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364 terms

Pediatrics Set I Growth & DEvelopment

STUDY
PLAY
Growth
increase in physical size
Development
increase in abilities (skills)
Cephalocaudal development
skills develops head downward through body towards feet.
Proximodistal development
skills develops from center to extremities.
Anticipatory guidence
Nurses use this to predict upcoming development task and needs of child.
Development Theory
Erikson
Erikson's Psychosocial Stages of Development
Eight Psychosocial stages - each has a unique developmental task; birth through old age; stages have 2 possible outcomes: either a healthy one or unhealthy.
Trust vs. mistrust
Birth to 1 yr.
Autonomy vs. shame/doubt
1 to 3 yrs.
Initiative vs. guilt
3 to 6 yrs.
Industry vs. inferiority
6 to 12 yrs.
Identity vs. role confusion
12 to 18 yrs.
Piaget
Four stages of cognitive development.
Sensorimotor
Birth to 2 yrs.
Preoperational
2 to 7 yrs
Young child thinks by using words as symbols; logic is not well developed..
Preoperational
Transductive reason (Stage Name)
Unrealistic cause/effect relationships, "magical thinking"
Concrete operational
7 to 11 yrs.
More accurate understanding of cause/effect.Concept of conservation - matter doesn't change when its form is altered.A child can reason well in this stage if concrete objects are used in teaching.
Formal Operational
11 years to adulthood.Mature intellectual thought, can think abstractly, can consider different outsomes
Bandura
Social Learning Theorist - a child can learn attitudes, beliefs, and customs through social contact.
Social learning behaviors
If positively rewarded, they repeat behaviors.
Self-Efficacy
this is the expectation that someone can produce a desired event
T
(T/F) Regression is normal in a hospitalized child (1-3yrs.) / might start wetting the bed again.
6 months
Birth weight doubles by ___.
1 year
Birth weight triples by ___.
1 year
Height increases by about a foot each ___.
6 months
Teeth erupt at about ____ months.
6-8 teeth
How many teeth should be showing at 1 year?
1 year
Baby should beable to feed itself by ____.
2 years
Birth weight should quadruple by ____.
33 months
By ____ months, eruptinon of deciduous teeth is complete (20 teeth present)
Parallel play
Kids play next to but not with each other (jealousy)
1000
Toddlers have _______ word vocabulary.
2000
Preschoolers have ________ word vocabulary.
12-18 months
Anterior fontanel closes at ____ months.
2 - 3 months
Posterior forntanel closes at _______ months.
many childhood communicable diseases can be prevented thru
immunizations
streptococcal infections can lead to
serious cardiac complications
parasitic infections generally involve
the entire family and home enviornment
the most common cause of injury to a child is
trauma
SIDS
sudden and unexpected death of an apparently healthy infant during sleep
common skin disorders include
nevi, rashes, and eczema
neurologic disorders include
reyes syndrome and meningitis
miningomyelocele
the most serious form of spina bifida, may cause paralysis or other disorders
hydrocephalus can be detected by
OFC measurements
what food must children with celiac disease avoid
anything with gluten
gluten
a protein substance that remains when starch is removed from cereal grains. Ex. gives cohesiveness to dough
structural defects of the hear can result in
abnormal shunting of oxygenated and de-oxygenated blood
shunting
moving oxygenated blood into vital areas and bypassing less vital areas
leukemia
cancer of white blood cells
leukemias can be
acute or chronic
cystic fibrosis
a fatal disorder in which a thick, sticky mucus clogs passages to the lungs pancreas and liver
serious respiratory tract illnesses include
RSV,LTB, epiglottitis, and asthma
illness of the GI tract places the young child at high risk for
fluid and electrolyte imbalances or dehydration
Urinary tract infections problems
structural, autoimmune, cancerous, or infections
the most common reproductive disorder concerns
ambiguous genitalia and cryptorchidism
ambiguous genitalia
when the appearance of genitalia can't be used to determine sex
cryptorchidism
failure of one or both testes to move into the scrotum as the male fetus develops
solid foods are introduced
4-6months of age
nephrotic syndrome
loss of large amounts of plasma protein resulting in systemic edema
roseola
Any rose-colored rash marked by maculae or red spots on the skin
pediatrics
the area of care that deals with children and adolescents
Pediatric Susceptibility to URI
Immature immune system
Small airway (small tubular passage ways)
Decrease ability to clear airway
Everything in mouth
School aged siblings
reyes syndrome
this disorder is associated with aspirin intake, usually seen in children recovering from viral illness
s/sx of URI
fever, dyspnea, with thick tenacious sputum and mucus and edema of the throat
tx of URI
antibiotics, humidity, and rest. O2 may be nec.
