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Paediatrics Flashcards

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1
Q

What are the ABCs of the Paediatric Assessment Triangle?

A

Appearance: Abormal Tone, Low Interactiveness and Consolability, Abnormal Look/Gaze and Abnormal Speech/Cry

Breathing: Abnormal Sounds and Position, Retractions, Flaring and Apnoeas and Grunting

Circulation: Pallor, Mottling and Cyanosis

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2
Q

What is a normal blood glucose level for children?

A

Between 4mmol/L to 7mmol/L

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3
Q

What is a normal heart rate for children who are under one-year old?

A

Between 100 to 160

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4
Q

What is a normal respiratory rate for children who are under one-year old?

A

0-6Months: 30 to 60
6-12Months: 24 to 30

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5
Q

What is a normal blood pressure reading for children who are under one-year old?

A

0-6Months: 65 to 90
6-12Months: 80 to 100

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6
Q

What is a normal temperature range for children under eleven-years of age?

A

Between 36.5° to 37.5°

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7
Q

What is a normal heart rate for children under elven years of age?

A

Between 70 to 120

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8
Q

What is a normal respiratory rate for children under eleven years of age?

A

1-5Years: 20 to 30
6-11Years: 12 to 20

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9
Q

What is a normal blood pressure range for children under eleven years of age?

A

Between 90 to 110 mm/Hg

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10
Q

Name 6 Anatomical and Physiological differences between children and adults

A

→ smaller alveoli
→ smaller trachea
→ children are obligate nasal breathers under 6 Months of age
→ big head
→ big tongue
→ they use their tummies as accessory muscles to breathe

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11
Q

Define Acute Respiratory Distress Syndrome

A

It occurs when fluid builds up in the alveoli, and leads to severe shortness of breath. It will usually develop within a few hours after precipitating injury or infection.

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12
Q

Name 2 Complications of ARDS

A

Pneumothorax due to the collapse of the lungs, or pulmonary fibrosis as the scarring of lung tissue can occur and further prevents oxygen passage through the alveoli.

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13
Q

What is Croup?

A

Croup is caused by a virus and leads to cold and flu symptoms that worsen at night.

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14
Q

What are symptoms of Croup?

A

Symptoms are hoarse voice, stridor, fever, barking cough and increased work of breathing.

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15
Q

What are signs that indicate a child is deteriorating if they have croup?

A

These are increased restlessness, unable to swallow, cyanosis, rapid breathing, intercostal retractions and tracheal tug.

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16
Q

What is Otitis Media?

A

It is an infection of the middle ear that leads to inflammation. Occurs as a result of a cold, sore throat or respiratory infection. In an infection of the middle ear, the tympanic membrane looks red, bulging and there may be clear, yellowish or greenish fluid.

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17
Q

What are some treatment options for Croup?

A

Treatment is analgesia and NSAIDs, penicillin, local anesthetic and tympanostomy tubes which enables drainage of the middle ear and allows air to flow into ear and prevents the build up of fluid behind the tympanic membrane

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18
Q

Name 5 Croup Risk Factors

A
  • Premature Baby
  • Low Birth Weight
  • Early Onset
  • Family History
  • Altered Immunity
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19
Q

What is Meningitis?

A

Meningitis is an inflammation of the meninges or the upper arachnoid space. The infection can be caused by bacteria, viruses, fungi or protozoa.

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20
Q

Name the 3 Layers of the Meninges

A
  1. Dura Mater: Outer layer lining the skull.
  2. Arachnoid + Sub-Arachnoid: Contains blood vessels and the cerebrospinal fluid.
  3. Pia Mater: Cover the brain.
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21
Q

True or False: Bacterial Meningitis has a lower mortality rate than Viral Meningitis.

A

False

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22
Q

Name 3 Bacteria that may cause Meningitis

A

It is caused by Streptoccocus Pneumoniae, Streptoccocus Aureus, Haemophilus Influenza Type B and Neisseria Meningitidis bacteria.

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23
Q

What are symptoms of bacterial meningitis?

A

These may be fevers, seizures, headaches, neck stiffness, photophobia, irritability, raised intracranial pressure, altered level of consciousness, and rapidly evolving non-blanching rash.

