Peds Study Guide Exam #1

Front 1

nightmares

Back 1

-takes place during REM sleep folloed by full waking
-after dream, child wakes and cries/calls NOT during the nightmare itself
-ocurs mainly in the second half of the night, when dreams are most intense
-all children have freight, young kids cry
-is aware of and reassured by others presence
-returning to sleep delayed b/c of fear
-can describe dream

Front 2

interventions for nightmares

Back 2

-accept dream as real fear
-sit with child, offer comfort, assurance, and sense of protection
-avoid taking child to own bed
-consider prof help if recures or unresponsive to above approaches

Front 3

sleep terrors

Back 3

-partial arousal from very deep sleep (state IV, non REM)
-during terrror child screams, when awake calm
-happens 1 to 4 hours after falling asleep, when nonREM sleep is deepest
-child may sit up, thrash, run, heart race, sweat, cry, scream, talk, moan, be afraid= disappears when awake
-is not very aware of others presence, not comforted
-can rapidly fall back to sleep
-no memory of terror

Front 4

interventions for sleep terrors

Back 4

-observe child, w/out interfering, until child becomes calm or wakes fully
-intervene only if necessary to protect child from injury
-guide child back to bed if needed
-stress to parents that sleep terrors are normal, common phenomenon in preschoolers that require relatively little intervention.

Front 5

when are the prime time for sleep disturbances?

Back 5

preschool years. As toddlers and preschoolers cope with autonomy, separation, and object permance= more sleep problems.

Front 6

how to deal with children that delay going to bed...

Back 6

-counsel parents about the importance of a consistent bedtime ritual and emphasizing the normalcy of this behavior.
-ignore attention seeking behavior
-do not take child into parents bed
-do not allow the child to stay up past a reasonable hour.
-keep a night light in the room
-provide transitional objects (blanket, toy, water) by the bed.
-helping the child slow down before bed (bath or story).
-TV not good before bed.

Front 7

the time from the appearance of breastbuds to full maturity may be how long?

Back 7

1 and half years to 6 years

Front 8

Sequence of maturational changes in girls:

Back 8

1. breast changes
2. rapid increase in height and weight
3. growth of pubic hair
4. appearance of axillary hair
5. menstruation (usually begins 2 years after first signs of changes)
6. abrupt deceleration of growth

Front 9

thelarche occurs when?

Back 9

-appearance of breast buds
-between 9 and 13 1/2 years

Front 10

adrenarche occurs when?

Back 10

-2 to 6 months after thelarche
-growth of pubic hair on mons pubis
++some girls pubic hair proceeds breast development++

Front 11

menarche occurs when?

Back 11

-2 years after 1st signs of pubertal changes
-9 mths after peak height growth
-3 mths after peak weight growth
- normal range is 10 1/2 to 15 yrs
-mean= 12 & 91/2 mths

Front 12

pubertal delay in girls is defined as:

Back 12

-breast development has not occured by 13
-menarche has not occured w/in 4 yrs of breast development

Front 13

sequence of maturational changes

Back 13

1. enlargement of testes
2. pubic hair, axillary hair, upper lip hair, facial hair (face hair usually 2 yrs later after pubic hair)
3. increase in height
4. changes in larynx and voice, with continued growth of penis
5. nocturnal emissions
6. abrupt deceleration of linear growth
-occurs btwn 9 1/2 and 14 yrs.
++gynecomastia common in 1/3 boys, goes away in 2 yrs++

Front 14

pubertal delay in boys is defined as:

Back 14

-no enlargement of the testes or scrotal changes by 13 1/2 to 14 yrs.
-genital growth not complete by 4 yrs after testicles begin to enlarge.

