Pediatric Nursing Final Exam Review Notes

Final Review: Comprehensive Study Notes

Chapters 26-33 Content

• Pyloric Stenosis
  • Definition: Narrowing of the pylorus, leading to obstruction of the gastric outlet.
  • Signs and Symptoms: Non-bilious projectile vomiting, olive-shaped mass palpable in the epigastrium (hypertrophied pylorus), visible peristaltic waves, dehydration, and weight loss.
  • Post-feeding Positioning: Placing an infant on their right side after feeding helps facilitate good drainage into the intestines.
  • Reference: Page $661$
• Poison Control
  • Prioritization of Care: What is the first instruction for a parent if a child ingests medication or a cleaning product? Immediately call Poison Control; do not induce vomiting without specific instruction.
  • Reference: Page $681$
• Tinea Pedis (Athlete's Foot)
  • Definition: A common fungal infection of the foot, often characterized by itching, scaling, and redness between the toes and on the soles.
  • Reference: Page $708$
• Hemophilia A
  • Description: A genetic clotting disorder caused by a deficiency in clotting factor VIII, leading to prolonged bleeding.
  • Lab Test: Know about the lab test that assesses clotting times (e.g., activated partial thromboplastin time - aPTT), which will be prolonged.
  • Clinical Manifestations: Excessive bleeding from minor injuries, joint bleeds (hemarthrosis), and bruising.
  • Reference: Page $645$ (for the specific test)
• Diarrhea in Children
  • Fluid Management: What type of fluids should be offered to a child with diarrhea? Oral rehydration solutions (ORS) are preferred; avoid sugary drinks, milk, and full-strength fruit juices initially.
  • Reference: Page $668$ (Chapter 28)
• Pediculosis Capitis (Head Lice)
  • Definition: The medical term for head lice, small parasitic insects that live on the human scalp and feed on blood.
  • Signs and Symptoms: Intense itching of the scalp, presence of nits (lice eggs) firmly attached to hair shafts, small red bumps on the scalp.
  • Reference: Page $709$
• Tracheoesophageal Fistula (TEF)
  • Suggestive Signs: How would one suspect a child has TEF? Often presents with the "$3$ C's": Coughing, Choking, and Cyanosis during feeding, excessive drooling, and respiratory distress.
  • Nursing Observation: The first feeding is crucial for observing immediate signs of TEF and preventing aspiration.
  • Reference: Page $660$
• Rickets
  • Deficiency: What nutrient deficiency causes rickets? A chronic deficiency of Vitamin D, essential for calcium and phosphate absorption, leading to soft and weakened bones.
  • Reference: Page $677$
• Kidney Function and Renin
  • Basic Function: Review of kidney function (from pharmacology), including blood filtration, waste removal, and fluid/electrolyte balance regulation.
  • Renin Secretion: Kidneys secrete renin, an enzyme that initiates the renin-angiotensin-aldosterone system (RAAS), which regulates blood pressure.
  • Clinical Application: A tumor on the kidney can lead to high blood pressure due to abnormal (excessive) renin secretion, activating the RAAS cascade.
  • Reference: Page $686$
• Urinary Tract Infections (UTIs) in Female Patients
  • Parental Teaching: Essential teaching points for parents regarding UTIs in female children include wiping front to back after toileting, ensuring adequate fluid intake, avoiding bubble baths, and wearing cotton underwear.
  • Reference: Page $691$
• Type 1 Diabetes Mellitus
  • Somogyi Phenomenon vs. Dawn Phenomenon: Understand the difference between these two phenomena (both involve morning hyperglycemia).
  • Somogyi Effect: Rebound hyperglycemia that occurs in response to undetected nocturnal hypoglycemia, often requiring lower insulin doses at night.
  • Dawn Phenomenon: Early morning hyperglycemia due to normal circadian release of growth hormone and cortisol, which decrease insulin sensitivity.
  • Reference: Page $731$
  • Diagnosis of Diabetes: Fasting blood sugar on two separate occasions ($\ge 126$ mg/dL) is considered diagnostic. Other criteria include a random plasma glucose concentration $\ge 200$ mg/dL with classic symptoms, or an oral glucose tolerance test (OGTT) $\ge 200$ mg/dL in the $2$-hour sample.
