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Peds Exam1

How old is a neonate? birth to 28 days
How old is an infant? 28 days to 1 year
How old is a toddler? 1 to 3 years
How old is a preschooler? 3 to 5/6 years
How old is schoolager? 5/6 to 12 years
How old is an adolescent? 12 to 18 years
What is growth and what is it measured by in a child? it is an increase in physical size and is measured by feet and inches, pounds and ounces
What is development in a child and what is it measured by? it is an increase in skill or ability to function. it is measured by motor skills
Growth and development are continuous process from conception to death
G & D proceed in a ( ) sequence. Orderly sequence. (ex: sit before we stand and we stand before we walk)
Different children pass through ( ) at different rates. pass through stages at different rates
What does it mean when development is cephalocaudal? development starts from head and continues to the "tail". This means first a child moves it head up, then can move its abdomen, then it can roll on to it's back, then sit up etc.
Development proceeds from distal to proximal? or proximal to distal body parts? proximal to distal
Development proceeds from gross skills to ( ) skills refined skills
There is an optimum time for what in a child? for initiation of experience or learning
What must happen to neonatal reflexes? they must be lost before development can proceed
When is the BLINK reflex lost? never
What is the ROOTING reflex, and when is it lost? When you stroke the child's cheek, they turn their head and open their mouth. It is lost at 6 weeks.
What is the SUCKING reflex? When is it lost? And what is important about this reflex? When you touch the child's lip they suck, it is lost at 6 months. If this reflex is never stimulated, it is lost immediately.
When is the SWALLOWING reflex lost? Never
What is the EXTRUSION reflex? When is it lost? If you touch or place something on or in their mouth, they will try to push it out. It is lost at 4 months
What is the PALMAR GRASP reflex? When is it lost? If you put something in their hand, their fingers will grab it. It is lost 6 weeks to 3 months
What is the STEPPING/WALKING reflex? If you are hold the child up and you go to set their feet on the floor, their toes will curl and only one foot touches the floor as the other foot is raised. Look like a puppet.
When is the STEPPING/WALKING reflex lost? It is lost at 3 months
What is the PLANTAR GRASP reflex? When is it lost? If you touch the sole of the foot, their toes will curl. It is lost at 8 to 9 months
What is the FENCING/TONIC NECK reflex? When is it lost? If you turn the head to one side, the arm extends. (looks like superman pose). It is lost at 2 to 3 months
What is the MORO/STARTLE reflex? When is it lost? If you touch the child's crib, or bump into their high chair, they are started and their arms extend. It is lost at 4 to 5 months.
What is the BABINSKI reflex? When is it lost? When the sole of the foot is firmly stroked, the toes flare out. It is lost at 3 months.
A great deal of skill and behavior is learned in a child by what? By practice
What are two primary factors that affect growth and development? Genetics and Environment
How are boys and girls different regarding their gender? girls are usually born lighter and shorter than boys, girls reach puberty 6 mo. to 1 year before boys. After puberty, boys are taller and heavier
How does health affect children? children with genetically inherited diseases will not grow normally
How does intelligence affect children? children with higher intelligence tend to advance faster
Environment can have a ( ) or ( ) impact on a child. positive or negative impact
How does socioeconomic level affect children? If there is access to health care, their health will be better
What does ordinal position mean? The first born will talk sooner because they are around adults. The second born learns to walk and talk sooner but is slower developmentally
When are solid foods introduced and what occurs at this time to allow for this? 4 to 6 months. The extrusion reflex must be lost
Erikson: Infant is in which phase? Trust vs. Mistrust
Erikson: Toddler is in which phase? Autonomy vs. shame and doubt
Erikson: Preschooler is in which phase? initiative vs. guilt
Erikson: School Age is in which phase? industry vs. inferiority
Erikson: Adolescent is in which phase? identity vs role confusion
Erikson: Young adult is in which phase? intimacy vs. isolation
What 6 reactions are in Piaget's sensorimotor phase (birth-2yrs)? Reflexes, primary circular reaction, secondary circular reaction, coordination of secondary reactions, tertiary circular reaction, and interventions of new means
What is primary circular reaction? objects are an extension of selves. (ex. my mom is and extension of me)
What is secondary circular reaction? child learns that activities make changes in the environment (when they hit a toy accidentally and it moves)
What is coordination of secondary reactions? child plays to attain a goal
What is tertiary circular reaction? child experiments with new properties of objects and events (the cube with different shapes, have to match the shaped blocks to get into cube)
What is interventions of new means? Child makes believe and play
What age does preoperational thought occur at? 2 to 7 years
What happens in preoperational thought? rapid learning of language, everything relates to me
What age does concrete thought occur? 7 to 11 years
What happens in concrete thinking? systematic reasoning
What age does formal operational thought occur? 11 to 15 years
What happens in operational thinking? solve hypothetical problems and use rational thinking
What age is prereligious stage and what occurs? Infant, little thought of any forces other than the caregiver
What age is preconventional stage and what occurs? Toddler: punish vs. obedience Preschooler: individualism
What age is the conventional stage and what occurs? schoolage, maintain order and rules
What age is postconventional stage and what occurs? adolescent, follow standards of society and good for all.
