đź‘Ľ373: Pediatrics Flashcards
What are normal vitals for Newborn - 3 month olds?
HR: 100-150
RR: 35 - 55
BP: (65-85)/(45-55)
What are normal vitals for 3 months to 1 year old?
HR: 80 - 120
RR: 25 - 45
BP: (70-100)/(50-65)
What are the normal vitals for 1-3 year olds?
HR: 70-100
RR: 20-30
BP: (90-105)/(55-70)
What are normal vitals for 3-6 year olds?
HR: 65-100
RR: 20-25
BP: (95-110)/(60-75)
What are normal vitals for 6-12 year olds?
HR: 60-95
RR: 14-22
BP: (100-120)/(60-75)
What are normal vitals for 12+ year olds?
HR: 55-85
RR: 12-18
BP: (110-135)/(65-85)
What is the general pattern of growth in weight?
6 months: birth weight x2
1 year: birth weight x3
2.5 years: birth weight x4
What are the 3 directional trends of physical development?
- Cephalocaudal
- Proximodistal
- Differentiation
What is the general pattern of growth in length?
1 yr: birth weight x1.5 2 yrs: half adult height 4 yrs: birth length x2 4 - height cm = weight lbs (40,40) 13 yrs: birth weight x3
What is the general pattern of growth in dentition?
Erupt by 6 months
1 yr: 6-8 teeth, molars
2 yr: molars
3 yr: 20 baby teeth
6 yr: baby teeth fall out, adult teeth come in
What are major developmental milestones at 3 months?
- Eyes focus
- Hold head up
- Palmar grasp
- “Upward dog”
What are major developmental milestones at 4-5 months?
- Roll front to back
- another month for back to front
What are major developmental milestones at 6 months?
- Transfer objects from one hand to other
- Sit supported (unsupported 7-8 months)
- Support weight on legs
- Babbling one syllable
What are major developmental milestones at 8 months?
Pinser grasp- can pick things up!
What is the average age babies start to crawl?
10 months
What is the average age children start to walk?
13 months
What are major developmental milestones at 10 months?
- Pull themselves up
- Can cruise standing
- Vocalize one words (“muma”, “dada”)
What are major developmental milestones at 1-3 years?
- Vocabulary increases
18 months = 10+ words - Can hold a crayon at 1 yr
What are major developmental milestones at 2-3 years?
- Draw shapes
- 2-footed jump
- Turn pages of a book
300+ words
What are major developmental milestones at 4-5 years?
- Scissors
- Stairs independently
- Can write their name
- Hop on 1 foot
What is Erickson’s Psychosocial Development Theory?
Describes core problems/conflicts that the individual strives to master in personality development
- No core conflict ever mastered, but remains a current problem throughout life
8 stages - 5 in childhood
What are the first 5 of Erikson’s Stages that relate to childhood?
- Trust vs Mistrust
- Autonomy vs Shame and Doubt
- Initiative vs Guilt
- Industry vs Inferiority
- Identity vs Role Confusion
What is the Erikson’s 1st stage, and when does it occur?
Trust vs Mistrust
Birth - 1 year
- nurture attachment
What is the Erikson’s 2nd stage, and when does it occur?
Autonomy vs Shame and Doubt
1-3 years
- nurture choices and independence
What is the Erikson’s 3rd stage, and when does it occur?
Initiative vs Guilt
Preschool (3-6 years)
- engage in play
- goal-directed
What is the Erikson’s 4th stage, and when does it occur?
Industry vs Inferiority
School age (6 - 12)
- eager to develop skills and knowledge
What is the Erikson’s 5th stage, and when does it occur?
Identity vs Role Confusion
Adolescent (13-18 years)
- identity, peer pressure, appearances
- give privacy
What are the Piaget’s 4 Stages?
- Sensorimotor (birth - 2)
- Preoperational (2-7 years)
- Concrete operations (7-11 years)
- Formal operations (11 - adulthood)
What are the sleep patterns for newborns?
16 hours, for 3-4 hours at a time
What are the sleeping patterns of infants?
2-6 months: 14-16 hours (3 naps)
6-18 months: 14 hours (2 naps)
What are the sleeping patterns of toddlers?
10-12 hours/day (1 nap)
What are the sleeping patterns of preschoolers?
12 hours/night
What are the sleeping patterns of school-aged children?
10-12 hours/night
What are signs and symptoms of salicylate (ASA) overdose?
Hyperventilation Diaphoresis N/v Tinnitus Dizziness Confusion Seizures Bleeding
What is the treatment for salicylate (ASA) overdose?
