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M6 13-005

Exam 11: Growth, Development and the Hospitalized Child

Growth an ↑ in # & size of cells as they divide & synthesize new proteins; results in ↑ size & weight of the whole or any of its parts.
Development a gradual change & expansion; advancement from lower to more advanced stages of complexity; emerging & expanding of the individual's capacities through growth, maturation & learning.
Maturation an ↑ in competence & adptivity; aging; usually used to describe a qualitative change; a change in the complexity of a structure that makes it possible for that structure to begin functioning; to function at a higher level.
Differntiation Process where early cells & structures are systematically modified & altered to achieve specific& characteristic physical & chemical properties; sometimes used to describe the trend of mass to specific; development from simple to more complex function.`
Quantitive change Growth
Qualitive change Development
Developmental task A set of skills & competencies peculiar to each developmental stage that children must accomplish or master to deal effectively with their environment.
Patterns of Growth and Development (Trends) Directional Trends- Sequential Trends- Developmental Pace- Sensitive Periods
Directional Trends (Patterns) First: Cephalocaudal (Head-to-tail). Second: Proximoddistal (Near-to-far). Third: Differentiation.
Cephalocaudal Head-to-tail. Head of the organism develops first (large and complex), the lower end is small and simple and takes shape at a later period.
Proximodistal Near-to-far. Trends applies to midline-to-peripheral concept.
Diffentiation Development from simple operations to more complex activities and functions.
Sequential Trends Predictable sequence with each child normally passing through before every stage. Crawl before you walk.
Developmental Pace Pace at which various functions of the body develops at different times, based upon the needs of the individual.
Sensitive periods Times in the lifetime of an organism is more susceptible to positive or negative influences.
5 Developmental Age Periods Prenatal. Infancy. Early Childhood. Middle Childhood. Later Childhood/adolescence.
Prenatal (conception to birth) Rapid growth rate. Total dependency. Most crucial period.
Infancy (birth to 12 months) Rapid motor, cognitive and social development. Trust is developed. Foundation for future interpersonal relationships is laid.
Early childhood (1 to 6 years) Intense activity and discovery. Time of marked physical and personality development. Learn role standards, gain self control and acquire language and wider social relationships.
Middle childhood (6 to 12 years) Developing away from the family group and centered on the world of peer relationships. Developing skill competencies and social cooperation and early moral development take on more importance.
Later childhood/adolescence (12 to 19 years) Tumultuous period of rapid maturation and change is known as adolescence. Considered to be a transitional period that begins at the onset of puberty and extends to the point of entry into the adult world.
Vital Signs: Infants Temp: wide variation in temperature from 96.5 to 99.5. Pulse: apical pulse average 120 beats/min. Respiratory Rate: average is 30 breaths per minute. Related to activity level. Blood Pressure: average 90/60.
Vital Signs: Toddlers Temperature ranges from 98 F to 99 F. Pulse ranges from 90 to 120 beats/min. Respirations range from 20 to 30 breaths/min. Blood pressure averages 80 to 100 systolic and 64 diastolic.
Vital Signs: School Age Temperature ranges between 98F and 99F. Pulse is between 55 and 90. Respiratory rate averages 22 to 24 breaths/min. Blood pressure averages 110/65.
Vital Signs: Adolescent Temperature is the same as the school age. Pulse averages 70 beats/min. Respiratory rate averages 20 breaths/min. Blood pressure averages 120/70.
Erikson Psychosocial Development
Psychosocial Development Stages Trust vs Mistrust (birth to 1 year). Autonomy vs Shame (1-3 years) Initiative vs Guilt (3-6 years) Industry vs Inferiority (6-12 years) Identity vs Role Confusion (12-18 years)
Trust vs Mistrust (birth to 1 year) Establishment of trust dominates the first year of life and describes all the pleasurable experiences in life. Mistrust develops when trust-promoting experiences are lacking or when basic needs are not met.
Autonomy vs Shame (1-3 years) Autonomy centers on the child’s ability to control their bodies, themselves and their environment. They want to do things for themselves.
Initiative vs Guilt (3-6 years) Children explore the physical world with their senses and powers. They develop a conscience.
Industry vs Inferiority (6-12 years) Children are ready to be workers and producers. They want to engage in tasks and activities they can carry through to completion. Children learn to compete and cooperate with others and learn the rules and consequences.
