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)
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
3
Q
Age of majority
A
18
4
Q
Exceptions to parental consent
A
Consent By Proxy – coach or school when unable to get parents
Life-Threatening Emergencies – stabilize then consent
5
Q
If the parent refuses treatment, then as healthcare providers what can you do?
A
stabilize life-threatening then call CPS
6
Q
Eval for abuse and neglect
A
Irregular and different healing bones and bruises
Scared in presence
7
Q
“Medically Emancipated” Conditions
A
STIs
Mental Health Services
Alcohol And Drug Addiction
Contraceptive Advice
8
Q
what should you say when getting VS
A
Checking not taking
9
Q
Neonatal Assessments
A
10
Q
Pediatric Assessments
A
11
Q
Atraumatic Care for VS
A
1st - Respirations
2nd - Heart Rate
3rd – Oxygen Saturations
Last - Blood Pressure And Temperature
12
Q
Crying and disruptive behaviors does what to heart rates
A
raises it
13
Q
Newborn
normal pulse and respirations
A
P 100-160
R 30-60
14
Q
1-11 months
normal pulse and respirations
A
P 100-150
R 25-35
15
Q
1-3 years (toddlers)
normal pulse and respirations
A
P 80-130
R 20-30
16
Q
3-5 years (pre-schooler)
normal pulse and respirations
A
P 80-120
R 20-25
17
Q
6-10 years (school age)
normal pulse and respirations
A
P 70-110
R 18-22
18
Q
10-16 (adolescent)
normal pulse and respirations
A
P 60-90
R 16-20
19
Q
Why are VS higher as a newborn than an adult?
A
higher metabolic rate
20
Q
Where are you watching for the respiration rate of a newborn to 7 y/o?
A
abdominal mvmt bc diaphragm to breathe
21
Q
Where are you watching for the respiration rate of a 7 y/o +?
A
thoracic
22
Q
You should count the respiration rate for a
A
full minute
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)
24
Q
To check the pulse of a 2-year-old + where do you check and for how long?
A
radial
25
What blood pressure cuff would you use for the most accurate reading when none of the normal sizes fit?
too big and false decrease of BP is to be accounted for
26
The temperature of the newborn could be affected by
active exercise
stress, cry
environment
27
Pharmacologic Interventions of Fever in Children
**1st Acetaminophen**
Ibuprofen (not if less than 6 months)
NO ASPIRIN
28
Ibuprofen is not given to infants less than 6 months due to
high risk of renal failure
29
What should not be given to children for a fever?
aspirin
Could trigger rare but fatal Rays syndrome
30
A change in environment should be considered after how long of the antipyretic
1 hour ****check recording****
31
Nonpharmacologic interventions for children with a fever include
rest**
encourage fluids such as water and gatorade
32
Newborns are ___________ driven
respiratory
born hypoxic 60% then 10 mins later 90%
33
What is the most critical adaptation in a newborn adjustment to extrauterine life?
initiation of respirations
34
What factors after birth stimulate breathing?
chemical (low pH)
thermal (reason for room to be warm)
tactile
35
Newborns' blood circulation is different from adults in what ways?
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
36
Is it okay to hear a heart murmur in a newborn?
yes, due to the shunts closing
37
What is critical to the newborn's survival
thermoregulation
38
Principal thermogenic sources
Heart
Liver
Brain
Brown adipose tissues (BATs)
39
With every degree of increase in temperature mortality increases by
10%
due to more energy being used
40
Normal temperature for a newborn
36.5-37.5 C
97.7-99.5 F
41
initial Newborn assessments
Provide warmth
Stimulation
Newborn Identification in the room
Medication Administration
42
Newborn assessment tool
APGAR
43
APGAR score used to assess
adjustment to extrauterine life
reflects general condition of the baby
44
When should you complete the APGAR score?
minute 1
minute 5
45
What is the APGAR score not used for
determining the need for resuscitation
46
Factors affecting the APGAR score
Physiologic immaturity, infection, maternal sedation, congenital disorders
47
The higher the APGAR
greater condition of the newborn
48
The lower the APGAR,
the lower the condition of the newborn
49
What does the APGAR score system use for signs?
Heart rate
respiratory effort
muscle tone
response
color
50
If the heart rate during the APGAR scoring is scored a 0,1, or 2 what does that mean?
