4: Pediatrics 1 Flashcards
What is Normal development: 18 months
• Gross motor
– Walks well alone
– May walk up steps and run
• Fine motor
– Drinks from a cup, feeds
self with spoon
– Can help get undressed
• Social/ emotional – Temper tantrums – Stranger anxiety – Affectionate towards familiar people – Points to show others something interesting and to indicate a want
• Language/communication
– Several single words
– “No” andcanshake head
• Cognitive
– Knows what ordinary things are for (phone,
toothbrush, comb)
– Points to one body part
– Scribbles
– Can follow one-step command without gesture
What are some considerations you must take when examining an 18 moth old?
- Distraction–Do worst exams @ the end & use distraction.
- Position for comfort
- Leave the most intrusive parts for last
- Be flexible
Which of the following are developmental skills did a baby demonstrates? Check all that apply:
A. Follows with eyes B. Eye contact C. Cooing D. Holds head up when on stomach E. 2 hands together
All of the above
How do you know that a baby is healthy?
- Tone/Posture
- Attitude
- Color
- Respiratory rate
Describe sick vs well in pediatric patients concerning Color
Sick: Cyanosis, pale, yellow, petechiae, sallow, etc.
Well: Pink
Describe sick vs well in pediatric patients concerning Posture
Sick: Limp (floppy), Tripod position, curled on side
Well: Good tone, sitting comfortably
Describe sick vs well in pediatric patients concerning Respirations
Sick: Shallow, fast, noisy, slow, retractions, nasal flaring
Well: Normal rate and depth
Describe sick vs well in pediatric patients concerning Attitude
Sick: Irritable (crying without consolation)
Well: Consolable
See case on pgs. 16 - 24
-
PMH in pediatrics includes _______ history.
birth
We want to know if premature or born full-term, jaundice, etc.
For immunizations: we want to know if pediatric patient received __,__,__,__ month vaccines.
For immunizations: we want to know if pediatric patient received 2, 4, 6 and 12 month vaccines (start multiplying by 2, four times).
What are normal vital signs for children (15 month old)?
- Temp: 38.5 C
- Respirations: 20 - 25 breaths/ min
- BP: 70/50 mmHg
- HR: 100 BPM
What is stridor?
Stridor is a high-pitched musical breath sound resulting from turbulent air flow in the larynx or lower in the bronchial tree. Stridor is a physical sign which is caused by a narrowed or obstructed airway. Stridor is always pathological.
Causes:
- Congenital anomalies
- Trauma (post intubation)
- Foreign body
- Metabolic disorders
• Inflammatory disease
– Retropharyngeal abscess
– Epiglottitis
– Laryngotracheobronchitis
What is a steeple sign on x-ray?
In radiology, the steeple sign is a radiologic sign found on a frontal neck radiograph where subglottic tracheal narrowing produces an inverted “V” shape within the trachea itself. The presence of the steeple sign supports a diagnosis of croup.
What is Croup?
Croup is inflammation of the subglottic tissues (laryngotracheobronchitis)
It is caused by Parainfluenza virus, influenza, adenovirus, RSV
Peak age of onset is 3 months to 3 years
Clinical features: Prodrome of low-grade fever, rhinorrhea, stridor and hoarse voice
Imaging: Steeple sign on AP neck film
Treatment: Supportive, oxygen/mist, & corticosteroids
What is Epiglotitis?
Epiglotitis is inflammation and edema of the epiglottis and aryepiglottic folds
It is caused by Haemophilus influenzae type b, Staph aureus, strep pneumococcus
Peak age of onset is 3- 5 years
Clinical features: Fever, ill or toxic appearance, sore throat, stridor, drooling
Imaging: Thumb print on lateral neck radiograph film
Treatment: Emergent (surgical) airway management, parenteral antibiotics, fluids
When examining a pediatric patient, we use the _______ due to the smaller area–localizes sounds better. You can use the _____ for breath sounds.
When examining a pediatric patient, we use take _______ that the infants give us to do other exams–like him waving his arms can do neuro & musculoskeletal exams. ______ exam = doing things @ the best time you can do it.
When examining a pediatric patient, we use the bell or short side of stethoscope due to the smaller area–localizes sounds better. You can use the diaphragm (big part) for breath sounds.
When examining a pediatric patient, we use take opportunities that the infants give us to do other exams–like him waving his arms can do neuro & musculoskeletal exams. Opportunistic exam = doing things @ the best time you can do it.
Upper airway sounds = _____
Lower airway sounds = _____
Upper airway sounds = Rochi - mucous plug. Musical sound.
Lower airway sounds = Rales–when you hear sound in lower airway, if you listen over the nose it cant be a rale because over mouth (since lower airway sound)
_____ percussion is easier & scratch test for organ sizes is best.
With children of a certain age, you can percuss/ palpate with _______.
Scratch percussion is easier & scratch test for organ sizes is best.
With children of a certain age, you can percuss/ palpate with just one finger.
