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PEDS > lecture 2 [health & risk in first year + fluid balance] > Flashcards

lecture 2 [health & risk in first year + fluid balance] Flashcards

1
Q

when do anterior fontanels close?

A

12-18 months old

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2
Q

where to detect HR in infants?

A

4th-5th intercostal space to LMCL

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3
Q

when do posterior fontanels close?

A

2-3 months old

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4
Q

what do nurses need to assess for positive attachment of parent and child?

A
  • proximity
  • reciprocity
  • commitment
  • paternal engrossment
  • family-centeredness (involvement of siblings)
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5
Q

what are the challenges for parent-newborn bonding?

A
  • colic
  • teething
  • sleeping
  • daycare
  • abuse
  • injuries
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6
Q

how do you identify colic (paroxysmal abdominal pain)?

A
  • vigorous crying
  • drawing legs to abdomen
  • onset in afternoon
  • episodes last from 30 minutes to < 3hours
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7
Q

how can you alleviate colic?

A
  • antispasmotics
  • sedatives
  • antihistamines
  • antifluctuents
  • position changes
  • nursing mother’s change diet
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8
Q

when do deciduous teeth erupt?

A

6-10 months old

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9
Q

what are the symptoms of teething?

A
  • irritability
  • difficulty sleeping
  • refuses to eat
  • drooling
  • chewing
  • biting
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10
Q

what can you give to infant to relieve teething?

A
  • firm & cold chewing objects
  • analgesics–preferably Acetaminophen (NO aspirin)
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11
Q

what is the recommended dose for Acetaminophen for infants?

A

10-15mg / kg / dose
(max. 5 doses)

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12
Q

what do babies need for healthy & safe sleep?

A
  • sleeping in their own bed close to parent’s bed
  • no soft bedding
  • no smoking
  • no overheating
  • supine position
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13
Q

which characteristics make a child most at risk for abuse?

A
  • under 3 years of age
  • unwanted pregnancy
  • physcially disabled
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14
Q

what do 1-6 month old infants need for adequate nutrition?

A
  • breastfeeding
  • Vitamin D (200 IU / day)
  • iron-fortified formula (do not microwave)
  • formula 6x daily
  • iron fortified cereal (4-6 months old)
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15
Q

what do 6-12 month old infants need for adequate nutrition?

A
  • formula / breastmilk 4-5 times a day
  • spoon feeding by pushing food to back of tongue
  • introducing solid foods one at a time
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16
Q

when can babies eat fruits and vegetables?

A

6-8 months old

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17
Q

when can babies eat meat, fish, and poultry?

A

8-10 months old

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18
Q

when do babies get to eat finger food?

teething crackers, fruit and vegetables

A

6-7 months

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19
Q

when can babies eat chopped table foods?

A

9-12 months

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20
Q

what are some conditions that put infants at risk for nutritional disorders?

A
  • Protein-energy malnutrition
  • Kwashiorkor
  • Food allergy / hypersensitivity / intolerance
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21
Q

organic failure to thrive is caused by

A

mechanical failure to intake, absorb or digest food due to illness

short-gut syndrome

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22
Q

nonorganic failure to thrive is caused by

A

social components such as
* poverty
* beliefs around food
* knowledge deficit
* stress
* insufficiency

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23
Q

idiopathic failure to thrive is caused by

A

unexplained instances that are not organic nor environmental

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24
Q

what causes protein-energy malnutrition?

A
  • renal dialysis
  • GI malabsorption
  • anorexia
  • cystic fibrosis

chronic illnesses

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25
Q

what causes Kwashiorkor?

A
  • high starch diet
  • lactose intolerance (muscle wasting & skin depigmentation)
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26
Q

why does Kwashiorkor usually lead to blindness?

A

Vitamin A deficiency

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27
Q

how can you conteract lactose intolerance?

A

take probiotics

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28
Q

what is a sign that infants have FTT?

A

they have inadequate growth

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29
Q

how can you classify a child who has inadequate growth?

A
  • weight falls below the 5th percentile
  • persistent weight loss
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30
Q

how can you treat a child with FTT?

A
  • consistent primary caregiver
  • unstimulating atmosphere
  • face-to-face
  • slowly introduce foods
  • give directions about eating
  • build structure & routines
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31
Q

what is Sudden Infant Death syndrome?

A

unexplained death of child younger than 1 year old

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32
Q

what are the risks for SIDS?

