Pediatrics

o Bench Marks
Birth wt doubles at 6 months and triples at 12 months
Birth length increases by 50% at 12 months
Post ontanel closes by ! wks
"nt ontanel closes by 12#1! months
Moro rele$ disappears at % months
&teady head control achie'ed at % months
(urns o'er at 5#6 months
)and to hand transers at * months
&its unsupported at ! months
+rawls at 10 months
,alks at 10#12 months
+ooing at 2 months
Monosyllabic Babbling at -#6 months. /inks syllables 6#0 mo
Mama. 1ada 2 a ew words at 0#12 months
(hrows a ball o'erhand at 1! months
1aytime toilet training at 1! mo # 2 years
2#- word sentences at 2 years
50% o adult )t at 2 years
Birth /ength doubles at % years
3ses scissors at % years
(ies shoes at 5 years
4irls5 growth spurt as early at 10 years 6 Boys catch up 7 "ge 1%
4irls inish growing at 715 6 Boys 7 1*
o "utosomal 8ecessi'e 1iseases
+9. P:3. &ickle +ell "nemia. (ay#&achs. "lbinism.
25% chance i; "& <trait only= > "& <trait only=
50% chance i; "& <trait only= > && <disease=
o "utosomal 1ominant 1iseases
)untington5s. Marans. Polydactyl. "chondroplasia. Polycystic :idney 1isease
50% i one parent has the disease?trait <trait @ disease in autosomal dominant=
o >#/inked 8ecessi'e 1iseases
Muscular 1ystrophy. )emophilia "
9emales are carriers <ne'er ha'e the disease=
Males ha'e the disease <but can5t pass it on=
50% chance daughters will be carriers <can5t ha'e disease=
50% chance sons will ha'e the disease <not a carrier @ can5t pass it on=
(his translates to an o'erall 25% chance that each pregnancy will result in a child that has the
disease
o &coliosis 6 Milwaukee Brace A 2- hrs?day. /og rolling ater &$
o 1own &yndrome @ (risomy 21 6 &imian creases on palms. hypotonia. protruding tongue.
upward outward slant o eyes
o +erebral Palsy 6 &cissoring @ legs e$tended. crossed. eet plantar#le$ed
o P:3 6 leads to M8 6 4uthrie (est 6"spartame <Butra&weet= has phenylalanine in it and
should not be gi'en to P:3 patient
o )ypothyroidism 6 /eads to M8
o Pre'ent Beural tube disorders with 9olic "cid during P4
o Myelomeningocele 6 +o'er with moist sterile water dressing and keep pressure o
o )ydrocephalus 6 &igns o increased C+P are opposite o shock 6
&hock @ Cncreased pulse and decreased BP
CC+P @ 1ecreased pulse and increased BP 6 <2 "ltered /D+ @ Most sensiti'e sign=
Cnants EEE CC+P @ Bulging ontanels. high pitched cry. increased hd circum. sunset eyes. wide
suture lines. lethargy 6 (reat with peritoneal shunt A don5t pump shuntE Dlder kids CCP+ @
,idened pulse pressure
CC+P caused by suctioning. coughing. straining. and turning A (ry to a'oid
o Muscular 1ystrophy 6 >#linked 8ecessi'e. waddling gait. hyper lordosis. 4ower5s &ign @
diiculty rising walks up legs <like Minor5s sign=. at pseudohypertrophy o cal'esE
o &eiFures 6 Bothing in mouth. turn hd to side. maintain airway. don5t restrain. keep sae 6
(reat with Phenobarbitol </uminol=. Phenytoin <1ilantin; (8 @ 10#20 6 4ingi'al )yperplasia=.
