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Pediatrics > Week 2.1 - Peds Assessment > Flashcards

Week 2.1 - Peds Assessment Flashcards

1
Q

What is the ABCDEFG assessment?

A

Airway
Breathing
Circulation
Disability (Neuro)
Exposure
Fluids
Glucose

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2
Q

What are the three aspects of the pediatric assessment triangle?

A

Appearance
–> Tone, interactiveness, consolability, abnormal gaze, abnormal speech/cry

Work of Breathing
–> Abnormal sounds or position, retractions, flaring, apnea/gasping

Circulation to Skin
–> Pallor, mottling, cyanosis

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3
Q

What combination of the triangle assessment would indicate CNS or metabolic issues?

A

Altered appearance
–> Tone, consolability, interactivness, gaze, speech/cry

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4
Q

What combination of the pediatric assessment triangle would indicate shock?

A

Issues with circulation to skin with or without changes in appearance

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5
Q

What changes in the pediatric assessment triangle would indicate respiratory distress?

A

Changes in work of breathing

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6
Q

What combination of findings in the pediatric assessment triangle would indicate respiratory failure?

A

Changes in work of breathing and appearance

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7
Q

What changes in the pediatric assessment triangle indicates cardiopulmonary failure?

A

Changes in appearance, circulation to skin, and work of breathing.

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8
Q

How does the pediatric airway differ from the adult airway?

A

The airway is smaller and softer
–> Edema causes a significant difference is airway patency

+tongue is larger, prominent occiput, higher larynx

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9
Q

What kind of behaviour might be seen with a partially obstructed pediatric airway?

A

Agitated or drowsy

Tripod/sniffing position

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10
Q

What are some signs of a partial upper airway obstruction in a pediatric patient?

A

Stridor
–> on exertion is mild, at rest is moderate, with exhaustion is severe

Drooling, gurgling, snoring

Changes in colour, behaviour, tripod

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11
Q

What are some signs of a partial lower airway obstruction in a pediatric patient?

A

Wheezes
–> End expiratory is mild, expiratory is moderate, ins/ex is severe

Crackles
–> May be fine or coarse

Decreased Air Entry
Increased Respiratory Effort

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12
Q

Does loudness of airway noises have significance?

A

Not necessarily.
A quiet wheeze means that not much air is entering the lungs

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13
Q

Should you person a head tilt-chin lift with an infant?

A

No, can cause airway obstruction d/t shape of head

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14
Q

what is the most common cause of cardiac arrest in the pediatric population?

A

Hypoxia secondary to respiratory arrest

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15
Q

Children are abdominal breathers, what does this mean?

A

Rely on diaphragm as principal muscle to breathe

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16
Q

What is the normal respiratory rate for an newborn (0-3 months)

A

30-60 rpm

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17
Q

Why should breathing in children be assessed over 60 seconds?

A

Breathing in children is irregular

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18
Q

What is considered apnea in children?

A

Cessation of breathing for more than 20 seconds

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19
Q

What is considered bradypnea and tachypnea in children?

A

RR less/more than the normal range for age - normal ranges are age dependent

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20
Q

What should we assess about the quality of pediatric breathing?

A

Effort to breathe
–> Work of breathing

Efficacy of breathing
–> Effective gas exchange

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21
Q

Why is pediatric grunting a sign of increased resp effort?

A

To slow the rate of expiration and decrease alveoli surface tension, prevent alveoli collapse, to decrease effort of inhalation
(Positive end expiratory pressure)

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22
Q

Which age group does not have enough surfactant and struggles to prevent alveoli collapse?

A

Pre-term babies

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23
Q

The following:

Agitated/confused behaviour, drowsiness, being unable to talk/cry /eat, grunting, severe recessions, and changes in colour, and significantly increased respiratory rate apnea lasting longer than 20+ seconds

Are signs of what in pediatric patients?

A

Severe respiratory distress
–> Hypoxia not corrected with oxygen

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24
Q

Intermittent irritability, difficulty talking/crying/eating, and nasal flaring are signs of what in pediatric patients?

A

Moderate respiratory distress
–> Mild hypoxia that can be corrected with oxygen

Also might be associated with moderate increase in resp rate and moderate retractions

25
Q

What is a normal arrythmia in children?

A

A sinus arrhythmia

26
Q

How long should you listen to a pediatric heart rate?

A

60 seconds.

27
Q

What is considered pediatric bradycardia? What might this indicate?

