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Peds > Week 1: Characteristics of Pediatrics/Behavioral > Flashcards

Week 1: Characteristics of Pediatrics/Behavioral Flashcards

1
Q

Definitions

Newborn:
Neonates:
Infants:
Children:

A

Newborn: 0- 24 hours old
Neonates: 1-28 days of age
Infants: Between 28 days - 1 y/o
Children: >1 y/o - puberty

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2
Q

Definitions

Gestational age:

Post-conceptual age: & what does it indicate?

A

Gestational age: the actual # of weeks the baby was in utero

Post-conceptual age = gestational age + chronologic age of the neonate
- indicates the functioning of the various organ systems.

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3
Q

Definition

Prematurity:

Preterm infant:

A
  • neonates who weight <2500 g at birth
  • born before 37 weeks of gestation\
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4
Q

Term newborn

A

born after 37 weeks and before 42 weeks gestation

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5
Q

Post-term newborn

A

born after 42 weeks gestation

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6
Q

SGA
AGA
LGA

A

Small for gestational age
Appropiate for gestational age
Large for gestational age

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7
Q

Definitions

  1. Low birth weight (LBW)
  2. Very low birth weight (VLBW)
  3. Extremely low birth weight
  4. Micropremies
A
  1. <2500 grams
  2. <1500 g
  3. <1000 g
  4. <750 g
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8
Q

T/F Infants <1 generally suffer from separation anxiety

A

False- they do NOT

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9
Q

In healthy children, routine lab work is not required unless the surgical procedure requires it examples:

A
  • Craniosynostosis
  • Spine or
  • Pelvic/femoral surgery
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10
Q

Preop

In african american or mixed-race ancentry consider neonatal __________ screening results or consider a _________ screen.

ENT may consider a HCT prior to:

A
  • Sickle; sickle cell
  • Tonsillectomy or adenoidectomy
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11
Q
  • The child with seasonal or viral rhinitis, who does not have a _______ or _________ , may proceed with surgery on a case-by-case basis. Inquire about fever, cough, wheezing, antipyretics.
  • The risk of perioperative respiratory complications is increased; however, it may be difficult to find a disease-free window.
A
  • fever or lower respiratory symptoms
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12
Q
  • Information available on anesthesia adverse outcomes suggests _______ are at higher risk than are _________.
  • __________ are at greater risk than pediatric patients older than 2 years of age.
A
  • neonates, older infants
  • Older infants
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13
Q

Anatomy

  1. Anterior fontanelle
  2. Posterior fontanelle
A
  1. closes between 9-18 months
  2. closes by 2-4 months

* cranial molding occurs in LBW and is usually of no clinical importance

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14
Q
  1. Cranial vault increases rapidly in size and after ______ y/o it increases marginally in size.
  2. Face and base of skull develop at a _______ rate:
    - at birth mandible is ________. Forward growth occurs with developing
    - failure to do so can represent which congenital defects?
    - facial configuration substantive changes after 2 y/o
    - Maxilla grows quick to accomodate growing teeth
A
  1. 2
  2. slower
    - small

  • Pierre Robin Sequence
  • Treacher collins
  • Goldenhar Syndromes
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15
Q
  • Cranial base = rapid growth completed by ___ y/o
  • Skull base= grows quick until _______ and slower growth after.
A
  • 2 y/o
  • 6 y/o
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16
Q
  • Frontal sinuses develop ___-___ year old.
  • maxillary, ethmoidal, and sphenoidal after _______ y/o
A
  • 2 - 6;
  • 6
17
Q

Respiratory system

  1. begins during _______ of gestation.
  2. Bronchial tree to terminal bronchial it is formed by _______.
  3. Alveoli grow mainly after birth until ______ y/o in number # and in size until growth of chest wall stops.
  4. Pulmonary vessels until ___________
A
  1. 4th week
  2. 16 weeks
  3. 8
  4. late adolescence
18
Q

Chest wall and respiratory muscles in infancy

  • Accessory muscles of inspiration are ______.
  • Ribs extend _________. Moving little with inspiration - which depends on descent of the diaphragm.
  • Neonate chest wall is __________ due to noncalcified cartilage and ribs.

This increase workload on diaphragm = risk for fatigue and respiratory failure - * in preterm infant

A
  • ineffective
  • horizontally
  • floppy

Muscle strength depends on the presence of type I (slow twitch) muscle fibers to respond to an increased workload.
Preterm infants have limited number type I

19
Q

FRC

  • Neonate in supine = small FRC due to ________ elastic lung recoil and ________ outward forces of the complaint chest wall.
  • Large abdomen pushes the diaphragm up.
A
  • increased; weak
20
Q

Closing capacity: (air trapping)

  • Related to ____ and _____.
  • Closely related to _______
  • ________ throughout childhood and adolescence; and _______ throughout adult life.
  • Not possible to measure closing volume in children <_____ y/o. But because the elastic recoild pressure is _______ in infancy some airways likely remain close through tidal breathing.
  • Infants have a large “trapped gas volume” not free.
A
  • elastic tissue and recoil pressure.
  • age
  • Decreasing; increasing
  • 5 y/o; small
21
Q

Heart rate:

  • Anatomic control in utero mainly by the _____.
  • Only shortly after bitrh SNS beings to appear; but PNS continues to dominate until _______.
A
  • PNS
  • adolescense
22
Q

Age and HR

Premature:
0 - 3 months:
3 - 6 months :
6 - 12 months:
1- 3 years:
3 - 6 yers:
6 - 12 years:
> 12 years:

A

Premature: 120 - 170
0 - 3 months: 100 - 150
3 - 6 months : 90 - 120
6 - 12 months: 80 - 120
1- 3 years::70 -110
3 - 6 yers: 65 - 110
6 - 12 years: 60 - 95
> 12 years: 55-85

23
Q

Bloop pressure:

  • Less in lower extremeties vs. upper in children.

