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Fall 2020 Primary Care FNP > Infant 2-10 Months > Flashcards

Infant 2-10 Months Flashcards

1
Q

Erickson’s Psychosocial Development

=

A

Trust vs. Mistrust

  • fullfillment of basic needs such as nourishment, warmth, and physical contact
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2
Q

Piaget’s Theory of Cognitive Development

Argues that we have to conquer 4 stages of cognitive development

S______

______ Operational

______ Operational

______ Operational

A

Argues that we have to conquer 4 stages of cognitive development

Sensorimotor

Pre

Concrete

Formal

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3
Q

Growth and Development

  • Physical Characteristics
    • ​W____
    • H_____
    • Head ______
    • G____ chart plots WHO/CDC
  • Use the ____ growth charts to monitor growth for infants and children ages 0-2 y of age in the US
  • Use the ____ growth charts to monitor growth for children age 2 and older
A
  • Weight
  • Height
  • Circumference
  • Growth
    • WHO 0-2y
    • CDC >2y
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4
Q

Newborn to 2 months

Gross Motor Skills

  • Head =
    • When does the head lag disappear?
  • Neck =
  • Hands =
A
  • Can lift and turn head when lying on back
    • Complete head lag when newborn, slight at 12 wks, should disappear at 20wks
  • Unable to support head when sitting
  • Fisted, arms flexed
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5
Q

3-4 months

  • Eyes =
  • Hands and feet =
  • When lying face down =
  • Neck =
  • Primitive reflexes =
  • Rolling =
A
  • Track objects (better muscle control), increased vision to tell objects apart from backgrounds
  • Begin to control but not fine tuned, no grasp just swiping at objets
  • Cobra (raises up upper torso, shoulders, head)
  • can Sit with support, keep head up
  • Dissappeared
  • Stomach to back at 4 months

STOMACH to BACK 4m, BACK to STOMACH 5-6

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6
Q

5-6 months

  • Sitting =
  • Hands =
  • Rolling =
  • When lying on tummy =
A
  • Sit alone WITHOUT support (only moments at first then up to 30sec)
  • Grasps blocks or cubes with ulnar palmar grasp (doesn’t use thumb)
  • Back to Stomach
  • Push up with arms to raise shoulderes and head to look around and reach objects
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7
Q

6-9 Months

  • What gross motor activity begins?
  • Sitting =
  • Standing =
A
  • Crawling
  • Sit without support for long periods of time
  • Pulls into standing position while holding furniture, can sit down from standing
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8
Q

9-12 Months

  • Standing =
  • Walking =
A
  • Begins to balance while standing alone
  • Takes steps holding hand, may take few steps alone
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9
Q

Fine Motor

  1. 2-4m
  2. 4-6m
  3. 6-8m
  4. 8-10m
A
  1. hands open, plays with hands and feet
  2. palmar grasp, manipulates small objects
  3. holds bottle, bangs objects
  4. pincer grasp
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10
Q

Positioning 1-12 months

Pictures

A
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11
Q

Sensory Development

Vision/Sensory

  1. 2-4m =
  2. 4-6m =
  3. 6-8m =
  4. 8-10 =
A
  1. follows objects, turns head to side when sound is made
  2. begins eye hand coordination, smiles at mirror
  3. recognized parents, focuses on small objects
  4. localizes sound by turning head in appropriate direction
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12
Q

Sensory Development

  • Hearing begins when? Prefers the ____ voice
  • Touch, taste, and smell mature at _____, what taste is preferred?
  • Vision of newborn infant can see within a range of?
  • When do they get color vision? By 2 months can track objects up to ____ degrees, and prefers looking at?
  • Inner ear (v_____) senses, the infant responds to (2)
A
  • before birth, mature at birth, human
  • birth, sweet
  • 8-12 inches
  • 4-6m, 180 degrees, faces
  • vestibular, rocking and changes in position
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13
Q

Socialization/Vocalization

  1. 2-4m =
  2. 4-6m =
  3. 6-8m =
  4. 8-10m =
A
  1. coos, babbles, starts to laugh
  2. laughs aloud, babbles one syllable sounds
  3. imitates sounds, plays peek a boo, two syllable words
  4. says “dada” and “mamma” ,comprehends “no”
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14
Q

