EXAM 1 Flashcards
_______ and _______ provide a framework for child health.
Healthy People 2030 and Bright Futures
What GOALS are included in the framework for child health
Family support
Development
Mental health
Nutrition
Healthy weight
Physical activity
Oral health
Healthy sexual development and activity
Safety and injury prevention
Community relationships and resources
What age group is included when describing Neonatal mortality
<28 days of life
What age group is included when describing Postnatal mortality
28 days to 11 months
A low birth weight is considered ______ or below
<2500 g (5.5 lbs)
what is the difference between Atraumatic care and family centered care
Family-centered care involves recognizing the family as the constant in a child’s life and respecting the family’s role in the child’s well-being.
Atraumatic care focuses on minimizing the psychological and physical distress experienced by a child during healthcare interactions.
difference between growth, development, and maturation
Growth: (Quantitative) An increase in number and size of cells as they divide and synthesize new proteins; results in increased size and weight of whole or any of its parts
Development: (Qualitative) A gradual change and expansion; advancement from lower to more advanced stage of complexity; increased capacity through growth, maturation, and learning
Maturation: An increase in competence and adaptability, usually described as a qualitative change to function at higher level
Define Differentiation
The processes by which early cells and structures are systematically modified and altered
Describe Cephalocaudal development
a term used to describe the universal “head-to-toe” direction of humans’ growth and functional motor development. It is most obviously observed in infants’ spatial proportions change, continuing to adulthood.
Describe Proximal-distal development
Proximodistal development refers to a growth pattern where development radiates from the center of the body outwards.
what are the 3 developmental ages during the prenatal period
germinal (conception-2 weeks)
embryonic (2-8 weeks)
fetal (8-40 weeks/birth)
most crucial stage and most related to health of mom
what are the Patterns of growth and development
Directional trends
Sequential trends
Developmental pace
Sensitive periods
what is the Single most important influence on growth
Nutrition
Appetites fluctuate related to growth periods
what are the 5 psychosexual stages of Freud
oral, anal, phallic, latency, genital
oral stage age range (Freud)
0-1 years. Sucking, tasting, putting things in mouth
anal stage age range (Freud)
2-3 years potty training
phallic stage age range (Freud)
3-6 years
boys are more attached to mom
girls are more attached to dad
latency stage age range (Freud)
6 years to puberty
children mostly interact with same sex peers
genital stage age range (Freud)
beyond puberty. attracted to opposite sex peers
what are the 8 stages of Erickson psychosocial stages
infancy, early childhood, play age, school age, adolescence, early adulthood, middle age, old age
infancy stage age range (Erickson)
0-1 year trust/mistrust that basic needs will be met
early childhood stage age range (Erickson)
1-3 years develops sense of independence in many tasks
play stage age range (Erickson)
3-6 years take initiative with some activities, may develop guilt if unsuccessful/makes someone mad
school stage age range (Erickson)
7-11 years develop self confidence/inferiority
adolescence stage age range (Erickson)
12-18 years experiment/develop identity/roles
early adulthood stage age range (Erickson)
19-29 years establish intimacy and relationships with others
middle stage age range (Erickson)
30-64 years contribute to society and be part of the family
old stage age range (Erickson)
65 onward asses meaning of life and contributions
What are the 4 stages of cognitive development (Piaget)
sensorimotor, preoperational, concrete operational, and formal operational
sensorimotor stage age range (Piaget)
0-2 years old
motor coordination, sensory curiosity about the world, language used for demands, object permeance developed
preoperational stage age range (Piaget)
2-7 years old
symbolic thinking, use of grammar/syntax, stong imagination/intuition, conservation developed
concrete operational stage age range (Piaget)
7-11 years old
time/space/quantity understood can can be applied
formal operational stage age range (Piaget)
11 years and older
theoretical, hypothetical, and counterfactual thinking. abstract logic/reasoning. Strategy.
