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Pediatrics Exam 1 > Week 3 - Culture & Pediatric Assessment > Flashcards

Week 3 - Culture & Pediatric Assessment Flashcards

1
Q

What is health promotion & in what ways can nurses practice it?

A

Activities encompassing well-being & enhancing wellness or health

  • Maintenance – screening, vaccinations, safety to prevent injury
  • Supervision – well-child
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2
Q

What are the main health promotion items that are focused on by patient age?

  • newborn / infant
  • toddler / pre-schooler
  • school age / adolescent
A
  • Newborn / Infant: close to caregiver, parent’s mood, behave as expected, oral health, bottle use
  • Toddler / Pre-schooler: respond to questions, age-appropriate play, interaction with staff
  • School-age / Adolescent: interaction with parents, praising / partnering, divorce / separations, patient answers, independence
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3
Q

What is goodness of fit? What does it mean? What recommendations a nurse could offer parent?

A

Parent’s expectation of their child’s behavior consistent with the child’s temperment type
* Easy - 40%
* Difficult - 10%
* Slow to warm up - 15%
* Mixed - 35%

Recommendations:
* Active - many periods of play then rest before sleep
* Shy - allow time to adapt
* Easily Stimulated - quiet room
* Short Attention Span - projects completed in short time; gradually encourage longer periods at activities

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4
Q

Sequence of Physical Assessment in young children vs. older children

A
  • Young Children = toe-to-head
  • Older Children = head-to-toe
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5
Q

What is the HEEADSSS screening tool for adolescents?

A
  • Home environment
  • Education & employment
  • Eating
  • Activities
  • Drugs (substance use)
  • Sexuality
  • Suicidal thoughts
  • Safety, savagery (exposure to violence)
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6
Q

Normal Heart Rate Ranges for each age group when awake & asleep

  • Neonate
  • Infant
  • Toddler
  • Preschool
  • School age
  • Adolescent
A

Neonate: 80 - 180

Infant: 75 - 160

Toddler: 60 - 110

Preschool: 60 - 110

School-Age: 60 - 110

Adolescent: 50 - 90

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7
Q

Normal Heart Rate for Neonates

KNOW THIS!!!!!

A

80 - 180

  • A: 100 - 180
  • S: 80 - 160
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8
Q

Normal Heart Rate for Infants when awake & asleep

KNOW THIS!!!!!

A

80 - 180

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9
Q

Normal Heart Rate for Toddlers when awake & asleep

KNOW THIS!!!!!

A

60 - 110

  • A: 80 - 110
  • S: 60 - 90
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10
Q

Normal Heart Rate for Preschoolers when awake & asleep

KNOW THIS!!!!!

A

60 - 110

  • A: 70 - 110
  • S: 60 - 90
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11
Q

Normal Heart Rate for School-Age when awake & asleep

KNOW THIS!!!!!

A

60 - 110

  • A: 65 - 110
  • S: 60 - 90
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12
Q

Normal Heart Rate for Adolescents when awake & asleep

KNOW THIS!!!!!

A

50 - 90

  • A: 60 - 90
  • S: 50 - 90
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13
Q

Normal Respiration Ranges fro each age group

  • Infant
  • Toddler
  • Preschool
  • School Age
  • Adolescent

KNOW THIS!!!!!

A
  • Infant: 30 - 60
  • Toddler: 24 - 40
  • Preschool: 22 - 34
  • School Age: 18 - 30
  • Adolescent: 12-16
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14
Q

Normal Respiration Range for Infants

KNOW THIS!!!!!

A

30 - 60 breaths per minute

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15
Q

Normal Respiration Range for Toddlers

KNOW THIS!!!!!

A

24 - 40 breaths per minute

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16
Q

Normal Respiration Range for Preschoolers

KNOW THIS!!!!!

A

22 - 34 breaths per minute

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17
Q

Normal Respiration Range for School-Aged Children

KNOW THIS!!!!!

