Chapter 10 Wong's Essential Of Pediatric Nursing (8Ed)

Front 1

weight gain in infant up till 5/6 months of age, then 1 year is?

Back 1

1. gain 150-210 grams weekly until 6 months. Aver w at 6mth: 7.3 kg (16lbs)
6mth= double
1 year= triple in weight with aver: 9.75 kg (21.5 lbs)

Front 2

What attributes to the decreased weight in breastfed babies compared to bottle fed babies?

Back 2

breast-fed babies have self-regulation of energy intake.

Front 3

Height growth by 6mth and then 1 year in infants is?

Back 3

increase in height by 2.5 cm (1 inch) a month by 6 mth. Happens in sudden bursts.
Aver h at 6mth: 65cm (25.5 inches).
Aver h at 1yr: 74cm (29 inches) increased by 50% at 1 yr. Happens in trunk rather than legs.

Front 4

Growth of head in infant

Back 4

increases at 1.5 cm (0.6 inches) per month.
Aver at 6 mths: 43 cm (17 inches)
Aver at 1 year: 46 cm (18 inches)
By 1 yr increased 33 %

Front 5

posterior fontanels fuse by

Back 5

6 to 8 weeks of age

Front 6

anterior fontanels fuse by

Back 6

12 to 18 months of age (average 14)

Front 7

Brain development at 1 year

Back 7

end of first year brain increased in weight by 21/2 times. Maturation is shown in development achievements of infant.

Front 8

Chest of infant

Back 8

has an adult contour, lateral diameter becomes larger than anterposterior diameter. Chest circ = head circ by end of 1 year.

Front 9

Heart growth of infant

Back 9

grows slow.
doubles by 1 year
width takes up 55% of chest cavity

Front 10

RR in infants is like what and what 3 factors effect the RR in what way?

Back 10

-stable
-abdominal
-1.close proximity of trachea to bronchi and braches, 2.short and straight eustachian tube, 3. inability to produce IgA in the mucosal lining= more resp. problems/infections

Front 11

Infant HR and rhythm

Back 11

rthythm= sinus arrhythmia
Rate increases with inspiration
Rate decreases with expiration

Front 12

Infant BP

Back 12

systolic rises in 1st 2months
diastolic decreases in 1st 3 months then gradually rises to values at birth.

Front 13

The majority of digestive processes begin functioning until when?

Back 13

until 3 months, when drooling is common b/c of poor swallowing reflex.

Front 14

Gastric digestion in the stomach consists of action by what?

Back 14

action of:
hydrochloric acid
rennin- formation of milk curds

Front 15

What are pancreatic digestive enzymes and what do they do and when do they begin functioning?

Back 15

-amylase
-breaks down complex carbs in the duodenum
-deficient until the 4th to 6th month

Front 16

Lipase does not achieve adult levels of fat absorption until

Back 16

4 to 5 months

Front 17

What digestive enzyme is secreted in sufficient amounts to catabolize proteins?

Back 17

trypsin

Front 18

What is the most immature of all gastrointestinal organs throughout infancy?

Back 18

liver

Front 19

What emerges and parallels the changes in the GI tract which prepare infants for solid foods?

Back 19

the maturation of suckling, sucking, swallowing reflexes and the eruption of teeth.

Front 20

What immunoglobulins are present at birth and when do they reach adult levels?

Back 20

IgG= present at birth, 40% of adult levels by 1 yr.
IgM= at birth, adult levels at 9 mths.
IgA= not at birth, but found in saliva and tears at 2 to 5 wks, don't reach adult levels until childhood along with IgD and IgE.

Front 21

thermoregulation

Back 21

-more effective with skin ability to contract and muscles shiver (thermogenesis).
-capillaries constrict in response to cold
-capillaries dilate in response to heat
-increase adipose tissue during 1st 6 mths

Front 22

infant changes in total body fluid

Back 22

at birth= 75% water, 40% ECF
adult= 20% ECF, ? water

Front 23

Renal immaturity of infant causes?