Pneumonia
Inflammation of lungs
Alveoli bathed in exudate (interferes w/gas exchange)
Viral or bacterial
Often extension of URI
Pneumonia Symptoms
Dry cough progressing to productive cough
Paroxysmal cough
Fever
Respiratory distress
Anorexia
Cranky, irritable
Cyanosis (late symptom)
Pneumonia Treatment
Rest
Humidified O2
Nebulizer Tx
Chest physiotherapy
Antibiotics
Increased fluids
Close observation
croup is a syndrome that results in
a harsh barky cough
Laryngotraceobronchitis (Croup)
Inflammation of the larynx, trachea and bronchi
Usually viral (often follows a cold)
Narrowing of air passages causing varying degrees of airway obstruction
Common age 3months- 3yrs
More common in winter
Laryngotraceobronchitis (Croup) Symptoms
Restlessness
Hoarseness
Brassy, barking cough (classic symptom)
Inspiratory stridor - narrowed airway
Respiratory distress
Fever (low grade)
Condition usually occurs suddenly during the night
With a hx of croup, if showing signs during the daytime, admitted to hospital.
Laryngotraceobronchitis (Croup) Treatment
Close observation - make sure airway patent
Bedrest
Cool humidified environment - cool mist humidifier (clean 2x's day)
Encourage fluids - thins secretions
Antipyretics - Tylenol, Motrin, if fever
Corticosteroids - decrease airway inflammation (used for severe cases)
Epinephrine - opens airway (used for severe cases)
Epiglottitis
Inflammation of the glottis
Escalation of croup
Edema of tissues above the vocal cords
Narrowing of airway that can lead to complete obstruction
* Throat examined with extreme care as throat stimulation can lead to laryngoaspasm and obstruction
DO NOT TRIGGER THE GAG REFLEX DO NOT EXAMINE THR CHILD'S THROAT WITH TONGUE DEPRESSOR
Epiglottitis Symptoms
Anxious, apprehensive, fearful expression
Severe respiratory distress
High fever
Absence of cough
Drooling of saliva(w/refusal to swallow due to an extreme sore throat)
Dyspnea with rapid progression of distress
Red inflamed throat with cherry red epiglottis
Muffled, croaking voice
Very ill appearance
Epiglottitis Treatment
Corticosteroids
Epinephrine
Antibiotics
Cool mist humidifier
Oxygen
Close monitoring of respiratory status and O2 saturation
Bronchitis
Inflammation of bronchi
Viral or bacterial
Main concern is airway obstruction and pneumonia
Often related to URI (moves down)
Bronchitis Symptoms
Dry non-productive cough- worse at night
Cough eventually breaks and is productive of purulent tenacious (hard to break up) sputum
Improves when cough begins to break up
Fever
Malaise
Fatigue
Anorexia
Bronchitis Treatment
Antibiotics (prevents movement to the lungs)
Cool mist humidifier
Rest
Increased fluids
Nebulizer Tx
Expectorants (thins secretions)
Postural drainage > chest physiotherapy
1st nebulizer
2nd cupping & clapping (not after meal)
3rd postural drainage
Bronchiolitis
Common in infants
Inflammation of bronchioles with mucous plugs blocking small tubules
Air trapped and can not pass out on expiration
Increased CO2 levels and respiratory acidosis
Viral origin, does not respond to antibiotics
Respiratory synctial Virus (RSV) 50% of cases
Respiratory distress common symptom
Bronchiolitis Treatment
Rest
Humidified o2
Nebulizer treatments (best when sleeping)
Fluids
Chest physiotherapy
Close monitoring
Babies often vulnerable to resp. arrest
Tonsillitis
Inflammation of the tonsillar structures in the oropharynx
Bacterial or viral
Inflammation of tonsils
Erythema and exudate (whit mucous) in throat
Tonsillitis Symptoms
Dyspahgia- difficulty swallowing
Bad breath
Mouth breathing - abdominal pain
Nasal muffled voice
Persistent cough
Fever
WBC count is elevated
Ear infection may develop (usually in Eustachian)
Tonsillitis Treatment
Rest
Antibiotics
Increased fluids
Nebulizer tx
Cool mist humidifier
Frequent recurrence may require tonsillectomy
Tonsillectomy Pre-op
Routing assessment
Bleeding and clotting times
Explain procedure
Informed consent
Reassure child and parents
NPO midnite b4 surgery
No URI
Tonsillectomy Post- op
Pulse and respirations frequently
Observe for signs of bleeding
Restlessness
Rapid pulse
Frequent swallowing
N&V
Bright red & flank bleeding
Ice collar
Ice pops (no red ice pops)
Soft diet
No straws
Not hot beverages
No carbonated beverages
Analgesics
Discourage swallowing of secretions
Discourage coughing and clearing of throat
Otitis media
Middle ear infection
Extension of URI > Eustachian tube
Fluid build up behind tympanic membrane
Microbial growth supported by warm, dark, moist environment
Bacterial or viral
Otitis media Symptoms
Earache (pulling at ears) - Major Symptom
Fever
Irritability, cranky
Anorexia
Crying
Otoscopic exam reveals red, bulging TM
Purulent drainage possible
Otitis media Treatment
Antibiotics (if viral usually won't give)
Analgesics
Antipyretics (decrease fever)
Decongestants
Assessment of hearing if frequent infections - especially if fl remains in ear
Myringotomy with insertion of tubes
Myringotom
Incision of eardrum
Drainage of fluid
Insertion of tubes to continue draining fluids
