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ME 536- Patient Care II > The Pediatric Visit and the Newborn > Flashcards

The Pediatric Visit and the Newborn Flashcards

1
Q

Neonate/Newborn

A

First 28 days of life

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2
Q

Infant

A

29 days - 1 year

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3
Q

Early childhood

A

1-4 years old

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4
Q

Middle childhood

A

5-10 years old

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5
Q

Adolescence

A

10-20 years old

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6
Q

Early adolescence

A

10-14 years old

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7
Q

Middle adolescence

A

15-16 year old

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8
Q

Late adolescence

A

17-20 years old

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9
Q

Pediatrics technically go to age ______

A

21

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10
Q

Predictable development

A

age specific milestones

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11
Q

A ___________ or a milestone is always concerning

A

Loss/delay

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12
Q

Children mature at ________ rates

A

different

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13
Q

Development is impacted by

A

physical, social and environmental factors

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14
Q

H&P ________ depending on the developmental stage of the child

A

varies

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15
Q

Pediatric health supervision visits are also known as

A

well child check (WCC)

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16
Q

Goals of pediatric visit

A

disease of detection
disease preventions
health promotion
anticipatory guidance

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17
Q

Components of pediatric visits

A

interval history
surveillance of development
review of symptoms
observation of parent/child interaction
physical exam screening, including measurement of growth
screening (universal and risk assessment)
immunizations
anticipatory guidelines

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18
Q

Surveillance vs. screening

A

surveillance is ongoing
developmental screening is a formal process

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19
Q

Developmental surveillance

A

ongoing process
done at every visit
parental history
skilled, experienced observation

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20
Q

Developmental screening

A

formal process
uses a standardized tool
universal screening at specified ages
selective screening when risk assessment raises a concern

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21
Q

HPI for an acute pediatric problem

A

content is very similar to an adult- determine what is age appropriate

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22
Q

Differences in pediatric vs. adult

A

getting a history from a parent
Need to get both child’s parents perspectives (especially as child ages)
Note parent-child interaction
Parental emotions and behaviors

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23
Q

HPI for well child visit

A

Any parental concerns and child concerns as they age

Since last visit:
any changes
general status
other priorities depend on the age of the child

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24
Q

Past medical history pediatric visit

A

includes medical illnesses, surgeries, hospitalizations, psychiatric, OB-GYN)

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25
Q

Additional past medical history for pediatric visit different from adult

A

prenatal history of the mother
birth history
newborn history (included for all children age 3 and under, included for other children if pertinent, often listed first under PMH)

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26
Q

Prenatal history

A

mother’s age at history
previous pregnancy history (which number of pregnancy, any difficulty getting pregnant, miscarriages/abortions)
Maternal illnesses during pregnancy
Medication exposure during pregnancy
Complications of pregnancy
Newborns: mother’s blood type, infectious disease screening

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27
Q

Birth history (Perinatal)

A

duration of pregnancy
kind and duration of labor
Type of delivery
use of medications during delivery
conditions of the child at birth
need for resuscitation at birth
APGAR scores
complications of delivery

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28
Q

APGAR

A

A: activity
P: pulse
G: Grimace (reflex irritability)
A: Appearance (skin color)
R: Respirations

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29
Q

Newborn history

A

Birth weight, length and head circumference
Complications after birth (jaundice, respiratory problems, seizure, bleeding, cyanosis, feeding problems, excessive weight loss, cardiac concerns)
Did the baby go home with the mother

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30
Q

28yo G2P2002 )+ mother
Mother received prenatal care in the first trimester
prenatal labs were GBS-, HIV-, GV-, chlamydia-, RPR (syphilis) reactive
Mom reports no medications taken during pregnancy or delivery

A

Example Prenatal history

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31
Q

Full term
Normal spontaneous vaginal delivery (NSVD)
Delivery was uncomplicated, no resuscitation was required
APGARS: 8 at 1 min, 9 at 5 min

A

Example Birth history

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32
Q

3445 grams, HC 35 cm, length 50cm
Nursery course was uncomplicated
Infant went home with mom on day of life (DOL #2)

A

Example Newborn history

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33
Q

health maintenance pediatric note

A

Feeding/nutrition
Growth and development
immunizations
sleep patterns
elimination patterns
dental care
safety

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34
Q

Feeding history/nutrition pediatric note

A

breast vs bottle fed (how much, how frequent)
weaning
Solid foods (when what type)
Current diet
Food likes/dislikes, appetite, intolerances
Vitamin supplements

