Week 1 - Infants (DOES NOT INCLUDE MILESTONES)
For children 4 years and older that have received a vaccine, the nurse knows that what does tactile stimulation do?
Tactile stimulation involves rubbing the skin near the injection site. Supposed to decrease pain
The nurse knows that key crib safety interventions include...
-KEEPING RAILS UP -NEVER LEAVING THE CRIB SIDE WHEN ONE RAIL IS DOWN. Babies can easily roll -NO TOYS IN THE CRIB -Sleep baby on back (to avoid SIDS)
The nurse recognizes which of the following soy based formulas?
-Isomil -Nursoy -Prosobee -Soyalac -Good Start Supreme Soy
The nurse knows that a mother can expect for breastfeeding to be...
"On demand". Infants will develop their own breastfeeding schedule. NORMALLY, infants breastfeed q2-3hrs each day. During each session, they spend about 15-20 min on each breast
Percentiles for weight for length growth chart
< 5th percentile = underwt > 95th percentile = overweight
When parents begin to question the skills of the care team taking care of their child, the nurse can respond by saying...
-"we're all on the same team" -"we're all here to work with you and your child to help your child get better"
BMI percentiles on growth chart (ht and wt).
-5th - 85th %ile → normal - < 5th %ile → undert -85th-95th %ile → R/F overwt - > 95th %ile → overwt
BEFORE administering a vaccine to an infant, the nurse knows that parents should be given a vaccine information statement (VIS) that explains the (+)/(-) of the vaccine. The nurse recognizes which of the following as things to consider with a VIS?
-A VIS MUST be provided to the parent BEFORE administration because it's a federal law. Not doing this = big trouble -Accommodate to the language that the family speaks. Not everyone speaks English. If VIS in family's language isn't available... get an interpreter. -Offer the parents enough time to read the information and encourage the parents to share their concerns after reading the VIS
Expected normal musculoskeletal findings in an infant:
-Ability to move all extremities well w/ good ROM -Negative Ortolani's sign & equal gluteal folds
The nurse recognizes which of the following as NORMAL assessment findings of an infant's nose and mouth?
-Absence of nasal discharge -Pink and moist oral mucosa with intact upper AND lower palates -Roughly 4-8 teeth by the time the infant is 1 y/o. But... the age in mo. of an infant is roughly how much teeth they should have in total (e.g. at 6 mo, they should have 6 teeth)
Infant bowel movements (assess this when asking about infant nutrition)
-As a newborn: typically 8-10 BMs a day but could be as low as 1 stool every day/every other day -NORMAL for infant to grunt, strain, and cry while trying to have BM d/t immaturity of GI tract. This would be concerning if stools were hard and dry -# of BMs/day DECREASES as the infant ages. Infrequent stooling = normal if the BMs are soft -Low BMs could potentially indicate improper nutrition or other issues
When speaking to a mother about breastfeeding, the nurse knows it is important to...
-Ask if the mom breastfeeds and if she chose not to, respect her decision -Encourage the mother to continue breast/formula feed -Offer resources to assist with successful breastfeeding techniques (e.g. lactation nurse, etc.)
In order to establish consistency and maintain normalcy for both the parent and the infant, what can the nurse do?
-Assess their daily routines: "normally, when is bed time for you? when is story time? when do you eat?". Helps establish consistency -Ensure consistent staff members are assigned to the pt. Makes things easier and less stressful. The same people know how you want things done and the issues w/ your kid. Keeps care constant and efficient
The 3 vital signs that a nurse can expect to check in an infant include...
-Axillary temperature -Apical heart rate at the 4th intercostal space mid clavicular -Respiratory rate (determined by abdominal mvmt w/ inspiration & expiration) -O2 sat on finger, toe, ear, foot, or forehead
The nurse knows what kinds of effective distraction techniques can be employed while administering a vaccine to an infant?
-Blowing bubbles -Reading a book -Singing a song -Mom can breastfeed (but she should be warned that she might get bitten)
To prevent diaper dermatitis, the nurse recognizes which of the following as appropriate interventions?
-Changing diapers frequently & allowing for time off of the diaper in order to let the area covered by the diaper air out -AVOIDING rubber pants over diapers: common for parents to do this in the summer when they take children to the pool
Once redness (in any capacity) appears in the area where diapers are placed, the nurse should...
