Growth & Development
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| Cephalocaudal | Head to Toe
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| Proximodistal | Center to periphery
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| Erickson | Psychosocial Development
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| Piaget | Cognitive Development
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| Freud | Orality, anality, oedipal, latency, genitality
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| Kohlberg | Preconventional, Conventional, Postconventional
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| Weight Characteristics of An Infant | Doubles by 4-6 months of age; Triples by 1 year
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| Length Characteristics of an Infant | Increases approximately 1”/month for first 6 months
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| Vital Signs in Infant | Heart rate: 100-140/minute; More rhythmic pattern by 1 year 20-40/minute; BP: 80-100/40-60
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| Posterior Fontanel | Triangular shaped; Closes by 2 months of age; Head circumference increases by approximately 1 cm/month; Head circumference > chest circumference by about 1”
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| Urine Output in an Infant | 2mL/kg/hour; Low urine SG
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| The 2-3 Month Old | May lift head briefly when prone; Hands mostly open*; Coos, social smile*; Posterior fontanel closes; Holds objects placed in hands at 3 months; Palmar grasp as a reflex is fading; Tears present at 2 months; Primitive Reflexes: MoroTonic neck (fencing)
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| The 4-6 Month Old | Good head control*; Laugh, make “raspberries, vocalize in response to voices; Respond to name; Roll from prone to supine; By 5 mths, grasp rattle, reach for object; solids at 4-6 mths; Sit w/support; Balance head; Primitive reflexes fade or disappear
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| The 6-7 Month Old | Rolls completely; Sits in tripod position at 6 months; Can sit unsupported by 7-8 months; Holds bottle at 6 months; Can transition to cup for juice; By 7 months, transfers objects
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| The 6-7 Month Old...continued | Shows beginning fear of strangers – have infant sit in parents lap for assessments; Imitates sounds* Laughs, squeals; Develops more regular sleep pattern; First deciduous teeth appear; Parachute reflex replaces Moro
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| The 8-11 Month Old | Creeps then crawls;Sit independently; Pull self to stand; abdomen off floor; Pincer grasp by 1yr; Stranger fear*; Object permanence; Likes “peek-a-boo”; Responds to name; says “mama” &“dada” Babble; interactive in play; Anticipate food, Begin finger food
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| The 12 Month Old | Has tripled birth weight; may have 6 teeth; afraid of strangers; neat pincer grasp; transition to table foods; able to feed self with cup/spoon; will try to feed self-messingly; says "mama" and "dada" with meaning; walks holding on with one hand.
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| Warning Signs that may indicate problems with language development | No sounds at 4 months; no laughs/squeal by 6 months; doesn't babble by 8 months; doesn't use single words with meaning by 1 year.
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| Iron Deficiency/Anemia | Maternal iron stores are depleted by 6 months of age
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| Risk Factors for Iron Deficiency/Anemia | Preterm Birth, low birthweight, poverty, not receiving iron-fortified formula or foods, early introduction of cow's milk.
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| Promoting Oral Health | Number of teeth: Age (in months) - 6 = expected number of teeth
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| Promoting Infant Safety | Rear facing until 20 lbs and 2 years of age; no sunscreen before 6 months.
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| Immunizations | Birth, 2 months, 4 months, 6 months, 12 months
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| Immunity | Ability to destroy and remove a specific antigen from the body
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| Killed | Vaccine contains dead organisms; cannot reproduce but can produce an immune response.
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| Live Attenuated | Modified living organisms that are weakened; cannot reproduce but can produce immune response.
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| Toxoid | Contain protein products produced by bacteria. Toxin is heat treated to weaken it but it can produce an immune response.
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| Immunizations: Conjugate | Portions of bacterial cell wall are linked with proteins to produce increased immune response.
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| Immunizations: Recombinant | Genetically engineered organisms capable of producing antigens for use in vaccine production.
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| Two Factors That Affect Oral Absorption | Increased gastric pH and delayed gastric emptying.
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| Pediatric Patients Have... | Less Body fat, immature liver function, immature blood-brain barrier, immature kidney function.
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| Promoting Infant Comfort | Assess pain on a regular basis sush as with vital signs and always after you have implemented a comfort measure. Use appropriate pain tool for age (ex: FLACC, CRIES)
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| Hospitized Infant Assessment | Get baseline measurements: Vital signs, length, weight, head circumference; proceed from least intrusive to more intrusive.
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| Hospitalized Infant Interventions | Provide consistency of care; encourage parent participation; anticipate needs (feeding,naps,cuddling); promote development, stimulation of senses; use your resources: child life specialist, other staff.