A

18 - 30 breaths per minute

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18
Q

Normal Respiration Range for Adolescents

KNOW THIS!!!!!

A

12 - 16 breaths per minute

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19
Q

Normal Temperature Range for Pediatrics

KNOW THIS!!!!!

A

< 36.5°C
& ≥
38°C

  • 97.7 - 100.4 °F
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20
Q

How do you estimate the “normal” SBP for children 1+ years?

KNOW THIS!!!!!

A

90 mmHg + (2 x age in years)

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21
Q

Chest circumference?

KNOW THIS!!!!

A
  • taken for first year of life
  • Chest circumference is measured across the nipple line
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22
Q

Head circumference

KNOW THIS!!!!

A
  • Until age 3
  • Measure twice = Should be 2 cm larger than chest until 2 years
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23
Q

Expected weight changes during first year of life

KNOW THIS!!!!

A
  • 2x birth weight at 5-6 months
  • 3x birth weight at 1 year
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24
Q

Neonate Vitals (HR, RR, SBP)

KNOW THIS!!!!

A

HR: 80 - 180
* 100 - 180 (awake)
* 80 - 160 asleep

RR: 30 - 60

SBP: < 60 mmHg

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25
Q

Infant Vitals (1 - 12 months) (HR, RR, SBP)

KNOW THIS!!!!

A

HR: 75 - 160
* awake: 100 - 160
* asleep: 75 - 160

RR: 30 - 60
SBP: < 70 mmHg

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26
Q

Toddler Vitals (1-3 yr) (HR, RR, SBP)

KNOW THIS!!!!

A

HR: 60 - 110
* awake: 80 - 110
* asleep: 60 - 90

RR: 22 - 40

SBP: < 90 mmHg + ( 2 x age in years)

3 year old normal SBP would be:

90 + (2 x 3) = 90 + (6) = 96

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27
Q

School Age (6-10) (HR, RR, SBP)

KNOW THIS!!!!

A

HR: 60 - 110
* awake: 65 - 110
* asleep: 60 - 90

RR: 18 - 30

SBP: < 90 mmHg + (2 x age in yr)

28
Q

Adolescent Vitals (10+) (HR, RR, SBP)

KNOW THIS!!!!

A

HR: 50 - 90
* awake: 60 - 90
* asleep: 50 - 90

RR: 12 - 16
SBP: < 90 mmHg + (2 x age in yr)

29
Q

Skin Assessment Components

KNOW THE BOLD!!!!

A
  • color
  • temperature
  • moistness
  • check skin for color variation
  • abnormalities: decreased pigment, Mongolian spot, moltting, bruises, erythema, pallor, cyanosis, jaundice
  • texture
  • hair texture
  • turgor = assess abodmen
  • edema = boggy skin
  • Cap refill < 2 seconds
  • lesions
30
Q

Primary Lesions

A

Lesions arising from previously normal skin
* pimples / acne

31
Q

Secondary lesions

A

lesions that result in changes in primary lesions
* scratching at a pimple
* ulcers
* scars

32
Q

Head Assessment

KNOW THE BOLD!!!!

A
  • Sutures
  • Flat & soft fontanelles
  • posterior fontanelle closed by 2-3 months
  • anterior fontanelle closed by 12-18 months
  • Prominent occipital area
  • no significant head lag after 6 months
33
Q

Eye Assessment

KNOW THE BOLD

A
  • conjunctivae pink & glossy
  • visual acuity at 3 months (infant should be able to follow an object)
  • Binocularity by 3-4 months (infant should be able to focus on object with both eyes)
  • 6 cranial fields of gaze
  • Pupils round, clear, & reactive
  • sunset sign (visual gaze downward = hydrocephalus)
34
Q

Sunset Sign

A

White sclera visible above colored pupil

  • indicates retracted eyelids or hydrocephalus
35
Q

White Reflex

A

Reflex indicatvie of retinoblastoma or leukocoria

36
Q

Ear Assessment

KNOW THE BOLD

A
  • < 3 = pull pina down & back
  • > 3 = pull pina up & back
  • Position, shape, & symmetry
  • tympanic membranes = pearly, translucent, reflective
  • hearing loss indications: no speech by 2, regression in speech, no startle
37
Q

Nose Assessment

KNOW THE BOLD!!!!

