What Jacobson said to focus on: Part 1 Flashcards by Melissa Johnson

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

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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

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Elicited by placing an object in an infants palm–infant grasps object

Palmar grasp

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Elicited by touching the SOLE of an infants foot–infants toes curl DOWNWARD

Plantar grasp

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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

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Elicited by clapping hands or by a loud noise–newborns will abduct arms at the elbows, and the hands will remain clinched

Startle reflex

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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

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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

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Elicited by holding an infant upright with his feet touching a flat surface–infant makes stepping movements

Stepping reflex

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Expected age of moro?

Birth-4 m

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Expected age of tonic neck reflex?

Birth- 3or4m

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Expected age of babinski reflex?

Birth-1y

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Expected age of plantar grasp?

Birth-8 m

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Expected age of palmar grasp?

Birth-3 m

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Expected age of sucking/rooting reflex?

Birth-4 m

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Expected age of startle reflex?

Birth-4m

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Expected age of stepping reflex?

Birth-4weeks

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What does infant do at 1 month?

Demonstrates head lag

Has a grasp reflex

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What does infant do at 2 months?

Lifts head off mattress when prone

Holds hands in a open position

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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

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What does infant do at 4 months?

Rolls from back to side

Places objectes in mouth

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What does infant do at 5 months?

Rolls from front to back

Uses palmar grasp dominantly

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What does infant do at 6 months?

Rolls from back to front

Holds bottle

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What does infant do at 7 months?

Bears full weight on feet

Moves objects from hand to hand

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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?

1. Separation 2. Object permanence 3. 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?

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?

1. Breast development 2. Pubic hair growth (some girls experience hair growth before breast development) 3. Axillary hair growth 4. Menstruation

What is sexual maturation order for boys?

1. Testicular enlargement 2. Pubic hair growth 3. Facial hair growth 4. 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

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?

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