Peds: Test Two: Growth/Development, Infectious Disease Flashcards
0
Q
How long should a newborn only have breast milk or formula before adding in new foods?
A
up until 4 months when you can add cereal/baby food
1
Q
What type of play do newborns like?
A
Faces, mobiles, black & white
2
Q
What type of anticipatory guidance should you expect with a newborn?
A
Nutrition, NB care safety, infant stimulation
3
Q
What are the effects of hospitalization for a newborn until 8 months?
A
Separation, disruption of routines, regression
4
Q
What are some safety hazards for ages newborn through at least 10 months?
A
Positioning, choking, falls, aspiration, suffocation, car safety, burns, choking, pulling objects.
5
Q
What ages are Erikson’s Trust vs. Mistrust stage occuring?
A
Birth until 1 year.
6
Q
What ages is Erikson’s Autonomy vs Doubt & Shame occurring?
A
1-3 years.
7
Q
What ages does Erikson’s Initiative vs. Guilt occur?
A
3-6 years.
8
Q
What ages does Erikson’s Industry vs. Inferiority occur?
A
6-12 years.
9
Q
What ages does Erikson’s Identity vs. Role Confusion occur?
A
12-18 years.
10
Q
What ages is Piaget’s Sensorimotor Stages?
A
birth until 2 years.
11
Q
What ages are Piaget’s Preoperational Stage?
A
2-7 years
12
Q
What ages are Piaget’s Concrete Operational stage?
A
7-11 years.
13
Q
What ages are Piaget’s Formal Operational stage?
A
11-adulthood
14
Q
What are Kohlberg’s Stages of Moral Development?
A
Preconventional (4-7 years); Conventional (7-11 years); Postconventional (12+)
15
Q
What are the gross and fine motor skills of a 2 month old?
A
Gross=lift head; Fine=open hands
16
Q
When does a baby begin to follow with their eyes?
A
2 months.
17
Q
When does a baby coo and have different cries?
A
2 months.
18
Q
What types of play do babies at 2 months like?
A
Colors, talk, rattle.
19
Q
What is some anticipatory guidance for a 2 month old?
A
Dtap, IPV, Hib, Hep#2
20
Q
What are some gross and fine motor skills for a 4 month old?
A
Gross=head control, rolls, plays with feet; Fine=regards hands, reaches
21
Q
When does a baby turn its head to locate sound?
A
4 mos
22
Q
When do babies chuckle?
A
4 months.
23
Q
When can you add cereal/baby food to the baby’s diet?
A
4 months
24
What is some anticipatory guidance for a 4 month old?
Dtap, IPV, Hib
25
What are some gross and fine motor skills for a 6 month old?
Gross=sits with support; fine=palmar grasp, transfers hand-hand
26
When can a baby fixate on a small object?
6 months.
27
What age can a baby do 1 syllable babble & vowel sounds?
6 months
28
When does a baby have stranger anxiety?
6 months & 15-18 months
29
What does a baby at 6-7 months like to play?
peek-a-boo
30
What is the anticipatory guidance for a 6-7 month old?
Dtap, IPV, Hib, injuries, diet
31
At what age does a baby pull to stand?
8-10 months.
32
At what age do babies have depth perception?
8-10 mos.
33
At what age can babies say "dada" and understand simple commands?
8-10 mos
34
What age do babies have object permanence?
8-10 mos.
35
At what age can you add fruits/veggies & soft table foods?
8-10 months.
36
What age do babies like to play with balls, books, & food?
8-10 months.
37
What anticipatory guidance do you expect at 8-10 months?
HBV #3, IPV, Dtap, diet, safety
38
What age do babies get separation anxiety?
8-10 months.
39
What age can a baby begin to walk and then run?
12 months=cruises; 15-18=walks/runs
40
What age does a baby have fine motor skills like finger foods, holding crayons?
12 months
41
What age does a baby follow moving objects and have symbol recognition?
12 months
42
How many words does a baby have at 12 months?
3-5 words
43
At what age does a baby search for objects?
12 months
44
At what age do you stop bottle and do whole milk?
12 mo
45
What are the effects of hospitalization for ages 1-2?
Separation, confusion, regression, loss of control.
46
What are the safety concerns for 12 month olds?
falls, outlets, pulling objects.
47
What are the gross and fine motor skills for 15-18 mos?
Gross=walks, runs; Fine=2 cube tower, scribbles, spoon
48
How many words does a 15-18 month old have?
10-15
49
What types of toys do 15-18 month olds like?
push-pull toys and balls
50
What anticipatory guidance do you expect at 15-18 months?
safety, nutrition
51
What safety concerns do you worry about at 15-18 months?
choking, falls
52
What age can a child go up and down stairs with 2 feet?
2 years.
53
When can a baby walk backwards/forwards?
2 years.
54
What are the gross and fine motor skills of a two year old?
Gross=narrow gait, up and down stairs with 2 feet, walks forward/backwards; fine=increased manual dexterity, circle.
