Term
| adrenarche (begins with puberty) |
|
Definition
| adrenocortical maturation that signals onset of sebum production from sebaceous glands. Apocrine glands respond to emotional stimuli and result in body odor |
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Term
|
Definition
| grows proportionately with body during infancy and is 90% developed by age 6 |
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Term
|
Definition
| varies. toddlers have low nasal bridge and mandible and maxilla are small making the face seem too small compared to cranium. then around school age face grows much faster then cranium making teeth look too large. |
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Term
|
Definition
| well developed at birth but continues to grow rapidly till age 10 or 11 where it exceeds adult size and then atrophies after puberty. |
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Term
|
Definition
| less spherical than adults and children remain farsighted until age 6 or 7 |
|
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Term
|
Definition
| inner ear matures, eustachian tube lengthens, but still may be occluded by growth of lymph tissue (adnoids), and eventually canal shortens and straightens and pinna can be pulled up and back like adult |
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Term
|
Definition
| there are 20 and they are lost between ages 6-12 |
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Term
|
Definition
start formation at 6 months and replace deciduous teeth at age 6 usually starting with incisors.
They appear earlier in African americans than in causcasians |
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Term
|
Definition
| starts at same time as secondary sex characteristics. growth starts at 12 and ends at 16 for girls and 18 for boys. |
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Term
|
Definition
| maxillary and ethmoid are present at birth, but too small to be examined until child is much older. Frontal sinuses develop at 7 yo and sphenoid sinuses develop later in pubery |
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Term
|
Definition
| continue development till 8 yo and by adolesence we have 300 million alveoli. children have smaller airway and are at higher risk for aspiration. |
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Term
|
Definition
| Children have smaller chest wall, soft and pliable ribs, and a moveable xiphoid |
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Term
|
Definition
| children age 7 and younger are abdominal breathers and respiratory rate is much faster. Age 8-10 respiratory rates lower and breathing becomes thoracic |
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Term
|
Definition
| growth of brests between ages 8 and 13 that is primarily result of fat deposits however duct system development grows as well. Tenderness and asymmetric development are common. |
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Term
|
Definition
| breast tissue growth in boys that takes place during adolescents but is normally temporary. |
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|
Term
| palpable abdominal organs |
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Definition
| Right kidney may be palpable in young children especially with inspiration and liver is palpable in small children 1-2 cm below costal margin. |
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Term
|
Definition
| heart is more horizontal. Apical pulse felt at 4th ICS left of MCL until 7 yo when it becomes similar to adult. Heart sounds are louder, higher pitched and shorter. Split S2 is normal at 2nd left ICS. S3 may be heard at apex. Sinus arrhythmia is normal |
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Term
|
Definition
| circular and prominent (pot-belly) in toddlers when standing and changes to adult shape with adolescence. Visible perstaltic waves could indicate diseases or disorders. |
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Term
|
Definition
| develop in 2-5 year period. pubic hair is the onset of puberty. Pubic hair and penile enlargement concur with testicular growth. Yet axillary and facial hair devolop later in puberty. |
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Term
|
Definition
| grows rapidly during puberty to 2x as big as prepubertal state |
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|
Term
|
Definition
| external genitals increase in size and sensitivity, internal genitals increase in weight and mass. Pubic hair grows early in puberty. Axillary hair procedes menarche which is in late puberty |
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Term
|
Definition
| Menarche beings 2.5 years after puberty begins and is irregular for the first 2 years because of physiologic anovulation |
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Term
|
Definition
| mainly cartilage in toddlers, but bones begin to form through ossification beginning in gestational period and continuing rapidly through infancy and childhood. |
