PEDS Exam 1 Flashcards
health equity vs health equality
health equity: pts are given the resources they need to get better
health equality: everyone gets the same care
infant pain assessment - FLACC
face
legs
activity
cry
consolability
infant (0-12mo) - physical growth
- double weight by 6mo, triple by 1yr
- posterior fontanelle closes at 2mo
- anterior fontanelle closes at 18mo
infant (0-12mo) - gross & fine motor, sensory, vocalization
1mo: lift head, grasp reflex, poor vision, calms to voice, makes comfort sounds
3mo: raise chest when prone, brings objects to mouth, follows objects, coo/squeal
4mo: rolls side to side
6-8mo: sit, pincer grasp, visually pursue dropped object, imitate sounds
8-10mo: crawl, object permanence, comprehend “no”
1yr: pull to stand, “cruise,” release object into cup, 4 words plus “mama” & “dada”
infant (0-12mo) - developmental theories
trust vs. mistrust (rely on caregivers to meet their needs)
sensorimotor
infant (0-12mo) - nutrition
- breastmilk for 6-12mo, may need vit d supplementation
- iron fortified formula
- no honey
- whole milk at 1yr
colic baby vs failure to thrive
Colic
- crying for >3hrs/day, >3days/week, >3weeks
- still growing/gaining weight as expected
- unknown cause, disappears at 3mo
FTT
- inadequate growth
toddler (12-36mo) & preschool (3-5yr) - gross motor
- walk at 15mo
toddler (12-36mo) & preschool (3-5yr) - language
- 18mo: >10 words
- 3yr: 2-4 word sentences
- 4yr: lots of questions
toddler (12-36mo) & preschool (3-5yr) - socialization
- 15mo: imitates
- 24mo: parallel play
- 4yr: play w friends
- 5yr: eager to please
toddler (12-36mo) & preschool (3-5yr) - developmental theories
(1-3) autonomy vs shame & doubt
(3-6) initiative vs guilt
preoperational: magical thinking, egocentrism
toddler (12-36mo) & preschool (3-5yr) - nutrition
- caloric needs decrease, infants need more calories than preschooler
- picky eating *food jags
toddler (12-36mo) & preschool (3-5yr) - other milestones
- primary dentition at 30mo
- bowel/bladder control at 30mo (3-4 at nighttime)
toddler (12-36mo) & preschool (3-5yr) - parent education
- carseat/booster seat until 80lbs (~12yr)
- leading cause of death: MVA, drowning, suffocation, burns, chokin
school age (6-12) - growth & dev
- growth slows but is steady
- growth spurt 10-12 in F, ~12 in M
school age (6-12) - developmental theories
industry vs inferiority *peers are important
concrete operational; can see other POV
school age (6-12) - puberty
- breast dev is 1st sign of puberty in females
- prepubertal weight gain, pubic hair growth, growth/changes in genitals are early signs in males
school age (6-12) - injury prevention
- MVA most common cause of death
school age (6-12) - screenings
- hyperlipidemia 9-11
- scoliosis 10-12
adolescence (early 10-13, middle 14-17, late 18-21) - developmental theories
early: identity vs role confusion
late: intimacy vs isolation
formal operational
adolescence (early 10-13, middle 14-17, late 18-21) - sexual health
1/2 of all STIs are found in adolescents
adolescence (early 10-13, middle 14-17, late 18-21) - other important topics
- teens are less likely to report sexual abuse/assault
- drinking and driving is leading cause of death
- emancipation/confidentiality when treating substance abuse, STI, pregnancy
respiratory a&p
- child resp tract is shorter & narrower
- NBs are obligatory nose & belly breathers
- 15 sec apnea is normal
- higher metabolic rate = higher O2 demand
upper airway infectious disorders - otitis media
- s/s earache, pulling at ears, buldging red or opaque TM, yellow purulent fluid
- tx with abx
upper airway infectious disorders - otitis media w effusion
- fluid collection in middle ear *buldging
- can present as hearing loss
upper airway infectious disorders - otitis externa
- inflammation of external ear canal
upper airway infectious disorders - sinusitis
- pres: cold-like s/s for 7-14 days, facial pain, HA, fever, postnasal drip, bad breath, N/V, yellow/green nasasl discharge, swelling around eyes
- intervention: supportive care, internasal steroid, antihistamine, abx, saline nasal drops, sinus rinse
upper airway infectious disorders - pharyngitis
- causative agents: virus, bacteria, fungi
- dx: nasal/throat swab
intervention: supportive care, abx for strep
upper airway infectious disorders - tonsilitis
- pres: sore throat, enlarged tonsils - may be red/covered in exudate, difficulty swallowing, halitosis
