Infant Care (module 19) Flashcards
What to do if immunization series is not completed?
continue with the series; no need to restart series from beginning (except in very rare cases)
Run at the state level, keeps vaccination history
Participation is voluntary
Immunization information system
what length of time is considered newborn/ neonatal?
begins at birth and lasts for the first 28 days of life
when does newborn assessment typically take place?
48-72 hrs after discharge
Begins to smile at people
Can briefly calm herself (may bring hands to mouth and suck on hand)
Tries to look at parent
Social-emotional development for 2 month old
Coos, makes gurgling sounds
Turns head toward sounds
Language/Communication development for 2 month old
Pays attention to faces
Begins to follow things with eyes and recognize people at a distance
Begins to act bored (cries, fussy) if activity doesn’t change
cognitive development for 2 month old
Can hold head up and begins to push up when lying on tummy
Makes smoother movements with arms and legs
Movement/Physical Development 2 month old
Smiles spontaneously, especially at people
Likes to play with people and might cry when playing stops
Copies some movements and facial expressions, like smiling or frowning
Social and Emotional development 4 month old
Begins to babble
Babbles with expression and copies sounds he hears
Cries in different ways to show hunger, pain, or being tired
Language/Communication 4 month old
Lets you know if he is happy or sad
Responds to affection
Reaches for toy with one hand
Uses hands and eyes together, such as seeing a toy and reaching for it
Follows moving things with eyes from side to side
Watches faces closely
Recognizes familiar people and things at a distance
Cognitive development 4 month old
Holds head steady, unsupported
Pushes down on legs when feet are on a hard surface
May be able to roll over from tummy to back
Can hold a toy and shake it and swing at dangling toys
Brings hands to mouth
When lying on stomach, pushes up to elbows
Movement/Physical Development 4 month old
Knows familiar faces and begins to know if someone is a stranger
Likes to play with others, especially parents
Responds to other people’s emotions and often seems happy
Likes to look at self in a mirror
Social and Emotional 6 month old
Responds to sounds by making sounds
Strings vowels together when babbling (“ah,” “eh,” “oh”) and likes taking turns with parent while making sounds
Responds to own name
Makes sounds to show joy and displeasure
Begins to say consonant sounds (jabbering with “m,” “b”)
Language/Communication 6 month old
Looks around at things nearby
Brings things to mouth
Shows curiosity about things and tries to get things that are out of reach
Begins to pass things from one hand to the other
Cognitive development 6 month
Rolls over in both directions (front to back, back to front)
Begins to sit without support
When standing, supports weight on legs and might bounce
Rocks back and forth, sometimes crawling backward before moving forward
Movement/Physical Development 6 month old
May be afraid of strangers
May be clingy with familiar adults
Has favorite toys
Social and Emotional 9 month old
Understands “no”
Makes a lot of different sounds like “mamamama” and “bababababa”
Copies sounds and gestures of others
Uses fingers to point at things
Language/Communication 9 month old
Watches the path of something as it falls
Looks for things she sees you hide
Plays peek-a-boo video icon
Puts things in his mouth
Moves things smoothly from one hand to the other
Picks up things like cereal o’s between thumb and index finger
Cognitive Development 9 month old
Stands, holding on Can get into sitting position Sits without support Pulls to stand Crawls
Movement/Physical Development 9 month old
Is shy or nervous with strangers
Cries when mom or dad leaves
Has favorite things and people
Shows fear in some situations
Hands you a book when he wants to hear a story
Repeats sounds or actions to get attention
Puts out arm or leg to help with dressing
Plays games such as “peek-a-boo” and “pat-a-cake”
Social and Emotional development 1 year
Responds to simple spoken requests
Uses simple gestures, like shaking head “no” or waving “bye-bye”
Makes sounds with changes in tone (sounds more like speech)
Says “mama” and “dada” and exclamations like “uh-oh!”
