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PSP > Infants > Flashcards

Infants Flashcards

1
Q

Principles of child development

A

. Development proceeds along predictable pathway/trajectory
. Range of normal development is wide
. Variety of factors affect child’s health (medical/social factors)
. Child’s developmental level affects the nature of examination

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2
Q

Pediatric health promotions

A

. Age=appropriate developmental milestones
. Health supervision visits per schedule
. Integrate physical exam findings w/ history/age
. Immunization schedule
. Screening per guidelines
. Anticipatory guidance
. Partnership and developing bond btw provider and patient

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3
Q

What are you checking during well child visits?

A 
. Physical growth
. Motor skills 
. Cognitive growth/milestones 
. Emotional growth and independence 
. Social growth and communication
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4
Q

Motor milestone in 1st year

A 
. 3 mo: holds head up 
. 4 mo: rolls from front to back 
. 6mo: rolls from back to front, sits 
. 9 mo: crawls, stands w/ support, cruises 
. 12 mo: stands, walks a few steps
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5
Q

Schedule of pediatric appointments

A 
. 2-5 days 
. 2 weeks 
. 1 mo
. 2 mo
. 4 mo
. 6 mo
. 9 mo
. 1 yr 
. 15 mo
. 18 mo 
. 24 mo
. 30 mo
. 3 years 
. Then yearly after that
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6
Q

Screenings completed in newborn nursery

A 
. Newborn screen 
. Bilirubin level at 24 hrs 
. CCHD screen at 24 hrs 
. Hearing screen before discharge 
. Car seat check
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7
Q

Screenings completed at 1, 2, 4, and 6 months

A

. Post partum depression screen

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8
Q

What screening is completed at 12 mo

A

. Lead and Hb levels

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9
Q

Neonatal resuscitation at birth

A 
. Place infant under radiant heat warmer 
. Dry and stimulate 
. Position w/ head in sniffing position 
. Clear airway w/ bulb suction 
. Assign APGARs 
. Further resuscitation if necessary
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10
Q

What do you do if baby is not to term, doesn’t have tone, is not breathing, or is not crying?

A

. Warm and maintain normal temperature
. Position airway
. Clear secretions, dry, and stimulation

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11
Q

What do you do if the baby had apnea, gasping, or HR under 100 bpm

A

. PPV
. SpO2
. Monitor
. Consider ECG monitor

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12
Q

What do you do if baby hands labored breathing or persistent cyanosis?

A 
. Position and clear airway
. SpO2 monitor 
. Supplemental O2 as needed 
. Considered CPAP 
. Complete post-resuscitation care and team briefing if situation gets better
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13
Q

What do you do if baby’s HR is under 100 bpm

A

. Check chest movement
. Ventilation corrective steps if needed
. ETT or laryngeal mask if needed

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14
Q

What do you do if baby’s HR is under 60 bpm?

A

. IV Epi

. If it is persistently below 60 then consider hypovolemia or pneumothorax

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15
Q

APGAR score

A

. Assesses newborn after birth
. Appearance: blue/pale = 0, pink body/blue extremities = 1, pink all over = 2
. Pulse: none = 0, under 100 = 1, over 100 = 2
. Respiration: absent = 0, slow and irregular = 1, good/strong = 2
. Activity: flaccid = 0, slow flexion of arms/legs = 1, active = 2
. Grimace: no response = 0, grimace = 1, crying/sneeze/cough = 2
. Performed at 1, 5, and 10 min after
Birth
. Low score doesn’t necessarily mean there is an issue

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16
Q

1 minute APGAR score ranges and meaning

A

. 0-4: severe depression, requiring immediate resuscitation
. 5-7: some nervous system depression
. 8-10 normal

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17
Q

5 minute APGAR score ranges and meanings

A

. 0-7: high risk for subsequent CNS and other organ system dysfunction
. 8-10 normal

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18
Q

Tips for examining newborns

A

. Have infant in parent’s arms or in car seat
. Prioritize comfort level of infant
. Best to examine 1 hr after feeding
. Hands and equipment should be warm
. Dim lights and swing baby to encourage eye opening
. Look at ears and mouth last

