PEDI/OB EXAM 1

What is growth?

A physical change that can be measured (quantitative)

What are examples of growth?

height, weight, head circumference

What is development?

the body’s increase in function and development (quantitative)

What are examples of development?

motor/language/social skills

What is the meaning of the cephalocaudal growth pattern?

head to toeW

What is an example of the cephalocaudal growth pattern?

head control before walking

What is the proximodistal growth pattern?

where the growth starts from the center and then outW

What is an example of the proximodistal growth pattern?

arm control before finger control

What is the general to specific growth pattern?

this is when a broad response becomes targeted as development progresses.

What is an example of the general to specific growth pattern

crying/flailing becomes ear tugging

What is the simple to complex growth pattern?

pattern where skills build on prior skills

What is an example of the simple to complex growth pattern?

two-word phrases before stories

What is the single most important influence on froth and development?

NUTRITION

what is an expected finding for a baby aged 3-4 days?

may lose up to 10% of birth weight

What is an expected finding for a baby that is 10-14 days old?

the baby regains their birthweight

What is an expected finding for a baby aged 4-6 months?

the birth weight DOUBLES`

What is an expected finding for a baby aged 12 months?

the birth weight triples

Babinski reflex disappears

What is an expected finding for a baby aged 2 years?

the birth weight quadruples

baby is about 50% of adult height

What age does the posterior fontanel close?

Around 2-3 months

What age does the anterior fontanel close?

12-18 months

When is the best time to assess fontanels?

when the baby is calm and sitting up right; not crying

What does a bulging fontanel suggest?

increased intracranial pressure

What does a sunken fontanel suggest?

dehydration

What happens to the gross motor skills at 2-3 months?

the baby can lift their head when prone

What happens to the fine language/motor/social skills at 2-3 months?

social smile

What happens to the gross motor skills at 4-5 months?

no head lag by 4 months;

can roll from abdomen to their back

What happens to the fine motor/social/language skills at 4-5 months?

baby can grasp a rattle, and can start to babble

What happens to the gross motor skills at around 6 months?

the baby can sit in the tripod position

the baby can roll both way

What happens to the fine motor/language/social skills at 6 months?

the baby can transfer things from hand to hand

stranger anxiety begins

What happens to the gross motor skill at 8-9 months?

the baby can sit unsupported

begins to crawl

baby can pull to stand

What happens to the fine motor/social/language skills at 8-9 months?

Pincer grasp develops

object permanence

stranger anxiety peaks

What happens to the gross motor skills at 10-12 months?

the baby can stand and takes first steps

What happens to the baby’s fine motor/language/social skills at 10-12 months?

refined pincer grasp

can speak 2+ words

baby can start to finger feed (think pinching and eating a cheerio)

What happens to baby’s gross motor skills at 15-18 months?

The baby can usually start to walk well by 18 month

What happens to the baby’s fine motor/language/social skills by 15-18 months?

the baby starts to increase their independence

What happens to a baby’s gross motor skills at around 2 years old?

The baby can begin to walk stairs

What happens to a babysitter fine motor/language/social skills at around the 2 year mark?

the baby starts to know around 300 words, and can speak in 2-3 word phrases.

Why is a baby having a persistent head lag after 4 months a red flag?

It may indicate underlying neurological issues or developmental delays, as by this age, babies should have sufficient neck strength to maintain head control.

Why is no social smile by 3 months a red flag?

It may suggest potential developmental issues, as a social smile is an important early milestone indicating social engagement and emotional development in infants.

Why is the babinski reflex being present after 12 months a red flag?

It may indicate neurological concerns, as the Babinski reflex typically disappears by 12 months and its persistence could signify an underlying neurological/musculoskeletal issue

Why is no 2-word phrases at the age of 2 a red flag?

It may suggest delays in language development or communication skills, as the emergence of 2-word phrases is an important milestone for expressive language in toddlers.

What Erikson stage are infants usually developing?

Infants are typically developing the Trust vs. Mistrust stage, where they learn to trust caregivers for their needs, forming the foundation for future relationships.

What Erikson stage are toddlers typically developing?

Toddlers are typically developing the Autonomy vs. Shame and Doubt stage, where they gain a sense of personal control and independence while exploring their environment.

What does an infant need when dealing with the trust vs. mistrust stage?

consistent need fulfillment; consistent caregivers, parent presence, cuddling, non-nutritive sucking

What does a toddle need when dealing with autonomy vs. shame/doubt stage?

Independence and control; offer two acceptable choice, prevent routines, and allow participation

What Erikson stage is a preschooler typically dealing with?

initiative vs. guilt

What does a preschooler need when dealing with the initiative vs. guilt stage?

purpose and imagination: play therapy, sensory explanations, reassure that illness is not punishment

What Erikson stage is a school-age child usually dealing with?

industry vs. inferiority

What does a child need when dealing with the industry vs inferiority stage?

achievement and competence: give tasks, step-wise explanations, and allow demonstration

What Erikson stage are adolescents typically dealing with?

identity vs. role confusion

What do adolescents need when dealing with the identity vs. role confusion stage?

indentity; privacy; peer connection: speak directly to them; include in decisions, address body image and privacy

What piaget stage takes place at the 0-2 year age mark?

Sensorimotor

What is the key concept when dealing with sensorimotor stage?

object permanence develops at around 8-12 months—→ best to keep parents visible and use sensory play

What Piaget stage taks place at the 2-7 age mark?

Preoperational

What is the key concept when dealing with the pre operational stage?

They use magical thinking, animism, egocentrism → need simple/literal words, play therapy, and need sensations explained

What is the piaget stage that takes place at the 7-11 year mark?

concrete operational

What is the key concept when dealing with the concrete operational stage?

