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đź‘Ľ373: Pediatrics Flashcards

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1
Q

What are normal vitals for Newborn - 3 month olds?

A

HR: 100-150
RR: 35 - 55
BP: (65-85)/(45-55)

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2
Q

What are normal vitals for 3 months to 1 year old?

A

HR: 80 - 120
RR: 25 - 45
BP: (70-100)/(50-65)

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3
Q

What are the normal vitals for 1-3 year olds?

A

HR: 70-100
RR: 20-30
BP: (90-105)/(55-70)

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4
Q

What are normal vitals for 3-6 year olds?

A

HR: 65-100
RR: 20-25
BP: (95-110)/(60-75)

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5
Q

What are normal vitals for 6-12 year olds?

A

HR: 60-95
RR: 14-22
BP: (100-120)/(60-75)

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6
Q

What are normal vitals for 12+ year olds?

A

HR: 55-85
RR: 12-18
BP: (110-135)/(65-85)

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7
Q

What is the general pattern of growth in weight?

A

6 months: birth weight x2
1 year: birth weight x3
2.5 years: birth weight x4

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8
Q

What are the 3 directional trends of physical development?

A
  1. Cephalocaudal
  2. Proximodistal
  3. Differentiation
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9
Q

What is the general pattern of growth in length?

A 
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
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10
Q

What is the general pattern of growth in dentition?

A

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

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11
Q

What are major developmental milestones at 3 months?

A
  1. Eyes focus
  2. Hold head up
  3. Palmar grasp
  4. “Upward dog”
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12
Q

What are major developmental milestones at 4-5 months?

A
  1. Roll front to back

- another month for back to front

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13
Q

What are major developmental milestones at 6 months?

A
  1. Transfer objects from one hand to other
  2. Sit supported (unsupported 7-8 months)
  3. Support weight on legs
  4. Babbling one syllable
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14
Q

What are major developmental milestones at 8 months?

A

Pinser grasp- can pick things up!

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15
Q

What is the average age babies start to crawl?

A

10 months

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16
Q

What is the average age children start to walk?

A

13 months

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17
Q

What are major developmental milestones at 10 months?

A
  1. Pull themselves up
  2. Can cruise standing
  3. Vocalize one words (“muma”, “dada”)
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18
Q

What are major developmental milestones at 1-3 years?

A
  1. Vocabulary increases
    18 months = 10+ words
  2. Can hold a crayon at 1 yr
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19
Q

What are major developmental milestones at 2-3 years?

A
  1. Draw shapes
  2. 2-footed jump
  3. Turn pages of a book

300+ words

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20
Q

What are major developmental milestones at 4-5 years?

A
  1. Scissors
  2. Stairs independently
  3. Can write their name
  4. Hop on 1 foot
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21
Q

What is Erickson’s Psychosocial Development Theory?

A

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

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22
Q

What are the first 5 of Erikson’s Stages that relate to childhood?

A
  1. Trust vs Mistrust
  2. Autonomy vs Shame and Doubt
  3. Initiative vs Guilt
  4. Industry vs Inferiority
  5. Identity vs Role Confusion
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23
Q

What is the Erikson’s 1st stage, and when does it occur?

A

Trust vs Mistrust

Birth - 1 year

  • nurture attachment
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24
Q

What is the Erikson’s 2nd stage, and when does it occur?

A

Autonomy vs Shame and Doubt

1-3 years

  • nurture choices and independence
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25
Q

What is the Erikson’s 3rd stage, and when does it occur?

A

Initiative vs Guilt

Preschool (3-6 years)

  • engage in play
  • goal-directed
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26
Q

What is the Erikson’s 4th stage, and when does it occur?

A

Industry vs Inferiority

School age (6 - 12)

  • eager to develop skills and knowledge
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27
Q

What is the Erikson’s 5th stage, and when does it occur?

A

Identity vs Role Confusion

Adolescent (13-18 years)

  • identity, peer pressure, appearances
  • give privacy
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28
Q

What are the Piaget’s 4 Stages?

A
  1. Sensorimotor (birth - 2)
  2. Preoperational (2-7 years)
  3. Concrete operations (7-11 years)
  4. Formal operations (11 - adulthood)
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29
Q

What are the sleep patterns for newborns?

