pediatric

apgar

perfect score 10

• never 10 because babies have acronosis

• done at 1 and 5 mins

newborns

normal respiratory rate 30-60

• using bulb syringe by suctioning mouth than nose

vital signs

the younger the baby is → the higher the HR/RR

• BP opposite → low as they’re younger and increase with age

pulse

brachial pulse

• check for no longer than 10 seconds → if not begin CPR

• if pulse present measure for a minute

respiratory

shoulder roll to open

meconium

first dark stool

• if does not pass within 24 hours great concern

want 6-10 wet diapers a day

meconium aspiration

if it occurs in utero

• can ingest and end up in the lungs

• baby can get stained

NICU immediately

• suction immediately and intubation

• IV fluids and abx

pathologic jaundice

occurs during birth

• immediately address

• could be liver, abo

• can lead to kernicterus

• treatment → phototherapy

  • dont exposure eyes and private part

  • fluids hydrate feed

tricuspid atresia

valve doesn’t grow

• cyanosis

• must be repaired

hypoplastic left heart syndrome

left sided doesn’t develop normally

• single ventricle

• SEE hepatomegaly + murmurs

  • blood MUST SHUNT to ASD

  • but blood is not being returned into body

  • leads to shock

  • treatment → iv and start prostaglandins

4 D’s of epiglottis

dysphagia

dysphonia

drooling

distress

MUST GET CHILD CALM AND GET AIRWAY EQUIPMENT

• dont stick anything in mouth

bronchiolitis

• inflammation of bronchioles

• mucus build up

  • RSV common cause

• contagious

  • peak on day 4-6

• difficulty eating

croup

barky cough

• treatment

  • steroids

  • racemic epi

• keep patient calm to prevent distress

cystic fibrosis

meconium ileus

• sweat chloride test → pt taste salty

• high calorie meal low fats

  • need pancreatic enzymes and vitamins

neural tube defect

check for dimple

• meningocele → closed

• myelomeningocele → open

must place baby on PRONE position

• cover opening with warm sterile dressing

microcephaly

• small head

  • zika, drugs/alcohol

• see developmental delay

• can experience seizures

cleft

cleft lip → done at 3-6 months

• supine or side lying

cleft palate → 6-24 months

• prone position

feed upright and burp frequently

placed in elbow restraints

nothing hard in mouth

pyloric stenosis

• non bilious

• projectile vomit

  • right after eating

• palpable olive shaped mass

omphalocele

• abdominal contents protrude through umbilicus

• complications

  • hypothermia, dehydration, sepsis (abx)

• feed thru TPN

• gastroschisis

  • no seal increase risk for infection

intussusception

intestine folds into itself

• red currant jelly stool

• sausage shaped mass

Hirschsprung

end of intestine with no nerve cells

• no peristalsis

• see a MEgACOLON → ribbon like stool

sick cell crisis

• severe joint pain + decrease oxygen

• poor perfusion

• give hydroxyurea

kawasaki diseasse

acute

• inflammation of blood vessels

• strawberry tongue

• red hands and feet

• ONLY TIME WE GIVE ASPIRIN

  • REDUCE CLOTS

reye’s syndrome

aspirin toxicity

• acute encephalopathy

• monitor for signs of ICP + monitor clotting system

phenylketonuria

can’t break down amino acids

• need to be eating so heal stick done 24-48 hours

• avoid proteins and phenylalanine

rickets

softening of bones

lack of vitamin D

• see bow legs

dysplasia of the hip

• femur displaced from hip

• infant

  • barlow test (pop)

  • ortolani test → abduct with thumbs (clunk)

• pavlik harness or spica cast

osteogenesis imperfecta

brittle bone from lack of collagen

• loose joints

• treatment

  • fall precaution

  • bisphosphate

muscular dystrophy

lack of protein for muscle protein

• no cure just management

• wheelchair in late childhood

impetigo

bacterial contagious

• honey crust

• need abx

pediatric burn injuries

splash marks → could be accidental

infants

erikson’s → trust vs mistrust

• cry and needs are met

Piaget’s

• sensorimotor 0-6

• mobile toys

3 months milestones of an infant

cooing signs

smile at people

hold head up during tummy time

6 months

babbling

• can start to crawl

• birth weight doubles

9 months

• imitation

  • animals

  • mama dada

• can sit up without support

12 months

1-2 words

• say yes or no

• recognize objects

• should be standing

18 months

anterior fontanelle should close

• walking

• 18 words or more

babinski

• absent at 1 year old

• positive fan out is good

• negative is bad

palmar grasp

ends at 3-4

car seat

rear safety until 2

flu shot

6 months

toddlers

erikson autonomy vs shame and doubt

• potty training

• dressing self

• shame → punished for mistakes

piaget’s

• preoperational

• fantasy

• parallel play

2 years old

run and hit a ball

• dramatic play

finger foods

• avoid popcorn grapes hot dogs

preschoolers

3-5

• initiative vs guilt

piaget’s

• preoperative

• cognitive play and magical thinking

• regression may occur

4 year old

• 4 or more word sentences

• playing pretend

• put on button

• education

  • allow them to handle equipment

  • vax → dtap, MMR, varicella flu

school age

7-11

• industry vs inferiority

  • industry → achievements

  • inferiority → perfection

• concrete thinking

• immunization → tdap meningo, HPV

adolescent

13-21

identity vs role confusion

• hypothetical thinking