-Encourage the parents to keep the baby diaperless for a period of time to expose this area to air and allow it to heal -If available, can set blow dryer on warm (not hot) and blow dry the area for 3-5 min -could put zinc. do NOT put baby powder
The nurse recognizes which of the following as MILK based formulas?
-Enfamil Lipil -Good Start -Similac
Things to assess for when observing interactions btwn parents and infant?
-Eye contact: are the parents making eye contact with the child (and vice versa)? Or do the parents look away from their child and are glued to their phones? -Dynamics btwn parents can have an impact on -Do the parents securely hold and comfort the child? If none of this is occurring... assess further
Common themes among parents/families of hospitalized children...
-Feeling helpless -Questioning the skills of the staff -Accepting the reality of the hospitalization -Needing to have information explained in simple language -Dealing with fear -Coping with uncertainty
The nurse knows that the BMI and blood pressure of an infant are not checked until when?
-For BMI: when the pt is > 2 y/o -For BP: when the pt is > 3 y/o.
Because procedures in a hospital (VITAL SIGNS, IV insertion, etc...) are uncomfortable/intrusive to anyone of any age, what should the nurse instruct a parent to do with their child while these procedures need to get done?
-Hold and comfort the child while the procedure is getting performed in order to gently immobilize and secure them -DO NOT PIN THE CHILD DOWN -Employ distractions: touch, voice, pacifier, bottle, breastfeeding (but they might bite) -After the procedure is done, ask parent to hold, rock, and/or sing to infant
Things that are done during a well-infant/child visit
-Ht, wt, head circumference (only up until 2 y/o) -Growth chart plotting -V/S -Developmental screening -Nutritional assessment -Physical exam -Anticipatory guidance: family/caregiver teaching -Administration of immunizations
The nurse can help relieve families/parents of the stressors that come with their children being hospitalized by...
-Involving them in the child's care -Explaining EVERY PROCEDURE, even when doing something as simple as taking vital signs -Simple/plain language explanation (preferably 5th grade level) -Inform parents of plan of care and any changes. Most places have family centered rounds
For infants in pain, the nurse knows that infants are often...
-Irritable -Restless -Feeding poorly -May experience a disturbed sleep pattern -Tachycardic -Tachypneic -Lethargic Use FLACC (face, legs, activity, cry, consolability) to assess pain
Common sibling rxns to a hospitalized sibling
-Loneliness, fear, worry -Anger, resentment, jealousy, guilt —> why is my sibling get more attention? -Perception that their parents will tx them different -Receiving little info about their sibling's illness
When assessing for dislocated hips in an infant, the nurse knows that this can be done by...
-Looking for uneven gluteal folds (gluteal folds are the bottoms of the buttcheeks). Normally, gluteal folds are even. Uneven gluteal folds prompt further assessment -Assisting a clinician when they are assessing for the presence of a click/clunk sound that is palpable or audible as the Ortolani maneuver is being performed.
The nurse recognizes which of the following as normal assessment findings when examining an infant's respiratory status?
-Lungs clear to auscultation bilaterally -Symmetrical movement of chest and abdomen while breathing -Obligate nose breathing (until about 5 mo) -Respirations w/o chest retractions (sinking in of the chest wall while breathing) and/or accessory muscle use
The nurse can expect which of the following to be normal findings when assessing an infant's head/neck area?
-Normocephalic head shape -An open and flat anterior fontanelle that remains open until about 12 mo of age -Neck w/ good ROM
Considerations for growth chart plotting
-Plotting +/- 1 to 2 standard deviations is OK -Don't round month up or down -If the child plots < or > 2 standard deviations: 24 hr diet recall, feeding/nutrition assessment, BM, urine, # of wet diapers
The nurse can expect to see what 2 normal findings when assessing infant eyes
-Positive PERRLA pupils -Bilateral positive red reflex: reddish-orange reflection of light from the back of the eye noted when using an ophthalmoscope or retinoscope
The nurse knows that while sibling visitation is encouraged as much as possible, barriers may include...
-RSV and flu seasons: usually siblings aren't allowed to visit —> could worsen loneliness, fear, and worry -In NYC: kids might have to show proof of vaccines (esp MMR). Does the sibling have these vaxes?
The nurse can expect to find what when assessing the heart of a healthy infant?