A

16 hours, for 3-4 hours at a time

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30
Q

What are the sleeping patterns of infants?

A

2-6 months: 14-16 hours (3 naps)

6-18 months: 14 hours (2 naps)

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31
Q

What are the sleeping patterns of toddlers?

A

10-12 hours/day (1 nap)

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32
Q

What are the sleeping patterns of preschoolers?

A

12 hours/night

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33
Q

What are the sleeping patterns of school-aged children?

A

10-12 hours/night

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34
Q

What are signs and symptoms of salicylate (ASA) overdose?

A 
Hyperventilation
Diaphoresis 
N/v
Tinnitus
Dizziness 
Confusion 
Seizures 
Bleeding
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35
Q

What is the treatment for salicylate (ASA) overdose?

A
  1. Activated charcoal
  2. Gastric lavage
  3. Sodium bicarbonate
  4. Vit K
  5. Anticonvulsants
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36
Q

What are signs and symptoms of acetaminophen overdose?

A 
Diaphoresis 
Abdominal pain
Lethargy
Weakness
N/v

(Don’t Allow Little Weaklings Near Vomit)

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37
Q

What is the treatment for acetaminophen overdose?

A
  1. Gastric lavage

2. Acetylcysteine (mucomyst)

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38
Q

What are signs and symptoms of lead poisoning?

A 
Unexplained vomiting 
Chronic abdominal pain
Anemia 
Drowsiness, irritability 
Ataxia
Seizures 
Brain damage
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39
Q

What is the treatment for lead poisoning?

A

Chelation therapy

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40
Q

What are signs and symptoms of iron poisoning?

A 
Vomiting blood
Blood in stool 
Hypotension 
Tachypnea
Cyanosis
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41
Q

What is the treatment for iron overdose?

A
  1. Gastric lavage

2. Chelation therapy

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42
Q

What are signs and symptoms of corrosives/chemicals ingestion?

A

Severe respiratory issues

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43
Q

What is the treatment for corrosives/chemical ingestion?

A
  1. Dilute with water
  2. Oxygen
  3. Maintain airway
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44
Q

What are the 3 stages of separation anxiety?

A
  1. Protest
  2. Despair
  3. Detachment/denial
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45
Q

What are stressors of hospitalization for children?

A
  1. Separation anxiety
  2. Loss of control
  3. Fear of bodily injury/pain
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46
Q

What are 7 functions of play?

A
  1. Sensorimotor development
  2. Intellectual development
  3. Socialization
  4. Creativity
  5. Self-Awareness
  6. Therapeutic Value (emotional outlet)
  7. Moral Value
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47
Q

What are the 4 types therapeutic play?

A
  1. Normative Play
  2. Emotional Outlet Play
  3. Instructional Play
  4. Physically Enhancing Play
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48
Q

What is the normal potassium range?

A

4.1 - 5.3

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49
Q

What are fluid issues in the paediatric population?

A
  1. Body Surface Area
  2. Basal metabolic Rate
  3. Kidney function
  4. Fluid Requirements
50
Q

What is isotonic dehydration?

A

Sodium loss = water loss

Normal serum sodium levels

51
Q

What are 3 common causes if isotonic dehydration?

A
  1. Fluid loss
  2. Reduced fluid intake
  3. Fluid shift out of vasculature (3rd spacing)
52
Q

What is hypotonic dehydration?

A

Sodium loss > water loss

Serum sodium < 130 mmol/L

53
Q

What are 2 common causes if hypotonic dehydration?

A
  1. Excessive sodium loss

2. Increased water gain

54
Q

What are specific signs and symptoms of hypotonic dehydration?

A

Lethargy, confusion, headache, seizures, coma

55
Q

What is hypertonic dehydration?

A

Sodium loss < water loss

Serum sodium > 150 mmol/L

56
Q

What are 2 common causes of hypertonic dehydration?

A
  1. Excessive free water loss

2. Sodium excess

57
Q

What are specific signs and symptoms of hypertonic dehydration?

