Pedi mod 2 exam

Chapter 16: The Infant - Developmental Milestone

• Erikson's theory focuses on trust vs mistrust, helping parents navigate care with medical equipment.
• Freud's theory centers on orality, exploring the world through the mouth.
• Kohlberg's theory notes that infants at the preconventional/premoral stage cannot distinguish right from wrong.
• Sullivan's theory looks at varying levels of emotional response.
• Piaget's sensorimotor stage occurs from birth to 2 years, as infants become curious.

Normal Vitals

• Respiratory rate for infants typically ranges from 25 to 55 breaths per minute.
• Heart rate in infants ranges from 80 to 150 beats per minute.

Oral Stage and Motor Development

• Holding infants during feeding times is important.
• Sucking provides comfort and relieves tension.
• Pacifiers are useful for infants on IV fluids to meet sucking needs.
• The grasp reflex disappears around 3 months of age.
• Prehension develops around 5-6 months in an orderly sequence, using fingers and opposing thumbs to grasp.
• Object permanence establishes when an infant remembers objects exist even when out of sight.
• The parachute reflex occurs around 7-9 months as a protective response, extending arms when lowered.
• Pincer grasp is well-established by 1 year old.

Primitive Reflexes and Emotional Development

• The Moro (startle) reflex disappears at 1-3 months.
• The Rooting reflex disappears at 3-4 months.
• The Extrusion reflex disappears at 5-6 months.
• The Babinski reflex disappears at 12-18 months.
• Consistency is key for developing trust in infants.
• Infants picked up when crying tend to have fewer crying episodes and less aggressive behavior later.
• Guidance and encouragement are key when an infant shows readiness to learn.

Infant Skin Characteristics

• Milia are small white papules typically found along the nose.
• Nevi, or "stork bites," are small red spots typically located on the forehead.
• Mongolian spots are common in darker skin tones and should be charted at birth to prevent misinterpretation as signs of abuse.

Infant Care and Development Milestones

• Sensory play is important for infant development.
• Soothing crying is essential for infant comfort.
• Feed infants when hungry, rather than strictly adhering to a schedule.
• Infants recognize warmth and affection.
• At 1 month, infants have a present head lag and sleep about 20 hours a day.
• Infants at 1 month sleep on their backs.
• Hormones received from the mother can cause swollen labia in infants.
• Tummy time is allowed but must be supervised.
• Small streaks of blood ("baby period") may be present.
• At 2 months, the posterior fontanel closes.
• At 2 months, infants can briefly hold their head erect.
• Recommended immunizations at 2 months: Dtap, IPV, HIB, RV, HepB, and PCV.
• At 2 months, infants show responsive smiling and are learning to cry.
• At 2 months, infants may experience colic, with episodes of crying and irritability.
• By 3 months, infants have good head control.
• At 3 months, infants bring their hands to their mouth for exploration.
• At 3 months, infants can hold rattles and enjoy interaction.
• By 4 months, infants drool and may be teething.
• At 4 months, infants can lift their head and shoulders when on their belly.
• At 4 months, infants reach for objects.
• At 4 months, recommended immunizations are: Dtap, IPV, RV, PCV, and HIB.
• By 5 months, infants can sit up with support.
• At 5 months, infants are interested in their toes.
• By 6 months, infants reach for and try to hold a bottle.
• By 6 months, infants typically take 2-3 naps per day.
• By 6 months, an infant usually doubles their birth weight.
• By 6 months, infants can turn over and pull up to a sitting position.
• By 6 months, infants can drink from a cup and speak in babble.
• Introduce solid foods like rice cereal around 6 months.
• By 6 months, infants grab objects with their whole hand.
• At 6 months, recommended immunizations include: Dtap, HIB, PCV, RV, HepB, and IPV.
• By 7 months, infants begin to crawl and can transfer objects, still using their whole hand.
• By 7 months, infants experience mood swings and teething pains.
• Lower teeth typically erupt first at 7 month.
• Fruits and finger foods (crackers) can be introduced at 7 months.
• At 7 months, infants can grasp with their hand.
• By 8 months, infants can sit alone and begin using the pincer grasp.
• Add vegetables to the diet around 8 months.
• By 8 months, infants typically take 2 naps a day.
• By 9 months, hand performance improves and they imitate sounds they hear.
• Cruising (holding onto surfaces) should be allowed for exploration at 9 months.
• Meats/beans (chopped or mashed) can be added to the diet around 9 months.
• By 10 months, infants can stand with support and recognize their name.
• By 10 months, infants drink juice or water from a cup.
• By 11 months, infants understand simple directions and have lots of gross motor activity.
• By 12 months, infants triple their birth weight, have about 6 teeth, and have a well-developed pincer grasp.

