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Peds > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Erikson’s 8 stages of social-emotional development

A

Trust vs Mistrust (Birth -12 months)

Autonomy vs Shame and Doubt (12-36 months)

Initiative vs Guilt (preschool 3-5 years)

Industry vs Inferiority (school age)

Identity vs Role Confusion (12-18 years)

Intimacy vs isolation (18–25 years)

Generativity versus self-absorption and stagnation (25–65 years)

Integrity versus despair (65 years–death)

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2
Q

Kohlberg’s 3 stages of moral development

A
  • Preconventional level
  • Conventional level
  • Postconventional, autonomous, or principled level
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3
Q

Piaget’s 4 stages of cognitive development

A
  • Sensorimotor (birth to 2 years)
  • Preoperational (2 to 7 years)
  • Concrete operations (7 to 11 years)
  • Formal operations (11 to 15 years)
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4
Q

Family-centered care 3 key concepts

A
  • Recognizes family as constant source of security and structure in child’s life
  • Systems must support, empower and improve competence of family to maintain their control
  • Needs of all family members must be considered (excess stress in family can impact child)
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5
Q

4 topics that can be discussed with adolescence w/o parental involvement

A
  • pregnancy
  • STDs
  • mental health concerns
  • substance abuse
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6
Q

Informed consent and children

Who can give informed consent?
Who can give assent?

A
  • emancipated minors or parents of children give informed consent
  • assent given by children over 7 which says they permit and understand the procedure but this is not legally binding
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7
Q

3 parenting styles

A
  • Authoritarian- negative, demeaning (control via unquestioned mandates)
  • Permissive (little or no control)
  • Authoritative- strict, consistent, respect child
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8
Q

Cultural beliefs and practices: Mexican American

Health Practices (2)
Family (2)
Communication (3)

A

Health Practices
- care received from curandero
- herbs and hot and cold practices

Family
- extended families key
- children valuable

Communication
- may shake hands or use long hug
- may use extended eye contact
- relaxed concept of time

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9
Q

Cultural beliefs and practices: Vietnamese

Health Practices (2)
Family (2)
Communication (2)

A

Health Practices
- use coining, cupping, pinching of skin
- use herbs and spiritual practices

Family
- extended families key
- father = decision maker

Communication
- usually does not ask questions
- avoids eye contact

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10
Q

Cultural beliefs and practices: Chinese

Health Practices (2)
Family (2)
Communication (3)

A

Health Practices
- illness= imbalance
- use herbs, ying/yang, tai chi, acupunture

Family
- extended families key
- self reliant

Communication
- may smile out of politeness vs understanding
- excess eye contact may be rude
- may limit expressions

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11
Q

5 attributes of development

A
  • physical (growth, sleep, nutrition, organ maturation)
  • cognitive
  • motoric (fine and gross)
  • communication (speech, language)
  • social/emotional
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12
Q

What are contraindications to live vaccines? (4)

Live vaccines (MMR, Nasal flu, Varicella)

A
  • transfusions, Immunoglobins (including maternal), chemo in past 3-6 months
  • under 12 months
  • pregnant
  • immunocompromised
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13
Q

What are the following?

VIS
VAERS

A
  • VIS (Vaccine Information Statement) must be provided and reviewed by patient/caregiver prior to vaccine administration.
  • Vaccine Adverse Events Reporting System (VAERS)- All vaccine adverse reactions need to be reported
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14
Q

Vaccine absolute contraindications (2)

A
  • severe febrile illness (> 100 F)
  • allergy to past vaccine or vaccine components
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15
Q

Vaccine contraindications

  • Hep B
  • rotavirus (2)
  • pertussive
  • Polio (3)
  • influenza
  • varicella(2)
A
  • yeast allergy for Hep B vac
  • intussusception or severe combined immunodeficiency for rotavirus vac
  • encephalopathy in previous 7 days for pertussis vac
  • formalin, neomycin/streptomycin, polymixin B for IPV vaccine
  • egg allergy for influenza vac
  • gelatin or neomycin allergy for varicella
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16
Q

Theories (what do they focus on?)

Family Systems Theory
Family Stress Theory

A

Family systems discusses the family functions as a unit based on the interactions.

Family stress focuses on adaptability of the family based on reaction to stress.

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17
Q

2- month immunizations (6)

A

Pneumococcal/PCV13
Hib
IPV
Hep B (birth, 1-2)
DTap
Rotavirus

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18
Q

4 month immunizations (5)

A

Pneumococcal/PCV13
Hib
IPV
DTap
Rotavirus

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19
Q

6 month immunizations (7)

A

Influenza (annually)
Pneumococcal/PCV13
Hib
IPV (6-18m)
Hep B (6-18m)
DTap
Rotavirus

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20
Q

12-15 month immunizations (9)

A

Influenza (annually)
Varicella
MMR
Pneumococcal/PCV13
Hib (12-18m)
Hep A (12-23 m)
IPV (6-18m)
Hep B (6-18m)
DTap (12-18m)

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21
Q

4-6 yr old immunizations (5)

A

IPV
Varicella
MMR
DTap
Influenza (yearly)

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22
Q

11-12 yr old immunizations (4)

A

HPV (9-26)
Meningococcal (also 16-college years for booster)
Influenza (yearly)
TDap booster

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23
Q

7 Tips for immunizations and IM injections

A
  • Use calm and neutral words (here I go vs here comes the sting)
  • Do not give in Dorsogluteal site (potential for nerve damage and less immunity)
  • give multiple immunizations at same time in separate sites or at least 1 inch apart
  • Do not manually stimulate injection site
  • children do not need to restart series after dose missed, just continue where they left off
  • vastus lateralis (preferred) or ventrogluteal (okay for 2m+)
  • wake up sleeping children or may fear going back to sleep
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24
Q

Expected Findings for child with Autism (5)

A
  • Delays in social interaction and imaginative play before age 3 years
  • Avoidance of eye and physical contact
  • Short attention span
  • Rhythmic movements
  • Attached to routines
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25
Q

Interventions for autism (7)

A
  • Early screening and intervention to maximize their social skills
  • Behavior Modification i.e. Limit setting
  • Decreasing environmental stimuli
  • Introduce new situations slowly
  • Involve parents b-c warm up to new people slowly
  • Promote consistency in caregiving
  • Ensure safety (May have poorer safety cues)
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26
Q

Physical Growth: Infants

Weight (3)
Length (3)

A

Weight
- Regain birth weight by 2 weeks (up to 10% loss)
- Double birth weight by age 6 months
- Triple birth weight by age 1 year

Length
- measured until 24-36 months
- length should increase by 50% by 1 year
- faster growth in first 6 months vs 2nd 6 months

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27
Q

Physical Growth: Infants

Head circumference (4)
Fontanels (2)

A

Head Circumference
- increase by 33% by 1 yr
- important determinant of brain growth (microcephaly indicates neurological insult and macrocephaly can indicate increased ICP)
- measured above eyes and ears until 36 months
- equals chest circumference by 1 yr

Fontanels
- anterior closes b/w 12-18 months
- posterior closes b/w 6-8 weeks

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28
Q

Maturation of Systems: Infants

Hematopoietic
Digestion (2)
Renal
Immunity (2)

A

Hematopoietic
- physiologic anemia 3-6 months due to fetal Hgb disappearing before adult hgb compensates

Digestion
- drooling around 3m due to poorly coordinated swallowing reflex
- Enzymes specific for breaking down milk till 5-6m (amylase and lipase develop then)

Renal system
-immature so meds stay in system longer till age 3 yrs

Immunity
- lack IgA (in colostrum)
- has vernix caseosa (white oily substance in creases w/ protective properties

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29
Q

Age appropriate toys: infants

A
  • nesting toys
  • teething rings
  • rattles
  • mobile
  • high contrast (0-6m)
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30
Q

Gross motor development: Infant

What age are the following accomplished?

  • Head control
  • Rolling over (2)
  • Sitting (supported vs unsupported)
A

Head control-2-3 months

Rolling over- as early as 2 months
- Age 5 months: abdomen to back
- Age 6 months: back to abdomen

Sitting: supported by hands at 7m and unsupported by 8m

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31
Q

Gross motor development: Infant

What age are the following accomplished?

  • Crawls (on belly) then creeps (on hands)
  • Move from prone to sitting position
  • Cruises around furniture
  • Sits from standing
  • Bear full weight on feet
A

Crawls (on belly) then creeps (on hands) 8 months

Move from prone to sitting position: age 10 months

Cruises around furniture -11months

Sits from standing- 12 months- some walking

Bear weight on feet- 7 months

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32
Q

Fine motor development: Infant

What age are the following accomplished?

  • grasping object
  • palmar grasp
  • holds bottle
  • transfers objects from hand to hand
  • pincer grasp
A

Grasping object: ages 2 to 3 months

Palmar grasp 5 months

Holds bottle: age 6 months

Transferring object between hands: age 7 months

Pincer grasp: crude begins at 8 months and neat by 11 months

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33
Q

Fine motor development: Infant

What age are the following accomplished?

