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Pediatrics Exam 1 > Week 3 - Culture & Pediatric Assessment > Flashcards

Week 3 - Culture & Pediatric Assessment Flashcards

(65 cards)

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1
Q

What is health promotion & in what ways can nurses practice it?

A

Activities encompassing well-being & enhancing wellness or health

  • Maintenance – screening, vaccinations, safety to prevent injury
  • Supervision – well-child
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2
Q

What are the main health promotion items that are focused on by patient age?

  • newborn / infant
  • toddler / pre-schooler
  • school age / adolescent
A
  • Newborn / Infant: close to caregiver, parent’s mood, behave as expected, oral health, bottle use
  • Toddler / Pre-schooler: respond to questions, age-appropriate play, interaction with staff
  • School-age / Adolescent: interaction with parents, praising / partnering, divorce / separations, patient answers, independence
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3
Q

What is goodness of fit? What does it mean? What recommendations a nurse could offer parent?

A

Parent’s expectation of their child’s behavior consistent with the child’s temperment type
* Easy - 40%
* Difficult - 10%
* Slow to warm up - 15%
* Mixed - 35%

Recommendations:
* Active - many periods of play then rest before sleep
* Shy - allow time to adapt
* Easily Stimulated - quiet room
* Short Attention Span - projects completed in short time; gradually encourage longer periods at activities

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4
Q

Sequence of Physical Assessment in young children vs. older children

A
  • Young Children = toe-to-head
  • Older Children = head-to-toe
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5
Q

What is the HEEADSSS screening tool for adolescents?

A
  • Home environment
  • Education & employment
  • Eating
  • Activities
  • Drugs (substance use)
  • Sexuality
  • Suicidal thoughts
  • Safety, savagery (exposure to violence)
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6
Q

Normal Heart Rate Ranges for each age group when awake & asleep

  • Neonate
  • Infant
  • Toddler
  • Preschool
  • School age
  • Adolescent
A

Neonate: 80 - 180

Infant: 75 - 160

Toddler: 60 - 110

Preschool: 60 - 110

School-Age: 60 - 110

Adolescent: 50 - 90

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7
Q

Normal Heart Rate for Neonates

KNOW THIS!!!!!

A

80 - 180

  • A: 100 - 180
  • S: 80 - 160
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8
Q

Normal Heart Rate for Infants when awake & asleep

KNOW THIS!!!!!

A

80 - 180

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9
Q

Normal Heart Rate for Toddlers when awake & asleep

KNOW THIS!!!!!

A

60 - 110

  • A: 80 - 110
  • S: 60 - 90
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10
Q

Normal Heart Rate for Preschoolers when awake & asleep

KNOW THIS!!!!!

A

60 - 110

  • A: 70 - 110
  • S: 60 - 90
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11
Q

Normal Heart Rate for School-Age when awake & asleep

KNOW THIS!!!!!

A

60 - 110

  • A: 65 - 110
  • S: 60 - 90
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12
Q

Normal Heart Rate for Adolescents when awake & asleep

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A

50 - 90

  • A: 60 - 90
  • S: 50 - 90
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13
Q

Normal Respiration Ranges fro each age group

  • Infant
  • Toddler
  • Preschool
  • School Age
  • Adolescent

KNOW THIS!!!!!

A
  • Infant: 30 - 60
  • Toddler: 24 - 40
  • Preschool: 22 - 34
  • School Age: 18 - 30
  • Adolescent: 12-16
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14
Q

Normal Respiration Range for Infants

KNOW THIS!!!!!

A

30 - 60 breaths per minute

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15
Q

Normal Respiration Range for Toddlers

KNOW THIS!!!!!

A

24 - 40 breaths per minute

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16
Q

Normal Respiration Range for Preschoolers

KNOW THIS!!!!!

A

22 - 34 breaths per minute

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17
Q

Normal Respiration Range for School-Aged Children

KNOW THIS!!!!!