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35
Q

Growth and development pediatric note

A

summarize growth history
developmental milestone history (fine motor, gross motor, language-expressive and receptive, social)

Older children: pubertal development, school issues, keeping up compared to peers and siblings

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36
Q

Immunization history pediatric note

A

Need the actual dates and types of vaccines documented
include reactions/complications
must be specific- DO NOT WRITE UP TO DATE

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37
Q

Other health maintenance pediatric note

A

sleep patterns, elimination patterns, dental care, safety issues

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38
Q

Family history pediatric note

A

age of parents, siblings, grandparents and their health

Focus common pediatric diseases: asthma, ADHD, febrile seizures, diseases with genetic components

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39
Q

Pediatric focused history interview

A

needs to be age and problem specific
Include family history pertinent to the chief complaint

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40
Q

Social history pediatric note

A

age dependent

Living situation: who is in the home, what are the relationships, marital status of the parents/involvement

Childcare: who, where, ages

Activities/hobbies

School: how is it going, relationships with peers and teachers

Stressors at home: financial, relationships, deaths

Pets

Exposure: tobacco

Safety: Firearms (locked, secured, ammo), Water source (well vs city), Smoke and CO detectors, sun protection

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41
Q

HEADSS

A

Home: living arrangements
Education and Employment: school, future plans
Activities: hobbies, exercise, risk-taking
Drug use: cigarettes, alcohol, drugs, caffeine
Sexual activity and sexuality: onset, safe sex,
Suicide: depression, mental health

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42
Q

Pediatric ROS note

A

follows same structure, age appropriate
weight changes, patterns of growth
unusual head shape, strabismus, visual complaints
dental issues
wheezing
heart murmurs, exercise tolerance
scoliosis
puberty
fussy, clingy

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43
Q

Prenatal visit note

A

recommended early in 3rd trimester to help build a relationship with the provider, answer parental concerns, identify potential issues

Provide education: newborn screening, community resources, circumcision, breast feeding, car seats, sleeping on back, pets, water temperature for baths/feeding

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44
Q

Initial evaluation of the newborn: Immediate

A

drying, clearing airway, warming

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45
Q

Initial evaluation of the newborn: key questions

A

full term?
Good muscle tone?
Is the intent breathing or crying?

If yes to all 3, likely no need for resuscitation and keep the baby with mom

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46
Q

APGAR score

A

scoring system to assess the need for resuscitation and the response to the resuscitation (if needed)

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47
Q

when is APGAR scoring performed

A

Done at 1 minute and 5 minutes in all newborns

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48
Q

Scoring for APGAR goes from ________

A

0 to 10

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49
Q

APGAR score: 0-4

A

Severe depression, requiring immediate resuscitation

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50
Q

APGAR score: 5-7

A

some nervous system depression

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51
Q

APGAR score: 8-10

A

normal

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52
Q

APGAR score post 5-minutes

A

0-3: low (likely NICU)
4-6: moderately abnormal (needs close attention)
7-10: reassuring

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53
Q

APGAR scores does not predict ________ or __________ outcome

A

individual mortality, neurologic outcome

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54
Q

APGAR scores during resuscitation are NOT the equivalent of an APGAR in a baby with __________

A

spontaneous repirations

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55
Q

Newborn assessment

A

should happen during the first day of life.
A comprehensive exam.
Parents present and 1-2 hours after a feeding

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56
Q

Newborn history

A

review of pregnancy, labor and delivery (including screening tests and risk factors for sepsis)

Review of past pregnancies (congenital abnormalities, still birth)

Review mother and father medical and genetic history

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57
Q

Newborn physical exam

A

Look before touching

At rest, moving all extremities, turns to a parent’s voice, inspect facies, pink, good tone, respiratory effort, obvious deformities

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58
Q

Order for Newborn physical assessment

A

Inspect
HEART LUNGS (require a quiet baby)
then spine/hip assessment/agitation last

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59
Q

Newborn vitals Temp, RR, HR

A

Temp: 36.5-37.5 (97.7-99.5)
RR: 35-60 (count for a full minute)
HR: 120-160 (can be as low as 80-90 during sleep)

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60
Q

Newborn head circumference

A

done at every visit until age 2

61
Q

Should you see jaundice in a newborn or in the first day of life?

A

skin should NOT be jaundiced at birth or within the first day of life

62
Q

When does physiologic jaundice start?