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24
Q

What is the treatment for Bacterial Meningitis?

A

Treatment includes IVABx, CSF cultures, travel history, steroids and anticonvulsants.

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25
What is Meningococcal Meningitis?
It is an inflammation of the of the protective membranes covering the brain and spinal cord, the meninges. Bacteria enters the CSF and grows in this compartment and leads to inflammation.
26
What are symptoms of Meningococcal Meningitis?
Symptoms are similar to the flu but advances quickly. Can begin with a high fever, severe headache, stiff neck, then vomitting and drowsiness, rash and light sensitivity and decreased level of consciousness.
27
Name 6 Viruses that may cause Viral Meningitis
It is caused by Herpes Simplex virus, Varicella Zoster virus, Mumps, Echovirus, Toscana virus and HIV.
28
True or False: The treatment for Viral Meningitis is rest and pain analgesia.
True
29
Explain the pathophysiology of Paediatric Asthma
It involves chronic airway inflammation and hyperresponsiveness. Environmental triggers (allergens, irritants, infections) cause mast cell degranulation and inflammatory mediator release in genetically susceptible children. This leads to bronchospasm, mucus hypersecretion, and airway edema. The airway remodeling process can begin early in childhood, with structural changes including smooth muscle hypertrophy and basement membrane thickening.
30
Are spacers recommended for children with asthma?
Yes, for a more effective delivery of medication.
31
What is the Asthma focused assessment?
Signs + Symptoms Allergies Medication Past Medical History Last Meal Events Leading to Current Illness
32
Name 3 pharmacological interventions for children with Asthma
1. Salbutamol: This is a Short-Acting Beta2-Agonist to dilate airways as it is a bronchodilator. 2. Steroids: Inhaled corticosteroids such as Budesonide for inflammation control. 3. Nebuliser Therapy: For children unable to use inhalers effectively.
33
Name 2 side effects of Salbutamol
Tremors and Tachycardia
34
What is Rheumatic Fever?
It is an autoimmune sequela of Group A Streptococcal pharyngitis in genetically predisposed children. Molecular mimicry occurs when antibodies directed against streptococcal antigens cross-react with cardiac, joint, brain, and skin tissues. The inflammatory response primarily affects the heart (carditis), joints (arthritis), central nervous system (neurological movement disorder called Sydenham's chorea), and skin, leading to the characteristic clinical manifestations.
35
What are some treatment options for Rheumatic Fever?
1. Anti-Inflammatory: High-dose aspiring for arthritis and carditis. 2. Corticosteroids: Prednisone for severe carditis with heart failure. 3. Long-Term Penicillin
36
What are some long-term considerations for children with Rheumatic Fever?
Antibiotic prophylaxis, cardiac monitoring for valvular disease development, endocarditis prophylaxis and regular cardiology follow-up.
37
What is Cystic Fibrosis?
It is an autosomal recessive disorder caused by mutations in the CFTR gene, leading to defective chloride transport across epithelial cells. This results in thick, viscous secretions in multiple organ systems. In the lungs, impaired mucociliary clearance leads to chronic infection and inflammation. The pancreas develops exocrine insufficiency, and other systems including the GI tract, liver, and reproductive system are affected.
38
What diet is recommended for children with Cystic Fibrosis?
A high-calorie, high-fat diet with fat-soluble vitamins.
39
What are some therapies for children with Cystic Fibrosis?
Chest physiotherapy for airway clearance, mucolytics to thin secretions, hypertonic saline to improve mucociliary clearance and antibiotics as chronic suppressive therapy.
40
What is Peadiatric Epilepsy?
It involves recurrent, unprovoked seizures due to abnormal electrical activity in the brain. The underlying mechanisms vary by epilepsy syndrome and include genetic mutations affecting ion channels, neurotransmitter systems, or brain development. Seizures result from imbalance between excitatory and inhibitory neurotransmission, leading to synchronized neuronal discharge. The developing brain is particularly susceptible to seizure activity.
41
Name the 4 Stages of Seizures