9osphenytoin <+ereby$=. Galproic "cid <1epakene=. +arbamaFepine <(egritol=
o Meningitis <Bacterial= 6 /umbar puncture shows Cncreased ,B+. protein. CC+P and decreased
glucose
May lead to &C"1) <(oo much "1)= 6 ,ater retention. luid o'erload. dilutional
hyponatremia
o +9 :ids taste salty and need enFymes sprinkled on their ood
o +hildren with 8ubella @ threat to unborn siblings <may reHuire temporary isolation rom Mom
during P4=
o Pain in young children measured with 9aces pain scale
o Bo MM8 CmmuniFation or kids with )$ o allergic r$n to eggs or neomycin
o CmmuniFation &ide Iects 6 ( J 102. redness and soreness at inKection site or - days 6 gi'e
(ylenol and bike pedal legs <passi'ely= or childE
o +all Physician i seiFures. high e'er. or high#pitched cry ater immuniFation
o "ll cases o poisoning 6 +all Poison +ontrol +enter 6 Bo CpecacL
o Ipiglottitis @ )E inluenFa B 6 +hild sits upright with chin out and tongue protruding <maybe
(ripod position= 6 Prepare or intubation or trach 6 1D BD( put anything into kid5s mouth
o Csolate 8&G patient with +ontact Precautions 6 Pri'ate room is best 6 3se Mist (ent to
pro'ide D2 and 8iba'irin A 9lood tent with D2 irst and wipe down inside o tent periodically so
you can see patient
o "cute 4lomerulonephritis 6 "ter B strep A "ntigen#"ntibody comple$es clog up glomeruli
and reduce 498 @ 1ark urine. proteinuria
o ,ilm5s (umor @ /arge kidney tumor 6 1on5t palpate
o (I9 @ (racheoesophageal "tresia 6 - +5s o (I9 @ +oughing. +hoking. +yanosis
o +let /ip and Palate 6 Post#Dp A Place on side. maintain /ogan Bow. elbow restraints
o +ongenital Megacolon @ )irschsprung5s 1isease 6 /ack o peristalsis due to absence o
ganglionic cells in colon 6 &uspect i no meconium w?in 2% hrs or ribbon#like oul smelling
stools
o Cron 1eiciency "nemia 6 4i'e Cron on empty stomach with citrus Kuice <'itamin + enhances
absorption=. 3se straw or dropper to a'oid staining teeth. (arry stools. limit milk intake J -2
oF?day
o &ickle +ell 1isease 6)ydration most important 6&+ +risis @ e'er. abd pain. painul
edematous hands and eet <hand#oot syndrome=. arthralgia 6($ 2 rest. hydration 6 "'oid high
altitude and strenuous acti'ities
o (onsillitis 6 usually &trep 6 4et P( and P(( Pre#Dp <ask about )$ o bleeding= 6 &uspect
Bleeding Post#Dp i reHuent swallowing. 'omiting blood. or clearing throat 6 Bo red liHuids.
no straws. ice collar. sot oods 6 )ighest risk o hemorrhage @ irst 2% hrs and 5#10 days post#
op <with sloughing o scabs=
o Primary meds or I8 or respiratory distress @ &us#phrine <Ipinephrine )+l= and (heophylline
<(heo#dur= 6 Bronchodilators
o Must know normal respiratory rates or kids 6 8espiratory disorders @ Primary reason or
most medical?I8 'isits or kids 6
Bewborn 6 -0#60
1#11 mo 6 25#-5
1#- years 6 20#-0
-#5 years 6 20#25
6#10 years 6 1!#22
11#16 years 616#20
+ardio'ascular 1isorders
o "cyanotic @ G&1. "&1. P1". +oarc o "orta. "ortic &tenosis
"ntiprostaglandins cause closure o P1" <aorta # pulmonary artery=
o +yanotic @ (etralogy o 9allot. (runcus "rteriosis <one main 'essel gets mi$ed blood=. (G4
<(ransposition o 4reat Gessels= 6 Polycythemia common in +yanotic disorders
- (5s o +yanotic )eart 1isease <(etralogy. (runcus. (ransposition=