55
When does a baby begin to explore with all senses?
2 years.
56
What is the vocab of a baby at 2 years old?
"No"; 200-300 words; 2 word sentences
57
What age do babies develop sibling rivalry, temper tantrums, and negativism?
2 years (terrible twos)
58
What do kids at 2 years like to play with?
parallel, water.
59
What safety concerns do you have with a child at 2 years of age?
falls, burns, collision injuries, poisoning
60
What are the gross and fine motor skills of a 3-5 year old?
Gross=rides bike, walks on tip toes, jumps; fine=refinement of eye-hand coordination, O (3yr) + (4yr)
61
What are the vocal capabilities of ages 3-5?
900 words, 4-5 sentences, talks incessantly, stutters, sings songs
62
At what ages do kids start to show off and begin to have fears?
3-5 years
63
What what age is it important to start a low fat, high calcium diet?
3-5 years
64
What do 3-5 year olds like to play with?
imaginary friend, associate play, imitative, imaginative
65
What are the effects of hospitalization for ages 3-5?
Loss of control, regression, fear of altered body image, mutilation, aggression, fantasies
66
What are the safety concerns of ages 3-5?
MVA's, drowning, falls, poisoning, burns, fire prevention
67
What are the gross and fine motor skills of ages 6-11?
Increased muscle mass & coordination, tie shoes, cut with scissors, etc.
68
What are the vocal capabilities of 6-11 year olds?
Increased language skills, love jokes/puns.
69
At what ages do boys associate with boys/girls with girls?
6-11 years
70
What nutrition is important for 6-11 year olds?
low fat food guide pyramid.
71
What type of play do 6-11 year olds like?
cooperative, rules, teams, games
72
What is the anticipatory guidance for 6-11 year olds?
Nutrition, physical fitness, dental care, hygiene, smoking and drug edu, Bike safety
73
What are the effects of hospitalization for 6-11 year olds?
Fear of loss of family place, fear of harm/body injury, fear of death, loss of control, regression, boredom, concerns for privacy
74
What are the safety concerns with ages 6-11?
bikes, risk taking activities, latchkey kids, firearms.
75
What are the gross and fine motor skills of ages 12-18?
awkwardness develops into muscle control and coordination; adult fine motor control
76
At what ages do kids define independence, peers are very important, emotional/social turmoil, and interested in the opposite sex?
ages 12-18
77
What is the anticipatory guidance for 12-18 year olds?
areas of mental health, sexual bx, violence, MVA's, nutrition/eating d.o's, fad diets.
78
Effects of hospitalization for ages 12-18?
Loss of independence and control, loss of identity, body image disturbance, separation of peers
79
Safety concerns for ages 12-18?
Risk taking activities, MVA's, drugs, sun protection
80
What is the expected weight gain for the new infant?
1.5/month for first 5 months; should double by 5-6 months; should triple by 12 mos.
81
What is the height increase amount for the new infant?
increase 1 inch/mos; increase by 50% by 12 mos.
82
What is average head growth for the new infant?
increase 1.5 cm/mo; by one year, has increased 33%
83
Binocularity (fusion of 2 ocular images into one cerebral picture) begins to develop by ___weeks and well developed by ___ mos.
6; 4
84
Fetal hemoglobin is present for the first ___ mos. Results in shortened survival of RBC's and results in ___
5; physiologic anemia.
85
Maternal iron stores are present for ___ mos and gradually diminish.
5-6.
86
The digestive process in the infant is immature because ___ & __ are deficient.
amylase (responsible for digestion of complex carbs); lipase (limited amt makes if difficult to digest fats).
87
Infants have an inability to conjugate bilirubin and secrete bile until _____
couple weeks old
88
The infant receives passive immunity (maternal IgG) until about ___; has 40% adult levels by age ____
3 mos; 1 year.
89
Production of IgA, IgD, and IgE not attained completely until _____
early childhood (6 yo)
90
Moro Reflex aka _____
startle reflex
91
The Moro Reflex begins when? fades by about ___ mos and disappears by ___
at birth; 4; 6
92
The Stepping Reflex is usually gone by about ___
4-8 weeks
93
How do you elicit the Moro Reflex and what is the expected result?
Startle the infant with a sudden noise or change in position; The arms should extend and the fingers form a C as they spread. The arms slowly move together as in a hug. The legs may make a similar motion.
94
The Palmar grasp reflex begins and ends when?
present at birth; disappears by about 3 months.
95
How do you find the Palmar grasp reflex? What is the expected result?
Place finger across infant's palm and avoid touching the thumb. A strong grip around the finger is normal.
96
How do you elicit the Plantar grasp and what is the expected result?
Place finger across the foot at the base of the toes. The toes normally curl as if gripping the finger.
97
When does the Planter grasp reflex start and end?
present at birth; disappears at about 8 months.
98
How do you elicit the Stepping Reflex and what is the expected result?
