Gross motor skills for 12 monthsSits from standing position Walks independentlyWhich taste is preferred by infants?sweetHow much does the birth weight increase by 4-5 months?doublesHow much does the birth weight increase by 1 years old?triplesWhat are primitive reflexes?-Root -Suck -Moro -Asymmetric tonic neck -Palmar grasp -Plantar grasp -Babinski -StepWhat are the protective reflexes?-Neck righting -ParachuteReflex where the infant's cheek is stroked and the infant turns to that side, searching with mouthRootReflexive sucking when nipple or finger is placed in an infant's mouthSuckWith sudden extension of the head, the arms abduct and move upward and the hands form a "C"MoroWhile laying supine, extremities are extended on the side of the body to which the head is turned and opposite extremities are flexedAsymmetric tonic neck or fencingInfant reflexively grasps when palm is touchedPalmar graspInfant reflexively grasps with bottom of foot when pressure is applied to plantar surfacePlantar graspWith one foot on a flat surface, the infant puts the other foot down as if to "step"Stepstroking along the lateral aspect of the sole and across the plantar surface results in fanning and hyperextension of the toesBabinskiErikson's Stage of Development for newborns/infantsTrust vs. MistrustErikson's Stage of Development for Toddlers (1-3 years)Autonomy vs. Shame and DoubtErikson's Stage of Development for Preschooler (3-6 years)Initiative vs. GuiltErikson's Stage of Development for School-Age child (6-12 years)Industry vs. InferiorityErikson's Stage of Development for Adolescents (10-20 years)Identity vs. Role ConfusionFine motor skills for 1 month oldFists mostly clinched Involuntary hand movementsFine motor skills for 3 month oldHolds hands in front of face, hands openFine motor skills for 4 month oldBats at objectsFine motor skills for 5 month oldGrasps rattleFine motor skills for 6 month oldReleases object in hand to take anotherFine motor skills for 7 month oldTransfers object from one hand the otherFine motor skills for 8 month oldGross pincer grasp (rakes)Fine motor skills for 9 month oldBangs objects togetherFine motor skills for 10 month oldFine pincer grasp Puts objects into container and takes them outFine motor skills for 11 month oldOffers objects to others and releases themFine motor skills for 12 month oldFeeds self with cup and spoon Makes simple mark on paper Pokes with index fingerA 3-year old comes in with a 102 fever, red pharynx, chills, and a rash on her hands and feet. She also has a sandpaper-like rash to her trunk. She was treated for strep 2 weeks ago. She likely has?Scarlet feverWhat is the treatment for scarlet fever?PenicillinWhat is a delayed sequela of group A streptococcal pharyngeal infection that usually develops 2-4 weeks after the initial strep infection?Acute rheumatic feverS/sx of acute rheumatic feverSydenham chorea (movement disorder of face and upper extremities) Classic rash - erythema marginatum (maculopapular rash with central clearing and raised edges) Subcutaneous nodules to the wrist, elbows, knees CarditisWhat is the treatment for acute rheumatic fever?A full 10 day course of penicillin along with corticosteroids and NSAIDs **Prophylaxis is continued into adulthood (monthly penicillin G benzathine IM injections or oral penicillin or erythromycin)Difference between scarlet and rheumatic feverScarlet fever has more localized effects while rheumatic fever attacks the joints, CNS, and heart!What is sickle cell anemia?a group of inherited hemoglobinopathies in which the RBCs do not carry the normal adult hemoglobin, but instead carry a less effective typeHow is sickle cell anemia trasmitted?Autosomal recessive inheritance (both parents have the trait)If both Mom and dad have sickle cell trait, but not the disease, what are the chances their 3rd child will have sickle cell disease?1 in 4 for every pregnancyTreatment of vaso-occlusive episodes in sickle cell disease-oxygen -hydration with IV fluids -monitor Hgb, Hct, reticulocytes -PRBC administration -antibiotics if infection presentSymmetric swelling of the hands and feet in the infant in sickle cell diseaseDactylitis - immediately report!!!Which of the following treatments would you anticipate for the 4-month infant admitted with RSV?Saline and suctionTreatment for viral upper respiratory infection or nasopharyngitis (common cold)?Normal saline drops or nasal spray Cool mist humidifier Adequate oral intakeTreatment for sinusitis?Normal saline nose drops or spray Cool mist humidifiers Adequate oral fluid intake AntibioticsTreatment for influenza?Antiviral drugs as prescribed (started within the first 48 hours)Treatment for pharyngitis or tonsilitis?Saline gargles Analgesics - tylenol or ibuprofen Throat lozenges Cool mist humidifiers Maintain hydrationWhat teaching would you provide a child with strep throat?The child may return to school 24 hours after starting antibiotics.Your patient comes to the clinic on 4/26/22 at 10:15am and is prescribed amoxicillin for strep throat. When can the child return to school?4/28/22This viral respiratory illness is characterized by a barky cough that is worse at night.CroupTreatment for croup?Exposure to humidified air (take the child to a steamy bathroom for 10 minutes) Dexamethasone Racemic epinephrine - lasts about 2 hoursTreatment for infectious mononucleosis?Analgesics Warm salt water gargles Corticosteroids to decrease inflammation of the throatIs epiglottitis is a medical emergency?YESTreatment for epiglottis?