Peds - Exam 1 - Concepts Flashcards
Communication by age
Infancy:
- Non-verbal, crying (caregiver best to interpret cries)
Early childhood
- Focus on child when communicating - explain what, how, why
- Use words child will recognize
- Be consistent with emotions (don’t smile while giving a shot)
School-age children
- They will want to know why and ask for explanations
- Concerned about their body integrity and need reassurance
Adolescents
- Be honest with them and aware of their privacy needs
- Very self-conscious - need to know something is normal
- Peers are very important to them
- Realize illness may cause regression
- Give undivided attention and be open-minded
Growth measurements - physical exam
- Recumbent length for infants up to 36 mos + weight and head circumference
- Standing height + weight after 37 mos
- Plot on growth chart - Less than 5th or greater than 95th percentile considered outside expected parameters
Clinical manifestations of food hypersensitivity
Systemic - anaphylactic, growth failure
GI - abdominal pain, vomiting, cramping, diarrhea
Respiratory - cough, wheezing, rhinitis, infiltrates
Cutaneous - urticaria, rash, atopic dermatitis (eczema)
Most common food allergens
Eggs
Cow’s milk
Peanuts
(Should be introduced after 1 years)
Vitals order for children
- Count respirations
- Count apical heart rate
- Measure blood pressure
- Measure temperature
Feeding difficulties
Regurgitation and spitting up is normal - except if persistent, large quantities, issues with weight
- If so, look into work up with GERD (actual diagnosis of reflux disease)
Colic:
- Loud crying, infant will pull legs up to abdomen
- Most common in infants < 3 mos
- Typically resolves 12-16 weeks
- Usually happens in evenings
Education for colic
- Swaddling
- Using pacifier after feedings
- Massaging abdomen
- Smaller, more frequent feedings
- Using a swing
- Don’t change formula too quickly - some degree of colic is normal
- It’s okay to take turns, walk away (prevent shaken baby syndrome)
- Breastfed - try having mom take dairy out of diet
Diaper dermatitis
Prolonged contact with irritant - usually urine or feces
(But soaps, detergents, wipes can cause as well)
Classic - skin folds are spared - no redness or irritation
Candida/yeast - WILL see extending into skin folds, well-demarcated borders, satellite lesions
Treatment:
avoid wetness - change diaper frequently, use barrier cream (zinc oxide or aquaphor)
Keep open to air when possible - time with diaper off if possible
Candida - antifungal (Nystatin front line)
Barrier cream - wipe some of cream (but not all) during diaper change, then add little more
Candida - antifungal first then barrier cream on top of it
Nonorganic FTT
- No known cause
Management:
- Consistent nurse caring for patient
- A lot of parent education
- Decreasing stimulation during feeds
- Persistence
- Positive feeding environment
- Established routine
Children with nonorganic FTT:
- May have trouble with behavioral interactions
- May be more interested in toy than personal interaction
- May not want to be held
Seborrheic Dermatitis
Chronic, recurrent, inflammatory reaction of the skin
Cause unknown - very common in infants
Scalp - cradle cap
Eyelids - blepharitis
External ear - otitis externa
Cradle cap - nursing considerations
- Olive oil or coconut oil on scalp - let it sit before shampooing
- Shampoo it daily
- Fine-toothed comb or soft brush to help brush afterwards to LIGHTLY remove scales (don’t be aggressive)
Atopic dermatitis (eczema)
- Category of dermatologic diseases and not a specific etiology
- Pruritic (itchy)
- Usually associated with allergy, asthma, seasonal allergies
- Hereditary tendency
- Common to see on face in infants
Therapeutic management - atopic dermatitis
Really good skin care:
- Take warm baths (not hot)
- Uses gentle soaps (like Aveeno)
- Older children - Dove sensitive skin BAR SOAP (less additives than liquids)
- After bath, PAT child dry, not wipe
- Immediately after, apply emmolient (Aquaphor or euceryn cream)
- Relieve itching - benadryl @ night to avoid night-time scratching, cool compresses
- Teach them to prevent secondary infections: don’t itch it; too young to understand that - put mitts on, keeping nails short and filing to avoid sharp edges
- Can use topical steroids if bad case or primary interventions didn’t work well
- Periods of remissions and flares - winter it’s dry, common to see flare
SIDS
Sudden death of infant less than 1 year old that remains unexplained after autopsy
Risk factors:
- Low birth weight
- Low apgar scores
- Recent viral illnesses
- Siblings of two or more SIDS victims
- Male sex
- Infants of Native American or African-American ethnicity
- Back to Sleep Campaign - push to lay infants on their backs not prone (reduced rate of SIDS by 53% in US)
Practices that reduce risk of SIDS
- Avoid smoking during pregnancy and near infant
- Breast feeding
- Supine sleeping position (BACK)
- Avoid soft moldable mattresses, blankets, and pillows
- Avoid bed sharing
- Avoid overheating during sleep
- Vary infant head position to prevent plagiocephaly (the same spot of head pressure)
Apnea of Infancy
Definition - unexplained respiratory pause lasting 20 seconds or more OR less than 20 seconds accompanied by pallor, cyanosis, bradycardia, or hypotension (term infant)
Causes: Hypoglycemia Respiratory condition Seizure Sepsis GI problem such as reflux Cardiac anomalies Preterm infants (risk)
What to do?
