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scc pediatrics

pediatrics

QuestionAnswer
anterior fonatanel closes at_______& posterior fonatanel closes at _______ anterior 12-18 months posterior 6-8 weeks
INFANT/TODDLER age range BIRTH TO ONE YEAR ONE TO THREE YEARS
PRESCHOOLER/SCHOOL-AGE AGE RANGE THREE TO FIVE YEARS SIX TO 12 YEARS
ADOLESCENT AGE RANGE 12-18 YEARS
Freud stage? birth -1yr ; sucking biting, exploring the world Oral
freud stage? age 1-3 yrs- toilet training Anal
freud stage? age 3-6yrs-discovers difference between boys and girls; loves the opp sex parent Phallic
freud, immediate gratificaton Freud- Id
freud,conscious rational,sensors the id Ego-
freud, conscience and ideals-constant battle with the id Superego-
freud Latency Freud; child expands on traits- no particular body part 6-12
freud Genital Freud; incr sex maturation- capacity for love and maturity 12-18
Children tend to _____ report their pain. under
Erickson's birth–1 year Trust vs. mistrust: develops trust as caregiver meets child's needs
Erickson's 1-3 years Autonomy vs. shame and doubt Child learns to control body functions, increasing independent; toilet training
Erickson's 3-6 years Initiative vs. guilt Learns about the world thru play; develops conscience; dresses self; makes choices
Erickson's 6-12 years Industry vs. inferiority Works on projects & competes with others; follows rules; school age
Erickson's 12-18 yearsIdentity vs. role confusion Trying to establish own identity
Piaget Preoperational Stage 2-7 yrs, egocentrism, imitation,exploration, questions,concrete thinking, intuitive reasoning,observation, Magical thinking, symbols & language Transductive reasoning- (items that share characteristics are the same)
Piaget Sensorimotor Stage Birth-2 yrs,object permanence,Develop sense of self,language explosion,Explore environment w/mouth,Causality,Spatial relationship(square peg/ round hole)
Piaget Concrete Operational Stage 7-11 yrs,more logical & coherent,Concept of time, Inductive reasoning(uses past experiences for new conclusions)ordering,& classifying facts for problem solving,Less self centered,sports,Concept of conservation and reversibility are mastered
Piaget Formal Operational Stage 12 yrs to Adulthood incr abstract, logical, analytical,creative,complex thinking Alternative solutions for problems, inductive/deductive reasoning;Primary task= develop philosophy of life//
Infant weight/height Doubles by 6 mos/triples by 1 yr. Best for nutritional status Grows about 1 in/mo ( 1st/6mo’s)/ then ½ (next 6mo’s)Best to indicate growth
Infant rest 13- 16hrs/day including frequent naps
0 - 3 mo's milestone palmar/Reflexive grasp only Rooting and sucking Recognizes familiar faces/objects
4-6 mo's milestone Good head control Sit w/ support, can roll voluntary grasp Smiles at mirror image
7-9 mo's milestone Sits independently,Crawls, stands with assist, pulls to stand Rakes with fingers/Crude pincer grasp Chewing movements Increasing fear of strangers,Imitates
10-12 mo's milestone Stands alone,Walks w/& w/o support self-feed,neat pincer grasp Imitates expressions;“object permanence
9-12 mo's language 4 words mama, papa, etc
Infant play solitary
toddler play parallel
toddler Weight gains/grows 4-6lbs a year 2 to 2.5 inches a year
toddler's rest 10hrs/day wean down to 1 nap a day; 0 naps needed by 3yo
toddlers eating habits are related to _______ _______, growth_____ and they need _____ food & become _______eaters physiologic anorexia; slows;less;picky
Toddlers are ready to start potty training when 3 things occur: 1. periods of dryness for at least 2 hr 2. walking 3. can take off clothes