-Provide 100% oxygen in the least invasive measure -Ensure emergency tracheostomy equipment is at the beside -Stay with the patient -Do not place the child in a supine position!!Treatment for pneumonia?-Ensure adequate hydration for thinning of secretions -Head of bed stays elevated -Analgesics for pain -Supplemental O2What is the treatment for bullous impetigo?Antibiotics (oral first gen cephalosporins)What is used to treat localized Non-bullous impetigo?Mupirocin Remove honey-colored crust with cool compresses twice dailyTreatment for folliculitis?Warm moist compresses Topical mupirocin Oral antibioticsTreatment for cellulitis?IV cephalosporinsTreatment for staphylococcus scalded skin syndrome?IV antibiotics and IV fluidsTreatment for tinea capitis?Oral griseofulvin for 4-6 weeksTreatment for diaper candidiasis?Nystatin cream with each diaper changeTreatment for athletes foot?Topical antifungal cream, powder, spray for 4-6 weeksTreatment for diaper dermatitis?zinc oxide creamTreatment for eczema or atopic dermatitis?Good thick moisturizer (Vaseline, generic petrolatum, Aquaphor, Eucerin)Treatment for contact dermatitis (hypersensitivity reaction)?topical steroidsTreatment for psoriasis?Skin hydration, tar preparations, UV light, tazarotene (topical retinoid)Which of the following would the nurse expect the provider to prescribe for atopic dermatitis?Good thick emolient (vaseline, eucerin, Aquaphor)Give an example of trust vs. mistrust.A baby will learn to trust their caregiver when they feed and change them when they cry - they understand their needs will be met.What theorist gave us the trust vs. mistrust stage of development?EriksonGive an example of initiative vs. guilt.The preschooler likes to please parents and plans activities (uses their imagination). They feel remorse when making wrong choices or behaving badly.Name 3 teaching points to help a patient understand how to prevent a UTI.-Female- wipe front to back; drink enough fluid; drink cranberry juice to acidify urine; wear cotton underwear; avoid tight jeans or pants; wash perineal area daily with soap and water; change sanitary pads frequently while menstruating -Infant - frequent diaper changes -Adolescent - avoid caffeine (bladder irritant); void immediately after sexual intercourse -Infant/child - avoid bubble bathsWhat is your highest priority for a patient with thrombocytopenia?Prevent injury that may cause bleedingOther management for thrombocytopenia may include?-observation and reevaluation of lab values -avoid aspirin, NSAIDs, and antihistamines which can lead to anemia -Acetaminophen is best -Prevent trauma (no contact sports) -Teach parents signs/sx of bleeding and to whom to reportAn adolescent is admitted to your unit with a wound. What nursing care might you anticipate?•Cleanse wound •tDap? •Suture set-up vs. steri-strips •Self-harm evaluationName the maximum safe dose of ibuprofen and the age at which it can safely be administered to a child.Max safe dose is 10 mg/kg/dose Can be given starting at 6 moName the maximum safe dose of acetaminophen and the age at which it can safely be administered to a child.Max safe dose is 15 mg/kg/dose Can be given starting at 2 moName the ONE time you may receive an order to give a child aspirin.Kawasaki DiseaseWhat is Kawasaki Disease?An acute systemic vasculitis in the arteries, occurring most commonly in children 6 months to 5 years of age.S/Sx of Kawasaki Disease-Bilateral conjunctivitis without exudate -Dry, fissured lips -Strawberry (cracked and reddened) tongue -Pharyngeal and oral mucosa erythema -Diffuse, erythematous, polymorphous rash -Edema of the hands and feet -Erythema and painful induration of the palms and soles -Desquamation (peeling) of the perineal region, fingers and toes, extending to the palms and soles -Possible jaundice -Cervical lymphadenopathyName the other pharmacological treatment for Kawasaki's Disease.-Acetaminophen for fever management -Immunoglobulin (IVIG) **avoid MMR and varicella vaccine for 11 months after high dose IVIG administrationGlascow Coma Scale ratingsSevere Head Injury - GCS score of 8 or less Moderate Head Injury - GCS score of 9 to 12 Mild Head Injury - GCS score of 13 to 15What chromosomal abnormality is often associated with atlanto-axial instability?Down's Syndrome or Trisomy 21What diagnostic study is recommended for these patients at age 4-6?Cervical x-rayWhat is atlanto-axial instability?increased mobility of the cervical spine at the first and second vertebraeName side effects of albuterol.-Tachycardia -jittery feeling -palpitations -tremor -nervousness -muscle cramps -nausea -dizziness -insomniaWhich asthma medication is given first in the treatment of acute treatment of bronchoconstriction?Albuterol (short-acting bronchodilator)What are some triggers of asthma?-Tobacco smoke -Dust mites -pet dander -cockroaches -indoor molds -outdoor molds, pollen, and air pollutionWhat is phenylketonuria (PKU)?