chapter 15 Peds

"bring them back when they are 4m old for their second dose"

the nurse has just finished administering the DTaP vaccine to a 2-month-old and is educating the parent about immunization. what should the nurse say?

"the cereal should be a fairly thin consistency at first"

the nurse is providing anticipatory guidance to a mother of a 5-month-old boy about introducing solid foods, what should the nurse recommend?

8months

the parent of a 3-month-old infant is concerned because the infant does not yet sit by oneself. when do infants normally sit up by themselves?

"It is hard to know for sure, but research shows that it is possible for newborns to experience pain."

the parents of a newborn are deciding if they want their newborn circumcised. the parents ask the nurse if their newborn can feel any pain during the procedure. How should the nurse respond?

at 40th percentile as well

the nurse is measuring an infant's head circumference and charts it to be at the 40th percentile, what will the length be like?

"what does the stool look like?"

The father of a 6-week-old infant voices concerns about his son's stooling. He further shares that his son grunts and cries when having a bowel movement. What response by the nurse is most appropriate?

assess the infants hearing and ears

The nurse is assessing a 7-month-old infant at a well-child visit and the parent mentions that they are surprised their infant is not talking as much as their other children at this age. Which action should the nurse prioritize at this time?

Moro

The nurse is examining an infant who is 4 days old. The nurse puts the infant on the back, supporting the weight of the infant by the arms, without using a lifting motion. The nurse then releases the arms suddenly. The nurse is assessing which newborn reflex?

Measuring from above the eyebrows through the prominent part of the occiput.

The nurse is observing a novice nurse measure the head circumference of a 9-month-old infant. The nurse determines that the novice nurse is performing the skill correctly based on which action?

Assess family to determine if nurturing is consistent, and if parental attachment has occurred.

The nurse is planning interventions for an infant. The infant has been hospitalized for several weeks due to a chronic illness. Which intervention will assist the infant in developing a sense of trust?

infant laying prone with a colorful toy in front

The nurse is watching a group of infants playing in an infant room at day care. When analyzing the developmental characteristics exhibited, which infant would the nurse identify as being approximately 3 months of age?

Placing all liquids given the child in a "no spill" sippy cup.

What feeding practice used by the parents of an 8-month-old should the nurse discourage?

sleep patterns

When children are not able to communicate pain verbally, the nurse can use a behavioral assessment. The nurse knows that this assessment will least likely include:

babinski

When performing neurological reflexes on the infant, which primitive reflex will be present longest?

the 24-month-old born at 28 weeks' gestation

the nurse is conducting home visits for several families with children born prematurely. when screening for growth and development of the children, the nurse would use the infant's corrected age for which child?

1. position the infant upright 2. offer the infant a bottle of formula 3. remove the bottle and squirt the medication on the side of the tongue toward the cheek 4. offer the infant the bottle again.

the nurse is preparing to give a 4-month-old an oral medication. how would the nurse give it?

place tape around the head just above the eyebrows

what is important to know when measuring the head circumference in an infant?

no, they weigh less than expected

a 12-month-old seen at a walk-in clinic weighed 8 pounds 4 ounces at birth. their weight now is 20 pounds 8 ounces (9300 g), is this normal?

- conducted at: newborn, 1m, 2m, 4m, 6m, 9m and a year -involve parents and caregivers. -assess on caregivers lap -auscultate first -perform the most invasive procedures last. -assess for hip dysplasia until 3m

what is important to know for health assessment of newborns?

infant is focused on oral sensations for pleasure

what is oral motor in infants?

-"cradle cap." -scales and erythema, usually only in scalp. -not painful or itchy. -resolves by 12m -remove scales with soft brush. -hydrocortisone cream if extends beyond scalp

what is seborrhea?

infants learn about the world around them through sensations

what is sensorimotor in infants?

-20/400 vision at birth -7m: color vision -hearing: likes high-pitched voices -taste: prefer sweet over sour -touch: soft, gentle touch

what is sensory development like in infants?

-face, legs, activity, cry, consolability -each domain scored 0 to 2 -scores 0 to 10; higher score indicates more pain

what is the FLACC scale?

