Pediatrics Study Guide

Denver II Developmental Screening Test - What does it assess?

a tool used to identify developmental delays in infants, toddlers, and preschoolers → test to assess their

cognitive development

Toddler Development

age of weaning to using a cup (usually by 12 months) age when toilet training started and completed, language development, play patterns and activities, sleep patterns, discipline and limit setting*, dental checkups (as early as 12 months), teaching safety for mobile and lack of judgement to protect themselves, observe caregiver-toddler interactions

Assessment of a Teenager

focus on puberty, smooth transition to young adulthood; may be embarrassed

to ask questions

consult w/o others around or separately → promotes voicing concerns*

brochures and pamphlets can be helpful as well*

Protest

cries and reacts aggressively, rejecting healthcare personnels*; normal + denotes a healthy attachment to

family

Despair

pt. becomes inactive and sad

signs → thumb sucking and clutching a blanket (comfort measures), watches for family, is quiet and

withdrawn, and is uninterested in food or play*

if not cooperative, allow pt. to be with family or caregiver when with them

Normal Vitals for Infants

Pulse: 80 - 180*; Respiration: 20 - 40; BP: 74 - 100/ 50 - 70

2 yrs. take apical pulse; > 2 yrs. radial pulse

temp. assess → < 6 yrs. take tympanic, axillary, or rectal; > 6 yrs. take oral or tympanic

first assessment upon admitting an infant

respirations

Best Restraint for Infants Pulling on Things

mitts or gloves

always check for physician's order is usually required for a restraint

Administering a Suppository

lubricate and hold in place by gently pressing on the child's anal sphincter

Giving Medications to Children

do not give a choice, sneak up on child, or say it won't hurt

know the s/e of the medication; use the smallest syringe for accuracy

Immunizations

begins after child's birth and regularly continued → provides temporary or permanent

protection against certain diseases

1st immunization received as a newborn →

hep B

Pertussis

whooping cough; mostly common in young children

highly contagious bacterial respiratory disease

Red Measles Transmission

a.k.a rubeola, measles, 10-day measles

a virus found in nose, mouth, throat, and eyes

transmitted → direct contact*

Chickenpox

varicella; same virus that causes herpes zoster (shingles)

first develops into papules* then vesicles

Strep Throat

streptococcal pharyngitis

white patches on the tonsils*

Rheumatic fever

rheumatic heart disease; autoimmune, continued streptococcal infections

Lab for Rheumatic fever

ESR

elevated WBC count

Child Abuse

o emotional neglect → ignoring or blaming

○ physical neglect → fails to provide their basic needs

○ emotional abuse → insults, criticism, humiliation

○ physical abuse → intentional bodily injuries

○ sexual abuse

○ failure to thrive → expect flat affect = no expression

○ Considerations: report to authorities*, believe child's words, observe their reaction, document

observations, teach the child

Mongolian Spots +

commonly seen in asians

○ irregular dark, blue-green areas found on the lower back

Dysplasia Precautions

handle the pt. w/ care*

Celiac Disease Food to Avoid

opt. for gluten-free

avoid wheat*, barley, rye, or oats

Leukemia in Children under 15

o in relation to blood and lymph disorders

○ acute lymphoid leukemia (ALL)*

○ acute myeloid leukemia (AML)

○ chronic lymphoid leukemia (CLL)

○ chronic myeloid leukemia (CML)

Acute Asthma Signs

a.k.a status asthmaticus; respiratory tract disorders

○ common S/S: wheezing, difficulty breathing, chest tightness

Meckel Diverticulum

congenital disorder in which a small portion of the child's ileum end in a blind pouch just before the junction w/ the colon

S/S: bloody or tarry stool

Lactose Intolerant Foods to Avoid

avoid dairy like milk, yogurt*, cheese

Lyme Disease considerations

can lead to the development of arthritis and facial palsy*

encourage preventative measures when in area where ticks may be; if tick attaches, use tweezers to remove*

Lyme disease s/s

erythema migrans w/in 3 to 31 days after flu-like symptoms (fever, headache, fatigue, regional lymphadenopathy)

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Lyme disease Tx.

antibiotics

Acne Vulgaris cause

age, genetics, pressure on skin, cosmetics, severe stress, few medications, cigarette smoking, steroids, food which increase blood glucose

Acne Valgaris Tx.

keep skin clean, avoid irritating skin, avoid certain chemicals → topical and systemic medications can be used, well-balanced nutritional diet, mild cleansers, exfoliating cleansers and masks, retinol

education on topical medication → can bleach hair or clothing*

What to be alert for when it comes to Acne Valgaris

it is not influenced by diet

Impetigo

types → nonbullous, bullous

○ begins near nose, mouth, face, neck, hands, or diaper area

○ → direct contact; highly contagious

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Impetigo Tx.

antibiotics, properly cleanse area, keep fingernails short, standard precautions, discourage scratching or touching infected area