Hold the infant erect and touch the bottom of one foot on the surface of the table or chair. The feet lift in an alternating pattern as if to walk.
99
When does the Stepping Reflex begin and end?
Begins at birth and disappears between 4-8 weeks
100
How do you elicit the Tonic Neck reflex and what is the expected result?
Place infant in supine position and, when relaxed, turn the head to one side. Repeat by turning the head to the opposite side. The arm and leg on the face side normally extend and the opposite arm and leg flex, as if to assume a fencing position.
101
Tonic neck reflex aka ____
fencing reflex.
102
When does the tonic neck reflex begin and end?
Appears about 2 mos of age; decreases by 4 months; disappears no later than 6 months; it must disappear before the infant can turn over.
103
What is nutrition like for the newborn?
2-3 ounces breast or bottle every 2-3 hours.
104
How long does it take for the umbilical cord to fall off?
about 10-14 days
105
What is the average amount of sleep for a newborn?
16-18 hours.
106
What is a schedule for a follow-ups with the MD after the newborn is discharged?
2-3 days, then week after that, then 2 weeks age, then 1 month, then 2 months.
107
At what age can the newborn start daycare?
At about 6-8 weeks (after they've started their immunizations)
108
How long should the car seat face backwards for a child?
until 1 year of age or 20 lbs.
109
How long should you keep a baby out of the sun?
until at least 6 mos when they're allowed to wear sunscreen
110
What is some umbilical cord care?
Don't put over diaper; practices vary according to region/institution; objectives are to prevent infection and promote cord separation; Practices include: no care, application of triple dye, application of povidoneiodone, isopropyl alcohol, or antimicrobial ointments. Aseptic care decreases bacterial colonization but delays cord separation.
111
What are three types of formula?
Ready to feed (won't have needed fluoride like others bc you don't mix it with water), Concentrated (add H2O), Powder (add H20 and shake well).
112
Where is the most accurate temperature taken in babies?
Rectally.
113
Any temp greater than ___ rectally is a fever.
100.4
114
The anterior fontanel is ___ shaped and smaller than ___ in diameter at 6 months and then becomes progressively smaller. It close between ____
diamond shaped; 5 cm (2 in.); 12-18
115
The posterior fontanel close between ___ months.
2-3
116
What is some circumcision care for the newborn?
Cover head of penis with petroleum jelly with each diaper change until redness goes away (and keeps it from sticking to diaper); Pale yellow crust around the incision and on glans is normal for several days; use cotton ball moistened with tap water to gently clean head; contact MD if increased redness, bleeding, or swelling of head occurs.
117
It would be a red flag if there was no responsive smile at ____ weeks.
8
118
What age are the following motor skills beginning: Open hands often, brings hands to midline, holds rattle, positive head lag, holds head and supports weight on forearms while prone, turns from side to back?
2-4 months
119
What age are the following motor skills beginning: draws arms and legs to trunk with cry, holds hands in fist, may lift head briefly?
newborn.
120
What age does the baby know the parent's voices and follows them?
2-4 months.
121
How do you heat up a baby's bottle?
Not in microwave (creates "hot spots"); use bowl of water and put it in microwave/boil, then put bottle inside bowl to warm it
122
At what age do teeth begin to erupt?
4-6 mo
123
When does the baby double its weight?
by 6 months.
124
May be a red flag if the baby doesn't reach for objects by ___
5 mo
125
What age is the following motor skills: Regard hand, reaches and grasps, mouths objects, holds feet ("find their feet"), intentional palmar grasp, lift head/chest 90, rolls back to stomach, pos. head control?
4-6
126
When does a baby watch the course of a falling object, respond readily to sounds, explores objects with mouth and all senses?
4-6 mo
127
When does a baby laugh out loud and babble using consonant sounds (HNGKP)?
4-6
128
When does a baby's play become more manipulative behaviors and solitary play?
4-6 mo
129
What is the extrusion reflex and when is it gone?
When something touches the baby's lips/mouth, the tongue extends forward; it is gone by 4-6 mo
130
What should you delay feeding the infant until 1 year of age to prevent allergic reactions?
Eggs, strawberries, tomatoes, wheat, corn, fish, nuts
131
What age can you introduce fruits/veggies?
6-8
132
What age can you introduce meats?
8-10 mo
133
How long should you avoid giving babies honey?
until 1 year old because of botulism (after 1, body can handle spores)
134
A baby shouldn't have normal milk until age ___
1
135
What age can you start introducing "table foods" to a baby?
10-11; make sure soft
136
What age does teething start?
6-8 months
137
A red flag may be if there's a positive head lag at ___ months.
6
138
What age group are these motor skills: palmar grasp, feet to mouth (discovers feet), better eye/hand coordination, bangs objects, transfers object hand to hand?
6-8 months.
139
What age do babies imitate sounds, have vowel sounds, and one syllable babble?
