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Infants Flashcards

1
Q

Principles of child development

A

. Development proceeds along predictable pathway/trajectory
. Range of normal development is wide
. Variety of factors affect child’s health (medical/social factors)
. Child’s developmental level affects the nature of examination

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2
Q

Pediatric health promotions

A

. Age=appropriate developmental milestones
. Health supervision visits per schedule
. Integrate physical exam findings w/ history/age
. Immunization schedule
. Screening per guidelines
. Anticipatory guidance
. Partnership and developing bond btw provider and patient

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3
Q

What are you checking during well child visits?

A 
. Physical growth
. Motor skills 
. Cognitive growth/milestones 
. Emotional growth and independence 
. Social growth and communication
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4
Q

Motor milestone in 1st year

A 
. 3 mo: holds head up 
. 4 mo: rolls from front to back 
. 6mo: rolls from back to front, sits 
. 9 mo: crawls, stands w/ support, cruises 
. 12 mo: stands, walks a few steps
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5
Q

Schedule of pediatric appointments

A 
. 2-5 days 
. 2 weeks 
. 1 mo
. 2 mo
. 4 mo
. 6 mo
. 9 mo
. 1 yr 
. 15 mo
. 18 mo 
. 24 mo
. 30 mo
. 3 years 
. Then yearly after that
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6
Q

Screenings completed in newborn nursery

A 
. Newborn screen 
. Bilirubin level at 24 hrs 
. CCHD screen at 24 hrs 
. Hearing screen before discharge 
. Car seat check
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7
Q

Screenings completed at 1, 2, 4, and 6 months

A

. Post partum depression screen

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8
Q

What screening is completed at 12 mo

A

. Lead and Hb levels

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9
Q

Neonatal resuscitation at birth

A 
. Place infant under radiant heat warmer 
. Dry and stimulate 
. Position w/ head in sniffing position 
. Clear airway w/ bulb suction 
. Assign APGARs 
. Further resuscitation if necessary
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10
Q

What do you do if baby is not to term, doesn’t have tone, is not breathing, or is not crying?

A

. Warm and maintain normal temperature
. Position airway
. Clear secretions, dry, and stimulation

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11
Q

What do you do if the baby had apnea, gasping, or HR under 100 bpm

A

. PPV
. SpO2
. Monitor
. Consider ECG monitor

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12
Q

What do you do if baby hands labored breathing or persistent cyanosis?

A 
. Position and clear airway
. SpO2 monitor 
. Supplemental O2 as needed 
. Considered CPAP 
. Complete post-resuscitation care and team briefing if situation gets better
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13
Q

What do you do if baby’s HR is under 100 bpm

A

. Check chest movement
. Ventilation corrective steps if needed
. ETT or laryngeal mask if needed

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14
Q

What do you do if baby’s HR is under 60 bpm?

A

. IV Epi

. If it is persistently below 60 then consider hypovolemia or pneumothorax

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15
Q

APGAR score

A

. Assesses newborn after birth
. Appearance: blue/pale = 0, pink body/blue extremities = 1, pink all over = 2
. Pulse: none = 0, under 100 = 1, over 100 = 2
. Respiration: absent = 0, slow and irregular = 1, good/strong = 2
. Activity: flaccid = 0, slow flexion of arms/legs = 1, active = 2
. Grimace: no response = 0, grimace = 1, crying/sneeze/cough = 2
. Performed at 1, 5, and 10 min after
Birth
. Low score doesn’t necessarily mean there is an issue

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16
Q

1 minute APGAR score ranges and meaning

A

. 0-4: severe depression, requiring immediate resuscitation
. 5-7: some nervous system depression
. 8-10 normal

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17
Q

5 minute APGAR score ranges and meanings

A

. 0-7: high risk for subsequent CNS and other organ system dysfunction
. 8-10 normal

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18
Q

Tips for examining newborns

A

. Have infant in parent’s arms or in car seat
. Prioritize comfort level of infant
. Best to examine 1 hr after feeding
. Hands and equipment should be warm
. Dim lights and swing baby to encourage eye opening
. Look at ears and mouth last

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19
Q

How to calm crying baby

A 
. Swaddle
. Sidelying 
. Sway/swing 
. Suck
. Shush
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20
Q

Gestational age considered preterm

A

. Under 34 weeks

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21
Q

Gestational age considered late preterm

A

34-36 weeks

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22
Q

Gestational age considered term

A

. 37-42 weeks

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23
Q

Gestational age considered post term

A

. Over 42 weeks

24
Q

Classification of birth weights

A

. Extremely low: under 1,000g
. very low: 1,500g
. Low: under 2500g
. Normal: equal to or over 2500 g

