sucking and rooting reflex
Birth to 4 months
palmar grasp
Birth to 6 months
plantar grasp
birth to 8 months
moro reflex (startle)
Birth to 4 months
Tonic neck reflex
birth to 3-4 months
Babinski reflex (stroke the infant's foot and their toes fan out)
Birth to 1 year
Car safety for an infant
�Should be placed in rear facing car seat in the back seat.
�Should be placed in the back until 1 year of age or until they weigh 9.1kg.
Normal 2 month old HGB level
9.0 - 14.0 g/dL
Normal 6 - 12 years old HGB level
11.5 - 15.5 g/dL
Normal 12 - 18 years old HGB level
12 - 16 g/dL
Normal 2 month old Hct level
28% - 42%
Normal 6 - 12 years old Hct level
35% - 45%
Normal 12 - 18 years old Hct level
37% - 49% males
36% - 46% females
Appropriate activities for toddlers
>filling empty containers
> plaing with blocks
> looking at books
> playing with toys that can be pushed or pulled
> tossing balls
Appropriate toys for an infant
> rattles
> mobiles
> teething toys
> nesting toys
> playing pat-a-cake
> playing with balls
> reading books
Reasons to withold vaccines
> Any anaphylactic reaction to a vaccine or vaccines containing that substance.
> allergies to contents in the vaccine
> Moderate or severe illnesses with/without symptoms. (with common cold and other minor illnesses are not contraindicted)
> inmmunocompr
End-of-life decisions require
> honest information regarding prognosis
> disease progression
> treatment options
> the impact of the treatments
These decisions are made during a
highly stressful time. It is important that all health care personnel are aware of the child and family's d
Pain Management for burns
> Establish ongoing monitoring of pain and effectiveness of pain treatment.
> Avoid IM or subcutaneous injections.
> Use intravenous opioid analgesics, such as morphine sulfate, hydromorphone (Dilaudid), and fentanyl(Sublimaze).
> Monitor for respiratory
Nutritional support for burns
> Increase caloric intake to meet increased metabolic demands and prevent
hypoglycemia.
> Increase protein intake to prevent tissue breakdown and promote healing.
> Provide enteral therapy or total parenteral nutrition (TPN) if necessary due
to decreased
Rotavirus clinical manifestations
� Commonly causes diarrhea in young children
� Induces fever and vomiting for 2 days
� Produces watery diarrhea for 5 to 7 days
(transmitted oral-fecal and is intubated in 48 hours)
Signs and symptoms of Digoxin toxicity
> bradycardia
> dysrhythmias
> nausea,
> vomiting
> anorexia
Insulin lispro
(Humalog)
> rapid acting
> onset is less than 15min
> peak 0.5-1hr
> Duration 3-4hr
Regular insulin
(Humulin R)
> short acting
> onset 0.5-1hr
> peak 2-3hr
> duration 5-7hr
NPH insulin
(Humulin N)
> intermediate acting
> onset 1-2hr
> peak 4-12 hr
> duration 18-24hr
Insulin glargine
(Lantus)
> long acting
> onset 1hr
> peak none
> duration 10.4 -24 hr
Antiinflammatory agents for Asthma
Antiinflammatory agents decrease airway inflammation for long-term management.
? Corticosteroids (fluticasone [Flovent] and prednisone [Deltasone])
? Leukotriene modifiers (montelukast [Singulair]), mast cell stabilizers (cromolyn sodium [Intal]), and mon
Agents that trigger asthma
? Smoke
? Dust
? Mold
? Sudden weather changes (especially warm to cold)
? Seasonal allergens (grass, tree and weed pollens)
? Animal dander
? Stress
Status asthmaticus (A life-threatening episode of airway obstruction that is often unresponsive to common treatment)
? Prepare for emergency intubation.
? Administer humidified oxygen.
? Administer three nebulizer treatments of a beta2 agonist, 20 to 30 min apart. Ipratropium bromide may be added to the nebulizer to increase bronchodilation.
? Obtain IV access.
