Term
| How do you prevent heat loss in the newborn? |
|
Definition
Dry infant immediately after birth
Wrap newborn warmly, cover head or place in especially warm area
Place newborn in warm surface
Skin to skin contact with the mother |
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Term
|
Definition
A – appearance
P – pulse
G – grimace
A – activity
R – respirations
a. No perfect 10
b. 8 is a good APGAR
c. Improving APGAR is OKAY -> 1 min APGAR of 5 and 10 min APGAR of 8 is OKAY
d. Anything below 5 is NOT OKAY
Used to evaluate the newborn in five specific categories at 1 and 5 minutes after birth
The one minute score reflects transitional values
The five minutes provides the best direction for the planning of newborn care |
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Term
|
Definition
| Phenylketonuria (PKU) is caused by a missing enzyme needed to properly digest a food protein called phenylalanine. |
|
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Term
|
Definition
| It is treated by changing a baby’s milk to special milk that does not contain phenylalanine. PKU occurs in about 1 of every 17,000 babies. |
|
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Term
| What is the effect of PKU? |
|
Definition
| If not treated, PKU will cause brain damage |
|
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Term
| Should you child be drinking breast milk 24-48 hours prior to the PKU screening test? |
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Definition
|
|
Term
| What is Caput succedaneum? |
|
Definition
echymotic, oedematous swelling of soft tissues
crosses the midline
disappears after first few days |
|
|
Term
|
Definition
Cephalhematoma is a collection of blood between the periosteum of a skull bone and the bone itself.
DOES NOT CROSS MIDLINE |
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Term
| How long is the recommended breast feeding time? |
|
Definition
American Academy of Pediatrics (AAP) recommends infants be breastfed exclusively for first 6 months of life
Breastfeeding should continue for at least 12 months and thereafter as desired
Complementary foods can be introduced after 6 months |
|
|
Term
| What are the benefits of breast feeding? |
|
Definition
Associated with health benefits for mother and infant
Psychological benefits
Convenience
Economical
Environmental benefits |
|
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Term
| What are the cultural influences of infant feeding? |
|
Definition
Hispanic women BF is the norm
African-American families more likely to formula-feed
Muslim and Jewish cultures value BF
Cultural knowledge about BF
Must be comfortable in social settings |
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Term
| Who is breast feeding contraindicated in? |
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Definition
Maternal cancer therapy or diagnostic and therapeutic radioactive isotopes
Active tuberculosis not under treatment
Human immunodeficiency virus
Maternal herpes simplex lesion on a breast
Galactosemia in infant
Varicella
Maternal substance abuse
Maternal human T-cell leukemia virus type 1 or type 2
Some medications may be incompatible with BF |
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Term
| What are the nutrient needs of the new born? |
|
Definition
Fluids
Energy
Carbohydrate
Fat
Protein
Vitamins
Vitamin D
Vitamin K
Minerals |
|
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Term
|
Definition
|
|
Term
| What is the ideal food for human infants? |
|
Definition
BREAST MILK!
Dynamic substance to meet the changing needs of the infant
Contains immunologically active components |
|
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Term
|
Definition
More concentrated than mature milk
Extremely rich in immune globulins
Higher concentration of protein and minerals
Less fat than mature milk |
|
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Term
| What are special considerations for breast feeding? |
|
Definition
Sleepy baby
Fussy baby
Slow weight gain
Jaundice
Preterm infants
Late preterm infants
Multiple infants |
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Term
| What is the important information to give for care of the mother breastfeeding? |
|
Definition
Diet
Breast care
BF and contraception
BF and pregnancy
BF and obesity
Medications, smoking, alcohol, caffeine
Herbal preparations |
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Term
| What are common concerns of the mother breastfeeding? |
|
Definition
Engorgement
Sore nipples
Insufficient milk supply
Plugged milk ducts
Mastitis
Follow-up after hospital discharge |
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Term
| Parents have been asked by the neonatologist to provide breast milk for their newborn son, who was born prematurely at 32 weeks of gestation. The nurse who instructs them about pumping, storing, and transporting the milk needs to assess their knowledge of lactation. What statement is valid? |
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Definition
| A premature infant more easily digests breast milk than formula. |
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Term
| What are dysconjugate eye movements? |
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Definition
| where the eyes appear to move independently. Eyes may transiently appear crossed or divergent. This phenomena is particularly noticeable when the infant is falling asleep or being woken from sleep |
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Term
| What dysconjugate eye movement should you alert the ophthalmologist to? |
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Definition
| If the dysconjugate movement is fixed (one eye is always out, or always in, relative to the other |
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Term
| What are Dacrocystoceles? |
|
Definition
| bluish nodules inferior to the medial canthi of both eyes, widely spaced eyes (hypertelorism), and a flat nasal bridge. |
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Term
| What is Subconjunctival hemorrhage? |
|
Definition
It results from the breakage of small vessels during the pressure of delivery.
