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NURS 629 EXAM 2 QUESTIONS AND ANSWERS
1. Infant assessment and development: Proportional changes: weight, height,
head, nervous system, chest Ï Weight increases 6-8lbs, up to 20lbs in the 1st year of life Posterior fontanelle closes by 2 months of life Eye alignment Ï Some children get cross eyed at times, but usually resolve close to 4 months Red reflex should be symmetrical The abdominal muscles do not close until 3 years of life For boys: Ï Both testicles are descended by 6 months Ï Note any hydrocele For girls: Ï Assess for labial adhesions Musculoskeletal Ï Leg fold symmetry Ï Hip abduction Ë To make sure there are no hip clicks. Ë Barlow maneuver and Ortolani maneuver will assess for hip click Ï Foot shape and flexibility Skin: rashes Ï Common - infantile eczema Ï Lesions Ï Bruising or burns Ë Mongolian spots are normal
Feeding difficulties Ï Regurgitation and spitting-up Ë Acid reflux is prevalent d/t sphincters are not mature Ë Encourage parents to break up feeding after ~15mL. burp the child and then return to feeding Ë Spitting up can be large amount and it is normal for it to come out of the nose Ï Colic Ë Common during newborn period, usually resolves by 6 months of life
2. Toddler development: Toddler
Ï Weight gain 4-6lbs per year Ï Height: 3 inches per year Ï Visual acuity 20/ Ï Brain growth is 75% completed Ï Respiratory tract is rapidly developing closer to that of an adult, but still anatomi- cally is much smaller.
GI system, cardiovascular system becomes that of an adult Ï Bladder capacity increases Ï Immune system improves Ï Bones become hard and they are not as pliable as it was in the early ages Ï Prepubescent Ï Vital signs: approaching adult values by the end of the school age Ë Blood pressure Ë Vision screening Ë Hearing screening
5. Adolescence development and assessment: Extremities grow faster than
trunk and head Facial proportions change Ï Nose and chin enlarge first
Figure changes Ï Pelvis enlarges in females Ï Shoulders enlarge in male Subcutaneous fat increases Increased function of sweat glands Increased function of sebaceous glands Puberty begins Ï Girls: 9-13 years Ï Boys: 11-14 years Girls Ï Breast enlargement begins 8-13 years Ï Axillary hair develops 11-13 years Ï Pubic hair develops 10-12 years Ï Menarche begins 10-16 years Boys Ï Genital enlargement begins 9-13 years Ï Axillary hair begins 12-14 years Ï Facial hair develops 11-14 years Ï Pubic hair develops 12-15 years Physical Exam Ï Vitals, height & weight with BMI Ï Head to toe examinations Ë Acne Ë Athletic teens may have lower heart rate Ë Changes related to puberty - including Tanner staging
8. 6 month old milestones and red flags: Milestones
Sits up without support. Rolls in both directions (front to back, back to front). Says single-syllable sounds "ba, da, ma." Tries to get things out of reach by "raking" (uses palms to reach). Red flags Lack of babbling. Does not laugh. Inability to turn head past midline (180 degrees).
9. 9 month old milestones and red flags: Milestones
Pincer grasp (fine motor). Plays "pat a cake" and "peek-a-boo." Says "good-bye." May be afraid of strangers (can be clingy). Can stand holding on. Red flags Infantile reflexes strong. Persistence of primitive reflexes (startle, fencing, etc.). does not babble. Does not bear weight on legs with support. Unable to site with help.
10. 1 year milestones and red flags: Milestones
Supports own weight. Walks with hands held. Parallel play. Separation anxiety. Can "climb" stairs by crawling up or down. Starts to cruise (moves from one piece of furniture to the other for support). Red flags Unable to support own weight. Lack of babbling. No response to smiles, poor eye contact, loss of previously learned skills (autism).
11. 2 years milestones and red flags: Milestones
Walks. Runs. Climbs stair up and down on own by holding onto handrails. Speech mostly understood by family. Follows two or three step instructions. Copies a line. Red flags Unable to speak meaningful two-word "sentences." Does not understand simple commands. Loss of speech, social skills, previously learned behaviors and/or does not say words by 16 months (autism).
12. 3 years old milestones and red flags: Milestones
Speaks 3-4 words sentences; understood by strangers. Copies a circle with a crayon or pencil. Rides tricycle. Builds towers of more than 6 blocks. Runs and climbs easily. Red flags Speech hard to understand or unclear speech. Unable to understand simple
age 10-
17. Tanner stage 3 girls: Breast enlargement without separate nipple contour
Pubic hair fills out but is straight Ï Age 13-
18. Tanner stage 4 girls: Areola and nipple projects as secondary mound
Pubic hair is more coarse - no triangle yet Ï Age 14-
19. Tanner stage 5 girls: -breasts reach final adult size, areola returns to contour
of surrounding breast, with projecting central papilla -pubic hair distribution similar to adults, covering pubis medial thighs -15+
20. Tanner stage 1 boys: preadolescent
no pubic hair
21. Tanner stage 2 boys: -Sparse growth of long, slightly pigmented pubic hair at
penis base -Penis slightly enlarging or no enlargement -Testes and scrotum larger, reddened, and altered in texture -Age 11-
22. Tanner stage 3 boys: -darker, coarser, curlier pubic hair spreading across
pubis -penis enlarging in length -testes scrotum further enlarging -Age 13-
23. Tanner stage 4 boys: -pubic hair is curse and more curly, but not quite
adult-like -enlarged penile length -enlargement of scrotum and increased pigmentation -Age 14-
24. Tanner stage 5 boys: Adult genitalia
Age 15-
25. History Infants: Include birth history in documentation of history of children
until age 2, then when relevant after age 2 Ï Prenatal and birth history Ï Complications Feeding history Ï Breast, bottle, solids Developmental history
27. Adolescence History: PMH & Family history
HEADSS assessment as a guideline (psychosocial history) https://depts.washington.edu/dbpeds/Screening%20Tools/HEADSS.pdf Ï H - home Ï E- education and employment Ï A- activities Ï D- drugs Ï S- sexuality Ï S- suicide and depression
