peds exam 1

what are the sensory development outcomes for a school-aged child?

20/20 visual acuity, color discrimination, mature sense of smell

what are the physical development outcomes for a school-aged child?

grows taller & loses baby fat, average weight gain is about 4 to 6lb & growth is about 2 inches per year, beginning of puberty changes

what are the language development outcomes for a school-aged child?

can elaborate, uses words more accurately

what are the psychosocial development outcomes for a school-aged child?

industry vs. inferiority (sense of confidence through mastery of skills, realization of competence)

what are the moral development outcomes for a school-aged child?

mostly conventional (internalized rules, morality of cooperation & recognition of interaction with bigger worldview, motivated to adhere to laws for order)

what are the cognitive development outcomes for a school-aged child?

memory deepens, mostly concrete operational (can organize thoughts in logical order, categorize & label objects, & solve concrete problems)

what are the behavior expectations for a preschooler?

what is the nature of social interaction for a toddler?

toddler imitates people & much of behavior is replication

child learns to balance independence against uncertainty

parallel play

what are the cognitive development expectations for an adolescent?

formal operational (uses abstract reasoning to handle difficult concepts & can analyze both sides of an issue)

what are the sensory development outcomes for a toddler?

well-developed vision, distinguishes food preferences

what are the physical development outcomes for a toddler?

growth has slowed by age 1, gains 3 to 5 lb per year & grows 3 inches per year

motor skills: run, jump, move up & down, tricycle or slide by age 3, hold spoon or large crayon, manipulate smaller toys

what are the cognitive development outcomes for a toddler?

at age 3, pre-operational (not capable of logical thinking but is increasingly able to connect cognitively to the world)

toddler imitates others & much of behavior is replication; toddler learns through repetition & likes predictable routines

what are the language development outcomes for a toddler?

can listen to & understand short explanations, more understandable language system, moves from single words to short phrases

what are the psychosocial development outcomes for a toddler?

autonomy vs. shame & doubt (balances independence & uncertainty, establishes willpower, determination, & can-do attitude)

freud’s anal stage (develops sense of self as separate from the mother)

begins to internalize behavioral standards

what are the moral development outcomes for a toddler?

pre-conventional (toddler identifies good & bad & right & wrong by whether it is rewarded or punished)

which of erikson’s developmental stages would a toddler be in?

autonomy vs. shame & doubt

what is the nature of social interaction for a school-aged child?

what are the safety considerations for each age group?

infants: breastfeeding, introduction to solid foods, immunizations, crib, car seat, on back to sleep, supervision when mobile

toddlers: self-feed, CPR, toddler bed, windows & blinds, bike helmet, sunscreen

preschoolers: oral health, childproofing, secure guns/meds/outlets, stranger safety

school-aged children: encourage exercise, watch mood, smoking/substance abuse avoidance, saying no to sex, booster seat, playground & sports safety, rules for being home alone

adolescents: weight management, discuss sex, preventing STIs & pregnancy, stress, seatbelt/driving, no tanning salons

what is cultural competence in regard to caring for a child?

understand common conditions, health beliefs/practices, etc.

what are piaget’s stages of cognitive development?

sensorimotor, pre-operational, concrete operational, formal operational

which pain rating scales are used for each age group?

FLACC (face, legs, activity, cry, consolability): infants & children that cannot self-report

wong-baker faces scale: 4 to 7 years (if then can distinguish happy or sad face)

numeric scale: age 7 & up (if they can identify which number is larger)

what are some needs of a child with a disability & their parents?

consider emotional concerns (disruption of routine, continuous “bad news”, financial implications)

provide self-care techniques

respite care

what are some abnormal physical exam findings for an infant?

cradle cap, depression (dehydration) or fullness (increased ICP) of anterior fontanelle

low-set or misshapen ears may indicate down’s syndrome

antero-posterior diameter should be fairly equal to lateral diameter, healthy weight is 5th to 85th percentile

how is pain perceived by a preschooler?

may see pain as a punishment, may not report pain because they believe the adult already knows it exists

how is OLDCAT or OLDCARTS used?

onset, location, duration, characteristics, aggravating factors, [relieving factors], timing, [severity] to explore chief complaint

how is pain perceived by a school-aged child?

understands that injury/illness accompanies pain, but not the cause

more descriptive words to express pain

can begin to differentiate between physical & emotional pain

what are some abnormal physical exam findings for a child of any age?

skin discoloring (excess carotene, liver dysfunction, cardiorespiratory compromise, blood disorder, etc.), tenting (dehydration), clubbing of nails (cardiac disease), fusing of cranial sutures, flattening of occiput, shortened chin, flattened nasal bridge, enlarged/protruding tongue, dark undereye rings, wide & flattened philtrum, painful lymph nodes, lateral deviation of trachea, thyroid abnormalities, conjunctivitis/styes/chalazions, erythema/swelling/discharge of sclera, pain with pressure on tragus, purulent drainage from ear, clear drainage from ear (CSF leak), abnormal mucosa, fissures at corners of mouth (B2 deficiency), clefts, equal chest diameters after age 2, sternal deviation

bilateral singular horizontal palm crease is common with Down’s syndrome

how is pain treated for a preschooler?