Tubes can remain in place for weeks- months
Avoid immersing head in water
Avoid blowing nose forcefully
Not always effective, may need to be repeated
Bronchial Asthma
Lower airway disorder characterized by bronchospasm, increased thickened secretions and mucosal edema
Common disorder
Most common chronic condition of childhood
Can be precipitated by allergies, URI, emotional stress
Bronchial Asthma Symptoms
Hacking, irritative, non- productive cough
SOB, flared nares
Prolonged expiratory phase
Audible wheeze
Restlessness
Increasing respiratory difficulty
Bronchial Asthma Treatment
Prevention - avoid allergens, treat URI, cool mist humidifier in home, air purifier
Children w/food allergies tend to be more prone
Rest
Bronchodilators - used to open airway and relax smooth muscle during acute attack
Corticosteroids - often nebulizer for acute attacks attacks
Intal(cromolyn sodium) used to prevent
Education regarding meds, prevention and treatment
Group A Beta Hemolytic Streptococcus Aureus
Promptly treated to avoid:
Rheumatic carditis - invasion of mitral valves
Glomerulonephritis - attacks nephrons
Gullain Barre syndrome - body's immune system attacks your nerves
URI symptoms persisting beyond 5-7 days require a throat culture (probably not viral)
Positive throat cultures are treated with Antibiotics
Follow up culture to ensure resolution
Rheumatic carditis
invasion of mitral valves
Glomerulonephritis
attacks nephrons
Gullain Barre syndrome
body's immune system attacks your nerves
Sudden Infant Death Syndrome (SIDS)
Exact cause unknown
Common in premature infants
Peaks in 10-12 weeks with over ½ cases occur by 3 months
Infant suffers from apnea and dies in sleep
Parents devastated
Apnea monitor
SIDS Foundation
*infants sleep on back*
Infectious Mononucleosis
Caused by Epstein Barr Viris (EBV) - one of the herpes viruses
Transmitted by droplets in saliva, cough, sneezes, contact w/mucous membranes
"kissing disease"
Child has extreme soar throat
s/sx of Infectious Mononucleosis
Flu like
HA
Low grade fever, anorexia
Cervical lymphadenopathy (swollen lymph glands in neck)
Enlarged spleen or liver
dx of Infectious Mononucleosis
CBC and Mono Test
Infectious Mononucleosis Treatment
Symptomatic
Rest, Fluids
Analgesics
If liver/spleen enlarged > greatest risk of rupture is during 2 to 4 weeks of illness
Strenuous exercise & contact sports should be avoided while organs are enlarged
Systemic steroids to reduce pharyngeal inflammation
Edema
Fatigue & weakness for several weeks
Lyme disease
Bacterial infection - Borrelia
Tick bites
Lyme disease Sx
appear 3 to 31 days after bite:
"bulls-eyed" ring rash
Flu like symptoms
Lyme disease Tx
Antibiotics
w/out rash can go undetected:
Goes thru the blood > settles in tissues & multiply > chronic symptoms as pain, loss of muscle function, psychiatric disturbances, etc.
Early detection is best
Prevention
Pediculosis
Infestation w/head lice
Highly contagious
Nits attach firmly to head shaft
Pediculosis Tx
Prediculocidal shampoo (RID or Nix)
Manual removal
Keep home until knit free
Wash clothes, bedding, towels
scabies
Infestation w/itch mite
Burrows under skin & lays eggs
Contagious
scabies Tx
Scabicide (rinse off in shower, on for 8-12 hrs)
Keep home until resolved
Wash clothes, beeding, towels
Dermatophytoses (Tinea)
Superficial fungal infection of skin
Scaly red patches, itching
Areas of baldness (capitis)
Blister of toes w/vesicles & burring (pedis)
Tinea Capitis
ringworm of scalp
Tinea Corporus
ringworm of body
Tinea Pedis
athletes foot
Dermatophytoses (Tinea) Tx
Topical antifungal creams, powders, sprays
Oral Griseofuluin
Keep area clean & dry
Impetigo
Infection of skin caused by Straphylococcal & Streptococcal bacteria
Red raised area, vesicles form, rupture, creating honey yellow crust; face & hands
Highly contagious; keep home from school
Separate towels & washcloths
Impetigo Tx
Antibiotics
Frequent hand washing, don't touch
Can be dangerous in newborns
Infantile Eczema
Non-specific dermatitis
Common when new foods are introduced
High incidence of food allergies
Increase incidence of Asthma
Infantile Eczema Tx
Protect from scratching
Mitts on hands
Aveeno baths
Dermatitis
Contact or irritant
Exposure to irritating substance
Redness, warmth, vesicles, burning
Dermatitis Tx
Avoiding irritant
Hydrocortisone cream
Acne Vulgaris
Overactive sebaceous glands
Hormonal & hereditary factors
Papules (solid), pustules (contains pus), & comedones (blackheads) on face, chest, & back
Acne Vulgaris Tx
Facial cleaning, Benzoyl peroxide
Don't pick or squeeze
Accutane or Retin-A
Congenital Heart Disease
Heart damage resulting from developmental defects
Classified as:
Cyanotic - causes cyanosis
ayonotic- no cyanosis
Congenital Heart Disease Cyanotic
causes cyanosis
Congenital Heart Disease Acyanotic -
doesn't cause cyanosis
Congenital Heart Disease Cyantoic defects (lack of O2)
R to L shunting deoxygenated blood mixing w/oxygenated blood
Congenital Heart Disease Acyanotic defects (O2)
L to R shunting