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Term
|
Definition
| correlated with tanner's stage 2 for girls and 3 for boys and growth continues till stage 5 for both sexes. The growth spurt peaks at age 12 for girls and 14 for boys |
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Term
|
Definition
| grows in diameter and length. diameter growth happens mainly in children. Growth in length is at epiphyseal plates. |
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|
Term
| Bone growth is effected by |
|
Definition
| pituitary growth hormone and thyroid hormone |
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Term
|
Definition
| linked to underlying bone growth. and both bone and muscle growth are influenced by use of extremities for weight bearing activities |
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Term
|
Definition
| develops at 12 to 18 months when child starts walking |
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Term
|
Definition
| develops in head-to-neck to trunk-to-extremities sequence and varies in progression with every child |
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Term
| Nurse-to-parent communication |
|
Definition
| use open ended questions. Ask "what do you see as the problem?" and also ask what they have found to be effective or ineffective in managing their child's problems. |
|
|
Term
| nurse-to-child communication |
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Definition
| direct communication (open ended questions) mixed with indirect communication (drawings, play, and sentence completion) and make sure you are at eye level |
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|
Term
| barriers with nurse-to-child communication |
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Definition
| nurses tend to overestimate the understanding ability of younger children and underestimate the ability of older children/adolescents. Children are also sometimes completely excluded. |
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Term
|
Definition
| be aware of privacy issues especially with talk of sex, sexuality, drugs and other sensitive issues. Patient may perfer their parents step out of the room |
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|
Term
|
Definition
| child's name, nickname, parent's names, primary health care provider, last well-child care appt., address, do parents live in the same residence, who else lives there, are parents married, single, divorced, homosexual, and what are parent's ages, child's age and bday, is childe adopted, foster, or natural, what is child's ethnicity and religion, what are parent's jobs |
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|
Term
|
Definition
| compare it to 1 and 5 years ago. Include chronic illness (asthma, cerebral palsy) and allergies. For allergies nurse needs to determine how child reacts especially with medications, because parents often confuse side effects with allergies. Finally look at medications (over the counter, prescription, and home remedies) and what they are being used for. |
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Term
|
Definition
| ask them to point to where it hurts and to point to a face on the faces scale. |
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|
Term
| Past health history (pregnancy) |
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Definition
| planned pregnancy? prenatal care? parents general health during pregnancy? problems, accidents, meds during pregnancy? tobacco, alcohol, or drugs? where was the child born? type of delivery? problems with delivery. child's apgar score, weight, height, head circumfrence and problems after birth. |
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Term
| Past Health History (for child) |
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Definition
| past illnesses, hopitalizations, major illnesses and injuries and immunizations |
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Term
|
Definition
| same as for adult patient except nurse must be understanding of children that are fostered or adopted |
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Term
|
Definition
| Change in hair texture, scalp itching (infestations, allergies, ringworm, seborrhea), changes in nails, exposure to infectious diseases (chicken pox, measles, lice, ringworm, scabies...), rashes or acne, excessive bruising or burns, cosmetics, tattoos, piercings, birthmarks |
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|
Term
|
Definition
| head injury, headaches and frequency, swollen neck glands for any long period of time, or neck stiffness (sign of meningitis) |
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|
Term
|
Definition
is child: excessively cross eyed, frequently rubbing eyes or blinking repeatedly, strainin/squinting to see distant objects, tested for vision, or wearing glasses/contacts.