-S1 S2 rhythm w/ no murmurs -Pink lips and pink, non-cyanotic skin -3+ femoral, pedal, and brachial pulses bilaterally -Bilateral cap refill < 3 sec
Things to consider for an infant physical assessment
-Smile! And let the baby touch the equipment -Have the parent hold the baby during the exam
The nurse knows that normal findings upon assessment of an infant's ears include...
-Symmetrical, appropriately positioned ears w/ no sinuses or tags -Hearing that is grossly intact: infant responds to directions, noisy stimuli, etc...
A mother asks the nurse what baby formula can get mixed with. The nurse is correct in teaching the mother that formula can be mixed with...
-TAP WATER, preferably cold water. Warm water isn't recommended since it tends to pick up more lead. If the mother & her family live in an older home, they should run the water for 2 minutes before using it to mix into formula since this minimizes the amount of lead in the water. -BOTTLED WATER can also be used to mix formula feeds with.
A mother asks the nurse if she can expect for anything to happen to her infant after having received a vaccine and if so, what she should do about it. The nurse should tell the mother that...
-The infant may develop a LOW GRADE fever (100.5 - 102.2) and may look like she is in a LITTLE BIT of pain. This is expected and Tylenol can be given to relieve this. There isn't really a need to go to the hospital if this happens -The area in which the vaccine was administered may be red and slightly swollen. Ice can be applied here and if she notices if the baby is itching at the injection site, benadryl can be given -Although rare, the mother should take note if the fever lasts more than 3 days; if a fever is higher than 105 F; if the baby has a high pitched cry; and if the baby has seizures (shaking, staring blankly, etc...) and take her infant to the hospital immediately
When looking at the 2019 ACIP CDC Vaccine Schedule, the nurse should be sure to pay attention to...
-The minimum interval btwn vaccines -The youngest age to get a vaccine -The details BELOW the vaccine schedule (footnotes) -The catch up schedule
When assessing the skin on an infant, the nurse would consider which of the following as NORMAL findings?
-Warm, dry skin w/ normal for ethnicity skin tone -No rashes -No lesions
Home safety for infants
-landlords (in NYC) are REQUIRED to put window guards in -Cordless blinds to prevent infants from getting their necks stuck in cords -Poison control in NYS: 1-800-222-1222. Locks on med cabinets/places where substances are stored. Keep medicines OUT of trash -dressers/closets should all be secured. bolted to the wall, anchors on furniture —> SECURE THEM. they can tilt and crush a kid —> kids can die. Harper's law: furniture companies should be providing anchors to furniture -Safety plugs on electrical outlets -Assess and appropriately address violence in the home
FLACC pain scale scoring
0 through 10, with 0 representing no pain. Five total criteria (Face, Legs, Activity, Cry, Consolability) with the lowest amount for each criteria being 0 and the highest being 2.
From 6 months old to 12 months old, the nurse can expect for an infant's length to increase by how much per month?
0.5 in per month
For infants under twelve months, the nurse can expect to use what needle gauge size for an IM injection?
1 in
The nurse is correct in teaching parents that an infant's gums should be wiped how often?
1 to 2 times/day. However, if a baby feeds (breast or bottle), gums should be wiped immediately afterwards. Teething wipes exist and can be used to do so
The nurse knows which of the following are 3 different types of breastmilk preparations?
1). ready to feed 2). concentrate 3). powder
From birth to 3 months of age, the nurse knows that infant nutrition needs at this time are...
1-6 oz of breastmilk or formula q2-4 hrs. The lowest it will be during the first year of life for an infant
The nurse is examining an 1 y/o infant. When measuring the infant's head circumference, the nurse can expect for the infant's head circumference to be...
10 cm larger than the infant's head circumference measured at birth. Ex: if the baby's head circumference at birth was 35 cm, then at this point it should be 45 cm.
From birth to 3 months, the nurse knows that infants should get how many hours of sleep per day?
10 to 16 hrs of sleep per day. The most anyone will ever sleep at any time in their life probably
The nurse knows that during the first weeks of life, an infant loses how much of their body weight?
10% of their body weight
From 6 months to 12 months of age, the nurse knows that infants should sleep how many hours a day?
12 to 14 hours a day.
From 3 months to 6 months of age, the nurse should teach parents that their infant should be getting how many hours of sleep a day?
14 hours of sleep/day. Somewhat less than how much an infant sleeps from birth to 3 months.
The nurse knows that from birth to 6 months old, an infant should be gaining how much weight a day?
