lecture 2 [health & risk in first year + fluid balance] Flashcards
when do anterior fontanels close?
12-18 months old
where to detect HR in infants?
4th-5th intercostal space to LMCL
when do posterior fontanels close?
2-3 months old
what do nurses need to assess for positive attachment of parent and child?
- proximity
- reciprocity
- commitment
- paternal engrossment
- family-centeredness (involvement of siblings)
what are the challenges for parent-newborn bonding?
- colic
- teething
- sleeping
- daycare
- abuse
- injuries
how do you identify colic (paroxysmal abdominal pain)?
- vigorous crying
- drawing legs to abdomen
- onset in afternoon
- episodes last from 30 minutes to < 3hours
how can you alleviate colic?
- antispasmotics
- sedatives
- antihistamines
- antifluctuents
- position changes
- nursing mother’s change diet
when do deciduous teeth erupt?
6-10 months old
what are the symptoms of teething?
- irritability
- difficulty sleeping
- refuses to eat
- drooling
- chewing
- biting
what can you give to infant to relieve teething?
- firm & cold chewing objects
- analgesics–preferably Acetaminophen (NO aspirin)
what is the recommended dose for Acetaminophen for infants?
10-15mg / kg / dose
(max. 5 doses)
what do babies need for healthy & safe sleep?
- sleeping in their own bed close to parent’s bed
- no soft bedding
- no smoking
- no overheating
- supine position
which characteristics make a child most at risk for abuse?
- under 3 years of age
- unwanted pregnancy
- physcially disabled
what do 1-6 month old infants need for adequate nutrition?
- breastfeeding
- Vitamin D (200 IU / day)
- iron-fortified formula (do not microwave)
- formula 6x daily
- iron fortified cereal (4-6 months old)
what do 6-12 month old infants need for adequate nutrition?
- formula / breastmilk 4-5 times a day
- spoon feeding by pushing food to back of tongue
- introducing solid foods one at a time
when can babies eat fruits and vegetables?
6-8 months old
when can babies eat meat, fish, and poultry?
8-10 months old
when do babies get to eat finger food?
teething crackers, fruit and vegetables
6-7 months
when can babies eat chopped table foods?
9-12 months
what are some conditions that put infants at risk for nutritional disorders?
- Protein-energy malnutrition
- Kwashiorkor
- Food allergy / hypersensitivity / intolerance
organic failure to thrive is caused by
mechanical failure to intake, absorb or digest food due to illness
short-gut syndrome
nonorganic failure to thrive is caused by
social components such as
* poverty
* beliefs around food
* knowledge deficit
* stress
* insufficiency
idiopathic failure to thrive is caused by
unexplained instances that are not organic nor environmental
what causes protein-energy malnutrition?
- renal dialysis
- GI malabsorption
- anorexia
- cystic fibrosis
chronic illnesses
what causes Kwashiorkor?
- high starch diet
- lactose intolerance (muscle wasting & skin depigmentation)
why does Kwashiorkor usually lead to blindness?
Vitamin A deficiency
how can you conteract lactose intolerance?
take probiotics
what is a sign that infants have FTT?
they have inadequate growth
how can you classify a child who has inadequate growth?
- weight falls below the 5th percentile
- persistent weight loss
how can you treat a child with FTT?
- consistent primary caregiver
- unstimulating atmosphere
- face-to-face
- slowly introduce foods
- give directions about eating
- build structure & routines
what is Sudden Infant Death syndrome?
unexplained death of child younger than 1 year old
what are the risks for SIDS?
- maternal smoking
- co-sleeping
- prone sleeping position
- soft bedding
- SGA
- bronchopulmonary dysplasia
- persistent apnea
- twins
- premature
what is apnea?
20 seconds or more breathing cessation
what causes apnea?
- sepsis
- seizures
- electrolye imbalance
- upper / lower respiratory infection
- hypoglycemia
- acid reflux
- metabolic problems
what are the classifications of an Apparent Life Threatening Event (ALTE)?
- apnea
- gagging
- coughing
anything that would cause for CPR
management for apnea
- theophylline
- caffeine
- CPR
- continuous respiratory monitor
why are children more likely to have fluid & electrolyte imbalances?
- higher basal metabolic rate
- immature kidney function
what are the causes of water depletion?
- fever
- vomiting
- diarrhea
- burns
- diabetes
- shock
- high UOP kidney failure
- environmental heat
- phototherapy
what are the signs of water depletion in children?
- weight loss
- increased HR
- depressed fontanels
- decreased UOP
- altered LOC
- dry skin
- tacky mucous membranes
lab results for water depletion
- high urine specific gravity
- increased BUN
- increased Hct
- increased Na+
- increased serum osmolarity
- variable serum electrolytes
what are the causes of water excess?
- water intoxication
- IV overload
- incorrect feeding (parents use too much water for formula reconstitution)
- swimming lessons
- too rapid dialysis
- tap water enemas
what are the signs & symptoms of water excess?
- crackles
- increased venous pressure
- slow & bounding pulse
- weight gain
- lethargy
- increased spinal pressure
- seizures
- “full” fontanels
lab results for water excess
- low urine specific gravity
- decreased Hct
- decreased serum electrolyes
conditions associated with water excess
- CHF
- SIADH
- increased ICP
- oliguric renal failure
what is the definition of anasarca?
generalized fluid accumulation in body tissues
signs of edema
- increased central venous pressure
- decreased plasma proteins
what can the nurse do to manage decreased plasma proteins related to edema?