Do glasses help and is child using them as needed |
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|
Term
|
Definition
| Does child: appear to be paying attention when you speak (could indicate hearloss or neuro problem), can they speak, when did they start? listen to loud music? use hearing aids (does it help them communicate and understand) frequent ear infections? tubes in ears? how frequently is hearing tested (should be regularly) |
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|
Term
| Mouth, throat, nose, sinuses subjective |
|
Definition
| difficulty swallowing/chewing? past history of strep, tonsilitis, or oral infections? frequent oral lesions? when did teeth erupt? when did you lose baby teeth? when did adult teeth erupt? dental problems or appliances? see dentist regularly? experience nosebleeds or sinus problems |
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|
Term
| Thorax and lungs subjective |
|
Definition
| any cough, wheezing, shortness of breath, nocturnal dyspnea, if so when does it occur? recieved a flu shot? (children +6months and high risk of health conditions should recieve one) does child smoke, when did they start and how much? is child exposed to second hand smoke? |
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|
Term
|
Definition
| begin thelarche? when? is there any abnormal breast development in males or females? |
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|
Term
|
Definition
| any chest pain, heart murmurs, congenital heart disease or hypertension? complaints of fatigue ( decreased cardiac output), fainting, or turning blue during activity? do parent's believe child is meeting normal growth requirements? |
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|
Term
|
Definition
| any excessive vomiting or abdominal pain? describe it. and digestive problems (bowel problems should be explored), trauma to abdomen or any henias? |
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Term
|
Definition
| how often does child urinate? Age they were toilet trained? at night? any wetting of the pants? any frequency, burning, pain during urination? any masturbation? any inappropriate touching by someone other than child or doctor? started puberty? who gives sex talk? Child know how to give self breast/testicular exam? any mental or physical discomfort with period? use tampon and change frequently? |
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|
Term
|
Definition
| age of first intercourse, HPV vaccine? ever had pap smear? any pain or discomfort with sex? how many sex partners have you had? type of contraceptive being used? any STDs or pregnancies (what was the result of pregnancy)? ever had gynecologic exam? |
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Term
| Anus and Rectum subjective |
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Definition
| how often are bowel movements? what do they look like? when was child toilet trained (bowels)? ever soil pants? any bleeding, constipation, diarrhea, hemorroids (very abnormal in children) or rectal itching? |
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|
Term
| Musculoskeletal subjective? |
|
Definition
| any history of limited ROM, joint pain, stiffness, paralysis, or bone deformity? any fractures? corrective devices (scoliosis brace)? describe child's posture. child invoved in sports? what protective gear is used? |
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|
Term
|
Definition
| any learning diabilities or attention problems at home or school? any memory problems? history of seizures or head injury? any motor coordinatioon problems? |
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|
Term
| Toddler developmental growth |
|
Definition
| height and weight increase is steplike because of growth spurts and lags. Bow leggedness is normal in toddlers because of leg muscles bearting weight of relatively large top |
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Term
|
Definition
| is equal to 1/2 of their adult height |
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|
Term
|
Definition
| reaches chest circumfrence by age 1 to 2 yrs. total increase at age 2 is 2.5 cm then the rate increases slowly at .5 cm per year until age 5 |
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|
Term
| Preschoolers developmental growth |
|
Definition
| slender, graceful, and agile. avg 4 yo is 101.21 cm tall and 16.8 kg in weight |
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Term
| School aged developmental growth |
|
Definition
| Girls grow faster than boys. At age 10-13 children experience a rapid uneven growth. So where a 6yo is 112.5 cm tall and 21 kg. an avg. 12 yo is 147.5 cm and 40 kg |
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|
Term
| Adolescent developmental growth |
|
Definition
| 20-25% of adult height and 30-50% of adult weight is achieved. Girls grow 5-20cm until 16 or 17 yo. Boys grow 10-30 cm til 18-20 yo. Puberty begins for girls between 8-14 and is 3 years long and for boys they start at 9-16 yo and it lasts 3-4 years |
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|
Term
| Toddler motor development |
|
Definition
| can children walk, play with blocks, go up and down steps, jump with both feet, and do they scribble spontaneously? |
