Peds Unit II Flashcards
Weight gain at 6 months
Double (1.5 lb/ month 1st 6 months)
Weight gain at 12 months
Triple (3/4-1 lb/ month for 2nd 6 months)
Height increase at 12 months
50% (1 inch/ month first 6 months, 1/2 inch per month for second 6 months)
Posterior fontanel fuses how many months after birth?
2 (triangular shaped)
Anterior fontanel fuses how many months after birth?
12-18 (diamond shaped)
What does a normal fontanel look like?
soft/ flat
Infants are obligatory….
nose breathers. (abdominal breathing)
Bp difference from utero to birth
70/55 to 90/55
HR difference from utero to birth
HR slows from 120 to 80
When hemoglobin decreases with decreased RBCs at 2-3 months
physiologic anemia
This cannot be digested until 4-6 months
Complex CHO (good carbs) amylase/ lipase/ trypsin enzymes must be increased
Rule for determining # teeth appropriate for age
age in months -6 = number of teeth
Most immature system at birth
Liver: difficulty with bilirubin (hyperbilirubinemia
What must never be given to a newborn due to immature kidneys
Potassium
Hand/ finger play and toys 1 month
grasp reflex (rattle) hands are closed
Hand/ finger play and toys 2-3 months
almost voluntary grasp, hands open, have hand regard, startle reflex fading
Hand/ finger play and toys 4-5 months
plays with hands, hands to mouth, grasp voluntary, use textured toys
Hand/ finger play and toys 6-7 months
holds bottle, feeds self crackers
transfers objects between hands, unidextrous
has repetitive movements
peek-a-boo, large toys/ moveable parts, noise-makers
Hand/ finger play and toys 8-9 months
start pincer grasp, can start finger foods
releases objects, claps (pat-a-cake)
Hand/ finger play and toys 10-12 months
strong pincer grasp, large crayons, turn pages of books, squeeze toys
attempts to stack 2 blocks but fails: large puzzles, nested blocks
can pick up cheerios
Gross motor skills 1 month
moves head side-to-side, marked head lag, weakest head will be
Gross motor skills 2-3 months
lifts head 45 degrees when prone, increased head control
slight bobbing, use infant swing
Gross motor skills 4-5 months
raises head and chest to 90 degrees, slight head lag
rolls from abdomen to back, back to side
sits with a prop
scoots backward
Gross motor skills 6-7 months
sits alone with support of hands
rolls from back to abdomen
no head lag, bears weight on feet
develops parachute reflex, newborn reflexes gone
Gross motor skills 8-9 months
sits unsupported, stands with help
crawls, usually in reverse first stronger extensors than flexors
Gross motor skills 10-12 months
crawls forward
pulls self to sitting position, sit-stand
walks with support, push toys (only when walking), ball
Psychosocial development: Erikson
Trust vs. Mistrust
feeling of physical comfort and security, basic needs met by caregiver
Psychosocial development: Erikson
Trust vs. Mistrust
Narcissism
Total concern for oneself
Psychosocial development: Erikson
Trust vs. Mistrust
RESULTS
trust or inability to trust
lack of forming meaningful relationships
dependency problems/ feeding disorders
Cognitive development: Piaget
Infants learn
separation (others control the environment)
object permanence
use of symbols for mental representation
time/ space concepts start at end of stage
Cognitive development: Piaget
Sensorimotor stage
1st substage 0-1 month
REFLEXES: ROOTING, SUCKING, GRASP, CRY FENCING, REFLEXIVE STAGE
Cognitive development: Piaget
Sensorimotor stage
2nd substage 1-4 months
Primary circular reactions
reflexes become voluntary
stimulus produces response (cry, hear moms voice, stop crying)
Place rattle in hand, grasp and shake it
Cognitive development: Piaget
Sensorimotor stage
3rd substage 5-8 months
Secondary circular reactions
repeated acts for certain results, shaking and banging rattle repeatedly
begin imitation play
beginning to develop object permanence/ stranger and separation anxiety
6 months, preference for mom or primary caregiver
Cognitive development: Piaget
Sensorimotor stage
4th substage 9-12 months
Coordination of secondary schemata and application to new situations
begins intellectual reasoning, starts to associate symbols with events (bye-bye)
does intentional acts, can remove obstacles
Social development
1 month
watches parents face
Social development
1-2 months (6 weeks)
eyes move forward
Social development
2 months
social smile
Social development
3 months
stops crying when parent is seen
recognized familiar objects
Social development
4-5 months
laughs out loud
smiles at mirror image
