Exam 1 Flashcards
Factors that affect infant growth
smoking, nutrition, dynamics of the family, education, interactions within the home
Normal weight parameter
2x bw by 5 months, 3 x bw by 12 months
Normal Height Parameter for infant
1inch a month first 6 months
@12mo 50% of birth length
Normal Head parameter
10cm growth by 12 months.
Infant heart rate..
decreases
Infant respirations…
decrease
Infant blood pressure…
increases
Anterior Fontanel closes…
12-18 mo
Posterior Fontanel closes…
6-8 weeks
Why are infants susceptible to heat loss?
Capillary are closer to skin
Infants bodies are mostly water which can increase risk of…
dehydration/ F and E imbalances
Indented fontanel indicates
dehydration
Bulging Fontanel indicates…
ICP
vitals in nb
bp
s:70-105
d: 35-55
Hr: 110-160
rr: 30-60 irregular
Animism is…
when objects come to life
To assess the need for fluoride we need to assess
home water supply source.
Infants are at risk of..
URI
Why are infants at higher risk for URI?
from 3-6 months mom will provide immunity, but then they stop so baby has to produce their own immunity. In the meantime, they are more at risk for more infections.
when do infants start to get their first baby teeth?
6-10 months and they start at the bottom of the mouth.
-her thing says 6-8 teeth by 12 months so now im confused :,) -kelli
Why do we introduce veggies to infants before fruits?
Babies like sweet-tasting stuff, so if we introduce fruit, they may not want to eat veggies.
The very first solid food we introduce to infants is
iron fortified cereal
when do we start introducing solid foods to infants
4-6 months
Should infants have cow’s milk their first year of life?
no
Breastfeeding is recommended exclusively for first ____ months with iron supplement added at ___ months
6 ; 4
What do we introduce lastly to infants?
fruit
What must be extinguished before babies can start switching to solids?
Extrusion reflex
Why do we need to introduce foods every 3-5 days?
If an infant has a food allergy, we can pinpoint the allergy.
What is an infant’s first way of communicating?
crying, around 2-4 hr a day by 6 weeks then decreases at 12 weeks.
At 3 months what is the language pattern for infants?
cooing, and will start to turn heads to rattle sounds. They will start to cry differently for different reasons.
Language Development at 6 months?
laughing, babbling, squeals, respond to name, distinguish emotions
based on voice tone.
Language development for 12 mo
3-5 words, understands simple commands, recognize words for common items
4 month old gross motor marker
hold head erect without floppig, or lagging behind
roll from back to side.
4 month fine motor
holds object with 2 hands
6 Months Gross motor
roll from back to front
6 months fine motor
holds bottle
9 month old gross motor
sits unsupported
creeps on hands and knees
Fine motor benchmark for infant at 9 months
crude pincer grasp
12 month gross motor
sits down from standing, walks with one hand or on own
12 months fine motor skills
feed self with cup and spoon, 2 block tower
turn pages in a book.
Erickson’s stage infant
trust vs mistrust
What effects the trust vs. Mistrust stage?
quality of the caregiver
When does separation anxiety start?
8 months old
An important event during Erickson’s stage in infants
feeding
How to promote trust in infants?
younger: swaddle, rocking, sucking, holding
Older: parents near, calm environment, same caregiver.
Piaget stage in Infant
sensory-motor : learn about themselves and the world through sensory, motor, listening and grasping
Major tasks accomplished in Piagets for infants
Separation: separation from themselves and objects
Object permanence: object leaves visual field, still exist
Mental Representation: ability to visualize things that are not physically there
Age appropriate activities for infant
solitary play, do not share,
ex: rattles, stuffed animals, teething toys, read to them, music box, balls.
when does object permanence form?
8 months old
Infant bottle feeding safety
burp 2-3 times a feeding
hold while feed
do not overfeed, they will spit up.
Sensory development in infants (sight and smell)
sight: prefer contrast, nearsighted, full color by 7 mo
Smell: differentiate smell and taste of moms breast milk (love sweets)
Do Primitive reflexes disappear?
yes
Palmer grasp
stroke palm and hand closes
4-6mo
Plantar grasp
toe curls around your finger
9mo-1y
Moro reflex
head lower than body, arms will raise , and may cry afterwards
caused by sudden loud noise
disappears at 6mo
Rooting Reflex
touch cheek, will turn head towards the side that was touched and open mouth, attempt to suck
disappears 4mo
Sucking reflex
touch top of mouth
becomes voluntary
4mo
Babinski
Baboon Balls
stroke from bottom to top of foot, and toes spread outwards.
