Flashcards in Peds Midterm Week 1 Deck (131):
Children living with chronic violence may exhibit what behviors?
1. difficulty concentrating in school and memory impairment.
2. aggressive play & uncaring behavior
3. constricted activities and thinking for fear of reliving traumatic event
The slight decline since 2002 in American youth's illicit drug use is attributed?
1. education regarding the adverse effects of illicit drugs
2. parental disapproval
3. decreased availability of drugs
4. consistent participation in church and organized activities such as scouts and sports.
Death in first year of life
Recorded per 1000 live births
____ is the major determinant of neonatal death in technologically developed countries.
What factors increase risk of infant mortality?
2. AA race
3. Male gender
4. short or long gestation,
5. maternal age
6. lower level of maternal education
What is the leading cause of death in children over age 1 year?
What age group has the lowest group of death and why?
5-14 year olds b/c of importance in following rules results in less accidents
What age group has a drastic increase in violent deaths? and why?
10-25 year olds b/c of "nothing can happen to me" attitude
Childhood ____ includes actue illness, chronic disease or ____.
Which illness accounts for 50% of all acute conditions in childhood morbidity?
What is the new pediatric social illness?
1. behavior, social and educational problems
2. psychosocial factors
3. mental health issues
What risk factors contribute to childhood injuries?
1. sex- male
2. temperament- high activity level & negative rxn to new situations
3. stress- increased risk taking & self destructive behavior
4. alcohol and drug use- higher incidences of MVA, drowning, homicide and suicide
5. Hx of previous injury
6. development characteristics
7. cognitive characteristics
What developmental characteristics contribute to childhood injury?
1. mismatch b/w childs developmental and skill level
2. natural curiousity to explore the environment
3. desire to assert self and challenge rules
4. in older child, desire for peer approval and acceptance
Describe cognitive characteristics that contribute to childhood injuries in the infant.
sensorimotor- explores thru taste/touch
Describe cognitive characteristics that contribute to childhood injuries in the young child.
1. Object permanence: actively search for attractive object.
2. Cause and effect: lacks awareness of consequential dangers
3. Transductive reasoning: fails to learn from experience
4. Magical and egocentric thinking: unable to comprehend danger to self or others
Describe cognitive characteristics that contribute to childhood injuries in the school age child.
Transitional cognitive processes:
1. unable to fully comprehend causal relationships
2. dangerous acts w/o detailed planning re: consequences
Describe cognitive characteristics that contribute to childhood injuries in the adolescent.
1. preoccupied with abstract thinking and loses sight of reality
2. feeling of invulnerability
Describe anatomic characteristics that contribute to childhood injuries.
1. large head- predisposed to cranial injury
2. large spleen and liver- predisposed to direct trauma
3. small/light body: thrown easily esp moving vehicle
What factors beyond cognitive, developmental and anatomical contribute to childhood injury?
2. family stress
3. substandard alternative child care
4. young maternal age
5. low maternal education
6. multiple siblings
What 3 concepts support family centered care?
3. Practicing cultural diversity
What is the definition of Atraumatic Care?
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
What is the goal of Atraumatic Care?
Do No Harm
Describe developmentally appropriate communication in infants.
nonverbal- use crying to communicate
Describe developmentally appropriate communication in Early childhood (under age 5).
Egocentric- focus on child
Explain what, how, why
be consistent, dont smile while doing painful things
Describe developmentally appropriate communication in school age.
want explanations- why
concern about body integrity
Describe developmentally appropriate communication in Adolescents.
Be honest with them
Be aware of privacy needs
Think about regression
Realize impotance of peers
Describe therapeutic play with newborns
mobiles, music, mirrors, cuddlers
Describe therapeutic play with toddlers.
peek a boo
hide and seek
read favorite stories
use of transitional objects- Ex. talk to teddy bear first
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
Describe therapeutic play with school age child.
age appropriate crafts, games
tasks for sense of mastery/accomplishment
Describe therapeutic play with adolescents.
loss of independence and regaining control
peer contact via phone/visits
interact with other teens
Identify the following age ranges:
5. school age
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
Describe growth measuremnts for the infant.
recumbent- length up to 36 months
Describe growth measuremnts for children over 36 months.
(head and chest circumference should be equal around 1 to 2 years)
How is corrected age determined in children born prematurely?
Calculated Age = Chronolgical Age - # of weeks premature
CA= CH - #
What is the correct order for vital sign measurement in infants and toddlers?
2. apical HR
3. BP (if required)
What are the avg RR in the following age ranges:
2. early childhood
3. late childhood
4. 15 years and older
1. newborn: 30-60
What special breathing patterns exist in infants and early childhood?
infants: periodic breathing and diaphragmatic breathing (with abdominal movement)
early childhood: same breathing movement
What are the avg heart rates at the follwing ages:
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
If the BP cuff size is too small how will the reading be impacted?
the reading on the device is falsely high.
If the BP cuff size is too large how will the reading be impacted?
the reading is falsely low.
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?
What are normal systolc BPs at the following ages:
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
With oscillometry (Ie Dinamap), are BP readings higher or lower than measurements with auscultation?
higher- 10 mmHg
If BP is 95 percentile?
4. hypertensive repeat at least 2x to confirm
What is the desired temp range for the neonate?
