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Peds N304 > Peds Midterm Week 1 > Flashcards

Peds Midterm Week 1 Flashcards

1
Q

Children living with chronic violence may exhibit what behviors?

A
  1. difficulty concentrating in school and memory impairment.
  2. aggressive play & uncaring behavior
  3. constricted activities and thinking for fear of reliving traumatic event
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2
Q

The slight decline since 2002 in American youth’s illicit drug use is attributed?

A
  1. education regarding the adverse effects of illicit drugs
  2. parental disapproval
  3. decreased availability of drugs
  4. consistent participation in church and organized activities such as scouts and sports.
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3
Q

Infant ____:
Death in first year of life
Recorded per 1000 live births

A

mortality

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4
Q

____ is the major determinant of neonatal death in technologically developed countries.

A

Birth Weight

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5
Q

What factors increase risk of infant mortality?

A
  1. BW
  2. AA race
  3. Male gender
  4. short or long gestation,
  5. maternal age
  6. lower level of maternal education
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6
Q

What is the leading cause of death in children over age 1 year?

A

accidents

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7
Q

What age group has the lowest group of death and why?

A

5-14 year olds b/c of importance in following rules results in less accidents

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8
Q

What age group has a drastic increase in violent deaths? and why?

A

10-25 year olds b/c of “nothing can happen to me” attitude

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9
Q

Childhood ____ includes actue illness, chronic disease or ____.

A

Morbidity

disability

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10
Q

Which illness accounts for 50% of all acute conditions in childhood morbidity?

A

respiratory

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11
Q

What is the new pediatric social illness?

A
  1. behavior, social and educational problems
  2. psychosocial factors
  3. mental health issues
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12
Q

What risk factors contribute to childhood injuries?

A
  1. sex- male
  2. temperament- high activity level & negative rxn to new situations
  3. stress- increased risk taking & self destructive behavior
  4. alcohol and drug use- higher incidences of MVA, drowning, homicide and suicide
  5. Hx of previous injury
  6. development characteristics
  7. cognitive characteristics
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13
Q

What developmental characteristics contribute to childhood injury?

A
  1. mismatch b/w childs developmental and skill level
  2. natural curiousity to explore the environment
  3. desire to assert self and challenge rules
  4. in older child, desire for peer approval and acceptance
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14
Q

Describe cognitive characteristics that contribute to childhood injuries in the infant.

A

sensorimotor- explores thru taste/touch

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15
Q

Describe cognitive characteristics that contribute to childhood injuries in the young child.

A
  1. Object permanence: actively search for attractive object.
  2. Cause and effect: lacks awareness of consequential dangers
  3. Transductive reasoning: fails to learn from experience
  4. Magical and egocentric thinking: unable to comprehend danger to self or others
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16
Q

Describe cognitive characteristics that contribute to childhood injuries in the school age child.

A

Transitional cognitive processes:

  1. unable to fully comprehend causal relationships
  2. dangerous acts w/o detailed planning re: consequences
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17
Q

Describe cognitive characteristics that contribute to childhood injuries in the adolescent.

A

Formal operations:

  1. preoccupied with abstract thinking and loses sight of reality
  2. feeling of invulnerability
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18
Q

Describe anatomic characteristics that contribute to childhood injuries.

A
  1. large head- predisposed to cranial injury
  2. large spleen and liver- predisposed to direct trauma
  3. small/light body: thrown easily esp moving vehicle
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19
Q

What factors beyond cognitive, developmental and anatomical contribute to childhood injury?

A
  1. poverty
  2. family stress
  3. substandard alternative child care
  4. young maternal age
  5. low maternal education
  6. multiple siblings
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20
Q

What 3 concepts support family centered care?

A
  1. Enabling
  2. Empowerment
  3. Practicing cultural diversity
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21
Q

What is the definition of Atraumatic Care?

A

provision of therapeutic care in settings, by personnel, and through the use of interventions that eliminate or minimize the psychologic and physical distress experienced by children and their families in the health care system

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22
Q

What is the goal of Atraumatic Care?

A

Do No Harm

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23
Q

Describe developmentally appropriate communication in infants.

A

nonverbal- use crying to communicate

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24
Q

Describe developmentally appropriate communication in Early childhood (under age 5).