Child gets spanked if they ran out in the street is an example of what theory of moral dev.? preconventional (Toddler)
Child does good out of personal interest like cleaning their room so that they can stay up late is an example of what theory of moral dev.? preconventional (Preschooler)
A kid cuts in line during school lunch and another kid says "hey that's not fair! He cutted!" is an example of what theory of moral dev.? conventional(schoolage)
Getting a flu shot to help the people around you not get sick is an example of theory of moral dev.? Postconventional (adolescent)
How long in advance should you prepare (tell) child regarding hospitalization? 1 day per chronological age (2-7yrs) so if the are 6 years old, tell them 6 days before
What are some hospital changes that may impact a child? intrusive procedures (stranger danger), strange equipment, aloneness, terminology, disruption of normal sleep cycle, violation of personal space, restraining and confinement
A child's response to hospitalization/illness depends on the disease/illness itself, preparation for the experience, previous illness, support of family and health professionals, cultural background, and child's emotional status
Parent's reaction of their child's hospitalization may be affected by other family stressors, perceived seriousness of threat to child, previous experience with illness, available support system, personal ego strengths, cultural/religious beliefs, coping abilities, communication patterns in family
What type of anxiety may a child experience while in the hospital? separation anxiety: distressing and fustrating
What is the fear of an infant? fear of seperation
What are the fears of toddlers? fear of pain and injury, children have a difficulty time expressing vague symptoms
What is the fear of a preschooler? fear of bodily injury, provide comfort, "the skin keeps me in" bandaids
what is the fear of a schoolage child? fear of disability and death
What is the fear of an adolescent? fear of separation of peers, fear of being different, encourage friends to come and visit, give reassurance
When there are alterations in body image of a child, what factors affect the perception? Nature of the change (how does is look?), Stage of development (age/stage), response from significant other (child: parents, adolescent: peers)
What are the 4 psychological defense mechanisms of a child towards illness/hospitalization? Regression, denial, aggressive behaviors, and passive behaviors
when a child goes from sippy cup to bottle, or from potty to diapers this is an example of what defense mechanism? regression (they will go back to regular behavior)
When a child is acting like nothing is happening and they aren't even there when they are sick is an example of what defense mechanism? denial
When a child hits, bites, or screams when they are in the hospital; this is what type of defense mechanism? aggressive behaviors
When a child does not care what you do, and they just lay there and want to just get it done and over with; is what type of defense mechanism? passive behaviors (get them involved more)
What are the 5 types of play that can be observed in children? observant, solitary, parallel, associative, cooperative
When a child watches others play but does not join is what type of play? observant
When a child is playing alone, even when there is a room full of people is an example of what type of play? solitary
When a child plays among the others, even with the same type of toy, but does not interact with the others is what type of play? parallel
When children play in the same activities but is not organized is what type of play? associative (there are 12 mommies, and 4 daddies, all playing house, it isnt organized)
When play is organized and there is similar goals and outcomes is an example of cooperative play (1 mommy, 1 daddy, 7 children playing house, it is organized)
What are some different types of therapeutic play? role playing where the child is the doctor or nurse, use dolls, drawing, give equipment to play with (safety)
What is the optimum physical environment for a child being hospitalized? space for parents to visit comfortable, anything invasive needs to be in the "treatment room", bed=safe, provision for overnight stay, age groupings, age appropriate recreational space
Children who do not initiate a sucking reflex need a pacifier or they will develop a food aversion
When a child rejects to being comforted, cries loudly and demanding is protest
there is a decrease in the child's activity, flat facial expression, may cry quietly, lose developmental skills is despair
child is disinterested in parents, tend to be more interested in hospital staff denial
What are 8 important topics to talk about when obtaining a health history of a child? introduction/explanation demographic data chief concern history of chief concern health/family profile past health history family health history review of systems
What is a technique to use when doing a physical assessment on a newborn? undress only the body part being examined or use a radiant heat warmer to conserve heat.