Pressure is higher due to L side
Cyanotic Defects
Deoxygenated blood(venous) & Oxygen blood (arterial) mixes
systemic circulation due to left ventricles sending this mixed blood to the body
* will cause cyanosis*
Cyanotic Defects Tricuspid Atresia
No opening b/w the R atrium & L ventricle
No blood flows from R atrium to L ventricle, which decreases pulmonary blood flow
* will cause cyanosis*
Transposition of Great Cyanotic Defects Vessels (TGV):
Aorta and the pulmonary artery are reversed, so that each connect to the wrong side of heart
High death rate
* will cause cyanosis*
Cyanotic Defects Tetrology of Fallot
Combination of 4 major defects:
Ventricular Septal Defect (VSD):
Pulmonary Stenosis:
Overriding aorta:
Right Ventricular Hypertrophy:
Cyanotic Defects Tetrology of Fallot: Ventricular Septal Defect (VSD):
A hole in the septum separating the R & L ventricles
Cyanotic Defects Tetrology of Fallot: Pulmonary Stenosis:
Narrowing of pulmonary artery
Cyanotic Defects Tetrology of Fallot: Right Ventricular Hypertrophy:
Enlarged R ventricle due to heart pumping harder in an attempt to increase blood flow to lungs
Cyanotic Defects Tetrology of Fallot: Right Ventricular Hypertrophy:
Enlarged R ventricle due to heart pumping harder in an attempt to increase blood flow to lungs
Acyanotic Defects:
Patent Ductus Arterious:
Ductus Arterious connects fetal pulmonary artery to fetal aorta (closes after birth)
Patent is when ductus remains open
can lead to pulmonary hypertension
Coarctation:
Aorta narrows, obstructing blood flow
Coarctation is further away from heart
Atrial Septal Defect:
Abnormal opening b/w the R and L atria
Acyanotic Defects: Coarctation:
Aorta narrows, obstructing blood flow
Coarctation is further away from heart
Acyanotic Defects: Atrial Septal Defect:
Abnormal opening b/w the R and L atria
Acyanotic Defects: Ventricular Septal Defect:
Abnormal opening b/w R and L ventricle
Acyanotic Defects:Pulmonary Stenosis:
Narrowing of the R ventricular outflow tract, including valve, which decreases blood flow to lungs
Valve replacement
Acyanotic Defects:Aortic Stenosis:
L ventricular outflow tract,
Aortic valve malfunction causes the heart to work harder to pump blood to the body
Congenital Heart Disease Symptoms
Generalized cyanosis (cyanotic defects)
Cyanosis on exertion (crying, feeding, straining)
Dyspnea & fatigue (especially w/feeding)
FTT (failure to thrive)
Tachypnea, murmurs, dysthrymias
Growth delays
Clubbing of fingernails & squatting (cyanotic defects)
Squatting is the PED for of orthopnea
Small for age
Delicate, frail body
Tachycardia
Difference in pulse b/w upper & lower extremities (coarctation of aorta)
Susceptibility to infection, especially URI's
Congenital Heart Disease Treatment
Symptomatic initially
Surgical repair performed as soon as child able to tolerate
Major defects are repaired in stages
Digoxin & Lasix (tx's CHF)
Antihypertensives
Low Na diet, supplements, vitamins, & iron
Congenital Heart Disease Nursing Care
Assess rate & quality of pulse
Monitor respirations, observe for cyanosis & dyspnea
Avoid temperature extremes
Daily wt's
Monitor G&D
Feed slowly, rest periods
I&O
Administer drugs as prescribed
Protect from infection
Kawasaki Disease
Systemic vasculitis
Under age 5
Cause unknown
Inflammation of small vessels, pericarditis, aneurysm formation
Stasis & blood clot formation
25% of children develop heart damage
Kawasaki Disease Sx
High fever
Red and dry conjunctiva
Inflammation of pharynx & oral mucosa
Strawberry tongue
Perineal rash
Redness of palms & soles of feet
ECG changes & CHF can develop
Kawasaki Disease Tx
IV fl's
Gamma Globulin (given IV) - "immunoglobulin" boost body's immune system
Antipyretic > ASA very effective
Heparin
Rest
Close monitoring for CHF, Resp. distress & Thrombus
Recovery common
Iron Deficiency Anemia
Deficiency of dietary iron
Common in school aged child, adolescence, & infants fed cow's milk
Iron Deficiency Anemia Tx
Iron rich diet & iron supplement
Take w/food
Change stool's color (tarry green)
Discolors teeth (in liquid form, use straw)
Iron take w/Vit C to enhance absorption
leukemia
Cancer of blood forming organs
WBC production increases, cells are immature & poorly formed
Leukemia the Dominant Symptoms:
Anemia
Thrombocytopenia (low platelet count)
Frequent infection
Acute lymphocytic Leukemia
most common in young, symptoms much more rapid & severe
Chronic lymphocytic Leukemia
common in adults, symptoms less severe
Hemophilia
Bleeding disorders: sex linked genetic defect
Passed to sons by mother
Hemophilia A (defect of factor 8)
Hemophilia B (defect of factor 9)
Inability to clot blood
Bleeding into tissues & joints
Hemophilia sx
Prolonged bleeding from anywhere in body
Prolonged bleeding from circumcision, teething, umbilical cord, injection & nose bleeds
Easy bruising
Hemophilia tx
Restrict activity
Avoid contact sports
Replacement of clotting factor
Safety
Don't over protect
Develop milestones
rolling, crawling, standing, walking, talking, teething, socialization.
