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N396 Midterm > Critical Differences in Peds > Flashcards

Critical Differences in Peds Flashcards

1
Q

Family does not equal

A

Nuclear family

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2
Q

4 parts of communicating with peds patient and parent

A
  • Introduce yourself
  • Establish trust and follow privacy
  • Comfort and reassure
  • Advocate
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3
Q

Communication with children

A
  • Be aware of developmental stage (consider age, disability)
  • Evaluate for language barriers
  • Use multiple techniques
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4
Q

What is the PK importance of infants with increased skin permeability and larger body surface area?

A

Greater penetration of med and greater risk for toxicity

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5
Q

What is the PK importance of reduced gastric emptying and intestinal motility?

A

Increased time to reach therapeutic concentrations

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6
Q

What is the PK importance of infants with higher proportion of body water?

A

Important consideration related to water solubility of a drug (reach adult values by 12)

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7
Q

What is the PK importance of lower proportion of body fat?

A

Lower doses of lipophilic drugs are required

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8
Q

What is the PK importance of glomerular filtration and tubular secretion being reduced at birth?

A

Gradual increase in renal function with adult values reached the first 1-2 years of life

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9
Q

Pediatric Respiratory Rate

A
  • Variation: fever, chronic conditions (baseline tachypnea), environment (too hot), fever
  • Must count
  • Average range decreases over time
  • Patterns: tachypnea, nasal flaring, retractions and use of intercostal muscles, bradypnea
  • Abdominal breathers until age 7
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10
Q

Pediatric Heart Rate

A
  • Must count
  • Affected by meds, activity, hyperthermia, hypothermia, hypoxia, apprehension, pain, intracranial pressure, hypovolemia, hemorrhage
  • Comparisons: baseline, previous documentation, ask family
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11
Q

Pediatric Blood Pressure

A
  • Start annual measurement around age 3 but younger in hospital
  • Must have correct cuff size or will cause variations: small = high BP and large = low BP
  • HTN = systolic or diastolic BP in 95% or higher 3+ times
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12
Q

Pediatric Temperature

A
  • Normal temp is 98.6 F or 37 C
  • Increase temp from exercise, crying, environment
  • Body temp lowest 1-4 am and higher 4-9 pm
  • Birth-2 years: axillary, rectal over 1 month
  • 2-5 years: axillary, tympanic, oral, rectal
  • Over 5: oral, axillary, tympanic
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13
Q

Fever in Newborns - 3 months

A

Temp over 38 C or 100.4 F

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14
Q

Fever in Infants 3 - 36 months

A

Temp over 38.9 C or 102 F

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15
Q

Fever in children of any age

A

Temp over 40 C or 104 F

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16
Q

Hyperthermia

A
  • Caused by external conditions

- Treat with cooling: cooling blankets, compress, tepid tub bath at 37 C

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17
Q

Hyperpyrexia

A
  • Elevation in set point caused by virus or bacteria
  • Treatment: meds, acetaminophen or ibuprofen, no aspirin
  • Can use cooling measures if done 1 hour after med admin
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18
Q

Peds General Appearance

A
  • Faces
  • Posture
  • Position
  • Body movement
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19
Q

Skin

A
  • Tissue turgor

- Rashes

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20
Q

Iron deficiency

A
  • Iron deficient children often look pale and weak
  • Infants may be overweight due to excessive milk ingestion and toddlers may be underweight
  • Cows milk is not a good source of iron and interferes with iron absorption
  • Adolescents are at risk due to poor eating habits and rapid growth rate
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21
Q

What is IgG?

A
  • Immunoglobulin that crosses the placenta
  • Makes up 75-80% of all antibodies in the system
  • Newborn levels should be similar to mothers but disappear by 6-8 months of age
  • Decreases risk of infection
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22
Q

What is IgA?

A
  • Prevents colonization of bacteria
  • Not present at birth and normal values not achieved until 6 years of age
  • Children under 6 tend to be ill more often due to lack of full complement of immunoglobulins
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23
Q

What is IgE?

A
  • Binds to allergens
  • Not present at birth and normal values not achieved until 6 years of age
  • Children under 6 tend to be ill more often due to lack of full complement of immunoglobulins
24
Q

What is the immune system benefit for breastfed infants?