A

Egocentric- focus on child
Explain what, how, why
be consistent, dont smile while doing painful things

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25
Q

Describe developmentally appropriate communication in school age.

A

want explanations- why
concern about body integrity
Reassurance needed

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26
Q

Describe developmentally appropriate communication in Adolescents.

A

Be honest with them
Be aware of privacy needs
Think about regression
Realize impotance of peers

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27
Q

Describe therapeutic play with newborns

A

mobiles, music, mirrors, cuddlers

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28
Q

Describe therapeutic play with toddlers.

A

peek a boo
hide and seek
read favorite stories
use of transitional objects- Ex. talk to teddy bear first

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29
Q

Describe therapeutic play with preschoolers.

A

outline of body or doll to address fear of body harm.
play with safe hospitol equipment
crayons, color books, play dough
pet therapy

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30
Q

Describe therapeutic play with school age child.

A

regress developmentally
age appropriate crafts, games
tasks for sense of mastery/accomplishment

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31
Q

Describe therapeutic play with adolescents.

A 
loss of independence and regaining control
therapeutic recreation
peer contact via phone/visits
interact with other teens
physical activities
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32
Q

Identify the following age ranges:

  1. newborn
  2. infant
  3. toddler
  4. preschooler
  5. school age
  6. adolescents
A
  1. newborn= birth to 1 month
  2. infant= 1 to 12 months
  3. toddler= 1 to 3 years
  4. preschooler= 3 to 5 years
  5. school age= 6 to 11 years
  6. adolescents= 12 to 18 or 20 years
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33
Q

Describe growth measuremnts for the infant.

A

recumbent- length up to 36 months
weight
head circumference

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34
Q

Describe growth measuremnts for children over 36 months.

A

Standing height
weight
(head and chest circumference should be equal around 1 to 2 years)

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35
Q

How is corrected age determined in children born prematurely?

A

Calculated Age = Chronolgical Age - # of weeks premature

CA= CH - #

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36
Q

What is the correct order for vital sign measurement in infants and toddlers?

A
  1. RR
  2. apical HR
  3. BP (if required)
  4. temp
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37
Q

What are the avg RR in the following age ranges:

  1. newborn
  2. early childhood
  3. late childhood
  4. 15 years and older
A
  1. newborn: 30-60
  2. 20-40
  3. 15-25
  4. 15-20
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38
Q

What special breathing patterns exist in infants and early childhood?

A

infants: periodic breathing and diaphragmatic breathing (with abdominal movement)
early childhood: same breathing movement

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39
Q

What are the avg heart rates at the follwing ages:

  1. birth
  2. 0 to 6 months
  3. 6 to 12 months
  4. 1 to 2 years
  5. 2 to 6 years
  6. 6 to 10 years
  7. 10 to 14 years
A
  1. birth= 140
  2. 0 to 6 months= 130
  3. 6 to 12 months= 115
  4. 1 to 2 years= 110
  5. 2 to 6 years= 103
  6. 6 to 10 years= 95
  7. 10 to 14 years= 85
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40
Q

If the BP cuff size is too small how will the reading be impacted?

A

the reading on the device is falsely high.

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41
Q

If the BP cuff size is too large how will the reading be impacted?

A

the reading is falsely low.

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42
Q

Generally, is the systolic pressure in the lower extremities (thigh or calf) greater or lower than pressure in the upper extremities?

Is systolic BP in the calf higher or lower than that in the thigh?

A

greater

higher

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43
Q

What are normal systolc BPs at the following ages:

  1. birth
  2. 6 months
  3. 1 year
  4. 6 years
  5. 10 years
  6. 16 years
A
  1. birth: 50
  2. 6 months: 70
  3. 1 year: 95
  4. 6 yrs: 100
  5. 10 yrs: 110
  6. 16 yrs: 120
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44
Q

With oscillometry (Ie Dinamap), are BP readings higher or lower than measurements with auscultation?

A

higher- 10 mmHg

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45
Q

If BP is 95 percentile?

A
  1. normotensive
  2. prehypertensive
  3. prehypertensive
  4. hypertensive repeat at least 2x to confirm
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46
Q

What is the desired temp range for the neonate?

