Peds test 3
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What are the 9 factors that influence growth and developing
- Health status
- Parent attitudes
- child rearing philosophies
When does an infant double his birth weight? triple it? How much weight should an infant gain per week?
double by 6 months; triple by 1 year; 5-7 ounces per week
The infant should increase his birth length by 50% by when? The height should increase by how much per month for the first 6 months?
- by 1 year; for the first 6 months it should increase by 1 inch/month;
- (growth occurs in spurts)
For the first 6 months, how much should the head circumference grow? When do the anterior fontanels close? Posterior?
>0.5in/mo for first 6 months; AF: 12-18mo; PF: 2 months
When do signs of teething appear? What comfort measures can be done for teething infants?
5 months; cold teething rings, Tylenol (ibuprofen) if > 6 months; clean teeth with washcloth; no bottles in bed
When is the earliest eruption of the 2 lower center incisors? When is the average age? What about for chewing and biting?
6 months; 8 months for both average age and chewing
By 12 months the infant should have what physical developmentally-wise? Neorologically?
head and chest circumference are equal. 6-8 teeth; babinski reflex disappears ( normal up to 2 years); Brain growth is rapid 2.5 times in weight;
by 4 months neurologically
primitve reflexes dissapear (moro, tonic neck, and rooting)
In infants in the first year: respiratory? Cardiovascular? Immune? GI? Liver? Renal?
- lung size increases; vulnerable to respiratory difficulties; Eustachian tubes are short and horizontal
- cardio: shunts close; heart doubles in size and weight by one year; rate slows and BP rises
- immune: Passive for 3-4 months; production of immuniglobulins; has approx 40% of adult levels by one year
- max protection not available until early childhood
- GI: Stomach capacity increases to 200ml by 12 months; enzymes for digestion ; fat digestion 4-5 months; complex carbs 4-6 months
- Liver: most immature of organs; decreased capacity for glucogenesis formation of plasma proteins and ketones and storage of vitamins
- Renal: low GFR risk for fluid & electrolyte imbalance
In the first year how many wet diapers should there be a day?
In infancy how does the motor development differ?
- increased control of reflexes
- more purposeful movements
- cephalocaudal development
- accelerations are rapid
- begins to explore
- risk of accidents and injury
What are milestones?
- Essential aspects of development
- They lay the foundation for the achievement for more advanced skills
What is the cognitive development that occurs from 1 to 12 months?
- Progresses from reflex activity to imitate simple repetitive acts
- progresses ability to differentiate self from others
- Piaget: Sensorimotor stage birth to 24 months, separates himself from the environment, mental recognition of symbols
How can nurses promote cognitive development?
By teaching parents to interact with infant and provide with stimulation
What is the sensory development that occurs from 1 to 12 months?
- Vision: Eye growth is rapid. Acuity improves. Preference for high contrast colors. Uncoordinated eye movements after 4 to 6 months needs evaluations.
- Hearing: Relatively acute even at birth, with myelinization. Responses become more specialized.
What is the language development that occurs from 1 to 12 months?
Can understand more than they can express. Siblings enhance development. Encourage talking and not just pointing.
What is the social development that occurs form 1 to 12 months?
- Erikson: Trust that needs will be met vs mistrust.
- Froid: Oral, mouths provides sense of pleasure.
- Parent infant attachment: Begins in utero
- Separation anxiety: Occurs between 4 to 8 months increases at 7 months, by 12 months can anticipate parent leaving and will protest.
- Play activity: Solitary play, involve sensory motor skills (Ex: toys)
How does a difficult child best responds?
He responds best to structure routine.
How does a highly dis tractable child best responds?
responds to soothing measures.
How does a high activity child best responds?
by providing opportunities for increased gross motor activities.
How does the slow to warm up child best responds?
Needs additional time to adjust to new situations.
What is the issue with the easy child?
It is sometimes easy to forget their needs.
What is the nurses responsibility in promoting the health of the infant and family?
- Address parents concerns
- Provide anticipatory guidance for growth and development
- Instruct in safety needs
- Assess patterns of eating and sleeping.
What is the nurses responsibility in promoting the health of the infant and family in regards of sleeping, crying and rest?
- Encourage bed time rituals
- Place awake infant in own crib
- The infant who learns to follow sleep on own has longer periods of sleep than those with the parents present.
Feeding and nutrition, What provides complete nutrition during the first six months of life?
If not breast milk fed, what kind of formula should be used?
Iron fortified formula
When can you begin to star weaning to a cup?
At six months
When can you start solid food, what should you start with, and what are the implications?
- 4 to six months
- Start with iron fortified rice cereal, then fruits and vegetables
- Implications: Introduce foods on at the time over a period of 5 to 7 days
What foods should not be given to a baby until after 12 months?
cows milk, eggs, wheat, peanuts, peanu butter, citrus and Honey
What are the top 3 causes of death in the infant? What are other common causes of injury?
- Automobile accidents
How can we avoid injury in infants?
- constant supervision
What are the association that provide the recommendations for immunizations?
- Advisory Committee on Immunization Practices (ACIP)
- Center for disease Control and prevention (CDC)
- Committee on Infections Diseases of the American Academy of Pediatrics (AAP)
What is the purpose of the vaccine adverse event reporting system? VAERS
To report any adverse reactions after administration of any vaccine
What are vaccine information statements? VIS
They are information statements that must be given to parents before administration of vaccines and to provide updated information for the parent or guardian of the child being vaccinated
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