Front 15

Nonpharmacologic Measures (effectiveness should be evaluated around 30 to 60 minutes following interventions):

Back 15

Allow parent to stay with child during painful procedure
Positioning- pillow under knees, proper flexion
Distraction- video games, cartoons, videos
Being held or rocked
Breathing and relaxation techniques
Calm environment- low noise and reduced lighting

Front 16

Nonpharmacologic Measures (effectiveness should be evaluated around 30 to 60 minutes following interventions):

Back 16

Ice to swollen or injured area
Warm blankets, swaddling
Guided imagery
Non-nutritive sucking for infants during procedures
Cutaneous stimulation
Positive Self-talk- "I will be feeling better soon."
Thought stopping- Identify positive facts about the painful event; "It does not last long."
Informal and formal behavioral contracting- use stars, tokens, or cartoon character stickers as rewards; use a written contract

Front 17

FLACC:

Back 17

2 months to 7 years;
facial expression, leg movement, activity, cry, and consolability
each on a scale of 0-2 (total score between 0 and 10)

Front 18

CHEOPS:

Back 18

1 to 5 years;
cry, facial, child verbal, torso, touch, legs; scale of 4 to 13

Front 19

FACES:

Back 19

3 years and older;
uses drawings of 6 happy and sad faces, brief word descriptions, and numbers to depict levels of pain
0-5 or 0-10 scale

Front 20

OUCHER:

Back 20

3 to 13 years and child should be able to rate 6 geometric shapes from largest to smallest; 6 photographs of Caucasian, African-American, or Hispanic child's face representing no hurt to biggest hurt ever
scale 0-100

Front 21

Poker chip tool:

Back 21

as young as 4 years; 4 poker chips placed horizontally in front of child; "How many pieces of hurt do you have?"
-chlids needs to be able to identify the larger of any two numbers

Front 22

Numeric scale:

Back 22

as young as 5 years as long as they can count and have some concept of numbers and values in relation to other numbers; straight line marked 0-10 child points toprt of the #ed line that best describes the pain

Front 23

VAS (Visual Analog Scale):

Back 23

as young as 4.5 years, preferably 7 years;
-child marks on the line that best describes his pain.

Front 24

Color tool

Back 24

-child uses 8 markers colors and is asked to construct own scale, what color if for "worst pain". etc and then color his own body outline.
-children as young 4 yrs.

Front 25

behavioral responses to pain in young infants

Back 25

rigidity
thrashing
local reflex withdrawal
loud crying
face= brows lowered and drawn together, eyes tightly closed, mouth open & squarish

Front 26

behavioral responses to pain in older infant

Back 26

-localized body response w/ deliberate withdrawal of stimulated area
-loud crying
-face= pain and anger
-physical resistance, especially when pushing the stimulus away

Front 27

behavioral responses to pain in young child

Back 27

loud crying
"ouch", "ow", "it hurts"
thrashing arms and legs
push stimulus away
lack of cooperation
requests stopping procedure
clings to parent
requests emotional support (hugs)
restless, irritable
behaviors occur in anticipation of procedure

Front 28

behavioral responses to pain in school-aged child

Back 28

-same in young child, but less in anticipatory period
-stalls: "wait a minute", "i'm not ready"
-muscle rigidity, clenched fists, white knuckles, gritted teeth, contracted limbs, body stiffness, closed eyes, winkled forehead

Front 29

behavioral responses to pain in adolescent

Back 29

-less vocal protest
-less motor activity
more verbal expressions: "it hurts", you're hurting me
increased muscle tension and body control

Front 30

Pain in Neonates

Back 30

Difficult to assess
Can only be based on physiologic and behavioral responses
Assessment tools:
CRIES
PIPP (Premature Infant Pain Profile)
NPASS (Neonatal Pain, Agitation, and Sedation Scale)

Front 31

Pain in Children with Communication and Cognitive Impairment

Back 31

At greater risk for undertreatment of pain
Primary caregiver important source of information
Pain measurement tools:
Non-communicating Children’s Pain Checklist
PICIC (Pain Indicator for Communicatively Impaired Children)

Front 32

Children with Chronic Illness and Complex Pain:
Important components of assessment

Back 32

A trusting relationship with child and family
Onset of pain
Pain duration or pattern
Effectiveness of current treatment
Factors aggravating or relieving pain
Concurrent symptoms and complications

Front 33

Eczema causes

Back 33

unknown, but
1. genetics= family history of eczema, asthma, food allergies, allergic rhinitis
2. abnormal function of skin= perspirations, peripherial vascular function, heat tolerance.
3. s/s improve in humidity and get worse in the fall and winter seasons.