self-administration with close supervision, therapeutic play, cooling measures

how should you prepare an infant for a procedure?

describe procedure to parents, remind parents that infants often cry for other reasons but be honest about discomfort that the infant may experience, identify what restraints may be used & why, allow parents to decide whether they would like to be present for the procedure

how should you prepare a toddler for a procedure?

describe procedure to parents, use play to demonstrate the procedure, use simple, concrete language to describe the procedure & how it may feel, identify what restraints may be used & why, allow parents to decide whether they would like to be present for the procedure

how should you prepare a preschooler for a procedure?

explain procedure in terminology the child can understand, begin preparation immediately before the procedure so the child doesn’t worry for long, use play to demonstrate the procedure, set limits for the child so that they are aware of expectations (ex: you can yell but you must hold still), give legitimate choices when possible, allow parents to decide whether they would like to be present for the procedure, use distraction techniques

how should you prepare a school-aged child for a procedure?

explain procedure in terminology the child can understand, use play to demonstrate the procedure (for younger children), allow the child to touch & explore equipment used & involve the child in simple tasks when possible, set limits for the child so that they are aware of expectations, give legitimate choices when possible, allow parents & the child to decide together whether the parents will be present for the procedure, teach techniques such as deep breathing

how should you prepare an adolescent for a procedure?

describe the procedure & explain exactly what will happen, describe potential risks & pain associated with the procedure, allow the child to take as active a role as possible in the procedure, provide a peer video of the procedure if possible, allow adolescent to make decisions such as when the procedure should take place (if possible), allow the adolescent the option of having a parent present, offer tips for distraction

what is foreign body aspiration?

when any solid or liquid substance becomes caught in the respiratory tract & blocks air passage

what are the signs & symptoms of foreign body aspiration?

vary

rapid onset of hoarseness, chronic croupy cough, aphonia (can’t speak), unilateral wheezing, recurrent pneumonia, dyspnea, cyanosis

how is foreign body aspiration diagnosed?

x-ray can be helpful

definitive diagnosis: bronchoscopic examinaton

how is foreign body aspiration prevented?

avoid forceful feeding

avoid anything that could be a choking hazard for young children

what is some discharge instruction for foreign body aspiration?

avoid giving nuts, undercooked carrots, or other foods that are broken into pieces to infants & children before molars have erupted

don’t give toys with small pieces or balloons, marbles, coins, etc. to small children

is acute epiglotitis a medical emergency?

yes

what are the signs & symptoms of acute epiglotitis?

sudden

high fever, sore throat, dyspnea, drooling, tripod or sniff position, protruding tongue, muffled voice, frog-like croaking sound on inspiration

what are the priority interventions for acute epiglotitis?

get a trach tray if suspected & set up at the bedside

what are some contraindications with acute epiglotitis?

never try to assess with a tongue blade (this can cause a laryngospasm)

what are the signs of secondary infection?

regular signs of infection

viral infection can occur with a bacterial infection 6 to 8 days after initial onset because of viral insult of protective mechanisms

what are the normal respiratory behaviors for each age group?

newborn: airway is narrow & more easily occluded; obligate nose breathers

children under 6: abdominal breathers

what are the normal respiratory rates for each age group?

preterm: 40 to 70

newborn: 30 to 50

1 year: 20 to 40

3 years: 20 to 30

6 years: 19 to 22

10 & above: 16 to 20

what are the signs & symptoms of mild persistent asthma?

bronchial smooth muscle spasm, inflammation, edema of bronchial mucosa, production & retention of thick secretions

age 0 to 4: symptoms 3-6 days a week, 1-2 night awakenings per month

age 5 to 11: symptoms 2 days a week or more (not daily), 3-4 night awakenings per month

how is mild persistent asthma treated?

age 0 to 4: SABA use less than 2 days a week, minor limitations to activity

age 5 to 11: SABA use 2 days a week or more (not daily)

also inhaled corticosteroids, leukotriene receptor agonists, or chromosomes

what is some discharge instruction for RSV?

proper hand-washing, reduce exposure to & transmission of RSV, avoid secondhand smoke

feed small amounts while sitting up, avoid dehydration

how should you prioritize respiratory concerns?

airway, breathing, circulation, disability, exposure

what is some teaching & health promotion for cystic fibrosis?

priority is to ensure respiratory function is at highest level

encourage nutrition, may need antibiotics

reassure that this could not have been prevented by the parents

what is some information about the flu vaccine?

annual vaccine

2 doses are recommended the first year

contraindicated with egg allergy, immunocompromised, or pregnant

nasal spray option is LAIV

what is some information about the vaccine for RSV?

HiP

not required but encouraged for immunocompromised individuals or individuals with respiratory illness

really high risk of RSV with preemies

what is some information about the pertussis vaccine?

