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Pediatrics > Test 1 > Flashcards

Test 1 Flashcards

1
Q

Developmental Stages

A

0-1=trust vs. mistrust/sensiomotor

1-3=autonomy vs. shame & doubt/sensio & preoperat.

3-6…..initiative vs. guilt/pre-operational

6-12…..industry vs. inferiority/concrete operational

12-19…..identity vs. confusion/formal operations

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2
Q

Morbidity

A

presented as rates per 1000, denotes chronic illness, chronic disease or disability.

Prevalence of a specific illness in a population

new morbidity = behavioral, social and educational problems that can significantly alter a child’s health

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3
Q

Congenital Disability

A

-a disabiltiy that has existed since birth but is not necessarily hereditary

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4
Q

Erythema Toxicum Neonatorum

A
  • flea bite dermatitis or newborn rash
  • benign, self-limiting
  • usually appears within the first 2 days of life
  • firm, pale yellow or white papules or pustules on an erythematous base
  • face, proximal extremeties, trunk, buttocks
  • anywhere except palms and soles
  • lasts 5-7 days
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5
Q

Malformations

A
  • congenital anomaly that are abnormal formations of organs or body parts resulting from an abnormal developmental process.
  • most occur before 12 wks gestation
  • Example: cleft lip
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6
Q

Association

A
  • nonrandom pattern of malformations for which a cause has not been determined
  • Example: VACTERL (vertebral defects, anal atresia, cardiac defect, trachoesophagel fistula, renal and limb defects)
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7
Q

FLACC scale

A

-2 mo-7 yr

–Face

–Legs

–Activity

–Cry

–Consolability

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8
Q

FACES Scale

0-10 Pain Scale

A
  • for children as young as 3 years
  • for children as young as 5 years
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9
Q

PKU

A
  • genetic-autosomal recessive
  • absence of enzyme needed to metabolize the essn aa phenylalanine
  • dx and tx to prevent cognitive impairments
  • restrict dietary protein
  • lower IQ, other cognitive deficiencies
  • parents are carriers
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10
Q

Galactosemia

A
  • rare autosomal recessive
  • enzyme deficiency-enzyme involved in conversion of galactose into glucose
  • hepatic dysfunction–cirrhosis, jaundice
  • enlarged spleen (portal hypertension)
  • cataracts
  • lethargy, hypotonia
  • vomiting, diarrhea, weight loss
  • E.coli sepsis
  • ovarian dysfunction, cataracts, cognitive impairment, growth restriction, motor delay
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11
Q

PKU

A
  • genetic
  • autosomal recessive
  • lack enzyme to metabolize phenylalanine (proteins, fruits/veggies)
  • high phenylalanine levels = severe cognitive impairments and eratic behavior
  • degeneration of gray and white matter
  • growth failure, vomiting, irritable, erratic behavior, spasticity, seizures, cognitive impairments
  • best if tx is started bf 3 weeks of age
  • test after exposure to milk but before 7 days old
  • diet low in phenylalanine (20-30 mg/kg/day)
  • blood level 2-8 mg/dl (cognitive deficits if 10-15)
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12
Q

Vaccines

A
  • DTaP-IPV = diphtheria (airway obstruction, sequelae), tetnus (fatal), acellular pertussis (resp distress) and inactivated polio virus characteristic fever 24-48h
  • Hib = Haemophilus influenzae type b-protects against: bacterial meningitis, epiglottitis, pneumonia, sepsis
  • MMR = measles, mumps, rubella-live, attenuated-subcut-dz-encephalitis, mumps-also deafness, sterility, rubella-teratogenic
  • Var = varicella vaccine - (chicken pox) live attenuated-subcut, complxn of dz-encephalitis, secondary infections (neuro-complications)
  • HB = Hep B (IM)(cirrhosis, liver cancer), blood/body fluids
  • Hep A - IM, 2 doses (not req’d for school), complications of dz-liver, fecal-oral (req’d food service)
  • PCV Prevnar- IM, for immunosupprsessed, prevention of strep pneumo (ear inf (OM), sinusitis and pneumonia)
  • Men-C (MCV) = megingococcal C conjugate vaccine, IM, crowded living conditions-adolescents
  • Tdap = diphtheria, tetanus, acellular pertussis vaccine (adult/adolescent formulation)
  • Inf = influenza IM (nasal version is live)-egg allergy; for all children >6 months
  • IPV = inactive polio

