Infant needs rear facing car seat leave child unattended car

NFDN 2005 SLOs Pediatrics

UNIT 1: GROWTH AND DEVELOPMENT IN CHILDREN

o Fine Motor Skill: Using smaller muscles like holding a pen.

o Language

preschool (3-5), school-age (6-11), and adolescence (12+ to about 16 to 17).

Family as Context: A family is who they say they are*****. Types of families include: Nuclear, step (1 parent has a child, the other doesn’t), blended (both parents have children), extended, adoptive, skip-generation (Grandparents raising the grandkids), and single-parent, alternative.

- Should be developmentally appropriate.

1) Identify principles of growth and development.

i. There is an optimum time for initiating experiences or learning. IE: Toilet training.

j. Neonatal reflexes must be lost first before development can proceed.

q. Development refers to ability to complete tasks.

2) Describe factors that influence growth and development.

ii. DO NOT get concerned unless child is at extremes of weight or changes growth pattern by 2 percentiles.

1. Extremes of weight are: >95th percentile or <5% percentile.

5. Intensity of reactions: hold onto things and never let it go (Keep reacting) or absorb the info and let it go.

6. Distractibility: able to be distracted or stay focused
7. Attention span and persistence: Can also be age related. Give up and not being able to persist through something.

2

NFDN 2005 SLOs Pediatrics

ii. Ordinal position in the family:
1. First borns are often the leaders, take on more, and parents are still learning.

2. Last borns are often spoiled or “Babied”
3. Children can be compared to their siblings and that can be frustrating.

v. Adolescence: 13-20 (or 21) years.

d. Erickson’s Theory of psychosocial development: examines how children interact with others. Characterized by “Conflicts” that must be resolved to further development. Stresses the importance of culture and society in the development of personality. Divided the human life span into 8 stages (5 are childhood). Involves opposing forces that conflict with each other.

3

NFDN 2005 SLOs Pediatrics

ii. Conventional morality preschoolers and school age 1. Good interpersonal relationships
2. Maintaining the social order
iii. Postconventional morality: adolescents
1. Social contract and individual rights
2. Universal principles.

4) Describe the growth and development of children including infant, toddler, preschooler, school-age, and adolescent according to the following:
a. INFANT: On growth chart, child should be between 5-95%***** Regain birth weight within a month and Double birth weight by 6 months, triple by 1 year.

iv. Fine Motor Development: Grasp reflexes
1. 1 month: grasp reflex, difficult to extend fingers
2. 2 months: hands open, not closed, may hold an object for a few moments before dropping it., grasp reflex is fading
3. 3 months: reach for items they want, but usually miss as grasp is unpractised. Rolling by 3-4 months.

4. 4 months: thumb opposition/pincer grasp, can’t pick up small objects
5. 5 months: grasp with the whole hand.

1. 2 months: Cooing, differentiates cry (Wet, hungry).

2. 3 months: laughs out loud
3. 6 months: vowel sounds
4. 8 months: first word (da-da, ma-ma)
5. 12 months: a couple more words.

5. ****Encourage parents to continue to visit hospitalized child regardless if separation anxiety – Reassure them that this reaction is common and that trust through consistency is important during this stage.

viii. Infant Psychosocial Development:
1. Trust vs. Mistrust – (birth-1yr) Infants whose needs are met as the need arises.

NFDN 2005 SLOs Pediatrics

a. 1st stage: use of reflexes of sucking, rooting, grasping, and crying. Associations of an act and a sequential response (cry = milk).

b. 2nd stage: primary circular reactions, understanding voluntary actions such as crying is a stimulus that elicits a response (milk), cause and effect.

5. Develops goal-directed behavior (Understanding cause and effect) a. IE: Baby knows when he hits the mobile, it moves.

x. Infant Moral Development: Kohlberg.

old or 40 pounds (2-3 years old)
b. Until 20 pounds, infant needs to be in a rear facing car seat.

bit, but cannot sustain this.

i. Physical: chest circumference is now greater than head.

1. Gains about 5-6lbs (2.5kg) and 5(12cm) inches per year.

6. RR and HR decreases, BP increase.

7. Up to 8 new teeth this year
8. Toilet training now possible as myelination of spinal cord is complete so there is control of urinary and anal sphincters.

a. Can understand a lot of simple commands
b. A 2-year old has mastered a two-word, noun-verb, sentence (Daddy come). IF NOT, it should be assessed.** Can indicate hearing loss.

c. Parents can encourage language development by stating what they are doing. IE: Here’s your ball. Let’s put on your pajamas.

iii. Emotional Development:
1. Erickson: Autonomy vs. Shame or Doubt: toddlers recognize that they are separate from their parents. Realize they can make

7

iv. Toddler Socialization: once mobile and walking, they become resistant to sitting on laps or being cuddled. This is not being antisocial, they just want to interact with people who are willing to do so on the go. By 18 months will imitate behavior. “Sweep”, “Study”, take a pill, etc.

v. Toddler Play:Parallel Play: beside each other but not with one another (one has blocks other has a doll) - can’t share or understand others have feelings. Action toys – they can move them (nesting toys), make noise. 1. Squeeze/squeaky toys.

others.

d. Draw conclusions from obvious facts. IE: Dad shaved yesterday before going to work so if he shaves today he must be leaving soon.

viii. Moral Development: Kohlberg:
1. Formulates sense of right and wrong: this is based only on what parents say, not on societal motivation.

