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Pediatrics Flashcards

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1
Q

1 Month

A

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

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2
Q

Developmental Milestones
2-3 months

A

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

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3
Q

Developmental Milestones
4-5 months

A

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

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4
Q

Developmental Milestones
6-9 months

A

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

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5
Q

Developmental Milestones 10-12 months

A

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

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6
Q

Developmental Milestones 12 months

A

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)

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7
Q

Developmental Milestones 18 months

A

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

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8
Q

18 month old what finding should the nurse report too the provider for follow up development screening

A

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

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9
Q

Developmental Milestones 2 years old

A

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

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10
Q

Developmental Milestones
3 Years

A

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

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11
Q

Developmental Milestones
4 years old

A

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

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12
Q

Fine motor skills of a 2 year old

A

Draws a vertical line

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13
Q

Gross motor skill at 18 months of age

A

Jumps in place with both feet

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14
Q

4 month old (full term) the nurse is most concerned with which finding?

A

The infants head lags when pulled from laying to sitting position

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15
Q

5 month old, the nurse expects to make which observation

A

The infant rolls to back (supine) from prone position

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16
Q

Child walks up and down steps, has steady gait and can use short sentences, how many months?

A

24 months

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17
Q

9 month old, need for further investigation?

A

Child is not babbling

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18
Q

6 month old expected finding

A

Rolls over in both directions

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19
Q

3 year old developmental delay

A

Unable to use a spoon to feed himself

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20
Q

3 year old age appropriate development

A

Copies a circle
Rides a tricycle
Undresses without help

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21
Q

Expected growth and development by 12 months

A

Walks while holding onto someones hand

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22
Q

24 month old child Highest level developmental milestone

A

The child opens a door. by turning the doorknob

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23
Q

Language and communication

A

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

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24
Q

expected growth and development at 9 months

A

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

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25
Q

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?

A

9 months

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26
Q

Toddlers and preschool 1-5 years

A

Priority finding: 2 year does not talk to respond while being assessed

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27
Q

Assessing speech development refer to further examination

A

An 18 month old who only says no

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28
Q

Speech impairment

A

a 5 year old who only answers with single words

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29
Q

School age 6-12 years

A

Uses logic

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30
Q

Adolescence 12-18

A

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

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31
Q

16 year old refusing classmates visit. Which concern will the nurse plant o address first

A

Social isolation

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32
Q

a 16 year old admitted to the hospital which nursing intervention is most appropriate

A

Allow the client to interact with others in his or her same age group

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33
Q

14 year old girl, hospitalized and has been places in traction. Which nursing action would be appropriate to meet the Childs needs?

A

Let the child wear her own clothing when friends visit

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34
Q

Piaget theory 0-2

A

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

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35
Q

Piaget theory 3-6

A

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”

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36
Q

Piaget theory 7-11

A

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

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37
Q

Piaget theory 12-15

A

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

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38
Q

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

A

Clients psychosocial developmental stage

39
Q

Which of the following children would be classified as being in the concrete operational stage, as defined by Piaget

A

An 8 year old third grade student

40
Q

Which phase of cognitive development are infants

A

Sensorimotor

41
Q

What description characterizes normal cognition during the period of early adolescence (11-14)

A

Limited abstract thoughts

42
Q

Bhevauour is characterized of the formal operational stage

A

The child has the ability to think abstractly

43
Q

6 year old does not recognize the objects exist when the objects are outside the visual filed which action should the nurse take

A

Report it to the paediatrician

44
Q

Pain assessment 0-6 months

A

CRIES Scale
Crying
Requires oxygen
Increased vital signs
Expression
Sleepless

45
Q

FLACC Scale 2 months - 7 years

A

Face
Legs
Activity
Cry
Consolability

46
Q

Faces Scale 3 years and up

A

View pain as magical thinking
Pusnishment or blame someone or pain

47
Q

4 year old child when experiencing pain the nurse anticipates

A

Views pain as punishment
Blames someone else for the pain
believes pain will disappear magically

48
Q

Numeric Scale 5 years and up

A

Rate pain on scale of 1-10

49
Q

Pedicatric physical exam

A

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

50
Q

Physical examination of a toddler appropriate nursing interventions

A

keep the medical equipment out of the toddlers sight until its needed

51
Q

While preparing a physical assessment on 22 month old child the nurse should complete the following actions in which order?

