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Pediatrics > Exam 1 - Health Promotion of the Newborn and Infant PP > Flashcards

Exam 1 - Health Promotion of the Newborn and Infant PP Flashcards

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1
Q

The neonate normally loses about 10% of birth weight by age 3 or 4 days.

A

Infant’s ability to fixate is greatest in 1st hour of life

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2
Q

Tracts that develop myelin first are the sensory and cerebellar tracts.

A

Touch is especially important and so is the most acute sense in the neonate.

All newborn senses are very acute, except for sight.

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3
Q

First reactivity period

A

30-60 minutes after delivery: alert, interested in environment
- Full-term infant may breast-feed

1-4 hours after delivery: sleepy and relatively calm
- All systems slow down, temperature falls

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4
Q

Second reactivity period

A

Occurs when infant wakes from first deep sleep

Lasts 2-5 hours: alert and responsive

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5
Q

Postpone erythromycin ointment immediately after birth. But must be given within two hours by law.

A

Ophthalmia neonatorum–
Chlamydia
Gonococcal conjunctivitis

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6
Q

Motor development is based on infant reflexes

A 
Rooting
Sucking
Doll’s eyes
Moro
Palmar
Step
Babinski
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7
Q

Nutrition

A

Breast milk or iron-fortified formula only for first 6 months of life

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8
Q

Promotion of 
Successful Breast-Feeding

A

Frequent and early breast-feeding (within first hour of life is important)

Promotion of skin-to-skin contact

Correct positioning of infant at breast

Feeding-on-demand schedule

Baby-Friendly hospital initiative

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9
Q

Breast Milk

A

Newborn has deficiency of pancreatic lipase for fat absorption, making cow’s milk indigestible

Breast milk contains enzymes – lipase

-This enables the high fat content of breast milk to be easily digested by the infant’s GI tract

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10
Q

Breast Milk

A

Breast milk contains vitamin D but may not have levels sufficient to prevent rickets

Recommendation is for breastfed infants to receive vitamin D supplementation if not receiving sunlight exposure

Formula fed infants do not need vitamin D supplementation

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11
Q

of wet diapers

A

1 for each day of life until day 5 or 6

5 or 6 per day until day 14

After that – 6 – 10 per day

Stools –

Bottle feeding: 1 stool every 2 – 3 days

Breast feeding: 2 or 3 per day

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12
Q

Sudden Infant Death Syndrome

A

Occurs during first year of life, peaks at 2 – 4 months

Occurs between midnight and 9am

Increased incidence in winter

Back-to-Sleep campaign

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13
Q

Colic

A

Inconsolable crying that lasts 3 hours or longer per day and for which there is no physical cause.

Usually resolves by 3 months

Frequent burping
Formula modification
Warmth to abdomen
Cuddling and closeness

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14
Q

1 week/2 week visit

A

Weight

Feeding, peeing, pooping

Discuss how the parents are feeling and how things are going in the home.

- Postpartum depression -- 
- Shaken baby syndrome

Assess attachment
Colic?

Never leave infant alone with pet or sibling

Warm formula in cup of warm water, never microwave

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15
Q

Neonatal Normal Vital Signs

A

Temp: 36.3oC – 37oC (97.3o – 98.6oF) axillary

Heart rate: 120 – 160

Resp rate: 30 – 60

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16
Q

1 – 3 month old – Physical

A

Rapid weight gain – 1.5 lb/mo (for 1st 6 mo)

Ht. – gain 1 inch/mo (for first 6 months)

Posterior fontanel closes at 2 months

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17
Q

2 month visit

A

By two months smiling spontaneously – social smile

Follows past midline

Loves looking at faces.
Imitate facial expressions.

Strabismus is normal in the young infant, but should not be present after about 3 months of age.