6-8 wet diapers/day

what is the correct amount of wet diapers a mature infant should produce each day?

cephalo: attainment of skills head to toe proxi: attainment of skills from trunk to extremities

what is the difference between cephalocaudal pattern vs proxiodistal pattern?

newborn through 12m of age

what is the infant stage of growth & development?

drowning

what is the leading cause of death in the pediatric population?

-facial expression, cry, breathing pattern, arms, legs, and state of arousal are scored. -scale of 0 to 1 for all except cry, which is scored 0 to 2. - higher score indicates more pain.

what is the neonatal infant pain scale (NIPS)?

-0.5 to 1 inch (1.5-2.5cm) per month for 6m -0.5 inch (1cm) per month until 1y

what is the normal length increase in newborns?

infants learn to rely on caregivers, so their basic needs are met

what is trust vs mistrust in infants?

-lose 10% body weight the first week of life, but regained by end of the 2nd week. -gain 20 to 30 g per day for the first 3 months. -doubles by 4 to 6 months and triples by 12 months.

what is weight growth like in infants?

sitting without support

what milestone should the nurse expect from a 8m old?

they have less constipation then bottle fed infants

when an infant is breastfed, what does the stool look like?

- 6 months of age -when there is disappearance of tongue extrusion reflex and ability to sit in high chair with good head control -start with iron-fortified cereal, then add other pureed foods slowly to prevent allergies

when should you start solid foods?

- weight doubles by 5 to 6 months of age - triples by 1 year of age -5 to 7 oz gain per week for first 6 months, 3-5oz per week until 1y

what is normal weight gain in newborns?

by 6m

when does an infants first teeth erupt?

3m

when does the posterior fontanel close?

pack her favorite toy

a 8m old is being hospitalized for a surgery, what is important to tell the parents beforehand?

"warm the milk under warm water instead"

a mother asks the nurse where the microwave is so that she can warm up breast milk to feed her baby. what is the best response by the nurse?

the infant can hold their head erect and steady

a nurse is assessing a 3-month-old infant. which developmental milestone would the nurse expect?

monitoring their height and weight

a nurse is assessing a 6m old infant at a clinic, what is the priority for this patient?

" I will switch to whole milk when my infant is around 6 months of age."

a nurse is providing health promotion education to a family of an infant at the family birth center. the nurse knows the parents need more education when they state which response?

noisy or light up, soft dolls, teething toys, board books, and large block toys

a nurse is working with occupational therapy to plan what developmentally-appropriate toys should be given to her 10-month-old patient. Which of the following toys would be most appropriate?

8oz every 6h

a parent asks the nurse if her 9-month-old son is drinking the recommended amount of breast milk or formula every day. what should the nurse say?

-diptheria, tetanus, acellular pertussis (DTaP) -haemophilus influenzae type b (Hib) -pneumococcal conjugate vaccine (PCV13) -inactivated polio virus (IPV): -rotavirus (RV)

what are 4month old infant immunizations?

-sucking, rooting -babinski, moro (startle), stepping, palmar grasp, plantar grasp, tonic neck (fencer). - disappear over the first year of life. -babinski lasts until 24 months.

what are examples of primitive reflexes?

-develop after the disappearance of primitive reflexes -not present until after 12m -in toddlers and older children.

what are protective reflexes?

-rear-facing car seat with a five-point harness until 2y -never leave alone on a high surface -look for small objects on the floor that infants can choke on -keep plastic bags & hot liquids away from infants

what are some safety recommendations for infants?

"My infant should be able to sit on their own by 3 months." "At 6 months, my baby should be able to feed themselves." "I will be able to play games like peek a boo when they are 4m old"

A nurse in a pediatrician's office is educating a parent of a 2-month-old infant about developmental milestones. The parent requires further education when the parent states..?

"how old is your baby?"

A mother calls a clinic nurse to ask if her infant born prematurely should receive the seasonal influenza vaccine. The nurse's next question should be:

24 pounds (10.8 kg) and 30 inches (75 cm)

After noting the birth weight was 8 pounds (3.6 kg) and length was 20 inches (50.8 cm) long, which measurements reflecting height/weight would the nurse expect to document for a year old?