o (etralogy o 9allot 6 3no$ygenated blood pumped into aorta
Pulmonary &tenosis
G&1
D'eriding "orta
8ight Gentricular )ypertrophy
(I( &pells 6)ypo$ic episodes that are relie'ed by sHuatting or knee chest position
o +)9 can result 6 3se 1igo$in 6 (8 @ 0E!#2E0 or kids
o 1uctus Genosus @ 3mbelical Gein to Cnerior Gena +a'a
o 1uctus "rteriosus @ "orta to Pulmonary "rtery
o 8heumatic 9e'er 6 "cHuired )eart 1isease 6 "ects aortic and mitral 'al'es
Preceded by beta hemolytic strep inection
Irythema Marginatum @ 8ash
Ile'ated "&D titer and I&8
+hest pain. shortness o breath <+arditis=. migratory large Koint pain. tachycardia <e'en during
sleep=
(reat with Penicillin 4 @ Prophyla$is or recurrence o 89
Maternity
o 1ay 1 o cycle @ 9irst day o menses <bleeding= 6 D'ulation on 1ay 1% 6 2! days total 6
&perm -#5 days. Iggs 2% hrs 6 9ertiliFation in 9allopian (ube
o +hadwick5s &ign @ Bluing o Gagina <early as % weeks=
o )egar5s &ign @ &otening o isthmus o cer'i$ <! weeks=
o 4oodell5s &ign @ &otening o +er'i$ <! weeks=
o Pregnancy (otal wt gain @ 25#-0 lbs <11#1% kg=
o Cncrease calorie intake by -00 calories?day during P4 6 Cncrease protein -0 g?day 6 Cncrease
iron. +a22. 9olic "cid. " M +
o 1angerous Cnections with P4 6 (D8+) @ (o$oplasmosis. other. 8ubella. +ytomegalo'irus.
)PG
o Bra$ton )icks common throughout P4
o "mniotic luid @ !00#1200 m/ <J -00 m/ @ Dligohydramnios @ etal kidney problems=
o Polyhydramnios and Macrosomia <large etus= with 1iabetes
o 3mbelical cord; 2 arteries. 1 'ein 6 Gein carries o$ygenated blood to etus <opposite o
normal=
o 9)8 @ 120#160
o 9olic "cid 1eiciency @ Beural tube deects
o Pre#term @ 20#-* weeks
o (erm @ -!#%2 weeks
o Post#term @ %2 weeks2
o (P"/ @ (erm births. Pre#term births. "bortions. /i'ing children
o 4ra'ida @ N o Pregnancies regardless o outcome
o Para @ N o 1eli'eries <not kids= ater 20 wks gestation
o Bagale5s 8ule 6 "dd * days to irst day o last period. subtract - months. add 12 months @
I1+
o )gb and )ct a bit lower during P4 due to hyperhydration
o &ide#lying is best position or uteroplacental perusion <either side tho let is traditional =
o 2;1 /ecithin;&phingomyelin 8atio @ 9etal lungs mature
o "9P in amniotic luid @ possible neural tube deect
o Beed a ull bladder or "mniocentesis early in P4 <but not in later P4=
o /ightening @ 9etus drops into true pel'is
o Besting Cnstinct @ Burst o Inergy Kust beore labor
o (rue /abor @ 8egular contractions that intensiy with ambulation. /BP that radiates to
abdomen. progressi'e dilation and eacement
o &tation @ Begati'e abo'e ischial spines. Positi'e below
o /eopold Maneu'er tries to reposition etus or deli'ery
o /aboring Maternal Gitals 6 Pulse J 100 <usually a little higher than normal with P4 # BP is
unchanged in P4=E ( J 100E%
o BDB#&tress (est 6 8eacti'e @ )ealthy <9)8 goes up with mo'ements=
o +ontraction &tress (est <Dcytocin +hallenge (est=6 3nhealthy @ /ate decels noted <positi'e
result= indicati'e o 3PC 6 OBegati'eP result @ Bo late decels noted <good result=
o ,atch or hyporele$ia with Mag &ulate admin E E E 1iaphragmatic Cnhibition
:eep +alcium gluconate by the bed <antidote=
o 9irsts
9etal )B 6 !#12 weeks by 1oppler. 15#20 weeks by etoscope
9etal mo'ement @ Quickening. 1%#20 weeks