A

18 - 30 breaths per minute

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18
Q

Normal Respiration Range for Adolescents

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A

12 - 16 breaths per minute

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19
Q

Normal Temperature Range for Pediatrics

KNOW THIS!!!!!

A

< 36.5°C
& ≥
38°C

  • 97.7 - 100.4 °F
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20
Q

How do you estimate the “normal” SBP for children 1+ years?

KNOW THIS!!!!!

A

90 mmHg + (2 x age in years)

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21
Q

Chest circumference?

KNOW THIS!!!!

A
  • taken for first year of life
  • Chest circumference is measured across the nipple line
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22
Q

Head circumference

KNOW THIS!!!!

A
  • Until age 3
  • Measure twice = Should be 2 cm larger than chest until 2 years
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23
Q

Expected weight changes during first year of life

KNOW THIS!!!!

A
  • 2x birth weight at 5-6 months
  • 3x birth weight at 1 year
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24
Q

Neonate Vitals (HR, RR, SBP)

KNOW THIS!!!!

A

HR: 80 - 180
* 100 - 180 (awake)
* 80 - 160 asleep

RR: 30 - 60

SBP: < 60 mmHg

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25
**Infant Vitals (1 - 12 months)** (HR, RR, SBP) | **KNOW THIS!!!!**
**HR: 75 - 160** * awake: 100 - 160 * asleep: 75 - 160 **RR:** 30 - 60 **SBP:** < 70 mmHg
26
**Toddler Vitals (1-3 yr)** (HR, RR, SBP) | **KNOW THIS!!!!**
**HR: 60 - 110** * awake: 80 - 110 * asleep: 60 - 90 **RR:** 22 - 40 **SBP:** < 90 mmHg **+ (** 2 **x** age in years**)** ## Footnote 3 year old normal SBP would be: 90 **+ (**2 **x** 3**) =** 90 **+ (**6**) =** 96
27
**School Age (6-10)** (HR, RR, SBP) | **KNOW THIS!!!!**
**HR: 60 - 110** * awake: 65 - 110 * asleep: 60 - 90 **RR:** 18 - 30 **SBP:** < 90 mmHg **+ (**2 **x** age in yr**)**
28
**Adolescent Vitals (10+)** (HR, RR, SBP) | **KNOW THIS!!!!**
**HR: 50 - 90** * awake: 60 - 90 * asleep: 50 - 90 **RR:** 12 - 16 **SBP:** < 90 mmHg **+ (**2 **x** age in yr**)**
29
**Skin Assessment Components** | **KNOW THE BOLD!!!!**
* color * temperature * moistness * check skin for color variation * **abnormalities: decreased pigment, Mongolian spot, moltting, bruises, erythema, pallor, cyanosis, jaundice** * texture * hair texture * **turgor = assess abodmen** * **edema = boggy skin** * Cap refill < 2 seconds * lesions
30
**Primary Lesions**
**Lesions arising from previously normal skin** * pimples / acne
31
**Secondary lesions**
**lesions that result in changes in primary lesions** * scratching at a pimple * ulcers * scars
32
**Head Assessment** | **KNOW THE BOLD!!!!**
* Sutures * *Flat & soft fontanelles* * **posterior fontanelle closed by 2-3 months** * **anterior fontanelle closed by 12-18 months** * Prominent occipital area * **no significant head lag after 6 months**
33
**Eye Assessment** | **KNOW THE BOLD**
* conjunctivae pink & glossy * **visual acuity at 3 months** (infant should be able to follow an object) * **Binocularity by 3-4 months** (infant should be able to focus on object with both eyes) * **6 cranial fields of gaze** * Pupils round, clear, & reactive * sunset sign (visual gaze downward = hydrocephalus)
34
**Sunset Sign**
**White sclera visible above colored pupil** * **indicates** retracted eyelids or **hydrocephalus**
35
**White Reflex**
Reflex indicatvie of **retinoblastoma or leukocoria**
36
