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NSG 304 Exam 1 Review Guide
Fhp Pediatrics (NSG 304)
Misericordia University
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Chapter 28 – Overview of Growth & Development and Nutrition
Overview of the G & D theorists o Freud - All behavior is MEANINGFUL Infancy : comfort/pleasure obtained via mouth = feed infants promptly. Provide oral objects. Toddlers : gratified by controlling body excretions. Provide child potty chair. Avoid training during illness/stress. Reprimand carefully with “uh oh”/ “these things happen” Begin toilet training with signs of “readiness” Preschooler : Gender difference curiosity/masturbation exploration (Teach what’s appropriate and not appropriate) School-age/Adolescent : Encourage contact with friends. Answer questions honestly Privacy during doctor exams, changing clothes/showering.
o Erikson – “ tasks ” Infant: Teach parents to meet infant’s basic needs in a timely/appropriate manner. Toddler: Allow opportunity for toddler to be independent Preschooler: Provide preschoolers with a variety of experiences to explore, ask questions, and create School-age: Encourage school-age children to interact with peers Adolescents: Support adolescent’s choices, be available to listen , and offer guidance
o Kohlberg – Moral ability Set LIMITS/EXPLAIN CONSEQUENCES Based on Piaget’s with suggestion of moral development is sequential. Preconventional – obedient due to fear of punishment (4-7yrs) Conventional – conformity/loyalty, obey rules (7-11yrs) Postconventional – moral values developed to solve complex problems (12-older)
o Piaget – Cognitive/intellectual ability Children learn AT DIFFERENT RATES/DIFFERENT WAYS Children have inherited potential/must be developed Sensorimotor – REFLEXES sensations/simple learning (birth-2yrs) Preoperational – EGO intuitive phase/transductive reasoning (2-yrs) Concrete operations – CAUSE & EFFECT inductive reasoning/beginning logic (7-11yrs) Formal operations – SCIENTIFIC PROCESS deductive/abstract reasoning (11-15yrs)
Erikson’s stages of G&D Developmental “ tasks ”. (doesn’t have to excel prior task to reach the next) Infant : Trust vs. Mistrust From a sense of trust vs. mistrust. Learns to love and be loved. (Birth-1yr) Toddler : form autonomy vs. shame. (1-3yrs) Preschooler : form initiative vs. guilt. (3-6yrs) School-age : sense of industry vs. inferiority. (6-12yrs) Adolescent : sense of identity vs. role confusion. (12-18yrs)
Freud o Psychosexual stages Infant : explores world by mouth. Toddler : learns to control urination/defecation. Preschooler : Learns sexual identity from genitalia awareness. School-age : Personality development nonactive/dormant. Adolescent : Sexual maturity/establishes satisfactory relationships with others. o Id, Ego, Superego – all 3 must balance each other out! Id: Unconscious mind - “pleasure and gratification” (bottom of 3) Ego: Conscious mind - “reality principle” Superego: Conscience/moral arbitrator – “the ideal” Growth charts – Denver II WIDLEY USED developmental screening o Measured in dimensions: length/height, weight, volume, tissue thickness o Compare measurements to other children of same age/sex o Children in good health follow a consistent growth pattern Key terms: Growth – an increase in physical size Development – progressive increase in bodily function toward maturity Maturation – total way a person grows and develops Cognitive development – ability to learn/understand from experience Universal language of children is PLAY. The “work” of the child.