15 g (0.03 lbs) to 30 grams (0.06 lbs) a day.
When an infant is due for more than 1 vax during a visit, the nurse knows that it is possible for...
2 different nurses to each give a different vaccine in different sites at the same time
The nurse knows that the typical birth height is...
20 in (50 cm)
By 4 months old, the nurse should expect an infant to weight how much?
2x their birth weight. Ex: if a baby had a birth weight of 7.5 lbs, they should weight 15 lbs by 4 months of age.
The nurse knows that the typically newborns weight how much?
3.4 kg (7.5 lbs), with boys being slightly heavier than girls
When weighing a 1 y/o infant, the nurse can expect for the infant's weight to be...
3x its birth weight. Ex: if an infant weight 7.5 lbs at birth, then it should weight 22.5 lbs at 1 y/o.
The nurse knows that from birth to 6 months old, an infant should be gaining how many ounces a week?
5 to 7 oz per week.
For infants under twelve months, the nurse can expect to use what needle length for an SQ injection?
5/8 in
The nurse knows that nutritional needs for an infant between 4 to 6 months of age are...
6-8 oz of breastmilk or formula q4-6 hrs
While the normal infant heart rate ranges btwn 80 to 150 BPM, the nurse should be concerned if the infant's heart rate is...
< 80 BPM or > 150 BPM. Abnormally low or high heart rates would obviously warrant further assessment. Keep in mind that an excited or febrile infant may have a heart rate has high as 200 BPM.
A mother thinks that vaccines regulations and standards are controlled completely by pharmaceutical companies trying to make money. The nurse should tell the mother that...
A specific committee of the CDC (a govt. agency) that consists of healthcare (nurses, docs) and public health professionals determines regulations and standards. Pharmaceutical companies simply just make the vaxes and have no input in policy
The nurse knows that diaper dermatitis occurs d/t...
An inability to change diapers. Diapers are expensive. You can easily go through 10 diapers in a day. Parents could get tired of doing this
A mother tells the nurse that she often finds herself preparing way too much formula so that she can save money by letting the infant drink whatever they don't finish. The nurse should correct the mother because...
ANY amount of formula that the baby doesn't drink SHOULD BE DISCARDED d/t R/F bacteria growing and developing in leftover formula.
The nurse knows that the FIRST DOSE of the 3 dose HBV vax series is given when?
AT BIRTH. Proven to be effective to reduce the risk of an infant developing HBV
When assessing the head of an infant, the nurse knows to assess what in regards to the infant ears?
Alignment of the ears.
When weighing an infant, the nurse should be sure to use what kind of scale?
An INFANT scale. Infant scales go down to the nearest GRAM. Very precise measurement.
Palmar grasp reflex
An infant reflex in which the infant grasps hands when the palm is touched w/ a finger. Present at birth but then disappears at 4-6 months.
Plantar grasp reflex
An infant reflex in which the infant reflexively grasps the bottom of the foot (toes curl down) when pressure is applied to the plantar surface with a finger. Present at birth but then disappears at 9 mo.
Moro reflex
An infant reflex in which the infant's arms suddenly abduct and move upward while the hands form a C after their heads are suddenly extended. Present at birth and disappears at 4 months
When assessing an infant, the nurse considers which of the following as NORMAL neurological findings?
An infant that demonstrates a good cry and is happy and interactive. Depending on the infant's age, the nurse may see certain primitive reflexes (moro, grasp, and babinski).
When conducting a general head-to-toe survey of an infant, the nurse knows that NORMAL findings include...
An infant that is alert, maintains good eye contact, interactive, and successfully demonstrates the appropriate developmental milestones
The nurse knows that what kinds of medications should NOT be given before the administration of a vaccine to an infant?
Antipyretics (e.g. acetaminophen). Could give antipyretics AFTER the vaccine though.
The nurse knows that which of the following are 2 good measures of secure infants growing up in healthy, nurturing environments that have been established by the parents?
Appropriate growth & exhibiting the appropriate developmental milestones. Shows that the parent(s) actually care about the child and are doing everything right (playing with the child, adequately feeding the child, etc...)
When determining the apical heart rate of an infant, the nurse knows that accurate apical heart rate measurements are obtained by...
Auscultating over the 4th intercostal space midclavicular for 1 FULL MINUTE. It's necessary to listen for 1 full minute d/t irregularities.