Identity vs Role Confusion (12-18 years) Adolescents become overly preoccupied with the way they appear in the eyes of their peers. They struggle to fit in the roles they have played and those they hope to play with current roles and fashions adopted by their peers.
Development of Self Concept How one describes him or herself. One’s self concept may or may not reflect reality. Self concept is crystallized during later adolescence as young people organize their self concept around a set of values, goals and competencies.
Body image image refers to the concepts and attitudes one has towards their body.
Self Concept (Other) Infants receive input through self explorations & sensory stimulation from others. Toddlers identify the various parts of their bodies & are able to use symbols to represent objects. Preschoolers aware of their bodies and discover their genitals.
Body Image and Self Concept: School Age Children begin to learn internal body structure and function and are aware of differences in size.
Body Image and Self Concept Adolescence when kids become most aware of the physical self. They face conflicts over what they see and what they visualize as the ideal body structure.
Self esteem the value one places upon themselves and the overall evaluation of oneself.
Factors that influence the formation of a child’s self esteem include: Temperament and personality. Ability to accomplish age appropriate tasks. Significant others. Social roles and expectations.
How does growth and development impact nursing care of children? Approach to care, response to illness, application of nursing process, expected development, individual temperament, and intervention to prevent diseases &/or accidents.
Approach to care, response to illness, application of nursing process, expected development, individual temperament, and intervention to prevent diseases &/or accidents. Media, role models, and lack of parenting knowledge.
Major Stressors of Hospitalization Separation anxiety. Loss of control. Fear of pain.
Separation anxiety occurs from middle infancy throughout the rest of their life.
three phases of Separation anxiety Protest. Despair. Denial or detachment.
Psychosexual Development Id. Ego. Superego.
Id unorganized part of the personality structure that contains a human's basic, instinctual drives. Id is the only component of personality that is present from birth
Ego reality principle; i.e. it seeks to please the id’s drive in realistic ways that will benefit in the long term rather than bring grief.
Super-ego internalization of cultural rules, mainly taught by parents applying their guidance and influence.
Protest Child reacts aggressively to separation. Child protests loudly. May repeatedly call out for parent. Protests increase as strangers approach. Child is inconsolable in their grief.
Despair Appears after protest stops. Child may appear sad, depressed and withdrawn and does not play actively. Child is uninterested in food and may refuse to drink.
Denial or Detachment Superficially appears to have adjusted. Disinterested when parents visit. Behavior is a result of resignation and not contentment. Can alter bonding if stage is prolonged.
Developmental Stage: Infants & Toddlers Separation anxiety is the greatest stressor. Will attempt to bargain with parents so they will stay.
Developmental Stage: Preschooler Protest using quiet methods and constantly asking questions. Will become aggressive and hit or refuse to cooperate during activities.
Developmental Stage: School Age Children Better able to cope. React to separation from peers. Feelings of loneliness, boredom, isolation. Express feelings as irritability, withdrawal, rejection of siblings or aggression towards parents.
Developmental Stage: Adolescents Welcome parental separation. Fear loss of group acceptance and peer group contact. Express feelings as irritability, withdrawal, rejection of siblings or aggression towards parents.
cognitive development a blueprint that describes the stages of normal intellectual development, from infancy through adulthood. This includes thought, judgment, and knowledge.
cognitive development (stages) Sensorimotor Stage (0-2 years). Preoperational Stage (2-7 years). Concrete Operational Stage (7-11 years). Formal Operational Stage (11-15 years).
Sensorimotor Stage (0-2 years). They focus on what they see, what they are doing, and physical interactions with their immediate environment.
Preoperational Stage (2-7 years). During this stage, young children are able to think about things symbolically. Their language use becomes more mature. They also develop memory and imagination, which allows them to understand the difference between past and future.
Concrete Operational Stage Children's thinking becomes less egocentric and they are increasingly aware of external events. They begin to realize that one's own thoughts and feelings are unique and may not be shared by others or may not even be part of reality.
Formal Operational Stage Fourth stage of intellectual development and are able to logically use symbols related to abstract concepts, such as algebra and science. They can think about multiple variables in systematic ways, formulate hypotheses, and consider possibilities.
Loss of Control Lack/loss of control increases perception of threat and affects coping skills. Experiences vary depending on the child’s developmental stage.