- Stimulate - rubbing trunk
- If prone, put on back
- 10-15 seconds LONGEST to try, then call 911/start CPR (or call code in hospital)
Apnea of Prematurity
- Cessation of breathing longer than 20 seconds, or any period with bradycardia and cyanosis not associated with any predisposing conditions
Therapeutic management:
- Theophylline, caffeine (stimulants)
- Home apnea monitors
- Lots of family support
- CPR training
Biologic development of toddlers
- Weight gain slows to 4-6 lbs/year
- Height increases about 3 inches per year
- AOM (acute otitis media - middle ear infection), tonsillitis, upper respiratory infections common
Why AOM are common:
- Eustacean tubes (inner ear tubes) - short and straight
- Have large lymphoid tissue compared to everything else
Gross and fine motor development of toddlers
Gross motor:
- Toddling gait
- Walks up and down stairs with 2 feet on each step
Improved coordination between ages 2 and 3
Fine motor development
- Improved manual dexterity ages 12-15 months
- Throw ball by age 18 months
Toddlers - psychosocial development
- Erikson - developing autonomy
“Autonomy” vs “shame and doubt” - developing sense of autonomy while overcoming shame and doubt
- Continued dependency creates sense of doubt - compounded by sense of shame for feeling this urge to revolt against others; will and a fear they will exceed their own capacity for manipulating the environment
“Ritualization” - need to maintain sameness and reliability
- provides sense of comfort
- Hospitalization can disrupt that sense of sameness, and cause distress
“Negativism”
As toddlers attempt to express their will, they often act with negativism
- giving negative response to requests – the words “no” or “me do” can be the sole vocabulary
- can become violently after if unable to manipulate something, throw tantrum over being scolded
Toddlers - Cognitive Development
- Piaget - sensorimotor and preconceptual phase (begins about age 2 - transition between self-satisfying behavior and socialized relationships)
- Awareness of causal relationships between two events (such as flipping light switch they know lights turn on) - not able to transfer that knowledge to new situations
- Learn spatial relationships - recognize different shapes and their relationship to one another – for example, can fit slightly smaller boxes into each other (nesting), place round object into a hole
- Tertiary circular reactions (13-18 months) - active experimentation to achieve previously unattainable goals - beginning of rational judgment and intellectual reasoning
Tertiary circular reactions (13 - 18 mos)
Cognitive development:
- Active experimentation to achieve previously unattainable goals
- Increased concept of object permanence
- Differentiation of oneself from objects
- Early traces of memory
- Beginning awareness of spatial, causal, and temporal relationships
- Able to enter into an action at any point without reproducing entire sequence
Behavior:
- Insatiable curiosity about environment
- Uses all sensory cues for exploration
- Ventures away from parent for longer periods
- Uses physical skills to achieve particular goal
- Can find hidden objects, but only in first location
- Able to insert round object into hole
- Fit smaller objects into each other (nesting)
- Gestures “up” and “down”
- Puts objects into container and takes them out
- Realizes that “out of sight” is not out of reach; opens doors and drawers to find objects
- Gains comfort from parents voice even if parent is not visible
Preoperational phase (2 - 4 years)
Cognitive development:
- Increased use of language as mental symbolization
- Egocentrism still present in thought, play, and behavior
- Increased sense of time, space, causality
Behavior:
- Uses two- or three-word phrases
- Increased vocabulary
- Refers to self by pronoun
- Possessive of own toys; uses word “mine”
- Begins to use past tense of verbs
- Uses phrases “going to” “in a minute” “today” “all done”
- Uses many future oriented words such as “tomorrow” “next day” “afternoon” but has poor concept of passage of time
Follows directions using prepositions such as “up” “behind” “under” “in back of”
Object permanence in toddlers
- Toddlers cannot find an object that has been displaced and is no longer visible or has been moved from one pillow to another without their seeing the change - however, increasingly aware of existence of objects behind closed doors, in drawers, and under tables
Egocentrism
- Inability to envision situations from perspectives other than one’s own
Animism
Attributing lifelike qualities to inanimate objects
Toddlers - moral development
- Kohlberg - preconventional level or premoral level - punishment and obedience orientation - if punished for it = bad; if not punished = good
- Basic understanding of moral judgment
- No concern for “why” something is wrong
- CONSISTENCY is important
Toddlers - Body image
- Refer to body parts by name (do not understand internal organs yet)
- Recognize sexual differences by age 2
Toddler - Sexuality
- Exploration of genitalia is common
- Gender roles understood by toddler
- Playing “house”
Toddler - Language
- Increasing level of comprehension
- Increasing ability to understand
Toddlers - Personal Social Behavior
- Skills for independence may result in strong-willed, volatile behaviors
- Skills include feeding, playing, and dressing and undressing self
- Imitation of behaviors
- Domestic mimicry
Assessing Readiness for Toilet Training
- Voluntary sphincter control (18-24 mo) - physically no control before that
- Able to stay dry for 2 hours
- Fine motor skills to remove clothing
- Willingness to please parents
- Curiosity about adult’s or sibling’s toilet habits
- Impatient with wet or soiled diapers
Optimum sleep for toddlers
11-12 hours of sleep a night
Toddler - dental health
- Regular dental exams
- Removal of plaque
- Fluoride (if not in water)
- Soft toothbrush
- Discourage child from going to bed with bottle or milk
Regressive behavior in toddlers - education
- Ignore regressive behavior - praise when acting developmentally appropriate