Front 34

eczema goal of mgmt:

Back 34

1. hydrate skin
2. relieve pruritus
3. reduce flare-ups and inflammation
4. prevent and control secondary infection

Front 35

eczema mgmt:

Back 35

-tepid or colloid baths with emollients, no bubble baths
-wet compresses
-oral antihistamines
-topical steroids for flare-ups (watch out for reduced bone density and linear growth) Tacrolimus & pimecrolimus
-shorten fingernails, glove stockings,
-avoid hypoallergenic foods

Front 36

identifying children at risk for atopy

Back 36

-family history of allergy
-increased immunogloblin E in cord blood and postnatal serum
-dry flaky skin

Front 37

prenatal precautions in third trimester

Back 37

-avoid any known food allergens
-avoid milk and other dairy products, peanuts, and eggs
-minimize ingestion of other hyperallergenic foods

Front 38

postnatal precautions of eczema

Back 38

-breast or casein whey formula exclusively for at least 6 mths, no solids
-no cows milk or soy formula for at 12 mths
-no eggs, fish, corn, citrus, peanuts, nuts, chocolate for 12 to 18 mths
-one new food added at 5 to 7 intervals.
-limit exposure to dust, molds, furry animals, cig smoke.

Front 39

infants social behavior is influenced by what behavior?

Back 39

the reflexive behavior like grasp, then depends on relationship with caregiver. Smiling is early step in communication. Attachment is seen in second half of first year.

Front 40

What are the two components of cognitive development required for attachment?

Back 40

1. the ability to discriminate the mother from other individuals
2. the achievement of object permanence.
=which help the infant deal with separation from parent.

Front 41

separation-individuation

Back 41

should occur as a harmonious, parallel process with emotional attachment.

Front 42

the four overlapping stages of attachment are:

Back 42

1. 1st weeks= respond to everyone the same
2. 8 to 12 wks= start to vocalize more to mom (cry, smile) but continue to respond to others too.
3. 6 months= infant distinctly prefers mom
4. 7 mths= infant starts to attach to other family members like father.

Front 43

reactive attachment disorder (RAD)

Back 43

a psychological and developmental problem that stems from maladaptive or absent attachment btwn infant and parent and may persist into childhood or adulthood.

Front 44

2 different patterns of RAD are:

Back 44

1. emotionally withdrawn-inhibited pattern
2. indiscriminate-disinhibited pattern

Signs are seen before 5 yrs.

Front 45

separation anxiety begins when?

Back 45

4 to 8 mths
at the same time as object permanence is developing

Front 46

stranger fear begins when?

Back 46

6 to 8 mths

Front 47

language development

Back 47

-1st wks= crying as reflexive and increases in duration during first 12 wks
- end of 1st year=crying for attention fear, or fustration
-5 to 6wks= throaty sounds
-2 mths= single vowel sounds, ah, eh
-3 to 4 mths= constants, n,k,b and the coo, gurgle and laugh aloud.
-8 mths=imitate sounds and add constants t, d, w and combine syllables, dada
-9 to 10 mths= can comprehend meaning of "no" and obey simple commands
-1 year can say three to five words with meaning.

Front 48

the progression of infant "play"

Back 48

-birth to 3m= responses to environment are undifferentiated and dependent
-3 to 6m= show more discriminate interest and begin to play with a toy or someone else
-4m (when the start to laugh) show preference for certain toys, get excited for food, like image in mirror
-6 to 1yr= play involves sensorimotor skills, pee a boo, pat a cake, refuse to play with strangers (want parents), extend arms to be picked up

Front 49

infant play is c/a as

Back 49

solitary play=
* play alone with toys different from others
* don't try to interact with other children
* centered on own activity

Front 50

play activities and toys great for infants

Back 50

-play around with color, textures, sounds, facial expressions, contact, movements (rocking etc.)

