Peds Exam 1 (growth & development, diseases)

infant normal VS*!

-HR 90-160

-RR 30-53

-BP 72-104/37-56

Erikson’s stages*!

-trust vs mistrust (0-1)

-autonomy vs shame & doubt (1-3)

-initiative vs guilt (3-6)

-industry vs inferiority (6-12)

-identity vs role confusion (12-18)

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: autonomy vs 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 guilt

-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

chicken pox*

-S/S: rash, fever, itch

-caused by VZV

-contact + airborne precautions

-vaccine available

-Rx: treat S/S (antihistamines, oatmeal baths, Tylenol)

diphtheria*

-S/S: tachycardia, like a cold

-may cause sepsis & ulcers

-bacterial

-droplet + contact precautions

-vaccine available

-Rx: antibiotics, equine antitoxin

fifths disease*

-S/S: slapped face rash that spreads to body

-caused by parvovirus

-treat S/S

-risk for immunodeficiency or RBC disorders

roseola*

-S/S: high fever, rash w/o itch

-caused by herpesvirus 6

-treat S/S

-risk for febrile seizures

mumps*

-S/S: fever, headache, earache, swollen parotids

-caused by paramyxovirus

-droplet & contact precautions

-Rx: Tylenol, soft foods, neck compress, push fluids

-vaccine available

measles*

-S/S: flu-like, Koplik spots, facial rash

-viral

-contact & airborne precautions

-Rx: dim lights, Tylenol

pertussis*

-upper respiratory infection

-cough

-bacterial

-droplet precautions

-may lead to pneumonia, atelectasis, apnea, hemorrhage, hernia, rib fractures

polio*

-S/S: fever, sore throat, headache, N/V, neck pain, CNS paralysis

-caused by enterovirus

-contact precautions

-Rx: PT, possibly sedate & ventilate

rubella*

-S/S: flu-like, rash

-droplet precautions

scarlet fever**

-S/S: high fever, N/V, tachycardia, headache, tonsillitis, strawberry tongue, rash (not face), skin slough

-caused by group A beta-hemolytic strep

-droplet precautions

conjunctivitis*

-S/S: redness, swelling, discharge

-may be viral, bacterial, allergic, or d/t foreign body

-Rx: warm, moist compress

giardiasis

-intestinal parasite

-dx: stool sample

-transmit: stagnant water or food

-S/S: diarrhea, constipation, vomiting, anorexia, cramping, foul/watery/pale/greasy stool

-Rx: antiparasitic

pinworms

-intestinal parasite

-dx: tape test

-transmit: stagnant water or food

-re-infect via scratching

-S/S: rectal itch, irritability, restlessness, poor sleep, bed-wetting, low attention span

-Rx: Pyrantel pamoate, one-piece PJs, short nails

sexual abuse S/S*

psychological

-extreme behavior change

-aggressive

-withdrawal

-phobias

-sleep disturbances

-sexually inappropriate activity for age

physiological

-difficulty walking or sitting

-bruises or tears near genitals

-vaginal discharge/bleeding/itching

-STI

-pregnancy

physical abuse S/S (physiological)*

physiological

-vomiting

-hand or finger marks

-bruises (numerous, small, bandlike, narrow/curved)

-small round burns (from cigarettes)

-symmetric scald burns (from immersion)

-bite marks

-mouth scar (from being gagged)

-patchy hair

-fractures (especially to femur)

physical abuse S/S (psychological)*

-confusion

-lethargy

-fussiness, irritability

-poor sleep

-depression, anxiety

-PTSD

-violence or suicidal ideation/behavior

-fearfulness

reasons to suspect abuse*

-parent is reluctant to give history of injury

-hx does not match injury or child’s developmental stage

-hx changes

-parent is too concerned or not enough

-delayed seeking care

-unusual injury

-internal organ damage without cause

-retinal hemorrhage (esp d/t SBS)