NR 509 Final

NR 509 Final Childhood immunizations Birth- Hep B, Flu 1-2 mos- DTap, Hep B(2), HIB, Polio, Pneumococcal, Rotavirus 3-4 mos- DTap (2), HIB (2), Polio (2), Pneumo (2), Rotavirus (2) 5-6 mos- Dtap (3), HIB (3), polio (3), pneumo (3), Rotavirus (3), Flu 7-11 mos- flu 12-23 mos- Varicella, DTap (4), HIB (4), MMR (1), Polio (3), Pnuemo (4), Hep A, Hep B (3), Flu 2-3 years- Flu 4-6 years- DTap (5), Polio (4), MMR (2), Varicella (2), Flu 7-10 years- Flu, HPV 11-12 years- Mening, HPV (2), Tdap (1) 13-18 years- Mening (2), Serogroup B Mening (2) Apgar scale a standard measurement system that looks for a variety of indications of good health in newborns. Score at 1 min and again at 5 min 3 pt scale (0,1,2) score ranges 0-10 HR: absent- 100- 100 Resp: Absent- slow- good Color: Blue/pale- Pink body/blue arms- pink Muscle tone: Flaccid- Some flexion- Active Reflexes: None- Grimaces- Vigorous Cry Gestational Age Assessment Performed within 2 to 12 hr of birth Newborn Measurements and New Ballard Scale Gestational age estimation and baseline to assess growth and development. *Neonatal morbidity and mortality are related to gestational age and birth weight. Large gestational age above 90th percentile risk for hypoglycemia- s/s include jitteriness, irritability, cyanosis small gestational age 10th percentile babies who weigh substantially less than is normal for whatever their gestational age May be caused by fetal, placental, maternal factors, maternal smoking Preterm appropriate gestational age at risk for respiratory distress, apnea, patent ductus arteriosis (PDA) with left to right shunt and infection Preterm small gestation age at risk for asphyxia, hypoglycemia, hypocalcemia tremors after 4 days old suggest CNS disease, asphyxia, drug withdrawal, central or peripheral neurologic defect, or birth injuries s/s include asymmetric movements of arms or legs failure to thrive 1) growth 5th percentile 2) drop 2 quartiles in 6 months 3) weight for length 5th percentile Causes include environmental, psychosocial, GI, neurologic, cardiac, renal, and endocrine diseases Macrocephaly 95th percentile or 2 standard deviations above mean Hydrocephalus, subdural hematoma, brain tumor, inherited familial, megaloencephaly Causes of HTN in newborns renal artery disease (stenosis, thrombosis), congenital renal malformations, coarctation of aorta Polycythemia A disorder characterized by an abnormal increase in the number of red blood cells in the blood Ruddy complexion- reddish/purple Cutis marmorata Lattice-like, bluish mottled skin seen in premature infants, hypothyroidism, down syndrome Acrocyanosis Temporary cyanotic condition, usually in newborns resulting in a bluish color around the lips, hands and fingernails, feet and toenails. May last for a few hours and disappear with warming. If color doesn't return to normal in 8 hours consider congenital heart disease harlequin dyschromia Occasionally in newborns there is a transient cyanosis over one half of the body or one extremity, presumably from vascular instability African American newborns skin tone light except for nailbeds, genitals, and ear folds which are dark Dark/Bluish pigment over buttocks lower lumbar (slate blue patches) Neonatal acne red pustule/papules over cheeks and nose of newborns seborrhea salmon red, scaly eruption on face, neck axilla, diaper area, and ears atopic dermatitis