0 = Absent
1 = < 100 bpm
2 = > 100 bpm
51
If the respiratory effort during the APGAR scoring is scored a 0,1, or 2 what does that mean?
0 = Absent
1 = irregular; slow, weak cry
2 = good, strong cry
52
If the muscle tone during the APGAR scoring is scored a 0,1, or 2 what does that mean?
0 limp
1 some flexion
2 well flexed
53
If the response during the APGAR scoring is scored a 0,1, or 2 what does that mean?
0 no response
1 grimace
2 cry sneeze
54
If the color during the APGAR scoring is scored a 0,1, or 2 what does that mean?
0 blue, pale
1 body pink, extremities blue
2 completely pink
55
The baby's general posture
flexion posture
56
Baby's general behavior
Easily awakened by a loud noise
Easily comforted
Satisfied after feeding
Level of responsiveness to noxious stimuli
The transition of sleep states is evident
57
You can usually get a good full assessment when
1 hour
58
Newborn skin texture
Smooth
“Puffy” areas – pressure and swelling
Vernix – cream cheezy white substance – skin protection
Lanugo – hair that comes out – skin protection
59
Vernix
cream cheezy white substance – skin protection
60
Lanugo
hair that comes out – skin protection
from the eyebrows up and over down the back
comes off later
61
Newborn skin color
Acrocyanotic or pink with no jaundice
on the first day of life.
62
Acrocyanotic
hands and feet are blue
BUT rest of the body is pink
63
Jaundice occurs where in babies
eyes **best indicator**
from top to bottom
then reverses when fixed
64
Millia
sebaceous glands exposed = don't touch
white little dots
65
Mongolian Spots
bruise
66
Vernix builds up where
in rolls and armpit areas
67
Jaundice is normal in a baby between which times
24 hours to 2 weeks
68
Assess for what on a newborn's head
contour of the head
fontanels (anterior and posterior)
degree of head control and lag
69
Results of birth trauma
Caput succedaneum
Cephalohematoma
Physiologic craniotabes
70
Caput succedaneum
71
Cephalohematoma
72
Physiologic craniotabes
73
The anterior fontanel closes
12-18 months
74
The posterior fontanels closes
2 months
75
Neonatal Assessment
Eyes
8-12 inches for eyes for vision depths
Cross eyes normal in newborns
2 months for tear production
No drainage
No yellowing
76
How long does it take for tear production
2 months
77
Neonatal Assessment
Ears
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
78
Neonatal Assessment
Nose
Patency
Discharge thin translusent
Sneezing
Bruising from delivery
Blood or flaring is problems
79
Neonatal Assessment
Mouth
Clefts
Natal teeth – pulled because no good root system
Epithelial cysts
80
Neonatal Assessment
Throat
midline
81
Neonatal Assessment
Neck
webbing - down syndrome
82
Neonatal Assessment
Chest
Lift up chin for breakdown
Nipple alignment
Extra
Witch’s milk = discharge from chest
83
What is a witch's milk?
discharge from baby's nipples
84
Normal respiration rate for newborns
30-60 irregular pattern
- could be quicker but should cont down
85
Newborn lungs should be what when the infant is quiet?
auscultated
clear, equal, bilateral WNL
86
Is it normal for the baby to ave periodic breathing?
yes
87
What is not normal for a newborn regarding their breathing?
stridor and contractures
88
Crackles could occur later on in life due to
fluid from womb
89
Periodic breathing should resolve around
6-8 hours of life
90
The apical heart rate of a newborn is
100-160
91
Is a murmur normal in newborns?
yes
BC THE SHUNTS ARE CLOSING
92
Where is the murmur usually heard?
left sternal border (3-4th intercostal space)
93
Dextria cardia
heart is flipped to the right
94
Abdomen of a newborn
More rounded contour
peristaltic waves
95
Bowel sounds can be taken from
**20 mins** to an hour after birth
96
The umbilical cord has
2 arteries and 1 vein
97
If the umbilical cord does not have 2 arteries and 1 vein then what could happen to the baby
kidney damage
98
The umbilical cord clamp takes how long to fall off
10-14 days
- dry, crust, black
(keep clean and dry)
99
The baby should poop (meconium) for how long after birth?