A

Agitation, restlessness, hyperirritability, decreased LOC, seizures, coma

58
Q

How do you calculate fluid volume deficit?

A

Weight x %Dehydration

59
Q

Oral Rehydration Therapy (ORT)

A

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.

60
Q

Hypoxia vs hypoxemia

A 
Hypoxia = low oxygen in the tissues 
Hypoxemia = low oxygen in the blood
61
Q

What are 3 causes of anemia?

A
  1. Impaired erythrocyte production
  2. Blood loss
  3. Increased erythrocyte destruction
62
Q

What is the hallmark sign of anemia?

A

Tissue hypoxia

63
Q

What are causes of impaired erythrocyte production?

A
  1. Iron deficiency anemia (IDA)
  2. B12 deficiency anemia (large RBCs)
  3. Folate deficiency (large RBCs)
  4. Thalassemia
  5. Leukaemia or malignancy infiltrating bone marrow
64
Q

Why is iron important in children?

A
  1. Necessary for oxygen binding to Hg
  2. Chronic hypoxia
  3. IDA impairs immune fxn
  4. Iron involved in myelin and dopamine synthesis
65
Q

What are important considerations with iron supplementation?

A
  1. Vitamin C increases absorption

2. Calcium reduces absorption (no milk 2 hours before/after)

66
Q

When should iron supplementation start?

A

2 months until 12 months

67
Q

What is Beta Thalassemia?

A
  1. Autosomal recessive disorder
  2. Hgb A forms smaller and abnormal rate

Treatment: frequent blood transfusion and iron chelation, Splenectomy in some cases

68
Q

What are 4 causes of increased erythrocyte destruction?

A
  1. Sickle Cell Disease
  2. ABO Incompatibility
  3. G6PD Deficiency
  4. Infection
69
Q

Sickle Cell Disease

A

Hemoglobin S - rigid and sticky cells, stick to walls of vessels

RBC lifespan only 10-20 days (Normal= 100-120, infants 80-90)

70
Q

What are differences in the Pediatric Respiratory System?

A
  1. Upper airway shorter and more narrow
  2. Newborns - 3 months Obligatory nose breathers
  3. Larynx is more flexible and easily simulated to spasm
  4. Intercostals not fully developed
  5. High, irregular RR
  6. Higher metabolic rate
  7. Fewer alveoli
  8. Right bronchus enters lung at steeper angle
  9. Cartilage surrounding trachea more flexible
  10. Eustachian tubes shorter and horizontal
  11. Tonsils and lymphoid tissue larger
  12. Decreased immune fxn
71
Q

What are causes of Respiratory Distress in children?

A
  1. Infection
  2. Asthma
  3. Trauma
  4. Inability to clear secretions
  5. Foreign body aspiration
  6. Sedation
72
Q

What are early signs of respiratory distress?

A
  1. Tachypnea
  2. Hyperpnea
  3. Tachycardia
  4. Restlessness/irritability
73
Q

What are LATE signs of respiratory distress?

A
  1. Nasal flaring
  2. Retractions/indrawing
  3. Trach Tug
  4. Head bobbing
  5. Abdominal breathing
  6. Grunting
  7. Stridor
  8. Pallor/mottling/cyanosis
74
Q

What are reasons for code Blue/Pink in Pediatrics?

A
  1. Hypoxemia
  2. Acidosis
  3. Respiratory Deterioration
  4. Cardiac Deterioration
75
Q

What are nursing interventions to ease respiratory effort?

A
  1. Positioning (high Fowler’s)
  2. Suctioning
  3. Oxygen
  4. Humidity
  5. Medications
76
Q

What is the emergency equipment for tracheostomy?

A
  1. 2 spare trachs (one same size, one smaller)
  2. ETT (one same size, one smaller)
  3. Suctioning equipment
  4. Spare trach ties
  5. Lubricating jelly
  6. Bag-valve mask
77
Q

What is the pathophysiology of Respiratory Syncytial Virus (RSV)?

A

Causes overproduction of IgE

- Results in airway obstruction

78
Q

What is the pathophysiology of pneumonia?

A
  • invading organism enters lungs
  • Inflammation of lung parenchyma
  • Accumulation of fluid and cellular debris in bronchioles and alveoli
  • Impaired has exchange
79
Q

What are the 3 dimensions of pain?