-posterior fontanelles: smaller, closes between 2-3m -anterior fontanelles: larger, closes between 12-18m -strabismus is common until 6m -pinna of the ear: pull it back and down. -appears barrel chested, and diaphargmic breathing -irregular respirations with occasional pauses. -acrocyanosis may be present -HR: often irregular, presence of S3 -asymptomatic murmurs: present and normal -incomplete bone ossification -benign metatarsus adducts is normal -passive immunity until 6m -high levels of fe

what are some physical variants in the newborn?

-fever up to 102°F, redness or swelling at the injection site, increased fussiness and sleepiness for 24 hours after immunizations -when to call: >105°F, seizures, uncontrolled crying for >3h

what are some side effects of immunizations and when do you call the provider?

-risks: tobacco, food/ housing insecurity, substance abuse -protective: support, good family relationships, adequate care

what are some social determinants of infant health?

-meconium: thick and green - breastfed: thinner, seedy and yellow -formula: pastier, darker in color -constipation: focus on consistency and not quantity, grunting is not a sign

what does stool look like in infants?

-diptheria: is a serious infection of the throat that can block the airway. -tetanus is a nerve disease. -pertussis: respiratory infection with serious complications.

what does the DTAP immunizations prevent?

-haemophilus influenzae type b -bacteria that causes meningitis (mostly in children under the age of 5).

what does the HIB vaccine prevent?

- polio virus - can cause paralysis and death

what does the IPV vaccination protect against?

-pneumococcal conjugate vaccine -protects against 13 types of pneumococcal bacteria.

what does the PCV13 vaccine protect against?

-rotavirus -causes severe diarrhea and can lead to dehydration

what does the RV vaccine protect against?

-cyanosis or pallor -irregular, slowed, or absent breathing -hypertonia or hypotonia -altered level of responsiveness -last less than 60 seconds. -higher risk: <2 months of age, prematurity

what is BRUE?

-self-limiting condition of increased fussiness and inconsolable crying. -peaks at 6w and resolves by 3-6m -often worse in the evening -no treatment -lay the infant in the crib when frustrated

what is colic in newborns?

-communicate through crying. -different pitches of cries based on needs. -2m: cooing -6m: babbles -9m: copies sounds -12m: simple gestures and follow simple directions, few words

what is communication like in infants?

-skin breakdown in the diaper region -skin is erythematous and excoriated. -skin folds not affected. -painful for infants. -treatment: leaving diapers off and allowing skin to dry -barriers can be used. -odor, fever, or purulent drainage is present=notify provider

what is diaper dermatitis?

-temp over 100.4°F (38°C). -indicates illness and sign of infection. -only administer antipyretic if symptomatic and irritable. -tachypnea, irritability, and tachycardia common. -do not place in cool bath -monitor for poor perfusion, hyperventilation, or hypoventilation.

what is fever like in infants?

-increases rapidly the first 6 months, then slows until 12 months

what is head circumference growth like in infants?

-fever helps the body mount an antibody response against viral and bacterial pathogens -giving an antipyretic reduces the antigen response -only give antipyretics if high fever or extreme fussiness.

what is important to know about anti-pyretic use in infants?

-first tooth at 4 to 7 months -teething: fussy and irritable, increased salivation, low grade fever, insomnia -may use frozen teething rings and topical analgesics -wash gums with soft washcloth or infant toothbrush until tooth eruption. -avoid refined sugars and propping bottles.

what is important to know about infant oral health?

-room sharing in own bed until 6 months of age is recommended -sudden infant death syndrome (SIDS) prevention techniques. -sleep on back. - sleep about 16 hours per day.

what is important to know about infants and their sleep?

gains gross before fine motor skills

what is important to know about motor skills for the newborn?

-engage in solitary play -playtime: reading, singing, and playing with age-appropriate toys. -younger infants: kicked or batted, unbreakable mirrors, and contrasting patterned toys -older infants: noisy or light up, soft dolls, teething toys, board books, and large block toys

what is important to know about playtime in infants?