**Ear Assessment** | **KNOW THE BOLD**
* **< 3 =** pull pina **down** & back * **> 3 =** pull pina **up** & back * Position, shape, & symmetry * **tympanic membranes = pearly, translucent, reflective** * **hearing loss indications:** no speech by 2, regression in speech, no startle
37
**Nose Assessment** | **KNOW THE BOLD!!!!**
* size, shape, symmetry * **nasal flaring = respiratory distress** * color, discharge, swelling, patency, smell
38
**Mouth Assessment** | **KNOW THE BOLD**
* Lips * Teeth # & dental caries * Mucosa * Tongue * palate * Throat * Tonsils (0 - 4+)
39
**Neck Assessment** | **KNOW THE BOLD**
* **Inspect for symmetry, color, swelling** * **Palpate for tenderness, teachea deviations, & thyroid enlargement ** * **Range of motion**; indicates torticollis or meningismus
40
**Lymph Node Assessment** | **KNOW THE BOLD**
* Palpate in circular motion * Usually **non-palpable if small/non-tender**
41
**Chest Assessment ** | **KNOW THE BOLD**
* Inspect for shape/size * **Diameter of 2:1 = normal** * Pectus carnatum & pectus excavatum * scoliosis causes lateral deviation
42
**Pectus Carnatum** | **KNOW THIS!!!!**
**Forward protrusion of sternum;** pigeon chest
43
**Pectus Excavatum** | **KNOW THIS!!!!**
**Sunken sternum & adjacent cartilages;** funnel chest
44
**Respiratory Assessment** | **KNOW THE BOLD**
* Inspect for chest / abdominal expansion * **Retractions between ribs indicate distress** * **"Headbobbing" in young infants = distress** * Palpation (crepitus or tactile fremitus) * Auscultation (fine crackles, coarse crackles, wheezing, rhonchi, stridor)
45
**Respiratory Expansion in children under 6**
* **Inspect abodmen** * Diaphragm muscle primarily used
46
**Respiratory Assessment in children over 6**
* **Inspect chest**
47
**What should be inspected when looking at respiratory expansion in children under 6 versus children over 6?**
**Under 6 =** inspect the **abdomen** * diaphragm muscle primarily used **Over 6 =** inspect the **chest**
48
**Cardiac Assessment** | **KNOW THE BOLD**
* Inspect shape & symmetry of chest * **Palpate apical pulse** * Thrills = palpable murmur * **Auscultate (S1 & S2)**
49
**What is a thrill?**
**Palpable murmur** on cardiac assessment
50
**Abdominal Assessment** | **KNOW THE BOLD**
* **Umbilical stump** * Shape * Movements * **Auscultate bowel sounds 10-30 seconds** * Percussion * Femoral pulses
51
**Genital Assessment - Females** | **KNOW THE BOLD**
* Color, size, symmetry * Masses, swelling inflammation, lacerations, or discharge * Tanner Staging
52
**Genital Assessment - Male** | **KNOW THE BOLD**
* Structural development * Hypospadias * Foreskin * Testicles * Tanner Staging * Have child sit in the tailor position ## Footnote When palpating the scrotum for discended testicles & spermatic cords, place the index finger over the inguinal canal to keep the testicle in the scrotum. Gently palpate the testicle with only enough pressure to detect the size & shape
53
**Hypospadias** | **KNOW THIS TERM!!!**
**opening of penis is on the underside** rather than at the tip
54
**Tanner Staging** | **KNOW THE BOLD**
**Sexual maturity rating** used widely to assess & monitor the degree of maturation of an adolescent's primary & secondary sexual characteristics. -- **stages 1-5** * **Stage 1 = Pre-pubertal** * **Stage 5 = Adult** ## Footnote **Stage 1 (pre-pubertal): No pubic hair present in either sex** * Male - **small penis & testes** * Female - have **flat chest** **Stage 2: soft pubic hair appears** * Male - measurable testes enlargement * Female - breast buds appear **Stage 3: pubic hair becomes coarser** * Male - penis begins to enlarge in size & length * Female - breast mounds form **Stage 4: pubic hair begins to cover pubic area** * Male - penis begins to widen * Female - breast enlargement forms "mound-on-mound" breast contour **Stage 5 (Adult): Pubic hair extends to inner thigh** * Male - penis & testes enlarge to adult size * Female - Breast takes on adult contour
55