  • remove objects from container
  • two block tower but fails
  • pick up dropped objects
  • develops dominant hand preference
A

Removing objects from container: age 11m

Building tower of two blocks but fails: age 1 year

Pick up dropped objects: 6m

Develops dominant hand preference: 9m

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34
Q

In what order do these occur?

  1. Nesting objects
  2. Use crude pincer grasp
  3. Holds rattle
  4. Look for objects dropped
  5. Grasp reflex strong
  6. Transfer items from 1 hand to another
  7. Rake food
  8. Turns many pages at a time
A

5, 3, 4, 6, 7, 2,1,8

Grasp reflex strong
Holds rattle
Look for objects dropped
Transfer items from 1 hand to another
Rake food
Use crude pincer grasp
Nesting objects
Turns many pages at a time

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35
Q

Psychosocial Development: Infant

Trust Development (2 )
Mistrust Development (2)
Social behaviors (2)

A

Trust
- Feeding
- Stimulation and Comfort (quality care)

Mistrust
- when gratification of needs is delayed
- when needs met before infant asks (does not learn delayed gratification)

Social modifications
- Grasping (pleasurable tactile)
- Biting (first conflict is biting w/ breastfeeding)

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36
Q

Cognitive Development: Infant

Progression of sensorimotor stage (6)

A
  1. Primitive Reflexes (birth- 1m)
  2. Voluntary Acts (1-4 m)
    - reaching and grasping for a wanted toy
    - realize causality i.e. primary circular reactions)
  3. Imitation of sounds and gestures (play) – 4-8 m
  4. Repetition
    - Apply to a new situ ation-drop the toy, someone will pick it up
    - recognize others also control environment
  5. Affects- Wave “bye bye” mom goes to work (reason for separation anxiety)
  6. Object permanence (6 months w/ peek a boo; 8-12 Advanced object permanence, separation anxiety)
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37
Q

Age-specific difficulties: Infants

2 notes and age ranges

A
  • separation anxiety b/w 4-8 months
    (insecure attachment disorders form here if failure to learn object permanence and discriminate parent from others)
  • stranger fear b/w 6-8 months
    (nurse should be soft, eye-level, stay safe distance and avoid sudden invasive gestures; child may refuse to play with strangers)
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38
Q

Language Development: Infants

What age do the following occur?

  • Pronounces vowels
  • Verbalizes consonants
  • Understand words such as “no, mama, dada”
  • Speaks 3-5 words with meaning
A
  • Pronounces vowels by 2 months
  • Verbalizes consonants by 5-6 months
  • understands simple commands and gives meaning to words by 9-10 months
  • Understand words such as “no, mama, dada” by 10 months
  • Speaks 3-5 words with meaning - 12 months (besides dada, mama)
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39
Q

Sleep: infants

Average amount of hrs a day
SIDS prevention (5)

A

15 hrs each day (9-11 at night by 4m)

SIDS prevention
- back to sleep
- sleep in crib w/ firm mattress
- no loose objects, crib bumpers, soft toys, and bedding out of baby’s sleep area
- avoid letting baby overheat at night
- breastfeed first 6 months

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40
Q

Nutrition: Infants

Primary nutrition (2)
Supplements (3)
Food introduction (3)

A

Primary nutrition
- breastfeed exclusively w/ iron supplements for first 6m
- iron fortified formula okay alt (do not microwave)

Supplements
- Vitamin D in first few days of life
- iron supplements or iron-fortified formula
- fluoride supplements if at risk for caries

Food introduction
- solids okay around 6m (teeth appear, extrusion reflex gone, head control)
- one new food a week (q4-7 days)
- start w/ cereal then veggies, fruit, meat

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41
Q

Nutrition: Infants

Things to avoid (4)
Weaning from bottle/breast (3)

A

Things to avoid
- avoid cow milk, honey, citrus, eggs, strawberries early
- do not mix food in bottle and feed through large nipple
- do not give add’l fluids in first 4 months
- avoid propping bottle, milk in bed, and fruit juices to prevent caries

Weaning from bottle/breast
- replace one feed at a time
- night feed is last to go
- usually done around 2 yrs

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42
Q

Dental Care: Infant and toddler

Guidelines (5)
Teeth (2)

A
  • first dental visit at 6 month
  • wipe teeth with moist cloth till teeth/6m
  • brush with water till 2 yrs
  • pea size of toothpaste at 2 yrs

Teeth
-Age of child in months- 6 = # of teeth
- relieve teething w/ cold or acetaminophen

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43
Q

5 safety concerns for infants - Preschool (and recommendations)

A

ASPIRATION- check for small objects, feed sitting up, small food bites, avoid pits and bones

SUFFOCATION- “Back to sleep”, avoid extra blankets and pillow, avoid unsafe sleep, crib slats, 6cm apart, no crib bumpers, remove bibs, avoid bags, balloons, and buckets

DROWNING- supervise baths, fence pools, keep bathroom doors closed, keep appliances shut; teach toddlers and up how to swim and not go in water too deep

FALLS-crib rails, car seats, supervise when on furniture, avoid scatter rugs, fence the stairs, keep furniture away from the window.

BODILY DAMAGE-Secure furniture, supervise with animals, keep away sharp items, walk w/ scissors down

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44
Q

Poisoning Safety Promotion: Infants - School age (7)

A
  • check paint for furniture and toys- no lead
  • All toxic substances on high shelf
  • Keep plants out of reach
  • Child safe caps and all meds stored out of reach (SAFETY LOCK FOR TODDLERS)
  • Know poison control number (1-800-222-1222)
  • Give medications as a drug, do not call it “candy”
  • Carbon monoxide detector in home
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45
Q

Burns Safety Promotion: Infants- School age (9)

A
  • Smoke detectors
  • Check temperature of all formula and bath waters
  • Water heater set under 120 degrees
  • Avoid cigarettes/ashes near child
  • Flame retardant clothes
  • Store all candles, matches, lighters in high place
  • Caution with sun exposure, use sunscreen
  • Safe cooking (microwave and pot handles turned inward)
  • Do practice fire drills
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46
Q

Physical Development: Toddlers

Weight
Height (3)
Stature/Posture

A

Weight- quadruple birth weight by 30 months

Heights
- grow 3 in a year
- measured starting at age 2 yrs
- growth via leg elongation

Stature- potbelly and wide legged (under after 2 yrs)

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47
Q

Maturation of Systems: Toddlers

Neurological (2)
Elimination (2)

A

Neuro
- all brain cells present by 1 yr
- myelination of spinal cord complete

Elimination
- voluntary control around 18-24 m
- hold urine 2 hrs by 14-18m

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48
Q

Fine motor Development: Toddler

What can be done at the following ages?

15 months (3)
18 months (3)
2 years
2.5 years (2)

A

15 months
- Uses a cup well
- Builds a tower of 2 blocks
- play fetch

18 months
- Manages a spoon
- Turns pages in book 2-3 at a time
- Throws ball overhand w/o losing balance

2 years
- Builds a tower of 6-7 blocks

2.5 years
- Draws circles
- Has good hand-finger coordination

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49
Q

Gross motor Development: Toddler

What can be done at the following ages?

15 months (2)
18 months (2)
2 years
2.5 years (2)

A

15 months
- Walks without help w/ wide stance
- Creeps up stairs

18 months
- Assumes a standing position
- tries to run but falls

2 years
- Walks up and down stairs

2.5 years
- Jumps in place with both feet
- Stands on one foot momentarily

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50
Q

Cognitive Development: Toddlers

2 Piaget stages
5 developmental concepts

A
  • sensorimotor stage (until 2 years)
  • preoperational stage (2-7)
  • Cannot distinguish safe from unsafe (so must physically remove from danger)
  • object’s appearance dictates its functions based on child’s memory of what that object does
  • Domestic mimicry (playing house, role play)
  • Beginning sense of time (“Wait a minute”)– spatial relations
  • object permanence advances
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51
Q

Moral Development: All ages

  • Punishment and obedience orientation
  • Naive instrumental orientation
  • school age morals
  • adolescent morals
A
  • Punishment and obedience orientation (2-4 yrs): action is good or bad based on rewards or punishments
  • Naïve instrumental orientation (4-7 yrs): actions directed toward satisfying their need and less so the needs of others; concrete sense of justice and fairness based on what others say
  • School age- morality of the rule and situation determine the children reaction
  • Adolescent- moral standards are subjective so they question everything and decide for themselves
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52
Q

Language Development: Toddler

Differences b/w 1, 2, and 3 yr old

3 tips

A
  • by 1, say one-word sentences or holophrases
  • by 2, can use multiword sentences and string 2-3 words together
  • by 3, can use simple sentences, grammatical rules and know age

Tips
- use adult-child conversations (reading, storytelling, interaction)
- avoid screen use for under 18 m
- child usually understands more than they can say

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53
Q

Body Image and Sexuality: Infant - Preschool

Developmental milestones (4)
Two tips to answer sex education questions

A
  • body image by 1 yr
  • recognize gender differences by 2
  • gender identity by 3 yrs (may fondle genitalia, “play doctor”)
  • Notice body size in comparison to others by 5 yrs

Sex education tips
- Find out what child knows and thinks
- Be honest (most info is forgotten but correct info can be repeated till child comprehends

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54
Q

Psychosocial development: Toddler

6 concepts related to Autonomy vs Shame and Doubt

A
  • Independence (differentiate self from others; accept separation from others, control bodily functions)
  • Negativism (negative responses; so reduce opportunities to say no)
  • Ritualism (provides them comfort)
  • Transitional objects
  • Animism
  • Centration- focus on one thing
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55
Q

Age-appropriate activities: toddlers (7)

A
  • Blocks
  • Books
  • Push/pull toys
  • Balls
  • Large piece puzzles
  • Finger paints/thick crayons
  • Imagination (Boxes, kitchen pots/spoons)
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56
Q

What is the purpose of play?

