lecture 2 [health & risk in first year + fluid balance] Flashcards
1
Q
when do anterior fontanels close?
A
12-18 months old
2
Q
where to detect HR in infants?
A
4th-5th intercostal space to LMCL
3
Q
when do posterior fontanels close?
A
2-3 months old
4
Q
what do nurses need to assess for positive attachment of parent and child?
A
- proximity
- reciprocity
- commitment
- paternal engrossment
- family-centeredness (involvement of siblings)
5
Q
what are the challenges for parent-newborn bonding?
A
- colic
- teething
- sleeping
- daycare
- abuse
- injuries
6
Q
how do you identify colic (paroxysmal abdominal pain)?
A
- vigorous crying
- drawing legs to abdomen
- onset in afternoon
- episodes last from 30 minutes to < 3hours
7
Q
how can you alleviate colic?
A
- antispasmotics
- sedatives
- antihistamines
- antifluctuents
- position changes
- nursing mother’s change diet
8
Q
when do deciduous teeth erupt?
A
6-10 months old
9
Q
what are the symptoms of teething?
A
- irritability
- difficulty sleeping
- refuses to eat
- drooling
- chewing
- biting
10
Q
what can you give to infant to relieve teething?
A
- firm & cold chewing objects
- analgesics–preferably Acetaminophen (NO aspirin)
11
Q
what is the recommended dose for Acetaminophen for infants?
A
10-15mg / kg / dose
(max. 5 doses)
12
Q
what do babies need for healthy & safe sleep?
A
- sleeping in their own bed close to parent’s bed
- no soft bedding
- no smoking
- no overheating
- supine position
13
Q
which characteristics make a child most at risk for abuse?
A
- under 3 years of age
- unwanted pregnancy
- physcially disabled
14
Q
what do 1-6 month old infants need for adequate nutrition?
A
- breastfeeding
- Vitamin D (200 IU / day)
- iron-fortified formula (do not microwave)
- formula 6x daily
- iron fortified cereal (4-6 months old)
15
Q
what do 6-12 month old infants need for adequate nutrition?
A
- formula / breastmilk 4-5 times a day
- spoon feeding by pushing food to back of tongue
- introducing solid foods one at a time
16
Q
when can babies eat fruits and vegetables?
A
6-8 months old
17
Q
when can babies eat meat, fish, and poultry?
A
8-10 months old
18
Q
when do babies get to eat finger food?
teething crackers, fruit and vegetables
A
6-7 months
19
Q
when can babies eat chopped table foods?
A
9-12 months
20
Q
what are some conditions that put infants at risk for nutritional disorders?
A
- Protein-energy malnutrition
- Kwashiorkor
- Food allergy / hypersensitivity / intolerance
21
Q
organic failure to thrive is caused by
A
mechanical failure to intake, absorb or digest food due to illness
short-gut syndrome
22
Q
nonorganic failure to thrive is caused by
A
social components such as
* poverty
* beliefs around food
* knowledge deficit
* stress
* insufficiency
23
Q
idiopathic failure to thrive is caused by
A
unexplained instances that are not organic nor environmental
24
Q
what causes protein-energy malnutrition?
A
- renal dialysis
- GI malabsorption
- anorexia
- cystic fibrosis
chronic illnesses
25
what causes *Kwashiorkor*?
* high starch diet
* lactose intolerance *(muscle wasting & skin depigmentation)*
26
why does *Kwashiorkor* usually lead to blindness?
Vitamin A deficiency
27
how can you conteract lactose intolerance?
take probiotics
28
what is a sign that infants have *FTT*?
they have *inadequate growth*
29
how can you classify a child who has *inadequate growth*?
* weight falls below the 5th percentile
* persistent weight loss
30
how can you treat a child with *FTT*?
* consistent primary caregiver
* unstimulating atmosphere
* face-to-face
* slowly introduce foods
* give directions about eating
* build structure & routines
31
what is *Sudden Infant Death syndrome*?
unexplained death of child younger than 1 year old
32
what are the risks for *SIDS*?
