-
diaper rash
satellite leasions
-
acutane
causes depressed mood
-
you should always use what type of diapers
disposable
-
acrocyanosis
cyanosis of the hands and feet. NOrmal in newborn
If crying makes the cyanosis better or worse, you need to know. Crying may affect a shunt in the heart if it is present
-
what is often the first sign of heart disease
tachypnea
-
Older children may have _____ present in heart failure
cough
-
If no lower extremity pulses, think?
coarctation of the Aorta (narrowing of the aorta)
-
Bounding puses in
heart failure and PDA
-
Hallmark of hypoplastic left heart disease
decreased or absent pulses
underdevelopment of the left heart
-
Heart failure may present with what skeletal abnormatility
barrel chest
-
In an infant with CHD, you should suspect a
murmur
-
Gallop rhythm is a late sign of
heart failure
abnormal sound caused by dilation of the ventricles. Heard as 3rd sound on auscultation. BAd sound
heard in left to right shunts
-
S2 is heard
- left upper sternal border
- listening to aortic and pulmonic valves
-
What happens if no S2 is heard
maybe a valve is missing
-
Oliguria is late sign of
CHF
-
Still Murmur
- FUnctional, normal
- Typically in 2-7 year olds
- Heard LMSB-LLSB-RUSB
- MAY BE LOUDER IN SUPINE POSITION
- Probably due to extra chord attatched to mitral valves
- Increased metabolic needs by the heart
- Decreased tissue perfusion
- Weak cry, lethargy
- Difficulty bottle feeding
- Sweating
- Difficulty with activities
-
Hyperoxia test
For infants with respiratory disease, the administration of O2 will usually increase saturation or pO2
If pO2 doesnt change or little change, think CHD
-
EKG are helpful if infant has _______ but not ____________
arrhythmias
ischemia
-
Best way to clear an infants nowe?
BBG
-
Why do you treat strep?
Could lead to rheumatic fever
-
Peak respiratory flow meter
Take highest reading
-
CCHD test
- Critical congenital heart disease
- Mandated screening by law
- Do after 24 hrs of age, but before discharge
- Easy, inexpensive, quick
- Great to pick up Coarctation of Aorta before signs present
- Done with a pulse ox
-
When can children return to school who have lice?
after first treatment
-
Dont wash hair for _______ after lice treatment
1-2
-
Special rules for clothing, stuffed animals, hair accessories with lice
- Bedding and clothing must be changed daily, washed in hot water and dried in a hot dryer for 20 minutes
- Stuffed animals placed in plastic bag for 14 days
- Hair accessories- discarded or soaked in hot water (130 degrees for 10 minutes)
-
If patient has tonsillitis, will they mouth or nose breath?
mouth breath
-
Pharyngitis is common in
4-7
RARE in infancy
-
Common cold
nasopharyngitis
-
Symptoms of pharyngitis
- sore throat
- difficult swallowing
- drooling
- inability to swallow secretions
- inflammation of pharynx
- enlargement of tonsils
- fever
- vomiting
- cough
- HA
- hoarseness
-
Conductive hearing impairment
tympanic membrane cannot fibrate freely or sounds cannot enter middle ear
-
Sensorineural hearing impairment
damage to cochlea or auditory nerve; may be congenital from congental rubella syndrome or aquired from ototoxic drugs. May be genetic
-
Viral pharyngitis treatment
- relieve symtpoms
- soft or liquid diet
- no citrus juices
- acetaminophen
-
Bacterial pharyngitis treatment
- alagesics
- Antibiotics (Amoxicillin)
-
One of the most common childhood surgeries
tonsilectomy
-
Child should be free from symtpoms of tonsillits for at least _____________ before surgery?
one week
-
Tonsilectomy indications
- recurrent tonsilitis
- peritonsillar abcess
- resp compromise
- airway obstruction
-
DIscharge teaching for tonsilectomy
- continue to force fluids
- advance soft diet as tolerated
- avoid strenuous activity for 7-10 days
-
Post op care for tonsilectomy
- Analgesic and ice collar for pain
- Dont give red popsicle, need to monitor for blood
- CLear, chilled fluids
- Sore throat approx 1 week post op
-
dont bend forward, drink hot liquids after
epitaxis
-
________________ common source of bleeding in nose bleeds
superficial veins
-
bronchodilator for asthma
SE: tachycardia, restlessness, increased activity, inhaled with more rapid onset
-
Antiinflammatory agent for asthma
- Prednisone (Deltasone)
- budesonide (pulmicort)
SE: growth retardation, fluid retention, increased appetite, mood changes, inhaled have fewer SEs
-
Acute laryngotracheobronchitis
viral infection that causes inflammation, edema, and narrowing of larynx trachea and bronchi
most common in infants and toddlers, affects boys more than girls
most common of croup syndromes
-
Meds for Acute LTB
PO or IM dexamethosone three times daily for 72 hours to decrease inflammation and edema
-
Education on LTB
- symptoms worse at night, may occur for several nights
- Can be cared for at home if able to take PO fluids and no stridor at rest
- Cool mist humidifier and presence of parents
- breathing labored=seek medical attention stat
-
Assessment for Epiglotitis
- Sudden onset of high fever (102.2)
- Sits upright leaning on arms with chin thrust out and mouth open
- muffled voice
- drooling
- cant swallow
- DO NOT EXAM THROAT
-
Jones criteria
- Carditis involving mitral valve
- chest pain caused by pericardial inflammation
polyarthritis in large bones, can alternate between joints
subQ nodules on bony prominences
Nonpuritic rash on trunk but not face and hands
St. Vitas dance
2 major
1 major and 2 minor
-
change trach tube every
1-2 weeks
-
Trach suctioning
BID and PRN
- Infants 60-100
- Children 100-110
-
What is most common cause of Broncholitis?
