Peds Midterm Week 1 Flashcards
1
Q
Children living with chronic violence may exhibit what behviors?
A
- difficulty concentrating in school and memory impairment.
- aggressive play & uncaring behavior
- constricted activities and thinking for fear of reliving traumatic event
2
Q
The slight decline since 2002 in American youth’s illicit drug use is attributed?
A
- education regarding the adverse effects of illicit drugs
- parental disapproval
- decreased availability of drugs
- consistent participation in church and organized activities such as scouts and sports.
3
Q
Infant ____:
Death in first year of life
Recorded per 1000 live births
A
mortality
4
Q
____ is the major determinant of neonatal death in technologically developed countries.
A
Birth Weight
5
Q
What factors increase risk of infant mortality?
A
- BW
- AA race
- Male gender
- short or long gestation,
- maternal age
- lower level of maternal education
6
Q
What is the leading cause of death in children over age 1 year?
A
accidents
7
Q
What age group has the lowest group of death and why?
A
5-14 year olds b/c of importance in following rules results in less accidents
8
Q
What age group has a drastic increase in violent deaths? and why?
A
10-25 year olds b/c of “nothing can happen to me” attitude
9
Q
Childhood ____ includes actue illness, chronic disease or ____.
A
Morbidity
disability
10
Q
Which illness accounts for 50% of all acute conditions in childhood morbidity?
A
respiratory
11
Q
What is the new pediatric social illness?
A
- behavior, social and educational problems
- psychosocial factors
- mental health issues
12
Q
What risk factors contribute to childhood injuries?
A
- sex- male
- temperament- high activity level & negative rxn to new situations
- stress- increased risk taking & self destructive behavior
- alcohol and drug use- higher incidences of MVA, drowning, homicide and suicide
- Hx of previous injury
- development characteristics
- cognitive characteristics
13
Q
What developmental characteristics contribute to childhood injury?
A
- mismatch b/w childs developmental and skill level
- natural curiousity to explore the environment
- desire to assert self and challenge rules
- in older child, desire for peer approval and acceptance
14
Q
Describe cognitive characteristics that contribute to childhood injuries in the infant.
A
sensorimotor- explores thru taste/touch
15
Q
Describe cognitive characteristics that contribute to childhood injuries in the young child.
A
- Object permanence: actively search for attractive object.
- Cause and effect: lacks awareness of consequential dangers
- Transductive reasoning: fails to learn from experience
- Magical and egocentric thinking: unable to comprehend danger to self or others
16
Q
Describe cognitive characteristics that contribute to childhood injuries in the school age child.
A
Transitional cognitive processes:
- unable to fully comprehend causal relationships
- dangerous acts w/o detailed planning re: consequences
17
Q
Describe cognitive characteristics that contribute to childhood injuries in the adolescent.
A
Formal operations:
- preoccupied with abstract thinking and loses sight of reality
- feeling of invulnerability
18
Q
Describe anatomic characteristics that contribute to childhood injuries.
A
- large head- predisposed to cranial injury
- large spleen and liver- predisposed to direct trauma
- small/light body: thrown easily esp moving vehicle
19
Q
What factors beyond cognitive, developmental and anatomical contribute to childhood injury?
A
- poverty
- family stress
- substandard alternative child care
- young maternal age
- low maternal education
- multiple siblings
20
Q
What 3 concepts support family centered care?
A
- Enabling
- Empowerment
- Practicing cultural diversity
21
Q
What is the definition of Atraumatic Care?
A
provision of therapeutic care in settings, by personnel, and through the use of interventions that eliminate or minimize the psychologic and physical distress experienced by children and their families in the health care system
22
Q
What is the goal of Atraumatic Care?
A
Do No Harm
23
Q
Describe developmentally appropriate communication in infants.
A
nonverbal- use crying to communicate
24
Q
Describe developmentally appropriate communication in Early childhood (under age 5).
A
Egocentric- focus on child
Explain what, how, why
be consistent, dont smile while doing painful things
25
Describe developmentally appropriate communication in school age.
want explanations- why
concern about body integrity
Reassurance needed
26
Describe developmentally appropriate communication in Adolescents.
Be honest with them
Be aware of privacy needs
Think about regression
Realize impotance of peers
27
Describe therapeutic play with newborns
mobiles, music, mirrors, cuddlers
28
Describe therapeutic play with toddlers.
peek a boo
hide and seek
read favorite stories
use of transitional objects- Ex. talk to teddy bear first
29
Describe therapeutic play with preschoolers.
outline of body or doll to address fear of body harm.
play with safe hospitol equipment
crayons, color books, play dough
pet therapy
30
Describe therapeutic play with school age child.
regress developmentally
age appropriate crafts, games
tasks for sense of mastery/accomplishment
31
Describe therapeutic play with adolescents.
