Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
wvc peds lecture
wvc peds lecture Visser
| Question | Answer |
|---|---|
| Growth | – increase in physical size or a quantitative change |
| Development | – increase in skill or ability to function (qualitative change or maturation) |
| Factors Influencing Growth & Development | Genetic; Gender; Race & nationality; Intelligence; Health; Environmental Influences. |
| Principles of Growth & Development | Continuous process from conception to death; Proceeds in orderly fashion; Predictable stages occur, but @ different rates/times; Body systems do not develop @ same rate (Cephalocaudal &Proximal to distal body parts) |
| Growth Proceeds from | gross to refined skills |
| Play is the work of the child | Child practices complicated, stressful process of living, communicating & achieving satisfactory relationships w/ others; Play is the universal language of the child |
| Role of adult in play is to be | Sensitive; Understanding; Accepting; Facilitator of opportunities for play |
| Erickson’s Theory of Psychosocial Development Each state has specific central conflict or developmental task | 8 tasks; divided into stages of development; described in terms of a positive or negative resolution; Actual resolution of a specific conflict lies somewhere along a continuum between a perfect positive & a perfect negative |
| Erickson’s stages are | Infant: trust vs mistrust/ toddler: autonomy vs shame/ preschool l: initiative vs. guilt/ School-age: industry vs inferiority/ adolescent: identity vs. role confusion. |
| Paiget’s Stages of Cognitive Development Sensorimotor (0-2 years) | learns by doing, reflexive behavior, object permanence….(if mom steps out of room child thinks mom is gone) |
| Paiget’s Stages of Cognitive Development Preoperational (2-7 years) | egocentric abstract ideas, reality based, magical thinking, beginning cause/effect reasoning, uses symbols |
| Paiget’s Stages of Cognitive Development Concrete operational (7-12 years) | Classify; Collect; Master facts |
| Paiget’s Stages of Cognitive Development Formal operational (>12 years) | Abstract ideas; Reality based |
| Freud’s Theory of Psychosexual Development | Oral (0-1 yr); Anal (1-3 yr); Phallic (3-6 yr). Id w/ parent of opposite sex (By end of stage, id w/ parent of same sex); Latency (6 -12 yr). Provide privacy. (Calm before storm); Genital (12-18 yr). Focus on genital function & relationships. |
| Principles of Communicating with Children Key Concepts | Communication is a set of behaviors (verbal and nonverbal) by which one individual consciously or unconsciously affects another/ Children are more similar to adults in feelings; less similar to adults in thinking. |
| When communicating with children | Nurse must learn to understand and to convey understanding of child’s experiences from his point of view. |
| Children view Nonverbal Behavior as : | Perceived as more believable than verbal behavior in conveying messages; Tactile stimuli seen as most important in conveying care for a person |
| Children make judgments on who you are through nonverbal cues | Nurse’s interest conveyed by: wearing something other than all white; planning movements; opportunity to observe; explaining info before touching them; maintaining eye level communication; keeping soft, even voice; interested face. |
| Combination of verbal & nonverbal behaviors | Necessary to enhance complete communication Requires active listening & observation; Requires stimulation of varied sensory receptors |
| Truthful, concise, relevant messages | Give positive “Do” messages versus “Don’t”; Offer TRUE choices; NEVER make promises that you are not SURE you can keep; Prepare child in advance; Actively listen for feelings & intent of child’s message, not just the content; Use interpreter. |
| Assessment of the Child’s Health Status | Goal in assessing kids is the same, whatever the environment (hospital, clinic, camp, school, day care, home) -to determine how sick the child is and what kind of intervention he needs. |
| Three parts to assessing | the across-the-room assessment; the head to toe physical assessment; the pt’s medical history |
| Across the Room Assessment Takes place as nurse asks parents about the child & what brings the child to be seen | general appearance; ABCD’s; Awake & alert? Or sleepy & confused?; (Red flags: dyspena; Apnea; Active bleeding; Altered LOC; “He just doesn’t look right”; STOP ASSESSMENT; Ask for help; Caution fits hand in hand w/ safety |