The red area may be large or small but is always confined to the limits of the sclera.
It is asymptomatic, does not affect vision, and spontaneously resolves in several days. |
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Term
| What is gonococcal conjunctivitis? |
|
Definition
When gonococcal conjunctivitis occurs, it typically presents in the first few days of life with copius, purulent discharge in the eyes.
In this infant, the marked edema of the eyelids was the first symptom noted, but with just slight pressure on the lids, purulent material oozed out .
OPTHALMIC EMERGENCY
TREATMENT: Treatment is very aggressive and includes systemic intravenous antibiotics, frequent eye washes, and monitoring in a neonatal intensive care unit. |
|
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Term
| What are congenital cataracts? |
|
Definition
the opacities here occur behind the pupil, as the pupil is easily and clearly seen along its entire circumference.
Red light reflexes could not be obtained from either eye |
|
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Term
|
Definition
the opacity is central and could be mistaken for opacity of the lens, a view from a more oblique angle shows the cloudiness extends over parts of the iris as well.
Still see red reflex |
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|
Term
|
Definition
|
|
Term
| What are the persistent symptoms of acute sinusitis? |
|
Definition
10–30 days (no improvement)
Nasal discharge (any quality)
Daytime cough (worse at night)
Fever – variable
Headache and facial pain – variable |
|
|
Term
| How is sinusitis diagnosed? |
|
Definition
Differentiate between sequential episodes of URI and sinusitis
Establish that symptoms are NOT improving |
|
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Term
| What are the severe symptoms of acute sinusitis? |
|
Definition
High fever (T ≥39o C) and
Purulent nasal discharge concurrently for at least 3–4 days |
|
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Term
| What are the worsening symptoms of acute sinusitis? |
|
Definition
Typical viral URI symptoms
Nasal discharge or cough or both for 5–6 days which is improving
Sudden worsening manifests as
Increase nasal discharge or cough or both
Onset of severe headache
Onset of new fever |
|
|
Term
| What are the orbital complications of sinusitis? |
|
Definition
a. sympathetic effusion
b. subperiosteal abscess
c. orbital abscess
d. orbital cellulitis
e. cavernous sinus thrombosis |
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|
Term
| What are the CNS complications from sinusitis? |
|
Definition
Suspected with very severe headache, photophobia, seizure, other focal neurologic findings
Subdural empyema
Epidural empyema
Venous thrombosis
Brain abscess
Meningitis |
|
|
Term
| What is no longer recommended with sinusitis? |
|
Definition
Adjunct therapy
Imaging of the sinuses |
|
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Term
|
Definition
| Bronchiolitis is a common infection of the lower respiratory tract. |
|
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Term
| What causes bronchiolitis? |
|
Definition
-(over 50% of cases) being respiratory syncytial virus (RSV)
-parainfluenza virus,
-influenza virus,
-mycoplasma, and
-some adenoviruses |
|
|
Term
| When does bronchiolitis occur? |
|
Definition
| during the first two years of life, peaking at about six months of age. |
|
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Term
| What are the s/s of bronchiolitis? |
|
Definition
stuffiness, runny nose, mild cough. These symptoms last a day or two and are followed by gradually increasing breathing difficulty characterized by wheezing; rapid, shallow breathing (60 to 80 times a minute); rapid heartbeat; retractions (the drawing in of neck and chest with each breath); and cough. The child may have a fever.
may tire out from the work of breathing and, due to the clogging and collapse of the small airways, have poor air movement in and out of the lungs
infant can become dehydrated due to the increased work of breathing and decreased fluid intake. |
|
|
Term
| How long does bronchiolitis last? |
|
Definition
| last about seven days, but children with severe cases can cough for weeks. Children who have two or more episodes of wheezy breathing may be more likely to develop asthma. |
|
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Term
| Is bronchiolitis contagious? |
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Definition
| is contagious, and winter epidemics tend to occur every two or three years. The viruses responsible may be transmitted by airborne droplets. Infants in day care centers are at greater risk. |
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Term
| IS there a treatment for bronchiolitis? |
|
Definition
Virus so not really!