Turns head to sounds

Coos

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18
Q

Two month milestones 


A

Raises head and chest when lying on stomach and supports upper body with arms – called Head-up 450 


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19
Q

2 month visit immunizations

A

DTaP – Diphtheria, Tetanus, acellular Pertussis

Hib – Haemophilus influenzae type B

Rotavirus

IPV – Polio (inactivated poliovirus vaccine)

Pneumococcal

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20
Q

Age appropriate toys

A

Birth – 2 months: Mobiles – dark and light, black and white

2 – 4 months: rattles, cradle gym

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21
Q

3 month cause for concern

A

No response to loud noises

Does not try to find speaker’s face with his eyes

Does not coo, vocalize

Constant fisted hand

Stiff legs

Does not lift head when lying on stomach

Crosses eyes most of the time

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22
Q

4 – 6 mo – Motor

A

Sits with support

Discovers hands, begins reaching and grabbing

Brings hands to midline

Begin playing with rattles, squeaky toys, etc.

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23
Q

4 – 6 mo – Motor

A

Moro, tonic neck, and rooting reflexes disappear

Tonic neck reflex disappears. Infant turns over – abdomen to back at 5 mo; back to abdomen at 6mo

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24
Q

4 – 6 months– Motor

A

Tongue thrust diminishing

Teething begins – drooling

Putting weight on feet when held upright

Fine motor – Rakes objects

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25
Sensory/Language ( 4 – 6 mo)
Ma-ma, Da-da vocalizations Begins consonant sounds first, then vowel Responds to rhythms Tracks objects with eyes– 180 degrees
26
Social/Emotional ( 4 – 6 mo)
Smiles and laughs Comforting habits such as thumb sucking begins Demands attention by fussing Smiles at mirror image Has increased interest and attachment to parent
27
Parent-Infant Attachment
Reciprocal cycle establishes trust and produces confidence in parents
28
Age Appropriate Toys 4 – 6 months:
Bright colored, soft toys | Small enough to grasp
29
Nutrition ( 4 – 6 mo)
Fetal iron stores -- depleted by 4 months for term infant By 2mo in preterm infant Should continue BF or iron-fortified formula Milk alternatives like rice milk are low in protein, calcium, vit D
30
4 mo visit immunizations
``` DTaP #2 Hib #2 Rotavirus #2 IPV #2 PCV (Pneumococcal) #2 ```
31
6 months -- Physical
Double their birth weight Weight gain slows to a pound a month Length ½ inch a month Teeth eruption
32
6 months– Key milestones
Good head support – No head lag Rolling in both directions Bears weight on legs Sitting with support– tripod sitting Reaches for objects
33
Nutrition
4 – 6 months begin solids
34
Dental
First tooth about 6 months Clean teeth with plain water and washcloth {First tooth comes in at 6 months, and lose 1st tooth at 6 years} Age of child in months minus 6 = # of teeth
35
Dental
Routine fluoride supplementation is not recommended for infants younger than 6 months Fluoride supplementation if there is not adequate fluoride in the water supply
36
6 mo visit immunizations
Hepatitis B #3 (between 6 & 18 mo) DTaP #3 Hib #3 Rotavirus #3 PCV #3
37
Infants 7 - 9 months
Developing object permanence Strong attachment behavior. Stranger anxiety. Develops attachment to blanket, teddy bear, etc. Crawling
38
Motor : 7 – 9 mo
Crawls vs Creeps Fine motor – rake objects initially, progressing to crude pincer grasp Feeds self cheerios Transfers objects from hand to hand
39
Motor: 7 – 9 mo
Goes from tripod sitting to sitting alone (about 8th month), to pulling to stand Stands while holding onto something
40
Nutrition – Beginning to feed self
Raking to crude pincer grasp Continue introducing foods slowly– soft mashed table foods No egg white until after 1 year of age
41
Foods NOT to feed a baby
``` Honey Hot dogs Grapes Hard candies Raw carrots Popcorn Nuts Peanut butter Cow’s milk of any kind before 1 year of age ```
42
Sensory/Language 7 – 9 mo.
