Ped- 244 final

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Ped- 244 final
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2010-12-12 19:53:37
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Peds
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  1. What info do you collect in a pediatric health history?
    Maternal history, biographic data, labor and delivery, present health status, and family history
  2. What does anxitey indicate?
    Teaching need
  3. What is the approach you should take to the peds assessment?
    • developmetnal readiness
    • get acquainted time
    • determine best exam place
    • be systematic, yet flexible
    • examine intrusive or painful areas last
  4. What is a newborn?
    • Newborn- birth to 28 days
    • Pre- term: <37 weeks
    • term: 37-42 weeks
    • Post-term- >42 weeks
  5. What are infants?
    • Birth- 6 months: Immoblie, safety, comfort, sensory stimulation
    • 6 months-12 months: Separation/stranger anxity, warm up play techniques, examine infant on parents lap if appropriate
  6. What is a toddler?
    age 1-3 years, parent's lap provide security, play, least inrusive assessment first, avoid no responses, offer choices, and let touch equipment
  7. What is a pre-school age child?
    age 3- 5/6, keep parent close, exam table, protect modesty, consider magical thinking, use safe words, let touch equipment
  8. What is a school age child?
    age 6-10/12: Head to toe exam , address questions directly to child, give concrete explanations, answer questions honestly
  9. What is pre adolescent and adolescent?
    • Pre- 10-12 years
    • Adolescent: 13-18/21
    • Confidentiality
    • privacy (exam alone)
    • Preventive services
    • Issues: body issues, eating disorders, pregnancy, STD, violence
  10. What do you look for in the lungs and thorax for pediatrics?
    • Tachypnea: rapid breathing
    • Retractions: intercostal retractions- trouble breathing
    • Dyspnea: SOB
    • Grunting
    • Faring
    • Anxiety & air hunger
    • Inspriatory stridor
    • Second hand smoke
  11. What is the difference in a child's trachea?
    It is higher and shorter so more respiratory problems
  12. What are signs of airway obstruction?
    Restlessness, anxiety or agitation indicate hypoxia, increased HR and RR, stridor/retractions, pallor/xyanosis, avoid sedatives that deress repirations
  13. What are the differences in RR in children?
    • Higher than adults go to 12-20 a min b/w 10-18 years
    • Respirations should be counted for a full minute
    • Assess when child is calm
    • Infants/children under 7 are abdominal breathers
    • BV in lungs when younger
  14. What is croup?
    • Acute spasm of larynx resulting in partial airway obstruction
    • Peak: 6 months-2 years, grow out of
    • Cause: Viral
    • Mild fever, inspiratory stridor, barking cough
    • Give plenty of fluids
  15. What is epiglottitis?
    • Medical emergency
    • Severe inflammation of eiglottis that progresses rapidly
    • peak: 3-8 years
    • Bacterial
