Pediatrics Flashcards
1 Month
Gross motor: head lag (poor head control
Fine motor: grasp 0-3 months
Babinski reflex: 0-12 months
Rooting reflex: 0-4 months
Tonic neck reflex: 0-4 months
Language: responds to touch and voices, sensory motor communication
Social/Cognitive: Finds safety with caregiver and looks at face
Developmental Milestones
2-3 months
Gross motor: Kick legs
Raises head when prone
Less head lag
FIne motor: Grasp reflex finishes
Language: responds to sounds, able to make sounds with mouth
Social/cognitive: smiles and coos when seeing a familiar face
Developmental Milestones
4-5 months
Gross motor: no more head lag
(report head lag is found after 4 months)
“infants head stays behind the shoulders when raised from supine to sitting position”
At 5 months can roll from front to back
Fine motor: grabs object voluntarily
Diminished moro reflex and other reflexes
Language: mimics sounds heard, sable to change cry tone for different needs
Social/cognitive: soothed by caregivers voices
Copies expressions
Cries when doesn’t get their way
Developmental Milestones
6-9 months
Gross motor: birth weight doubles at 6 months
Rolls from back to front
Can sit up unsupported
Can pull self up
Avoid having toys from crib
Fine motor:
Holds a big bottle
7 months: transfers objects from 1 hand to the other
language: babbling words “mama, dadda” responds to name
Not babbling 9 months - MUST REPORT IT
Social/cognitive:
Identify faces and strangers, separation anxiety begins at 6 months
Developmental Milestones 10-12 months
Gross motor:
Prone to sitting position
Fine motor:
10 months
Pincer grasp “pick up small finger foods”
11 months: neat pincer grasp (thumb and pointer)
Grasps a rattle or doll by the arm
Transfer objects from hand to had
Language:
Able to make a variety of sounds
Mimics gestures
Understand simple works: yes or no
Social/cognitive: Vocalization and speech (talking toys and books are best)
Purposeful play - build, sort, stack, make
Developmental Milestones 12 months
Gross motor
Birth weight triples
Sit down from standing
Crawl upstairs
Walks 1 step while holding hand
Fine motor:
fully developed 2 finger pincer grasp
Tries to build 2 block tower unsuccessfully
Attempts to turn book pages
Language: 3-4 words, nonverbal gestures (waving, head nodding)
Social/cognitive
Shy: stranger danger
Can follow short simple directions
Search for hidden objects (object permanence)
Developmental Milestones 18 months
Gross motor: walk up/down stairs while holding a hand
Throws ball
Jump in place with both feet
Fine motor: turns 2 pages in a book at a time (Uncoordinated)
Holds cup and spoon
Build tower of 4 blocks
Scribble with crayons
No finger dexterity (no scissors, no colouring pencils)
language: 10+ word vocabulary
Follow commands
Use gestures to show what they want
Social/Cognitive:
Angry baby
Temper and ownership “mine”
Parallel play 1-3 years
Okay next to each but not direct interaction with others
18 month old what finding should the nurse report too the provider for follow up development screening
Uses 4 words
Cannot hold a spoon or cup
Unable to sit down from sanding position
Finds it difficult to pick up small food items with dumb and index finger
Developmental Milestones 2 years old
Gross motor:
walks without help
run and kick ball
Walks up and down stairs independently 1 step at a time
Toilet trained by two
Fine motor:
builds a tower pf 7 blocks
Draws vertical lines
Able to turn 1 page at a time
Opens doors by turning door knobs
Language: says own name
300+ words
2-3 woord sentences
Identifies pictures with named
Social/cognitive imitates adult behaviour
Gaining independence
Developmental Milestones
3 Years
Gross motor:
Tricycle and jumps forward
Learning balance
Walks up stairs with alternating feet
FIne motor:
Draws circles
Spoon feeds self
Undress self
Holds crayons with gingers instead of first
Can use scissors
Zips up zipper
Language:
3-4 word sentences
Asks “why” a lot
Knows age
Follows more complex instructs
Social/Cognitive
Associative play 3-6 years
Unorganized play without goals or rules encourage imagination play
Developmental Milestones
4 years old
Gross motor
Skips, hops on 1 foot
Catches a ball 50% of the time
Climbs and jumps
Fine motor: draw 4 sides shapes like a square/rectangle
Can pour drinks and make food
Language: able to tell stories, can memorize alphabet and numbers
Social/cognitive
Imaginary play, dress up and tea party
Play with older children rather than alone
Fine motor skills of a 2 year old
Draws a vertical line
Gross motor skill at 18 months of age
Jumps in place with both feet
4 month old (full term) the nurse is most concerned with which finding?