What are the 6 stages of moral development (Kohlberg)
principle, social contract, law and order morality, good boy attitude, self interest, avoiding punishment
Describe the pre-conventional stage of moral development (Kohlberg)
3-7 years: self interest, avoiding punishing
Moral reasoning based on reward and punishment
Describe the conventional stage of moral development (Kohlberg)
8-13 years: law and order morality, good boy attitude
moral reasoning based on external ethics
Describe the post-conventional stage of moral development (Kohlberg)
Adulthood (above 13 years): principle, social contract
moral reasoning based on personal ethics
Describe Social-affective play
infants take pleasure in relationships with people
infant learns how to garner these relationships with smiles, coos, or initiating games
Describe sense-pleasure play
whenever there isn’t anyone to be social with the infant finds something to entertain them. Related to senses.
Describe Skill play
once infants learn how to grasp and manipulate they do it over and over again, can often result in frustration until they get it right
Describe unoccupied play
when children are not playful but aimlessly walk around looking at anything that strikes their interest
Describe dramatic/pretend play
beings 11-13 months and is the predominant form of play in preschool age. Act out certain jobs or tasks adults do to help them better understand complex roles in society
Describe games play
young children participate in imitative games such a patty cake and peek a boo. Preschool learn ring around the rosy and London bridge, they don’t do competitive games. Its isn’t until school age that children begin to enjoy competitive games.
Describe onlooker play
child watches other children but makes no movement to join. Example: younger sibling watching an older sibling bounce a ball
Describe solitary play
children play alone with different toys than other children in the same area
Describe parallel play
play with similar toys in a smaller space, but toys are used in the way the child sees them (toddler)
Describe associative play
kids play together with the same toys but no organization or leadership (beehive soccer)
Describe cooperative play
children play together in an organized groups- each person has a role (sports, house)
Ages and stages is also called
ASQ-3
takes 10-15min for parents to complete
19 questions from 1mo to 5.5 years old
Assessment of child with developmental disabilities
ASQ in primary pare setting
Congenital anomalies
occur in 2-4% of live birth
Deformations: caused by extrinsic mechanical force (club foot cause by uterine constraint)
Disruptions: breakdown of previously normal tissues (Ex: genital amputations from amniotic bands wrapping around and cutting off circulation)
Dysplasias: abnormal organization of cells (can happen to teeth, hair, nails)
Malformations: malformations of organs or body parts (cleft lip)
Disorders of the intrauterine environment effect on baby’s genes
Teratogens (drugs that causes congenital abnormalities ex: warfarin, phenytoin)
Substance abuse: alcohol, cocaine
Infectious agents: cytomegalovirus, rubella
Physical agents: hyperthermia, maternal ionizing radiation
metabolic agents: maternal PKU
how are the Sequence for pediatric assessments generally altered to accommodate child’s developmental needs
Exam of opportunity
Do eyes, ears, mouth last
T/F: For infants and young children- count apical pulse.
T. Radial pulse is too fast to count. count for full 60 seconds
T/F: Count respirations first when examining a child
T. count for full 60 seconds
Pediatric blood pressure (BP)
Measurement devices
Selection of cuff
Cuff placement
start at age 3
choose a cuff where the bladder is at least 40% of the arm circumference. Should cover 80-100% of the circumference of the arm
measure with upper arm rested at heart level
systolic will always be greater in the legs
describe the Physical Assessment of the Eyes (External structures
Internal structures
Funduscopic examination)
Vision testing
Occular alignment
Visual acuity in children
Visual acuity in infants and difficult to test children
Peripheral vision
Color vision
fundoscopic exam shows the back of the eyeball (fundus) if light is shined it should come back as red
photoscreen vision screening for 3-5 y/olds
ocular alignments happens at 3-4 months. when they don’t align it can turn into a lazy eye. must be corrected before 4-6 y/old or can become blind
use the sloan letter chart for testing visual acuity in children. stand 10ft away. to pass the majority of symbols on each line needs to be recognized
test vision in infants by shining light in eye for reflexes and seeing if they can follow a point around the room
check peripheral vision by having them stare straight ahead and measure when they see movement out of the corner of their eye. should be able to see 90 degrees
check color vision with the book where you have to look for the letters/numbers in the weird circle pattern