(Mean systolic/diastolic)
Premature :
0 - 3 months:
3 - 6 months :
6 - 12 months:
1- 3 years:
3 - 6 yers:
6 - 12 years:
> 12 years:

A

(Mean systolic/ diastolic)
Premature : 55-75/ 35-45
0 - 3 months: 65 - 85/ 45 - 55
3 - 6 months : 70-90/ 50-65

6 - 12 months: 80-100/ 55-65
1- 3 years: 90-105 / 55-70
3 - 6 yers: 95- 110 / 60-75.
6 - 12 years: 100-120/ 60-75
> 12 years: 110-135/ 65-85

24
Q

Renal system

  1. Development begins in week 4 gestation until adulthood
  2. Fetus maintain metabolic homeostasis throguh the placenta until bith when kidneys take ove.
A
25
Q

Tubular function

  • The #/function threshold for resorption of Na+/K+-ATPase are _______ at bith.
  • The renal tubular threshold for resorption of Na+, glucose, and bicarb are decreased in neonatal
  • Putting babies at risk of:
A
  • reduced

explains why babies become acidotic quickly

  • hyponatremia
  • osmotic polyuria
  • metabolic acidosis
26
Q

Endogenous acid production in small children (50-100% greater than in adults) d/t deposition of _______ in bone. (0.5-1 mEq/L acid per day)

Explains tendency of infants to become profoundly acidotic when suffering from ___________.

Neonates/Infant are living near its limit of acid compensation making them prone to acidosis when sick/starving.

A
  • calcium
  • gastroenteritis
27
Q

Neonates/ preterm infants are obligate salt loosers.
- They cannot ____________ a large salt load or ___________ urine effectively.
- due to immature distal tubular function and relative _______________.

This increases the risk for:

A
  • excrete; concentrate
  • hypoaldosteronism

Hyperkalemia

28
Q

LES pressures are _______ at birth but _______ steadily. Reaches adult by ____ - ______ weeks postnatal.
Daily vomititng or “spitting up”: 50% of infants 0-3 months of age and 2/3 of infants 4-6 months of age.

A

Reduced; increase
3-6

**mostly normal “happy spitters”

29
Q

Hemoglobin

  1. Neonate normal hemoglobin range
  2. In term neonates, the hemoglobin concentration decreases during the ________ to ________ week to a nadir of __________ to ____________ (Hematocrit _____ to _______) but increases thereafter.
  3. Infants weighing <800-1000g may reach _________.
  4. after 3 months until 2 hemoglobin: _____ - _________
  5. Gradual increase until puberty (14 F) - 15.5 (M)
A
  1. 14-20g/dl
  2. 9th-12th; 10-11g/dL (30-33%)
  3. 8 g/dL
  4. 11.5 - 12

oxygen delivery is not compromised

30
Q

At birth, vit.K-dependent factor (i.e., II,VII,IX, and X) are 20% to 60% of adult values (preterm even less). The result is prolonged __________.

All neonates hould receive prophylactic vit.K soon after birth to prevent ___________ of the neonate.

Bone marrow is immature

A
  • prothrombin time
  • hemorraghic disease
31
Q

Most common etiologies of cerebral palsy

A
  • ischemic stroke
  • white matter disorder
  • intrauterine inflammation

  • <5% d/t perinatal asphysia
32
Q

Strongest predictors of cerebral palsy (6)

A
  • congenital anomaly (**congenital heart disease)
  • low birth weight
  • multiple fetuses
  • preterm delivery
  • intrauterine infection
  • abnormal fetal position before L&D
33
Q

Two growth spurs

Neuronal cell multiply between ____-_____ wks gestation

Glial cell multiply starting ______ wks gestation until ______ year of life.
- Myelination continue into the 3rd year.
- Myelination usually completed by _______
- malnutrition in this phase = ____________ effects.

A
  • 15-20
  • 25; 2
  • 7y/o
  • handicapping

Growth spurs in brain affected by stress and nutrition

34
Q

In preterm neonates stressed by hypoxia, the BBB may become permeable to the water-soluble _____ ______, with possible damage to the brain.

A

unbound bilirubin

35
Q

Immature pancres

Neonates who are SGA are frequently hypoglycemic possibly due to:

A
  • Malnutrition in utero
  • Hepatic glycogen stores are inadequate
  • Deficient gluconeogenesis exists
36
Q

Emergence delirium

  • First maladaptive behavioral change in children
  • S/S: (6)
A
  • Nonpurposeful restlessness
  • Agitation
  • Trashing
  • Crying
  • Moaning
  • Disorientation
37
Q

Emergence delirium

Risk factors

A
  • young age: 2-6 y/o
  • preop anxiety
  • type of anesthetic (VAs>TIVA; Halothane)
  • type of sx. (painful vs. nonpainful)
  • previous sx.

**rapid emergence and depth of ANE do not predict delirium

Peds (14 decks)

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