    • High fever, trouble swallowing, cherry red color, severe distress, upper airway obstruction, DO NOT examine throat
  16. What is laryngotracheobronchitis?
    • Inflammation of larynx, trachea, and bronchi.
    • Predominately in infacts and toddlers
    • Viral
    • Gradual onset
    • Labored inspirations
  17. What is pneumonia?
    • Inflammation of bronchioles and alveoli
    • Retractions, tachypnea, labored resps
    • percussion: dullness
    • vesicular BS change to Bronchial or BV
  18. What is the difference in HR of children?
    • Higher HR than an adult
    • In infants under 1 year take aprical pulse because radial pulse is difficult to palpate, count for a full minute
  19. What are normal BP in children?
    • Birth to 1 year: 80/50
    • 1 to 5 years: 90/60
    • 5 to 10 years: 100-110/60-70
    • 10 to 16 years: 110-120/70-80
    • Measure annaully at age 3 and up
    • use dynamap in infants
    • use appropraite pediatric cuff
  20. What do you assess in a CV/PV assessment?
    • -Apical impulse at 4th ICS left of MCL, by age 7 reaches 5th ICS at MCL
    • -Heart sounds louder and more high pitched
    • -Some children have physiologic murmurs, does not indicate disease
    • -Assess peripheral pulse, especially newborns
  21. What do you look for in CV/PV history?
    Growth patterns, clubbing, SOB, fatigue, suck reflex, having trouble keeping up with activity, murmurs, chest pain
  22. What do you look for in an abdominal assessment in an infant?
    • Infant history: breast or bottle fed, spitting up, response to new foods, bowel movements, food allergies.
    • Infants have a soft, round abdoment with slight protrusion- bowel sounds in center of abdomen
    • -Diastatis recti- when crying, muscle seperation
    • -Umbilical cord: 2 arteries, 1 vein
    • -Liver palpable .5-2.5 cm below right costal margin for newborns, 1-2 cm below for infants
  23. What do you look for in an abdominal assessment in children?
    • -24 hr diet recall, likes, dislikes, Pica- eating non-nutritional foods like stuffed animals
    • -liver palpable 1-2 cm below right costal margin
    • -Spleen 1-2 cm below left costal margin
    • -Less palpable with age
  24. What do you look for in an abdominal assessment for an adolescent?
    • -Eatting patterns, 24 diet recall, weight loss or gain, level of activity
    • -laxative use, vomiting
    • -View self as thin or overweight
    • -Same assessment as the adult
    • -Privacy issues with exam
  25. What are some eating disorders?
    • Anorexia
    • Bulimia
    • OBessesd with food, weight, distorted body image
    • Control issue
    • Tooth decay, anemia, dry skin, hypotension, etc
  26. What do you look for in musculoskeletal in infants?
    • Cranial bones soft at birth (soft sport)
    • Sutures ossify around age 6
    • assess for congenital birth defects
    • Bones arent fused at birth
  27. What do you look for in musculoskeletal in children and adolescents?
    • Children: Height, weight each visit, look at percentiles
    • Assess gait, knees for alignment
    • Toddlers have a wide stance which ends after 2.5 years

