health promotion and well child care Flashcards

Question

Fontanel

Answer 1

1. assess while infant sitting up and not crying 2. Posterior font- closes by 2 mos of age 3. anterior fontanel should be no larger than 4-5 cm 4. Anterior fontant. closes by 18 mos a. early closure leads to synostosis b. late closure seen in increaed ICP, hypothyroid, rickets, syphilis, down syndrome, Ost. Imperfecta 5. large font: chronic increased ICP, subdural hematoma, rickets, hypothyroid,, O.I. 6. sunken AF seen with sever dehydration (more than 10%)

Answer 2

head circ more and 2 standard deviations below the mean for age, sex, gestation. Causes: intrauterine infection, genetic defects, drug usage during preg (esp alcohol)

Answer 3

head circ >2 standard deviations above mean causes: hydrocephalous, masses, increased ICP, skeletal dysplasias, familial tendency

Answer 4

strabismus, CNS lesions, short sternocleidomastoid muscle (congenital torticollis)

Answer 5

diffuse edema of the soft tissue of th escap that crossess suture lines, may be seen with bruisin due ot traumatic vaginal birth, seen at birth, no specific treatment usually resolves in 2-3 days

Answer 6

suberpiosteal collection of blood that does not cross suture lines, does not appear until severl hours or over 24hrs, no specific treatment, resolves over a few weeks to months, observation for hyperbilirubinemia

Answer 7

premature or irregular closure of sutures, causes unusual head shape

Answer 8

bulging of frontal area associated with rickets, prematurity, and preamture closing of sutures

Answer 9

flattening or asymmetry of cranium (brachycephaly, scaphocephaly)

Answer 10

4 mos of age- head held erect and in midline 6 mos- no head lag when pulled to sitting, if present may indicate nueromuscular disorder, 1st sign of cerebral palsy

Answer 11

restriction of motion, can result from birth trauma ( inury to sternocleidomatoid muscle with bleeding into the muscle), muscle spasm, viral infection or drug ingestion

Answer 12

webbed neck, 99% in females, anormal ears, micronathia, lymphedema of hands and feet, short stature

Answer 13

filled with fluid from epithelial cells, seen near midline of neck, cyst moves up and down with protrusion of tongue, may become infected, and present as abscess, surgical excision recommended

Answer 14

can appear as swelling anterior to sternocleidomastoid muscle or as opening along anterior border of scm, may drain and become infected

Answer 15

common in breech deliveries

Answer 16

1. Preterm infant risk for ROP 2. infant who doesn't track, absent blink in response to bright lights/sudden mvmt 3. children younger than 6 yrs of age: who rub eyes excessively, squint, photophobia, difficulty reaching for or picking up small objects, engage in head tilting, hold objects close to face, presence of retinal hemorrhage 4. school age children who sit to close to TV, poor progress in school 5. any child who has white area in pupil visible in photographs (retinoblastoma), any white, gray-white, yellow colored material in cornea/lens (congenital cataracts), complains of headache that progresses throughout day (not present in morning), excessive tearing, strabismus, drooping eyelid/head tilting, papilledema

Answer 17

blocked tear duct, may lead to infection *dacrocystitis

Answer 18

telangiectatic nevi- disappears by 12 mos

Answer 19

soft swelling around eye may be related to renal or cardiac problems or sinusitis acute onset, unilateral eyelid edema with erythma tenderness- periorbital cellulitis

Answer 20

EOAE testing is the universal screening tool for the newborn; however, the EOAE does not quantify hearing deficit and may not identify auditory nerve dysfunction. Evoked otoacoustic emission

Answer 21

VRA testing is a type of behavioral test that measures the response of the child to speech and frequency-specific stimuli. It is generally performed on a child between 5-24 months old.

Answer 22

Tympanometry is of little use in children younger than 7 months of age because their ear canals are hypercompliant in response to pressure from the tympanometer.

Answer 23

ABR measures the initiation of sound-induced electrical signals in the cochlea and the functioning of the peripheral auditory system and neurologic pathways related to hearing. It is a physiological test that averages the number of brainstem responses to brief tones or clicks. It does not require an audiologist for interpretation; the results are pass/fail, and inferences can be made about hearing thresholds. For this reason, it is often used in newborn hearing screening. Since the infant must remain still, it is often performed during sleep or occasionally under sedation

Answer 24

child who presents with anorexia, growth retardation, skin changes, and immunologic abnormalities.

Answer 25

Dry skin and follicular keratosis are often seen in vitamin A deficiency. Night blindness, corneal lesions, and an increased susceptibility to infections are other signs of deficits of this important fat-soluble vitamin. In most cases, vitamin A deficiency results from insufficient dietary intake (sources include liver, milk, eggs, green and yellow vegetables, fruits).

Answer 26

Rickets and delayed dentition are signs of vitamin D deficiency.

Answer 27

A child deficient in vitamin C would display scurvy and easy bruising

Answer 28

Toddlers need about 12 to 14 hours of sleep in a 24-hour period, and most toddlers transition to one nap around 18 to 22 months of age. Preschoolers generally require 11 to 13 hours of sleep each night, and most do not nap after 5 years of age. Children ages 5 to 12 years old need 10 to 11 hours of sleep. Adolescents are notorious for not getting enough sleep; most get less than the 8 to 9 hours recommended by the CDC.