A

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

52
Q

Pedicatric physical exam 0-12 months

A

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

53
Q

Which assessment finding should the nurse report to the health care provider?

A

6 month old with birth weight of 8lbs 5oz who now weights 14lbs 4oz

54
Q

8 month of client possible delay in growth and development

A

my child has almost doubled the birth weight

55
Q

Nutrition 0-12 months

A

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

56
Q

Infant assessment

A

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

57
Q

Head Fontanelles

A

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

58
Q

Infant respiratory distress

A

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

59
Q

Infant Teeth

A

First tooth 6-10 months (lower central incisor)
Signs of teething:
drooling and irritability
Intervention: teeth care with washcloth

60
Q

Infant reflexes

A

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

61
Q

9 month old the nurse expects which reflex?

A

Babinski

62
Q

What is the reflex assessed by stroking the outer sole of the foot

A

Babinski

63
Q

How will the nurse assess the rooting reflex

A

By stroking the cheeks of the newborn

64
Q

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?

A
65
Q

3 month old monitoring for signs of increased intracranial pressure, anterior fontanel is soft and flat, most appropriate action?

A

Document the finding

66
Q

infant GI assessment

A

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

67
Q

What colour stool would the nurse explain to expect on the their day of life

A

Yellowish brown coloured stools

68
Q

Toddlers 1-3 Growth assessment

A

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

69
Q

a 39month of child. Which finding requires immediate follow up with the primary care provider

A

Weight is 6 times greater than birth weight

(should only be 4x greater)
Family and meal habits need to be discussed

70
Q

Toddlers 1-3 Head assessment

A

Head circumferences increase by 1 inches by the 2nd year then slows by half until age 5
Taller more slender appearance

71
Q

Toddlers nutrition

A

Limit Milk: 16 to 24 oz per day (2-3 cups)
Juice 2-6oz per day
Encourage more solid foods

72
Q

Safety teaching toddlers 1-3

A

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

73
Q

Physical exam 3-6 preschool/kindergarten

A

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

74
Q

4 year old beliefs

A

Believe that an injury is the result of misbehaving
Feels responsible for being placed for adoption

75
Q

4 year old child when experiencing pain the nurse anticipates

A

Veins pain as punishment
Blames someone else for the pain
Believes pain will disappear magically

76
Q

Ear assessment

A

Less than 3 years pull down and back
Over 3 years: pull up and back

77
Q

Position the pinna to visualize the eardrum of a 4 year old child

A

Pull up and back

78
Q

Direction to pull the pinna of an infant during an ear exam

A

Down and back

79
Q

School age 6-12 physical exam

A

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

80
Q

11 year old client with abdominal discomfort what are the best actions during a physical exam

A

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

81
Q

Adolescents 12-18 physical exam

A

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

82
Q

Growth different between girls and boys

A

growth in height ceases 2 to 2.5 Years after menarche in girls

83
Q

General puberty age for girls and boys

A

10 years for girls
12 years for boys

84
Q

16 year old girl who has not started menstruation

A

refer the adolescent for an evaluation

85
Q

Which of the following should the nurse asses first on a well-child exam in a 6 week old infant who is sleeping?

A

Auscultation off lung and heart sounds

86
Q

Paediatric vital signs Heart rate

A

Neonate 0-28 days 110-180
Infant 0-12 months: 110-160
Toddler 1-3: 80-110

87
Q

Paediatric vital signs Respiratory rate

A

neonate 1-28 days: 30-60
Infant 0-12 months: 30-60
Toddler (1-3): 24-40

88
Q

Pediatric vital signs Blood pressure

A

Neonate 1-28 days:
60-90/20-60

Infant 0-12months:
70-105/35-55

Toddler 1-3:
85-105/40-65

89
Q

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

A

Client is now lethargic with tachycardia

90
Q

Assessing the heart rate of a 1 year old

A

Listen to apical pulse for a full minute

91
Q

12 month old with respiratory infections, respiratory rate of 36

A

Document the findings

92
Q

Blood pressure 2 year old 92/60, this blood pressure would be:

A

Normal

93
Q

Temperature

A

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

94
Q

Child has oxygen saturation of 88% most appropriate initial action

A

Verify the position off the pulse oximerty probe

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