1. Prodromal Stage: Consists of signs or activity that precede a seizure such as insomnia, headaches, irritability, ill temper, increased agitation and depression. 2. Aural Stage: A sensory warning such as extreme fear, sensations in the stomach, dreamlike experiences or hallucinations. 3. Ictal Phase: Full seizure. 4. Post-Ictal Phase: The period of recovery after the seizure. This phase may be absent, weak, brief or last for several hours or days.
42
What is important in assessing and documenting a seizure?
The onset, its duration and its characteristics.
43
Explain Congenital Heart Disease
It encompasses structural abnormalities present at birth. Defects can involve septal abnormalities (ASD, VSD), outflow tract obstructions (coarctation, aortic stenosis), or complex mixing lesions (tetralogy of Fallot, transposition). The pathophysiology varies by defect type but commonly involves altered blood flow patterns, pressure/volume overload, cyanosis, and potential for heart failure or arrhythmias.
44
What is important to assess for in a cardiovascular assessment for an infant with Congenital Heart Disease?
Assess for murmurs, capillary refill, cyanosis, heart rate trends, saturations, fluid balance and monitoring for medication side effects.
45
True or False: ACE-Inhibitors, Aspirin and Diuretics can be used to manage Congenital Heart Disease.
True
46
What is the emergency weight calculation for a child?
(Age + 4) x 2 = ? kg
47
What is the daily fluid maintenance calculation for children between 3.5kg and 10kg?
For infants 3.5kg to 10kg the daily fluid requirement is 100ml/kg.
48
What is the daily fluid maintenance calculation for children between 11kg and 20kg?
For children 11kg to 20kg the daily fluid requirement is 1000ml + 50ml/kg for every kg over 10kg.
49
What is the daily fluid maintenance calculation for children over 20kg?
For children >20kg the daily fluid requirement is 1500ml +20ml/kg for every kg over 20kg up to a maximum of 2400ml daily.
50
What are the Pediatric ABCDEs Red Flags?
Airway: Difficulty speaking Breathing: Silent chest Circulation: Pale, nasal flaring Disability: LOC, AVPU and don’t forget the Glucose: Used up when sick
51
What does TILCS stand for when assessing a neonatal patient?
A tool used to assess for neonatal appearance and stands for: Tone Interactiveness Look and Gaze Consolability Speech and Cry
52
What indicates increased Work of Breathing in a newborn?
Tachypnoea, nasal flaring, grunting, intercostal retractions, uneven breathing and central cyanosis.
53
What weight loss percentage is normal for a neonate in their first week of life?
A weight loss of approximately 7% to 10% is normal.
54
Describe the pathophysiology of Bronchiolitis
It is an acute viral infection of the lower respiratory tract affecting infants The virus spreads from the upper respiratory tract to the medium and small bronchi and bronchioles, causing epithelial necrosis and initiating an inflammatory response. The developing oedema and exudate result in partial obstruction, which is most pronounced on expiration and leads to alveolar air trapping. Complete obstruction and absorption of the trapped air may lead to multiple areas of atelectasis.
55
Name 3 Viruses that can cause Bronchiolitis
It can be caused by the Respiratory Synctitial Virus, Rhinovirus or Parainfluenza virus.
56
What are common signs and symptoms of Bronchiolitis?
Signs and Symptoms are increasing respiratory distress, tachypnoea, retractions and a wheezy cough, apnoeas, cyanosis, audible wheezing and lethargy.
57
Name 3 treatment interventions for Bronchiolitis
Supportive therapy, Oxygen administration and IV Fluids
58
What are nursing cares associated with treatment of bronchiolitis?
Nursing Cares include maintaining a patent airway, check level of consciousness, monitor input and output and ensure adequate hydration.
59
What virus spreads Measles?
It is a highly contagious infection that is caused by the Paramyxovirus. Transmission is via respiratory droplets from secretions of the throat, nose or mouth.
60
What are common signs and symptoms of Measles?
It is characterised by fever, cough, coryza, conjunctivitis, an enanthem (kolpik spots) on oral mucosa, and a maculopapular rash that spreads cephalocaudally (head to toe).
61
What are potential complications of Measles?
Complications are pneumonia, bacterial superinfection, acute thrombocytopenic purpura and encephalitis.
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