RSV
-
RSV most prevelent
first 2 years of life, more common in spring and winter
-
RSV, assess respiratory how often?.
hourly
-
Perform ____________ to obtain resp secretions in RSV
nasopharyngeal
-
_________ used to prevent RSV for high risk under 2 year olds
palivizumab
-
Nutrition for CF
- Pancreatic enzymes with every meal
- High calorie, high protein diet
- Promote breatfeedings
- Gavage feedings may be necessary for infants
- Suppress GI acid
- May need salty snacks
-
amplyopia
most common cause is untreated strabismus
-
leading cause of decreased vision in children
amblyopia (lazy eye)
-
strabismus
- cross eyed
- occlussion therapy 1-2 hr/day
-
Otitis media
- Inflammation of middle ear
- 70% of infants will have before 1 year of age
- Occurs more frequently in : Boys, children in day care, kids with allergies, kids exposed to smoke, prequent pacifier use, cleft lip, downs
- Less likely in breast fed
-
Associative play
Interacts with others during play
PRESCHOOLERS
-
Preschooler should be able to
- Brush teeth
- Button clothes
- Tie shoes
- Draw 6 part person
- Draw circles, cross, square
- use fork
-
Preschoolers behavior
- should feel guilty if misbehaves
- Actions based on reward/punishment
- Begin to understand justice and fairness at 6 yrs
- Compare themselves with peers
- Little to no separation anxiety
-
neonatal period
- wt: 6-8 lbs. gains 5-7 oz/week x 6 months
- ht: 20 in. grows 1 in/mo x 6 months
head circ greater than chest circ
-
pulsations in anterior not
posterior
-
posterior fontanel closes
2-3 months
-
Anterior fontanel closes
12-18 months
after 18 months evaluate
-
infancy
1-12 months
head grwoth rapid
-
ht increases by _________ by age 1
50%
-
wt doubles birth wt in _______
5-6 months
-
Weight _________ after 1 year
triples
-
1 month
- demonstrates head lag
- has a grasp reflex
-
2 moths
- lifts head of mattress when prone
- holds hands in open position
-
3 motnths
- Raises head and shoulders off mattress when prone
- only slight head lag
- No longer has grasp reflex
- Keeps hands loosely open
-
4 months
- Rolls from back to side
- Places objects in mouth
-
5 months
Rolls from front to back Uses palmar grasp dominantly
-
7 months
- bears full weight on feet
- moves objects from hand to hand
-
8 months
- sits unsupported
- begins using pincer grasp
-
9 months
- stands holding furniture
- has crude pincer grasp
-
10 motns
- crawls with abdomen on floor
- rasps rattle by handle
-
11 months
- creeps with abdomen off floor
- places objects into a container
- neat pincer grasp
-
12 months
- walks with one hand held
- tries to build a two block tower w/o success
-
-
6 months
- rolls back to abd
- holds bottle
-
sucking and rooting reflexes
gone by 4 months
-
Palmar grasp reflex
gone by 3 months
-
Plantar grasp reflex
gone by 8 months
-
Moro reflex
gone by 4 months
-
Tonic neck feflex
gone by 3-6 months
-
Babinki reflex
gone by 1 year
-
startle refelx
gone by 4 months
-
Stepping reflex
gone by 4 weeks
-
Iron fortified formulas used for bottle feeding recommended for ________ if not breastfed
first 12 months
-
NO solids before
6 months
-
Cooked chopped table food by
9 months
-
No citrus fruits, meat and eggs until
6 months
-
limit 100% fruit juice to ____________ after 6 monts
4-6 oz/day
-
Vegetables and fruits between
6-8 months
-
Iron fortified rice cereal at
4-6 months
-
rearfacing car seat until
2 years
-
do not place rear facing car seats where?
front seat with airbag
-
crib rails should be no more than
2 3/8 in apart
-
Separation Anxiety happens when
- between 6-30 months
- peaks around 15 months
-
Stages of separation anxiety
- protest: appears sad, agitated, agnry, inconsolable, watches desperately for parents to return
- despair: appears sad, hopeless, withdrawn, acts ambivalent when parents return
- detachment: appears happy, interested in environment. Becomes attatched to caregivers, may ignore parents
-
Tetralogy of Fallot
exhbit bluish skin during episodes of crying or feeding
-
Kawasaki's disease
- Multisystem disorder involving vasculitis
- AKA mucocutaneous lymph node syndrome
- Leading cause of aquired heart disease in children
Stage one (1-2 wk) fever lasting > 5 days unresponsive to antipyretics, conjunctivitis, crusted and fissured lips, swelling of hands and feet, erythema, lymphadenopathy
Subacute stage (2-4 wk) fever lowers, irritability, anorexia, desquamation of hand and feet, arthritis, cardiovascular
Convalescent stage (6-8 wk) drop in ESR and diminishing signs of illness
-
Asprin used in
kawasakies
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