6-8 mos
140
What age is peek-a-boo popular?
6-8
141
Why should you add vegetables before fruits into a babies diet?
fruits are sweet so if you give them first they won't want anything else.
142
What age can you put juice into a cup?
6-8
143
What age are we going to start worrying about dental caries prevention?
6-8 mo
144
Reflex when you hold the child upright and then rotate his body quickly face forward (as if falling). The baby will extend his arms forward as if to break a fall
Parachute reflex
145
What age does the parachute reflex begin?
8-10 mos
146
What age does the baby get the Pincer grasp?
8-10 mo
147
What age does a baby pull to stand and army crawl?
8-10 mos
148
When does a baby start to say "no" and understand words?
8-10 mos
149
What is a good rule of thumb for deciding if something is a choking hazard?
if it can fit through a TP roll = choking hazard
150
Stranger anxiety occurs around ___ months and may last until ____
7-9 mos; 16-30 mos
151
What age can a baby "cruise" (close to walking, can hold things and walk) and stand alone?
10-12 mos
152
What age do babies start to hold crayons?
10-12 mos
153
At what age is it a red flag if they are not pointing at objects?
10-12 mos
154
How many words does a baby have at 10-12 mos?
3-5 words
155
What age do babies like to play with push-pull toys, empty out, and stack up/knock down?
10-12 mos
156
What age do we stop the bottle?
10-12 mos
157
What is a food jag?
when a baby only wants one thing to eat all the time
158
When do food jags start in babies?
12-15mos
159
At what age is it a red flag if they can't walk?
18 mos
160
What age does a baby use a spoon well, scribbles, and does a 2 cube tower?
15-18 mos
161
How many words does a 15-18 month old have?
10 words
162
When does stranger anxiety peak?
15-18 mos
163
When do you put kids in booster seats?
at about 40 pounds (4-5 yo) and can go up to 9ish
164
When does the baby's growth start slowing down and body proportion changes are occurring?
Toddlers 1-3
165
What age are gross motor skills locomotion and can walk, jump, run?
toddlers (1-3)
166
What age does the child have an increase in skillful manual dexterity, can imitate a circle, build tower, and start to hold a crayon like pencil?
1-3 year
167
What age do kids start expressive jargon and speak short sentences?
1-3 years
168
How many words do toddlers 1-3 have?
minimum of 200-300
169
At what age do kids play parallel to each other? What age is associative play?
Toddler (1-3, around 2); Preschooler (3-5).
170
When does toilet training start?
1-3; usually start around 12-18, but can't expect them to be trained until 3
171
Give toddlers whole milk from ages ____; at age ___ give 2% milk (about 24oz/d).
1-2; 2
172
During the toddler years, what times do they get well check-ups?
15 ,18, 2 year, 3 year; usually no shots from 18-4y, except flu vaccine
173
What age does kinesthesia begin (awareness to position of body parts)?
Preschooler (3-5)
174
What age do kids start to ride a tricycle, walk on tiptoe, balance on one foot, climb stairs alternating feet?
Preschooler (3-5)
175
How much weight do 3-12 year olds gain each year?
4-6 pounds
176
What age does a kid know if he's a boy or girl (same with his mom and dad)?
3
177
How many words does a 3 year old have?
900 words
178
When does a child start to sing songs?
3
179
What type of vocab does a 4 year old have?
4-5 word sentences, 2100 words
180
What age is telegraphic speech, imaginary friends, nightmares, stuttering, and animism?
Preschooler 3-5
181
What age is the eruption of deciduous teeth complete?
Preschooler (3-5)
182
What age group is the age of the loose teeth? What age do kids lose all their teeth by?
6-12; 12-13
183
What age group does play become "cooperative"?
6-12
184
What are some car safety recommendations for the school age child?
- Over 40 lb (generally 4-8), use a forward-facing booster seat (with belts positioned on lap and shoulder) in the backseat.
- Kids 4'9" and taller can sit in a regular car seat restrained with lap/shoulder belt.
- Backseat is preferred for all kids and should be the only location used for kids 12 and under.
185
During the "Terrible teens" weight almost ____; height increases by ___%; Girls (until age 16) and boys (until age 18) grow ___ inches per year until age 16; there's the development of secondary sex characteristics.
doubles; 15-20%; 3-6
186
What is the staging called that is used for physical development in kids?
Tanner Staging.
187
What is of utmost importance in adolescent communication?
Confidentiality and privacy
188
Which vaccine can be given at birth?
Hep B
189
What is the Hep B vaccination schedule for kids?
Dose 1: Birth
Dose 2: 1-2 mos.
Dose 3: 6-18 mos.
190
What is the DTaP vaccination schedule for kids?
Months: 2, 4, 6, 15-18, then 4-6 years.