Back 23

dehydration
electrolyte imbalance
Urine often, with SG= 1 to 1.01
maturity occurs in during later half of 2yr, when the cuboidal epithelium of the glomeruli flatten.

Front 24

Auditory acuity is at adult levels when?

Back 24

during infancy

Front 25

Binocularity

Back 25

fusion of two ocular images into one cerebral picture begins at 6wks and completes by 4mths.

Front 26

Stereopsis

Back 26

depth perception
begins at 7 to 9 mths
matures at 2 or 3 yrs= risk of falling

Front 27

Fine motor development:
the progression of the grasp (prehension) are:
palmer grasp= whole hand
pincer= using thumb and index finger

Back 27

-1 mth hands closed
-3 mth hands mostly open, grasp with eyes, hold tightly onto given objects
-4mths looks back and forth from hands to object
-5 mths able to voluntarily grasp object
- 6 mths increased skill, can feed themselves a cracker
- 7mths transfer objects from one and to another, bang things alot
- 8mths to 10 crude pincer grasp
- 11mths neat pincer grasp
- 12 mths try to build blocks but will fail.

Front 28

Gross motor movement: head control

Back 28

-birth briefly hold head midline, lift and turn side to side. NOT out of depressed of an object.
-Lag is shown when infant is pulled from lying position to sitting position.
- 4 mths can lift head and front chest 90 degrees above table
- 4 to 6 head control well established

Front 29

If child still displays head lag at what mth should have a developmental and neurological evaluation?

Back 29

6 months

Front 30

The ability to willfully turn from abdomen to back occurs at

Back 30

5 mths

Front 31

parachute reflex occurs when?

Back 31

a protective response to falling
happens at 7 mths

Front 32

sitting progrsession

Back 32

-2 to 3 back is uniformly round
- 3 to 4 convex cervical curve forms with head control
- 4 mths starts to sit when convex lumbar curve appears
- 7mths can sit alone as spinal column straightens
- 8mths sit well and explore
- 10 mths can go from prone to siting position.

Front 33

locomotion progression

Back 33

-4 to 6 mths move backward by pusinh with arms
- 6 to 7 mthscan bear weight on feet, crawl (abd on floor), go from sitting to kneeling
- 9 mths creeping (abd off floor), stand while holding funiture, get down.
- 11 mths walk while holding funiture or both hands held
- 12 mths walk with one hand held.

Front 34

Erikison's phase of birth to one year is called what?

Back 34

trust vs. mistrust

Front 35

Failure to learn what, leads to mistrust?

Back 35

delayed gratification, too much or too little.

Front 36

Erikson divided the first year into two oral-social stages which are:

Back 36

1st stage: narcisim, food intake most important, use of bodily processes like grasp, importance of touch stimulation.
2nd stage: more active and aggressive, biting, first conflicts like breastfeeding and biting and teething.

Front 37

Piaget cognitive period of birth to 24 months is called

Back 37

sensorimotor phase with six stages.

Front 38

What are 3 crucial events that take place and the six stages that occur during the Piaget's sensorimotor phase?

Back 38

1. seperation= infants learn to separate from objects in environment
2. object permanence= happens at 9 to 10 mths
3. use of symbols or mental representation.
Stages:
1. use of reflexes -birth to 1mth
2. primary circular reactions- 1 to 4 mths. (reflexes become voluntary)
3. secondary circular reactions- up to 8mths (play, imitation, affect)
4. coordination of secondary schemas and their application to new situations.

Front 39

Revised Infant Temperament Questionaire (RITQ)

Back 39

a screening tool ideal for 4mths old or older that focuses on nine temperament variables, and 95 questions about sleep, feeding, play, diapering, and dressing.

Front 40

Why is it important for nurses to have knowledge about the infant's temperament?

Back 40

1. provide parents with background info to help them see child in better perspective
2. offer more organized picture of child's behavior and possibly reveal distortions in their perspective
3. guide parents in childrearing techniques.

