Peds Test 1 Flashcards
Trust vs mistrust
30 days-12 months
If parents provide reliable care than trust. If not mistrust.
Stranger and separation anxiety.
Use distraction, let parents hold them.
What is the best way to assess an infant?
Observation
What is the age range for early childhood?
What is the basic conflict?
1-3
Autonomy vs shame/doubt
What is important for early childhood to develop?
A sense of control of physical skills and independence.
Success leads to autonomy. Failure results in shame and doubt.
What are the most important things to focus on with early childhood exam?
Verbal, motor skills. Independence and behavior.
Toddlers-
Make exam into a game.
Give them a choice.
Give safety blanket or toys.
Avoid lying if painful procedures
What is the age range for preschool kids?
3-5
What is the basic conflict with preschool?
Initiative vs guilt
Need to begin asserting control and power over the environment.
Success leads to sense of purpose.
Failure leads to guilt and disapproval.
What are some things to assess during preschool age?
Appropriate language.
Allow them to inspect the equipment.
What are some of the changes that happen with a preschool age child?
Knock knees. Increased coordination. Tonsils appear enlarged. No new teeth develop.
Pulse decreases to about 85.
What are some of the things that preschoolers can do?
Undress self. Stack blocks. Draw a stick figure and cross.
Runs, throw overhand.
Getting very imaginative, likes games with letters and numbers.
What is the age range for school age?
6-11
Basic conflict for school age?
Industry vs inferiority
Child needs to cope with new social and academic demands.
Success leads to sense of competence.
Failure leads to feelings of inferiority.
When doing a head to toe, what is the last thing to assess?
Genitalia.
Respect their modesty.
Is it good to use dolls and diagrams for school age?
Yes.
Also answer questions honestly.
What is the age range for adolescents?
12-18.
Basic conflict for adolescence?
Identity vs role confusion.
Need to develop sense of self and personal identity.
Success leads to ability to stay true to self.
Failure leads to confusion and weak sense of self.
What are some important things to consider when examining an adolescent?
Confidentiality, privacy, protection of modesty are important.
Allow option to examine without parent.
May ask why are you here?
What are some common concerns among adolescent girls?
Body image
Loss of appetite and weight.
Lack of satisfaction
What are some common concerns among adolescent boys?
Drop in grades.
Social withdrawal
Irritability.
How old do we stop doing head circumference test?
After 2 years old.
As child gets older, how do VS change?
Pulse and RR go down. And BP goes up.
Measure RR first, then pulse, then BP, temp last
Are sore, warm, swollen nodes common in children?
No, could be infection.
Small non tender single nodes are common.
When does the anterior fontannel close?
12-18 months.
Apical pulse location for baby and bigger kid
4th intercostal and 5th
Medication admin
Infants- safe, secure positioning
Toddlers- brief explanation, concrete. Puppets. Needeless syringe.
Preschool- educate family, magical thinkers.
School age- explore their feeling. Give choice.
Adolescent- explain, give time to digest. Then explain again.
Do we give medications in the play room?
No, this is their safe place.
What finger do you use for a suppository?
Pinky is under 3.
Index if over 3.
Always use a volutrol when giving IV fluids.
D
What is the normal bolus amount?
20ml/kg
Significant characteristic of how we are different.
Skin is thin and permeable.
Stomach lacks acid to kill bacteria
Lungs lack mucus barriers.
Liver and kidneys are immature. (Metabolism and excretion is impaired)
Body temps are poorly regulated and dehydration occurs easily.
How often do you change the site of the o2 probe?
Q 4
Probably on the test
Oral hygiene
What is the most common type of abuse?
Neglect
What is cutaneous pain?
Burns
What is somatic pain?
Muscles, joints
What is visceral pain?
Organs. Tummy ache
What are 4 measures to determine pain?
Behavioral, physiologic, self report, multidimensional (what makes it better or worse)
What is the regular urine output?
1-2ml/kg/hr
How long do you leave EMLA cream on for?
1 hour. Then do procedure
When to give pain meds
Round the clock RTC.
PO as much as possible.