1y
Crawling
push against bottom of foot, and they will try to crawl away from you
few weeks
Step reflex
Hold upright
disappears at 4 months
Tonic (fencing)
when infants head is turned to a particular side, the leg and arm on that side will extend while the arm and leg on other will flex
disappear at 4months
What years of life are toddlers
-ages 1-3 years
hr/ rr for toddlers
hr: 80-110
RR: 40 regular
The challenge when handling toddlers is to
encourage independent and autonomy while keeping toddler safe
Rule of weight for a toddler?
4 times birth weight by age 30 months
Physical growth and acquisition of new motor skills in a toddler increase or decrease from that of an infant?
-slow / decrease
How many lbs a year do toddlers gain
4-6
Height rule for toddlers
grows up to 3 in per year
toddlers reach half of their adult height by age
2
Head circumference becomes equal with chest conference by age
1-2 years (toddler)
Anterior fontanels close by
18 months
Head size is more proportioned to the body by age
3
By age 2, the head size of a toddler is _____ % of adult sized
90
Myelination of brain and spinal cord is complete by
24 months
What does myelination of brain and spinal cord allow for
-improved equilibrium
-control of anal and urethral sphincters for potty training
What type of play do toddlers evolve into
-parallel play
what is parallel play?
- toddlers sit and play next to each other but do not engage with each other
Toilet training may begin when,
toddlers have the sensation or need to urinate and defecate
do toddlers like to share toys?
no because they are egocentric
Erikson’s theory of development for toddlers
autonomy vs shame and doubt
Age-appropriate activities for a toddler
-filling/emptying containers
-blocks
-looking at books
-push-pull toys
-tossing balls
-finger paints
-large - piece puzzles
-thick crayons
What four categories fall under the autonomy vs shame and doubt
- independence
- ritualism
- negativism
- egocentric
+ temper tantrums and regression
Parents should limit television viewing for toddlers and encourage
creative and physical play
Ex of independence in toddlers
-attempt to do everything for themselves
the short attention span of toddlers will make them …
change toys frequently
Ex of ritualism in toddlers autonomy vs shame and doubt
-consistency and maintaining routines
Temper tantrums are common in toddlers and result when
toddlers are frustrated with restrictions on their independence
Ex of negativism in toddlers autonomy vs shame and doubt
saying no repetitively .. expressing independence
Separation anxiety may re-emerge between ages
18-24 months
Ex of egocentric in toddlers autonomy vs shame and doubt
toddlers are unable to see things from the perspective of others . “this is mine”
How many hours of sleep do toddlers require?
12 hours
Aggressive behavior is typical in toddlers and may result in
hit, bite, or take other children’s toys
What may be used for comfort and security as a child sleeps
transitional objects such as a favorite blanket or favorite bear
An example of shame and doubt experienced by toddlers is commonly caused by
-potty training
-caregivers shaming children for accidents
Car safety for children under two
rear facing with harness straps and clip until age 2 / manufacturer guidelines
During times of high stress, what may we notice in our toddlers
-regression (ex is new sibling or hospitalization)
Car safety for after age two
forward facing seat but in rear seat of a car
Cognitive development, or Piaget’s Theory of Learning transitions from the sensory motor to the ______ stage around _____ yrs
preoperational ; 2
If appropriate rear seat is unavailable, how do we promote safety in the car for our toddlers?
disabling airbags so they do not deploy
During the Preoperational stage of Cognitive development, toddlers develop
symbolic thought
Why are toddlers at risk for injury?
- curiosity
- lack of impulse control
- mobility
What is symbolic thought
-pretending a broom is a horse
-use an object to represent something else
By providing a childproof environment, what does this allow the toddler to do
explore and learn
What is domestic mimicry seen in the preoperational stage
when they imitate previously seen activities (ex. sweeping, carrying a baby)
Exposure to tobacco (even on clothes) in the toddler puts that at risk for
- otitis media
- upper respiratory infection
- decreased respiratory function
Why are toddlers likely to develop iron deficiency anemia?