  • Reference: Page $722$
  • Signs of Hypoglycemia: Irritability, sweating, tremors, hunger, pallor, lethargy.
  • Signs of Hyperglycemia: Polyuria (frequent urination), polydipsia (increased thirst), polyphagia (increased hunger).
• Immunity Types
  • Categories: Understand the differences between natural (innate, non-specific defenses), acquired (adaptive, specific immunity developed over time), passive (temporary immunity via antibodies transferred from another source, e.g., maternal antibodies or immunoglobulin injection), and active (long-lasting immunity developed when the body produces its own antibodies in response to antigen exposure, e.g., vaccination or infection) immunity.
  • Reference: Pages $742-743$ (general review), Page $743$ (acquired immunity specific).
• Respiratory Syncytial Virus (RSV)
  • Precautions: What type of infection control precautions are needed for RSV patients? Contact and Droplet precautions are essential to prevent transmission.
  • Description: A common respiratory virus that causes infections of the lungs and respiratory tract, especially in infants and young children, often leading to bronchiolitis.
  • Reference: Page $600$
• Hypoglycemia in Children
  • Signs and Symptoms: Know the clinical manifestations of hypoglycemia in a child, including shakiness, dizziness, sweating, hunger, irritability, headache, pallor, and confusion. Severe hypoglycemia can lead to seizures and loss of consciousness.
  • Reference: Page $731$
• Wilms Tumor (Nephroblastoma)
  • Description: An abdominal mass, usually on the kidney, referred to as a nephroblastoma, which is a highly malignant tumor of the kidney in children.
  • Characteristics: It is malignant and encapsulated; disruption of the capsule can cause metastasis.
  • Crucial Nursing Principle: DO NOT PALPATE THE ABDOMEN in a child with a suspected or diagnosed Wilms tumor. Palpation can rupture the encapsulated mass, leading to widespread cancer metastasis.
  • Clinical Manifestation: Often associated with hypertension due to interference with renin secretion by the kidney and subsequent activation of the RAAS.
  • Nursing Action: Place a prominent sign (e.g., on the crib, door) stating "No Abdominal Palpation."
  • Reference: Page $696$
• Scurvy
  • Deficiency: What nutrient deficiency causes scurvy? A chronic deficiency of Vitamin C (ascorbic acid), vital for collagen synthesis, leading to symptoms like bleeding gums, easy bruising, and poor wound healing.
  • Reference: Page $677$
• Dysuria
  • Definition: Know what "dysuria" means: painful or difficult urination, often accompanied by a burning sensation.
  • Reference: Page $689$ (along with other terms in Chapter 29).
• Infantile Eczema (Atopic Dermatitis)
  • Treatment of Choice: The preferred treatment for infantile eczema involves hydration of the skin (e.g., frequent moisturizing with emollients after bathing), topical corticosteroids to reduce inflammation, and identifying/avoiding triggers.
  • Reference: Page $705$
• Burns and Skin Function
  • Greatest Risk: The primary risk for a burn patient is infection, as the skin (the body's largest organ) provides a crucial protective barrier against pathogens, regulates temperature, and prevents fluid loss.
  • Reference: Page $699$
• Burn Patient Nursing Care (Acute)
  • Airway Management: Ensure a patent airway, especially if facial burns or smoke inhalation occurred, as this can lead to rapid edema and breathing difficulty; intubation may be necessary.
  • NPO Status: Keep the patient NPO (nothing by mouth) due to the risk of ileus and potential for immediate surgical intervention.
  • IV Access: Establish an intravenous (IV) line immediately, preferably two large-bore IVs, to administer fluids for burn shock resuscitation.
  • Lab Samples: Collect blood and bodily fluids for testing (e.g., CBC, electrolytes, ABGs, carboxyhemoglobin).
  • Urinary Catheter: Insert a Foley catheter to monitor urine output hourly, which is a critical indicator of kidney perfusion and overall organ function and adequacy of fluid resuscitation. Maintain urine output $\ge 0.5-1$ mL/kg/hr.