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Term
| Preschoolers motor development |
|
Definition
| preschoolers at 3 years should be able to go up stairs using different feet, stand on one foot, and can build relatively tall block towers. 4yrs can skip go downstairss on alternating feet, catch a ball. 5 yrs. jump rope, write their name, tie shoes, and balance on one foot with eyes closed. |
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Term
| School aged motor development. |
|
Definition
| should be able to do more complex tasks such as ride a bike, rollerblade, and write in cursive |
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Term
| adolescent motor development |
|
Definition
| does child have a job, hobby or interests that involve hand skills and do they play sports? |
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|
Term
| Toddler sensory devolopment |
|
Definition
| Visual acuity & depth perception improve and they can recall images. Able to listen and comprehend slightly. Olfactory and gustatory senses are influenced by voluntary control so children wont eat anything that doesnt look pleasant to them |
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|
Term
| Preschool sensory development |
|
Definition
| color & depth perception become fully developed. Hearing reaces max level and listening further develops |
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|
Term
| Schoolaged sensory development |
|
Definition
| visual capacity reaches 20/20 by age 6 or 7 and hearing acuity is almost complete |
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|
Term
| Adolescent sensory development |
|
Definition
| all senses have reached mature capacity |
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|
Term
| Toddlers cognitive development |
|
Definition
| in sensorimotor phase (12-24 months) substage tertiary circular reactions (12-18 months) invlove trial and error and exploration and in substage mental combinations (18-24months) child devises new means for accomplishing tasks through mental calculations. at 15 months toddlers begin to speak and by 2 years they can say 300 words and 2-3 word phrases |
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Term
| Preschoolers cognitive development |
|
Definition
| Preoperational thought (2-7 years) has 2 phases. Preconceptual phase (2-4 years) forms concepts that are not complete or logical. The intuitive phase (4-7) capable of classifying, quantifying, and realationg objects but they are unable to see viewpoints of others. by 5 child can say 2,100 words and they know 4 of 5 colors and the days of the week |
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|
Term
| school aged cognitive development |
|
Definition
| 7-11 years stage of concrete operations which is marked by inductive reasoning, logical operations, and shift from egocentric to objective thinking. They often seek validation and ask many questions. They like to collect and sort objects and enjoy electronic games |
|
|
Term
| adolescent cognitive development |
|
Definition
11-15 years
substage 1: they see relationships involving the inverse of the reciprocal
substage 2: they develop the ability to order triads of propositions and relationships
substage 3: they develop the capacity for true formal thought.
they think beyond the present and form theories about everythign |
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|
Term
|
Definition
| Toddlers need less calories cus of slower growth and by 12 months they eat similar food to fam. but become picky eaters. Preschoolers are very similar to toddlers but they enjoy social aspects of the dinner table. school children need to develop good diet at home to stick with them at school. Adolescents food should be balance by food pyramid |
|
|
Term
|
Definition
| Toddlers sleep 12 hours a day with nap once a day. Preschoolers sleep 11-13 hours a day and need afternoon nap. but sleeping problems are normal with toddlers and preschoolers because of anxiety. school age children get 8-9.5 hours of sleep and adolescents go to bed and sleep late at every opportunity |
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|
Term
| leading killer of young people |
|
Definition
suicide
ask if child has ever thought of killing themselves |
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|
Term
| toddlers physical assessment |
|
Definition
| allow toddler to sit on parents lap; enlist parents aid; use play; praise cooperation |
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|
Term
| preschoolers physical assessment |
|
Definition
| use story telling; use doll and puppet play; give choices when able. |
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|
Term
| school age physical assessment |
|
Definition
| maintain privacy, use gown, explain procedures, and equipment; teach about bodies |
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Term
|
Definition
| ensure privacy, provide option of having no parent present, emphasize normality, provide teaching |
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|
Term
|
Definition
| look for lack of eye contact, pained or axious faces, posture, hygiene (could show neglect), abnormal development to assess for mental retardation, abuse, neglect, or a psych disorder |
