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SAC Peds Exam Test#3

Module 6,7,8

What is growth? physiologic increase in size
What is development? Psychological, physiological, cognitive changes during life span
Biologic infant milestone (0-3mos) Sleeps a lot, improved head lag, head support in prone position
Biologic infant milestone (3-6mos) Improved head control, Posterior fontanel closes (2mos), Grasping, Sitting w/out support, rolls abd-back, 2x BIRTH WEIGHT (6mos), Teething, Social smile (2-5mos)
Biologic infant milestone (6-9mos) Sits without support, rolls back-abd, scoots, pull up to walk, pincer grasp, Object Permanence
Biologic infant milestone (9-12mos) crawls, stands, may walk, 3x BIRTH WEIGHT, imitates expressions, first words
Biologic Toddler milestone (1-3yrs) Growth slows, anterior fontanel closes (15-18mos), head proportional, fine motor skills improve, bones lengthen/straighten, walk (15mos), climbs (18mos)
Biologic Preschooler milestone (3-5yrs) slow growth, body systems control, hop/skip/jump, tricycle, improved fine motor, dresses self
Biologic School-age milestone (6-12yrs) Steady, physical growth, inc. skeletal growth, Inc/strengthening muscles, improving motor skills
Biologic Adolescent milestone (13-18+yrs) Puberty, growth spurt
Key to Erikson's Psychosocial development Inter-relationship between emotional/ physical variables, conflict resolution stages
Key to Piaget's Cognitive development Shaped by actions/consequences, follows orderly progression
Psychosocial developement - Infancy (birth - 1 1/2yrs) TRUST VS MISTRUST - basic needs met, Stranger/ Separation Anxiety (6mos - 3yrs)
Psychosocial developement - Toddler (1 1/2 - 3yrs) AUTONOMY VS SHAME/DOUBT - sense of control, "no", ritualism, parallel play
Psychosocial developement - Preschooler (3 - 6yrs) INITIATIVE VS GUILT - behavior goal-directed and imaginative, criticism = guilt
Psychosocial developement - School-Age (6 - 12yrs) INDUSTRY VS INFERIORITY - mastery of skills (fosters self esteem), rules important, predictability
Psychosocial developement - Adolescent(12 - 21yrs) IDENTITIY VS ROLE CONFUSION - egocentric, peers important, independence from parents
Piaget's Cognitive development Period 1 (birth - 2yrs) SENSORIMOTOR PERIOD - reflexive-intentional behavior, egocentric, Object Permanence
Piaget's Cognitive development Period 2 (3-7yrs) PRE-OPERATIONAL - magical thinking, animism, NO reversibility, thoughts cause actions
Piaget's Cognitive development Period 3 (7-11yrs) CONCRETE OPERATIONS - systematic/logical, fact from fantasy, sense of time, transductive reasoning (cause/effect), reversibility
Piaget's Cognitive development Period 4 (11yrs-adult) FORMAL OPERATIONS - abstract thinking, analytical, new ideas
What hinders advancing to Piaget's Formal operations stage? poor comprehension, lack of education, learning disabilities, substance abuse
Different screenings throughout childhood Apgar, newborn, lead, vision/hearing, scoliosis
What do well child check-ups check for? Height, weight, head circumference
How long do infants need breastmilk or Fe-fortified formula? 12mos
When should infants start to eat solids? Progression? 4-6mos; rice cereal--> veggies--> fruits--> meats
When can infants start finger foods? Restrictions? 8+mos; nuts, raisins, hot dogs, peanut butter, raw honey
When do Toddlers need whole milk? 1-2yrs
What should the daily intake of milk be for toddler? why? 16-24oz; so they can eat other food as well
Key to nutrition for pre-schooler? Establish good eating habits/schedule
Keys to nutrition for school age children? Inc. appetite, busy schedule = rush eating to play, independent food choices
Keys to nutrition for adolescents? Growth--> inc. protein, Fe, Ca needs (especially for athletes), appearance and peer acceptance
What concepts contribute to childhood obesity? Genetic influence AND environmental exposure
Cardio affects of obesity? HTN, CAD, Lt ventricle hypertrophy, dyslipidemia, MI, stroke
Respiratory affects of obesity? Asthma, PE, enlarged tonsils/adenoids, sleep apnea
Endocrine affects of obesity? IDDM, insulin resistance, Polycystic Ovarian syndrome
GI affects of obesity? Steatohepatitis (fatty liver), cirrhosis, gall bladder disease (cholecystitis)