-Phenylketonuria (PKU) is a rare metabolic disorder. -Children with PKU can't process an amino acid called phenylalanine -As they continue to take in protein and phenylalanine through their diets, they may have growth, mood, behavior, and thinking problems, seizures as well as other problemsDiet restrictions for a child with phenylketonuria-Meat -fish -poultry -dairy -soy -dried beans -nutsFoods to eat for celiac disease-Potato, soy, rice, or bean flour -Cornmeal -Plain, fresh, frozen, or canned vegetables made with allowed ingredients -All milk and milk products except those made with gluten additives, aged cheese -All meat, poultry, fish, and shellfish -Dried peas and beans, PB, soybeans, cold cuts -butter, salad dressings, sauces, soups, and desserts with allowable ingredientsFoods to avoid in celiac disease-All wheat products, including rye, barley, oats -Any creamed or breaded vegetables, canned baked beans, some french fries -Some commercial fruit pie fillings and dried fruit -Any meats or poultry prepared with wheat products -Commercial salad dressings, soups, sauces, etc made with avoided products -Flavored instant coffeeYour 7 month old patient receives digoxin at 8am. What must the pulse rate be above before you can give this medication?90 bpmDigoxin Nursing Considerations-Prior to administering each dose, count apical pulse for 1 full minute, noting rate, rhythm, and quality -Withhold if apical pulse is <60 in an adolescent, or <90 in an infant -Avoid giving oral form with meals -Therapeutic range is 0.8-2 -Note signs of toxicity: nausea, vomiting, diarrhea, lethargy, and bradycardia -Ginseng, hawthorn, and licorice increases risk for toxicity -Give at regular intervals every 12 hours -If a dose is missed, give the next dose as soon as possible. If close to the next dose, withhold the missed dose -Monitor potassium levels (hypokalemia causes toxicity) -If the child vomits within 15 minutes, give the dose again. But do not repeat the dose a second time if the child vomits.Name teaching points for an adolescent taking NSAIDS.-GI upset - take with meals -monitor LFTs for long term use -do not use if severe kidney disease -watch S/S bleeding -do not give aspirin to anyone under 18 because of its link to causing Reyes syndrome -notify Dr. if stools become black and tarry or you see streaks of bloodYour patient is an adolescent with type 1 diabetes. She comes to you because she wants to know if it is safe for her to play sports. What is the appropriate answer?Yes it is safe!! Your patient will need to increase their food intake and keep a snack with them in case of hypoglycemia.Type 1 Diabetes Mellitus-Caused by a deficiency of insulin secretion due to pancreatic beta cell damage (autoimmune)Type 2 Diabetes Mellitus-Consequence of insulin resistance that occurs at the level of skeletal muscle, liver, and adipose tissue with different degrees of beta cell impairment -Pancreas produces insulin but the body is resistant to the insulin or their is inadequate insulin secretion responseWhy would you place an infant in elbow restraints post-op after cleft palate surgery???To protect the child's incision!!!!What items should not be placed in the infants mouth that has a cleft lip or palate?-suction catheter -spoon -straw -pacifier -plastic syringeWhat is your goal for a 4 year old patient diagnosed with nasopharyngitis?Symptomatic supportIs torticollis a medical emergency?NOWhat is torticollis?Torticollis is a condition where the child's neck muscles causes their head to twist and tilt to one sideKernig sign-Tested by flexing legs at the hip and knee, then extending the knee -Report of pain along the vertebral column and/or inability to extend the knee indicates irritation of the meningesBrudzinski sign-Tested by the child lying supine with neck flexed -Positive sign occurs if resistance or pain is met -Child may also passively flex the hip and knees in reaction, indicating meningeal irritationDecorticate posturinglate sign of increased ICP where the extremities are flexedDecerebrate posturinglate sign of increased ICP where the extremities are extended and pronatedHow long is clubfoot treated with serial casting?around 12 weeksT or F: A child with meningocele will likely be unable to walk and lack bowel or bladder continence.FalseMeningocele-less serious form of spina bifida cystica -meninges herniate through a defect in the vertebrae -spinal cord is usually normal -no neuro deficitsMyelomeningocele (spina bifida)-most severe form of neural tube defect -spinal cord often ends at the point of the defect, resulting in absent motor and sensory function beyond that point -children are at increased risk of latex allergies due to frequent catheterization -neural tube fails to close at the end of the fourth week of gestation -hydrocephalus occursMATH -Patient weight: 30 lb -Physician order: prednisolone 1mg/kg by mouth now -Pharmacy provides: prednisolone 15mg/5ml How many ml will you give the patient?4.5 mLMATH What is the maintenance fluid rate for a 78 lb child?75 mL/hrMATH Patient weight: 7kg Physician order: Ceftriaxone 50mg/kg IM now. Medication supplied: Ceftriaxone 1gr/2ml How many ml's will you give your patient???0.7 mLMATH An overly concerned Mom calls your after-hours nurse line and asks how much acetaminophen she can give her 8 month old who is showing signs and symptoms of teething. She reports that the child weighs 21 pounds. She has OTC acetaminophen 160mg/5ml at home.4.5 mLWhat is the bladder capacity of a newborn?30 mLFor pediatric patients, what oxygen delivery device is appropriate for delivering 1-4 liters of oxygen?pediatric nasal cannulaIt is ok to bribe peds patients with these?stickersI will draw my CBCs in this when I become a nursePurple/lavenderAn infant weighing 52 lbs needs maintenance fluids hung. At what rate would you hang the D5 1/2 NS?66 mL/hrMost pediatric IVP medications should be given with this syringe?3 mLIn tetralogy of Fallot, blood leaving the aorta will be what color?PurpleRed flag or green flag? My seven year old cannot hold his head up.REDWhat is the analgesic of choice for a patient in sickle cell crisis?MorphineThis electrolyte abnormality causes increased risk of digoxin toxicity.Hypokalemia

