Peds Flashcards
Sensorimotor Stage
age, understands, and teach
0-2 y/o
-Understands world through senses and actions
-Only understand the present tense - teach as you do procedure
don’t understand play
Pre operational stage
age, understands, teach
3-6years
-understand world through language and mental images
- fantasy oriented, imaginative, understand future and past
- think injuries are punishment
- teach in the future tense, 2 hours before, or morning or day of procedure ( don’t give too much time to imagine)
- learn by play, teach on stuffed animal
Concrete operational
age, understands, teach
7-11 y/o
-understands world through logical thinking and categories
- Live and die by the rules, cannot think abstract, one way to do things, everything else is wrong
*7/11 grocery stores are surrounded by concrete - no trees, no flowers
- teach a day or two ahead of time, what and how do do skills and use age appropriate reading and demonstration
Formal operational
age, understanding, teaching
12-15
- Understands world through hypothetical thinking and scientific reasoning
- can abstract thing and use cause and effect
- when they turn 12 teach like and adult, regular med surge
At what age can a child manage their care and what is required to do this?
12 and they must think abstract
manage= 12
skill= 7
Safety measures regarding toys
- no small toys under 4
- no metal around oxygen
- fomites on toys can make immunosuppressed sick (give hard plastic)
Toys for 0-6 months
- best toy is musical mobile
- toys should be large and soft
- worst toy after 6 months is musical mobile because they can stand up and cause strangulation
Toys for 6-9 months
- Toys teach object permanence
- jack in box/ peak a boo
- toys should be large and firm
Toys 9-12 months
- Teach vocalization
- tickle me elmo, woody cowboy, talking books
- purposeful play= 9 months old: build, sort, stack, make
- in womb for 9 months, another 9 for purposeful play
Toys for 1-3 y/o
- teach gross motor skills, running jumping
- best toys are push/pull, lawn mowers, wagon, dog with flappy feet
- can paint with hand
-parallel play- play next to but not with each other, think terrible twos
Toys for 3-6 y/o
- teach fine motor skills
- finger dexterity= write, draw, use colored pencils, scissors
- work on balance- dance, ice skate, tricycles, tumbling,
- cooperative play- work together to again a common goal, no winner
Toys for 3-6 y/o
- teach fine motor skills
- finger dexterity= write, draw, use colored pencils, scissors
- work on balance- dance, ice skate, tricycles, tumbling,
- cooperative play- work together to again a common goal, no winner
- highly imaginative
Toys for 7-11
- concrete
- 3 C’s
1. Creative- give paper to draw
2. Collective- barbies, cards, Webkinz
3. Competitive- winners and losers
12-18 y/o
Need peer association
-allow to be in each other’s rooms unless one is post op less than 12 hrs, immunocompromised, contagious
When does toilet training take place?
1 1/2- 2 years
Does bladder or bowel control develop first?
Bowel control first
2- 3 month developmental milestones
Coo, smile, kick legs, raise head in prone position
4-5 month developmental milestones
Head lag should be gone (report if present), grabs obejects, diminished rooting and moro reflex
6- 9 months
birth weight doubles
- roll from front to back, sit themselves up unsupported, push themselves up, babble few words, hold bottle at 7 months, transfer objects in hand, respond to name, separation anxiety begins
6- 9 months
birth weight doubles
- roll from front to back, sit themselves up unsupported, push themselves up, babble few words, hold bottle at 7 months, transfer objects in hand, respond to name, separation anxiety begins
10-12 months
Use pincher grasp, learn how to speak, birth weight triples at 12 months, take steps while holding hand, build blocks, turn pages, 3-5 words
10-12 months
Use pincher grasp, learn how to speak, birth weight triples at 12 months, take steps while holding hand, build blocks, turn pages, 3-5 words
18 months
walk up and down stops, throw a ball, turn pages, build tower with 4 blocks, scribble, ten words, follow commands