What kind of play do different ages engage in?

A
  • relief of stress, energy, tension (a way to cope)
  • intellectual and social development

Infants- sensory affective and solitary play
Toddlers - parallel play (usually do not share)
Preschool- associative play (group play w/o rigidity)
School age- cooperative and competitive

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57
Q

Toilet training

Factors (3)
Tips (3)

A

Factors needed
- Voluntary sphincter control begins 18-24 months train at 22-30 months
- child feels urge to urinate or defecate and communicates the need
- child can stay dry 2 hours

Tips
- Nighttime develops last- should master before 6 years
- Limit practice sessions to 5-8 minutes
- stay with child, give clear directions, rewards

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58
Q

6 Discipline Methods

A
  • Reasoning (appropriate for older children esp related to morals; may involve contracting)
  • Behavior modification (positive reinforcement and rewards)- Call out the behavior not the child; suggest appropriate alternatives
  • Ignoring (useful b-c Child may experience “response burst” i.e. increase negative behavior at the start of parental ignoring to test limits
  • Time-out ( 1 minute per year of age in non stimulating environment; withholding privileges)
  • Corporal punishment (short-term decrease in behavior but teaches children that violence is acceptable and can harm them)– not recommended
  • verbal ( stern voice, sustained eye contact) for young children
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59
Q

3 Age-specific Difficulties: Toddlers and preschoolers

What are they? (3 concerns)
How to manage them?

A

Temper Tantrums (kicking, screaming, holding breath)
- manage w/ consistent expectations, ignore noninjurious behavior, time outs
- normal part of development (problem if > 15 mins, > 5x per day, or after 5 yrs

Sibling rivalry (upset by dethronement; preschoolers may act out)
- manage by preparing child before the birth

Regression (during stress or discomfort)
- manage w/ ignoring and praising appropriate behavior

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60
Q

Sleep: Toddlers

Avg amount of hrs
Tips related to bedtime (3)

A

11-12 hours a day w/ one nap a day

Tips
- move to bed at 35 inches
- establish bedtime ritual (same hr, snack, stuffed animal or blanket)
- may be resistant or have night wakings

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61
Q

Nutrition: Toddlers

Serving Sizes
Limits (2)
Concerns (2)

A

Serving size
- 1 tbsp/year of age

Limits
- 24-30 oz/day of milk (can be lowfat at 2 yrs)
- 4-6 oz/day of juice

Concerns
- physiologic anorexia (18m) due to picky eating and food fads (one food over others)
- tactile learners so play with food

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62
Q

Motor Vehicle Safety Promotion: All ages (9)

A
  • all children in rear seat until 13 yrs
  • rear-facing carseat until 2 yrs
  • front-facing carseat until 4 yrs/ 40 pounds
  • booster seat until 80 pounds or 4 ft 9 in
  • keep trunk closed
  • do not leave child unattended in car
  • seat belt use
  • no phone, alc, or drugs while driving (for adolescents)
  • do not add extra padding to car seats
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63
Q

Physical Development: Preschool

Weight
Height (2)
Posture

A

Weight: 2-3 kg per yr

Height
- 6.5-9 cm per yr
- elongation of legs vs trunk

Posture: graceful, slender and sturdy

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64
Q

Gross motor development: preschool

3 yrs (4)
4 yrs (2)
5 yrs (4)

A

3 years
- Rides tricycle
- Jumps off bottom step and broad jumps
- Stands on one foot for a few seconds
- tiptoe

4 years
- Skips and hops on one foot
- Throws a ball overhead

5 years
- Jumps rope, skates, swims
- Walks backward heel to toe
- Throws and catches ball easily
- skips on alternate feet

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65
Q

Fine motor development: preschool

3 yrs (2)
4 yrs (3)
5 yrs (2)

A

3 years
- Copies circle and cross
- Tower of 9-10 cubes

4 years
- Uses scissors
- Laces shoes but can’t tie bow
- dress self

5 years
- Ties shoes but may need help
- Uses scissors and pencil well

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66
Q

Psychosocial Development: Preschool (Initiative vs guilt

When does conflict occur?
Tasks (2)

A
  • guilt due to consequences of misbehavior

Tasks
- develop consciousness
- magical thinking (b-c I thought it, it happened)

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67
Q

Typical Age-specific difficulties: Pre-school (2)

A
  • fear of bodily harm (dark, animals, procedure; think broken skin = insides will come out) until 5-6 yrs
  • Aggression due to frustration (thwart self-satisfaction), modeling (parent aggressive), and reinforcement (get attention)– usually normal
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68
Q

Cognitive Development: Preschool

  • Preoperational: preconceptual (2)
  • Intuitive (4)
A

Pre-conceptual thought (2-4 yrs)
- problem solving based on what is seen vs memory
- concerned w/ why and how of things

Intuitive thought (later preoperational phase)
- Classify information, aware of cause/effect
- Understand time w/ regard to daily events (mom will come after lunch))
- begin to consider others POV (may give brief explanations and expect others to fully understand (transductive reasoning))
- very literal thinking

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69
Q

Language Development: Preschool

  • Sentence Development (2)
  • Speech problems (and 4 tips management)
A

Sentences
- telegraphic speech (3-4 word sentences w/ essential info) at 3-4 yrs
- 4-5 word sentences w/ adjectives, verbs, prepositions by 4-5 yrs

Speech Problems: stuttering or stammering around 2-5 yrs
- Manage w/ speaking slow, not interrupting, not completing child’s sentences, and listening

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70
Q

Social Development: Preschooler (4)

A
  • Completion of separation-individuation (began in infancy)– aware of their position and role in family
  • why replaces toddler’s no
  • able to understand warnings of danger
  • develops imaginary friends (usually rid at school entry)
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71
Q

Age-appropriate activities: Preschool (7)

A
  • Tricycles, wagons, sports equipment
  • alphabet or number flash cards AND books
  • Electronic games and educational TV for learning
  • Paints, crayons
  • musical toys
  • Imaginative or dramatic play such as dress up clothes, dolls, housekeeping, puppets, Construction sets
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72
Q

Sleep: preschool

Avg time
Tips for bedtime (2)

A

12 hrs a day (some may nap)

Tips
- do not let sleep w/ parents
- use night light for fears of dark, nightmares, terrors which are common

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73
Q

5 R’s to promote school readiness for preschoolers

A
  • Read with their children daily
  • Rhyme, play, and cuddle with their children daily; maintain family
  • Routines for meals, playtime, and sleeping
  • Reward their children with praise for successes
  • Establish strong, nurturing relationships with their children.
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74
Q

Nutrition: preschool

Serving Size
Difficulties
Health Promotion (3)

A

Serving size
- half serving size of as adults

Difficulties
- picky eating improves by age 5

Health Promotion
- choose low fat over high fat (fat < 30% of diet)
- ensure calcium and vitamin D
- ensure 1-2 hrs/day of activity

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75
Q

Physical Development: School age

Weight
Height
Physical appearance (2)

A

Weight- 2-3 kg/yr
Height- 5cm/yr

Physical appearance
- doubled strength
- refined coordination

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76
Q

Maturation of Systems: School age (2)

A
  • prepubescent around age 9 (2 yrs prior to puberty)
  • last deciduous tooth shed at beginning and final permanent teeth added at the end
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77
Q

Social Development: School age (4)

A
  • self-concept (concious awareness of self and ideals) develops and is influenced by others
  • peer pressure (need to conform and belong; may need to bullying)
  • clubs (groups w/ rigid rules)
  • dyadic relationships w/ same-sex i.e. best friends
78
Q

Psychosocial Development: School Age

Industry criteria (2)
Inferiority criteria (2)

A

Industry
- sense of accomplishment (competitions, meaningful work)
- extrinsic motivation (rule follower, like to win, rewards)

Inferiority
- fear ridicule by peers
- unable to excel in areas (all children must learn that they can not master everything)