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Suppose that the classes Dog and Cat derive from Animal, which in turn derives from Creature. Suppose further that pDog, pCat, pAnimal, and pCreature are pointers to the respective classes. Suppose that Animal and Creature are both abstract classes.

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Animal a;

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An adiabatic air compressor is to be powered by a direct-coupled adiabatic steam turbine that is also driving a generator. Steam enters the turbine at 12.5 MPa and 500 $^\circ{}$ C at a rate of 25 kg/s and exits at 10 kPa and a quality of 0.92. Air enters the compressor at 98 kPa and 295 K at a rate of 10 kg/s and exits at 1 MPa and 620 K. Determine the net power delivered to the generator by the turbine.

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Challenge your knowledge of the ear by filling in the correct terms for the following definitions. Fill in the blanks.

Calcium particle in the vestibule ________________

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Two forces

\vec { \mathbf { F } } _ { \mathrm { A } } \text { and } \vec { \mathbf { F } } _ { \mathbf { B } }

are applied to an object whose mass is 8.0 kg. The larger force is

\vec { \mathrm { F } } _ { \mathrm { A } }

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0.50 \mathrm { m } / \mathrm { s } ^ { 2 }.

However, when

\vec { \mathbf { F } } _ { \mathbf { A } }

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\vec { \mathbf { F } } _ { \mathbf { B } }

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\vec { \mathbf { F } } _ { \mathrm { A } }

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\vec { \mathbf { F } } _ { \mathrm { B } }

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