Pediatric Health Facts, Exams of Nursing

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PNCB-PC 2024 infant iron stores depleted when? - 5-6 mo of age vitamin d start when and how much? - 400 IU start 2 mo-adolescents flouride supplement not needed for first - 6 months initially, infants lose up to - 10% of body weight infant weight doubles by - 6 mo infant weight triples by - 12 mo infants regain lost weight after leaving hospital in how many days? - 7-14 days school age kids gain how many lbs/year? - 5-7 teeth erupt around how many months? - 6 mo first molars at what age? - 6 years denver is birth to how many years? - 6 years fine motor, reach for object at how many mo? - 3-4 months hand to hand transfer - 5-6 mo pincer grasp - 9 mo which strains of HPV are for cancer? - 16 and 18 wide fontanelle would happen why? - prematurity, hydrocephaly, DS, hypothyroidism, IUGR DDH - barlow and ortalni separation anxiety when? - 8 mo stranger anxiety when? - 6 mo fever during first mo of life most likely - GBS fever during 2nd mo most likely - s pneumon and h. influ toddler play - onlooker, parallel preschool play is more - assoicative toddlers use utensils when? - 15-17 mo (spoon) school age, cognitive development - concrete, operational, conservation, cencept of space, concept time ADHD sx present before what age? - 7 years of age ADHD must have sx for at least - 6 mo and must interfere w/ @ least 2 (home, school, play) ADHD diag also includes ___ sx of inattention or ____ sx of hyperactivity/impulsivity - 6; 6 strabismus tests - hirchberg, pupil light reflex unequal refer if still there at 6 mo and/or if hypo/hyper treat syphillis with what? - benzathine penicillin G herpes 2 - genitalia in infants, how do we confirm HIV - HIV PCR in older children how do we confirm HIV? - ELISA confirming HIV - western blot start antiretroviral treatment (ART) no later than when patient has a CD4 of what? - 350 uL normal cD4 lymphocyte count - 800 cells/uL type 1 herpers - found on lips, face, mucosa initial herpes outbreak: - fever, malaise, dysuria, painful ulcers for 12 days recurrent herepes - less painful ulcers for 5 days most definitive diag for HSV - viral culture osteoscarcoma peaks at what age? - 15-18 most common bone tumor before age 5 - neuroblastoma s/sx of neuroblastoma - FTT, enlarged abdominal mass, sweating cystic fibrosis, important to replace what? - pancreatic enzymes (amylase, lipase, trypsin) appendicitis: which sign? - psoas sign appendicitis: if untreated, gangrene and perforation may develop within - 36 hours intusussceptoin - surgical emergency pyloric stenosis: bilious or non bilious vomiting? - non-bilious *infant hungry after vomiting most common cause of gastroentiritis - viruses! rotavirus in 50% of cases treatment for kawasaki - ASA REFER bilateral conjunctivitis, fever for 5 days, inflam changes, polymorphous rash, edematous extremeties, cervical lymphad, desquam think what? - kawasaki disease what disease follows group A strep infectoin of URT and is most common in ages 6-15? - rheumatic fever rheumatic fever symptoms - carditis, polyarthritis, chorea, erythema marginatum diag of rheumatic fevere - acute phase: positive thorat culture, increased or rising strep antibody titer echo & ECG Kawasaki disease typically occurs in kids how old? - <2 years old leading cause of coronary artery disease in children of an infectious etiology? - kawasaki disease *most often in asians most common innocent murmur, heard best LLSB, musical, systolic ejection - still's murmur venous hum - continuous humming murmur, RUSB venous hum disappears when - heard best in sitting position and disappears in supine also disappears when turn head or compress neck ipsilaterally innocent murmurs occur in - more than 50% of children prolonged ____ interval on ECG with - PR; rheumatic fever *evidence of group A strep infection kawasaki ECG changes - prolonged PR or QT interval knee/chest squat - tetralogy of fallot tet of fallot - large VSD, pulm stenosis, overriding aorta, RVH x-ray: boot shaped heart coarctation of aorta - BP in lower extremities will be lower than in upper extremities *turner's ASD - heard best at LUSB, RVH and cardiomegaly VSD - holosystolic thrill felt at LLSB, LVH, cardiomegaly most common heart defect in kids? - VSD cyanotic is - right to left shunting school age congitive - concrete (6-12 yo) stuttering: when to refer - if it lasts > 6 mo if child is greater than 6 years, if child avoids speaking Autism - characterized by altered response to environmental stimuli and impaired social interactions autism classification - must impede functioning esp in school and occupational areas social communication deficits must be unrelated to level of