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Module 5 (Pediatrics) > Pediatric G&D Assessments > Flashcards

Pediatric G&D Assessments Flashcards

1
Q

Parental responsibility for verbal consent if not present

A

voluntary (2 cosigns from healthcare providers and physician on conference with parent)

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2
Q

Someone can be an emancipated minor for

A

Pregnancy (over their care and the baby) they go under parents consent after but they are still the baby’s consent
Marriage
High School Graduation
Independent Living - no support from parents
Military Service – special circumstances

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3
Q

Age of majority

A

18

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4
Q

Exceptions to parental consent

A

Consent By Proxy – coach or school when unable to get parents
Life-Threatening Emergencies – stabilize then consent

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5
Q

If the parent refuses treatment, then as healthcare providers what can you do?

A

stabilize life-threatening then call CPS

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6
Q

Eval for abuse and neglect

A

Irregular and different healing bones and bruises
Scared in presence

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7
Q

“Medically Emancipated” Conditions

A

STIs
Mental Health Services
Alcohol And Drug Addiction
Contraceptive Advice

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8
Q

what should you say when getting VS

A

Checking not taking

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9
Q

Neonatal Assessments

A
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10
Q

Pediatric Assessments

A
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11
Q

Atraumatic Care for VS

A

1st - Respirations
2nd - Heart Rate
3rd – Oxygen Saturations
Last - Blood Pressure And Temperature

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12
Q

Crying and disruptive behaviors does what to heart rates

A

raises it

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13
Q

Newborn
normal pulse and respirations

A

P 100-160
R 30-60

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14
Q

1-11 months
normal pulse and respirations

A

P 100-150
R 25-35

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15
Q

1-3 years (toddlers)
normal pulse and respirations

A

P 80-130
R 20-30

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16
Q

3-5 years (pre-schooler)
normal pulse and respirations

A

P 80-120
R 20-25

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17
Q

6-10 years (school age)
normal pulse and respirations

A

P 70-110
R 18-22

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18
Q

10-16 (adolescent)
normal pulse and respirations

A

P 60-90
R 16-20

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19
Q

Why are VS higher as a newborn than an adult?

A

higher metabolic rate

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20
Q

Where are you watching for the respiration rate of a newborn to 7 y/o?

A

abdominal mvmt bc diaphragm to breathe

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21
Q

Where are you watching for the respiration rate of a 7 y/o +?

A

thoracic

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22
Q

You should count the respiration rate for a

A

full minute

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23
Q

To check the pulse of a newborn to 2 year old where do you check and for how long?

A

apical pulse (resting or sleeping)

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24
Q

To check the pulse of a 2-year-old + where do you check and for how long?

A

radial

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25
Q

What blood pressure cuff would you use for the most accurate reading when none of the normal sizes fit?

A

too big and false decrease of BP is to be accounted for

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26
Q

The temperature of the newborn could be affected by

A

active exercise
stress, cry
environment

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27
Q

Pharmacologic Interventions of Fever in Children

A

1st Acetaminophen
Ibuprofen (not if less than 6 months)
NO ASPIRIN

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28
Q

Ibuprofen is not given to infants less than 6 months due to

A

high risk of renal failure

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29
Q

What should not be given to children for a fever?

A

aspirin
Could trigger rare but fatal Rays syndrome

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30
Q

A change in environment should be considered after how long of the antipyretic

A

1 hour check recording

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31
Q

Nonpharmacologic interventions for children with a fever include

A

rest**
encourage fluids such as water and gatorade

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32
Q

Newborns are ___________ driven

A

respiratory
born hypoxic 60% then 10 mins later 90%

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33
Q

What is the most critical adaptation in a newborn adjustment to extrauterine life?

A

initiation of respirations

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34
Q

What factors after birth stimulate breathing?

A

chemical (low pH)
thermal (reason for room to be warm)
tactile

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35
Q

Newborns’ blood circulation is different from adults in what ways?

A

Patent ductus arteriosus shunts to close after birth
- allows blood flow to enter the lungs for the 1st time
- pressure change in heart, lungs, and vessels after the umbilical cord has clamped

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36
Q

Is it okay to hear a heart murmur in a newborn?