Antibiotics have no value unless there is an additional (secondary) bacterial infection
Albuterol perhaps |
|
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Term
| What are 2 conditions that can occur later in life when someone has previously had RSV bronchiolitis? |
|
Definition
| Reactive airway disease and pulmonary function deficits are two conditions known to strike those who have suffered from RSV bronchiolitis in their first year of life, even in children whose initial illness did not require hospitalization. |
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Term
| What kind of sputum does pnuemococci produce? |
|
Definition
| bloody or rust-colored sputum. |
|
|
Term
| What kind of sputum does psuedomonas, haemophilis and pneumococcal cause? |
|
Definition
|
|
Term
| What kind of sputum does Anaerobic cause? |
|
Definition
|
|
Term
| What kind of sputum does Klebsiella and type 3 pneumococci produce? |
|
Definition
| sputum resembling currant jelly |
|
|
Term
| What are the symptoms of pneumonia? |
|
Definition
Malaise
Myalgias
Exertional dyspnea (dyspnea at rest with progressive disease)
Pleuritic chest pain
Abdominal pain
Anorexia and weight loss
Sudden onset of symptoms and rapid illness progression are associated with bacterial pneumonias. |
|
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Term
| What are the findings of physical examination of pneumonia? |
|
Definition
Fever
Tachypnea
Tachycardia or bradycardia
Cyanosis
Decreased breath sounds
Wheezes, rhonchi, and rales
Egophony on auscultation
Pleural friction rub
Dullness to percussion
Altered mental status |
|
|
Term
| What is the most common cause of pneumonia in infants and children? |
|
Definition
|
|
Term
| What is the difference between RSV and Influenza epidemics? |
|
Definition
| Influenza usually is seen in epidemics and pandemics in late winter and early spring. On the contrary, RSV infection is seasonal, with rates that increases in the fall, peaks in winter, and returns to baseline in the spring. Peak attack rates for RSV occur in the winter in infants younger than 6 months. |
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|
Term
| When is parainfluenza most commonly seen? |
|
Definition
| seen most often in late fall or winter and is the second most common cause of viral illness in infants after RSV infection |
|
|
Term
| What do you start with on a physical exam on a child? |
|
Definition
HISTORY
-Past History
-Previous Illnesses
-Developemental
-Personality and Habits
-Past and Present Medications
-Immunizations
-Present Illness
-Family/Genetic History |
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Term
| What is included in past history? |
|
Definition
| The information in this section might include birth date, hospital, city, weight, and length. The type of delivery, for example, spontaneous and the type of presentation; vertex or breech. Apgar scores, age of mother, length of gestation, exposures to infectious diseases, and medications, drugs, or alcohol including tobacco used during pregnancy should be recorded if pertinent to the case. Information regarding the newborn, might include hypoglycemia, cyanosis, pallor, seizures, jaundice, skin lesions, muscle skeletal deformities, respiratory distress or feeding problems. |
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Term
| What is important to note about previous illnesses? |
|
Definition
Age, severity, complications, and sequeli.
Serious childhood illnesses
Surgical procedures, approximate dates, and complications
Injuries and fractures
Hospitalizations
Nutrition: Questions regarding nutrition should be appropriate for the child’s age. |
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Term
| What is important to note about developmental history? |
|
Definition
| Record information regarding a child’s current developmental status with regard to each of the four following areas: gross motor, fine motor, social, and language skills. When children are of school age also include information regarding academics and physical activities such as sports. |
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Term
| What is included in social history? |
|
Definition
Living circumstances: place and nature of dwelling, sleeping arrangements,daycare arrangements.
Economic circumstances
Parents occupations and marital status
Household pets
Potential exposures to toxins in home, for example, cigarette smoke exposure
Age of home of children less than 3 (possible lead exposure)
Water source |
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|
Term
| What vital signs need to be taken? |
|
Definition
| Record vital signs which include temperature, pulse, respiratory rate, and blood pressure (arm and legs). Weight, height, and head circumference should be measured, preferably using the metric system, and should include percentiles. Plot these parameters on a growth chart if not previously done. |
|
|
Term
| What systems need to be reviewed? |
|
Definition
HEENT
- Respiratory
- Cardiac
- Gastrointestinal
- Genital, urinary
- Neuromuscular
- Muscle/Skeletal
- Hematologic
- Recent infectious disease contacts |
|
|
Term
| What is to be noted about the head? |
|
Definition
: Normal or abnormal faces and normal or abnormal cephalic.
Head measurement |
|
|
Term
| What is to be noted about the neck? |
|
Definition
Anatomy of the neck - location of congenital cysts
Lymph node: If abnormal in size or texture
record location, consistency, tenderness,
size in centimeters.
Flexibility,
masses.
Thyroid - size. |
|
|
Term
| What is to be noted about the eyes? |
|
Definition
Include all positive findings on eye examination and include anisocoria (abnormal pupil size), sclera, conjunctivae, strabismus, photophobia, and fundoscopic exam.
