Midterm Flashcards
Define family centred care
An approach to planning, delivery, and evaluation of healthcare that is grounded in mutually beneficial partnerships among healthcare providers, patients, and families
What are the four core concepts of family centred care? Define each
Dignity and respect - honour a family’s wishes, in terms of cultural and religious practices and respecting their decision making
Information sharing - what content and information does a family need?
Collaboration - interdisciplinary collaboration; team working together to support the patient/family
Participation - involving families in the level they are comfortable with
What are the four developmental age groups and their ranges?
Infancy - Newborns span from birth to 28 days, and infants span from 1 to 12 months
Early childhood - Toddler is from 1-3 years and preschool is 3-6 years
Middle childhood - 6-10 years
Later childhood - prepubertal spans from 10-13 years and adolescence 13-18years
What are Freud’s five stages and their age ranges?
- Oral (derives pleasure from mouth) - birth to 1 year
- Anal (control over body secretions/potty training)- 1 to 3 years
- Phallic (works out parental relationships) - 3 to 6 years
- Latency (sexual energy is at rest) - 6 to 12 years
- Genital (mature sexually) - 12 years to adulthood
What are Piaget’s four stages and their respective ages?
- Sensorimotor - birth to 2 years
- Preoperational - 2 to 7 years
- Concrete operational - 7 to 11 years
- Formal operational - 11 years to adulthood
Define the sensorimotor and pre-operational stages of Piaget’s theory. Provide examples for each
- Sensorimotor is reflex activities and simple imitative behaviour (i.e., smiling back at an adult smiling at them)
- Pre-operational is egocentric behaviour, magical thinking, increasing ability to use symbols and language (i.e., focused on themselves, fear from imaginative thinking)
Define the concrete operational and formal operational stages of Piaget’s theory. Provide examples for each
- Concrete operational - thought process has become more logical and coherent, less self-centred (i.e., may now use medical play and medical explanations)
- Formal operational - thought process is more adaptable and flexible, contains abstract thought and test hypotheses (i.e., more advanced explanations are used)
List the first 5 stages of Erikson’s theory & age ranges
- Trust v mistrust - brith to 1 year
- Autonomy v shame/doubt - 1 to 3 years
- Initiative v guilt - 3 to 6 years
- Industry v inferiority - 6 to 12 years
- Identity v role confusion - 12 to 17 years
Briefly define trust v mistrust and autonomy v shame/doubt
Trust - baby develops a sense of trust when basic needs are met
Autonomy - the toddler becomes increasingly independent
Briefly define initiative v guilt, industry v inferiority, & identity v role confusion
Initiative - the child enjoys engaging in play and expressive activities
Industry - the school-aged child’s self-worth is linked to activities and participation in social groups
Identity - the adolescent is searching for their identity, reliant on peers more than family
What are the five minimum milestone expectations in infancy?
- Holds head up and supports weight with arms
- Can turn from side to back
- Follows objects and will turn head to look for voices and sounds
- Can hold head steady when sitting
- Supports most of weight when held standing
At what age do we expect to see furniture walking?
Around 1 year
What age do we observe full head turns?
4 months
At what age can babies sit independently?
6 months
What are the six minimum milestone expectations in toddlerhood?
- Scribbles on paper
- Throws a ball
- Likes to push and pull toys
- Can undress self and learning to dress self
- Learns how to pour
- Increasingly enjoys talking
What are the five minimum milestone expectations in preschool?
- Learn how to use scissors
- Brushes teeth, can close buttons, and tie shoes
- Rides a bicycle w/ or w/o training wheels
- Communicates with a widening array of people
- Enjoys playing with other children
What are the four minimum milestone expectations in school-age?
- enjoy taking part in activities that require practice (i.e., sports)
- have an ability to talk and discuss topics for increasing lengths of time
- can read and concentrate by filtering out surrounding sounds
- jumps rope and rollerblades
What are the four minimum milestone expectations in adolescence?
- eager to try new sports and activities
- may lack coordination, especially during growth spurts
- spend increasing amounts of time with peer group and friends
- can apply abstract thought analysis to conversations and have opinions
What are the four Rs that may occur during hospitalization in children? Define each
- Regression - hitting previous milestones (i.e., thumb sucking, bed wetting)
- Repression - blocking out memories or high stress moments
- Rationalization - trying to reason and understand why they are being hospitalized and connecting behaviours with illness
- Fantasy
What are key components/issues when assessing a toddler?