Failure to thrive (FTT)
not growing, gaining wt, etc.
Protest
Loud crying, rejecting Healthcare personnel
Most commonly seen
Despair
Inactive & sad, withdrawn, & uninterested
Regression is seen here
Denial
Detachment, rejection of family caregivers
IV assessment
monitor frequently for infiltration and infection
Dressing changed daily
Tubing is changed per facility policy (about 72 hrs)
All tubing securely tightened
Assess the opening and closing controls
Keep tubing behind the child and out of their reach
All pediatric infusions are on a pump for precise delivery
Gavage feeding
button peg, used bolus
Parenteral fluids
given IV
Managing a Fever
Keep child quiet, minimize crying
Do not overdress
Encourage fluids - ice pops
Antipyretics (no Aspirin do to Ray's syndrome)
Sponge bath, cool compresses on the pulse points
Check temperature every 30 min.
What develops first: head control vs trunk? Hands vs eye control? Shoulders vs hands? PNS vs CNS?
Head (3mos)- trunk (7mos sit). Eye (2mos) - hands (5mos). Shoulders - hands. CNS - PNS (cephalocaudal & proimodistal)
3 main physiologic measures of kid devlopment?
Length/height, weight, head circumference (1st - 3rd yr)
Timeline of 1st year events: Height. Wgt double & triple & quadruple? Teething? Fontanels close?
6-8 wks: Post fontanel. 4-7 months: wght doubles. 6 mos: Lower incisor teething. 12 months: 50% hght increase, Anterior fontanel closes. Wght triples. 6-8 teeth. 2-2.5 yrs: quadruple wght
At what age will a child coo? Transfer objects? Crawl?
2 mos, 6-8 mos, 9-10 mos
At what age will a child have head control? Sit? Learn a few words?
4 mos, 8-9 mos, 9-12 mos
At what age will a child have palmar grasp of objects? Walk with assist?
4 - 6 mos, 12 mos
Time line in months of coo, head control, palmar grasp, transfering objects, sits, crawls, learns few words, walks w/assist?
2, 4, 4-6, 6-8, 8-9, 9-10, 9-12, 12
When will a child be able to draw a circle, Jump, & Throw overhand?
2-3 yrs
When will a child be able to build a tower of 4 blocks, run/walk up stairs?
1-2 yrs
In growth of kids, what's predictable, the timing of developmental milestones or the sequence?
sequence...timing diff per kid
Prenatal time: germinal, embryonic, & fetal?
Conception - 2 wks, 2-8 wks, 8 - 40 wks
At 2 months gestation (start of fetal) head = ?% of bdy lngth? In infancy & childhood what grows most rapidly?
50%. Trunk, then legs
How can you estimate a 2 yr olds full grown height?
double their current height
The avg newborn weighs how many grams?
2500 to 4000g (7 - 7.5 lbs)
Infants gain __g/wk for 5-6mos. Avg __kg (lbs) at 6 mos? At 1 yr?
150 to 210 g/wk. 7.5kg (16 lbs at 6 mos). 1 yr= 9.75 kg (21.5 lbs)
Who weighs more, brst fed or formula fed?
formula fed
Hght inc __cm (inch)/mo until 6 mos. Avg at 6 mos = ? 12 mos?
2.5 cm (1in)/mo. 6 mos = 65 cm (25.5in). 1 yr = 74 cm (29 in)
Avg head circ at birth, 6 mo, 1 yr:
32-37cm, 43cm, 46cm
Most accurate msre of general dvlmpt? Where?
skeletal or bone age (radiologic determination of osseous maturation - hand/wrist best)
Who is in deep sleep more? The infant or adolescent?
adolescent. 50% (50 mins) to 80% (90 mins)
To promote mastery motivation (do task well & inc cooperativeness) should parent or child have more control in play? Interrupt infant immdtly when something done wrong? Stimulation?