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19
Q

How to calm crying baby

A 
. Swaddle
. Sidelying 
. Sway/swing 
. Suck
. Shush
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20
Q

Gestational age considered preterm

A

. Under 34 weeks

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21
Q

Gestational age considered late preterm

A

34-36 weeks

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22
Q

Gestational age considered term

A

. 37-42 weeks

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23
Q

Gestational age considered post term

A

. Over 42 weeks

24
Q

Classification of birth weights

A

. Extremely low: under 1,000g
. very low: 1,500g
. Low: under 2500g
. Normal: equal to or over 2500 g

25
Q

Risks for preterm infants

A

. Risk for both short term complications (respiratory and cardiovascular)
. Long term sequuelae (neurodevelopmental)

26
Q

Risks for late preterm infants

A

. Prematurity-related complications

27
Q

Posters infants risk

A

. Perinatal mortality or morbidity through asphyxia and meconium aspiration

28
Q

What is directly related to inc. muscle tone and resistance to passive manipulation?

A

. Greater fetal maturity

29
Q

Seesaw respiration

A

. Chest wall retracts and abdomen rises w/ inspiration

30
Q

Moro reflex

A

. Extend head -> extension, flexion of arms, legs
. Appears at birth
. Disappears 4-6 mo
. CNS origin: brainstem vestibular nuclei
. Persistence beyond 8 mo suggests cerebral dysfunction

31
Q

Grasp reflex

A

. Finger in palm -> hand, elbow, shoulder flexion
. Appears at birth
. 4-6 mo disappears
. CNS origin: brain stem vestibular nuclei
. Persistence beyond 4 mo suggests cerebral dysfunction
. Persistence of clenched hand beyond 2 months suggests CNS damage, esp. if fingers overlap thumb

32
Q

Rooting reflex

A

. Cheek stimulus -> turns mouth to that side
. Appears at birth
. Disappears 4-6 mo
. CNS: brain stem trigeminal system
. Absence indicates severe generalized or CNS disease

33
Q

Trunk incurvation reflex

A

. Withdrawal from stroking along ventral surface
. Appears att birth
. Disappears 6-9 months
. CNS: spinal cord
. Absence suggests transverse spinal cord lesion or injury
. Persistence may. Indicate delayed development

34
Q

Placing reflex

A

. Steps up when dorsum of foot stimulated
. Appears at birth
. Disappears 4-6 mo
. CNS: cerebral cortex
. Absence may indicate paralysis
. Babies born breech delivery may not have placing reflex

35
Q

Tonic neck reflex

A 
. Fencing posture when supine 
. Appears at birth 
. Disappears 4-6 mo 
. CNS: Brea is stem vestibular nuclei 
. Persistence beyond 2 months suggests neuro disease
36
Q

Parachute reflex

A 
. Stimulate fall-> extends arms 
. Appears 6-8 months 
. Never disappears 
. CNS: brains stem vestibular 
. Delay in appearance may predict future delays in voluntary motor development
37
Q

positive support reflex

A

. Hold the baby round trunk and lower him until his feet touch a flat surface
. Hips, knees, and ankles will extend and it will stand up, partially bear weight and then sag after 20-30 s
. Lack of reflex suggests hypotonia or flaccidity
. Fixed extension and adduction of legs (scissoring) suggests spasticity due to neuro disease

38
Q

Plantar grasp reflex

A

. Birth to 6-8 months
. Touch sole at base of toes
. Toes will curl
. Persistence beyond 4 mo suggests neuro disease, beyond 6 mo strongly suggests it
. Asymmetric response suggests fracture of clavicle, humerus, or brachial plexus injuries

39
Q

Landau reflex

A

. Birth to 6 mo
. Suspend the baby prone w/ 1 hand
. His head willing up
. Persistence may indicate delayed development

40
Q

Plethora

A

. Excess of bodily fluid, particularly blood (overheated, facial presentation, polycythemia)
. Indicative of cyanotic heart disease