```
loss of independence and regaining control
therapeutic recreation
peer contact via phone/visits
interact with other teens
physical activities
```
32
Identify the following age ranges:
1. newborn
2. infant
3. toddler
4. preschooler
5. school age
6. adolescents
1. newborn= birth to 1 month
2. infant= 1 to 12 months
3. toddler= 1 to 3 years
4. preschooler= 3 to 5 years
5. school age= 6 to 11 years
6. adolescents= 12 to 18 or 20 years
33
Describe growth measuremnts for the infant.
recumbent- length up to 36 months
weight
head circumference
34
Describe growth measuremnts for children over 36 months.
Standing height
weight
(head and chest circumference should be equal around 1 to 2 years)
35
How is corrected age determined in children born prematurely?
Calculated Age = Chronolgical Age - # of weeks premature
| CA= CH - #
36
What is the correct order for vital sign measurement in infants and toddlers?
1. RR
2. apical HR
3. BP (if required)
4. temp
37
What are the avg RR in the following age ranges:
1. newborn
2. early childhood
3. late childhood
4. 15 years and older
1. newborn: 30-60
2. 20-40
3. 15-25
4. 15-20
38
What special breathing patterns exist in infants and early childhood?
infants: periodic breathing and diaphragmatic breathing (with abdominal movement)
early childhood: same breathing movement
39
What are the avg heart rates at the follwing ages:
1. birth
2. 0 to 6 months
3. 6 to 12 months
4. 1 to 2 years
5. 2 to 6 years
6. 6 to 10 years
7. 10 to 14 years
1. birth= 140
2. 0 to 6 months= 130
3. 6 to 12 months= 115
4. 1 to 2 years= 110
5. 2 to 6 years= 103
6. 6 to 10 years= 95
7. 10 to 14 years= 85
40
If the BP cuff size is too small how will the reading be impacted?
the reading on the device is falsely high.
41
If the BP cuff size is too large how will the reading be impacted?
the reading is falsely low.
42
Generally, is the systolic pressure in the lower extremities (thigh or calf) greater or lower than pressure in the upper extremities?
Is systolic BP in the calf higher or lower than that in the thigh?
greater
higher
43
What are normal systolc BPs at the following ages:
1. birth
2. 6 months
3. 1 year
4. 6 years
5. 10 years
6. 16 years
1. birth: 50
2. 6 months: 70
3. 1 year: 95
4. 6 yrs: 100
5. 10 yrs: 110
6. 16 yrs: 120
44
With oscillometry (Ie Dinamap), are BP readings higher or lower than measurements with auscultation?
higher- 10 mmHg
45
If BP is 95 percentile?
1. normotensive
2. prehypertensive
3. prehypertensive
4. hypertensive repeat at least 2x to confirm
46
What is the desired temp range for the neonate?
36.5 to 37.5 degrees Celsius
47
What is:
| Marked asymmetry; abnormal and may indicate premature closure of the sutures
craniosynostosis
48
Head control:
| At what age should head lag diminish? what does this indicate late?
4-6 months
Significant head lag after 6 months of age strongly indicates cerebral injury and is referred for further evaluation.
49
What is opisthotonos?
Hyperextension of the head with pain on flexion is a serious indication of meningeal irritation and is referred for immediate medical evaluation.
50
What is:
child holds the head to one side with the chin pointing toward the opposite side a result of injury to the sternocleidomastoid muscle.
wryneck, or torticollis
51
At what age does the anterior fontanel close?
12 to 18 months
52
At what age does the posterior fontanel close?
6-8 weeks
53
At what age should vision screening start?
3 years old then annually
54
What is strabismus?
| What is amblyopia?
Lazy Eye
| Both eyes unable to focus simultaneously, brain suppresses image by deviating the eye
55
What tests could be performed to indicate strabismus?
Hirschberg or corneal light reflex
56
What vision test would the 3-5 year old use?
| 6 and older?
Illiterate or HOTV Allen card
| Snellen
57
To examine the eardrum, would the pinna be pulled up and back or down and back at <3 over 3?
under 3: down and back
| over 3: up and back
58
what does S1 signify?
closure of the tricuspid and mitral valves
59
what does S2 signify?
closure of the pulmonic and aortic valves
60
As a child, when is S2 splitting normal?
always, widens during inspiration
61
When is S2 splitting abnormal?
FIXED splitting is abnormal. Ie, if it doesn't widen during inspiration, can be a sign of atrial septal defect
62
what is coarctation of the aorta?
lower extremity pressure is less than the upper extremity pressure.
