Lecture 1 Flashcards
1
Q
what is the most common cause of death and disability in children in the US?
A
- childhood injuries
2
Q
what are the leading causes of mortality in those less than 15?
A
- unintentional injury
- violence
- accidents
3
Q
what accounts for 50% of acute conditions in children?
A
respiratory illness
4
Q
discuss the overarching goals of Healthy People 2020
A
- high quality, longer lives free of preventable dz, disability, injury, and premature death
- health equity, eliminate disparities, improve health of all groups
- create social and physical environment that promote good health for all
- promote quality of life, healthy development and health behaviiors across all life spans
5
Q
why are global health concerns important to address?
A
- inc travel–>inc incidence of bringing things to US
- effects of “war” on children
- inc in foreign adoptions–>new dz and concerns we aren’t used to
- supporting maternal and child health is an investment for all
6
Q
what contributes to 50% of deaths globally?
A
malnutrition
7
Q
explain “family centered care”
A
- recognize that the family is integral to a child’s life
- family is essential part of health care team
- family is expert in care of child
- enable and empower the famiyl
- meeting the families needs healps eet the child’s needs
- may need social work, pastoral care, etc
- the family IS the patient
- you cannot separate out the family and the child
8
Q
explain “atraumatic care”
A
- use procedures and approaches to minimize trauma
- physical and psychological trauma
- 3 principles:
- prevent/minimize separation from family
- promote a sense of control
- prevent/minimize bodily injury and pain
- child’s bed needs to be a safe place–>try to minimize trauma in the bed
9
Q
what are the goals of pediatric hospital care?
A
- use developmentally appropriate approach and care (NOT always the same as chronological age)
- use important assessment and observation skills
- minimize distress
- honest, truthful approach
- use of play to interact, teach, assess, and to help with coping
- play is the work of the child
- hospitalization interrupts their development
- respect of family as experts of their child
- safety!
10
Q
how to correct for gestational age?
A
- example:
- if normal gestation is 40 weeks, and the child is born at 25 weeks, if you plot that child on a developmental growth chart, then that child will always be below the bar
- if child born at 25 weeks, subtract 40-25=15 weeks premature
- if child is now 6 mos old–>~24 weeks, so then 24-15=9 weeks
- so then the child has a corrected gestational age of 9 weeks
- if child is now 6 mos old–>~24 weeks, so then 24-15=9 weeks
- if child born at 25 weeks, subtract 40-25=15 weeks premature
- we will correct for gestational age up until 2 years old where it becomes obvious then if the child is going to be back on the normal growth chart or if they never will be
- if normal gestation is 40 weeks, and the child is born at 25 weeks, if you plot that child on a developmental growth chart, then that child will always be below the bar
11
Q
explain “regression”
A
- return to an earlier developmental level or ability
- a coping mechanism
- occurs when there is a threat to autonomy–>often occurs when ppl/child admitted to the hospital
- common to occur in times of stress–>hospitalization, family stresses, etc.
- temporary
- best approach: ignore and praise appropriate behavior
12
Q
children and pain
A
- pain tends to be underestimated in children
- there are physiological and psychological effects when pain is not treated adequately
- myths:
- infants do not experience pain
- children are more prone to complications of pain mgmt
- children are always honest about pain
- if a child is sleeping or playing, they must not be in pain
13
Q
multiple ways to treat pain
A
- pharmacologic:
- non-opioids and opioids
- PCA
- epidural
- topical: have to make sure child can’t touch/take off/eat patches
- non pharmacologic:
- sucking kangaroo care, distraction like music/tv
- CAM
14
Q
PCA
A
- must be physically able to push button and understand it
- advantages:
- pain won’t spike b/c of basal rate
- if it does spike, it requires more medication
- if not on PCA, want pt on ATC pain meds NOT PRN b/c with PRN they are more likely to need breakthrough pain
- if on PCA and have breakthrough pain, need to talk to provider and see if level is therapeutic
- pain won’t spike b/c of basal rate
15
Q
WHO Analgesic Ladder
A
- Step 1:
- Mild to Moderate Pain:
- non-opioids–aspirin, NSAIDs, or paracetamol
- Mild to Moderate Pain:
- Step 2:
- moderate to severe pain:
- mild opioids (ie codeine) w/ or w/o non-opioids
- moderate to severe pain:
- Step 3:
- severe pain:
- strong opoiods (ie morphine) w/ or w/o non-opiods
- severe pain:
16
Q
explain “equianalgesic opioid dosing”
A
- tells you how much PO med you need to get the same effect as IV meds
- must use this otherwise pt will be in tremendous pain b/c PO meds take so long to get into system and IV meds out of system almost immediately
- ie. if on PCA and want to switch to PO, slowly titrate down on the PCA and inc PO–>don’t stop PCA w/o having PO in the system
17
Q
pain assessment in children
A
- pain is whatever person says it is
- ask parents: they often have good insight
- self report is the GOLD standard
18
Q
FLACC Tool
A
- use for children, if non-verbal, if sedated/under anesthesia
- score from 0 to 10
- higher score–>higher pain
- stands for:
- Face
- Legs
- Activity
- Cry
- Consolability
- Patients who are awake:
- observe for 1-5 min
- observe legs and body uncovered
- reposition pt/observe activity
- assess body for tenseness/tone
- initiate consoling if needed
- patients who are asleep:
- observe for 5 min
- observe body uncovered
- if possible, reposition patient
- touch body/assess for tenseness
19
Q
FACES tool
A
- point to each face using words to describe pain intensity
- ask the child to choose face that best describes own pain and record the appropriate #
- rating scale is recommended for persons 3 years and older
20
Q
Numbers/NRS/Visual Analogue tool
A
- most used tool
- 0-10: 0 being no pain, 10 being worst pain
- developmentally appropriate tool, meaning must understand numbers and their relationships to one another
- so have to know that 5 is more than 0, and 10 is more than 5
21
Q
what are important concerns in newborns?