Impetigo precautions & complications

keep the any linens away from others*

Comp. if untreated: rheumatic fever, glomerulonephritis

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Tinea Pedis

athlete's foot

tx. OTC antifungal medications, treat or discard infected shoes or socks, apply medication up to 2 weeks after infection has cleared; persistent tinea pedis may need oral antifungal medications and possible antibiotics if open skin lesions

Tinea Pedis considerations

air feet out whenever possible

DM Type 1 S/S - Children

children often rebel against tx

polyuria, polydipsia, polyphagia, dry mouth, itchy skin, fatigue, weight loss or failure to gain weight, lack of energy, general malaise, irritability, blurred vision, yeast infections, uncontrolled blood glucose

DM Type 1 Considerations

education on concerning insulin therapy, exercise, weight loss, nutritional changes like regular and consistent meals, psychological support (involve the family), encourage self-care, ensure all adults involved in child's life know about the condition and proper response

Ulcerative colitis symptom & Tx.

severe diarrhea, weight loss, fever, fatigue, tenesmus, delay in puberty

if chronic, S/S: bloody diarrhea

Tx: depends on severity and extent of involvement of tissues; medications; surgery

Dysmenorrhea

Severe menstrual pain; may be due to endometriosis, excessive bleeding, complaint of abdominal or pelvic pain

○ Tx: give NSAIDs 1 to 2 days before menses begin

Sleep Apnea Symptoms

stop breathing for short periods

Somnambulism

sleep walking

Anorexia Nervosa

severe, obsessive, self-imposed undernourishment, sometimes to the point of starvation and death, interferes w/ growth and development

Anorexia Nervosa s/s

abnormally low body weight, intense fear of weight gain, distorted perception of weight gain ■ important sign → extreme and persistent hunger*

complication: Bradycardia

Bulimia nervosa

habitual episodes of eating large amounts of food followed by forceful vomiting, excessive use of laxatives or diuretics, extreme exercise, combination of behaviors

Bulimia nervosa s/s & risks

usually not overweight, feeling guilt and depression, fear weight gain, often complain about weight gain

risk for → dental caries, erosion of enamel from front teeth, throat irritation, electrolyte imbalance, death

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Standard IQ Test

used to determine ability → predictors of academic achievements

Dysfluency

stuttering

an interruption in natural flow of speaking

Considerations: speech therapy, surgery to correct deformity, referrals to specialist, evaluate hearing

Positive reinforcement for kids with learning disabilities Considerations

need to cooperate w/ family when teaching skills to children, encourage a collaborative approach (w/ family, primary pediatrician, healthcare specialist, therapy providers, community support system, educational services)

Genetic Dosorders: Tay Sachs, Down Syndrome, Sickle Cell, Neurofibromatosis Considerations

genetic counseling

help people understanding and adapt to condition, involves multiple factors, available to help provide information, support, and options → promote informed decisions about family planning

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Fetal Alcohol Syndrome

highly preventable condition, but effects on fetus are permanent

○ appearance → small body size for age = growth retardation*

○ conditions related → ARND, ARBD, fetal alcohol effects

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Neonatal Abstinence Syndrome

group of medical problems due to exposure of additive opiate or narcotic drugs as a fetus, can include prescription or illegal narcotics

○ fetus becomes addicted, goes through withdrawal after birth and abrupt discontinuation of drug

○ Considerations: decrease environmental stimulations* due to withdrawal → comfort

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ADHD characteristics

inattentiveness, impulsivity, hyper activity

Considerations for autistic child

involve family or caregivers in tx. planning

Plumbism

lead poisoning (ex. paint)*, occurs slowly

○ screening of high-risk individuals important

Muscular Dystrophy Gowers Sign

child's gait may appear as a waddle = positive sign

child uses the upper extremities muscles to compensate for weak hip muscles

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Spastic Cerebral Palsy s/s

common S/S: ataxia, dyskinesia, spasticity. including speech deficits*, involuntary contractions, increased muscle tone

Spastic Cerebral Palsy subclassifidation

spastic diplegia/ diparesis; spastic hemiplegia/ hemiparesis; spastic quadriplegia/ quadriparesis

Depression Sign

periods of sadness, hopelessness, mood swings, negative thoughts about one's self; may be withdrawn, have difficulty expressing feelings and emotions, marked change in behavior*

causes → combination of genetic, biologic, environmental, psychological factors ○ risk factors → associated w/ suicide

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Risk Factors for Suicide

can be suicide gesture, ideation, attempt

depression, prior attempts, family history, domestic violence, child abuse, incarceration, access to lethal methods, impulsive and aggressive behavior, chronic illness ○ Considerations: mandate to report

Schizophrenia

o occur → early onset or childhood

○ genetic, environmental, family cause

○ Tx: hospitalization may be necessary

○ Considerations: education, long-term therapy required, encourage supportive counseling*

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