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Pediatrics Exam 1 Study Guide
1. What are some frequent causes of death in adolescents? Accidents (unintentional injuries), homicide, suicide, cancer, and heart disease make up the five leading causes of death for teenagers. Motor vehicle fatality (MVA) is the leading cause of accident death among teenagers, representing over one-third of all deaths to teenagers. 2. Know what type of teaching you should use with a toddler. Have them demonstrate memories, use domestic mimicry (play house), maintain routines and reliability, use short and simple sentences. 3. Know the ways to prevent Lyme disease. Wear tightly woven clothing, long pants, long sleeve shirts, long socks, shoes, gloves, and a hat when in wooded or grassy areas. Tuck pants into socks, wear light colored clothing so ticks are easily visible. Follow paths and avoid dense areas. Avoid known tick infested areas. Apply DEET to skin or Permethrin to clothing (tick repellent) before exposure and reapply every 1 to 2 hours. (Do NOT get in eyes or mouth, do NOT apply to hands, wash hands and skin/change clothing upon returning indoors.) Use repellents w/ caution in infants due to risk of encephalopathy, do not get into open wounds. Tick proof your yard by clearing brush and leaves, mow grass and keep wood stacked neatly to discourage rodents that carry ticks. Check children, pets, and yourself regularly for ticks after spending time outdoors. Remove ticks ASAP w/ tweezers. (Gently grasp near the head w/o squeezing and carefully pull to remove entire tick including the head. Flush the tick and apply antiseptic to the bite area.) 4. Know the normal developmental milestones of an infant and a toddler. o Infant Gross Motor: o 1 Month - Head Lag. o 2 Months - Lifts head when prone. o 3 Months - Lifts head and shoulders when prone. o 4 Months - Rolls from back to side. o 5 Months - Rolls from front to back. o 6 Months - Rolls from back to front. o 7 Months - Bears full weight on feet, Sits learning forward. o 8 Months - Sits unsupported. o 9 Months - Creeps on hands and knees. o 10 Months - Changes from prone to a sitting position. o 11 Months - Walks while holding on to something. o 12 Months - Sits down from standing position without assistance. Walks with one hand held. -Infant Fine Motor: o 1 Month – Strong grasp reflex. o 2 months - Holds hands in an open position; grasp reflex disappearing. o 3 months - No longer has grasp reflex; holds rattle. o 4 months - Holds object with both hands.
o 5 months - Able to grasp objects voluntarily; takes objects directly to mouth. 6 months - Holds bottle; pick up object if dropped. o 7 months - Moves objects from hand to hand. o 8 months - Uses thumb and index finger in crude pincer grasp. o 9 months - Pincer grasp is more precise. o 10 months - Grasps rattle by handle. o 11 months - Neat pincer grasp; Deliberately drops objects for them to be picked up; Places objects into a container. o 12 months - Tries to build a two-block tower without success; Can turn pages in a book (many at a time). -Infant Language: Crying, coos and babbles, laughs aloud by 4 months; Comprehends “no” by 9 months; 3-5 words other than “dada” or “mama” by 12 months. -Infant Social Development: Bonding, separation anxiety (4 – 8 months); Fear of strangers (6-8 months). -Infant Play: Solitary play, shake rattles, looking in mirrors, chewing on teething toys, play pat – a – cake, play with blocks, listens to someone read. -Toddler Gross Motor: o 15 months - Walks without help; Creeps up stairs. o 18 months - Runs clumsily; throws a ball overhand; jumps in place. o 2 Years - Walks up and down stairs by placing both feet on each step. o 2.5 Years - Jumps across floor and off a step using both feet; takes a few steps on tiptoe. Parallel play might engage in activities nearby. Filling and emptying containers; plays with blocks; looks at books; uses thick crayons. -Toddler Fine Motor: 15 months – Uses cup well; Builds tower of two blocks. 18 months
- Manages a spoon; Builds tower of three or four blocks. 2 YEARS – Builds a tower of 6 – 7 blocks. 2.5 YEARS – Draws Circles; Has good hand-finger coordination. -Toddler Language: Language increases to about 300 words by the age of 2 years. Use of one word sentences at 1 year. Multiword sentences by 2 years. Independent - attempt to do everything for themselves. Often use negativism – NO. 5. Know about Varicella. How do you catch it? What does it look like? CHICKENPOX: Caused by varicella-zoster virus. Transmitted by direct contact, droplet spread, contaminated objects Incubation period 2-3 weeks Period of communicability – Day before eruption of lesions to 6 days after first crop of vesicles when crusts have formed Manifestations: Prodromal Stage – Slight fever, malaise, anorexia for first 24 hours o Itchy rash progression: Macule (flat discolored area) → papule (small raised bump) → vesicle(blister) → crust o All 3 stages (papule, vesicle, crust) present in varying degrees at same time Elevated temperature, irritability from itching