- they are stranger shy, cautious, anxious, and wary
- keep the parent nearby
- demonstrate the assessment on parent or yourself first
- don’t ask if you can examine the toddler because they will say no
- save instruments until the end
At what age is a child usually cooperative in an assessment, if their parent is nearby?
Preschoolers (3-6 years)
Can parents be asked to leave during an adolescent assessment?
Yes
What components are part of the paediatric assessment triangle? Explain each
- Appearance - Positioning, comfort in position, emotional responses
- Work of breathing - Rapid, apnea, relaxed
- Circulation - Pale, pink, cyanotic, circulatory colour
What does the pediatric assessment triangle allow us to do/see?
It gives us a baseline visual of how the child is doing, prior to making physical contact - their general appearance and behaviour
How/what do we assess skin and hair?
Temperature, texture, rashes, lesions, moles, ulcers, burns, incisions, dressings, and skin pigmentation
When do we draw borders on dressings?
If shadowing is present
How should the anterior and posterior fontanels feel on assessment? What does sunken or bulging indicate?
Flush/flat on the head
Sunken - dehydration
Bulging - cerebral/intercranial swelling
What age does the posterior fontanel close? Anterior?
Posterior closes after two months and anterior after 1-2 years
Who is the expert for a child’s LOC presentation?
The parents
What is acrocyanosis?
Cyanosis of the periphery that is normal in newborns
What is a normal HR in newborns?
110-160 bpm
What two vital signs will change first in children prior to BP?
HR and temperature
What is the latest vital sign to change when a child is unwell?
BP
What is the number one reason children get hospitalized in Lethbridge?
Influenza and RSV
What is QUESTT? What is it used for?
Question the child
Use pain rating scales
Evaluate behavoir and physiological changes
Secure the parents’ involvement
Take into consideration - cause of pain
Take action and evaluate results
What is the FLACC scale? What populations is it best for?
Face - no facial expression, occasional grimace, or consistent frowning/jaw clenching
Leg - Normal position/relaxed, uneasy/restless/tense, kicking or legs drawn up
Activity - lying/normal position, squirming/shifting back and forth, tense, arched/rigid
Cry - no cry, moans/whimpers, crying constantly/screams/sobs
Consolability - content/relaxed, reassured by touch/hugging/distractible, difficult to console or comfort
What populations is the FLACC scale best for?
Good choice for neonates, infants, toddlers, and any non-verbal children
What age/population is the FACES scale best for?
Best choice for preschool and earlier school-aged
Why might the FACES scale be problematic to use?
Children may point to the face they like the most rather than the one they feel
What age/population is the VAS scale best for?
School-aged or adolescents
What is the VAS scale?
Visual analog scale
A continuum of numbers from 0 (no pain) to 10 (worst pain)
How can we explain the numerical scale to children so they understand what each number may represent?
” a mosquito bite feels like a 1 and then goes to a 0 “
How early should women begin to start taking folic acid?
up to 3 months prior to conception
What components are part of preconception planning?
- complete health hx
- evaluate pre-existing medical conditions and medications
- prenatal vitamins
- safe food handling and environmental risks
- avoid alcohol and smoking
How long is the ovum viable for in the fallopian tube?
viable for 24 hours
How long is sperm viable in the vagina?
Viable for 48 to 72 hours (highly fertile for 24 hours)
What is Nagele’s rule? How is it calculated?
The way we calculate a due date
First of last menstrual period and subtract 3 months and add 7 days
What % of babies are born on their due date?
Less than 10%
What is the prenatal doctor visit schedule during gestation?
Every 4 weeks for the first 28 weeks
Every 2 weeks from 28-36 weeks
Every week after 36 weeks
What 4 general things are assessed in a prenatal visit?
- vital signs and weight
- uterine size and fetal heartbeat
- urinalysis, blood tests, GBS
- expected physiological stage of pregnancy
What does gravida + TPAL stand for?
Gravida - any pregnancy, regardless of duration, including present pregnancy
T - number of term infants born (38-42 weeks)
P - number of preterm infants born, after 20 weeks but before end of 37 weeks
A - number of pregnancies ending in either spontaneous or therapeutic abortion
L - number of current living children
Are stillbirths prior to 20 weeks considered in TPAL?