| Head to Toe Physical Assessment Airway | Infants: up to 6 wks old – obligate nose breathers; smaller narrower airway makes children more susceptible to airway obstruction & R distress; laryngospasm & bronchospasm may lead to airway obstruction in preschoolers. |
| respiratory distress at the assessment | – can lead to cardio/pulm arrest & death; Watch R rate. Rate > initially w/ R distress, but < later because of FATIGUE & worsening HYPOXIA; Drop in rate ‘tricks’ caregivers into thinking child’s condition has improved; Know norms (different from adults!) |
| ATI pages 19 and 20 | child 75-100 bpm/ newborn 110-160 bpm / adolescent 60-90 bpm |
| What can bring about tachypnea besides R distress? | dehydration, |
| What can bring about bradypnea? | medications, |
| Children rely heavily on diaphragm for breathing | Places them @ high risk for Respiratory failure if diaphragm is unable to contract – abdominal distention, for example can contribute to respiratory failure. |
| Breathing concerns in PEDS (Tongue larger in proportion to mouth, making it more likely obstruct the airway if child is unconscious.) | Lower tidal volume (less pulmonary reserves);Intercostal muscles aren’t as well developed and therefore less able to help with breathing. |
| When ascultating breath sounds, | All lung fields; Child’s chest wall thin & breath sounds easily transmitted; If hear wheezing, suspect lower airway obstruction; Bilateral wheezes suggest asthma or bronchiolitis; Unilateral wheezes may indicate foreign body aspiration |
| Stridor on inspiration = | upper airway obstruction |
| Stridor that is high-pitched = | croup or foreign body aspiration Stridor is lower-pitched & muffled in epiglottitis |
| Decreased breath sounds or no breath sounds: suspect | Pneumothorax, hemothorax, atelectasis, or pneumonia; |
| Grunting on expiration a late sign of severe R distress, Cause: | chest wall contracting & glottis closing too early during expiration |
| Flaring = | respiratory distress |
| Retractions of sternum = | respiratory distress |
| Two terms describing respiratory distress | GFR = grunting, flaring, retractions/ IWR = increased work of breathing |
| Circulation (Smaller lung capacity & underdeveloped intercostal muscles give children less pulmonary reserve.) Clues to look for | Color and temperature; Cap refill; Strength of central & peripheral pulses; |
| Color on assessment | Pallor = < oxygenation; Cyanosis = severe R distress (1/2 blood must be deoxygenated before cyanosis is evident…child would be in real trouble); Check w/ parents re: child’s usual color; Heart defects = typically cyanotic |
| Fluid volume (Most of infant’s body wt is H2O so vomiting & diarrhea can quickly lead to fluid deficit) (Circulating blood volume less so even small blood loss can be dangerous (lead to shock) | ALERT: children can hemorrhage longer before experiencing a drop in BP; Hypotension, late sign of shock & ALWAYS an emergency; Earliest sign of shock in children = tachycardia |
| Bulging fontanel suggests | increased intracranial pressure. |
| Sunken fontanel may mean | dehydration |
| Greater metabolic rate & larger trunk relative to rest of body make children more prone to | dehydration & hypothermia. |
| Thermoregulation (Infants have an unstable temperature control mechanism, so mottling of extremities is common) | With fluid loss, become hypothermic d/t child’s higher metabolic rate & larger trunk relative to rest of body (% of water greater than in adult) Keep warm (Only expose part of body assessing) |
| D = disability = Neurologic Keys to Assessment (Listen to parents, since they know child best) | Assess LOC; Hypoxic, may be irritable or agitated initially, but increasingly lethargic later; Progressive drop in LOC is late sign of hypoxia and may indicate severe R distress |
| Other factors leading to decreased LOC | Shock, sepsis, ingestion of depressants, metabolic abnormalities, hypothermia, & head injury; Report any change in LOC to MD immediately!; Report other abnormal neurologic findings immediately!Unequal or unreactive pupils; Extreme irritability; |
| Making Sense out of Cardiac S & Sx | Arrhythmia; SVT most common arrhythmia in children under 1 year; Poisoning or underlying congenital heart dz; Tachy (140-160) can lead to < cardiac output; Do not overlook just cause rate normally > in kids; Brady (< 60) always an emergency |
| Child’s heart less muscle mass than adults; Can’t significantly increase stroke volume (amount of blood ejected from ventricle @ each contraction) | Stroke volume becomes inadequate when heart rate falls; Leads to drop in cardiac output & eventually cardiac arrest if cause of brady isn’t corrected (Most common cause = hypoxia) |
