Peds Exam 1

Increased risks for children with disabilities 

  • Increased risk for child abuse 

  • Increased risk of harm (safety concerns) 


Intellectual disabilities 

  • Many potential causes, genetics, environment, substances, unknown, etc. 

  • Many medical comorbidities 

  • Psychiatric comorbidities 

  • The rate is increasing for unknown reasons 


Downs Syndrome  

  • Trisomy 21 = 95% of Down Syndrome cases 

  • Incidence is higher in boys and the Caucasian population  

  • Maternal age is the biggest risk factor  

  • Most are mild to moderately intellectually impaired 

  • Many comorbidities such as cardiac defects, vision, and hearing impairments, leukemia, umbilical hernia, TEF & imperforate anus, premature aging + Alzheimer's  


Fragile X 

  • Common inherited cause of cognitive impairment 

  • Known genetic cause of autism 

  • Physical characteristics such as large prominent ears and narrow face 

  • The mother carries the gene 

  • Boys are more typically affected than girls  


Fetal Alcohol Syndrome 

  • There is no cure, prevention is key 

  • No amount of alcohol is ok during pregnancy 

  • Causes physical and mental stunting 

  • Symptoms range from mild to severe 


Autism – 3 Questions 

  • Ranges from mild to severe 

  • Symptoms usually noticed by 3, and can be gradual or sudden 

  • Many potential causes, no cure 

  • Lack of attachment or socialization 

  • Tx. Focuses on symptoms and behavior management  


Failure to Thrive – 2 Questions 

  • Children whose weight or weight gain is significantly below normal 

  • Organic: Causes within the child (chromosome abnormalities, heart/lung defects, toxins) 

  • Inorganic: Familial issues (socioeconomic issues, parental relationship, parental emotional state)

  

ADHD – 1 Question 

  • More common in boys than girls 


Drug Abuse – 2 Questions 

  • Opiate usage is trending upwards 

  • Pharmaceutical parties (Risky, random drug parties consisting of raided pills) 

  • Vaping is a big concern 

  • Marijuana and Alcohol usage 35% of 12th graders, very concerning and damaging to development of adolescents 


General Growth & Development – 7 Questions 


Infant-Specific Milestones/Behaviors/Concerns – 13 Questions 

Fontanelles: A: 18 Months P: 2 Months 

Growth:  

2 Months: Move head, Verbal noises babbling, Smiles, Holds head up on stomach 

4 Months: Babbles, reaches for toys, remembers faces, rolls over, likes to play 

6 Months: Sits up without support, recognizes name, stranger anxiety, early vowels babbling 

5-7 Months: Hand to hand  

8-9 Months: Crawling, Stands up holding onto objects, Pincer Grasp, object permanence 

10-12 Months: Begin walking, Simple commands, Putting objects in containers / smacking things, simple words, Separation anxiety

    

Toddler-Specific Milestones/Behaviors/Concerns – 12 Questions 

1-3 years 

Skills: Running, Throwing, Drawing, 3 word sentences,  

2-3 4x body weight 

T: Tantrums, Erikson Autonomy,  

O(OTM): Safety concerns, carseat rear facing if under 2 years 20lbs,  

D(Diaper): 18-24yo potty training, most trained by 4-5 yo, 3yo night time 

Development: Egocentric, parallel play, symbolic play, Push-pull toys, pretend


Preschool Specific Milestones/Behaviors/Concerns – 2 Question 

  • Initiative vs. Guilt 

  • Magical thinking 

  • Separation anxiety 

  • Open choices for preschoolers  


School Age Specific Milestones/Behaviors/Concerns – 2 Questions 

  • Puberty becomes a topic of concern, with girls developing sooner than boys and sexual maturation in boys being less apparent. 

  • Children should increase their ability to think and consider the intention of rules rather than the punishments/rewards involved in them. 

  • Conformity and social pressures increase. 

Adolescent Specific Milestones/Behaviors/Concerns – 8 Questions 


Animism, centration, egocentrism, irreversibility, & magical thought – 5 Questions 

  • Animism: Child believes that nonliving things are alive  or have living qualities (Teddy bear) 

  • Centration: The child can only think about one aspect of an object, like it’s color but not it’s volume 

  • Egocentrism: The child can only think about themselves and their needs 

  • Irreversibility: Difficulties in a child reversing the order of events in their minds 

  • Magical Thought: I think something bad will happen and it happens, must have something to do with my thoughts 


• Erikson – 2 

• Piaget – 2 Questions 

• Kholberg – 1 Question 


Infectious Diseases:


What is diphtheria? S/S? Assessment and management?

  • S/S: Sore throat, fever, difficulty swallowing, airway obstruction

  • Administer abx, immunization status, closely observe respiratory status, droplet precautions for a child, no longer infectious 9 days following parotid swelling

  • What is pertussis? S/S? Assessment and management?

  • “Whooping cough” paroxysmal coughing spells (difficulty breathing)

  • Lack of immunization is a big risk factor

  • Humidity, suctioning of the nose, fluids, antibiotics, droplet precautions

  • Often misdiagnosed as RSV


What is tetanus? S/S? Assessment and management?

  • S/S: lockjaw, trouble swallowing, muscle spasms, change to bp and hr, PE, pneumonia

  • Lack of immunization (go figure)

  • Wound care, TIG (human tetanus immune globulin), tetanus vaccine, drugs for muscle spasms, antibiotics, ventilation possible


What is Haemophilus influenzae Type B? (Hib) S/S? Assessment and management?

S/S: Fever, confusion, headache/stiff nech, light sensitivity, nausea, poor reflexes (meningitis), 

Mostly affects children less than 5

Can cause meningitis, pneumonia, swelling of the throat, infection to joints, bones, and heart, sepsis, otis media, conjunctivitis

Antibiotics, respiratory support, meds to treat symptoms, droplet precautions


What is measles? S/S? Assessment and management?

Highly contagious, 

S/S: Fever, cough, coryza(cold symptoms), conjunctivitis, rash, koplik spots

Treated with bedrest, fluids, antipyretics, cool mist

Airborne precautions


What is Mumps? S/S? Assessment and management?

Fever, swelling of parotid (cheeks), orchitis in boys (can result in sterility in boys), meningitis/encephalitis, 

Supportive tx, airway, icepack for testicles if orchitis present

Droplet precautions


Rubella (German measles)

  • Can be transmitted mother to fetus

  • Spread up to a week before rash appears

  • Facial rash that spreads to other areas of the body

  • Supportive tx.

  • Maternal rubella can result in miscarriage, fetal demise, or congenital malformations

  • Screen for pt contact with pregnant women and notify them of possible exposure

  • Vaccines :/ 


Chicken Pox

  • Highly contagious, airborne + Contact precautions

  • Approx 90% not immune will become infected with close contact

  • Supportive tx, vaccine!!!

  • Symptoms can take 10-21 days to develop. It can spread 1-2 days before appearance.


Poliomyelitis 

  • Vaccines!!!

  • There is no cure for polio

  • Flu like symptoms and possible paralysis / permanent disability

  • Manage respiratory, contact precautions

  • Limit contact with saliva and feces, VERY GOOD HAND HYGIENE

  • Flu-like symptoms, paralysis 


Parasite Diseases: Pinworms (helminthic)

  • Fecal oral route of transmission

  • Anal itching 

  • Dx tape worms and microscope

  • Vermox med

  • Keep fingernails short and hand washing!This helps prevent the spread of infection and reduces irritation.

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