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203 Cards in this Set
- Front
- Back
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How long do you measure head circumference? |
through the 2nd year (until they turn 3) |
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Tips for exam on infants |
warm and with parents, 1-2 hrs after feeding, slow, sleeping is ok, invasive assessments last |
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Tips for exam on toddlers |
parent's lap, talk to parent first (let child warm up), use stuffed animal for exams, let play with equipment, games, toys, stickers |
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Tips for exam on pre-schoolers |
parents present (lap or on table), simple explanations, games, play, last = head, eyes ears, nose, throat |
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Tips for exam on school age |
parents present, privacy, demonstrate equipment, teach about body |
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Tips for exam on adolescents |
parents GONE, reassurance, body image, reasure normality |
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Obesity percentage BMI |
>85% |
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Apgar scale/scoring |
1 min and 5 min after birth, heart rate, respirations, muscle tone, reflex irritibility, color, we want 7-10 BOTH times |
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Sequence of Vital signs |
1. Respirations, 2. Pulse (apical, 1 full minute), 3. Blood pressure 4. Temperature |
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Respirations |
>60 is bad |
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Temperature |
<36 degrees C is WORRISOME. cover with blanket, etc and check every 15 min. |
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FLACC scale |
face, legs, activity, cry, and consolability. We want a lower number |
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Fontanelles (what's normal and what's not) |
bulging - when crying = ok, when not = ^ICP |
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4mo = __ head control |
Good |
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Molding |
coneheads - after birth |
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Caput Succedaneum |
bruising/swelling of presenting part of head due to birth trauma |
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Cephalhematoma |
subperiosteal hemorrhage due to birth trauma |
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plagiocephaly |
flat head |
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Torticollis |
limited range of motion of head due to injury of sternocleidomastoid muscle |
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Tinea Capitus |
Ring Worm |
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Pediculosis Capitus |
head lice |
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Cradle Cap |
sebaceous glands stimulated by mom's hormones (oil and scrubby brush cleans it up) |
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Low set ears |
Renal abnormalities and Down's syndrome |
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Tympanostomy tubes |
for lots of infections, drains, will fall out over time |
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tympanometry |
going into middle ear and measuring pressure |
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mongolian spots
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normal in AA, or Asians |
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Cafe au lait spot |
normal, if more than 6 big - maybe disease |
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Erythema toxicum |
"flea bite". normal (not actually flea bites) |
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acrocyanosis |
normal, esp if cold in extrimities |
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physiologic jaundice |
normal, if after first few weeks - not normal |
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Infant age |
0-1 |
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Toddler age |
1-2 |
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Preschool age |
3-5 |
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Schol age |
5-8 |
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Adolescent |
8+ |
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What part of physical exam do you perform last on an infant? |
Most invasive Ears, noses, eyes, throat |
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What are some signs of child abuse? |
Child avoids eye contact No separation anxiety Parent is disgusted by child's odor, sounds, drooling, stools Deprivation of physical or emotional care |
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How to weigh an infant/toddler |
Platform balance scale Guard for falling Weigh to the nearest 1/2 oz for infant and 1/4 pound for toddler |
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What age do you use an upright scale? |
2 or 3 Maintain modestly with light clothing or underwear |
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How do you measure length up to 2 years? |
Supine, horixontal measuring board. One person holds top of head against the head plate, extend legs to foot plate |
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What age do you begin measuring a child upright? |
2-3 Shoulders, buttocks, heels should touch the wall Nearest 1/8" |
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What is the best index of a child's general health? |
Physical growth |
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What types of growth measurements should you further explore? |
Falls below 5% or above 95% with no genetic explanation Wide percentile difference between height and weight Growth that had been steady suddenly stops Fails to show normal growth spurts during infancy and adolescence |
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The most important evidence for growth potential appears to be (3) |
Economic Nurtiotional Environmental |
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How often should you measure the child's head circumfrance? |
Every well visit for first two years Yearly up to age 6 |
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What the average size of a newborn's head? |
32-38 cm (2 cm larger than chest circumfrance) |
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When does enlarged head circumfrance occur? |
Increased intercranial pressure |
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What order should you take an infant's vital signs? |
Respiration Pulse Temperature |
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What type of thermometer should you try to use? |
Tympanic membrane thermometer |
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When do you use the oral route for temperature? Rectal? |
Oral: When child is old enough to keep mouth closed between age 4-6 Rectal: Infants or with any age group that is unable to cooperate, unconscious, critically ill or prone to febrile seizures |
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How far should you insert the rectal thermometer? |
No more than ONE inch |
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Do children have higher fevers than adults do when they are sick? |
Yes, up to 6-8 years of age - fevers may elevate to 103-105 |