What is a technique to use when doing a physical assessment on an infant? As with newborns, being examination with heart and respiratory assessment, then follow heat-to-toe procedure, performing all manipulative procedures such as throat and ears last. Talk to them like its "a game"
What is a technique to use when doing a physical assessment on a toddler? Allow toddlers to handle equipment; include games such as blowing out otoscope light, to relax the child.
What is a technique to use when doing a physical assessment on a preschooler? Use games such as "simon says" to ease the child's fright. Allow them to handle instruments before use and assure them the do not hurt.
What is a technique to use when doing a physical assessment on a school-aged child? Ask whether the child wants the parent present or not. Teach whys and hows of procedures.
What is a technique to use when doing a physical assessment on an adolescent? Teach them about good health care during examination. Include health teaching on self exams.
All newborns receive a physical examination when? immediately after birth and again after the first 24 hours of life. Blood pressure on all 4 extremities
Begin to include blood pressure as part of routine assessment at 3 years of age, or if child has known heart, renal, or hepatic problems
When do females perform self breast exams? 20 years
At what age do you discuss testicular exams? 13 years
What are components/concepts to know about getting a child's weight? weigh them w/out clothing they should be 2X their birth wt. by 6 months. AND 3X their birth wt. by 1 year.
How is height measured on a child? measure on a firm surface, mark from crown to heel. 1.5X birth height in 1 year.
What concepts are important to know when measuring head circumference? Measure until 2 years, newborns head is greater than chest by 1 inch. 2 yr old head is equal to their chest. 3 year old head is bigger than their chest
Where do you measure chest and abdominal circumference? at the nipple line
What needs to be inspected during a skin assessment? color, temp, turgor, texture, and presence of any lesions
What are you looking for on a newborn/infants head? newborn may show molding (elongated shape from birth), fontanelles, seborrhea (cradle cap)
What are you looking for on a toddler, preschooler, or schoolaged child's head? checking for lice, round circular areas or weeping in center (ringworm)
What are you looking for on an adolescents head? balding, lice, perfect circles of missing hair (stress), inspect to see that their scalp and hair are healthy underneath the styling
What is conjunctivitis and how is it treated? pink eye, and in children both eyes need to be treated with ATB
What is hordeolum and how is it treated? it is a stye and use of warm compresses or draining out the stye. also use of ATB
What is ptosis and what is it indicative of? drooping of the eye lid and denotes neurological involvement
What is strabismus? crosseyed or eyes not evenly aligned
What is esotropia and exotropia? Esotropia the eye always turns in, exotropia the eye always turns out
If you observe flaring of the nostrils in a child, what is that a sign of? a need for oxygen
What color should the inside of the nose be? and what do other signs indicate? nose should be pink, pale may be allergies, red may be infection
How do newborns and infants breathe? nose breathers so check for patency by suctioning
When are sinuses fully developed? not until about 6 years
In older children, what is reddened nasal mucous membranes and purulent discharge indicative of? upper respiratory infections
In older children what can cause clear discharge and pale mucous membranes? allergies.
What is the correct technique when examining a child's ear canal? down and back
If a child has low set ears (below eye level) what is that indicative of? certain chromosomal abnormalities such as down syndrome
What is the number one rule when a child has or suspected of having epiglottitis? do not depress the tongue, it can obstruct the respiratory tract so completely, the child is immediately unable to breathe.
What is a common abnormal finding you need to assess for in newborns and infants mouth? Assess for white patches that do not scrape away from the buccal membrane or tongue, which is thrush.