Use only one drug, maximize dose.
Escalate dose, not frequency.
Live vaccines
Gives life long immunity in 1-2 doses.
Attenuated
Weakened version of pathogen.
Toxoid
Make body learn how to fight
Conjugated
Immune system makes antibodies to block pathogen.
What are some expected reactions to vaccines?
Temp, crabby, pain at site.
What are some severe reactions to vaccines?
Hives, rash, anaphylaxis.
Report to VAERS.
What are prodromal symptoms
Early S/S from onset. Can spread during this stage. Sniffles.
What are some contraindications for vaccines?
Allergy to components
Moderate to severe illness.
Immunodeficiency
Recent steroid use. (Asthma).
Varicella zoster (chicken pox)
Rash pruritic and progresses from Macules to papules to vesicular lesions before crusting.
Goes from top-down, mostly trunk.
Can spread day before breakout, and one week after crusting.
Put mittens on, keep them cool.
Never give ASA!
Diphtheria
Direct contact.
Sore throat, fever, bull neck, bad cough.
Watch for myocarditis
Roseola
Contracted through open membrane. Febrile seizures. Rash- flat/raised pink spots or patches. Pink patch with white ring. Does not itch. Covers entire body.
Erythema infectiosum (fifth disease)
Respiratory secreations, blood. Fetal death if mother pregnant. Slap in the face first. Then lacy rash. If overheated than rash will return. Stay out of sun and hot water.
Rubeola (measles)
Secretion, and droplet transmission.
Communicable 4 days before and after rash.
Starts at head and goes down.
Rash inside mouth, otitis media, PNA.
Can only get it once. White/blue patch in mouth.
Can be fatal.
Mumps
Droplet or direct contact. Highly contagious.
Fever, HA, malaise, earache, deaf, severe swollen glands.
Can get orchitis.
Can pass on one week before swelling.
Pertussis
Droplet or direct contact. Contagious.
Short, rapid coughs. With crowing (whoop)
The smaller the child the more dangerous.
Polio
Feces, urine, oropharyngeal secreations.
Complications- paralysis, stiffness in neck, back, legs.
Attacks nervous system.
Rubella ( German measles)
Direct or indirect contact, airborne. Highly contagious. 5 days before and after rash.
Complications- rare, greatest danger is teratogenic effect on fetus, miscarriage or death.
Rash- red, slightly raised, may be pruritic. Swollen lymph nodes.
More mild than rubeola. Only lasts about 3 days.
Scarlet fever
Droplet or direct contact.
Complications- rheumatic fever, peritonsillar abcess, glomerulonephritis.
Rash- bright red covering most of the body. Looks like a sunburn, feels like sandpaper. gets in creases. Starts with white tongue then strawberry red.
Usually starts with strep throat and can lead to glomerulonephritis.
Rotavirus
Fecal-oral
Comp- severe dehydration, serous if pregnant(birth defects, stillbirth)
Diarrhea, dehydration.
Can be fatal.
What is a crisis influenced by?
Age, past experiences, coping skills, level of knowledge, support and seriousness of the illness.
What is a toddles favorite word?
No.
Let parent hold them. They wonder why parent cant save them.
Give choices.
Make schedule as close as possible to home schedule.
Encourage one family member to stay with them.
What are preschools most afraid of?
Abandonment.
They think they’re sick because of something they did.
They are magical thinkers.
They think a tube will last forever. Have no concept of time.
What is the biggest fear of school age?
Loss of control.
Explain procedure simply.
They remember everything.
Give choices.
What is the biggest fear of the adolescent?
Loss of control, fear of altered body image, disability, death. Separation from peer group. Loss of privacy/identity. They get angry and kick the dog. They regress back to a better time. Explain the procedure multiple times.
What are the phases of separation anxiety?
Protest- cry and cling to parent.
Despair- depression. Not interested in food or play.
Detachment- sad even with parent. Withdrawn.
What age group does regression happen most?
Toddlers 1-3
Altered family roles
Anger and jealousy between siblings and ill child.
Ill child feels obligated to play sick.
Parents continue to be over protective.