No, they are not accounted for
where does the umbilical cord develop from?
The amnion
what is Wharton’s jelly?
specialized connective tissue that protects the blood vessels of the UC
where does the placenta originate from?
Develops at the site where the embryo attaches to uterine wall at 3rd week of conception
When does the fetal heart begin beating?
4 weeks
At what age in utero do all body organs form?
8 weeks
At what point can the fetal heart rate be detected?
8-12 weeks
At what point can the sex of baby be detected?
16 weeks
At what age can the fetal heart beat be detected?
20 weeks
When does the mother begin to experience quickening ? What is quickening?
20 weeks - rapid movements of the baby
At what age are vernix and lanugo first present?
20 weeks
When does the baby develop a ‘regular schedule’?
20 weeks
What are lanugo and vernix?
lanugo - hair around the baby’s body
vernix - thick, cheesy substance on the skin
When do respiratory and sucking movements begin in utero?
24 weeks
When will the baby weigh 1lb 10oz/780g in utero?
24 weeks
When is surfactant developed in utero?
28 weeks
what is surfactant?
a protective mechanism that lines the lungs in babies
When can baby breathe and eyes open/close?
28 weeks
When are fingernails and toenails formed?
32 weeks
When is subcutaneous fat developing in utero?
32 weeks
When will the baby receive antibodies from the mother in utero?
38+ weeks
What weeks make up the first trimester?
Weeks 1-12
What are common symptoms associated with first trimester (10)?
extreme fatigue, tender and swollen breasts, nausea and vomiting, taste changes, mood swings, constipation, urinary frequency, headache, heartburn, and weight changes
What are presumptive signs?
changes in the body, but we cannot confirm they are pregnant
Often these symptoms cause women to go to the doctor or take a pregnancy test
What weeks make up the 2nd trimester?
Weeks 13-28
What symptoms are involved in the 2nd trimester (9)?
Body aches, stretch marks, darkening skin around the nipples, linea nigra, darker patches on the face, carpal tunnel syndrome, insomnia, itchiness, swelling of the ankles/fingers/face
what is linea nigra?
vertical line on the abdomen
What causes darkening of the nipples in the second trimester?
Hormonal changes
What weeks are the 3rd trimester?
Weeks 29-40+
What symptoms are common in the third trimester (9)?
SOB, heartburn, swelling, hemorrhoids, tender breasts w/ or w/o colostrum leakage, umbilical protrusion, difficulty sleeping, lightening, Braxton Hicks
What is lightening in the 3rd trimester?
baby is descending into the pelvic space
How often can women exercise during pregnancy?
5x per week for 30 minutes per day
What HR should exercise not exceed in pregnancy?
150 bpm
What can pelvic physiotherapy be helpful for and when can it be started?
Can be started pre or post-natal and is helpful for urine retention and muscle tone
How long after delivery should women wait to exercise?
4-6 weeks
After a C-section, how much heavy lifting can women do?
Nothing greater than 10lbs
What sexual positions should be avoided during pregnancy? Why?
Supine or prone
These positions may compress the vena cava
How long should sex be abstained for after delivery?
4-6 weeks
What is the safe amount of caffeine/coffee intake per day during pregnancy?
1-2 cups per day
What 4 foods should be avoided during pregnancy?
unpasteurized dairy products, raw fish, raw eggs, and deli meats
How many extra calories should be added in the 2nd and 3rd trimesters?
2nd = +340kcal
3rd = +452kcal
What should the total weight gain be during pregnancy?
25-40lbs
How many additional calories should women have in the first six months of breastfeeding and after six months of breastfeeding?
First six months, +330kcal per day
> 6months, +400kcal per day
Why should women take folic acid?
reduces the incidence of spina bifida
What 5 things are tested/done in a prenatal screening?
blood tests, GBS, urinalysis, STIs/HIV, and ultrasound
at what week is the gestational diabetes test done?
24-28 weeks
When is WinRho required?
If mom is Rh negative and baby is Rh positive
When is GBS tested for? How is it tested?
36 weeks
Vaginal and rectal swab
How is GBS treated and when?
If positive, they will be treated in labour 3 hours prior to delivery with 2 doses of Penicillin
(first is 5 million and second is 2.5 million units)
What is the GBS protocol for premature babies?