191
What is the vaccination schedule for Rotavirus (RV)?
months 2,4,6
192
What is the vaccination schedule for Haemophilus influenzae type b (Hib)?
months 2, 4, 6, 12-15 mos
193
What is the vaccination schedule for inactivated poliovirus (IPV)?
months 2,4, 6-18, 4-6 years
194
What is the influenza vaccine schedule?
yearly starting at 6 mos.
195
What is the minimum age for the influenza vaccine?
6 mos
196
What is the vaccine schedule for Measles, Mumps, Rubella (MMR) vaccine?
12-15 mos then 4-6 years
197
What is the vaccine schedule for Varicella?
12-15 mos then 4-6 years
198
What is the vaccination schedule for Hep A?
First dose at 12-24 then the second one 6-18 mos after that.
199
What is the youngest age for the Meningococcal vaccine?
9 mos
200
What are 3 vaccines that have a minimum age of 12 mos?
MMR, VAR, HepA
201
What is an infants first line of defense?
Passive Immunity (aquired from maternal antibodies)
202
What is the only Immunoglobulin that transfers through the placenta?
IgG
203
What is a newborn's second line of defense?
Active Immunity (Immunity produced by the body in response to stimulation by a disease-causing organism or other agent.)
204
Which type of immunity is present at birth?
Passive Immunity
205
Active immunity isn't fully functional until what age?
6 years
206
What type of immunity are Vaccines?
Active Immunity
207
_____ immunity occurs when exposure to a disease organism (naturally or thru a vaccine) triggers the immune system to produce antibodies against that disease. How long does it last?
Active; long-lasting, sometimes life-long
208
________ immunity is provided when a person is given antibodies to a disease rather than producing them through his or her own immune system. Examples are a baby acquiring it through the placenta or when antibody-containing products like immune globulin are given. How long does it last?
Passive; short-term--weeks or months
209
What is the average gauge and length of needle used for kids injections?
25-27; 1 inch
210
What is the average volume (in mL) for Sub-Q kids injections?
0.5 mL
211
What are the 4 preferred IM injection sites for kids vaccinations?
Vastus lateralis; Ventrogluteal; Dorsogluteal; Deltoid.
212
What is a range of safe volumes for IM injections in kids?
0.5 mL-2.5mL depending on age and size of child
213
What are some ways to reduce pain and anxiety before an injection?
- Vapocoolant
- Give 2 injections at same time
- Apply pressure to site for 10 secs prior to administration
- Prepare parent and encourage them to hold/talk with child
- 25% sucrose water to young infants
- Be efficient and honest
214
What do you have to document with immunizations?
- Name and Date
- Vaccine given
- Manufacturer, Lot #, Exp. Date
- Site/Route
- Info given to parents (imm. record, instructions for home, Adv. Rxn's--type, response)
215
the time elapsed between exposure to a pathogenic organism and when symptoms and signs are first apparent
Incubation period
216
The period when the person is first starting to see symptoms of the disease =
Prodromal Period
217
Stage when the disease process reaches its peak =
Acute phase
218
What are 3 commonalities in viral infections?
- Rash (exanthem)
- Fever
- Cold or flu-like symptoms (fatigue, weakness, rash, fever, irritability, tachycardia, vomiting, diarrhea, resp. difficulties
219
What is the transmission of Varicella-Zoster?
Direct contact with droplets or airborne particles
220
What is the infectious period for Varicella-Zoster?
1-2 days before onset of rash until all lesions are crusted over.
221
During what phase is Varicella-Zoster most infectious?
Prodromal Phase; lesions begin as macular
222
What do Chicken Pox (Varicella-Zoster) lesions look like?
Macular/Papular/clear-filled vesicles/pustules
223
How long do Chickenpox lesions erupt for and how long does it take before they're all crusted?
erupt for 1-5 days and take 1-3 weeks before all are crusted.
224
What are some complications of Chickenpox?
Cellulitis, Meningitis, Encephalitis, Thrombocytopenia, and Reyes Syndrome.
225
Seen in children who were infected with Chicken pox before 1 year or immunity waning =
Shingles
226
What is a common analgesic not given to kids under 19 and why?
Aspirin; Reye's Syndrome
227
What can one do if they are exposed to Varicella-Zoster?
The vaccine may be given within 72 hours after exposure to prevent or significantly modify the disease.
228
Oral or IV _____ can be given for immunocompromised patients with onset of Varicella-Zoster
Acyclovir
229
What virus causes Hand Foot Mouth Disease?
Coxsackievirus
230
When is Hand Foot Mouth Disease (Coxsackievirus) most common and what is its transmission?
Summer & fall; Fecal-Oral and Respiratory
231
What is the infectious period for Hand Foot Mouth Disease (Coxsackievirus)?
2 days before rash up to 2 days after it disappears.
232
What do the lesions for Hand Foot Mouth Disease look like?
Grayish papulovesicular ulcerative pharyngeal, hand, and feet
233
What are some complications for Hand Foot Mouth Disease?
Rare, persistent, central nervous system infection several months (immune deficient); Neonates, severe disseminated sepsis, multi-organ failure.
