Pediatrics Flashcards
Anterior fontenel closes when?
Posterior?
Anterior: 12-18 months
Posterior: 2-3 months
How to introduce foods to infants? Why?
One at a time because of allergies
Have an immature GI tract causing vomiting…. What caused the vomiting?
Most common reason for failed potty training How much milk should a 15mo drink/day? When is the best friend stage Major accident causes up to age 1? Accidents between 6-12?
Not ready
2-3 cups - BALANCED diet and not just milk
9-10
Falls, poison, burns
MVA - biks, 4 wheelers, increased kidnapping risk
How is the growth rate between 6-12?
Calories for a school-age kid?
How much sooner is girl puberty?
DEC - getting ready for a spurt
2400 calories
1-2 years
Vitals/assessment
Start with what? Best way to get VS? Talk to who first? What if you can't get them? Order of VS? How long to mx RR and HR When we can't do rectal T? When is rectal T recommended? Who can we do axillary T? Temporal? When to start oral T? Do we add a degree ever?
Observation Distraction Parents Record that you couldn't RR, HR, BP, T 1 full minutes - bc of abnormalities When immunosuppressed Recommended for kids younger than 2 All ages; All ages Age 5-6; can be cooperative NO!! always note where recorded
Common site for O2?
How to record O2?
Make sure monitor matches what?
Fingers, toes
Record what is going on when recording
Monitor matches radial pulse
Communication: NEWBORN
Age? Primary mode of communication? How do they express themselves? What do they respond to? What has a positive effect? Encourage parents to what?
Birth - 1 month
Nonverbal Express though crying Respond to voice end presence Touching = positive encourage touching
Communication: INFANT
Age? Primary mode of communicant? Being doing what? How do they express themselves? Do they comprehend words? Respond to what? Nursing strategies?
1 month - 12 months
Primarily nonverbal Begin vocalizations Express through crying, facial expressions NO COMPREHENSION of words Respond to patting, rocking, stroking
Nurse: high-pitch voice, cuddle, pat, rub to calm
Communication: TODDLER
Age? Evolving what? What kind of language is greater? How do they think? What is their vocal like? Primary question? Attention span? What is there memory like?
1-5 years
Evolving verbal skills Greater receptive than expressive CONCRETE thinkers Vocal depends on development & family use WHY WHY WHY Short attention span Limited memory
Toddler - Cognitive development
How to they like to express themselves?
How does play help development?
Egocentric
Magical thinkers
Animism
Through dramatic play and drawing
Play is the work of the child
School - Age: Cognitive development
Age?
They can now use what?
They can understand what?
What is there vocab like? Expressive vs/ receptive? Do they misinterpret things? Can they interpret nonverbal stuff? How do they express themselves?
6-12
Use logic
Understand POV, cause/effect, body functions
Big vocab Good balance of express/receptive Commonly misinterpret things Can interpret non-verbal stuff Express through thoughts and feelings
Adolescent
Age? What kind of thinking? Do they understand medical terminology? Drive for what? What are they building? Need what?
Nursing strategies?
13-18 Abstract without full adult comprehension Med is limited Drive for independence Building trust and understanding Need PRIVACY
Private area talking, straightforward, bye bye parents for part of interview
How might a child with disability feel if they can’t communicate?
Nursing strategies
Helpless, fearful, anxious
Gestures, picture boards, writing tablets
System of head knows or eye blinks
What is circumoral pallor?
Other S/S RR distress?
Blueness/pallor around the mouth
S/S RR distress
Accessory muscle use, nasal flare, sternal retractions, cap refill
LTB (Laryngotracheobronchitis)
What is it?
Primarily affects who?
Caused from what? - Ex?
S/S
CROUP
Viral upper airway infection
Kids under 5
RSV, parainfluenza, adenovirus
SOB, barking cough, increased T
Treatment of LTB (Croup)
Mild croup @ home?
More severe?
Meds?
Mild: steam, fresh air, cool temp therapy
Severe
Meds: Neb Epi; observe for relapse w/in 2 hr
CS to decrease airway inflammation
Epiglotitis - DON’T CONFUSE W CROUP
Key differences? - S/S; sound vs look?
Severe and obstructive inflammation
No cough, dysphagia, RAPID progression to severe RR distress
Epiglotitis: Worse than they sound
LTB: Worse than they look
Also remember that asthma is not a virus and also leads to obstruction
RSV
What is it?
Leading cause of what?
Risk Factors?
How to we PREVENT is?