- Activated charcoal
- Gastric lavage
- Sodium bicarbonate
- Vit K
- Anticonvulsants
What are signs and symptoms of acetaminophen overdose?
Diaphoresis Abdominal pain Lethargy Weakness N/v
(Don’t Allow Little Weaklings Near Vomit)
What is the treatment for acetaminophen overdose?
- Gastric lavage
2. Acetylcysteine (mucomyst)
What are signs and symptoms of lead poisoning?
Unexplained vomiting Chronic abdominal pain Anemia Drowsiness, irritability Ataxia Seizures Brain damage
What is the treatment for lead poisoning?
Chelation therapy
What are signs and symptoms of iron poisoning?
Vomiting blood Blood in stool Hypotension Tachypnea Cyanosis
What is the treatment for iron overdose?
- Gastric lavage
2. Chelation therapy
What are signs and symptoms of corrosives/chemicals ingestion?
Severe respiratory issues
What is the treatment for corrosives/chemical ingestion?
- Dilute with water
- Oxygen
- Maintain airway
What are the 3 stages of separation anxiety?
- Protest
- Despair
- Detachment/denial
What are stressors of hospitalization for children?
- Separation anxiety
- Loss of control
- Fear of bodily injury/pain
What are 7 functions of play?
- Sensorimotor development
- Intellectual development
- Socialization
- Creativity
- Self-Awareness
- Therapeutic Value (emotional outlet)
- Moral Value
What are the 4 types therapeutic play?
- Normative Play
- Emotional Outlet Play
- Instructional Play
- Physically Enhancing Play
What is the normal potassium range?
4.1 - 5.3
What are fluid issues in the paediatric population?
- Body Surface Area
- Basal metabolic Rate
- Kidney function
- Fluid Requirements
What is isotonic dehydration?
Sodium loss = water loss
Normal serum sodium levels
What are 3 common causes if isotonic dehydration?
- Fluid loss
- Reduced fluid intake
- Fluid shift out of vasculature (3rd spacing)
What is hypotonic dehydration?
Sodium loss > water loss
Serum sodium < 130 mmol/L
What are 2 common causes if hypotonic dehydration?
- Excessive sodium loss
2. Increased water gain
What are specific signs and symptoms of hypotonic dehydration?
Lethargy, confusion, headache, seizures, coma
What is hypertonic dehydration?
Sodium loss < water loss
Serum sodium > 150 mmol/L
What are 2 common causes of hypertonic dehydration?
- Excessive free water loss
2. Sodium excess
What are specific signs and symptoms of hypertonic dehydration?
Agitation, restlessness, hyperirritability, decreased LOC, seizures, coma
How do you calculate fluid volume deficit?
Weight x %Dehydration
Oral Rehydration Therapy (ORT)
Preferred treatment for mild to moderate dehydration
Takes advantage of co-transport system of upper intestines. Glucose couples with sodium and both are absorbed in the intestinal membrane, and then water follows.
Hypoxia vs hypoxemia
Hypoxia = low oxygen in the tissues Hypoxemia = low oxygen in the blood
What are 3 causes of anemia?
- Impaired erythrocyte production
- Blood loss
- Increased erythrocyte destruction
What is the hallmark sign of anemia?
Tissue hypoxia
What are causes of impaired erythrocyte production?
- Iron deficiency anemia (IDA)
- B12 deficiency anemia (large RBCs)
- Folate deficiency (large RBCs)
- Thalassemia
- Leukaemia or malignancy infiltrating bone marrow
Why is iron important in children?
- Necessary for oxygen binding to Hg
- Chronic hypoxia
- IDA impairs immune fxn
- Iron involved in myelin and dopamine synthesis
What are important considerations with iron supplementation?
- Vitamin C increases absorption
2. Calcium reduces absorption (no milk 2 hours before/after)
When should iron supplementation start?
2 months until 12 months
What is Beta Thalassemia?
- Autosomal recessive disorder
- Hgb A forms smaller and abnormal rate
Treatment: frequent blood transfusion and iron chelation, Splenectomy in some cases
What are 4 causes of increased erythrocyte destruction?
- Sickle Cell Disease
- ABO Incompatibility
- G6PD Deficiency
- Infection
Sickle Cell Disease
Hemoglobin S - rigid and sticky cells, stick to walls of vessels
RBC lifespan only 10-20 days (Normal= 100-120, infants 80-90)
What are differences in the Pediatric Respiratory System?
