Ped's New born and adolescent WCC Flashcards
1
Q
What is apart of the APGAR scoring?
A
Appearance Pulse Grimace Activity Respiration's
2
Q
Describe scoring for appearance with APGAR
A
0 = blue all over 1= blue exremities 2= no coloration
3
Q
Describe scoring for Pulse with APGAR
A
0= no pulse 1= <100 bpm 2= >100bpm
4
Q
Describe scoring for Grimace with APGAR
A
0= no response to simulated 1= feeble cry when simulated 2= sneezing, coughing or pulling away when stimulated
5
Q
Describe scoring for Activity with APGAR
A
0= no movement 1= some movement 2= active movement
6
Q
Describe scoring for Respiration’s with APGAR
A
0= No breathing 1= weak to slow or irregular breathing 2= strong cry
7
Q
Describe a baby with good, fair and poor scoring for APGAR
A
8-10 good normal
4-7 fair possible intervention
0-3 poor- requires resuscitation
8
Q
when is APGAR checked?
A
Immediately after birth and 5 minutes after
9
Q
how many weeks is a term infant?
perterm?
postterm ?
A
term 37-40
premature <37 weeks
post-mature > 42 weeks
10
Q
what is small gestational age
what is average gestational age
Large gestational age
A
SGA <10th %
AGA 10-90%
LGA >90%
11
Q
What is the Ballard scoring for?
A
to estimate Gestational age
12
Q
what is the thick white substance on neonate after birth
A
Vernix caseosa
13
Q
what is the “fine” hair on a baby after birth?
A
Lanugo
14
Q
What is it called when a baby after birth is blue on palms and soles?
A
Acrocyanosis
15
Q
what are pinpoint vessels with a red base all over new born body that usually disappear in one week
A
Erythemia toxicum
16
Q
what is a splothy pink area on the back of the neck or on the eye?
A
Salmon patch
“storke bite”
“angel kiss”
17
Q
what are areas of darken skin found on a new born commonly found on buttocks
A
Mongolian spots
18
Q
what are pin point size smooth white spots with no erythema that are commonly found on the face and will eventually disappear
A
” baby ache” millia
19
Q
when should the posterior fontanel close?
A
2 months
20
Q
when should the anterior fontanel close?
A
by 2 years
21
Q
what will follow fontanel closure? what other developmental stage?
A
Teeth
its a sign of skeletal development
22
Q
what is soft tissue swelling across the suture lines ?
will it resolve?
A
Caput succdaneum
will resolve in a few days
23
Q
what is subperiosteal hemorrhage that does not cross the suture lines ?
will it resolve?
A
Cephalohematoma
takes a few weeks for the blood to be reabsrobed
may see some jaundice will all that extra blood break down
24
Q
What could be the cause of a suken fontanelle
what could cause a tense or bulging fontanelle
A
sucken: dehydration
buldging: hemotoma or fluid that increases the intracranial pressure
25
What is common to happen in the eyes after birth?
conjunctival hemorrhage and strabisms
26
what are you looking for an a eye exam ?
| what are abnormals?
1. red light reflex
abnormal - cataracts, glaucoma, retinoblastoma
refer all
27
when do you refer a patient to ophthalmologist with strabisms
if present at 4 months and older
28
What are small white cysts in a new born mouth?
Epistein pearls
| normal and will resolve in a few weeks
29
What are you inspecting for on a new born's neck?
1. torticollis (contracted SCM)
2. palpate for masses
3. make sure they will try and pick their head up on moms chest
4. as they get older will lift head and turn to both sides
30
When do you do tummy time with a baby?
as soon as possible
when new born you can take the baby to your chest and lay down flat
when they get older you can place them on their tummy with arms propped up
31
How long is breast feeding recommend for ?
6 months at the latest try for 1 year
if not try and pump
if not do formula
32
How often should a new born be breast feeding?
| how long should it take them to feed?
usually every 2-3 hours
should take 15-20 mins
if taking longer and baby gets tired could be underlying problem
if not gaining weight need to wake baby up to feed and supplement with formula
33
How can you tell a new born is getting adequate nutrition?
1. weight gain
| 2. wet and poopy dipers every day
34
When should an infant be back to birth weight?
normal to loose weight in the first few days of life but should not loose more than 7% of body weight \
* back to birth weight in 7-10 days
35
When should formula be started? how often? how much?
1 year
| start with 2 ounces every 2-3 hours if infant finishes you can add more as tolerated
36
```
What is the normal urine pattern for a new born? how often at :
24 hours?
2 days?
3-4 days?
5th day ?
```
24 hours = increases
2 days = 2- 3 voids
3-4 days = 4-6 voids
5th day = 6=8 voids
37
what is the normal poop pattern for a new born? how often and what does it look like?
2-3 days of meconium which is thick black like
3rd day should transition to yellow brown mustard seedy normal to have a little red specks in it
Normal poop: thin seedy and pooping 3 times a day
38
What are some risk factors for SIDS
```
Premature (lungs are mature)
low birth weight
<20 year old mom
smoker mom
drug use during pregnancy
low social eco status
sleeping on tummy !
soft bed
sleeping with parents
sibling dying of SIDS
```
39
How do you prevent SIDS ?