A
  • Continue to receive antibodies via breastmilk or passive immunity (immunoglobulins)
25
Q

Palmar creases

A
  • Normal = multiple creases

- Simian crease = one large crease across middle of palm

26
Q

Vision testing

A
  • Fixation and following should be present by 3 months of age or should be referred to ophthalmologist
27
Q

Color blindness

A
  • School age children may have great difficulty in performing academic skills that use colors as a visual aid
  • Adolescents may not be eligible for certain vocational opportunities
28
Q

Malformed auricle/pinna or low-set ears

A
  • Associated with syndromes, genitourinary, or chromosomal abnormalities
29
Q

Eardrum position

A
  • Remember to position properly and restrain if necessary for child’s safety
  • Infants: pull pinna down and back
  • Children over 3: pull pinna up and back
30
Q

Nasal flaring

A
  • Indicates respiratory difficulty and should be reported to provider
31
Q

Mouth and throat exam

A
  • Tonsil size varies during childhood but should report if swollen/red/white patches
  • Leave until end of exam bc difficult to have them open their mouths
  • Put tongue depressor to side of mouth so you don’t elicit gag reflex
32
Q

Chest and back exam

A
  • Size/shape/symmetry
  • Movement
  • Nipples
  • Breast development
  • Scapular asymmetry
  • Spinal curvature
  • ROM
33
Q

What is the importance of CV system being proportionately larger in relation to body size?

A

Understand where to auscultate and expect PMI

34
Q

What is the importance of immature heart?

A

More sensitive to volume changes or pressure overload

35
Q

What is the importance of muscle fibers less developed and less organized?

A

Limited functional capacity

36
Q

What is the importance of less compliance?

A

Stroke volume cannot increase substantially

37
Q

What is the importance of small oral cavity and large tongue?

A

Increased risk of obstruction, nasal potency critical in infants

38
Q

What is the importance of newborns and young infants being nose breathers?

A

Will not automatically open mouth if nose is obstructed

39
Q

What is the importance of rapid growth of tonsils and adenoids during childhood, atrophy after age 12?

A

Larger tissues in smaller pharyngeal structures, infection can easily cause obstruction of upper airway

40
Q

What is the importance of larynx and glottis high in neck?

A

Increased chance of aspiration

41
Q

What is the importance of large amount of soft tissue and loosely anchored mucous membranes lining length of airway?

A

Increased likelihood of airway edema and obstruction

42
Q

What is the importance of long, floppy epiglottis?

A

Vulnerable to swelling resulting in possible obstruction

43
Q

What is the importance of fewer functional muscles in airway?

A

Less able to compensate for edema, spasm and trauma, may swallow more mucus than able to sneeze or cough out

44
Q

What is the importance of alveoli not fully developed and lung tissue contains only 25 million?

A

Decreased area for gas exchange

45
Q

What is the importance of bronchioles being narrow and few in number?

A

Swelling could cause difficulty in air exchange

46
Q

What is the importance of relying on diaphragm to breathe and intercostal muscles being less strong?

A

Use of accessory muscles due to decreased efficiency in ventilation

47
Q

What is the importance of trachea being shorter and angle of right bronchus at bifurcation being more acute?

A

Aspirated objects may move quickly out of trachea

48
Q

What is the importance of no voluntary control over swallowing until 6 weeks of age?

A

Evaluate ability to suck, swallow, breathe

49
Q

What is the importance of stomach capacity of newborn being smaller and peristalsis being greater than older children?

A

Newborn needs small, frequent feeding, increased frequency and liquid consistency of stools

50
Q

What is the importance of relaxed cardiac sphincter?

A

Infants frequently regurgitate small amounts of feedings

51
Q

What is the importance of deficiency in amylase, lipase, trypsin to aid digestion?

A

Abdominal distention from gas is common

52
Q

What is the importance of immature liver function?

A

Decreased ability to conjugate bilirubin and excrete bile

53
Q

What is the importance of smaller bladder capacity and insufficient nerve development?

A

Children less than 2 cannot maintain bladder control

54
Q

What is the importance of decreased fat padding?

A

Kidneys are more susceptible to trauma

55
Q

Fractures

A

Bone healing occurs more rapidly in children than adults

56
Q

Shape of bones

A

Bow legs are a normal finding until age 3

57
Q

Neuro Assessment

A
  • Cerebellar function
  • Reflexes
  • Sensation
  • Cranial nerves

N396 Midterm (4 decks)

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