NUR 1390 Blueprint for Exam 2 PDF

NUR 1390 Blueprint for Exam 2 Naegele’s Rule: determine estimated date of delivery for women. Estimated date of delivery (EDD)— First day of last menstrual period + 7 days – 3 months Effect of hormone production in pregnancy Secreted by placenta. Placenta develops through integr...

NUR 1390 Blueprint for Exam 2 Naegele’s Rule: determine estimated date of delivery for women. Estimated date of delivery (EDD)— First day of last menstrual period + 7 days – 3 months Effect of hormone production in pregnancy Secreted by placenta. Placenta develops through integration of embryonic and decidual cells. Formation of chorionic membranes and amniotic membranes—amniotic fluid protects fetus. Allows maternal-fetal blood exchange to nourish fetus—chorionic villi. o Selective exchange of nutrients without mixing maternal-fetal blood o Some drugs may cross placenta. Decreased placental function stimulates labor. Postdates (> 42 weeks) is major concern. Placental Function: Metabolic: maintains uterus in quiet state Immunologic: membranes prevent fetal infection Transport: nutrition and waste elimination § Endocrine: secretes 4 hormones during pregnancy (estrogen, progesterone, hCG, hPL) § Estrogen: Increase uterine blood flow and increase uterine and breast growth. § Progesterone: Stimulates the formation of endometrial cells known as the decidua to shed, which supplies nutrition for embryo for up to 8 weeks. § Human Chorionic Gonadotropin (hCG): Sustain estrogen and progesterone production in early pregnancy, and it is also the hormone detected in pregnancy tests. § Human Placental Lactogen (hPL): Ensures adequate fetal nutrition, increases insulin reduction, and stimulates production of growth hormones. What medications are contraindicated during pregnancy? Antibiotics Short term: most not harmful Tetracyclines (pregnancy category D): cause teeth discoloration in fetus & inhibit bone growth causing deformities. Anticonvulsants Hydantoin (Dilantin)—fetal hydantoin syndrome; microcephaly, (small skull/brain) retardation, cleft lip/palate, congenital heart disease Barbiturates (phenobarbital)—newborn addiction Substance abuse—major health threat Alcohol, opioids, cocaine, meth, others Aspirin (acetylsalicylic acid) and acetaminophen Safe in recommended dosages ASA—maternal/newborn bleeding if close to delivery Acetaminophen—liver toxicity Ibuprofen—prolonged labor (anti-prostaglandin) Stages of labor Dilation stage (1st stage) Onset labor to complete cervix dilation Three stages: latent, active, transition Presenting part of fetus beings to press on cervix. Station: descent of fetus into birth canal -5 to +5 −5 (floating) → 0 (ischial spine) → +5 (crowning) Pushing stage (2nd stage) From complete dilation of cervix to birth Fetus descends through lower birth canal toward perineum. Placental stage (3rd stage) Birth to delivery of placenta (2-15 minutes) (2-30 min) After birth of the newborn until placental expulsion *highest risk for post-partum hemorrhage Recovery stage (4th stage) First 2-4 hours after childbirth; physiological and psychological adjustments First two hours after childbirth – greatest risk of postpartum hemorrhage Blood loss > 1000 ml with s/s hypovolemia Tachycardia common to compensate for blood loss. Meconium: fetal stool (can be sign of distress) Fetal bradycardia: HR < 100 bpm for full term Things that encourage bonding between mother and infant Freudian psychoanalytic theory emphasizes that the bond between the child and mother develops as a result of the mother’s fulfillment of the infant’s innate desire to socialize and the physical requirements for survival. Social learning theory contributes the principles of reinforcement to the attachment process; as the mother meets the infants needs, discomfort is reduced or removed. Reviewing 11 functional health patterns and matching example to health pattern § Health Perception-Health Management pattern: § View of pregnancy: illness vs natural or combo § View of pregnancy affects healthy lifestyle choices. § View affects decisions concerning prenatal care. § 50% American pregnancies are unintended. § Risk for fetal exposure to ETOH (Alcohol), tobacco, sexually transmitted infections (STIs) or child abuse § Vulnerable populations and minorities at risk § Healthy People 2030 addresses reducing unintended pregnancies. Nutritional-Metabolic pattern: Good nutrition essential for proper growth & development