    • Adolescents:
    • Screen for scoliosis
    • Injuries due to sports or trauma
  28. What do you look for in an infants lymphatic assessment?
    • System develops at 20 weeks, very susceptible to infection due to inability to produce immunoglobulins
    • Receive IgG from Mother through passive immunity
  29. What do you look for in a child lymphatic assessment?
    increase b/w ages 6-9, larger than adults, shotty nodes 3mm to 1 cm in cervical and inguinal areas, small nontender nodes
  30. What to look for in a infant & pediatric HEENT
    • Head: Symmetry of skull and face
    • Neck: Structure, movment, trachea, thyroid, vessels, lymph nodes
    • Eyes: vision, placement
    • Ears: hearing, external ear, ear canal, and otoscopic exam of tympanic membrane
    • Nose: nose and sinuses
    • Mouth: Structures of mouth, teeth and phaynx
  31. Assessment of head: Infant
    Head circumference: asses each visit for first 2 years of life Measure just above eyebrows, rapid increase in HC during first 3 months of life 34-35 cm at birth

    Fontanels: Anterior 2.5-4 cm, close by 24 months. Sunken- dehydration, bulging: increased hemorrhage

    Molding: cone head, overlapping of sutures due to pressure from birth. Resolves in a week
  32. What is caput succedaneum?
    • Accumulation of fluid beneath scalp
    • crosses the suture line
    • Normal findings: resolves in 3-4 days after birth
  33. What is cephalhematoma?
    • -Collection of blood and fluid beneath scalp, localized over one cranial bone, does not cross suture line
    • Normal finding: take 3-4 weeks to resolve
  34. Assessment of the Face
    • Assess for symmetry, twitching-should be none, tics, edema
    • Assess expression
  35. Assessmentof the eyes
    • Symmetry: outer canthus should align with pinna of ear
    • Wide set or close eyes can indicate chromosomal problems
    • Assess conjunctive for drainage
    • 2-4 weeks: can focus on objects
    • 3-4 months: coodination of EOM and follow objects
    • 5-6 months: Follows peoples movements, plays with hands
  36. Visual acuity in children
    • Gets to 20/20 at age 6
    • Use E on snellen chart to assess vision until age 6
    • Color vision age 4-8
  37. Assessment of the Neck
    • Turns head side to side by 2 weeks of age
    • Steady head control at 3-5 months
    • Assess for short neck (Down Syndrome) or webbing (turners Syndrome)
    • Head lag (poor neck control) after 6 months may indicate CP
    • Assess shape and size of thyroid
  38. Oral Pharynx assessment
    • Assess color, drainage, uvula size
    • Tonsils
    • Bed breath can indicate chronic sinusitis, infected tonsils
    • Tonsils grow to maximum size between 2-6 years, can obstruct airway
  39. Nose Assessment
    • Assess nasal patency
    • Infants are nose breathers
    • Nasal flaring is respiratory distress
    • watery discharge with allergies
    • Yellor or green discharge: infection
  40. Sinuses Assessment
    • Maxillary and Ethmoid sinuses present at birth
    • Frontal sinuse develops around age 7
    • palpate and transilluminate
  41. Mouth Assessment
    • Inspect mucosa, gingivae, tongue
    • Assess for cleft palate
    • Tongue movement
    • Lips for color
    • Salivary glands developed by 3 months
  42. Ears/Hearing Assessment
    • 4-6 months- infant turns head to sound
    • 6-10 months- responds to name and follows sounds
    • Assess for hearing loss if decreased vocabulary
    • Assess ears for abnormalities of auricle
    • Low set ears- mental retardation
    • Tragus and auricle pain: otitis externa
    • To examine pull pinna down and back to straighten out until age 3
    • hearing screenings at birth
  43. Neurologic Assessment
    • Primary concerns: Reflex, posture, tone
    • closely tied with developmental tasks
    • voluntary control will take over as brain develops
    • Functions develop in orderly process
  44. What are the soft signs in school-age children
    • Signs are vague and conroversial
    • Clumsiness, language distrubances
    • delay in child to perform age specific activites
    • continued presnce is a developmental delay or lag
  45. What are infant reflexes?
    • Moro or startle
    • Tonic: Head to one side, other side arm and leg up disappears 4- 6 months
    • Palmer grasp: Disappers 3-4 months
    • Step in place
    • Babinski- Disappears at 18 months
    • Rooting: disappears at 3 months
  46. Infant Skin
    • Newborn red in color-decreased fat, vasomotor instability
    • Covered with white wazy coating (Vernix Caseosa)
    • Immediately after birth lips, nail beds, and feet may be cyanotic
    • Temp regulation not develop
    • Sub-Q fa layer is poorly developed
    • Apocrine glands not active until adolescense-mid perspiration odor
  47. What are some infant skin conditions?