Parent should be unobtrussive, letting infant initiate and troubleshoot 1st. Give early kinesthetic stim (pick up/rock) w/audio/visuals
*Timing of Freud's stages: Oral, Anal, Phallic, Latency, Genital
Birth to 1, 1-3yrs, 3-6, 6-12, >12
*During this stage of Freud kids elaborate on prev acquired traits w/vig play vs when kids recognize sex diffs & Oedipus/Electra complexes, penis envy & castration anxiety occur
Latency (6-12 yrs). Phallic (3-6 yrs)
*Erikson's Stages: Birth - 1, 1-3, 3-6, 6-12, 12-18
Trust/mistrust. Aut/shame-doubt. Initiative/guilt. Industry/Inf. ID/Role confusion
*Piaget's 4 stages of congition?
Sensorimotor (0-2yrs) Preoperational/transductive/intuitive: 2-7. Concrete (inductive): 7-11. Formal (deductive/abstract): 11-15
*Name the Piaget stage: Egocentrism (inability to put oneself in other's place), transductive rsng (becuz 2 things together they cause each other - wmn w/big bellies = always pregnant)
Preoperational (2-7 yrs)
*Name the Piaget stage: conservation (permanence), inductive rsng, socialized thinking.
7-11 yrs. Concrete operations
*3 stages of Kohlberg's moral dvlmpt?
Preconventional (Good/bad based on rewards) (0-6). Conventional: Conformity/loyalty/be nice. Postconventional: rghts/chngelaws/justice (12 - 18)
*At which Kohlberg moral stage do kids want to earn approval by being nice/obeying rules? Pre-, conventional, post-?
Conventional (6-12sh)
Toys: why avoid those w/strings > 7" for infant? Avoid what for kid<8? For <5? BB guns?
could strangle themselves. <8 no electric toys w/heating. <5 no arrows/darts. BB>16yrs
Where take kid's temp? (0-2yrs), (2-5), (>5)?
0-2: Axillary/rectal. 2-5: Axil, tympanic, oral (when can hold under tongue), rectal, >5: Oral, Axil, Tymp. Rectal only if definite temp needed.
What is level of fever for infant <3 mos? 3mos - 36 mos? Kids?
100.4 (38). 102 (38.9). 104 (40)
Normal neonate core temp?
36.5 - 37.6 (99.7F)
Norm HR: Newborn. 1wk - 1yr. 1-3yrs. 3 - 5. 6-10. >10
1) 100-160 (2) 100-150 (3) 80 - 130 (4) 80 - 120 (5) 70 - 110. >10 = 60-90/100
Normal HR for 1-3 yr old?
80-130
Norm RR for newborn, up to 1 yr. 1-3? 3-5? 6-10? 10-16 (adolescent)?
30 - 60. 25-35. 20-30. 20-25. 18-22. A: 16-19
BP:Newborn, 1 yr old? 6r old?
75/55, 90/50. 100/60
In dark skin, what do cyanosis & pallor look like? Where find jaundice (4)?
Ashen gary lips/tongue. (yellowsh/brown in brown skin). Jaundice: sclera, hard palate, palms, soles.
Hyperextension of head (opisthotonos) w/pain on flexion could indicate what?
meningitis - Immte Referral!
An RN notes that a 7 mo old does not have good head control. What does she do?
Refer for further neur/dvlpmt eval. Could be cerebral injury. Usually control @ 4 mos.
Why do kids (<2) have inc risk for otitis (fluid & infctn in ear)?
Some (not all) kid's eustachian tubes more horizontal than adults making ears more diff to drain
Hydrocephalus vs encephaly?
Fluid build up in brain (can shunt & drain it) vs Brain dvlps outside skull (almost always fatal)
An RN notes strabismus (eyes do not line up) in a pre-mie baby, what does she do? Should she do a vision test?
Documents it. It's normal. No but vision should dvlp by 3-4mos...test done in MD office.
What do you look for in Resp Assessment?
Chest shape, retractions, Nasal flaring, grunting, access muscles, breath sounds (rales, rhonci, wheeze)
Moro, stepping, galant reflexes, babinski? What? Age limit?
Moro: Startle (sprds arms, brings in, cries) 34 wks - 5 mos.
Stepping: 0 - 6 wks. Galant: 0 - 6 mos. Stroke side of spine & baby swings toward stroked side (patho if longer). Bab: flare toes - 1 yr
What is the Babkin reflex? When observed?
Press babies palms & will flex/rotate head or open mouth. MORE prominent in preemies!
With anticipatory guidance what 3 areas must always be addressed?
1) Safety: (car seats, sleep on back, sun, smoke...). 2) Nutrition. 3)Health care plan (vaccines, dental, next visit?)
What does a tense/boardlike abdomen indicate?
Paralytic ileus and intestinal obstruction
Absence of femoral pulse sign?
Sign of coarctation of aorta - referred for medical eval.
For first few mos for infant what do w/head when in supine pstn?
Put head on either sides to prevent plagiocephaly (flat head) when asleep or awake
At birth an infant has bdy wgth that's 75% water (high ECF) & imm Renal w/low spcf gravity. This predisposed them to?
more rapid loss of total body fluid (dehydration)
Name 5 grps of Meds that need to be double checked w/RN
Anticoags, Antiarrhythmics, Chemo, E-lytes, Insulin
In kids, are chewed solids, swallable tabs, or liquids preferred? Why?