  • Reference: Page $711$
• Endocrine System
  • Functions: Understand the primary functions of the endocrine system, including regulating metabolism, growth and development, tissue function, sexual function, reproduction, sleep, and mood, by producing and secreting hormones.
  • Reference: Page $719$
• Hypothyroidism
  • Screening: Early screening is vital; hypothyroidism is often part of the routine newborn screening (PKU test) via a heel stick blood sample.
  • Irreversible Damage: Untreated congenital hypothyroidism in infancy can cause irreversible mental retardation or brain damage if not treated promptly.
  • Treatment: Lifelong medication (thyroid hormone replacement, e.g., levothyroxine) is required.
  • Monitoring: Regular blood level monitoring ($T4$ and TSH) is necessary to ensure adequate dosing.
  • Prognosis: Early treatment prevents further intellectual impairment, but existing damage from delayed diagnosis is generally not reversible.
  • Reference: Page $721$
• Rheumatic Fever
  • Affected Organ: Primarily affects the heart, especially the mitral valve, causing scarring (rheumatic heart disease). It can also affect joints, brain, and skin.
  • Treatment: Aspirin is often administered for inflammation and pain. Antibiotics (e.g., penicillin) are used to eradicate residual Group A Streptococcus infection and prevent recurrence.
  • Associated with: Untreated or inadequately treated Group A Streptococcus (strep throat) infection.
  • Reference: Page $631$
• Emotional and Behavioral Issues in Children
  • Normal vs. Deviation: Importance of understanding normal developmental behaviors and milestones to accurately identify deviations that may indicate underlying emotional or behavioral issues.
  • Reference: Page $765$
• Attention-Deficit/Hyperactivity Disorder (ADHD)
  • Signs and Symptoms: Be familiar with the signs and symptoms (potential "select all that apply" question), which include inattention (difficulty sustaining attention, easily distracted, forgetful), hyperactivity (fidgets, restless, runs/climbs excessively, talks excessively), and impulsivity (interrupts, difficulty waiting turn, acts without thinking). These symptoms must be present in two or more settings (e.g., home and school) and interfere with functioning.
  • Reference: Page $768$
• Children of Alcoholic Parents
  • Nursing Care: Understand the specific nursing care needs for these children, focusing on building trust, providing a stable environment, and addressing emotional and developmental delays.
  • Behavioral Patterns: Often exhibit role reversal, assuming parental responsibilities, and appearing more mature than their age ("parentification"). They may also struggle with trust, emotional regulation, and self-esteem.
  • Reference: Page $775$
• Leukemia (Visitation)
  • Infection Risk: Children with leukemia have numerous immature white blood cells (blasts), which are ineffective in fighting infection, compromising their immune system (immunocompromised state).
  • Visitation Restrictions: Restrict visits from young siblings or others who may carry germs, have recent infections, or are not fully vaccinated, to minimize infection risk. Strict hand hygiene for all visitors is crucial.
  • Reference: Pages $647-648$
• Intussusception
  • Stool Type: Know the characteristic stool associated with intussusception (a telescoping of one part of the intestine into another), which is often described as currant jelly-like stool (due to blood and mucus).
  • Treatment: Often reduced by hydrostatic (saline or air) enema; surgery may be required if reduction fails or bowel necrosis occurs.
• Natural Pain Relievers
  • Concept: Implied to be endorphins, natural opioid peptides produced by the body that interact with opioid receptors in the brain to reduce pain perception and produce feelings of euphoria.
• Tinea Cruris (Jock Itch)
  • Description: A common fungal infection of the groin area, characterized by an itchy, red, often ring-shaped rash, typically seen in warm, moist environments.
• Hypospadias and Epispadias
  • Definitions: Understand the difference between these congenital conditions affecting the urethra.
  • Hypospadias: Urethral opening is located on the underside (ventral surface) of the penis, or in the perineum in females.
  • Epispadias: Urethral opening is located on the upper side (dorsal surface) of the penis, or above the clitoris in females.
  • Reference: Pages $689-690$
• Complication of Gastroenteritis in Children
  • Primary Concern: What is a significant complication of gastroenteritis in children? Dehydration, leading to electrolyte imbalances and potentially life-threatening consequences if not promptly managed.