24 hours
100
Imperforate anus means
they have no anus and a surgical anoplasty needs to occur
101
Sacral dimple
102
Sacral Tuft
103
Pilonidal sinus or cyst
104
Spina bifida (occulta)
105
Meconium is used for
drug testing
dark green black thick, sticky, amniotic
can last up to 24 hours
106
Transitional poop
dark green brown
sticky but getting softer
meconium and breastfeeding/formula
within 2-4 days
107
Breastfeeding poop
yellow or yellow-green
soft squishy
usually sweet smell
within 3-5 days
-mature breast milk
108
Formula poop
yellow-brown, green-tan
thick and firm
smellier
1st - 2nd week
109
Breastfeeding/Formula combo poop
dark yellow, brown
thicker
within the first month
110
Solid food poop
dark brown, yellow
4-6 months or when solids are started
111
Genitalia females as newborns
labia majora and minora
hymenal tag
vaginal discharge
pseudo menstruation
112
Genitalia males as newborns
penis
foreskin and urethral opeing
scrotum, testes
(hydrocele, hernias
113
pseudo menstruation
females can have a streak of blood
due to hormonal imbalances from mother
114
By what hour do you need to have frequent urination by
1st 24 hours
115
DO NOT __________ the foreskin on newborns
retract
116
Extremities of a Newborn Assessment
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
Polydactyl
118
Syndactyl
119
Moro startle reflex response
scared
muscle tone and equal mvmt symmetrically
120
Neurologic Newborn assessment
Reflexes (grasp and Babinski)
Posture, tone, head control, and body movement
Behavioral response to care
Consolability (should be easy)
Cry (frequency and pitch)
121
Grasp reflex
can grab finger
122
Babinski
swipe the foot and all toes are displayed
123
What are some indications of neuro problems?
unable to be consoled
high pitch crying varies
124
What senses are newborns able to perceive and react?
smell (sensitive to perfume and cologne)
taste (polyubisaul)
touch
125
What is the priority goal in the nursery?
maintain a pt airway
126
Maintain a pt airway for nursey babies
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
What place should you suction 1st?
mouth before nose
with time to recuperate
128
Newborn Interventions
Safety (Identification halos /Airway)
Vitamin K administration
Hepatitis B vaccine administration with consent 1/3 IM
Newborn Screening for Disease
Universal hearing screening
129
Vitamin K
prevents hemorrhagic clots factor
need consent
IM in vastus lateralis
If don’t want tell them surgery will not be done till older
130
Newborn Screening for Diseases
any disorder inherited or congenital
**within 24 hours of life with a protein ingested (breast milk or formula**
131
Heel sticks
outside of the heel to prevent pain and gait problems
132
Eye Care drugs
prophylaxis (ophthalmia neonatorum)
Erythromycin (0.5%) - ointment
Tetracycline (1%)
Silver nitrate (1%)
133
If the baby does not pass the hearing test the first time in the room, then
could be due to the loud noises or fluid in the ears
and flow up later
134
prophylaxis (ophthalmia neonatorum) is given to prevent
blindness from chlamydia
**within the 1st year of life**
cheap
24 hour thickness in eyes to get the clog out
135
Newborn Discharge Teaching and Parental Support
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
What type of bath should you give the baby when they still have the umbilical intact?
sponge bath
137
Circumcision
personal or religious
elective procedure to remove the foreskin
138
Contraindications of Circumcision
RISK OF BLEEDING
- anything more than a quarter of blood concern
139
Benefits of Circumcision
decrease of penile CA and STIs
140
Procedure of circumcision
before feeding
sweetease, Tylenol, penile block
they are awake
141
Assessment of Attachment Behaviors
Emotional bonding between the parents and newborn
En face position
“Falling in love” with the newborn
142
You should assess the mom for what after giving birth
post partum depression
- not wanting to bond
psychosis
143
With multiple births, the nurse should help the mother with what
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
Cumulative and subjective impression of a pedicatric assessment
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
Skin of a pediatric assessment
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
The head assessment of a pediatric pt
General Shape/Symmetry
**Better Head Control/ROM**
Sutures
Fusion of Fontanels
- Posterior 2-4 months
- Anterior 12-18 months
147
Pediatric Assessment of EYES
Size, Shape, And Spacing
PERRLA (reactive to light)
**Color could change color between 4-6 months**
148
By 3-4 months, what occurs in regards to the pediatric assessment of the eyes
Binocularity - fixate on more than 1 thing
149
Strabismus
cross-eyed
- Brain muscle control is slowing down due to the eye not wanting to work
150
Strabismus treatment may include
Glasses
Patching - over the strong eye
Eye Drops
Surgical Intervention - loosen or heighten the muscle nerve
151
If not detected and corrected by 4-6 years, then
Amblyopia (“Lazy Eye”)
152
If a baby has strabismus what should you do as a nurse regarding patches?