36.5 to 37.5 degrees Celsius
Marked asymmetry; abnormal and may indicate premature closure of the sutures
At what age should head lag diminish? what does this indicate late?
Significant head lag after 6 months of age strongly indicates cerebral injury and is referred for further evaluation.
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.
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
At what age does the anterior fontanel close?
12 to 18 months
At what age does the posterior fontanel close?
At what age should vision screening start?
3 years old then annually
What is strabismus?
What is amblyopia?
Both eyes unable to focus simultaneously, brain suppresses image by deviating the eye
What tests could be performed to indicate strabismus?
Hirschberg or corneal light reflex
What vision test would the 3-5 year old use?
6 and older?
Illiterate or HOTV Allen card
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
what does S1 signify?
closure of the tricuspid and mitral valves
what does S2 signify?
closure of the pulmonic and aortic valves
As a child, when is S2 splitting normal?
always, widens during inspiration
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
what is coarctation of the aorta?
lower extremity pressure is less than the upper extremity pressure.
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.
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
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
What does capillary refill asess?
hydration and circulation
Where are murmurs heard the easiest?
Why is the abdomen of infants and young children cyclindrical and fairly prominent when erect?
physiologic lordosis of the spine
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.
What does a tense, boardlike abdomen indicate?
paralytic ileus and intestinal obsturction
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
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”
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
What is medial tibial torsion? by what age may it improve?
When is the Babinski reflex normal?
until 18 months
Balance and coordination using the following tests what?
finger to nose, heel to shin and Romberg test
What direction does motor maturation occur?
What are cranial nerves I and II?
How is the optic nerve tested in the infant?
infant: eye blink with light
What are cranial nerves III, IV and VI?
How are cranial nerves III IV and VI tested?
Infant: focus on tracking
Child: cardianl gaze
*note symmetry and eyelid drooping and PERRLA
What is cranial nerve V? and how is it tested?
Infant: root reflex
Child: chewing on cracker; cotton test on the forehead
What are cranial nerves VII and VIII?
Facial and Acoustic
Response to sound
Facial expressions and bilateral symmetry
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
What is cranial nerve XI? test?
infant: not tested
child: raise shoulders; turn head against resistance
What is cranial nerve XII? test?
infant: observe feeding
child: stick out tongue, midline and no tremors
What impacts growth vs development?
development: interaction w/ peers, family and environment
What does linear growth reflect?
skeletal growth and oxygenation
what does weight reflect?
growth, nutrition and fluid balance
what does head circumference reflect?
By what age should you be half your adult height?
2 years old
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
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
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
When does teething begin
6 to 8 months
What reflexes does the neonate have and when do they disappear?
2. Rooting, sucking
3. tonic neck
6. tongue extrusion
7. spinal incurvation
8. moro response
***All disappear by 6 months execpt Babinski
If the primitive reflexes continue beyond 6 monts, what does it indicate?
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
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
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
What are advantages of breast milk?
decreased incidence of
otitis media, allergies, RTI
Meningitis, other infections
Obesity and Type I and II diabetes
At what age can breast milk be supplemented with iron?
Vit D supplementation?
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)
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.
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.
Define Colic and related theory.
crying (unconsolable rather than irritable), theories include interaction b/w mom and baby, smoking, gas.
Why do babies "spit up"?
immature esophageal sphincter allows regurgitation when laying down after eating (burp and sit up after eating)
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
What are signs of teething?
increased finger sucking
biting on hard objects
irritability and difficulty sleeping
mild temperature elevation (fever over 39 is illness)
decreased appetite for solid foods.
Are frequent waking periods related to teething or other factors?
related to environmental, behavioral, or developmental changes rather than teething
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
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
When does the anterior fontanel close?
non-palpable at 12 months and closed completely by 18 months
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
What age group is associated with solitary play?
infants and toddlers -due to limited social, cognitive and physical skills
What age group is associate with Parallel Play?
toddlers -due to egocentricity
What age group is associated with Associative play?
usually preschoolers -imagination and decreased egocentricity
What age group is associated with Cooperative Play?
Team: late preschool associated with school age child (Erickson's industry)
What age group is associated with recreational play?
adolescents, need for peer presence
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
How much food should a child receive?
1 tablespoon of food per each year of age
What are early childhood caries defined as?
one or more decayed, missing teeth in a child < 5 years of age
At what age does the child have a full set of 20 deciduous teeth?
2 years old
What are deciduous teeth important for?
language development, spacing for permanent teeth and foster positive dietary habits
What are the 4 common hazards for the toddler or preschooler?
What two age groups have the highest incidence of poisoning?
highest in 2-year-old age group
under 6 years of age
What are the S/s of acute or chronic salicylate ingestion?
disorientation, coma, seizures
What are appropriate nursing interventions for salicylate poisoning?
external cooling measures
hemodialysis (not peritoneal)
What is the most common drug poisoning in children?
Acetaminophen (acute ingestion)
What are the S/s of Acetaminophen poisoning?
pallor and sweating
hepatic involvement: jaundice, confusion, coag problems, RUQ
What is the treatment for Acetaminophen overdose?
Second: antidote -N-acetylcysteine (Mucomyst) PO q4h for 17 doses after the loading dose