PEDS TEST 1

Psychosexual Development

Birth to 1 yr"

1-3 yrs

3-6 yrs

6-12 yrs"

Greater than 12 yrs."

Psychosocial Development

Birth to 1 yr

1-3 yrs"

3-6 yrs

6-12 yrs

12-18 yrs"

Cognitive Development

Birth to 2 yrs

2-7 yrs

7-11 yrs

11-15 yrs

Nutrition

Birth history, Growth history, Developmental history Immunizations, Likes/Fears, Family structure, Family history- congenital anomalies, siblings

6 months

1 year

3 months

9-18 months

2-3 months

7 months

10 months

11 months

12 months

5-6 months

7 months

10 months

6-7 months

9 months

11 months

12 months

Hepatitis A, Hepatitis B (at birth), Diphtheria, Tetanus, Pertussis (DTaP), Polio Rotavirus Measles, Mumps, Rubella (MMR) Pneumococcal, Haemophilus influenza B (Hib), Varicella (chickenpox), Influenza Meningococcal, Human papilloma virus (HPV)

8-12

LARGER

• Viral Infections (80-90%)
• Strep Throat (10-20%)

• Headache
• Fever
• Abdominal Pain
• Tonsils and throat red and inflamed"

24 hrs after ABX therapy initiated

• 1st line - PCN, Amoxicillin, Augmentin
• 2nd line - Cepalosporins, Azithromycin, if allergy to PCN or resistant strain

• Warm or cold compresses to the neck
• Warm saline gargles
• Cool liquids, Ice Chips

3 or more in 1 yr

• Soft to liquid diet
• Cool mist vaporizer
• Warm salt water gargle
• Throat lozenges

• Analgesics - Tylenol w/ codeine, Lortab (hydrocordone/acetaminophen) elixer
• Antipyretics - no NSAIDS
• Antiemetics - Zofran

• Positioning: on side or abdomen until awake then sitting up
• No coughing, blowing nose, straining,
• May have dark brown drainage, foul breath, ear
• pain, & low-grade fever are common.
• Watch for hemorrhage (bright red, fresh
• blood).
• Watch for frequent swallowing, tachycardia, pallor! Suction equipment & oxygen at bedside
• Ice collar; food and fluids restricted until child fully
• awake; then cool water, ice chips, popsicles, diluted fruit juice,
• NO STRAWS

12-36 months

Toddler

18-24 months

18 months

1 year

2 years

3 years

TODDLERS

3-5 yrs

Approx. 5lb/yr

2.5-3 inches/yr

• Developing sense of initiative
• Chief psychosocial task of preschool period
• Feelings of guilt, anxiety, and fear may result from thoughts that differ from expected behavior Development of superego (conscience)
• Learning right from wrong/moral development

Pre-schoolers

Pre-schoolers

Opposite sex parent

• Dark
• Being left alone
• Animals (e.g., snakes, large dogs)
• Ghosts
• Sexual matters
• Objects or people associated with pain

Children under 15 yrs

Zoster (herpes zoster/shingles)

Standard Contact Airborne Until all lesions are crusted over and no new lesions

Droplet

• Analgesics for pain
• encourage fluids
• soft/bland food
• heat/cool to neck
• tight fitting underpants

Droplet Contact

Provide O2 with humidification

6-12 yrs

Same sex peers

Conservation (changing the shape of things doesn't alter their properties)

Physical force

Psychological (rumors, ostracism)

• Lie
• Steal
• Cheat

15 minutes

Motor vehicle crashes - pedestrian or passenger

• Stimulants
• Non-stimulants

Beginning of puberty to 18-20 yrs or at cessation of body growth

Estrogen

Androgens

Rapid growth

• 9-13 yrs
• appearance of breast buds

• 2-6 mo after Thelarche
• Growth of pubic hair on Mons Pubis

• Approx. 12 yrs
• Initial appearance of menstruation

Over 6 months

5 yrs

BLEEDING (Watch for frequent swallowing, tachycardia, pallor!)

Acute systemic vasculitis of unknown cause

• Cough suppressants
• Antihistamines

An inflammation of the middle ear without reference to etiology or pathogenesis

Boys Under 2 yrs

Croup

Inspiratory stridor

• A serious obstructive inflammatory process requiring IMMEDIATE MEDICAL ATTENTION!
• It is usually caused by Haemophilus influenzae type b (Hib)"

• Fever, sore throat, pain
• Tripod positioning (leaning forward, chin out, mouth
• open, tongue out)
• Retractions;
• Drooling
• Inspiratory stridor (“frog-like”
• croaking sound on inspiration),
• Mild hypoxia
• Irritable, restless, anxious, frightened

• Potential for respiratory obstruction
• Medical emergency(nasotracheal
• intubation or trachesostomy possible)
• Medications: Racemic epinephrine treatments, Heliox, Steriods, ABX