Visual acuity (Snellen chart), |
|
|
Term
| What is to be noted about the ears? |
|
Definition
Hearing, discharge, tympanic membrane appearance.
TM movement
Acute otitis media |
|
|
Term
| What is to be noted about the nose? |
|
Definition
Air movement, mucosa,
septum, turbinate appearance,
perinasal sinus tenderness. |
|
|
Term
| What is to be noted about the mouth/throat? |
|
Definition
Color, dryness, fissure;
appearance, teeth - number and caries, gum –
color and hypertrophy, epiglottis –
appearance, tonsils - size and appearance. |
|
|
Term
| What is to be noted about the external chest? |
|
Definition
Thorax: Appearance and contour, respiratory rate and
effort, regularity of breathing, symmetrical chest
movement, character of respirations such as retractions |
|
|
Term
| What is to be noted about the lungs? |
|
Definition
| Percussion, palpation, fremitus, auscultation. |
|
|
Term
| How should you perform auscultation of the heart? |
|
Definition
|
|
Term
| What is important to note about heart murmurs in children? |
|
Definition
Pay attention to any murmurs and
character and timing as related to S1 and S2. Murmurs are
fairly common in children but any systolic murmur greater
than grade 3, any diastolic murmur or any murmur that gets
louder with Valsalva should be investigated |
|
|
Term
| What is the common murmur in older children? |
|
Definition
|
|
Term
| What is the common murmur in infants? |
|
Definition
|
|
Term
| What is to be noted about the abdominal exam? |
|
Definition
Abdominal tenderness, masses,
rigidity, or enlargement of the
Liver or spleen requires further
Evaluation. Females past
Puberty should be examined for
a gravid uterus in the midline
from the Xyphoid process to the
Symphysis pubis. |
|
|
Term
| What are the different tanner stages for breast development? |
|
Definition
I - Preadolescent
II - Bud
III - Areolar Diameter Enlarges
IV - Secondary Mound; Separation of Contours
V - Mature Female |
|
|
Term
| What are the different tanner stages for pubic hair development? |
|
Definition
I - None
II - Sparse, long, straight
III - Darker, curling, increased
IV - Coarse, curly, adult type
V - Extends to thighs |
|
|
Term
| What are the different tanner stages for the male genitalia? |
|
Definition
I - Childhood size
II - Enlargement of scrotom/testicles
III - Penis grows in length, testes continue to enlarge
IV - Penis grows in length/breadth, scrotum darkens, testes enlarge
V - Adult shape.size |
|
|
Term
| What do you need to check for in young boys? |
|
Definition
Testicular masses and how to check for them themselves
Check for hernia and un-descended testicles.
The leading cause of cancer deaths in young men
is Testicular cancer. |
|
|
Term
| What should you look for in the lower extremities? |
|
Definition
Look for symmetry in length and girth.
Have child stand on toes, then on heels |
|
|
Term
|
Definition
. Flat feet in an older child may
cause pain in the heel or arch, or may cause pain when
the child is walking and running. Look at the child's
Feet to make sure that the pain isn't caused by a
problem in the hip or the knee |
|
|
Term
| What is metatarsus adductus? |
|
Definition
Metatarsus Adductus used to worry us
(and parents) until we figured out that it is
normal and corrects itself in 99% of kids.
