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pedi exam 1
Terms in this set (114)
When do the fontanels close?
anterior: 18 mos
birth weight doubles at... triples at... quadruples at...
6 months; 1 year; 2-3yrs
birth length increases how much per month in the first year?
1"/mo. 1st 6mos; 1/2" until 1st yr
when do you begin walking?
head circumference when born?
how does the head circumference grow?
1.5cm/month first 6 months
half of this growth occurs in the 1st year
head to toe growth
center to outward growth
when do babies gain control of their heads?
what influences growth?
how do you encourage walking or crawling?
place the child on the floor
how do you encourage fine motor skills?
giving child rattles, blocks, finger foods
how do you encourage language?
sing, talk, read to them
milestones at age 2
climb 2 stairs, 2-3 word sentences, throw a ball
milestones at age 3
tricycle, run, jump, repeat 3 digits, ask why
milestones at age 4
copies 4 sides of a square
cognitive development - sensorimotor, preoperational, concrete operational, formal operational
exploring w/ senses, touching everything
egocentric - wants to do everything themselves
using manipulatives to learn
logical and systematic thinking
abstract thinking, new ideas
trust vs. mistrust
autonomy vs. doubt/shame
initiative vs. guilt
industry vs. inferiority
identity vs. role confusion
trust vs. mistrust - infancy
if a caregiver meets their needs, they will develop trust and see the world as good
autonomy vs. shame/doubt - toddler
sense of control over their body/body functions - elimination
gaining some independence
initiative vs. guilt - preschool
can do attitude, goal directed, competitive
industry vs. inferiority - school age
mastering skills and learning how to work with others
identity vs. role - adolescence
gain independence from parents, develops sense of "I"
moral development, understanding right from wrong
no awareness of their actions on others but eventually understands punishment if they get caught - will not do this b/c i don't want to get in trouble w/ mom
avoiding disapproval - i will do this so dad is happy with me
understanding what is good for society, not just individual
indicators of overall physical well being
height, weight, BMI
Denver development screening
used for children 0-6 years old to ID personal, social, fine/gross motor and language development
Ages and stages
another developmental test
when a child hasn't reached expected milestones by expected time period
temporarily behind - can occur from illness, hospitalization
returning to a previous developmental stage d/t stress
regresses to a time they felt the safest but will reverse when anxiety subsides
toddlers doing the same thing as peers but not doing it together - all using chalk
preschool age doing group play w/o group goals - all playing in the sand with the same toys
lack of formal organization
late preschool age
someone is the leader and there are group goals - a game of kickball
one child observing others playing - occurs with toddlers
using imagination - preschoolers
letting kids play with the medical equipment prior to a procedure
who do immunizations protect?
those who are immunized
those who cannot be immunized d/t having a compromised immune system
what happens if parents refuse immunizations?
it must be documented in the school system
how long do you breastfeed for?
exclusively for 6 months but do it for the whole year
when are solid foods introduced?
what should baby drink when you stop breastmilk?
whole milk for brain development - don't have fat free until at least 2yrs
what food group is the biggest source of energy?
carbs and then fats
what is the leading cause of death of children under 8?
at what age will children understand procedures if you explain them beforehand?
at 6 years; before this explain in a play by play
when is informed consent needed
at any time there is an invasive procedure performed
what is general consent?
nothing has to be signed but you have to tell them what you are doing - meals, IVs
whenever a painful procedure is planned, use the Rx room and encourage the parents to stay with them and also have a security item
is swaddling a good restraint?
used not for psych purposes but to perform procedures so they don't touch or pull anything
secretions except sweat
non intact skin
how would you transport an infant in the hospital?
a parent can hold them while being wheeled in a wheelchair
how can toddlers/preschoolers be transported in a hospital?
wagons but they cannot just walk down the hall
temp never over 100, test beforehand yourself
only 3 inches of water
assess skin color, temp, parental interaction
soft tooth brushes
1st tooth erupts at 6 months (bottom teeth)
floss when all primary teeth are in
go to dentist at 2.5yrs to become comfortable
don't fall asleep with a bottle b/c of dental carries
why should you never prop up bottles?
