exam 2 Flashcards
in infants weight increases - lbs
up to __ lbs in 1st year of life
■ Proportional changes: weight, height, head, nervous system, chest
● Weight increases 6-8lbs, up to 20lbs in the 1st year of life
■ Posterior fontanelle closes by
■ Posterior fontanelle closes by 2 months of life
Eye alignment in infants:
some children get _____, but usually resolves close to __ ___
Red reflex should be
■ Eye alignment
● Some children get cross eyed at times, but usually resolve close to 4 months (Strabismus)
■ Red reflex should be symmetrical
The abdominal muscles do not fully develop until
Make sure to assess for any ____ or ____
The abdominal muscles do not fully develop until 3 years of life
Make sure to assess for any hernias or masses
For boys make sure to assess ___
both should be ___ by ___ ___
Note any _____
■ For boys:
● Both testicles are descended by 6 months
● Note any hydrocele
For girls make sure to asses for ____ ___
■ For girls:
● Assess for labial adhesions
When assessing the musculoskeletal system make sure to assess
1)
2) - do this by
3)
■ Musculoskeletal
● Leg fold symmetry
● Hip abduction (if born breech get hip ultrasound at 6 months)
○ To make sure there are no hip clicks.
○ Barlow maneuver and Ortolani maneuver will assess for hip click
● Foot shape and flexibility (look for club footing)
Make sure to assess skin for
1) - most common
2)
3)
________ are normal and can look like a bruise
■ Skin: rashes
● Common – infantile eczema
● Lesions
● Bruising or burns
○ Mongolian spots are normal
Growth and development in infants should be ____
1
2
3
4
5
Growth and development in infants should be proportional
weight
height
head
nervous system
chest
During newborn visit make sure to ask about
1)
2)
such as
3)
4)
5) complications such as ____ or ____
6) ____ admission
7) any ____
8) what _____ they received
1) Birth history
Vaginal/C-section (reason)
Weeks gestation
Stay in hospital (# days)
2) Complications during pregnancy
PIH, Pre-E, Eclampsia, HELLP
GDM
Maternal/infant blood work
3)Complications during delivery
Operational birth
Infection
4) Birth weight and Discharge Weight
5) Jaundice or Infection
6) NICU Admission
7) any Medications
8) Immunizations
Concerning signs when checking weight
1)
2)
Assess for _____ feedings
1) Lost more than 6% of birth weight
2) Not back to birth weight by 2 weeks
Assess for poor feedings
Make sure to check ____ in elevated in hospital or at newborn visit.
bilirubin
Make sure to assess for infection of
1)
2)
umbilical cord
circumcision
Feeding difficulties
Regurgitation and spitting up occur because
How to help prevent spitting up in regards to feeding
Can be normal but may seem alarming to some parents
Make sure _____ is ____ ___. If not thats when we ____
■ Feeding difficulties
● Regurgitation and spitting-up
○ Acid reflux is prevalent d/t sphincters are not mature
○ Encourage parents to break up feeding after ~15mL. burp the child and then return to feeding
○ Spitting up can be large amount and it is normal for it to come out of the nose
Make sure weight is going up. If not thats when we give meds for acid reflux
Colic def-
usually disappears at age
___ ____ crying is normal
colic - crying over 3 hours multiple days a week
disappears at age 3-6 months
night time crying is normal
What increases the risk of SIDs
(5)
Preemies
Siblings of SIDS victims
Smoking during pregnancy & in the home
Multiple births
Low Apgar scores
What is the Moro Reflex
when does it disappear by
sudden loud noise will cause symmetric abduction and extension of the arms followed by adduction and flexions of the arms over the body
disappears by 3-4 months (although some references state disappears between 4-6 months)
Describe the placing/stepping reflex
when does it disappear by
hold baby upright and allow the dorsal surface of one foot to touch the edge of the table – baby will flex the hip and knee –(make stepping motion)
Disappears around 2 months old
Describe the Babinski reflex
When does it disappear
Stroke on the sole of the foot, foot turns in and toes flare up
Disappears around 6-24 months
Describe the tonic neck reflex
Appears at _ to _
disappears at age
turning head to one side with jaw over shoulder causes the arm and leg on side where head is turned to extend. The arm and leg opposite with flex.
Appears birth to 2 months, disappears 4-6 months
Describe the rooting reflex
Disappears by age
stroking the corner of the mouth causes baby to turn toward the stimulation and suck
Disappears by 3-4 months.
Describe the grasp reflex
disappears by age
Pressing a finger or object to baby’s palm, baby makes a fist and tries to grab object
Disappears 3-6 months old
Grasping reflex disappears at age
Crude pincer starts at
Neat pincer starts by
Reflex at 3-6 months
Crude pincer grasp 7-8 months (grabbing object with all fingers)
Neat pincer by 11-12 months (able to pick up cheerio with index finger and thumb)
What gross motor development will the infant start to develop ? (4)
Head control
Rolling over
Sitting
Locomotion
what is head lag?
