Exam 1 Well Child: Toddler-Preschool

Question 1

Toddlers = ____ years
Preschoolers = _____ years
Leading cause of death (1-4) =

Answer 1

1-3 yo
3-6 yo
Unintentional injury (motor vehicle injuries)

Question 2

Health Supervision visits for toddlers and preschoolers take place at what ages? (9)

Answer 2

15 months, 18 months, 24 months, 2 1/2 years, 3 years, 3/12 years, 4 years, 5 years, 6 years

Question 3

Toddler Vital Signs

1) Heart Rate =
2) Respirations =
3) Temperature =
4) Blood Pressure =
5) Growth = (2) height and weight /year

Answer 3

1) 70-110
2) 20-30
3) 98-99 F
4) 90-105/ 55-70
5) 3 inches/year (4-6 lbs/year)

Question 4

Head circumference is taken until ___ yo
BP start at ___ yo
BMI, Height starts to be taken at ___ yo

Answer 4

3
3
2

Question 5

Developmental Screenings

1) __% of children have a developmental delay
2) Less than ____ are identified prior to starting school (and we know that if we catch it early and intervene early, we can help child “ ______ ______ _____”
3) Early intervention (3) therapies

Answer 5

1) 17%
2) half, “MEET MAXIMUM POTENTIAL”
3) Occupational therapy (fine motor skills), Physical therapy, speech therapy

Question 6

Causes of developmental delays

1) _____ syndromes
2) P_____
3) ______ infections/____exposures (fetal alcohol syndrome)
4) _____ during delivery
5) V____/H____ impairments
6) L____ exposure

Answer 6

1) Genetic
2) Prematurity
3) Perinatal infections/Toxin exposures
4) Hypoxia
5) Visual/Hearing impairments
6) Lead

Question 7

Developmental Screening Tools

1) Ages & Stages 15$
2) Bayley Infant Screener 25$
3) Infant development inventory $15
4) Denver Developmental Screening $58
5) Parents’ Evaluation of Development $15
6) CDC Developmental Milestones ______ (learn the signs. act ___!)

Answer 7

6) FREE (act early!)

Question 8

Gross Motor Skills =
Fine Motor Skills =

What types of therapy?

Answer 8

= movements that use the large muscles in the arms, legs, torso, and feet (standing, walking, running, jumping) PT

= movements that use the small muscles of the fingers, toes, wrists, lips and tongue (grabbing using thumb and index finger, hand to mouth) OT

Question 9

Oral and Motor Skills =
Social/Emotional Skills =
Cognitive Skills =

What type of therapy?

Answer 9

= language and communication, eating ST (speech therapy)
= Eye contact, smiles, interaction SE (special ed teacher)
= learning, thinking, problem solving SE (special ed teacher)

Question 10

CT: What are we looking for in developmental screenings?

Answer 10

We’re looking for red flags, to see if child is delayed. We want to catch it EARLY. We are checking for all of the potential causes

Question 11

CT: What do you suspect if a child walks on tiptoes, has repetitive speech and little eye contact?

Screening test =
At ___ and ___ months

Answer 11

Autism

MCHAT
18, 30

Question 12

What is the concern with too much milk in a child’s diet?

Answer 12

1 cause of anemia in US

Iron Deficiency Anemia! bc too much calcium does not allow iron to be absorbed

Question 13

Nutritional Needs for Toddlers (1-3)

1) Toddlers need ____ calories per day than infants
2) Preschoolers need ___ cal/kg
3) _____ meals/day (not big meals) + ____ snacks/day
4) ** Avoid (2)**
5) No more than ___ cups of milk/day
6) Food jags =
7) NO ___ feeding, it can lead to
8) Mealtime should be a ____ experience
9) P____ and HEALTHY ____ are super important until age 3 for ____ development

Answer 13

1) fewer
2) 90
3) 3, 2-3
4) Juices, Soda
5) 2 cups of milk
6) only eats a few foods
7) Force -> eating disorders
8) pleasant
9) Protein, Healthy Fats, important for Brain development

Question 14

Physical Assessment

1) Allow “___ up” time prior to touching child
2) Remove only clothing _____ for each part of assessment
3) Proceed from ___ to ___ intrusive (listen to heart/lungs before anything painful)
4) Give ____ when possible
5) Primary dentition ___ teeth completed by __ months
6) Child sits where during assessment?

Answer 14

1) “warm up”
2) needed
3) Least to Most
4) Choices
5) 20 teeth by 30 months
6) On top of parent

Question 15

Sleep Patterns

• ______ hrs of sleep each day
• Naps during 16-20 months?
• Nightmares occur when?
• Night Terrors occur when? Because of what?