can discriminate family/ stranger
Social development
6-7 months
imitates, starts biting
peek-a-boo
starting object permanence/ stranger anxiety
Social development
8-9 months
separation/ stranger anxiety wants to please fear of bed and being alone sibling jealousy starts to remove obstacles
Social development
10-12 months
joy when task mastered
frustrated if not mastered
may have security object
Language development
1 month
cries, makes throaty sounds
Language development
2-3 months
cooing, “ah”, vocalizes as if in response, squeals
Language development
4-5 months
laugh, varies tone
can pronounce n,k,g,p,b
Language development
6-7 months
imitates sounds
vowels in 1-2 syllables (ma, da, hi, da-da, baba)
talks to self
Language development
8-9 months
no-no
pronounces t,d,w
Language development
10-12 months
3-5 words
starts to comprehend meaning of words and objects
Sensory development
1 month
fixates on moving objects (tracking tube)
follows to midline
quiets to voice
objects at 8-10 inches in front of face (faces)
black and white mobiles
Sensory development
2-3 months
binocular fixation (eyes fixate together; if they are social smiling, they are looking at you)
Sensory development
4-5 months
localizes sounds
beginning to have hand-eye coordination
Sensory development
6-7 months
adjust posture to visual search (beginning of object permanence)
responds to name (autism by 6-18 months if they don’t)
begins to understand depth and space
can fixate on very small objects
taste preference
Sensory development
8-12 months
increased understanding of depth and space
follows rapidly moving objects
nursery rhymes, imitates animal sounds (repeating)
Play development
solitary play/ social interaction enhances play
teach infant ways to play
explores with mouth/ increasing abilities to move about
Patient teaching with nipples and pacifiers that stick together when squeezed
throw away
Breast feeding regimen in the first month
3-4 hrs X 6 per day (breast or bottle)
Breast milk storage: refrigerated/ frozen
8 days/ 12 months
At 4-6 months, first food considerations
First rice/ wheat last (allergies): rice easiest to digest
Mix cereal with formula or breast milk or fruit juice
***try one new food at a time 14-7 days (allergies)
wheat, nuts, eggs, and milk often manifest allergies
Immunizations HBV: IM
birth, 1-2 months, 6-18 months
hepatitis B; don’t give if allergic to baker’s yeast
Immunizations DTaP: (IM)
2 months, 4 months, 6 months, 15-18 months, 4-6 years
- diphtheria: no absolute immunity (last 10 years)
- tetanus lasts 10 years
- pertussis: acellular, more allergic reaction >7 years, do not give to neurologically impaired child
Immunizations IPV: (SC or IM)
2 months, 4 months, 6-18 months, 4-6 years
(polio vaccine)
- don’t give with anaphylaxis to neomycin, streptomycin or pregnancy
Immunizations Hib: (IM)
2 months, 4 months, 6 months, 12-18 months
Haemophilous influenza-type B; meningitis, epiglottitis, bacterial pneumonia, septic arthritis, sepsis
Immunizations Rotavirus (Oral)
2 months, 4 months, 6 months
Oral most common in Peds; diarrhea is associated with oral med
Immunization PCV (IM)
2 months, 4 months, 6 months, 12-18 months
pneumococcal-conjugate vaccine
Immunization Influenza (IM, Nasal)
every year starting at 6 months to 5 years
Common reactions to immunizations
101 degree fever, soreness, redness at injection, behavior changes
Pertussis: allergic temp > 105 degrees, seizures, shock
Common reaction to MMR immunization
MMR: anorexia, malaise, rash, fever
Immunization nursing care
- Tylenol q 4-6 hrs X 3 doses
- EMLA cream prn, treatment room, sugar water/ passifier
- give injections simultaneously/ comfort immediately after
Contraindications to Immunization
- fegrile illness/ temp over 101
- blood transfusion within 3 months
- pregnancy
- known allergy
S/S ICP
- altered LOC, pupil changes (fixed/ dilated)
- headache, dizzy, visual disturbance, bulging fontanel, dilated scalp veins, high-pitch cry, increased BP, bradycardia
- Increase between systolic/ diastolic: brain edema
Hyperpyrexia (fever)
elevated set point so the body is regulated at a higher level (infective agent)
Hyperthermia
body temp exceeding set point (Usually heat, not infection)
Tylenol ineffective due to altered set point/ use cooling measures
Temperature to begin administering febrile meds
101 F
First line anticonvulsants (fever)
Phenobarbitol (Dilatin has serious S/E)
-valium/ Ativan if seizing (Status Epilepticus)
Feeding ESSR
Enlarge nipple
Stimulate suck
Swallow fluid
Rest
