Shared Flashcard Set

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Intro to Peds
N/A
85
Nursing
Graduate
04/03/2016

Additional Nursing Flashcards

 


 

Cards

Term
Neonates
Definition
< 30 days
Term
Preterm
Definition
< 37 weeks
Term
Term
Definition
37-42
Term
Postterm
Definition
> 42 weeks
Term
Preterm Assesment of Gestational Age
Definition

Shapless, pliable ear

Edematous, thin skin 

Creases on anterior 3rd sole of foot 

Undescended testes

Gaping large majora

Hypotonic limbs

Weak gasp reflex

Complete but exhaustible Moro reflex 

Weak sucking reflex 

Term
Moro Reflex
Definition

Present up to 4 to 5 of age 

 

spreading out the arms

 

unspreading the arms

 

crying 

Term
Normal Growth
Definition

birth weight doubles by 6 months

 

birth weight triples by 1 year

 

Length doubles by 4 years 

 

growth slows at 2 years 

Term
Weight
Definition

Term infants lose 5-10% of their body weight during 1st 72 hours

 

Birth weight regained in 7-10 days 

 

Total body H20 decreases at the expense of ECF compartment 

 

Adult levels attained at 1 year of age

Term
Weight by Years Old
Definition

1 year= 10 kg 

 

3 years= 15 kg

 

5 years= 19

 

7 years= 23 

Term
Head Circumference
Definition

9 months head is 50% of adult size

 

2 years it 75%

Term
Anterior Fontanel
Definition
closes at 9-18 months
Term
Posterior Fontanel
Definition
closes by 2-4 months
Term
Face
Definition

2 years the upper jaw grows rapidly to accommodate teeth 

 

Failure of this forward growth= pierre robin, goldenhar treacher collins 

Term
Teeth
Definition

First tooth= 6 months

 

All baby teeth complete= 28 months

 

permanent teeth= 6 year---> grown by 12-14 

Term
Fetal Circulation
Definition

Perfuses low resistance placental circulation

 

40% of ventricular output goes to placenta 

 

5-10% goes to lungs 

Term
Closure of Fetal Circulation
Definition

Ductus contract first few days--> fibroses in 2-4 weeks 

 

foramen ovale closes in 1st few days--> may repoen in next 5 years

 

Avoid hypoxia and acidosis

Term
Heart Rates in Infants
Definition

First 24 hours= 120

 

1 month= 160 

 

Hyoxia, hypothermia, and laryngscopy cause bradycardia 

Term
Premature HR
Definition
120-170
Term
0-3 month HR
Definition
100-150
Term
3-6 months
Definition
90-120
Term
6-12 months
Definition
80-120
Term
1-3 years HR
Definition
70-110
Term
Stroke Volume
Definition

Limited blood volume 

 

80 ml/kg (full term)

 

Limited stroke volume 

 

Have high HR to maintain CO 

Term
C.O
Definition

2-3X greater in neonates than in adults 

 

220-350 ml/kg 

 

reflects greater metabolic rate and O2 consumption 

Term
EKG
Definition

PR & QRS intervals increase with age

 

At birth QRS right sided (RV intrauterine development)

 

1st month it moves leftward as LV muscle develops 

Term
Urine production
Definition
Begins in utero at 12 weeks, helps maintain amniotic fluid
Term
GFR
Definition

25% of adult levels at term

 

Adult levels by 2 years

 

impaired saline, H20 loads, and drug excretion 

 

Decreased tubular function: at risk for hyponatremia, osmotic polyuria, metabolic acidosis 

Term
Acid Production
Definition

50-100% >/kg in children than adults

 

Live near limit of acid compensation.... prone to acidosis during acute illness 

Term
Meds Dosing
Definition
the 1/2 life of medications excreted by means of GFR will be prolonged and require longer intervals between dosing
Term
Renal Overview
Definition

Decreased GFR

 

Decreased concentrating capacity

 

Decreased Na Reabsorption

 

Decreased Bicarb

 

Decreased free H2O clearance 

 

Increased urinary loss of K and Cl

Term
Hepatic System
Definition

Albumin levels are adult values at birth but reduced in preterm infants

 

Drug metabolism less efficient (P450 50% adult values at birth)

 

Decreased serum proteins so decreased drug binding 

Term
Preterm Infants Pancreas
Definition

Prone to hypoglycemia 

 

inadequate glycogen stores

 

deficient gluconeogenesis 

Term
Full Term Infant Pancreas
Definition

Hypoglycemia

 

glucose < 45 mg/dl after 24 hours of birth 

 

Infants may not demonstrate symptoms of hypoglycemia could lead to irreversible CNS damage 

Term
Neurological Signs of Hypoglycemia
Definition

Jitteriness

 

Lethergy

 

Weak Suck

 

Temperature instability 

Term
Neonate Hemoglobin
Definition
14-20 g/dl
Term
Infant Hemoglobin
Definition

9-12 weeks

 

10-11 g/dl --> due to decrease in erythropoesis 

 