Loss of Control: Infants & Toddlers Trust is being developed. Control environment through emotional expressions. Toddlers seek autonomy. React with aggression to loss of control.
Loss of Control: Preschoolers Egocentric, magical thinking. Fantasize reasons for hospitalization/illness. Uses transductive reasoning and deduct from particular to particular, rather than from the specific to the general.
Loss of Control: School Age Children Particularly vulnerable to loss of control. Respond well as long as they have a measure of control. Problems will arise from boredom and activity limitations. They respond with depression, hostility or frustration.
Loss of Control: Adolescents Struggles are for independence, self-assertion and liberation. Threats to identity results in loss of control. React with rejection, uncooperativeness or withdrawal, anger or frustration.
Nurse's Role Be sensitive to the signs of separation anxiety. Allow parents to “room-in”. Maintain daily routine. Allow the child to have familiar items from home (toy or pajamas). Promote freedom of movement and independence by giving choices.
Interventions to Lessen Parents Stress Inform parents of what to expect and what is expected of them. Encourage them to be involved. Remain objective and understanding. Encourage parents to “room-in”. Listen to both verbal and nonverbal messages.
Interventions to Lessen Siblings Stress They experience feelings of lonliness, fear, anger, worry, resentment jealousy and guilt. Encourage them to visit. Encourage the parents to spend time with them.
What interventions can the nurse do to help decrease the stress of the parents of a hospitalized child? Inform parents what to expect and what is expected of them, encourage them to room-in and participate in their child’s care, listen to verbal and non-verbal messages
What are the three phases of separation anxiety? Protest, despair, denial or detachment.
QUESTT Question. Use a pain rating scale. Evaluate behavioral and physiologic changes. Secure parents’ involvement. Take the cause into account. Take action and evaluate results.
Name some scales used to assess pediatric pain. Faces, Numeric, and Poker Chip Tools
What are some examples of nonpharmacological pain management? Distraction, relaxation, guided imagery, positive self-talk, thought stopping and Cutaneous stimulation.
Play Children learn through
Classifications of play Social-affective play. Skill play. Unoccupied behavior. Dramatic play. Games.
Social-Affective Play Where infants take in pleasure in relationships with people. Infants learn to provoke emotions and responses with behaviors such as cooing, smiling or crying.  
Skill Play after the infants have developed the ability to grasp and manipulate, they demonstrate their abilities through skill play, repeating the same actions over and over again.
Unoccupied Behavior Where children are not playful but focusing their attention on anything that strikes their interests. Children daydream, fiddle with clothes or other objects, or walk aimlessly.
Dramatic, or Pretend Play Begins in late infancy and is the predominant form of play in the preschool child. By acting out events of daily life, children learn and practice the roles and identities modeled by the members of their family and society.
Onlooker play child takes an interest in other children's play but does not join in. May ask questions or just talk to other children, but the main activity is simply to watch.
Solitary play the child is are completely engrossed in playing and does not seem to notice other children. Most often seen in children between 2 and 3 years-old.
Parallel play the child mimics other children's play but doesn't actively engage with them. For example they may use the same toy.
Associative Play now more interested in each other than the toys they are using. This is the first category that involves strong social interaction between the children while they play.
Cooperative Play some organisation enters children's play, for example the playing has some goal and children often adopt roles and act as a group.
developmental delays and regression Children who have prolonged or repeated hospitalizations are at risk for
NONDIRECTIVE play (examples) Bean bag toss. Play dough. Wagon rides.
Creative Expression When art is used to help ease the anxieties and fears. Can be used by the nurses as a springboard for future conversations. Music can be used to help the child ambulate and move around the room.
What is therapeutic play? Therapeutic play is a planned activity where the child is encouraged to express their feelings. It includes activities such as permitting the child to give an injection to a doll or a stuffed toy to reduce the stress of injections.
Explain the difference between play therapy and expressive activities. Play therapy is a psychological technique used by trained and qualified therapists and expressive activities include therapeutic play where the child had nondirected play time to express themselves freely.
Culture Pattern that frames or guides. Composed of individuals. Culture and subcultures contribute to the uniqueness of children.
Cultural Factors Heredity Physical Characteristics. Customs and Folkways. Relationship with Health Care Providers. Food Customs.
Created by: jtzuetrong



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