Exam 1 Well Child: Infant

Question 1

Well child visit includes

1) H___, W_____, Head _____ and P____
2) ____ signs
3) Developmental ______
4) ______ Assessment
5) ______ Examination
6) Anticipatory ________
7) I________

Answer 1

1) Height, Weight, Head circumference, Plotting
2) Vital Signs
3) Developmental Screening
4) Nutritional
5) Physical
6) Guidance
7) Immunizations

Question 2

How do you measure height on an infant?

Answer 2

1) Fully extend the body holding the head in midline, grasping knees together gently and pushing down on the knees
2) Measure from top of head to heels of feet (feet with toes pointing directly to ceiling)

Question 3

How do you measure weight on an infant?

Average weight for an infant =

Answer 3

Should be weighed naked (diaper off) on an infant scale, in lying position

Balance the scale before each weight with clean sheet of paper

7-8 lb

Question 4

How do you measure head circumference?

1) Repeat it __ times to get average
2) Should measure until ___ years of age

Answer 4

Measure head at greatest circumference, slightly above eyebrows and pinna of the ears and around the occipital prominence at the back of the skull

1) 3
2) 3

Question 5

Microcephaly =

Complication)

Answer 5

= Proportionally small head

If skull is not growing, there isn’t enough room for brain to grow

Question 6

Macrocephaly =

Complication)

Answer 6

= Proportionally large head

Can lead to too much fluid in brain

Question 7

Plotting =

1) Should stay within __ standard deviations
2) Ex) Child goes from 75th to 25th percentile what should be done?
3) Height, weight, and head circumference should be _____

Answer 7

= Comparing the child to him/herself

1) 2
2) Cardiac, Renal workups, blood work to rule out many conditions
3) proportional

Question 8

Normal growth Birth - 6 months

1) Weight gain =
2) Height =
3) Head circumference =

Answer 8

1) 5-7 oz/wk, double birth weight by 5-6 months
2) 1 inch/month
3) 1.5cm increase/month

Question 9

Normal growth 6 months - 1 year

1) Weight gain =
2) Height =

Answer 9

1) 3-5 oz/wk, triple birth weight by 1 year

2) 1/2 inch/month

Question 10

Infant Vital Signs

Temperature =

How do you take temp?

Answer 10

99-99.7F

Place tip under arm in center of axilla and keep close to skin, hold infant’s arm firmly against side

Question 11

Infant Vital Signs

Heart Rate =

1) Can go up to ___ bpm with excitement, fever
2) How do you take the apical heart rate?

Answer 11

80-150 bpm

1) 200
2) hold stethoscope at apex of heart (4th intercostal space, midclavicular), count for 1 full minute because of irregularities

Question 12

Infant Vital Signs

Respiratory Rate =

How do you take respiratory rate?

Answer 12

24-50

Observe abdominal movements, count for 1 full minute due to irregular respirations

Question 13

What is the most widely used developmental screening test?

1) 4 Areas of Focus =
2) Mostly used to screen for =
3) Examiner should be trained by =
4) Client is expected to =

Answer 13

Denver II

1) Gross Motor, Language, Fine motor, Personal-social
2) developmental delays
3) Master instructor
4) perform every item to the left of the line (of their age) and items that intersect the line are in 75-90th percentile (shaded box)

Note: important to identify delays early on to provide early intervention

Question 14

Head lift (when supine)

1) at 2 months =
2) at 4-6 months =

If chid is unable, it is a sign of =

Answer 14

1) 45 degrees
2) 90 degrees

Cerebral palsy

Question 15

Head Lag

1) at 4 months =
2) if seen at 6 months =

Answer 15

1) should not be seen

2) may be linked to cerebral palsy

Question 16

1) AAP (American Academy of Pediatrics) recommendations=

2) Nurses should =

Answer 16

1) - Breastfeeding is the best source of nutrition for babies at least through first birthday and longer when possible
- Exclusive breastfeeding for the first 6 months is recommended

2) - Inquire about breastfeeding, encourage mother to continue breastfeeding, and offer resources to assist with successful breastfeeding techniques

Question 17

Nutritional Needs

1) Newborn - 3 months =
2) 4-6 months =
3) 7-11 months =

• Feedings should be ______
• Depends on _____ of baby as well

Answer 17

1) 1-6 oz every 2-4 hours
2) 6-8 oz every 4-6 hours
3) 6-8 oz every 6-8 hours, with max 32 ox per day

• on demand
• weight

Question 18

Types of Formulas (2)

Answer 18

1) Milk based formulas (Enfamil Lipil, Good Start, Similac)

2) Soy based formulas (Isomil, Nursoy, Prosobee, Soyalac, Good Start supreme Soy)

Question 19

Different prepartions of formula (3)

Answer 19

• Ready to feed
• Concentrate (2 oz formula, 2 oz water)
• Powder (2 oz water with one scoop of formula)

Question 20

Formula alerts

1) Can be mixed with =
2) Use only ___ water from tap because =
3) If its an older home, run the tap for __ minutes before using to minimize ____
4) Must _____ formula once mixed to =
5) Formula that baby does not drink must be ____ bc of ____
6) To minimize waste =

Answer 20

1) tap or bottled water
2) cold, lead doesn’t separate from hot water
3) 2 min, minimize led
4) Refrigerate, decrease bacteria
5) discarded, bacteria
6) only prepare as much as infant can consume

Question 21

Can you give cow’s milk? Why or why not?