A

yes, due to the shunts closing

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37
Q

What is critical to the newborn’s survival

A

thermoregulation

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38
Q

Principal thermogenic sources

A

Heart
Liver
Brain
Brown adipose tissues (BATs)

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39
Q

With every degree of increase in temperature mortality increases by

A

10%
due to more energy being used

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40
Q

Normal temperature for a newborn

A

36.5-37.5 C
97.7-99.5 F

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41
Q

initial Newborn assessments

A

Provide warmth
Stimulation
Newborn Identification in the room
Medication Administration

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42
Q

Newborn assessment tool

A

APGAR

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43
Q

APGAR score used to assess

A

adjustment to extrauterine life
reflects general condition of the baby

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44
Q

When should you complete the APGAR score?

A

minute 1
minute 5

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45
Q

What is the APGAR score not used for

A

determining the need for resuscitation

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46
Q

Factors affecting the APGAR score

A

Physiologic immaturity, infection, maternal sedation, congenital disorders

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47
Q

The higher the APGAR

A

greater condition of the newborn

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48
Q

The lower the APGAR,

A

the lower the condition of the newborn

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49
Q

What does the APGAR score system use for signs?

A

Heart rate
respiratory effort
muscle tone
response
color

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50
Q

If the heart rate during the APGAR scoring is scored a 0,1, or 2 what does that mean?

A

0 = Absent
1 = < 100 bpm
2 = > 100 bpm

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51
Q

If the respiratory effort during the APGAR scoring is scored a 0,1, or 2 what does that mean?

A

0 = Absent
1 = irregular; slow, weak cry
2 = good, strong cry

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52
Q

If the muscle tone during the APGAR scoring is scored a 0,1, or 2 what does that mean?

A

0 limp
1 some flexion
2 well flexed

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53
Q

If the response during the APGAR scoring is scored a 0,1, or 2 what does that mean?

A

0 no response
1 grimace
2 cry sneeze

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54
Q

If the color during the APGAR scoring is scored a 0,1, or 2 what does that mean?

A

0 blue, pale
1 body pink, extremities blue
2 completely pink

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55
Q

The baby’s general posture

A

flexion posture

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56
Q

Baby’s general behavior

A

Easily awakened by a loud noise
Easily comforted
Satisfied after feeding
Level of responsiveness to noxious stimuli
The transition of sleep states is evident

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57
Q

You can usually get a good full assessment when

A

1 hour

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58
Q

Newborn skin texture

A

Smooth
“Puffy” areas – pressure and swelling
Vernix – cream cheezy white substance – skin protection
Lanugo – hair that comes out – skin protection

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59
Q

Vernix

A

cream cheezy white substance – skin protection

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60
Q

Lanugo

A

hair that comes out – skin protection
from the eyebrows up and over down the back
comes off later

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61
Q

Newborn skin color

A

Acrocyanotic or pink with no jaundice
on the first day of life.

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62
Q

Acrocyanotic

A

hands and feet are blue
BUT rest of the body is pink

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63
Q

Jaundice occurs where in babies

A

eyes best indicator
from top to bottom
then reverses when fixed

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64
Q

Millia

A

sebaceous glands exposed = don’t touch
white little dots

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65
Q

Mongolian Spots

A

bruise

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66
Q

Vernix builds up where

A

in rolls and armpit areas

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67
Q

Jaundice is normal in a baby between which times

A

24 hours to 2 weeks

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68
Q

Assess for what on a newborn’s head

A

contour of the head
fontanels (anterior and posterior)
degree of head control and lag

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69
Q

Results of birth trauma

A

Caput succedaneum
Cephalohematoma
Physiologic craniotabes

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70
Q

Caput succedaneum

A
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71
Q

Cephalohematoma

A
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72
Q

Physiologic craniotabes

A
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73
Q

The anterior fontanel closes

A

12-18 months

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74
Q

The posterior fontanels closes

A

2 months

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75
Q

Neonatal Assessment
Eyes

A

8-12 inches for eyes for vision depths
Cross eyes normal in newborns
2 months for tear production
No drainage
No yellowing

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76
Q

How long does it take for tear production

A

2 months

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77
Q

Neonatal Assessment
Ears

A

Positioning
Pinea is even with the outer campus of the eye
If not then symptom of down syndrome
Little drainage from amniotic fluid possible
Pinea flexible with some cartilage

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78
Q

Neonatal Assessment
Nose

A

Patency
Discharge thin translusent
Sneezing
Bruising from delivery
Blood or flaring is problems

79
Q

Neonatal Assessment
Mouth

A

Clefts
Natal teeth – pulled because no good root system
Epithelial cysts

80
Q

Neonatal Assessment
Throat

A

midline

81
Q

Neonatal Assessment
Neck

A

webbing - down syndrome

82
Q

Neonatal Assessment
Chest

A

Lift up chin for breakdown
Nipple alignment
Extra
Witch’s milk = discharge from chest

83
Q

What is a witch’s milk?