63
# Define each murmur:
1. No anatomic or physiologic abnormality exists.
2. No anatomic cardiac defect exists, but a physiologic abnormality such as anemia is present.
3. A cardiac defect with or without a physiologic abnormality exists.
1. Innocent
2. Functional
3. Organic
64
What is sinus arrythmia and is it normal in the child? how do you test for it and where is it heard the best?
Normal: HR increased w/inspiration & decreased w/expiration
test: have child hold breath. HR will remain steady with sinus arrythmia
Heard at Pulmonic area
65
Where is the PMI located in the child under 7? over 7?
under 7: 4th ICS, lateral to mid clavicular line
| over 7: 5th ICS, also LMCL
66
What does capillary refill asess?
hydration and circulation
67
Where are murmurs heard the easiest?
Erbs point
68
Why is the abdomen of infants and young children cyclindrical and fairly prominent when erect?
physiologic lordosis of the spine
69
What does a midline protrusion from the xiphoid to the umbilicus or symphysis pubis indicate?
diastasis recti: failure of the rectus abdominas muscles to join in utero.
70
What does a tense, boardlike abdomen indicate?
paralytic ileus and intestinal obsturction
71
What is the Ortolani maneuver?
during hip check: If the femoral head can be felt to slip forward into the acetabulum on pressure from behind, it is dislocated
72
What is the Barlow maneuver?
Sometimes an audible “clunk” can be heard on exit or entry of the femur out of or into the acetabulum. If, on pressure from the front, the femoral head is felt to slip out over the posterior lip of the acetabulum and immediately slips back in place when pressure is released, the hip is said to be dislocatable or “unstable”
73
What is genu varum? until what age is it ok?
| What is genu valgum? age?
1. bowleggedness, lateral bowing of the tibia: until 2 years old
2. Knock knees: 2 to 7 years
74
What is medial tibial torsion? by what age may it improve?
pigeon toes
| age 3
75
When is the Babinski reflex normal?
until 18 months
76
Balance and coordination using the following tests what?
| finger to nose, heel to shin and Romberg test
Cerebellar function
77
What direction does motor maturation occur?
cephalocaudal progression
78
What are cranial nerves I and II?
Olfactory
| Optic
79
How is the optic nerve tested in the infant?
| child?
infant: eye blink with light
| visual acuity
80
What are cranial nerves III, IV and VI?
Oculomotor
Trochlear
Abducens
81
How are cranial nerves III IV and VI tested?
Infant: focus on tracking
Child: cardianl gaze
*note symmetry and eyelid drooping and PERRLA
82
What is cranial nerve V? and how is it tested?
Trigeminal
Infant: root reflex
Child: chewing on cracker; cotton test on the forehead
83
What are cranial nerves VII and VIII?
Facial and Acoustic
Response to sound
Facial expressions and bilateral symmetry
84
What are cranial nerves IX and X? how are they tested?
```
Glossopharyngeal and Vagus
Palatal reflex: test by stroking side of uvula
infant: swallowing during feeding
child: speak clearly
Gag reflex
```
85
What is cranial nerve XI? test?
Spinal accessory
infant: not tested
child: raise shoulders; turn head against resistance
86
What is cranial nerve XII? test?
Hypoglossal
infant: observe feeding
child: stick out tongue, midline and no tremors
87
What impacts growth vs development?
growth: oxygenation
development: interaction w/ peers, family and environment
88
What does linear growth reflect?
skeletal growth and oxygenation
89
what does weight reflect?
growth, nutrition and fluid balance
90
what does head circumference reflect?
brain growth
91
By what age should you be half your adult height?
2 years old
92
Describe weight increases for the first year of life.
- Weight increases by 6-8 oz per week
- 2x birthweight by 6 months
- 3x by 12 months
93
Describe head circumference change for 0 to 6 months of life.
Describe length increase for 0 to 6 months of life.
HC: 0.5 inch per month
Length: 1 inch per month
94
Describe weight, length and head circumference increase for 6 to 12 months.
weight: 3-4 oz /week
HC: 0.25 inch per month
Length: 0.5 inch per month; height also increases by 50% by 12 months
95
When does teething begin
6 to 8 months
96
What reflexes does the neonate have and when do they disappear?
1. Grasp
2. Rooting, sucking
3. tonic neck
4. dance/step
5. Babinski
6. tongue extrusion
7. spinal incurvation
8. moro response
* **All disappear by 6 months execpt Babinski
97
If the primitive reflexes continue beyond 6 monts, what does it indicate?
neuromuscular deficit
98
What is the landau reflex?
When infant is suspended in a horizontal prone position, the head is raised and legs and spine are extended; appears at 6 to 8 months, lasts until 12 to 24 months
99
Describe proper car seat use for the following:
1. infants and toddlers
2. children over 2 years old
3. booster seat
4. lap and shoulder seatbelt
5. at what age can the child move to the front seat?