What are you assessing for in an older child's mouth? reddened or tender tonsils, since their tonsils reach maximum growth at early school age
What are you assessing for in the neck of newborns and infants? if they are less than 4 months old, they will have a head lag where you hold them up by their arms, the head will fall back and then they lift it.
In adolescents, what are you assessing with the neck? palpate the thyroid gland for symmetry and possible nodes.
What is retraction? indentation of intercostal spaces or the suprasternal and substernal areas that reflect difficult respirations.
Children with chronic lung disease develop what kind of chest? barrel chest (retaining CO2)
If a child has an enlarged heart, the left side of the chest may appear larger
What is pectus excavatum? funnel chested, the sternum is inward and if severe they may need surgery bc of cardiac problems
Scoliosis can cause what serious problems? cardiac problems
Both male and female newborns may have breast edema from what? the influence of maternal hormones
What are the causes of murmurs? altered blood flow, turbulent blood flow
What is the approximate center of all the valvular centers? Erb's point
When you hear or see an irregularity and splitting of the heart tones with inspiration in a child, what is this indicative of? it is normal, have child hold their breath to listen to their heart (sinus arrhythmia and physiologic splitting)
Where is the PMI in children under the age of 7? lateral to the nipple line and at the fourth intercostal space.
Where is the PMI in children older than 4? at the nipple line or just medial to it at the fifth intercostal space.
a swishing or blowing sound that occurs if there is an outpouching if the aorta is a? bruit
For a preschooler or school age child, what is a good technique to palpate their abdomen if they are "tickle-ish"? Place their hand under yours while palpating their abdomen to make them feel more relaxed
What are you observing for in the genitorectal area of a child? hemorrhoidal tissue (rare), Fissures (chronic constipation, intra-abdominal pressure, or sexual abuse)
How would you assess for an inguinal hernia in an infant? observe the groin area for any bulding, especially while the infant is crying.
How would you assess for an inguinal hernia in an adolescent or school aged child? with the child standing, place a fingertip against the inguinal ring in the groin area and ask the child to cough.
Signs of bitten fingernails in the school-age child ,ay reflect a high level of stress
a blue or purple tinge in a children's fingernails denotes cyanosis
yellow tinged nails denotes jaundice
clubbed fingers indicate decreased respiratory function or heart disease
linear hemorrhages under fingernails may mean endocarditis
what can cause extremely spoon shaped fingernails (concave) iron deficiency anemia
what is the normal capillary refill in a child? <5 seconds
How do you check for developmental hip dysplasia in infants? by attempting to abduct the hip fully
If there is a tuft of hair at the base of the spine, dimple, or pinpoint opening, this may be indicitave of spina bifida occulta
What are you assessing for when you test for motor and sensory function, balance, and coordination? deep tendon reflexes
When do routine vision screenings start in a child? early screen at 1 yr old, then 3 yrs old it becomes routine, or if the have a congenital abnormality, low birth weight, fetal alcohol syndrom, or received high levels of O2 at birth
With vision, newborns should be able to focus on a moving object such as a finger and follow it to the midline.
Infants see what kind of objects better than others? Infants see black and white better than color
Vision chart that uses the alphabet for school aged children Snellen
Vision chart used between ages 3 and when they can read the alphabet Preschool E chart
Vision chart that uses pictures Allen cards (preschool)
When is it routine screening for hearing levels begin? 3 years of age
Which infants are at high risks for hearing defecits History of childhood hearing impairment in family, perinatal infection, head/neck abnormality, birth wt. less than 1500 g, hyperbilirubinemia, bacterial meningitis, severe birth asphyxia, newborns who received ATB
What is the brainstem auditory evoked response? an earphone is placed on the infant and an electrode is attached the scalp, when sound is transmitted through the childs ear through the earphone, the electrical potential created as sound is processed by the brainstem and is read by the electrode.
Acoustic Impedence testing is based on the principle that sound entering the ear canal meets resistance at the tympanic membrane, if the middle ear is functioning correctly, there will be a symmetric pattern on the printout.