Stabalizes at 3rd month--> 11-12 g/dl

Term
Preterm Infant Hemglobin
Definition
nadir is reached at 4-8 weeks
Term
Hemoglobin in Infants
Definition

At birth 70-90% of Hgb is HgbF 

 

Within 3 months HgbF is 5% 

 

Hgb drops over 3 months as circulating volume increases more rapidly than bone marrow function

 

Despite reduced hemoglobin, 02 delivery not compromised as O2/ hemoglobin dissociation curve is shifted to the right--> more delivery 

Term
Coagulation
Definition

Vitamin K, II, VII, IX, X (20-60% of adult values)

 

Prolonged PT

 

Immature liver

 

All neonates should recieve prophylactic Vitamin K to prevent hemorrhagic disease 

Term
Neurological Development
Definition

nervous system anatomy complete at birth

 

Functional myelination not complete until 7 years old 

 

Preterm infants should be assessed in terms on conceptual age 

 

cerebral autoregulation is present and functional from birth

Term
Common Causes of CP
Definition

perinatal ischemic stroke 

 

white matter disorder

 

intrauterine inflammation 

Term
Preterm Infants Neurological Development
Definition

Cerebral vessels are thin walled and fragile

 

Prone to intraventricular hemorrhages

 

Risk increased with hypoxia, hypercarbia, hypermatremia, low Hct, awake airway manipulations, rapid bicarbonate administration and fluctations in BP and cerebral blood flow 

Term
Spinal Cord
Definition

Birth extends to L3

 

1 year old, ends at L1, permanent position 

Term
Sensitivity to Pain
Definition

Tendency to ignore the need for analgesia in infants and small children

 

Neonates including those born prematurely, may have INCREASED sensitivity to pain

 

Infants who have inadequate analgesia may experience an increase sensitivity to pain as older children 

Term
Retinopathy of Prematurity
Definition

Caused by retinal vessel proliferation and retinal detachment

 

Leading cause of blindness 

 

Common among neonates weighing < 1500 g

 

Cause by increase O2 tension in retinal arteries

 

Safe PO2 level now considered 50-70 mmHg  

Term
Causes of ROP
Definition

Hypoxia

 

Hyper/hypocarbia

 

Blood tranfusion

 

exposure to light

 

recurrent sepsis 

Term
Infant Thermoregulation
Definition

Large surface area to weight ratio with minimal subQ fat and less brown fat

 

Poorly developed shivering, sweating, and vasoconstrictive mechansims 

Term
Developmental Issues
Definition

Cognitive Development

 

Attachment

 

Separation

 

Temperment 

Term
Cognitive Development
Definition

Pre-logical explanation= magical thinking

 

to

 

Concrete Logical= contamination (eating bad food)

 

to

 

Formal- logical= physiologic causes of illness 

Term
Attachment
Definition

Most stressful for infants, toddlers, and pre-school children

 

< 10 months= tolerate short periods of separation

 

11 months- 6 years= cling to their parents

 

> 6 years= accept brief periods of separation (use to school) 

Term
Securely Attached
Definition

Deal better with stress of brief separation

 

Use caregivers as a secure, stable base 

Term
Anxiously Attached
Definition

Distressed by unfamiliar situations (pre-op area) even in the prescence of their caregivers 

 

After brief separation exhibit anger, distress, and avoid physical contact

Term
Stress
Definition
Separation from parents and induction of anesthesia have been found to be the most stressful times for a child during the surgical experience
Term
Temperment
Definition

Emotionality, activity, reactivity, and sociability

 

Ease at which infant becomes aroused or anxious

 

energy or intensity of behavior

 

tendency to avoid or approach strangers 

Term
Risk Factors for Pre-OP Anxiety
Definition

Ages 1-5 at greatest risk of extreme anxiety (Peaks at 1 year*)

 

Previous procedures

 

Trait Anxiety- shy, inhibited, lack social adapative abilities 

 

Parental Behaviors- anxious parents increase anxiety risk of chid 

Term
Child Life Specialists
Definition

Facilitate coping skills and adjustments of children and parents

 

Reduce anxiety during the pre-op period only 

 

Use play experiences, puppet shows, role rehersal using dolls, DVDs

Term
Ages for Behavioral Interventions
Definition

Negative effect on < 3 y.o

 

6 y.o benefit program 5 days before surgery- need time to process (more anxiety if just 1 day before surgery)

 

3-6 y.o increased ability to distinguish fantasy from reality 

Term
Parental Prescence During Induction of Anesthesia (PPIA)
Definition

Evidence does not support routine use of PPIA 

 

May disrupt OR routine, sterility, or refuse to leave child

 

Parents become anxious seeing child flaccid or going thru stage 2

 

Parents may cause excessive reassurance, commands, criticism--> need adequate prepartion (Must be informed) 

 

Privilege not a Right!

 

Term
Pre Meds
Definition

Pre-med + PPIA= less anxiety for the parent

 

Pre-med + PPIA= no further reduction in anxiety for the child 

 

Children recieving pre-med are less anxious and more compliant than those who are accompanied to the OR by the parent 

Term
Emergence Delirium
Definition

Nonpurposeful restlessness, agitation, thrashing, crying, moaning and disorientation.