2. May not obey commands from anyone but parents: parents are ultimate authority and may have to reinforce instructions.

c. PRESCHOOLER AGE: reduced negativity. Pre-operational skills improve.

i. Physical Changes:
1. Future Body Type:
a. Ectomorphic: slim body build
b. Endomorphic: larger body build 2. Weight gain is slight during this period
3. Height gain is minimal
4. Appetite does not change much from toddler 5. Have all 20 deciduous teeth.

4. Can only carry out one request at a time.

5. Unable to understand figurative speech, take literal meaning of words.

6. You can assist preschoolers to do tasks independently (Matching outfits together – shirts and pants).

iv. Emotional Development: achieve a sense of initiative (Realization that learning new things is fun). Imitation and role playing. Fantasy (Cannot differentiate between fantasy and reality).

v. Cognitive Development: at 3 years, still preoperational. Lack insight to view themselves as others or put themselves in another’s place. Feel they are always right. Basic numbers, colours, alphabet. Do not understand conservation, believes 1 big piece of cake is less than 2 small pieces of cake. Egocentric. Increasingly uses language without understanding their meaning, might not understand right and left in some situations when asked, but understand when placing shoes on. Can explain a concept they heard described by others, but has limited understanding. Associating time with daily events than words like “tomorrow” will help them learn temporal relationships. Believe in the power of words and thoughts.

vi. Moral Development: strong sense of the rules.

viii. Parental Concerns: health problems, fears (Dark, mutilation, separation) - vivid imaginations, behavior variations (telling tall tales, imaginary friends, sharing), new siblings, sex ed., choosing preschool or child care center, broken fluency, bathroom language.

1. Incidence of minor illnesses is exceptionally high, more than any other age group. Immune response is still developing.

2. Tonsils and adenoid tissues enlarge: swollen tonsils, appendicitis.

3. Left ventricle enlarges: to pump blood to the growing body.

6. Fine motor: tie shoes, print (penmanship & cursive), paint, write script, complex crafts, and build models (lego).

ii. Sexual and Physical concerns: school age is a good time for parents to discuss with children the physical changes that will occur and the sexual responsibility these changes dictate.

iv. Emotional Development: Erickson’s Industry vs. Inferiority.

1. Industry: they have learnt how to do things, now they are learning how to do things well.

6. Must learn they cannot master every skill they attempt. Will feel some degree of inferiority.

v. Socialization:
1. 6 years: play in groups, but when they are tired, prefer one to one contact. Normal for them to want individual parent time at the end of the day.

6. 11 years: girls interest in boys increase. Mixed sex activities.

vi. Cognitive Development: age 5-7 is a shift from pre-operational thought to concrete operational thought as several new concepts are developed.

2. Accommodation: Understand more than one reason for someone’s actions. Understanding having different nurses for several days as they need days off.

3. Conservation: ability to understand that 1 is the same as 2 halves of 1. That simply altering their arrangement in space does not change certain properties of the environment (changing the shape of a lump of clay does not change total mass). Recognize size does not necessarily relate to weight and volume.

3. May interpret accidents or misfortunes as punishments
4. Older school children may take in the concept of treating others as they would like to be treated. Rules and judgements become less absolute.

viii. School-aged Play: reading books, video games, require more props for play (Badge and gun), collecting (Rocks, sports cards, dolls - doesn’t matter what they collect, only quantity), music lessons, latter stages (Sex-separated group). Can understand concepts better when you they can see them.

12

NFDN 2005 SLOs Pediatrics

5. Hormones cause acne.

6. Sweat glands produce a strong odor in response to emotions.

4. May spend a great deal of time alone in their rooms.

5. Part time jobs
6. Helping to care for younger siblings.

viii. Cognitive development: Piaget: Formal Operational Thought. 1. Think abstractly. Can use scientific methods to draw conclusions.

2. Use of this reasoning to plan futures: “What if I go to college?”3. Can imagine a sequence of events that might occur and how things might change in the future and the consequences of their actions 4. Capable of mentally manipulating more than 2 categories of variables at the same time. Can detect logical consistency and inconsistency in a set of statements and evaluate a set of values.

NFDN 2005 SLOs Pediatrics

2. Concept of justice on making amends for misdeeds.

xii. Common health problems: hypertension, poor posture, body piercing, tattoos, fatigue. Menstrual irregularities, acne. Obesity, sexuality, stalking, hazing.