Physical Assessment
Ears
External structures
Internal stuctures
Positioning the child
Otoscopic examination
Auditory testing
Nose
External structures
Internal structures
ears set below eyeline are associated with renal/genetic issues
the entire external ear is called pinna or auricle
the internal ear consists of the ear canal, and tympanic membrane
ear check often upsets kids so prepare them and them potentially restrain them with parents. the kid sits on parents lap with their body facing parents side, parent holds head against chest with ear facing nurse OR have kid hug parent in parent’s lap and have parent hold head to either side for check
when inserting scope, start w/ scope upside down, push down on and forward on the meatus while inserting. INFANTS pull ear down and back OVER 3 YEARS pull ear up and back
ear canal walls should be pink, tympanic membrane should be pearly pink/gray
test hearing with 500, 1k, 2k, nd 4k Hz. Must be able to hear at 20dB
Heart murmurs- physiologic vs pathologic
physiologic heart murmur is also known as a FUNCTIONAL murmur, still able to pump blood but anemic or something
pathologic heart murmurs are also known as ORGANIC murmurs that are usually anatomic and do not have any physiologic cause
Physical assessment
Mouth and throat
Internal structures
Chest
Lungs
Auscultation
Heart
Auscultation
Origin of heart sounds
look at tonsils, uvula, oropharynx, buccal mucosa, lips
look for color, white patches, ulceration, petechiae, bleeding, sensitivity, and moisture
check for plaque and brown spots on teeth
make sure soft/hard palate are intact
have all 12 ribs on either side. check chest size unrelations to head size. breathing symmetrical. sternum isn’t protruding or depressed or bumpy, BREATHING IS MOSTLY ABDOMINAL/DIAPHRAGMATIC UNTIL AGE 6/7 YEARS, nipples symmetrical, no gynecomastia
right lung has 3 lobes, rate/rhythm/depth/quality of respirations,
point of maximum intensity should be heard at apical pulse of heart, check cap refill by pressing shown for 5 sec and return should take less than 2 sec, auscultatory site are located at valves s1 loud at apex of heart (mitral/tricuspid) and S2 louder at base of heart (pulmonic/aortic), check sound quality, intensity, rate, and rhythm
physical Assessment ()
Abdomen
Inspection
Auscultation
Palpation
Genitalia
Male genitalia
Female genitalia
Anus
acultate then palpate abdomen, percuss abdomen to find organmegaly, masses, fluid, and flatus. abdomen is cylindric when standing in infants/young children/flat when lying, shouldn’t be hard/board like, no distended vein in abdominal skin, can sometimes see peristaltic waves, hernias common and should be treated around the umbilicus and inguinal (around scrotum) laugh to test in hernia is present, palpate femoral ulses in inguinal space
check gentaliai by having them lay and put bottoms of feet together. scratch anus to check for anal wink.
Physical Assessment
Back and extremities
Spine
Extremities
Joints
Muscles
Neurologic assessment
Cerebellar function
Reflexes
Cranial nerves
check along spine for tufts of hair, dimples, or discoloration. have pt stand straight and bend over to see if back is symetrical. make sure fingers/toes are normal,
no pigeon toeing (toes in) d/t torsional deformities to tibia, make sure Babinski sign is gone after 1 year of age, normal joint ROM
check muscle development is the same on both sides by asking them to show me their muscles, check strength by pulling/pushing on extremities.
test gross motor skills by as=king them to balance on one foot, heel toe walk. fine motor skills by buttoning shirt, tie shoes, draw straight line. Do the Romberg test (see if they fall when standing with eyes closed)
check deep tendon reflexes by checking patellar
reflex
check cranial nerves that control all of the senses by performing various tests
genuvalgum vs genuvarum
genuvalgum: knees together and feet spread apart, normal in years 2-7 years old
genuvarum: outward bowing of the legs d/t lateral bowing of tibia. can be normal younger than 2=3 years old
How can we assess pain in children??
Behavior- crying, irritability, quiet
Physiologic s/s- inc HR, inc RR, inc BP, sweating
Self-report
What are the 4 Behavioral pain measures
Facial expression, Leg movement, Activity, Cry, Consolability (FLACC)
COMFORT scale
Children’s and Infant’s Post Operative Pain Scale (CHIPPS)
Premature Infant Pain Profile (PIPP)
Describe the FLACC Scale
face, legs, activity, cry, and CONSOLability
scale from 0-2
what age can pts start Self-report pain-rating scales
Older than 4 years
describe Chronic and Recurrent Pain
Pain that persists for 3 months or longer than the expected period of healing
Nonpharmacologic management in children
Distraction
Relaxation
Guided imagery
Cutaneous stimulation
Containment and swaddling
Nonnutritive sucking
Kangaroo care
pediatric BP measurement and interpretation
use child’s height, age, and sex to determine percentile.
