Test 1 Flashcards
Why do children deteriorate more quickly than adults?
They have less physiologic reserve than adults
What are the 3 most common neonatal diagnoses?
newborns, hemolytic jaundice and prenatal jaundice, and premies
What are the 3 most common pediatric diagnoses?
Pneumonia, asthma, and acute bronchitis
As an infant what % of their body is their head?
25%
Growth and development are continuous process from what stages of life?
conception to death
When are the 2 biggest growth spurts in children?
0-18 months, and puberty
Growth and development is based on what?
age, sex, genetics, and enviroment
All body systems do not do what in kids?
do not develop at the same rate
Development is what?
cephalocaudal and proximodistal
What needs to be lost in neonates before development can proceed?
neonatal reflexes
What are some neonatal reflexes?
sucking, rooting, stepping, asymmetric neck reflex, grasping, and moro (startle)
When do neonates lose the neonatal reflexes?
4-6 weeks
age range for full term neonate?
38-42 weeks
age range for infant?
1-12 months
age range for a toddle
12-36 months
age range for preschool child
3-5
age range for school age child
6-12
age range for adolescent
12-18
age range for adult
> 18 years
In the toddler age the brain grows how much?
90%
Skills of a preschool child
undress self, can do simple buttons, draws 6 part man, always in motion,
skills of school age child
first molar, skipping, always in motion, coordination improves, puberty
Anatomic differences in peds and adults
smaller airways, inc. resistance to flow (Poiseulle’s law), lymphoid tissue and tongue is bigger, larynx is more anterior, epiglottis is stiffer and U shape, trachea is funnel shaped and narrowest at cricoid (softer, small cricoid membrane, shorter), carnia is at T-3
Implication for intubation in PEDs
harder to find epiglottis, use Sellick maneuver (cricoid pressure), R. mainstem intubation happens more than likely, usually used non cuffed tubes
lung growth continues postnatally until when?
8-12 years of age
Children do no have what when it comes to alveoli?
no Pores of Kohn, alveoli shallow and thicker membranes
Pediatric patients are dependent on what?
diaphragmatic breathing
What demand is higher in infants and children?
metabolic rate
Infants use how much more oxygen per kg?
2 times
How do infants and peds respond to the need to increase minute ventilation
inc. RR
recognition of strangers begins at what age?
6-30 months (worse at these ages)
Separation from what is most difficult part of being hospitalized?
family and friends
stranger anxiety peaks at what age ranges?
8-10 months
Separation anxiety peaks at what age ranges?
12-30 months
What are the phases of separation between child and caregivers?
protest, despair, depression/grief, detachment
What age is the most routine oriented?
toddlers
physical stressors for PEDS in a hospital
pain/discomfort, immobility, sleep deprived, changes in pee habits, changes in diet
Enviromental stressors for PEDS in a hospital
unfamiliar surroundings/sounds/people, unpleasant smells, constant lights, activity related to other patients
Psychological stressors for PEDs in a hospital
lack of privacy, inability to communicate, inadequate level of knowledge, perception of illnee, parental behavior
Social stressors for PEDs in a hospital
disruption of routine, disrupted relationships, concern about missing school/work, play deprivation, financial effect on family
What are the most frequent injuries in PEDs
falls, bed and crib entrapment, choking, strangulation, electrocution
What is the most common form of restraint for children
manual
What are the 3 effects that affect the FiO2 available in an oxygen enclosure
seal, size of enclosure, flowrate
What FiO2 would you recommend an infant in an isolette would you also use a hood?
> 40%
Documentation of hypoxemia in an infant?
PaO2 <95%
Documentation of hypoxemia in NICU?
PaO2 <90% ( if higher could cause issues)
Signs and symptoms of hypoxemia
inc. HR/RR, grunting, nasal flaring, retractions, paradoxic breathing, cyanosis, bradycardia, modeling
What are some complications associated with excessive O2 use
PDA (patent ductus arteriosus), retinopathy of prematurity, hypoventilation with chronic lung disease, atelectasis, pulmonary vasodilation- not good if heart problems
Flow for nasal catheter in infant
0.2-1 LPM
flow for nasal cannula for infant
0.2-2 LPM
flow for nasal cannula for PEDs
0.5-4 LPM
Approx FiO2 for nasal cath in an infant
24-35%
Approx FiO2 for nasal cannula in an infant and PEDs
21-50% can get up to 70%
Nasal cannula is used on what in a NICU?
a blender/helped to wean babies
Nasal cannula needs to be right size because of what?
unintended CPAP
Simple masks flows for an infant
5-8 LPM, Peds 5-10 LPM
FiO2 for simple masks
35-50%
Partial rebreather LPM
10-12 LPM
Non rebreather LPM
10-15 LPM
Partial rebreather FiO2
60% and up
Non rebreather FiO2
80% and up
Air entrainment flow and FiO2
flow needs to exceed inspiratory flow, FiO2 is 24-50%
Masks are not good for long term in PEDs because of what?
aspiration
LVN are bad for babies because of what?
infection, absorb too much fluid, chilling baby, noise, and possible bronchospasm
Tents and Huts LPM
> 10 LPM
Tents and Huts FiO2
21-40%
Hoods LPM
> 7 LPM
Hoods FiO2
21-100% possible
If 100% is in a hood what could be the possible problem it is trying to fix
small pneumothorax
What ages can you give a SVN meds?
any age
What ages can you give a MDI without a spacer
> or equal to 5
What ages can you give a DPI?
> or equal to 6, as young as 4 if the patient can demonstrate good technique
Peds and neonatal patients may only get what percentage of aerosolized meds no matter what device is used?
1%
MDI in conjunction with a ventilator has what advantages?
no additional flow is needed, less disruption of circuit, less time consuming
In the NICU if the patient needs an MDI what is usually done?
take baby off vent and hook ambu and MDI together