* maternal smoking
* co-sleeping
* prone sleeping position
* soft bedding
* SGA
* bronchopulmonary dysplasia
* persistent apnea
* twins
* premature
33
what is *apnea*?
20 seconds or more breathing cessation
34
what causes *apnea*?
* sepsis
* seizures
* electrolye imbalance
* upper / lower respiratory infection
* hypoglycemia
* acid reflux
* metabolic problems
35
what are the classifications of an *Apparent Life Threatening Event (ALTE)*?
* apnea
* gagging
* coughing
| anything that would cause for CPR
36
management for apnea
* theophylline
* caffeine
* CPR
* continuous respiratory monitor
37
why are children more likely to have fluid & electrolyte imbalances?
* higher basal metabolic rate
* immature kidney function
38
what are the causes of water depletion?
* fever
* vomiting
* diarrhea
* burns
* diabetes
* shock
* high UOP kidney failure
* environmental heat
* phototherapy
39
what are the signs of water depletion in children?
* weight loss
* increased HR
* depressed fontanels
* decreased UOP
* altered LOC
* dry skin
* tacky mucous membranes
40
lab results for water depletion
* high urine specific gravity
* increased BUN
* increased Hct
* increased Na+
* increased serum osmolarity
* variable serum electrolytes
41
what are the causes of water excess?
* water intoxication
* IV overload
* incorrect feeding *(parents use too much water for formula reconstitution)*
* swimming lessons
* too rapid dialysis
* tap water enemas
42
what are the signs & symptoms of water excess?
* crackles
* increased venous pressure
* slow & bounding pulse
* weight gain
* lethargy
* increased spinal pressure
* seizures
* "full" fontanels
43
lab results for water excess
* low urine specific gravity
* decreased Hct
* decreased serum electrolyes
44
conditions associated with water excess
* CHF
* SIADH
* increased ICP
* oliguric renal failure
45
what is the definition of *anasarca*?
generalized fluid accumulation in body tissues
46
signs of *edema*
* increased *central venous pressure*
* decreased plasma proteins
47
what can the nurse do to manage *decreased plasma proteins* related to edema?
* give *albumin* to allow fluid back into the cells
* then administer *lasix* to urinate remaining fluid
48
what are the types of dehydration?
* isotonic
* hypotonic
* hypertonic
49
isotonic dehydration
* equal loss of electrolytes & fluid
* lose circulating blood volume
* Na+ levels normal
50
what is the biggest concern for *isotonic dehydration*?
hypovolemic shock
51
hypotonic dehydration
* loss of electrolytes greater than water
* Na+ levels are < 135
52
hypertonic dehydration
* water loss is greater than that of electrolytes
* seizures are more likely to happen
* Na+ levels > 150
53
which type of dehydration is the most dangerous?
hypertonic dehydration
54
what is the earliest sign of dehydration?
* tachycardia
* poor perfusion *(cap refill)*
55
mild degree of dehydration
* loss of less than 50mL / kg
* cap refill of less than 2 seconds
56
moderate degree of dehydration
* loss of about 50-90mL / kg
* cap refill of 2-3 seconds
57
severe degree of dehydration
* loss of greater than or equal to 100mL / kg
* cap refill of more than 3 seconds
58
oral management of dehydration
rapid fluid replacement over 4-6 hours
59
IV management of dehydration
* use 0.9% solution
* rapid expansion of ECF to prevent shock *(NS 20mL / kg bolus)*
60
why are nurses not supposed to give *dextrose* to pediatric patients?
they will get easily overwhelmed systemically
61
what are the 3 phases of IV management for dehydration?
1. expansion
2. replace deficits
3. maintenance
| IV fluids or oral solutions
62
what is the first intervention for dehydation in pediatrics?
oral rehydration therapy with Pedialyte or Gatorade ONLY
63
what is the nursing action for a child who is dehydrated but NPO?
spray mouth
64
what are the different kinds of interventions for dehydration among pediatrics?
