Pediatrics Flashcards
1
Q
Introduction
A
- children differ from adults in their anatomy, physiology, and emotions
- know baseline and expectations of different ages
- your approach to pediatric patients:
- must be based on age -> can effect cognitive markers based on age
- must accommodate developmental and social issues
2
Q
neonate and infant
A
- neonatal period- first month of life **
- infancy- first 12 months*
- first birthday -> toddler
- during assessment:
- keep child warm -> do not have intrinsic thermoregulation (cant shiver) -> NEVER let them get cold
- cold child = dead child
- support a young infants head and neck - head and neck are disproportionate
- if child is quiet, listen to heart and lungs first
3
Q
birth - 2 months
A
- controls gate - track movement but stare into space
- turns head
- begins crying to communicate needs -> three needs -> im hungry, im tired, i have to poop
- crying peaks at 6 weeks
- trust develops in parents
4
Q
2-6 months
A
- can recognize caregivers*
- makes eye contact
- use both hands
- rolls over- babys cant fall off the ground
- most sleep through the night
- increase awareness
- explore their own body
- uses expression of joy, anger, fear, surprise
- seeks attention
5
Q
6-12 months
A
- sits without support
- crawls
- puts things in month
- teething begins
- eats soft foods
- babbles (learns first word by 12 months)- girls learn before boys
- remembers objects
- curious about what objects do
- separation anxiety disorders
- start of tantrums
- self determination while eating
6
Q
neonate - infant
A
-birth to 12 months
7
Q
toddler
A
-12 to 36 months
8
Q
12-18 months
A
- crawls
- walks*
- front teeth emerge ahead of molars*- teething
- sensory development
- imitates others*
- makes believe
- understands more than expressed
- knows major body parts
- knows 4-6 words
- basic reasoning
- understands object permanence
- separation anxiety
9
Q
18-24 months
A
- improved gait and balance
- runs
- climbs
- head grows more slowly than body
- begins to understand cause/effect*
- labels object *- “this is my toy”
- speech picks up to about 100 words by 24 months* -> rapid growth in speech
- attachment to certain objects, such as pacifier, doll, or blanket
10
Q
group 10
A
- rare
- can lead to death of baby
- conflicting evidence to manage
11
Q
24-36 months
A
- develops fine motor skills
- toilet training
- goes up and down stairs with help
- jumps with both feet
- can draw a circle
- follows 2 step commands*
- names at least 1 color
- knows 250-500 words
- can came a friend
- separates fairly easily from parents
12
Q
toddler
A
- 1 to 2
- use the pediatric assessment triangle (PAT) to assess the child
- PAT- appearance, circulation to skin, work of breathing
- PAT tells you if the child is sick or not sick
- strategies for examination:
- examine on parents lap (separation anxiety)
- get down to the child’s level
- have a parent assist when possible if they arnt making the situation complicated
- engage the parents!
- be flexible
13
Q
preschool age child
A
- ages 3-5
- becoming verbal and active
- respect modesty- they dont want people around when they go to the bathroom, embarrassed when naked
- let child participate
- set limits on behavior if the child acts out
14
Q
school age child (middle childhood)
A
- ages 6-12
- greater understanding may increase fear
- know the finality of life
- by age 8, anatomy and physiology is similar to adults
- explain steps in simple language
15
Q
adolescence
A
- ages 13-17
- with respect to CPR, once secondary sexual characteristics (breasts, underarm hair) have developed, treat as an adult
- address and reassure patient
- address them as children but equal person in care
- offer as much control as appropriate
16
Q
the head
A
- infants and young children’s heads are large relative to the rest of their bodies
- children grow into their head
- take care when positioning airway
- airway is more anterior to the neck
- cover head to prevent heat loss
- cover head, feet, hands, torso (in that order)
- during infancy, the anterior and posterior fontanelles are open -> fuse when toddler
17
Q
the neck and airways
A
- short neck, smaller airway
- more prone to obstruction
- epiglottis is at the back of posterior oral pharynx
- epiglottis is long and floppy
- difficult to see vocal cords during intubation
- lungs -> height
- medication -> weight
- airway-> age
18
Q
vocabulary
A
- vocabulary expands a bit - 20 to 25 words
- 12 months - know a few words -> goal is 5
- 24- 100 words
- 24-36- 250-500 words
19
Q
toilet trained
A
age 3
20
Q
managing neck and airway
A
- keep nares clear with suctioning
- smaller holes/size are easier to block
- avoid hyperextension of neck
- keep the airway clear of all secretions
- use care when managing the airway
21
Q
the respiratory system
A
- smaller tidal volume (height)
- double metabolic oxygen demand- younger the child -> higher heart rate
- heart rate is 150 when born
- smaller functional residual capacity
- faster breathing
- neonate (0-1 month)- 30-60 respirations
- infant (1 month- 1 year)- 25-50
- toddler- (1-3 years)- 20-30 respirations
- preschool (3-5 years)- 20-25 respirations
- school age- (6-12 years)- 15-20
- adolescent (13-17)- 12-20
- adult (>18)- 12-20
22
Q
diaphratic breathers
A
- infants use diaphragm during inspiration
- belly breathers
- haven’t developed muscles of respiration yet
- diaphragm connects torso to abdomen
- experience muscle fatigue quicker
- highly susceptible to hypoxia
- can spiral into cardiovascular collapse
- bradycardic child is hypoxic until proven otherwise- administer oxygen
23
Q
children rely on pulse rate to:
A
- blood pressure is meaningless number in initial assessment for children
- compensate for decreased oxygenation
- increase heart rate -> increase cardiac output
- maintain cardiac output
- if a child has a decreased heart rate -> failure/death -> past compensatory mechanism
- neonate (0-1 month) - 100-180
- infant (1 month -1 year)- 100-160
- toddler (1-3 years)- 90-150
- preschool age (3-5 years)- 80-140
- school age (6-12 years)- 70-120
- adolescent (13-17)- 60-100
- 18+ - 60-100
24
Q
2 leading causes of cardiac arrest in children
A
- respiration causes -> hypoxia -> cardiac collapse (disease, obstruction)
- trauma from bleeding
25
Q
cardiovascular system
A
- limited but vigorous cardiac reserve
- can shoot up their heart rate to compensate to their condition -> much faster and more meaningful in a child but much shorter lasting
- injured children can be in shock and maintain BP for long periods
- more blood loss before hypotension
- hypotension is an ominous/late sign- failure
26
Q
cardiovascular system
A
- limited but vigorous cardiac reserves
- children can increase rate to compensate for conditions faster and more meaningful that adults but shorter
- injured children can be in shock and maintain blood pressure for long periods
- more blood loss before hypotension
- hypotension is an ominous/late sign- failure/death
27
Q
the heart
A
-ECG: Large right-sided forces are normal in
young infants (in adults its left sided)
-Cardiac output is rate dependent in infants
and young children.
-Mediastinum is more mobile.
-High risk of injury to mediastinal organs
28
Q
the nervous system
A
- neural tissue and vasculature are fragile
- brain, spinal cord is not as well protected
- pediatric brain- nearly twice the blood flow -> bleed out a lot quicker
- makes even minor injuries significant
- increases risk of hypoxia
- head has a lot more flexibility with swelling bc sutures of not fused yet
29
Q
spinal column
A
- vertebral fractures and spinal cord injuries in young children are uncommon
- rare because of seat belts, air bags, car seats now
- with a significant mechanism of injury:
- assume cervical spine injury
- transport with spinal immobilization
30
Q
spine
A
- most likely to be injury in places where the spine has nothing to protect
- cervical and lumbar spine