How can you determine intake in a breast fed baby? weigh the baby before feeding and after the feeding determines the INTAKE
How can you measure output of a child in diapers? Do not change the diaper, you weigh it dry then weigh it wet
How much fluid can an infant have when administering an enema? less than 250ml (exact amount should be stipulated by physicians orders)
How much fluid from an enema can a preschooler have? 250-350 ml
How much fluid from an enema can a school age child have? 300-500 ml
How much fluid from an enema can an adolescent have? 500ml
What type of fluid is most commonly used in an enema for a child? what should not be used? Normal saline is used, and do NOT use tap water because the child would be at risk for water intoxication
What is the preferred site in infants when giving an IM injection? Vastus lateralus or rectus femorus
Why would you not use the dorsogluteal site in a child under a year? Their muscle is not fully developed because they aren't walking until 1 yr
What is the most successful form of giving younger children oral medication? liquid, using a syringe and pushing it in their cheek is a good method
For older children what is a good technique when giving an oral medication? Offer a chaser afterwards
What do you NOT want to use as practice with a child for taking their oral medication? candy, you do not want to confuse them that medicine is like candy
Never give injections to children who are sleeping in the hope they will not wake up and will be terrified of being attacked
What is the best way to give a child an injection? Always give a short explanation of what you are going to do, be honest about the pain involved, ask for a prescription of an analgesic cream to be applied an hor before the injection to decrease pain, do not delay the injection and try to distract them
What is the IV fluid administered to children and infants and why? Isotonic fluid (lactated ringers or 0.9% NS) to prevent destruction of red blood cells or water intoxication.
Where is an alternativr site for IV insertion on an infant? scalp because they are less likely to infiltrate
Why are automatic rate-flow infusions pumps best for small children? because they regulate the flow accurately to a few drops per minute
What are the use of fluid chambers? devices that only allow 50-100 mls of fluid in the drip chamber to prevent overloading of IV fluid in a child
Other than IV, what is the quickest route to administer medications, fluid, and blood products? intraosseous infusion
Where is an intraosseous infusion usually inserted? into the bone marrow cavity of a long bone usually the tibia, femur, or iliac crest
sharp pain, it generally occurs abruptly after an injury. acute pain
pain that lasts for a prolonged period (often 6 months) and can lead to depression and less ability to achieve chronic pain
pain that arises from superficial structures such as the skin and mucous membrane, like a paper cut cutaneous pain
pain that originates from deep body structures such as muscles or blood vessels, like a sprained ankle somatic pain
involves sensations that arise from internal organs such as the intestines visceral pain
pain that is perceived at a site distant from its point of origin, Right lower lobe pneumonia is often first thought to be abdominal pain because the pain of this is coming from the abdomen referred pain
allows the cells of the brainstem that register an impulse as pain to be preoccupied with other stimuli so a pain impulse cannot register distraction
What is observed when an infant is in pain? because they are preverbal, observing cues such as diffuse body movement; tears; a high-pitched, sharp, harsh cry; stiff posture; lack of play; eyes squeezed shut, quivering chin and fisting are all cues to reveal discomfort
What are you assessing for in the toddler and preschooler's when they are explaining their pain? they have limited vocabularies (my boo boo), they have difficulty comparing pain from the past and present
What are comforting mechanism preschoolers use when in pain? gritting teeth, pressing a hand against forehead, pulling on their ear, holding their throat, rubbing an arm, or grimacing to control or express pain.