Babbles contentedly to self on waking Responds to simple commands Understands “no-no” Depth perception developing
43
Sensory/Language 7 – 9 mo.
Object permanence -- Playing peek-a-boo is associated with development of object permanence Identify causal relationships Motor activity is necessary for cognitive development
44
Age Appropriate Toys 6 – 9 months
Large toys with bright colors and moveable parts and noise makers Pots and pans, nesting containers
45
Physical -- 10 – 12 months
Triple birth weight by 1 year of age Head and chest circumference are equal Length increases by 50% from birth length Babinski reflex disappears Lordosis evident during walking
46
Fine Motor: 10 – 12mo
Neat Pincer grasp by 11 mo. Feeding self with spoon Wave bye-bye
47
Sensory Language
Says “dada”, “mama” specifically Responds to simple verbal requests Knows own name Uses simple gestures like shaking head for “no” Says simple words to communicate needs – about 5 word vocabulary
48
Nutrition
Wean from bottle to cup Whole milk after 12 months Eating 3 meals and snacks No egg white until after 1 year of age
49
Dental
Toothbrushing – Use a non-fluoride tooth paste until they are able to swish and spit “Bottle-mouth” -- caries in primary teeth from sleeping with bottle in mouth
50
Age Appropriate Toys 9 – 12 months
Books with large pictures, push-pull toys, teddy bears, balls
51
Causes for concern – 10 – 12 mo
Not crawling Not pulling to stand Says no single consonant sounds (da-da,ma-ma) Does not use gestures Does not respond to baby games like “Pat-a-cake” or “Peek-a-boo”
52
Poison prevention
``` Most victims of poisoning are under 5 yr. age Everything up and locked Never store non-edible things in containers that are meant for edible things Adult meds Alcohol Plants Ashtrays 1-800-222-1222 ```
53
12 month visit
Lead screening Hematocrit screening 4th dose of HIB and PCV 13
54
Lead Blood Levels
Blood test done if infant is at risk at any time Universal Lead Serum Test is done at 1 year and 2 years
55
Lead Poisoning
The Blood Lead Level (BLL) for people living in the U.S. dropped from 12.8 mcg/dl in 1980 to 1.9 mcg/dl in 1999. The level of concern for an elevated BLL has dropped from 80 mcg/dl in 1950 to 5 mcg/dl today.
56
Lead poisoning – Nursing Interventions
Family education for preventing childhood exposure to lead Wash toys and pacifiers frequently Make sure that home exposure is not occurring from parental occupations or hobbies Hot water dissolves lead, so use only cold water for consumption (drinking, cooking, making baby formula
57
Lead poisoning – Nursing Interventions
Assist family to obtain sources of help for removing lead from the environment Family education for preventing childhood exposure to lead Do not vacuum hard-surfaced floors or windowsills or window wells in homes built before 1960, because this spreads dust Wash and dry child’s hands and face frequently, especially before eating
58
New immigrant communities have a higher risk of lead poisoning
Ayurvedic medicines from India Eye makeup (surma) from India Greta, Azarcon from Mexico (home remedies) Day Tway from Thailand (digestive aid) Ba-baw-san from China
59
Car Seat
Continue rear facing car seat until child out-grows rear facing car seat by reaching the top height or weight limit allowed by your car seat’s manufacturer.
60
Psychosocial Development
Erikson Infancy 0 – 12 months
Trust vs. Mistrust Require consistent, predictable, reliable care to accomplish this developmental task Hope
61
Hospitalization– Infant Major fears:
Separation, strangers Interventions: Provide consistent caretaker Attachment object Minimize separation from parents and significant others
62
Stages of Separation Anxiety
Stage 1 – Protest Stage 2 – Despair- depressed signs Stage 3 – Detachment- appears happy but is faking it
63
Communication with Infants
Touch Soft voice Responsive to crying Take turns in baby conversation Develop from babbling & cooing to single word production
64
Normal Infant Vital Signs
Temp: 36.5oC – 37.5oC (97.6o – 99.8oF) axillary Heart Rate: 110 – 160 Respiratory Rate: 30 -- 60

Pediatrics (24 decks)

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