- tonsillectomy post-op care: side-lying or prone, gentle oral assment, avoid coughing, using a straw, & blowing nose
- s/s of post-op hemorrhage: restlessness, tachycardia, frequent swallowing
upper airway infectious disorders - croup
- pres: “barky” cough, stridor, resp distress, hoarseness
- dx: x-ray may show “steeple sign” (narrowing of larynx), clinical signs
- intervention: admin meds; beta-adrenergic (racemic epinephrine) corticosteroids (dexamethasone), monitor resp status, cool mist & cold night air, O2, hydration
upper airway infectious disorders - epiglottitis
- inflammation of larynx & epiglottis *life threatening
- pres: 4Ds; drooling, dysphagia, dysphonia, distressed inspiratory air mvmt)
- dx: x-ray shows narrow airway, inverted thumb
- considerations: do not inspect mouth w/o intubation supplies
lower airway infectious disorders - bronchiolitis
- causative agents/patho: caused by viruses that trigger inflammation of bronchioles (RSV most common), inflammation partially occludes airway causing wheezing & allowing less O2 to enter lungs
- pres: cold sx, nasal congestion, fever, cough, decreased appetite, rapid breathing, wheezing, presistent cough, difficulty feeding
intervention: supplemental O2 (humidified), hydration, suctioning
lower airway infectious disorders - pneumonia
- causative agents/patho: virus, bacteria, mycoplasma, fungus, aspiration; bacteria cause fluid accumulation (consolidation) viral causes impaired gas exchange
- pres:
viral - flu & RSV, retractions, tachypnea, fever, cough, crackles, wheezing, CXR hyperinflation or consolidation
bacterial - recent hx of URI, fever/chills, decreased breath sounds, retractions, tachypnea, CXR consolidation - intervention: supportive care (viral), supplemental O2, abx (bacterial), pneumococcal vaccine
upper airway noninfectious disorders - esophageal atresia & tracheoesophageal fistula
- pres: resp distress within minutes, day, or weeks of birth, excessive oral secretions, cyanosis, abdominal distension
- dx: prenatal US, polyhydramnios (excessive amniotic fluid)
- intervention: prep for surgery, constant oral suction, supplemental O2, monitor ABGs & resp status
upper airway noninfectious disorders - laryngomalacia
- pres: inspiratory stridor within first 2 weeks of life, crowing noise w resp, normal VS & O2
- dx: flexible laryngoscopy
- intervention: sx usually resolve by age 2 w/o intervention
upper airway noninfectious disorders - subglottic stenosis
- pres: stridor, increased work of breathing
- dx: narrowing of airway as a result of intubation
- intervention: oral/IV/inhaled epi, prep for surgery, supplemental O2
upper airway noninfectious disorders - apnea
NB
- risk factors: gestational age, maternal drug use, thermal instability, prematurity, infection, insufficient O2, metabolic/CNS disorder
- intervention: CPAP, BiPAP
Obstructive
- risk factors: enlarged tonsils, craniofacial abnormalities
- intervention: CPAP, tonsillectomy
lower airway noninfectious disorders - resp distress syndrome
- underdeveloped lungs in NB
- patho: deficient surfactant
- pres: s/s of resp distress within minutes of birth
- dx: “ground glass” (cloudiness) on CXR
- intervention: CPAP, admin surfactant
lower airway noninfectious disorders - cystic fibrosis
- autosomal recessive disorder of exocrine glands
- patho: excessive mucus production in lungs that leads to infection
- dx: prenatal DNA testing
- intervention: med admin - dornase alfa (things mucus)
lower airway noninfectious disorders - asthma
- chronic obstructive inflammatory disorder
- patho: narrowing, mucus
- risk factors: genetics, environment
- pres: cough (worse at night), SOB, wheezing, hx of allergies, hyperresonance
- dx: hx & physical, pulmonary function test (ages 5+)
lower airway noninfectious disorders - foreign body aspiration
- pres: coughing, wheezing, stridor, gagging, cyanosis
- dx: hx & clinical s/s, CXR, CT, MRI
- intervention: assess resp status, child assume position of comfort, prep for removal of object, monitor, abx, cool mist
lower airway noninfectious disorders - pneumothorax
- patho: air enters chest w inspiration, but cannot exit w expiration - accumulation of air compresses lung
- dx: CXR & clinical pres (decreased or absent breath sounds unilaterally)
- intervention: O2, needle aspiration/chest tube placement