234
What virus causes Erythema Infectiosum (Fifth Disease)?
Human Parvovirus B-19
235
What is the transmission for Erythema Infectiosum (Fifth Disease)?
Direct contact with droplets, airborne particles, blood, and transplacental transmission.
236
What are the stages of Fifth Disease?
Stage 1: Flu-like symptoms; Prodromal period (up to 1 week)
Stage 2: Rash appears
Stage 3: Rash reappears with sunlight or irritation 1-3 weeks
237
Disease that has the "slapped cheek" sign =
Fifth Disease (Erythema Infectiosum)
238
What does the rash for Fifth Disease look like?
- Fiery, red edematous rash
- Maculopapular, lacy rash on trunk and extremities
- "Slapped cheek" sign
239
What are some complications of Fifth Disease?
Children with hemolytic conditions, Aplastic crisis; Arthritis and Arthralgias
240
What is the transmission of Measles (Rubeola)?
Airborne, respiratory droplets, and contact with infected persons
241
What is the infectious period for Measles (Rubeola)?
3-5 days before rash until 4 days after rash disappears.
242
What is the worst phase of Measles (Rubeola)?
Prodromal phase (3-5 days)
243
What are some of the s/s that occur during Measles in the prodromal phase when the kid is quite ill?
3 c's: conjunctivitis, cough, coryza (runny nose); also Koplick's Spots (small, irregular, bluish-white spots on a red background on buccal mucosa) occur at 2 days before rash; also fever, malaise.
244
What does the rash for Measles look like?
Red maculopapular that gradually turns brownish; begins behind ears at hairline and spreads downward toward feet
245
What are some complications of Measles (Rubeola)?
Diarrhea, Otitis Media, Bronchitis, Croup, Encephalitis, Death.
246
What is the transmission of Rubella (German Measles)?
Direct contact with droplets or transplacental
247
Baby has maternal antibodies for Rubella (German Measles) until ____
about 9 months
248
What is the infectious period for Rubella (German Measles)?
7 days before onset of symptoms to 14 days after rash appearance.
249
Rubella (German Measles) aka =
3-day Measles
250
What is Forschheimer's Sign?
seen during Prodromal Phase of Rubella (German Measles): discrete, erythematous pinpoint or larger lesions/petechiae on the soft palate
251
What does the rash look like for Rubella (German Measles)?
Pinkish maculopapular; begins on face, neck, scalp, and spreads downward to feet over 3 day period; as rash develops on a new area, the rash over the previous area fades
252
What are some complications of Rubella (German Measles)?
Thrombocytopenia, Congenital Rubella (mental retardation, retinopathy, cardiac anomalies, sensiorneural deafness), Encephalitis.
253
What years do you typically get vaccinated for Rubeola & Rubella?
1 and 4 years.
254
What is some nursing management for Rubella and Rubeola?
- Cool Mist humidifier
- Vitamin A (100,000 IU 6mos-1yr; 200,000 1 yr and older): dec. the morbidity/mortality
- Suction nose
- Antitussives
- Dim light--photophobia
- Elevate HOB
- Push fluids
255
Which diseases from this section can be helped with the administration of Vitamin A?
Rubeola & Rubella
256
What virus causes Roseola Infantum (6th Disease)?
Human herpesvirus type 6
257
What is the transmission of Sixth Disease (Roseola Infantum)?
most likely through secretions of asymptomatic people
258
What is the infectious period for Roseola Infantum (6th Disease)?
- Thought to extend from febrile stage until the rash appears
- Lifelong virus shedding in healthy individuals
259
S/S: Sudden high fever (105) for 3-8 days; Erythematous maculopapular rash =?
Roseola Infantum (6th Disease)
260
Complications of Roseola Infantum (6th Disease)?
Febrile convulsions; Encephalopathy
261
What is the transmission of Mumps Parotitis?
Airborne droplets, salivary secretions
262
What is the infectious period of Mumps Parotitis?
1-2 days before swelling to 9 days after onset
263
S/S: Fever, earache, h/a, Pain with chewing, parotid gland swelling, Lymphadenoma, Meningeal signs (in 15%) =?
Mumps Parotitis.
264
What are some complications of Mumps?
Aseptic meningitis, Orchitis, Sterility, Pancreatitis, Glomerulonephritis, Thrombocytopenia, Hearing Impairment.
265
What is the transmission of Pertussis (Whooping Cough)?
Direct contact or resp. droplets from coughing
266
What is the infectious period for Pertussis?
1 week after exposure; Most contagious during paroxysmal cough stage; communicable for 5-7 days after antibiotic therapy
267
DTaP is given to ___ while TDaP is given to ___
kids; adults
268
What are the stages of Pertussis?
