pediatrics (final exam)

social character of play at 0 to 3 months

unoccupied

social character of play at 0 to 2 years

solitary

social character of play at 2 years

onlooker

social character of play at 2 to 3 years

parallel

social character of play at 3 to 4 years

associative

social character of play at 4+ years

cooperative

how much should an infant weigh after two weeks?

back to birth weight

how much should an infant weigh after six months?

double birth weight

how much should an infant weigh after one year?

triple birth weight

how much should an infant weigh after two years?

quadruple birth weight

what temp is considered to be a fever for newborns?

100.4 F (38 C)

what should be ruled out if a newborn has a temperature of 100.4 F?

sepsis

newborn language development pattern

cries (newborn)

smiles (2 months)

coos, gurgles, laughs (3 to 4 months)

word sounds (4 to 8 months)

3 to 5 intentional words (12 months)

what is object permanence and when does it develop in infants?

the concept that objects and people still exist even when they are out of sight

at 8 to 9 months

what GROSS motor milestone is seen at 4 months?

head lag disappears

what GROSS motor milestone is seen at 7 months?

can sit in tripod position

what GROSS motor milestone is seen at 12 months?

stand alone, first steps

what GROSS motor milestones are seen at 3 years?

kick a ball, ride a tricycle

what GROSS motor milestones are seen at 4 years?

hop, jump, skip on one foot

what FINE motor milestone is seen at 7 months?

can transfer objects hand to hand, raking grasp

what FINE motor milestone is seen at 8 to 10 months?

pincer grasp

what FINE motor milestone is seen at 12 months?

point to things they want

what FINE motor milestone is seen at 2 years?

builds 6 to 7 block tower

what FINE motor milestones are seen at 3 years?

draws circles, uses a fork, builds 9 to 10 block tower

what temperature should home water heaters be set at to prevent newborn/infant injury?

120 F max

a respiratory rate of what is a sign of respiratory distress in pediatric patients?

> 60

what can typically be said about HR and BP in pediatric patients?

variable heart rate is normal

BPs may appear low

what is our best indication of pain in the nonverbal child?

cry, behavior, and facial expression

what kind of vaccines should not be given to immunosuppressed patients?

live attenuated vaccines

what are examples of live attenuated vaccines?

MMR and varicella

what is the only true contraindication to vaccines?

a history of a severe allergic reaction to a vaccine component

when is it okay to hold a vaccine?

when a child is febrile (100.4 F)

what is baby's first vaccine?

hep b

if baby has a Hep B POSITIVE mom, what should be given and when?

HBIG within 12 hours of life

when should DTaP be given?

< 7 years old

when should Tdap be given?

>/= 7 years old

when should a child receive tetanus booster?

for wounds if immunization status unknown OR if it has been > 5 years since dose

what type of vaccine is rotavirus? what risks are associated with this?

live and oral

slightly increased risk of intussusception

when should pneumovax 23 be given (PPSV23)?

additional pneumococcal coverage for patients > 2 years of age and with certain high-risk conditions like sickle cell disease

what are MMR and varicella more likely to cause in children?

fevers or febrile seizures up to 1 to 2 weeks later

what symptom is associated with the HPV vaccine? what nursing intervention should be done after administration?

dizziness

have patient sit or lie down for 15 minutes after injection

HPV is only a 2-dose series if given before what age?

15 years

(3 doses if started after age 15)

if a child is under 9 years of age and getting a flu shot for the first time, how many doses should they receive?

2 doses, 1 month apart

what vaccine is given at birth?

Hep B

("Hurray, Baby")

what vaccines are given at ages 2, 4, and 6 months?

DTaP

IPV

Hep B

Hib

PCV

Rota

("DIHHPeR")

what vaccines are given at ages 12 to 15 months?

Hib

Hep A (x2)

Varicella

PCV

MMR

DTaP

("HArry V. Potter MD")

what vaccines are given at ages 4 to 6 years?

IPV

DTaP

MMR

Varicella

("I Did My Vaccines")

what vaccines are given at ages 11 to 12 years?

TDaP

HPV (x2 or 3)

Meningococcal

("Tweens Have Money")

what vaccines are given at age 16?

meningococal

meningococcal B (x2)

("M&Ms")

what are NORMAL occurrences when it comes to sleep for a toddler/preschooler?

resistance to bedtime, fears ("monsters under bed," nightmares/night terrors), and enuresis

bedwetting is still common through what age?

7 years

what booster shots should a child receive before kindergarten (4 to 6 years)?

DTaP+IPV and MMR+V

what vaccines should be given at 11 years?

Tdap, HPV, MCV

where is physical growth first seen in adolescense?

first growth is in feet then extremities then neck/trunk

what age is the female growth spurt?

10 to 13 years

when is peak height velocity for females?

peak height velocity (2 to 3") then start menses within that year (6 to 12 months later)

when do girls stop growing in height?

2 years after onset of menses

what age is the male growth spurt?