Braces, reverse last shoes, casts and surgery
were done--needlessly!--in years past and
we virtually never do any of those things
anymore. |
|
|
Term
| What is the erikson stage of school age kids? |
|
Definition
|
|
Term
|
Definition
Eager to develop skills and participate in meaningful and socially useful work
Acquires a sense of personal and interpersonal competence
Growing sense of independence
Peer approval is a strong motivator |
|
|
Term
|
Definition
Feelings may derive from self or the social environment
May occur if incapable or unprepared to assume the responsibilities associated with developing a sense of accomplishment
All children feel some degree of inferiority regarding skill(s) they cannot master |
|
|
Term
| What is piaget's stage in school age kids? |
|
Definition
Use thought processes to experience events and actions
Develop an understanding of relationships between things and ideas
Able to make judgments based on reason (conceptual thinking) |
|
|
Term
| What is erikson's stage of adolescents? |
|
Definition
1. Group identity versus alienation
2. Development of personal identity versus role diffusion
3. Sex role identity
4. Emotionality |
|
|
Term
| What is piaget's stage of adolescents? |
|
Definition
1. Formal operations period
2. Abstract thinking
a. Think beyond present
b. Mental manipulation of multiple variables
c. Concerned about others’ thoughts and needs |
|
|
Term
| What is the cephalocaudal development of locomotion? |
|
Definition
b. Crawling age—7 to 9 months
c. Creeping age—9-10 months
d. Walk with assistance—11 months
e. Walk alone—12 months |
|
|
Term
| What is the gross motor skill of the 3 month old? |
|
Definition
i. Raises head to 45 degree angle in PRONE position
ii. Slight head lag in pull to sit |
|
|
Term
| What is the gross motor skill of the 4 month old? |
|
Definition
i. Lifts head and looks around
ii. Rolls from prone to supine
iii. Head leads body when pulled to sit |
|
|
Term
| What is the gross motor skill of the 6 month old? |
|
Definition
|
|
Term
| What is the gross motor skill of the 12 month old? |
|
Definition
i. Sits from standing position
ii. Walks independently |
|
|
Term
| What can cause decreased thermoregulation/cold stress in an infant? |
|
Definition
BODY SURFACE/WEIGHT RATIO
DECREASED SUBCUTANEOUS FAT
THIN SKIN
DECREASED FLEXION
VASOCONSTRICTION DECREASED
DECREASED BROWN ADIPOSE |
|
|
Term
| What are the steps to examination of the newborn? |
|
Definition
-Introduce yourself
-Answer any questions mom has
-Fully examine baby
-Give advice, info, arrange follow up and provide reassurance when appropriate. |
|
|
Term
| What is the order of examination? |
|
Definition
1.) Remove Clothing
2.) Feel the AF for tension
3.) LOOK at the face for color or abnormalities
4.) Estimate RR, HR
5.) Listen to heart
6.) Palpate abdomen
7.) Return to head to examine scalp, skull, OFC
8.) Examine the eyes, ears, nose, and mouth
9.) Examine neck and clavicles
10.) Examine arms, hands, legs, and feet
11.) Feel the femoral pulse (SYSTEMIC!)
12.) Examine the genitalia and the anus
13.) Turn baby to the prone position and examine back, spine, and assess tone. (Look for dimple or hair)
14.) Return infant to supine to evaluate CNS
15.) Examine hips |
|
|
Term
| What are you looking for in newborn skin? |
|
Definition
colour , texture , cyanosis , icteurs , pallor
skin rashes erythema toxicum , transient neonatal pustular melanosis , Miliaria rubra |
|
|
Term
| What is the abnormal thing to note about hands? |
|
Definition
|
|
Term
| What should you note when assessing the head? |
|
Definition
Fontanelle
wide
bulging - tension
closed
2. Sutures
overriding
widely separated > 5 mm
3. Cephalhaematoma
bleeding under periosteum on the parietal bones
does not cross the midline
Caput succedaneum
echymotic, oedematous swelling of
soft tissues
crosses the midline
disappears after first few days |
|
|
Term
| What should you note when assessing the face? |
|
Definition
Dysmorphic features
Down’s :epicanthal folds, hypertelorism, low set ears
Other syndromes
Oedema
face presentation
prolonged labour
Isolated abnormalities
Mouth: precocious dentition/ cleft lip / palate/ Epstein pearls (self resolving white inclusion cysts on palate/gums)
Ear abnormalities (deformities, preauricular skin tags)
Eye: cataract – red reflex, conjunctival / retinal haemorrhaege
micrognathia
Facial nerve palsy |
|
|
Term
| What can you NOT miss in a newborn exam? |
|
Definition
Red reflex: Cataract
Femoral pulse: coarctation of aorta
DDH – Hip Dysplasia |
|
|
Term
| How do you test for hip dysplasia? |
|
Definition
Barlow- pushes backwards to try to dislocate it
Ortolani - Opening the hips to try to relocate it |
|
|
Term
| What kind of car seat, position for children? |
|
Definition
Rear facing until 1 y/o
Have to be in car seat until 90 lbs or 9 yrs old (can be booster seat as well) |
|
|
Term
| What is the nutrition of a 2 month old? |
|
Definition
Breast milk or formula
Held upright, first few days of life may only eat ½ to 1 oz.. then up to 2-3 oz., feed 6-8 times a day but
Bottle needs to be iron fortified
Cannot swallow food until 4-6 months old |
|
|
Term
|
Definition
Usually play alone next to someone else, starting to play with others but not exclusively.
Exploration of genitalia is common
Gender roles understood by toddler
Playing “house”
Skills include feeding, playing, dressing, and undressing self |
|
|
Term
| How can infants fall into respiratory distress? |
|
Definition
Obligate nose breathers! If this is interrupted, they cannot breathe and will fall into distress!
When they code, it is a respiratory event NOT cardiac! |
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|
