NU580 Midterm Study Guide

NU580 Midterm Study Guide

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Purdue University Global

NU580 FNP II – Primary Care of Children and Adolescents’ Health

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Date

Pediatric Primary Care Midterm Study Guide: 

This pediatric midterm study guide covers the most important assessment, diagnosis, management, and referral concepts for infants, children, and adolescents. High-yield topics include newborn respiratory conditions, dehydration, congenital heart disease, developmental milestones, adolescent health concerns, endocrine disorders, and preventive pediatric care. Understanding when to reassure, treat, monitor, or refer is essential for safe pediatric practice.

Newborn and Infant Conditions

Transient Tachypnea of the Newborn (TTN)

Transient tachypnea of the newborn occurs when fetal lung fluid is not completely cleared after birth. It is most common in full-term infants and typically resolves within 24 to 48 hours.

Clinical findings may include:

• Rapid breathing shortly after birth

• Mild respiratory distress

• Nasal flaring or grunting

• Oxygen requirement in some infants

Management is usually supportive, including monitoring oxygen levels and respiratory status.

Signs and Management of Infant Dehydration

Infant dehydration requires prompt assessment because young infants can deteriorate quickly.

Signs of dehydration include:

• Decreased urine output

• Dry mucous membranes

• Sunken fontanelle

• Poor feeding

• Lethargy

• Weight loss

• Reduced tears

Management depends on severity:

• Mild dehydration: Oral rehydration therapy with close monitoring

• Moderate dehydration: Medical evaluation and possible supervised fluid replacement

• Severe dehydration: Emergency care with intravenous fluids

Pyloric Stenosis

Pyloric stenosis is caused by thickening of the pyloric muscle, leading to gastric outlet obstruction.

Typical findings include:

• Projectile, non-bilious vomiting

• Hunger after vomiting episodes

• Weight loss or poor weight gain

• Palpable “olive-shaped” abdominal mass

Treatment requires correction of dehydration and electrolyte abnormalities before surgical repair.

Hirschsprung Disease

Hirschsprung disease results from the absence of ganglion cells in a portion of the colon, causing functional obstruction.

Symptoms include:

• Delayed passage of meconium

• Chronic constipation

• Abdominal distention

• Poor growth

• Explosive stool after rectal examination

Diagnosis is confirmed through rectal biopsy. Surgical removal of the affected bowel segment may be required.

Congenital Hydronephrosis

In utero hydronephrosis is detected through prenatal ultrasound and requires monitoring after birth.

Management may include:

• Postnatal renal ultrasound

• Monitoring urinary symptoms

• Evaluation for urinary obstruction or reflux

• Referral to pediatric urology when indicated

Pediatric Cardiology

Important Congenital Heart Defects and Murmur Findings

Atrial Septal Defect (ASD)

ASD commonly presents with:

• Wide, fixed splitting of the second heart sound (S2)

• Systolic flow murmur

Ventricular Septal Defect (VSD)

VSD is characterized by:

• Harsh holosystolic murmur

• Murmur intensity depends on defect size

Patent Ductus Arteriosus (PDA)

PDA findings include:

• Continuous “machine-like” murmur

• Bounding pulses

• Possible widened pulse pressure

Coarctation of the Aorta

Findings may include:

• Weak or delayed femoral pulses

• Higher blood pressure in upper extremities

• Lower blood pressure in legs

• Systolic murmur

Pulmonary Stenosis

Pulmonic stenosis causes:

• Harsh systolic crescendo-decrescendo murmur

• Best heard at the left upper sternal border

Aortic Stenosis

Aortic stenosis presents with:

• Loud harsh systolic crescendo-decrescendo murmur

• Location at the upper right sternal border

• Radiation to the neck

Pediatric Murmur Classification

Innocent Murmurs

Common innocent murmurs include:

• Still’s murmur: Musical or vibratory sound; louder when the child is supine

• Pulmonary flow murmur

• Venous hum

Pathologic Murmurs

Characteristics requiring referral include:

• Harsh quality

• Diastolic murmurs

• Symptoms such as poor feeding, cyanosis, or exercise intolerance

Pediatric Cardiology Referral Guidelines

Infants should receive urgent cardiology evaluation when they have:

• Oxygen saturation below 95%

• Poor feeding

• Cyanosis

• Signs of heart failure

• Abnormal cardiac examination findings

Children with congenital heart disease require cardiologist approval before participating in competitive sports.

Children with repaired congenital heart defects may require subacute bacterial endocarditis (SBE) prophylaxis with amoxicillin for six months after repair when indicated.

Children exposed to cardiopulmonary bypass, red blood cells, or plasma should avoid live vaccines for six months after surgery. Pneumococcal conjugate vaccine (PCV13) may still be administered because it is not a live vaccine.

Trisomy 21 and Heart Disease

Children with Down syndrome are at increased risk for complete atrioventricular canal defects.

Possible findings include:

• Heart murmur

• Poor feeding

• Congestive heart failure symptoms

• Poor weight gain

Pediatric Blood Pressure Evaluation

Normal pediatric blood pressure is based on age, sex, and height percentiles.

