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NURS 373: Pediatrics > Lecture 2: Assessment of the Pediatric Pt > Flashcards

Lecture 2: Assessment of the Pediatric Pt Flashcards

1
Q

how much % of brain growth is achieved in
1) 1st yr of life
2) by age 3
3) by age 6

A

1) 50%
2) 75%
3) 90%

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2
Q

how much does ur brain weigh at…
1) birth
2) by 1st bday
3) by 5-6 yrs of age

A

1) 12%
2) doubles
3) triples

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3
Q

how does the pediatric CNS and nerve fibres look
- discuss reflexes, the BBB, and myelination

A
  • CNS immature
  • nerve fibres poorly developed
  • numerous reflexes present initially
  • BBB not mature until 2 yrs, so increased risk for meningitis
  • myelination over 1st yr of life
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4
Q

what are fontanelles and sutures

A
  • sutures are separations between bones of skull that have not yet joined
  • fontanelles are formed at the intersection of these sutures

allow pass thru birth canal, which cause the brain to grow and expand

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5
Q

what are fontanelles covered by

A

tough membranous tissue that protects the brain

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6
Q

when does the posterior fontanelle close by

A

2-3 months

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7
Q

when are the anterior fontanelle and sutures palpable up till

A

18 months of age

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8
Q

what is included in a complete neuro assessment

A
  • PEERLA
    ○ Pupils equal and reactive to light
    • Newborn Reflexes (When they are present, when they should disappear, etc.)
    • Coordination
    • Can they follow commands
    • Can they move all their limbs
    • Hypertonicity - what diagnosis can cause this: NAS (neonatal abstinence syndrome)
    • Hypotonicity - what diagnosis can cause this: Ehlers Danlos syndrome, down syndrome
    • Ask about seizures
    • Palpate the Fontenelle
    • Bulging Fontenelle: increased intracranial pressure or fluid overload
    • Sunken Fontenelle: dehydration
    • Ask pt how old they are, pets, grade are you, who’s here with you?
    • Is the behaviour or development appropriate for their age?
    • Having no interest in anything -> NOT GOOD
    • Correcting their age -> for preemies they should meet their milestones normally at 2 yrs otherwise a bad sign
    • Intercranial pressure signs: swelling of their fontanelle, crying
    • Cardiac babies don’t have a strong cry
    • High pitched cry: sign of increased intracranial pressure or NAS
    • Pain: good strong cry
    • Neuro Vitals: PERLA, Glasgow coma scale, pupils, and motor strength
      Strength of suck
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9
Q

what is the #1 code in peds

A

respiratory arrest

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10
Q

when does a pediatric resp tract constantly grow/change until

A

12 yrs

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11
Q

what are 5 upper airway differences in peds

A
  • neck is shorter, resulting in airway structures closer together
  • trachea is shorter and narrower, creating risk for obstruction
  • newborns are obligatory nose breathers - will not automatically open mouth if nose is obstructed therefore nasal patency is critical
  • larynx and glottis high in neck therefore increases risk of aspiration
  • tongue is large relative to small nasal and oral airway passages

*nose breathers so keep nasal patency open

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12
Q

what are 6 lower airway differences in pediatrics

A
  • at birth the lung tissue contains only 25 million alveoli, which are not fully developed
  • # of alveoli increases to 300 mil by age 8
  • smaller alveoli predispose infants to alveolar collapse
  • less lung volume
  • children up to age 6 are primarily dependent on their diaphragm to breathe
  • CO2 is not effectively expired when child is distressed, making child susceptible to metabolic acidosis
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13
Q

what is airway resistance

A
  • greater in children than in adults - children airway is narrower than adults
  • in infants, airway resistance is about 15x that of an adult
  • w edema and swelling the airway is further narrowed
  • airway resistance = harder to breathe = increased WOB