Acanthosis nigricans Hyperpigmentation d/t insulin resistance in axilla or back of neck
AAP prevention of childhood obesity 5-2-1-0 5 servings fruit/vegs, <2hrs screen time, 1+hrs phys activity, 0 sugared bevs
Psychosocial affects of obesity? Depression, social isolation, anxiety, poor self-esteem, bullying, suicidal, eating d/o, discrimination
Why are childhood immunizations given? Primary prevention of many communicable diseases
what are live, attenuated vaccines? examples? Weakened form of disease; MMR, Varicella, Nasal flu vaccine
what are inactivated vaccines? examples? killed/synthetic bacteria/virus; DTaP, Polio (IPV), HepB
How long to attenuated vaccines last? 20+ years for single dose
Disadvantage of inactivated vaccine? Need frequent boosters
Disadvantage of attenuated vaccines? Can't give to immunocompromised (can give inactivated vacc)
When is HepB vaccine given (hint: 3stages) birth--> 1-2mos--> 6-18mos
What is RV vaccine? When given? Rotavirus vaccine against severe diarrhea; given @ 2,4,6mos
what is DTaP vaccine? When given? Diptheria (resp dz that causes paralysis, heart failure, death), Tetanus (lockjaw; causes muscle spasms & death), Pertussis (whooping cough); given @ 2,4,6, 15-18mos, and 4-6yrs
what is Hib vaccine? When given? Haemophilus influenzae type B (can cause illnesses that affect brain, lungs, and bones or joints); given @ 2,4,6, & 12-15mos
Difference between DTaP and Tdap? DTaP for <7yrs old; Tdap for 8+yrs old
what is PCV vaccine? When given? Pneumococcal Conjugate Vaccine (against bacteria that causes PNA); given @ 2,4,6, 12-15mos
what is IPV vaccine? When given? Inactivated Polio Vaccine (against Poliomyelitis virus that causes inflammation of spinal cord that leads to paralysis/death); given @ 2,4,6-18mos, 4-6yrs
what is MMR vaccine? When given? Measles, Mumps, Rubella attenuated vaccine given @ 12-15mos & 4-6yrs
what is Varicella vaccine? When given? Chicken Pox attenuated vaccine given @ 12-15mos & 4-6yrs
When is HepA vaccine given? Given in 2 doses between 12-24mos
When is flu shot given? Key thing to know? Yearly starting at 6mos; if 1st time between 6mos-8yrs, given in 2 doses, 4 wks apart; if only 1 dose given, next season, give 2 doses
What if vaccine is missed? Provider will catch up with next vaccination with first dose
Contraindications for vaccinations? Immunocompromised (oncology pts, chronic steroid meds), allergies, illness, pregnancy
What immunizations can be given at 2mos? HepB, RV, DTaP, Hib, PCV, IPV
What immunizations can be given at 4mos? RV, DTaP, Hib, PCV, IPV
What immunizations can be given at 6mos? HepB, RV, DTaP, Hib, PCV, IPV, flu shot
What immunizations can be given at 12mos? HepB, Hib, PCV, IPV, flu shot, MMR, Varicella, HepA
What immunizations can be given at 4-6yrs? DTaP, IPV, flu shot, MMR, Varicella
What allergies can contraindicate vaccine to be given? allergy to eggs, poultry, latex, gelatin, neomycin
Vaccine site for infants/children? Vastus lateralis
When to call healthcare provider after vaccine? High fever over night (>100.5F), Bx changes, severe adverse reaction
#1 injury for infants? Scalding burns
How to prevent scalding burns in bath tubs? Adjust thermostat on water heater
Leading causes of injuries for toddlers? Drownings and burns
When should 1st dental exam be done? 3yrs old
What to know about water? need fluoride supplements if drinking water <0.7ppm
Leading cause of death for School age children? Accidents
Leading cause of injury for adolescents? MVA, firearm accidents, sports
When is deceased diagnosed as SIDS? autopsy is inconclusive
When does SIDS usually occur? what time of year? to who? 95% before 6mos; peak at 2-4mos; more in winter; preemies/low birth wt babies
#1 intervention for SIDS? Supine sleeping; "back to bed"
Where is Pb absorbed? Thru GI, accumulates in bones, teeth, brain, kidneys
Acceptable Pb level? when needed to treat? <10mcg/dl; must treat >20mcg/dl
What does Pb poisoning lead to? Pb absorbed into bones instead of Ca and breaks down RBCs, = Anemia (dec H&H)
How is Pb poisoning treated? EDTA chelating agent given IV that absorbs Pb out of bones back into blood and excreted thru kidneys
When possible poisoning, first questions? 1. What was it? 2. When did it happen?