Tries to say words you say
Language/Communication 1 year old
Explores things in different ways, like shaking, banging, throwing
Finds hidden things easily
Looks at the right picture or thing when it’s named
Copies gestures
Starts to use things correctly; for example, drinks from a cup, brushes hair
Bangs two things together
Puts things in a container, takes things out of a container
Lets things go without help
Pokes with index (pointer) finger
Follows simple directions like “pick up the toy”
Cognitive development 1 year
Gets to a sitting position without help
Pulls up to stand, walks holding on to furniture (“cruising”)
May take a few steps without holding on
May stand alone
Movement/Physical Development 1 year old
startle reflex
Moro
When corner of mouth stroked, infant turns head in that direction to find breast/bottle
Rooting reflex
Stroking the palm of a baby’s hand causes the baby to close his/her fingers in a grasp
Palmar Grasp
is turned to one side, the arm on that side stretches out and the opposite arm bends up at the elbow. “Fencing Position”
Asymmetric Tonic Neck
Flexion of baby’s toes when the ball of the foot is stroked
Plantar Grasp
When the sole of the foot is firmly stroked laterally, the big toe bends back toward the top of the foot and the other toes fan out
Babinski Reflex
Waving bye-bye
9-12 months
What to recommend to parents after baby gets vaccines
Fevers, fussiness, local site reactions (redness, warmth, swelling)
APAP doses, NEVER ASA
Premedication is not recommended
who should not get vaccines
Previous allergic reaction to a vaccine or any component of the vaccine
Anyone moderately to severely ill (fever
Minor illness without fever (ie cold) ok to give
Spread through blood and body fluids (transmitted through birthing process)
Hep B
3 IM injections
First 24 hrs of birth, 1 month and 6 months
Some people are “non-responders” give booster then retest. If still negative start new series.
The younger the person, the more likely to have long term side effects ( scarring of liver, liver cancer)
CI: hypersensitivity to yeast
Hep B
Live attenuated oral formulation
Give before 15 weeks of age, complete series before 8 mos
Rotavirus Vaccine
3 doses at 2 mos, 4 mos, and 6 mos for Rotavirus
RotaTeq
2 doses at 2 mos and 4 mos for Rotavirus
Rotarix (RV1)
Highly contagious GI illness that can cause severe dehydration
Commonly misperceived contraindications:
Prematurity
Household members who are immunosuppressed or pregnant
Rotavirus
CI of Rotavirus Vaccine
CI: severe combined immunodeficiency (SCID) Intussusception (past immunization could cause this, new one does not) Moderately or severely ill (d/v) (Mildly ill can get vaccine)
Infants and children should receive 5 doses
2, 4, and 6 months, 15-18mos, and 4-6yrs
Booster given at age 11-12
6:21
DTaP
DT and Td for ages 0-7?
7 yrs +?
DTaP for 0-7 years
Tdap for 7yrs+
Causes thick covering in the back of the throat and can lead to difficulty breathing, heart failure, paralysis, and death
Corynebacterium diphtheria
Clostridium tetani
Spores of bacteria are everywhere in the environment, including soil, dust, and manure; the spores develop into bacteria when they enter the body
puncture wounds that are hard to clean
Stepping on rusty nail
Burns, crush injuries, or injuries with dead tissue
Avg 30 cases per year (almost all cases unvaccinated)
Incubation period 3-21 days, most cases within 14 days
Can give booster within 3 day of injury
Tetanus (Lock Jaw)
“Whooping cough”
Coughing can last 10 weeks or more. AKA “100 day cough”
Spread via droplet and close contact
Can affect all ages, most severe and sometimes fatal in infants less than 1 year
½ babies less than 1 who get pertussis need hospitalization
Pregnant women are vaccinated in 3rd trimester
Bordetella pertussis
DTap Contraindications
Guillain Barre syndrome w./in 6 weeks of previous dose
hx of anthus type reaction
moderate or severe acute illness w/ or w/out fever
Contraindications to acellular pertussis component
pts who developed encephalopathy
Once the leading cause of meningitis in kids <5
Since vaccine less than 50 cases in US in 2014 (mostly unvaccinated)
Historically the leading cause of peds epiglottitis. (can also be caused by other organisms)
3-4 immunization series → 2, 4, and 6 mos (depending on brand), and 12-15 months
No special contraindications
Haemophilus influenzae type b (Hib)
13 stereotypes
Previous version (PCV7) reduced disease by 97%
4 doses:
2, 4, 6, and 12-15 months
Children who miss shots or start later should still get vaccine (# of doses and intervals depends on age when vaccination begins) → CDC catch up schedule
No special contraindications
PVC 13 → Pneumococcal conjugate
Oral version not available in US since US (OPV)
No cases in US since 1979
Still present in Afghanistan, Pakistan, and Nigeria
No cure
Virus causes paralysis
IPV → inactivated polio vaccine
