#5 Pregnancy Test #4 114 (Pediatric Physical Variations)

kelsscoot's version from 2015-11-26 18:15

Section 1

Question Answer
IntegumentaryIncreased risk of heat and water loss, Decreased heat tolerance, Presence of other things listed next.
Miliaareas of tiny white facial papules (keratin-filled cysts that appear just under epidermis, little bumps like pimple)
Salmon patches (stork bites)irregular red or pink patches found most commonly on the back of the neck
mongolian spotsgray, blue, or purple spots in the sacral and buttocks area of newborns
Acrocyanosisbluish or purple coloring of the hands and feet caused by slow circulation
Vernix caseosawhite, cheeselike mixture of sebumm and epidermal cells. At birth, newborn's skin typically covered with it.
Strawberry hemangiomasmay appear anywhere on the body, but are most common on the face, scalp, back, or chest. They consist of small, closely packed blood vessels. They may be absent at birth, and develop at several weeks. They usually grow rapidly, remain a fixed size, and then subside. In most cases, strawberry hemangiomas disappear by the time a child is 10 years old. Some slight discoloration or puckering of the skin may remain at the site of the hemangioma.)
HemangiomaBright red, raised lesion about 2-10cm in diameter that does not blanch with pressure and is usually present at birth. Typically, disappears by age 10. Caused by a cluster of immature capillaries. Cause is unknown; may be hereditary. may appear anywhere on body.
Cavernous hemangiomassimilar to strawberry hemangiomas but are more deeply situated. They may appear as a red-blue spongy mass of tissue filled with blood. Some of these lesions may disappear on their own -- usually as a child approaches school age.
Morbilliform or "measles-like" rashesconsists of macular lesions that are red and usually 2–10 mm in diameter but may be confluent in places.
Atopic dermatitis - eczemaaffects your skin's ability to hold moisture. Your skin becomes dry, itchy, and easily irritated. You itch, Scratching causes the dry skin to become red and irritated (inflamed). Infection often occurs. Tiny bumps that look like little blisters may appear and ooze fluid or crust over. These symptoms-dryness, itchiness, scratching, and inflammation-may come and go. Over time, a recurring rash can lead to tough and thickened skin..

Section 2

Question Answer
headPresence of fontanels on newborns
Posterior fontanelslocated at superior occiput, may not be palpable at birth
Anterior fontanel2-4cm diamond, closes between 9 and 18 months
Bulgingcaused by increased intracranial pressure
Caput succedaneumcollection of fluid in the tissues (edema) at the top of the skull. "Cone head"
cephalohematomasBlood collections inside the skull's periosteum and do not cross suture lines.
During the first week of life, children with cephalohematomas are at an increased risk for developing what ?jaundice
Head disproportionate to bodyhead is largest surface area in infants, heat loss and cold stress are a concern, and head remains disproportionate until approx. 5 years of age
what is the largest surface area in infants?head
Until what age, does the head remain disproportionate?5 years
fontanels1.a space between the bones of the skull in an infant or fetus, where ossification is not complete and the sutures not fully formed.
moldingshaping of the head by pressure on the bony structures as the head moves through vaginal canal during delivery

Section 3

Question Answer
NoseSmaller sinuses, proportionately smaller than in adults
What sinus's are present at birth?Maxillary and ethmoid sinus
Eyes and VisionMeasurement of visual acuity
Why do you inspect the inner and outer structures?Checking for symmetry, position, movement, and appearance
Decreases until what age?7
Snellen ExamVision exam with E's pointing in different directions
myopiainability to see objects at a distance
Smaller the fraction in visionthe worse the vision
20/200 vision is considered to be what?legal blindness
Changes in vision can be related to dysfunction of which cranial nerve?cranial nerve II
hyperopiainability to see objects at close range
Presbyopiainability to accommodate for near vision (common in persons over 45 years of age)
Corneal light reflection testSitting eye level with pt, pt stare straight ahead while pen light is held 12in from both eyes. Shine light into eyes. Reflection of light should appear in the same spot on both pupils. appears as a "twinkle" inthe eye.
Retinoblastomamay be present if an absent or white glow red reflex
congenital cataractscauses the cornea to apear hazey
If the reflection of light is not symmetric, what could this mean? Weakness in the extraocular muscles
Can babies see at birth?yes, their visual acuity just is not as sharp as an adult's. Typically, children have 20/20 vision by age 7.
When does the babies eye color begin to change to a permanent color?3rd month
When do tears begin for a baby?little to no tears present at birth bu begin to appear by fourth week
What is Binocular vision?vision in both eyes
When does binocular vision begin to develop?by 6 weeks of age
When do the eyes reach the size of an adult's?by age 8