A

36.5 to 37.5 degrees Celsius

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47
Q

What is:

Marked asymmetry; abnormal and may indicate premature closure of the sutures

A

craniosynostosis

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48
Q

Head control:

At what age should head lag diminish? what does this indicate late?

A

4-6 months

Significant head lag after 6 months of age strongly indicates cerebral injury and is referred for further evaluation.

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49
Q

What is opisthotonos?

A

Hyperextension of the head with pain on flexion is a serious indication of meningeal irritation and is referred for immediate medical evaluation.

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50
Q

What is:
child holds the head to one side with the chin pointing toward the opposite side a result of injury to the sternocleidomastoid muscle.

A

wryneck, or torticollis

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51
Q

At what age does the anterior fontanel close?

A

12 to 18 months

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52
Q

At what age does the posterior fontanel close?

A

6-8 weeks

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53
Q

At what age should vision screening start?

A

3 years old then annually

54
Q

What is strabismus?

What is amblyopia?

A

Lazy Eye

Both eyes unable to focus simultaneously, brain suppresses image by deviating the eye

55
Q

What tests could be performed to indicate strabismus?

A

Hirschberg or corneal light reflex

56
Q

What vision test would the 3-5 year old use?

6 and older?

A

Illiterate or HOTV Allen card

Snellen

57
Q

To examine the eardrum, would the pinna be pulled up and back or down and back at <3 over 3?

A

under 3: down and back

over 3: up and back

58
Q

what does S1 signify?

A

closure of the tricuspid and mitral valves

59
Q

what does S2 signify?

A

closure of the pulmonic and aortic valves

60
Q

As a child, when is S2 splitting normal?

A

always, widens during inspiration

61
Q

When is S2 splitting abnormal?

A

FIXED splitting is abnormal. Ie, if it doesn’t widen during inspiration, can be a sign of atrial septal defect

62
Q

what is coarctation of the aorta?

A

lower extremity pressure is less than the upper extremity pressure.

63
Q

Define each murmur:

  1. No anatomic or physiologic abnormality exists.
  2. No anatomic cardiac defect exists, but a physiologic abnormality such as anemia is present.
  3. A cardiac defect with or without a physiologic abnormality exists.
A
  1. Innocent
  2. Functional
  3. Organic
64
Q

What is sinus arrythmia and is it normal in the child? how do you test for it and where is it heard the best?

A

Normal: HR increased w/inspiration & decreased w/expiration
test: have child hold breath. HR will remain steady with sinus arrythmia
Heard at Pulmonic area

65
Q

Where is the PMI located in the child under 7? over 7?

A

under 7: 4th ICS, lateral to mid clavicular line

over 7: 5th ICS, also LMCL

66
Q

What does capillary refill asess?

A

hydration and circulation

67
Q

Where are murmurs heard the easiest?

A

Erbs point

68
Q

Why is the abdomen of infants and young children cyclindrical and fairly prominent when erect?

A

physiologic lordosis of the spine

69
Q

What does a midline protrusion from the xiphoid to the umbilicus or symphysis pubis indicate?

A

diastasis recti: failure of the rectus abdominas muscles to join in utero.

70
Q

What does a tense, boardlike abdomen indicate?

A

paralytic ileus and intestinal obsturction

71
Q

What is the Ortolani maneuver?

A

during hip check: If the femoral head can be felt to slip forward into the acetabulum on pressure from behind, it is dislocated

72
Q

What is the Barlow maneuver?

A

Sometimes an audible “clunk” can be heard on exit or entry of the femur out of or into the acetabulum. If, on pressure from the front, the femoral head is felt to slip out over the posterior lip of the acetabulum and immediately slips back in place when pressure is released, the hip is said to be dislocatable or “unstable”

73
Q

What is genu varum? until what age is it ok?

What is genu valgum? age?

A
  1. bowleggedness, lateral bowing of the tibia: until 2 years old
  2. Knock knees: 2 to 7 years
74
Q

What is medial tibial torsion? by what age may it improve?

A

pigeon toes

age 3

75
Q

When is the Babinski reflex normal?

A

until 18 months

76
Q

Balance and coordination using the following tests what?

finger to nose, heel to shin and Romberg test

A

Cerebellar function

77
Q

What direction does motor maturation occur?