Answer 29

Treatment guidelines for AOM include: Any child with moderate/severe bulging TM with otorrhea not associated with AOM Any child with mild bulging of the TM with recent (<48 hours) onset pain (holding, tugging, etc.) or intensely erythematous TM Babies 6 months old or older with severe signs of AOM (fever >102.2F [39C], otalgia for at least 48 hours) Any child 6-23 months old with acute bilateral otitis media without severe symptoms, without fever, and sick less than 48 hours

Answer 30

"watch and wait" with close follow-up: Young children with unilateral AOM without severe symptoms and fever <102.2F [39C] Children 24 months old or older without severe symptoms Children not treated and no improvement in 48 to 72 hours

Answer 31

vitamin B1: Thiamin vitamin B6 is pyridoxine. Vitamin B3: niacin. Vitamin B2: Riboflavin

Answer 32

- Trust vs mistrust stranger anxiety - separation anxiety - fear; separation from parents and pain

Answer 33

1-3y: 98-109/54-67 4-6y: 106-117/66-76 7-10: 110-119/74-78 11-14: 117-128/78-84 15-17: 126-136/81-89

Answer 34

Exam on extra ocular mvmd: 6 cardinal positions when child is able to follow pen or light inner cantal distance average 2.5cm -eyelids same color as surrounding skin -sclera is shiny, clear, white -pupils equal size

Answer 35

Hypertelorism- wide spaced (downs) epicentral folds (downs, renal genesis, glycogen storage disease, NORMAL IN ASIAN) Ptosis- could be normal or paralysis of oculomotor nerve Exopthalamus: hypertelorism, protruding eyeballs, tumor

Answer 36

-stork bite- telangiectatic nevi disappear by 12 mos -blocked tear duct (dacrostenosis)- swelling, redness, discharge of lacrimal sac if infected -periorbital edema- soft swelling maybe assoc with renal or cardiac problems or sinusitis, acute onset of unilateral eyelid edema with erythema , induration, tenderness +periorbiral cellulitis -"allergic shiners" bluish discoloration and soft edema below eyes due to allergies

Answer 37

Bulbar conjunctiva- (covers sclera) is moist and transparent, palpebral conjunctiva lines the eyelids is pink and moist spots of brown melanin may be seen in dark skin races yellow sclera- jaundice redness- infection, allergy, irritation excessive pallor of palpebral conjunctiva- anemia cobblestone of palpebral conjunctiva severe allergy or contact lens irritation

Answer 38

unequal pupils= anisocoria- congenital or normal, can indicated increased ICP from head trauma, meningitis dilated fixed pupils: severe brain damage dilated pupils- anticholinergic drugs and substance abuse small pupils- brain damage, use of morphine, substance abuse

Answer 39

ability to fixate on one visual field with both eyes simultaneously BY 3-4 months

Answer 40

normal 0-6 mos of age

Answer 41

cover-uncover test corneal light reflex

Answer 42

-Reflections of both eyes are equivalent in color, intensity and clarity with no opacities or white spots -abnormal red reflex referred to ophthalmologist for complete exam - all infants/children with positive family history of retinoblastoma , cataracts (congenital, infantile, juvenile), glaucoma, retinal abnormalitites should be referred to optho regardless of red light status

Answer 43

Allen cares (2-3yrs) Snellen chart for other children - 20/20 not possible <6 years -20/30 or less at 3 yrs -20/40 or less at 4 years

Answer 44

-no babbling after 6 mos -no communicative speech, reliance on gestures after 15 mos -language delays

Answer 45

genitourinary or chromosomal abnormalities

Answer 46

1. pull auricle down and back <3 yrs 2. pull auricle up and back >3 yrs 3. Decreased TM mobility= fluid in middle ear 4. if have PE tubes- decreased mobility indicates obstruction or dysfunction of tubes 5. if presence of chromic TM perforation referral indicated

Answer 47

bluish, pale, edematous with serous drainage= allergic rhinitis

Answer 48

foreign body

Answer 49

riboflavin or niacin deficiency

Answer 50

excessive fluoride intake

Answer 51

oral iron intake

Answer 52

submucosal cleft palate

Answer 53

involvement of glossopharyngeal or vagus nerve

Answer 54

abnormally large tongue suggestive of trisomy 21, congenital hypothyroidism, other rare syndromes

Answer 55

tonsillar lymphoma

Answer 56

normal immunologic response, largest in size between 8-9yrs, then decreases after puberty

Answer 57

croup, cretinism (congenital iodine deficiency), tetany chronic: , vocal cord abnormality

Answer 58

The diagnosis of CH is usually made during the first week of life, detected by newborn screening tests. Any infant (birth through 3 months of age) with a low T4 and high TSH concentration (>40 mU/L) is considered to have CH and thyroid hormone replacement therapy ( levothyroxine sodium) should be initiated at 10 to 15 mcg/kg/day as soon as confirmatory serum tests are performed.

Answer 59

Referral for speech and language (which should include hearing) should occur if the child does not have the following receptive and expressive skills at the appropriate age: 9 months: does not use single or double consonant sounds, lack of response to name or voice, does not respond to any words, lack of reciprocal vocalizations 12 months: does not imitate speech sounds or recognize their name when called, does not babble, cannot localize to sound, does not point or use sounds to get the desired object or may just cry 15 months: has no words and only single words by 16 months, lack of consonant production, uses mostly vowel sounds, does not imitate words, no gestures or pointing 18 months: does not follow simple directions, does not use mama, dada, or other names with recognition