1) Catarrhal Stage (1-2 weeks): Nasal congestion, low grade fever, mild cough
2) Paroxysmal Stage (1-6 weeks): cough more severe/spasms/mucous, Forceful inspiration through a narrowed glottis=stridor, Whoop, Cyanosis, dehydration
3) Convalescent stage: (up to 6 weeks after above stage): symptoms gradually subside
Whole thing can last up to 16 weeks. Can be fatal, especially for young infants under about 4 months.
269
What are two meds that are given for Pertussis?
Erythromycin (to infected child and all close contacts) & Corticosteroids.
270
We usually don't give cough meds anymore to kids under ____
6
271
A common cause of epiglottitis, Croup, pneumonia, bronchitis, and meningitis =
Haemophilus Influenzae B
272
What is the transmission of Haemophilus Influenzae B and when are they infectious?
direct contact and droplet; infectious 3 days from onset of symptoms.
273
Disease often occurs in babies 2-15 mos/in Daycare centers and is diagnosed with a blood culture =
Haemophilus Influenzae B (Hib)
274
What med can be given for Haemophilus Influenzae B?
Rifampin
275
What would be the isolation precaution for someone with Haemophilus Influenzae B?
Droplet
276
S/S: Fever, dysphasia, malaise, chills, h/a, abd. pain, vomiting, beefy red pharyngitis with white/yellow exudate; abrupt onset of symptoms
Streptococcus A
277
What can you get if Streptococcus A is not treated right away? (12-48 hours after first symptom)
Scarlet Fever
278
S/S: Fine papular rash in axillae, groin, & neck with sandpaper feel; blanches with pressure; Strawberry tongue day 4-5 after s/s =?
Scarlet Fever.
279
What med can be given for Scarlet Fever?
Penicillin
280
S/S: begins as single erythematous macule then rapidly progresses to a vesicle or pustule; mildly painful/itchy/burn; **ruptures and leaves honey-colored crust; often on face, neck, arms, hands or legs
Impetigo
281
How are Impetigo and Chicken Pox alike and different (related to the lesions)?
both start as vesicle/pustule and turn into honey-colored crusts; However, with chicken pox, you don't treat the crusts and with Impetigo you do (with Bacitracin or Bactroban 3-4 x daily x 5-7 days).... Impetigo also gets treated with a systemic abx if there's no response to the topical within 72 hours. Acyclovir may be given for chicken pox in immunocompromised pt's.
282
With Impetigo, how long do you have to be on antibiotics before being able to return to school?
24h
283
Impetigo is highly ____
contagious. Can be spread after scratching on infected site.
284
Impetigo Skin Care:
Soak crusts in warm water, gently cleanse with antibacterial soap and remove crusts, do not touch or pick lesions, wash child's hands frequently with antibacterial soap, fingernails short/clean, may put mittens on kids.
285
Transmission of Rocky Mountain Spotted Fever =
Wood or Dog Tick Bite
286
S/S: Flu-like, fever, Rash (red macules/papules that blanch; starts on hands and feet 2nd-5th day; can become widely disseminated; petechial and purpura), Enlarged liver and spleen
Rocky Mountain Spotted Fever
287
How are Hand Foot Mouth Disease lesions similar to Rocky Mountain Spotted Fever?
both often start on hands and feet; Hand Foot Mouth's look more blistery than Rocky's
288
Complications of Rocky Mountain Spotted Fever:
Gangrene of distal parts of body (from thrombosis); DIC; ARDS
289
Drug of choice for Rocky Mountain Spotted Fever?
Doxycycline
290
Transmission of Lyme Disease =
infected deer tick bite
291
S/S: flu-like, fever, Painful Joints, Bull's Eye Rash (erythema migrans; expands over weeks and eventually multiply); Cranial nerve palsies (regress with developmental milestones); Arthralgias; h/a; meningitis; CNS changes during stage 3; and Carditis
Lyme Disease
292
Complications of Lyme Disease:
Neuro deficits, Encephalopathy, Optic neuropathy, Cognitive/behavioral changes
293
Drugs used for Lyme Disease:
Doxycycline for 9yr+ and Amoxicillin for kids under 9
294
Kids of smokers often have ___ infections.
Ear
295
Children are obligate ___ breathers.
nose.
296
There is growth in the respiratory system until about age ____
12
297
Bifurcation of the trachea is at ___ in kids until about age 12; it's at __ in adults.
T3; T6
298
Kids have __ breathing, with the diaphragm being the main muscle of respirations.
abdominal
299
Why do kids have more ear infections?
because of the positioning of the Eustachian tube--it's more horizontal and shorter = decreased drainage, trap stuff.
300
It is not uncommon to feel enlarged ___ normally in kids.
lymph nodes (lymph tissue more active until 6 years.)
301
I should probably skim over the respiratory chapter 25
.
302
Normal RR for Newborn =
30-60
303
Normal RR for 1 year old =
20-40
304
Normal RR for 3 year old =
20-30
305
Normal RR for 6 year old and 10 year old?