Answer 21

NO!

Babies cannot digest cow’s milk, it can cause GI bleeding (formula/breast milk is pre-digested)
Goal is brain development with protein, fat, calories - cow’s milk doesn’t have enough to cause highest amount of brain development

Question 22

Solid Foods

1) Newborn - 3 months =
2) 4-6 months =
3) 7-11 months =

Answer 22

1) No solid foods
2) begin introduction with iron fortified cereal products; then protein/veg/fruits
3) offer finger foods, introduce the cup

Question 23

Why are fruit juices not recommended?

__g of sugar = __ teaspoons of sugar

Answer 23

Due to high sugar content that contributes nothing to brain development
-40, 10

Question 24

Solid foods should be introduced with a spoon why?

Answer 24

To stimulate digestive juices, expose to different textures, not for nutirional reasons, but with motor skills, but should not replace what they need for full brain development

Question 25

Physical Assessment Tips 1) Be = 2) Have parent = 3) Proceed from = 4) Expect tearless cry until at least __ months 5) Posterior fontanel closes by __ months 6) Anterior fontanel closed by ___ months 7) Teeth eruption, usually __-__ teeth by __ year 8) check ____ alignment

Answer 25

1) Happy, Smile! let baby touch equipment 2) hold baby during exam 3) Least intrusive to most intrusive assessment4) 3 5) 2 6) 12 7) 4-8 teeth, by 1 year 8) ear

Question 26

Pain Scale - FLACC components Severe pain score = What vital signs change with pain?

Answer 26

1) Face 2) Legs 3) Activity 4) Cry 5) Consolability 8-10 Heart rate, RR

Question 27

FLACC Scores (0, 1, 2) 1) Face 2) Legs 3) Activity 4) Cry 5) Consolability

Answer 27

1) - No expression - Occasional grimace - Frequent to constant quivering chin 2) - Normal position or relaxed - Uneasy restless and tense - Kicking or legs drawn up 3) - Lying quiet - Squirming or shifting back and forth, tense, moaning - Arched, rigid, or jerking 4) - No cry - Moans or whimpers - Crying steadily 5) - Content, relaxed - Reassurance, hugging - Difficult to console

Question 28

PE Vital Signs (2)

Answer 28

- Temp, HR, RR | - O2 sat if any respiratory issues

Question 29

PE Weight, height, head circumference + percentiles (2)

Answer 29

- Plot height, weight, and head circumference on growth chart every visit - BMI over 2 years

Question 30

PE General (2)

Answer 30

- Alert, good eye contact, interactive | - Developmental Screening

Question 31

PE Skin (3)

Answer 31

-warm, dry, no rash or lesions

Question 32

PE Head/neck - ____cephalic - Posterior fontanel closes by = - Anterior fontanel appears _____ and ____, closes by = - Neck with good ____

Answer 32

- Norma - 2 months - open, flat, 12 months - ROM

Question 33

PE Eyes - ________ - _____ red reflex bilaterally - Expect tearless cry until at least ___ months

Answer 33

- PERRL - positive - 3

Question 34

PE Ears - __mmetrical, appropriately ______, no ____ or ____, _____ grossly intact - Check ear _____ - can indicate _____ (ex. downs)

Answer 34

- Symmetrical, positioned, sinuses or tags, hearing | - alignment, anomalies

Question 35

PE Nose/Mouth - ___ nasal discharge, oral mucosa ___ and ___, palate ____, - teeth eruption =

Answer 35

- no, pink and moist, intact | - 4-8 teeth by 1 year

Question 36

PE Respiratory - Lungs bilaterally ____, respirations ___ without any ______ - obligate _______ until __ months - don't know how to breath from mouth

Answer 36

- clear, easy without retractions | - nosebreathers 5

Question 37

PE Cardiovascular | - __ and __ sounds, no ____, lips ___, femoral pulses ___ and ___ bilaterally

Answer 37

- S1 and S2, no murmur, pink, strong and equal

Question 38

PE Abdomen - S___, __ distended, bowel sounds x __ - What can be felt ?