A

discharge from baby’s nipples

84
Q

Normal respiration rate for newborns

A

30-60 irregular pattern
- could be quicker but should cont down

85
Q

Newborn lungs should be what when the infant is quiet?

A

auscultated
clear, equal, bilateral WNL

86
Q

Is it normal for the baby to ave periodic breathing?

A

yes

87
Q

What is not normal for a newborn regarding their breathing?

A

stridor and contractures

88
Q

Crackles could occur later on in life due to

A

fluid from womb

89
Q

Periodic breathing should resolve around

A

6-8 hours of life

90
Q

The apical heart rate of a newborn is

A

100-160

91
Q

Is a murmur normal in newborns?

A

yes
BC THE SHUNTS ARE CLOSING

92
Q

Where is the murmur usually heard?

A

left sternal border (3-4th intercostal space)

93
Q

Dextria cardia

A

heart is flipped to the right

94
Q

Abdomen of a newborn

A

More rounded contour
peristaltic waves

95
Q

Bowel sounds can be taken from

A

20 mins to an hour after birth

96
Q

The umbilical cord has

A

2 arteries and 1 vein

97
Q

If the umbilical cord does not have 2 arteries and 1 vein then what could happen to the baby

A

kidney damage

98
Q

The umbilical cord clamp takes how long to fall off

A

10-14 days
- dry, crust, black
(keep clean and dry)

99
Q

The baby should poop (meconium) for how long after birth?

A

24 hours

100
Q

Imperforate anus means

A

they have no anus and a surgical anoplasty needs to occur

101
Q

Sacral dimple

A
102
Q

Sacral Tuft

A
103
Q

Pilonidal sinus or cyst

A
104
Q

Spina bifida (occulta)

A
105
Q

Meconium is used for

A

drug testing
dark green black thick, sticky, amniotic
can last up to 24 hours

106
Q

Transitional poop

A

dark green brown
sticky but getting softer
meconium and breastfeeding/formula
within 2-4 days

107
Q

Breastfeeding poop

A

yellow or yellow-green
soft squishy
usually sweet smell
within 3-5 days
-mature breast milk

108
Q

Formula poop

A

yellow-brown, green-tan
thick and firm
smellier
1st - 2nd week

109
Q

Breastfeeding/Formula combo poop

A

dark yellow, brown
thicker
within the first month

110
Q

Solid food poop

A

dark brown, yellow
4-6 months or when solids are started

111
Q

Genitalia females as newborns

A

labia majora and minora
hymenal tag
vaginal discharge
pseudo menstruation

112
Q

Genitalia males as newborns

A

penis
foreskin and urethral opeing
scrotum, testes
(hydrocele, hernias

113
Q

pseudo menstruation

A

females can have a streak of blood
due to hormonal imbalances from mother

114
Q

By what hour do you need to have frequent urination by

A

1st 24 hours

115
Q

DO NOT __________ the foreskin on newborns

A

retract

116
Q

Extremities of a Newborn Assessment

A

Symmetry (shape, size, and movement)
Passive Range of motion (ROM), malformation
Digits (polydactyly, syndactyly)
Palmar crease (multiple)
Muscle tone (flexed)
Webbing = down syndrome
Moro (startle) reflex response

117
Q

Polydactyl

A
118
Q

Syndactyl

A
119
Q

Moro startle reflex response

A

scared
muscle tone and equal mvmt symmetrically

120
Q

Neurologic Newborn assessment

A

Reflexes (grasp and Babinski)
Posture, tone, head control, and body movement
Behavioral response to care
Consolability (should be easy)
Cry (frequency and pitch)

121
Q

Grasp reflex

A

can grab finger

122
Q

Babinski

A

swipe the foot and all toes are displayed

123
Q

What are some indications of neuro problems?

A

unable to be consoled
high pitch crying varies

124
Q

What senses are newborns able to perceive and react?

A

smell (sensitive to perfume and cologne)
taste (polyubisaul)
touch

125
Q

What is the priority goal in the nursery?

A

maintain a pt airway

126
Q

Maintain a pt airway for nursey babies

A

supine positioning for sleep
suction the oral and nasal secretions with a bulb syringe
neutral position with the chin
more forceful mechanical suctioning gently
sufficient time to recuperate

127
Q

What place should you suction 1st?