Sleep Pattern

  1. 2-4m =
  2. 3-4m =
  3. 4-10m =
A
  1. 15 hrs/day nocturnal
  2. Circadian rhythm normalization
  3. varies by infant
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15
Q

Feeding

  • What is best? What is used alternatively?
    • 2-4m = how much per feeding? how many feedings per day?
    • 6-8m =
    • When to introduce SOLID food? - recommended by AAP
  • Developmental readiness includes
    1. Ability to ___ with or no support
    2. Has good ____ control
    3. Able to open ____ and ____ forward when food is offered
A
  • Breastfeeding, Formula
    • 4oz, 6/day
    • Chews and bites
    • 6 months
  • Readiness
    1. sit
    2. head
    3. mouth, lean forward
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16
Q

Solid Foods

  • Progression of solid food =
    • Add one new food every?
  • Portion sizes
    • Cereal =
    • Vegetables/Fruits =
  • 8-10m = picks up small morsels and feeds self, able to use _____ with much spilling, r____ motion
  • Introduce _____ around ___ months
A
  • Iron fortified cereal -> pureed fruits and veggies -> meats
    • 3-4 days
  • Portions
    • 2-4 tbs bidaily
    • 2 tbs bidaily
  • spoon, raking
  • proteins at 8m
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17
Q

History Overview for Every Visit

  • S______
  • E______
  • A______
  • D______ M______
  • Last visit…..I______
  • _ _ visits
A
  • Sleeping
  • Eating
  • Activity
  • Developmental Milestones
  • Immunization
  • ER
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18
Q

Anticipatory Guidance

  • Nutrition and F______
  • Fever > ______ degrees F __-__ months of age
    • ​AAP recommends only using _____ thermometers in children
    • Where to take most accurate temp?
  • S____ pattern
  • T____ eruption
  • Imm______
  • S____ tips
  • Soc______
  • When months are the follow up visits? (4)
  • Common problems
A
  • feeding
  • 102.2, 3-36m
    • digital
    • rectal
  • Sleep
  • Teeth 5/6m to 1 yr, theres a range, we don’t rly worry about it
  • Immunization
  • Safety
  • Socialization
  • 2, 4, 6, 9
19
Q

Diarrhea

Acute =

Chronic =

Causes (2)

A

transient, self limited

> 2 weeks

Viral or bacterial

20
Q

Diarrhea History

  • L_____ of illness
  • Stool fr_____, l___ness, presence of any?
  • Oral _____.. assoc vomiting?
  • A_____ symptoms..fever, rash
  • U____ output
  • Contacts with other _____ illness
A
  • Length
  • frequency, looseness, gross blood?
  • intake
  • associated
  • urine
  • infectious
21
Q

Diarrhea PE: Hydration Status

What do you look at?

  • Moist _____
  • Presence of s____ and t___
  • Skin ____
  • W___
  • # of _____
  • A____ness
  • T_____
  • 2 body systems?
A
  • mucosa
  • saliva, tears
  • turgor
  • weight
  • diapers
  • alertness
  • temp
  • HEENT, ABD
22
Q

Acute Diarrhea

​Causes

  • Viral enteritis (2)
  • Enterotoxin (1)
  • Prasitic (1)
  • Extraintestinal infection (2)
  • ____ induced? esp ampicillin
  • BLOOD IN STOOL -> MUST _____
A
  • Norwalk, Adenovirus
  • E.coli
  • Giardia
  • OM, UTI
  • Abx
  • TEST
23
Q

Chronic Diarrhea

  • _____ COMMON
    • ​Chronic constipation…with _____ diarrhea
    • Formula ______
    • ______ with >2 wks
A
  • MOST
    • overflow
    • intolerance
    • collaborate
24
Q

Diarrhea Dehydration

  • ​Mild, Moderate, Severe
    • ​6-9% ___ mouth, absence of ____
    • >10% sunken (2), poor _____
A
  • dry, no tears
  • eyes, fontanels, poor turgur
25
Q