A

Day 2-3 of life

63
Q

Lanugo

A

Fine downy growth of hair over the entire body, more common in preemies, shed in the first few weeks of life

64
Q

Vernix Caseosa

A

cheesy casing present at birth

65
Q

Normal cyanosis findings in a newborn

A

Acrocyanosis
palms and soles
perioral

66
Q

ABNORMAL cyanosis findings in a newborn

A

mucous membranes, central/trunk

67
Q

If central or mucous membrane cyanosis is present this indicates _________

A

possible congenital heart disease

68
Q

How long does acrocyanosis last

A

first 24-48 hours of life

69
Q

what is Milia

A

AKA newborn acne
pinhead white raised areas due to retention of sebum in the openings of sebaceous glands.

70
Q

When does milia appear?

A

Can be present at birth or appear in the first few weeks of life.

71
Q

Milia treatment?

A

Nothing. Gradually disappear.

72
Q

What is Pustular melanosis

A

small, vesicolopustular lesions with a brown macular base.

73
Q

What population presents with pustular melanosis

A

Black babies

74
Q

How long does pustular melanosis last

A

several months

75
Q

What is erythema toxicum

A

erythematous macula’s with central pinpoint vesicles that cover the body.

76
Q

When does erythema toxicum appear

A

appear on day 2-3

77
Q

How do you treat erythema toxicum

A

disappear in a week or so

78
Q

what are other names for Nevus simplex

A

AKA salmon patch or stork bite

79
Q

What is congenital dermal melanocytosis

A

AKA mongolian spot
blue-gray patch usually in the sacral-gluteal region or shoulders

80
Q

What population is most common in congenital dermal melanocytosis

A

Asian (85-100)
Black (60%)
Hispanic (45-75)
Less than 10% white

81
Q

How long does it take for a congenital dermal melanocytosis to resolve

A

fade during first 1-2 years of life but can stay until age 10 (really age 8 seen in Waldron’s practice)

82
Q

What is another name for a port wine stain

A

nevus flammeus

83
Q

What is a nevus flammeus

A

AKA port wine stain
Capillary malformation in the skin, usually an isolated patch that grows in proportion to the child’s growth

84
Q

What conditions are related to nevus flammeus

A

If in V1/2 of CN5
Sturge-Weber syndorme (rare, congenital)
Capillary-venous malformations in the brain and eye

85
Q

Neonatal head inspection

A

Inspect for symmetry

86
Q

Neonatal head palpation

A

Anterior fontanelle (closes between 4-26 months)
Posterior fontanelle (closes by 2 months of age)

87
Q

Neonatal facial exam

A

look for symmetry, palsies, abnormal feature

88
Q

Features associated with Down syndrome on facial exam

A

epicanthal folds
slanted palpebral fissures
flat nasal bridge
protruding tongue

89
Q

Neonatal eye exam

A

Eyelids often edematous at birth
symmetry
Spacing
pupils
red reflex
eye movements

90
Q

Normal ear measurement

A

line drawn across acanthi of the eye to the occipital protuberance should cross 1/3 down the pinna or auricle

91
Q

Ear abnormalities can be associated with

A

congenital kidney defects or congenital hearing loss, turner syndrome, Down syndrome, trisomy 18

92
Q

Can you do an eye exam on a newborn with an otoscope?

A

No, vernix cases obstructs the tympanic membrane for several days

93
Q

How do neonates breathe

A

most infants are obligate nose breathers

94
Q

Neontal nose exam

A

assess patency of nasal passages

95
Q

Do you suck out the mouth or the nose first after a birth

A

mouth

96
Q

Neonatal mouth and pharynx exam

A

palpate gums, assess for cleft lip and palate, inspect tongue and frenulum

97
Q

Natal teeth

A

early eruptions of normal teeth but can be part of congenital syndromes

98
Q

Epstein pearls

A

white cystic vesicles on median palate, resolve spontaneously

99
Q

Ankyloglossia

A

tongue tie

100
Q

What does ankyloglossia cause

A

potential breast feeding/latching issues, potential speech issues later in life

101
Q

Neonatal neck and clavicle exam

A

inspect for masses, branchial cleft cysts and clavicle fractures

102
Q

What does a webbed neck indicate

A

Turner’s syndrome

103
Q

Where are branchial cleft cysts located

A

dimples or openings located anterior to the SCM

104
Q

If crepitus is found on the clavicle in the neonate it can indicate

A

clavicle fracture

105
Q

Neonatal chest and lung exam

A

inspect for symmetry, breasts, respirations, auscultation

106
Q

Breast enlargement on neonates is due to ________ and can produce ___________

A

maternal estrogen, witches milk

107
Q

Widely spaced nipples can be a sign of

A

Turner syndrome

108
Q

Abnormal respirations in a neonate would be

A

retractions, grunting, nasal flaring

109
Q

Compared to adults what are infant breath sounds like

A

louder and harsher than adults

110
Q

Is percussion helpful in neonates

A

no

111
Q

Neonatal heart exam

A

inspect for cyanosis, palpate for peripheral pulses (femoral, brachial), thrills

112
Q

Where is PMI located on a baby

A

4th intercostal space

113
Q

Auscultation of neonate exam

A

S1, S2 (split is normal but you probably won’t be able to hear it)

114
Q

Is S3 in a neonate a red flag?

