Peds Midterm Week 1 Flashcards Preview

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Flashcards in Peds Midterm Week 1 Deck (131):
1

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

2

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.

3

Infant ____:
Death in first year of life
Recorded per 1000 live births

mortality

4

____ is the major determinant of neonatal death in technologically developed countries.

Birth Weight

5

What factors increase risk of infant mortality?

1. BW
2. AA race
3. Male gender
4. short or long gestation,
5. maternal age
6. lower level of maternal education

6

What is the leading cause of death in children over age 1 year?

accidents

7

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

8

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

9

Childhood ____ includes actue illness, chronic disease or ____.

Morbidity
disability

10

Which illness accounts for 50% of all acute conditions in childhood morbidity?

respiratory

11

What is the new pediatric social illness?

1. behavior, social and educational problems
2. psychosocial factors
3. mental health issues

12

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

13

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

14

Describe cognitive characteristics that contribute to childhood injuries in the infant.

sensorimotor- explores thru taste/touch

15

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

16

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

17

Describe cognitive characteristics that contribute to childhood injuries in the adolescent.

Formal operations:
1. preoccupied with abstract thinking and loses sight of reality
2. feeling of invulnerability

18

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

19

What factors beyond cognitive, developmental and anatomical contribute to childhood injury?

1. poverty
2. family stress
3. substandard alternative child care
4. young maternal age
5. low maternal education
6. multiple siblings

20

What 3 concepts support family centered care?

1. Enabling
2. Empowerment
3. Practicing cultural diversity

21

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

22

What is the goal of Atraumatic Care?

Do No Harm

23

Describe developmentally appropriate communication in infants.

nonverbal- use crying to communicate

24

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

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