Women are always treated for GBS, even if negative, as they won’t be tested in time
What does GBS increase the risk of in babies?
Sepsis, meningitis, and pneumonia
What three things are we testing for in a urinalysis and what does their presence indicate
Protein - gestational hypertension due to overloaded kidneys
Glucose & ketones - GDM
How is an HIV+ pregnancy managed?
- want to reduce viral counts, so they do not transmit to baby
- treated with antiretroviral that is safe for pregnancy
- breastfeeding not permitted
- ALWAYS scheduled for c-section
What diagnostic tool will all invasive procedures be accompanied with in pregnancy?
ultrasound
What are the 7 premonitory signs of labor?
- lightening
- loss of mucous plug, bloody show, cervix softens, partially effaced and dilated
- weight loss or surge of energy
- spontaneous rupture of membranes (SROM)
- braxton-hicks
- nesting
- backache
what is the role of progesterone and estrogen in labor?
Progesterone causes relaxation of smooth muscle tissue - assists in passing the baby through the canal
Estrogen causes stimulation of uterine muscle contractions
What is an epidural injection?
injection of anaesthetic into epidural space that produces little to no feeling from the uterus down
what is a spinal block?
local anaesthetic injected directly into the spinal canal and the level of anesthesia depends on level of administration (may be administered higher for C/S)
what is a pudendal block/local infiltration?
local anesthetic injected into the pudendal nerve which produces anesthesia to the lower vagina and perineum or
local infiltration into the perineum prior to episiotomy to provide relief only for the episiotomy procedure
What are the 5 Ps of labor?
Passenger (fetus and placenta)
Passageway (brith canal)
Powers (contractions)
position of mother
Physiological response
How do we assess the cervix?
Left hand, second and third fingers
What are we assessing for with contractions?
Frequency, duration, and intensity
What will a mild versus strong contraction feel like on palpation?
a mild contraction will feel like touching your cheek, whereas a strong contraction will feel like the forehead
When is the fetus under the greatest amount of stress in labor? What is most important to monitor during this time?
During height of contraction - the HR will drop and should increase as the contraction reduces
FHR
What is a normal FHR during labor?
110-160
What is the 1st step of the 1st stage of labor called?
The latent stage
What will the cervix present as during the latent stage of labor?
Cervix is dilating from 0 to 3cm and effacement is from 0 to 40%
What will contractions and mother’s presentation be like during the latent stage?
Contractions become established and increase, but they can mostly labor at home
Women may be anxious, but talkative, smiling, and eager to talk
What is the second stage of the 1st stage of labor called?
active phase
What is the average duration of the latent phase? Nullipara and multipara
Null - 6hrs
Multi - 4hrs
What will the cervix present as during the active stage of labor?
Cervix will dilate from 4 to 7 cm and effacement will move from 40 to 80%
What is the average duration of the active phase? Nullipara and multipara
Null - 9 hours
Multi - 6 hours
How will contractions and mother present during the active stage of labor?
Contractions will be every 2-5 mins, and last 45-60 seconds
Mom’s anxiety will increase as contractions do
what stage is the prime time to administer an epidural?
active stage
What will the cervix present as during the transition stage of labor?
Cervix will dilate from 8cm to 10cm and effacement will change from 80 to 100%
What are the three stages of the first stage of labor?
Latent, active, transition
What is the average duration of the transition phase? Nullipara and multipara
Null - 3 hours
Multi - 1 hour
How will contractions and mother present during the transition stage of labor?
Frequent, strong contractions ~1-2 minutes lasting 60-90 seconds
Women may show significant anxiety and discomfort
What is the shortest stage of labor?
the transition phase
When may women report feeling the ring of fire?
During the active stage
What is the second stage of labor?
Refers to the time from full dilation to baby birth
What degree of tears will require suturing?
3rd and 4th
What occurs during the 3rd stage of labour?
Delivery of the placenta
How long does placental delivery take after birth?
Within 30 minutes
What are four signs of placental separation from the uterus?
Absence of cord pulse, lengthening of UC, a sudden gush of blood, change in uterine shape
What is normal vaginal and C/S blood loss?
Vaginal - 500 mL
C/S - 500 - 1000 mL
What happens during the fourth stage of labour?
Significant physiologic adjustment of the mother’s body
What stage of labour is the bladder hypotonic?
