Peds Exam 1 (growth & development, diseases)

infant normal VS

-HR 90-160

-RR 30-53

-BP 72-104/37-56

infant assessment

-posterior fontanel closes by 6-8 weeks, anterior by 12-18 mo

-irregular breathing, pause for <20 sec

-sinus arrhythmia

-anemia risk 3-6 mo

-maternal immunity for 3 mo

-develop shivering

-dehydration risk 0-6 mo d/t high ECF

-vax in vastus lateralis (deltoid for kids)

infant motor development

-4 mo:

—neonate reflexes gone (Moro/startle, grasp, rooting)

—plays with hands, sit propped up

-5 mo:

—no head lag

—roll belly to back

—palmar grasp

-8 mo: stand supported

-9 mo:

—creeps, sits, pulls up to stand

—develop a dominant hand

-11 mo:

—walks with help

—neat pincer grasp

-12 mo:

—lose Babinski reflex

—cruise well, one hand

-15 mo: crawl up stairs

infant language development

-2 mo: single vowel sounds

-3-4 mo: consonant sounds, coo, gurgle, laugh

-6 mo: obey simple commands

-10-11 mo: say words on purpose

-12 mo: speak 1-2 words, understand more

infant psychosocial development

-separation anxiety 6-30 mo

-Erikson = trust vs mistrust

-Piaget = sensorimotor

-balance frustration levels

-teething 6-10 mo (# = age in mo minus 6)

—cold soothes

—may drool, suck, bite, be irritable

-intro foods starting 4-6 mo

—no water or honey or milk till 12 mo (no low-fat till age 2)

—delayed food intro does not prevent allergies

infant issues

-colic

—crying

—self-limiting after 3 mo

—may be d/t milk allergy

—risk for SBS and decreased bonding

-plagiocephaly

—prevent w/ tummy time & helmet

-FTT

—decreased caloric intake/absorption

—increased metabolism

SIDS

-increased risk with minorities

-prevent:

—no co-sleeping

—sleep on back

—firm mattress

—nothing else in bed

—no secondhand smoke

—breastfeed

—paci

—no overheating

vaccine schedule

-birth: Hep B

-2 mo: Hep B, Tdap, rotavirus, Hib, IPV, PCV13

-4 mo: Tdap, rotavirus, Hib, IPV, PCV13

-6 mo: flu

-1 yr: Hep A, MMR, Hib, PCV13, varicella

toddler vitals

-HR 80-140

-RR 22-37

-BP 86-106/42-63

toddler motor development

-13 mo: walk with wide stance

-18 mo: try to run, fall easily, throw ball overhand

-24 mo: walk up & down stairs

-30 mo: jump w/ 2 feet. stand on one foot briefly

-36 mo: stand on one foot, walk on tiptoe, climb stairs w/ alternate footing

toddler psychosocial

-control bladder/bowels by 18-24 mo

-Erikson: shame/doubt

-Piaget: cognitive

-ego develops, negativism, ritualism

-gender identity age 3

-sleep 11-12 hr, 1 nap

-parallel play

-tantrums, like control and saying “no”

-physiological anorexia at 18 mo

toddler language development

-4 words by 12 mo

-300+ words by 2 yrs

-2100 words by age 6

-words together by age 2

-sentences by age 3

lead poisoning

-screen age 1-2_may cause renal/bladder/neural problems, low IQ, reproductive problems

-risk: old house, paint, urban, poor, <6 years, iron deficiency

-need chelation therapy

preschool vitals

-HR 65-120

-RR 20-28

-BP 89-112/46-72

preschool psychosocial

-Erikson: initiative vs inferiority

-Piaget: intuitive

-know good vs bad

-curious about body, fear intrusion

-follow commands, assert self, mutual play

-ask “why”

-need more protein and less fat

preschool motor development

-3 yrs: ride a tricycle, walk on tiptoe, broad jump, balance on one foot

-4 yrs: skip, hop on one foot, catch a ball

-5 yrs: skip on alternate feet, jump rope

school age vitals

-HR 58-118

-RR 18-25

-BP 97-120/57-80

school age physical development

-lose baby teeth

-girls grow faster

-more illness first 1-2 years of school

-puberty:

—prepubescence = 1-2 years before

—starts age 10 (F) or 12 (M), may be as early as age 8

—more outward for girls

school age psychosocial

-Erikson: industry vs inferiority

-Piaget: cognitive

-can see others’ POV, judge intent of actions

-want peer approval, make friends, follow rules

-9-11.5 hr sleep

school age issues

-enuresis

—urine in bed/clothes 2x/wk or 3x/mo if over age 5

—physical assessment, then emotional

-encopresis

—BMs into bed/clothes 1x/wk or 3x/mo if over age 4

-PTSD: fight or flight→calm/denial/numb→flashbacks

adolescence

VS:

-HR 50-100

-RR 12-20

-BP 110-131/64-83

also:

-puberty age 8-13 (F) or 9-14 (M)

-abstract thought, consider others, question rules/beliefs

-Erikson: identity vs role confusion

-sexual assault

—1 in 3 women, 1 in 4 men

— >50% by an acquaintance

separation anxiety

protest→despair→detachment

diphtheria

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sexual abuse S/S

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