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When is the temperature more naturally elevated? |
Late afternoon, after vigorous playing, after eating |
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What pulse should you use for infants and toddlers? How do you take it and for how long? |
Ausulcate or palpate the apical pulse for one minute |
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What pulse site should you use for children over age TWO? |
Radial - full minute |
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How should you observe RR in an infant? For how long? |
Watch abdomen for movement While sleeping One minute |
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At what age do you start measuring BP |
3 years or older - annually OR in younger children at risk |
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What type of machine do you use to measure BP in individual's under 3 |
Dinamap Doppler Ultrasound |
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At what age can children report pain and POINT to it? |
2 |
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At what age can you introduce pain rating scales? What do they look like? |
Age 4-5 6 drawings of faces - avoids smiles and tears OR Oucher scale - 6 faces |
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Describe the preschooler |
Age 2-6 Egocentric Scared of BP cuff waking up and biting them |
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Telegragphic speech |
2-3 word sentences |
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Describe school age children |
7-12 years old Can tolerate and understand other viewpoints Wants to know how things work Interview the parent and child together |
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Describe the adolescent |
Begins with puberty Changing body effect self concept Value peers are alouf Use respect, communication, and truth Use icebreakers Explain every step of physical
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Have long term pain biological markers for chronic pain been developed for infants/childres |
No, must evaluate the whole individual. Look for changes in temperment, expression, activity Illness that produces PAIN in adults WILL produce pain in an infant/child |
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By three months gestation, most of the fetus is covered in ___ |
Lanugo |
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Fine downy hain on newborn infant |
Lanugo |
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After first few months of life, lanugo is replaced with ___ |
Fine Vellus Hair |
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Thick, cheesy substance made up of sebum and shed epithelial cells |
Vernix Caseosa |
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Differences between newborn skin and adult skin |
Newborn: This, smooth, elastic, more premeable, greater risk for fluid loss
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What holds water in the skin and is present the first few weeks of life? |
Sebum |
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What does sebum produce in some babies? |
Milia and cradle cap in some babies |
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What are the sebacous glands like in newborns? |
Decreased size and production and do not resume functioning until puberty Leads to ineffective temperature regulation
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Describe Eccrine sweat glands in newborns |
Do not secrete in response to heat for first few months of life and then minimially throughout childhood |
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Can a babies skin protect well against cold? |
No, it cannot contract and "shiver" because subcutaneous layer is inefficient |
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Is the pigement system working at birth? |
No - inefficient at birth |
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As the child grows, what happens to the skin and sweat glands? |
Epidermis thickens, toughens, darkens Better lubricated Hair growth accelerates Puberty --> aprocrine sweat glands (odor) Sebacous glands more active - acne Subcutaneous fat deposits in females during puberty |
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What happens to the integument sex characteristics during puberty? |
Areola darkens/larger Breast tissue develops Coarse pubic hair, axillary hair, facial hair
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Moist, this roofed vesicles with this erythematous base - rupture to form honey colored crusts. Contagious bacterial infection of skin common in children/infants |
Impetigo |
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Impetigo |
Moist, this roofed vesicles with this erythematous base - rupture to form honey colored crusts. Contagious bacterial infection of skin common in children/infants |
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Pulse rate to respiratory rate = |
4:1 |
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Normal RR for neonate |
30-40 |
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Normal RR for 1 yr |
20-40 |
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Normal RR for 2 yr |
25-32 |
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Normal RR for 8-10 |
20-26 |
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Normal RR for 12-14 yr |
18-22 |
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Normal RR for 16 yr |
12-20 |
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Normal RR for adult |
10-20 |
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What happens to the lung development during fetal life? |
First 5 weeks - primitive lung bud emerges 16 weeks - Conducting airways = same as adult 32 weeks - surfactant in present in adequate amts Birth - Lungs have 70 million alveoli present |
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Complex lipid substance needed for sustained inflation of the air sacs |
Surfactant |
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Surfactant |
Complex lipid substance needed for sustained inflation of the air sacs |
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Does the respiratory system function while in utero? |
NO - birth demands instant respiratory effect First cry = baby is alright :) |
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When does the foramen ovale close? |
Just after birth |
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Liks pulmonary artery and aorta |
Ductus arteriosus |
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What happens when the cord is cut? |
Blood is cut off from placenta Gushes into pulmonary circulation
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When does the ductus arteriousus close? |
Hours after birth - when systemic and pulmonary circulation are functional |
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When do children reach the adult range of 300 million alveoli |
Adolescence |
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What can second hand smoke cause prenatally? |
Chronic Hypozia and low birth weight Increased risk of addiction (sensitizes fetal brain to nicotine) |
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What are the effects of post natal second hand smoke? |
SIDS Lower Respiratory illnesses acute and chronic otitis media breathlessness asthma adverse lung function |