September spike in asthma exacerbation

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14
Q

what is included in a complete respiratory assessment

A
  • Work of breath
    • If u see ribs they have intercostal indrawing or retraction
    • Auscultating the lungs: crackles, wheezes, stridor (tracheal swell in croup)
    • Oxygen Delivery
    • Airway obstruction
    • Newborns are periodic breathers
    • Air passing through nasal congestion
    • Decreased air entry - what intervention: reposition
    • Mucus
    • Notice any cough
      Apnea classification: 20 seconds
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15
Q

describe wheezing

A
  • musical high pitched squeaking sounds often heard mid to late expiration
  • air is squeezed or compress through passageways narrowed almost to closure through collapsing airways, swelling, secretions
  • may be high or low pitched
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16
Q

describe crackles

A

fine - high pitched crackling or popping sound heard on inspiration not cleared by coughing
- inhaled air collides w previously deflated airways which will pop open
course - low pitched bubbling and gurgling sounds that start in early inspiration and may be present in expiration
- inhaled air collides with secretions in trachea or large bronchi
- sounds like velcro

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17
Q

stridor

A
  • high pitched crowing sound
  • originated in larynx or trachea
  • obstruction from swollen inflamed tissues or lodged foreign body
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18
Q

transmitted sounds heard on auscultation

A
  • may seem to originate in the lungs but is referred from the upper airway i.e. mucous in the throat or nose
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19
Q

what to look for when doing an assessment for work of breathing

A
  • retractions/in drawing
  • accessory muscle use
  • grunting
  • head bobbing
  • nasal flaring
  • tracheal tug
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20
Q

what do kids usually have tachypnea more than adults

A

Kids hearts beat fast, because they cannot beat harder so tachycardia is very common

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21
Q

what are CVS pediatric differences

A
  • cardiac output is rate dependent not stroke volume dependent
  • HR is labile
  • during stress, exercise, fever, or respiratory distress, infants and children become tachycardic, which increases their cardiac output
  • lower BP: thought to be related to underdeveloped left ventricle
  • lower absolute blood volume: vulnerable to fluid and electrolyte imbalances
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22
Q

what are potential causes of tachycardia

A

Infection, stress, trouble breathing/respiratory distress, dehydration

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23
Q

what is low bp a late sign in children for…

A

dehydration, otherwise their bp doesn’t change much

Children - dehydration is a priority they cannot handle it like adults can

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24
Q

what is included in a complete CVS assessment

A
  • Murmur - abnormal blood flow
    • Capillary refill, less than 3 secs
    • Colour of skin: not cyanotic, not pale, not jaundice
    • Heart rate for a whole minute
    • Cant feel radial until about 4-6 years of age, so feel apically
    • Best time to do infant bp is when they r sleeping
    • Where are you going to see edema in children: their face and their eyes (periorbital edema), genitals
    • Hydration status via skin turgor, weight, mucus membranes
    • When dehydrated they won’t have tears or sweat when they are dehydrated
      Temperature
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25
Q

normal peds vital sign ranges for infants

A

systolic: 74-100
diastolic: 50-70
HR/min: 120-160
Resp/min: 30-60

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26
Q

normal peds vital sign ranges for toddlers

A

systolic: 80-112
diastolic: 50-80
HR/min: 90-140
Resp/min: 24-40

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27
Q

normal peds vital sign ranges for preschoolers

A

systolic: 82-110
diastolic: 50-78
HR/min: 80-110
Resp/min: 22-34

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28
Q

normal peds vital sign ranges for school aged children

A

systolic: 84-120
diastolic: 54-80
HR/min: 75-100
Resp/min: 18-30

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29
Q

normal peds vital sign ranges for adolescents

A

systolic: 94-140
diastolic: 62-88
HR/min: 60-90
Resp/min: 12-16

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30
Q

why might an infant be cyanotic

A
  • an infant may be cyanotic bc of cardiac or pulmonary disorder
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31
Q

cyanosis that worsens with crying is likely due to…

A

a CVS issue

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32
Q

what does crying due to the CVS

A

increases the pulmonary resistance to blood flow, resulting in increased right to left shunt