• Examination only where emergency airway equipment available
• Do NOT attempt examination of throat
• Delay start of IV or any procedure that may agitate child
• Apply oxygen
• Prepare for intubation
• Reduce anxiety/keep comfortable
• Prevention: Hib vaccine

Acute Laryngotracheobronchitis (LTB)

• Inspiratory stridor
• Suprasternal retractions
• Barking or "seal like" cough
• Increasing respiratory distress and hypoxia
• Can progress to resp. acidosis, resp. failure and death"

• Airway management
• Maintain hydration, orally or intravenously
• High humidity with cool mist
• Medications: Nebulizer treatments (Racemic Epinephrine), Corticosteroids (Dexamethsone (Decadron), Oral prednisolone)
• Vigilant observation and assessment
• Intubation equipment available

RSV

Asthma

• December or January
• Peaks in late March

• Affects the epithelial cells of the respiratory tract
• Bronchiolar mucosa swells
• Lumina fills with mucus and exudate
• Symptoms at peak 5-7 days

• Usually happens after an URI or may have no symptoms except slight lethargy
• poor feeding or irritability
• S/sx progress to severe runny/stuffy nose
• Wheezing, retractions, crackles, dyspnea, tachypnea, diminished breath sounds
• Apnea may be 1st symptom in very young infants

Antibody tests on secretions via nasopharyngeal (NP) swab

• Synagis (palivizumab)- specialized monoclonal antibody is given to children who were premies
• children with congenital heart problems and other chronically ill children
• Very expensive - $900/mo

• Assigned to private rooms or in with other RSV children
• Contact and droplet precautions
• Certain RNs care for only the RSV children
• Infants may have copious nasal secretions
• Feeding is difficult but should PO intake
• Saline drops
• Suctioning (NP or BBG) is done and parents are also taught to use bulb syringe
• Pulse oximetry
• Humidified oxygen administration
• Cluster care
• Bronchodilator therapy if responsive
• IV fluids if feeding difficulties

• Chronic inflammatory disorder of airways with wheezing, breathlessness
• chest tightness
• Non productive cough usually in the morning or at night

• Reliever” (rescue) medications SVNs or fast acting inhalers Albuterol, levalbuterol, metaproterenol, terbutaline: short acting Atrovent- reduces
• hospital admissions with use during ED visits
• Corticosteroids during exacerbations
• IV methylprednisolone (Solumedrol)
• Oral Prednisone, prednisolone (Orapred/Prelone)"

Exercise Induced Bronchospasm (Asthma)

Swimming (air is moisturized)

• Respiratory distress continues despite vigorous therapeutic measures
• May lead to coma & death if not recognized & treated PICU
• Concurrent infection in some cases: PNA, influenza

• Back to back treatments
• Magnesium sulfate
• Emergency treatment: Epinephrine 0.01 ml/kg subcutaneously (maximum dose 0.3 ml)
• Heliox

Cystic Fibrosis (CF)

• Increased viscosity of mucous gland secretions
• Striking elevation of sweat electrolytes
• Increase is several organic and enzymatic constituents of saliva
• Abnormalities in autonomic nervous system function

Sweat Chloride test Sodium and Chloride will be 2-5 times greater than controls

Barrel shaped

• Thick secretions block ducts
• Prevents pancreatic enzymes from reaching duodenum
• Impaired digestion/absorption of fat & protein

Bulky Loose Frothy Foul smelling

Incurable Life expectancy 37.4 yrs

• volume of blood pumped by the heart in ONE MINUTE
• HR x Stroke Volume

volume of blood pumped by the heart in ONE BEAT

A hole located between right and left atria. Since pressure is higher on the left side of the heart, blood gets pushed through the hole from left to right. This may cause the right atrium to become enlarged

Failure of the fetal ductus arteriousus (artery connecting the aorta and the pulmonary artery) to close within first weeks of life

• An obstructive disorder, usually just past left subclavian artery (narrowing of the artery).
• It signifcantly decreases blood flow to abdomen and legs with the majority of the blood shunted to the heart and arms

• A narrowing of the aortic valve
• Obstructs blood flow from left ventricle
• Creates pulmonary HTN

• Pulmonary stenosis
• Ventricular septal defect
• Overriding aorta
• Right ventricular hypertrophy

Unoxygenated

• Cyanosis- mild to acute “Blue spells” or “tet spells” Occur when oxygen demand exceeds oxygen supply
• Usually during crying or feeding Systolic murmur- moderate intensity
• Risk for emboli, seizures, loss of consciousness and
• death

Boot shape

Prostoglandin E1

Underdevelopment of the left side of the heart.