| Hypertension May be: | increased intracranial pressure; Coarctation of aorta (narrowing of aorta); Renal dz |
| A Word about Vital Signs | show patterns; Monitor frequently, particularly after interventions so can be monitored; BP – make sure width of cuff 2/3rds length of child’s upper arm. (large = too low; sm = too high); Weight important D/T weight base meds |
| Children’s baseline temperatures change as they grow | Temp: Most common reason parents seek health care for their children; Viral infections most common cause of fever in kids; Although fever itself usually isn’t dangerous, it can be a sign of serious infection in kids < 3 months; Have these babies come in. |
| Level of hydration | Mucous membranes; Skin turgor; Ask about v/d (because most of an infant’s body wt is water, dehydration can quickly occur) Child < 18 months, to assess hydration check anterior fontanel. Sunken or depressed if dehydrated. |
| Assessment of Chest and Abdomen Check for asymmetrical movement of chest | Sign of rib fx, rare in children & usually r/t abuse; Look for abdominal distention; Sign of malnutrition, intestinal blockage or tumor; Listen to bowel sounds; Order of GI assessment: |
| Consider Abuse (Consider abuse if see lots of bruises in various stages of healing, or other suspicious injuries like burns or belt marks on chest, back, or buttocks.) | Signs of sexual abuse; Bruising or tears around anus or vagina; Sexually precocious behavior; Mandatory reporting of suspected child abuse; Extremities; Assess for bruising, swelling, discoloration, or pain (May suggest strains, sprains, or fractures) |
| Patient’s Medical Hx (Obtain hx: some info before and rest of info as you do your head-to-toe assessment) | Biographical info, chief complaint, hx, system by system, past hospitalizations, nutrition, psychosocial; Rely on parents for info; Listen to their impressions of child’s behavior; Family involvement is key to nursing process |
| Communication is key to obtaining data | “Tell me about “; “What is Clair eating now?”;“You were starting to say . . .”; Minimum verbal: maximum listening; Keep in mind development age; Always introduce self, insure privacy & confidentiality; Avoid idle talk w/ colleagues. |
| When English is not First Language | Use interpreter when needed; Avoid asking more than 1 question at a time; Direct conversation to pt, not interpreter; Plan enough time for communication; Avoid medical jargon (for any patient) |
| Adolescent concerns | Substances: “When was the last time you had a drink or took drugs?”; Sexuality: “Tell me about your social life.”; Avoid asking if sexually active cuz this term is too vague; “Are you having sex with anyone?” |
| Approaches (By developmental level (of course) | In general, do not ask parents to restrain the child for any painful procedures; Save most invasive for last; Save anything painful for last; Generally follow head to toe procedure |
| Specific Physical Exam Techniques Body Measurements: Plot ht & wt on standardized graph; Normal = trend of progressive > & values between 10th and 90 percentile | Measure head circumference @ occipital protuberance & supraorbital prominence & chest circumference @ nipple line. Double weight by 4-6 months; triple by 1 year. |
| Specific Physical Exam Techniques Vital signs | oral 3yrs; Ax temps infants after initial Rectum temp; . Ax temps in children; Aural temps not in newborn (wet canal); Apical P more accurate in up to 2yrs; femoral pulses in newborn to r/o coarctation of aorta; Count R for 1 min infants b/c variability; |
| Specific Physical Exam Techniques Skin | note color & texture; Be alert for abuse marks (patterns are a clue); Many variations of normal; freckles, mongolian spots in dark skin; In newborn examine hands & feet for |
| Specific Physical Exam Techniques Head | Asymmetrical head not uncommon @ birth; Posterior fontanelle closes approx 2 months; Anterior fontanelle closes approx 18 months; Fontanelles should not be indented or bulging unless baby is crying.; fontanelles allow brain to expand. |
| Specific Physical Exam Techniques Visual System Examine eyes in dimly lit room: | Holding infant upright, suspended under its arms, over a shoulder encourages infant to open its eyes. Adult visual acuity achieved by 6 years of age; Medial & lateral canthi should be hortizontal ; “Red reflex” present. |
| Specific Physical Exam Techniques Auditory System | Top of ear pinna should be in line w/ inner & outer canthus of eye; Wong 1006; Pull auricle down & back for child< 3 yrs; up & back > 3 years; Usually examine ears, nose & throat until the last; Evaluate response to sounds(crinkle up paper) |