A
  • size, shape, symmetry
  • nasal flaring = respiratory distress
  • color, discharge, swelling, patency, smell
38
Q

Mouth Assessment

KNOW THE BOLD

A
  • Lips
  • Teeth # & dental caries
  • Mucosa
  • Tongue
  • palate
  • Throat
  • Tonsils (0 - 4+)
39
Q

Neck Assessment

KNOW THE BOLD

A
  • Inspect for symmetry, color, swelling
  • **Palpate for tenderness, teachea deviations, & thyroid enlargement **
  • Range of motion; indicates torticollis or meningismus
40
Q

Lymph Node Assessment

KNOW THE BOLD

A
  • Palpate in circular motion
  • Usually non-palpable if small/non-tender
41
Q

**Chest Assessment **

KNOW THE BOLD

A
  • Inspect for shape/size
  • Diameter of 2:1 = normal
  • Pectus carnatum & pectus excavatum
  • scoliosis causes lateral deviation
42
Q

Pectus Carnatum

KNOW THIS!!!!

A

Forward protrusion of sternum; pigeon chest

43
Q

Pectus Excavatum

KNOW THIS!!!!

A

Sunken sternum & adjacent cartilages; funnel chest

44
Q

Respiratory Assessment

KNOW THE BOLD

A
  • Inspect for chest / abdominal expansion
  • Retractions between ribs indicate distress
  • “Headbobbing” in young infants = distress
  • Palpation (crepitus or tactile fremitus)
  • Auscultation (fine crackles, coarse crackles, wheezing, rhonchi, stridor)
45
Q

Respiratory Expansion in children under 6

A
  • Inspect abodmen
  • Diaphragm muscle primarily used
46
Q

Respiratory Assessment in children over 6

A
  • Inspect chest
47
Q

What should be inspected when looking at respiratory expansion in children under 6 versus children over 6?

A

Under 6 = inspect the abdomen
* diaphragm muscle primarily used

Over 6 = inspect the chest

48
Q

Cardiac Assessment

KNOW THE BOLD

A
  • Inspect shape & symmetry of chest
  • Palpate apical pulse
  • Thrills = palpable murmur
  • Auscultate (S1 & S2)
49
Q

What is a thrill?

A

Palpable murmur on cardiac assessment

50
Q

Abdominal Assessment

KNOW THE BOLD

A
  • Umbilical stump
  • Shape
  • Movements
  • Auscultate bowel sounds 10-30 seconds
  • Percussion
  • Femoral pulses
51
Q

Genital Assessment - Females

KNOW THE BOLD

A
  • Color, size, symmetry
  • Masses, swelling inflammation, lacerations, or discharge
  • Tanner Staging
52
Q

Genital Assessment - Male

KNOW THE BOLD

A
  • Structural development
  • Hypospadias
  • Foreskin
  • Testicles
  • Tanner Staging
  • Have child sit in the tailor position

When palpating the scrotum for discended testicles & spermatic cords, place the index finger over the inguinal canal to keep the testicle in the scrotum. Gently palpate the testicle with only enough pressure to detect the size & shape

53
Q

Hypospadias

KNOW THIS TERM!!!