-no longer getting it from breast milk / formula and cow’s milk is a poor replacement
Toddlers are able to open drawers, so if there are guns in the home they should be
locked in cabinets with ammunition in a separate location
What is physiologic anorexia seen in toddlers?
when the growth rate slows decreasing the need for protein and fluid as compared to infancy
As toddlers gain hand dexterity, they can reach for dangerous items on the stoves and counters leading to
burns
What are food jags seen in toddlers
when toddlers want certain foods for time periods and then not wanting them after that.
teach parents do not give into junk foods
Why is it important to push furniture against the wall or deadbolt it
when toddlers begin climbing on them they can fall on top of them
What is ritualism seen in the nutrition of toddlers
have to use same dish, cup or spoon, or will not eat
What is the leading cause of death for children ages 1-4
drowning
What kind of foods do toddlers prefer
finger foods
Drownings for toddlers can occur in what places
- bath tubs 2. pools
Why do we wean toddlers at 12-15 months
prevent dental carries
Substances such as button batteries, detergent pods, and house plants increase toddler risk for
poisoning
How many full meals and snacks should toddlers eat
-3 full meals and two snacks
How to prevent poisoning in the home
-make cabinets unaccessible
-keep safety caps on with original bottles
-do not refer to medicines as candy
Before initiating any intervention, if children have potential poisoning, what should parents do
contact poison control
Is syrup of ipecac still used to prevent posioning in toddlers?
No; this should not be used to induce vomiting
Toddler safety DANGERS acronym
Drowning (even small amounts of water)
Auto Accidents (car seat safety)
Nose - dives (FALLS)
Getting burned (outlets, stove, fires)
Eating toxins (pills, liquids)
Revolvers/rifles (unsecure firearms)
Suffocate/ choke (small things, foods)
Why do toddlers have increased risk for UTI
short urethra in males and females
Why do toddlers have an increased risk for ear infections
short and straight Eustachian tube
toddler atraumatic care strategies
- allowing parents to do most thing
- giving them choices (autonomy)
- keeping consistent routine
- distractions with music
- consistent caregivers
An example of telegraphic sentences said by toddlers
‘mommy cookie’
toddlers often repeat words spoken to this. this is known as
echolalia
How much do pre-schoolers grow?
2.5-3.5 inches a year
How much weight do preschoolers gain a year?
4.5-6.5
Preschoolers lose what and start to gain?
baby fat, muscle
When are baby teeth complete?
30 months
Preschoolers can hold their breath by what age?
4
Biggest milestone for Preschoolers?
getting ready for school.
Does height slow down in pre-schoolers?
yes.
Type of play Preschool
associative play
What is Associative play?
children will play side by side, and will start to share toys but not working together on a common goal
Average weight and heigt preschool
w: 41 lbs
h: 43.5 inch
Organ system highlights Preschool
alveoli increase: decrease risk of URI
loss of teeth around 5/6
Immature musculoskeletal: higher risk for injury
Nutrition for Preschoolers
less picky at this stage
obeseity prevention
Erickson’s stage Preschooler
Initiative vs. Guilt
Initiative stage Preschool
can explore, make decisions, and initiate activites.
Sense of accomplishment and pride when successful
Guilt stage Preschool
initiation is repressed through critisism and controlled, will believe they have misbehaved or unable to complete task
Self concept development (ps)
feel good about themselves with regard to mastering skills that allow independence
Regression (ps)
stress or illness, may go back to previous immature behaviors or develop habits
(bed wetting after Potty training)
Piagets Stage (Ps)
Preoperational continued
Preopoerational thought (ps)
Preconceptual (2-4)
sees world through egocentric point of view only.
Intuitive (4-7)
moves from totally egocentric thoughts to social awareness and ability to consider other’s viewpoints
4 big in Piagets (ps)
magical thinking
imaginary friend
animism
time: begin to understand time
Magical thinking
all thoughts are powerful, step on a crack, break moms back.
Emotional ans social development (PS)
Moral develop: actions based whether or not it will result in reward of punishment.
-imagination allows anything to be possible: god
Body image ps
age 5 begin to compare themselves to peers
begin to recognize difference in appearance and identifying acceptable vs unaccetpable.
Huge thing that develops in ps?
fears: due to vivid imagination
what can cause fears?
Animism.
toys that look scary, make loud noises
can invent monsters
fear of dark
doctors.
acknowledge these, do not minimize.