Some preschoolers do not mention their pain because they assume their parents already know they are in pain, or they dont want to be "punished" because it is their fault
A tool consisting of 8 questions for the child and 8 questions for the child's parents. It should also be used before the child has pain. Pain Experience Inventory
10 point scale on which 5 physiologic and behavior variables frequently associated with neonatal pain can be assessed and rated (like their VS, sleep, type of crying) CRIES neonatal postoperative pain measurement scale
pain rating scale devised by nurses to rate pain in very young infants the COMFORT Behavior Scale
a scale by which health care providers can rate a child's pain when a child cannot give input, such as during circumcisions FLACC Pain Assessment Tool
uses 4 red poker chips in front of child in a horizontal line in front of the child, used as young as 4 years, "these are the pieces of hurt" poker chip tool
this scale consists of 6 cartoon-like faces ranging from smiling to tearful, children as young as 3 FACES pain rating scale
consists of 6 photographs of actual children's faces, children as young as 3 OUCHER pain rating scale
uses a line with end points 0 to 10, school aged children and adolescents numerical or visual analog scale
combines visual activity and a numerical scale, it shows an anterior and posterior view of a child, children 8-17 adolescent pediatric pain tool
children note when pain occurs and then rate the pain each tie it occurs, used for children with chronic but intermittent pain logs and diaries
what is the reversal agent for versed (short acting sedative)? romazicon
What is the reversal agent for opiods? Narcan
What is EMLA? a topical anesthetic cream, applied hour before injections
What is LET? an anesthetic used on non intact skin
What are good oral analgesics and bad analgesics for children? good: tylenol, nsaids like ibuprofen Bad: aspirin (reye's=flu like symptoms)
Why should other routes be used for opiates instead of IM injections? IM injections produces great fear in children, pain, uneven absorption, unpredictable onset of action, and nerve and tissue damage
What is the maximum dose of tylenol for a child? 10-15 mg/kg/dose (4 doses/day)
What is the dosage for motrin for a child? 8-10 kg/mg/dose (every 6 hrs)
Can you use tylenol and motrin at the same time? you have to alternate between them
an abnormal restriction of the tongue caused by an abnormally tight frenulum (tongue-tied) Ankyloglossia (if child develops a speech or feeding problem, they will release this)
fusion fails to occur in varying degrees, causing to range from a small notch in the upper lip to total separation of the lip and facial structure up to the floor of the nose cleft lip (happens more in boys)
an opening of the palate, tends to happen more in girls cleft palate
What is the preoperative care for a child receiving surgery for a cleft palate or lip? focus on bonding and support with the family, good oral care, bulb syringe the child, instruct parents on feeding nipples, feeding techniques, burp more frequently, surgical repair
What is the postoperative care for a child that had cleft palate or lip surgery? address pain, elbow restraints to keep from picking, position on back or side, nothing hard in mouth, use dropper for fluids, no nipple at first, rinse after feedings, prevent crying to protect sutures, emotional support
metal bar taped to upper lip to keep in a relaxed position and no pressure on suture line logan's bar
hydramnios, born with a large amount of mucus in the mouth, blowing bubbles, or if they choke on their first feed are signs of tracheoesophageal atresia and fistula
What would you do if you suspected tracheoesophageal atresia or fistula? place child on NPO until doctor sees them
Why is emergency surgery needed for a child with tracheoesophageal atresia or fistula? to prevent pneumonia or dehydration
a protrusion of abdominal contents through the abdominal wall at the point of the junction of the umbilical cord and abdomen. They are usuallly covered by membrane. Omphalocele
condition similar to omphalocele, except that the abdominal wall disorder is a distance from the umbilicus, usually to the right, and the abdominal organs are not contained by a membrane but rather spill freely from the abdomen gastroschisis
common in the duodenum, difficult passing or no stool intestinal obstruction
What is the therapeutic management for an intestinal obstruction? NG tube to low intermittent suction, IV fluids, repair of obstruction, temporary colostomy
an extremely hard portion of ( ) that has completely blocked the intestinal lumen, causing a bowel obstruction meconium plug syndrome
What is used to treat meconium plug syndrome? saline enemas, mucomyst
what needs to be tested if a child has a meconium ileus? cystic fibrosis
a protrusion of an abdominal organ through a defect in the diaphram into the chest cavity Diaphragmatic hernia
What is the danger of a diaphragmatic hernia? respiratory compromise
What are you going to do for a child that has a diaphragmatic hernia? NPO, maybe surgery, head of the bed up to work with gravity, monitor respirations, closely monitor child
excess of cerebospinal fluid in the ventricles or subarachnoid space hydrocephalus
what is communicating hydrocephalus? the CSF can reach the spinal cord
what is obstructive hydrocephalus? the CSF is blocked