79
Q

Cognitive Development: School age

6 developments in Concrete Operations

A
  • Masters concept of conservation (numbers, substance, weight, volume/displacement)
  • Can see other POV (understands emotions)
  • Understand relational concepts (Tells time, understands size and color gradients)
  • Classifications (into groups based on attributes or logical order)
  • Learn to read (Understands rules of grammar and that a word can have many meanings)
  • conceptual thinking (judge what they reason)
80
Q

Age-appropriate activities: School Age (5)

A
  • Teams (Clubs and peer groups; organized sports)
  • Hopscotch, jump rope
  • Ride bicycles
  • Quiet activities (Building models, Crafts, board games)
  • Collections (rocks, stamps, cards, coins, stuffed animals)
81
Q

Age-specific difficulties: School age

School (3)

A
  • see teacher as mentor
  • may be latchkey (need activities and safety guidance)
  • may have stress (teach coping skills )
82
Q

Disinhibited behavior: Preschool- School age

3 types and why they happen

A
  • Lying (most know it is wrong but still may do it to escape punishment ( young child) or to meet expectations of others (older child)
  • Stealing (Limited sense of property rights b/w 5-8 yrs so take what they are attracted)
  • Cheating ( 5-6 yrs, may not recognize it is wrong and do it automatically)
83
Q

Sleep: School age

Avg amount of sleep
Age-specific tips (3)

A

Avg amount: 9-11 hrs a night (no naps)

  • younger (6-7) have fewer bedtime problems)
  • middle (8-11) may need reminders and be resistant so have routine
  • Older (12) may listen to music or read prior to bed
84
Q

Nutrition: School age

Difficulties (2)
Tips (4)

A

Difficulties
- Don’t know what kids eat when away (even if parent packs lunch
- Junk food and fast foods common

Tips
- Provide nutritious snacks
- Role model healthy eating
- eat less than preschoolers and adolescents
- do not need to eat as promptly as preschoolers

85
Q

Bicycle Safety: Preschool-Adolescent (5)

A
  • Wear helmets when riding bike, motorcycle, ATV, skateboards, scooters
  • Learn rules of road (Ride with direction of traffic away from parked cars, use hand signals)
  • Walk bike if busy area
  • Use lights and reflectors, light clothes at night
  • Don’t ride double unless equipped
86
Q

Bodily harm Safety: School age- adolescent (5)

A
  • protective equipment during sports
  • locked firearms
  • window guards to prevent falls
  • teach address, phone, and stranger safety
  • no trampoline in under 6 yr olds
87
Q

Physical development: Adolescence

Girl Height (2)
Girl Weight
Boy Height (2)
Boy Weight

Growth pattern

A

Girl Height- stop growing 2-2.5 years after menarche/puberty, grow 2-8 inches

Girl Weight- gain 7-25 kg (15 - 55 pounds)

Boy height- stop growing at age 18-20 years, grow 4-12 inches

Boys weight- 7-30 kg (15.5-66 pounds)

Growth pattern: lanky b-c extremities and neck grow prior to rest of body

88
Q

Sexual maturation order: Girls (4)

A
  • Appearance of breast buds (thelarche)– 9-10 yrs (delay if not by 13 yrs)
  • Growth of pubic hair (Adrenarche)-follows thelarche in 2-6 months
  • Axillary hair growth
  • Onset of menstruation (menarche)– 10-15 yrs (delay after 15 yrs)
89
Q

Sexual maturation order: Boys (7)

A
  • Testicular enlargement (delay if not by 14 yrs)
  • gynecomastia (transient for 2 yrs)
  • Appearance of pubic hair
  • Growth of genitalia
  • Growth of axillary hair
  • Facial hair growth (2 yrs after pubic hair)
  • Change in voice
90
Q

Cognitive development: Adolescence

Formal Operations Concepts (5)

A
  • Abstract thinking/ imaginative
  • use analytical thinking to make decisions
  • Able to think through more than 2 variables concurrently
  • Evaluate own thinking and others (Able to understand how actions/factors influence others)
  • Idealistic
91
Q

Psychosocial development: Adolescence

Identities developed (3)
Concepts (1)

A

Identities
- Personal sense of identity (coherent picture of past, present, future; autonomy from parents)
- Group identity with peer group (best friends, rejection of adult group; very important)
- sexual identity (Increased interest in romantic relationships, may experiment, body image))

Concepts
- View themselves as invincible

92
Q

Age-appropriate activities: Adolescence

A
  • Non-violent video games and music
  • Social Media
  • Sports
  • pets
  • Career training programs
  • Reading
  • Social events- dances, movies, football games
93
Q

Nutrition: Adolescence

Difficulties (8)

A
  • May omit meals (esp breakfast)
  • Common deficiencies: vitamins (folic, b6, A) and mineral (iron, calcium, zinc)
  • Excess in sugar, fat, cholesterol, and sodium
  • Eating disorders (Anorexia and bulimia)
  • Obesity
  • hyperlipidemia (screen 9 yrs and up)
  • hypertension (screen 3 yrs and up)
  • doubled nutrition requirements
94
Q

Bright Futures Areas to Assess in Well-Child Visits (5)

A
  • Emotional well-being (coping, mood regulation, mental health, sexuality, Suicidal ideation)
  • Physical growth and development (physical and dental health, body image, healthy nutrition, physical activity)
  • Social and academic competence (relationships with peers and family, school performance, interpersonal relationships)
  • Risk reduction (tobacco, alcohol, other drugs, pregnancy, STIs)– important in adolescence b-c risk taking behavior
  • Violence and injury prevention (safety belt and helmet use, substance abuse and riding in a vehicle, interpersonal violence, bullying)– encourage safe driving
95
Q

Mental Health Concerns: Adolescence

4 signs

A
  • Poor school performance
  • Lack of interest/ Social isolation
  • Sleep or appetite disturbances (should get 9 hrs)
  • Expression of suicidal thoughts (suicide 3rd leading cause of death; screen ALL)
96
Q

Health Promotion: Adolescence (3)

A
  • discourage tanning (suggest lotions and SPF sunscreen)
  • encourage sterilized equipment for body art (tattoos and piercings) esp if diabetic, asthmatic, or skin disorders
  • if working, do not do more than 20 hrs a week
97
Q

Sexuality: School age and Adolescence

Tips for sex education (5)

A
  • school age need concrete answers
  • Ask about sex in nonjudgmental way (do not assume sexual orientation)
  • do not try to force adolescents to disclose things to family w/o safety plan
  • Address questions in “matter of fact” way using proper terminology
  • Protect adolescents to access of unrealistic expectations through media devices
98
Q

Body Surface Area

Equation
Units

A

Equation: √((ht (cm) x wt (kg))/3600))

Units: m2

99
Q

Fluid Requirements

Daily fluid requirements
Measuring Output (3)

A
  • Based on child weight i.e. 100 (first 10 kg)+ 50 (2nd 10kg) + 20 (remaining kg)

Output
- q2h
- subtract weight of dry diaper from wet diaper (unable to distinguish stool from urine)
- minimum 1 mL/kg/hr (30 mL/hr if > 30 kg)

100
Q

Normal Temperature for children

A

36.7-37.5

101
Q

Normal Heart Rates for 3mo-2 yrs, 2yrs-10yrs, and 10 yrs+

Resting (awake)
Resting (sleeping)

A

3mo-2 yrs
Resting (awake): 80-150 beats/min
Resting (sleeping): 70-120 beats/min

2yrs-10 yrs
Resting (awake): 70-110 beats/min
Resting (sleeping): 60-90 beats/min

10 yrs+
- 60-100 beats/min

102
Q

Normal Respiratory rates:

1-11 mo
2-6 yrs
8-10 yrs

A

1-11 mo: 30-60 breaths/min
2-6 yrs: 21-25 breaths/min
8-10 yrs: 19-21 breaths/min

103
Q

Normal blood pressure:

1-2 yrs
5 yrs
10 yrs
14 yrs

What may discrepancy of lower and upper extremity BP indicate?