toddlers motor skills include: Walks alone, runs,Kicks ball Open/close hand, fine grasp, scribble,Turns knob
language skills at 2 yrs 200 words;
language skills by end of 3 yo 1000 words/short sentences
hospitalzied toddler experiences 3 periods of adjustment;1____;2_____;3_____ 1.protest;2.despair;3. denial
Nursing consideration for the hospitalized toddler include: preserve child’s trust,Reassure of parents return,leave personal item, Maintain routines and rituals
preschoolers weight gains preschoolers height grows 4-5 lbs/yr 2-3 inches/yr
preschooler rest needs are: 9-10 hrs, no naps
preschooler motor skills include: Runs, climbs, throws ball overhead, stand on one foot, hop and stand on tiptoe Dresses self,Buttons,Draws stick figures Brushes teeth
preschooler play include Associative play(more interactions w/ each other)Imagination; Drama play
school age grows school age gains 2 inches/yr 5 lbs/yr
school age play cooperative play, sports, win approval
preschooler hospitalization fears R/T mutilation( magical thinkers); viewed as punishment
school age hospitalization fears R/T death, lack of control, better able to cope
adolescent females grow_____ and gain_____ 3- 6” in height & gain 20-25 lbs
adolescent males grow_____ and gain_____ 3-5” in height & gain 15-20 lbs
Adolescent rest at least 8hrs
adolescent hospitalization fears R/T Altered achievement of identity,Disruptions of plans,Decreased access to friends;fragility of life
Infant & Toddlers view of death & dying Lack understanding
Preschoolers view of death & dying Temporary & reversible
School age view of death & dying Irreversible; not necessarily inevitable
Adolescents view of death & dying Irreversible, universal & inevitable
Physiologic Measures of Pain Increased-HR,RR,BP O2-decreases
Behavioral Pain Signs Vocalization,Facial Expression,Body movement, altered sleep, irritability
Young Infants Response to Pain rigidity thrashing,Loud crying,Facial expression; No understanding between stimuli and pain
Older Infant Response to Pain Withdrawal from painful stimuli Loud crying;Facial grimace;Physical resistance
Young Child’s Response to Pain Loud crying screaming, Verbalizations; Thrashing limbs; Attempts to push away stimulus
School-Age Child’s Response to Pain Stalling behavior; Muscle rigidity; May use all behaviors of young child
Adolescent’s Response to Pain Less vocal protest less motor activity; Increased muscle tension and body control; More verbalization
Toddlers are _____ thinkers and May view pain as __________ and only report to ______ _____ magical; punishment; their parents
preschoolers have trouble with _____vs________; are ________ thinkers;and need _____ that pain will end, but they have an ability to use_____ ____ reality vs fantasy; concrete; proof; coping skills
School Age children response to pain may _______ and may________ emotionally and can _______ their pain exagerate;withdraw; verbalize
Adolescents ____ or ____ ___ be honest about their pain,may have an _______ ______, be ____-________ & have a ______ of pain may or may not;imaginary audience;self-focused; fear
pharmacological pain management include Ibuprofen: (5-10mg/kg/dose Q 8 hrs) Keterolac:(Toradol)(0.25mg to 1mg/kg/dose Q 6 hrs)(Not to exceed 5 days of treatment) Morphine(opiod of choice) Dilaudid Fentanyl
mild cognitive impairment IQ IQ: 50-55 to 70-75
moderate cognitive impairment IQ 35/40 - 50/55
severe cognitive impairment IQ 20/25 - 35/40
Profound cognitive impairment IQ below 20-25
DOWN SYNDROME signs IN INFANT UPWARD SLANT TO EYES LARGE SPACING BETWEEN EYES PROTRUDING THICK TONGUE SHORT BROAD NECK MOTTLED SKIN HYPOTONIA
etiology of visual deficiencies Refractive/Nonrefractive Perinatal Infections- (TORCH) Retinopathy of Prematurity Trauma Postnatal Infections