What are the signs and symptoms of hydrocephalus? enlarged fontanelles, transillumination, inc. head circumference, inc. temp, inc.blood pressure, dec. pulse, dec. respirations, shrill cry, sunset eyes
what is the treatment for hydrocephalus? placement of a shunt, ventricular peritineal shunt, ventricular atrial shunt. a loop that drains the cavity into the peritineal space and only lasts a few years
What is the preoperative care for a child undergoing surgery for hydrocephalus getting a shunt? change positions frequently, support head, quiet environment, little stimulus, HOB is up, monitoring head circumference
what is the preoperative care of a child that had a shunt placed for the tx of hydrocephalus? pain control, watch s&s of infection, if fontanelle is flat lay them flat to slow down the CSF movement, avoid pressure on the site
What happens if the CSF comes off to quickly after a child had a shunt in place for tx of hydrocephalus? risk for seizures and intracranial bleeds
absence of the cerebral hemispheres ancephaly (parents have an option for the child to be organ donor)
brain growth is so slow that it falls more than three standard deviations below normal on growth charts microcephaly
when the posterior laminae of the vertebrae fail to fuse spina bifida occulta
What is a meningocele? meninges covering the spinal cord herniate through unformed vertebrae, it is a protruding mass (usually size of an orange) at the center of the back. there is no motor or sensory problems
What is a myelomeningocele? the spinal cord and the meninges protrude through the vertebrae, the spinal cord ends at the point, so motor and sensory function is absent beyond this point
What type of therapy might a patient with a myelomeningocele need? braces to walk, bowel training, bladder training, laxatives, catheterized
What environment do children with myelomeningocele need? a latex free environment
What is the postoperative care for myelomeningocele? position them in prone, monitor for infection, monitor their ICP, watch for hydrocephalus, monitor the extremeties that are affected
what is polydactyly? 1 or more extra digits
what is syndactyly? digits are fused together
What is torticollis? congenital anomaly when the sternocleidomastoid muscle is injured and bleeds during birth, neck is twisted to the side
What do the parents need to do to relieve torticollis? begin a program of passive stretching exercises, lying the infant on a flat surface and rotating the head in full ROM. Encourage the infant to turn and stretch their neck
a premature closure of the sutures of the skull craniosynostosis
what is the danger of craniosynostosis? compromises brain growth
a failure of bone growth inherited as a dominant trait that causes a disorder in the cartilage production. achondroplasia
Which is worse.. bilateral achondroplasia or unilateral achondroplasia? unilateral
What is the treatment of achondroplasia? growth hormones, bone lengthening, straightening activities, cast the foot, or surgery
improper formation and function of the hip socket where the acetabulum or pelvis is flattened or shallow developmental hip dysplasia
what are the signs of developmental hip dysplasia? limited abduction of knees, affected limb is shorter, unequal skin folds, unequal knee heights, when you move the hip you hear ortolani sign (popping when rotating)
What is the treatment for developmental hip dysplasia? maintain them in abduction and flexion, multiple diapers at once for 4 to 8 wks, pavlik harness, spica cast (watch for circulation)
what might be necessary in the correction of developmental hip dysplasia? surgery may be the final correction, reassure parents that they need to hold their child regardless of a cast and that they will catch up and learn to walk
At what PO2 level do you start to see cyanosis? 40%
retraction of the upper chest muscles (supraclavicular and substernal) suggests upper airway obstruction
retraction of intercostal or subcostal muscles suggests lower airway obstruction
What lab tests can be used to confirm or rule out the presence of a respiratory disorder? ABG's, nasopharyngeal culture, and sputum analysis
What is the cause of resp. ALKALOSIS? HYPERventilation rapid deep breathing
What is the cause of resp. ACIDOSIS? HYPOventilation shallow breathing (just think that if the child isnt breathing ENOUGH the acid is staying inside him)
How is a respiratory syncytial virus nasal washing done? saline is squirted into the nose, sucked out with a bulb syringe, then sent to the lab
What is pulmonary function studies? measure the forces of inertia, elasticity, and flow resistance. Peak flow is the amount of air that can be moved out of the lungs with a forceful breath
What can be given to loosen or liquify mucus? robitussin, saline nose drops, or saline nasal sprays
emit steam of air moistened by fine droplets into a room, providing either cool or warm mist into the entire room vaporizors
mechanical devices that provide a stream of moistened air directly into the respiratory tract nebulizers
nasal sprays like normal saline cane be administered to moisten and loosen nasal secretions
decongestants cause vasoconstriction leading to the shrinkage of mucous membranes
Caution parents not to give cough and cold medications to children under 2 unless prescribed by their HCP
What do you need to watch for when caring for a patient with a tracheostomy? infection
What technique is used when suctioning a trach? sterile technique!