Liquids using syringe. Less risk of aspiration
W/kids w/neuro impairments how get them to elicit swallow reflex?
blow small puff of air in their face
Max amt of med admin IM is __ml for older infants & smll kids
1 ml
VAD stands for?
Venous Access device (central lines - CVAD - best for chemo, repeated bld draws, hyperalimentation or frequent antbcs)
When will the moro, tonic neck (turn head while supine & extends that side), Galant (rub on side of spine) & rooting reflex disappear?
4-6mos
How long does the doll's eye reflex stick around? crawling (touch soles of feet)?
~1 mo, ~1mos
When does the parachute reflex appear? when the plantar grasp disappear?
8-9mos
When can an infant change from prone to sitting & stand holding furniture?
10 mos
When will an infant transfer objects from one hand to other? grasp feet and pull to mouth? coo? make consonants?
7 mos, 6 mos, 2 mos, 4 mos
head circumference msred (1st - 3rd yr) (36 mos) ave newborn & 36 mos? chest new?
New: 32-37 cm. Chest: 30 - 35
36 mos: 46 - 51
Strabismus (lazy eye) common in infant but gone by? If not tx early leads to?
4 mos. Amblyopia (reduced visual acuity) or perm loss of vision.
What is abmlyopia. How rt to strabsimus?
Reduced visual acuity. If strabismus not tx early (if present after 4mos after birth) could lead to this.
PHENOBARBITAL
a barbiturate used as a sedative/ anticonvulsant /Hypnotic
PHENYTOIN
anticonvulsant drug (trade name Dilantin) used to treat epilepsy and that is not a sedative.Diminish seizure activity
CARBAMAZEPINE
(Klonopin), anticonvulsant/ mood stabilizer
VALPRATE
(Depakene) Anticonvulsant / Vascular headache supressant
CLONAZEPAM
Klonopin - Antiepileptic,Anticonvulsant,
ZANTAC
a histamine blocker and antacid-used to treat peptic ulcers and gastritis and esophageal reflux
ROBINUL
ANTICHOLINERGIC: GLYCOPYRROLATE / ADJUNCT FOR PEPTIC ULCER
ATIVAN
tranquilizer (trade name Ativan) used to treat anxiety and tension and insomnia.Lorazepan
TOPAMAX
topiramate (seizures), anticonvulsant
SCOPOLAMINE
alkaloid with anticholinergic effects that is used as a sedative and to treat nausea and to dilate the pupils in ophthalmic procedures
FORADIL
formoterol (bronchodilator)
BACLOFEN
Skeletal Muscle Relaxant. (Kemstro, Lioresal)
REGLAN
(metoclopramide) antinausea and vomiting, chemo induced
TRILEPTAL
Oxcarbazepine; anticonvulsant
LAMICTAL
lamotrigine, Anticonvulsant
PULMICORT
budesonide (corticosteroid)
DUONEB
(Ipratropium + Albuterol soln) Antiasthmatic/Bronchodilator/ Allergy/ Cold
KEPPRA
anticonvulsant (Levetiracetam) Decrease severity of seizures
DIGOXIN
digitalis preparation (trade name Lanoxin) used to treat congestive heart failure or cardiac arrhythmia
Care of G-Tube
...
Care of J-Tube
...
Care of Tracheostomy
...
Growth
Increase in physicial size,measurable, can be studied & observed.
Development
Progressive increase in function of body (ability to digest food)
Maturation
Total way in which a person grows...
Growth Chart for Children
Assess child's development (compare to others & present w/ former rate of growth)Length & height: shows % position to show underweight or overweight (< or > 50th %)
Five factors that influence growth & development
Heredity
Nationality & race
Ordinal position in family- motor development in youngest may be proolonged
Gender-Male weights more
Environment- Home,immunizations,positive energy & intelligence.
Nursing implications
Identify sources for homeless families
Help families modify eating habits
...
Raises head
1 month
Disappearance of Moro (stratle)and rooting reflexes
4 months
Sleeps through the night
...
Rolls from abdomen to back
4 months
Sits with support
6 months
Rolls from back to abdomen
4 months
Say's "ma-ma"
...
COGNITIVE Developmental Theory
PIAGET- intelligence consists of interaction and coping w/ environment
Sensorimotor (2yrs) sensations
Preoperational (2-7) egocentric
Concrete Operations (7-11) some reasoning
Formal Operations (11-16) abstract concepts
MORAL Developmental Theory
KOHLBERG-Conscience w/in society
Preconventional(4-7)obedient-fear of punishment
Conventional (7-11) conformity & loyalty
PostConventional- (12 >) moral values developed
Erickson's Stages
-Trust/Mistrust (infant)- recognized mother
-Autonomy/shame & doubt (Toddler)-acceptance of reality
-Initiative/Guilt (Preschool) questioning/diferentiation of sexes
-Industry/Inferiority (School-Age)- recognition by producing things
-Identity/Role diffusion (Adolescent)- Abstract reasoning,identity,investigate
Feeding practices for infants
...