If below 90th percentile, the child is NORMOTENSIVE.
BP between 90-95 are prehypertensive (or more than 120/80 in adolescents).
If above 95 hypertensive, but must be high two times in a row to confirm
what are the 2 stages of development during the infancy period
neonatal (birth to 28 days old)
infancy (1 month to 12 months old)
rapid motor, cognitive, and social development. Establishes basic trust and the foundation for future relationships.
what are the 2 stages of development during the early childhood period
toddler (1-3 years)
preschool (3-6 years)
intense activity and discovery. marked physical and personality development. sense of self (independence, dependence, role awareness)
what is the age range for middle childhood
6-12 years old
school age. child is less family centered and more peer centered. develops skill competencies. social cooperation and morals develop.
what are the 2 stages of development during the later childhood period
prepubertal (10-13 years)
Adolescence (13-18 years)
biologic and personality maturity mixed with physical and emotional turmoil leads to redefined self-concept. They begin to internalize all previously learned values and focus on their own identity.
Use the child’s height, age, and sex to determine pediatric BP percentile. If below 90th percentile, the child is ___________.
NORMOTENSIVE
pediatric Orthostatic hypotension
supine, wait 2 min, take bp
then stand, wait 2 min, take bp
if systolic dropped by 20 mmhg or diastolic dropped more than 10 mm Hg w/ little increase in HR then autonomic deficit
What is the difference between complementary and alternative medicine??
Complementary and alternative medicine are often lumped under the acronym “CAM” because they both refer to the same types of practices. But the difference is in how these practices are used: Complementary medicine means these therapies are used in addition to mainstream medicine.
examples of Coanalgesic drugs
are medications whose primary indication is for a purpose other than pain relief, but that demonstrate some analgesic effects. Antidepressants, anticonvulsants, corticosteroids, and other drugs may be used as coanalgesics.
Outline essential pain management strategies to reduce pain in children.
State the components of a complete health history.
Describe four communication techniques that are useful with children.
Provide appropriate anticipatory guidance at any age throughout growth and development.
stressors experienced at each level of growth and development.
evolution of relationships at all levels of growth and development.
infants should have__to__oz weight gain per week
5-7
infants should be double their birth weight by age____months
6
infants should be triple their birth weight by age___year
1
after a child’s first birthday, Height increases by__ inch per month every ___ months
1 inch
6 months
T/F: After 18 months, children grow in spurts rather than on a gradual incline
true
describe the maturation of bodily systems as children age
Slowing of respiratory rate
Slowing of heart rate
Hematopoietic changes
Head growth
Differentiation of the nervous system
Maturation of digestive processes
Maturation of immunologic system
Thermoregulation
Maturation of renal function
Increase in auditory acuity and perception
when do children begin Grasping objects
ages 2 to 3 months
when do children begin to Transferring object between hands
age 7 months
children develop the Pincer grasp at age
age 10 months
children begin Removing objects from container at age
age 11 months
children begin Building tower of two blocks at age
age 1 year
at what age do babies start Rolling over
Age 5 months: abdomen to back
Age 6 months: back to abdomen
at what age should babies begin to sit on their own
age 7 months
at what age should babies be able to move from prone to sitting position
age 10 months
at what age should a baby begin to crawl
ages 6 to 7 months
at what age should a baby begin Walking with assistance:
age 11 months
describe Reactive attachment disorder (RAD)
Reactive attachment disorder (RAD) is a condition where a child doesn’t form healthy emotional bonds with their caretakers (parental figures), often because of emotional neglect or abuse at an early age. Children with RAD have trouble managing their emotions. They struggle to form meaningful connections with other people.