Classifications:

• Normotensive: Below the 90th percentile

• Elevated blood pressure: 90th to less than 95th percentile

• Stage 1 hypertension: 95th percentile or 120/80 mmHg up to 5 mmHg above the 99th percentile

• Stage 2 hypertension: Greater than the 99th percentile

Most pediatric hypertension is related to renal or renovascular causes.

Evaluation may include:

• Urinalysis

• Electrolytes

• Renal function testing

• Plasma renin testing

Children with persistent hypertension should be referred to specialists experienced in pediatric hypertension management.

Pediatric Obesity Management

Children with BMI above the 95th percentile require:

• Nutrition counseling

• Increased physical activity

• Family-based lifestyle changes

• Screening for obesity-related complications

Developmental and Behavioral Health

Speech Development at Age Two

Expected language milestones include:

• Combining two words

• Following simple commands

• Expanding vocabulary rapidly

Speech delay requires developmental evaluation.

School-Age Development

School-age children develop:

• Friendships

• Independence from parents

• Academic skills

• Social confidence

A child who avoids school, has poor grades, or frequently complains of illness may require evaluation for:

• Learning disorders

• Anxiety

• Social difficulties

Adolescent Health

Amenorrhea Evaluation

Evaluation of adolescent amenorrhea includes:

• Pregnancy testing

• Menstrual history

• Assessment of nutrition and exercise patterns

• Evaluation for endocrine disorders

Athletic adolescents may experience menstrual irregularities due to reduced body fat.

NU580 Midterm Study Guide

Signs of Anabolic Steroid Use

Possible findings include:

• Testicular enlargement changes

• Acne

• Increased muscle mass

• Mood changes

• Altered puberty progression

Adolescent Stress and Risk Behaviors

Following stressful events, adolescents may show:

• Withdrawal

• Irritability

• School difficulties

• Changes in sleep or appetite

Counseling and mental health support may be recommended.

Common Pediatric Disorders

Retinopathy of Prematurity (ROP)

Infants treated for ROP require scheduled ophthalmology follow-up.

Any abnormal red reflex requires immediate referral.

Warning signs include:

• Asymmetric reflexes

• White reflex

• Dark spots

• Eye opacities

Retinoblastoma must be considered.

Hearing Loss Evaluation

A four-month-old infant with suspected hearing loss requires:

• Hearing screening

• Audiologic evaluation

• Developmental assessment

Celiac Disease

Signs may include:

• Chronic diarrhea

• Abdominal pain

• Poor growth

• Iron deficiency anemia

Hypothyroidism Monitoring

Infants with hypothyroidism require monitoring of:

• Thyroid-stimulating hormone (TSH)

• Free thyroxine (T4)

Type 1 Diabetes Management

Primary care priorities include:

• Blood glucose monitoring education

• Insulin administration education

• Recognition of hypoglycemia and diabetic ketoacidosis symptoms

Laboratory tests differentiating diabetes types include:

• Autoantibodies

• C-peptide levels

Genetic and Metabolic Disorders

Phenylketonuria (PKU)

Possible findings include:

• Developmental delay

• Intellectual disability if untreated

• Seizures

• Musty body odor

Inborn Errors of Metabolism

Children suspected of metabolic disease require:

• Immediate evaluation

• Metabolic laboratory testing

• Specialist referral

Preventive Pediatric Care

The American Academy of Pediatric Dentistry recommends the first dental visit:

• When the first tooth erupts

• No later than 12 months of age

Common Pediatric Acute Concerns

Acute Otitis Media

Management may include:

• Pain control

• Observation in selected children

• Amoxicillin as first-line antibiotic therapy when indicated

Ceftriaxone may be used when oral medications cannot be tolerated.

Recurrent Abdominal Pain

Children with recurrent abdominal pain and anemia require evaluation for organic causes.

Possible concerns include:

• Gastrointestinal disease

• Celiac disease

• Inflammatory disorders

Learning Disorder Referral Indicators

Referral is recommended when a child has:

• Persistent academic difficulties

• Poor grades despite intervention

• Frequent school avoidance

• Difficulty reading, writing, or mathematics

• Behavioral concerns related to school performance

References

American Academy of Pediatrics. (2023). Bright Futures guidelines for health supervision of infants, children, and adolescents. American Academy of Pediatrics. https://brightfutures.aap.org

Centers for Disease Control and Prevention. (2024). Child and adolescent immunization schedule. CDC. https://www.cdc.gov/vaccines/schedules/

American Academy of Pediatric Dentistry. (2024). Guideline on infant oral health care. AAPD. https://www.aapd.org

NU580 Midterm Study Guide

Kliegman, R. M., St. Geme, J. W., Blum, N. J., Shah, S. S., & Tasker, R. C. (2023). Nelson textbook of pediatrics (22nd ed.). Elsevier. https://www.elsevier.com

Hagan, J. F., Shaw, J. S., & Duncan, P. M. (2017). Bright Futures: Guidelines for health supervision of infants, children, and adolescents (4th ed.). American Academy of Pediatrics.