A
  • maternal smoking
  • co-sleeping
  • prone sleeping position
  • soft bedding
  • SGA
  • bronchopulmonary dysplasia
  • persistent apnea
  • twins
  • premature
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33
Q

what is apnea?

A

20 seconds or more breathing cessation

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34
Q

what causes apnea?

A
  • sepsis
  • seizures
  • electrolye imbalance
  • upper / lower respiratory infection
  • hypoglycemia
  • acid reflux
  • metabolic problems
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35
Q

what are the classifications of an Apparent Life Threatening Event (ALTE)?

A
  • apnea
  • gagging
  • coughing

anything that would cause for CPR

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36
Q

management for apnea

A
  • theophylline
  • caffeine
  • CPR
  • continuous respiratory monitor
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37
Q

why are children more likely to have fluid & electrolyte imbalances?

A
  • higher basal metabolic rate
  • immature kidney function
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38
Q

what are the causes of water depletion?

A
  • fever
  • vomiting
  • diarrhea
  • burns
  • diabetes
  • shock
  • high UOP kidney failure
  • environmental heat
  • phototherapy
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39
Q

what are the signs of water depletion in children?

A
  • weight loss
  • increased HR
  • depressed fontanels
  • decreased UOP
  • altered LOC
  • dry skin
  • tacky mucous membranes
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40
Q

lab results for water depletion

A
  • high urine specific gravity
  • increased BUN
  • increased Hct
  • increased Na+
  • increased serum osmolarity
  • variable serum electrolytes
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41
Q

what are the causes of water excess?

A
  • water intoxication
  • IV overload
  • incorrect feeding (parents use too much water for formula reconstitution)
  • swimming lessons
  • too rapid dialysis
  • tap water enemas
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42
Q

what are the signs & symptoms of water excess?

A
  • crackles
  • increased venous pressure
  • slow & bounding pulse
  • weight gain
  • lethargy
  • increased spinal pressure
  • seizures
  • “full” fontanels
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43
Q

lab results for water excess

A
  • low urine specific gravity
  • decreased Hct
  • decreased serum electrolyes
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44
Q

conditions associated with water excess

A
  • CHF
  • SIADH
  • increased ICP
  • oliguric renal failure
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45
Q

what is the definition of anasarca?

A

generalized fluid accumulation in body tissues

46
Q

signs of edema

A
  • increased central venous pressure
  • decreased plasma proteins
47
Q

what can the nurse do to manage decreased plasma proteins related to edema?

A
  • give albumin to allow fluid back into the cells
  • then administer lasix to urinate remaining fluid
48
Q

what are the types of dehydration?

A
  • isotonic
  • hypotonic
  • hypertonic
49
Q

isotonic dehydration

A
  • equal loss of electrolytes & fluid
  • lose circulating blood volume
  • Na+ levels normal
50
Q

what is the biggest concern for isotonic dehydration?

A

hypovolemic shock

51
Q

hypotonic dehydration

A
  • loss of electrolytes greater than water
  • Na+ levels are < 135
52
Q

hypertonic dehydration

A
  • water loss is greater than that of electrolytes
  • seizures are more likely to happen
  • Na+ levels > 150
53
Q

which type of dehydration is the most dangerous?

A

hypertonic dehydration

54
Q

what is the earliest sign of dehydration?

A
  • tachycardia
  • poor perfusion (cap refill)
55
Q

mild degree of dehydration

A
  • loss of less than 50mL / kg
  • cap refill of less than 2 seconds
56
Q

moderate degree of dehydration

A
  • loss of about 50-90mL / kg
  • cap refill of 2-3 seconds
57
Q

severe degree of dehydration

A
  • loss of greater than or equal to 100mL / kg
  • cap refill of more than 3 seconds
58
Q

oral management of dehydration

A

rapid fluid replacement over 4-6 hours

59
Q

IV management of dehydration

A
  • use 0.9% solution
  • rapid expansion of ECF to prevent shock (NS 20mL / kg bolus)
60
Q

why are nurses not supposed to give dextrose to pediatric patients?

A

they will get easily overwhelmed systemically

61
Q

what are the 3 phases of IV management for dehydration?

A
  1. expansion
  2. replace deficits
  3. maintenance

IV fluids or oral solutions

62
Q

what is the first intervention for dehydation in pediatrics?

A

oral rehydration therapy with Pedialyte or Gatorade ONLY

63
Q

what is the nursing action for a child who is dehydrated but NPO?

A

spray mouth

64
Q

what are the different kinds of interventions for dehydration among pediatrics?