Maturation of Systems o Respiratory Slows/stable. Abdominal breathing. URI common due to: Shorter eustachian tube (drains ear canals)/proximity to resp tract is MUCH SMALLER Trachea and bronchi are SMALLER AND CLOSER TO UPPER AIRWAYS Mucosal lining not effective in protection of infection o Immune Maternal transfer IgG provides PASSIVE immunity for several months Form IgM/IgA antibodies within several weeks Adult levels of IgG/IgM not reached until 1 year Early immunization is NECESSARY o Cardiovascular HR slows Rhythm: Sinus arrhythmia o Hemo Physiologic anemia common Maternal iron stores last 5-6months (encourage iron fortified rice cereal) Adult Hgb forming at 3-5months o GI Digestive process doesn’t begin until 3months old IMMATURE FIRST FEW MONTHS Peristalsis is RAPID (NEED TO POOP DURING/AFTER A FEED) Simple CHO/proteins are okay; complex CHO/proteins NOT HANDLED WELL UNTIL 3-5MONTHS JUST FORMULA/BREASTMILK UNTIL 6MONTHS Touch o MOST HIGHLY DEVELOPED SENSE o LIPS/TONGUE/EARS/FOREHEAD o NEED TOUCH find it soothing/comforting Hearing o Sounds heard WELL BEFORE 10 DAYS o Response is CRY, EYE MOVEMENT, CESSATION OF ACTIVITY/STARTLE REACTION o BAER done at birth o Ability to hear CORRELATES with ability to ENUNCIATE WORDS o Ask for HX of otitis media/hearing aids o Referral for fluid in ears (will need) repeat hearing test/speech therapy Vision o Follow objects IN LINE OF VISION BY 6-8 WEEKS Taste o Bitter/sour resisted. Sweet is accepted Smell o ONLY EVIDENT IN SMELLING BREASTMILK
o Cognitive - PIAGET Object permanence EX: can find a toy hidden under a blanket. Objects that leave the visual field still exists Sensorimotor phase: (6 stages/birth – 24 months) Reflex stage: birth – 1 month Primary circular reaction: 1-4 months (Hit their mobile, recognize movement) Secondary circular reaction: 4-8 months (recognize they caused mobile movement) Coordination of secondary schema 8-12 months (they repeat secondary reaction) o Emotional Consistency to DEVELOP TRUST Pickup and comfort when crying/change diaper when soiled Shows readiness to learn a task, provide encouragement Emotions are unstable-change crying/laughter 10 months BEGIN express anger, sadness, pleasure, jealousy, and affection 12 months above emotions are distinguishable Locomotion (movement – walking) o Cephalocaudal (head-to-tail) direction of development o Creep/crawl 9 months o Pull to standing 10 months o Cruises (walk with assistance) 11 months o Stand-alone 12 months Daily care of the infant o Crying baby needs to be soothed o Attend baby’s needs/baby develops trust (ERIKSON TRUST VS. MISTRUST) o You WON’T SPOIL A CHILD BY HOLDING THEM TOO MUCH o Express emotion through cry, hunger, pain/discomfort o Sleep allows for repair/recovery of tissues Newborns: sleep most of the time (short intervals) Infants: sleep decreases until 4-6months/sleep longer periods of time Will continue to decline until around age 10/increases due to growth spurt o Physical exams 5 TIMES IN THE FIRST YEAR Hearing/vision Growth grids/charts Immunizations/nutritional counseling o Cradle cap First 3 months Resolves by 8-12 months Rub baby/olive oil to soften plaques brush out
Infant nutrition o “spitting up” Burp baby frequently No cause for concern if weight isn’t affected Sit infant up for an hour after feed o Breastfeeding/bottle feeding Best for infants younger than 6 months Whole’s milk not given until after 1 year Check expiration/do not heat in microwave/don’t save formula left in bottle cause diarrhea Follow formula instructions/lead to malnutrition o When/how to introduce solids. 6 MONTHS o SLOWLY ADD SOLID FOOD AROUND 6 MONTHS o One food at a time for 4-7 days o Don’t introduce new food if INFANT IS ILL o Do not mix cereal with formula in bottle o Rice cereal as first food (fortified with iron) o NO HONEY due to infant botulism Dental care for the infant and toddler o ERUPTION OF TEETH begins at 5-6 months (incisors come first) o HINT: child’s age in months minus 6 is equal to approximate number of teeth (12month old should have 6 teeth) o Permanent teeth ERUPT BY 6 YEARS Dental health o Don’t put infant to sleep with formula/milk/juice bottle/WATER ONLY o Fever is NOT ASSOCIATED with teething/not normal o Replace tooth brush every 3 MONTHS or after illness Colic o Caused by excess gas production o Lay them on belly with forearm to help gas move Childhood obesity – heredity/genetic, lack of nutrition/poor diet Infant safety o Safe sleep/SIDS prevention Most common in winter months Cannot be predicted Place infant supine/no co-sleeping or prone sleeping/remove pillows, blankets, moldable mattresses o Position infants on their backs/firm mattress/tight-fitting sheets o Car seat safety Rear facing seat for infants younger than 1 year or less than 22lbs Appropriate play/toys for the infant (EX: don’t give asthmatic kid a stuffed animal) o Imitation – explore the world around them. Imitate sounds/behaviors o Safety mirrors – love to look at themselves
