PBL midterm

normal body temp range

35.8 to 37.3

temp monitoring method 0-2 years

rectal, axillary

temp monitoring method 2-5 years

rectal, axillary, tympanic

temp monitoring method 5+ years

oral, axillary, tympanic

temp monitoring Peds rectal range

36.6 to 38

temp monitoring Peds ear range

35.8 to 38

temp monitoring Peds oral range

35.5 to 37.5

temp monitoring Peds axillary range

36.5 to 37.5

pulse normal range

60 to 100 beats/min

pulse rhythm classifications

regular, regular irregular, irregular irregular

pulse strength grading system

4+ bouncing 3+ increasing, 2+ normal, 1+ weak, 0 weak

RR inspiration diaphragm movement

down, muscles and ribcage go up

BP ventricles relax

diastole

BP ventricles contract

systole

Formula for BP

systole/diastole

BP normal range

<120 mmHg/ <80 mmHg

2 types of pain fivers

A(delta) and C

A (delta) fibers characteristics

insulated, large quick conduction

C fibers characteristics

smaller, not insulated, slow conduction

Pulse: bradycardia range

slow HR <60 bpm

Pulse: Tachycardia range

fast HR, >100 bpm

RR: tachypnea

elevated RRdue to pain, fever, illness, condition

RR bradypnea

slow RR

RR: apnea

absence of breathing

RR: normal range

14 - 20 breaths/ min

BP: hypertension range

> 130/80 mmHg

Questions to ask for pain assessment

onset, provoking, quality, region, severity, treatment, understanding, values

qualitative pain assessment optiosn

self reporting (VRS: 0 to 10, descriptor: no, moderate, worst pain), visual analog scale (100 mm line)

BP: target BP range in >60 old

<145/85 mmHg

HR: pediatric 1 degree increase in temp

increase 10 bpm

RR: pediatric

measure over 1 min (dont average) until >3 y/o, 1 degree increase in temp leads to RR increase by 3 breaths/min

BP: pediatric normal range (>13 y/o)

<120/80 mmHg

BP: pediatric elevated range (>13 y/o)

120/<80 to 129/<80 mmHg

BP: pediatric stage 1 hypertension range (>13 y/o)

130/80 to 139/89 mmHg

BP: pediatric stage 2 hypertension range (>13 y/o)

>140/90 mmHg

pediatric pain assessment scale

Face, Legs, Activity, Cry, Consolability

location of temp control in the body

hypothalamus

location of heat production

liver, muscles

location of heat loss

skin, lungs

responsibilities of the hypothalamus

regulating sleep, endocrine funciton, temperature

cells involved in fever(pyrexia)

enhanced production of neutrophils and T-lympocyte proliferation

fever range

temp over 38C (rectal)

fever relationship with hypothalmic set point

fever changes hypothalmic set point

hyperthermia

not response to illness, bodies loss of control over temp, CNS dysfunction leading to delirium, convulsions, or coma

hyperthermia relationship with hypothalmic set point

no change, patients with hyperthemia d o not respond to antipyretics

fever cause

exogenous and endogenous pyrogens

hypothalmic set point change during fever

fever releases arachidonic metabolites (prostaglandin) in response to pyrogens, interacts with endothelial cell so f the hypothalamus, increases set point, increases heat conservation and heat production, prostaglandin E2 is increased centrally and peripherally during fever leading to nonspecific myalgias (muscle pain) and arthralgias (joint pain)

fever etiology:

infection, autoimmune/noninfectious inflammatory disorders, cancer, endocrine disorders, intrinsic hypothalmic disorders, medication and vaccines

autoinflammatory diseases in which fever is characteristic

still’s disease, cryopyrin-associated periodic syndromes (CAPS), familial mediterranean fever, Hyper IgD syndrome, Behcets syndrome, macrophage activation syndrome, normocomplementic urticarial vasculitis, antisynthetase myositis, PAPA syndrome, Blau syndrome, gouty arthritis

drugs associated with fever

fever accompanying symptoms:

myalgias and arthralgias, headache and backache, fatigue and malaise, chills and rigors

red flags for fever

MAJOR: age < 3 months, stiff neck, seizure, localized pain, swelling /heat, new wheeze/cough, recent cancer theraphy, chillys: excessive fussiness,