A
  1. Cognitive (awareness of pain)
  2. Affective (behavioural responses)
  3. Sensory (neurons and pain intensity)
80
Q

What are the different self-reported measurements for pain?

A
  1. Facial Scales (ages 3-12)
  2. Visual Analogue Scale (VAS) (6-7+)
  3. Numerical Rating Scale (NRS) (6-7+)
  4. Verbal Descriptor Scales (VDS) (4-5+)
81
Q

What is the FLACC pain score?

A
  1. Face
  2. Legs
  3. Activity
  4. Cry
  5. Consolability
82
Q

What is the PIPP pain Scale?

A

For newborns

  1. Change in HR
  2. Oxygen Sat %
  3. Brow bulge
  4. Eye squeeze
  5. Naso-labial furrow
  6. Gestational Age
  7. Behavioural state (awake/active/asleep/quiet)
83
Q

What is the difference between tolerance and dependence?

A

Tolerance = dec in drugs effect over time

Dependence = need to co ti he drug to maintain homeostasis and prevent withdrawal

84
Q

When would 24% sucrose be contraindicated?

A
  1. Short bowel Syndrome
  2. Carbohydrate intolerance
  3. Unconscious or heavily sedated with absent gag reflex
85
Q

What are the 6 situational factors modifying pain?

A
  1. Cognitive factors (ability to understand, coping mechanisms, perceived control)
  2. Behavioural factors (responses, distress, expression of pain)
  3. Emotional factors (fear, depression, anxiety)
  4. Tissue damage/ pain source
  5. Chil factors (age, experience, etc)
  6. Pain sensation
86
Q

What are the types of ADHD?

A
  1. Hyperactive-impulsive
  2. Inattentive
  3. Combined hyperactive-impulsive and inattentive (majority)
87
Q

What are the different types of eating disorders?

A
  1. Anorexia nervosa (AN)
  2. Bulimia nervosa
  3. Binge eating disorder
  4. Avoidant/Restrictive Food intake Disorder (ARFID)
88
Q

What is CRAFFT a screening tool for?

A

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
89
Q

What is the primary nursing diagnosis for shock?

A

Inadequate tissue perfusion

90
Q

What are the 3 causes of inadequate tissue perfusion?

A
  1. Heart function
  2. Vascular tone
  3. Blood volume
91
Q

What are the 3 types of shock?

A
  1. Hypovolemic
  2. Distributive
    (septic, anaphylactic, neurogenic)
  3. Cardiogenic
92
Q

What is the most common form of shock in pediatrics?

A

Hypovolemic Shock

93
Q

What are the main causes of hypovolemic shock?

A

Fluid loss:

  1. Blood loss (trauma, postop, hemorrhage)
  2. Plasma loss (sepsis, burns, 3rd spacing)
  3. Extra cellular fluid loss (dehydration)
94
Q

What are signs and symptoms of Hypovolemic shock?

A 
High SVR, high HR 
Falling BP
Increased cap refill 
poor skin turgor, thirst, 
Oliguria
95
Q

What are the 3 types of Distributive shock?

A
  1. Septic shock
  2. Anaphylactic shock
  3. Neurogenic Shock

Intravascular Volume remains normal, but fxnal or relative hypovolemia occurs

96
Q

What are the 3 primary symptoms of Distributive Shock?

A
  1. Vasodilation
  2. Dec vascular tone
  3. Dec cardiac output
97
Q

What is the mechanism of septic shock?

A

Massive inflammatory response -> vasodilation and damage to the capillaries

= Permeability of capillaries is increased and results in 3 spacing

98
Q

What are signs and symptoms of septic shock?

A 
Low BP, low SVR
Tachycardia 
Temperature instability 
Tachypnea 
Increased cap refill 
Altered WBC 
N/v/diarrhea 
Decreased LOC
99
Q

What is the mechanism of anaphylactic shock?

A

Allergic reaction + hemodynamics instability

= vasodilation and increased vascular permeability
= constriction if extravascular smooth muscle

100
Q

What are signs and symptoms of anaphylactic shock?