Fears of hospital enviornment
hospitalization: they are sick because of something they did.
sickness punishment
Procedures: mutliation of body.
Myelination of spinal cord allows for what?
bowel and bladder control
Langage Development in PS
5 word sentences
2000 words
Gross motor milestones PS
agile now, hopping, skipping, tip toes, climbing, up and down stairs
use body to understand concepts
Fine motor skills ps
write, scissors, tie shoes, button shirts, grasp utensils, feed themselves, copy and write name.
age appropriate activities PS
reading books, sandbox, messy play, puzzles/ playing ball, pretend, dress up, puppets
Atraumatic care PS
speak honestly
simple terms
allow choices
puppets/story telling
participate in imaginary play
Nutrition PS
1200-1400 kcal a day
screen time <2 hr
physical activity for an hour or more a day.
Taste discirmination is poor in ps, putting them at risk for?
posioning
why may PS resist bedtime?
fear of dark and nightmares
Leading cause of death in PS
unintentional injury
Car safety for ps
forward facing car seat with harness and top thether until they outgrow it.
When can children transition to booster seat?
4’9, fastend properly
Sleep ps
12 hours a night with a nap during the day
Dental Ps
Baby teeth are in by 5-6 will start to lose them
dentist appointments every 6 months
school age vs
hr: 65-110
rr:18-30
sys:97-120
dia:55-70
How old is a school - aged child
6-12 (accompanied by periods of slow progressing physical growth)
What is Erickson’s stage for the school aged child
Industry vs Inferiority
What is the goal for a school-aged child during Industry (Erikson’s theory)
Competency (acquiring new skills and developing confidence to achieve goals)
What is industry in Erikson’s industry for inferiority (school aged)
-development of skills and knowledge
-development of self-worth and social skills
What is inferiority in Erikson’s stage
-can develop when the child is unable to complete the tasks or acquire skills as ‘expected’ and alters child’s self esteem
Piaget’s theory for cognitive development in the school aged child (occurs mostly during the 7-11 age)
Concrete operations
What are the obtained goals during Piaget’s Concrete Operations
- Concrete thinkers (takes a statement for exactly how it is said)
- Principle of conservation
- Understand reversibility
- classify and sort things
- Learn to tell time
What is an example of concrete thought seen in Piaget’s Concrete Operations stage
‘its raining cats and dogs’
-child will think it is literally raining cats and dogs
What is the principle of conservation seen in Piaget’s Concrete Operations?
properties of objects remain the same even when appearance changes
(think of same amount of spaghetti on two different sized plates)
What is reversibility seen in Piaget’s stage of concrete operations>
’s or objects can be changed or returned to their original state
Developmental concert topics for a school - aged child?
Moral development
Self Concept Development
Body image
Moral development in a school-aged child
-early: believe what they think is wrong and what others tell them is right
-late: understand different points of view
-conceptualize treat others the way they would like to be treated
Self- concept development in the school aged child
-awareness of themselves and their own characteristics, values, and abilities
-feedback from teachers, parents, coaches influences child self-esteem, worth and confidence
Body image development in the school aged child
-very interested in how others view their clothing, body, and bodily changes
-feeling accepted is important
-solidification of body image occurs
Are school aged children more or less modest than pre-schoolers?
more (enjoy their privacy)
Peer relationships in the school aged child
-peer pressure takes effect
-clubs and BFFs popular
-bullies target those who do not associate with peer norms
Teacher and school influences in the school-aged child
-school is second only to the family
-teachers play a role in guarding intellectual development and shaping child’s values
Family influence in the school-aged child
-parents continue to influence self ideals
-middle childhood opinions of peers and teachers become more valuable
School aged children 4-8 years who are moderately active need ____ calories a day ; gas 9-13 need ____ calories a day
1400-1600 ; 1600-2000
School aged children aged 4-8 need ______ mg of calcium and 9-13 need ______ mg of calcium
1000, 1300
Risk factor for obesity in school aged child
HEAVY acronym
H igh caloric diet
E xercise lacking (need 1 hr daily)
A ccessibility to healthy foods limited
V iew food as a way to deal with stress
Y our genetics and family dynamics
Education on managing or preventing obesity in the school-aged child
-make it a family effort (set obtainable goals and start slow)
-replace junk food that child likes with creative healthy foods
Obese children have 2x higher risk for ?