18 months
walk up and down stops, throw a ball, turn pages, build tower with 4 blocks, scribble, ten words, follow commands
2 years
walk on own independently, know first and last name, form 2-3 word sentences, potty trained
2 years
walk on own independently, know first and last name, form 2-3 word sentences, potty trained
4 years
draw a shape with 4 sides , skip on 1 foot, catch a ball
4-6 months
begin solid food one at a time and 1 food per week
fontanels
anterior- closes 12-18 months
posterior- 2-3 months
bulging at rest means infection or increased ice
0-4 months reflexes
rooting reflex and tonic neck reflex
Blood in newborn diaper
normal
18 months
walk up and down stops, throw a ball, turn pages, build tower with 4 blocks, scribble, ten words, follow commands
stool on third day
yellow brown
2 years
walk on own independently, know first and last name, form 2-3 word sentences, potty trained
10-12 months
Use pincher grasp, learn how to speak, birth weight triples at 12 months, take steps while holding hand, build blocks, turn pages, 3-5 words
Intussusception
bowel within a bowel
s/s: currant jelly stools (bloody)
sausage shaped abdominal mass
n/v
green emesis
treatment: enema to attempt to push intestine
Epiglottitis
caused by HIB
s/s: fever, cherry red epiglottis, drooling, dysphagia, tripod, stridor, no cough, dysphonia
treatment: IV antibiotics
Oxygen
intubate and mechanical vent
A child with HIV should receive what vaccine
IPV
Hirschsprung’s disease
absence of enteric neurons= no peristalsis
stool builds up and becomes a megacolon
s/s: delayed passage of meconium
ribbon like stool
swollen belly, vomit withe green/brown substance constipation, gas
treat: surgery
Pyloric stenosis
hypertrophy of the pylorus, causing narrowed lumen
s/s: olive shaped mass, projectile non- bilious emesis
treat: dehydration, malnutrition, pyloromyotomy
Omphalocele
Congenital abnormality where the abdominal contents protrude through the umbilicus while remaining in the peritoneal sac.
● Occurs during weeks 9-10 of gestation.
complication: dehydration, sepsis, hypothermia
treatment: Keep exposed intestines moist
● Cover with sterile gauze soaked
in saline
● IV fluids
● IV antibiotics
● Thermoregulation
Hydrocephalus
Increased accumulation of cerebrospinal fluid
● Increases ICP
treat: VP shunt- drains out as urine
or EVD
Spina Bifida
○ Failure of the vertebrae to close with protrusion of neural tube contents
○ Meningocele (closed spina bifida)
■ Protrusion of spinal fluid–filled meninges through a vertebral defect
○ Myelomeningocele (open spina bifida)
■ Protrusion of spinal fluid–filled meninges AND the spinal cord
through a vertebral defect
S/s: tuft of hair or sacral dimple, Paralysis possible
○ More likely the higher the defect is located on the spine
● Developmental delay
● Speech delay
● Intellectual disability
● Impaired coordination
● Pre-op
○ Cover the sac with a moist, warm, sterile dressing
○ No diapering if defect is low- keep the sac clean with a protective barrier
○ Prophylactic antibiotics
○ Prone positioning
● Post-op
○ Remain prone until surgical site is healed
Microcephaly
Head circumference is smaller than normal ○ Brain did not develop properly or stopped growing.
Microcephaly
Head circumference is smaller than normal ○ Brain did not develop properly or stopped growing.
cause: Genetic abnormalities
○ Drug or alcohol use during pregnancy
○ Virus during pregnancy
Impaired cognitive development
● Delayed motor function
● Delayed speech development
● Facial distortion
● Dwarfism
● Hyperactivity
● Seizures
cleft lip/ palate
Surgically corrected
○ Cleft lip first at 3-6 months of age
○ Cleft palate second at 6-24 months of age
● Pre-operative care
○ Monitor for aspiration
○ Assess airway patency frequently
● Post-operative care
○ Positioning:
■ Position upright for feedings
■ Cleft palate - can be prone post op to help drain secretions
■ Cleft lip should NOT be prone as this could disturb the suture line
○ Protect suture line
○ Elbow restraints to avoid toddler putting things in the mouth that would compromise the sutures
○ No hard foods, straws, pacifiers, etc.