Toy safety for infants
Avoid string toys, necklaces, cords near the infant. Esp if older sibling is involved - ensure that their toys are in a safe place AWAY from the child. Encourage parents to speak w/ older sibling(s) about the potential dangers that their toys can cause to their younger sibling(s)
The nurse knows that the first dose of the rotavirus vaccine should be given when?
Before an infant is 15 weeks old. If an infant is after 15 weeks and hasn't gotten the first dose of the rotavirus vaccine, they can't get it
The nurse can expect for the posterior fontanelle on an infant's head to close when?
By 2 months of age. The posterior fontanelle closes SOONER than the anterior fontanelle.
"Never shake the baby" when frustrated with baby/when baby is crying.
Causes injuries a lot. Instead: put child safely in crib with all rails up and distance yourself from the child and take deep breaths in another room
The nurse knows that some vaccines are administered as what?
Combination vaccines. Really helps when an infant is due for multiple vaccines at a time - you don't have to keep sticking them over and over. Example: Pentacel (combo of Hib, inactivated poliovirus vax, and DTap).
The nurse is assessing a 2 month old infant and notices that the baby is crying with no tears. An appropriate action by the nurse is to...
Document this and proceed with the physical assessment. Infants typically demonstrate TEARLESS CRIES up until at least 3 months of age.
The nurse knows that when administering a vaccine, it is important to have which 2 medications on hand and easily accessible at the time of administration?
Epi-pen and benadryl. Although rare, it's possible that an infant may go into anaphylaxis after getting a vaccine. Better safe than sorry
In order to avoid diaper dermatitis, the nurse should encourage the parents to use what kinds of baby wipes?
FRAGRANCE FREE baby wipes. Avoid fragrance or preservative containing baby wipes
By 7 to 11 mo of age, an infant should be offered...
Finger foods. Additionally, a cup should be introduced
When examining the genitalia of a male infant, the nurse understands that...
Foreskin usually isn't retractable until 1 to 2 y/o. Additionally, the testes should be descended into the scrotum usually by 9 mo,
When washing the area covered by a diaper, the nurse knows that correct technique that can help avoid diaper dermatitis involves what?
Pouring soapy water on the area and dabbing dry. Do NOT rub this area.
The nurse knows that fruit juice should NOT be given to infants because...
Fruit juice has a large amount of concentrated sugars. (example from slides: 40 grams of sugar in one serving of fruit juice = 10 teaspoons of sugar). Additionally, fruit juice tastes good and is easy to suck/sip from a cup. It's really easy for a kid to get TOO much juice, which could contribute to tooth decay
A mother who feeds her infant with powder feeding formula tells the nurse that she has been saving money by diluting the powder with more water than the recommended amount. The nurse knows that this is incorrect and requires teaching because...
Giving too much water to an infant is dangerous. This could dilute out all of the Na in their body → low Na → potential seizures
Unlike live vaccines, non-live vaccines are usually administered how?
IM
The nurse can expect what normal findings to be present when assessing an infant's abdomen
INSPECT, AUSCULTATE, PALPATE, PERCUSS -Soft, non-tender, and non-distended abdomen -Potential palpation of the lower edges of the liver -Normal bowel sounds throughout all 4 abdominal quadrants
Infants between 4 to 6 months old are able to be introduced to some solid foods. The nurse is correct in teaching parents that...
IRON-FORTIFIED CEREAL PRODUCTS SHOULD BE INTRODUCED FIRST. Afterwards, the parents can introduce different healthy proteins, veggies, and fruits to the infant. Per AAP recommendation, infants should still be breastfeeding at this time (they recommend breast for formula feeding exclusively for the first 6 mo. of life).
The nurse knows that an infant's crib should be placed where?
In a QUIET, DARK ROOM. The AAP recommends that the crib be placed in the same room as where the parents sleep until 1/yo (but can you really establish a consistent routine and pattern of sleep when parents might be in and out of the room constantly?)
The nurse should explain things to parents how?
In simple language (5th grade level - but this obv depends on the level of education of the parents. Just simple language in general)
The nurse notices that a 3 month old infant is breathing exclusively through her nose. The nurse knows that this is the case because...
Infants are OBLIGATE nose breathers UNTIL ABOUT 5 MONTHS OF AGE.
