Critical Differences in Peds Flashcards
1
Q
Family does not equal
A
Nuclear family
2
Q
4 parts of communicating with peds patient and parent
A
- Introduce yourself
- Establish trust and follow privacy
- Comfort and reassure
- Advocate
3
Q
Communication with children
A
- Be aware of developmental stage (consider age, disability)
- Evaluate for language barriers
- Use multiple techniques
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
5
Q
What is the PK importance of reduced gastric emptying and intestinal motility?
A
Increased time to reach therapeutic concentrations
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)
7
Q
What is the PK importance of lower proportion of body fat?
A
Lower doses of lipophilic drugs are required
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
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
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
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
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
13
Q
Fever in Newborns - 3 months
A
Temp over 38 C or 100.4 F
14
Q
Fever in Infants 3 - 36 months
A
Temp over 38.9 C or 102 F
15
Q
Fever in children of any age
A
Temp over 40 C or 104 F
16
Q
Hyperthermia
A
- Caused by external conditions
- Treat with cooling: cooling blankets, compress, tepid tub bath at 37 C
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
18
Q
Peds General Appearance
A
- Faces
- Posture
- Position
- Body movement
19
Q
Skin
A
- Tissue turgor
- Rashes
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
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
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
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
Palmar creases
- Normal = multiple creases
| - Simian crease = one large crease across middle of palm
26
Vision testing
- Fixation and following should be present by 3 months of age or should be referred to ophthalmologist
27
Color blindness
- 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
Malformed auricle/pinna or low-set ears
- Associated with syndromes, genitourinary, or chromosomal abnormalities
29
Eardrum position
- 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
Nasal flaring
- Indicates respiratory difficulty and should be reported to provider
31
Mouth and throat exam
- 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
Chest and back exam
- Size/shape/symmetry
- Movement
- Nipples
- Breast development
- Scapular asymmetry
- Spinal curvature
- ROM
33
What is the importance of CV system being proportionately larger in relation to body size?
Understand where to auscultate and expect PMI
34
What is the importance of immature heart?
More sensitive to volume changes or pressure overload
35
What is the importance of muscle fibers less developed and less organized?
Limited functional capacity
36
What is the importance of less compliance?
Stroke volume cannot increase substantially
37
What is the importance of small oral cavity and large tongue?
Increased risk of obstruction, nasal potency critical in infants
38
What is the importance of newborns and young infants being nose breathers?
Will not automatically open mouth if nose is obstructed
39
What is the importance of rapid growth of tonsils and adenoids during childhood, atrophy after age 12?
Larger tissues in smaller pharyngeal structures, infection can easily cause obstruction of upper airway
40
What is the importance of larynx and glottis high in neck?
Increased chance of aspiration
41
What is the importance of large amount of soft tissue and loosely anchored mucous membranes lining length of airway?
Increased likelihood of airway edema and obstruction
42
What is the importance of long, floppy epiglottis?
Vulnerable to swelling resulting in possible obstruction
43
What is the importance of fewer functional muscles in airway?
Less able to compensate for edema, spasm and trauma, may swallow more mucus than able to sneeze or cough out
44
What is the importance of alveoli not fully developed and lung tissue contains only 25 million?
Decreased area for gas exchange
45
What is the importance of bronchioles being narrow and few in number?
Swelling could cause difficulty in air exchange
46
What is the importance of relying on diaphragm to breathe and intercostal muscles being less strong?
Use of accessory muscles due to decreased efficiency in ventilation
47
What is the importance of trachea being shorter and angle of right bronchus at bifurcation being more acute?
Aspirated objects may move quickly out of trachea
48
What is the importance of no voluntary control over swallowing until 6 weeks of age?
Evaluate ability to suck, swallow, breathe
49
What is the importance of stomach capacity of newborn being smaller and peristalsis being greater than older children?
Newborn needs small, frequent feeding, increased frequency and liquid consistency of stools
50
What is the importance of relaxed cardiac sphincter?
Infants frequently regurgitate small amounts of feedings
51
What is the importance of deficiency in amylase, lipase, trypsin to aid digestion?
Abdominal distention from gas is common
52
What is the importance of immature liver function?
Decreased ability to conjugate bilirubin and excrete bile
53
What is the importance of smaller bladder capacity and insufficient nerve development?
Children less than 2 cannot maintain bladder control
54
What is the importance of decreased fat padding?
Kidneys are more susceptible to trauma
55
Fractures
Bone healing occurs more rapidly in children than adults
56
Shape of bones
Bow legs are a normal finding until age 3
57
Neuro Assessment
- Cerebellar function
- Reflexes
- Sensation
- Cranial nerves