? Monito
Nursing Care during a seizure
� Protect the child from injury (move furniture away, hold head in lap if on the
� floor).
� Position the child to provide a patent airway.
� Be prepared to suction oral secretions.
� Turn the child to the side (decreases risk of aspiration).
� Loosen res
Nursing care after a seizure
� Maintain the child in a side-lying position to prevent aspiration and to facilitate drainage of oral secretions.
� Check vital signs.
� Assess for injuries
� Perform neurologic checks.
� Allow the child to rest if necessary.
� Reorient and calm the chil
Nursing care for meningitis
The presence of petechia or a purpuric-type rash requires immediate medical attention.
� Isolate the child as soon as meningitis is suspected.
� Initiate and maintain isolation precautions (droplet precautions) per facility protocol. This requires a priva
For nutrition, advise parents to:
� Avoid using food as a reward.
� Emphasize physical activity.
� Ensure that a balanced diet is consumed. Healthy food recommendations are posted by the United States Department of Agriculture
� Teach children to make healthy food selections for meals and
Maltreatment
� Maltreatment of infants and children is attributed to a variety of predisposing factors, which include parental, child, and environmental characteristics. Child maltreatment can occur across all economic and educational backgrounds and racial/ethnic/rel
Subjective and objective data of maltreatment
� Inconsistency between nature of injury and developmental level of the child.
� Repeated injuries requiring emergency treatment
� Inappropriate responses from the parents or child
� Physical signs such as growth failure, bruises, burns, fractures, poor h
Assessment for maltreatment
� Assess for unusual bruising on the abdomen, back, and/or buttocks.
� Assess the mechanism of injury, which may not be congruent with the physical appearance of the injury. Many bruises at different stages of healing may indicate continued beatings. Obse
Lab values for Reye's Syndrome
� Liver enzymes (alanine aminotransferase [ALT], aspartate aminotransferase [AST]) - Elevated
� Serum ammonia level - Elevated
� Serum electrolytes - Metabolic alkalosis, hypocalcemia, hyponatremia, and hypernatremia
� Serum blood glucose - Hypoglycemia
�
Nursing interventions for a child with club foot
� Encourage parents to hold and cuddle the child.
� Encourage parents to meet the developmental needs of the child.
� Assess and maintain the cast or harness used to treat clubfoot or DDH.
� Perform neurovascular and skin integrity checks after cast or ha
Therapuetic interventions for club foot
� Passive exercise should be performed for a minor deformity
� Serial casting is begun after birth before the newborn is discharged home. Weekly casting to stretch the skin and other structures of the foot is done until maximum correction is accomplished.
Failure to thrive
Organic causes may include cerebral palsy, chronic renal failure, congenital heart
disease, and/or gastroesophageal reflux. However, factors related to nonorganic
failure to thrive (NFTT) may include:
Risk factors of failure to thrive
� Parental neglect, lack of parental knowledge, or a disturbed maternal-child attachment
� Poverty
� Health or childrearing beliefs
� Family stress
� Feeding resistance
� Insufficient breast milk
Signs of symptoms of failure to thrive
� Less than the fifth percentile on the growth chart for weight
� Malnourished appearance
� Signs of dehydration
� Decreased activity level
� Developmental delays
� Negative interactions between the child and parents (no eye contact, irritability, pushing
Signs and symptoms of MILD dehydration
> Normal: behavior, mucous membranes, anterior fontanel, pulse, and blood pressure.
> Capillary refill is between 2 and 4 seconds
> slight thirst may be experienced
> urine specific gravity 1.020
Signs and symptoms of MODERATE dehydration
> Capillary refill between 2-4 seconds
> thirst and irritability
> pulse slightly increased with orthostatic hypotension
> mucous membranes are dry and tears and skin turgor are decreased
> urine specific gravity 1.020
Signs and symptoms of severe dehydration
> capillary refill is greater than 4 seconds
> tachycardia and orthostatic hypotension, may progress to shock
> mucous membranes are very dry and skin is tented
> anterior fontanel is sunken
> oliguria or anuria is present