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33
Q

cyanosis that improves w crying is most likely due too…

A

pulmonary - deep breathing improves tidal volume

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34
Q

acrocyanosis

A

cyanosis of extremities - normal in newborn

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35
Q

peripheral cyanosis

A

extremities, perioral - may represent hypothermia or decreased flow

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36
Q

central cyanosis

A
  • inside mucous membranes, reduced hemoglobin sat
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37
Q

central cyanosis

A
  • in their mouth
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38
Q

what is most often hear in resp system in peds

A

transmitted noises

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39
Q

why are peds at more risk for getting things stuck in their throat

A

trachea shorter and more narrow

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40
Q

when does saliva production begin

A

4 months

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41
Q

when is the sucking and extrusion reflex present until

A

3-4 months

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42
Q

how much does stomach capacity increase in the 1st yr of life

A

30-300 mls

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43
Q

what happens to the intestinal flora in the 1-3 yrs of life

A

becomes more adult like - stomach acid increases

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44
Q

what happens around 2 yrs with the myelination of nerves

A

w the myelination of nerves to the anal sphincter it allows physiologic control of bowel function around 2 yrs

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45
Q

what causes babies regurg

A

lower esophageal sphincter muscle tone not fully developed until 1 month

does not hurt them bc their stomach acid isn’t like adults yet it doesn’t burn

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46
Q

what is extrusion reflex

A

tongue pushes stuff out until 3-4 months

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47
Q

size of small intestine in infants vs adults

A

infants: 250 cm
adults: 600 cm

48
Q

in kids how much does the liver weigh in comparison to adults

A

liver is 5% of body wt compared to 2% as adult

49
Q

is the liver mature/immature at birth

A

liver is immature at birth inefficient detoxifying of substances and medications

50
Q

why are infants more prone to hypoglycemia

A

slow development of glycogen storage capacity

51
Q

what are infants more prone to *constant theme

A

infants more prone to dehydration and fluid and electrolyte imbalances - more body water than adults - higher for fluid deficit w illness

52
Q

why are liver and spleens more susceptible to trauma

A

abdomen offers poor protection

53
Q

is gastric digestion less or more functional in kids

A

less duh

54
Q

what is included in a complete GI assessment

A

Auscultate bowel sounds and palpate all 4 quadrants
Observe: is it distending, etc.
Post op abdominal sounds will be extremely decreased
Stool charting - what it looks like, undigested material
Seeing if abdomen is soft, and palpable
Any vomiting, bile, etc?
Passing gas, have they had a BM.

55
Q

how much kidney wt change in 1st month of life

A

doubles in wt

56
Q

why are infants more vulnerable to dehydration and fluid overload

A

bc they can’t concentrate or excrete urine in response to changes in fluid status

57
Q

what is the bladder capacity of infants/adults

A

infants: 15-20mls
adults: 600-800mls

58
Q

why is the kidney susceptible to trauma

A

relatively large for body size and age

59
Q

describe urethra in females, and in infants

A

shorter in females, closer to rectum in infants

60
Q

describe bladder control in children less than 2

A

maintain bladder control due to insufficient nerve development

61
Q

for the 1st yr the child has: KNOW THIS

A
  • poor fluid volume control
  • less ability to conserve water
  • prone to over and dehydration
  • unable to excrete excessive sodium, nitrogenous wastes and drug metabolites
  • can’t conserve alkaline buffers or actively secrete hydrogen ions
  • risk for acidosis
  • infants lungs provide little opportunity for fast removal of CO2
62
Q

term neonate

% water by wt:
ECF:
ICF:

A

% water by wt: 75%
ECF: 45%
ICF: 30%

63
Q

6 months

% water by wt:
ECF:
ICF:

A

% water by wt: 65%
ECF: 25%
ICF: 40%

64
Q

2 yrs

% water by wt:
ECF:
ICF:

A

% water by wt: 60%
ECF: 20%
ICF: 40%

65
Q

adult

% water by wt:
ECF:
ICF:

A

% water by wt: ~60%
ECF: 20%
ICF: 40%

66
Q

whats included in a complete GU assessment

A

Toilet training at 2 is earliest
Urethra is closer to rectum - UTI
1st yr of life is an ability to conserve water
Urine outs and ins (1-2mL per hour)
Children’s intestine is greater than an adult
Infants are prone to hypoglycemia
*remember the 421 rule

Ex: calculate the TFI for a pt weighing 17Lg using the 421 rule” answerb 54

67
Q

daily fluid calculation for peds

A

100 mL/kg for first 10kg
+50mL/Kg for 2nd 10kg
+20mL/kg for each kg >20kg
= mL/day

68
Q

hourly fluid calculation for peds

A

4mL/kg x first 10 kg
+2mL/kg x second 10 kg
+1mL/kg x for each kg >20kg
= mL/hr

69
Q

S/S of increased fluid

A

fever, vomiting, diarrhea, diabetes insipidus, burns, tachypnea, chemo

70
Q

S/S of decreased fluid

A

meningitis
congestive heart failure
renal failure
SIADH

71
Q

until puberty, the percent of ________ if higher and why

A

percent of cartilage in ribs is higher, making them more flexible and compliant

72
Q

what are pediatric bones like

A

bones are soft and more easily bent and fractured
bones tend to heal faster - more osteogenic potential, younger you are faster you heal

73
Q

during infancy how are the muscles doin

A

muscles lack tone, power, and coordination

74
Q

muscle mass in % in infant and adult

A

infant: 25%
adult: 40%

75
Q

pediatric differences in endocrine system in relation to thermoregulation and temp

A

thermoreg is immature in infants therefore hypothermia is a risk
temperature lability present - temp can increase to very high levels even in minor infections

76
Q

what is the ratio to temp elevation in peds

A

elevation is 4:1 (4 extra breaths for every 1 degree F above N)

77
Q

children have ________ metabolic rate, ___________ oxygen needs, ______ caloric needs

A

higher!

78
Q

skin surface area in kids is approximately what in comparison to adults

A

skin surface area is approx 2.5 x that of an adult

79
Q
A
80
Q

describe pediatric immune system

A
  • immune system immature, slow response to infection
  • immunization schedule
  • GI infections common
81
Q

how many infections per yr for infants

A

6-9 resp infections/yr

82
Q

how many infections by age 6

A

4-5 resp infections/yr

83
Q

describe peds allergies

A
  • allergies common (may manifest in skin, resp, GI) important to ask about family history of allergies
  • allergies/sensitivities to meds should be carefully monitored and recorded
84
Q

how to assess pain sympt in peds

A

behaviour, linguistic, physiological

85
Q

how do you do pain assessments in peds

A

validated pain scales
- numeric, faces, FLACC, NIPS

86
Q

what are 4 pieces to the puzzle to determine pediatric risk

A

appearance, behaviour, cognition, thoughts = risk

87
Q

mental status exam - ASEPTIC

A

Appearance
Speech
Emotions
Perception
Thoughts
Insights
Cognition

88
Q

for an aseptic exam describe A

A
  • grooming, facial expression, tremors, dress, skin condition, identifying characteristics (ex: tattoos, piercings), scars, age, body build, position, alertness, affect
  • psychomotor: gait, pacing, crying, threatening, withdrawn, angry, suspicious, attention to events, eye contact, agitation, tremor, grimace
89
Q

describe the S in ASEPTIC

A
  • rate, amount, style, tone of speech
  • loud, quiet, slow, rapid, over-talkative, pressured, mute, slurred, incoherent, stuttering, long pauses, mute
90
Q

describe the E in ASEPTIC

A

emotional state (mood) and visible expression (affect: description and variability; congruence of mood, range

