Pediatric nursing immunization 800 words due 1/18/2020

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N371PPT_Chapter_25.pptx

Chapter 25 Growth and Development of the Newborn and Infant

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Developmental Changes in the Newborn and Infant

Growth

Increase in physical size

Development

Sequential process by which infants and children gain various skills and functions

Maturation

Increase in functionality of various body systems or developmental skills

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Assessing Newborns and Infants for Developmental Milestones

The nurse may ask the parent if the skill is present or the infant may demonstrate the skill during the interview.

The nurse may elicit the skill from the infant.

Screening tools may be used to assess development.

Denver II Developmental Screening Test

Prescreening Developmental Questionnaire (PDQ II)

Ages and Stages Questionnaire (ASQ)

Infant–Toddler Checklist for Language and Communication

Infant Development Inventory

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Assessing Growth and Development of a Premature Infant

Use the infant’s adjusted age to determine expected outcomes.

Subtract the number of weeks that the infant was premature from the infant’s chronologic age.

Plot growth parameters and assess developmental milestones based on adjusted age.

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Question #1

The nurse is assessing developmental milestones for a 7-month-old premature infant born at 28 weeks’ gestation. What would be the adjusted age upon which the nurse would base the assessment?

a. 2 months

b. 3 months

c. 4 months

d. 5 months

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Answer to Question #1

c. 4 months

The nurse assessing developmental milestones for a 7-month-old premature infant born at 28 weeks’ gestation would adjust the age to 4 months.

The infant was born 12 weeks early (3 months); therefore, the nurse would subtract 3 months from the chronologic age of 7 months to obtain an adjusted age of 4 months. Healthy growth would be demonstrated if the infant were the size of a 4-month-old and achieved the developmental milestones of a 4-month-old.

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Question #2

Is the following statement True or False?

The nurse is assessing a 6-month-infant and obtains the following measurements: weight: 15 lb; length: 26 in; head circumference: 17 in. It has been determined that these are average measurements for a 6-month-old infant.

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Answer to Question #2

True.

The following measurements: weight: 15 lb; length: 26 in; and head circumference: 17 in are average measurements for a 6-month-old infant.

The average weight for a 6-month-old infant is 15 lb, the average length is 25 to 27 in, and the average head circumference is 16.5 to 17.5 in.

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Infant Organ System Maturation

Neurologic system

Cardiovascular system

Respiratory system

Gastrointestinal (digestive) system

Renal system

Hematopoietic system

Immunologic system

Integumentary system

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Newborn States of Consciousness

Deep sleep: infant lies quietly without movement.

Light sleep: infant may move a little while sleeping and startle to noises.

Drowsiness: eyes may close; the infant may be dozing.

Quiet alert state: infant’s eyes are open wide and body is calm.

Active alert state: infant’s face and body move actively.

Crying: infant cries; body moves in disorganized fashion.

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Newborn Primitive Reflexes

Moro

Root

Suck

Asymmetric tonic neck

Plantar and palmar grasp

Step

Babinski

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Respiratory System of the Infant Versus Adult

The nasal passages are narrower.

The trachea and chest wall are more compliant.

The bronchi and bronchioles are shorter and narrower.

The larynx is more funnel shaped.

The tongue is larger.

There are significantly fewer alveoli.

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Maturation of the Cardiovascular System of the Infant in First Year of Life

The heart doubles in size.

The average pulse rate decreases from 120 to 140 in the newborn to about 100 in the 1-year-old.

Blood pressure steadily increases, from an average of 60/40 in the newborn to 100/50 in the 12-month-old.

The peripheral capillaries are closer to the surface of the skin, making the newborn and young infant more susceptible to heat loss.

Thermoregulation becomes more effective.

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First Year of Life Changes

Eruption of teeth

Consistency and frequency of stools change over the first year of life

Acrocyanosis is normal in newborns and that they often experience mottling of the skin

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Immunologic System of the Infant

Newborns receive large amounts of immunoglobulin G (IgG) through the placenta from their mothers.

This confers immunity during the first 3 to 6 months of life for antigens to which the mother was previously exposed.

Infants then synthesize their own IgG, reaching approximately 40% of adult levels at age 12 months.

Immunoglobulin M (IgM) is produced in significant amounts after birth, reaching adult levels by 9 months of age.

Immunoglobulin A (IgA), immunoglobulin D (IgD), and immunoglobulin E (IgE) production increases very gradually, maturing in early childhood.

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Psychosocial Development

Erik Erikson theory

Crisis of infancy as trust versus mistrust

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Jean Piaget’s Theory of Cognitive Development

Sensorimotor stage: birth to 2 years

Four stages

Reflexes

Primary circular reaction

Secondary circular reaction

Coordination of secondary schemes

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Gross and Fine Motor Skills

Phenomenal increases

First 12 months

Development in this stage in a cephalocaudal fashion

Fine motor development includes maturation of hand and finger use and develops in proximodistal fashion

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Question #3

Is the following statement True or False?

Fine motor skills develop in a cephalocaudal fashion (from the center to the periphery).

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Answer to Question #3

False.

Fine motor skills develop in a proximodistal fashion (from the center to the periphery).

Gross motor skills develop in a cephalocaudal fashion (from the head to the tail).

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Warning Signs Indicating Problems With Sensory Development

Young infant does not respond to loud noises.

Child does not focus on a near object.

Infant does not start to make sounds or babble by 4 months of age.

Infant does not turn to locate sound at age 4 months.

Infant crosses eyes most of the time at age 6 months.

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Warning Signs Indicating Problems With Language Development

Infant does not make sounds at 4 months of age.

Infant does not laugh or squeal by 6 months of age.

Infant does not babble by 8 months of age; infant does not use single words with meaning at 12 months of age (mama, dada).

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Social and Emotional Development of the Infant

Stranger anxiety

Indicates infant recognizes self as separate from others

Separation anxiety

Infant becomes distressed when parent leaves

Temperament

Ranges from low to moderately active, regular, and predictable, to highly active, more intense, and less adaptable

Cultural differences

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Nutritional Requirements

Essential for growth and development

Breast-feeding and bottle-feeding of infant formula are both acceptable

Needs related to the tremendous growth

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Exceptions to Recommended Breast-feeding

Infants with galactosemia

Maternal use of illicit drugs and a few prescription medications

Maternal untreated active tuberculosis

Maternal HIV infection in developed countries

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Breast-feeding

Advantages

Teach new mother proper techniques

New mothers should be assessed for pain upon breast-feeding

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Bottle-Feeding

Proper preparation

Proper storage of formula

Care of bottles

Only formulas that are fortified with iron should be used

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Nutritional Plan First Year of Life

Optimal feeding pattern

Infant feeding opportunity to establish good eating behaviors

Special formulas have been developed to meet the nutritional needs of infants with allergies or disorders

After 6 months

Nutrients available in solid foods in addition to breast milk or formula

Introduce one new food every 4 to 7 days for identification of food allergies

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Role of Nurse

Promote early learning, safety, proper nutrition, healthy sleep and rest, healthy teeth and gums, and appropriate discipline techniques

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Common Developmental Concerns in Infancy

Colic

Spitting up

Thumb sucking, pacifiers, security items

Teething

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Anticipatory Guidance

Parents need tools to support their infant’s development in a safe fashion

Parents can promote growth and development of an infant through solitary play

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