What Jacobson said to focus on: Part 1 Flashcards
What may be seen on an infants tongue? What are ways they get it? How can it be treated?
White coatings on their tongues from milk= easily removed
Oral candidiasis coating= not easily removed
Oral candidiasis: can get from birth canal or antibiotics
Treat with mycostatin PO and systemic
Elicited by stroking an infants cheek or edge of an infants mouth–the infant turns her head toward the side that is touched and starts to suck
Sucking and rooting reflex
Elicited by placing an object in an infants palm–infant grasps object
Palmar grasp
Elicited by touching the SOLE of an infants foot–infants toes curl DOWNWARD
Plantar grasp
What is moro reflex?
Elicited by allowing head and trunk of an infant in a semi-sitting position to fall backward to an angle of at least 30 degrees–> infants arms and legs symmetrically extend, then abduct while fingers spread to form C shape
Elicited by clapping hands or by a loud noise–newborns will abduct arms at the elbows, and the hands will remain clinched
Startle reflex
What is the tonic neck reflex (fencer position)?
Elicited by turning an infants head to one side—the infant extends the arm and leg on that side and flexes the arm and leg on the opposite side
Elicited by stroking the OUTER EDGE of the sole of an infants foot up toward the ones–infants toes fan UPWARD and OUT
Babinski reflex
Elicited by holding an infant upright with his feet touching a flat surface–infant makes stepping movements
Stepping reflex
Expected age of moro?
Birth-4 m
Expected age of tonic neck reflex?
Birth- 3or4m
Expected age of babinski reflex?
Birth-1y
Expected age of plantar grasp?
Birth-8 m
Expected age of palmar grasp?
Birth-3 m
Expected age of sucking/rooting reflex?
Birth-4 m
Expected age of startle reflex?
Birth-4m
Expected age of stepping reflex?
Birth-4weeks
What does infant do at 1 month?
Demonstrates head lag
Has a grasp reflex
What does infant do at 2 months?
Lifts head off mattress when prone
Holds hands in a open position
What does infant do at 3 months?
Raises head and shoulders off mattress when prone
Slight head lag
No longer has grasp reflex
Keeps hands loosely open
What does infant do at 4 months?
Rolls from back to side
Places objectes in mouth
What does infant do at 5 months?
Rolls from front to back
Uses palmar grasp dominantly
What does infant do at 6 months?
Rolls from back to front
Holds bottle
What does infant do at 7 months?
Bears full weight on feet
Moves objects from hand to hand
What does infant do at 8 months?
Sits unsupported
Begins using pincer grasp
What does infant do at 9 months?
Pulls to standing position
Creeps on hands and knees instead of crawl
Crude pincer grasp
What does infant do at 10 months?
Changes from prone to sitting position
Grasps rattle by its handle
What does infant do at 11 months?
Walks while holding onto something (cruising)
Places objects into container
Neat pincer grasp
What does infant do at 12 months?
Sits down from standing position w/o assistance
Tries to build a 2 block tower w/o success
What are 3 important tasks accomplished during birth-24 months, according to Piaget?
- Separation
- Object permanence
- Mental representation
What are good toys for infants?
Rattles Teething toys Nesting Pat-a-cake Playing with balls Reading books Mirrors Brightly colored toys Playing with blocks
What provides a complete diet for infants during the first 6 months?
Breastfeeding
-Iron fortified formula=acceptable alternative to breast milk
Cows milk= not recommended
When do we begin vit. D supplements for babies?
During first few days of life
When are iron supplements recommended for infants who are being exclusively breastfed?
If they are being exclusively breastfed after age of 4 m
Do we need juice or water during first 4 m of life?
Not needed
When should 100% fruit juice be limited to 4-6 oz per day in infants?
After age 6 m
When are solids introduced?
Around 4-6 m of age
What are indicators for readiness in solids?
- Interest in solids
- Voluntary control of head and trunk
- Disappearance of extrusion reflex
What solid is typically introduced first?
Iron fortified cereal
How do we introduce new foods?
One at a time, over 4-7 day period to observe for allergy or interolerance (fussiness, rash, V/D, constipation)
When are vegs and fruits started?
Between 6-8 months; after both have been introduced, meats may be added
What foods are NOT started until after 6 months?
Citrus fruits
Meats
Eggs
Should breastmilk/formula be increased or decreased as intake of solid foods increase?
Decreased–but should remain primary source of nutrition through first year
When can infants get table foods that are cooked, chopped, and unseasoned?
9 m
What are good finger foods?
Ripe bananas Toast strips Graham crackers Cheese cubes Noodles Peeled chunks of apples, pears, or peaches
When can weaning be accomplished?
When infants show signs of readiness
Able to drink from a cup
*somewhere in second 6 months
What are the last feedings to be stopped?
Bedtime
What age often use negativism?
Toddlers
What age often uses ritualism?
Toddlers
Toddlers are unable to see things from the perspectives of others; they can only view things from their personal points of view. What is this?
Egocentric thinking
When do toddlers develop gender identity?