Front 41

small family childcare home

Back 41

cares up to 6 children for part of a 24 hour day and does not include informal arrangements. Often includes the daycare providers own children under 5 living in the home

Front 42

large family childcare home

Back 42

cares for 8 to 12 children. Often operate without license and may have a large number of infants without adequate staff and facilities.

Front 43

child center-based care

Back 43

licensed daycare facility with 6 or more kids for 6 or more hours in a 24 hour period.

Front 44

work-based group care

Back 44

employers provide childcare to their employees

Front 45

sick-child care

Back 45

Often located in community hospitals or in work settings.

Front 46

What are the first primary teeth to erupt?

Back 46

lower central incisors, which appear at 6 to 10mths of age (ave. 8mths). They are followed by the upper central incisors.

Front 47

The quick assessment tool of deciduous (primary) teeth during the firt two years is:

Back 47

Age of child (in months) -- 6 = # of teeth.
Example: 8mth -- 6 = 2 primary teeth at this time.

Front 48

When should footwear counseling begin for parents?

Back 48

at 6 mths (well before they begin walking) DO NOT get shoes with hard soles. Shoes only purpose is protection, should have a 1.25 cm (.5inch) space btwn big toe and shoe, check growth every three months.

Front 49

All infants (including breast-fed infants) should receive what supplements beginning at 2 mths?

Back 49

200 IU of vit D, prevents rickets and vit D deficiency.

Front 50

For infants who are only breast fed after 4 to 6 moths should receive what dietary supplement?

Back 50

iron, b/c offsets the decrease in iron in human milk at this time and enhances erythropoiesis.

Front 51

What is an ideal first solid food?

Back 51

iron fortified cereal, rice cereal, b/c low allergic potential. One food at a time!

Front 52

Portion sizes for infants are?

Back 52

1 tablespoon per year of age.

Front 53

two major categories for small children sleep problems are:

Back 53

1. dyssomnias= child has trouble either falling asleep or staying alseep, or staying awake during the day.
2. parasomnias= confusion arousals, sleep walking, sleep terrors, nightmares, and rhythmic movement disorder. Seen 3 to 8 yrs.

Front 54

Hep A, what is it? What are the s/s? and when are immunizations recommended?

Back 54

-spread fecal-oral, person to person contact, water contamination, rarely blood.
-s/s= abrupt, fever, malaise, anorexia, nausea, ab pain, dark urine, jaundice.
- vaccine at age 1yr, second dose 6 mths later.

Front 55

Hep B vaccine

Back 55

mother who are Hep B positive= infant gets vaccine within 12 hours of birth.
- if newborn weighs less than 2000 g(4.4lbs) first dose given at 1 month (only if mom is negative)
- strongly encourage Hep B be given before infant DC's from hospital.
- 2nd dose at 1 to 2 months
- 3rd dose no earlier than 24 weeks (6mths)

Front 56

Polio vaccine

Back 56

since 2000 only IPV (inactivated poliovirus vaccine) is given in four doses b/c of risk of VAPP
1. 2mths
2. 4mths
3. 6 to 18 mths
4. 4 to 6 years

Front 57

Measles (rubeola), Mumps, and Rubella vaccine (MMR)

Back 57

1st given at 12 to 15mths of age
2nd given at 4 to 6 yrs, provided 4 weeks have passed since the first dose.

Front 58

Haemophilus influenzae type b vaccine

Back 58

-min age 6 wks
??? 2, 4, 6 mths and then one from 12-15mths??

Front 59

Varicella vaccine

Back 59

Varivax,
1st dose at 12 to 15 mths
2nd dose 4 to 6 yrs
if 13 yrs or older, 2 doses should be 4 weeks apart.

Front 60

Pneumococcal vaccine

Back 60

given at 2,4, 6 mths, with 4th dose at 12 to 15 mths of age

Front 61

influenza

Back 61

look up
-don't give if child is allergic to eggs

Front 62

meningococcal vaccine

Back 62

look up

Front 63

when is there almost no head lag when pulled to sitting position?