&howing @ 1% weeks
Bra$ton )icks A % months and onward
o Iarly 1ecels @ )ead compression @ D:
o Gariable 1ecels @ +ord compression @ Bot 4ood
o /ate 1ecels @ 3tero#placental insuiciency @ B"1L
o C Gariable or /ate 1ecels 6 +hange maternal position. &top Pitocin. "dminister D2. Botiy
Physician
o 1C+ 6 ($ is with )eparin <sae in P4= 6 9etal 1emise. "bruptio Placenta. Cnection
o 9undal )eights
12#1% wks 6 "t le'el o symphysis
20 weeks 6 20 cm @ /e'el o umbilicus
8ises 7 1 cm per week
o &tages o /abor
&tage 1 @ Beginning o 8egular contraction to ull dilation and eacement
&tage 2 @ 10 cm dilation to deli'ery
&tage - @ 1eli'ery o Placenta
&tage % @ 1#% )rs ollowing deli'ery
o Placenta &eparation 6 /engthening o cord outside 'agina. gush o blood. ull eeling in
'agina 6 4i'e o$ytocin ater placenta is out A Bot beoreE
o &chultF Presentation @ &hiny side out <etal side o placenta=
o Postpartum G& &chedule
I'ery 15 min > 1 hr
I'ery -0 min > ne$t 2 hours
I'ery )our > ne$t 2#6 hours
(hen e'ery % hours
o Bormal BM or mom within - days @ Bormal
o /ochia 6 no more than %#! pads?day and no clots R 1 cm 6 9leshy smell is normal. 9oul
smell @ inection
o Massage boggy uterus to encourage in'olution 6 empty bladder "&"P A may need to
catheteriFe 6 9ull bladder can lead to uterine atony and hemorrhage
o (ears 61st 1egree @ 1ermis. 2nd 1egree @ mm?ascia. -rd 1egree @ anal sphincter. %th
1egree @ rectum
o "P4"8 @ )8. 8. mm tone. 8ele$ irritability. +olor 6 1 and 5 minutes 6*#10 @ 4ood. %#6 @
moderate resuscitati'e eorts. 1#- @ mostly dead
o Iye care @ I#mycin 2 &il'er Bitrate 6 or gonorrhea
o Pudendal Block @ decreases pain in perineum and 'agina A Bo help with contraction pain
o Ipidural Block @ (10#&5 6 Blocks all pain 6 9irst sign @ warmth or tingling in ball o oot or
big toe
o 8egional Blocks oten result in orceps or 'acuum assisted births because they aect the
mother5s ability to push eecti'ely
o ,B+ counts are ele'ated up to 25.000 or 710 days post partum
o 8ho<1= immune globulin <8ho4"M= is gi'en to 8h# mothers who deli'er 8h2 kids6 Bot
gi'en i mom has a 2+oombs (est 6 &he already has de'eloped antibodies <too late=
o +aput &uccedaneum @ edema under scalp. crosses suture lines
o +ephalhematoma @ blood under periosteum. does not cross suture lines
o &uction Mouth irst A then nostrils
o Moro 8ele$ @ &tartle rele$ <abduction o all e$tremities= A up to % months
o 8ooting 8ele$ 6 up to % months
o Babinski 8ele$ 6 up to1! months
o Palmar 4rasp 8ele$ 6/essens by % months
o Ballard &cale used to estimate gestational age
o )eel &tick @ lateral surace o heel
o Physiologic Saundice is normal at 2#- days 6 "bnormal i beore 2% hours or lasting longer
than * days 6 3nconKugated bilirubin is the culpritE
o Gitamin : gi'en to help with ormation o clotting actors due to act that the newborn gut
lacks the bacteria necessary or 'itamin : synthesis initially 6 Gastus lateralis mm CM
o "brutio Placenta @ 1ark red bleeding with rigid board like abdomen
o Placenta Pre'ia @ Painless bright red bleeding
o 1C+ @ 1isseminated Cntra'ascular +oagulation 6 clotting actors used up by intra'ascular
clotting A )emorrhage and increased bleeding times result 6 "ssociated with etal demise.
