peds Flashcards
growth and developemnt
growth = increase in physical development = increase in capability or function
***development does not always follow growth and chronological age
cephalaocaudal development
moes from head downward through body and towards feet
proximodistal development
moves from center of body outward to extremities
play and toys
play is the “work” of children
when born they have involuntary grasp reflex
general peds info
anterior fontanel close 12-18months
posterior fontanel close 2-3months
foods are introduced r/t allergies & immature GI tract
peanuts are dangerous to aspirate because when wet they swell and crumble
when giving IM injections the ventrogluteal muscle is contraindicated in children who have not been walking
pull earlobe down and back
they are not ready if they fail at toileting
should drink 2-3 cups of milk if 15mon
best friend stage occurs at 9-10 yo
suffocation and drowning are common deaths
teach stranger safety
growth rate decreases between 6-12yo
school age child requires 2400 cal/day
VS/assessment
begin with observation
use distraction
talk with parents first
VS: least invasive first observe before touching or talking to them progression of obtaining: RR HR BP Temp infants and toddlers can RR and HR for one full minute
Temps: rectal: most reliable DO NOT give newborns, diarrhea, rectal lesions, chemo, immunosuppressed axillary: all ages when oral is not possible oral: 5-6yo tympanic: all ages
O2:
obtain a picture of the blood oxygen level through the skin
check perfusion, skin temp, edema to determine the best location for the sensor probe
finger and toe
communication w/ newborn
nonverbal express through crying respond to human voice and presence touch has a positive effect enough parent to touch infant
communication w/ infant (1-12months)
primarily nonverbal begin verbal with repeating cosinents communicate through crying and facial expressions attentive to human voice and presence minimal comprehension of words responds to touch through patting, rocking, and stroking speak in gentle toned voice cuddle pat rub to calm encourage the presence of parents
communication w/ toddlers and preschoolers (1-5yo)
verbal skills
3-4 form 3-4 word sentences called telegraphic speech
concrete thinking
vocabulary depends on development and family’s use
may ask a lot of questions
short attention span
limited memory
cognitive development: egocentric magical thinking animism object performance
nonverbal communication:
dramatic play
drawing
play is the work of the child
communication with school age children (6-12yo)
cognitive development: able to use logic understand other point of view understand cause and effect understand body functions
verbal communication:
big vocabulary
receptive and expressive language is balanced
misinterpretation of phrases is still common
nonverbal:
interpret nonverbal messages
expression of thoughts and feelings
communication w/ adolescents (13-18yo)
abstract thinking without full adult comprehension
interpretation of medical terminology is limited
independence
trust and understanding build rapport
privacy
strategies:
straightforward
talk in private
part of interview without parents present
communication w/ children w/ physical and or developmental disabilities
may feel hopeless, fear, and anxiety if cannot communicate
family may experience fear and anxiety
strategies: use gestures picture boards writing tablets head nods eye blinks
observable signs of respiratory distress in children
use of accessory muscles
nasal flaring
sternal retractions
grunting with respirations
any illness than affect O2 and CO2
ex: pneumonia, atelectasis, pneumothorax, pleural effusion
laryngotracheobronchititis
aka croup
viral infection that causes slight/severe dyspnea, barking cough, brassy cough, high temp
viral organisms that cause this:
parinfluenza
adenovirus
RSV
treatment:
steam from hot showers
cool temp therapy (constricts the swollen blood vessels in the trachea that are swelling)
nebulizer epinephrine (fast, improvement 10-15minutes, watch for relapse and return of symptoms) or corticosteroids
epiglottis
obstructive inflammatory process absence of cough presence of dysphagia drooling rapid progression to severe respiratory distress
primary organism cause: H flu
prevention: Hib vaccine
caused by infection of the epiglottis
can lead to occluded airway
medical emergency
** the less noise they may the worse the airway is obstructed
don’t visualize throat with tongue depressor
RSV
respiratory syncytial virus
leading cause of lower respiratory tract illness in children less than 2yo
caused by acute viral infection that affects the bronchioles
RF:
prematurity
congenital disorders
smoke
s/s begins with simple URI nasal discharge fever wheezing nonproductive paroxysmal cough tachypnea with flaring nares dyspnea and retractions know the onset of s/s because RSV will worse at 2-3 days
treatment:
mild: antipyretics
severe:
IV fluids
albuterol sulfate
antipyretics
suction
O2
pneumonia
inflammation of the lungs
causes: bacterial viral fungal aspiration of foreign substance
s/s fine crackles rhonchi w/ cough decreased/absent breath sounds chest pain back/abdominal pain fever
treatment: depends on type ABCs O2 fluids antibiotics for bacteria pneumonia supportive care for viral (hydration, antipyretics, nebulizers)
cleft palate/cleft lip
orofacial defect that affects the oropharynx and increases the risk of malnutrition and aspiration
treatment:
preop:
fed with an elongated nipple or medicine dropper
burp frequently because they swallow lots of air (risk for abdominal distension)
correct cleft lip first because it helps with feeding and promotes parents bonding
post op:
protect the suture line
position supine or side lying
DONT place them prone
avoid putting hard/rough food or utensils down their mouth
soft diet
should be repaired before speech deevlops
GERD
backwash or reflux of gastric contents into the esophagus
risk for aspiration of gastric contents into the lungs which can lead to pneumonia
treatment:
upright position with feeding and 30minutes after
upright postion
frequent burping
thickened formula may be tolerated better
pyloric stenosis
projectile vomiting during/after feeding
s/s
feel an olive shaped mass in the epigastric region near the umbilicus
lots of pressure behind the vomitus