6=16-22; 10=16-20
306
Cardinal Signs of Mild Resp. Distress/Failure:
Restlessness
Tachypnea
Tachycardia
Diaphoresis
307
Clinical Manifestations of Moderate Resp. Distress:
```
Mood changes
Headache (lack of 02)
Change in depth/pattern of respirations
Nostril flaring
Retractions
Grunt
Wheeze or prolonged expiration
Anorexia
CNS changes--anxiety, confusion, irritability
```
308
Clinical Manifestations of Severe Respiratory Distress/Hypoxia:
```
Bradycardia
Cyanosis (from peripheral to central)
Dyspnea
Hypotension or Hypertension
Dimness of vision
Somnolence
Stupor
Coma
```
309
What are some pulse ox locations for a baby?
wrist, toes, earlobes, fingernail; a clean and dry spot where blood vessels are relatively close to the skin
310
How do you measure a NP (nasopharyngeal) tube before suctioning a baby?
from nose to ear
311
How do you measure an NT (nasotracheal) tube before suctioning?
Kinda like an NG: ear to nose to sternum
312
How long would you suction a kid with an NT or NP suction?
5 seconds, then rest 1-2 mins between
313
A cessation of breathing for a period of 20 secs or longer or a shorter period accompanied by bradycardia or cyanosis =
Apnea
314
Apnea of prematurity occurs at weeks ___ and resolves by ___; usually presents around ____ days of life.
24-32; 38; 2-7
315
Infant apnea can be characterized in 3 ways:
Central: complete cessation of breathing effort
Obstructive: absence of nasal airflow when respiratory efforts are present
Mixed: central respiratory pause that either precedes or follows airway obstruction
316
Management of Apnea of Prematurity (AOP)?
Cutaneous stimulation (touching); O2; CR monitor; CPAP, Caffeine, Theophylline/Aminophylline, Neutral thermal environment, Avoid suctioning, Monitor closely while being fed, Family edu on home monitor and CPR.
317
Sudden, unexplained death of an infant younger than 1 year of age =
SIDS
318
SIDS occurs most often between what age and to what gender? What times of year?
2-4 mos; Males; winter and spring
319
Risk factors for SIDS:
Infant: race (#1=amer. indians, #2=alaskans, then non-hispanic blacks, non-hispanic whites ), gender (males), Prematurity, age (2-4 mos often, but overall less than 1 year old), Time of year (winter/spring), Passive smoke exposure, sleeping habits (prone=bad), overheating, sleeping with others and/or with toys/quilts and pillows with bedding.
Mom: <20 years at first pregnancy, short interval between pregs, single parenthood, poor prenatal care, lower SES
320
Educate parents on activities that can reduce risk of SIDS:
Positioning ("Back to sleep"--should sleep on back); Pacifiers; No sleeping with others; Use of fan in room, etc
321
Most common complication of URI =
Otitis Media
322
Manifestations of Otitis Media in baby:
Fussiness, fever, pulling at ears, anorexia
323
When are tubes recommended in ears for kids who have frequent ear infections?
if they have 6 ear infections in one year or 1 ear infection (with an effusion--fluid) for 3 months
324
Management of Otitis Media :
5/7/10 days of Antibiotics (amoxicillin or omnicef); Acetaminophen or Ibuprofen; Possibly Myringotomy with insertion of tympanostomy tubes
325
When trying to manage Otitis Media, when should you call the MD?
if no improvement in 48 hours or if drainage noted from ear.
326
4 Common causes of Upper Airway Obstruction:
Foreign object, Croup, Epiglottitis, Congestion.
327
Acute inflammation and edema of the larynx, trachea, bronchial tubes that can be caused by Para influenza I, II, III virus, H-flu, Adenovirus, Pertussis, RSV, or Mycoplasm pneumonia =
Croup (ALTB- acute laryngeotracheobronchiitis); mostly viral (so antibiotics won't work)
328
Croup Symptoms:
Barking cough, hoarse cry, muffled vocal sounds, inspiratory stridor, increased use of accessory muscles, varying degrees of resp. distress, increased symptoms at night, inc. agitation/crying.
329
Meds for Croup:
Racemic epinephrine inhaled, Corticosteroids, Antibiotics (for non-viral cases).
330
Bacteria that can cause Epiglottitis =
Beta hemolytic strep, group A
331
Condition where epiglottis becomes swollen, cherry red, and surrounded with copious secretions; edema can be severe and painful and obstruct airway=life-threatening
Epiglottitis.
332
S/S of epiglottitis: begins as mild URI, develops high fever, sore throat with dysphasia, froglike croaking, agitation, severe resp. distress, stridor, retractions; Cardinal signs= Drooling, Dysphagia, Dysphonia (hoarseness), Distressed (resp effort).
.
333
If you suspect Epiglottitis, never _____
stick anything in their throat (ie tongue blade).
334
4 cardinal signs of Epiglottitis:
Drooling, Dysphagia, Dysphonia, Distressed (resp. effort)