-CV disease, high cholesterol, type II diabetes, sleep apnea, orthopedic problems, and MH problems
What is the definition of bullying?
Physical , emotional, destruction of personal property
-can be digital or in person
-causes harm or control someone
Signs that a child is being bullied
-physical injuries child can’t explain
-school items missing
-doesn’t want to go to school (sick)
-behavior changes
-poor grades
Behavior changes seen in school aged child being bullied?
low self-esteem, withdrawing, agitated, depressed, suicidal behavior
Children that bully often have these characteristics:
-low self esteem
-poor grades
-poor interpersonal skills
What is school refusal or school phobia seen in a school aged child
-refusal to attend school or stay the whole day
-may fear teachers, bullying, changing in locker rooms, riding the bus, etc
School refusal symptoms in the young school aged child
headache and stomachache
School refusal symptoms in the older school aged child
palpitations or feeling faint
Sexual development in the school aged child can lead to
negative perception of physical appearance and low self esteem
Delayed sexual development in boys and early development in girls may lead to? (school aged child)
-altered body image, embarrassment, risk taking behaviors
Brain growth in the school aged child is complete by age?
10
-head is longer and facial bone proportion changes
During the school-aged years, abdominal breathing is replaced by
diaphragmatic breathing
Frontal sinuses develop in the school aged child by age
7
Tonsil development in the school aged child
-decrease in size but remain large
in school aged children, is the heart small or large compared to body size ?
small
In the school aged child, 20 baby teeth are replaced by
28-32 permanent teeth (excluding wisdom teeth)
School aged children grow ___ in per year
2
Does the stomach capacity increase or decrease in the school aged child
-increases but caloric needs lower
School aged children gain about ______ lbs/ yaer
4.5-6.5
IgA and IgG reach adult levels by age _____ (School aged child)
10
In school aged years, are girls or boys typically taller
girls
Why may school aged children have more infections first 1-2 years?
-new exposure to pathogens
What is important to remember about the growth rate and emotional maturity of school aged children
-slow growth rate may not indicate that a child is not mature emotionally
(even though they look 7 they may actually be 10 and needed to be treated that way)
Bladder capacity in the school aged child
-girls greater than boys
-capacity = age in years + 2 oz
What kind of play does school aged children participate in
cooperative play
Musculoskeletal changes in the school aged child
-greater coordination and strength
-muscles immature and easily injured
-bones continue to ossify but not fully mineralized
Types of play in a school aged child
-board games, card games, computer games, action figures, scrapbook, diary, joining clubs and gangs
Age of onset for puberty for boys and girls (school aged)
girls: 9-10
boys: 10-11
-characterized by development of secondary sex characteristics
Age appropriate activities for school aged child
ride bicycles, building models, collecting rocks/ cards, organized sports
What age is preadolescence considered?
middle childhood and age 13
How old is the adolescent
11-20
Hearing deficits that are less severe may not be diagnosed until child?
-enters school and has learning or speech difficulties
Do adolescents experience rapid or slow growth
-rapid
(second only to infancy)
Peripheral vision and color discrimination are developed by age
7
Puberty occurs in girls around
9-10
The typical school aged child has what type of vision
20/20
Puberty occurs in boys around
10-11
the final _____ % of height occurs during puberty
20-25
Girls typically grow _____ in and gain _______ lbs during adolescence
2-8 in ; 15-55
Boys grow ____ in and gain _____ lbs during adolescence
4-12 ; 15-65
Height increase in girls is rapid before menarche and ceases _____ years after menarche
2-2.5
Boys stop growing around ____ years of age
18-20
Muscle increases in boys during adolescence and ______ increases in girls
fat deposits
Increasing myelin sheath growth in adolescence allows for
speed, accuracy , and coordination of motor skills
Is lung volume capacity greater in adolescent boys or girls
boys
By adolescence, RR reaches
adult rate
Voice changes that occur for both boys and girls during adolescence
deepening of voice (more pronounced in males) , growth in larynx and vocal cords cause voice changes
Does heart muscle increase in size and strength during adolescents?
yes
Is blood volume higher in boys or girls during adolescents? why?
