Pediatrics (Test 1)

Use to study for test friday

What age does WIC provide up to?

Age 5

What is the major contributer to infant death?

Low birth weight

Normal heart rate for an infant

120-160 BPM

Normal resp rate for an infant

30-60 breaths per min

Normal blood pressure for infant

74-100/50-70

Weight _at 6 mo and _ at one year

Doubles at 6 months

Triples at a year

Height at 6 months and one year for an infant (expected)

Increase about 6 inches in first 6 months

Increases about 50% by one year

Posterior fontanelle expected closing time

Closes by 6-8 weeks

Anterior fontanelle expected closing time

Closes by 12-18 months

Palmar grasp

Palmar = closing hand around someone’s finger for example goes away around 3-5 months

Pincer grasp

Using index finger and thumb to grasp

Well established after 1 year

At what age should a child be able to control head and neck/lift head

5-8 months

At what age can an infant sit with no assasit

8-12 months

At what age can an infant transfer an object from one hand the another

7 months

At what age can an infant crawl

5-8 months

What age does the infant smile and coo

Approx 2 months

What stage of ericksons is the infant in?

trust vs mistrust

* developing a sense of trust in caregivers, themselves and the environment

What vaccines are recommended in the first 6 months?

* Hep B doses 1 and 2 and 3
* DTaP (__Diphtheria__, __tetanus__, and __whooping cough__ (pertussis) doses 1 and 2 and 3
* Hib (*Haemophilus influenzae* type b disease)
* Polio (IPV) doses 1 and 2 and 3
* PCV (Pneumococcal disease) doses 1 and 2 and 3
* Rotavirus (RV) doses 1 and 2 and 3
* Flu virus after 6 mon

what vaccine is sometimes given right after birth

Hepatitis B (1st dose)

At what age can an infant begin to drink cows milk

1 year

At what age can an infant have solids?

4-6 months

* after extrusion reflex (pushing solids out of mouth) is mostly gone

How do you administer ear gtts to an infant?

Pull the ear down and back

Admin of liquid meds to an infant

* syringe along the side of tongue and back of mouth
* suck med out of empty nipple

Administering ear gtts to a child above 3

Pull ear up and back

What is the max volume to be given IM on an infant

1 mL MAX

Meningitis

* inflammation of the meninges (membranes on brain and spinal cord)
* organisms invade meninges via teeth, sinuses, tonsils, lungs, ear infections, skull fractures

S/S of meningitis

* crying
* nuchal rigidity (neck stiffness)
* poor feeding
* vomiting
* bulging fontanelles
* opisotolonos (arching of body)
* petechiae

Brudzinski’s sign

* assessment for meningitis
* positive if pt cannot touch head to chest without extreme pain

Kerrin’s sign

* assessment for meningitis
* cannot move leg past 90 degree flexion without extreme pain

How is meningitis diagnosed/tx

Spinal tap

* treated with antibiotics if bacterial, steroids and pain meds
* ISOLATION

Nursing management for a patient with meningitis

* NPO
* isolation until 24 hrs of antibiotics
* Low stimulation
* Position changes
* temp control of pt
* Watch for s/s of increased ICP
* no bright lights

spinal tap findings in someone with meningitis

* pus
* protein
* high wbc

Complications of meningitis

* SIADH in 60 %


* deafness

What should you teach a parent regarding prevention of meningitis

vaccines!

* meningitis vaccine
* pneumonia vaccine
* haemophilus influenzae (hib) vaccine

ALL help prevent

Bronchililits

* caused by RSV
* oxygen get trapped in lungs
* can exhale but hard to inhale

S/S of bronchilitis/RSV

* cough
* shallow respirations
* cyanosis

Nursing management for bronchilitis/RSV

* isolation
* oxygen
* elevate HOB
* push fluids
* VS
* clear secretions regularly

Cystic fibrosis

* affects lungs, pancreas, liver
* thick mucus obstructs all above
* 1st symptom is usually meconium ileus

Meconium ileus

* absence of infants “first poop”
* normally occurs before 24 hours after birth
* Common in kids with CF

S/S of cystic fibrosis

* meconium ileus
* high levels of salt in tears, sweat
* malnutrition but always hungry
* atelectasis
* emphysema

Pyloric stenosis

* pylorus (bottom of stomach) narrows
* food cannot get to intestines/out of stomach

S/S of pyloric stenosis

* PROJECTILE vomiting
* weight loss with no sign of other illness
* dehydration
* olive shaped mass in RUQ

Hirschsprung

* partial/complete intestinal obstruction due to absence of nerve cells that create peristalsis

S/S of hirschsprung

* persistent constipation
* absence of first meconium poop

Intussusception

* slipping of a portion of bowel
* surgical emergency

S/S of intussusception

* sudden onset severe abd pain
* vomiting
* jelly stools with blood and mucus

Infancy is considered

29 days to 1 year

Nutrition for infants

Breast milk q2-3 hours

formula q4

(about 1-2 months)

* 400 IU of vitamin D/day important

When do teeth come in?

Anywhere from 5-17 months

How do you measure head circumference

* mesure just above eyebrows, just below the crown on the back of the head

When does a fear of strangers develop

5-8 months

Babies under 1 month breathe how

Only through their noses

Checkups should occur at what ages

2 wks, 2 months, 4 months, 6 months, 9 months, 12 months

Do you need to wait to give an infant a vaccine if she has a cold

No, do not need to wait even if there is a low grade fever

Contraindications to vaccines

* very ill
* chronic diseases
* chemo
* long term steroids

How to feed baby with a g button

Provide a pacifier and attention + warmth when feeding through g tube to act as similar to breastfeeding

What is the rooting reflex

Helps baby find the nipple

By what age has the child mastered spoon feeding

2 years

Normal weight gain in first 6 months and # of wet diapers per day

4-7 oz per week

* 6 wet diapers per day

What food is often introduced first and why

rice cereal

* smaller chance of allergens

How should new foods be introduced?

New food one at a time, with 4-7 days before trying something else

* do not introduce new foods while the baby is ill

When can juice be offered?

9 months

* dilute at first, then gradually increase to 3-4 ounces per day

How many teeth does the 1 year old have

Approx. 6

Colic usually disappears by what age

3 months

Toddler pulse rate

90-140

School age child pulse rate

75-100

Preschool pulse rate

80-110

Toddler respirations

24-40

What is the last vital sign to take on a child

Temperature

What is ELMA cream and how long must it be on for?

Numbing cream used for injections and other procedures on children

* 60 minutes wait until cream is working

Head circumference is measured on __

All children under 36 months

* and children with neurological defects