at what age should a baby begin Walking alone:
age 1 year
what kinds of thing should babies eat during the first 6 months of life
First 6 months of life: human milk should be the only food
Second 6 months
Selection and preparation of solid foods
Introduction of solid foods
Weaning from breast or bottle
By ages 3-4 months, nocturnal sleep lasts _______ hours
9-11
start using fluoride on teeth at ___ months
6
Prevention of dental caries in infants
No bottle propping
No milk in bed
No fruit juices
children should be ina car seat until their ___ birthday
8th
a plagiocephaly skull looks
slanted and pointy on top
a braciocephaly skull looks
square with flat back of head
what are symptoms of a cows milk protein allergy in infants
gurguly, painful stomach
skin reaction
respritory reaction
name things that can cause Failure to Thrive (FTT)
Inadequate caloric intake
Inadequate absorption
Increased metabolism
Defective utilization
Apparent life-threatening event (ALTE)
used to be aborted SIDS where pt exhibits apnea and cyanosis/redness. choking, gagging, or coughing
Brief Resolved Unexplained Event (BRUE)
Aborted or near-miss SIDS
Unexplained respiratory pause > 20 seconds
Therapeutic management
Theophylline/caffeine
Home apnea monitors
Family support
CPR training
Risk factors for SIDS
prone position, soft bedding, overheating, co-sleeping, maternal smoking, genetic predisposition, prolonged Q-T interval, male, low APGAR, recent viral illness
Protective factors for SIDS
Breast feeding, pacifier use, sleeping on back, updated immunizations,
when are “The terrible twos”
Ages 12 to 36 months
a toddlers Weight gain should slow to ___ lb/year
4 to 6
Birth weight should be quadrupled
by age ___years
2½
a toddlers Height increases about __ inches/year
3
describe the progression of a toddlers growth
Elongation of legs rather than trunk
Growth is steplike rather than linear
Visual acuity of_____ is acceptable for toddlers
20/40
Most physiologic systems are relatively mature by the end of _____
toddlerhood
what kind of health problems are common among toddlers
Upper respiratory infections, otitis media, and tonsillitis
Refinement of coordination happens Between ages
2 and 3 years
a child should be able to throw a ball by
By 18 months
Child recognizes gender differences by age___years
2
Gender identity is formed by age ____ years
3
By age ___ years, child uses multiword sentences
2
Parallel play
when a child plays on their own with children around. Happens mostly with toddlers
Imitation play
a type of play where a child begins to copy or mimic another person. A child seeing another child play egg shakers, to match the feel of the music, or a child noticing that Mommy dances slower, when the music is slower, then matching her tempo, are examples of imitative play in action.
Tactile play
playdough, sand play
how do you asses readiness for Toilet Training
Voluntary sphincter control
Able to stay dry >2 hr
Fine motor skills to remove clothing
Willingness to please parents
Curiosity about adult or sibling’s toilet habits
Impatient with wet or soiled diapers
temper tantrums can be considered abnormal if pt is age __ or ___
<1 yr or >4 yr
Pathophysiology and clinical manifestations of lead poisoning
collects in bones and inhibits calcium which also leads to neurological deficits. if iron deficient they absorb lead more easily
Diagnostic evaluation of lead poisoning
elevation of EP level
Chelation therapy
treatment for extreme lead poisoning, monitor kidney function during treatment
school agePhysiologically begins with ____________; ends at puberty with _____________
shedding of first deciduous teeth
acquisition of final permanent teeth
a school age child’s height should increase by __ inches/year and weight increases by ___ kg/year
Height increases by 2 inches/year
Weight increases by 2-3 kg/year
Puberty begins at approximately age __ in girls and age __ in boys
10
12
Rules and rituals
Team play
Quiet games and activities
Ego mastery
Rules and rituals: children make their own weird rules
Team play: playing normal games and sports
quiet games and activities: collect things, play video games, read
ego mastery: children develop skills that they’re proud of
“Latchkey children”
children who are left to themselves after school
Dishonest behavior happens with ___ age children
school
Use of estrogens to control ht if….
initiated before menarche
Primary versus secondary enuresis
primary is bedwetting when they’ve never been dry
secondary is bedwetting when its never happened before
Primary - Secondary - Psychogenic Encopresis
primary is pooping their pants before age 4
secondary is pooping pants after age 4
Pediculosis Capitis
Head lice are tiny insects that feed on blood from the human scalp. They spread through direct contact
Scabies
Scabies is an itchy skin rash caused by a tiny mite that burrows under the skin and lays eggs. It can spread easily through close contact and is contagious.