Answer 38

- soft, non-distended, x4 | - lower edge of liver

Question 39

PE Genitalia - female and male, testes are ____ - Blood tinged vaginal mucosa is ___ in newborn - Foreskin is ___ _____ until age 1-2 years

Answer 39

- down - OK - non-retractable

Question 40

PE Musculoskeletal - Moves all extremities well with good ____, _____ ortalani's, ____ gluteal folds - Check for ____ hips by = - Feet may turn __ or __, this is okay if they can be turned back to normal position - If you cannot reposition =

Answer 40

- ROM, negative, equal - dislocated by looking for uneven gluteal folds or ortalani's clinck/clunk - in or out - may indicate club feet, needs to be cast

Question 41

PE Neuro | - good ____, interactive, h____, reflexes (3)

Answer 41

- good cry, happy, (moro, grasp, babinski)

Question 42

Anticipatory Guidance (6)

Answer 42

1) Sleep 2) Oral health 3) Mental health 4) Play 5) Disease prevention 6) Injury prevention

Question 43

Hours of Sleep Per day 1) birth - 3 months = 2) 3-6 months = 3) 6-12 months =

Answer 43

1) 10-16 hrs/day 2) 14 hrs/day 3) 12-14 hrs/day

Question 44

Sleep Interventions 1) Place baby in a = 2) Provide a consistent = 3) Establisth a consistent _____ and ___ (ex) rocking, cuddling 4) Put baby in crib while still _____ 5) Remain in room for = 6) Always place baby on ____ (SIDS prevention!) 7) If child wakes up in the middle of the night, what should you do?

Answer 44

1) quiet, dark room 2) transitional object (blanket) 3) routine, time 4) awake 5) few minutes 6) BACK! 7) verbally reassure it's still time to sleep (do the same thing every time)

Question 45

Oral Health - Wipe infants gums ____ times/day, even if: - Do not nurse or bottle while _____, why? - When teething, offer =

Answer 45

- 1-2, no gums! - bed, linked to carries - safe, cool teething toys for comfort

Question 46

Mental Health 1) What is a good measure of secure infants in nurturing environments? 2) Child and parent interactions include (3) 3) Difficulty in self comforting may indicate =

Answer 46

1) good growth and development 2) eye contact, secure holding and cuddling, comforting 3) mental health issues or other environmental factors

Question 47

Play 1) play with infant ____ 2) ____ frequently with infant - ____ inches from face 3) ____ to infant daily 4) Promote stimulation with (3) 5) Nurture infants by c___, r____, m_____, s____ 6) ____ time, ____ time 7) ____ large toys, ____ rattles

Answer 47

1) daily 2) vocalize, 12-15 3) Read 4) Mirrors, musical mobiles, bright colors 5) cuddling, rocking, massaging, singing 6) Floor, Tummy 7) Grasp, shake

Question 48

Immunizations Passsive Immunity = Explore patients = Do RN's need orders?

Answer 48

= passed from mother if she has immunity either through disease process or vaccination Concerns regarding immunizatins and provide evidence based information No, don't need to wait for provider to write an order

Question 49

Advisory Committee on Immunization Practices (ACIP) | Centers of Disease Control (CDC)

Answer 49

15 experts in vaccinology, immunology, pediatrics, nursing, internal medicine, family medicine, virology, public health, infectious disease and preventative medicine expert Evaluate scientific information about the vaccines, review the evidence regarding safety and effectiveness of the vaccines, the severity of the diseases prevented by the vaccines, the number of children who get the disease if there is no vaccine, how well the vaccines work for children of diff ages

Question 50

``` ACIP 2016 Vaccine Schedule Pay attention to: 1) _______ _____ between vaccines (max is irrelevant, body doesn't respond if given early) 2) ______ age to get vaccine 3) Any required _____ and ____ 4) Details below the schedule = 5) ____ __ schedule ```

Answer 50

1) Minimum interval 2) Youngest 3) boosters and when (at what age) 4) Footnotes 5) Catch-up

Question 51

VIS Vaccine Information Statements 1) Explains: 2) Federal law = 3) Available in ___ languages 4) Offer parent enough ____ to read info 5) Ask parent if he/she has any ____ after reading 6) Obtain ____ 7) _____ vaccine

Answer 51

1) risks and benefits of vaccine 2) MUST give to parent BEFORE vaccine administration 3) 40 4) time 5) questions 6) consent 7) administer

Question 52

``` Needle Lengths IM = - Newborns: SC = - only two live vaccines (2) ```

Answer 52

IM = 1 inch : may consider using 5/8 inch for IM if less than 4 weeks old SC = 5/8 inch - MMR, Varicella (come in powder form)

Question 53

Where to administer 1) IM = 2) SC = What is the preferred IM sight for < 3 years old

Answer 53

1) anterior lateral thigh 2) arm or thigh vastus lateralis (anterior lateral thigh)