MINOR: < 6 months, fever >40.5 C, persistent wheeze/cough, new onset rash/fever, confusion, serious underlying condition, recent surgery or dental procedure, recent travel, recent consumption of undercooked meat or fish, new medication

red flags: fever characteristics

fever above 40.5C, duration of fever >72 hours or 24 hours after starting antipyretic tx, associated symptoms

febrile seizures

common in kids 6 months to 5 years, jerky/stiffness/eyes rolling, last minutes, now brain damage, antipyretic medications do not prevent febrile seizures

non pharmacological management of fever

reomve layers, dress in light clothes, plenty of fluids, avoid physical exertion

fever 41- 42 C: sponging with tepid/cold water, ice pack or cooling blankets

Pharmacological treatments of fever

acetaminophen, ibuprofen, naproxen, aspirin

mechanism of action antipyretics:

decreased synthesis of prostaglandins

acetaminophen (APAP): adult daily max

4000 mg/day

IBP: daily max

1200 mg/day

naproxen: daily max

440 mg

aspirin: daily max

4000 mg/day

APAP: peds max

75 mg/kg/day

APAP: peds recommended

10-15 mg/kg/day

IBP: peds max

40 mg/kg/day

IBP: peds recommended

5-10 mg/kg/day

classes of nutrient

carbohydrates, water, proteins, lipids, minerals, vitamins

energy yielding nutrient

carbs, proteins, lipids

macros vs micros

macros: carbs, water, proteins, lipids

micros: minerals, vitamins

RDA

recommended dietary allowance

sufficient for 97-98 % of healthy individuals

EAR

estimated average requirement

median daily intake sufficient for 50 % healthy individuals

used to calc RDA

AI

adequate intake

average daily nutrient intake level based on observed or eperimentally determined approximations or estimates of nutrient intake

UL

tolerable upper intake level

highest average daily nutrient intake level likely to pose no risk of adverse health effects to individuals

RDA Carbs for 1- 70 years

130 g /day

FODMAPs

fermentable oligosaccharides, disaccharides, monosaccharides and polyols

triglycerides

3 x fatty acid + glycerol backbone

vitamins that the body can synthesize

D, K

water soluble vitamins

B1 (thiamine),2 (riboflavin),3 (niacin) ,5 (pantothetic acid),6 (pyridoxine), 7 (biotin), 9 (folic acid), 12 (cyanocobalamin), C (absorbic acid)

B1

thiamine

B2

riboflavin

b3

niacin

b5

panthothetic acid

b6

pyridoxineb

B7

biotin

B9

folic acid

fat soluble vitamins

A (retinol, beta-carotene), D (cholecaliferol), E (tocopherol), K

vit A

retinol, beta-carotene

vit D

cholecaliferol

Vit E

tocopherol

primary mineral deficiency

failure to ingest the nutrient in sufficient amounts to meet physiological needs

secondary nutrient deficiency

failure to absorb or otherwise USE a nutrient post-absorption

timing of breastfeeding: 1st week postpartum

8-12 feedings/ 24 hours ie. breastfeed every 2-3 hours

breastmilk changes

1. colostrum

   1. when: day 1 and 2

   2. yellow

   3. highly concentrated

2. transitional

   1. 2-3 days

   2. yellow/white

3. mature

   1. after 2 weeks

      1. white cream

diapers as signs of hydration intake

3-5 wet diapes/day day 3-5, 4-6 wet diapers a day for days 5-7

powder infant formula PREP

shelf life 1 month after open in cool dry place

1 scoop/60 mLs of sterilized water

use within 2 hrs

liquid concentrate infant formula PREP

sterile

mix with bioled or comercially sterilized water in 1:1 ration

store open cans in the fridge and use within 48 hrs

must be used within 24 hrs

ready-to-use infant formula PREP

sterile

no mixing required

expensive

what age to introduce food

6 months

when to give milk

between 9 to 12 months old for cow’s milk, 3.25 % to start,

can give higher when >2 years

nutrients of particular concern in geriatrics

Vit B12, Vit D, Calcium

forms of calcium salts

calcium carbonate

calcium citrate