Peds Exam 2 Flashcards
what area of the body has a higher likelihood of injury by the age 6-12?
increased muscle tissue puts the risk of injury higher.
the 2-year period that precedes puberty
what is the average age for boys?
girls?
prepubescence
10 for girls and 12 for boys
Piaget’s concrete development is between which age range?
The ability to understand and apply reasoning to ______ concepts.
They work to classify and order the environment. What are three key concepts for this period?
7-11
concrete (still within their environment and unable to understand more abstract and broader issues)
1. math, symbols
2. less egocentric
3. reading
As to God, during the ages of 6-12, what do they think about Him?
they just want to know who this God everyone is talking about.
younger school age children behave according to what?
what do older children abide by?
they use consequences as a guide for moral behavior.
Older children can judge an act based on intentions, they utilize the golden rule.
How about Erikson’s stage from ages 6-12?
the boy scout age. They want to be independent, to try out tasks, feel accomplished–they want to show how useful they are. This is the sense of industry; we need to promote a growth mindset rather than a fixed one.
what’s a better time to teach sex education?
middle childhood–treat it as a normal part of growing up.
how is the relationship with families around 6-12?
family values take precedence over peer value systems.
Due to spending a lot of time with peers, they can begin to question or criticize parents.
They need and want restrictions and boundaries to provide them with security.
Ego mastery
Play is more physical activity that uses larger muscles which helps them acquire the feeling of mastery over themselves, their environment, and others–this is also a great way to relieve frustrations.
discipline at 6-12 years old
you start to teach them why things are wrong and point out a more acceptable form of behavior for future situations. Start to stimulate the child’s ability to empathize with the victim of a misdeed.
physically aggressive disciplines are linked to:
poor internalizing behaviors, depression, anxiety, hopelessness, aggression, violence.
bedtime resistance is common until what age?
12
in between ages 5-11 the average hours of sleep goes down from _____ to ______
11.5 hours to 9 hours.
child uses a booster until what height?
backseat until when?
57 inches tall or 4 ft 9 inches.
over 13 years old
chronic enuresis is called so if it is occurring for at least 3 months by the age of ____ and _____ for encopresis.
5 and 4.
primary enuresis or encopresis
never been accident-free for extended periods (or never been potty trained)
secondary encopresis or enuresis
the onset of accidents after a period of established continence
what is one unlikely cause of enuresis
chronic renal failure, a disorder that impairs the concentrating ability of the kidneys.
DDAVP (Desmopressin)
used to stop the frequent urination of enuresis by controlling sodium levels.
is considered second-line management
what three deficiencies (2 low, and 1 high) are possible causes of encopresis
hypothyroidism, hypokalemia, hypercalcemia.
low and slow, and then too much calcium also never lets anything move well.
The people of Flint, MI have this problem in their young…
constipation–encopresis
muscular dystrophy
a cause of encopresis
ADD and oppositional disorder can be a cause of what?
encopresis
Vanderbilt assessment tool
for ADHD, used by parents and teachers.
ADHD treatment (in those >5 years old)
methylphenidate (LA or IR)
lisdexamfetamine; start low and slow (based on symptoms rather than weight)
NEVER use with children with tic-like behaviors or hx of Tourette’s.
Adjunct therapy: tricyclic antidepressants, clonidine.
side effects of ADHD treatment (significant for child, but maybe not for adult)
abdominal pain, anorexia, headaches, sleep disturbances.
these are common side effects, so we will have to be more flexible with feeding schedules because of them.
what treatment is most effective for ADHD
multimodal treatment
3 stages of PTSD response
1) initial response minutes to hours of fight or flight
2) approximately 2 weeks when defense mechanisms are mobilized.
3) 2 to 3 months of coping, inquiry, may appear to be getting worse, flashbacks.
fluoxetine is the first choice for which age group?
> 8 years old.