28. ËHead circumference obtained until what age?: 2 years old
29. What year do eye exams start?: 3 years old
30. At what year do we start checking blood pressure: 3 years old.
31. Sports physicals looks for: cardiovascular and musculoskeletal health
Look at PMH: Ï tetanus status, meds and supplements, steroid use, previous injuries, immuniza- tion status, weight concerns, eating disorders, pregnancy, allergies, excessive weight gain or loss, history of anaphylactic reactions, recent or previous concus- sions, dizziness or fainting with physical exertion, contacts or dental appliances that may require accommodations, mental health, sexual status, menstruation, alcohol/smoking/drug use Fam History: (*cardiac hx)
Ï related to sudden death, cardiac death, death with activity, and history of asthma Ht, wt, visual acuity, BP, skin (contagious conditions), eyes, heart, abdomen, musculoskeletal, genital area Chest pain, shortness of breath, feeling dizzy lightheaded or faint after physical activity Cardiac anomalies, murmurs, high blood pressure, irregular heart rate Displaced PMI felt with different positioning Changes in heart sounds with supine, standing, and Valsalva Asymmetric femoral pulses Stability, symmetry, deformity Hernias Ë Cardiac History The cardiac history is more sensitive than the physical exam in detecting condi- tions that could prohibit sports participation
33. Sports physical -What would need referral and follow up before clear-
ance?: Ï History of or current cardiac anomalies Ï Family cardiac history (cardiomyopathies, prolonged QT, Marfan syndrome, sig- nificant dysrhythmias, cardiac death in 1st or 2nd degree relative before age 40, connective tissue disorders) Ï History of or current concussions Ï History of or current injuries Ï Hernia Ï Hypertension Ï Murmur Ï Irregular heart rate or rhythm Ï Deformity, asymmetry, instability Ï Poor visual acuity
Ï Liver or spleen enlargement Ï Hernia Ï Contagious skin conditions
34. Other red flags for sports physical: Ï Hypertension indicated by BP >135/
mm Hg Ï Coarctation of aorta indicated by decreased intensity of pulse in femoral pulse Ï Hypertrophic cardiomyopathy indicated by systolic ejection murmur that intensifies with standing or Valsalva maneuver Ï Marfan syndrome indicated by aortic (decrescendo diastolic murmur) or mitral insufficiency (holosystolic murmur) Conditions that disqualify participation: Ï Carditis (inflammation of the heart) Ï Diarrhea Ï Fever
35. Questions to ask during sports physicals: Ï Dizziness, passing out, chest
pain with exercise? History of sudden death in a close relative? Ï Have you ever passed out or nearly passed out during exercise? Ï Have you ever had discomfort, pain, or pressure in your chest during exercise? Ï Does your heart race or skip beats during exercise? Ï Does anyone in your family have Marfan syndrome? Ï Concussion, knocked out, unconsciousness, memory loss, seizure, or severe or frequent headache? Ï Stinger, burner, pinched nerve, numbness or tingling in extremities? Ï Problems while exercising in the heat? Ï Asthma, allergies, wheezing, difficulty breathing, or chest pain? Ï
Ï Reassure them that usually symptoms resolve within 7-14 days Ï Refer to specialist if continue to have symptoms 10-14 days Ï Family to observe the patient for 24-48 hours
37. Anticipatory guidance newborn visit: · Social determinants of health: living
situation, environment, family support, WIC
· Parent and family health and well-being: maternal health and nutrition,
transition home, sibling relationship, accept help, spend time with other children
· Newborn behavior and care: infant capabilities, baby care, illness prevention,
calming your baby
· Nutrition and feeding: general guidance, 8-12 feedings for BF in 24hrs, at least 8
time if formula fed.
38. Anticipatory guidance first week 3-5 days old: · Parent and family health
and well-being: ask for help, rest and sleep when baby sleeps, spend time with other children
· Newborn behavior and care: early brain development, adjustment to home,
calming, when to call MD, illness prevention, sing/read/talk to baby, avoid TV/Digital media, help baby wake for feedings/diaper changes/undressing, calm baby by stoking head or gentle rocking, never hit/shake baby, take temp rectally, not by ear or skin, wash hands, avoid sun
· Nutrition and feeding: same, should have 5-6 disposable wet diapers a day, 3-
stools
· Breast feeding every 1-3hrs daytime, 3 hours nighttime for 8-12 feedings
· Formula feed 2 oz. every 2-3 hours
· Safety: car seat safety, heat stroke prevention, safe sleep, rear facing car seat
39. Anticipatory guidance 1 month: · Social determinants: risks, environment,
mold, no tobacco use
· Parent and family health and well-being: postpartum checkup, maternal depres-
sion, family relationship
· Infant behavior and development: sleeping, waking, fussiness, playtime, consider
pacifier, no TV, do tummy time, calm baby by rocking or stoking head
· Nutrition and feeding: same as 1st week
· Safety: same