Answer 15

• 8-13 hrs
• morning nap eliminated, one long afternoon nap 1-3 hrs
• early sleep
• second half of sleep, bc of active imagination, increased dream state, or can be related to stress/anxiety (recently divorced)

Question 16

Preventative Care for Dental Carries in preschools and toddlers (3)

Answer 16

1) Brush twice daily with soft brush and pea sized fluoride toothpaste
2) Limit sweet drinks and snacks
3) Visit dentist every 6 months, starting at age 2

Question 17

Temper Tantrums, the best way to handle is to ____ it, is common in toddler, should decrease with age

Answer 17

IGNORE

Question 18

Tantrum tips

1) ____ tantrums with distraction at early signs
2) _____ child from others
3) Keep child ____
4) Remain ____ (be a role model)
5) If it doesn’t stop should you just give in and give candy?
6) Reward improvement of _____ control
7) ____ reinforcement!
8) Avoid ____ during nap time

Answer 18

1) AVOID
2) Separate
3) Safe
4) Calm (be a role model)
5) NO, don’t give in
6) behavior control
7) Positive reinforcement!
8) Active activities

Question 19

Toddler Play Habits

Parallel Play =
Im____
What type of toys?

Answer 19

= Playing alongside but not WITH other kids (thats your toy, this is my toy)
Imitation
Push-pull toys, balls, riding toys, finger paint, crayons, puzzles with large pieces, blocks

Question 20

Signs that a child is ready for toilet training

1) Diaper is dry for more than __ hours
2) Child is able to do what with pants?
3) _____ parent/sibling in bathroom
4) Able to follow _____
5) Shows ____ in ____ activities

Most children are ready to begin around
_____ yrs for girls
______ yrs for boys

Answer 20

1) 2
2) pull pants on and off
3) imitates
4) instructions
5) interest in toileting

2-2 1/2
2 1/2 -3

Question 21

How to begin with toilet training

1) Have child select their own “___ ___” underwear
2) Place ______ in bathroom specifically for child
3) Child should be placed on chair at =
4) ____/____ success (ignore potty accidents)
5) If child doesn’t cooperate, what do you do?

Answer 21

1) “big boy”, “big girl” underwear
2) potty chair
3) regular intervals
4) Reward/Praise
5) wait a few weeks and try again

Question 22

NY requirements for Lead

• Lead levels must be drawn on every child at ___ and ___ years
• Older if child eats (3), or has a ____ with high lead levels

In NYC any lead level __ or greater is reportable

Answer 22

• 1, 2
• paint chips, plaster, soil, has sibling with high lead levels

5

Question 23

Lead pain was banned in ____

1) How can children get lead toxicity?
2) Found in what?
3) Can cause (3)

Answer 23

1978

1) By swallowing, breathing, or touching it
2) dust in lead paint
3) growth problems, behavior problems, difficulty learning (brain probs)

Question 24

Lead Toxicity Prevention (4)

Answer 24

• Wash children’s hands and toys often
• Mop floors and use damp cloth to clean windowsills often
• Repair any peeling pain
• Be careful that children do not eat or play with paint chips, plaster, dust or dirt
• use only cold water for drinking, cooking, and preparing infant formula (bc lead doesn’t separate from hot water)
• use lead free dishes and pots (seen in pots from latin america, middle east, india)

Question 25

Sources of Lead (3)

Keep water running for=

Answer 25

• For 1-2 minutes
• use only cold water for drinking, cooking, and preparing infant formula (bc lead doesn’t separate from hot water)
• use lead free dishes and pots (seen in pots from latin america, middle east, india)

Question 26

Lead Levels

How much of lead do we want to see in children?

1) < 9 =
2) 10-19 =
3) 20-44 =
4) 45-69 =
5) > 70 =

Answer 26

NONE!

1) Asymptomatic with some neurological deficits
2) Mild impairment in growth and cognition; anemia
3) Fatigue, motor impairment, difficulty concentration, tremors, abdominal pain, weight loss, anemia*
4) Severe abdominal pain, anorexia, vomiting, irritable, lethargy (will need hospitalization and NG tube)
5) Encephalopathy, seizures, coma, death

Question 27

Treatment for Lead

1) ____ lead from child’s environment
2) ___/___ for irone deficiency ____
3) >45 =

Answer 27

1) Remove
2) Test/Treat Anemia
3) Chelation therapy (agent that binds w lead, decreases its effects, increases excretion rate)

Question 28

Preferred site for IM in children < 3 =

When can you use the deltoid for IM?