SSRIs have a black box warning btw.
adrenal cortex is responsible for what?
the small amount of sex hormones released before puberty.
androgens increase rapidly around (___-___ years in boys) continuing for about ____ years
7-9 years, 15 years.
Thelarche ( ____ to_____ years):
Adrenarche (____to_____years):
Menarche: about _____ years after thelarche, menstruation begins.
8-13, breast buds.
8-13, pubic hair growth
2 years
puberty delay is classified if?
no thelarche by age 13
male maturation (9.5-14 years)
stage 1:
stage 3:
stage 5:
testicular enlargement and sparse pubic hair.
penile enlargement, voice changes, early facial hair.
gynecomastia occurs in 1/3 of midpuberty boys.
penile growth, first ejaculation, axillary, groin, and facial hair, final voice changes.
pubertal delay if:
no enlargement of testes or scrotal changes by 14 years old.
Erikson’s >12 identity development
group identity vs alienation
individual identity vs role diffusion/confusion: who they think they should be.
same-sex or opposite-sex friendships, and now romantic relationships.
The shift from concrete to formal operations in Piaget >11 years old.
abstract thinking
beyond the present
foresee a sequence of events
influenced by principles beyond their own thoughts and experiences.
–way past egocentrism.
Moral development by adolescence (highest step)
moral standards are considered subjective, and subject to disagreement. Justice, caring, and quality of life take precedence over established social norms.
“what’s the fairest most compassionate thing to do?–even if it contradicts laws or norms”
spiritual development by adolescence
During this period, there’s a shift towards introspection and personal belief systems rather than just following external rituals or practices. Teens often start to reexamine the beliefs and values they grew up with, questioning and sometimes reshaping them to fit their evolving identity and worldview.
What’s fascinating is that higher levels of religiosity and spirituality in adolescents are often linked to positive health behaviors. This can mean a greater sense of purpose, community, and support, leading to healthier lifestyle choices and a buffer against stress and adversity.
universal screening for hyperlipidemia is when?
first at ages 9-11 and then again at 17-21
adolescent vaccinations
tdap, meningococcal, HPV
if not complete: HepB, varicella.
enlarged testicular veins, resulting in pain or growth arrest of affected testicle may impair fertility; requires surgery or embolization.
varicocele
unilateral scrotal pain, redness, swelling, if sexually active, may be r/t STI
guess the treatment
often confused with what?
epididymitis (the key is that it is only affecting one area)
because it’s an infection, it can be related to a STI, and it needs antibiotic therapy.
often confused with testicular torsion.
surgical emergency; swollen and painful scrotum.
testicular torsion
what unlikely condition is r/t varicocele
gynecomastia. You will need plastic surgery for moobs
retin A, topical or systemic antibiotics can be used for what?
acne vulgaris
anorexia, bulimia, and female athlete triad need this for therapeutic management
nutrition, behavioral, pharmaco, psychotherapy.
hypothalamic disorder is linked to what in the female reproductive system?
secondary amenorrhea
pain during or before period
primary (ovulation)
secondary (endometriosis, PCOS)
dysmenorrhea
prostate is tender on exam–testicular torsion or epididymitis?
epididymitis
Turner Syndrome (the lost X)
Short Stature: Most girls with Turner syndrome are shorter than average1
.
Ovarian Dysfunction: The ovaries don’t develop properly, leading to infertility and lack of menstrual periods1
.
Physical Features: These can include a webbed neck, low-set ears, puffiness or swelling of the hands and feet at birth, and a low hairline at the back of the neck. Knock knees. Increased carrying angle of arms. Large hands.
Heart Defects: Some individuals may have heart defects, such as a narrowing of the aorta1
.
Kidney Problems: There can be abnormalities in kidney structure and function1
.
Skeletal Abnormalities: Issues like scoliosis (curvature of the spine) can occur1
.
Learning Difficulties: Some girls may have specific learning disabilities, particularly in math1
.
