NR 602 Midterm Study Guide (Spring 2018) | Complete Solution

NR 602 Midterm Study Guide (Spring 2018) | Complete

Solution

Infant development - -1m: dolls eyes, nose breathing, hands closed, sees 20-25cm away, sleeps 16-17 hrs a day

-2m: post fontanel closes, decr head lag, coos,follows toy side to side, sleeps 8.510rs/night & 6-7 hrs day

-3m: all primitive reflexes fading, holds head, bears weight on legs, does not reach for rattle, babbling, mirrors, recognizes familiar objects and faces, sleeps 15-16 hours per day.

Infant development - -4m: drooling, no morrow/tonic neck, sits if propped, plays with hands, pulls on things, shows mood, laughs, focus on things 1/2in from face, regular sleep/wake pattern

-                5m: double birth wt, rolls back to belly, pull objects to mouth, follows dropped object, sleeps 10-11 hrs & 3 naps.

-                6m: growth slows (3-5oz/week, 1/2in/month), rolls back to belly, sits in chair with back, recognize parent, definite likes/dislikes, 13-14 hours sleep, 2-3 naps.

-                7m: leans to tripod position, bounce when standing, bang objects, 4 vowels said, knows name, stranger anxiety

Infant Development - -8m: regular b/b pattern, sits unsupported, pincer grasp, knows

"no", more stranger anxiety, sleeps 11-12hrs + 2-3 naps

-                9m: refined pincer grasp, steadily sits unsupported, pulls to stand, wants to please parents, 2 naps

-10m: mature pincer,walks holding on, grabs by the handle, "mama/dada", object permanence, 2 naps

-11m: lower lat incisors, pivots when standing, imitates sounds, rolls ball when asked

-12m: triples birth wt, length by 50%, walks holding 1 hand, 5-7 words, security object

Tanner (pubic hair) - 1) no pubic hair

2)  initial, scarce pigmented hair along medial border of labia

3)  sparse, dark, visibly pigmented curly hair on labia

4)  hair coarse and curly, abundant but less than adult

5)  lateral spreading, triangle spread of adult hair to medial surface of thighs

Tanner (Males) - 1) Prepubertal

2)  enlargement of scrotum & testes & change in scrotum texture. May be reddened

3)  further penile growth (length first) & testes & scrotum

4)  significantly enlarged ion length & circumference penis. more development of glans penis. darkening of scrotal skin (facial hair after this only)

5)  adult genitals

Tanner (Breasts) - 1) prepubertal

2)  Breast buds palpable under areola, enlargement of areola

3)  breast tissue palpable outside areola- no areolar development or separation of contour

4)  Areola elevated above contour of breast forming "double scoop" appearance

5)  Areola mound recedes back into single breast contour with areolar hyperpigmentation, papillae development/ projection & nipple protrusion

chalazion - -chronic sterile inflammation of eyelid from a lipogranuloma of the meibomian gland

-  initially, mild redness & swelling, then after a few days, a slow-growing, round, nonpigmented PAINLESS mass remains. 

-  Acute tx: hot compress, refer to eye MD

Blepharitis - - acute or chronic bacterial (staph) inflammation of eyelash follicle or sebaceous gland of eyelid. bilateral usually

-flaky, scaly debris over eyelid margin when awakening

-  tx: warm compress, scrub with weak shampoo, sometimes bacitracin or erythromycin, -no contacts during tx

Otitis Media - - bulging TM, ear pain, , ETD, fever,irritability, otorrhea, absent TM mobility

-RSV/influenza most common viruses

-  s.pneumonia, haemophilus, strep (bacteria)

-  Tx: Amoxicillin (1st time), Amox/clavu (when AOM within 30 days), ceftriaxone, azith (penicillin allergy)

-  <2: treat 10 days, >2, 5-7 days

-  ofloxacin or cipro gtts is TM perforated, or draining PE tubes

Otitis Externa (Swimmer's Ear) - - swelling of EAC and pinna/TM

-  sx: itching, irritation, pain, pressure in eat, conductive or SNHL, pain with tragus or pinna movement, maybe lymphadenopathy, red, crusting lesions, dry canal,  -tx: DROPS- ciprodex, vasocidin (ok if rupture tm). cortisporin, cipro HC (TM intact), domeboro (cleaning only)

Conjunctivitis - -most common peds infection, yellow-green purulent discharge, matted eyes when waking, itching

-bacterial (unilateral), viral (bilateral)

-  usually self-limiting, but may treat with atbx

-  tx: sodium sulfacetamide or tmp+polymycin B, or erythromycin, azith (>12m), floxacins (>12m). no -mycins)

-newborn: chlamydia trach. (erythromycin PO), gonorrhea (ceftriaxone IM/IV). DFA conjunctival test

-   

Milia - - pearly, white papules over forehead, nose, and cheeks. 

-  no tx

salmon patch - - flat lesion or vascular malformation on back of neck, upper eyelids and glabella

-  60-70% of newborns have on back of neck

-  no spontaneous resolution

Cafe au lait spots - - First sign of Neurofibromatosis -Tan to brown macules found anywhere on skin.

hemangioma - -papule made of blood vessels

impetigo - -