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peds exam 2 Flashcards

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1
Q

height

A

Increase birth length by 50% by 1 year (Gain 1 inch/month first 6 months,
½ inch per month for second 6 months)

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2
Q

head

A

o Increase of birth OFC by 33%
o At 2 months, posterior fontanel fuses (triangular shaped)
o By 12-18 months, anterior fontanel fuses (diamond shapes)
o “normal” is soft/flat

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3
Q

chest

A

o Heart doubles in weight 1st year

o Shape of chest changes, becomes more wide laterally rather than posteriorly

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4
Q

respiration

A

o Abdominal breathing, respiration rate slows to 30 bpm
o Infants are obligatory nose breathers
o Close proximity of trachea to bronchi, narrow trachea and short Eustachian tubes predisposes infant to ear/UR

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5
Q

cardiac

A

o Heart rate slows from 120 to 80, is irregular (increase with breathe in, decrease with exhale)
o B/P increases from 70/55-90/55.
o Hemoglobin decreases with decreased RBCs at 2-3 months (physiologic anemia), and maternal stores of iron are used up by 5-6 months
o Levels are a low norm, not abnormal

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6
Q

GI

A

o Immature at birth, slow increase in saliva & digestive processes till more functional at approximately 3 months
o Can’t digest complex carbohydrates till increased enzymes (amylase/lipase/trypsin) at 4-6 months

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7
Q

teeth

A

o 4-5 months, drooling prior to teething (irritable/drowsy/anorexia prior to teeth)
o Get lower, then upper incisors at approximately 6-8 months (center teeth)
o Get upper, then lower lateral incisors at approximately 8-12 months
o Rule: age in months-6 = number of teeth

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8
Q

liver

A

**Most immature system at birth. Difficulty with bilirubin (hyperbilirubinemia)

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9
Q

thermoregulation

A

increased body fat 1st 6 months, insulates from cold. Begins to shiver by the end of the first year.

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10
Q

fluid/kidneys

A

Increased proportion of ECF than adults, easily dehydrated

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11
Q

neuro

A

Positive Babinski reflex, NB reflexes fade, acquire the parachute reflex @ 6-9 months;
“Santmyer” reflex: blow on face, baby will swallow

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12
Q

fine motor

2-3 months

A

almost voluntary grasp, hands open, have hand regard, startle reflex fading

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13
Q

fine motor

4-5 months

A

Plays with hands, hand to mouth

Grasp voluntary, (textured toys, can hold 1-2 toys)

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14
Q

fine motor

6-7 months

A

Holds bottle, feeds self crackers
Transfers objects between hands, unidextrous
Has repetitive movements (peek-a-boo, large toys/moveable parts, noise- makers)

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15
Q

fine motor

8-9 months

A

Start pincer grasp, (can start finger foods-bigger foods, not smaller foods)
Releases objects, claps (pat-a-cake)

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16
Q

fine motor

10-12 months

A

Strong pincer grasp, (large crayons, turn pages of books [cardboard or chunks of pages], squeeze toys)
Attempts to stack 2 blocks- but fails (large puzzles, ”nested” blocks)
Can pick up Cheerios

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17
Q

gross motor

1 month

A

Can move head side-to-side, marked head lag, weakest the head will be

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18
Q

gross motor

2-3 months

A

Lifts head 45° when prone, increased head control
Slight bobbing, Use infant seat, swing
Bassinette is only good for 1-2 months

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19
Q

gross motor

4-5 months

A

Raises head and chest to 90°, slight head lag
Rolls from abdomen to back, or back to side
Sits with a prop- sits on the couch with a pillow tucked in
Can start to “scoot” backwards- they will use their arms to push themselves

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20
Q

gross motor

6-7 months

A

Sits alone with support of hands
Rolls from back to abdomen
No head lag, bears weight on feet
Develops parachute reflex, newborn reflexes gone

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21
Q

gross motor

8-9 months

A

Sits unsupported, stands with help

Crawls, usually in reverse first strong extensors than flexors

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22
Q

gross motor

10-12 months

A

Crawls forward
Pulls self to sitting position, sit-stand
Walks with support, push toys (only when walking), ball

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23
Q

psychosocial development- erikson

A

**Trust vs. Mistrust
o Feeling of physical comfort and security, basic needs are met by caregiver
Narcissism-total concern for oneself
Results:
o Trust, or inability to trust
o Lack of forming meaningful relationships
o May end up with dependency problems or feeding disorders

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24
Q

cognitive devleopment- piaget

A

Infants learn:
o Separation (Others control the environment)
o Object permanence
o Use of symbols for mental representation
o Beginning of concepts of time/space by the end of stage