Don’t give vaccine if T > 38, long-term systemic sterioids, chemo-wait 3 months

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13
Q

IM

A
  • vastus lateralis
  • ventrogluteal
  • deltoid in older children (>2 yo)
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14
Q

Fever

A
  • Temp >38 or 100.4
  • Harmful if 41.7 or 107
  • most are VIRAL in origin

low grade temp within 24h of surgery-may be due to atelectasis (turn, cough, deep breath)

  • normal temp is 36.5-37.6
  • less than 28 days old-complete septic work up (lumbar punct, urine culture, blood culture)
  • eval and child >105
  • within 24hr-104-105, >3d, returns after 24 hours
  • seizure-6 months to 3 years, unusual after age 5; temp ususally exceeds 38.8 (101.8)
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15
Q

5th’s Disease

(Erythema Infectiosum)

A
  • Human parvovirus B19
  • respiratory secretions, blood
  • lacelike maculopapular rash on trunk and limbs, comes and goes for 1-3 wks.
  • can cause aplastic crisis
  • low grade fever
  • headache, malaise, 1 wk later-slapped cheek
  • avoid PG women
  • contagious prior to sx
  • keep out of sun
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16
Q

Tylenol Antidote

A

Mucomyst

(acetylcysteine)

(also used to loosen mucous)

17
Q

Lead Poisoning

A
  • hematology-lead competes with iron in making Hgb
  • renal-damages tubules; causes excretion of glu, prot, aa’s and phosphate–Fanconi Syndrome

-*CNS* -cerebral edema, encephalopathy, incresed ICP, seizures, MR, blindness, paralysis, death. CNS effects are irreversible

  • if less than 10, rescreen in 1 year, 10-19 = educ & re-screen, 20-44 = home and medical tx, 45-69 = chelation (painful injections) within 48 hrs, remove from environment, >70 immediate medical intervention.
  • chelating agents can cause death from hypocalcemia, nephrotoxic
  • DMSA - oral agent used for lower levels; EDTA and BAL–nephrotoxic–UA daily
  • adequate hydration to flush kidneys
  • Acute signs of poisoning = n/v, constipation, anorexia, abd pain, hypophosphatemia, glycosuria and aminoaciduria
  • Young children absorb 50% of lead they are exposed to while adults absorb 10%
18
Q

Early Motor Milestones

A

AGE
4 months Raises Head
5-6 months Rolls Over
8-9 months Sits Alone
10-12 months Crawls-Walks
15 months Walks Alone
18 months Climbs Stairs
22-24 months Throws Ball Overhand, Runs Well 2-3 years Turns a Hot Water Knob, Pedals Tricycle 3 years Alternates Feet up the Stairs 5 years Catches Ball Bounced

19
Q

Fontanels

A
  • posterior = 2 months
  • anterior = 18 months
20
Q

BMI

A
  • best indicator of healthy weight
  • kg/cm2 x 10,000
  • BMI above 95% is obese
  • BMI bt 85-94 is overweight
  • BMI > 85 should be screened for comorbidities
21
Q

Growth Rate

A
  • 1.5 lbs per month for first 5 months
  • BW doubles at 5 months
  • 3/4 lb per month for second half of infancy
  • BW triples by 12 months
22
Q

Dosing of

Tylenol & Ibuprofen

A

Tylenol: 10-15 mg/kg

Ibuprofen: 5-10 mg/kg

23
Q

Abuse

A
  • humanogram=total body x-ray
  • subdural hematoma from shake baby syndrome
  • hot water heater 120
  • Bruise color scale: RPGYB
  • SAM = sex abuse management team
  • history and developmental level of the child must correlate with the injury
24
Q

Minimal Urine Parameters

A

Infant 2mls/kg/hr

Toddler 1-2 mls/kg/hr

School Age 1 ml/kg/hr

Adolescent 0.5 ml/kg/hr

25
Q

Pediatric Lab Values

A

RBCs 3.2-5.2 million/mm3

Hct 30-54%

Hgb 10.3-18 g/dL (^polycythemia, COPD)