A

mouth before nose
with time to recuperate

128
Q

Newborn Interventions

A

Safety (Identification halos /Airway)
Vitamin K administration
Hepatitis B vaccine administration with consent 1/3 IM
Newborn Screening for Disease
Universal hearing screening

129
Q

Vitamin K

A

prevents hemorrhagic clots factor
need consent
IM in vastus lateralis
If don’t want tell them surgery will not be done till older

130
Q

Newborn Screening for Diseases

A

any disorder inherited or congenital
within 24 hours of life with a protein ingested (breast milk or formula

131
Q

Heel sticks

A

outside of the heel to prevent pain and gait problems

132
Q

Eye Care drugs

A

prophylaxis (ophthalmia neonatorum)
Erythromycin (0.5%) - ointment
Tetracycline (1%)
Silver nitrate (1%)

133
Q

If the baby does not pass the hearing test the first time in the room, then

A

could be due to the loud noises or fluid in the ears

and flow up later

134
Q

prophylaxis (ophthalmia neonatorum) is given to prevent

A

blindness from chlamydia
within the 1st year of life
cheap

24 hour thickness in eyes to get the clog out

135
Q

Newborn Discharge Teaching and Parental Support

A

Bathing (do not submerge till the umbilical cord falls off and same with the penis)
- mild soap and water with lotion
Opportunity for hygiene, assessment, and anticipatory guidance for parents
Umbilical care - no submerge needs to be dry
Circumcision
Skincare and skin concerns
“Couplet care” - stays with mom
Discharge teaching guidelines - feedings
Follow-up care – weight gain and bilirubin
Car seat safety

136
Q

What type of bath should you give the baby when they still have the umbilical intact?

A

sponge bath

137
Q

Circumcision

A

personal or religious
elective procedure to remove the foreskin

138
Q

Contraindications of Circumcision

A

RISK OF BLEEDING
- anything more than a quarter of blood concern

139
Q

Benefits of Circumcision

A

decrease of penile CA and STIs

140
Q

Procedure of circumcision

A

before feeding
sweetease, Tylenol, penile block
they are awake

141
Q

Assessment of Attachment Behaviors

A

Emotional bonding between the parents and newborn
En face position
“Falling in love” with the newborn

142
Q

You should assess the mom for what after giving birth

A

post partum depression
- not wanting to bond
psychosis

143
Q

With multiple births, the nurse should help the mother with what

A

Critical for mother to bond to each newborn
Nurses are instrumental in the promotion of bonding
Rooming-in and breastfeeding are encouraged
Early visitation of an ill infant
Identify unique characteristics of each

144
Q

Cumulative and subjective impression of a pedicatric assessment

A

Physical Appearance​ (clothes)
Nutrition​ (proper or junk)
Behavior (friendly attached)
Personality​ (positive or negative)
Interactions​ (shy with others)
Posture​ (slouched or)
Development​ (for age)
Speech​ (talking)

145
Q

Skin of a pediatric assessment

A

Color - pink
Texture - smooth
Temperature - normal, hot, cold
Moisture - sweating?
Turgor
Lesions
Acne - adolescent
Rashes
Hair And Distribution - Infant bald spots will grow back
-ticks and lice

146
Q

The head assessment of a pediatric pt

A

General Shape/Symmetry
Better Head Control/ROM
Sutures
Fusion of Fontanels
- Posterior 2-4 months
- Anterior 12-18 months

147
Q

Pediatric Assessment of EYES

A

Size, Shape, And Spacing
PERRLA (reactive to light)
Color could change color between 4-6 months

148
Q

By 3-4 months, what occurs in regards to the pediatric assessment of the eyes

A

Binocularity - fixate on more than 1 thing

149
Q

Strabismus

A

cross-eyed
- Brain muscle control is slowing down due to the eye not wanting to work

150
Q

Strabismus treatment may include

A

Glasses
Patching - over the strong eye
Eye Drops
Surgical Intervention - loosen or heighten the muscle nerve

151
Q

If not detected and corrected by 4-6 years, then

A

Amblyopia (“Lazy Eye”)

152
Q

If a baby has strabismus what should you do as a nurse regarding patches?