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Number of expected upper respiratory infections per year in child |
4-6 |
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What aged children like to use the stethoscope on themselves? |
School age |
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What should the AP:TD be in an infant? |
Equal |
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When should AP:TD equal 1:2 (what age)? |
6 |
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Barrel shape persisting after 6 years could be a sign for? |
Chronic asthma or cystic fibrosis |
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Why do newborns' breasts sometimes appear enlarged for first few days? |
Maternal estrogen "Witch's Milk" Lasts about a week |
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Horizontal groove in the rib cage at level of diaphragm |
Harrison's Groove |
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Is Harrison's groove normal? |
Yes, in some children NO in others - Rickets |
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When does the APGAR score happen |
1 minute after birth and 5 minutes after birth |
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What apgar score = a newborn in good condition needing only suctioning of nose/mouth? |
7-10 |
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In the immediate newborn, are depressed respirations normal? Why? |
yes! from maternal drugs, interruption from uterine blood supply and obstruction of trachea/bronchi with fluid |
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Apgar score of 3-6 after one minute = |
moderately depressed newborn needing resuscitaion and close observation |
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Apgar score of 0-2 = |
Severly depressed newborn needing full resuscitation, vent assistance, and ICU |
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How does the infant breath up to 3 months? |
Through nose ONLY |
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Do infants use intercostal muscles to breathe? |
No, not developed - abdomen (diaphragm) breathers |
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Are periods of apnea in a newborn normal? |
yes, brief periods of 10-15 seconds |
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Periodic breathing is most common in ___ infants |
Premature |
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Can can rapid RR indicate |
Pneumonia, fever, pain, heart disease, anemia |
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Pneumonia, fever, pain, heart disease, anemia |
Rapid RR |
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In infant, RR of 50-100 while asleep may be a sign of |
Early heart failure |
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Asymetric chest expansion occurs with |
Diaphragmatic hernia or pneumothorax |
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Forceps delivery may result in |
Fractured clavicle |
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Do you do percussion on an infant? |
NO |
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Breath sounds are __ and __ in infants |
Louder and harsh |
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Diminished breath sounds in an infant is could indicate |
pneumonia, atelectasis, pleural effusion, or pneumonothorax |
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Are fine crackles normal in a newborn |
Yes! Opening of airways and clearing of fluid |
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Persistent fine crackles are associated with? |
Pneumonia, bronchiolitis, atelectasis |
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Crackles in upper lung field = |
cystic fibrosis |
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Crackles in lower lung field = |
Heart failure |
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Expiratory wheezing occurs with |
lower airway obstruction Unilateral = foreign body aspiration/obstruction |
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Stridor is common with |
upper airway obstruction Croup Foreign body aspiration acute epiglottis |
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When does fetal heart begin to function? |
End of three weeks gestation, lungs non functional |
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There is no pumping of blood to the lungs invitro, so freshly oxygenated blood is rerouted in which two ways? |
2/3 shunted through atrial septum (foramen ovale) into left side of heart then pumped through aorta 1/3 pumped by the R side of the heart through pulmonary artery, detoured through ductus arteriosus to the aorta
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Foramen ovale |
Atrial septum |
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Are the ventricles invitro equal in thickness and weight |
yes |
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Why does foramen ovale close at birth? |
New lower pressure in the right side of the heart than in the left |
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When does the L ventricle become thicker/increased mass? |
At one year of age |
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Where is the apex located on a child? |
4th ICS |
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When does the apex reach the adult position? |
7 years |
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Abnormal opening in the atrial septum resulting usually in left to right shunt causing large increase in pulmonary blood flow |
Atrial septal defect |
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Atrial septal defect |
Abnormal opening in the atrial septum resulting usually in left to right shunt causing large increase in pulmonary blood flow |
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Is atrial/septal defect well tolerated? |
yes, symptoms in infants are rare in older children/adults = mild fatigue and DOE |
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Severe narrowing of descending aorta - usually at the junction of the ductus arteriosius and the aortic arch. Increases workload on L ventricle |
Coarctation of the aorta |
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coarctation of the aorta |
Severe narrowing of descending aorta - usually at the junction of the ductur arteriosius and the aortic arch. Increases workload on L ventricle |
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Symptoms of coarctation of the aorta |
Heart failure Diagnosis usally incidental to blood pressure findings Vague lower extremity cramping with exercise Can be asymptomatic |
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Heart failure Diagnosis usally incidental to blood pressure findings Vague lower extremity cramping with exercise Can be asymptomatic |
Symtoms of coarctation of the aorta |
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DM2 is most found in which cultural groups? |
American Indian, black, hispanic, asian Obese, family history |
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Common and normal murmurs in children are called? |
Innocent or functional murmurs |
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Murmur with no valvular or pathologic cause |
innocent murmur |
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murmur because of increased blood flow to teh heart (anemia, fever, pregnancy, hyperthyroidism) |
functional |