Question 54

if giving multiple , separate injection sites by at least = Why? Combination vaccines are given to =

Answer 54

1-2 inch To determine which injection caused it, if a local reaction occurred Decrease # of injections

Question 55

Rights of medication administration

Answer 55

- Right Patient - Right vaccine or diluent - Right time - Right dosage - Right route, needle length, technique - Right site - Right documentation Also correct age, appropriate interval, before vaccine or diluent expires

Question 56

Comfort measures during Vaccinations 1) What is given for fever/pain, but not as preventative measure? 2) _____ techniques 3) _______ immediately after injections 4) Order of injections = 5) Tactile stimulation = 6) Administration technique = 7) ____ analgesics are applied ____ (ex lidocaine) 8) Dual administration =

Answer 56

1) Antipyretics (tylenol) 2) Distraction 3) Breastfeeding 4) least to most painful 5) rubbing skin near injection can decrease pain (for age >4), but can cause more pain for child < 4 6) rapidly, without aspiration 7) Topical, prior 8) 2 nurses administer injection at same time in 2 sites

Question 57

Citywide Immunization Registry =

Answer 57

It is mandated in NYC that providers put every vaccine they administer into the registry

Question 58

Medical Management for Adverse Reactions (2) Reporting adverse reactions =

Answer 58

Epi-pen and Benadryl must be available Must report anything that happens to the child within 21 days of vaccination

Question 59

Home Management after vaccinations 1) Mild pain/fever = 2) Local redness and swelling (2) 3) Fever for more than __ days, high fever of ____, ___ pitched cry 4) Emergency =

Answer 59

1) analgesics (tylenol) 2) ice, benadryl 3) 3, 105, high 4) seizures - need immediate medical management

Question 60

Infant car seat should be

Answer 60

Rear facing until 1 year old , but recommended to keep rear facing until 2 years

Question 61

Crib safety =

Answer 61

rails up, avoid toys in crib

Question 62

Violence in the home | Never do what?

Answer 62

Shake baby! | - come up with a plan when parent becomes frustrated with baby, take deep breaths, count to ten, have someone else over

Question 63

Other methods of injury prevention 1) On stairs and windows = 2) For electrical outlets = 3) Avoid (3) 4) Medicine safety =

Answer 63

1) install gates and guards 2) safety plugs 3) string toys, necklaces, cords 4) install locks, keep medicine out of reach, poison control center = 1800 222 1222 (NY)

Question 64

Interventions to prevent separation anxiety in the hospitalized child (4)

Answer 64

1) Have parents stay with child 2) Assess daily routines (try to mimic schedule at home, establish similar daily patterns) 3) Assign consistent staff members 4) Assist parents in communicating their absences

Question 65

Interventions to minimize pain in the hospitalized child 1) ____ infant gently and securely by ____ 2) Distractions such as (4) 3) After procedure ask parent to = 4) Don't have parent do what during procedure? 5) Treatments/procedures should take place where?

Answer 65

1) Immobilize, swaddling in blanket 2) touch, voice, pacifier, bottle 3) hold, rock, sing 4) hold down during procedure, parent shouldn't be associated with pain/distress 5) NOT in patient's room

Question 66

Reactions to pain in a hospitalized child include (5)

Answer 66

Irritability, restlessness Poor feeding Disturbed sleep pattern, Tachycardia, increased respiratory rate Lethargy

Question 67

Pain scales (2)

Answer 67

Neonatal infant pain scale FLACC

Question 68

Common themes among parents of hospitalized infant include 1) Feelings of _____ 2) ______ skills of staff 3) Accepting _____ of hospitalization 4) Need to have information explained in = 5) Dealing with ____ 6) Coping with _____

Answer 68

1) helpless 2) Question 3) Reality 4) Simple language 5) Fear 6) Uncertainty

Question 69

How the nurse can help comfort parents with hospitalized infant 1) ______ parents in child's care 2) Explain every ______ 3) ______ parents in simple, plain language 4) Inform parents of plan of care using:

Answer 69

1) Involve 2) Procedure 3) Educate 4) Family centered rounds

Question 70

Sibling reactions to hospitalized infant Encourage ____ visitations

Answer 70

- loneliness, fear, worry, - anger, resentment, jealousy, guilt - perceive their parents to be treating them differently compared with before sibling's hospitalization - receive little info about siblings - perception of stress they experience is equal to that of hospitalized infant Sibling

Question 71

Safety, Safety, Safety! 1) ______ surroundings 2) ____ parents, they know their child! 3) Respond if child does not? 4) If vitals are off, what do you do? 5) Know your team (7) 6) Good ____ skills

Answer 71

1) Environmental 2) Trust 3) Doesn't look "right", something is going on 4) Recheck and respond 5) Charge nurse, nurse manager, attending, resident, nurse educator, respiratory therapist, response team 6) Communication