DTaP: administered at 2, 4, & 6 months, then a booster at 15 to 18 months & 4 to 6 years (needed for school)

indicated for childcare workers

does strep a need to be treated?

yes, if not it could lead to rheumatic fever

how is strep a treated?

supportive care as needed (pain & fever relief)

oral penicillin or chewable/suspended oral amoxicillin for children

• oral erythromycin for those with penicillin allergy

what are the signs & symptoms of pertussis?

cyanosis, exhaustion, sweating, severe coughing with reddening of the face, lasting up to 6 months

what is croup?

generic term encompassing a heterogenous group of illnesses affecting the larynx, trachea, & bronchi

usually caused by viral agents

at what age is croup most common?

age 2 but can also affect children 3 months to 5 years of age

how is croup treated?

single dose corticosteroids (dexamethasone), nebulized epinephrine

what are some interventions for acute diarrhea?

goal is stable weight for 2 days

serum electrolytes, CBC with differential, plus culture & stain with blood present in the stool

management is primarily supportive, other treatment is determined by extent & cause

• priority is to restore & maintain hydration

what is some information about acute diarrhea caused by rotavirus?

fecal/oral route

vaccine is available

most common

what is some information about acute diarrhea caused by c. diff?

caused by chronic antibiotic usage

how is acute diarrhea prevented?

hand-washing, proper food handling, proper care of soiled diapers & clothes

avoid juice & other triggers

what is pyloric stenosis?

enlargement of the pyloric sphincter often presenting with projectile vomiting

what are the signs & symptoms of pyloric stenosis?

postprandial nonbilious projectile vomiting, dehydration, olive-shaped mass in RUQ

how is pyloric stenosis diagnosed?

palpate mass

definitive diagnosis: ultrasound

• shows elongation & thickening of the pylorus, which can be confirmed by barium upper GI series

metabolic alkalosis

how is pyloric stenosis treated?

pyloromyotomy

what is failure to thrive?

the child does not hit milestones

at what age is solid food introduced?

4 months

no cow milk until 1 year of age

what are the nutrition guidelines for a toddler?

try to get them to eat the most nutritious option, be flexible with food acceptance, offer variety

what are the priority concerns for an inguinal hernia?

incarceration requires immediate surgery

if not cleared by age 5, surgery must be done

no straining (stool softeners, etc.)

what are signs & symptoms of appendicitis?

periumbilical or RLQ pain, vomiting, anorexia, stools low in volume & mucus-like, constipation

perforation: high fever, sudden relief of pain

what are some interventions for appendicitis?

appendectomy

what is some discharge instruction for appendicitis?

wound care, pain management, progression of activity, resumption of normal nutritional intake as tolerated

what are some feeding considerations for cleft lip & cleft palate?

short nipple with cleft palate

long nipple with cleft lip

how is intussusception treated?

barium enema

what is included in a celiac diet?

gluten-free

corn, rice, & millet are acceptable grains

what are some risk factors for development of short bowel syndrome?

volvulus, gastroschisis, necrotizing enterocolitis, Crohn’s

what are some precautions for an umbilical hernia?

good prenatal care for fetal development (premature & low birth-weight babies are more likely to develop this)

what is the priority assessment for pancreatitis?

Grey Turner’s sign, Cullen’s sign

labs: amylase, phosphorus, CRP, lipase

what are some urinary diagnostic tools?

creatinine, BUN, UA, specific gravity

what is genitourinary traumatic injury?

renal trauma - kidneys are known for rupturing, penetrating trauma

what is the most common cause of renal failure in children?

hemolytic uremic syndrome (HUS)

how is HUS prevented?

proper cooking of food

how is HUS managed?

antibiotics are contraindicated

supportive care (keep BP stable, etc.)

what are the priorities when caring for a patient with HUS?

cardiac monitoring

what are the goals of treatment for nephrotic syndrome?

monitor fluid & electrolyte imbalance, weight, edema, inflammation, etc.

what are some complications of chronic renal failure?

progressive deterioration of GFR

what is some education for a UTI?

void frequently, wash hands after elimination, wear loose-fitting clothes, wipe front to back, cotton underwear is preferred, drink plenty of water

what happens to blood pressure levels with renal disease?

BP increases

what are the causes of hematuria?

UTI, stones, sickle cell anemia, pyelonephritis, kidney disease/injury, glomerulonephritis

what are some contraindications of IV pyelogram?

allergy to shellfish

what are the signs & symptoms of testicular torsion?

neonates: dusky-colored scrotum, solid mass, scrotal edema preventing transillumination

older males: severe & persistent pain, may awaken patient at night, fever, anorexia, N/V

is testicular torsion an emergency?

yes; if surgery is not done in 4 to 8 hours of onset, patient can lose a testicle

what is some education for enuresis?

comfort patient, explain that they are not in trouble, discuss possible use of desmopressin (DDAVP) or imipramine (TCA) & motivational therapy