  • Reference: Page $667$

Cumulative Content (Review of Previous Material)

• Historical Figures
  • Karl Krede and Ignace Semmelweis: Know their contributions to healthcare.
  • Karl Krede: Introduced silver nitrate drops into the eyes of newborns to prevent ophthalmia neonatorum (gonorrheal conjunctivitis).
  • Ignace Semmelweis: Advocated for handwashing in obstetrical clinics to prevent puerperal fever (childbed fever).
  • Reference: Page $2$
• Twentieth Century Healthcare Changes
  • Evolution of Care: Understand how healthcare delivery changed in the $20^{th}$ century, including advancements in medical technology, pharmaceuticals, sanitation, increased focus on preventative care, and the rise of managed care.
  • Reference: Page $3$
• Puberty: First Outward Signs
  • Girls and Boys: Identify the initial physical manifestations of puberty in both genders.
  • Girls: Breast budding (thelarche) is typically the first sign.
  • Boys: Testicular enlargement is usually the first sign.
  • Reference: Pages $22-23$
• Fallopian Tubes
  • Function: Recall the primary function of the fallopian tubes – to transport eggs from the ovaries to the uterus and are the typical site of fertilization.
  • Reference: Page $27$
• Menstruation
  • Onset: When menstruation typically begins (menarche), usually between ages $9-16$, with an average of $12$ years.
  • Family Teaching: Key teaching points for families, including:
  • Initial cycles may be irregular and anovulatory (no ovulation, hence no possibility of pregnancy from these specific cycles).
  • Despite irregularity, ovulation can still occur in some cycles, meaning pregnancy is possible even with irregular periods.
  • Reference: Page $29$
• Ovaries & Eggs
  • Egg Production: Females are born with all their eggs (oocytes) they will ever have; they do not acquire them with age. Oogenesis begins prenatally.
  • Reference: Page $27$
• Sperm Lifespan
  • Durability: How long sperm can live inside the female reproductive tract (up to $5$ days) under favorable conditions, allowing for fertilization even if intercourse occurs several days before ovulation.
  • Reference: Page $31$
• Placenta
  • Function: Understand the vital functions of the placenta during pregnancy, including nutrient and oxygen exchange from mother to fetus, waste product removal from fetus to mother, and hormone production (e.g., hCG, progesterone, estrogen) essential for maintaining pregnancy.
  • Reference: Pages $39-40$
• Human Chorionic Gonadotropin (HCG)
  • Definition: Know what HCG is and its role – it is a hormone produced by the placenta after implantation, which supports the corpus luteum and its production of progesterone. It is the hormone detected by pregnancy tests.
  • Reference: Page $42$
• Nagele's Rule
  • Calculation: Be able to calculate the estimated date of delivery (EDD) using Nagele's rule.
  • Formula: Last Menstrual Period (LMP) - $3$ months + $7$ days + $1$ year.
  • Example: If LMP is April $1$, $2023$, then EDD is January $8$, $2024$.
  • Reference: Page $52$
• Aortic Valve Compression Syndrome (Supine Hypotension)
  • Troubleshooting: How to manage and resolve this condition by having the pregnant patient lie on her side (preferably left lateral position) or place a wedge under her right hip to displace the uterus from the vena cava.
  • Patient Presentation: How a patient with supine hypotension would present clinically (dizziness, nausea, pallor, cold clammy skin, decreased blood pressure) due to compression of the inferior vena cava by the gravid uterus, reducing venous return to the heart.
  • Reference: Page $57$
• Hyperemesis Gravidarum vs. Morning Sickness
  • Differentiation: Understand the key differences between severe hyperemesis gravidarum and typical morning sickness.
  • Hyperemesis Gravidarum: Persistent, severe vomiting beyond the first trimester, significant weight loss (often >5\% of pre-pregnancy weight), dehydration, and electrolyte imbalance (e.g., hypokalemia, metabolic alkalosis). Requires medical intervention.
  • Morning Sickness: Nausea with or without vomiting, typically subsiding by $12-16$ weeks, usually manageable with dietary changes, and does not cause severe dehydration or weight loss.