cover the strong eye to have the brain communicate to the lazy eye to work
153
Visual Testing in Children chart to use
Snellen Chart-Letters
HOTV/Tumbling E/Pictures
154
Visual Testing in Children requirements
10’ From Chart
Cover One Eye
Keep Both Eyes Open
Glasses Remain On If Worn
155
Normal ear alignment
eye-occiput line by 10 degrees up on top of ear
156
The Eustachian tube of a child is more
shorter and flat
- fluid and build-up can cause ear infections
157
Signs of hearing impairment in infants
**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
Signs of hearing impairment in children
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
How to test for hearing impairment?
go behind and ask them to repeat what you said
160
Nose should be
midline and patent
note any discharge and foreign bodies
**flared nostrils**
161
Mouth assessment of peds
Lips
Mucous Membranes
Gums
Teeth
Tongue
no bleeding
162
Early childhood caries
result of teeth bathing in carb rich solution
-lead to cavities
163
How do you avoid early childhood caries
do not prop the bottle or put the child to bed with one
soft cloth and clean around teeth and gums
164
General rule of Thumb for teething
Age In Months minus 6 = # Of Teeth
(8-month-old - 6 months = 2 teeth)
165
Teething should occur in normal variation between
6-9 months -
genetic pattern
166
Teething Order
Lower Central Incisors
Upper Central Incisors
Upper Lateral Incisors
Lower Lateral Incisors
167
Teething
Not Sure If The Discomfort Is From Teething?
Pressure makes the baby feel better
Gently Press On Gum Where The Tooth Should Erupt
168
Signs of teething
Difficulty sleeping
Increase In Nonnutritive Sucking/biting on hard objects
Ear rubbing/pulling
Excessive Drooling
Anorexia
169
Ways of helping teething
Cold breast milk in pacifier
Cold
Tylenol
Ibuprofen after 6 months of age
170
They should have a complete set of teeth by
24 months
171
Thumb sucking and pacifer use should stop by
4-5 y/o
172
Malocclusion
occur if thumb sucking persists beyond 5 years-of-age
open and over bite
173
Start loosing teeth at the age of
6 years
174
You lose how many primary teeth
20
175
You gain how many permanent teeth?
32 (16 top and 16 bottom)
176
IF PERMANENT TOOTH IS KNOCKED OUT, then
don’t touch the root and place it in Ca
- then put it back for implant maybe
177
During the age of losing teeth, you need to stress
dental hygiene
178
Inspection chest in infants looks like
circular
179
Inspection chest with growth looks like
flattens
180
Chest mvmt from birth to 7 years old
respiratory mvmt is abdominal and diaphragm
181
Chest mvmt 7 years old +
thoracic breathing
182
You can auscultate the apical pulse in children younger than 7 years
fourth left intercostal space
183
You can auscultate the apical pulse in children greater than 7 years
fifth intercostal space
184
Cap refill for pediatric pt
less than 2 seconds
185
Signs Of Respiratory Failure?
upper
lower
Stridor - upper
Wheezing - lower
186
Change the pulse ox site every
6 hours to prevent skin breakdown
187
Pulse Ox is 95+% what should the nurse do
continue to monitor
188
Pulse Ox is below 91% what should the nurse do
assess and intervene O2
189
Pulse Ox is less than 86% what should the nurse do
emergency rapid
190
The abdomen of a child is normally
round and protruding
191
Genitalia assessment of pediatric
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
What should be said to assure the patient od appropriate touch?
I can only be touching because of the parents, yours consent and another nurse in the room.
193
If the ped pt lets you know of inappropriate touching, then what do you do?
call in for assistance and CPS
194
Scoliosis
lateral curvature of the spine