inection and abruptio placentaE
o Magnesium &ulate used to reduce preterm labor contractions and pre'ent seiFures in Pre#
Iclampsia 6 Mg replaces +a22 in the smooth mm cells resulting rela$ation 6 +an lead to
hyporele$ia and respiratory depression A Must keep +alcium 4luconate by bed when
administering during labor @ "ntidote 6 Monitor or;
"bsent 1(85s
8espirations J 12
3rinary Dutput J -0?hr
9etal Bradycardia
o Pitocin <D$ytocin= use or 1ystocia6 C uterine tetany de'elops. turn o Pitocin. admin D2 by
ace mask. turn pt on sideE Pitocin can cause water into$ication owing to "1) eectsE
o &uspect uterine rupture i woman complains o a sharp pain ollowed by cessation o
contractions
o Pre#Iclampsia @ )tn 2 Idema 2 Proteinuria
o Iclampsia @ )tn 2 Idema 2 Proteinuria 2 &eiFures and +oma 6 &uspect i &e'ere )" 2
'isual disturbances
o Bo +oumadin during P4 <)eparin is D:=
o )yperemesis 4ra'idarum @ uncontrollable nausea and 'omiting 6 May be related to )E
pyolori 6 8eglan <metaclopromide=
o Cnsulin demands drop precipitously ater deli'ery
o Bo oral hypoglycemics during P4 A (eratogenic 6 Cnsulin only or control o 1M
o Babies born without 'aginal sHueeFe more likely to ha'e respiratory diiculty initially
o +#&ection can lead to Paralytic Cleus 6 Iarly ambulation helps
o Postpartum Cnection common in problem pregnancies <anemia. diabetes. traumatic birth=
o Postpartum )emorrhage @ /eading cause o maternal death 6 8isk actors include;
1ystocia. prolonged labor. o'erdistended uterus. abrutio placenta. inection
($ includes 6 9undal massage. count pads. G&. CG luids. D$ytocin. notiy physician
o Sitteriness is a symptom o hypoglycemia and hypocalcemia in the newborn
o )ypoglycemia 6 tremors. high pitched cry. seiFures
o )igh pitched cry 2 bulging ontanels @ CC+P
o )ypothermia can lead to )ypo$ia and acidoisis 6 :eep warm and use bicarbonate prn to treat
acidosis in newbornE
o /ay on right side ater eeding 6 Mo'e stomach contents into small intestine
o Saundice and )igh bilirubin can cause encephalopathy 6 J 12 @ normal 6 Phototherapy
decomposes bilirubin 'ia o$idation 6 Protect eyes. turn e'ery 2 hours and watch or
dehydration 6 (he dangerous bilirubin is the unconKugated indirect typeE
o ,hen in doubt on B+/I> 6 "nswer should contain something about e$ercise and nutritionE
"d'anced +linical +oncepts
o Irickson 6 Psycho#&ocial 1e'elopment
0#1 yr <Bewborn= 6 (rust 'sE Mistrust
1#- yrs <(oddler=6 "utonomy 'sE 1oubt and &hame 6 9ear intrusi'e procedures # &ecurity
obKects good <Blankies. stued animals=
-#6 yrs <Pre#school= 6 Cnitiati'e 'sE 4uilt 6 9ear mutilation A Band#"ids good
6#12 yrs <&chool "ge= 6 Cndustry 'sE Cneriority6 4ames good. Peers important 6 9ear loss
o control o their bodies
12#10 yrs <"dolescent= 6 Cdentity 'sE 8ole +onusion 6 9ear Body Cmage 1istortion
20#-5 yrs <Iarly "dulthood= 6 Cntimacy 'sE Csolation
-5#65 yrs <Middle "dulthood= 6 4enerati'ity 'sE &tagnation
D'er 65 <Dlder "dulthood= 6 Cntegrity 'sE 1espair