Affected by pre-pregnancy nutrition, finances, culture. Best nutritional teaching: before pregnancy  Anemia of pregnancy affects half pregnancies globally. Assess for pica of pregnancy. Teratogen: agent -> structural or functional injury to fetus Recommendation Weight gain 25-35 lb. (300 calories or more/day) Well-balanced diet (six food groups—MyPlate) 8-10 glasses water; 70 g protein Increase vits/minerals (Fe 30 g, folic acid 400 mcg) Fats/carbohydrates for energy needs Elimination pattern: Fetus: elimination through placenta Carbon dioxide Water; urea Pregnant woman Common discomforts of pregnancy owing to enlarging uterus and hormonal influences Urinary frequency, constipation, hemorrhoids UTIs associated with preterm labor. Anticipatory guidance: prevent complications and cope with changes. Activity-Exercise pattern: Fetus Early pregnancy: spontaneous movements reflexive Quickening: at 16 weeks; “kick counts” after quickening to monitor fetal activity (report decreased activity) Pregnant woman Need physical activity, at least 30 minutes/day of aerobic (walking/swimming) exercise. Exercise improves uterine tone, lowers risk diabetes. Avoid high-risk sports. Usual sexual activity unless pregnancy restrictions Sleep-Rest pattern: Fetus Four cyclical states of activity: complete wakefulness, drowsy wakefulness, rapid eye movement sleep, and quiet sleep Increasing levels of quiet sleep and quiet alertness as fetus develops Pregnant woman Fatigue significant during pregnancy Rest periods during day and adequate night sleep Sleep interruptions common (frequent urination, postural discomfort Cognitive-Perceptual pattern: Fetus Functioning senses (vision, hearing, taste, smell, touch, proprioception, vestibular sense) 25 weeks: able to respond to sudden noise. Pregnant woman Psychological and cognitive changes Emotional Progesterone affects mood → focus on child. Increased sensitivity and analysis of experiences Increased mood swings/variability Transitioning process In preschoolers: Can internalize family rules; sense of time. Piaget: Preoperational stage Ability to function symbolically with language. Concrete thought process Egocentrism is characteristic. Irreversibility Transductive reasoning: Associate an external event with an internal event (grabbing keys--> leaving) Imaginary friends Controlled by child, not a threat. Way to practice social interactions. In Infants: — Taste — Present at birth; salivation at 3 months of age — Touch and motion — Tactile sensation well developed. — Touch relieves infant tensions and speeds neuromuscular development. — Language development — Sensory stimulation important — Cooing by 2 months; babbling at 6 months, single words by 12 months, expressive jargon 15-18 mo. In toddlers: Autism Spectrum Disorder Self-Perception-Self-Concept pattern: Acceptance of pregnant body image Ambivalence vs acceptance vs yearning for pre-pregnant state Influences in assuming maternal role. Internal (personality, maturity level) External (societal, family) Nursing interventions Address expected cognitive/self-image issues. Encourage discussion ideas/feelings between woman/partner. In Infants: Separating “me” from “non-me” Developed through feedback. Effect of crying/smiling on others Ability to use body to influence others. Messages infant receives from body. Differentiates “self” in mirror images at 4 mo.  Develops body image as he or she experiences the environment through senses. Roles-Relationships pattern: — Paternal attachment/bonding: engrossment Pregnancy affects whole family. Single mother: isolation, dependent on family Male partner Possible resentment, financial stress, potential for abuse, concerns about role Children in family experience role changes Less attention from parents Changed relationship with mother. Extended family - expectant grandparents Reminded of own aging Feeling of resentment vs new closeness In preschoolers: Expanding influences Peers becoming increasingly significant. Gender expectations Older siblings Social interaction Play with peers – learn to negotiate “the rules.” Acquires readiness for group situations. Follow directions – recognize others’ rights. Demonstrate increasing independence. Sexuality-Reproductive pattern: Changing body image Influences on feelings of sexuality Concerns about effect of intercourse on pregnancy Potential for sexual dissatisfaction Nursing role Provide accurate information to facilitate intimacy needs during pregnancy. Provide support. Coping-Stress Tolerance Pattern Perception of stressors and coping for all life aspects affected. Anxiety Greatest in first and third trimesters May decrease blood flow to uterus and fetus. May be demonstrated through: Psychosomatic complaints/behaviors*** Dreams and fantasies Smoking/substance abuse Stress-relieving strategies encouraged. In preschoolers: Play approaches.  