The infants head lags when pulled from laying to sitting position
5 month old, the nurse expects to make which observation
The infant rolls to back (supine) from prone position
Child walks up and down steps, has steady gait and can use short sentences, how many months?
24 months
9 month old, need for further investigation?
Child is not babbling
6 month old expected finding
Rolls over in both directions
3 year old developmental delay
Unable to use a spoon to feed himself
3 year old age appropriate development
Copies a circle
Rides a tricycle
Undresses without help
Expected growth and development by 12 months
Walks while holding onto someones hand
24 month old child Highest level developmental milestone
The child opens a door. by turning the doorknob
Language and communication
New borns 0-1:
Noverbal communication
reports to touch and voices, sensory motor communication
Infants 1-12 months:
At around 10 months say “mama and dada”
Over 12 months says up to 3-5 words
expected growth and development at 9 months
Should be able to say mama and dada
Will pull up and stand for several seconds holding on to furniture
Will be able to pick up small pieces of food
An infant client is able to stand holding on to objects, plays peek a boo and is starting to say mama and dada which age?
9 months
Toddlers and preschool 1-5 years
Priority finding: 2 year does not talk to respond while being assessed
Assessing speech development refer to further examination
An 18 month old who only says no
Speech impairment
a 5 year old who only answers with single words
School age 6-12 years
Uses logic
Adolescence 12-18
Abstract thinking
Privacy - ask certain questions without the parents present
Encourage peer contact - risk for social isolation may lead to depression and anxiety - have friends come to visit at the hospital, meeting other teens who are receiving similar treatment
16 year old refusing classmates visit. Which concern will the nurse plant o address first
Social isolation
a 16 year old admitted to the hospital which nursing intervention is most appropriate
Allow the client to interact with others in his or her same age group
14 year old girl, hospitalized and has been places in traction. Which nursing action would be appropriate to meet the Childs needs?
Let the child wear her own clothing when friends visit
Piaget theory 0-2
Sensorimotor: thinks in the present moment through the senses (not the past or future)
Object permanence (objects are still there even if you can see it)
Teaching: teach in the present moment
Teach them you are going while you are doing
Piaget theory 3-6
Preschool
preroperational thinking: imaginative, symbolic thought
Magical thinking
(do not understand cause and effect)
Scraped knee was caused by earlier misbehaviour
Thinks being sick is their fault or being adopted is their fault
Teaching:
Teach shortly before a procedure
Day of
The morning of or a few hours before
What you’re going to do “I’m going to insert a Foley catheter”
Piaget theory 7-11
Skill learning
Concert operational
Logical thought, flows rules, rigid thinking
Only 1 way to do something
Teaching: teach day before include kills like insulin injections
Demonstration and reading
Tomorrow we will
You will do this everyday
Teach bandage placement skills at 7 years old
Piaget theory 12-15
Adolecents
Adult learning
Formal operational
Developing abstract thought
Causes and effect thinking (example: love, hate mortality)
Teach like an adult
Med sure + style
Manage their own care
tech them to: report these findings… if you see this, follow up with your provider
Which child can manage their own care?
14 year old with DM type 1
Risk taking behaviour = very non compliance
14 year old with type 1 diabetes ammiited to the ICU with a blood glucose 500mg/dl what is contributing to the no compliant behaviour
Clients psychosocial developmental stage
Which of the following children would be classified as being in the concrete operational stage, as defined by Piaget
An 8 year old third grade student
Which phase of cognitive development are infants
Sensorimotor
What description characterizes normal cognition during the period of early adolescence (11-14)
Limited abstract thoughts
Bhevauour is characterized of the formal operational stage
The child has the ability to think abstractly
6 year old does not recognize the objects exist when the objects are outside the visual filed which action should the nurse take
Report it to the paediatrician
Pain assessment 0-6 months
CRIES Scale
Crying
Requires oxygen
Increased vital signs
Expression
Sleepless
FLACC Scale 2 months - 7 years
Face
Legs
Activity
Cry
Consolability
Faces Scale 3 years and up
View pain as magical thinking
Pusnishment or blame someone or pain
4 year old child when experiencing pain the nurse anticipates
Views pain as punishment
Blames someone else for the pain
believes pain will disappear magically
Numeric Scale 5 years and up
Rate pain on scale of 1-10
Pedicatric physical exam
Interact with parents 1st and child 2nd
Encourage the parent to be involved with the child
Communicate with age appropriate simple language
Keep medical equipment out of sight
Invasive procedures always LAST
Ear exam and BP cuff
Physical examination of a toddler appropriate nursing interventions
keep the medical equipment out of the toddlers sight until its needed
While preparing a physical assessment on 22 month old child the nurse should complete the following actions in which order?