 

Up to 18% of children develop this

Term
Contributing Factors to Emergence Delirium
Definition

Age (2-5)

 

Previous Surgery

 

Type of Procedure (eyes, BMT, tonils & adenoids)

 

Type of Anesthesia (less with propofol) 

Term
Aspiration
Definition

Children < 3 years are greater risk of aspiration

 

 majority occurs during induction of children***

 

13% on emergence vs 30% in adults 

Term
NPO Standards
Definition

2 hrs= clears

 

4 hrs= breast milk

 

6 hrs= formula

 

8 hrs= extremely large meal or high fat intake 

Term
Clear Liquids
Definition

1/2 life empty clears from stomach is 15 mins

 

98% will be empty in 1 hr

 

water, fruit juice NO PULP, carbonated beverages, clear tea, black coffee 

Term
Fasting Beyond 2 hrs
Definition

Do no encourage

 

risk of hypoglycemia, poor child cooperation, hypotension on induction 

Term
Chewing Gum
Definition

Have child spit gum out

 

Continue with elective surgery--> no clear evidence that this increases aspiration risk

 

 

Term
Predisposing factors to Aspiration
Definition

Decreased competence of LES

 

Air swallowng during crying

 

Diaphragmatic breathing

 

Shorter esophagus 

Term
Second Hand Smoking
Definition

Children are more likely to have asthma, otitis media, hav fever, dental caries

 

Strong association between airway complications on induction and emergence 

Term
Informed Consent
Definition

Inadequate preparation of child and family may lead to traumatic indunction and post-op pyschological disturbances

 

Need to tell about BP cuff, EKG leads, Precordial stethoscope, pulse ox, CO2 monitor, IV post induction 

 

Give parents and child ample time for questions 

Term
Emancipated Minors
Definition

Married

 

in the military

 

economically independent

 

** deserve complete confidentiality**

Term
0-6 months Pre-Op considerations
Definition

max stress for parents

 

not old enough to be frightened by strangers

Term
6 months to 4 years Pre-Op considerations
Definition

Maximum fear of separtion ***

 

Significant post-op emotional upset and behavioral regression

 

Begins magical thinking 

Term
4-8 years Pre-Op considerations
Definition

Concerned about body integrity***

 

Begins to understand explanations

 

Fear of separations remains 

Term
8 years- adolescence Pre-Op considerations
Definition

May interpret everything literally ***

 

Tolerates seperation well

 

Understand explanations

 

Fear of not waking up at all 

Term
Adolescence Pre-Op considerations
Definition

Issues reguarding self-esteem and body image**

 

Developing sexuality so fear loss of dignity**

 

Fear of unknown 

 

Independent 

Term
Autism
Definition

Delay in developmental socialization and communication skills

 

onset before 3 years

 

Doesnt respond well to changes in routine

 

Sensitive to light, sound, touch, and pain

 

Decision to pre-med (ketamine vs versed) made on individual basis 

 

Highly benefit from PPIA 

Term
URI
Definition

Purulent URI with fever, wheezing, rales--> postpone elective surgery for 4 weeks***

 

Most kids have a runny nose all year long so use good judgement

 

Tailor anesthetic to decrease risk--> LMA/Mask, Propofol

 

Bronchospasm risk increase 10 fold in children with URI***

Term
Premature Considerations
Definition

Formerly premature infants must remain overnight if their post-op conceptual age (gestational age + chronological age) is < 50 weeks 

 

Risk of post op apnea and bradycarida is high! 

Term
Seizure Disorders
Definition

Anticonvulsants should NOT be withheld the day of surgery

 

Children receiving Depakote (valporic acid) should have documented LFTs in the past 6 months 

Term
Trisomy 21
Definition

Macroglossia, Narrowed Cricoid Cartilage, and greater frequency of airway obstruction

 

Often resistant to sedative premedication

 

Risk of suluxation of atlanto- occipital joint and

subsequent spinal cord injury with neck flexion 


Weakness and parathesias of upper extremities should be sought, routine C-spine NOT necessary 

Term
Perioperative Consequences of Medications in ADHD
Definition

Resistance to pre-med

 

Cardiovascular instability

 

Lower seizure threshold

 

Increased PONV 

Term
Commonly Used ADHD Drugs
Definition

Most increase catecholamines

 

Methylphenidate (Ritalin)

 

Dexamphetamine (Dexedrin)

 

Bupropion (Wellbutrin)

 

Atomoxetine (Strattera) 

Term
Diabetes
Definition

Child should always be 1st case in morning

 

1/2 total morning dose of insulin for out-patient surgery

 

IV- D5LR, monitor hourly glucose

 

Major surgery admited the night before- insulin and glucose drips 

Term
Pregnant Adolescent
Definition

Appropraite to inform ONLY adolescent

 

Careful not to disclose pregnancy while explaining postponement of surgery

 

parents have NO legal right to information 

Term
Jehovah Witness
Definition

Address acceptable tranfusion therapy with family/parents/patient

 

In emergencies the child should be protected by transfusing blood without a court ***

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