A

cephalocaudal progression

78
Q

What are cranial nerves I and II?

A

Olfactory

Optic

79
Q

How is the optic nerve tested in the infant?

child?

A

infant: eye blink with light

visual acuity

80
Q

What are cranial nerves III, IV and VI?

A

Oculomotor
Trochlear
Abducens

81
Q

How are cranial nerves III IV and VI tested?

A

Infant: focus on tracking
Child: cardianl gaze
*note symmetry and eyelid drooping and PERRLA

82
Q

What is cranial nerve V? and how is it tested?

A

Trigeminal
Infant: root reflex
Child: chewing on cracker; cotton test on the forehead

83
Q

What are cranial nerves VII and VIII?

A

Facial and Acoustic
Response to sound
Facial expressions and bilateral symmetry

84
Q

What are cranial nerves IX and X? how are they tested?

A 
Glossopharyngeal and Vagus
Palatal reflex: test by stroking side of uvula
infant: swallowing during feeding
child: speak clearly 
Gag reflex
85
Q

What is cranial nerve XI? test?

A

Spinal accessory

infant: not tested
child: raise shoulders; turn head against resistance

86
Q

What is cranial nerve XII? test?

A

Hypoglossal

infant: observe feeding
child: stick out tongue, midline and no tremors

87
Q

What impacts growth vs development?

A

growth: oxygenation
development: interaction w/ peers, family and environment

88
Q

What does linear growth reflect?

A

skeletal growth and oxygenation

89
Q

what does weight reflect?

A

growth, nutrition and fluid balance

90
Q

what does head circumference reflect?

A

brain growth

91
Q

By what age should you be half your adult height?

A

2 years old

92
Q

Describe weight increases for the first year of life.

A
  • Weight increases by 6-8 oz per week
  • 2x birthweight by 6 months
  • 3x by 12 months
93
Q

Describe head circumference change for 0 to 6 months of life.
Describe length increase for 0 to 6 months of life.

A

HC: 0.5 inch per month
Length: 1 inch per month

94
Q

Describe weight, length and head circumference increase for 6 to 12 months.

A

weight: 3-4 oz /week
HC: 0.25 inch per month
Length: 0.5 inch per month; height also increases by 50% by 12 months

95
Q

When does teething begin

A

6 to 8 months

96
Q

What reflexes does the neonate have and when do they disappear?

A
  1. Grasp
  2. Rooting, sucking
  3. tonic neck
  4. dance/step
  5. Babinski
  6. tongue extrusion
  7. spinal incurvation
  8. moro response
    * **All disappear by 6 months execpt Babinski
97
Q

If the primitive reflexes continue beyond 6 monts, what does it indicate?

A

neuromuscular deficit

98
Q

What is the landau reflex?

A

When infant is suspended in a horizontal prone position, the head is raised and legs and spine are extended; appears at 6 to 8 months, lasts until 12 to 24 months

99
Q

Describe proper car seat use for the following:

  1. infants and toddlers
  2. children over 2 years old
  3. booster seat
  4. lap and shoulder seatbelt
  5. at what age can the child move to the front seat?
A
  1. rear facing until 2 years old or reach wt/ht allowance
  2. forward facing
  3. if over forward facing allowance
  4. 4 feet 9 inches and 8-12 years old
  5. 13 years old
100
Q

What does the AAP recommend for all newborns (feeding wise)?

A

breast milk or formula exclusively until 4-6 months and BM or formula until 12 months
Give BM every 1.5-3 hours
Formula every 3-4 hours

101
Q

What are advantages of breast milk?

A 
decreased incidence of
otitis media, allergies, RTI
D/V
Meningitis, other infections
SIDs
Obesity and Type I and II diabetes
102
Q

At what age can breast milk be supplemented with iron?
Vit D supplementation?
Fluoride?

A
  1. 4-6 months with fortified cereals
  2. if decreased exposure to light: 400 IU/d
  3. 6 months if not in water (<0.3 ppm)
103
Q

Why shouldn’t infants have whole milk before 12 months?

what age can solid foods be introduced?

A

whole milk doesn’t have iron so whole milk can lead to anemia. Also problems with nutrient absorption.