A

HR less than 60 bpm
–> Impending arrest

28
Q

Can children maintain tachycardia for long periods of time?

A

Yes they can, but once exhausted they can decompensate quickly

29
Q

What is considered pediatric tachycardia?

A

Outside of normal range for age group

30
Q

What might cause mottling? What symptoms might accompany it?

A

Poor perfusion of extremities
–> Also seen with cap refill longer than 3 seconds, or weak pulses.

31
Q

A decrease in urine output in a pediatric patient can say what about perfusion?

A

Can indicate poor renal perfusion

32
Q

What might indicate a poor central perfusion in a pediatric patient?

A

Decreased LoC, agitation, irritability

Decreased muscle tone

33
Q

Hypotension in children indicates what?

A

That a child is very ill, systolic hypotension is a late sign of CDV compromise
–> Manual can be helpful d/t accuracy

34
Q

How is neuro assessed on children who cannot speak (under 2)?

A

A modified GCS

Assess with smiles, listens, follows vs cried but consolable, vs inappropriate persistent cry vs agitated, restless, vs no response

35
Q

Peripheral nerves on infants differ in myelination than adults in which ways?

A

They are not completely myelinated at birth. Motor control improves as myelination progresses

36
Q

What does proximodistal mean?

A

Centrally –> distal from core

37
Q

What is the moro reflex?

A

Startle reflex when infant feels like they’re falling

38
Q

When does grasp reflex disappear?

A

4-6 months

39
Q

How do neonates thermoregulation differ from adults? What about young children?

A

Immature hypothalamus in neonates means that fever response might be weak.

Immature immunity in young children means that fever response might be exaggerated

40
Q

How should temperature be assessed on a child?

A

Axillary
–> Least invasive

Rectal
–> Definitive

41
Q

What is a normal temperature range for children? What would be considered extreme high and lows?

A

36.5-37.5 C
Higher than 41.0 or lower than 34.5 is considered extreme hyper/hypo

42
Q

Petechiae and purpura on the hands and feet can indicate which infection?

A

Meningococcal - interferes with coagulation

43
Q

In what ways do children’s ratio of body surface differ from adults?

A

Brain, skin, and GI tract are larger

44
Q

How do children’s fluid spacing/composition differ from adults?

A

Infants have higher extracellular than intracellular water - means it is more easily lost

45
Q

What can indicate poor hydration status in an infants?

A

–> Sunken eyes, fontanelles
–> Pale, mottled, cool limbs, prolonged cap refill
–> Reduced urinary output
–> Dry mucous membranes
–> Tachypnea and tachycardia

46
Q

What is the first sign of dehydration in an infant?

A

Tachycardia - compensation for low stroke volume

47
Q

How to calculate fluid maintenance for for a an infant that is…

10 or less kg
10-20 kg
21+ Kg

A

First 10 kg
–> 4 ml/kg/hr

Second 10 kg
–> +2 ml/kg/hr

Subsequent kg
–> 1 ml/kg/hr

48
Q

What is the minimum urine output for children?

A

1ml/kg/hr minimum for infants and small children (prof emphasized this as minimum)

Or 4+ wet diapers/day

49
Q

What is the specific gravity of pediatric urine?

A

Less than 1.030

50
Q

hypoglycemia in children is more common because…

A

Children need more sugar than adults

51
Q

What are signs of hyperglycemia in children?

A

Increased urine output, excessive thirst, weight loss

52
Q

If there is any alteration in a child’s LOC, you should always check…

A

BGL

53
Q

What are two major notes when assessing and recognizing a sick child?

A
  1. Parental anxiety should not be discounted
  2. Any infant under 3 months presenting to the ED should be considered sick until proven otherwise.
54
Q

At what age can a radial pulse be taken? What must be used before then?

A

A radial pulse can be taken at 2 years of age
–> Must use apical before then

55
Q

How can children be diagnosed with hypertension?

A

If the SBP or DBP is greater than or equal to the 95th percentile for age, sex, and height. Must be measured on at least three separate occasions.

56
Q

What is strabismus?

A

When one eye deviated from fixation, can result in weakening of muscle and “lazy eye.”

Can result in amblyopia if not corrected by ages 4-6.

57
Q

How should the eardrum be visualized in children under 3?

A

By pulling the pinna down and back.

58
Q

What is the difference between a functional and organic murmur?

A

Functional - No autonomic cardiac defect, but with a physiological defect like anemia

Organic - A cardiac defect with or without a physiological abnormality exists.

Pediatrics (5 decks)

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