Front 51

toddler play is c/a as

Back 51

parallel play
-w/ imitation being one of the most distinguishing c/a
-tactile play= for exploring
-talking- music

Front 52

toys great for toddlers

Back 52

-the most educational is one that fosters interaction of an adult with a child in supportive unconditional play. toys are only there to enhance this interaction
-push-pull toys, ride on things
-finger paints, crayons, large puzzles,

Front 53

preschooler play is c/s as

Back 53

associative play
-w/ imitative, imaginative, dramatic play being most c/a
-imaginary playmates
-reality and fantasy can become blurred.
-running, jumping, climbing,

Front 54

toys great for preschoolers

Back 54

- general houshold items, like broom, bucket, rocks
-flashcards on letters, large puzzles, musical toys, dress up clothes, telephones, hand puppets,

Front 55

school age play is c/a as

Back 55

rules and rituals
-want and need rules, conformity
-team play
-collections, sorting
-enjoy quiet and solitary play like reading
-cooking, sewing, dancing, karate

Front 56

ADHD

Back 56

Kids that are more hyperactive, inattentive & impulsive than appropriate for their age
1. Diagnosed before age 7; must be present in at least two settings
2. Must not be a symptom of another disorder
3. Early identification is important b/c ADHD interferes with normal emotional & psychologic development
a. negatively affects social status, self esteem,
b. these kids develop maladaptive behavior patterns to cope w. their cognitive dysfunction

Front 57

Dx criteria for ADHD

Back 57

1. 6 of the following symptoms of inattention, hyperactivity-impulsivity for at least 6 months

Front 58

Therapeutic Management of ADHD

Back 58

Pharmacologic Therapy
Behavioral Therapy
Environmental Manipulation
Appropriate Classroom Placement

Front 59

Prognosis of ADHD

Back 59

ADHD can be managed for most kids thru early adolescence. Most children will carry symptoms into adulthood.

Front 60

Pharmacologic Therapy

Back 60

stimulants: Ritalin or Dexedrine are most common
i. side effects: nervousness, tics, insomnia, increased BP, decreased
appetite & subsequent weight loss. Long term use of Dexedrine may
suppress growth
b. TCA’s: imipramine, desipramine, nortriptyline.
c. Clonidine for ADHD children w. sleep disturbances
d.. Strattera (non stimulant) effective for adolescents

Front 61

Behavioral Therapy of ADHD

Back 61

a. focuses on the prevention of undesired behavior
b. parents also learn methods to help child become more successful at home & school
i. positive reinforcement, using charts for completing activities etc.

Front 62

Environmental Manipulation of ADHD

Back 62

a. consistency is important – i.e families & teachers reinforcing the same goals
b. children do well in highly structured environment (charts that list activities to be completed, minimizing distractions)

Front 63

Appropriate Classroom Placement of ADHD

Back 63

a. needs an orderly, predictable, consistent classroom environment with clear rules
b. may need more time on tests or less homework
c. schedule lessons after morning dose of meds for better concentration
d. provide frequent and regular breaks
e. computers helpful for kids with dysgraphia (difficulty with writing); their handwriting will not improve otherwise.

Front 64

Physical Readiness for toilet training

Back 64

* Voluntary control of anal and urethral sphincters, usually by 18 to 24 months of age
* Ability to stay dry for 2 hours; decreased number of wet diapers; waking dry from nap
* Regular bowel movements
* Gross motor skills of sitting, walking, and squatting
* Fine motor skills to remove clothing

Front 65

Mental Readiness for toilet training

Back 65

* Recognizes urge to defecate and urinate
* Verbal or nonverbal communicative skills to indicate when wet or has urge to defecate or urinate
* Cognitive skills to imitate appropriate behavior and follow directions