  • Reference: Page $88$ (Hyperemesis Gravidarum), Page $52$ (Morning Sickness).
• Ectopic/Tubal Pregnancy
  • Signs and Symptoms: Recognize the clinical manifestations of an ectopic pregnancy, where the fertilized egg implants outside the uterus, most commonly in the fallopian tube. Symptoms include unilateral abdominal pain (often sharp, stabbing), vaginal spotting, amenorrhea, and in cases of rupture, shoulder pain (referred pain from diaphragmatic irritation), dizziness, and signs of hypovolemic shock.
  • Reference: Page $93$
• Gestational Diabetes
  • Future Risk: Patients diagnosed with gestational diabetes are at an increased risk of developing Type $2$ diabetes later in life, making postpartum screening and lifestyle modifications crucial.
  • Management: Dietary management, exercise, and sometimes insulin are required to control blood glucose levels during pregnancy to prevent complications for mother and baby.
• Group B Streptococcus (GBS) Infection
  • Screening: Tested at $36$ weeks gestation (between $35$ and $37$ weeks), valid for $4$ weeks. If delivery extends past $40$ weeks without retesting, GBS status is unknown and intrapartum antibiotic prophylaxis is typically indicated.
  • Method: Rectal and vaginal swab.
  • Importance: Crucial to test because GBS can cause a deadly infection in newborns (e.g., sepsis, pneumonia, meningitis) if transmitted during vaginal birth. Intrapartum antibiotic prophylaxis (IAP) is given to GBS-positive mothers during labor.
  • Reference: Page $1$
• The Four P's of the Birth Process
  • Components: Understand what constitutes the four P's that influence labor and birth: Powers, Passenger, Passageway, and Psyche.
  • Powers: Includes uterine contractions (primary power, causing cervical dilation and effacement) and maternal pushing efforts (secondary power, expelling the fetus).
  • Passenger: Refers to the fetus and placenta (size, presentation, lie, attitude, position).
  • Passageway: The birth canal, consisting of the maternal pelvis and soft tissues.
  • Psyche: The maternal emotional state (anxiety, fear, support).
  • Reference: Pages $126-127$
• Signs of Impending Labor
  • Recognition: Identify the various signs that indicate labor is likely to begin soon, including lightening (fetus descends into the pelvis), Braxton Hicks contractions (irregular, mild contractions), cervical changes (softening, effacement), bloody show (mucus plug expelled with blood-tinged discharge), and rupture of membranes (water breaking).
  • Reference: Page $132$
• Normal Fetal Heart Rate (FHR)
  • Range: Know the normal range for FHR ($110-160$ beats/minute) during the entire pregnancy, with variations indicating fetal well-being or distress.
  • Reference: Page $138$
• VEL CHOP Acronym
  • Understanding: Although not a specific acronym in the book, understand the correlation between fetal heart rate decelerations and uterine contractions:
  • Variable decelerations with Cord compression
  • Early decelerations with Head compression
  • Late decelerations with Placental insufficiency
  • Ok (Accelerations are ok - indicating fetal well-being)
  • Reference: Page $142$
• Stages of Labor
  • Overview: Be familiar with all four stages of labor.
  • First Stage: From onset of regular contractions to full cervical dilation ($10$ cm). Divided into latent, active, and transition phases.
  • Second Stage: From full dilation to birth of the baby.
  • Third Stage: From birth of the baby to delivery of the placenta.
  • Fourth Stage: The first $1-4$ hours after placenta delivery.
  • Reference: Pages $155-156$
  • Fourth Stage of Labor: Focus on what is happening during this stage and the primary concerns (e.g., monitoring for hemorrhage due to uterine atony, assessing for bladder distention, promoting maternal-infant bonding, and recovering from birth). Nursing interventions include frequent fundal massage, vital signs, and perineal checks.
  • Reference: Pages $151-152$
• Apgar Score
  • Components: What factors are assessed: Appearance (color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), Respiration (respiratory effort). Each scored $0-2$, with a total possible score of $10$.