| Specific Physical Exam Techniques Mouth May need to try to examine while child is crying. If child refuses to open mouth, slide tongue blade through lips to back molars.) | Encourage child to smile, first, to examine mouth. Assess oral mucosa & gingivae for color, moisture, lesions; do not examine mouth/throat of child w/ epiglottitis (could completely obstruct airway) |
| Specific Physical Exam Techniques Neck | lymph node swelling – sequence; ears, jaw, occipital, cervical chain in neck |
| Specific Physical Exam Techniques Cardiovascular System | Acrocyanosis common @ birth; Normal BP infant 65/41; Assess heart when quiet; “S1>S2 @ apex: S2>S1 @ base”; Sinus arrhythmia common in children & w/ stresses, HR varies more than adults; S3 may be normal in some children |
| Murmurs | relatively frequent until 48 hrs after birth; Report any murmur occurring after birth that was not present initially |
| Peds heart rates are: | HR 110-160 newborn and 100-160 infant; HR pre school 80-110 & school age 75-100; HR 60-90 adolescent (Vigor & quality of heart sounds are major indicators of heart funx in newborn) |
| Find the heart apex | . Apical impulse usually 4-5 ICS just medial to MCL on left; S2 higher pitch & more discrete than S1; Vigor & quality of heart sounds are major indicators of heart funx in newborn; |
| Specific Physical Exam Techniques Respiratory System | Initial assessment is the APGAR; Report any nasal flaring, retraction, grunting (GFR) or unequal chest movements; To assess in newborn: use stethoscope plus hand on abd – rise & fall cuz.; Variability is normal. |
| Specific Physical Exam Techniques Abdomen/GI System ( assess when child is quiet, toward beginning of exam) | Palpate abd w/ legs of infant flexed; Visualize underlying structures; Cord falls off within 14 days; Abdomen rounded until school age; Meconium Indicates patent anus.; |
| Stools in the newborn | Breast fed newborn 6-8 stools/day, formula 4-6/day |
| Teeth in the child | By 12 months, 6-8 deciduous teeth; complete set by 2 ½ -3 years of age. Deciduous teeth replaced by permanent teeth by age 12-16; Wisdom teeth appear between age 18-25. |
| Specific Physical Exam Techniques Genitourinary System | inspection & palpation of genitalia; (Wong 1018 palpation of scrotum for descended testes); Genital hypertrophy (both sexes) & vaginal discharge (girls) occur secondary to maternal hormones & completely disappears by 1 month. |
| Urination patterns in the child | Newborns void 2-6x (small amounts) 1st 24 hr; then 8-10 x a day; Nighttime control by 5 years. Bowel training easier than urine; Maturational changes of sexual development begin at 10-12 years of age |
| Specific Physical Exam Techniques Musculoskeletal System | Observe child @ play; Child’s legs are straight & gait is smooth & coordinated; Palpate bones & muscle tone, evaluate for symmetry;; Beginning in 5th grade, scoliosis screen. Spine straight when child bends forward. |
| Infant musculoskeletal assessment | Evaluate muscle strength by holding infant upright w/ hands under axillae; Perform Barlow-Ortolani maneuver to detect hip dislocation. Gluteal folds symmetrical; Adduction of forefoot can be easily straightened. R/T position in uterus |
| Specific Physical Exam Techniques Nervous System (Generally suspect neurologic problems in the young because they are NOT doing something they should be doing ) | Ballard scale Assessment for gestational age to evaluate neuromuscular development; Observe level of activity & responsiveness to environment; Denver Test also used to evaluate development |
| Assessing Nutritional Status | General Growth, Skin, Hair, Head, Neck, Eyes, Ears, Nose, Mouth, Chest, Cardiovascular System, Abdomen, Musculoskeletal System, Neurologic system; Dietary intake; History Taking; Specific questions for parents of infants; Biochemical analysis |
| Denver II Prescreening Developmental Questionnaire | for parents about their children’s development; “Tracks” child from birth to 6 yrs; Signals “delays”; No delays = child developing normally; “Delay” = cannot perform an item which is passed by 90% of children of same age. |
| D. Disease prevention consists of assessing child, family & community health risks & planning for reduction of those risks to maintain homeostasis | Primary prevention – anticipatory action; Secondary prevention – early detection & treatment; Tertiary prevention - rehabilitation |