Strep Throat

Antistreptolysin O titer (ASO)

• Joints
• Skin
• Brain
• Serous surfaces Heart

• Damage to heart valves from RF
• Most common complication of RF

Acute systemic vasculitis of unknown etiology (inflammation of arterioles, venules and capillaries with potential damage to coronary arteries)

Menarche

• Red eyes with no discharge
• Palms of hand and soles of feet are red, swollen & peeling
• Dry, cracked, reddened lips
• Oropharyngeal reddening- “strawberry tongue”
• Polymorphous rash
• Cervical lymphadenopathy (one > 1.5 cm)"

• Fever - unresponsive to ABX and antipyretics, development of S/S, extreme irritability
• Resolution of fever,
• S/S start to go away, still irritable
• S/S resolved but labs still abnormal

• Aneurysms
• MI resulting from thrombotic occlusion of a coronary aneurysm
• myocardial ischemia from stenosis of aneurysm

• IVIG (Gamma globulin) Only if sure it’s kawasaki and it’s early in the disease
• High dose ASA therapy - anti-inflammatory effects Followed by low-dose
• ASA therapy - Antiplatelet effects Lovenox of Plavix for children with large CA aneurysms

• I & O
• Daily weights
• IV fluids with care
• Watch for signs of CHF

• Cool cloths, soft clothes
• Mouth care, lip moisturizer
• Clear liquids,
• Soft foods
• Comfort, quiet and respite care for parents

• Reassure parents that irritability is normal and may continue for up to 2 months
• Joint stiffness- Passive ROM exercises helpful Desquamation will continue for up to 3 weeks
• No immunizations for 11 months
• Follow-up essential

• Hemodilution: decreased peripheral resistance
• Increased cardiac circulation and turbulence: May
• have murmur & lead to cardiac failure
• Growth retardation
• Delayed sexual maturation
• Cyanosis usually not evident

• Transfusion of hemorrhage
• Nutritional intervention for anemias
• IVF to replace intravascular volume
• O2

• Prepare family/child for tests: Explain test, supportive person with child, allow child to play w/equipment, child participation, Topical application.
• Decrease O2 demands: assess energy level & minimize excessive demands
• Prevent complicatons: INFECTIONS
• Support family

• Caused by inadequate supply of dietary iron
• Newborn has iron stores from mother for 1st 5-6 months
• Children 12-36 months at risk because of cow’s milk

• Obstruction & Destruction
• Partial or complete replacement of normal Hgb with abnormal Hgb S
• Hgb in the RBCs takes on an elongated “sickle” shape
• & RBC are destroyed
• Sickled cells are rigid and obstruct capillary blood flow causing obstruction
• Hypoxia
• Stasis with enlargement
• Infarction with ischemia and destruction
• Replacement with fibrous tissue-scarring

• No cure
• Supportive care- prevent sickling episodes
• Frequent bacterial infections may occur because of immunocompromise
• Bacterial infection is leading cause of death in young children with sickle cell disease
• Strokes in 5% to 10% of children with disease

• Anything that increases body’s need for oxygen or alters transport of oxygen
• Trauma
• Infection
• Fever
• Physical and emotional stress
• Increased blood viscosity caused by dehydration
• Hypoxia

Acute exacerbations that vary in severity and frequency

• Most common type of crisis; very painful
• Stasis of blood with clumping of cells in microcirculation→ ischemia→infarction
• Signs: fever, pain, tissue engorgement

• Life threatening: death can occur within hours
• Blood pools in the liver & spleen
• S/SX: profound anemia, hypovolemia, and shock

• Diminished production and increased destruction of RBCs
• Triggered by viral infection or depletion of folic acid
• S/SX: profound anemia (hyperhemolytic crisis), pallor, jaundice

• Cord blood in NB
• Newborn screening done in 43 states
• Genetic testing to identify carriers and children who have disease
• Sickle-turbidity test, then electrophoresis
• May be diagnosed as a toddler after acute respiratory or GI infection

• Prevent sickling & treat medical emergencies of SCD
• Aggressive treatment of infection
• Possible prophylactic antibiotics from 2 months to 5 years
• Monitor reticulocyte count regularly to evaluate bone marrow function
• Blood transfusion, if given early in crisis, may reduce ischemia
• Frequent transfusion increases hemosiderosis (iron in tissues)
• Treat with iron chelation such as feroxamine + vitamin C to promote iron excretion
• Rx: hydroxyurea(cytotoxic) decreases production of abnormal blood cells and decreases pain

• Rest: Minimize energy expenditure and oxygen use
• Hydration: Oral, IV
• Electrolyte replacement: Hypoxia resulting in metabolic acidosis which means more sickling
• Analgesics: For severe pain from vasocclusion
• Blood replacement: To treat anemia and reduce viscosity of blood
• Antibiotic therapy: To treat any existing infection

• Monitor child’s growth; watch for failure to thrive (FTT)
• Careful multisystem assessment
• Assess pain
• Observe for presence of inflammation or possible infection; dehydration
• Carefully monitor for signs of shock
• Treat normally
• Assess for complications: CVA, chest syndrome (pulmonary infiltrate)