Coping with Irritable and Lethargic Infants

• Immunizations given at 12-15 months: HIB, PCV, MMR, Varicella, HepA, Dtap.
• Shield eyes from bright lights.
• Speak quietly, and eliminate excess noise.
• Swaddle infants snugly and change their position slowly.
• Provide nonnutritive sucking for comfort.

Developing Positive Sleep Patterns

• Newborns typically sleep in 4-hour intervals.
• 4-6 month old infants sleep up to 8 hours.
• Synchronizing an infant's circadian rhythm with the family is learned.
• Position infants on their backs on a firm mattress.
• Parents should soothe infants and help them become self-soothers like swaddling, cuddling, pacifiers, or thumb sucking.

Illness Prevention and Immunizations

• Measure growth parameters to monitor any significant changes and to notify the HCP if the change is 2 or more either way.
• Assess developmental levels to ensure milestones are being me.
• Follow the immunization schedule and draw labs as needed.
• Immunization schedule at birth: Hep B
• Immunization schedule at 2 months: D Tap
• Immunization schedule at 4 months: D Tap
• Immunization schedule at 6 months: D Tap
• Immunization schedule at 12-15 months: MMR, Hep A
• Immunization schedule at 4-6 years: D Tap, MMR
• Immunization schedule at 11-12 years: Tdap, HPV

Nutrition in Infancy

• Breast milk or formula should be the primary source of nutrition during the first year of life.
• Do not add foods into the bottle.
• Whole cow's milk should be avoided until after 1 year of age.
• Low-fat milk should not be given before they are 2 years old.
• Do not prepare bottles in advance, as they are only good for 24 hours.
• Throw away any formula left in bottles after 24 hours; do not reheat.
• Reheating bottles unevenly could cause burns.
• Introduce rice cereal at 5-6 months, after the extrusion reflex has disappeared.
• Solid foods should be given before formula.
• Diluted juices can be given at 5-6 months in a "sippy cup."

Play, Safety, and Rapid Growth

• Infants explore and imitate.
• Provide visual and touch stimuli.
• Provide manipulation toys for 1-year-olds such as push and pull toys.
• Always use car seats.
• Monitor closely for falls.
• Watch out for choking hazards.
• Ensure proper crib placement to prevent suffocation.
• Keep medications locked away to prevent poisoning.
• Protect against burns with sunscreen and outlet covers.
• Infants double their weight by 6 months and triple it by 12 months.
• The anterior fontanelle closes by 18 months and the posterior fontanelle closes by 2 months.

Fetal Circulation and Congenital Heart Defects

• Fetal circulation develops during the 3rd and 8th week of gestation.
• The foramen ovale diverts blood from the right to the left atrium, bypassing the lungs.
• The ductus arteriosus diverts blood from the pulmonary artery into the aorta.
• The ductus venosus diverts blood away from the liver.
• S/S of cardiac pathology: FTT, poor weight gain, cyanosis/ pallor, neck pulsations
• Other symptoms of congenital heart defects: tachypnea/dyspnea, irregular pulse, finger clubbing, fatigue during feeding, excessive forehead perspiration.
• Congenital heart disease causes prenatal rubella (1st trimester), maternal alcohol/drugs, radiation, diabetes, or advanced age.
• Atrial Septal Defect (ASD) increases pulmonary blood flow; mild murmur, may go undetected
• ASD treatment: surgery to close, cardiology follow ups for a year (excellent Pro)
• Ventricular Septal Defect (VSD) increases pulmonary blood flow
• Signs of VSD: loud murmur, FTT, poor feeding, fatigue
• Most common heart anomaly, treat mild w/ observation monitor/severe, surgery
• Mild VSD: observe, monitor, antibiotics with dental care
• Severe VSD: surgery to patch hole