| Stress Awareness & Management Goals | Wellness goal: to reduce & mediate stress situations to promote self-control, self-competence and satisfaction; Prevention goal: to reduce stress to minimize risks of illness |
| Stress Behaviors/Management Infant – what does stress look like? | crying; sudden changes in temperment , changes in sleeping or eating patterns, clinging behavior// |
| Infant – what does management look like? | regular schedules; Consistency; Secure confinement (wrapped snugly); Calming behaviors; Allow sucking & hand-mouth contact; Anticipate needs; Allow familiar objects from home; Make positive statements; Allow self-expression; Ignore temper tantrums |
| Stress Behaviors/Management Toddler: what does stress look like? | Separation anxiety (common in toddlers)(protest, despair in crying – wailing); Tantrum, negativism, biting, regression. ( Warm, loving communication; Clear family rules; Limit setting; Time out; Reward good behavior) |
| Stress Behaviors/Management Preschool: what does stress look like? | sep. anxiety may persist; feel illness is punishment, night fears, outbursts, aggression, fantasy, imaginary friend, protests, complaining, withdrawal. Preschool: management of stress: same as toddler; plus use clear, simple concrete - words to explain |
| Stress Behaviors/Management School age and adolescents: what does stress look like? | Worries about missing school & peer group; Concerned about body image/function; Mood swings; Regression; Controlling behavior; Uncooperative; Withdrawal// |
| Adolescent What does stress management look like? (Allow increasing independence within limitations of safety and well-being) | Use support sys., Cog. mastery, Accept individual, Avoid unreal expectations/ excessive competition, Limit setting, Clear family rules, Involvement in decision-making, Reasoning, Withholding priv., Contracting, Respect priv., Clear comm., Active listening |
| Health Promotion Education Infant | Teaching directed towards parents (child in sensorimotor stage) |
| Health Promotion Education Toddler and Preschool | Limit teaching for the child to activity, not rationale (child in preoperational stage) |
| Health Promotion Education School age (child in concrete stage) | Conceptualize the past, present & to some degree, the future; judge actions & separate intent, cause & outcome |
| Health Promotion Education Adolescents (formal operational) | Capable of abstract thinking, comprehending complex analogies and reasoning; Lack futuristic thinking and believe they are invincible |
| Hepatitis B vaccine | (3) Birth, 2 months, 6-18 months |
| Rotovirus Vaccine | (3) 2, months, 4 months, 6 months |
| Diphtheria, Tetanus, Pertussis vaccine DTaP | (5) 2, months, 4 months, 6 months, 15- 18 months , 4-6 years |
| Haemohilus influenza type b vaccine Hib | (4) 2, months, 4 months, 6 months, 12-18 months |
| Pneumococal vaccine PCV | (4) 2, months, 4 months, 6 months, 12-18 months |
| Inactivated Poliovirus vaccine (IPV) | (4) 2 months, 4 months, 6-18 months, 4-6 years |
| Influenza vaccine | 6 months (yearly) |
| Measles, Mumps, Rubella (MMR) | (2) 12-18 months, 4-6 years |
| Varicella | (2) 12-18 months, 4-6 years |
| Hepatitis A HepA | 12-24 months (2 doses) |
| Hepatitis B vaccine | (3) Birth, 2 months, 6-18 months |
| Rotovirus Vaccine | (3) 2, months, 4 months, 6 months |
| Diphtheria, Tetanus, Pertussis vaccine DTaP | (5) 2, months, 4 months, 6 months, 15- 18 months , 4-6 years |
| Haemohilus influenza type b vaccine Hib | (4) 2, months, 4 months, 6 months, 12-18 months |
| Pneumococal vaccine PCV | (4) 2, months, 4 months, 6 months, 12-18 months |
| Inactivated Poliovirus vaccine (IPV) | (4) 2 months, 4 months, 6-18 months, 4-6 years |
| Influenza vaccine | 6 months (yearly) |
| Measles, Mumps, Rubella (MMR) | (2) 12-18 months, 4-6 years |
| Varicella | (2) 12-18 months, 4-6 years |
| Hepatitis A HepA | 12-24 months (2 doses) |
| Wellness Issues for the Infant (1 month to 1 year) Growth & Development Physiological | Immature body systems; Differences in body fluid levels |
| Infant Communication | Behaviors – sensorimotor stage; Crying w/ differentiation; Cooing and babbling; Smiles; Imitates speech, can generally say two words by 12 months |
| Helpful communication techniques with infants | Skin touch; Gentle, relaxed, calm soft voice; Signing; Use of recording of parent’s voices; Familiar toy/ blanket; Maintenance of home routine: soothing & sleep-inducing behavior; Hold upright w/ parent in view; Prompt responses to infants’ communicating |