A

no. is frequently heard and normal

115
Q

Murmurs can be ________ vs __________

A

functional vs. pathologic

116
Q

Neontal abdominal exam

A

inspect, auscultate, palpate

117
Q

When is the umbilical cord remnant usually gone by

A

2 weeks

118
Q

Umbilical anatomy has

A

2 arteries, 1 umbilical vein

119
Q

What is a single artery in the umbilical cord associated with

A

abnormalities in 20% of cases

120
Q

Where is the liver edge felt on an abdominal exam of a neonate?

A

1-2cm below costal margin

121
Q

Can you feel a spleen in a neonate

A

yes, palpable spleen tip is normal

122
Q

When would you do a rectal exam on a neonate

A

if they have not pooped to check for imperforate anus, possible hirshprungs disease

123
Q

Neontal genital exam

A

done to identify gender

124
Q

Female neonatal genital exam

A

genitalia prominent d/t maternal estrogen, can have discharge from nipples

125
Q

Male neonatal genital exam

A

foreskin not retractible at birth, check for hypospadias, possible scrotal edema d/t maternal estrogen, determine location of testes (scrotum vs. abdomen)

126
Q

Neonatal MSK exam

A

count fingers and toes, look for deformities, inspect spine

127
Q

What is a normal finding in a newborn concerning their lower extremities

A

bowlegged

128
Q

What are pigmented spots, hairy patches, deep pits possibly associated with

A

neural tube defects

129
Q

Neonatal hip assessment should be performed for how long

A

Barlow and Ortolani maneuver done at newborn assessment through 3 months

130
Q

How do you do the Barlow maneuver

A

attempting to dislocate hip
knees and hips are flexed, adduct (in) while pushing posteriorly

Positive: clunk on dislocation
internal rotation

131
Q

How do you do the Ortolani maneuver

A

relocating the hip
legs at right angles, index over GT and thumbs over lesser trochanters, abduct both hips

Positive: clunk on relocation
external rotation

132
Q

How do you do the Ortolani maneuver

A

relocating the hip
legs at right angles, index over GT and thumbs over lesser trochanters, abduct both hips

Positive: clunk on relocation
external rotation

133
Q

Neonatal neuro exam

A

note muscle tone, symmetry of movement, moving all extremities, primitive reflexes

134
Q

Moro reflex

A

AKA startle reflex
sudden, slight dropping of head from slightly raised supine position. Open hands and extension/abduction of arms ant hen flextion and crying.

135
Q

When does the Moro reflex disappear

A

5-6 months

136
Q

When does the palmar grasp reflex disappear

A

5-6 months

137
Q

when does the plantar grasp reflex disappear

A

9-10 months

138
Q

When does the stepping reflex disappear

A

1-2 months

139
Q

When does the rooting reflex disappear

A

2-3 months

140
Q

When does the Babinski disappear

A

9-24 months

141
Q

Asymmetrical tonic neck reflex

A

AKA fencer’s position

142
Q

Neonatal preventative care: Eyes

A

Erythromycin ophthalmic ointment or silver nitrate to prevent gonococcal conjunctivitis

143
Q

Neonatal preventative care: heme

A

Vitamin K injection to prevent vitamin K deficient bleeding (VKDB) 1mg IM

144
Q

Neonatal preventative care: Hepatitis

A

Hepatitis B vaccination. If mom is + baby also get IVIG

145
Q

Universal Newborn Screening: pulmonary

A

pulse oximetry

146
Q

Universal newborn screening: ears

A

Hearing (otoacoustic emissions, automatic auditory brainstem response)

147
Q

Universal newborn screening: metabolic and genetic disorders

A

Cystic fibrosis, PKU (phenylketonuria)

148
Q

Universal newborn screening: endocrine disorders

A

congenital hypothyroidism, congenital adrenal hyperplasia

149
Q

Universal newborn screening: heme

A

sickle cell anemia

ME 536- Patient Care II (8 decks)

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