Answer 28

Anterior Vastus lateralis, NO BUTT!

Age over 1 year

Question 29

Injury Prevention for MVA =

Answer 29

Use approved safety seat, rear facing, in the back seat and use on ALL trips

Question 30

Injury prevention for Falls =

Answer 30

Supervise toddler closely, park for safe climbing

Question 31

Injury prevention for Poisoning =

Answer 31

Keep meds and all poisonous materials locked and away

Have poison control center number easily available

Question 32

Injury prevention for Burns =

Answer 32

= use fire screens, keep pot on back burners and turned inward on stove, keep water temp 120-125 degrees, check bath before putting toddler in

Question 33

Injury prevention for Drowning =

Answer 33

= Do not leave buckets filled with water around children when cleaning, supervise children in the bath tube and near water, use pool gates, pool covers, always use child life jackets near water or on boats

Question 34

Explaining Procedures

Answer 34

• Give explanation JUST before procedure (limited concept of time)
• Stress that procedure is necessary and that child did nothing wrong
• perform procedure in tx room
• immobilize child securely
• ** give SHORT explanations
• Do not give choices when none are available
• Allow child to cry or scream
• Comfort child after procedure
• Allow child choice of special sticker after procedure

Question 35

IV’s in Children

1) Veins are ___ and _____
2) How frequent do we assess the site and infusion pumps?
3) Common sites (3)
4) _____ pumps used when minimal fluid is given over an extended period of time
5) _____ lines used for long term IV therapy

Answer 35

1) small, fragile
2) HOURLY
3) hands, feet, sometimes scalp in infants
4) Syringe
5) Central

Question 36

_____ balance is critical!! why?

Answer 36

FLUID BALANCE

bc kids can into shock and arrest very quickly if they are over or under hydrated

Question 37

Weight Percentiles

1) Underweight =
2) Healthy weight =
3) Overweight =
4) Obese =

Answer 37

1) < 5 percentile
2) 5-85th percentile
3) 85-95th percentile
4) > 95th percentile

Question 38

Output should be ____ ml/kg/hr

1 oz = ___ ml

1 g of wet diaper = __ ml of urine

Answer 38

1-2 ml/kg/hr

1 oz = 30 ml

1 g = 1 ml

Question 39

What is the drug of choice for a fever, aspirin or acetaminophen, why?

How is it supplied?

Answer 39

NO aspirin bc Reyes syndrome

Tabs, chewable tabs, liquid/elixir, caplet, Geltab, Gelcap, capsules

Question 40

Pediatric dose of Acetaminophen = _____ mg/kg/dose every ____ hours

Max dose = ____g/24 hr, ___ doses/24 hr

Answer 40

10-15 mg/kg/dose every 4-6 hours

4g/24hr, 5 doses/24hr

Question 41

Overdose of Acetaminophen (Tylenol) can lead to =

Medication for OD =

Answer 41

Hepatotoxicity

Mucomyst

Question 42

8 Rights of Medication Administration

Answer 42

1) Right Patient
2) Right Medication
3) Right Dose
4) Right Route
5) Right Time
6) Right Documentation
7) Right Reason
8) Right Response

Question 43

Pediatric Variations
Oral meds are usually give in _____ form (elixir, syrup, suspension)

1) Why is it difficult to administer oral meds to children?
2) Avoid putting medication in =
3) Some tablets can be _____ and mixed with _____
4) Position _____ to avoid _____
5) Use oral ____ and give fast or slowly?
6) Aim where?
7) Preschoolers may prefer =

Answer 43

• liquid

1) Often don’t like the taste
2) Bottle with juice or formula bc we need to make sure they’re consuming ALL of the meds
3) Crushed, with applesauce or pudding, but use only a tablespoon so they eat all of it
4) Upright to avoid choking/aspiration
5) Syringe, give slowly
6) Inside of cheek
7) Medicine cup

Question 44

Administration of eye drops =

Answer 44

= Gently press lower lid down and have the child look up as the drop is instilled in the lower conjunctival sac

Question 45

Administration of ear drops

1) < 3 yo
2) > 3 yo

Answer 45

1) pull pinna down and back

2) pull pinna up and back

Question 46

Administration of nasal drops =

Answer 46

= hyperextend the head and place the tip of the dropper just at the nasal opening

Question 47

Administration of nasal spray =

Answer 47

= upright position, place tip of spray bottle inside the nasal opening and squeeze container