5) Describe how knowledge of growth and development theories can be utilized in adapting nursing care required for infant, toddler, preschooler, school-age child, and adolescent.

ii. Other risks: poisoning, railings, falling out of cribs.

c. Infant safety tips:
i. Aspiration Prevention: Don’t bottle prop, hold the infant for feeding.

iv. Sibling Safety: remind parents that children under 5 are not
knowledgeable enough to understand infants: may be too rough or give babies unsafe toys.

v. Bathing and swimming safety: NEVER leave infants unattended in a tub and supervise when near a body of water. Keep one hand on child at all times when in tub.

2. Baby walkers have been banned in Canada
3. Baby gates will be needed once child is crawling.

d. TODDLER safety:
i. Accidents are major cause of death in children of all ages.

ii. Automobile safety – Crossing roads, car seats.

iii. Imitation – may imitate someone taking medication.

f. SCHOOL AGE Safety: ready for some unsupervised time if reliable enough to follow instructions. Check weight of backpack (No more than 10% of body weight). - posture problems
i. Wears helmet when biking
ii. Back seat is safest for children until 12 years of age, can then sit in the front seat.

iii. Protective padding and eyeshields recommended in active sports.

iii. Developing healthy activity patterns appears to be important.

iv. Hypertension
v. Poor posture: especially with the girls (slouching)
vi. Body piercing/tattoos: Where are they going, is it sanitary. - infection vii. Acne (Try to avoid greasy foods, hands and hair off face, medical treatments)

a. Important nutrients: Calcium, iron, phosphorus, healthy fats, carbs (Complex are better), Vitamin C, Vitamin D, B vitamins, and protein.

b. Obesity: becoming increasingly common in infants and children.

vi. Avoid junk food and offer healthy foods – Healthy snacks are a great option.

Malnutrition: occurs when children don’t get enough nutrients. c.

i. Babies under 6 months to 1 year DO NOT need extra fluid apart from breastmilk/formula.

ii. Homo milk until age 2, then any kind is ok.

iii. Infants need approximately 120Kcal/Kg at birth ***. This decreases to 100kcal/kg by 1 year.

iv. Solid food can be introduced to diet at 4-6 months – when child taking more than 32oz of formula and are unsatisfied, this is a good indicator of readiness.

vii. Meat and eggs at 9 months.

viii. Children are ready to start trying self-feeding after 6 months of age. ix. NO COWS milk (Risk of GI bleeding) OR honey (botulism) until age 1 year of age or whole nuts (risk for choking)
x. Weaning: refers to relinquishing the breast or bottle for a cup, is a significant step as the infant is required to give up a major source of oral pleasure and gratification. Should be individualized and gradual.

xii. Bottle Feeding Issues: bottles SHOULD NOT BE PROPPED (leads to aspiration, otitis media, and tooth decay).

i. How can parents encourage toddlers to eat: food on the go, options,, small amounts at a time (Ensure balance), allow self-feeding, DO NOT RESTRICT FAT up to 2 years of age****.

1. Fat helps with the brain development during this age.

vi. Will self-adjust and may begin to have food preferences.

h. SCHOOL AGE: growth more constant in young school-agers. Growth patterns and energy needs vary within and between individuals.

NFDN 2005 SLOs Pediatrics

iv. Diet begins to diversify.

vii. Peer groups significantly influences diet.

viii. IRON AND CALCIUM are particularly important nutrients.

d. Emphasize that children grow and develop at their own rates.

Educate parents about proper baby and child care. e.

Adolescents especially need teaching at every visit. j.

UNIT 2: FOUNDATIONS OF PEDIATRIC NURSING
TOPIC 2.1: Treads and Issues in the Care of Children and Their Families

d. Follow court-ordered procedures. Try to be sensitive to the parents.

NFDN 2005 SLOs Pediatrics

2) Identify trends that impact the nursing care of children and their families.

c. Immigration: lack of skill in English has a direct impact upon their education attainment, economic viability, and ability to enter the society.

i. Debates about immigrants taking jobs, eligibility for local and federal benefits, meanwhile leading to poverty.

3. Many people bring cultural traditions and practices to Canada.

d. Poverty: If annual income falls below official poverty threshold (in the $20k would be considered poverty).

ii. Role expansion from strictly caregiver to advocate.

iii. A focus on promoting normal growth and development.

19

NFDN 2005 SLOs Pediatrics

1. Will not need parent/guardian consent*** 2. Parenting adolescents
4) Describe how to obtain an informed consent when caring for a child.

a. Who can give consent: parent or legal guardian, emancipated minor.

1. The minor is capable of understanding the nature and consequence of the medical treatment, AND
2. The medical treatment and the procedure to be used is in the best interest of the minor and his continuing health and well-being.

iv. Judge must consider: In deciding whether to agree or disagree with a minor’s decision, the judge must evaluate mental capacity of the minor using:
1. Age and maturity
2. Nature and extent of her dependency on their parents
3. The complexity of treatment.