Introduction of semi-solids and new foods
Rice cereal 1st solid food @ 6 months fed by spoon
Tablespoon of food per yr of age
Common food allergies seen in children
to food, allergens
Influence of family & culture
...
Play
...
Therapeutic play
Improtant for their therapy
Play as an assessment tool
...
Family centered care in pediatrics
...
Effects of illness & hospitalization upon child & family
Poor appetites
...
Cephalocaudal Development
From head to toe....
Proximodistal (midline to periphery development)
Cognition
the psychological result of perception,learning and reasoning. Intellectual ability.
Decidious
Baby teeth...
Fluorosis
a pathological condition resulting for an excessive intake of fluorine (usually from drinking water)
Neonate
Birth - 4 weeks...
Infant
4 Weeks- 1 yr (2x weight)
Toddler
1-3 yrs...
Cognitive development of infants first yr of life
...
Nutritional needs of growing infants
Require more calories,minerals,vitamins and fluids. .5 g of fober/ jg in childhood.
Breast milk & iron. Fat & cholesterol (development of CNS)
Food additivies should be minimized.
Select & prepare solid foods for infant
1 at a time btw 4-7 days
Four concerns of parents about feeding of infants
new foods
Until whn the milk-m 1 yr whole milk & 2 yrs skim
Development of feeding skills in the infant
Toddler: feed themselves @ end of 2yrs,parent present
Preschool:Finger foods(dawling & regress.)
School-Aged: Unpredictable-Empty calories
Adolescent: fatigue
Posterior fontanel has closed
18 months
Central Incisors appear
7 months
Birth weight has tripled
1 yr
4x (2yrs)
Child can sit steadily alone
...8 months
Child shows fear of strangers
...9 months
VS of 1 yr old Infant
HR- 70-110
RR: 25-30
BP: 90/56
Safety issues in the care of infants
cAR SAFETY
lOCK MEDS
HAVE PHONE NUMBERS HANDY
Approach & care of an infant w/ colic
Environment, put them in arm
Safety during infancy
...
Positive sleep patterns
routine, read a story
Avoid liquids before bedtime
Parachute Reflex
...
pINCER GRASP
8 months- index fiunger and thumb use to grab things
Prehension
...
Developmental tasks of Toddler period
self control & socially acceptable outlets for aggression
Ritualism
increasing independece & curiosity
Speech development in Toddler period
...
Combating children fears
...
Toilet training (bowel & bladder)
...
Preventing automobile accidents
...
Preventing burns & falls
...
Preventing suffocation
& choking
...
Preventing Poisoning
...
Preventing drowning
...
Preventing electric shock
...
Preventing animal bites
...
Play & toys for toddler
...
Guidance & discipline for toddler
...
Nutritional needs & self-feeding abilities of toddler
...
Pre-school age
3-6 yrs
Physical,Psychosocial & spiritual @ 3
...
Physical,Psychosocial & spiritual @ 4
...
Physical,Psychosocial & spiritual @ 5
...
Paiget's Development of preschool
...
Erickson's Theory of preschool
...
Kohlberg's Theory of Preschool
...
Characteristics of a good preschool
...
Value of play
...
Two toys for preschool & rationale
...
Timr-Out periods
...
Consistency
...
Role Modeling
...
Rewards at preschool
...
Predispose activities for accidents & preventions
...
Positive bedtime habits for preschool
...
Enuresis
...
Thumb sucking
until permanent teeth appears
Sexual curiosity at preschool age
...
Introducing the concept of death to preschool
...
Animism
the belief that spirits are present in animals, plants, and other natural objects
Artificialism
belief that all objects are made by people
Echolalia
automatic and immediate repetition of what others say
Enuresis
inability to control the flow of urine and involuntary urination-Bedwetting
Parallel Play
activity in which children play side by side without interacting
6 yrs
...
7yrs
...
8yrs
...
9yrs
...
10yrs
...
11yrs
...
12yrs
...
Theoretical viewpoints of school yrs
...
Pet ownership
...
Role of school Nurse
Referrals for homeless families ...
Androgynous
having both male and female characteristics
Latchkey Children
children who go home to empty houses after school and who are left alone until parents return from work
SIECUS
...
Stage of Industry
...
School-age
6-12 yrs
Adolescent
12-18yrs
Rapid growth periods
Infancy & puberty
Weight
Wt doubles 6 months
3x 1yr
4x 2-2 ½ yrs
Denver Developmental Screening
1. Language communication
2. personal social-interaction
3. fine motor adaptive- ability hand movement
4. gross motor skills- large body movement
Family APGAR
A- Adaptation:helps & shares
P- Partnership:communication
G- Growth:responsibilities shared
A- Affection: emotional interactions
R- Resolve: prevent & solve problems
Maslow's basic needs
Physiological needs
Activity
Safety
Love
Esteem
Self-Actualization
Primary Teeth
2.5 yrs
Avoid tetracycline
1 yr old has __ teeth
Six- 4 above & 2 below
Extrusion Reflex
Kids spit out food if you put it in the mouth
Ketogenic Diet
To control seizures (High in fats and no Carbs