A mother tells the nurse that she has been letting her infant sleep in the crib on her back with a bottle in her mouth, several blankets wrapped around her, and a few of her favorite stuffed toys. The nurse should intervene and teach the patient that...
Infants should be sleeping in cribs WITHOUT anything in their mouth (except MAYBE a pacifier). Infants also shouldn't be sleeping in the crib with other objects until 12 months old.
The nurse knows that an infant's respiratory rate should ALSO be assessed for 1 full minute. The nurse knows that this is the case because...
Infants typically exhibit periodic breathing in which they are tachypneic with BRIEF, INTERMITTENT APNEIC PERIODS.
Infant urination patterns
Infants urinate FREQUENTLY w/ urine that has a low specific gravity d/t immature renal structures. This makes an infant more susceptible to dehydration
A father asks the nurse if they could just give his breastfeeding son cow's milk from the grocery instead of breastfeeding since his wife is always tired from breastfeeding. The nurse is correct in saying that...
It isn't recommended to give infants cow's milk as a substitute for breastfeeding or even formula because: -Cow's milk doesn't digest as well compared to breastmilk or formula -Cow's milk does NOT have the same nutritional content as breastmilk or formula. It may actually overload the baby with way too much protein, Na, and minerals.
When positioning an infant for measurement of length, the nurse knows to...
Lay the infant SUPINE w/ full body extension while holding the head in midline. Knees should be grasped together gently and pushed down. The assistance of another nurse is needed for this since infants wiggle a lot. The best way to measure would ideally be on a table/length board.
Order of injections
MMR, PCV, then HPV. The most painful vaccine is saved for last! Typically, the IM injections are the most painful
When measuring an infant's head circumference, the nurse demonstrates correct technique by...
Measuring at the greatest circumference of the infant head, which is usually slightly above the eyebrow and pinna of the ears and around the occipital prominence at the back of the skull
When measuring the length of an infant, the nurse demonstrates correct technique by doing what?
Measuring from the top of the head (crown) all the way to the heels of the feet (as the feet are pointed directly to the ceiling)
To ensure maximal safety for an infant while obtaining its weight on an infant scale, the nurse should be sure to...
NEVER for any reason leave the infant alone on the scale (even if she is going to the other side of the room to grab something). The infant can easily roll over and fall - they squirm a lot.
When examining the genitourinary area of a female NEWBORN, the nurse notices blood-tinged mucus coming out of the newborn's vagina. The nurse understands that this is...
NORMAL. This is known as pseudomenstruation. The cause of this is the withdrawal of maternal estrogen.
From birth to 3 months old, the nurse knows that infants should...
NOT be introduced to solid foods. Instead, they should definitely be breastfeeding (preferred) or using formula.
When weighing an infant on an infant scale, the nurse knows that the infant should be...
Naked with DIAPERS TAKEN OFF in a lying position
After parents read the VIS and are okay with the administration of a vaccine to their infant, the nurse should then proceed to...
OBTAIN CONSENT from the parents. After consenting, you're good to administer the vaccine
When a baby is teething, parents should offer what?
Offer safe cool teething toys for comfort. These toys are usually made out of materials like silicone
Whenever an infant is awake, the nurse should encourage the parents to do what with the infant?
PLAY WITH THE INFANT!!!
Because the hospitalization of an infant is a very stressful time for both the infant AND the parents/family, the nurse knows it is important to...
PREVENT SEPARATION and reduce anxiety by: -Allowing parents to "room in": exactly what it sounds like -Keep things normalized -Assist parents in communicating their absences (from work, etc...)
FLACC pain scale
Pain scale indicated for the assessment of pain in: -Children who are too young to verbally or conceptually quantify their pain (usually 2 mo - 7 y/o) children w/ -neurodevelopmental delays that have cognition levels inappropriate for their age -Situations where there are language barriers -Adults in the ICU who aren't able to speak d/t ET intubation
The nurse knows it important to assist parents in communicating their reasons as to why they can't be at the hospital all of the time because...
Parents (if employed) need to go back to work to maintain their insurance plan. Therefore, the nurse should work together with the patient to establish the times when the parent will have to leave and also determine when the parent will return. Shows how important consistency of staff members is needed b/c in instances like this, a nurse that the child is familiar with can help decrease separation anxiety/nervousness in an infant whose parent needs to leave for a bit
When placing an infant in the crib, the nurse knows that the parents demonstrates correct technique when they...