Tinea corporis Tinea capitis
fungal infection that affects your child’s scalp and hair. Symptoms of tinea capitis include swollen red patches, dry scaly rashes, itchiness and hair loss. Mold-like fungi called dermatophytes cause tinea capitis. Treatment for a tinea capitis infection involves the use of an oral antifungal medication.
Molluescum Contagiosum
fairly common skin infection caused by a virus. It causes round, firm, painless bumps ranging in size from a pinhead to a pencil eraser. If the bumps are scratched or injured, the infection can spread to nearby skin. Molluscum contagiosum also spreads through person-to-person contact and contact with infected objects.
Associative play
Group play without rules
Imitative play
Imaginative play
Imaginary playmates
Dramatic play
Mutual play
preschoolers need ___________ calories per day
1400-1600
preschooler fluid requirement is ___ mg/kg
100 mL/kg
preschoolers should sleep_____ hours per night
12 hours per night
Erythema infectiosum (fifth disease)
Roseola infantum
Scarlet fever
Erythema infectiosum: swollen face with red spotty rash and fever/nausea
Roseola infantum: little red papules all over body with fever
Scarlet fever: intesne red rash around joints, super red mouth, pale face
Secondary sex characteristics
Result of hormonal changes: voice change, hair growth, breast enlargement, fat deposits
describe Hormonal Changes of Puberty
Anterior pituitary gland and hypothalamus play a role
Hormones stimulate gonads
Gonads secrete sex-appropriate hormones
Girls: estrogen increases until about___years after menarche
3
levels then remain at this maximum throughout reproductive life
Androgens are…
“Masculinizing hormones”
Secreted in small and gradually increasing amounts for up to 7-9 years
Tanner stages of sexual maturity
stage 1 immature - stage 5 mature
Females: breast size and pubic hair
Males: penis/scrotum shape and pubic hair
define Thelarche:
appearance of breast buds; ages 9-13 years
define Adrenarche:
growth of pubic hair on mons pubis; 2-6 months after thelarche
define Menarche:
initial appearance of menstruation, approximately 2 years after first pubescent changes; average age, 12 years 4 months in North America
Boys First pubescent changes:
testicular enlargement, thinning, reddening, and increased looseness of scrotum; ages 9½-14 years
Penile enlargement, pubic hair growth, voice changes, facial hair growth
__%-__% of total height achieved during puberty
Usually occurs within __ to __ months
20%-25%
24 to 36
top three causes of death for adolescents
- car crash
Second leading cause of death- suicide
Third leading cause of death- homicide, most by firearms (BUT this is rising rapidly!)
define Variocele
enlargement of veins in the scrotum, feels like a bag of worms
define Epididymitis
Inflammation of the tube at the back of the testicle that stores and carries sperm.
Epididymitis is often caused by a bacterial or sexually transmitted infection.
Pain and swelling in the testicle are common.
Treatment usually is antibiotics. Rarely, pus may need to be drained or part or all of the coiled tube may be surgically removed.
define Testicular torsion:
A twisting of the male organ that makes hormones and sperm (testicle).
When the testicle rotates (testicular torsion), it twists the cord supplying blood to the loose bag of skin (scrotum) beneath the penis. This may occur after vigorous activity, a minor injury to the testicles, or sleep.
Sudden, severe pain and swelling in the testicle are symptoms.
Surgery is required. Treated promptly, the testicle can often be saved. A longer wait may affect fertility.
what age group is notoriously egocentric
early childhood (younger than 5 years old)
when can you start doing head to toe assessments instead of an altered sequence assessment
starting preschool age
what are the Requirements for obtaining informed consent
The person must be capable of giving consent: age at majority (usually age 18)
The person must receive the information needed to make an intelligent decision
The person must act voluntarily when exercising freedom of choice
two licensed people have to be in room when giving informed consent
n95 for ______ precautions (measles and TB and varicella)
airborne
when kids get injections, to hold them still you should
utilize therapeutic holding
when kids get sutures or place an NG tube, to hold them still you should
Posey vest
Determining the injection site for walking vs. non-walking kids
not walking = vastus lateralis,
walking = deltoid or ventro-gluteal)
Older children ventrogluteal and hip for IM.
Use ____ artery for central line in babies
femoral
when would you do Rectal Administration of Medications
Alternative route when oral route is difficult or contraindicated
use pinky, dont do on babies under 28 days