  • Timing: When the score is assessed (typically at $1$ and $5$ minutes after birth); if the $5$-minute score is less than $7$, scores may be performed every $5$ minutes for up to $20$ minutes.
  • Reference: Page $158$
• Non-Pharmacological Methods of Pain Relief in Labor
  • Techniques: Know various methods to relieve pain during labor without medication, such as breathing techniques, relaxation, massage, hydrotherapy (showers/baths), effleurage, counterpressure, imagery, and changing positions.
  • Reference: Page $169$
• Epidural Blood Patch
  • Purpose: Why it is performed – to relieve severe post-dural puncture headache (PDPH), which can occur after spinal or epidural anesthesia if cerebrospinal fluid (CSF) leaks from the puncture site.
  • Procedure: Who performs it (anesthesiologist) by injecting a small amount of the patient's own blood into the epidural space, which then clots and seals the CSF leak.
  • Reference: Page $175$
• Augmentation vs. Induction of Labor
  • Distinction: Understand the difference between initiating labor (induction) in a non-laboring patient and stimulating an already established labor (augmentation) that is progressing slowly.
  • Methods: Both may involve oxytocin infusion or amniotomy.
  • Reference: Page $182$
• Amniotomy
  • Definition: Know what an amniotomy means – the artificial rupture of membranes (AROM), usually performed with an amniohook.
  • Risks: Increases the risk of umbilical cord prolapse, infection, and fetal head compression.
  • Reference: Page $184$
• Vaginal Birth After Cesarean (VBAC)
  • Primary Concern: The most significant concern with a VBAC is uterine rupture, a rare but life-threatening complication for both mother and fetus. Requires close monitoring.
  • Reference: Pages $203-204$
• Preterm Labor
  • Signs and Symptoms: Recognize the indicators of preterm labor, which is labor occurring between $20$ and $36$ weeks and $6$ days gestation. Symptoms include regular uterine contractions (often painless or mild cramping), pelvic pressure, vaginal discharge changes, and backache.
  • Reference: Page $201$
• Prolapsed Umbilical Cord
  • Plan of Care: What immediate nursing interventions are required for a prolapsed umbilical cord, which is an obstetric emergency where the umbilical cord presents before the fetal head. Actions include manually lifting the presenting part off the cord (with a sterile gloved hand in the vagina), placing the mother in a Trendelenburg or knee-chest position, administering oxygen, and preparing for an immediate Cesarean section.
  • Reference: Page $202$
• Hohmann Sign
  • Procedure: How to perform the Hohmann sign (possibly a typo for Homans' sign): dorsiflexion of the foot, checking for calf pain.
  • Purpose: What it tests for (e.g., deep vein thrombosis - DVT). Note: Homans' sign is generally considered unreliable and insensitive for diagnosing DVT.
  • Reference: Page $214$
• Most Important Newborn Care After Birth
  • Priorities: $1^{st}$ priority is establishing a patent airway (ensuring clear breathing), $2^{nd}$ priority is maintaining thermoregulation (e.g., drying the baby thoroughly, skin-to-skin contact with mother, placing under a radiant warmer) to prevent cold stress.
  • Reference: Page $224$
• Weaning from Breastfeeding
  • Timing/Method: Considerations for gradually stopping breastfeeding (e.g., typically around $6$ months when solids are introduced, or later based on maternal/infant readiness). Gradual replacement of one feeding at a time with a bottle (formula or expressed milk) helps prevent breast engorgement and allows the baby to adjust.
  • Reference: Page $240$
• Hypoglycemia in Term and Preterm Infants
  • Values: Know the diagnostic blood glucose levels for hypoglycemia in both term and preterm infants (e.g., blood glucose levels typically $\lt 40-45$ mg/dL are considered hypoglycemic and require intervention).
  • Reference: Page $317$
• Postpartum Hemorrhage Assessment
  • Firm Fundus, Continuous Trickle: Suspect a laceration of the cervix or vagina, as the uterus is contracting well but blood is still steadily flowing from a tear.
  • Pain Not Relieved by Analgesics, Firm Fundus: Suspect a hematoma (often unseen) in the perineum or vaginal area, causing pressure and severe pain despite a well-contracted uterus.