Doll or puppet play Mutual storytelling In infants: — Developmental crisis — Necessary part of growth/development — Learning new skills — Situational crisis—not anticipated as part of normal growth/development. — Separation from significant other — Protest: infant cries loudly; screams for mother — Despair: stops crying; withdrawn, apathetic — Withdrawal: ignores mother on her return — Infant: little initial coping ability – learns over time Values-Belief pattern: § Fulfillment vs fear of losing part of self. § Shifting in relationships Mother Friends § Shifting in values Self Partner § Influence/changing of spiritual values. Finding meaning in pregnancy Spiritual influences on pregnancy care decisions Healthy behaviors reflect positive values/beliefs. Values/beliefs are learned – needed for integrity. Toddler at Kohlberg Stage 1 – will behave so as to avoid punishment – rules are absolute. Developing morality depends on interaction with parents. Religious rituals/beliefs – What is right and wrong. Development facilitated by consistent behavioral expectations, reinforcing acceptable behavior. In preschoolers: Lack fully developed consciences. Age 4-5: some internal controls Modeling and inductive explanations Moving from specific to general Preschool typical behavior Control behavior to retain parental love/approval. Express likes/dislikes, ask endless questions. Death Fascinated by life beginning/death concepts. Needs support, possible counseling, to cope with loss. Newborn assessment: Typical things you see, and not typical. Delivery room assessments: — ABC’s — Thermoregulation — Evaporation — Convection — Conduction — Radiation — Nursing assessment and interventions — Protect infant - prevent complications. — Avoid cold stress; minimally disturb and maximally observe newborn. — Apgar scoring system. — Indicator of infant condition at 1 and 5 minutes — Scale of 1-10 based on five categories. General appearance: Diamond shaped Anterior fontanel. Triangular shaped Posterior fontanel. Head Circumference Average = 32 to 36.7 cms Birth weight: Average is 3400 grams. Range is 2,500 to 4,000 grams. Length: Average is 50 cms. Range is 45 to 55 cms. Chest Circumference: Average is 32 cms. Range is 30 -33 cms. Depending on age, race or ethnic group, temperature, crying. Often changes with environment and health. Acrocyanosis: hands & feet appear bluish in color for several days Jaundice: yellow coloring as body rids itself of excess red blood cells Chest: Thorax is cylindrical and symmetric. Ribs are flexible. Xiphoid process is visible. Breasts are engorged in both sexes. Whitish secretions from nipples Heart: Normal range is 120 – 160 beats per minute. Low pitched, musical murmur is common. 90% of murmurs are transient and benign.  Peripheral pulses must be evaluated for lags. Abdomen: Slightly rounded, symmetrical, soft abdomen Umbilical area is slightly bluish, white & gelatinous at birth. Two arteries and one vein are visible. Cord darkens and shrivels as it dries. Urogenital: May have undescended testicle(s) Penis may be red and shiny if circumcised. Female infant may have vaginal discharge. Genitals appear edematous. Musculoskeletal: Movement should be symmetrical. Size, shape and alignment of different body parts should be symmetrical. Limbs are flexed. May see slight tremors. Appearance may reflect position in utero. Should see spontaneous motor activity. Language development in infant: Vowels, babbling. 0-2 months — Alert to voices — Uses range of noises to signal needs, such as hunger or pain. 2- 4 months — Coos 4-6 months — Makes vowel sounds ("oo," "ah") 6-9 months — Babbles — Blows bubbles ("raspberries") — Laughs 9-12 months — Imitates some sounds. — Says "Mama" and "Dada" — Responds to simple verbal commands, such as "no" Definition of Developmental Pace Each child develops at their own pace. Some excel in language but are slower on motor skills and vice versa. It is worrisome if there is a reverse in developmental achievement. Development is qualitative. Definition of Critical Period Critical Period: Limited time in which an event can occur, usually to result in some kind of transformation. Newborn reflexes, what they are and when they disappear. 