91
Q

describe the P in ASEPTIC

A

hallucinations, illusions, depersonalizations, derealizations

92
Q

describe the T in ASEPTIC

A
  • content: suicidal, homicidal, guilt, worthlessness, hopelessness, obsessions, ruminations, phobias, paranoia, hallucinations, delusions
  • process: coherence, logical, perseveration, flight of ideas, blocking, tangential, attention (distractible, concentration)
93
Q

describe the I in ASEPTIC

A

insight into illness and treatment
judgement

94
Q

describe the C in ASEPTIC

A

LOC, orientation, attention, memory, intelligence

95
Q

mental health

A

a persons ability to process information

96
Q

emotional health

A

a persons ability to express feelings

97
Q

behavioural health

A

what a person does

98
Q

alexithymia

A

problem with feeling emotion

99
Q

describe anxiety

A
  • anxiety that interferes with enjoyment of life and ability to perform tasks
    (separation anxiety, generalized anxiety, obsessive-compulsive, panic, phobia, and PTSD)
100
Q

symptoms of anxiety

A

expressing symptoms of anxiety most days, trouble concentrating, being unusually irritable or easily upset, difficulty sleeping at night or being unusually tired and sleepy in the daytime

101
Q

anxiety nursing care

A
  • assess of mental, emotional, behaviour symptoms
  • Box 55.1
  • primary goal: to resume typical activities appropriate to development
  • learning to cope
  • learning about biological connection to emotions
  • cognitive behavioural therapy
  • medication
102
Q

temporary depression

A

acute depression precipitated by a traumatic event

103
Q

chronic depression

A
  • may accompany chronic illness or disability
  • familial circumstances
  • history of frequent disruptions in important relationship
104
Q

sympt of depression

A

Box 55.3

105
Q

nursing care of depression

A
  • careful assessment of child: assess for suicide risk, Box 55.4
  • treatment: CBT, meds, environmental supports, appropriate referrals
106
Q

suicide

A

deliberate act of self-injury with the intent of death
2nd leading cause of death in adolescents

107
Q

common warning signs of suicide

A
  • box 55.5
  • most children have psychiatric disorder before the suicide
  • individual factors
  • family factors
  • social and environmental factors
108
Q

high risk for suicide

A

indigenous and LBGTQ2S+

109
Q

suicidal ideation

A

a preoccupation with suicidal thoughts

110
Q

suicide attempt

A

intended to cause death or serious injury

111
Q

parasuicide

A

behaviours ranging from gestures to serious attempts to kill oneself

112
Q

suicide nursing considerations

A

recognizing warning signs
crisis management
prevention

113
Q

nursing alert for suicide in adolescents

A

youth expressing suicidal feelings and have a specific plan should be monitored at all times. have no access to anything that can harm them, and possibly restrained until a psychiatrist or psychologist can assess them.

114
Q

substance abuse + greatest concern

A

use of substances for peer approval or for intoxication

Box 55.7

greatest concern:
- high doses or mixed drugs w the danger of overdose
- individuals vulnerable to dependence, withdrawal syndromes, an altered lifestyle

  • tabacco
  • electronic cigarettes
  • smokeless tobacco
  • cannabis
115
Q

2 CNS stimulants

A

cocaine
methamphetamine

116
Q

disturbances in eating related behaviour nursing care

A
  • complete history + physical
  • Box 55.8
  • focus on complications of altered nutritional status and purging
  • assess for physical side effects of eating disturbances: electrolyte imbalance, UTI
117
Q

what are the 3 goals for disturbances in eating related behaviour

A
  • reinstitution of normal nutrition or reversal of severe malnutrition
  • resolution of disturbed pattern of family interactions
  • individual psychotherapy to correct deficits and distortions in psychological functions

NURS 373: Pediatrics (9 decks)

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