etiology of conjuctivitis in newborns chlamydia, gonorrhea, herpes
etiology of conjuctivitis in infants tear duct obstruction
etiology of conjuctivitis in children bacterial(#1), viral, allergy, foreign body
retinoblastoma- definition, sign, tx Congenital malignant intraocular tumor,Cat’s eye Reflex- (white reflection in eye, white glow)tx-surgery, laser, cryotherapy, chemotherapy
infants/ children increased risk of otitis media due to poor eustachian tube function, shorter no slant ear canal L/T decr drainage, incr chance of infection, less antibodies
Kernig's sign neuro test for meningitis flex leg @ knee & hip then straighten (pos if painful)
Brudzinski’s sign neuro test for meningitis lie supine raise head up (pos if painful)
glasgow coma scale measure what 3 areas? max score/meaning? low score/meaning? eyes, verbal response, motor response max=15 unaltered LOC min= 3 extremely decr LOC
Clinical Manifestations of Increased ICP in Infants Irritability, poor feeding High pitched cry, difficult to soothe Fontanelles: tense, bulging Cranial sutures: separated Eyes: setting-sun sign Scalp veins: distended
Clinical Manifestations of Increased ICP in Children Headache Vomiting: with or without nausea Seizures Diplopia, blurred vision
Behavioral Signs of Increasing ICP Irritability, restlessness Drowsiness, indifference, decrease in physical activity and motor skills C/O fatigue, somnolence Inability to follow commands, memory loss Weight loss
Late Signs of Increasing ICP Decreased LOC Decreased motor response to command Decreased sensory response to painful stimuli Alterations in pupil size and reactivity Papilledema Decerebrate or decorticate posturing Cheyne-Stokes respirations
Indications for ICP monitoring Glasgow coma scale <7 Glasgow coma scale <8 with respiratory distress
ICP non-pharm Tx Neuro position: HOB up 10 to 20 degrees Head and neck neutral Temperature: Normothermia w/o cooling devices or meds Encourage presence of family Uninterrupted periods of sleep and rest
ICP pharm Tx Medication: Mannitol, Lasix IV drip of midasolam (Versed) Pain meds Pavulon to decrease muscle response to stimuli Anticonvulsants Steroids w/neoplasms
ICP Assessment LOC Pupillary reaction Vital signs assessment frequency Q15-q2hrs
Meningitis Sx: Child/Adolescents: abrupt fever, chills, HA, vomiting, sz, Kernig and Brudzinski signs, nuchal rigidity
Meningitis Sx: Infants and Neonates poor feeding, poor tone with lack of mvt, poor cry, hypothermia or fever, full, tense, bulging fontanel may not be present til late
Meningitis Dx: LP with elevated WBC, decreased glucose, increased protein, increased pressure
Meningitis management IVF, Isolation, analgesics, anitbiotics, antipyretics, monitor respirations, dexamethasone for ICP (short term)
meningitis causes viral/bacterial strep most common
encephalitis causes herpes most common
encephalitis sx cerebral edema and ICP,: HA, malaise, fever, dizziness, apathy, nuchal rigidity, n&v, tremors, hyperactivity, speech difficulties
encephalitis severe sx High fever, stupor, seizures, disorientation, spasticity, coma, death
encephalitis management acyclovir, antibiotics, Neuro checks, LOC, ICP monitor
encephalitis dx LP- normal to cloudy, WBC sl elevated w/ increased lymphs, Protein normal to sl elevated, IgM for type 1 herpes simplex decr neuro signs
Hydrocephalus syndrome resulting from disturbances in fluid balance of CSF caused by impaired absorption or obstruction of flow thru ventricular system.
Hydrocephalus sx in infancy head grows abnormally, ant. fontanel tense, bulging, dilated scalp veins, bones of skull become thin, frontal protrusion “bossing”, setting sun sign.