25
Risks for preterm infants
. Risk for both short term complications (respiratory and cardiovascular) . Long term sequuelae (neurodevelopmental)
26
Risks for late preterm infants
. Prematurity-related complications
27
Posters infants risk
. Perinatal mortality or morbidity through asphyxia and meconium aspiration
28
What is directly related to inc. muscle tone and resistance to passive manipulation?
. Greater fetal maturity
29
Seesaw respiration
. Chest wall retracts and abdomen rises w/ inspiration
30
Moro reflex
. Extend head -> extension, flexion of arms, legs . Appears at birth . Disappears 4-6 mo . CNS origin: brainstem vestibular nuclei . Persistence beyond 8 mo suggests cerebral dysfunction
31
Grasp reflex
. Finger in palm -> hand, elbow, shoulder flexion . Appears at birth . 4-6 mo disappears . CNS origin: brain stem vestibular nuclei . Persistence beyond 4 mo suggests cerebral dysfunction . Persistence of clenched hand beyond 2 months suggests CNS damage, esp. if fingers overlap thumb
32
Rooting reflex
. Cheek stimulus -> turns mouth to that side . Appears at birth . Disappears 4-6 mo . CNS: brain stem trigeminal system . Absence indicates severe generalized or CNS disease
33
Trunk incurvation reflex
. Withdrawal from stroking along ventral surface . Appears att birth . Disappears 6-9 months . CNS: spinal cord . Absence suggests transverse spinal cord lesion or injury . Persistence may. Indicate delayed development
34
Placing reflex
. Steps up when dorsum of foot stimulated . Appears at birth . Disappears 4-6 mo . CNS: cerebral cortex . Absence may indicate paralysis . Babies born breech delivery may not have placing reflex
35
Tonic neck reflex
``` . Fencing posture when supine . Appears at birth . Disappears 4-6 mo . CNS: Brea is stem vestibular nuclei . Persistence beyond 2 months suggests neuro disease ```
36
Parachute reflex
``` . Stimulate fall-> extends arms . Appears 6-8 months . Never disappears . CNS: brains stem vestibular . Delay in appearance may predict future delays in voluntary motor development ```
37
positive support reflex
. Hold the baby round trunk and lower him until his feet touch a flat surface . Hips, knees, and ankles will extend and it will stand up, partially bear weight and then sag after 20-30 s . Lack of reflex suggests hypotonia or flaccidity . Fixed extension and adduction of legs (scissoring) suggests spasticity due to neuro disease
38
Plantar grasp reflex
. Birth to 6-8 months . Touch sole at base of toes . Toes will curl . Persistence beyond 4 mo suggests neuro disease, beyond 6 mo strongly suggests it . Asymmetric response suggests fracture of clavicle, humerus, or brachial plexus injuries
39
Landau reflex
. Birth to 6 mo . Suspend the baby prone w/ 1 hand . His head willing up . Persistence may indicate delayed development
40
Plethora
. Excess of bodily fluid, particularly blood (overheated, facial presentation, polycythemia) . Indicative of cyanotic heart disease
41
Cyanosis in infants
. Would be visible if deoxygenated Hb content is over 3g . If present throughout the body including the mucous membranes and tongue (central cyanosis) . Cyanosis in just extremities (peripheral cyanosis/acrocyanosis) . Acrocyanosis from exposure to cold and polycythemia
42
Erb-duchene deformity
. Paralysis of upper brachial plexus (C5-6) . Arm hangs at side w/ elbow extended and the forearm pronated . Waiter’s tip hand/erb’s palsy occurs
43
Klumpke’s deformity
. Paralysis fo lower brachial plexus (C8-T1) | . Claw hand w/ forearm is supinator and wrist and fingers are flexed
44
Caput succedaneum
. Edematous swelling formed on presenting portion of scalp of infant during birth . Effusion overlies periosteum . Anatomic landmark that enables this condition to cross suture lines
45
Cephalohematoma
. Swelling in which effusion lies under periosteum . Consists of blood not serum . Anatomic location does not cross suture lines
46
Epstein pearls
. Happen when skin of baby’s mouth is trapped during development process . As mouth continues to develop and take shape, this trapped skin can fill w/ Keratin . Keratin is what makes up inside of epistein pearl
47
Vernix caseosa
. Coating that protects unborn baby’s skin from amniotic fluid . W/o protection, baby’s skin would chap or wrinkle in uterus
48
Harlequin color change
. Newborn babies . Momentary red color changes of half the child sharply demarcated at body midline . Transient change occurs in 10% of healthily newborns . Usually seen btw 2 and 5 days of birth . Lasts from 30 s to 20 minutes and then fades
49
Mottling
. In contrast w/ cutis marmorata, the mottling does not resolve when skin is warmed . Discoloration is blue instead of red . Lesion is more intense and is persistent
50
Erythema toxicum neonatorum
. Common rash seen in full term newborns | . Appears in 1st few days after birth and fades w/in a week
51
Assessment of hip dysphasia
. Develops due to acetabulum that is too shallow . More common in girls . More common w/ left hip . Risk factor: LGA, breech . Treatment: hip immobilization, rarely surgery
52
Barlow’s and Orotolani’s
Barlow: evaluates hip to determine if they can be easily dislocated . Orotolani’s: detect dislocated or subluxation hips, determines if they can be reduced . If either test is abnormal do hip ultrasound to confirm findings j
53
Failure to thrive
. Decelerated or arrested physical growth . Weight and height measurements fall below the 3rd or 5h percentiles or a downward trend in percentiles . Usually weight change precedes height change . Can be from inadequate caloric intake, inadequate caloric absorption/usage . Inc. metabolic demands
54
Formula intolerance
. Baby has trouble digesting formula . May be sensitive to ingredient . Different than allergy, allergy means the baby’s immune system reacts to protein in formula and can be life threatening . Diarrhea, blood/mucus in your baby’s stools, vomiting, pulling legs up to tummy, colic makes your baby cry constantly, trouble gaining weight or weight loss
55
Gastroenteritis
. Infection in bowel causing diarrhea . For the 1st 24-48 hrs a child may have vomiting and fever . Diarrhea develops during this time and lasts 4-10 days
56
Cystic fibrosis
. Caused by mutation in a gene (CFTR) . Controls flow of salt in and out of cells . Condition causes thick mucous to build up in body . All babies have a newborn screening test for CF so it can be found and treated early
57
Hirschsprung disease
. Involves missing nerve cells in muscles of part or all of the large intestine . Present at birth . Causes issues passing stool . Symptoms: failure to have bowel movement w/in 48 hours after birth, swollen belly, vomiting . Surgery needed to bypass affected part of colon or remove it

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