Acute VIRAL infection affecting the bronchioles - includes RSV pneumonia, bronchiolitis, RSV
Leading cause of lower R illness in kids
RF: premie, congenital, smoke
Prevention: Palivizumab
RSV
S/S
How fast does it progress?
How to treat? mild vs severe
S/S: UR infection, nasal discharge, fever, SOB, NP cough, ^RR, nasal flaring, retraction
Worse in 2-3 days!! CAN PROGRESS FAST!
Treatment
Mild: anti-paretics
Severe
Suction, O2 and possible MV
IV fluids
Albuterol, anti-paretics
Pneumonia
Causes -- Viral Bacterial Mycotic Aspiration
S/S
Tx
Inflammation of the lungs
Viral - RSV, Adenovirus
Bacterial - Strep, kids
Mycotic - walking, adolescent
Aspiration
S/S: RR distress symptoms
Tx: Depends on type
ABC, O2, fluids, antibiotics, hydrate, nebulizer
Good pet for asthma?
Important to teach?
FISH
triggers
CF
2 body systems affects?
What do they need with food?
Diet?
Vitamins?
RR and GI
Pancreatic enzymes within 30 min of eating - DONT crush/chew or will burn mouth
High fat, calories, protein (Don’t absorb fat well, malnourished)
Water-soluble bc don’t absorb fat well (ADEK)
S/S CF
Taste?
Stool?
E imbalance?
1 sign in newborn?
How do you get the gene?
Tx?
SALTY BABY; sweat chloride test dx Steatorrhea Decreased Na No meconium (bc thick and sticky poop) Thick & sticky secretions - clog lungs and pancreas; can't secrete enzymes
Must get gene from BOTH parents
Intense pulmonary tx to mobilize the secretions every day
Down syndrome
Prone to what infections? Why?
Frequent problems?
Importan to inform parents of what?
RR infections d/t poor immune system
Heart defects
Genetic counseling for risks
HF is usually due to what in children?
Early S/S?
Tx?
Meds?
Congenital defects
^ HR @ rest and with slight exertion
^ RR
Scalp sweating
Sudden weight gain (FLUID = HEART)
Treatment
Anything to decrease CO
Cool humid O2
Uninterrupted sleep
Meds
Digoxin
ACE I
Furosemide
Digoxin
Main S/S toxicity?
Hold if HR is ____ ; infant vs kids
Infant usual dose?
When else to hold it?
When to give it? Can we mix it?
What if you miss a dose?
What needs checked with another nurse?
Bradycardia and vomiting
Infant- HR
Nutrition for HF in children
What to do before meals? Size/frequency? Calories? Baby - feed how often? Max time to feed? Kind of nipple? What about breastfed babies?
What is different between kids and adults?
Rest before eating Small frequent meals Increased calories Baby - feed q3h (enough rest) Feed max 30 min Soft nipple; big hole BF baby may need more calories
Usually don’t need Na or fluid restriction
What are hyper cyanotic spells?
Often seen with what defect?
Treatment-- Position? O2? Meds? Clothes? Stimuli? what if they cry? Infections?
Tet spells, Tet of ballot
Knee-chest; dec venous return , ^ preload
100% O2
Morphine for sedation
Loose diapers/clothes
DECREASE STIMULI - NO STRESS
Respond to cries fast
Treat infections fast - can’t handle fever
What are the effects of chronic hypoxia?
Polycythemia - Increased RBC
Body makes a lot of RBC but there isn’t enough O2 for them to bind causing THICK blood –> Hydrate, no room for platelets
Clubbing - late sigh
Poor growth and development
Squatting
Heart defects are classified by what?
Blood flow
Cleft palate/lip
Top concern?
What to correct first?
Need to do what frequently?
Best way to feed?
Nutrition
Correct lip - palate not boney enough
Burp - risk aspiration
Long nipple/syringe to side of mouth
Cleft lip repair
Position?
Goal?
Clean with what post?
Restraint type?
Back or side lying, NEVER PRONE
Protect suture line
Saline
Elbow - keep arm straight
Cleft palate repair
Best time to do it?
Avoid what?
Diet?
Are speech deficits common after?
Before speech develops; between 1-2
Hard things in mouth (straw, therm, cookie)
Soft diet
YEAH
What does GERD lead to?
Feed what position?
Sleep what position?
Best way to feed?
Tissue damage to RR structures –> pneumonia and bronchospasm
Feed upright
Sleep: elevated prone - dec reflux, improves stomach emptying
Small frequent meals with thickened formula
(tbsp rice)
What essential is pyloric stenosis?
Dx?
Tx?