Conservation; logic, and rules → they use models, graphs, and step-by-step facts

What is the Piaget stage that is used at the age of 12+?

Formal operational stage

What is the key concept when dealing with the formal operational stage?

Abstract and hypothetical thoughts —> need to discuss consequences and want to be included in planning

What are the three main hospital stressors?

Separation anxiety

Loss of control

Fear of pain/bodily injury

How to help toddler that is dealing with stressed while hospitalized?

Parallel play; give choices;

always use a bandage after puncture because body boundaries are poorly defined.

How to help child in preschool that is deal with stress while hospitalized?

associative/cooperative play;

reassure that hospitalization is not punishment

How to help school age children who are stressed while hospitalized?

cooperative'/rule based play

provide productive activities.

How to help adolescents who are stressed while hospitalized?

peer-focused

protect privacy and body image

How should assessments/procedures go when working young children/adolescents?

perform assessments least invasive → to most invasive;

prepare honestly

keep frightening equipment out of site until needed

praise them afterward

How do infants breathe?

through their nose; may need suctioning to help improve feeding and breathing

“stuffy nose → they can’t eat or breathe”

since infants have such a small airway, what can create a major obstruction

such as mucus, swelling, or foreign objects.

What increases the risk of otitis media in children?

horizontal Eustachian tubes because they allow for easier access of pathogens to the middle ear.

Why do retractions appear more easily in children?

the intercostal muscles are less developed

Children have a higher oxygen demand, why?

Their metabolic rate is higher than that of adults, requiring more oxygen for growth and activity.

since children have a higher oxygen demand, what can happen?

They may quickly develop hypoxia or respiratory distress if oxygen supply is inadequate

What are the signs of respiratory distress in children/adolescents?

grunting, retractions, accessory muscle use, nasal flaring tachypnea

Severe signs: restlessness that becomes lethargy, breath sounds diminish, tachypnea becomes bradypnea, cyanosis

What is one of the hallmark signs of otitis media in children/adolescents?

ear pulling, otalgia, bulging/opaque tympanic membrane, fever

pt has short/horizontal eustachian tubes

What is treatment/ nursing management when dealing with otitis media?

pain/fever control

amoxicillin when prescribed

recurrent disease may need tubes in the ears due to fluid accumulation

hearing protection

What is the hallmark sign of strep throat (strep pharyngitis)

ABRUPT, severe sore throat, high fever, strawberry tongue, sandpaper rash

What is the diagnosis for strep throat?

Rapid strep test

What is the treatment/nursing priorities for strep throat?

penicillin —> can return to school/work after 24 hours with antibiotic course

replace toothrush

prevent rheumatic fever and glomerulonephritis

What is the hallmark thing to precent after a tonsillectomy?

Post-op hemorrhage risk

What does the treatment/nursing management look like for a tonsillectomy?

Laying on side/abdomen for drainage

cool/soft foods

no red/brown food dye (will look like blood)

What is the earliest sign of bleeding post-tonsillectomy?

Frequent swallowing or throat clearing

What is the hallmark s/s of croup?

GRADUAL/NIGHT ONSET, barking cough, hoarseness, inspiratory stride, steeple sign

Is croup a viral or bacterial disease?

iviral

What is the steeple sign when talking about croup?

The steeple sign is a radiological finding observed on a lateral neck X-ray, indicating narrowing of the upper airway at the level of the larynx, resembling a church steeple.

What does the treatment/nursing management look like when dealing with croup?

keeping pt calm to not make respiratory distress worse

cool mist/humidity

dexamethasone (this is a steroid that reduces inflammation) and nebulized epinephrine for severe cases.

EMERGENCY CARE FOR STRIDOR AT REST

What is the hallmark s/s of epiglottitis in children?

SUDDEN high fever

DROOLING- tell-tell sign

dysphagia, muffled voiuce

tripod position, thumb sign (this is an indication of an enlarged epiglottis seen on X-ray, where the epiglottis appears swollen and resembles a thumb

what does the treatment/nursing management look like for epiglottitisi

AIRWAY EMERGENCY

keep calm/upright

DO NOT INSPECT THROAT

prepare for intubation,

IV antibiotics

HiB prevention

What is HiB?

Haemophilus influenzae type b, a bacterium that can cause severe infections in children, notably meningitis and epiglottitis. Vaccination has significantly reduced its incidence.

What should you never do when a child is dealing with epilottitis?

never use a tongue blade (throat is already swollen → could cause obstruction)

never force supine positioning

never obtain a throat culture at beside

never leave child alone

what age group is RSV common in?

common in infants especially under 6 months

What are the s/s of RSV Bronchiolitis

wheeze, crackles, tachypnea, retractions, poor feeding, apnea

What is the priority care/ nursing management when dealing with RSV bronchiolitis?

suction with saline

HOB up

oxygen/hydration

frequent reassessment

palivizumab prevention for eligible high risk infants

What is the precautions for RSV?

RSV is contact precautions

What are the s/s of pertussis (whooping cough)

paroxysmal whoop

infants may present with apnea

What does the priority care / treatment for pertussis/whooping cough

airway/hydration

antibiotics

DTap/Tdap prevention

What is the isolation precautions for RSV?

Droplet precautions → continues for 5 days after antibiotics

is pneumonia bacterial or viral?

pneumonia can be both viral and bacterial

What are the s/s of pneumonia?

fever, cough, tachypnea, crackles/decreased breath sounds

What does priority care/ treatment look like for pneumonia?

oxygen/airway support

fluids

rest

fever/pain control

antibiotics if bacterial

CLUSTER CARE—> decrease respiratory/metabolic workload