**Explain each stage of Tanner Staging** | **KNOW THE BOLD**
**Stage 1 (Pre-Pubital): No pubic hair present in either sex** * Male - small penis & testes * Female - flat chest **Stage 2: soft pubic hair appears** * Male - measurable enlargement of testes * Female - breast buds **Stage 3: Pubic hair becomes coarser** * Male - penis begins to increase in size & length * Female - breast mounds **Stage 4: Pubic hair begins to cover pubic area** * Male - penis widens * Female - breast enlargement forms "mound-on-mound" breast contour **Stage 5 (Adult): pubic hair extends to inner thigh** * Male - penis & testes enlarged to adult size * Female - breasts take on adult contour
56
**Musculoskeletal Assessment** | **KNOW THE BOLD**
* Inspect legs & arms for symmetry / deformities * Skin folds bilaterally * Redness / swelling / pain * Palpate bones & muscles for tone * **Observe ROM during play** * Muscle strength * Posture * Allis' Sign = hip dislocation
57
**Signs / Symptoms of Hip Dysplasia** | **KNOW THE BOLD**
* **Asymmetrical gluteal / thigh folds** * Limited hip abduction * Shortening of femur * **Ortolani click** (< 4 weeks old) ## Footnote Hip Dysplasia = shallow hip socket * Positive Ortolani or Barlow Test is indicative of developmental dysplasia of the hip (hip dysplasia)
58
**Neuro Assessment** | **KNOW THE BOLD**
* Behavior * LOC * Cranial nerve function * **Reflexes** (grasp, rooting, moro, tonic neck, Babinski sign, Parachute)
59
**Tactile Fremitus**
**Vibrations produced by crying or talking** (usually palpated over the entire chest) ## Footnote * *Decreased sensations indicate that air is trapped in the lungs* (as occurs with ashtma)
60
**Crepitus**
**crackling sound & sensation that occurs when air is trapped under the skin**
61
**Fine Crackles** | Definition & Cause **KNOW THE BOLD!!!!**
**High-pitched, discrete, non-continuous crackling** * heard at the **end of inspiration** * NOT cleared by coughing ## Footnote *CAUSE:* air passing through watery secretions in the smaller airways (alveoli & bronchioles)
62
**Coarse Crackles** | Definition & Cause **KNOW THE BOLD!!!!**
**Loud, low-pitched, bubbling & gurgling** * Heard during / on **inspiration** * NOT cleared by coughing ## Footnote *CAUSE:* air passing through thicker secretions in airway
63
sibilant **Wheezing** | Definition & Cause **KNOW THE BOLD!!!!**
**High-pitched, musical, squeaking or hissing** * heard **continuously** during/on **inspiration or expiration** * does NOT clear by coughing ## Footnote *CAUSE:* air passing through mucus or fluids in a narrowed lower airway (bronchioles) * typically asthma
64
**Rhonchi** (sonorous wheezing) | Definition & Cause **KNOW THE BOLD!!!!**
**Coarse, low-pitched sound** (like a snore) * heard during / on **inspiration or expiration** * may clear with coughing ## Footnote *CAUSE:* air passing through thick secretions that obstruct large bronchi and/or trachea
65
**Stridor** | Definition & Cause **KNOW THE BOLD!!!!**
**High-pitched, piercing sound** * most often heard during / on **inspiration without a stethoscope** ## Footnote *CAUSE:* whistling as air passes through narrowed trachea & larynx * associated with croup

Pediatrics Exam 1 (7 decks)

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