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Term
|
Definition
| there should be no lags for their age category |
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|
Term
|
Definition
3 months-2 years = 80-150
2 years- 10 years = 70-110
10 years - adult = 55-90 |
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|
Term
|
Definition
6 months-2 years= 20-30
3 years-10 years= 20-28
10 years-18 years= 12-20 |
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|
Term
|
Definition
1-7 years= age in years X 90
8-18= (2x age in years) X 90 |
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|
Term
| Blood Pressure- Diastolic |
|
Definition
1-5 years= 56
6-18 years= age in years +52 |
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Term
|
Definition
| the percent a childs blood pressure should fall between. If they are above the 95% for more than 3 readings in a row they are considered to have high BP |
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Term
|
Definition
| should be in 5th- 95th percentile and less then 5% may be microcephaly where greater than 95% may be macrocephaly. Increased HC in children older than 3 may be from seperation of cranial sutures from intracranial pressure |
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|
Term
|
Definition
| pallor in skin suggests anemia and redness can be from fever, irritation, or allergies |
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|
Term
| Excessive piercings/homemade tattoos |
|
Definition
| may be from self abusive tendencies, and homemade tattoos could have been infected with Hep B or HIV from unsanitary needles |
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Term
|
Definition
| suggests incontinence, dirty diapers, or uremia |
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|
Term
|
Definition
| if mother notices skin is salty when kissing child, it may indicate cystic fibrosis |
|
|
Term
| Excessive Burns and Bruising |
|
Definition
| Strong sign of abuse, but may be cultural practices such as cupping and coining |
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Term
|
Definition
| port wine stains, hemangiomas, cafe-au-lait spots(unless there are more thans cafe-au-lait spots, which could indicated neurovascular problem |
|
|
Term
| Petechiae, lesions, rashes |
|
Definition
| could indicate serious problems |
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|
Term
|
Definition
| poor nutrition, excessive bathing, or endocrine problem |
|
|
Term
|
Definition
| indicates eczema or fungal infection |
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|
Term
|
Definition
| suggests renal or cardiac disorders |
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|
Term
|
Definition
| abrasions or scarring on the joints of index and middle fingers from self induced vomiting |
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|
Term
|
Definition
| poor nutrition, hypertension, or overuse of chemical hair products (often seen with teens) |
|
|
Term
|
Definition
| Grey translucent flakes suggest lice nits or ova. Grayish brown bodies suggest ticks |
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Term
|
Definition
| Suggests neglect, hair pulling, skin diseases, or chemo |
|
|
Term
| tufts of hair on the spine |
|
Definition
| could be from spina bifida occulta |
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|
Term
| coarse body hair before puberty |
|
Definition
| usually suggests an endocrine problem |
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|
Term
|
Definition
white nails with scaly lesions = fungal infection
spoon nails (koilonychia)= iron deficiency anemia
macerated thumbs are seen with chronic thumb sucking
inflammation of nail base= paronychia |
|
|
Term
|
Definition
| very large head and "sun setting" appearance of the eyes |
|
|
Term
|
Definition
| premature closure of the sutures |
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|
Term
|
Definition
| Third fontanelle, unusually proportioned face, and short webbed neck,short broad extremities, hyperextensible joints, palmar simian crease, wide set eyes (hypertelorism), upward slant, and thick epicanthal folds, and brushfield's spots on the sclera. |
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|
Term
|
Definition
| osteoporosis of outer skull. palpating firmly with thumbs with cause indentation on the skull |
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|
Term
| Range of Motion in the neck |
|
Definition
| hyperextension suggests opisthotonos or serious menigeal irritatation. limited ROM in the neck can be from torticollis (wryneck), or rheumatoid arthritis (this is indicitave of decreased ROM anywhere) |
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|
Term
|
Definition
| can be hereditary or can be from certain syndromes (Down's or fetal alcohol) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| seen with mumps or bulemia |
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|
Term
|
Definition
| seen with crease across the nose, shiners, and mouth agape |
|
|
Term
| distended veins in the neck |
|
Definition
| indicated difficulty breathing |
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|
Term
| Trachea shift away from midline |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
