatment:
surgery to remove that portion of bowel
23
head lice
scalp itching
can spread to other parts of the body
spread through direct contact
treatment:
antiparasitic meds
24
pin worms
intense rectal itching
general irritability
restlest
poor sleep
bed wetting
distractibility
short attention span
spread from hand to mouth
whole family should be treated
use tape test (clear tape to rectum) to collect specimen
treatment:
mebendazole
good handwashing
keep fingernails short
25
mononucleosis
the kissing disease
s/s
sore throat
fatigue
swollen lymph nodes
liver/spleen enlargement
virus that causes:
epstein barre
spread by direct intimate contact
treatment:
rest
analgesics
fluids
good nutrition
spleen is enlarged so limit participation in contact sports to prevent injury
26
tonsillectomy and adenoidectomy
used for recurrent URI or obstructive sleep issues
place on their side and elevate HOB
place prone
prevent aspiration
brown and red fluids not given post op because we don't want it to be confused with blood
frequent swallowing = hemorrhage
at risk for hemorrhage for 10days postop
common complaints post op:
sore throat
slight ear pain
low grade temp
bad breath
27
otitis media
infection in middle ear
bulging, bright red, tympanic membrane
preceded by URI
treatment:
antibiotics
avoid chewing
soft foods
may not be able to hear well
avoid smoke
may need tympanovstomy tubes or pressure equalizing tubes (help middle ear drain)
if they have PE tubes in their ears, they must wear earplugs in the bath or swimming
prevention:
sit up for feedings
no bottle propping
gentle nose bleeding
play "blowing" games
avoid smoke
28
cystic fibrosis
genetic
exocrine gland symptoms
GI system and respiratory system
pancreatic enzymes must be given to help improve digestion with every meal/snack-- take within 30 minutes of eating and the beads should not be crushed or chewed
nutrition is a major concern: underweight, high fat, high cal
s/s
steatorrhea (fatty, frothy stools)
trouble absorbing fat soluble vitamins because they cannot absorb fat well (need ADEK vitamins)
sweat chloride test
earliest sign:
meconium ileus
mucous secretions are thick and sticky
***must get gene from both parents (autosomal recessive disorder)
29
down syndrome
trisomy 21
prone to developing respiratory infection because they have a poor immune system
often have congenital heart defects
advanced maternal age increases risk of having down syndrome baby
30