Least invasive to most invasive
Interact with the parent first
use a toy to play with the child
Take the child weight and height
Listen to heart and lung sounds
Obtain vitals
Pedicatric physical exam 0-12 months
Height: 1 inch per month
50% increase at 12 months
Weight: doubles ta 6 months
Triples at 12 months
Anything under bench marks must be reported to HCP
Which assessment finding should the nurse report to the health care provider?
6 month old with birth weight of 8lbs 5oz who now weights 14lbs 4oz
8 month of client possible delay in growth and development
my child has almost doubled the birth weight
Nutrition 0-12 months
Breast milk for iron fortified formula (no cows milk)
Solids begin at 4-6 months
Only 1 new food per week to assess unknown allergies
Infant assessment
Head circumference should be slightly bigger than the chest
equals in size around 12-19 months
Newborns have two fontanels = soft spots, should be flat and only slightly pulsate when the baby cries, coughs or lies flat
Head Fontanelles
Bulging at rest = meningitis, increased ICP
Sunken fontanells = dehydration, fluid volume defect
Report both to HCP immediately
Closure of fontanelles
Posterior = 2 months
anterior = 2-18 months
Infant respiratory distress
Nasal flaring
Accessory muscle use
Abdominal breathing
Nonproductive cough
Excessive crying:
“cry all the time”
1-3 hours per day is normal
Assess infants pattern frequency and quality of crying
High pitched = increased ICP or brain damage
Infant Teeth
First tooth 6-10 months (lower central incisor)
Signs of teething:
drooling and irritability
Intervention: teeth care with washcloth
Infant reflexes
babinski reflex: 0-12 months
Toes fan out when stroking sole or bottom foot
Rooting (sucking) reflex: 0-4 months, sucking motion when stroking the side of the cheek or mouth
Tonic neck reflex: 0-4 months, when placed on the back the head turns to one side and infant flex the arm of the opposite side
Moro reflex: 0-4 months
Startle reflex: in response to loud noise or sudden movement infant stretches out arms and legs like they’re startled then immediately pulls back into body
Stepping reflex 1 month +
Baby steps in air when helped up
palmer grasp 0-3 months: grabs on to any object placed in their plan
plantar grasp: 0-8 months, placing object under toe, infants will curl their toes attempting to grab it
9 month old the nurse expects which reflex?
Babinski
What is the reflex assessed by stroking the outer sole of the foot
Babinski
How will the nurse assess the rooting reflex
By stroking the cheeks of the newborn
2 month old infant placed on their back and head turned to one side, The infant responds by flexing arm on the opposite side and extending the arm that is pointing the same direction she is facing. Which of the following bets describes this reflex?
3 month old monitoring for signs of increased intracranial pressure, anterior fontanel is soft and flat, most appropriate action?