A
  • IV therapy
  • intraosseous infusion
  • central venous lines
  • oral rehydration therapy
  • mouth sprays
65
Q

what measure is needed to implement for IV therapy?

IV therapy = continous maintenance

A

add potassium

66
Q

under which circumstances is Potassium not appropriate to give?

A

when the child has a decreased UOP

67
Q

intraosseous infuson is only appropriate for emergent situations

A

true

68
Q

where is the intraosseous needle most appropriate to drill?

A

flat part of tibia or humerus

69
Q

babies double their birth weight in the first 6 months

A

true

70
Q

how much do babies grow per month during 1 - 6 months?

A

1 inch

71
Q

what are the neurological & muscular developments of children by 6 months?

A
  • palmar grasp
  • head control
  • turning from abdomen to back
72
Q

babies triple their birth weight when they’re 7 - 12 months

A

true

73
Q

how much do babies grow per month during their 7 - 12 months?

A

1 - 2 inches

74
Q

what are the neurological & muscular developments of babies from 7 -12 months?

A
  • pulling objects to mouth
  • pincer grasp
  • head control
  • back straight
  • walking
  • sitting down / sitting up
75
Q

babies learn to sit by themselves at 7 months

A

true

76
Q

how does Piaget define cognition?

A

the ability to know

77
Q

when do babies develop object permanence?

A

9 - 10 months

78
Q

what is object impermanence?

A

the realization that objects exist even if not visible

79
Q

when do babies develop attachment to caregiver?

A

6 months

80
Q

how do infants develop attachment?

A

when they can discriminate their caregiver from others

81
Q

when are babies able to recognize their parent’s voice & presence?

A

3 - 6 months

82
Q

when do babies develop fear of strangers?

A

6 - 8 months

83
Q

when do babies develop separation anxiety?

A

onset at 9 months, peaks at 18 months, can continue until 3 years old

84
Q

when can infants recognize faces?

A

1 month

85
Q

when do babies smile back?

A

2 months

86
Q

when can babies smile at themselves in the mirror?

A

4 months

87
Q

when do babies begin looking for dropped objects?

A

6 months

88
Q

when can babies start playing “peek a boo”?

A

7 months

89
Q

when do babies start responding to “no”?

A

8 months

90
Q

when do babies start waving goodbye?

A

10 months

91
Q

when can babies play hand games?

A

10 months

92
Q

definition of oral-social stages

A

satisfaction through oral gratification

93
Q

what are the two oral social stages among infants?

A
  • food intake (3 -4 months)
  • grasping and bring to mouth / biting
94
Q

what are the two sides to babies developing a sense of trust by crying?

A
  1. failure to learn delayed gratification
  2. being neglected
95
Q

what does separation mean in regards to cognitive development among infants?

A

being able to separate self from others

96
Q

what does play mean for an infant?

A

being able to derive pleasure from mastering a skill

97
Q

how does the attitude between parent & child affect their relationship?

A
  • develops sense of permanence
  • solidifies the relationship
  • leads to stranger anxiety
98
Q

what kinds of toys are appropriate for 1 year olds?

A
  • rattles
  • toy cars
  • teething toys
  • nesting toys
  • balls
  • reading books
99
Q

NEVER give babies 6 months old and younger water

A

true

100
Q

babies under 6 months old CANNOT have Ibuprofen

A

true

101
Q

why are babies not allowed to take Aspirin?

A

they will have a higher risk for Reye’s syndrome

102
Q

how long do newborns sleep?

A

16 - 20 hours

103
Q

how often do newborns need to be fed over night?

A

about 6 times–every 3 hours

104
Q

how long do 1-3 month old babies sleep?

A

10-16 hours

105
Q

how long do 6-12 month old babies sleep?

A

12-14 hours with 1-2 day naps

106
Q

what do parents need to ensure that a daycare has?

A
  • appropriate child-staff ratio
  • discipline policies
  • environmental safety precautions
  • meal provisions
107
Q

to whom do nurses mandatorily report child abuse to?

A

social workers

108
Q

when can babies start drinking cow’s milk?

A

1 year old

109
Q

how many times do parents feed the same food to children before determining allergic reaction?

A

3 times one at a time

110
Q

what can nurses teach parents regarding anticipatory guidelines?

A
  • suffocation
  • falls
  • poisoning
  • burns
  • motor vehicles
  • abuse
111
Q

it is normal for infants to hold their breath and have irregular breathing patterns

A

true

but they SHOULD NOT stop breathing for more than 20 secs.

PEDS (11 decks)

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