increases risk of aspiration
assessing temperature and norms
axillary for children 4-6 and under
if they have a fever, lukewarm sponge bath
newborn temp norm: 97.1-99.1
4yrs and up norm: 97.5-98.6
assessing pulse and norms
apical pulse for children <2 for a full minute
radial > 2
4 yrs: 80-125
10 yrs: 70-110
16 yrs: 55-90
assessing respirations and norms
they are irregular so listen for a full minute - ideally they are calm, good place is parents lap
4 yrs: 20-30
10 yrs: 16-22
16 yrs: 15-20
how do you collect specimens for children who aren't toilet trained?
urine collection bag
when do you verify NG tube placement?
at insertion, before bolus feeding, every 4-8 hours for continuous feeds
how do you test if a child can tolerate tube feedings?
increase calories per ounce
if the stool is bloody or runny, they are not tolerating
use 360-480mL of fluid and insert w/ lubricate 2.5-10cm
diaper or commode immediately
always need an assist
suction to maintain patentcy, may have to suction oral cavity after
pre op care
younger children have higher risk for dehydration so NPO period is shorter
clear fluids are stopped 2 hours prior
taking a history from the parents (if child isn't old enough)
prenatal and birth history (child <3)
family composition and lifestyle
what order do you assess a child?
head to toe but least invasive to most
example: ear and oral exam are last
assessing optic nerve in children
Tumbling E chart for very young kids
Snellen and HOTV for young
tonsils in children
large tonsils is common, snoring is a sign
what do you do if a child is ticklish during abdominal palpitation?
examiner places their hand on top of child to do the exam together
when should infant reflexes disappear?
toes flaring out when brushing the bottom of their foot
if pt. still has this at 2 yrs old - indicates neuro problem
when do infants begin smiling at faces?
when are children nose breathers?
first 1-2 months
why is it not possible to spoil an infant?
they are developing trust w/ a caregiver and need to have their needs met
what occurs at 6-7 months?
looking in the mirror/talking to the mirror
lifting their head and chest
turning from back to tummy
bear weight on legs
reach for things
transplacental immunity lasts until now
object permanence (sensorimotor)
walker toys to help stand
using spoons, crayons - may see hand dominance
using 2 or more words
understand no, wave goodbye
recognizing their own body parts
stomach upset, cranky
holding them and patting their back can help
watch for a fever
biggest causes of infant mortality
1. congenital anomalies
2. prematurity conditions
3. SIDs - have infant sleep on their back on a firm mattress
when do all primary teeth come in?
when does climbing and running occur?
15 mos, 18 mos
by what age is head circumference 90% of adult size?
how much do toddlers need to sleep?
10-14 hours - they will nap
when is hand dominance established?
when does toilet training occur?
girls train first
you know they are ready when they are walking and removing their own clothes
when does separation anxiety decrease?
preschool age - they realize other people besides their parents can meet their needs
why is it important to discipline a preschooler?
develops self control and a conscious
give them guidance, tell them right from wrong
consistent rules important
when and why do temper tantrums occur?
they have limited language abilities for their anger
can be tired, hungry, bored, excessively stimulated
how much do preschoolers sleep?
when are ritualistic behaviors important?
what is growth like at school age?
slow and steady
when is the brain mostly developed?
10 years old
school age oral hygiene
all 28 permanent teeth are present
responsible for own oral hygiene, may need a reminder
braces = higher risk for dental carries
what is occurring with school age children's friends and family?
joining teams and clubs
making emotional bonds, not just proximity
how do you promote a school age child's self esteem?
giving them "jobs" around the house
allow them to solve problems and make choices but be accountable for mistakes
when is vision fully developed?
how much sleep should school age children get?
growth spurts - boys vs. girls
early school age boys are bigger
girls catch up at 10-12 hrs
characteristics of puberty
primary and secondary sexual characteristics
maturation of sex organs
begins 8-9yrs; menarche 9-15yrs
breast budding --> pubic hair --> menarche
stop growing after period has been regular for 2-2.5 years
reproductive maturity 2-5 yrs after menarche
begins 12-14 yrs
testicular enlargement --> pubic hair --> penis enlargement
voice deepens/cracks stage 3-4
increased testosterone and facial hair stage 4-5
sperm production stage 5
girls: no budding/hair by 13
boys: no testicular enlargement/hair by 14
causes of delayed puberty
what kind of questions do you need to ask adolescents?
how much sleep do adolescents need?
girls especially still need calcium, iron and folic acid