○ No oral or nasal suctioning
Specialized bottle to facilitate a good suction/latch
● Small, frequent feedings
● Upright position
● Burp frequently - will swallow a lot of air
● May take longer to feed than other children
● Monitor for aspiration
Sickle cell anemia
The sickled cells are not able to carry oxygen like they should
○ Decreased perfusion
● Due to their shape, they can get caught in vessels and cause obstruction
Sickle cell crisis
The decreased blood flow to the tissues leads to hypoxia, ischemia, and infarction.
● There is severe joint pain
● Sequestration
○ Blood pools
○ Often in the spleen
○ Splenomegaly and tenderness
● Acute exacerbation can be caused by hypoxia, exercise, high altitude (due to low oxygen), and fever.
treatment: IV Fluids
○ This helps dilute the blood so that the sickled cells are not so concentrated
○ Provides hydration
● Blood transfusion
○ Provides normal RBCs
○ Helps optimize oxygenation and better perfusion
● Oxygen
○ Increase oxygen to the tissues if the client is hypoxic
● Medications
○ Pain management - Analgesics often necessary ○ Hydroxyurea
■ Increases production of fetal hemoglobin to reduce crises
Kawasaki Disease
Strawberry tongue - red and swollen
● Rash
● Bilateral conjunctivitis
● Red cracked lips/mucous membranes
● Red, swollen hands and feet
● Lymphadenopathy
● Arthralgia
● High fever
● Abdominal pain/Diarrhea/Vomiting
●Innflammation!! Elevated: ○ CRP
○ ESR
○ WBC:
treatment:Aspirin
○ Reduces the fever, swelling, pain and rash
○ Prevents blood clots
● IVIG
Reye syndrome
Acute encephalopathy following viral illness
● Diagnosed by liver biopsy
● Characterized by cerebral edema and fatty changes in liver
● Most commonly follows influenza or varicella
● Associated with aspirin use in pediatrics during viral illness!
s/s: Viral illness
● Nausea, vomiting
● Fever
● Signs of liver dysfunction: lethargy, jaundice
● High ammonia levels in blood
● Altered mental status
treatment: ● Monitor neuro status and signs of increased ICP!!
● Monitor liver function
● Monitor I&O
● Monitor for impaired coagulopathy
● Rest and low stimulation
** Acetaminophen and ibuprofen are the medications of choice for fever in viral illness due to risk of Reye Syndrome!**
Developmental dysplasia of the hip
An abnormality in the development of the femoral head, acetabulum, or both.
● Causes the femur to become displaced from the hip.
● Can occur in one or both hips
● Catching it early is key to treatment!
Infant
○ Ortolani & Barlow Tests
● Toddler
○ Limb length inequality (legs with
different lengths)
○ Abnormal walking or gait
Brace
○ Pavlik harness
● Cast
○ Spica body bast
● Surgery
○ Usually followed by a cast!
Impetigo
Contagious bacterial disease
● Cause
○ Staphylococcus aureus
● Toxins from this bacteria produce a weeping lesion with a ‘honey colored crust”
● Treatment
○ Topical antibiotics
○ Oral antibiotics
Assessment to determine if meconium has been passed in utero:
Visible meconium in fluid/on infant
● Discolored or foul smelling amniotic fluid
● Discoloration of the cord
● Discoloration of the nails/tonge on the infant
treat: Suction immediately after birth - before they take their first breath.
● Intubation
● IV antibiotics
● IV fluids
Croup
viral respiratory tract illness
○ Results in inflammation and edema of the larynx and/or trachea
s/s: Hoarse, “bark-like” (or seal-like) cough
● Stridor
● Chest wall retractions
● Runny nose, fever
● Symptoms often worsen at night
treat: ● Corticosteroids
● Epinephrine via nebulizer ○ “Racemic epi”
● Keep patient calm and decrease anxiety levels ○ Agitation can lead to respiratory distress
Cystic Fibrosis
Respiratory
○ Excessive mucus
○ Frequent respiratory infections
○ Hypoxemia
■ Clubbing
■ Cyanosis
■ Barrel chest
● Gastrointestinal
○ Intestinal obstruction
○ Meconium ileus
○ Large, bulky, frothy, foul smelling stool
○ Fat soluble vitamin deficiency
■ ADEK
■ Malnutrition
elevated chloride in sweat