A

opening of penis is on the underside rather than at the tip

54
Q

Tanner Staging

KNOW THE BOLD

A

Sexual maturity rating used widely to assess & monitor the degree of maturation of an adolescent’s primary & secondary sexual characteristics. – stages 1-5

  • Stage 1 = Pre-pubertal
  • Stage 5 = Adult

Stage 1 (pre-pubertal): No pubic hair present in either sex
* Male - small penis & testes
* Female - have flat chest

Stage 2: soft pubic hair appears
* Male - measurable testes enlargement
* Female - breast buds appear

Stage 3: pubic hair becomes coarser
* Male - penis begins to enlarge in size & length
* Female - breast mounds form

Stage 4: pubic hair begins to cover pubic area
* Male - penis begins to widen
* Female - breast enlargement forms “mound-on-mound” breast contour

Stage 5 (Adult): Pubic hair extends to inner thigh
* Male - penis & testes enlarge to adult size
* Female - Breast takes on adult contour

55
Q

Explain each stage of Tanner Staging

KNOW THE BOLD

A

Stage 1 (Pre-Pubital): No pubic hair present in either sex
* Male - small penis & testes
* Female - flat chest

Stage 2: soft pubic hair appears
* Male - measurable enlargement of testes
* Female - breast buds

Stage 3: Pubic hair becomes coarser
* Male - penis begins to increase in size & length
* Female - breast mounds

Stage 4: Pubic hair begins to cover pubic area
* Male - penis widens
* Female - breast enlargement forms “mound-on-mound” breast contour

Stage 5 (Adult): pubic hair extends to inner thigh
* Male - penis & testes enlarged to adult size
* Female - breasts take on adult contour

56
Q

Musculoskeletal Assessment

KNOW THE BOLD

A
  • Inspect legs & arms for symmetry / deformities
  • Skin folds bilaterally
  • Redness / swelling / pain
  • Palpate bones & muscles for tone
  • Observe ROM during play
  • Muscle strength
  • Posture
  • Allis’ Sign = hip dislocation
57
Q

Signs / Symptoms of Hip Dysplasia

KNOW THE BOLD

A
  • Asymmetrical gluteal / thigh folds
  • Limited hip abduction
  • Shortening of femur
  • Ortolani click (< 4 weeks old)

Hip Dysplasia = shallow hip socket

  • Positive Ortolani or Barlow Test is indicative of developmental dysplasia of the hip (hip dysplasia)
58
Q

Neuro Assessment

KNOW THE BOLD

A
  • Behavior
  • LOC
  • Cranial nerve function
  • Reflexes (grasp, rooting, moro, tonic neck, Babinski sign, Parachute)
59
Q

Tactile Fremitus

A

Vibrations produced by crying or talking (usually palpated over the entire chest)

  • Decreased sensations indicate that air is trapped in the lungs (as occurs with ashtma)
60
Q

Crepitus

A

crackling sound & sensation that occurs when air is trapped under the skin

61
Q

Fine Crackles

Definition & Cause KNOW THE BOLD!!!!

A

High-pitched, discrete, non-continuous crackling

  • heard at the end of inspiration
  • NOT cleared by coughing

CAUSE: air passing through watery secretions in the smaller airways (alveoli & bronchioles)

62
Q

Coarse Crackles

Definition & Cause KNOW THE BOLD!!!!

A

Loud, low-pitched, bubbling & gurgling

  • Heard during / on inspiration
  • NOT cleared by coughing

CAUSE: air passing through thicker secretions in airway

63
Q

sibilant Wheezing

Definition & Cause KNOW THE BOLD!!!!

A

High-pitched, musical, squeaking or hissing

  • heard continuously during/on inspiration or expiration
  • does NOT clear by coughing

CAUSE: air passing through mucus or fluids in a narrowed lower airway (bronchioles)

  • typically asthma
64
Q

Rhonchi (sonorous wheezing)

Definition & Cause KNOW THE BOLD!!!!

A

Coarse, low-pitched sound (like a snore)

  • heard during / on inspiration or expiration
  • may clear with coughing

CAUSE: air passing through thick secretions that obstruct large bronchi and/or trachea

65
Q

Stridor

Definition & Cause KNOW THE BOLD!!!!

A

High-pitched, piercing sound

  • most often heard during / on inspiration without a stethoscope

CAUSE: whistling as air passes through narrowed trachea & larynx

  • associated with croup

Pediatrics Exam 1 (7 decks)

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