• Thrombophlebitis
  • Signs and Symptoms: Know the clinical indicators of thrombophlebitis (inflammation of a vein with clot formation), which include pain, tenderness, warmth, redness, and swelling in the affected extremity, often with a palpable cord-like structure.
• Post-Term Infants
  • Presentation: How a post-term infant (born after $42$ weeks gestation) would typically appear (e.g., dry, cracked, peeling skin; long nails; depleted subcutaneous fat resulting in a "wasted" appearance; often meconium-stained skin, nails, and cord). They are at increased risk for meconium aspiration syndrome.
  • Reference: Pages $324-325$
• Newborn Vital Signs
  • Normal Ranges: Differentiate between normal and abnormal vital signs for a newborn:
  • Heart Rate: $110-160$ bpm (sleeping may be lower, crying higher).
  • Respirations: $30-60$ breaths/minute (often irregular, shallow, abdominal).
  • Temperature: $36.5-37.5^\circ$C (97.7-99.5^
    \circF) axillary.
  • Reference: Pages $292-293$
• Moro Reflex
  • Elicitation: How to trigger this reflex by jarring the crib or allowing the infant's head to gently fall back a short distance.
  • Response: Describe the classic response: the infant's arms fan out (abduct) and extend, fingers extend, then the arms smoothly come back towards the midline (adduct) in an embrace-like motion, often accompanied by a cry. The legs may also flex.
  • Reference: Page $285$
• Infants Born to Diabetic Mothers
  • Risks/Presentation: What risks these infants are prone to (e.g., hypoglycemia due to continued hyperinsulinism after birth, macrosomia or large for gestational age (LGA) due to maternal hyperglycemia, respiratory distress syndrome, polycythemia, hyperbilirubinemia, congenital anomalies).
  • Reference: Page $351$
• Hip Dysplasia (Developmental Dysplasia of the Hip - DDH)
  • Testing: How to test for hip dysplasia, including the Ortolani maneuver (relocates a dislocated hip into the acetabulum with a "clunk") and Barlow maneuver (dislocates an unstable hip from the acetabulum).
  • Signs and Symptoms: Clinical signs include asymmetric gluteal and thigh folds, limited hip abduction on the affected side, and a positive Trendelenburg sign (in older children).
  • Treatment: Preferred treatment is early intervention with a Pavlik harness for $3-6$ months continuously to keep the hips abducted and flexed, promoting proper hip development.
  • Reference: Page $338$
• Phototherapy for Newborns
  • Purpose: Patient/family education on why phototherapy is used – to treat hyperbilirubinemia/jaundice by breaking down unconjugated bilirubin in the skin through photo-oxidation, making it water-soluble and easily excreted.
  • Nursing Care: Ensure infant's eyes are covered (wearing eye protection), monitor temperature, ensure frequent feeds to promote excretion, and reposition frequently for maximum skin exposure.
  • Reference: Page $346$
• Cephalocaudal Development
  • Meaning: Development proceeds from head to toe (e.g., an infant gains head control before control of the trunk for sitting, and sitting before walking).
  • Reference: Page $357$
• Regression
  • Definition: Understand what regression means in developmental terms – a return to an earlier, less mature stage of development, often in response to stress, illness, or change (e.g., a toilet-trained child starts having accidents when a new sibling arrives).
  • Reference: Page $45$
• Developmental Communication with a Toddler
  • Approach: Toddlers do not understand time well; communicate in concrete, simple terms and use play. Give simple, direct instructions. Avoid "why" questions.
  • Reference: Page $492$
• Separation Anxiety
  • Phases/Stages: Know the stages of separation anxiety:
  • Protest: Child cries, screams, clings to parents, resists caregivers.
  • Despair: Child is withdrawn, sad, quiet, less active.
  • Detachment (Denial): Child appears to adjust, becomes interested in environment, may ignore parents upon their return; this is a sign of emotional resignation, not true adjustment.
  • At-Risk Population: Which patient population is most susceptible – toddlers and preschoolers ($6$ months to $3$ years) due to their developing object permanence and dependency on primary caregivers.
