Exam 1

satellite leasions

causes depressed mood

disposable

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

tachypnea

cough

coarctation of the Aorta (narrowing of the aorta)

heart failure and PDA

decreased or absent pulses

underdevelopment of the left heart

barrel chest

murmur

heart failure

abnormal sound caused by dilation of the ventricles. Heard as 3rd sound on auscultation. BAd sound

heard in left to right shunts

• left upper sternal border
• listening to aortic and pulmonic valves

maybe a valve is missing

CHF

• 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

For infants with respiratory disease, the administration of O2 will usually increase saturation or pO2

If pO2 doesnt change or little change, think CHD

arrhythmias

ischemia

BBG

Could lead to rheumatic fever

Take highest reading

• 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

after first treatment

1-2

• 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)

mouth breath

4-7

RARE in infancy

nasopharyngitis

• sore throat
• difficult swallowing
• drooling
• inability to swallow secretions
• inflammation of pharynx
• enlargement of tonsils
• fever
• vomiting
• cough
• HA
• hoarseness

tympanic membrane cannot fibrate freely or sounds cannot enter middle ear

damage to cochlea or auditory nerve; may be congenital from congental rubella syndrome or aquired from ototoxic drugs. May be genetic

• relieve symtpoms
• soft or liquid diet
• no citrus juices
• acetaminophen

• alagesics
• Antibiotics (Amoxicillin)

tonsilectomy

one week

• recurrent tonsilitis 
• peritonsillar abcess
• resp compromise 
• airway obstruction

• continue to force fluids 
• advance soft diet as tolerated
• avoid strenuous activity for 7-10 days

• 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

epitaxis

superficial veins

• albuterol 
• epinephrine

SE: tachycardia, restlessness, increased activity, inhaled with more rapid onset

• Prednisone (Deltasone)
• budesonide (pulmicort)

SE: growth retardation, fluid retention, increased appetite, mood changes, inhaled have fewer SEs

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

PO or IM dexamethosone three times daily for 72 hours to decrease inflammation and edema

• 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

• 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

• 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

1-2 weeks

BID and PRN 

• Infants 60-100
• Children 100-110

RSV

first 2 years of life, more common in spring and winter

hourly

nasopharyngeal

palivizumab

• 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

most common cause is untreated strabismus

amblyopia (lazy eye)

• cross eyed
• occlussion therapy 1-2 hr/day

• 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

Interacts with others during play 

PRESCHOOLERS

• Brush teeth
• Button clothes
• Tie shoes
• Draw 6 part person
• Draw circles, cross, square
• use fork

• 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

• 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

posterior

2-3 months

12-18 months

after 18 months evaluate

1-12 months

head grwoth rapid

50%

5-6 months

triples

• demonstrates head lag
• has a grasp reflex

• lifts head of mattress when prone
• holds hands in open position

• Raises head and shoulders off mattress when prone 
• only slight head lag

• No longer has grasp reflex
• Keeps hands loosely open

• Rolls from back to side
• Places objects in mouth

Rolls from front to back Uses palmar grasp dominantly

• bears full weight on feet 
• moves objects from hand to hand

• sits unsupported
• begins using pincer grasp

• stands holding furniture
• has crude pincer grasp

• crawls with abdomen on floor 
• rasps rattle by handle

• creeps with abdomen off floor
• places objects into a container 
• neat pincer grasp

• walks with one hand held
• tries to build a two block tower w/o success

10-12 months

• rolls back to abd
• holds bottle

gone by 4 months

gone by 3 months

gone by 8 months

gone by 4 months

gone by 3-6 months

gone by 1 year

gone by 4 months

gone by 4 weeks

first 12 months

6 months

9 months

6 months

4-6 oz/day

6-8 months

4-6 months

2 years

front seat with airbag

2 3/8 in apart

• between 6-30 months
• peaks around 15 months

• 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

exhbit bluish skin during episodes of crying or feeding

• 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

kawasakies