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| Toddler Physical Development | Gains 3-5 lbs/year and 3"/year (adult hegith = twice height of age two years)
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| When does the Anterior Fontanel Close? | By 18 months.
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| When do toddlers achieve bladder/bowel control? | By 2 1/2 - 3 years of age; Minimum urine output 1mL/kg/hour
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| How many teeth does a 2 1/2 year old toddler have? | 20 deciduous teeth
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| Toddler Vital Signs | Heartrate- 70-120; Respirations: 20-30; BP- (age in years) + 90 = systolic BP (up to 7 years)
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| Sensorimotor/Preconceptual Phase | OObject permanence developedd by one year of age - will search for hidden object; Separation anxiety peaks at 18-24 months; imitates from memory; develops strong likes/dislikes; inability to conserve; learn by investigations and exploration.
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| Autonomy vs. Shame and Doubt | Negativism, exerting independence and autonomy, minimal tolerance for frustration; Ritualistic: familiar people and transitional objects are comforting.
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| The 15-18 Month Old | Walks independently,climbs stairs with assistance, pulls toys while walking, points to body parts,eats table foods, feeds self finger foods, drinks whole milk (limit to 24 ounces/day),2 servings/day iron rich foods, limit juice 4-6 ounces, wean bottle
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| The 18-24 Month Old | Separation Anxiety Peaks: Protest, Despair, Denial; egocentric (have difficulty sharing); can name familiar objects; able to walk up stps with 2 feet on each step.
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| The 2 year Old | Kicks ball, block tower of 4, speaks 2-3 word sentences, uses (I, me, mine), after 2nd birthday transition to forward facing seat, begins toilet training with signs of readiness.
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| The Three Year Old | Ability to share, dress self, button clothing, brush teeth with help, walk up stairs using alternate feet, block tower 9-10 blocks, pedal a tricycle, stand on one foot and hop, draw circles and squares.
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| Toddler Play | Play in toddlers is active; helps develop moto skills; push/pull toys; large blocks; balls that can be tossed; manipulative toys; toddlers are imitative; define parallel play.
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| Toddler Nutrition | Transition to low fat milk after 2nd birthday
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| Chelation Therapy | Agents (medications) that bind to lead in the tissues so that the excess lead can be excreted by the kidneys.
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| Chelation Therapy Outcome | Reduce effects of lead encephalopathy; reduce hematological effects.
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| Chelation Nursing Care | Monitor Urine Output, neurological assessments; nutrional guidance; resources (social services, developmental referral).
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| NH Chelation Action Level | 110mcg/dL but many landlords act at 7mcg/dL
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| Hospitalized Toddlers | Separation Anxiety; provide limited choices; say what you are going to do and proceed.
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| The 4-5 year Old | Start to look like little boys and girls; grow 2.5 - 3 inches per year; gains 4-5 pounds/year; Erikson: Initiative vs. Guilt; Piaget: Preoperational Thought-egocentric (magical thinking, imaginary friends, animism); Freud: Phallic Stage
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| 4-5 year old Vital Signs | HR: 80-110 (average 90), RR: 20-25/min, Systolic BP: Age in years + 90, PMI4th ICS, sinus arrhythmia.
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| 4-5 Year Old Gross Motor Skills | Alternates feet going up and down steps; stands on one foot 10 seconds or more; throws ball overhand; kicks ball forward; hops and skips; dresses/undresses self.
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| 4-5 Year Old Fine Motor Skills | Can use scissors, draws person with body, copies triangle, prints some letters, ties shoelaces.
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| 4-5 Year Old Social Communication | Strong emotions, vivid imagination (fears are real), imitates adults/playmates, shows affection to familiar playmates, aim to please, able to take turns, beginning interest in sexuality and masturbation, may lie to avoid punishment
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| Preschool Child: Growth & Development | Self Esteem-simple tasks, routines provide structure, limit setting, annual vision/hearing screenings.
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| Preschool Child: Play | Becomes more cooperative, loves to create things, vivid imagination, encourage physical activity.
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| Preschool Child: Language | Parent is the first teacher, role model language, enjoy boods with repeated phases.
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| Preschool Child: Nutrition | Requires 500-800mg calcium and 10mg of iron daily, limit juice to 6 oz daily.
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| Hospitalized 4-5 year old | May perceive as punishment for behavior, fear dark, pain, body mutilation (faces pain tool), fantasy, magical thinking, strong feelings may be expressed through dramatic play, playdoh, drawings, poor body boundaries (bandaids), acareness of gender.
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