Platelets 150,000-465,000 (^ infections, acute blood loss and splenectomy; v cancer, renal/liver dz, aplastic anemia)

WBCs 5,000-13,000/mm3 (^ bacterial infections, burnes, leukemia, and sickle cell; v aplastic anemia/viral infections)

26
Q

Potassium

Sodium

A

3.5-5.5 (hyperkalemia in renal failure, severe burns, tissue trauma, metabolic acidosis; hypokalemia in vomiting, diarrhea, dehydration, gastric suctioning, metabolic acidosis)

135-145 (^dehydr, severe vomiting, diarrhea; v gastric suctioning, burns, tissue injury)

27
Q

FTT

A

-

  • inadequate intake
  • inadequate absorption (CF, hepatic dz, vit/min def)
  • increased metabolism (CHD, hyperthyroidism, immunodeficiency)
  • defective utilization (metabolic or genetic anomaly)
28
Q

Common Allergens

A
  • NSAIDs
  • analgesics
  • vaccines
  • antibiotics
  • peanuts, treenuts
  • shellfish
  • eggs
  • dairy
  • strawberries
29
Q

Body Water Content

A
  • Preemie 90%…newborn 70-80%…>2 60%
  • Intracellular vs. Extracellular

25% 65%

30% 45%

40% 20%

-vulnerable to rapid F/E imbalance due to greater body surface area and increased metabolic rate

30
Q

Dehydration

A
  • isotonic (loss from ECF)–SHOCK
  • hypotonic (loss from ECF)—SHOCK
  • hypertonic (water moves from ICF to ECF)–SEIZURE/CNS-HR increases initially, then decreases
31
Q

Significant Weight Changes

A
  • infant = 50 g in 24 hrs
  • child = 200 g in 24 hrs
  • adolescent = 500 g in 24 hrs
32
Q

Massive Diarrhea

A
  • causes acidosis–give bicarb
  • Serum Carbon Dioxide–important for acid base balance, part of BMP, (child 20-28 mEq/L)
33
Q

Fluid Volume Loss

A
  • Mild < 50ml/kg (pale) [give ORS]
  • Moderate 50-90 ml/kg (gray) [give ORS]
  • Severe >100 ml/kg (mottled) (marked oliguria and azotemia, BP is lowered, cap refil >3)
  • Bolus is 20-30 ml/kg
  • don’t ignore stool output
  • orders usually say no K until first void (to be assured of kidney function)
  • a common sign of dehydration is abnormal respiratory pattern.
34
Q

Sickle Cell

A
  • 1 in 12 AfrAmer’s is carrier (has sickle cell trait)
  • dz not seen until 6 months bc of HgbF
  • Hydroxyurea increases production of HgbF (on this for life)
  • Damage tissue in organs = impaired function
  • Splenic sequestration–shock, hypovolemia, ruptured spleen, autosplenectomy, “asplenic” by age 5
  • bone marrow transplants may help
  • transfusions/hypertransfusions, fluids, O2
  • Dilauded (hydromorphone) is best drug, also NSAID-ketorolac, NO Aspirin or Demerol (CNS toxic)
  • must get immunizations (immunocompromised)
  • stroke-neurodevelopmental delay, cognitive disabilities
  • sickle cell crisis–trauma, increased O2 needs, infection, fever, dehydration, hypothermia (vasoconstriction)

—–vaso-occlusive thrombotic–painful, most common type of crisis; s/s = fever, pain, tissue engorgement

—–splenic sequestration-life threatening-s/s profound anemia, hypovolemia, shock (tachy)

——aplastic crisis-triggered by viral infection or depletion of folic acid; s/s profound anemia, pallor

Acute Chest Syndrome–VOC or infection causes sickling in the lungs, chest pain, fever, cough, tachy, wheezing, hypoxia (O2 sats drop), lungs aren’t perfused….pulmonary HTN

35
Q

Hemophilia

A
  • Hemarthrosis = bleeding into joints-immobilize, splinting, ice, analgesics, ROM when bleeding stops to prevent contractures
  • avoid obesity to minimize joint stress
  • Bump head - evaluate for bleed
  • Prolonged PTT
  • Normal platelets, PT and fibrinogen
  • DDAVP (increases factor 8)
  • transfusions

Pediatrics (3 decks)

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