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25
sensorimotor 1st substage 0-1 months- reflexes
1st substage: 0-1 month: Reflexes: Rooting, sucking, grasp, cry, fencing, reflexive stage
26
sensorimotor 2nd substage 1-4 months primary circular reactions
Reflexes become voluntary Stimulus produces response; I cry, I hear mom’s voice, I quiet down Placing a rattle in hand, they can grasp and shake it
27
3rd substage: 5-8 months: Secondary Circular Reactions
Repeated acts for certain results, shaking and banging rattle repeatedly. Begin imitation, play. Beginning to develop object permanence, stranger and separation anxiety. By 6 months, child has a definite preference for mom or primary caregiver
28
4th substage: 9-12 months
Coordination of secondary schemata and application to new situations Begins intellectual reasoning, starts to associate symbols with events (bye-bye); does intentional acts, can remove obstacles
29
social development | 1 month
watches parent’s face
30
social development | 2 months
social smile
31
social development | 3 months
stops crying when parent is seen, recognized familiar objects
32
social development | 4-5 months
laughs out loud, smiles at mirror image, can discriminate family/stranger
33
social development | 6-7 months
imitates, starts biting, peek-a-boo, starting object permanence/stranger anxiety
34
social development | 8-9 months
separation/stranger anxiety, wants to please, fear of bed and being alone, sibling jealousy, starts to remove obstacles
35
social development | 10-12 months
joy when task mastered, frustrated if not mastered, may have security object
36
language | 1 month
cries, makes throaty sounds
37
language | 2-3 months
cooing, “ah”, vocalizes as if in response, squeals
38
language | 4-5 months
laugh, varies tone, can pronounce n, k, g, p, b (don’t need to know consonants)
39
language | 6-7 months
mitates sounds, vowels in 1-2 syllables, “ma, da, hi, da-da, baba” talks to self
40
language | 8-9 months
“no-no”, pronounces t, d, w
41
language | 10-12 months
3-5 words, starts to comprehend meaning of words and objects
42
sensory | 1 month
Fixates on moving objects (tracking tube) Follows midline (will not follow 180°) Quiets to voice Objects at 8-10’’ in front of face (esp. like faces) Black and white mobiles
43
sensory | 2-3 months
Binocular fixation (focus with two eyes) Follows beyond midline Visual search (often because they hear something) Bright objects, mirrors
44
sensory | 4-5 months
``` Localizes sounds (visual search) Beginning to have hand-eye coordination ```
45
sensory | 6-7 months
Adjust posture to visual search (beginning of object permanence) Responds to name An early sign of Autism is not responding to name Begins to understand depth and space Can fixate on very small objects Taste preference
46
sensory | 8-12 months
Increased understanding of depth and space Follows rapidly moving objects Nursery rhymes, imitates animal sounds
47
play
Solitary play, social interaction enhances play Teach infant ways to play Explores with mouth, and increasing abilities to move about
48
communication with infants
``` Hold with feedings, soft voice, high-pitched voice Hold, rock, talk to them often Talk & sing freq. during care Tell names of objects Wrap snugly, hold close, pacifier ```
49
pacifiers
Infants have sucking needs, instruct parents, but the child will choose themselves. Explain that studies have shown preterm babies have increased weight and decreased crying with use of pacifier. Educate on safety-throw away if pacifier sticks together. May help prevent SIDS. NOT recommended for nurses to encourage pacifiers when baby is born, unless parent asks. May increase chance of Otitis Media. Provides analgesic effect during procedures (would add sugar water.
50
nutrition | 1 month
Breast/bottle q 3-4 hours (x 6 per day) “Healthy People 2020” had goal to have 75% all new mothers attempt breastfeeding (is 63%) May add Vitamin D if breastfeeding.
51
nutrition | 2-4 months
Breast milk is ok in frig for 5 days and 12 months if frozen (see. 439 for microwave instructions)
52
nutrition | 4-6 months
1st food-cereal with iron added • First, usually rice, oats, wheat is last (more allergies) • Check for tongue protrusion, place small spoon to back of tongue, scoop up what has fallen out. • Mix cereal with formula or breast milk, or fruit juice. • Regular milk may cause iron deficiency anemia, low zinc & Vitamin C, GI bleeding or indigestion. • Can mix with bottled water, never mix cereal in bottle with enlarged nipple (unless it is used for an infant with reflux). • Very individualized, try a new food at the beginning of a meal. • May try only one new food at a time q 5-7 days (allergies). • Most often find allergies to wheat, nuts, eggs and milk. • Avoid sweetened foods, or foods with “empty” calories, high fat. • Avoid using food for reward, punishment, or comfort. • May start fluoride treatments- consult Dr.