4th stage
When does the 4th stage of labor occur?
1-4 hours after birth
How long can the postpartum period last?
Typically 6-8 weeks, but the body goes through changes for months and years after
When does milk replace colostrum?
within 72 hours after delivery
How can heat and cold application effect milk supply?
Heat will encourage milk supply and relieve discomfort
Cold will decrease swelling and decrease milk supply
How much should the uterus descend per day after birth?
Descends from the level of the umbilicus by 1cm/day (i.e., U/U, U/1, U/2)
What is involution?
The uterus contracts to shrink itself back to normal size after birth
What two things would cause the uterus to not drop properly after birth?
Bleeding (PPH) or full bladder
What are the three colours lochia can be?
Rubra (red), serosa (pink), alba (white)
What does REEDA stand for when assessing the perineum?
redness, edema/swelling, ecchymosis, discharge, approximation
Why are women at increased risk of DVT after birth?
The body hyper-coagulates the blood to protect the body throughout labor to reduce hemorrhaging
Why would the body be bradycardic after birth?
Related to central circulation no longer perfusing the placenta
Why is profuse diaphoresis common after birth?
Hormonal changes
What are two symptoms associated with pulmonary embolisms?
Shallow breaths and chest pain
How often is an APGAR done?
1 min, 5 min, and 10 min
What is the golden hour after birth?
The best time to perform the first feed and skin-to-skin
When should baby have their first mec and void?
within 24-48 hours
What will babe’s poop look like when BF and formula feeding?
BF = seedy and white
FF = creamy like natural PB
What does a ruddy newborn appearance indicate?
Excess blood cells in the body that the baby cannot break down fast enough and may lead to jaundice
How do we assess for jaundice in baby?
in the forehead or chest by applying pressure and looking at the blanching colour
When is jaundice normal to appear? Why may it occur?
After 24 hours; immature liver that has difficulty conjugating bilirubin
Is fever an indicator of infection in babies/NB? What are the indicators?
Fever is NOT an indication, baby will become more lethargic, difficult to arouse, and hypothermia
When/what circumstances would we broaden the VS parameters in babies?
if the baby is in a deep sleep or crying because their vitals may be depressed or elevated
When would head circumference checks be done more frequently?
If baby is born with vacuum
How much larger should the head circumference be than the chest circumference?
Head circumference should be 2cm greater than chest circumference
What are signs of Down Syndrome?
low-lined ears, slanting of the eyes, flat nose, oral changes that present feeding challenges, decreased muscle tone, and heart murmur
How large is baby’s stomach on day 1, 2, and 10?
1 = marble
2 = golf ball
10 = egg
What is 90% of breastmilk?
water
What vitamin is recommended for newborns and infants to take and how much?
400 IU of vitamin D per day
How frequent should feeds be at first and once established?
2-3 hours, and then 3-4 hours
What are the 4 As of breastfeeding?
Alignment
Areolar grasp
Areolar compression and suck
Audible swallow
Is pain normal with BF?
Pain is not normal with breastfeeding (i.e., cracking and bleeding) but discomfort is okay, especially when the baby is first learning
What are early hunger signs?
Rooting, sucking on fist, stirring/moving around
How many wet diapers and dirty diapers should baby have per day?
Wet - 6 to 8/day
Dirty - 2 to 4/day
When will the cord fall off?
7-14 days
Should the umbilical cord be cleaned with alcohol?
Cleaning the cord with alcohol creates premature drying and is not best practice
Define a drug
Any chemical that affects the physiological processes of a living organism
Define pharmacodynamics
Studies what a drug does to the human body, behaviour of the drug at a cellular level
Define pharmacotherapeutics
The clinical use of drugs to prevent and treat diseases
Define pharmacokinetics
Movement of drugs throughout the body via absorption, distribution, metabolism, and excretion
What basic physiological factors in children cause there to be safety/factors that affect medication metabolism?
Skin is thin and permeable, total body water differences increases distribution, stomach lacks acid to kill bacteria, weaker mucus membranes, liver and kidney immaturity
Why would a child be given higher doses of a drug than an adult?
They may metabolize certain drugs quicker due to immature liver and kindeys
What three drugs are often involved in severe medication errors?