    • Storkbites, Angelkiss- Vascular birthmarks
    • Strawberry Mark- Immature hemangioma, slightly raised sharp demarcation 2-3 cm in diameter, disappear by age 5
    • Cavernous Hemangiomas- reddish round mass blood vessels, may continue to grow until 10-15 months, regularly reassess
  48. Infant hair and nails
    • Lanuago- soft fine hair on ears, shoulds, and back-sheds 10-14 days after birth
    • Postmature infants will have long nails
    • Tufts of hair on back of spine- spina bifida
  49. Children skin, hair and nails
    • Bruising-inconsistent brusing with development= suspicion
    • Common lesions associated with communicable diseases
    • Varicella-Chickenpox
    • Rubella, Rubeola, Roseola
    • Tinea corporis
    • Impetigo
    • Pediculosis
    • Scabies
  50. What is diaper Rash?
    • Result of prolonged contact with urine and feces
    • Can be fungal with lesions
    • Treatment: If dry, wet it. If wet, dry it!
    • Caldesene medicated powder or desitin cream
  51. What is Impetigo?
    • Most common cause is Staphyloccus aureus, can be strptococcal.
    • Predisposing factors; poor hygiene, antecednet lesions
    • Occurs around the mouth and nose as oozing that becomes honey-crusted lesions
    • Scratching will spread the infection
    • Treatment: antiseptic soap/water, ATB
  52. What is Tinea corporis?
    • Ringworm: superficial fungal infection that is most prevalent in hot, humid climates and children
    • Transmitted by direct or indirect contact and is communicable as long as lesion is present
    • Treatment: fungal cream or griseofulvin for systemic treatment
    • Keep skin dry, avoid tight clothing
  53. What is scabies?
    • Caued by mites that burrow under the skin to lay eggs
    • Pruitus is caused by feces and ova
    • Highly communicable and spread skin to skin
    • Most common sites are the finger webs, wrists, and anticubial fossa
    • Lesions are linear, threadlike, grayish burrows
    • Treatment: Elimite cream applied and left on skin 8-14 hours head to toe
  54. Adolescent Skin
    • Apocrine glands enlarge and become active
    • Incresed sebaceous gland activity
    • Have oiler skin
  55. Adolescent hair and Nails:
    • Increased andrgoen levels
    • Axillae adn pubic areas will develop coarse terminal hair
    • Nails: same as adults
  56. Adolescents
    • Tanner Stages- developmental assessment
    • Asymmtrically-normal may resolve
    • Gynexomastia- normal, resolves
  57. Should children warm up before sports?
    Yes, if not many injuries can occur
  58. What is the most common disorder in babies?
    Aorta problems
  59. What is the test used to assess development of a newborn/infant/child?
    The Denver developmental Screening Test- tests approproiate milestones for a child's gross motor, language, fine motor, and personal social development
  60. What are the developmental stages of infants/newborns?
    • Cognitive and Language development (Piaget)- Sensorimotor stage
    • Moral Development (Kolberg)- Love and affection of the parents, follows them
    • Psychosocial Development (erikson)- Trust v. Mistrust
    • Psychosexual Development (Freud)- Oral Stage
  61. What is the APGAR scoring in Newborns.
    • Check at 1 and 5 minutes after birth
    • Score less than 8 may indicate poor transiton from intrauterine to extrauterine life
  62. Female Breast Development Rating
    • Stage 1-5 based on Tanner
    • 1: none
    • 5: highest
  63. Male Genitalia and Public Hair Rating
    • Stage 1-5, based on Tanner
    • Stage 1: No hair
    • Stage 5: Adult configuration, adult pattern hair
  64. Female Pubic Hair Rating
    • Stage 1-5, based on Tanner
    • Stage 1: No hair
    • Stage 5: Inverse Triangle
  65. Developmental Stage based on Piaget from Toddler to Adolescents
    • Toddler- Sensorimotor to Preoperational Stage
    • Preschoolers- Preoperational
    • School-age children: Operational
    • Adolescents: Formal Operations Stage
  66. Moral Development by Kolberg from Toddler to Adolescent
    Toddler- precoventional stage, punishment and obedience

    Preschooler- preconventional stage, 10 years, external control

    School-age child- role conformity-please others

    Adolscent- postconventional, individual conscience and defined set of moral values
  67. Psychosocial Development by Erikson from Toddler to Adolescent
    • Toddler- Autonomy versus shame and doubt
    • Preschooler- initiative v. guilt
    • School-age child- industry v. inferiority
    • Adolescent- identity v. role diffusion
  68. Psychosexual Development by Freud from Toddler to Adolescent
    • Toddler: Anal stage
    • Preschooler: Phallic Stage
    • School-age chld: Latency period
    • Adolescent: Genital Stage

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