Hydrocephalus sx in children/adults sutures closed so s/s match ICP-Headache Vomiting: with or without nausea Seizures Diplopia, blurred vision
Hydrocephalus dx & tx Dx-MRI/CT Tx-VP shunt
S/S of shunt malfunction incr ICP Decr neuros/LOC
S/S of shunt infection fever infalmmation of tract abdominal pain shift to the left
Reye Syndrome (RS) damaged hepatic mitochondria (from ASA)disrupts the urea cycle L/T hi ammonia, low bs, , incr serum short chain fatty acids.Fatty infilitration occurs in renal, neuronal, myocardial,muscle tissue which L/T encephalopathy, heart & kidney damage
Reyes Syndrome Stages 1. Initial viral infection-(URI) 2.Brief recovery period 3.few day later vomiting w/ lethargy, changed mental status- (agitation, confusion)rising BP,RR,HR & hyperactive reflexes 4. coma 5. coma deepens, sz’s, decr. tendon reflexes, respiratory failu
Reye Syndrome (RS)- dx/tx dx-evaluation-LOC; liver biopsy/enzymes, ammonnia levels(high), BS(low), PTT-prolonged tx-IV fluid, Insulin, Corticosteroids, Diuretics,ICP monitoring,
Neuroblastoma malignant tumor developed from nerve tissue, usually occurs in infants & children. First symptoms are usually fever, malaise, pain
Sz etiolgy/signs in infants birth injury, congenital effects, infection(meningitis)(febrile), metabolic dx, toxic substances- bicycling, lip smacking
Sz etiolgy children alcohol/drugs, trauma, infection, congenital conditions, genetic factors, brain tumor, neurological problems
Sz dx & assessment Diagnosis- ECG (determines type of Sz); LP, BS, CBC- to rule out Assessment- record Sz activity, neuro status, VS
Sz management/types Management- anticonvulsants, ketogenic diet, afebrile Types- partial (specific area in brain) or generalized (complex) (multiple areas of the brain)
Craniosynostosis congenital defect that causes one or more sutures on a baby's head to close earlier than normal. The early closing of a suture leads to an abnormally shaped head. Etiology- Associated with inherited syndromes
Craniosynostosis management Management- Relieve any pressure on the brain, Make sure there is enough room in the skull to allow the brain to properly grow; surgery
near drowning categories Category A- awake minimal injury, fully conscious,hypothermia, ABG abn Category B- mod injury, stuporous, hypothermia,resp distress, aBG’s abn Category C- severe comatose, severe anoxia, posturing or flacid
near drowning complications Hypoxia Aspiration Hypothermia
neural tube defects? types? Neural Tube Defects-failure of the neural tube to close after 28 days conception Anencephaly, spina bifida
types of spina Bifida SB Occulta: a defect not visible externally SB Cystica: a visible defect -meningocele &myleomenigocele
spina Bifida dx Elevated alpha-fetoprotein (AFP), ultrasound, xrays, ct
spina Bifida Tx prevention R/t Supplementation—0.4 mg/ day if hx 4.0 mg/day
Spina Bifida Occulta complication Altered gait Bowel/bladder problems Foot deformities
Myelomeningocele s/s contains meninges, spinal fluid, & nerves neural deficit of varying degrees : Flaccid or spastic paralysis, bowel/bladder incontinence, clubfoot, knee contractures, hydrocephalus, mental retardation, Arnold chiari malformation, curvature of the spine
Cerebral Palsy Nonprogressive neuromuscular ds w/ varying degrees of damage or developmental defects in the part of the brain that controls motor functions, may be partially paralyzed, have normal intelligence
Etiology of CP Intrauterine hypoxia/asphyxia, preterm, LBW mat infection, mat drugs, radiation, anoxia, toxemia, mat diabetes, malnutrition, isoimmunization
spastic cp s/s Incr DTR’s, hypertonia, incr. flexion, contractures, muscle spasms, underdevelopment of affected limbs, walks on toes w/ scissor gait, crossing one foot in front other
Athetoid/dyskinetic CP s/s Athetoid- chorea( involuntary, irregular jerking movements) slow, wormlike, writhing mvmts when voluntary mvmt is attempted Dystonic- slow twisting mvmts of the trunk/extremeties