BACK SLEEPING
nothing in the crib but light blanket
sleeping sacks
-since the push for babies to sleep on their back SIDS has decreased significantly
40
If a child has pectus excavatum what do you think of?
corac of the aorta
41
What is important to check that could revel a coractation of the aorta
FEMORAL PULSES
42
what is the umbilical cord comprised of?
```
2 arteries small thicker wall
1 large thin vein
should fall off by 2 weeks
once it has falled off its okay to bathe
if may bleed a little that's normal
```
43
What is a omphalocele
herniation through the umbilicus
| bowel is in the umbilical cord covered by peritoneum
44
what is a gastroschisis
defect in abdominal wall
2-3 cm lateral of umilicus
no covering over bowel*
Emergency
45
What if you have a new born female with milky vaginal discarge?
if breast feeding thats normal from moms estrogen
46
what is hypospiadia
| what is important to note?
urethra down
| cant circumsice refer for urologist
47
what is epispiadia
| what is important to note?
urthra is up
| cant circumsice refer for urologist
48
What do you inspect the anal area for?
fissures and fistulas
| can be normal due to straining
49
what do you inspect the extremities of a new born for?
deformities
symmetry
palpate spine, mass, hair tuff, scaral cleft or dimple
50
what test? hip adduction and posterior pressure
Barlow
| for hip dysplasia
51
what test? hip abduction
Ortolani
| for hip dysplasia
52
What is the Babinski test
dorifflexion of the big toe and fanning of the
| can be present up to two years
53
How do you acess neuro exam in a birth from 3-4 month
palmar and plantar grasp
| rooting - if you stroke the peioral mouth will open
54
How do you acess neuro exam in a birth- 4 month old
Moro- reflex
| should startle pull up and drops arms
55
what is the moro-reflex
birth - 4 months should startle pull up and drops arms
56
How do you acess neuro exam in a birth-2 month old
asymmetric tonic neck reflex
turn head and opposite arm and left reflex
trunk incurvation (galant) stroke one side and baby will turn to that side
57
What would a decrease in reflexes possilby mean?
CNS abnormaility
| PNS or motor unit problem
58
What is given in the hospital to a new born to prevent hemorrhagic disease
prevent clotting- Vitamin K
59
What is given in the hospital to all new borns
```
vitamin K
opthalmic antibiotic ointment for eyes
1st dose of Hep B
New born screen - heel prick
hearing screen
lactation consult
```
60
What can you tell a mom to expect after newborn discharge about things to expect and f/u
```
follow up with peds doc in one week
feeding every 2-3 hours
urine 6-8 times a day
stool 3-4 times a day
repeat new born screen
safe sleeping
water temperature
smoking
car seat
```
61
Surfactant is made up mostly of what ?
90 % lipids and mainly phosphytidycholine (lecithin)
and will increase with maturity
Shigomyelin stays constant
62
At what weeks is surfactant made ?
32-34 weeks
| 34-36 weeks into alvelor lumen and amiotic fluid
63
What does a decrease in surfactant lead to?
Atelectasis
decrease in functional residual volume
arterial hypoxemia
respiratory distess
64
decrease in synthesis of surfactant leads to?
hypovolemia
hypothermia
acidosis
hypoxemia
65
What laboratory tests can you use to evaluate lung maturity?
Lecithin/shingomylin ratio
2:1 = mature
the lecithin should be rising as lung mature
the shinomylin stays the same
66
CXR showing ground glass haze, air broncograms or white out
| should make you think what diagnosis?
respiratory distress syndrome RDS
| hyaline membrane disease
67
what are ways to prevent respiratory distress syndrome
1. cerclage - stitch in the cervic
2. bed rest
3. tocolytics- stop contractions
if you cant prevent give bethmethasone to mom
68
Treatment for respiratory distress syndrome
```
OXYGEN!
intubation
ventilation
fluid & nutrition
exogenous surfactant
```
69
What are complications of respiratory distress syndrome
1. patent ductus arterious
2. pneumothroat from vent
3. bronchopulmonary dysplasia - BPD
70
what is bronchopulmonary dysplasia
chronic lung disease
36 weeks of oxygen dependance
fail to improve at 2 weeks
need for prolonged ventilation
71
what are long term side effects of respiratory distress syndrome
reactive airways
hyperinflation
development delays
high risk for RSV - give syngirs vaccine prior to RSV season
72
Why do new borns more prone to hyperbilirubinema
3x greater rate of bilirubin because of increased RBC's and shorter RBC life time. Jaundice on first day of life is abnormal
73
what are s/s of Jaundice
yellowing of skin sclera and mucous membranes
| will be noticeable 5-10mg/dL in infant
74
At what level is Jaudice noticeable ?
5-10mg/dL
75
what type of jaundice is lipid soluble and toxic to the CNA
| insoluablein water and limited excretion
unconjugated or indirect
76
what type of jaundice is conjugated by the liver and is water soluble which is then exrected in the stool and urine
Conjugated
77
is jaundice at birth normal?
NO
78
What is usually the peak of jaundice
preterm should be less than ?
infant less than?
peaks at 3 days
preterm <15mg
infant <12
79
what are cause of physiologic jaundice
when does it peak ?
what value should it be under?
when will it decrease
Breast milk
peaks in 1-2 weeks
less than 12
it should rapidly decrease if breastfeeding stops 1-2 days