Place the infant in the crib while the infant is still awake & lie the infant on their back (reduces incidence of sudden infant death syndrome. The thought is that infants sleep so well when sleeping on their belly that they forget to breathe)
When taking the temperature of an infant, the nurse can expect to...
Place the tip of the probe at the center of the axilla. The tip should be kept CLOSE TO SKIN, not clothing. To facilitate this, the infant's arm should be firmly against its side.
During every infant well visit, the nurse can expect to do what with the infant's weight, length, and head circumference?
Plot the infant's weight, length, and head circumference during every infant well visit.
To minimize the amount of wasted formula (remember - formula is EXPENSIVE), the nurse should teach the parents to do what?
Prepare as much formula as the infant typically consumes
The nurse knows that passive immunity from the mother does what for the infant?
Provides some immunity for the first 6 mo. of life. Ex: mothers in their 3rd trimester (around 28 wks gestation) are given the Tdap vax (with their consent of course). This causes mom to make antibodies AGAINST pertussis, which can be transferred to the fetus. Pertussis is bad for mom and fetus. Additionally, anyone else in the household (other parents, other family members) should also get a booster Tdap
Regardless of the technique of administration of the vaccine (whether it be SQ for a live vaccine or IM for a non-live vaccine), the nurse knows that the vaccine should be administered how?
QUICKLY and w/o aspiration to reduce pain/discomfort. Don't bring in one needle at a time. Ensure that you have all vaccines and all necessary equipment ready once you enter the room - don't drive the kid crazy
The nurse can expect to teach a mother that breastfeeding is recommended for how long?
Recommended exclusively for the first 6 mo. of life and should continue until the infant's first birthday at 12 mo.
After putting an infant to sleep in the crib, the nurse should teach the parents to do what afterwards?
Remain in the room for a few minutes
If an infant's current measured length is 1 inch LESS than last month's length... the nurse can expect to do what?
Remeasuring the infant's length 3 more times & notifying the pediatrician. Ideally, out of all of the 3 repeat measurements, 2 consistent measurements are desired. However, this might be hard to obtain since kids wiggle around a lot. It's also possible someone made a mistake in measurement in the past.
Med rights to check when administering a vaccine
Right pt, right vaccine/diluent, right time, right dose, right route/needle length, technique, right site, right documentation + correct pt age, appropriate interval, and expiration date of vaccine/diluent
Typically, the nurse can expect to administer a LIVE vaccine through which technique?
SQ. Therefore, you can expect to administer MMR SQ
A nurse is watching a newly hired nurse assess an infant's respiratory rate. The new nurse demonstrates correct technique when...
She observes abdominal movements for 1 full minute while paying attention to how symmetrical the abdominal movements (symmetrical? retractions? is one side moving but the other isn't?) are and the infant's breathing pattern
The nurse knows that parents should vocalize frequently to an infant by...
Speaking 12-15 inches in front of the infant's face. The infant not only wants to hear you but they also want to see you. Newborn babies can't see much more than just blurry images in front of them → getting close will allow them to see details of your face better
From 7 to 12 months of age, the nurse can expect for infant to be consuming how much breastmilk how often?
Still 6-8 oz of breastmilk or formula BUT q6-8 hrs, with a daily max of 32 oz breastmilk/formula. At this point the baby will also start eating solid foods (e.g. gerber baby food).
The nurse knows that a mother should avoid nursing or bottle feeding in bed because...
Sugar is in breastmilk → sugar stays in teeth → being in bed/placing baby in bed immediately after could cause parent to forget to wipe gums after feeding.
Before weighing an infant on an infant scale, the nurse knows to...
ZERO the scale out before each weight with a clean sheet of paper on the scale.
An infant's axillary temperature is 100.5 F. The nurse notices that the infant is wrapped in a warm blanket. Instead of telling the pediatrician that the infant may possible have an infection, the nurse is correct in doing what?
Temporarily removing the blanket and RECHECKING the axillary temperature.
The nurse knows that parents reading to an infant DAILY is beneficial to the infant because...
The fact that an infant is able to (hopefully) hear words and associate them with pictures in the book is beneficial for the cognitive development of the infant. Ideally, reading daily to an infant should start from birth.
When palpating the abdomen of an infant, the nurse might expect to palpate what?
The lower edge of the liver.
How should the nurse can expect for an infant's length to grow?