41
Q

Cyanosis in infants

A

. Would be visible if deoxygenated Hb content is over 3g
. If present throughout the body including the mucous membranes and tongue (central cyanosis)
. Cyanosis in just extremities (peripheral cyanosis/acrocyanosis)
. Acrocyanosis from exposure to cold and polycythemia

42
Q

Erb-duchene deformity

A

. Paralysis of upper brachial plexus (C5-6)
. Arm hangs at side w/ elbow extended and the forearm pronated
. Waiter’s tip hand/erb’s palsy occurs

43
Q

Klumpke’s deformity

A

. Paralysis fo lower brachial plexus (C8-T1)

. Claw hand w/ forearm is supinator and wrist and fingers are flexed

44
Q

Caput succedaneum

A

. Edematous swelling formed on presenting portion of scalp of infant during birth
. Effusion overlies periosteum
. Anatomic landmark that enables this condition to cross suture lines

45
Q

Cephalohematoma

A

. Swelling in which effusion lies under periosteum
. Consists of blood not serum
. Anatomic location does not cross suture lines

46
Q

Epstein pearls

A

. Happen when skin of baby’s mouth is trapped during development process
. As mouth continues to develop and take shape, this trapped skin can fill w/ Keratin
. Keratin is what makes up inside of epistein pearl

47
Q

Vernix caseosa

A

. Coating that protects unborn baby’s skin from amniotic fluid
. W/o protection, baby’s skin would chap or wrinkle in uterus

48
Q

Harlequin color change

A

. Newborn babies
. Momentary red color changes of half the child sharply demarcated at body midline
. Transient change occurs in 10% of healthily newborns
. Usually seen btw 2 and 5 days of birth
. Lasts from 30 s to 20 minutes and then fades

49
Q

Mottling

A

. In contrast w/ cutis marmorata, the mottling does not resolve when skin is warmed
. Discoloration is blue instead of red
. Lesion is more intense and is persistent

50
Q

Erythema toxicum neonatorum

A

. Common rash seen in full term newborns

. Appears in 1st few days after birth and fades w/in a week

51
Q

Assessment of hip dysphasia

A

. Develops due to acetabulum that is too shallow
. More common in girls
. More common w/ left hip
. Risk factor: LGA, breech
. Treatment: hip immobilization, rarely surgery

52
Q

Barlow’s and Orotolani’s

A

Barlow: evaluates hip to determine if they can be easily dislocated
. Orotolani’s: detect dislocated or subluxation hips, determines if they can be reduced
. If either test is abnormal do hip ultrasound to confirm findings j

53
Q

Failure to thrive

A

. Decelerated or arrested physical growth
. Weight and height measurements fall below the 3rd or 5h percentiles or a downward trend in percentiles
. Usually weight change precedes height change
. Can be from inadequate caloric intake, inadequate caloric absorption/usage
. Inc. metabolic demands

54
Q

Formula intolerance

A

. Baby has trouble digesting formula
. May be sensitive to ingredient
. Different than allergy, allergy means the baby’s immune system reacts to protein in formula and can be life threatening
. Diarrhea, blood/mucus in your baby’s stools, vomiting, pulling legs up to tummy, colic makes your baby cry constantly, trouble gaining weight or weight loss

55
Q

Gastroenteritis

A

. Infection in bowel causing diarrhea
. For the 1st 24-48 hrs a child may have vomiting and fever
. Diarrhea develops during this time and lasts 4-10 days

56
Q

Cystic fibrosis

A

. Caused by mutation in a gene (CFTR)
. Controls flow of salt in and out of cells
. Condition causes thick mucous to build up in body
. All babies have a newborn screening test for CF so it can be found and treated early

57
Q

Hirschsprung disease

A

. Involves missing nerve cells in muscles of part or all of the large intestine
. Present at birth
. Causes issues passing stool
. Symptoms: failure to have bowel movement w/in 48 hours after birth, swollen belly, vomiting
. Surgery needed to bypass affected part of colon or remove it

PSP (35 decks)

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