| Infant Play is initially narcissistic & dependent By 6 months play more sophisticated & involves sensorimotor skills; Play is solitary or one-sided, but infant needs to be played with for developmental growth. | Peek-a-boo by 10 months; Interaction; 0- 6 months: |
| Infant appropriate toys | mobiles (especially bB&W or brightly), crib mirror, rattles, stuffed toys, rocking cradle or swing; 6-12 months: colored blocks, ‘nested’ boxes or cups, strings of large beads, large ball, large puzzles, squeeze toys, teething toys, push-pull toys, swing |
| Infant Developmental Task (Erikson) Trust vs mistrust: Nursing implications | Assist parents in feeling confident w/ parenting skills; Promote love & interaction w/ child; Encourage routines & consistency in care & care giver; Encourage gently, reassuring handling of infant |
| Cognitive Development (Piaget) Sensorimotor (0-2 years) Characteristics | Learns through the senses; touches/manipulates objects: Some sense of cause & effect; Learn separate identity; Beginning object permanence |
| Nursing implications for sensorimotor & trust vs mistrust stage of development | Safety; Health Promotion; Prevent aspiration; Prevent falls; Immunizations; Screenings at birth; |
| Teething | Acetaminophen (Calculated by weight) Kids are miserable; Teething tablets: not harmful; ora-gel not recommended; Wash cloth recommended (wet a corner; freeze, then have child suck/chew on it) |
| Thumb sucking: | normal; not thought to affect jaw line as long as stops by school age |
| Temperatures: | Tylenol (acetaminophen) by weight; Motrin (ibuprophen) use when Tylenol is not working; Fluids: Mom’s assignment give fluids; Gatorade: Not under age 2 months; Pedialyte: < age Non flavored 6m-1 yr |
| Is baby dehydrated? | ant. Fontanel sunken? skin (abdomen) ‘tents’? mouth mucus membrane dry? lips dry and /or cracking? |
| Colic (Triad of “3’s”) | 3 mon.; lasting up to 3 hours/day; occurring @ least 3 days q week; Treat baby & parents/ stressful/frustrating; decrease parents’ anger -> baby; Consider small, freq. feedings adequate burping; position baby on abdomen over a rolled towel on parent lap. |
| Spitting up: | assess quantity, what it is associated with, duration of spitting up |
| Sleep problems | “Back to sleep” campaign to avoid SIDS |
| Nursing caries, nursing bottle caries, bottle-mouth caries, (old name: Baby bottle syndrome) | Bottle of milk or juice @ nap or bedtime; Milk ‘pools’ in mouth; Caries formation Prevention: avoid nap/bedtime bottle; substitute water for milk |
| Wellness Issues for the Toddler(1 to 3 years) Growth & Development Physiological | gains 5-6 lbs & grows 5 inches a year; By age 2, birth wt quadrupled and ht is ½ adult ht; Immune system mature for IgG & IgM; Gross motor develops rapidly: running, riding toys; Developmental Milestones; |
| Communication (Wellness Issues for the Toddler(1 to 3 years) | Behaviors, Favorite word often in “No”; Spontaneous vocalizations, echolalia(repeating), and expressive jargon (unintelligible but sounds like normal speech – correct intonation)/ Attempts to use adult language to communicate |
| Helpful Communication Techniques (Wellness Issues for the Toddler(1 to 3 years) | Interact w/ child to provide practice talking; Read to child; Answer child’s questions |
| Developmental Task (Erikson) toddler: Autonomy vs shame | or doubt Nursing implications Encourage independence & beginning problem solving while providing for safety/ Understand that toddler’s recognition of self as separate individual & desire for autonomy may look like defiance & stubbornness. |
| Toddler Cognitive Development (Piaget) Characteristics Transition to preoperational thought | trial and error; solve basic problems; Draw conclusions only from obvious facts/previous cause & effect relationships |
| Health Promotion Promote Toddler Safety | Emphasize preventing aspiration, drowning accidents, falls, accidental poisoning, burns |
| Toilet Training | Individual task to Physiologic development – when child walks well, independently/ Cognitive development – child understands what is being asked , Avoid starting too soon, start w/ 2 week trials; start w/ bowel training; avoid making feel shameful/ dirty |
| Negativism (Wellness Issues for the Toddler(1 to 3 years) | Normal for toddler; Frustrating for parent ; Part of learning how to become independent & think independently; Avoid yes/no questions; offer two reasonable choices |
| Temper Tantrums (Wellness Issues for the Toddler(1 to 3 years) | Toddler does not have the cognitive ability to express feelings related to developmental stage/tasks. Explore reasons for tantrums: Unrealistic parent demands; Constantly being told “No” or “Stop doing that”, |