CNS drugs, anticoagulants, chemotherapeutic drugs
Define near miss, no harm event, medication error, and critical incident
Near miss = did not reach the patient, results in no harm
No harm = reaches patient, results in no harm
Med error = causes harm
Critical incident = results in serious harm
When is the best time to take prenatal vitamins? Why?
Take before bed - this vitamin may cause nausea and taking it at night may reduce these symptoms
When should you stop taking prenatal vitamins?
Until initial post-partum check-up
When should women start taking prenatal vitamins?
3 months prior to conception
What are prenatal vitamins contraindicated with?
iron overload syndrome, use of alcohol/alcohol deficiency, vitamin B12 deficiency, colitis
What does WinRho help prevent against?
Prevents against miscarriage and abortion for future pregnancies
Does WinRho administration during pregnancy pose risk to the fetus?
No
Why is vitamin K given to NB?
Concerned about impaired clotting due to immature livers and coagulability
Vitamin K will help prevent against neonatal hemorrhaging
When is it safe and unsafe for women to take Advil in pregnancy?
Cautious use in first and second trimester and no use in the third due to potential alterations to the umbilical cord
Why is aspirin not given to children?
May cause Reyes syndrome
What % of a child’s weight is water?
75 to 80% of a child’s body is water
Define diffusion and osmosis
In diffusion- solutes move from an area of higher concentration to an area of lower concentration
In osmosis- fluid moves passively from areas with more fluid (and fewer solutes) to areas with less fluid (and more solutes)
What is albumin and how does it assist with fluid balance?
a protein that acts like a magnet to attract water and hold it inside the blood vessel
Albumin may be ordered to help stabilize a patient and allow their body to absorb more fluids
How much fluid should a child be outputting per hour?
0.5-2.0mL/kg/hr
What are indications of dehydration and overhydration in children?
Dehydration - delayed cap refill, poor skin turgor, sunken fontanelles and eyes, cold extremities
Over - puffy eyes, pitting edema, moon face, bulging fontanelles, CNS changes, crackles, laboured breathing
What is a standard fluid bolus for a child?
20mL/kg
Give examples of hyper, hypo, and isotonic solutions
Hyper - D5W
Hypo - 0.45% NS
Isotonic - 0.9% NaCl, RL
What solution would we give if we want to increase energy?
D5W, due to additive glucose
What three electrolytes will we often not see abnormalities in children?
Magnesium, chloride, and phosphate due to adequate diet
What are the 4 major signs/symptoms of hyponatremia?
hypotension, tachycardia, decreased urine output, neurological/CNS changes (i.e., decreased reflexes, seizures, decreased LOC, cerebral edema)
What are the 4 signs/symptoms of hypernatremia?
excess thirst, weight gain, bounding pulse and hypertension, neurological changes (i.e., muscle twitches, hyperreflexia, decreased LOC, cerebral hemorrhage)
What are the adverse effects of sodium administration via oral and IV routes?
PO - nausea, vomiting, cramps
IV - venous phlebitis, edema
What factors may cause hypo/hypernatremia?
Hypo - pure losses, low intake, or too many boluses
Hyper - excess Na gain or water loss
What factors may cause hypo/hyperkalemia? which is more rare to see in children and why?
Hypo - reduced intake, cellular hyperpolarization
Hyper - very rare in children due to efficient renal excretion - increased intake, insulin deficiency, cellular trauma, renal issues
What are the 4 signs/symptoms of hypokalemia?
decrease in neuromuscular excitability, skeletal muscle weakness and smooth muscle atony, cardiac dysryhtmias (i.e., weak and irregular pulses, postural hypotension, cardiac arrest), N/V/decreased GI motility
What are 5 signs/symptoms of hyperkalemia?
increased neuromuscular irritability, restlessness, abdominal cramping, diarrhea, cardiac changes (i.e., dysrhythmias, bradycardia, cardiac arrest)
How should oral forms of potassium be administered?
Must be diluted in 100-250mL of water or fruit juice and taken with food or immediately after meals to minimize GI issues and too rapid of absorption
How should parenteral potassium be administered?
must not be given at rates faster than 10 mmol/hour to patients who are NOT on cardiac monitors
can potassium be given undiluted or bolus?
NEEVVVVVEEERRRRR
What three factors cause children to be at greater risk for acid-base balance changes?
lower residual lung volume, higher metabolic rate, and immature organs
What does partial pressure carbon dioxide indicate?
reflects the adequacy of ventilation by the lungs and may suggest respiratory alkalosis or acidosis
What lab value will show respiratory acidosis/alkalosis?