* IV therapy
* intraosseous infusion
* central venous lines
* oral rehydration therapy
* mouth sprays
65
what measure is needed to implement for IV therapy?
| IV therapy = continous maintenance
add potassium
66
under which circumstances is *Potassium* not appropriate to give?
when the child has a decreased UOP
67
intraosseous infuson is only appropriate for emergent situations
true
68
where is the *intraosseous needle* most appropriate to drill?
flat part of tibia or humerus
69
babies **double** their birth weight in the first 6 months
true
70
how much do babies grow per month during 1 - 6 months?
1 inch
71
what are the neurological & muscular developments of children by 6 months?
* palmar grasp
* head control
* turning from abdomen to back
72
babies **triple** their birth weight when they're 7 - 12 months
true
73
how much do babies grow per month during their 7 - 12 months?
1 - 2 inches
74
what are the neurological & muscular developments of babies from 7 -12 months?
* pulling objects to mouth
* pincer grasp
* head control
* back straight
* walking
* sitting down / sitting up
75
babies learn to sit by themselves at 7 months
true
76
how does Piaget define *cognition*?
the ability to know
77
when do babies develop *object permanence*?
9 - 10 months
78
what is *object impermanence*?
the realization that objects exist even if not visible
79
when do babies develop attachment to caregiver?
6 months
80
how do infants develop attachment?
when they can discriminate their caregiver from others
81
when are babies able to recognize their parent's voice & presence?
3 - 6 months
82
when do babies develop fear of strangers?
6 - 8 months
83
when do babies develop separation anxiety?
onset at 9 months, peaks at 18 months, can continue until 3 years old
84
when can infants recognize faces?
1 month
85
when do babies smile back?
2 months
86
when can babies smile at themselves in the mirror?
4 months
87
when do babies begin looking for dropped objects?
6 months
88
when can babies start playing "peek a boo"?
7 months
89
when do babies start responding to "no"?
8 months
90
when do babies start waving goodbye?
10 months
91
when can babies play hand games?
10 months
92
definition of oral-social stages
satisfaction through oral gratification
93
what are the two *oral social stages* among infants?
* food intake *(3 -4 months)*
* grasping and bring to mouth / biting
94
what are the two sides to babies developing a sense of trust by crying?
1. failure to learn *delayed gratification*
2. being neglected
95
what does *separation* mean in regards to cognitive development among infants?
being able to separate self from others
96
what does *play* mean for an infant?
being able to derive pleasure from mastering a skill
97
how does the attitude between parent & child affect their relationship?
* develops sense of permanence
* solidifies the relationship
* leads to stranger anxiety
98
what kinds of toys are appropriate for 1 year olds?
* rattles
* toy cars
* teething toys
* nesting toys
* balls
* reading books
99
NEVER give babies 6 months old and younger water
true
100
babies under 6 months old CANNOT have Ibuprofen
true
101
why are babies not allowed to take *Aspirin*?
they will have a higher risk for *Reye's syndrome*
102
how long do newborns sleep?
16 - 20 hours
103
how often do newborns need to be fed over night?
about 6 times–every 3 hours
104
how long do 1-3 month old babies sleep?
10-16 hours
105
how long do 6-12 month old babies sleep?
12-14 hours with 1-2 day naps
106
what do parents need to ensure that a *daycare* has?
* appropriate child-staff ratio
* discipline policies
* environmental safety precautions
* meal provisions
107
to whom do nurses mandatorily report child abuse to?
social workers
108
when can babies start drinking cow's milk?
1 year old
109
how many times do parents feed the same food to children before determining allergic reaction?
3 times one at a time
110
what can nurses teach parents regarding *anticipatory guidelines*?
* suffocation
* falls
* poisoning
* burns
* motor vehicles
* abuse
111
it is normal for infants to hold their breath and have irregular breathing patterns
true
| but they SHOULD NOT stop breathing for more than 20 secs.