The nurse can expect for an infant's length to grow very quickly from birth to 6 mo. of age. However, from 6 to 12 mo. of age, infant length grows slower.
When administering an intramuscular injection of a vaccination to an infant, the nurse knows that...
The preferred injection site is IM into the vastus lateralis (front of quads kind of off to the sides) with a needle length btwn 5/8th to 1 inch and a needle gauge of 22, 23, 24, or 25.
The nurse knows to teach the patient that an infant should go to the dentist when...
Their first tooth erupts. Afterwards, they can expect to go to the dentist every 6 months.
When determining an infant's ability to self comfort, the nurse knows that this means that...
You should be able to put an infant in the crib when they aren't totally asleep and they should be able to put themselves to sleep at around 4 months
The nurse knows that grasping and shaking toys is beneficial during play for an infant because...
This allows babies to "see then do". This is how babies learn.
Once formula is mixed, it should be put in the fridge. The nurse knows that this is the case because...
This decreases the amount of bacteria that could form while the formula is in the bottle.
A new couple tells the nurse that they find themselves exhausted all the time because their 2.5 month old infant sleeps in bouts of 45 min at a time throughout the day. The nurse should tell the parents that...
This is normal. Infants choose when and how they sleep. They don't sleep like adolescents/adults, who normally sleep for 6-10 hr straight throughout the night. Overtime though, an infant's sleeping pattern should get more put together and established.
A father asks if his 5 month old infant can sleep with him in the bed instead of sleeping in the crib so that him and his son can "bond better". The nurse should correct the father because...
This is not safe. Infants who sleep in adult beds are at increased risk of suffocation - they could roll on their bellies, the parents could roll over onto the kid. Additionally, infants can easily roll off of the bed.
Once the infant's first tooth erupts, the nurse should teach the infant's parents to do what?
To have the dentists see their child
The nurse knows that a very common cause of infant death is...
UNINTENTIONAL INJURY, especially a motor vehicle accident.
The nurse knows that parents should be taught that children should be kept in a rear facing car seat until when?
Until they are 2 years old. The necks of kids are VERY unstable —> big heads and very little bodies
The nurse knows that infants usually have how many teeth that have erupted by 12 months of age?
Usually about 4-8 teeth
Unlike the posterior fontanelle, the nurse knows that the ANTERIOR fontanelle closes when?
Usually by 12 months of age. The anterior fontanelle stays open LONGER and closes LATER than the posterior.
Although babies should be put "back to sleep", the nurse knows that it is ok to leave a baby sleeping on their back when?
When a baby is able to roll from front to back AND back to front. Babies learn how to roll front to back. They then can roll back to front afterwards. So if the baby has developed both of these skills, then they should be able to roll back to front easily
The nurse knows that immediately after a vaccination, it is encouraged that moms should...
breastfeed!
When examining an infant, the nurse notices that the infant's knees are apart but his ankles are touching. The nurse recognizes that this infant is...
demonstrating a "bowed" appearance. This usually resolves once the lower back and leg muscles are well developed.
The nurse knows that parents of hospitalized children should never be...
dismissed of their concerns. They know their child the best. If the child does not look "right" something is going on...respond. If vital signs are off, recheck and respond. Know your team (charge nurse, nurse manager, attending, resident, nurse educator, respiratory therapist, response team).
The nurse knows that the stress a sibling of a hospitalized child perceives is...
equal to that of the hospitalized child
The nurse knows that tummy (floor) time is beneficial for the infant because...
it strengthens infant neck muscles, advances gross motor strength & flexibility, and helps w/ meeting milestones like rolling over and eventually crawling. Parents can join their children on the floor while doing tummy time
Babinski reflex
stroking the bottom of the stole and across the bottom of the foot results in the toes fanning out upwards. Present at birth but disappears after 12 mo.
When performing a physical assessment on a newborn, the nurse is correct in performing what assessments first?
the LEAST intrusive/invasive assessments first. After those are done, the most intrusive should be performed.
The nurse knows that the rotavirus vaccine is...
the ONLY vaccine that is administered orally in 3 separate doses (2 mos, 4 mos, and 6 mos).
The nurse knows that normal axillary temperature for an infant is between 97 F to 100.4 F. Further assessment of temp and the pt's overall condition is indicated if...
the infant's axillary temp is < 97 F or > 100.4 F
