NURS 345 Pediatric Assessment Exam With Complete Solutions.

At what age does the social smile start in infants? - Answer-2-4 months What is the best order to do the physical assessment in in a toddler? - Answer-toe to head How old (age range) are toddlers? - Answer-1-3 years old How old (age range) are preschoolers? - Answer-3-5 years old How old (age range) are school-age children? - Answer-6-12 years old How old (age range) are adolescents? - Answer-13-24 years old What four things should you do when performing physical assessment of adolescents? (p__ p__, r__ m__, a__ c__, p__ r__) - Answer-1. provide privacy 2. respect modesty 3. address concerns 4. provide reassurance In which age range is it good to use the physical assessment as an educational opportunity? Why? - Answer-school-age children (6-12 yo) because they are very fascinated by how the body works at this age In which age range do children start becoming very modest about their bodies? - Answer-school-age children (6-12 yo) what order should you do physical assessment in 1. infants 2. toddlers3. school-age child 4. adolescents - Answer-1. infants--toe to head 2. toddlers 3. school-age child--head-to-toe 4. adolescents--head-to-toe How does body surface area in infants and children compare to that of adults? What are the implications for i & c? - Answer-Body surface area is large for weight. Implications: increased risk for hypothermia; need to be covered w blankets bc get cold quickly How does metabolic rate in infants and children compare to that of adults? What are the implications for i & c? - Answer-Metabolic rate is higher in i & c. Implications: higher oxygen needs & higher caloric needs; faster heart rate, need to eat more often, when stressed they will use more O2 What is true about brain cells in infants & children in terms of: 1. are all brain cells present at birth 2. what occurs to brain cells during the first year of life (2 things) - Answer-1. yes, all brain cells are present at birth 2. during the first year of life, (1)myelinization and (2)further development of nerve fibers occur during first year of life; specific reflexes that are present at birth should disappear by a certain age & if they haven't this may indicate a delay How does head size in infants and children compare to their body size (proportionately larger or smaller)? What is the implication for i & c? - Answer-Head size is proportionately larger Implication: susceptible to head injuries The anterior fontanel & the sutures are open in infants & children until how many months of age?What about the posterior fontanel? - Answer-anterior fontanel & sutures: open until about 18 months posterior fontanel: open until about 3 months If close too soon or too late, can present problems. How does tongue size in infants & children compare to nasal and oral airway passages? What is the implication for i & c? - Answer-Tongue size is large relative to small nasal and oral airway passages. Implication: Airway may be blocked easily by tongue. The trachea in infants and children under age ___ can be described as ___(length) & ___(diameter). What is the implication for i & c? - Answer-trachea in children under age 5 is short and narrow Implication: higher risk of foreign body obstruction How does the percent of cartilage in the ribs of infants & children compare to that of adults? When does this change? What is the implication for i & c? - Answer-The percentage of cartilage in the ribs of i & c is higher than in adults. This changes in puberty. Implication: ribs are more flexible & compliant How does the respiratory rate in infants & children compare to adults. At what age does respiratory rate become more similar to adults? -respiratory rate -number & size of alveoli -lung volume - Answer-infants & children: -respiratory rate: faster -number & size of alveoli: fewer and smaller-lung volume: less lung volume These characteristics persist until about 10 years old. Describe cardiac output in infants & children in terms of: -is it rate dependent? -is it stroke volume dependent? What is the implication for heart rate? - Answer--is it rate dependent? YES -is it stroke volume dependent? NO What is the implication for heart rate? Heart rate is more rapid (because heart cannot pump harder to push out more blood, can only pump faster; the only mechanism of compensation is for heart to beat faster because heart muscle is not strong enough to beat harder to increase cardiac output) Which muscle is the primary breathing muscle in children? At what age does this change? Are infants belly breathers? What is the implication for infants & children? - Answer-The diaphragm is the primary breathing muscle until about 4-5 years old. Yes, infants are belly breathers. Implication: CO2 is not effectively expired when the child is distressed What is the concern about the abdomen in infants & children as far as protection for abdominal organs? Which organs? What is the implication for i & c? - Answer-Concern is that the abdomen provides poor protection for the liver and spleen Implication: liver & spleen are more susceptible to trauma in i & cWhat do you need to know about kidney function in infants & children? At what age does this change? What are the implications for i & c? -electrolyte secretion & absorption -dehydration - Answer-The kidneys do not effectively concentrate urine until about 12-18 months old. Implication: -electrolyte secretion and absorption is not optimally controlled -dehydration: get dehydrated more easily What do you need to know about bones in infants & children? At what age does this change? What is the implication for i & c? - Answer-The bones of infants & children are soft until puberty. Implication: bones are more easily bent and fractured in i & c How does the proportion of body weight in water in infants & children compare to adults? Do i & c have more or less water in extracellular spaces than adults? Is the daily water exchange rate in i & c higher or lower than in adults? What is the implication for i & c? - Answer-The proportion of body weight in water is larger in infants and children. Water in extracellular spaces: more in i & c Daily water exchange rate: higher in i & cImplication: more susceptible to skin breakdown The blood volume in infants & children is weight dependent. It is ___mL/kg. - Answer-80 mL/kg What are the components of the physical exam in infants & children? (3 things) - Answer-1. general appraisal 2. anthropometric measurements 3. head-to-toe assessment When performing the general appraisal of an infant or child, what are the four things you need to take note of? - Answer-1. appearance 2. child's behavior 3. parents' behavior--do they seem really upset about child's condition? parents very good at picking up subtle changes in their kids 4. parent-child interaction