peds: assessment (slides 1-50) Flashcards
4 categories of growth (that differ for each age group)
physical, cognitive, emotional and social growth
at what age do we generally start to screen BP and BMI
BP after age 3
BMI after age 2
*but BP At least once during infancy – digital doppler method is easiest
The best way to conceptualize a single health supervision visit (well visit) is not as one visit but as a visit of multiple encounters encompassing what 4 objectives?
disease detection
disease prevention
health promotion
anticipatory guidance
what two phases is infancy divided into?
Neonatal period- first 28 days
Postnatal period- 29 days to 1 year
baby: when is the first exam? what is the comprehensive exam?
First exam is at delivery
Comprehensive exam within 24 hours
when do kids start having yearly visit?
3yr- middle school
when are the doc visits in early childhood?
Early childhood- 12 mth, 15mth, 18 mth, 24 mth, 30 mth, 3 yr, 4yr
when are the doc visits in infancy
Infancy- 3-5 days, 1month, 2 mth, 4 mth, 6 mth, 9 mth
when is apgar score done? what is included?
1 min and 5 min
Heart rate, respiratory rate, muscle tone, reflex irritability, color
(appearance, pulse, grimace, activity, respiration)
what is the scale of apgar score and what does each score mean? (1 min)
8-10 - normal
5-7- some nervous system depression
0-4 - severe depression, immediate resuscitation
score of 0-7 on apgar at 5 min means what?
0-7 – high risk for subsequent central nervous system and other organ system dysfunction
a baby with a low apgar may need what two things?
Oxygen and clearing out the airway to help with breathing
Physical stimulation to get the heart beating at a healthy rate
is apgar meant to predict the future health of the child?
no
how off can the ballard score be?
accuracy may be off by 2 weeks
what is the ballard score ?
estimate gestational age based on baby height, weight + muscle tone
newborn complex behavior: habituation
ability to selectively and progressively shut out negative stimuli
newborn complex behavior: attachment
A reciprocal, dynamic process of interacting and bonding with the caregiver
newborn complex behavior: state regulation
ability to modulate the level of arousal in response to different degree of stimulation
newborn complex behavior: perception
ability to regard faces, turn to voices, quiet in presence of singing, track colorful objects, respond to touch, and recognize familiar scents
what ages are early and middle childhood?
Early childhood 1-4 years
Middle childhood 5-10 years
late childhood/adolescence is divided into what 3 phases
Early- 10-14 year olds
Middle 15-16 year olds
Late 17 to 20 year olds
By 1 year child should _____ birth weight and increase height by ____
triple , 50%
Neurologic development progresses from ______ to ________
central, peripheral
what are the 3 key stages of language development and what are the 3 ages?
cooing at 2 months
babbling at 6 months
one to three words at 1 year
what are the international growth charts for children 0-2 yo
WHO
pulse at birth and by 12 months
birth - 140
12 months- 115
what can the RR be for infant?
< 2 months anything over 60/min
2-12 months anything over 50/min
*observe at least 60sec
*most reliable when sleeping
fever can raise RR in infants up to __ respirations per minute for _____ degree centigrade of fever.
10, EACH
high RR + fever in infant?
Get the fever down THEN check RR again. - switch tylenol and Motrin so they get something every 2-3 hrs
at what ages do you do rectal temp?
0-2 mo
what is acrocyanosis?
blue hands/ feet
what is central cyanosis a sign of? where do you look for it?
(sign of congenital heart disease) at tongue and oral mucosa
what is lanugo?
fine, downy hair over entire body concentrated more at shoulders and back ( Sheds first few wks)
what is miliaria rubra?
scattered vesicles on reallyy red base - face and trunk
- from obstruction of sweat glands
what is erythema toxicum?
rash- red macules, w/ central pinpoint vesicles scattered all over body (looks like flea bites)
what is pustular melanosis?
more in black infants- small vesicles on brown base
what is milia?
pinhead white raised bumps - seen on nose + around.
-in sebaceous glands
what is normal “physiologic” jaundice? how do you test it?
2nd or 3rd day, peaks about 5th day, usually gone within a wk
- yellowish blanching = jaundice
when do the anterior + posterior fontanelles close?
Anterior fontanelle – closes between 4 and 26 months of age
Posterior fontanelle – closes by 2 months of age
eyes may be ____ for the first few weeks of life
fixed
babies have swelling where from birthing process?
eyes
Babies can get intermittent strabismus but should be gone by ___ months
3
how do you check visual acuity in newborn?
use visual reflexes to assess vision
- pupil constriction, optic blink reflex, blinking with movement of object toward eye.
looking in the eye, red =? black =? white =?
red- normal
black- cataract
white- retinoblastoma
ears: ______ _______ _______ for several months before becomes cone-shaped
Diffuse light reflex
how can you look at TM? why might you not be able to see TM in infant?
pull pinna down to look- might be full of “stuff” (vernix caseosa)
Palpate _______ _______ _____ after birth to ensure it is intact
upper hard palate
how do teeth come in? (with what frequency? what location comes up first? )
1 tooth per month for 6-26 months of age, Central and lateral incisors erupt first, molars last
if birth extraction was difficult, what should you be sure to check?
crepitus of clavicles (maybe fracture)
what part of thorax exam is not helpful to do in infants? why?
percussion: not helpful in infants; hyperresonant*
NOTE: thorax is more rounded in infants than in older children and adults
what do you palpate thorax for?
tactile fremitus (if making noise/crying)
lung sounds upper vs lower airway?
Upper airway: loud, symmetric transmission throughout the chest, loudest as stethoscope is moved upward; coarse during inspiratory phase
Lower airway: loudest over site of pathology; asymmetric; often occur during expiration
how is auscultation of lungs different for infants than kids/adults?
sounds are louder and harsher generally
respiratory problems: what two aspects do we check for infant breathing?
audible breath sounds + work of breathing
audible breath sounds that indicates resp. problem (4)
Grunting
Wheezing
Stridor
Obstruction (often right lung)
work of breathing that indicates resp. problems (3)
Nasal flaring
Grunting
Retractions- supraclavicular, intercostal, subcostal
what is sinus dysrhythmia? is this normal?
normal in infant - Inc. rate on inspiration and dec. on expiration
PMI in infants
located 1 interspace higher than in adults
checking pulses in infant- check all 4 extremities for what?
coarctation of aorta
central cyanosis is what color?
Raspberry red (desat) vs. strawberry pink (normal)
why might breasts be slightly enlarged in newborn?
from estrogen of mother
when should umbilical cord fall off by?
2 wks