Ataxic CP s/s , non spastic; wide based gait, poor balance and muscle coordination, rapid repetitive movements
Mixed/dystonic combination spactic & dyskinetic; poor eating/sucking; no specific motor pattern delay
Possible Signs of CP Poor head control after age 3 mos Stiff limbs Arching back/pushing away Floppy tone Unable to sit w/o support at 8 mos Clenched fists after 3 mos irritability No smiling by 3 mos Feeding difficulties tongue thrusting gagging/choking w/ feeds
which dx has a high incidence of latex allergies cp
Muscular Dystrophies Absence of muscle protein dystrophin, (helps support structure of muscle fibers) results in degeneration of muscles. Fat & connective tissue replace the degenerating muscle fibers.progressive wasting of skeletal muscles, genetic
Characteristics of DMD Calf muscles hypertrophy,Waddling gait, frequent falls, Gowers sign (only able to get up from a prone position with the use of upper arms) Lordosis,Progressive generalized weakness
DMD dx Suspected based on clinical appearance EMG, muscle biopsy,CPK and AST
Management of DMD No effective treatment maintain function in unaffected muscles as long as possible,Genetic counseling for family
Respiratory Distress Syndrome Pulmonary immaturity, together with surfactant deficiency, leads to alveolar collapse.Lungs collapse between breaths, making the infant work harder
Bronchopulmonary Dysplasia Chronic disease in premature infants treated w/ vents, from early lung injury chronic respiratory distress, hypoxemia, reduced lung compliance, increased airway resistance, and expiratory flow limitation
Respiratory Distress Syndrome Pulmonary immaturity, together with surfactant deficiency, leads to alveolar collapse Lungs collapse between breaths, making the infant work harder
S/S uri in children Fever Anorexia, vomiting, diarrhea, abdominal pain Cough, sore throat, nasal blockage or discharge adventagious Respiratory sounds
Tonsillitis infection of the tonsils R/T pharyngitis; viral or bacterial Inflammed lymphoid tissue
Tonsillitis dx & tx dx:clinical eval & rapid strep test tx: tonsillectomy. ABT, opiods, antipyretics, analgesics, humidifier, soft liquid diet, salt water gargles
s/s Influenza in children & Tx 3-4 days; chills fever, lethargy, rhinitis,Fatigue, lethargy, non-productive cough Tamaflu (only for type A)w/in24-48hrs
otitis media- definition & dx inflammation of the Eustachian tube Diagnostics- evaluation of tympanic membrane
otitis media s/s s/s- ear pain(pulling),poor feeding, fever, irritability, low appetite, purulent drainage, nasal congestion/cough, vomiting/diarrhea
otitis media tx Pharmacologic- ABT Surgical-myringoectomy- surgical incision of the eardrum w/tympanostomy (tube)
croup Inflammatory mucosal edema, secretions, muscle spasm lead to airway obstruction Inflammation of the larynx LTB = Laryngotracheobronchitis Most common of the croup syndromes
s/s croup Characterized by hoarseness, “barking” cough, inspiratory stridor, and varying degrees of respiratory distress Can progress to respiratory acidosis, respiratory failure and death
croup tx Airway management Maintain hydration—PO or IV High humidity with cool mist Nebulizer treatments Epinephrine Steroids- methylprednisone iv
s/s Acute Epiglottitis Sore throat, pain, tripod positioning, retractions “cherry red” epiglottis = diagnostic Inspiratory stridor, mild hypoxia, distress High fever (102 of >) Immediate hospitalization required
epiglottitis tx/prevention prevent respiratory obstruction (intubation) Hib vaccine
Bacterial Tracheitis Inspiratory stridor Suprasternal retractions Barking or “seal-like” cough Increasing respiratory distress and hypoxia Can progress to respiratory acidosis, respiratory failure and death Thick, purulent secretions result in respiratory distress
Bacterial Tracheitis tx Humidified oxygen Antipyretics Antibiotics May require intubation Bronchodilators
Created by: 1317362810