- Upper airway shorter and more narrow
- Newborns - 3 months Obligatory nose breathers
- Larynx is more flexible and easily simulated to spasm
- Intercostals not fully developed
- High, irregular RR
- Higher metabolic rate
- Fewer alveoli
- Right bronchus enters lung at steeper angle
- Cartilage surrounding trachea more flexible
- Eustachian tubes shorter and horizontal
- Tonsils and lymphoid tissue larger
- Decreased immune fxn
What are causes of Respiratory Distress in children?
- Infection
- Asthma
- Trauma
- Inability to clear secretions
- Foreign body aspiration
- Sedation
What are early signs of respiratory distress?
- Tachypnea
- Hyperpnea
- Tachycardia
- Restlessness/irritability
What are LATE signs of respiratory distress?
- Nasal flaring
- Retractions/indrawing
- Trach Tug
- Head bobbing
- Abdominal breathing
- Grunting
- Stridor
- Pallor/mottling/cyanosis
What are reasons for code Blue/Pink in Pediatrics?
- Hypoxemia
- Acidosis
- Respiratory Deterioration
- Cardiac Deterioration
What are nursing interventions to ease respiratory effort?
- Positioning (high Fowler’s)
- Suctioning
- Oxygen
- Humidity
- Medications
What is the emergency equipment for tracheostomy?
- 2 spare trachs (one same size, one smaller)
- ETT (one same size, one smaller)
- Suctioning equipment
- Spare trach ties
- Lubricating jelly
- Bag-valve mask
What is the pathophysiology of Respiratory Syncytial Virus (RSV)?
Causes overproduction of IgE
- Results in airway obstruction
What is the pathophysiology of pneumonia?
- invading organism enters lungs
- Inflammation of lung parenchyma
- Accumulation of fluid and cellular debris in bronchioles and alveoli
- Impaired has exchange
What are the 3 dimensions of pain?
- Cognitive (awareness of pain)
- Affective (behavioural responses)
- Sensory (neurons and pain intensity)
What are the different self-reported measurements for pain?
- Facial Scales (ages 3-12)
- Visual Analogue Scale (VAS) (6-7+)
- Numerical Rating Scale (NRS) (6-7+)
- Verbal Descriptor Scales (VDS) (4-5+)
What is the FLACC pain score?
- Face
- Legs
- Activity
- Cry
- Consolability
What is the PIPP pain Scale?
For newborns
- Change in HR
- Oxygen Sat %
- Brow bulge
- Eye squeeze
- Naso-labial furrow
- Gestational Age
- Behavioural state (awake/active/asleep/quiet)
What is the difference between tolerance and dependence?
Tolerance = dec in drugs effect over time
Dependence = need to co ti he drug to maintain homeostasis and prevent withdrawal
When would 24% sucrose be contraindicated?
- Short bowel Syndrome
- Carbohydrate intolerance
- Unconscious or heavily sedated with absent gag reflex
What are the 6 situational factors modifying pain?
- Cognitive factors (ability to understand, coping mechanisms, perceived control)
- Behavioural factors (responses, distress, expression of pain)
- Emotional factors (fear, depression, anxiety)
- Tissue damage/ pain source
- Chil factors (age, experience, etc)
- Pain sensation
What are the types of ADHD?
- Hyperactive-impulsive
- Inattentive
- Combined hyperactive-impulsive and inattentive (majority)
What are the different types of eating disorders?
- Anorexia nervosa (AN)
- Bulimia nervosa
- Binge eating disorder
- Avoidant/Restrictive Food intake Disorder (ARFID)
What is CRAFFT a screening tool for?
2 positives suggests substance abuse
C - ridden in car driven by someone under the influence R - use alcohol/drugs to relax A - use while Alone F - forget things while using? F - family/friends tell you to cut down T - gotten into Trouble while using
What is the primary nursing diagnosis for shock?
Inadequate tissue perfusion
What are the 3 causes of inadequate tissue perfusion?
- Heart function
- Vascular tone
- Blood volume
What are the 3 types of shock?
- Hypovolemic
- Distributive
(septic, anaphylactic, neurogenic) - Cardiogenic
What is the most common form of shock in pediatrics?
Hypovolemic Shock
What are the main causes of hypovolemic shock?
Fluid loss:
- Blood loss (trauma, postop, hemorrhage)
- Plasma loss (sepsis, burns, 3rd spacing)
- Extra cellular fluid loss (dehydration)
What are signs and symptoms of Hypovolemic shock?
High SVR, high HR Falling BP Increased cap refill poor skin turgor, thirst, Oliguria
What are the 3 types of Distributive shock?