A

1-2 yrs: 90/56 mm hg (measured starting at 3 routinely OR for critical care)
5 yrs: 95/56 mm Hg
10 yrs: 102/62 mm Hg
14 yrs: 110/65 mm Hg

Discrepancy: Coarctation of the Aorta

104
Q

Pediatric Exam

General Tips (7)

A
  • Warm, child-friendly room
  • Include time to play and become acquainted
  • auscultate heart, abdomen lungs early before child disturbed (infants- toddlers)
  • Perform distressing procedures near the end of the exam (ears and mouth; areas of pain; temp and BP)
  • offer choices if they exist
  • be quick and efficient but do not rush
  • record in head to toe but perform in developmentally appropriate sequence
105
Q

Pediatric Exam: Health history (2)

A
  • able to participate by age 7 yrs
  • most of information is obtained from adult present (dont assume person is mom or dad)
106
Q

Pediatric Exam: Infant Tips (3)

A
  • perform with child on parent’s lap (or hold confidently
  • assess mouth while crying
  • talk in quiet, unhurried, nonthreatening voice (may need high-pitched voice and smiling)
107
Q

Pediatric Exam: Toddler tips (6)

A
  • Allow to sit on parent’s lap or stand near parent
  • Use play- count fingers, tickle toes, who can i see in here today (ears)
  • Introduce equipment slowly (let them play with it first; hide scary equipment)
  • Have parent remove outer clothing, leave underwear on until needed to remove
  • Explain things concretely and short sentences
  • Praise for cooperative behavior and use rewards
108
Q

Pediatric Exam: Pre-schooler tips (5)

A
  • Prefer parent’s closeness (Can be standing and/or sitting)
  • If cooperative (usually like to please), can examine head to toe
  • Request self-undressing. Leave underpants.
  • Demonstrate and let child examine equipment
  • Paper doll technique (demonstrate first on doll then child)
109
Q

Pediatric Exam: School age and adolescent tips (6)

A
  • Examine head to toe, genitalia last
  • Self-undressing, keep on underwear, provide a gown
  • Explain exam and findings to the child (include long-term benefits for adolescents)
  • Teach about body functions and care (esp sexual development)
  • Respect need for privacy/modesty (May or may not want parent present)
  • encourage them to share feelings and ask questions
110
Q

Signs of stress: younger children (8)

A

Sleep problems
Headaches
Stomach aches
Increased crying
Clingy
Bed wetting
Baby talk
Developing new fears

111
Q

Signs of Stress and anxiety: older children (7)

A

Poor coping skills (withdrawal)
Behavior and learning difficulties
Mood swings (aggressive or stubborn)
Sleep issues
Regression (bedwetting, thumbsucking)
Compulsive behaviors
Change in eating habits (overeating)

112
Q

Physical Exam: Infant Reflexes

7 and when they disappear
What does it mean if reflexes persist?

A

Stepping-0-4 weeks,
Sucking/rooting, palmar grasp, Moro (startle), tonic neck (fencing), 3-4 months
Plantar grasp-0-8 months
Babinski- 0-1 year (fanning of toes)

If they do not disappear, sign of CNS impairment

113
Q

Physical Exam: fontanels

How should they feel?
When are they bulging (3)?
When are they sunken

A

Normal: feel soft and flat

Bulging w/ crying, vomiting, increased ICP
sunken w/ dehydration

114
Q

Physical Exam: Ear

Expected Findings (3)
Unexpected Findings (2)
Procedures (3)

A

Expected Findings
- cerumen in ear
- newborn blinks to sound
- infant turn to sounds

Unexpected Findings
- foreign bodies in ear
- ear infections (more common than in adults b-c close proximity

Procedure
- pinna down and back if under 3 (up and back if older than 3)
- examine hearing in children with speech delays
- use whisper test up until preschool

115
Q

Physical Exam: Eyes

Expected finding (3)
Procedures (4)

A

Expected
- depth perception around 7-9 months (mature around 2-3 yrs)
- binocularity around 6 wks (esp by 4 months)
- visual acuity 20/40 in toddlers

Procedures
- visual screening for 3 and up (non-letter alternative to snellen for young children)
- corneal light reflex test AND cover-unconver test for strabismus
- check for red reflex
- hold head for H test in young children

116
Q

Physical Exam: Neck

Expected Findings (2)
Unexpected Findings (2)

A

Expected
- small, non-tender, mobile lymph nodes
- short neck w/ skin folds until 3-4 yrs

Unexpected
- tender, enlarged, warm lymph nodes = infection
- webbing of neck (extra skin fold= turners syndrome)

117
Q

Physical Exam: Mouth

Expected Findings (2)
Tips (2)

A

Expected Findings
- enlarged tonsils
- 6-8 teeth by age 1 for infants

Tips
- examine while crying in infant
- avoid tongue blade

118
Q

Physical Exam: Cardiac

Expected Findings (3)
Unexpected Findings (2)
Tips (3)

A

Expected Findings
- sinus arrhythmia (HR increases w/ inspiration, sleep, waking)
- S2 split on inspiration
- apical pulse at 4th ICS for under 7 yrs, 5th ICS for over 7 yrs

Unexpected Findings
- weak lower pulses (COA)
- murmurs (range from innocent (no problem) to organic (physiological conditions))

Tips
- evaluate while sitting and lying down
- always use apical HR for 60 seconds if < 2 yrs (best while sleep for infants)
- radial pulse okay after 2 yrs

119
Q

Physical Exam: Respiratory

Expected Findings (5)
Unexpected Findings (2)
Tips (3)

A

Expected Findings
- obligatory nose breathers (up till 4 months)
- diaphragmatic breathing (children under 6-7 yrs)
- irregular rhythm in infants
- 1:2 AP to lateral ratio by 6 yrs (barrel and 1:1 in infancy)
- Hiccups

Unexpected Findings
- s/s of respiratory distress
- allergic salute in allergy season

Tips
- take RR for 60 seconds
- hold feeds if newborn > 60 breaths/min
- take RR at end of each cry if crying b-c takes deep breath

120
Q

Physical Exam: Abdomen

Expected Findings (2)
Unexpected Findings
Tips (2)

A

Expected Findings
- protuberant abdomen (large liver= fast metabolism/drug usage in toddlers)
- umbilical hernia in infants

Unexpected findings
- sunken abdomen may be dehydration or malnutrition

Tips
- ticklish so place your hand over theres at first
- flex knees to relax abdomen

121
Q

Physical Exam: Neurological

Tips for:
CN exam
Cerebellar function tests
Sensation
Memory
DTR

A

-CN exam–make it a game! (“Give me a big frown”; “See how tight you can close your eyes”)

  • Cerebellar function tests (Finger to Nose, Romberg, balance, tandum walk) should be same as adult by school age ( “Walk like a duck”, “Walk on your tippy toes”
  • Sensation- use cotton or tickling, don’t use a pin; not tested in infants
  • Memory (ask about birthdays, recent events in toddlers and up

-DTRs in child over 5 yrs

122
Q

Physical Exam: Musculoskeletal

Expected Findings (2)
Unexpected Findings (2)
Procedures (2)

A

Expected Findings
- genu varum (bow legged) in infancy till 18 months
- genu valgum (knock kneed) around 2-7 yrs

Unexpected Findings
- scoliosis (screening school age and beyond via leaning forward w/ knees straight)
- hip dysplasia ( seen in infants via ortolani sign and barlow signs)

Procedures
- For leg discrepancy, compare level of malleoli OR child trendelenburg sign (place hands on illiac crest from behind and should be level)
- Romberg test (child close eyes and remains standing straight for 20 sec) for coordination

123
Q

Physical Exam: Integumentary

Expected Findings (3)
Unexpected Finding (2)
Tips (2)

A

Expected
- bruising on legs when learning to walk
- cyanotic extremities in newborn for first few hrs
- thin skin in young children (use tape w/ caution)

Unexpected
- bruising on padded areas (abdomen)
- diaper rash

Tips
- turgor on above clavicle for school age
- turgor on abdomen for infants-preschool

124
Q

Respiratory System Variations for children (3)

A
  • smaller and shorter airway
  • short straight eustachian tube
  • increased infections from 3-6 m when maternal antibodies leave and waiting for infant antibodies
125
Q

Signs of Respiratory Distress (8)

A
  • Retractions
  • Irregular sounds: wheezes (high pitched), stridor
  • Head bopping
  • Nasal flaring (unable to breath w/ an occluded nostril)
  • Mucus-y poops
  • Gargled speech
  • excessive crying
  • nonproductive cough
126
Q

Asthma: Pathophysiology (3)

A
  • Inflammatory response -> airway remodeling
  • Accumulation of secretions -> hypoxemia
  • Bronchoconstriction (Spasm of bronchi and bronchioles) -> respiratory acidosis
127
Q

Asthma: Clinical Manifestations (7)

A
  • Hacking, paroxysmal, irritative and nonproductive Cough (especially at night or early morning due to bronchial edema)
  • Frothy, clear, gelatinous sputum (as secretions increase)
  • Coarse and loud breath sounds (sonorous crackles, rhonchi, wheezing)
  • Prodromal itching at front of neck or upper back (seen in some children)
  • absent air movement and air hunger (no breath sounds, chest tightness)- medical emergency b-c sign of ventilatory failure
  • limited speech (unable to say more than 5 words) and anxiety
  • barrel chest (if repeated)
128
Q

Asthma: Management Priorities (6)

A
  • frequent assessment (esp pulse ox, lung sounds, breathing)
  • give oxygen (nasal cannula, face mask, blow by)
  • Calm environment and reassurance
  • encourage deep breathing (via games like blow out candles or big bad wolf)
  • give medications (bronchodilators then steroids; use spacer for better coordination)
  • suction as needed (mouth then nose)
129
Q

Asthma: Classifications (4)