1-2 months — Can lift and turn the head when lying on his or her back. — Hands are fisted, the arms are flexed. — Neck is unable to support the head when the infant is pulled to a sitting position. — Primitive reflexes include: — Babinski reflex -- toes fan outward when sole of foot is stroked. — Moro reflex (startle reflex) -- extends arms then bends and pulls them in toward body with a brief cry; often triggered by loud sounds or sudden movements. — Palmar hand grasp - infant closes hand and "grips" your finger — Placing - leg extends when sole of foot is touched. — Plantar grasp - infant flexes the toes and forefoot — Rooting and sucking - turns head in search of nipple when cheek is touched and begins to suck when nipple touches lips. — Stepping and walking - takes brisk steps when both feet are placed on a surface, with body supported. — Tonic neck response -- left arm extends when infant gazes to the left, while right arm and leg flex inward, and vice versa — Closed posterior fontanel at 2 months. — Grasp reflex decreases. 3-4 months — Better eye-muscle control allows the infant to track objects (coordinate). — Begins to control hand and feet actions, but these movements are not fine-tuned. The infant may begin to use both hands, working together, to accomplish tasks. The infant is still unable to coordinate the grasp, but swipes at objects to bring them closer. — Increased vision allows the infant to tell objects apart from backgrounds with very little contrast. — Infant raises up (upper torso, shoulders, and head) with arms when lying face down (on tummy) — Neck muscles are developed enough to allow infant to sit with support and keep head up (no head lag). — Primitive reflexes have either already disappeared or are starting to disappear. — Grasp reflex absent. — At 4 months, grasps object with two hands. 5-6 months Can begin to wean into using cup. Infantile extrusion reflex (tendency to push food out of mouth) needs to be absent by then. Eye movements mature by 6 months. Grasps with entire hand.  Weighs twice the birth weight. Able to sit alone, without support, for only moments at first, and then for up to 30 seconds or more. Infant begins to grasp blocks or cubes using the ulnar-palmar grasp technique (pressing the block into palm of hand while flexing or bending wrist in) but does not yet use thumb. Infant rolls from back to stomach. When on tummy, the infant can push up with arms to raise the shoulders and head and look around or reach for objects. 9-12 months — Infant begins to balance while standing alone. — Infant takes steps and begins to walk alone. — Loses Babinski sign at 12 months (1 years old). 18 months Closed anterior fontanel. Imitates behaviors of parents. Best strategy to gain a toddler’s trust during an examination. Get down to their level. Allow to examine equipment. Warm hands May be on parent’s lap. Sequence should be from least discomfort to most. Egocentrism An inability to put oneself in another’s shoes. Toddler’s advancing thought-processing skills and abilities to use the language are heralded by the development of this. In preschoolers: Exemplifies concept of critical thinking. Children concentrate solely on their own perspective. Different styles of parenting: Authoritative, Authoritarian, Permissive, Lenient Authoritative parenting is often considered the ideal style for its combination of warmth and flexibility while still making it clear that the parents are in charge. Children of authoritative parents know what is expected of them. Their parents explain reasons for the rules and consequences for breaking them. Parents also listen to their child’s opinions, but the parent remains the ultimate decision maker. Permissive parents might pride themselves on being their child’s best friend. These parents are warm and nurturing with open communication. They are actively involved in their children’s emotional well-being. They also have low expectations and use discipline sparingly. Permissive parents let children make their own choices, but also bail them out if it doesn’t go well. Authoritarian parenting uses strict rules, high standards and punishment to regulate the child’s behavior. Authoritarian parents have high expectations and are not flexible on them. The children might not even know a rule is in place until they’re punished for breaking it.  