Section 4

Question Answer
Ears and hearingSmaller external ear canals with shorter, straighter eustachian tubes
How do you examine the tympanic membrane with the otoscope of children under the age of 4 years?Pull the earlobe down and back
How do you examine the tympanic membrane with the otoscope of children over the age of 4 years?Pull the earlobe up and back
How does an increased frequency of colds and respiratory infections affect the ears?results in an increased incidence of otitis media, or middle ear infections, in children under the age of 4.
Otitis mediamiddle ear infection
Otitis externaswimmer's ear
Occurrence of otitis media peaks between which months of age?6 and 18
What do children with otitis media usually present with?fever, decreased appetite, irritability, and inability to sleep lying down.
Vascular tissue that appears red with infection, fevery, or any condition that results in skin flushintympanic membrane
How do you know you can rule out bacterial otitis media in a child?If the child has a red tympanic membrane but no purulent discharge in the middle ear space

Section 5

Question Answer
Mouth and NeckTeeth, thyroid, lymph tissue,
When does a child begin eruption and loss of primary teeth?between 4-6 years of age
How are teeth lost?lost in order they erupt
Thyroidshorterneck and nonpalpable thyroid gland
Are lymph nodes present at birth?yes
Differentiation and growth of lymphatic tissue occurs primarily between what years?4 and 8
What are shotty nodes?noninfected, nontender, slightly enlarge lymph nodes that move when palpated and feel firmer than normal
What changes can occur if the thyroid gland is over or undersecreted?May cause rapid weight gain or loss, heat or cold intolerance, fatigue, mood swings, tremor, anxiety, tachycardia and palpations, muscle weakness, changes in skin and hair

Section 6

Question Answer
Normal Childhood vital signspg 165
NewbornHR (90-160), RR (30-50), BP (60-90/40-60)
1-11 monthsHR (85-170), RR (24-45), BP (94-104/50-60)
1-2 yearsHR (70-150), RR (22-38), BP (98-109/56-63)
3-5 yearsHR (72-140), RR (31-30), BP (100-115/59-71)
6-10 yearsHR (69-130), RR (18-24), BP (105-123/67-80)
11-14 yearsHR (65-120), RR (14-20), BP (110-131/64-84)
15 years or greaterHR (55-100), RR (14-20), BP (113-130/50-84)

Section 7

Question Answer
Respiratory SystemLung development is complete in healthy full term newborns
Since the chest wall is thinner, how does that affect the breath sounds?thinner chest wall = louder and harsher breath sounds
Abdominal breathing is common until what age?6
When does chest breathing begin?in school-age years (6-10)
Why does the need for oxygen increase?Increased metabolic rates result in higher oxygen consumption.
Until adolescence, children are more prone to what? (in relation to their airway)More prone to airway collapse and blockage. Smaller more pliant airways - (more bendable) until early adolescence
This is greatest in infants, toddlers, and preschoolers, but children of all ages experiance it much more quickly than adults.Respiratory failure

Section 8

Question Answer
When does closure of ductus venosus, ductus arteriosus, and foramen ovale occur?With first breath baby takes
The ductus venosus may remain open for how many hours post birth?12-72
heart perid variability, heart rate increases during inspiration and decreases during expiration, common until early adultSinus Arrhythmias
Thinner chest meanslouder heart sounds
PMI is how many intercostal spaces higher than in adults?1 (adult = 5th, child = 4th)
PMIpoint of maximum impulse
What will make innocent murmurs more pronounced?any condition that increases metabolism, like fever or anemia