infection or immunodeficiency |
|
|
Term
|
Definition
| prodromal sign of measels |
|
|
Term
|
Definition
| caries may be from "bottle caries syndrome" and enamel erosion suggests bulemia |
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|
Term
|
Definition
| seen with allergies and cystic fibrosis |
|
|
Term
|
Definition
| blepharitis, dacryocystis, hordeolum |
|
|
Term
|
Definition
| CN III palsy, congenital syndrome, or familial trait |
|
|
Term
|
Definition
| osteogenisis imperfecta (brittle bone disease) |
|
|
Term
|
Definition
| iritis or overuse of narcotics |
|
|
Term
|
Definition
| emotional factors, truma or drug use |
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|
Term
|
Definition
| common during childhood but normally not visible |
|
|
Term
|
Definition
| 1 year= 20/200. 2 year= 20/70. 5 years= 20/30. 6 years= 20/20. Online difference between eyes, abnormal visual acuity, disability to distinguish colors should be referred |
|
|
Term
|
Definition
| seen when eye moves during cover test and when light is not aligned in both eyes when light is shined on pupils (hirshberg test) |
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|
Term
|
Definition
| unusual in children under 3 because fontanells are open so there should be less intracranial pressure |
|
|
Term
| Disc blurring and hemmoragess of internal eye |
|
Definition
| needs to be referred immediately |
|
|
Term
| low set ears with greater than 10 degree angle |
|
Definition
| mental retardation or congenital syndrome |
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|
Term
|
Definition
|
|
Term
| immobility of tympanic membrane |
|
Definition
|
|
Term
| Periods of apnea longer than 20 seconds and accompanied by bradycardia |
|
Definition
| cardiovascular or CNS disease |
|
|
Term
|
Definition
stridor is narrowing of upper bronchial tree
wheeze is narrowing of lower bronchial tree |
|
|
Term
|
Definition
| redness, edema, and tenderness in prepubertal breasts |
|
|
Term
|
Definition
| suggests right ventricular enlargement |
|
|
Term
|
Definition
| cardiomyopathy, pneumothorax, or diaphragmatic hernia |
|
|
Term
|
Definition
| seen with malnutrition and dehydration |
|
|
Term
|
Definition
|
|
Term
| Discharge, redness or lacerations of male or female genitals |
|
Definition
| maybe from abuse, but could be from infections or foriegn bodies. Discharge in adolescents could indicate STDs |
|
|
Term
|
Definition
| more frequently seen in premature babies, because testicles drop during the 8th month of gestation |
|
|
Term
|
Definition
| common in infants and normally resolve themselves spontaneously |
|
|
Term
| Partial or complete adhesion of the labia minora |
|
Definition
| sometimes seen in girls under 4 and they need to be referred to have the adhesion disintegrated |
|
|
Term
| Forate hymen ( no central orifice) |
|
Definition
| not significant unless it persists into puberty |
|
|
Term
|
Definition
| male pattern hair on females |
|
|
Term
|
Definition
| no anal opening. needs to be referrred |
|
|
Term
|
Definition
| very uncommon in children and may be seen with chronic constipation or abuse |
|
|
Term
| Pustules around anus and dark ring around anus |
|
Definition
| pustules may be from diaper rash or seborrhea and a dark ring indicates heavy metal poisoning |
|
|
Term
| Polydactyly (extra digits) or Syndactyly (webbing) |
|
Definition
| may be seen with mental retardation |
|
|
Term
| Fixed position of extremeties that do not return to normal with manipulation |
|
Definition
| seen with metatarsus varus which is inverted and adduction of forefoot |
|
|
Term
| talipes equinovarus (club foot) |
|
Definition
| adduction of forefoot, inversion of entire foot, and equinus (pointing downward) position of entire foot |
|
|
Term
|
Definition
| adduction of forefoot and inversion of entire foot |
|
|
Term
|
Definition
| neuromuscular disorder like cerebral palsy |
|
|
Term
|
Definition
| cause extremities that are asymmetric in size, shape, and movement |
|
|
Term
| "Toeing in" or "toeing out" |
|
Definition
| indicates tibial torsion or club foot |
|
|
Term
|
Definition
| indicates congenital hip dysplasia (toddlers), synovitis (preschoolers), legg-calve-perthes disease (school-aged) or slipped capital femora epiphysis and scoliosis in adolescents |
|
|
Term
| Inadequate muscle strength |
|
Definition
| neuromuscular disorder or muscular dystrophy |
|
|
Term
| Unintelligible speech by age 3 |
|
Definition
| seen with prolonged stuttering, slurring, and lisping indicates speech disorders and neuro problems |
|
|
Term
|
Definition
| may be from drug abuse or conditions such as diabetic ketoacidocis |
|
|
Term
|
Definition
|
|
Term
|
Definition
| decreases sensitivity to pain and inability to determain sharp from dull in 2 point senstation test |
|
|
Term
|
Definition
| gross and fine motor skills that have not reached the appropriate mark for that age group |
|
|
Term
|
Definition
| Hand preference that has not been developed by preschool age |
|
|
Term
|
Definition
| short attention span, poor coordination, hypoactivity, impulsiveness, labile emotions, distractibility, no demonstration of handedness, language problems, or learning problems |
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|