boys ; more muscle mass
What age do wisdom teeth erupt in adolescence
17-20
(have full set of permanent teeth as well)
Ossification of skeletal system boys vs girls
-boys late adolescents
-occurs earlier in girls
What happens when sex hormones erupt during adolescence
-closing of growth plates
Changes to the integumentary system with adolescents
-skin thick and tough
-sebacaceous glands active on face, hair, and genitals
-increased sebum production= oily hair and acne
-exocrine and apocrine sweat glands at adult level
What hormones are involved during adolescent changes
-Gonadotropin releasing hormone (GnRH) stimulates release of Follicle stimulating (FSH) and Luteinizing (LH)
Function of LH in girls
-leads to ovulation
function of LH in males
-Leydig cells in boys –> testicles mature, testosterone produced
FSH and LH in males stimulate
sperm production
Estrogen, progesterone, and testosterone lead to
changes in muscles, bones, skin and hair follicles
First menstrual period (menarche) occurs between what ages
9-15 (average 12 years)
When does breast budding (thelarche) occur ?
between ages 9-11
First sign of puberty in boys is ?
testicular enlargement in response to testosterone secretion
Order of puberty changes in girls
breast development –> pubic hair –> axillary hair –> menstruation
Order of puberty changes in males
testicular enlargement –> pubic hair growth –> penile enlargement –> facial hair –> vocal changes
What tool is used to evaluate the stages of puberty in males and females
tanner stages of puberty
Erikson’s theory in adolescence
Identity vs role confusion
What is identity in Erikson’s theory
-adolescent develops their own individual sense of self
What is role confusion in adolescents
-adolescent not successful in developing own sense of self
-believe they cannot express themselves in any manner due to societal restrictions
Self esteem and self concept is developed by what in the adolescent
perception of body image
Adolescents need how much sleep at night
10 h
Why do adolescents have difficulty getting up?
increase desire for independence causes for staying up later for school work
Adolescents still need dental visits every ___ months, should floss every day, and should brush teeth ___ times a day
6, 3
When is the most common time for orthodontics and need for proper teeth brushing to prevent gingivitis and caries
adolescence
What eating disorders are common in the adolescent
anorexia and bulimia
Obesity rates in the adolescents have ______ in the last 30 years due to poor diets and lack of activity
tripled
Average number of calories needed during adolescence
2000
What additional vitamins and minerals are needed during adolescents
calcium, iron, protein, and zinc
How much calcium is needed in the adolescent per day
1300 mg
How much iron is needed for girls and boys during adolescents per day
males 11 mg daily, females 15 mg daily
Sexual health in the adolescent
-contraception and safe sex practices are key teaching points for nurses
During sexual health discussions, what important part of relationships should be discussed
dating violence and unhealthy romantic relationships
What is the leading cause of death for adolescents
unintentional injuries
Leading causes of unintentional injury deaths in adolescent
- motor vehicle accidents
- poisoning (opioid overdose)
- drowning
- firearms (suicide and homicides)
risk factors for unintentional injuries in the adolescent
-rapid physical growth, impulsivity, inexperience, peer pressure, risk - taking behavior
What is the second leading cause of death in ages 10-24 years
suicide
assess for poor school performance, lack of interest, social isolation, disturbances of sleep
Developmental concerns for adolescents includes
-changes in body image
-peer groups
-violence
-homicide
-substance use
Hospitalization / illness level of understanding in the adolescent include
-their ability to understand cause and effect
-perceptions of illness severity are based on degree of body image changes
Impact of hospitalization in the adolescent
-body image disturbance
-attempts to maintain composure
-embarrassed about losing control
-isolation from peers
-worry about school outcome and activities
-may not adhere to medication / treatment plan due to peer influence
Atraumatic care approaches in the adolescent
-provide factual information
-include in the planning of care to relieve feelings of powerlessness
-encourage contact with peer group
Caring for the hospitalized adolescent includes
-provide opportunities for indpeendence
-encourage them to participate in decisions
-encourage socialization
-identify self care deficits
Communicating with teens in the hospital include
-allow sufficient time for conversation
-face to face
-ask open ended questions
- be honest
-ask for their input
-state expectations and set limits fairly
-be respectful
Nurses should educate teens and piercing under non sterile conditions because it increases the risk of
HIV/ Hep B, infections, metal allergies
Piaget’s development in the adolescent
Formal operations
Piagets formal operations (used for adolescents) includes
- abstract thinking
- invincibility (risk taking– think they are immune)