Section 9

Question Answer
What do you assess for when examining the breasts?Inverted nipples, breast discharge, Thelarche
Therlarchebreast budding
What is often the first pubertal sign in females?Therlache
Gynecomastiabenign development of breast tissue in males, results in tender, mobile knot under the areola in as many as one third of adolescent males
Gynecomastia is more common in who?overweight males and in teens that use performance enhancing steroids
Abdomenpresence/removal of umbilical cord, palpable liver edge, round in newborns and infants
The umbilical cord will dry and fall off how many days after birth?10-14
malignancy of the kidney commonly diagnosed in infants and toddlersWilm's tumor ( do not palpate if Wilm's tumor or mass is suspected, can disseminate the tumor seeds into the abdomen
causes protrustion at the umbilicus and are visible at birthUmbilical hernias
Wet diapers are a sign of what?hydration
Smaller bladder capacities meanincreased frequency
When do females attain bladder sphincter control?approximately 3 years
When do males attain bladder sphincter control?approximately 3.5
What is the normal urine output for a childat least 1-2ml/kg/hr
When does genital growth occur in females?11
When does genital growth occur in males?13
Infant vaginal discharge as result of maternal hormones is normal or abnormal?Normal

Section 10

Question Answer
How does a child's skeleton compare to an adult's skeleton?Children's has more cartilage and structurally weaker than adult's
Instead of injuring a ligament, muscle, or tendon, pre-adolescent children are more likely to have what occur?Bone fracture
When does the human skeleton ossify?18
Where does bone growth occur?at the epiphyseal plates located in the ends of the bones
What could cause bone growth failure and limb length discrepancy?fractures of the epiphyseal plates
Genu varumbow legged
Genu valgumknock knees
Scoliosislateral curvature of the lumbar or thoracic
When should screening for scoliosis begin?by age 5
Dysplasia of the hipcongenital disorder that results from inadequate development of the hip socket, often manifested in the early newborn period, may be noted anytime under 2 years of age
Common physical findings in the newborn period of dysplasia of the hip includeuneven glutial folds
Alli's signlevel knees when bent
Ottolani's signhips are flexed
Barlow's signIDK
Gower's signwhen child places hands on knees and pushes trunk up, may indicate generalized weakness
Growthmeasurable physical change and increase in size

Section 11

Question Answer
Muscular dystrophyX-linked genetic disorder that result in progressive loss of muscular function
Are males or females affected more by muscular dystrophy?Males, 4x more
When are the first signs of muscular dystrophy often noted?Around age 3
What types of muscles are affected by muscular dystrophy?both smooth and skeletal
What symptoms would the child with muscular dystrophy show?Muscle weakness, enlarged calf muscles, and impaired gait. May use Gower's sign (puts hands on knees and pushes themself up)
polydactylytoo many fingers
syndactylywebbed toes

Section 12

Question Answer
Myelin sheathfatty substance that covers neurons of the brain and spinal cord, speeds nerve impulse conduction
Myelin sheath grows until how many years of age?2 or 3
Presence of primitive reflexes pg 752-753Tonic, palmer grasp, planter reflex, Moro (startle), Rooting, Stepping, Babinski
Tonicturning the infant's head to one side while supine. The infant will extend the arms and legs onthe side the head is turned to while flexing opposite side, disappears 2-6months.
Palmer graspgrasps objects, disappears 3-4months
Planter reflexcurl toes when base of the toes is touched, disappears 6-8mo
Moro (startle)extend arms with fingers spread and flex legs with loud sounds or if infant's body drops suddenly, disappears 4-6months
Rootinglightly stroke infant's cheek. Infant will turn head with mouth open toward the stroked side. Disappears 3-4 months
Steppinginfant will flex leg and take steps if the infant is upright with feet touching a surface, disappears 4-5 months
Babinskigently stroke the plantar surface of the foot from heel to toe. Infants will extend and fan the toes and flex the food. Disappears 18-24mo

Section 13