What does head control look like?
Head lag is when the infant is helped to sit up the head falls back (unable to support their own head)
Head control - when you pull a baby up to seated position they are able to tuck their chin down and support their own head
When does locomotion usually start?
locomotion = movement
starts at 6 months of life
can be crawling or butt scooting
infant nutrition
breast vs bottle
introduce solid foods at age
when selecting foods start with
Wean from bottle at age
wait until ___ to give child cows milk
breast is better but let parent choose most important thing is to get the baby to eat
introduce solid foods at age 6 months to prevent GI disorders
when selecting foods start with
non-sweet vegetables first then do fruits later. Do 1 food/week. Give peanut butter and eggs at about 9 months old
Wean from bottle at age 18 months
wait until 1 year to give child cows milk
What kind of car seat should an infant be in
2 key points
should be in rear facing car seat until 2 years of age.
Should have a 5 point harness
6-9 month old visit - feeding/nutrition
ask if they are
How
Amount
any ___ ___ if so how much
any ____/____
any ____ ____
Breast / bottle fed or both
How often in 24 hour period
Amount each feeding
Solids yet? How much?
Amount of juice/water
Parental concerns?
6-9 month old visit - sleeping
1)
2)
3)
Number of nighttime awakenings
6 months should be able to sleep through night
if waking up at night don’t give bottle since they are getting solid foods during the day.
Hours sleeping during the day
should sleep through night and have 2-3 naps during the day
Where the infant sleeps
sleep in their own bed.
Sleep on back on hard mattress with no blankets, stuffed animals, or pillows until 1 year to decrease risk of SIDS.
6-9 month old visit - family assessment
any:
Ask the primary care provider if they have sufficient ____ and ___ ____
does the child ____ _____
Any changes in family situation
Ask Primary care provider if they have Sufficient rest and Support system
does the child attend Daycare? (there is an increased risk of getting sick when child attends daycare)
6-9 month old visit - ROS
1)
2)
3) (especially on that wakes them up at night or is ____)
4)
5) frequency and consistency of
6) #
7) use of
8)
9) up to date on
Temperament (will start to see a little bit of temper tantrums)
Nasal symptoms - @ 6 months that start to be able to breath out of their mouth more
Cough
Vomiting or spitting up - acid reflux usually resolves @ about 6 months with development of spinster
Frequency & consistency of stools (should occur with almost every feeding. can be a variety of colors depending on diet)
Number of wet diapers - 6/day is normal
Use of extremities – equal? Make sure the aren’t favoring one side
Rashes
immunizations - up to date
6-9 month old visit
make sure to start
discipline and parenting
make sure to start baby proofing house. Cover outlets, put poison away, no small pieces left out
discipline and parenting - use distraction and positive reinforcement. Save no for very harmful things infants do
6-9 month old visit dental health
teething starts around
no
teething doesn’t usually cause
can cause infant to _____ but should be evaluated for ____
dental health -
starts teething at about 6 months.
Remind no fluoride toothpaste can cause tooth staining in ingested.
No orajel can cause throat to become numb and suppress gag reflex
teething doesn’t usually cause high grade fevers
can cause infant to pull at ear due to increased pressure in ear but should be evaluated for ear infection
first flu vaccine administered
at
how
@ 6 months or older
must get 2 shots 1 month apart the first time they get flu vaccine up till age 8 then 1x/year
first flu vaccine administered
at
how
@ 6 months or older
must get 2 shots 1 month apart the first time they get flu vaccine up till age 8 then 1x/year
6-9 month old anticipatory guidance for parent
1) set
2) no
3) give them
4) make sure to have ____ and ___
5) don’t leave child
1) set Hot water thermostat less than 120◦
2) no Small parts / toys
3) Poison prevention - give parents number to poison control
4) make sure to have Safety locks and Stair gates
5) don’t leave child unattended by ANY standing water
6-9 month old common parental concerns
1) ____ and ____ ____
2) discipline - ___ don’t work
3) pacifiers - get rid of by age
1) _separation anxiety and stranger fears
2) discipline - timeouts don’t work
3) pacifiers - get rid of by age 2
babbling starts at
6 months
at 6-9 months play usually consists of
at 6-9 months play usually consists of putting things in mouth
Make sure to ___ to child nightly
read
how to help do an exam on this age group
do it on moms lap
show the instruments you are going to use and make it playful
pull down and out on ear lobe
6-9 month old socially appropriate games
make sure to establish a
6-9 month old socially appropriate games - pat-a-cake, peek-a-boo
make sure to establish a bedtime
