Pediatrics Exam 1 Study Guide

Infant Health Promotion Teaching on Leading Cause of Death Leading Cause of death: LBW, congenital anomalies, disorders relating to short gestation and unspecified LBW, SIDS, and newborn affected by maternal complications of pregnancy. Access to and use of high-quality prenatal care decrease early delivery and infant mortality. Teach parents about prenatal care, placing infant on back to sleep. Assist family on making informed decisions and that they are aware of all available health services, treatments and procedures. S/S of Pain in Infant Physiological Responses Vitals: Increased HR, Increased BP, rapid/shallow respirations Oxygenation: Decreased tcPo2, decreased Sao2 Skin: Pallor or flushing; diaphoresis; palmar sweating Other Observations: Increased muscle tone; dilated pupils; decreased vagal nerve tone; increased ICP; metabolic or endocrine changes; hyperglycemia; lowered pH, elevated corticosteroids. Behavioral Responses Vocalizations: Crying, whimpering, groaning Facial Expression: Grimaces, brow furrowed, chin quivering, eyes tightly closed, mouth open and squarish Body Movements and Posture: limb withdrawal; trashing; rigidity; flaccidity; fist clenching Changes in State: Changes in sleep-wake cycles; changes in feeding behavior; changes in activity level; fussiness, irritability; listlessness. Abuse Indicators Physical Abuse Physical Findings Bruises and Welts (May be in various stages of healing) • Face, lips, mouth, back, buttocks, thighs or areas of torso. • Regular patterns descriptive of object used, such as belt buckle, hand, wire hanger, chain, wooden spoon, squeeze or pinch marks. • May be present in various stages of healing Burns • On soles, palms, back, or buttocks. • Patterns descriptive of object used. • Absence of “splash” marks and presence of symmetric burns • Stun gun injury; lesions circular, fairly uniform. Fractures/Dislocations • Skull, nose, or facial structures. • Injury denoting type of abuse (spiral fracture or dislocation from twisting an extremity or whiplash from shaking a child) • Multiple new or old fractures in various stages of heeling Lacerations and Abrasions • On backs of arms, legs, torso, face, or external genitalia • Unusual symptoms abdominal swelling, pain, and vomiting from punching • Descriptive marks such as human bites or pulling out of hair Chemical • Unexplained repeated poisoning, especially drug overdose • Unexplained sudden illness (hypoglycemia form insulin admin.) Suggestive Behaviors Wary of physical contact with adults; apparent feat of parents or going home; lying very still while surveying environment; inappropriate reaction to injury, such as failure to cry from pain; lack of reaction to frightening events; apprehension when hearing other children cry; indiscriminate friendliness and displays of affection; superficial relationships; acting-out behavior, such as aggression to seek attention; withdrawal behavior. Emotional Abuse and Neglect Physical Findings: Growth failure, eating disorder, enuresis or sleep disorder. Suggestive Behaviors: Self-stimulatory behaviors; during infancy; lack of social smile and stranger anxiety. Withdrawal form environment and people; unusual fearfulness. Antisocial behavior; extremes of behavior; lags in emotional and intellectual development; suicide attempts. Sexual Abuse Physical Findings: Bruises, bleeding, lacerations, or irritation of external genitalia, anus, mouth or throat. Torn, stained, or bloody underclothing. Pain on urination or pain, swelling, and itching of genital area. Penile discharge. STD. Difficulty walking or sitting, unusual odor in the genital area, recurrent UTIs, presence of sperm, or pregnancy in young teen. Suggestive Behaviors: Sudden emergence of sexual problems; withdrawn behavior; preoccupation with fantasies; poor relationships with peers. Sudden changes in weight or behavior; excessive anger at parents. Regressive behavior; sudden onset of phobias. Running away from home, substance abuse, personality changes. Rapid declining school performance; suicide attempts. Nursing Care: Priority is removing child. Care for child the same way as any other; do not treat them as a victim. Implement teaching through demonstration. Infant’s Vital Signs Temperature: 97.7-99.7 F. Axillary temp is lower than rectal temp. Heart Rate: 120-140 bpm; Bradycardia <80-100 bpm; Tachycardia 160-180 bpm. Respirations: 30-60 breaths/min Blood Pressure: 65/41 in arm and calf. Systolic pressure greater than 90 considered hypertension. Indicator of Fluid Loss in an Infant Changing sensorium, decreased response to stimuli, decreased turgor, prolonged capillary refill. Increased HR, sunken eyes, sunken fontanels. Psychosocial Needs of a Hospitalized School Age Child Rely on what they know. They want explanations and reasonings. Concern about body integrity. They are interested in the functional aspect of things. They are beginning to be aware of how their body functions, they have an ability to describe pain and an increasing ability to understand cause/effect. They fear loss of control in hospital, seek information as a way to maintain control. They can sense when they aren’t being told the truth, and can experience stress of being separated from peers and regular routine. ..........................................................................CONTINUED