| Separation Anxiety | Fear of being separated from primary care givers starts around 6 months of age and persists through preschool period. |
| Wellness Issues for the Preschooler (3 to 5 years) growth & Development Physiological | Weight gain 5 |
| Communication Behaviors – preoperational stages (2-7 yrs) | 3 yr-old vocabulary of 900 words; 4 yr-old, 1500 words; 5 yr-old, 2100 ; Asks many questions. “Why?”; Uses words to shock; Talks to self; If bilingual home, learning 2 languages |
| Helpful Communication Techniques with the preschooler | To > vocabulary; 1 word per year + 1; Interact; Answer questions; Read aloud to child; Avoid multiple meaning words, complex words; Use truthful, simple, direct, concrete answers to children’s concerns |
| Play in the preschooler | Especially enjoy associative play; Play together & engaged in similar activity, but no organization leadership or mutual goal; Materials are shared, somewhat; Most characteristic preschool play is imitative, imaginative & dramatic; Short attention span |
| Imaginary playmates often appear in the preschooler | A friend to help w/ loneliness; A friend to be a scapegoat to avoid punishment; Someone to be in charge of (safe); Parents should acknowledge & accept playmate, but should not allow child to avoid punishment or responsibility. |
| Developmental Task (Erikson) Initiative vs guilt Nursing Implications | Encourage joy of learning; Expose to variety of experiences & play materials to foster creativity; Avoid “taking over” for child; Avoid “competing” w/ child; Support imitation & fantasy, but reassure child & help separate fact from fantasy |
| Preschooler Cognitive Development Preoperational | Characteristics; Egocentric; Concrete, rigid, inflexible thinking; Global organization; faulty reasoning/conclusions d/t ; no awareness of reversibility; ) centering on a single aspect of something (ex, O2 mask) |
| Promote Preschooler Safety | No rides from strangers; careful on “bicycles”: streets, cars;, Curiosity & imitation > risk of injury; Kidnapping; ADLs; Night time fears & vivid imagination; Bruxism (grinding teeth) @ noc; Hot H20 temps:; Drowning in tub (stay w/ child); Immunizations |
| Common Fears of the Preschooler (vivid imagination factor) | Fear of the dark; Fear of mutilation; Fear of separation or abandonment; Behavior Problems; Telling tall tales; Imaginary friends; Difficulty sharing; Regression; Sibling rivalry; prepare child for new sibling; prepare child for daycare or school |
| Wellness Issues for the School-age Child (6 to 12 years) growth & Development | Physiological; Weight: grows ~ 4.4-8.8 lb/year; Typically, wt gain between 10-12 yr prior to changes in ht that come after that; Ht: grows ~ 2 inches/year; Sexual maturation begins; |
| School aged children Cooperative play is organized | Child plays in a group w/ other children (team play); Also enjoys quiet & solitary activities; (hobbies, collections). Alone play allows ego mastery; Examples: team sports, clubs, board games, reading to self & being read to; cooking, sewing |
| Developmental Task Industry vs inferiority Nursing Implications | Encourage sense of accomplishment (“industry”) by assigning small chores w/ obvious results when the task is appropriate; Reward curiosity when child asks how to do something by explaining; Give frequent praise. |
| Concrete Operational Thought Characteristics | Concrete solutions for problems (systematic reasoning); Can classify & organize objects (moving away from magical thinking); Aware of “reversibility”, conservation, constancy, accommodation. |
| Nursing implications: Health Promotion for the School-age Child Promote School-age Safety | Accidents (result of not using common sense); Abuse; Safety equipment (bike helmet); Immunizations |
| Common Parental Concerns & Health Problems in preschoolers | Dental Caries: promote regular dental hygiene & dental care from infancy on; Malocclusion; School phobia (May be separation anxiety, situation @ school, over protectiveness, or other Keep going to school |
| Growth & Development in adolescents | puberty; Female: begins w/ growth spurt @ ~ age 10; Male: begins w/ growth spurt @ age 13; Privacy just one nursing implication; Cessation of body growth |
| Adolescent Communication | Behaviors – formal operation stage; |
| Helpful Communication Techniques with adolescents | Genuineness, honesty, acceptance; Privacy; humor; Explanations of scientific rationale for & significance of treatments; Promotion of problem solving by adolescents themselves; Listening more than talking; Use influence of peers |