Positive pressure machines deliver moistened or nebulized air or oxygen to the lungs under enough pressure and with appropriate timing to produce artificial, periodic inflation of alveoli, they rely on the elastic recoil of the lungs to empty the alveoli Assisted ventilation
a congenital obstruction of the posterior nares by an obstructing membrane or bony growth, preventing a newborn from drawing air through the nose and down the nasopharynx choanal atresia
What is acute nasopharyngitis? common cold, caused by a virus, stress can cause immunosupression making them susceptable
What are the symptoms of viral pharyngitis mild, sore throat, fever, malaise
What are the symptoms of streptococcal pharyngitis? more ill, reddened/enlarged tonsills, high fever, treat with ATB (give injection, pills=no compliance)
What is a potential risk of streptococcal pharyngitis? glomerunephritis or rheumatic fever
If on ATB for strept, what should you do with your toothbrush? throw it away or boil it after use (it harbors germs)
What are two common signs of tonsillitis? sleep apnea and bad breath
What is epistaxis? and how do you stop it? nose bleed, pinch nose and lean forward
infection and inflammation of the sinus cavities sinusitis
What is the best tx for laryngitis (inflammation of the larnyx)? resting the voice for atleast 24 hours
infants larynx collapses with inspiration and produces stridor, they usually have to stop sucking to breathe congenital laryngomalacia/tracheomalacia
inflammation of the larynx, trachea, and major bronchi. barking cough, inspiratory stridor, retractions croup
What is the tx for croup turn on hot water in bathroom and have the child in there with the steam, if it does not get better take to ER, they will give corticosteroids and humidification
What are the signs of epiglotitis stridor, high fever, hoarseness, sore throat, diff. swallowing, drooling, sitting up to breathe and mouth is wide open
What is the treatment of epiglottitis? moistened gases, ATB, calm, xray
what is bronchitis? inflammation of major bronchi and trachea, cough, fever, hacking, rhonci. It may be bacterial or viral
What is bronchiolitis? inflammation of fine bronchioles, nasal flaring, retractions, mild fever, RSV related
What is RSV? respiratory syncytial virus that is problematic condition, produces copious amounts of secretions, comorbitities can inc. risk
What is the medication given for RSV? ribiviren
What is bronchiectasis? chronic dilation and blocking of bronchi and follow asthma. Wheezes, chronic cough, cyanosis
When asthma does not respond to treatment it is... status asthmaticus
Why would you give fluids at room temperature to a child with status asthmaticus? because cold fluids can cause spasms
What is the treatment of pneumonia? ATB, turn and reposition freq. to prevent pooling of secretions, IV therapy, antipyretics, humidified O2, chest physiotherapy,
Newborns who do not breathe enough at birth to inflate lungs primary atelectasis
When children have a respiratory tract obstruction that prevents air from entering a portion of the alveoli is secondary atelectasis
the presence of atmospheric air in the plueral space causing alveoli to collaps is a pnuemothorax
chronic pulmonary involvement seen in premies who had to recieve mechanical ventilation, the need a lot of steroids (moonface) bronchopulmonary dysplasia
an autosomal recessive condition where there is a dysfunction of exocrine glands and mucus secretions become tenacious Cystic fibrosis
Why do children have issues with cystic fibrosis? there is no production of lipase, trypsin, and amylase so they have problems with malabsorption, fatty stools (steatorrhea), cant digest fats, proteins, or sugars, have protruberant abdominal, may see meconium ileus
What is the treatment for cystic fibrosis? pancreatic enzymes, fat soluable vitamins, high calorie/fat/protein diet, keep hydrated and keep room temp low
What happens to the lungs in children who have cystic fibrosis? thick secretions, pool in bronchioles, infection, emphysema from overinflation of alveoli from thick mucus, clubbing, barrel chest, ciliary dysfunction
What is the therapeutic management for the lung issues in children with cystic fibrosis? chest physiotherapy, percussion, postural changes, they may have repeated infections
What is the treatment for the sweat problems in cystic fibrosis? good hygiene, electrolytes, watch for overheating, they will taste salty bc of the sodium that binds to the chloride when the child sweats
Created by: taylor_rhoades