Peds HESI

• Erikson: Psychosocial Development

  Stages of psychosocial development across the lifespan
• Erikson's Psychosocial Stages

  • Infancy (Birth – 18 months): Trust vs. Mistrust
  • Early Childhood (18m – 3y): Autonomy vs. Shame and Doubt
  • Preschool (3-6y): Initiative vs. Guilt
  • School Age (6-12y): Industry vs. Inferiority
  • Adolescence (12-20y): Identity vs. Role Confusion
• Congenital heart disease is the most common associated defect in children with Down syndrome
• Tetracyclines cause enamel hypoplasia and tooth discoloration in children under 8 years of age. Contraindicated in children
• Therapeutic level of theophylline

  10-20 mcg/dL
• Hirschsprung's disease


  Mechanical obstruction caused by inadequate motility in a part of the intestines, resulting from failure of ganglion cells to migrate craniocaudally along the GI tract during gestation, causing constipation and small diameter, brown-colored stools
• Pyloric stenosis


  Projectile vomiting which contributes to metabolic alkalosis
• Infant caloric requirement


  108 cal/kg/day
• Hemophilia


  Blood disorder causing joint bleeding, treated with rest, ice, compression, and elevation (RICE)
• Tetanus immunization schedule


  Booster every 10 years or less if a traumatic injury occurs that is contaminated by dirt, feces, soil, or saliva, such as puncture or crushing injuries, avulsions, wounds from missiles, burns, or frostbite
• Tympanic membrane


  Normally pearly gray and not bulging or movable
• 1. year old children


  Egocentric and unable to share with other children
• Growth hormone


  Can cause polyuria and polydipsia
• 1. year old children


  Aggressive in their behavior and enjoy "tale telling"
• Prevention of abdominal palpation minimizes the risk of rupturing the encapsulated tumor and subsequent metastasis in a child with Wilms tumor. DO NOT PALPATE ABDOMEN
• Esophageal atresia


  Choking, coughing, and cyanosis signs
• Undescended testes (cryptorchidism)


  May be found in the inguinal canal due to exaggerated cremasteric reflex, treated with a trial of HCG (human chorionic gonadotrophic) hormone, but does not replace surgical repair for true undescended testes
• Celiac disease


  Intolerance to the protein gluten found in oats, rye, wheat and barley, causing symptoms such as diarrhea
• Developmental milestones


  Like to do and accomplish things, peers more important, adult-like thinking, body changes
• Birth length doubling


  4 years
• 50% of adult height reached

  2 years
• Sitting unsupported


  8 months
• Bronchodilator


  Used to treat symptoms of asthma, bronchitis, emphysema, and other lung issues
• Cystic fibrosis


  Genetic disorder causing thick, tenacious mucus to obstruct organs, leading to steatorrhea, foul-smelling stools, delayed growth, and pulmonary congestion
• Risk factors for cystic fibrosis

  • Both biological parents carry recessive trait
• Positive sweat chloride test for cystic fibrosis

  Greater than 60 mEq/L
• Postural drainage for child with cystic fibrosis


  Most effective when performed after nebulization and before meals, or at least 1 hour after eating to prevent nausea/vomiting, used to promote mucous removal after nebulization treatments which open the airways, should be done 3 to 4 times daily
• Steatorrhea


  Stools with an abnormally high fat content that are usually foul smelling and float on water, common in children with cystic fibrosis
• Toddler of 1-3 years old


  Capable of making two-to-three-word sentences
• Children ages 3-6


  In Erikson's "Initiative vs. Guilt" stage, characterized by vigorous, intrusive behavior, enterprise, and strong imagination, develop a conscience and must learn to retain a sense of initiative without impinging on the rights of others
• Ventricular septal defects (VSDs)


  Cyanotic defect, where unoxygenated blood enters the systemic circulation
• Closure of VSDs


  Stops oxygenated blood from being shunted from the left ventricle to the right ventricle
• Discipline


  Positive and necessary component of childrearing, started in infancy, teaches socially acceptable behavior, helps children protect themselves from danger, and channels undesirable behavior into constructive activity, should have clear, reasonable, and consistent parental attention
• Prevention of stress on the lip suture line is essential for optimum healing and the cosmetic appearance of a cleft lip repair
• First MMR vaccine


  Given no sooner than 12 months of age, ideally between 12 and 15 months, not given at 3-6 months due to maternal antibodies
• Second MMR vaccine


  Routinely administered at 4-6 years, provided at least 4 weeks have elapsed since the first dose, and if both doses were administered beginning at or after 12 months
• Tetralogy of Fallot


  Cyanotic defect, causing peripheral tissue hypoxia and nailbed clubbing, heart murmur should be resolved after repair, cyanosis with feeding, crying, and defecation should resolve, vital signs are normal
• Preschooler's major stressor


  Concern for body integrity, fears "insides will leak out", preschool children at this age are quite verbal so comprehension may be inaccurate while imagination and fears fantasize the reality
• Neonates with VSD


  May fatigue quickly during feeding and ingest inadequate amounts, should be monitored for weight gain and at least 6 wet diapers per day, feed at least every 2 hours, use softer (preemie) nipple or larger slit to reduce sucking effort, receive antibiotic prophylaxis but not mixed in bottle
• Use isolation droplet precautions for bacterial meningitis