Female Athlete Triad
-menstrual irregularities, weight loss, frequent injuries with slower recovery.
-hyper fixation on body image, mood shifts (Depression, anxiety)
-unhealthy eating behaviors, excessive exercise, improper recovery.
in the first few months of life, >2 week duration, no recognized pathogens.
intractable diarrhea of infancy
or in other words, non-trackable diarrhea.
6-54 months of life
normal growth
no blood in stool
no infection
maybe d/t dietary habits: name two of those
chronic nonspecific diarrhea
(so non-specific that it could really be anything causing it)
juice or artificial sweeteners
resembles food poisoning, watery diarrhea w/o blood.
norovirus
vomiting followed by onset of watery stools. Vaccine by age 5
rotavirus
traveler’s diarrhea
bloody diarrhea
E. coli
life threatening conditions like seizures, afebrile and nontoxic in infants, septicemia and meningitis, may last as long as 2-3 weeks. abx not recommended unless a complicated case
salmonella
what is a key therapy for vomiting and diarrhea (for fluid loss)
oral rehydration therapy
other therapies for diarrhea
probiotics
IV rehydration
could be abx
severe vomiting can contraindicate which rehydration therapy?
the oral one
why not the BRAT diet?
need other nutrients besides carbohydrates, but also nothing high in salt or sugar.
meconium ileus is a sign of what?
cystic fibrosis
if baby is breast fed and begin the switch to cow’s milk, what can happen?
constipation
Increased ICP
mechanical obstruction of GI
adrenal insufficiency
nephrologic disease
psychogenic problem
toxic ingestion
migraine HAs
these are all causes of what?
vomiting
reasons: can affect parts of brain that control n/v; the pressure builds up and relieves by coming out mouth; low cortisol, fucks up the GI; the high amount of toxins building up in body causes spewing; it’s all in your head; it needs to get out; again, a brain issue.
acute glomerulonephritis
-puffy eyes and face
-coca cola colored urine.
- immune complexes messing up the glomerular filtration system. Systemic diseases like lupus could be a cause.
get BUN/creatinine and serologic tests.
caused by strep infection
-just support and recovery will be spontaneous
nephrotic syndrome
neFROTHY urine
massive protein loss
hypoalbuminemia
hyperlipidemia
edema
–get UA, CMP, CBC, serum protein and cholesterol, and a renal biopsy.
–give steroids, low salt diet, and loop diuretics for edema.
what antinausea med should not be given to pediatric patients
ondansetron
mega tensed colon
lack of peristalsis
tiny sphincter reflex
more common in males
congenital anomaly- lacks nerve cells in colon, hence the lack of mvmt.
bulging abdomen
what is the diagnostic test needed?
How about surgery? Will they recover full function?
Hirschsprung Disease
rectal biopsy
three different surgeries–most reach full continence.
newborn: failure to mass meconium within 24-48 hours, bilious vomiting
infancy: FTT, enterocolitis
childhood: ribbon-like, foul smelling stools, visible peristalsis
Hirschsprung Disease
When does GER not resolve spontaneously by 4 months?
when FTT, respiratory conditions, and or dysphagia develop.
hence the asthma developing in childhood
complication of GER
recurrent pneumonia
esophageal issues
anemia
infants with GER treatment
upright positioning, prone positioning (not recommended for sleeping), thickened feedings.
when is surgery recommended for GER, what kind of surgery?
when there is aspiration pneumonia, FTT with failed response to meds or nutritional treatment.
procedure is fundoplication
acute appendicitis can lead to _______ which can cause ______
SBO, ileus
Dunphy sign
increased pain with cough
other appendicitis signs
McBurney point (RLQ)
Rovsing sign (LLQ referred pain)
Obturator sign (pain internal rotation)
s/s of appendicitis
rigid abdomen
decreased or absent bowel sounds
vomiting from pain
anorexia
constipation/diarrhea
stooped posture
rapid, shallow breathing
found in ultrasound and maybe CT screening for appendicitis
Enlarged Appendiceal Diameter: The appendix is wider than normal (usually more than 6 mm).