PaCO2
What lab value will indicate metabolic acidosis/alkalosis?
Bicarbonate levels
How adequate is a NB’s hearing when compared to an adult?
It is as acute as an adult
How do infants’ eustachian tubes differ compared to adults? Why might it be problematic?
They are shortened, wider, and horizontal - makes it easier for bacteria and viruses to access the ear
Define otitis media
Bilateral or unilateral infection of the fluid in the middle ear caused by bacteria or viruses
Why might otitis media lead to a perforation of the tympanic membrane?
As pressure increases and builds, it places pressure on the tympanic membrane
Why will otitis media lead to hospitaliztion?
Otitis media often will not lead to hospitalization, but the conjunction of multiple issues (i.e., sore throat, fever) from the infection that causes otitis media will result in hospitalization
What are 5 common complications of otitis media?
hearing loss, speech delay, scarring of tympanic membrane, acute mastoiditis, meningitis
What are the 8 signs/symptoms of otitis media?
fever, otalgia, irritability, inconsolability when lying down, tugging at the ears/moving side to side, poor feeding, lethargy, ear drainage
If ear drainage has a foul odor with otitis media, what might this indicate?
tympanic membrane perforation
Why may BF help reduce symptoms of otitis media?
Breastfeeding may help reduce pressure in the ears and will allow for uptake of antibodies from mom
What is the difference between narrow and broad spectrum activity anti-infectives?
Narrow - effective against only a few microorganisms with a very specific metabolic pathway/enzyme
Broad - useful in treating a wide variety of infections
What are the two most serious adverse effects that Gentamicin has in young children?
nephrotoxicity and ototoxicity
What gram is Gentamicin best at treating?
gram negative infections
How long will it take to see improvements in children once starting Gentamicin?
24-48 hours
What medication requires trough levels?
Gentamicin
Why would we administer an IV bolus prior to giving Gentamicin?
Ensure adequate kidney function
Amoxicillin may cause ___ if taken PO
Thrush
Is amoxicillin safe during pregnancy?
Yes
Why is amoxicillin often administered with clavulanate?
Helps prevent certain bacteria from becoming resistant to amoxicillin
Is an infant’s tongue larger or smaller in proportion to the rest of their mouth?
Larger
Do infants prefer sweet or salty flavors at birth?
sweet
What age will the first tooth typically erupt at?
4-5 months
What age do children begin to lose their baby teeth at?
5-6 years
By what age will children have all of their primary teeth and how many primary teeth do they have?
By age 3, they will have their full set of 20 primary teeth
What is the most common craniofacial anomaly? How many Canadian children does it affect per year?
Cleft lip & palate, approx. 400-500 per year
At what point prenatally will the cleft lip and palate be formed?
Around 5-6 weeks for the lip and 7-9 weeks for the palate
What are four primary risk factors for cleft lip/palate?
Hx of smoking, advanced age, infection during pregnancy, and use of anticonvulsants and steroids during pregnancy
What four other abnormalities is cleft lip/palate often associated with?
Heart defects, ear malformations, skeletal deformities, and GU abnormalities
What are four complications that arise from cleft lip/palate?
feeding difficulties, altered dentition, delayed/altered speech development, and otitis media
When will surgery of palate and lip occur?
2-3 months for the lip and 6-9 months for the palate
Why is extra burping important for a baby with a cleft lip/palate?
child takes in extra air and will be at greater risk for aspiration
What is non-nutritive sucking?
When baby is at the breast for comfort and not for feeding
Are kidneys larger or smaller in proportion to the body of a child?
Larger
Is GFR faster or slower in children?
Slower
At what age does the renal system reach functional maturity?
2 years
Why are young girls at greater risk of UTIs than boys?
Their urethra is shorter and closer to the anus
What is a voiding cystourethrogram?
Probe goes up the urethra, contrast is administered, and pictures of bladder and kidneys is taken
What is the cause of UTIs physiologically?
Bacteria ascends to the bladder via the urethra
When would a child be prescribed Lasix?
Hyperkalemia or pulmonary/cerebral edema
Why might we observe a deeper voice in those taking spironolactone?
It works on aldosterone