Document the finding
infant GI assessment
Small amount of bloody mucous inside stool
Yellow brownish stool
Continue to monitor the colour, amount and consistency if continues could mean something is wrong
What colour stool would the nurse explain to expect on the their day of life
Yellowish brown coloured stools
Toddlers 1-3 Growth assessment
Height: 3 inches per year
Weight: average yearly gain of 4-6 lbs
30 months (2.5 years) weight should be 4 times greater than birth weight
a 39month of child. Which finding requires immediate follow up with the primary care provider
Weight is 6 times greater than birth weight
(should only be 4x greater)
Family and meal habits need to be discussed
Toddlers 1-3 Head assessment
Head circumferences increase by 1 inches by the 2nd year then slows by half until age 5
Taller more slender appearance
Toddlers nutrition
Limit Milk: 16 to 24 oz per day (2-3 cups)
Juice 2-6oz per day
Encourage more solid foods
Safety teaching toddlers 1-3
Safety teaching
Choking hazard
Cut food into bite side pieces
Sit child up when eating
Avoid round food (popcorn, raisins, grapes, celery, candy) airway is small
Burns: cover allertical outlets and face handel inward = stove top pots and pans
Apply sunscreens pf 15 for greater before going outside and apply every 2-3 hours
Drowning:
Close bathrooms doors, never alone during body of water (bathtub, toilet, pools)
Crib safety:
Infant on back to prevent SIDS
Never on stomach/ prone position unattended = SIDS
dont put the infant to bed with a bottle = dental caries
Nothing in crib
Remove crib musical mobiles at 4-5 months
Car seat: rear facing in back seat at 45 degree snuggle
Never place the car seat in front seat
Never place padding under or behind an infant or child in a carseat (it can eject the child during a car crash)
Used until 30 lbs
Booster eat 8-12 years
4’9inches
35-80lbs
Physical exam 3-6 preschool/kindergarten
Growth:
height 2-3 inches per year
Weight gain 4.5
- 6.5lbs per year
Nutrition
50% less calories than adults
Activity and sleep
1 hour of activity
12 hours of sleep (at around 7:00pm)
Avoid sleeping with parents
4 year old beliefs
Believe that an injury is the result of misbehaving
Feels responsible for being placed for adoption
4 year old child when experiencing pain the nurse anticipates
Veins pain as punishment
Blames someone else for the pain
Believes pain will disappear magically
Ear assessment
Less than 3 years pull down and back
Over 3 years: pull up and back
Position the pinna to visualize the eardrum of a 4 year old child
Pull up and back
Direction to pull the pinna of an infant during an ear exam
Down and back
School age 6-12 physical exam
Growth:
Height: 2 inches per day
Weight: yearly gain of 4.5-6.5
Activity and sleep: competitive and team play
9 hours of sleep per night
Safety
Use car seat until 4 feet 9 inches
never in/near pool alone
treat them like mini adults
Same head to toe assessment
Same pain scale assessment
Same subjective assessment
Explain results of the exam to the child
Respect privacy
11 year old client with abdominal discomfort what are the best actions during a physical exam
Complete a full head to toe assessment in the same way as an adult
Explain the result of the examination to both parent and child
Ask the child to describe their primary symptoms
Respect the request to be examined without guardian present
Adolescents 12-18 physical exam
Boys stop growing 18-20 years old
girls from growing 2.5 years old after first period
Activity
Priority intervention
Encourage meeting with friends and peers
No socialization:
Immediate post op
Immunocompromised (chemo, radiation)
Contagious infectious disease
Growth different between girls and boys
growth in height ceases 2 to 2.5 Years after menarche in girls
General puberty age for girls and boys
10 years for girls
12 years for boys
16 year old girl who has not started menstruation
refer the adolescent for an evaluation
Which of the following should the nurse asses first on a well-child exam in a 6 week old infant who is sleeping?
Auscultation off lung and heart sounds
Paediatric vital signs Heart rate
Neonate 0-28 days 110-180
Infant 0-12 months: 110-160
Toddler 1-3: 80-110
Paediatric vital signs Respiratory rate
neonate 1-28 days: 30-60
Infant 0-12 months: 30-60
Toddler (1-3): 24-40
Pediatric vital signs Blood pressure
Neonate 1-28 days:
60-90/20-60
Infant 0-12months:
70-105/35-55
Toddler 1-3:
85-105/40-65
10 month old, crying and committing with abdominal distention for the past 6 hours. The infant is now quietly resting with a pulse 220min and blood pressure of 85/45
What should the nurse report to the HCP
Client is now lethargic with tachycardia
Assessing the heart rate of a 1 year old
Listen to apical pulse for a full minute
12 month old with respiratory infections, respiratory rate of 36
Document the findings
Blood pressure 2 year old 92/60, this blood pressure would be:
Normal
Temperature
Oral stem 5-6 year olds
Axillary all ages
Rectal: infants (most common)
risk for perforation of the bowel, to used for immunosuppressed clients and those on chemotherapy and radiation
Not for clients with cardiac conditions
Not for clients with diarrhea/fecal inaction
Child has oxygen saturation of 88% most appropriate initial action
Verify the position off the pulse oximerty probe