indiviudal development toilet training readiness begins - between 1.5 and 2.5 years avg daytime controla chieved by 2 - 2 years by age 2 ___ word vocabulary - 50 word gold standard for diagnosis of developmental delays in infants/toddlers to 42 months of age - bayley scales of infant and toddler development (separates into mental, motor and behavioral rating scales) measure HC - each visit to 2 years of age anterior font closes - by 18 mo chest and head equal at age - 1 preoperational/preconceptual thinking at what age? - toddler/preschool fever in infants - rectal temp > or equal to 110.4 temperatures higher than 101.8 during first 2 mo suggest - serious bacterial infections testicles fully descended by - 3 mo of age survival reflexes - breathing, temp control and feeding head control by - 4 mo hematocrit at - 9-12 mo physical: infant - gross motor (cephalocaudal) fine motor (proximal > distal) rubella at birth - cardiovascular and ophthalmic complications treat hearing loss by - 6 mo all 50 states require - screening at birth: PKU, galac, hemoglobin, congenital hypothyroidism newborn screening tested at - <24 hours of age macrosomia (large mouth) seen in - fetal alcohol syndrome microstomia (small mouth) seen in - edwards (trisomy 18) caput succedaneum - crosses midline (resolves in 2-3 days) cephalohematoma - does not cross midline bossing - rickets, prematurity unruly hair, SGA, microcephaly found in - down syndrome when red reflex is white think - retinoblastoma or cataracts brushfield spots of iris - salt and pepper specling; down sydrome strawberry marks begin to fade when - at 6 mo (soft, raised, hemangiomas) most newborn reflexes disappear when - at 3-4 mo (babinski @ 12 mo or when walking) mongolian spots almost always disappear by - puberty infants taht are LGA - maternal diabetes <37 weeks - premature >41 weeks - post term APGAR - appearance, pulse, grimace, activity, respirations LBW - <2500 g VLBW - <1500 g AGA - between 10 and 90 percentile adequate nutrition confirmed by weight gain - 30 g/day or 1 oz per day for first 3 mo iron - @ 6 mo for exclusively BF 1 mg/kg/day sinusitis occurs in kids - 9 and older prader willi - hypogonadism, short stature hospitalize asthamtic if peak flow less than - 60 liters/minute restrictive disease - eg pneumonia, trouble inhaling obstructive dsieas - trouble exhaling (asthma, cystic fibrosis) brochioloitis and asthma - hyperinflated lungs refer beyond mild ___ asthma - persistant treat pneumonia with - penicillin LCPD - limp and knee pain hip ---> knee pain groin pain think - SCFE scoliosis, refer when? - greater than 25 degrees or painful surgery @ 40 degrees most common musculoskeletal injyrt - abjke sorab simpel partial seizures - no LOC complex partia - LOC gernalized - bilateral (absence, tonic, tonic-clonic, atonic) febrile seizures peak between - 1 and 3 years old majority of febrile seizures are - tonic clonic last less than 5 min for febrile seizures - side lying, cooling measures, acetaminophen pediatric anemia - MMCV and MCHC are low (microcytic and hypochromic) but RDW is increased give iron with thalassemia?? - NO TIBC normal in - thalassemia treat IDA with - 3-6 mg/kg/day of iron second most common cause of microcytic anemia - thalassemia (more prevalent in SE asian, mediterraneans) sickle cell - shortened RBC life span (instead of 120 days, now 10 days) peak inceidence of infection between 1 and 3 yo SCD - autosomall recessive HgB S develops instead of Hgb S SCD most common in - AA lead poisoning - > 10 (houses prior to 1978 at risk) lead level at 45 - chelation s/sx of lead poisoning - gi symptoms, lethargy, burtonian lines neuropathies hemophilia a - deficiency of factor 8 affects males: bleeding after trauma ALL peak incdience - 4 years (most common leukemia) AML peak incidence - infants and older children leukemia and thrombocytopenia - thrombocytopenia present in up to 85% of cases and anemia usually present s/sx of leukemia - anemia, pale, listless, iritable, bleeding, bone and joint pain, lymphadenopathy and hepatosplenomgealy Normal A1C - 5.5-7 diabetes is serum fasting BS - > or equal to 126 on to separate occasions OR random blood sugar greater than or equal to 200 0and poly dipsia, polyuria and weightloss need to confirm w/ fasting A1C levels checked every - 3 mo metform used in kids? - yes for type 2 diabetes somogyi effect - hypoglycemia at night triggers raise in blood sugar --> pt hypoglycemic at 3 AM and rebounds with hyperglycemia at 7 AM tx reduce insulin at night dawn phemon - densentiziation to insulin at night --> blood sugar gets higher at night and is elevated at 7 AM. treatment is to add or increase dose of insulin majority of enuresis is primary enuresis - 95% functiona