  • Reference: Page $41$
• Conscious Sedation
  • Definition: Understand what conscious sedation involves – a medically induced state of depressed consciousness where the patient maintains their own airway, retains protective reflexes, and can respond to verbal commands.
  • Monitoring: Requires continuous monitoring of vital signs, oxygen saturation, and level of consciousness.
  • Reference: Page $44$
• Point of Maximum Impulse (PMI) / Apical Pulse in Young Children
  • Location: For children aged $5$ and younger, the PMI (apical pulse) is best heard at the mitral valve area (apex), which is typically felt at the $4^{th}$ intercostal space, medial to the midclavicular line. After age $7$, it shifts to the $5^{th}$ intercostal space, midclavicular line.
  • Reference: Page $502$
• Risk Factors for Ear Infections (Otitis Media)
  • Predispositions: What factors increase a child's risk for ear infections, including exposure to tobacco smoke, attendance at daycare, allergy, presence of siblings, lack of breastfeeding, and bottle-feeding in a supine position.
  • Reference: Page $539$
• Assessing Infant Hearing
  • Indicators: How to determine if a baby can hear: presence of a startle (Moro) reflex to loud sounds, turning head towards the source of sound by $4-6$ months, absence of babbling or speech development delays.
  • Reference: Page $541$
• Conjunctivitis
  • Parental Education: Key teaching points for parents regarding conjunctivitis ("pink eye"): good hand hygiene to prevent spread, avoiding touching the eyes, wiping discharge from inner to outer canthus, not sharing towels/linens, and administering prescribed eye drops/ointments as directed.
  • Reference: Page $545$
• Fracture of the Epiphyseal Plate
  • Complication: A fracture involving the epiphyseal (growth) plate (located at the ends of long bones in children) can interfere with bone growth and potentially lead to limb length discrepancies or angular deformities if not properly treated.
  • Reference: Page $573$
• RICE Acronym
  • Meaning: Understand the components of RICE (Rest, Ice, Compression, Elevation) for musculoskeletal injuries (e.g., sprains, strains):
  • Rest: Avoid using the injured body part.
  • Ice: Apply ice packs ($20$ minutes on, $20$ minutes off) to reduce swelling and pain.
  • Compression: Apply an elastic bandage to minimize swelling.
  • Elevation: Keep the injured part elevated above the heart to reduce swelling.
  • Reference: Page $572$
• Neurovascular Checks
  • Components: What to assess during neurovascular checks (often referred to as the "$5$ P's") particularly after orthopedic injuries or cast application: Pain, Pallor (color), Pulselessness (capillary refill and pulses), Paresthesia (sensation/numbness), Paralysis (motor function/movement). Also check temperature.
  • Reference: Page $577$
• Scoliosis
  • Demographics: Affects girls more frequently than boys, especially during adolescent growth spurts.
  • Milwaukee Brace: How long the Milwaukee brace should be worn (e.g., for $16-23$ hours a day) to prevent further curvature progression, typically until skeletal maturity. Compliance is key.
  • Reference: Page $584$
• Asthma
  • Presentation: How a child with asthma would typically present clinically: episodes of wheezing (high-pitched whistling sound), coughing (especially at night or with activity), shortness of breath (dyspnea), and chest tightness. Symptoms are often triggered by allergens, exercise, or respiratory infections.
  • Reference: Pages $605-606$
• Cystic Fibrosis
  • Digestive Needs: Patients with cystic fibrosis have a genetic defect that affects chloride transport, leading to thick, sticky mucus production that obstructs pancreatic ducts. Therefore, they require pancreatic enzyme supplements with all meals and snacks to facilitate proper digestion and absorption of fats, proteins, and fat-soluble vitamins.
  • Other Manifestations: Chronic respiratory infections, steatorrhea (fatty stools), growth failure, and high sweat chloride levels.
  • Reference: Pages $615-616$
• Proximal Distal Development
  • Meaning: Development proceeds from the center of the body outwards to the periphery (e.g., an infant gains control of their trunk and shoulders before control of their hands and fingers; they can grasp with their whole hand before developing fine pincer grasp).
  • Reference: Page $357$

Final Exam Structure

• Mathematics Questions: There