53
nutrition | 6-8 months
After cereal, veggies, then fruit Meats, strained foods, decrease formula as diet is increased. Avoid warming juices to prevent losing vitamin C. (No juices before 6 mo.) Offer cup, finger foods
54
9-12 months
Feeds self with spoon, can try junior foods At end of 1st year-may start soft table foods. Eggs & cheese at 12 mo. Avoid skins-no grapes, nuts, hot dogs, avoid eggs till > 1 year May have 3-4 meals, slowly decrease formula and wean off bottle (prn). If cold: 4 oz-30 secs., 8 oz-45 sec, invert 10 x, test on tongue or back of hand. Be sure to start brushing teeth when they get them.
55
injury prevention
Falls: can roll early- by accident, supervise Choking/suffocation: sleep on back, no co-sleeping, no plastic, appropriate foods Strangulation: crib slats, tight mattress, items around neck MVA- car seats/restraints- use correctly Poisoning, drowning: supervise around any water, look on floor, purses etc.
56
HBV timeline
Birth 1-2 mo. 6-18 mo. (IM)
57
HBV notes
Hepatitis B, don’t give if allergic to common baker’s yeast
58
HepA timeline
A: 1-2 yrs, (2 doses within 6 mo.) (IM)
59
DTaP timeline
2 mo. 4 mo. 6 mo. 15 -18 mo. 4-6 yrs., 12 yrs (Tdap only- “booster”) (IM)
60
DTaP notes
Diptheria-no absolute immunity lasts 10 years Tetanus toxoid-lasts 10 years Pertussis- “a”-acellular, vs. the “whole cell” vaccine, more allergies to this if not give if > 7 years. Don’t give with neurologically impaired child (may give D & T)
61
IPV timeline
2 mo. 4 mo. 6-18 mo. 4-6 yrs (SC or IM)
62
IPV notes
"Inactivated" polio virus Oral no longer used-this prevents vaccine associated polio paralysis Don’t give with anaphylaxis to neomycin, streptomycin or pregnancy
63
MMR timeline
12-18 mo. 4-6 yrs 11-12 yrs (SC)
64
MMR notes
Measles-maternal antibodies usually protect first 6-12 months, don’t give with HIV+ Mumps- not for prepubescent boys; Rubella-mostly for protection of unborn fetus shouldn’t give if woman is pregnant or will become pregnant. Don’t give with recent immune globulin products.
65
Hib timeline
2 mo. 4 mo. 6 mo. 12-18 mo. (IM)
66
Hib notes
Haemophilous influenza-type B causes meningitis, epiglottitis, bacterial pneumonia, septic arthritis, sepsis
67
influenza timeline
every year (poss. 2 doses/ year) starting at 6mo.- to 5 yrs. (IM, nasal)
68
influenza notes
Protects from Influenza A&B; given in early fall; H1N1 virus (swine flu) a form of influenza
69
VZV timeline
12-18 months 4-6 yrs (12 years prn) (SC)
70
VZV notes
Varicella zoster virus- chicken pox, give with MMR, no aspirin for 6 weeks after (why? Can cause Reye’s syndrome) Don’t give if immunosuppressed, on high doses of corticosteroids
71
Rotavirus timeline
2 mo, 4 mo, 6 mo. (oral);
72
Rotavirus notes
don't begin after 6-8 mo. (diarrhea)
73
HPV timeline
minimum @ 9 yrs.; 11-12 yrs., females ages 10-25 years, second dose in 1 month, last dose 4 mo. later (IM).
74
HPV notes
Can be given to boys 9-26 years
75
pneumococcal conjugate vaccine (PCV) timeline
2mo. 4mo. 6mo. 12-18mo. (IM)
76
pneumococcal conjugate vaccine (PCV) notes
(Give PCV too, if > 2 years up to 6 years with medical problems)
77
meningogoccal conjugate (MCV4) timeline
6 weeks- only if at risk, 11-12, 13-18 (IM)
78
meningogoccal conjugate (MCV4) notes
Most common bacteria: Neisseria Meningitidis; not needed from 2-10yrs. Mottling caused from petechiae
79
common reactions
* Fever to 101, soreness, redness at site of injection, behavioral changes- irritable * Pertussis: allergic: T> 105, seizures, shock * MMR-anorexia, malaise, rash, fever
80
nursing care for any immunizations
* May give Tylenol q 4-6 hrs x 3 doses * Use EMLA cream prn, treatment room, sugar water/pacifier, if more than 1 injection, give simultaneously; comfort immediately after * Change needle after drawing up med so there is no med on the outside of the needle that can cause irritation to the skin
81
vaccine contraindications
* Any severe febrile illness-temperature over 101° * May not be able to get if blood transfusion in the past 3 months (for allergy purposes) * Pregnancy * Known allergic response
82
fine motor | 1 month
Grasp reflex (rattle), hands are hands are closed

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