Patent Ductus Arteriosus (PDA) and Coarctation of Aorta

• PDA: increased pulmonary blood flow; dyspnea, full/bounding pulse, murmur
• PDA occurs twice as often in girls; oxygenated blood recycles to lungs, congestion
• Treat PDA with Indocin (preemies) ligation surgery (full term)
• Coarctation of Aorta: obstruction, differences in BP, pulse, systolic murmur, descends
• Prognosis is good with surgery, without it, it can lead to HTN or CHF.

Tetralogy of Fallot and Hypoplastic Left Heart

• Four defects: pulmonary artery stenosis, right ventricle hypertrophy, overriding aorta, ventricular septal defect (VSD).
• Tetralogy of Fallot Signs: cyanosis, clubbing, feeding problems, growth retardation, polycythemia, tet spells, respiratory infections, boot-shaped-heart, squatting position, bluish skin during crying.
• Tetralogy of Fallot Treatment: surgery to correct the defects, prophylactic antibiotics.
• Hypoplastic Left Heart Signs: gray/blue skin, dyspnea, weak pulses, murmur.
• Hypoplastic Left Heart Treatment: ventilator, prostaglandin E1, heart transplant needed in 1 month.

Fatal Heart Conditions and Parenting Concerns

• Prognosis for hypoplastic left heart is fatal if untreated. *Survival chances are small if the baby doesn't have PDA and patent foramen ovale.
• Left side of the heart is underdeveloped, LA and PA blood flow mix
• Help children adjust to normalcy, without overindulgence
• Hold immunizations if they are getting a heard transplant
• Importance about dental care.

Acquired Heart Disease, CHF, and Rheumatic Fever

• Acquired heart disease after birth includes CHF, rheumatic fever, systemic hypertension, Kawasaki's disease.
• HF means the decrease in cardiac output necessary to meet body's metabolic needs
• CHF is caused by respiratory infections, sepsis, HTN, and severe anemia.
• Signs of CHF:: cyanosis, pallor, tachypnea, tachycardia, feeding difficulties, FTT, edema, respiratory infections, nasal flaring
• CHF treatment: oxygen, Lanoxin, diuretics, small frequent feedings
• Nursing Intervention for CHF: cluster care, strict I/Os, recognize s/s for toxicity, teaching, dehydration and education of family members -HOLD dig if pulse rate is below 100bpm and notify HCP
• Rheumatoid fever: a reaction to group A hemolytic infection of throat. Causes a collagen disease- affecting joints, heart, CNS, skin, subcutaneous tissues. A risk factor is if the infant in surrounded by to many people while growing up.

Rheumatic Fever and Systemic Hypertension

• Rheumatic Fever Signs: migratory polyarthritis, skin eruptions, heart valve damage, abdominal pain, fever, pallor, fatigue
• Rheumatic Fever Dx: Jones criteria (x major or 2 minor), x-ray, throat culture, ESR elevation, CRP elecation, elevated temp
• Rheumatic Fever Treatment: penicillin or erythromycin (10 days monitored), aspirin, treat diagnosis
• *Systemic Hypertension Signs: headaches, vision problems, dizziness
• Treatment: Dietary mod, nutrition, weight loss, aerobic exercise
• Lipidemia-
• LDL=lazy and bad, HDL: healthy and better encourage fresh fruit, and low dairy consumption

Kawasaki Disease and Skin Disorders

• Kawasaki Disease: high fever w/out response to drugs, strawberry tongue, enlarged nodes, rash, swollen hands, peeling palms, feet
• Kawasaki Treatment: IV gamma globulin, aspirin, coumadin
• Nursing care- support and education.
• *Skin Development Functions: protection, prevents passage of harmful substances, loss of electrolytes, can repair itself
• Skin integrity-
• Infants have thinner epidermal layers, absorption, drier, chap easier, thinner subcutaneous tissue, cannot sweat until age 3. Problems thermoregulating.
• Skin Disfunction:
• Can be a sign of underlying medical or congenital issues and hair can indicated nutritonal status