| D. Developmental Task (Erikson) Identity vs role confusion Nursing Implications | Assist in accepting changes (body image); establishing a value system; making a career decision; becoming emancipated from parents; achieving a sense of intimacy (closeness); Educate about their bodies |
| Cognitive Development Formal Operations Characteristics | Can deal w/ abstract concepts; Can solve hypothetical problems w/ scientific reasoning; Can form & test hypothesis; Can think beyond present to past/future (but don’t always). |
| Health Promotion for the Adolescent | Motor vehicle crashes: leading cause of death; Homicides, 2nd leading cause of death; Suicide is 3rd leading cause of death |
| Common Health Problems in the adolescent | Poor posture/scoliosis; Fatigue (r/o anemia, mononucleosis, preg); Acne; Skin care, meds, Menstrual Irregularities; Hypertension; Malnourishment (under or over); Substance abuse; Sexual experimentation/STD’s; Pregnancy; Suicide; Runaways |
| Acquired Immunity | immunization has been Credited w/ Elimination & Control of many Serious Infectious Illnesses; Acquired immunity can be natural or artificial & be obtained actively or passively |
| Active Immunity | when the child gets a dz & develops antibodies against that dz |
| Artificial immunity, | which is obtained w/immunization; Antigen is introduced into the body as a accine, |
| Antigen stimulates body to produce | antibodies against that specific dz without causing the dz. Some immunizations require more than one dose to achieve immunity |
| Passive Immunity | Natural immunity is obtained by the neonate from the mom (in utereo); Immunity only last a few months; Measles immunity lasts up to 1 year; MMR immunization timed to match |
| Artificial immunity | which is obtained when antibodies, in the form of immunoglobins, are administered when an individual is exposed to a dz & requires protection more quickly than the body could respond to the agent |
| Vaccines Inactivated | vaccines composed of micro-organisms that have been killed w/ chemicals/ heat & are not infectious. micro-organisms are dead. Ex. vaccines against flu, cholera, bubonic plague, & hepatitis A. Most vaccines of this type are require booster shots. |
| Vaccines Live, (attenuated) | vaccines are composed of micro-organisms that have been cultivated under conditions which disable their ability to induce disease. These responses are more durable and do not generally require booster shots. Examples include yellow fever, mmr |
| Vacines Toxoids are | inactivated toxic compounds from micro-organisms in cases where these (rather than the micro-organism itself) cause illness, used prior to an encounter with the toxin of the micro-organism. Examples of toxoid-based vaccines include tetanus and diphtheria. |
| Subunit vaccines: composed of | small fragments of disease - causing organisms. a characteristic example is the subunit vaccine against Hepatitis B virus |
| Antitoxin is synonymous with | toxoid: circulating antibody formed by body, active immunity, to act against a specific toxin. Taken from blood serum of immunized animal/ person & injected into a person to prevent a specific disease: tetanus or diphtheria, by creating passive immunity. |
| Immunobiological agent: | serum administered to induce or provide artificial immunity. Also referred to as ‘vaccine’. |
| Specific immune globulin: | good for a specific pathogen: ex - hep B immune globulin, rabies ig , Resp syncytial virus ig |
| Live attenuated | Polio and some Typhoid and Cholera vaccines are given orally in order to produce immunity based in the bowel. |
| Most vaccines are given by hypodermic injection | as they are not absorbed reliably through the gut. |
| Pain in Kids Myths | Addiction; Respiratory distress; Don’t feel pain; don’t remember pain; Child is “overreacting”; Child is “just getting attention” |
| Pain Assessment According to Developmental Levels | Unrelieved pain has negative consequences; Aggressive pain prevention ‘pays off’ (has benefits) |
| Assessment & pain control depend are multidimensional | Nurse and patient; Child and parent; Nurse and parent; Assessment is based upon assessment and reassessment |
| What pain tools can we use? | The Oucher (preschoolers); Poker Chip Tool (school age); Adolescent and Pediatric Pain Tool uses words & descriptions; Faces Tool (school age or adolescent); Numerical Rating (school age or older); Poker Chips; Wong-Baker FACES Pain Rating Scale |
Created by:
wvc
Popular Nursing sets