o Piaget 6 +ogniti'e 1e'elopment
&ensorimotor &tage <0#2= 6 /earns about reality and obKect permanence
Preoperational &tage <2#*= 6 +oncrete thinking
+oncrete Dperational &tage <*#11= 6 "bstract thinking
9ormal Dperational &tage <11#adult= 6 "bstract and logical thinking
o 9reud 6 Psycho#&e$ual 1e'elopment
Dral &tage <Birth #1 year= 6 &el gratiication. Cd is in control and running wild
"nal &tage <1#-= 6 +ontrol and pleasure wrt retention and pooping A (oilet training in this
stage
Phallic &tage <-#6= 6 Pleasure with genitals. Dedipus comple$. &uperIgo de'elops
/atency &tage <6#12= 6 &e$ urges channeled to culturally acceptable le'el. 4rowth o Igo
4enital &tage <12 up= 6 4ratiication and satisying se$ual relations. Igo rules
o :ohlberg 6 Moral 1e'elopment
Moral de'elopment is seHuential but people do not aromatically go rom one stage to the ne$t
as they mature
/e'el 1 @ Pre#con'entional 6 8eward 'sE Punishment Drientation
/e'el 2 @ +on'entional Morality 6 +onorms to rules to please others
/e'el - @ Post# +on'entional 6 8ights. Principles and +onscience <Best or "ll is a concern=
+alculations 8ules M 9ormulas
o 8ound inal answer to tenths place
o 8ound drops to nearest drop
o ,hen calculating m/?hr. round to nearest ull m/
o Must include 0 in ront o 'alues J 1
o Pediatric doses rounded to nearest 100thE 8ound down or peds
o +alculating CG 9low 8ates
(otal m/ > 1rop 9actor ? 60 > N)rs @ 9low 8ate in gtts?min
o +alculating Cnusion (imes
(otal m/ > 1rop 9actor ? 9low 8ate in gtts?min > 60 @ )rs to Cnuse
+on'ersions
o 1 t @ 5m/
o 1 ( @ - t @ 15 m/
o 1 oF @ -0 cc @ -0 m/ @ 2 (
o 1 gr @ 60 mg
o 1 mg @ 1000 ug <or mcg=
o 1 kg @ 2E2 lbs
o 1 cup @ ! oF @ 2%0 m/
o 1 pint @ 16 oF
o 1 Huart @ -2 oF
o 1egrees 9 @ <1E! > += 2 -2
o 1egrees + @ <9 A -2= ? 1E!
-* + @ 0!E6 9
-! + @ 100E% 9
-0 + @ 102E2 9
%0 + @ 10% 9
9all Precautions
o 8oom close to nurses station
o "ssessment and orientation to room
o 4et help to stand <dangle eet i light headed=
o Bed low with side rails up
o 4ood lighting and reduce clutter in room
o :eep consistent toileting schedule
o ,ear proper non#slip ootwear
o "t home 6
Paint edges o stairs bright color
Bell on cats and dogs
Beutropenic <Cmmunosuppressed= Precautions
o Bo plants or lowers in room
o Bo resh 'eggies 6 +ooked oods only
o "'oid crowds and inectious persons
o Meticulous hand washing and hygiene to pre'ent inection
o 8eport e'er R 100E5 <immunosuppressed pts may not maniest e'er with inection=
Bleeding Precautions <"nticoagulants. etcE=
o &ot bristled tooth brush
o Ilectric raFor only <no saety raFors=
o )andle gently. /imit contact sports
o 8otate inKection sites with small bore needles or blood thinners
o /imit needle sticks. 3se small bore needles. Maintain pressure or 5 minutes on 'enipuncture
sites
o Bo straining at stool # +heck stools or occult blood <&tool soteners prn=
o Bo salicylates. B&"C1s. or suppositories
o "'oid blowing or picking nose
o 1o not change Gitamin : intake i on +oumadin