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
, erythema, scaly, dry intense itching
Candidal diaper dermatitis
bright red rash involves the intertriginous folds with small "satellite lesions" along the
edges
Contact Diaper Dermatitis
irritant rash is secondary to diarrhea or irritation & is noted along contact areas
Cafe au lait spots
Smooth edged tan-to-brown pigmentations on the skin measuring <1-2cm at birth if >5
spots seen in neurofibromatosis
erythema toxicum
pink rash that appears suddenly anywhere on the body of a term newborn during the
first 3 weeks may be mistaken for herpes or staph infection
presents with a pinpoint vesicle (looks like flea bite)
Midline hair tufts over the lumbosacral spine region suggest a possible
___________.
spinal cord defect
Jaundice
<24hrs hemolytic disease of the newborn
2-3wks old suggest biliary obstruction or liver disease
breast feeding jaundice resolves 10-14 days
salmon patch
common vascular marking disappears by 1 year
port-wine stain
a flat vascular birthmark made up of dilated blood capillaries, creating a large, reddish-
purple discoloration on the face or neck (opthalmic branch)
sign of sturge-weber syndrome- associated with seizures, hemiparesis, glaucoma,
mental retardation
impetigo
bacterial skin infection characterized by isolated pustules that become crusted and
rupture
bullous or crusty yellow from pus
Millaria rubra
scattered vesicles on an erythamatus base of face and trunk due to obstructed sweat
gland
Pustular melanosis
transient benign rash -- small dry superficial vesicles over a dark macular base, leave a
hyperpigmented region when they rupture -- more common in african american infants
Milia
small raised white spots on nose, chin, and forehead due to retention of sebum in
sebaceous glands. disappear in weeks
Pityriasis Rosea
Presents with a herald patch, Christmas-tree pattern.
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