4-6 months

104
Q

How are infants assessed for solid food readiness?

A
  • can sit
  • BW has doubled & weighs at least 13 lbs
  • can reach for an object, maintain balance
  • extrusion reflex gone
  • moves food to back of mouth, swallows during feeding.
105
Q

Define Colic and related theory.

A

crying (unconsolable rather than irritable), theories include interaction b/w mom and baby, smoking, gas.

106
Q

Why do babies “spit up”?

A

immature esophageal sphincter allows regurgitation when laying down after eating (burp and sit up after eating)

107
Q

Why do young children suck their thumb?

What are pacifiers used for?

A

Suck thumb: self-soothing when young, not recommended when teeth present
Pacifiers: comfort measure, also reduces risk of SIDs

108
Q

What are signs of teething?

A 
drooling 
increased finger sucking
biting on hard objects
irritability and difficulty sleeping
mild temperature elevation (fever over 39 is illness)
ear rubbing
decreased appetite for solid foods.
109
Q

Are frequent waking periods related to teething or other factors?

A

related to environmental, behavioral, or developmental changes rather than teething

110
Q

What oral care should parents perform during infancy?

A

wipe the infants gums with wet gauze 1-2x daily
Avoid bottles with sleep or bed
First dental visit 12-30 months

111
Q

What physical growth occurs during ages 1 to 4 years?

A

Weight increases 4 to 6 lbs per year
Height increases 3 inches per year
HC increases 1 inch per year

112
Q

When does the anterior fontanel close?

A

non-palpable at 12 months and closed completely by 18 months

113
Q

What are the classifications of play?

A
  1. Solitary Play
  2. Parallel Play: toddlers -due to egocentricity
  3. Associative Play: usually preschoolers -imagination and decreased egocentricity
  4. Cooperative Play (Team): late preschool associated with school age child
  5. Recreational Play: adolescents, need for peer presence
114
Q

What age group is associated with solitary play?

A

infants and toddlers -due to limited social, cognitive and physical skills

115
Q

What age group is associate with Parallel Play?

A

toddlers -due to egocentricity

116
Q

What age group is associated with Associative play?

A

usually preschoolers -imagination and decreased egocentricity

117
Q

What age group is associated with Cooperative Play?

A

Team: late preschool associated with school age child (Erickson’s industry)

118
Q

What age group is associated with recreational play?

A

adolescents, need for peer presence

119
Q

What is teh Denver Developmental screenting tool? what age is it applicable to?

A

Evaluates personal/social, fine motor, gross motor, language domains
- infants through 5.5 years

120
Q

How much food should a child receive?

A

Small portions:

1 tablespoon of food per each year of age

121
Q

What are early childhood caries defined as?

A

one or more decayed, missing teeth in a child < 5 years of age

122
Q

At what age does the child have a full set of 20 deciduous teeth?

A

2 years old

123
Q

What are deciduous teeth important for?

A

language development, spacing for permanent teeth and foster positive dietary habits

124
Q

What are the 4 common hazards for the toddler or preschooler?

A

Falls
Poisoning
Drowning
Burns

125
Q

What two age groups have the highest incidence of poisoning?

A

highest in 2-year-old age group

under 6 years of age

126
Q

What are the S/s of acute or chronic salicylate ingestion?

A 
N/V, dehydration
disorientation, coma, seizures
hyperpyrexia
oliguria
bleeding tendencies
tinnitus
127
Q

What are appropriate nursing interventions for salicylate poisoning?

A 
activated charcoal
sodium bicarbonate
external cooling measures
anticonvulsant/seizure precautions
vitamin K
hemodialysis (not peritoneal)
128
Q

What is the most common drug poisoning in children?

A

Acetaminophen (acute ingestion)

129
Q

What are the S/s of Acetaminophen poisoning?

A

N/V
pallor and sweating
hepatic involvement: jaundice, confusion, coag problems, RUQ

130
Q

What is the treatment for Acetaminophen overdose?

A

first: charcoal
Second: antidote -N-acetylcysteine (Mucomyst) PO q4h for 17 doses after the loading dose

131
Q

What should be assessed prior to administering all PO meds?

A

LOC

Peds N304 (4 decks)

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