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What makes a functional murmur? |
Increased blood velocity + smaller chest measurement |
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When does clubbing appear, if at all? |
Not until end of first year - even with extreme cyanosis |
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When should you assess the cardiac system after birth? |
Within the first 24 hours and 2-3 days later |
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Cyanosis at, or just after birth = |
oxygen desaturation of congenital heart disease |
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Most important signs of heart failure in an infant are |
Persistent tachycardia, tachypnea, liver enlargement Engorged veins, gallop rhythm, pulsus alternans |
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__ __ ___ occurs with heart disease |
failure to thrive |
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The infants heart has a more __ placement |
horizontal |
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Apex displaced to L = |
Cardiac enlargement |
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apex shifting away from one side = |
pneumothorax |
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Apex shifted to R = |
Diaphragmatic hernia |
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Heart on R side of chest = |
Dextrocardia |
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The HR is best ___ becuase pulses are hard to count accurately |
auscultated |
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HR immediately after birth = |
100-180 |
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Infant HR |
120-140 |
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Crying infant HR = |
170+ |
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Sleeping infant HR |
70-90 |
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Persistent tachycardia in newborn = |
more than 200 bpm |
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persistent tachycardia in infant = |
more than 150 bpm |
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Bradycardia for a newborn is |
less than 90 |
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Bradycardia for a infant/child = |
less than 60 |
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Is a sinus arrhythmia normal in infant/child? |
Yes |
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Fixed split S2 = |
atrial septal defect |
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Murmurs are especially normal in first __ to __ days |
2-3 |
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Cardiac enlargement can be noted with a precordial bulge to the __ of the __ |
Left of the sternum |
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Substernal heave = |
R Ventricular enlargement |
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Apical heave = |
Ventricular hypertrophy |
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Before age 4, the apical pulse is best felt where? |
4 ICS, L of interclavicular line |
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From age 4-6 the apical pulse is best felt where? |
4 ICS, midclavicular line |
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The apical pulse moves ___ with enlargement |
laterally |
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Is physiologic S3 common in children |
yes, early diastole, dull, heard at apex |
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Caused by a turbulence of blood flow in the jugular venous system - loudest in diastole |
Venous Hum |
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Where is the venous hum best heard? |
Bell, supraclavicular fossa, medial third of clavicle, on right OR Over anterior chest |
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Venous hum is easily obliterated by |
Occluding jugular veins with hands |
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How can you differentiate a venous hum from other cardiac murmurs? |
Occlude the jugular veins and the hum stops |
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By age __ lymphatic tissue reaches adult size. It ___ adult size during ___, then slowly ___ |
equals passes puberty atrophies |
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Lymph nodes are __ in children |
large, superfical are easily palpated |
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During upper respiratory infections, children sometimes get unexplained __ __ because of the excessive lymph node response |
abdominal pain |
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APGAR tests for (5) |
HR Resiratory effort Muscle town Relfex irritability (catheter in nares) Color (pink!) |
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Common variation in hyperpigmentation in black, asian, american indian, hispanic newborns |
Mongolian Spot NOT abuse |
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Large round or oval patch of light brown pigmentation |
Cafe au lait |
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six or more cafe au lait spots more than 1.5 cm are diagnostic of? |
an inherited neurocutaneous disease |
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The newborns skin has a ___ ___ flush = normal for first day |
beefy, red |
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for newborn, side lying position = lower half of body rutns red, upper half blanches = |
Harlequin color change Cause = unknown |
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Common rash that appears in the first days of lie "flea bite" |
Erythema toxicum Unknown cause - no treatment needed |
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Two temporary cyanotic occurences for newborns = |
Acrocyanosis Cutis Marmorata
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Bluish color around the lips, hands, fingernails, and feel and toe nails in new born, lasts a few hours and disappears with warming |
Acrocyanosis |
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Transient molting in the trunk and extremities in response to cooler room tepteratures - red/blue pattern on skin of newborn = |
Cutis Marmorta
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Persistent cutis marmorta occurs with |
Down syndrome or premature baby |
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Green/brown discoloration of skin, nails, and cord occurs with |
Passing of meconium in utero - indicates fetal stress |
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Common variation in about half of all newborns yellowing of skin, sclera and mucous membranes |
Physiologic Jaundice |
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What causes physiologic jaundice |
Increased numbers of RBC hemolyze after birth Hemoglobin in the RBC is metabolized by the liver and spleen Pigment is converted to bilirubin |
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Yellow-orange color in light skinned individual from ingesting large amount of carotene |
Carotenemia |
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Tiny while papules on the cheeks and forehead and acroom the nos and chin - sebum occludes opening of folicles |
Milia - DO NOT Squeeze |
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Flag, irregularly shaped red or pink patch on the forehead, eyelid, upper lip, or most commonly the back of the neck, present at birth, fades in a year |
Storkbite |