Wall Thickening: The walls of the appendix are thicker due to inflammation.
Fat Streaks: Strands of inflamed fat around the appendix, indicating irritation and swelling.
Phlegmon: A diffuse inflammation of subcutaneous connective tissue that spreads, often seen as a mass-like area around the appendix.
Fluid Collection: Accumulation of fluid around the inflamed appendix, which can indicate an abscess.
Extraluminal Gas: Presence of gas outside the appendix, which can suggest a perforation or advanced infection. Accuracy with imaging is 95%
therapeutic management for appendicitis
surgical removal of appendix, preop abx, IVF, electrolytes, RLQ incision or laparoscopic.
ruptured appendix- systemic abx, NG low intermittent gastric suction, delayed wound closure.
prognosis: less than 1% mortality rate with rupture.
conditions associated with esophageal atresia and tracheoesophageal fistula
Vertebral defects
Anal atresia
Cardiac defects
TracheoEsophageal fistula
Renal anomalies
Limb abnormalities
atraumatic care for appendicitis includes what?
light palpation, use stethoscope initially as children are more likely to let you do this.
-always assess degree of change in behavior.
inflammatory bowel disease medical management
biologics, immunomodulators, antibiotics, steroids, 5-ASAs.
IBD other info
at risk for growth failure/malnutrition; high protein/high calorie diet; TPN.
surgery: subtotal colectomy, ileostomy, segmental intestinal resection.
prognosis: chronic disease; higher risk for colorectal cancer.
anorexia, weight loss, and growth retardation may be high in Crohn’s or UC?
Crohn’s disease because it affects a greater range of the digestive system and can even be as high as the mouth.
anal and perianal lesions and fistulas/strictures are common in which of the two IBDs?
crohn’s disease because it goes much deeper in the mucosa.
often severe diarrhea (IBD)
U.C.
Facts about Meckel Diverticulum
abdominal pain similar to appendicitis. May be vague and recurrent.
bloody stools that are painless, bright or dark red with mucus (currant jelly-like stool) In infants, bleeding sometimes accompanied by pain.
- a presenting sign.
Occasional severe anemia, shock.
Usually only symptomatic in 2% of adult patients, more common in mend, symptomatic before 2 years of age mostly, 2% of population, about 2 inches long.
malrotation and volvulus
abnormal rotation of the intestine around the superior mesenteric artery during embryologic development; may manifest in utero or at any age, but the majority of patients present in the first month of life.
infants may have intermittent bilious vomiting, recurrent abdominal pain, distention, or lower GI bleeding.
most serious type of intestinal obstruction because if the intestine undergoes complete volvulus, compromise of the blood supply will result in intestinal necrosis, peritonitis, perforation, and death.
feeds well for half a month, but then starts projectile vomiting, and immediately after wants to feed again. Voracious appetite.
hypertrophic pyloric stenosis
-empty lower right quadrant called the Dance sign.
-sudden acute pain, child screams. After episode, they seem perfectly fine.
-red currant jelly-like stools.
-palpable sausage-shaped mass.
intussusception
treatment for intussusception
gas enema rather than a hydrostatic enema.
If nonoperative reduction is not successful, then surgery is required.
Short-Bowel syndrome
usually due to extensive resection of the small intestine.
decreased intestinal surface area for absorption of fluid, electrolytes, and nutrients.
a need for parenteral nutrition
steatorrhea
excessive foul-smelling stools
malnutrition, anorexia.
muscle wasting, anemia, abdominal distention.
irritability, uncooperativeness, apathy.
celiac disease
the mind-gut connection
celiac crisis
acute, severe episodes of profuse watery diarrhea and vomiting.