If bolus is ordered for unknown poisoning, what fluid used? why? NS, because other fluids can alter labs and may cause reaction
How does activated charcoal help in poisoning? absorbs agent and expels thru GI
When/What age do you usually see Separation Anxiety? 3 phases? Infancy to pre-school age (6mos - 4yrs); Protest, Despair, Detachment
Child concept of death by age? Infant= none; Preschool= temporary separation; School-age= sad,irreversible; Adolescent= inevitable, irreversible, distant
Most common type of child abuse? Neglect (then physical, sexual [usually not reported], psycho, medical, other)
Most common trigger for Shaken Baby Syndrome? What's it lead to? Crying; leads to whiplash induced intracranial/retinal bleed
What are pregnant teens at an increased risk for? Pre-eclampsia, CPD, preterm labor/birth, low birthweight, depression
Lack of growth and development leads to what? Failure to Thrive - decline on growth curve in ht/wt
Organic, physical factors of Failure to thrive? GI d/o, cardiac, chronic infxns, endocrine d/o, metab d/o
Inorganic, psychosocial factors of Failure to thrive? Poverty, poor social support, family stress, inadeq nutrition, diff bonding, maternal depression
Failure to thrive interventions? treat cause, multidisciplinary, observe, MONITOR HT/WT,I&O, teach, referrals
What is neonatal sepsis? Viral or bacterial infection of the blood in newborn
#1 cause of Neonatal Sepsis? Group beta streptococcus
Labs/Diagnostic tests for Neonatal sepsis? Urine, CSF, and Blood test
Blood tests in Neonatal sepsis? CBC w/ diff, CRP, ESR, Bands
What is CSF panel looking for in neonatal sepsis? Elev. WBC, low glucose
Common problems w/ Downs Syndrome? Cardiac problems, pyloric stenosis, hypothyroid, compromised immunity, sensitive skin, audio/visual impairment
Clinical manifestations of Down's syndrome? Low set ears, protruding tongue, hypotonia, simian crease, inner epicanthial folds, short,broad neck, wide, flat nasal bridge
Otitis Media? How treated? Inflammation of MIDDLE ear; oral antibiotics
How is child's eustachian tube different from adults which leads to more Otitis media infections? child's is more horizontal and shorter
S/S of Otitis media? DIFFICULTY FEEDING/SUCKING, pain, pulling at ears, fever, irritability, ear drainage
What is OME? Otitis media w/ effusion; middle ear inflammation w/ fluid behind tympanic membrane
What can chronic otitis media lead to? Usually at what age? can lead to hearing loss and delayed speech; older than 3mos
What is myringotomy w/ PE? Inserting pressure equalizing tubes to treat frequent otitis media infections
what may be needed for chronic OM? audiologist referral
Treatment for varicella? Acyclovir IV, fever mgmt, skin care, comfort measures
When can kid w/ chicken pox go back to school? After all vesicles are crusted over
What is Roseola? Virus that causes fever, then rosy pink macular rash to trunk that lasts a week in 6-18mos old
3 stages of pertussis? Complication? Catarrhal (URI symptoms), Paroxysmal (cyanosis; whopping cough), Convalescent (less coughs); PNA
What is impetigo? Complication? Superficial bacterial infection; cellulitis
3 Cs of Rubeola? Coriza (runny nose), Cough, Conjunctivitis
Created by: cobedad