Update immunizations. Immunizations can protect kids from serious childhood illnesses, so it's important that your child get them on time. Immunization schedules can vary from office to office, so talk to your doctor about what to expect. Order tests. Your doctor may assess your child's risk for anemia, lead exposure, and tuberculosis and order tests, if needed.
8. Know what autonomy is. Autonomy is letting children know that they have control over themselves and the choices that they make. 9. How should you assess a school aged child who is in pain? You should use the Oucher scale of six photographs to rate pain on scale of 0 to 5, for ages 3 to 13. Use the numeric scale for ages 5 and older, rate on scale of 0 to 10. For non-communicating kids age 3 and older observe behavior for 10 minutes. 10. How should you administer ear drops to a 4-year-old? Pull the pinna up and back. 11. Know these different types of play behavior: a. Peer Play: Also known as associative play is characterized by group play without group goals. Children in this type of play do not set group rules, and although they may all be playing with the same types of toys and may even trade toys, there is a lack of formal organization. This type of play can begin during toddlerhood and continue into the preschool age. b. Parallel Play: Toddlers engage in parallel play, in which children play alongside but not with other children. Little regard is given to the feelings of others. Children engage in this type of play frequently grab toys away from other children or may hit or fight to obtain a wanted toy. c. Premature Play: Pretend play allows children to learn to understand others' points of view, develop skills in solving social problems, and become more creative. Some children have imaginary playmates. These playmates serve many purposes, are a sign of health, and allow the child to distinguish between reality and fantasy. d. Adjacent Play: AKA onlooker play when the child observes others playing. Although the child may ask questions of the players, the child does not attempt to join the play, usually during toddler years. 12. Know what you would see in a toddler who has: a. PTSD: Initial response- Lasts a few minutes to 2hr. Increased stress hormones (fight or flight). Psychosis. Second phase- Last approximately 2 weeks. Period of calm (feeling of numbness, denial). Defense mechanisms decrease. Third Phase (coping)- extends 2-3 months. Clients get worse instead of better. Depression, phobias, anxiety, conversion reactions, repetitive movements, flashbacks, or obsessions.
b. Munchausen Syndrome: The caretaker falsifies illness in child through simulation or production of illness and then takes the child for medical care claiming no knowledge of how the child become ill. Under the supervision of other adults, the child exhibits no symptoms and may appear normal and healthy. c. Bipolar Disorder: Characterized by chronic, fluctuating, and extreme mood disturbances. Disturbances are much more extreme than the child's usual fluctuations of mood. Depression and lowered mood alternate with episodes of elation, irritability, anger, and aggression. The child or adolescent experiencing a manic mood state may be overly elated, grandiose, easily distracted, irritable, and aggressive, and may demonstrate increased risk-taking behavior, talks rapidly, and unable to sleep. In children, bipolar disorder most often manifests in rapidly changing, extreme mood swings. other signs include irritability, anger, aggressive behavior, rapid speech, sleep disturbances, psychosomatic complaints, sadness, decreased energy, and suicidal ideation. d. OCD: Manifests as repetitive unwanted thoughts (obsessions) or ritualistic actions (compulsions), or both. Obsessions are recurrent intrusive thoughts feelings and ideas. Compulsions are behaviors or actions that are repetitive and recurrent. Compulsions are designed to relieve the anxiety that the child usually realizes is irrational. Because young children cannot adequately describe their uncomfortable thoughts or concerns, they manifest extreme distress, particularly when ritual has been interrupted. Children often go through transient stages of obsessive thinking or compulsive behavior, usually at times of anxiety or stress, and these transient symptoms do not warrant the diagnosis such thinking is usually manifests in the need to count or check and recheck locks on doors.