May be precipitated by:
-infections (particularly GI related)
-prolonged fluid and electrolyte depletion.
-emotional disturbance
umbilical hernia
common, “incarceration” is rare, resolves spontaneously by 3-5 years.
inguinal hernia
opening in scrotum or round ligament in labia.
asymptomatic unless abdominal contents are forced into the patent sac.
painless inguinal swelling, reducible by gentle compression, appears when straining, coughing.
if herniated loop of intestine become incarcerated, risk for bowel strangulation/necrosis.
more common in premature infants <12 months, can be surgically repaired after 12–18 months.
rare birth defect.
bowel, liver, and sometimes other organs remain outset the abdominal wall in a sac.
omphalocele
bowel herniates through a defect in the abdominal wall.
no membrane covering exposed bowel.
gastroschisis
which options increases fluid requirements:
fever
cold stress
diabetes
liver failure
burns
shock
tachypnea
bradypnea
radiant warmer
phototherapy
fever, diabetes, radiant warmer, phototherapy, shock, burns, tachypnea.
which options decrease fluid requirements
heart failure
stroke
seizure
mechanical ventilation
after surgery
during surgery
increased ICP
TBI
heart failure, mechanical ventilation, after surgery, increased ICP.
a higher metabolic rate in infants can cause what? Why is it higher?
insensible fluid loss, to support tissue and cellular growth.
1-10 kg, what is the amount of fluid per day.
100ml/ kg
11-20kg, what is the amount of fluid per day.
1000ml plus 50 ml/kg for each kg >10kg
so essentially, if the child is 15 kg, that is 5 kg over 10, so you would do 50 ml*5= 250 ml.
Your base amount is 1000 ml+250= 1250 ml
> 20 kg, what is the amount of fluid per day.
1500ml plus 20 ml/kg for each kg >20 kg.
so if the child is 30 kg, then you’d take 20 ml*10 kg= 200+1500ml= 1700ml
electrolyte deficit exceeds water deficit, water transfer from ECF to ICF increasing ECF volume LOSS=shock.
hypotonic dehydration
what two types of dehydration can cause shock?
isotonic (dangerous because there is an equal loss of water and electrolytes, lessening ECF volume with no exchange happening) and hypotonic(loss of fluid from ECF to ICF–increasing ECF volume loss).
water loss in excess of electrolyte loss, most dangerous, requires specific fluid therapy, fluid shifts from ICF to ECF, shock is not a usual manifestation.
hypertonic dehydration
what is the most dangerous form of dehydration that requires specific fluid therapy
hypertonic dehydration
primary form for children, major fluid loss is from ECF, reduces plasma volume and circulating blood volume, major effects on skin, muscles, kidneys, risk for hypovolemic shock.
isotonic dehydration
which form of dehydration has an actual risk for hypovolemic shock
isotonic dehydration
what are some unlikely symptoms of urinary tract disorders or disease
poor feeding
failure to gain weight
vomiting
excessive thirst
hypertension
tetany
seizures
primary vs secondary reflux
primary: congenitally abnormal insertion of ureters into bladder.
secondary: result of acquired condition (high pressure in bladder, dysfunctional voiding, neurogenic bladder often secondary to spina bifida)
VUR facts
-puts you at an increased risk that a lower UTI will become pyelonephritis
-child receives continuous antibiotic prophylaxis
-surgery can happen, but usually condition resolves itself within 5 years.
-the biggest risk is kidney damage resulting from repeated UTIs.
which two conditions use serologic tests
Celiac’s disease and acute glomerulonephritis
which condition receives steroid and loop diuretic therapy?
nephrotic syndrome
which condition receives a renal biopsy?
nephrotic syndrome
with oral rehydration, for diarrhea
50-100 ml/kg is given + 10 ml/kg for each stool.
ORS for emesis?
2-5ml by syringe or medicine cup every 2-3 minutes (slow to every 5 min if emesis continues)