Miliaria, Intertrigo, Seborrheic dermatitis, Diaper Dermatitis, and Acne Vulgaris

• Miliaria: "prickly heat” or rash caused by excess body heat and moisture. -S/S: tiny pinhead-sized red papules, possible itchiness, diaper area rash or in skin folds
• Intervention for Miliaria: remove frequent diaper changes, remove excess clothing, give baths, change diapers
• Intertrigo: A “chafing dermatitis where skin rubs together
• S/S- red, and moist folds. Can be aggravated by urine, feces or moisture and is More common with obese infants
• Intervention: PREVENT this issues, Keep affected area clean and dry
• Seborrheic Dermatitis:,“cradle cap- inflammation of skin w/ sebaceous gland
• S/S- Thick yellow, scabs oily scales on scalp-No itch!
• Interventions: shampoo daily baby oil at night use a soft brush

Diaper Dermatitis and Acne Vulgaris

• Diaper Dermatitis: Beefy red rash on irritated skin from candidia
• Intervention : dry, wash dry with mild soap and put on O2 spray
• Acne Vulgaris sebum plugs causes irritation and or head and cysts
• Interventions: wash, balanced diet,. and clean products for skin
• Educate to take meds as prescribed and for to avoid pregnancy

Contagious Skin Irritations

• Herpes Simplex Type 1: cold sore or fever blister, most communicable during early phase, recurrence is common
• Activated by stress, sun, menstrual cycle, fever s/s,tingling,itching ,burning on mouth
• Intervention for Herpes Simplex: Antivirals DON'T touch
• Skin Integrity
• Infantile Eczema- supersensitive skin. and is related to family hx of allergies, oversensitivity make workse
• Intervention.- sMedications (antihistamines, topical steroids- NOT WITH VIRAL INFECTIONS ), NO HOT SHOWERS AVOID IRRITANTS
• Staph infection- a primary infection umbilical- S/S- pustules, treat immediately with ABT call
• Impetigo caused by staph or group A beta hemolytic strep; VERY CONTAGIOUS
• S/S: bullous form seen in infants, non-bullousseen in children and young adults
• New born re LOW with resistance so inter oral ABT

Fungal infections and skin lesions and burns

• Fungal Infections: stratum corneum, hair and nails invaded; larger than bacteria; tinea
• Treatment: clotrimazole (pedis and cruris too)
• Burns, due to fire, electrocution, radiation
• thermal, chemical Electrical, or radiation
• Treatment: Cool and or antimicrobials.
• Superficial:1st-red
• partial 2nd- blister
• deep partial: 2nd- white
• full 3-d non blanchable
• full thickness nerve ending destroy- muscle, need skin graft

Burn Treatment

• Cover with sterile dressing or blanket, apply antibiotics
• STOP burning process and ABCS

Child Behavior and Neurological Disorders

• Common manifestations: Nail-biting, finger-sucking, stuttering.
• organic disorder dyxelsia: trouble math, reading ect. Autism spectrum disorder: Manifestations: no babbling or pointing my Autistic treatment: structured lifestyle and behaviors. nurse need The nurse role: identify abnormality, referral, time schedule,. identify abnormality, referral,medsearly identify abnormality, referral,.

OCD and ADHA Behavior

• OCD Behavior: ritualistic behaviors,. social withdrawal, conflicts at school, Treat with floxetine and therapy
• ADHD Behavior: attention troubles, impulsivity, Treat with: focus techniques medsrilitilin ect:)

Eating Disorder

• Anorexia nervosa: starvation , low bp and constriction, Treat with underlying psychotherapy (mal nutritions) with Treat ssriss
• Bulmia Cycle
• nurse can educated identified present and support referral can caused suicide and substance abuse

More on Suicide and Substance Abuse

• Factors leading to substance abuse include: family history, other abuse, substance
• Children of Alcoholics: Increased risk of sexual, physical,. emotional nurses can play a role in supporting identifying and intervention
• Suicide is a 3rd leading cause if death
• Nurse need recgonise and treat
• Manifestation include: flat affect, droopping grades, and talking ibout suicide