Exam 1 Study Guide- Peds
Infant: birth to 1-year, oral stage
Toddler: 1 to 3 years, anal stage
Preschooler: 3 to 6 years, phallic stage
School Age: 6 to 12 years, latency stage
Adolescent:12-19 years, genital stage
Piaget
 Sensorimotor (birth to 2 years)- learning through sensory/motor
 Preoperational (2 to 7 years)- understanding past, present and future.
 Concrete operational (7 to 11 years)- understanding between objects and events but
limited to their own experiences.
 Formal operational (12+ years)- abstract thinking
Newborn
 First 28 days of life
 Trust vs mistrust-there is no such thing as “spoiling” a newborn holding too much, they
need to know that they can trust their caregivers
 Reflexes-rooting, sucking, babinski, palmar grasp, moro startle, fencing
Infant
 Weight doubles in 4-6 months and triples in 1 year
 Milestones
o 4-6 months- no head lag when pulled up to sitting, bears weight in standing
position reaches for objects beyond grasp, watches faces when they talk.
o 7-8 months- sits alone without support, holds bottle, pincer grasp, realization that
actions produce consequences.
o 9-12 months- goes from crawling to creeping to cruising, attempts to walk alone,
self-feed finger foods, develops object permanence
Toddler
 Pot belly appearance, half of adult height by 24 months
 Anterior fontanel closes by 12-18 months
 Milestones
o 13-18 months- walks a few steps, jumps with both feet, stacks 4 blocks, increased
hand-eye coordination, understands simple phrases, speaks 10 words
o 19-30 months- rides tricycle, stacks 8 blocks, developed balance, 20 teeth grown
in, speaks 2-3 word sentecnes, potty trained
o 30-36 months- gives first and last name, names body parts, uses 900 words
Pre-schooler
 Egocentricism, contrete thinking
 Imitative & imaginative play
 Milestones
o 3 years- balances on 1 foot, alternate feet on stairs, copy circle, dress/undress self
o 4 years- skips and hops on 1 foot, throws ball, draw stick figure with 3 parts
o 5 years- walks backwards, jump rope, draw person with at least 6 parts, ties shoes
School-Age
 Concrete operations
 Basic 6 motor skills- balancing, catching, throwing, running, jumping, climbing.
 First adult tooth by 6 years
 Puberty starts at 12 years old for girls, boys at 14 years old.
 Milestones
o 6-7 years- print letters, ride bike, bathes & dresses self, uses silverware, tell time,
reads, knows value of currency, demonstrates independence.
o 8-9 years- plays team sports, draws 3D pictures, knows date, loses thinking that
inanimate objects have senses, looks up to adults.
o 10-12 years- developing abstract thinking, influenced by TV & social media, likes
to discuss and debate, developing interest in opposite sex.
Adolescence
 Growth spurts- females reach max height at 11 years old, males about 14 years old
 Identity vs role confusion
 Gender identity, intimacy & dating, mental health
 Milestones
o 11-14 years- appetite increases and muscle mass increases.
o 15-17 years-physical endurance increases, acne due to hormonal changes
o 18-21- sexual maturity, stable appetite, dentition complete
Pain Assessment
 Initial pain evaluation, intervention, reassessment
 Physiological indications of acute pain- dilated pupils, increased HR RR BP, decreased
urine and stool output
 Pain scales
o CRIES- neonatal postoperative pain assessment
o FLACC- nonverbal assessment, used for infants.
o Wong Baker Faces- toddlers and school age
o Spoken scale (0-10)- age 7 to adult
 The goal in peds is to provide trauma preventative care, make things less scary and hurt
less
Fluid & Electrolytes
 Isotonic dehydration
o Electrolyte deficits= water deficits
o Most common
 Hypotonic dehydration
o Salt deficits, water level is mostly normal.
 Hypertonic dehydration
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o Water deficits, electrolyte sare mostly normal
Prerenal AKI- dehydration
Intrinsic AKI- inside the kidney; diseases, toxic agents
Postrenal AKI- obstructions, kidney stones, bladder obstructions
IV fluids
o Isotonic- LR (don’t use if renal function is unknown), 0.9% NaCl
o Hypotonic- 0.45% NaCl. ¼ NS, 1/5 NS
o Hypertonic- D10W, TPN
Metabolic Acidosis ( pH, CO2)- bicarbonate loss, diarrhea
Metabolic Alkalosis ( pH, CO2)- vomiting, diuretic therapy
Cardiovascular
 Foramen Ovale- functions as the opening between atria; allows blood to bypass lungs.
 Ductus Arteriosis- opening between pulmonary artery and aorta; allows blood to bypass
lungs. Becomes aortic ligament.
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Indications of Cardiac problems- poor feeding, tachypnea, tachycardia,
age/carpoor weight gain,
failure to thrive, activity intolerance, developmental delays, prenatal
history, family
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history of cardiac disease
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Acyanotic CHD
 shunts lesions; left to right blood flow.
o Atrial Septal Defect;ASD.
o Ventricular septal defect; VSD,
o Patent Ductus Arteriosus; PDA
o Atrioventricular canal (AV canal)
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Obstructive lesions
o Right ventricular outflow tract
o Pulmonary stenosis
o Left ventricular outflow tract
o aortic stenosis, coarctation of aorta
Cyanotic CHD- trunctus arteriosis, tricuspid atresia, tetraology of fallot
Defects with increased pulmonary blood flow-ASD (between L &R atria; asymptomatic),
VSD (between L &R ventricle, murmur L sternal border), PDA (between aorta and
pulmonary artery, murmur L sternal border)
Defects with decreased pulmonary blood flow- tetralogy of fallot, tricuspid atreasia (no
tricuspid valve)
Defects with obstruction of blood flow- tetralogy of fallot, tricuspid atresia (no tricuspid
valve)
Defects with obstructions of blood flow from the flow -COA (compacted aorta), aortic
stenosis narrowing of ventricular outflow tract)
Defects with mixed blood flow- trunctus arteriosis, transposition of the great arteries
Tet spells-hyper cyanotic periods (idiopathic)
Right sided heart failure- R for round; like swelling
Left-sided heart failure- L for lungs
Endocarditis- failure of valves due to s. viridah, usually had to have prosthetic/mech
valve
Rheumatic fever- inflammatory disease of the heart due to strep, always treated with PCN
Respiratory
Appearance, Work of Breathing, Circulation
o Tone, inter-activeness, console, look gaze, speech or cry
o Accessory muscles, respiratory rate
o Color, mottled, pale dusky
 Acute Otitis Media- associated with RSV, middle ear infection
o s/s-pain, pulling ear, temp, URI, enlarged lymph nodes, purulent discharge,
doesn’t want to lay down
 Croup- barking cough, swelling of the upper airway
 Epiglottis- swelling of trachea, life-threatening; happens to older children
o s/s- dysphonia, dysphagia, drooling, sore throat, fever, distressed respiratory
effort, tripod position; child refuses to lay down; leans forward & uses arms for
support; head in “sniffing position”.
 Laryngotracheobronchitis- most common; age 3 months to 4 years, viral infection of
upper airway, chest x-ray
 ‘steeple sign”
o s/s- barky cough, inspiratory stridor, retractions
 Bronchiolitis- lower respiratory tract, obstruction of airway from edema; happens with
RSV & COVID