Want to branch out, need security Increasing ability to control their bodies; “I can do it myself”
- Appropriate play/toys for the toddler o Parallel play – Plays ALONG SIDE BUT NOT WITH OTHERS o Parents should INSPECT TOYS/BUY TOYS WITH APPROPRIATE AGE
- Common complaints – o negativism (“no!”) – Countered by offering limited choices/use of distraction EX: “Do you want to go to the park? Or play in the backyard?” o Temper tantrums – peak incidence 18 months/most disappear by age 3 Teach toddlers to develop self-control/socially acceptable outlets for aggression. EX: go stomp your feet Occur most frequently when toddler is tired, irritable, or frustrated May occur if parent says “NO” too much. o thumb sucking – toddlerhood NOT AN ISSUE
- Fine motor developments o 1 -year-old: transfer objects from hand-to-hand o 2-year-old: hold a crayon/turn page of a book/build 6 block tower o 3-year-old: copy a circle and a cross
- Gross motor developments o 15 months: walk alone, creep upstairs, standing position w/out falling, hold a cup with all fingers o 18 months: hold cup with both hands, run, transfer objects at will o 24 months: climb stairs o 30 months: jump with both feet, jump from chair/step, handle stairs w/one foot, drink without assistance
- Speech/Emotional developments o Age 2: short/multi-word sentences “all gone”/”mama go bye-bye” o Respond to tone of voice/facial expressions o Stranger anxiety usually dissipates by 2 years old
- Daily care of toddler o Talk to toddler at eye level o Clothing should be easy to put on and remove maintain toddler autonomy o Shoes should fit 1/2” longer and 1/4" wider than the foot
- Potty training o Voluntary control of anal/urethral sphincters begins around 18-24 months o Signs of “readiness”: they “hide” somewhere to poop o Bladder training can begin when toddler stays dry for about 2 hours at a time
- Toddler nutrition o Limit milk intake to no more than 24 ounces/day o Chop food in small appropriate pieces/finger foods o Age-appropriate portions o Physiologic anorexia: CALM CHILD DOWN BEFORE EATING
- Sexual curiosity
o Notice sex differences. EX: I’m a boy, you’re a girl
Sexual curiosity o Matter of fact about sexual investigation o Play “doctor” o May be displayed in form of masturbation Harmless if child is not preoccupied with the activity/time and place where appropriate Rule out medical possibilities/cause of rubbing/touching Behavior is normal Play of the preschooler o 2-3 years old: “imitation” play o 3 years: “associative” play – independent but same type of play o 4 years: broader themes of play/magical thinking o Gradually moves from parallel/associative to cooperative o Healthy play helps child adjust to expanding world/increase in independence Thumb sucking o Not detrimental if stopped before permanent teeth erupt Safety o Accidents are a major threat from 3-5 year olds Falls: keep stairways free of clutter Car safety: proper seating for child age appropriate Burns: lighters, matches, flammable objects out of reach Poisoning: lock away medications, chemicals “stranger danger”: teach about talking to strangers (they ask but don’t need a child’s help), teach not to play in “lonely places” Dosage calc o Order: 6mg/kg/day. Q12hr divided in equal doses (divide by 2) Have: 125mg/5mL Weight: 88lbs (ALWAYS CONVERT TO KG) = 40kg 6mg X 40kg = 240mg. 240mg / 2 = 120mg. 120mg / 125mg X 5mL = 4
o Order: 3mg/kg/day. Q8hr divided in equal doses (divide by 3) Have: 40mg/mL Weight: 99lbs (ALWAYS CONVERT TO KG) = 45kg 3mg X 45kg = 135mg. 135mg / 3 = 45mg. 45mg / 40mg X mL = 1 = 1
Vaccination schedule o Recommended beginning of immunization schedule within 2 weeks o Hepatitis B – within 24hours of birth (1st), 1-2 months (2nd), 6-18 months (3rd) o Hepatitis A – 12-18 months (2 doses/6 months apart) o DTap (diphtheria, tetanus, pertussis) – 2 months (1st), 4 months (2nd), 6 months (3rd), 15-18 months (4th), 5-6 years (5th) o Polio – 2 months (1st), 4 months (2nd), 6-18 months (3rd), 4-6 years (4th) o MMR – 12-15 months (1st), 4-6 years (2nd) o Influenza – 2 doses (first year), 1 dose each year after o Varicella – 12-15 months (1st), 4-6 years (2nd) o Haemophilus influenza type b – 2-15 months (1st – 4th doses) o Pneumococcal disease – Same as Hib o Rota Teq – 2-6 months (1st-3rd doses)
NSG 304 Exam 1 Review Guide
Course: Fhp Pediatrics (NSG 304)
University: Misericordia University