12 to 15 years

when do men stop growing?

age 18 to 20 years

what is the first sign of puberty in females?

breast buds

what is the first sign of puberty in males?

testicular enlargement

what psychosocial development is seen in adolescence?

they believe they're INVINCIBLE (know they can get hurt/die but wont happen to them, risk taking behavior)

what is tanner staging?

scale that defines physical measurements of development based on external primary and secondary sex characteristics, such as the size of the breasts, genitals, and development of pubic hair

what are expected physical findings for a child with down syndrome?

flat square forehead with upward slant to eyes

flat nasal bridge

protruding tongue

mottled skin

hypotonia

epicanthal folds

short stature

plantar crease

high palate

small ears with short pinna

what accompanying medical conditions are typically seen in children with down syndrome?

heart malformations, septal wall defects (40 to 45% of patients with down syndrome)

hypotonia, atlantoaxial instability

what are erikson's stages of psychosocial development?

trust vs. mistrust (infancy)

autonomy vs. shame and doubt (toddler)

initiative vs. guilt (preschool)

industry vs. inferiority (school age)

identity vs. role confusion (adolescence)

what are piaget's stages of cognitive development?

sensorimotor (0-2)

preoperational (2-7)

concrete (7-11)

formal (11+)

what are symptoms of depression in children?

withdrawn

feeling lonely or isolated

spending less time with peers

lose or gain weight

decreasing school performance

difficulty concentrating

sleep disturbances

negative self-talk

what are examples of suicide red flags?

leaving suicidal posts/messages

telling people goodbye

becoming reclusive

outburst of anger and depression

giving things away

crying, fatigue, helpless, poor concentration, weight loss

having a plan

feeling let down

recent traumatic event

streptococcus pharyngitis (strep throat)

infection of the throat caused by group a beta-hem strep bacteria

what is the gold standard for strep throat diagnosis?

mono and viral pharyngitis can present like strep throat, so THROAT CULTURE is gold standard for diagnosis

bronchiolitis

disease of lower respiratory tract causing inflammation and obstruction in the small airways

begins with URI

what is the most common cause of bronchiolitis?

RSV

croup

viral infection of the larynx

what is the hallmark sign of croup? what exacerbates this?

barky cough + inspiratory stridor

especially when child is upset or agitated (keep them calm!)

epiglottitis

inflammation and swelling of the epiglottis caused by infection

what are the most common symptoms of epiglottitis?

THE 3Ds

drooling, dysphagia, distress

if epiglottitis is suspected, what should NOT be performed? why?

do not use a tongue blade or perform a throat culture

disturbance to the pharynx or throat can lead to the loss of airway

epiglottitis vs croup: viral or bacterial

epiglottitis: bacterial

croup: viral

epiglottitis vs croup: common or rare

epiglottitis: rare

croup: common

epiglottitis vs croup: most common age

epiglottitis: 6 to 10 years

croup: 3 months to 6 years

epiglottitis vs croup: x-ray findings

epiglottitis: thumb sign

croup: steeple sign

epiglottitis vs croup: symptoms/considerations

epiglottitis: do not do pharyngeal exam, keep child calm

croup: supportive cares, humidification, dexamethasone

epiglottitis vs croup: hospitalization or at home treatment

epiglottitis: immediate hospitalization for IV antibiotics, prepare for intubation

croup: rarely requires hospitalization

what education should be given to patient using an inhaler?

rinse mouth after inhaled steroid to prevent thrush use of spacer

cystic fibrosis

genetic disease causing thick, sticky mucus to clog the lungs, pancreas, and other organs, leading to breathing problems, infections, and digestive issues like malnutrition

what should be given with meals and snacks for a patient with cystic fibrosis? why?

pancreatic enzymes to help with digestion

what other dietary considerations should be implemented for a patient with cystic fibrosis?

increase fluid intake

high protein/calorie intake

fat soluble vitamin supplements (ADEK)

what are supportive nursing cares for a patient with cystic fibrosis?

chest PT and percussion/vibration

breathing exercises to loosen secretions before meals and several hours after to prevent vomiting

bronchodilator 30-60 min before chest PT

administer oxygen PRN

age range for newborn

0 to 2 months

age range for infant

2 months to 1 year

age range for toddlers

1 to 3 years

age range for preschoolers

3 to 5 years

age range for school-age children

6 to 12 years

age range for adolescents

12 to 21 years

what are signs of respiratory distress?

nasal flaring

retractions

anxious, irritability

pale skin, cyanosis

belly breathing, accessory muscles

tachypnea (RR > 60)

apnea

poor feeding, dehydration

noisy breathing, grunting

clammy, cool, mottled skin

orthopnea, change in body position

decreased oxygen saturation < 90-95%

what is pneumonia?

infection of lower respiratory tract and lungs

most commonly a viral infection

what are symptoms of pneumonia?

abrupt high fever, chills, cough, dyspnea, SOB, irritable, pain, lethargy, vomiting, anorexia, RD, RR > 60/min, fine crackles, grunting, retractions, nasal flaring

how is pneumonia treated?

antibiotics, IVF, oxygen therapy, suctioning, breathing treatments, symptomatic support, Motrin/Tylenol

what is hip dysplasia?

abnormal dislocation of the hip where the femoral head displaces from acetabulum