diagnosis:
abdominal ultrasounds
treatment: hydrate electrolytes i and o monitor urine specific gravity daily weight surgery
intususception
piece of the bowel telescopes in on itself forming an obstruction
s/s sudden onset cramping abdominal pain drawing up of knees inconsolability pain ****currant jelly stools monitor stools closely
Hirschsprung’s
congenital anomaly
agaglionic mega colon
mechanical obstruction
affects sigmoid colon
s/s constipation no nerves no peristalsis abdominal distension ribbon like stools that have foul smell
treatment:
surgery to remove that portion of bowel
head lice
scalp itching
can spread to other parts of the body
spread through direct contact
treatment:
antiparasitic meds
pin worms
intense rectal itching general irritability restlest poor sleep bed wetting distractibility short attention span spread from hand to mouth whole family should be treated use tape test (clear tape to rectum) to collect specimen
treatment:
mebendazole
good handwashing
keep fingernails short
mononucleosis
the kissing disease
s/s sore throat fatigue swollen lymph nodes liver/spleen enlargement
virus that causes:
epstein barre
spread by direct intimate contact
treatment: rest analgesics fluids good nutrition spleen is enlarged so limit participation in contact sports to prevent injury
tonsillectomy and adenoidectomy
used for recurrent URI or obstructive sleep issues
place on their side and elevate HOB place prone prevent aspiration brown and red fluids not given post op because we don't want it to be confused with blood frequent swallowing = hemorrhage at risk for hemorrhage for 10days postop common complaints post op: sore throat slight ear pain
low grade temp
bad breath
otitis media
infection in middle ear
bulging, bright red, tympanic membrane
preceded by URI
treatment: antibiotics avoid chewing soft foods may not be able to hear well avoid smoke may need tympanovstomy tubes or pressure equalizing tubes (help middle ear drain) if they have PE tubes in their ears, they must wear earplugs in the bath or swimming
prevention: sit up for feedings no bottle propping gentle nose bleeding play "blowing" games avoid smoke
cystic fibrosis
genetic
exocrine gland symptoms
GI system and respiratory system
pancreatic enzymes must be given to help improve digestion with every meal/snack– take within 30 minutes of eating and the beads should not be crushed or chewed
nutrition is a major concern: underweight, high fat, high cal
s/s
steatorrhea (fatty, frothy stools)
trouble absorbing fat soluble vitamins because they cannot absorb fat well (need ADEK vitamins)
sweat chloride test
earliest sign:
meconium ileus
mucous secretions are thick and sticky
***must get gene from both parents (autosomal recessive disorder)
down syndrome
trisomy 21
prone to developing respiratory infection because they have a poor immune system
often have congenital heart defects
advanced maternal age increases risk of having down syndrome baby
celiac disease
malabsorption due to an intestinal intolerance to gluten
treatment: lifelong no food with gluten (vegetable proteins) cannot have BROW B: barley R: rye O: oats W: wheat
can have RCS
R: rice
C: corn
S: soy
sickle cell disease
hereditary form of anemia
normal hemoglobin is partly or completely replaced by abnormal hemoglobin and sickle shaped RBCs
s/s pain anorexia exercise intolerance fatigue malaise
sickle cell crisis:
decreased blood flow– decreased O2– pain
treatment: bedrest ****hydration (push apart sickled cells and improves circulation) analgesics antibiotics blood transfusions O2 hydroxurea
duchennes muscular dystrophy
inherited as a x-linked recessive trait
s/s: lordosis (curvature of lower spine) waddling gait frequent falls weakness in muscles toe walking Gower's sign (climbing/walking up to get off of floor)
treatment: maintain optimal muscle function with PT prevent contractures steroids to improve muscle strength and respiratory function support groups palliative care
tet spells
hyper-cyanotic spells
seen in children with tetraology of fallot
treatment: knee to chest position (decreases venous return from the lower extremities and increases systemic resistance which diverts blood to the pulmonary artery for oxygenation) 100% O2 morphine for sedation monitor CO
prevention: quiet play minimize stress respond to crying quick usually do to congenital heart defects
UTI
s/s in newborns and children under 2 (nonspecific s/s seem to be a GI issue) failure to thrive feeding problems vomiting diarrhea
causes: renal anomalies constipation bubble baths poor hygiene pin worms sexual activity (sexual abuse)
s/s over 2yo: frequency dysuria fever flank pain hematuria foul smelling urine
diagnosis:
urine specimen
most accurate = catheterization
treatment: antibiotics teach prevention: proper wiping no bubble baths cotton underwear limited carbonated drinks
hydrocephalus
disturbance of the ventricular circulation of CSF
CSF builds up and causes high ICP
s/s bulging fontanelle with head enlargement dilated scalp veins depressed/sunken eyes irritable and changes in LOC high pitched cry setting sun sign (you can see white all the way around the iris)
diagnosis: head circumference (up to 3yo)
surgical treatment: insert VP shunt postop: measure head circumference assess for bulging fontanels and widening cranial suture lines monitor temp supine position
frequently associated with myelomeningocele:
protect the sack and don’t let it rupture
should be lying prone
cover sack with sterile dressing that is moist
scoliosis
musculoskeletal disorder consisting of lateral curvature and rotation of the spin
idiopathic or congenital
factors:
heavy backpacks
bags
carrying children on hips
treatment:
observation
orthosis (supports and braces)
operation (spinal fusion w/ rods)
chicken pox
communicable disease that is rare same virus causes shingles as they get older prevent infection of the lesions contagious varicella zoster (vaccine) home remedies: oatmeal bath and baking soda
authoritarian
highly controlling
expects to be obeyed
inflexible rules
authoritative
sets reasonable limits on behavior
encourages growing autonomy of child
open communication
permissive
few or no restraints unconditional love much freedom little guidance no limit setting
indifferent
no limit setting
lacks affection for the child
focused on own life