- Septic shock
- Anaphylactic shock
- Neurogenic Shock
Intravascular Volume remains normal, but fxnal or relative hypovolemia occurs
What are the 3 primary symptoms of Distributive Shock?
- Vasodilation
- Dec vascular tone
- Dec cardiac output
What is the mechanism of septic shock?
Massive inflammatory response -> vasodilation and damage to the capillaries
= Permeability of capillaries is increased and results in 3 spacing
What are signs and symptoms of septic shock?
Low BP, low SVR Tachycardia Temperature instability Tachypnea Increased cap refill Altered WBC N/v/diarrhea Decreased LOC
What is the mechanism of anaphylactic shock?
Allergic reaction + hemodynamics instability
= vasodilation and increased vascular permeability
= constriction if extravascular smooth muscle
What are signs and symptoms of anaphylactic shock?
Anxiety Difficulty breathing Dec SVR Hypotension Tachycardia Oliguria GI cramps Edema Hives Sensations of burning/itchiness Decreased LOC
What is the mechanism of neurogenic shock ?
Extreme persistent vasodilation = increased SVR
Due to parasympathetic stimulation
OR sympathetic inhibition
What are the signs and symptoms of neurogenic shock?
Low SVR Bradycardia Warm skin temperature Flushed skin Hypotension
What is the mechanism of cardiogenic shock?
*Final pathway for any other type of shock
Heart is unable to pup enough blood to meet body’s demand for oxygen
What are signs and symptoms for cardiogenic shock?
Tachycardia Tachypnea Hypotension Jugular vein distension Low CO Cyanosis, Skin mottling Rapid/faint/irregular pulses Low urine output Peripheral edema (occasionally)
What are the 3 phases of shock?
- Compensated
- Decompensated
- Irreversible
What are the 4 mechanisms of compensated shock?
- Increased HR and contractility improves CO
- Blood flow increased to essential organs
- Plasma volume increased by retention of sodium and water
- Glyconeogenesis increases energy for cell metabolism
What are clinical manifestations of compensated shock?
Anxiety, restlessness Pallor Dec peripheral skin temp Increased cap refill time Slight increase in HR Normal BP (progressively decreases) Thirst Decreased u/o
What clinical manifestations of Decompensated shock?
Hypotension
Metabolic acidosis
Core organs significantly compromised
What are the 3 major nursing interventions for shock?
- Ventilation
- Fluid administration
- Improvement of pumping action of heart (meds)
What is decorticate posturing indicate?
Flexor posturing
= problems with Cervical Spinal Tract or Cerebral Hemisphere
What does decerebrate posturing indicate?
Extensor posturing
= problems with Midbrain or Pons
What is the Rancho Los Amigos Scale?
For children with existing neurological impairment
1 = no responde 2 = generalized response 3 = localized response 4 = confused-agitator response 5 = confused-inappropriate response 6 = confused-appropriate response 7 = automatic-appropriate response 8 = purposeful-appropriate response
What are signs and symptoms of Increased Intracranial Pressure (ICP) in infants?
Bulging fontanels Separated cranial sutures Macewen sign Irritability/restlessness Drowsiness High-pitched cry Increased head circumference Distended scalp veins Poor feeding Setting-sun sign
What are the components of the palliative Supportive Care Model?
- Preserving integrity
- Connecting
- Doing For
- Doing With
- Empowering
- Finding Meaning
- Valuing
How do you calculate Hourly Fluid Maintenance requirements?
(4,2,1)
4mL/kg x first 10kg
+ 2mL/kg x second 10kg
+ 1mL/kg x each kg>20kg
How do you calculate DAILY Maintenance Fluid requirements?
100mL/kg x first 10kg
+ 50mL/kg x second 10kg
+ 20mL/kg x each kg>20kg
What are signs and symptoms of RSV?
Fever Severe cough (dry) Wheezing Rapid breathing Cyanosis Headache Lethargy/irritability
What’s are signs and symptoms of Epiglottitis in children?
Stridor Sore throat Anxious/restless Drooling Difficulty/pain swallowing
Relieved by sitting up or leaning forward
What are signs and symptoms of Acute Lymphocytic Leukemia (ALL)?
Bleeding from gums Bone pain Fever Neutropenia (frequent infections) Swollen lymph nodes Pallor Shortness of Breath Fatigue, weakness
What are signs and symptoms of a vaso-occlusive episode in a child with Sickle Cell Disease?
Jaundice
Fatigue
Edema in hands and feet