Back 63

4 months

Front 64

When does infant rolls from abdomen to back?

Back 64

5 months

Front 65

When does infant roll from back to abdomen?

Back 65

6 months

Front 66

starts to smile, when?

Back 66

2 months

Front 67

When does the infant transfer objects from one hand to another?

Back 67

7 months

Front 68

When is pincer grasp begin, crude and when is it mastered?

Back 68

8 months begins
9 months is crude use
10 months is good!

Front 69

Sensory Motor Period
(0 - 24 months):
Reflexive Stage
(0-1 or 2 months) (text says one)

Back 69

Simple reflex activity such as grasping, sucking.

Front 70

Sensory Motor Period
(0 - 24 months):
Primary Circular Reactions
(1 or 2 to 4 months)

Back 70

Reflexive behaviors occur in stereotyped repetition such as opening and closing fingers repetitively.

Front 71

Sensory Motor Period
(0 - 24 months):
Secondary Circular Reactions
(4-8 months)

Back 71

Repetition of change actions to reproduce interesting consequences such as kicking one's feet to move a mobile suspended over the crib.

Front 72

Sensory Motor Period
(0 - 24 months):
Coordination of Secondary Reactions
(8-12 months)

Back 72

Responses become coordinated into more complex sequences. Actions take on an "intentional" character such as the infant reaches behind a screen to obtain a hidden object.

Front 73

Sensory Motor Period
(0 - 24 months):
Tertiary Circular Reactions
(12-18 months)

Back 73

Discovery of new ways to produce the same consequence or obtain the same goal such as the infant may pull a pillow toward him in an attempt to get a toy resting on it.

Front 74

Sensory Motor Period
(0 - 24 months):
Invention of New Means Through Mental Combination
(18-24 months)

Back 74

Evidence of an internal representational system. Symbolizing the problem-solving sequence before actually responding. Deferred imitation.

Front 75

The Preoperational Period
(2-7 years):
Preoperational Phase
(2-4 years)

Back 75

Increased use of verbal representation but speech is EGOCENTRIC/ EGOCENTRISM. The beginnings of symbolic rather than simple motor play. TRANSDUCTIVE reasoning. Can think about something without the object being present by use of language.

Front 76

The Preoperational Period
(2-7 years):
Intuitive Phase
(4-7 years)

Back 76

Speech becomes more social, less egocentric. The child has an intuitive grasp of logical concepts in some areas. However, there is still a tendency to focus attention on one aspect of an object while ignoring others. Concepts formed are crude and irreversible. Easy to believe in magical increase, decrease, disappearance. Reality not firm. Perceptions dominate judgment.

In moral-ethical realm, the child is not able to show principles underlying best behavior. Rules of a game not develop, only uses simple do's and don'ts imposed by authority.

Front 77

Period of Concrete Operations
(7-11 years)

Back 77

Evidence for organized, logical thought. There is the ability to perform multiple classification tasks, order objects in a logical sequence, and comprehend the principle of CONSERVATION. Reasoning is inductive. The child is capable of concrete problem-solving.
Some reversibility now possible (quantities moved can be restored such as in arithmetic:
3+4 = 7 and 7-4 = 3, etc.)

Class logic-finding bases to sort unlike objects into logical groups where previously it was on superficial perceived attribute such as color. Categorical labels such as "number" or animal" now available.

Front 78

Period of Formal Operations
(11 years to 15)

Back 78

- adaptability and flexibility
- Thought becomes more abstract, incorporating the principles of formal logic. The ability to generate abstract propositions, multiple hypotheses and their possible outcomes is evident. Thinking becomes less tied to concrete reality.
Formal logical systems can be acquired. Can handle proportions, algebraic manipulation, other purely abstract processes. If a + b = x then a = x - b. If ma/ca = IQ = 1.00 then Ma = CA.