A

cover the strong eye to have the brain communicate to the lazy eye to work

153
Q

Visual Testing in Children chart to use

A

Snellen Chart-Letters
HOTV/Tumbling E/Pictures

154
Q

Visual Testing in Children requirements

A

10’ From Chart
Cover One Eye
Keep Both Eyes Open
Glasses Remain On If Worn

155
Q

Normal ear alignment

A

eye-occiput line by 10 degrees up on top of ear

156
Q

The Eustachian tube of a child is more

A

shorter and flat
- fluid and build-up can cause ear infections

157
Q

Signs of hearing impairment in infants

A

Lack of Moro reflex startle or blink reflex to loud sound
Absence of babble or voice by 7 months
Absence of well-formed syllables by 11 months

158
Q

Signs of hearing impairment in children

A

Use of gestures, rather than words, to express desires
Failure to develop intelligible speech by 24 months
Asking to have statements repeated
Avoidance of social interaction
With bad grades

159
Q

How to test for hearing impairment?

A

go behind and ask them to repeat what you said

160
Q

Nose should be

A

midline and patent
note any discharge and foreign bodies
flared nostrils

161
Q

Mouth assessment of peds

A

Lips
Mucous Membranes
Gums
Teeth
Tongue
no bleeding

162
Q

Early childhood caries

A

result of teeth bathing in carb rich solution
-lead to cavities

163
Q

How do you avoid early childhood caries

A

do not prop the bottle or put the child to bed with one
soft cloth and clean around teeth and gums

164
Q

General rule of Thumb for teething

A

Age In Months minus 6 = # Of Teeth
(8-month-old- 6 months = 2 teeth)

165
Q

Teething should occur in normal variation between

A

6-9 months -
genetic pattern

166
Q

Teething Order

A

Lower Central Incisors
Upper Central Incisors
Upper Lateral Incisors
Lower Lateral Incisors

167
Q

Teething
Not Sure If The Discomfort Is From Teething?

A

Pressure makes the baby feel better
Gently Press On Gum Where The Tooth Should Erupt

168
Q

Signs of teething

A

Difficulty sleeping

Increase In Nonnutritive Sucking/biting on hard objects

Ear rubbing/pulling

Excessive Drooling

Anorexia

169
Q

Ways of helping teething

A

Cold breast milk in pacifier
Cold
Tylenol
Ibuprofen after 6 months of age

170
Q

They should have a complete set of teeth by

A

24 months

171
Q

Thumb sucking and pacifer use should stop by

A

4-5 y/o

172
Q

Malocclusion

A

occur if thumb sucking persists beyond 5 years-of-age
open and over bite

173
Q

Start loosing teeth at the age of

A

6 years

174
Q

You lose how many primary teeth

A

20

175
Q

You gain how many permanent teeth?

A

32 (16 top and 16 bottom)

176
Q

IF PERMANENT TOOTH IS KNOCKED OUT, then

A

don’t touch the root and place it in Ca
- then put it back for implant maybe

177
Q

During the age of losing teeth, you need to stress

A

dental hygiene

178
Q

Inspection chest in infants looks like

A

circular

179
Q

Inspection chest with growth looks like

A

flattens

180
Q

Chest mvmt from birth to 7 years old

A

respiratory mvmt is abdominal and diaphragm

181
Q

Chest mvmt 7 years old +

A

thoracic breathing

182
Q

You can auscultate the apical pulse in children younger than 7 years

A

fourth left intercostal space

183
Q

You can auscultate the apical pulse in children greater than 7 years

A

fifth intercostal space

184
Q

Cap refill for pediatric pt

A

less than 2 seconds

185
Q

Signs Of Respiratory Failure?
upper
lower

A

Stridor - upper
Wheezing - lower

186
Q

Change the pulse ox site every

A

6 hours to prevent skin breakdown

187
Q

Pulse Ox is 95+% what should the nurse do

A

continue to monitor

188
Q

Pulse Ox is below 91% what should the nurse do

A

assess and intervene O2

189
Q

Pulse Ox is less than 86% what should the nurse do

A

emergency rapid

190
Q

The abdomen of a child is normally

A

round and protruding

191
Q

Genitalia assessment of pediatric

A

Wear gloves
Should be performed in the presence of the parent, guardian, or another health care professional
This is a great time to elicit questions or concerns about body function.
An opportune time to discuss appropriate vs inappropriate touch

192
Q

What should be said to assure the patient od appropriate touch?

A

I can only be touching because of the parents, yours consent and another nurse in the room.

193
Q

If the ped pt lets you know of inappropriate touching, then what do you do?

A

call in for assistance and CPS

194
Q

Scoliosis

A

lateral curvature of the spine

Module 5 (Pediatrics) (27 decks)

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