- give albumin to allow fluid back into the cells
- then administer lasix to urinate remaining fluid
what are the types of dehydration?
- isotonic
- hypotonic
- hypertonic
isotonic dehydration
- equal loss of electrolytes & fluid
- lose circulating blood volume
- Na+ levels normal
what is the biggest concern for isotonic dehydration?
hypovolemic shock
hypotonic dehydration
- loss of electrolytes greater than water
- Na+ levels are < 135
hypertonic dehydration
- water loss is greater than that of electrolytes
- seizures are more likely to happen
- Na+ levels > 150
which type of dehydration is the most dangerous?
hypertonic dehydration
what is the earliest sign of dehydration?
- tachycardia
- poor perfusion (cap refill)
mild degree of dehydration
- loss of less than 50mL / kg
- cap refill of less than 2 seconds
moderate degree of dehydration
- loss of about 50-90mL / kg
- cap refill of 2-3 seconds
severe degree of dehydration
- loss of greater than or equal to 100mL / kg
- cap refill of more than 3 seconds
oral management of dehydration
rapid fluid replacement over 4-6 hours
IV management of dehydration
- use 0.9% solution
- rapid expansion of ECF to prevent shock (NS 20mL / kg bolus)
why are nurses not supposed to give dextrose to pediatric patients?
they will get easily overwhelmed systemically
what are the 3 phases of IV management for dehydration?
- expansion
- replace deficits
- maintenance
IV fluids or oral solutions
what is the first intervention for dehydation in pediatrics?
oral rehydration therapy with Pedialyte or Gatorade ONLY
what is the nursing action for a child who is dehydrated but NPO?
spray mouth
what are the different kinds of interventions for dehydration among pediatrics?
- IV therapy
- intraosseous infusion
- central venous lines
- oral rehydration therapy
- mouth sprays
what measure is needed to implement for IV therapy?
IV therapy = continous maintenance
add potassium
under which circumstances is Potassium not appropriate to give?
when the child has a decreased UOP
intraosseous infuson is only appropriate for emergent situations
true
where is the intraosseous needle most appropriate to drill?
flat part of tibia or humerus
babies double their birth weight in the first 6 months
true
how much do babies grow per month during 1 - 6 months?
1 inch
what are the neurological & muscular developments of children by 6 months?
- palmar grasp
- head control
- turning from abdomen to back
babies triple their birth weight when they’re 7 - 12 months
true
how much do babies grow per month during their 7 - 12 months?
1 - 2 inches
what are the neurological & muscular developments of babies from 7 -12 months?
- pulling objects to mouth
- pincer grasp
- head control
- back straight
- walking
- sitting down / sitting up
babies learn to sit by themselves at 7 months
true
how does Piaget define cognition?
the ability to know
when do babies develop object permanence?
9 - 10 months
what is object impermanence?
the realization that objects exist even if not visible
when do babies develop attachment to caregiver?
6 months
how do infants develop attachment?
when they can discriminate their caregiver from others
when are babies able to recognize their parent’s voice & presence?
3 - 6 months
when do babies develop fear of strangers?
6 - 8 months
when do babies develop separation anxiety?
onset at 9 months, peaks at 18 months, can continue until 3 years old
when can infants recognize faces?
1 month
when do babies smile back?
2 months
when can babies smile at themselves in the mirror?
4 months
when do babies begin looking for dropped objects?
6 months
when can babies start playing “peek a boo”?
7 months
when do babies start responding to “no”?
8 months
when do babies start waving goodbye?
10 months
when can babies play hand games?
10 months
definition of oral-social stages
satisfaction through oral gratification
what are the two oral social stages among infants?
- food intake (3 -4 months)
- grasping and bring to mouth / biting
what are the two sides to babies developing a sense of trust by crying?
- failure to learn delayed gratification
- being neglected
what does separation mean in regards to cognitive development among infants?
being able to separate self from others
what does play mean for an infant?
being able to derive pleasure from mastering a skill
how does the attitude between parent & child affect their relationship?
- develops sense of permanence
- solidifies the relationship
- leads to stranger anxiety
what kinds of toys are appropriate for 1 year olds?
- rattles
- toy cars
- teething toys
- nesting toys
- balls
- reading books
NEVER give babies 6 months old and younger water
true
babies under 6 months old CANNOT have Ibuprofen
true
why are babies not allowed to take Aspirin?
they will have a higher risk for Reye’s syndrome
how long do newborns sleep?
16 - 20 hours
how often do newborns need to be fed over night?
about 6 times–every 3 hours
how long do 1-3 month old babies sleep?
10-16 hours
how long do 6-12 month old babies sleep?
12-14 hours with 1-2 day naps
what do parents need to ensure that a daycare has?
- appropriate child-staff ratio
- discipline policies
- environmental safety precautions
- meal provisions
to whom do nurses mandatorily report child abuse to?
social workers
when can babies start drinking cow’s milk?
1 year old
how many times do parents feed the same food to children before determining allergic reaction?
3 times one at a time
what can nurses teach parents regarding anticipatory guidelines?
- suffocation
- falls
- poisoning
- burns
- motor vehicles
- abuse
it is normal for infants to hold their breath and have irregular breathing patterns
true
but they SHOULD NOT stop breathing for more than 20 secs.