A
- temperature regulation
- hypoglycemia
- poor ability to fight infection–>immature immune system
- neonatal period: first 28 days
22
Q
infant vision
A
- eyes are fully formed, but vision and eyes muscles are immature
- bright or moving objects 8 in from face is easiest for them to focus on
- Strabismus (crossed eyes):
- common until 4 mos of age
- binocular vision is developed by 4 mos (seeing clearly out of both eyes)
- patching or surgery needs to be used to treat if it continues
- patch the strong eye
23
Q
thrush (oral candidiasis)
A
- white adherent patches on tongue, palate, and inner aspects of cheek
- painful–infant may refuse to suck
- concerned about dec oral intake–>dec urinary output
- use oral nystatin over the patches 4x per day and continue beyond symptoms for at least 2 days
- gentian violet may be used in chronic cases
24
Q
diaper dermatitis
A
- rash: caused by prolonged exposure to irritants
- mgmt is aimed at altering the pH, wetness, and irritants
- change diaper as soon as wet
- expose to air but no heat
- use barrier ointments: OTC with zinc oxide and petroleum based preparations
- super absorbent diapers are helpful but also expensive
- no talcum powder: risk of respiratory distress
25
diaper candidiasis
* common w/ prolonged diaper dermatitis, use of Abs, or immunocompromised state
* lasts longer than 72 hours, then usually candidiasis
* yeast like fungus with diarrhea, Ab use, and thrush as predisposing factors
* very confluent, red rash with "satellite lesions"
* treated w/ antifungal creams (such as nystatin)
26
dental care of the infant
* starts when the teeth erupt usually around 6 mos
* usually bottom, central teeth
* very pain--\>can use tylenol, cold rings
* NO ibuprofen b/c liver immature
* fluoride--start after 6 mos if non-fluoridated water and maintain until 3 yrs
* dental visits: start no later than age 3
* teething:
* cold is soothing
* but should discourage oragel and numbing agents
* low sugar diet
* baby bottle caries
* discourage baby bottles in bed
* discourage use of baby bottle as pacifier
27
why should you discourage baby bottles in bed?
* they don't need bottle in bed and can use pacifer
* until 5 yo, eustachian tube is horizontal to throat, so if laying down drinking, milk goes into eustachian tube to middle ear and causes otitis media
28
SIDS: what is it? cause? risk factors?
* unexplained, sudden death of an infant under age 1
* unknown cause
* risk factors:
* maternal smoking during pregnancy and tobacco exposure during infancy
* co-sleeping or soft bed surfaces
* prone sleeping
* pre term infants (LBW, low apgar), siblings of 2 or more with SIDS, male babies, recent viral illness
29
education for SIDS
* back to sleep
* firm sleep surface w/ no loose bedding
* do not cosleep w/ infant
* avoid overheating/overbundling
* sleep w/ pacifier and breast feeding may be protective
* provide supervised tummy time to avoid flat occiput and help develop neck and shoulder muscles
30
car seat safety
* most significant risk factor for death and serious injury in a car crash is the failure to use size appropriate restraint system
* use approved car seat for age and weight
* infants rear facing until at least 2 yrs and 30-40 lbs
* when child reaches max height and weight recommendations, then can turn carseat around
* convertible carseat w/ a weight limiit of 35 lbs can be used rear facing 2-4 yrs
* backseat is safest for all of those 13 yrs and younger
* toddler seating--appropriate harness placement and height of carseat
* proper lap belt placement for older children and those in boosters
* should be down around hips/thighs--\>not against abdomen b/c can destroy inner organs (splenic lac, etc)
* shouldn't be in front seat until 100 lbs
31
breast milk or formula
* prefer breast milk as complete diet for 6 mos
* it can dec respiratory infections, asthma, otitis media, obesity, diabetes, SIDS, leukemia
* prefer iron fortified formulas
* no add'l H2O needed
* do not microwave breast milk b/c can cause hot spots and change the composition of breast milk
* store breast milk in fridge
32
what is necessary for an infant to start eating food?
* 6 mos of age
* dec tongue thrust
* can hold head up when sitting
* interested
* can signal refusal
33
progression of food introduction
* rice cereal--\>fruits/veggies--\>meats--\>eggs
34
introduction of food to infants
* limit juice intake to less than 4 oz/day
* begin w/ rice cereal b/c least allergenic
* use single item foods only for 4-7 daus b/c want to look for allergic rxn and wait b/w to check for allergies
* no honey until after 1 yr--\>b/c of risk of botulism
35
juice recommendations
* should be 100% pasteurized fruit juice NOT fruit drinks
* should be less than 4 oz/day
* older children should be encouraged to eat whole fruits as opposed to drinking juice
36
infant feeding concerns
* spit up vs vomit
* spit up is a normal occurrence
* reduce by frequent burping, minimal handling during and after feeding
* colic: paroxysmal abdominal pain
* loud crying and drawing up of knees more than 3 hours per day more than 3x per week
* usualy gains weight and thrives
37
weaning from a bottle
* goal: to be weaned by 12 mos
* offer juice in cup, but limit
* switch to cow's milk at 12 mos b/c need the fats
* should use whole milk or 2%, not skim until 2 yo
* physiologic anorexia: stretch where child doesn't eat, but need to make sure still gaining weight
* prefer no more than 20-24 oz of cow's milk per day
* risk of iron deficiency anemia if more thn 32 oz of milk/day