Symptoms of Severe Dehydration

  • Severe dehydration is a? How do children appear?
  • ____ mucosal membranes/tongue
  • ______ or no urine output
  • _____ heart rate, ____ pulses, ____ breathing, and ___ extremities
  • ____ capillary refill
  • Deeply _____ eyes (and/or fontanel in a baby)
A
  • medical emergency, lethargic maybe even unconscious
  • dry
  • minimal
  • Increased, weak, deep, cold/mottled
  • slow
  • sunken
26
Q

Treatment of Diarrhea

(3)

  • ORS: __ ml/kg of body weight how often?
  • Treat associated ______
  • Continue what?
A

Hydration, Pedialyte, Ricealyte (ORS)

  • 1 ml/kg every 5 min over 3-4 hrs
  • infection
  • breastfeeding or formula
27
Q

Hospitalizable Diarrhea

  • Unable to keep ____ in
  • ____ diarrhea
  • L_____
  • Poor ____, few wet _____
  • Concern about p______
  • >10% _____, sunken ____, poor _____
A
  • fluids
  • Bloody
  • Lethargic
  • output, few diapers
  • parenting
  • dehydration, fontanels, turgor
28
Q

Follow Up Diarrhea

  • _____ in 12 and 24 hours
  • I____
  • # of _____
  • F___
  • Act____
  • F/U in ____ at 24-48 hrs
A
  • Phone
  • Intake
  • Diapers
  • Fever
  • Activity
  • Office
29
Q

Diaper Dermatitis

  • Etiology: (1) is often the causitive agent
  • Objective Data
    • ​B____, r___, shiny, sharply demarcated borders, s____ lesions: er_____ papules or pustules
    • _______ found in skin folds and _____ (thrush), inspect entire body
  • Assessment
    • ​Diagnosis through?
A
  • Candida Albicans​
  • Objective Data
    • Beefy, red, satellite, erythematous
    • Candidiasis, mouth
  • H and P
30
Q

Diaper Dermatitis Education and Follow Up

  • Education
    • ​Check entire body for _____
    • _____ diapers frequently and cleanse diaper area with ____ water at each diaper change, keep child ____ diapers as often as possible, do not use _____ pants
    • Keep baby clean and d____, especially warm ____ areas
    • Careful hand_____ technique
    • Topical _____ may be indicated, what drug?
  • Follow up
    • Check _____ frequently, call immediately if you see?
    • Call back in 3 day if?
A
  • rash
  • Change, tepid, without, plastic
  • dry, esp warm moist areas
  • handwashing
  • antifungal - Nystatin
  • mouth -> white spots
  • no improvement
31
Q

What is this a picture of?

A

Irritant Diaper Dermatitis

32
Q

Oral Thrush (Candida)

Normal vs. Buccal Mucosa Involvement

33
Q

SIDS/SUIDS Sudden Infant Death Syndrome

SIDS =

SUIDS =

A
  • sudden death of infant < 1 yr that remains unexplained after complete case investigation
  • sudden unexpected infant deaths that occur suddenly and unexpectedly in previous healthy infants and have no obvious cause of death prior to investigation (unexplained).
34
Q

SIDS/SUIDS Risk Factors

  • Infants sleeping on their _____
  • ____ infant sleep surfaces and _____ bedding, t___ or other objects in sleep environment
  • Maternal ____ during pregnancy
  • Over_____
  • ___maturity or low birth ____
  • ____ a bed with others
  • Sleeping place other than ____ (adult bed, couch, chair)
  • Faulty _____ of cribs or beds
  • Ob___, fa____, or d___ or alc___ use by persons supervising or sleeping with child
  • Quality of _____ at time of death
  • Family’s a_____ to provide safe sleep or play environment for child
A
  • stomach
  • soft, loose, toys
  • smoking
  • heating
  • premature, low birth weight
  • Sharing
  • crib
  • design
  • Obese, fatigue, drugs/alcohol
  • supervision
  • ability
35
Q