Lenient parents fulfill the child’s basic needs, but then pay little attention to the child. These parents tend to offer minimal nurturing and have few expectations or limitations for their child. It’s not always a conscious choice parents make, but can be forced by circumstance, such as the need to work late shifts, single parenting, mental health concerns or overall family troubles. Normal vital signs in toddler: Heart rate, blood pressure Grow in height 2-4 inches per year and in weight of 4 to 6 pounds per year. Birth weight quadruples by 2.5 and the height at 2 years old is approximately 50% of adult height. Daily urine excretion for 2-year-old is 500 to 600 mL, increasing to 750 mL for the 3- year-old. Full bladder control begins after 18-24 months. Blood pressure increases Heart rate decreases More effective thermoregulation Respiratory rate decreases from 30 at 1 years old to 25 breaths per minute at 3 years old. Heart rate: 80 to 120 beats per minute Blood pressure: 90/56 mm Hg. Depth perception: Starts at 4 months old, not fully developed until 4 years old. 6-9 months: Capable of organized depth perception 12-18 months: Depth perception more refined Sources of nutrition for infant and toddler — Breastfeeding: optimum source of nutrition — Exclusive: preferred method first 6 months — Continued: first year and beyond — Healthy People 2030 addresses breastfeeding — ACA requires accommodations & coverage. — Introduction of solid foods — 4-6 months: infant physiologically and developmentally ready — Wait until 6 months to lower risk of food allergies. — Sequence of solids: cereal, fruits, vegetables, meats Toddler: Ensure adequate iron intake. Moderate amount of milk (low in Fe) Prevent dental caries: bedtime bottle only water. Juice overconsumption is common. Appetite decreased from decreased growth rate. Assess intake over 3-5 days; obesity is a concern. Mealtime – toddlers often assert control. Opportunity to offer healthy, age-appropriate choices. Avoid over attention or punishment re food behavior. Things that place toddler at risk for injury Accidents – toddlers at high risk Appropriate supervision – accidents peak toddlerhood Decreased over 20 yrs. but mortality rate remains higher for black and native American children. Structural hazards – toddlers like to explore. “Baby-proof” the environment before toddlerhood Falls: stairs, furniture, windows, playground equip Inspect for hazards in unfamiliar environments. Gates, locks, gun-safety, large TVs Toys can if hazardous if not age-appropriate Sports Firearm hazards, weight-lifting equipment Wear bike helmets Drowning: highest risk ages 1-3 Can drown in water if covers nose/mouth. Danger: pools, tubs, toilets, pails of water All weight is forward – hard to straighten up from pail H2O. Burns – explore, pull – stove is hazardous. Hot liquids, electrical cords, fireplaces Lower water heater to 120°-125°F Difference between gross and fine motor skills Gross motor: walking, running, climbing. Fine motor: feeding themselves, drawing. What do Erikson and Piaget call infant period, toddler period, and preschool period? Erikson: — Infant needs maximum gratification/minimum frustration Trust vs. Mistrust: Infancy (first year) Develops trust of others to meet one’s own needs and begins to trust oneself and others. World will be a good and pleasant place to live. Autonomy vs. Shame and Doubt: Toddler (1 to 3 yrs.) To realize that one is an independent person who can make decisions. Initiative vs. Guilt: Early childhood (preschool years, 3-5 yrs.) To develop the ability to try new things and to handle failure. Industry vs. Inferiority: Middle and late childhood (elementary school years, 6 to puberty) To learn basic skills and to work with others. Identity vs. Role Confusion: Adolescence (12 to 20 yrs.) To develop a lasting, integrated sense of self. Intimacy vs. Isolation: Young adulthood (21-45 yrs.) To commit to another in a loving relationship Generativity vs. Isolation: Middle Adulthood (45 – 65 yrs.)  