4 doses
2, 4, 6-18 mos, and 4-6 years
5h dose is safe
Accelerated scheduled if traveling to affected area
If vaccinated abroad may revaccinate with IPV
No special contraindications
IPV → inactivated polio vaccine
Live vaccine
May be given as separate doses in other countries
2 doses
12-15 months, 4-6 years
CI: Severe immunodeficiency and pregnancy
MMR → measles, mumps, and rubella
Potential SE:
5-15% of vaccine recipients develop fever
5% develop mild rash
Fever and rash usu disappear in 7-12 days, no tx necessary
Mild form of measles
Not contagious
No special precautions needed (can still go to school)
MMR → measles, mumps, and rubella
Blister-like rash, itching, tiredness, and fever
Varicella-zoster virus (VZV; chickenpox
2 doses Live vaccine 12-15 months, 4-6 years 90% effective May still get illness , but milder presentation
Varicella
Spread through contaminated food/water or person to person through fecal-oral route
Rates decreased 95% since vaccine available in 1995
2-dose series
12 mos, 18 mos
No special contraindications
Hep A
Acute viral hepatitis
Formula changes each year
Nasal live version no longer used in peds- not as effective
Start at 6 mos
If under 36 mos, 2 pediatric version one month apart
Over 36 mos receive adult version of vaccine
CI: egg allergy (depending on the version of vaccine and severity of allergy)
Combination vaccines
Safe, limit number of injections. Ok if they are getting an extra dose of something
Influenza Vaccine
Recommended baby wellness schedule
3 day and 2 weeks 1 mos 2 mos 4 mos 6 mos 9 mos 12 mos
Normal Vital signs in newborns
Heart rate
120-160 bpm
Normal Vital signs in newborns
Respiratory rate
40-60
Normal Vital signs in newborns Systolic BP
60-90 mm HG
Normal Vital signs in newborn Temp
97.7- 99.5
Normal Vital signs in newborn weight
Females: Range= (6lb 3 oz - 8 lb 14 oz)
Males: Range: (6lb, 7oz-9lb 5 oz)
Normal Vital signs in newborn Length
20 in
Normal Vital signs in newborn head circumference
range 13-15 in
what is important to remember when doing newborn assessment
take temp rectally pulse: apical, counted for full minute to account for irregularity weight: undressed w/out diaper length: recumbant head cir: measure w/ tape at tip of ears
newborn red flags
- lack of return to birth weight by 2 weeks
- poor coordination of suck/ swallow
- tachypenea or bradycardia during feeding
- poor habituation to external stimuli
- asymmetrical movements
- hyper/ hypo tonia
- asymmetrical primitive reflexes
- fine motor skills - can they make fists and hold them? do they have asymmetrical palmar grasp? not normal for palmar grasp
- no startle to sound or sudden noises
- no quieting to voice
- high pitched cry
- diffuse nonverbal cues
- poor state transitions
- irritable
- dolls eyes, lack of red reflex, poor alert status
Erikson Stage for newborn to 12/18 months
trust vs mistrust
newborn/ infants
Back to sleep until 1 yo
Room share for 6-12 mos
how to Screen mom for PPD?
Edinburgh tool or 2-question screen
Refer if minor or major depression
Edinburgh score <20 = crisis intervention!
newborn weight changes - 2 weeks, 6 months, 1 year
Weight: 10% weight loss in first week normal
2 weeks should be back at birth weight
6 months: weight doubles from birth weight
1 year: weight triples
Social smile
Raise head when lying on stomach, support upper body (press up)
Leg kicks
Open and shut hands
Bring things to mouth
Grasp at things dangling, hand toys
Vision: track you, follow moving objects, recognize familiar things
Start to use hands and eyes with coordination
Hearing and speech: babble, imitate you, turn toward a sound they hear
3-4months development
Social play; peek a boo, find things hidden
Own face in mirror
Respond to expressions of emotion
Try to get things out of reach
May respond to name at this point
Can say no. can tell emotions by tone of voice
Express emotions
Roll both ways→ safety: rolling off things
Sit with support
Support weight on legs with help
Transfer objects from one hand to another
Anticipatory guidance: don’t leave alone with pet, siblings, tub. Avoid overexposure to sun or heat. Baby proof house (prep for crawling). Supervise while eating. Choking precautions (avoid hot dogs, raisins, peanuts). Read to babies! Great for language development. Babies love routines.
Brush their teeth- bedtime routines
6 months developmental milestones
Lead screening
Why?
Can cause neurological issues- nonreversible
Older homes- lead pipes, lead in paint, water soil, paint chips, pottery, jewelry, candy wrappers (some)
Lead levels over 5 mcg/dL in blood
9 mos-1 year and again at 2 years
Up to age 6 higher levels of absorption in guy
CDC Says it’s ok to give vaccines to kids ________
CDC Says it’s ok to give vaccines to kids with mild fever and mild illness!!*
vaccines given between birth and 4-6 years
Hep B Rotavirus DTap Hib Polio PCV Hep A MMR Varicella Influenza