Interventions for SIDS/SUIDS

  • What position?
  • Crib safety and bedding?
  • Room temp?
  • Avoid bed ____/ ___-sleeping
  • Avoid ____/_____ use: esp cigarette smoking in hour or car and during breastfeeding
A
  • “Back to sleep” (supine position)
  • Slats 2 3/8 inces apart, firm mattress, no plastic, crib alternatives include flat/low/firm surface, drawer, moses basket
  • Avoid overheating: room temp 68-72F
  • sharing, cosleeping
  • drug/alcohol
36
Q

Education

  1. Education in child____ classes and hospitals of expectant and new parents on safe infant sl____ environments
  2. In hospital assessments by nurses with parents to assess a baby’s sleep environment when it goes _____
  3. C___ distribution programs for families
  4. Parent education campaigns on ____-sharing NOT ___ sharing
  5. _____ cessation education and support for pregnant and parenting women and other caregivers
  6. Make sure that infant leaves hospital and has a ____ care provider established
  7. Encouraging _____feeding
  8. P_____ offered at each sleep
  9. Avoid products that claim to reduce the risk of ____
  10. Parents educated not to let baby get too ___
  11. The “____ to Sleep” campaign; baby sleeps on back everytime
    • Specific messaged targeted to families and childcare providers who traditionally practice stomach sleep positions and/or bed sharing
  12. _____ requirements for _____ providers on safe sleep environments and infant sleep positions
A
  1. childbirth classes, sleep
  2. home
  3. Crib
  4. room sharing NOT bed sharing
  5. Smoking
  6. primary
  7. breast
  8. Pacifier
  9. SIDS
  10. hot
  11. Back to Sleep
  12. Licensing requirements for daycare
37
Q

Bronchiolitis

=

  • Children < ____ months
  • Peak in ____ and early ____ seasons
  • _____ are the only source of infection
  • Route of transmission?
  • What virus can cause it?
    • Also viruses such as A____, In____, Mycloplasma _____, Rh_____
A

Inflammation of the bronchioles…VIRAL

  • <24
  • Winter, Early Spring
  • Humans
  • Direct/Close Contact
  • RSV (Respiratory Syncytial Virus)
    • Adenovirus, Influenza, M. Pneumonia, Rhinovirus
38
Q

Risk Factors for Bronchiolitis

(3)

A

Low Birth Weight

Prematurity

CHD (coronary heart disease), Respiratory diseases

39
Q

Bronchiolitis Presentation

  • Peaks at?
  • Symptoms and duration?
  • Fever?
  • How does the child feel, present?
A
  • 6 months
  • 2-3 days rhinorrhea, cough
  • Low grade temp
  • usually active, playful
40
Q

Hospitalizable Bronchiolitis

  • At what age?
  • RR of?
  • Poor ____ or signs of ______
  • L_____
  • Diagnosises such as? (3)
  • Care at home may not be _____
  • Signs of Respiratory Distress (4)
A
  • <6 months
  • Tachypnea 30-60
  • intake, dehydration
  • Lethargy
  • CHD, Respiratory, Neuromuscular dx, Prematurity
  • adequate
  • Distress -> RR>60, Nasal flaring, O2 <95%, Intercostal Retractions
41
Q

Bronchiolitis Treatment

(4)

F/U when?

A

Hydration

Steam

Do not typically use bronchodilators/nebulizers - not effective, may give one time trial if severe

Observe

24 hrs in office

42
Q

Intussusception

=

  • < __ yo with abdominal pain
  • Recent ____ infection
  • L_____ - does not play, pain resolves, plays again
  • Positive stool tests for?
  • Tx =
A

Invagination of one part of intestine into another-distal ileum into cecum

  • <2 y w abdominal pain
  • Viral
  • Lethargy
    • FOBT, Currant Jelly Stool w blood + mucous
  • Surgery
43
Q

Pyloric Stenosis

=

  • May present from infants at what age range?
  • Mostly in what gender?
  • Classic Symptom =
  • What will you feel?
  • Treatment =
A

Hypertrophy of pyloric muscle-obstruction of gastric outflow

  • >2 wks - 10wks
  • Male
  • Projectile non-bilious vomiting
  • Firm mobile-OLIVE shaped mass in epigastrium
  • Pyloromyotomy

Fall 2020 Primary Care FNP (11 decks)

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