1. rear facing until 2 years old or reach wt/ht allowance
2. forward facing
3. if over forward facing allowance
4. 4 feet 9 inches and 8-12 years old
5. 13 years old
100
What does the AAP recommend for all newborns (feeding wise)?
breast milk or formula exclusively until 4-6 months and BM or formula until 12 months
Give BM every 1.5-3 hours
Formula every 3-4 hours
101
What are advantages of breast milk?
```
decreased incidence of
otitis media, allergies, RTI
D/V
Meningitis, other infections
SIDs
Obesity and Type I and II diabetes
```
102
At what age can breast milk be supplemented with iron?
Vit D supplementation?
Fluoride?
1. 4-6 months with fortified cereals
2. if decreased exposure to light: 400 IU/d
3. 6 months if not in water (<0.3 ppm)
103
Why shouldn't infants have whole milk before 12 months?
what age can solid foods be introduced?
whole milk doesn't have iron so whole milk can lead to anemia. Also problems with nutrient absorption.
4-6 months
104
How are infants assessed for solid food readiness?
- can sit
- BW has doubled & weighs at least 13 lbs
- can reach for an object, maintain balance
- extrusion reflex gone
- moves food to back of mouth, swallows during feeding.
105
Define Colic and related theory.
crying (unconsolable rather than irritable), theories include interaction b/w mom and baby, smoking, gas.
106
Why do babies "spit up"?
immature esophageal sphincter allows regurgitation when laying down after eating (burp and sit up after eating)
107
Why do young children suck their thumb?
| What are pacifiers used for?
Suck thumb: self-soothing when young, not recommended when teeth present
Pacifiers: comfort measure, also reduces risk of SIDs
108
What are signs of teething?
```
drooling
increased finger sucking
biting on hard objects
irritability and difficulty sleeping
mild temperature elevation (fever over 39 is illness)
ear rubbing
decreased appetite for solid foods.
```
109
Are frequent waking periods related to teething or other factors?
related to environmental, behavioral, or developmental changes rather than teething
110
What oral care should parents perform during infancy?
wipe the infants gums with wet gauze 1-2x daily
Avoid bottles with sleep or bed
First dental visit 12-30 months
111
What physical growth occurs during ages 1 to 4 years?
Weight increases 4 to 6 lbs per year
Height increases 3 inches per year
HC increases 1 inch per year
112
When does the anterior fontanel close?
non-palpable at 12 months and closed completely by 18 months
113
What are the classifications of play?
1. Solitary Play
2. Parallel Play: toddlers -due to egocentricity
3. Associative Play: usually preschoolers -imagination and decreased egocentricity
4. Cooperative Play (Team): late preschool associated with school age child
5. Recreational Play: adolescents, need for peer presence
114
What age group is associated with solitary play?
infants and toddlers -due to limited social, cognitive and physical skills
115
What age group is associate with Parallel Play?
toddlers -due to egocentricity
116
What age group is associated with Associative play?
usually preschoolers -imagination and decreased egocentricity
117
What age group is associated with Cooperative Play?
Team: late preschool associated with school age child (Erickson's industry)
118
What age group is associated with recreational play?
adolescents, need for peer presence
119
What is teh Denver Developmental screenting tool? what age is it applicable to?
Evaluates personal/social, fine motor, gross motor, language domains
- infants through 5.5 years
120
How much food should a child receive?
Small portions:
| 1 tablespoon of food per each year of age
121
What are early childhood caries defined as?
one or more decayed, missing teeth in a child < 5 years of age
122
At what age does the child have a full set of 20 deciduous teeth?
2 years old
123
What are deciduous teeth important for?
language development, spacing for permanent teeth and foster positive dietary habits
124
What are the 4 common hazards for the toddler or preschooler?
Falls
Poisoning
Drowning
Burns
125
What two age groups have the highest incidence of poisoning?
highest in 2-year-old age group
| under 6 years of age
126
What are the S/s of acute or chronic salicylate ingestion?
```
N/V, dehydration
disorientation, coma, seizures
hyperpyrexia
oliguria
bleeding tendencies
tinnitus
```
127
What are appropriate nursing interventions for salicylate poisoning?
```
activated charcoal
sodium bicarbonate
external cooling measures
anticonvulsant/seizure precautions
vitamin K
hemodialysis (not peritoneal)
```
128
What is the most common drug poisoning in children?
Acetaminophen (acute ingestion)
129
What are the S/s of Acetaminophen poisoning?
N/V
pallor and sweating
hepatic involvement: jaundice, confusion, coag problems, RUQ
130
What is the treatment for Acetaminophen overdose?
first: charcoal
Second: antidote -N-acetylcysteine (Mucomyst) PO q4h for 17 doses after the loading dose
131
What should be assessed prior to administering all PO meds?
LOC