A
  • Intermittent <= 2 days a week
  • Mild persistent: > 2 days a week, but not daily
  • Moderate persistent: daily, night-time symptoms 3-4 times a week
  • Severe persistent: several times a day, continual symptoms, night-time symptoms more than once a week less than 5 or nightly greater than 5; Use beta agonist several times a day
130
Q

Asthma: Diagnostics (4)

A
  • Chest x-ray (may show hyperinflation or infiltrates))
  • Pulmonary Function Test (includes spirometry (5 yrs +), bronchoprovocation (direct exposure to antigens), exercise tolerance)
  • Allergy Testing (skin, Eosinophilia levels, IgE levels)
  • ABG
131
Q

Peak Flow meters

What is it?
Three levels

A
  • Peak flow meter (used in 5+ to manage asthma by measuring max flow of air forcefully exhaled in 1 second)

Levels
Green– keep doing regular acitivities

Yellow- may need extra treatment

Red- call provider or EMS

132
Q

Prevention of Asthma exacerbation (7)

A
  • Avoid triggers ( house and outdoor allergens, smoke, temp extremes)
  • Adherence to preventive medications (anti-inflammatories and LABA)
  • Exercise (best is swimming)
  • Hyposensitization/ allergen immunotherapy
  • Breathing exercises
  • Peak Flow Meters
  • use dehumidifiers or air conditioners
133
Q

Asthma: anti-inflammatories

Important notes for all following:
- Mast cell stabilizer (Cromolyn sodium, necromil) - 1
- Glucocorticoids (Prednisolone, Methylprednisolone)- 3
- Anti-leukotrienes (montelukast sodium) - 1
- Monoclonal antibodies (omalizumab) - 2

A

Cromolyn sodium
- maintenance for 2+

Glucocorticoids (Prednisolone, Methylprednisolone)
- first line for 5 yr +
- usually inhaled for maintenance; systemic for acute exacerbation
- may cause thrush or stunt growth

Anti-leukotrienes (montelukast sodium)
- for moderate persistent asthma in 12m _

Monoclonal antibodies (omalizumab)
- for moderate to severe persistent in 12 yr +
- black box warning for anaphylaxis so monitor for 2 hrs

134
Q

Exercise-induced bronchospasm

What is it?
When does it peak?
When does it stop?
Treatment (2)

A

EIB: airway obstruction during or after vigorous exercise

  • Peaks 5-10 minutes after stopping activity (usually during endurance activity)
  • Stops 20-30 minutes after activity

Treatment: prophylaxis with SABAs or cromolyn sodium before exercise

135
Q

Status Asthmaticus

What is it?
S/s (3)
Treatment (4)

A

Status Asthmatics: an episode of severe asthma that does not respond to normal treatment.

S/s: profuse sweating, sitting upright and refuses to lie down

Treatment
- same as asthma (cardiorespiratory and pulse oximetry monitoring, humidified oxygen, Inhaled SABA, systemic corticosteroid, anticholinergic)

  • IV magnesium sulfate (Muscle relaxant to decrease inflammation and improve pulmonary function)
  • Heliox (helium and oxygen)- decreases airway resistance and work of breathing via nonrebreathing face mask
  • Ketamine (Dissociative anesthetic causes smooth muscle relaxation)
136
Q

Asthma: bronchodilators

SABAs (Albuterol, Terbutaline)- 1
LABAs (Salmeterol)- 1
Anticholinergics (ipratropium, atropine)- 2

A

SABAs (Albuterol, Terbutaline)
- for acute relief or prevent EIB

LABAs (Salmeterol)
- never monotherapy, use w/ corticosteroid

Anticholinergics (ipratropium, atropine)
- anticholinergic effects (dry mouth, no secretions, blurry vision)
- for acute relief

137
Q

Nasopharyngitis/ Common Cold

Causative agent

Key s/s (2)

Treatment
- Do’s (4)
- Don’ts (2)

A

Cause: viral

Key s/s: open mouth breathing (up to 3 yrs), chilling sensations

The Do’s
- supportive care b-c no cure (raise HOB, suctioning, vaporization, acetaminophen)
- reassure family colds are common till age 5
- monitor for complications (fever, dehydration, ear infection)
- rule out strep

The Don’ts
- OTC cough suppressants (dextromethorphan w/ caution in 6 yrs and up)
- Expectorants, antibiotics, antihistamines are not used

138
Q

Bronchiolitis/RSV

Basic Pathophysiology
Key s/s (3)
Prevention
The Dont’s of treatment (4)

A

Patho: small airways become obstructed -> emphysema and patchy atelectasis at bronchiolar level

Key s/s:
- rhinorrhea
- apnea (first sign in infants under 1 months besides lethargy and irritability)
- low fever

Prevention-palivizumab (monoclonal antibody) once a month IM (given in NICU)

The Dont’s of treatment
- avoid Routine chest percussion and drainage
- Fluids by mouth may be contraindicated
- Bronchodilators rarely beneficial
- no antibiotics b-c viral

139
Q

Bronchiolitis/RSV

The Do’s of treatment (7)

A

The Do’s of Treatment
- Contact or droplet Isolation- lives 1 hr on hands
- Ribavirin-antiviral agent- inhalations (VERY DANGEROUS so limited use)
- Heated high-flow nasal cannula (HHFNC)- extra humidity with oxygen administration and CPAP
- CPAP, BiPAP, or intubation required if respiratory acidosis present)
- Suctioning (Nasal aspiration with aspirator to remove secretions; best treatment)
- IV fluids for acute phase
- Nebulized Hypertonic (3%) saline for those hospitalized more than 3 days to help w/ mucociliary clearance

140
Q

Acute Pharyngitis/ strep throat

Causative Agent
Key S/s (3)
Main risks (2)

A

Causative Agent: GABS

S/s
- pharyngitis (inflamed tonsils)
- cervical lymphadenopathy
- scarlet fever (erythematous sandpaper-like rash)

Main risks
- rheumatic fever (inflammatory of heart, CNS, joints)– within 18 days
- acute glomerulonephritis– within 10 days

141
Q

Acute Pharyngitis/ strep throat

Diagnostics
Treatments (4)

A

Diagnostics: rapid test to screen for strep and do throat culture if screen negative

Treatments
- Warm saline gargles
- Penicillin or macrolide antibiotic (infectious for 24 post initiation of antibiotic; no longer contagious after 24 hrs so can return to school) - unless viral
- cool drinks and foods (ice cream, ice chips)
- chloraseptic or acetaminophen or ibuprofen, for pain (liquid or chewable)

142
Q

Tonsillitis

Causative Agent
Key S/s (4)
Treatments (3)

A

Causative Agent: viral or bacterial, often w/ pharyngitis

S/s
- edematous tonsils (difficult breathing, swallowing, hearing (if adenoids))
- snoring and mouth breathing (noctural dyspnea)
- foul mouth odor
- persistent cough

Treatments
- Saline gargles, lozenges, non opioid pain meds
- soft to liquid diet
- If severe and not resolved by other methods, tonsillectomy or adenoidectomy

143
Q

Tonsillectomy

Contraindications (4)
The Do’s of Post-op care (5)

A

Contraindications: bleeding disorders, cleft palate, acute infection, under 3-4 yrs (b-c hypertrophy of lymphoid tissue possible)

Post-op care
- Pain management-meds (always give PO meds before IV meds run out) and ice collar
- Observe for complications (s/s of hemorrhage)- such as frequent swallowing, tachycardia, pallor, bright red emesis
- position for fluid drainage (prone, side lying)
- expect dark brown emesis (bright red is active bleeding)
- full recovery in 1-2 weeks

144
Q

Tonsillectomy

The Dont’s of Post-op care (5)

A

The Dont’s Post-op
- Avoid fluids until child alert and can swallow
- Citrus juice can cause discomfort
- Milk, ice cream and pudding not offered until clear tolerated because can cause child to clear throat
- Avoid gargle, coughing, suctioning, straws, nose blowing
- No red products or red dyes in fluids

145
Q

Infectious Mononucleosis (Mono)

Causative Agent
Key S/s (3)
Main risk
Severe S/s to report (4)

A

Causative Agent: EBV, viral

Key S/s:
- Sore throat (Exudative pharyngitis w/ petechiae)
- Lymphadenopathy
- Hepatosplenomegaly

Main risks: neurological (meningitis, seizures),

Severe S/s to report to HCP
- severe sore throat (unable to eat or drink)
- severe abdominal pain
- difficulty breathing
- respiratory stridor

146
Q

Infectious Mononucleosis (Mono)

Diagnostics (3)
Treatments (5)

A

Diagnostics
- heterophil antibody test (positive up to 6m post exposure in 4 yrs and up)
- mono spot test (earlier diagnosis)
- increased WBC (atypical leukocytes)

Treatments
- symptomatic (mild elixir analgesic, gargles, troches, warm drinks)
- corticosteroids
- avoid strenuous activities (contact sports until splenomegaly resolved)
- contagious (just don’t share hygiene products and drinks)
- viral so no antibiotics