A 
Anxiety
Difficulty breathing 
Dec SVR 
Hypotension 
Tachycardia 
Oliguria 
GI cramps 
Edema
Hives
Sensations of burning/itchiness 
Decreased LOC
101
Q

What is the mechanism of neurogenic shock ?

A

Extreme persistent vasodilation = increased SVR

Due to parasympathetic stimulation
OR sympathetic inhibition

102
Q

What are the signs and symptoms of neurogenic shock?

A 
Low SVR 
Bradycardia 
Warm skin temperature
Flushed skin 
Hypotension
103
Q

What is the mechanism of cardiogenic shock?

A

*Final pathway for any other type of shock

Heart is unable to pup enough blood to meet body’s demand for oxygen

104
Q

What are signs and symptoms for cardiogenic shock?

A 
Tachycardia 
Tachypnea 
Hypotension 
Jugular vein distension 
Low CO
Cyanosis, Skin mottling 
Rapid/faint/irregular pulses 
Low urine output 
Peripheral edema (occasionally)
105
Q

What are the 3 phases of shock?

A
  1. Compensated
  2. Decompensated
  3. Irreversible
106
Q

What are the 4 mechanisms of compensated shock?

A
  1. Increased HR and contractility improves CO
  2. Blood flow increased to essential organs
  3. Plasma volume increased by retention of sodium and water
  4. Glyconeogenesis increases energy for cell metabolism
107
Q

What are clinical manifestations of compensated shock?

A 
Anxiety, restlessness 
Pallor
Dec peripheral skin temp
Increased cap refill time 
Slight increase in HR 
Normal BP (progressively decreases) 
Thirst
Decreased u/o
108
Q

What clinical manifestations of Decompensated shock?

A

Hypotension
Metabolic acidosis
Core organs significantly compromised

109
Q

What are the 3 major nursing interventions for shock?

A
  1. Ventilation
  2. Fluid administration
  3. Improvement of pumping action of heart (meds)
110
Q

What is decorticate posturing indicate?

A

Flexor posturing

= problems with Cervical Spinal Tract or Cerebral Hemisphere

111
Q

What does decerebrate posturing indicate?

A

Extensor posturing

= problems with Midbrain or Pons

112
Q

What is the Rancho Los Amigos Scale?

A

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
113
Q

What are signs and symptoms of Increased Intracranial Pressure (ICP) in infants?

A 
Bulging fontanels
Separated cranial sutures 
Macewen sign
Irritability/restlessness 
Drowsiness
High-pitched cry 
Increased head circumference 
Distended scalp veins 
Poor feeding 
Setting-sun sign
114
Q

What are the components of the palliative Supportive Care Model?

A
  1. Preserving integrity
  2. Connecting
  3. Doing For
  4. Doing With
  5. Empowering
  6. Finding Meaning
  7. Valuing
115
Q

How do you calculate Hourly Fluid Maintenance requirements?

A

(4,2,1)

4mL/kg x first 10kg
+ 2mL/kg x second 10kg
+ 1mL/kg x each kg>20kg

116
Q

How do you calculate DAILY Maintenance Fluid requirements?

A

100mL/kg x first 10kg
+ 50mL/kg x second 10kg
+ 20mL/kg x each kg>20kg

117
Q

What are signs and symptoms of RSV?

A 
Fever 
Severe cough (dry)
Wheezing
Rapid breathing 
Cyanosis 
Headache
Lethargy/irritability
118
Q

What’s are signs and symptoms of Epiglottitis in children?

A 
Stridor 
Sore throat 
Anxious/restless
Drooling
Difficulty/pain swallowing

Relieved by sitting up or leaning forward

119
Q

What are signs and symptoms of Acute Lymphocytic Leukemia (ALL)?

A 
Bleeding from gums 
Bone pain
Fever
Neutropenia (frequent infections) 
Swollen lymph nodes
Pallor 
Shortness of Breath 
Fatigue, weakness
120
Q

What are signs and symptoms of a vaso-occlusive episode in a child with Sickle Cell Disease?

A

Jaundice
Fatigue
Edema in hands and feet

Nursing - Bloomberg (52 decks)

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