Pediatrics Part 1 Flashcards
Head size reflects what?
growth of brain; correlates with intracranial volume and brain weight
how much does head circumference increase in the first year of life?
10cm
when does head circumference reach 50% of the adult?
9 months
how much does the head circumference increase in the second year?
2.5 cm or 75% of the adult size
does the face and base of skull develop faster or slower than the cranium?
slower
3 abnormalities associated with the failure of prenatal development of the mandible?
Pierre Robin
Treacher Collins
Goldenhar syndrome
after age 2, cranial vault growth ____ and face grows ____.
cranial vault slows and face grows rapidly.
when do frontal sinuses develop?
2-6 years
when do maxillary, sphenoidal, and ethmoidal sinuses appear?
after age 6 years
when does the first tooth appear?
around 6 months
when are all teeth present?
around 20 months
when do permenant teeth begin to appear?
6 years
HR for premature infant
120-170
HR for 0-3 months
100-150
HR for 3-6 months
90-120
HR for 6-12 months
80-120
HR for 1-3 years
70-110
HR for 3-6 yers
65-110
HR for 6-12 years
60-95
HR for >12 years
55-85
SBP for premie
55-75
SBP for 0-3 mo
65-85
SBP for 3-6 mo
70-90
SBP for 6-12 mo
80-100
SBP 1-3 yrs
90-105
SBP 3-6 yrs
95-110
SBP 6-12 yrs
100-120
SBP >12 years
110-135
DBP premie
35-45
DBP 0-3 mo
45-55
DBP 3-6 mo
50-65
DBP 6-12 mo
55-65
DBP 1-3 yrs
55-70
DBP 3-6 yrs
60-75
DBP 6-12 yrs
60-75
DBP >12 yrs
65-85
Neonate
up to 4 weeks old
infant
4 weeks to 1 year
toddler
1-3 years
preschool
4-6 years
school age
6-13 years
adolescent
13-18 years
NPO for clear liquids
2 hours
NPO for breast milk
4 hrs
NPO for infant formula
6 hrs
NPO for solids (fatty or fried foods)
8 hrs
is the removal of piercings necessary to minimize complications?
yes
what are some potential complications of piercings?
electrocautery burns, airway difficulty, tissue damage
what are the recommendations to avoid electrocautery burns?
use bipolar cautery, harmonic knife, grounding pad should be remote from piercing
what are airway complications associated with piercings?
laryngospasm and hypoxia
pulmonary aspiration
tissue damage associated with piercings?
necrosis
bleeding
what are the primary implications associated with smoking?
increased carboxyhemoglobin levels decreased ciliary function decreased FVC decreased FEF 25-75% increased sputum production
what are the secondary considerations associated with smoking?
environmental tobacco smoke (ETS)
more likely to have astham, otitis media, atopid eczema, hay fevre, dental caries
factors to consider during preop evaluation
stressful for child and family family dynamics developmental and behavioral status cultural biarses ability to provide information
perioperative anxiety concerns for 0-6 months
maximum stress for parent
minimum stress for baby
perioperative anxiety concerns for 6mo-4 yrs
maximum fear of separation
not able to understand process and explanations
significant post op emotional upset and behavior regression
begins to have magical thinking
cognitive development and increased temper tantrums
perioperative anxiety concerns for 4-8yrs
begins to understand process and explanations
fear of separation remains
concerned about body integrity
perioperative anxiety concerns for 8years-adolescence
tolerates separation well
understands process and explanations
may interpret everything literally
may fear waking up during surgery or not waking up at all
perioperative anxiety concerns for adolescence
independent
issues regarding self-esteem and body image
developing sexual characteristics and fear of loss of dignity
fear of the unknown
parental presence during induction
some encourage it, some not ok with it, evaluate each situation, parents should remain informed.
unrelieved anxiety in child
renegotiate (rarely every successful)
hold mask farther from the childs face
IV or IM induction
factors to assess for respiratory system
cough
asthma
croup
apnea/bradycardia
possible anesthetic implications for respiratory system
irritable airway bronchospasm atelectasis subglottic narrowing postop apnea/bradycardia medication history?
factors to assess for cardiac system
murmur cyanosis history of squatting hypertension rheumatic fever exercise intolerance
possible anesthetic implications for cadiac system
septal defect avoid air bubbles in IV line R to L shunt TOF coarctation renal disease VHD CHF cyanosis
factors to assess for neurologic system
seizures
head trauma
swallowing incoordination
neuromuscular disease
possible anesthetic implications for neurologic system
medications metabolic derangement intracranial hypertension aspiration esophageal reflux hiatal hernia neuromuscular relaxant drug sensitivity malignant hyperpyrexia
factors to assess for GI/hepatic systems
vomiting diarrhea malabsorption black stools reflux jaundice
possible anesthetic implications for GI/hepatic system
electrolyte disturbance dehydration full stomach anemia hypovolemia possible need for full stomach precautions drug metabolism/hypoglycemia
factors to assess for GU system
frequency
time of last urination
frequent UTIs
possible anesthetic implications for GU system
UTI DM hypercalcemia state of hydration renal function
factors to assess for endocrine/metabolic systems
abnormal development
hypoglycemia
steroid therapy
possible anesthetic implications for endocrine/metabolic systems
endorinopathy hypothyroid DM hypoglycemia adrenal insuffiency
factors to assess for hematologic system
anemia
bruising
excessive bleeding
sickle cell
possible anesthetic implications for hematologic system
need for transfusion coagulopathy thrombocytopenia thrombocytopathy hydration possible transfusion
factors to assess for allergies
medications
possible anesthetic implications for allergies
possible drug interactions
factors to assess for dental system
loose or carious teeth
possible anesthetic implications for dental
aspiration of loose teeth
bacterial endocarditis prophylaxis
commonly expected problems with neonate based on maternal history of Rh-ABO incompatibility
hemolytic anemia
hyperbilirubinemia
kernicterus
commonly expected problems with neonate bsed on maternal history of toxemia
small for gestational age and its associated problems
muscle relaxant interactions with mag therapy
commonly expected problems with neonate bsed on maternal history of hypertension
small for gestational age and its associated problems
commonly expected problems with neonate bsed on maternal history of drug addiction
withdraw, small for gestational age
commonly expected problems with neonate bsed on maternal history of infection
sepsis
thrombocytopenia
viral infection
commonly expected problems with neonate bsed on maternal history of hemorrhage
anemia
shock
commonly expected problems with neonate bsed on maternal history of diabetes
hypoglycemia
birth trauma
large for gestational age
small for gestational age
commonly expected problems with neonate bsed on maternal history of polyhydramnios
tracheoesophageal fistula
anencephaly
multiple anomalies
commonly expected problems with neonate bsed on maternal history of oligohydramnois
renal hypoplasia
pulmonary hypoplasia
commonly expected problems with neonate bsed on maternal history of cephalopelvic disproportion
birth trauma
hyperbilirubinemia
fractures
commonly expected problems with neonate bsed on maternal history of alcoholism
hypoglycemia
congenital malformations
fetal alcohol syndrome
small for gestational age