To contribute to younger people, through child rearing, childcare, or other productive work Integrity vs. Despair: Late Life (66 and older) To view one’s life as satisfactory and worth living. Piaget: Sensorimotor- Birth to 2 yrs. Reflexes decrease, voluntary acts develop. Imitation predominates. Thought dominated by physical manipulation of objects. Develops object permanence – forms mental images. Preoperational – 2 to 7 yrs. No cause & effect reasoning, advanced use language Thought dominated by senses. Egotistical, animistic, magical thinking Uses representational thought to learn. Concrete operations – 7 to 11 yrs. Can consider other pts of view, collecting facts. Assume logical approaches to problem solving including cause and effect. Collecting, mastering facts; language perfected Thought influenced by social contacts. Formal operations – 11 to 15 yrs. True logical thought a manipulation of abstract concepts emerge. Morality established. Mastering simple coordination activities through senses and motor activity States that quantitative changes but not qualitative occur after age 15. Development precedes learning. Uses term “scheme” to describe a pattern of action or thought. Schemes are used to assimilate (take in) or accommodate (modify) new experiences. Individuals strive to maintain balance between assimilation and accommodation. Criticism is that he underestimated children’s capabilities and does not factor in culture. Language development in 2,3-year-old. 2 years old says more than 50 words. uses at least two-word sentences ("I go!") is understood half the time by a stranger. uses real words ("breakfast") instead of baby talk. 3 years old strings at least three words together to form sentences. is understood most of the time. asks "why?" often. understands spatial words (such as in, on, and under) Temperament types Temperament: Individual’s style of emotional and behavioral response across situations Foundation for coping – children have unique temperament – different “models” exist. Influenced by environmental characteristics. Influences psychosocial adjustments. Nurse can assist parents in recognizing temperament and developing management strategies. The style of behavior the child uses to cope with the demands and expectations of the environment. The ‘easy child’ – cuddly, affectionate, easy to manage. The ‘difficult child’- less adaptable, more intense and active, more negative moods The ‘slow to warm-up child’ – needs time and consistency, needs encouragement to engage with others. Sudden Infant Death Syndrome (SIDS) — Sudden, unexplained death of infant < 1 yr. — Most occur before 6 mo. — Risk factors — Prone sleeping (on stomach), exposure to tobacco smoke, soft sleeping surfaces, hyperthermia, bed sharing, lack of breastfeeding, SIDS sibling, preterm, near- SIDS — Recommendations — Avoid risk factors. — Supine sleep position – Safe to Sleep Campaign Safe to Sleep Campaign — Placing child in supine position (on back) not on abdomen (prone) for sleep — Avoids one of risk factors for SIDS. — Has significantly reduced incidence of SIDS — Increased incidence of occipital flattening — Flat spot located on occiput develops. — Supervised prone position when awake aka “Tummy Time.” — Place head facing alternate sides at bedtime. — Avoid excessive use of carriers. Child using Pincer Grasp 8-9 months: Uses thumb and index finger in pincer grasp to feed self. Typical development at beginning of preschool age 3 years old Has self-care skills. Knows own name, age, and sex. May comprehend sensations; differentiates big and small. Speech is 75% understandable. Engages in imaginative play; enjoys interactive play. Copies a circle, draws a person with two body parts (head and body) 4 years old Dresses self Engages in fantasy play. Engages in conversation. Pours, cuts, mashes own food Is aware of others sex. Draws a person with three body parts. 5 years old Tells simple stories. Dresses and undresses without supervision Engages in dramatic make-believe and dress-up play during which the child assumes a role and domestic role playing. Plays cooperatively with other children. Can count to 10. Draws a person with at least six body parts. 