147
Q

Bronchitis

Key S/s
Diagnostic
Treatments (3)

A

Key S/s: coarse, dry, hacking cough worse at night

Diagnostics: previous URI

Treatments
- symptomatic (rest, analgesics, antipyretics, humidity)
- antibiotics if bacterial
- cough suppressants (allow rest at night but interfere w/ secretion clearance)

148
Q

Cystic Fibrosis

Basic Pathophysiology
Etiology

A

Basic pathophysiology: thick, sticky mucus due to exocrine gland dysfunction

Etiology: autonomic recessive (1 in 4 chance each pregnancy if both parents are carriers)

149
Q

Cystic Fibrosis: Effects in Respiratory system

3 common
3 special concerns

A
  • chronic pneumonia (thick sputum)
  • emphysema (barrel chest, clubbed fingers)
  • recurrent URI due to bronchial obstruction

Severe
- pneumothorax and atelectasis
- hemoptysis (from recurrent infection, emergency if > 250 ml/24 hr)
- nasal polyposis (due to chronic inflammation, may need irrigation or corticosteroids)

150
Q

Cystic Fibrosis: effects in GI/Endocrine system (7)

A
  • meconium ileus (intestinal obstruction) or constipation – need stool softeners
  • malabsorption syndrome in pancreas (leads to steatorrhea (bulky frothy stools) and azotorrhea (foul smelling stools w/ putrefied protein))
  • Reduced digestive enzymes
  • Cystic-fibrosis Diabetes (common and need insulin)
  • Portal hypertension in bile and liver (due to biliary cirrhosis)
  • rectal prolapse - simple use lubricated finger to put back
  • Chronic GERD - use H2 antagonist and GI motility
151
Q

Cystic Fibrosis: Effects in

Musculoskeletal (2)
Reproduction (2)

A

Musculoskeletal
- Failure to Thrive due to malnutrition
- bone health concerns due to pancreatic insufficiency and steroid use – may need growth hormones

Reproduction
- most males are sterile
- mucus blocks cervix in females but pregnancy possible (higher risk for complications)

152
Q

Cystic Fibrosis: Diagnosis (4)

A
  • newborn screen w/ sweat chloride > 60 mEq/L (normal is 40)
  • absence of pancreatic enzyme
  • stool fat analysis (72 hr)
  • family history
153
Q

Cystic Fibrosis: Airway clearance Therapy (6)

A
  • usually BID
  • chest physical therapy (percussion, postural drainage, flutter/handheld percussor)
  • Positive expiratory therapy (PEP) - Breathing against resistance to keep airway open and get around mucus so it can be expectorated)
  • High-frequency chest compressions (HFCC)–vibration vest assists mucus breakdown and clearance)
  • Exercises (stimulate mucus excretion, muscle development, pulmonary vital capacity, and sense of well-being)- encourage sports
  • breathing exercises (deep breathing, bubbles)
154
Q

Cystic Fibrosis: Medication

Things to know

Mucolytics (Dornase alfa) - 2
Antibiotics - 2
Bronchodilators -1
Oxygen -1

A

Mucolytics (Dornase alfa)
- decreases mucus viscosity
- side effects are laryngitis and minor voice alts

Antibiotics
- long course so need PICC or implanted port
- IV vancomycin, inhaled tobramycin

Bronchodilators
- give before Airway clearance therapy

Oxygen
- w/ caution b-c often have CO2 retention

155
Q

Cystic Fibrosis: Medication

Things to know:
Pancreatic Enzymes (Pancrease) -2
Nebulized hypertonic saline -2
CFTR -2

A

Pancreatic Enzymes (Pancrease)
- enteric-coated given at every meal and snack (powder form in applesauce for infants)
- increase dose if fatty stools

Nebulized hypertonic saline
- only for 6 yrs + and severe b-c may cause bronchospasms
- increases mucus clearance and airway hydration

CFTR Modulator (cystic fibrosis transmembrane conductance regulator)– Ivacaftor
- for 2 yrs and up w/ specific mutation
- reduces likelihood of sticky mucus development

156
Q

Cystic Fibrosis: Diet (6)

A
  • high-protein, high-caloric diet
  • decreased fat
  • increased sodium
  • needs replacement of fat soluble vitamins
  • may need gastric feedings at night (growth failure despite PN may = deterioration)
  • remain upright post-feed to prevent Gerd
157
Q

Croup: Epiglottis

Causative Agent
Key S/s (5)
Main risk
Diagnostic

A

Causative Agent: bacterial (abrupt onset)

Key S/s:
- Absence of cough
- Drool (painful swallowing)
- Agitation
- Tripod position (sitting upright and leaning forward w/ mouth open, chin out, and tongue protruding)
- stridor

Main risks: severe respiratory distress

Diagnostics: cherry red epiglottis

158
Q

Croup: Epiglottis

Treatments (7)
Prevention

A

Treatments
- maintain airway (prep for intubation)
- keep calm (in parent’s lap)
- give IV cephalosporins (Ceftriaxone/cefotaxime or vancomycin )
- do not examine throat if suspected (need provider and resuscitation equipment prior to throat exam)
- Humidified oxygen via mask or blow-by to reduce agitation
- Corticosteroids (can reduce edema early)
- Droplet precautions 24 hrs after initiation of antibiotics

Prevention: Hib vaccine

159
Q

Croup: Acute Laryngotracheobronchitis

Causative Agent
Key S/s (4)
Main risk

A

Causative Agent: most common croup, viral

Key S/s
- barky, brassy cough and horseness (worse at night and w/ crying)
- stridor
- prior URI
- Dyspnea (due to narrow airway from inflamed mucosal lining)

Main risks: respiratory acidosis -> respiratory failure

160
Q

Croup: Acute Laryngotracheobronchitis

Treatments (6)

A

Treatments
- Cool mist (or cool car ride if no stridor at rest)
- Racemic Epinephrine Tx (short-term relief for moderate or severe croup—rapid onset but short duration)
- Frequent assessment
- Corticosteroids (dexamethasone PO)—standard treatment
- Heliox (helium with oxygen): moderate to severe croup
- Avoid aggravating child b-c can worsen respiratory distress

161
Q

Croup: Acute Spasmodic Laryngitis

Causative Agent
Key S/s (3)
Treatments (2)

A

Causative Agent: viral w/ allergic component

Key S/s
- recurrent paroxysmal nocturnal attacks of laryngeal obstruction (awakes in middle of night w/ barking cough that subsides the next day)
- hoarseness may remain next day
- no fever

Treatments
- humidity or cool night air
- epinephrine for severe

162
Q

Croup: Bacterial Tracheitis

Causative Agent
Key S/s (4)
Treatments (4)

A

Causative Agent: bacterial of trachea

Key S/s
- large, thick secretions
- stridor in every position
- no response to LTB therapy
- no drooling

Treatments
- intubation
- suctioning (endoscopy w/ HCP)
- antibiotics (erythromycins)
- antipyretics

163
Q

Speaking Child Language

Words to avoid (5)

A
  • Shot, bee sting — say poke
  • Deaden
  • Take your blood pressure
  • Stool
  • Test
164
Q

Children w/ Strict I & O measures in hospital (5)

A
  • Infants less than a year
  • Any child losing fluid through NG, stomas, sweat, drainage tubes
  • Children on IV therapy
  • Children who just had a recent surgery.
  • Children with medical diagnoses such as that are affected by fluid fluctuations ( Respiratory, Cardiac, Endocrine)
165
Q

Fever management (> 38C)

Mild (2)
Severe (2)

A

Mild
- oral fluids (water, juice, pedialyte)
- meds (acetaminophen or ibuprofen)

Severe
- IV rehydration
- call provider if > 40-40.6

166
Q

Procedure management

NPO and fluid restriction tips (6)

A
  • have clear liquids >2 hours
  • breast milk >4 hours and infant formula >6 hours before procedure (keep eye out for dehydration)
  • serve liquid in small container to give illusion of a lot
  • keep mouth moist w/ atomizer or ice chips
  • keep close eye on older children who may try to sneak liquids
  • do not leave fluids at bedside
167
Q

Alternative Feeding: Disorders which require

Structural (3)
Functional (2)
Malabsorption (2)

A

Structural
- Gastroschisis (born with GI outside of skin
- Short gut (lack of perfusion to guts in premature infants leads to gut death and surgical removal of dead parts)
- TEF- (malformations of trachea and esophagus)

Functional
- FTT-Failure to Thrive
- GERD-Gastroesophageal Reflux Disease

Malabsorption
- CF, Anorexia

168
Q

Alternative Feeding: Gavage Feeding (5)

A
  • give by gravity
  • check placement w/ x-ray, pH, measure mark
  • use 5 or 8 french tip
  • do in quiet calm environment
  • use nonnutritive sucking to improve digestion
169
Q

Medication Administration: 9 rules

A
  1. Do not give a child a choice of the medication.
  2. Allow choices the child can have some control over
  3. Do not lie, saying it won’t hurt or taste bad
  4. Give worst meds last (prednisone = bad taste)
  5. Give brief explanations
  6. Tell the child is ok to be scared.
  7. Always include the child and parent when talking during med administration.
  8. Be confident and positive when approaching the child (Do not use baby talk, you can just change your intonation)
  9. The younger the child the shorter time between explanations and administration.
    Involve the parent.
170
Q

Medication Administration: Oral

Tips (8)

A
  • orange tips = oral syringe
  • use nipple for infants to suck
  • chewables are good for preschoolers
  • give capsules w/ small amount of food or liquid
  • never mix in bottle b-c may not drink it all or not want to drink if nasty
  • place syringe on side of mouth (spraying at back can cause aspiration)
  • chase bad tasting w/ water, juice, ice pop (nondairy)
  • small puff in face can cause swallow reflex
171
Q

Medication Administration: IM

What is needle recommended gauge?