Enlarged pylori (opening of stomach to duodenum) - inc pressure causes projectile d/t tiny opening
Dx: Pyloric US
Tx: Hydrate, I/O, daily wight, monitor specific gravity
S/S intussusception
Onset?
**Stools?
what might fix it?
Backward bowel causes obstruction
Sudden onset
Cramping, abd pain intermittent, inconsolable
Drawing up knees
CURRANT JELLY STOOLS
Barium enema, then surgery if not
Celiac disease
Tx
Acronyms
Intolerance to gluten
NO
BROW - barley, rye, oats, wheat
YES
RCS - rice, corn, soy
Hirschsprungs
What it is?
S/S - stools?
Tx
Ganglionic megacolic - bowel obstruction d/t piece of intestine w/o nerves and poop building up
S/S
Constipation, distention
Ribbon-like stools w foul smell
Tx
Remove diseased part of bowel
UTI
S/S
Could lead to what untreated?
Predisposing factors? 2
Dx
Tx
FTT, feeding problems, vomiting/diarrhea
Kidney failure
RF 2
Frequency, dysuria, fever
Flank pain
Hematuria
Dx: UA
Tx: Antibiotics
Hematologic disorders
What kind of isolation needed?
High risk for what?
Teaching?
Protective isolation
Infection
Hygiene; hand washing
Sterile technique for central lines
Sickle cell disease
Path
S/S
Tx
Dec blood flow > dec O2 > Pain
S/S: PAIN, anorexia, exercise intolerance
Tx BEDREST AND HYDRATION Pain meds Antibiotics Blood Oxygen
How are these done
FLACC - 5 parts
Wong-Baker
Age
FLACC - 0/10, Face, legs, activity, crying, consolability
Age 2 mo - 7r
Wong: FACES; Age 3+
Hydrocephalus
Patho
S/S
Tx
Increased CSF; ^ICP
S/S Bulging anterior fontanel Dilated scale veins Depressed eyes Irritable, change in LOC High-Pitch cry Sun-setting eyes
Tx: VP shunt
Post of care of VP shunt
Measure what?
Assess what?
Monitor what?
Position?
Mx frontal occipital circumference
Assess frontal and cranial suture line
Monitor temp
SUPINE
What to do when a baby is born with spend bifida?
PROTECT THE SACK - NS dressing
Prone
What can contribute to scoliosis?
Tx: 3 Os
Heavy backpack
Bags
Carrying kids on hips
Observation
Orthosis (braces/support)
Operation (spinal fusion; rods)
Pin worms
Spread how?
How to collect specimens?
Who needs treated?
S/S
Tx
Med?
Hygiene?
Spread by hands to mouth (sandbox, dirt)
Tape test to rectum early in am before BM
WHOLE FAM - eggs can be everywhere
S/S
Bad butthole itch
Irritable, restless, poor sleep, distracted
Bed wetting
Tx
Mebedndazole
Wash hands; clean fingernails
Relieve itch chicken pox
baking soda paste
Mono
Virus name?
Spread how?
Tx
Epstein Barr
Direct intimate contact
Tx: rest, alagesics, fluid
Enlarged spleen > no contact sports
Tonsillectomy - postop
Position Avoid what fluids? Indication of hemorrhage? Risk for hemorrhage how long? Common complaints? Breath?
HOB elevate; prone Red/brown fluids Frequent swallowing 10 days (scabs slough off) Sore throat, ear pain, low grade T Bad breath d/t old blood
LOT of ear pain = bad
Otitis media
Patho
usually follows what?
S/S
Tx
what helps pain?
Avoid what?
Can they hear well?
Infection of the middle ear d/t blocked eustachian tubes
Upper RR infection
S/S Redness tympanic membrane
Rupture is ok it’ll grow back
Tx Heating pads Avoid chewing, smoke May need tubes to drain -ok if fall out Might have trouble hearing
How to prevent otitis media?
tubes?
Play what?
Baby it up for feeds
No bottle propping
No intense now blowing
Avoid smoke
tubes: wear ear plugs in water
Play blowing games
Why are peanuts dangerous?
Mentally challenged kids like what?
IM in butt
Swell and crumble
Attention - displease you
Muscle not well developed - bad
What is Syrup of Ipecac?
Makes you vomit
Poison
Give more if not working
Big bucket
NG lavage if REALLY not working
Age of Eriksons
Trust vs Mistrust Autonomy vs Shame & doubt Initiative vs guilt Industry vs inferiority Identity vs Role confusion
birth - 18 months 2-3 3-5 6-11 12-18