6 years old Bounces a ball; throws and catches. Rides a bicycle. Ties shoelace Prints own first name and numbers up to 10. Understands left from right. Draws a person with clothing. Abuse in toddlers, infants, and pregnant moms: what to see in each. Parents delay in seeking medical help. Inconsistencies in healing of injury Injury incompatible with child’s capabilities Old unexplained fractures on X-ray Repeated dental fracture or head trauma. Bruises limited to back surface – neck to knees. Bare spots – broken hair Belt/buckle, hand, cigarette, hot water injury Burns with sharply demarcated edges. Any kind of perineal injury and/or poor hygiene Why do we do hearing and vision screening (especially in preschoolers)? (brain?) Neurological issues Although infant hearing screenings are highly effective in identifying hearing loss early; children may have hearing problems later. During the preschool years, hearing develops to the level of an adult, when the ability to attend to and interpret what is being heard becomes more refined. By age 6, the child should approach a 20/20 visual acuity level. Counseling on immunizations — ICDC and AAP recommended schedule, reviewed often. Routine immunizations at birth; 1, 2, 4, 6 months; 12 mo.  — Flu vaccine recommended for children > 6 months. — Varicella vaccine now recommended. — Active immunization — Live, killed, or attenuated organism — Stimulates immune system to build immunity. — Diphtheria; tetanus; acellular pertussis; inactivated polio; measles, mumps, and rubella — Passive immunization – transient antibodies (mother) — Naturally occurs in newborns from maternal antibodies. § Infections: affect fetal growth/development § Effect on biological processes: related to timing of maternal infection. § Vaccines during pregnancy Safe: tetanus, diphtheria, influenza Unsafe (live): measles, mumps, rubella, polio (avoid pregnancy for at least 3 months after rubella vaccine) § TORCH screen § Done to detect the presence of teratogenic perinatal infections. Detects toxoplasmosis, hepatitis B, rubella, cytomegalovirus, herpes simplex. Schedule varies depending upon location, the child's health, the type of vaccine, and vaccine availability. Some vaccines may be given as part of a combination vaccine so that the child gets fewer injections. Birth — Hep B: Hepatitis B vaccine (HBV); recommended to give the first dose at birth but may be given at any age for those not previously immunized. 1–2 months — Hep B: Second dose should be administered 1 to 2 months after the first dose. 2 months — DTaP: Diphtheria, tetanus, and acellular pertussis vaccine — Hib: Haemophilus influenzae type b vaccine — IPV: Inactivated poliovirus vaccine — PCV: Pneumococcal conjugate vaccine — Rota: Rotavirus vaccine 4 Months — DTaP, Hib, IPV, PCV, Rota 6 months — DTaP, Hib, PCV, Rota — Influenza vaccine is recommended every year for children older than 6 months. 6-18 months — Hep B — IPV 12–15 months — Hib — MMR: Measles, mumps, and rubella vaccine — PCV — Varicella (chickenpox) vaccine 12-23 months Hep A: Hepatitis A vaccine; given as two shots at least 6 months apart. 15–18 months — DTaP Know which and when to give boosters to preschoolers. Boosters DTaP: fourth year MMR: between 4 and 6 years old Immunization concerns Religious Safety of immunizations Importance of accurate information Additional considerations New and combined vaccines Under-vaccination; “catch-up” schedules Leading causes of death in infancy, toddlers, preschoolers Infants: Falls o Most common after 4 months (rolling over) o Do not leave unattended on raised surface. Burns o Deaths from smoke/toxic gasses Swallowing and choking on foreign objects o Potential: any small object in mouth o Childproof environment o Infant CPR: parents and caregivers Toddlers 1-4 yrs. old: Motor vehicle accidents Preschoolers: Injuries: leading cause of death MVA: car seats; ride in back seat Household furniture/tools/equipment Firearm safety: child access protection  Burns Scald/direct flame burns Teach danger of matches, open flames, hot objects Drowning: swimming pool greatest risk Fencing, flotation device, water survival, supervision Counseling: Figure out what client knows, health literacy level, (assessment typically comes first, if already assessed then go to next step) Assessment Planning Diagnosis Implementation Outcome Identification Evaluation Expected growth patterns exist for all people. Growth is not steady throughout life. Slower rates of growth occur during toddler, preschool, and school- age periods. Extreme, rapid growth occurs during the prenatal period, infancy, and during adolescence. Growth is important indicator of child’s health. CDC recommends using 2006 WHO growth charts for age 0-24 months then use revised 2000 CDC charts for age 2-20 yrs. CDC and WHO charts account for weight, length and BMI – all for given age – and include percentiles. o Chart linear, weight, and head circumference (infants); body mass index for age o Serial measurements over time best reflect child’s growth pattern.