What is the needle size (length) AND max amount to administer in the following areas:

  • vastus lateralis and ventrogluteal
  • Deltoid
A

Gauge: 22-25

Vastus lateralis and ventrogluteal
Size: 5/8 - 1 inch
Max volume: 0.5 for infant, 2 ml small child

Deltoid
Size: 1/2 - 1 inch
Max volume: 0.5-1 ml

172
Q

Medication Administration: IV (7)

A
  • assess site q1-2 hrs
  • use 22-24 gauge for small veins
  • usually by IV pump ( if bolus, 20 ml/kg okay)
  • children 5 and up can use PCA pump (family version available too)
  • Use superficial hand, wrist, forearm, foot, or ankle veins in small infants
  • Avoid foot veins in children learning to walk or walking
  • Use scalp veins in infants up to 9 months after other sites have failed
173
Q

Medication Administration

  • Enema (4)
  • Intraosseous
A

Enema
- done if NPO due to vomiting or mental status
- contraindicated in immunosuppressed or thrombocytopenia
- max volumes (120-240 for infant, 240-360 small child)
- No soapsuds

Intraosseous
- done in pediatric resuscitation if IV not possible after 3 attempts or 90 seconds

174
Q

Medication Administration

  • Optic (4)
  • Otic
  • Nasal
A

Optic
- put pressure on lacrimal duct after administration for 1 minute to wash tear duct and prevent medicine from draining into body
- ointment goes inner to outer canthus
- give drops prior to ointment (3 mins apart)
- if eyes clenched, put in nasal corner and it will go in once eyes open

Otic
- warm to room temp to prevent vertigo

Nasal
- hyperextend head to prevent strangling sensation from trickling

175
Q

Vital Signs: Temperature

4 tips

A
  • Axillary preferred in infant to 2 years
  • Rectal temps if accuracy needed (age over 1 month)
  • 2-5 years axillary or TM
  • Can take orally when child can hold under tongue (5+)
176
Q

Pain assessment

Scales (and appropriate ages) - 5

A
  • NIPS- Neonatal Infant Pain Scale-birth -1 month
  • FLACC Pain Scale- 2 month -7 years
  • Face Legs Arms/Activitiy Crying Consolability
  • For non-verbal child
  • Oucher Scale 0-5 scale; have child place faces in order then choose
  • Faces Pain Scale- 3 years and older

*Numeric Pain Scale- Children 5 -7 years and older

177
Q

Pain Assessment

Infants (3)
Toddlers (3)

A

Infants
- Pre-verbal (physiologic response, crying, difficulty sleeping, feeding, relaxing)
- Facial expression most reliable
- Older infant may push or pull away

Toddlers
- loud cry
- words that indicate pain
- stay very still

178
Q

Pain Assessment

Preschooler (6)

A
  • verbal report as young as 3 yrs for pain, location, and degree
  • Views pain as a punishment for thoughts/behavior
  • Regression to earlier behaviors (bed wetting, thumb sucking, crying, kicking)
  • Denies pain – fear of pain relieving measures “shots”
  • Avoid telling child to be “brave” or good boy or girl after procedure
  • Fears body mutilation (Need all their parts; Band-aids are important, magical thinking)
179
Q

Pain Management

School age (3)
Adolescent (2)

A

School-age
- Describes pain and can quantify intensity (if scale is explained in simple terms)
- Awareness of death
- Bargains or tries to “make a deal” (I’ll let you change my dressing after this tv show)

Adolescent
- understands cause and effect
- quantifies and describes pain

180
Q

Pain Management: Reducing Needle Stick Pain (8)

A
  • Ice
  • Vapocoolant Sprays (may cause some constriction or may not be liked)
  • TENS units (stimulate nerves above location)
  • EMLA (eutectic mixture of lidocaine) cream- or Lidocaine- apply 60 minutes before poke)
  • Shot Blocker or buzzy (yellow thing which blocks some of the nerves or (distracts nerves)
  • sedation for infants or young children sometimes
  • change needle if pierced rubber stopper
  • apply pressure 10 sec before
181
Q

Pain Management: Nonpharmacological

Infants (2)
Toddlers and preschoolers
School age and adolescents (2)

A

Infants
- Nonnutritive sucking (pacifier, Sweet ease)
- touch, holding, rocking

Toddlers and preschoolers
- distraction (books, videos, music, bubbles–use child life)

School-age and Adolescents
- guided imagery
- breathing exercises

182
Q

How to minimize misbehavior? (6)

A
  • Phrase requests for appropriate behavior positively, such as “Put the book down” rather than “Don’t touch the book.”
  • Give advance notice or “friendly reminders,” such as “When the TV program is over, it is time for dinner” or “I’ll give you to the count of three, and then we have to go.”
  • Be consistent and commit to discipline
  • Praise good behavior
  • offer options when possible
  • role model good behavior esp honesty
183
Q

Respiratory Interventions: Ease Respirations at home (6)

A
  • Moisturized air (useful with hoarseness or laryngeal involvement) for 10-15 minutes
  • Steamed vaporizers, kettles, and boiling water are discouraged
  • Steam in shower is good method
  • Use nasal aspiratory or bulb syringe for young infants before feeding and sleeping
  • Saline nose drops (1/2 tsp salt, 1 cup water) useful
  • Topical vapor rub for 2 yrs and older ( never give orally or under the nose)
184
Q

Respiratory Interventions: Hydration (5)

A
  • Dehydration possible if febrile, anorexic, vomiting, or has diarrhea (esp if infant)
  • Parents should encourage small amounts of fluids (clear if vomiting) frequently (Infalyte and Pedialyte, water, or low-carb drinks)
  • Avoid drinks with caffeine that may act as diuretic
  • Do not force fluids or foods (IV fluids or NG tube may be needed if child dehydrated and not drinking)
  • Hydration is more important than food in acute illness
185
Q

Vital Signs: Heart Rate

Increases (5)
Decreases (3)

A

Increase
- Decreased perfusion (shock)
- Elevated temperature
- Pain
- Medications (atropine, morphine, epinephrine)
- Hypoxia

Decrease bradycardia more concern than tachycardia
- Vagal stimulation
- Increased ICP
- Medications (neostigmine [Prostigmin])

186
Q

Vital signs: Respiratory Rate

Increases (4)
Decreases (2)

A

Increase
- Respiratory distress
- Excess fluid volume
- Hypothermia
- Elevated temperature

Decrease
- Anesthetics
- Opioids ( compensated for w/ hyperpnea)

187
Q

Vital signs: Blood Pressure

Increases (4)
Decreases (3)

A

Increase
- Excess intravascular volume (severe in preterm b-c hemorrhage possible)
- Increased ICP
- CO2 retention
- Pain

Decrease
- Vasodilating anesthetic agents (halothane, isoflurane, enflurane)
- Opioids (e.g., morphine)
- shock (late sign due to elasticity and constriction of vessels to maintain cardiac output)

188
Q

Vital Signs: Temperature

Increases (3)
Decreases (4)

A

Increase
- Shock (late sign)
- Infection
- Environmental causes (warm room, excess coverings)

Decrease
- Vasodilating anesthetic agents (halothane, isoflurane, enflurane)
- Muscle relaxants
- Environmental causes (cool room) esp infants
- Infusion of cool fluids or blood

189
Q

Specimen Collection: Urine

Infants (5)

A

Infants
- parent may collect at home (diaper collection can alter results)
- Special urine collection bag often used for urine dipstick or urinalysis but not culture
- UTI confirmed with catheterization or suprapubic aspiration
- wipe abdomen with alcohol pad and fan dry for voiding in 2 minutes
- apply pressure over suprapubic area for Perez reflex (can cause urination)

190
Q

Specimen Collection: Urine

Toddlers/Preschoolers (2)
School-age
Adolescents

A

Preschoolers and toddlers
- may not void on request so give a liquid and wait 30 minutes
- May be anxious about voiding in unfamiliar place

School age
- cooperative but curious

Adolescents
- may paper bag to disguise (ask about menses)

Peds (4 decks)

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