13. Know parent teaching for caring with a child who has chicken pox. Very contagious, skin care to prevent secondary infection and emphasize the importance of absolute avoidance of any form of aspirin (including over the counter meds containing aspirins). 14. Know S/S of: a. Fifths Disease: Also known as Erythema infectiosum. Red rash on face (appears like a slapped cheek) with maculopapular rash on extremities. b. Rubella: Also known as German Measles. Red rash that starts on face, then spreads to rest of the body, can lead to birth defects. c. Scarlet Fever: Bright red rash that covers most of the body, a sore throat, and a high fever. d. Roseola: Also called sixth disease—Several days of high fever, followed by a rash. The rash may appear as many pink small spots.
Hematopoietic Effects: -Anemia Gastrointestinal Effects: -Anorexia, nausea, vomiting, constipation, lead line along gums. Skeletal Effects: -Increased density of long bones, lead line in long bones. Renal Effects: -Glycosuria, proteinuria, possible acute or chronic renal failure. Kidney damage is reversible early in the disease, but with continued lead exposure, permanent kidney damage can occur.
21. Know what an avulsion of a permanent tooth is and how to care for it. Avulsion: The tooth is no longer in the socket, and the socket itself may be damaged. Therapeutic Management: Complete avulsion of a permanent tooth requires care of the socket and the tooth itself. Survival of an avulsed tooth depends on prompt evaluation and replacement. Irreversible damage to the periodontal ligament because of dehydration of the open socket can occur after 60 minutes. Nursing Considerations: Parents should be instructed to keep the tooth moist. The tooth can be immersed in saline, water, milk, or a commercial tooth-preserving liquid. The tooth should not be cleaned or scrubbed. These actions increase the chances of tooth survival. The child should see a dentist, if possible, or should go to an emergency facility for care without delay. Parents should be given careful discharge instructions and appropriate referrals for continuing dental care. When appropriate, reassure the family that with proper care, a good cosmetic outcome is possible with injury to or loss of a child’s primary as well as secondary teeth. 22. What is the normal treatment for a child with a high blood level? Level >25 mcg/dL: Remove child from lead source, hospitalize if level is significantly higher. Administer chelating agents, Succimer (Chemet) orally for lead level of 35-45 mcg/dL; EDTA for level >70 mcg/dL given IV over several hours for 5 days (causes lead to be deposited in bone and excreted by kidneys); bronchoalveolar lavage every 4 hours for six doses for level >70 mcg/dL. Monitor kidney function because EDTA is nephrotoxic; monitor calcium levels because EDTA enhances excretion of calcium. o Provide adequate hydration. o Calcium, phosphorus, and vitamins C & D. o Anticonvulsants. o Oral or intramuscular iron for anemia. o Follow-up lead levels to monitor progress (lead is excreted more slowly than it accumulates in the body).
23. What is a late sign of shock in a child? Hypotension is a late sign of shock in children. The lower limit for systolic blood pressure for a child more than 1 year old is 70 mm Hg plus two times the child’s age in years. A systolic blood pressure of 58 mm Hg calls for immediate action. The nurse should be direct in relaying the child’s condition to the physician. **24. Know Erikson’s developmental stages.
- Parent teaching about preventing accidental poisoning.** Put cleaning products up or locked up. Hide the tide pods. Duh. Don’t leave your heroin out on the table.