3 years
What kind of play do toddlers do?
Parallel
What are good toys for toddlers?
- Filling/emptying containers
- Playing with blocks
- Looking at books
- Push/pull toys
- Tossing balls
- Finger paints
- Large piece puzzles
- Think crayons
Nutrition for toddlers: ____ occurs, resulting in toddlers becoming fussy eaters because of a decreased appetite
Physiologic anorexia
How much milk per day should toddlers consume?
24-30oz
When can toddlers switch from drinking whole milk to drinking low fat milk?
After 2 years
How much fruit should toddlers get?
1 cup daily
What is food serving size for toddlers?
1 tbsp for each year of age, or 1/4-1/3 of an adult portion
Why do toddlers generally prefer finger foods?
Increasing autonomy
What does a 3 year old do?
Rides tricycle
Jumps off bottom step
Stands on one foot for a few seconds
What does a 4 year old do?
Skips and hops on one foot
Throws ball overhead
What does 5 year old do?
Jump rope
Walks backward with heel to toe
Throws and catches ball with ease
Preschoolers make judgements based on visual appearances. Variations in thinking during this age include what 3 things?
Magical thinking
Animism
Centration
Preschoolers consume about ____ amount of energy that adults do
Half (so 1800kcal)
When do preschoolers become more willing to sample different foods?
5
How much protein do preschoolers need?
13-19g/d + adequate calcium, iron, folate, and vit A and C
Saturated fats should be less than ____ of preschoolers total caloric intake
Total fat over several days should be ____ of total caloric intak
10%
20-30%
By the end of the school-age years, children should eat ____ portions of foods.
Adult portions
What is an increasing concern for school age regarding nutrition?
Obesity!!
- Avoid food as reward
- Emphasize physical activity
What is sexual maturation order for girls?
- Breast development
- Pubic hair growth (some girls experience hair growth before breast development)
- Axillary hair growth
- Menstruation
What is sexual maturation order for boys?
- Testicular enlargement
- Pubic hair growth
- Facial hair growth
- Vocal changes
During times of rapid growth in adolescent, what additional supplements are needed?
Calcium
Iron
Zinc
Adolescents tend to stay up late, sleep in later in the morning. Do they need more or less sleep than school age years?q
MORE
When is it acceptable to give opioids? Ex?
Moderate-severe pain
Morphine sulfate
Oxycodone
Fentanyl
What does combining nonopijoid and an opioid med do?
Treats pain peripherally and centrally—this offers greater analgesia with less adverse effects
Are IM injections recommended for pain control in children?
No
What is EMLA and when should we apply?
Eutectic mixture of local anesthetics—equal quantities of lidocaine and priolocaine in the form of cream or disc
60 min prior for superficial puncture
2.5 hours prior to deep puncture
What age gets fentanyl?
Children older than 12
- used to provide continuous pain control
- onset of 12-24 hours, duration of 72 hours
How do we treat respiratory depression?
Naloxone
What are nonpharmalogic measures for pain control?
- Distraction
- Relaxation
- Guided imagery
- Positive self talk
- Behavioral contracting
- Containment
- Nonnutritive sucking
- Kangaroo care
- Complementary and alternative meds
A multidisciplinary approach that focuses on the process of dying rather than prolonging life in cases in which cures are no longer possible
Palliative care
What is focus of palliative care?
Control of managing the clients manifestation and offering supportive care
What is focus of hospice care?
- Family members are primary caregivers
- Nursing focus: pain control and comfort
- Family and client needs are EQUAL
- Provide support for family grieving process, which can continue after clients death
When death is expected or a possible outcome
Anticipatory grief
Grief that extends for more than a year following the loss
Complicated grief
CSF analysis for bacterial meningitis?
- Cloudy color
- Elevated WBC count
- Elevated protein content
- DECREASED glucose content
- Positive gram stain
CSF analysis for viral meningitis?
- Clear color
- Slightly elevated WBC count
- Normal-slightly elevated protein content
- Normal glucose content
- Negative gram stain
How long should client remain in bed after a lumbar puncture? What position?
Remain in bed 4-8 hours in a FLAT position to prevent leakage and a resulting spinal headache
*may not be possible for an infant, toddler, or preschooler
What vitamin can be given as a medication for the treatment of Reyes?
Vitamin K–improves synthesis of blood clotting factors in the liver
Signs of increased ICP in infant? (7)
- Bulging fontanel
- Separation of cranial suture
- Irritability
- Increased sleeping
- High pitched cry
- Poor feeding
- Setting sun eye
Signs of increased ICP in child? (7)
- N/V
- Headache
- Blurred vision
- Increased sleeping
- Inability to follow simple commands
- Seizures
What are late signs of increased ICP? (7)
- Alterations in pupillary response
- Posturing (decorticate and decerebrate)
- BRADYcardia
- Decreased motor response
- Decreased sensory response
- Cheyne-stokes respirations
- Coma
What is the dysfunction if child is in decorticate posture?
Cerebral cortex
What is the dysfunction if child is in decerebrate posture?
Midbrain
