Exam 1 Flashcards
COMM. & P.E. OF CHILD: therapeutic play
NB
- mobiles, music, mirrors, cuddlers
toddlers
- relieves tension, explores env’t., peek-a-boo, hide-and-seek, transitional objects [from home to hospital], reading fav. stories
pre-schoolers
- crayons, color books, use of body or doll to address child’s fear of bodily harm and mutilation
school-aged child
- regress developmentally, age-appropriate crafts/games for diversion, tasks to provide a sense of mastery and accomplishment
adol.
- loss of independence/regaining control, therapeutic recreation, peer contact w/ outside world and adol. on floor, physical activities
COMM. & P.E. OF CHILD: growth measurements
length and weight of child. up to 36 mo. of age should be taken in recumbent position
- head circumference should be measured
- pc 36 mo., child can be measured standing up
growth is plotted on chart
- < 5th or >95th percentile considered outside expected parameters for height, weight, and head circumference
- some pop. may need their own special charts [e.g. premmie’s, VLBW, down syndrome]
COMM. & P.E. OF CHILD: calculate corrected age from chronological age: baby J was born at 28 weeks gestation. Her chronological age today is 24 weeks, what is her corrected age in months?
(Chronological Age) ‐ (Weeks or Months of Prematurity) = Corrected Age
3 months
COMM. & P.E. OF CHILD: obtaining resp. rate on child.
1st VS performed b/c it is done w/o disturbing child
compared w/ adults, RR is more responsive to illness, exercise, and emotion
ranges:
- N.B. [30-60], tots [20-40], child. [15-25]
COMM. & P.E. OF CHILD: obtaining heart rate on child.
2nd VS performed, done so by auscultating apical pulse
rate increases w/ inspiration and decrease w/ expiration
ranges:
- infant [140 > 115], toddler [110], pre-schooler [103], older [103 > 85
COMM. & P.E. OF CHILD: obtaining B.P. on child.
3rd VS performed, if applicable
systolic BP increases gradually during childhood
ranges:
- infant [50 > 95/60], child. [95 > 120/75]
COMM. & P.E. OF CHILD: obtaining temp. on child.
last VS performed /c it is considered the most invasive
blue thermometers are used for PO and axillary readings; red for rectal readings
COMM. & P.E. OF CHILD: general appearance
face posture position body movement hygiene nutrition behavior development [fine/gross motor skills] dental
COMM. & P.E. OF CHILD: skin assessment
color
texture
temp.
moisture
tissue turgor [done on abd.]
pigment lesions [check size, configuration, distribution]
accessory structure [hair smooth and silky, nails concaved and pink]
COMM. & P.E. OF CHILD: head and neck
shape
- plagiocephaly [flat back of head] occurs when baby spends too much time on back; rotate during wakeful hours]
symmetry
head control [pc 4 mo., head control occurs]
head posture
ROM of neck [for infants/toddlers, have them follow a toy]
fontanels
- anterior closes b/w 12-18 mo., posterior fontanel and cranial sutures close b/w 6-8 we.
lymph nodes
- may present as pea-sized, non-tender, mobile masses; common up until age 12
COMM. & P.E. OF CHILD: eye assessment
size
shape
symmetry
conjunctiva
cornea [iris color not fully established until age 6 mo.]
pupils
fundoscopic exam [fundus, red reflex, blood vessels]
vision testing [ocular alignment,, visual acuity, peripheral/color [not fully developed until age 2 mo.] vision
COMM. & P.E. OF CHILD: strabismus leading to amblyopia
amblyopia is 1 of the most common causes of diminished vision in child.
in “lazy eye” both eye are unable to focus simultaneously brain suppresses image by deviating the weaker eye
lazy eye may be normal in child. up to age 3 mo.
COMM. & P.E. OF CHILD: ear assessment
externally [position, cerumen]
internally [landmarks, light reflex]
- pull pinna down and back when looking internally in child. ages 3 y. and younger b/c of the shorter canal
COMM. & P.E. OF CHILD: nasal assessment
externally [position, placement, nasal flaring [normal up to age 6 mo.]
internally [mucosa, turbinates, septum]
nasal drainage or odor
sinuses [aren’t fully developed until pc age 3]
COMM. & P.E. OF CHILD: oral assessment
by 6 mo., deciduous teeth start coming in
by 20 mo. all 20 deciduous teeth should be in
tonsils may be slightly enlarged
- normal unless causing airway obstruction
COMM. & P.E. OF CHILD: chest & back assessment
size, shape [e.g. pectus exCAVtum {CAVing in}, pectus carinatum], symmetry
movement
nipples
breast development [should be checked in both genders]
scapular asymmetry
spinal curvature
ROM
COMM. & P.E. OF CHILD: cardiac assessment
a physiologic splitting of S2
normal sinus arrhythmia
HR increased w/ inspiration and decreased w/ expiration
physiologic murmurs
nursing considerations: assess the child. wile they are upright and supine
COMM. & P.E. OF CHILD: abdominal assessment
assess contour, movement, umbilicus, hernias, bowel sounds, palpation [deep and superficial]
COMM. & P.E. OF CHILD: musculoskeletal & extremities
hips: infant ortolani and barlow maneuvers
assess: muscle strength, gait, sole and palm creases
normal findings:
- bowleggedness until 2 y
– abnormal if only present in 1 leg or exceeds 2 y of age
- knock knees 2-7 y
- appearance of flatfoot [ac walking]
- tibial torsion [pigeon toes]
- babinski until 18 mo. or once child begin walking
COMM. & P.E. OF CHILD: neurological assessment
assess:
- cerebellar fx [balance and coordination]
- reflexes [triceps, biceps, achilles]
- cranial reflexes
- 2 optic [infant: eye blink w/ light shining in eyes]
- 3 oculomotor, 4 troclear, 6 abducens [infant: focus on tracking; child: move object/toy through 6 points of gaze; note symmetry or eyelid drooping, PERRLA], 5 trigeminal [infant: foot reflex, child: chewing/ cotton test], 7 facial, 8 acoustic [response to sound, facial expressions and blilateral symmetry], 9 glossopharyngeal, 10 vagus [palatal reflex; infant: swallowing; child: clear speech], 11 spinal accessory [child: raised shoulders, turn head side to side against resistance], 12 hypoglossal [infant: observe feeding; child: tongue mid-line w/ no tremors]
GROWTH AND DEVP’T: assessing growth
linear growth reflect skeletal growth [assessed by recumbent length or height for child. that cannot sit yet]
weight reflects growth, nutrition, fluid balance
length remains more stable than weight does
head circumference reflects brain growth
plot weight, height, and head circumference on growht chart
- monitor that the child fits a trend line
by age 2, child has attained 50% of adult height
never again will a child have such high metabolic rate or intake requirements that during infancy
GROWTH AND DEVP’T: physical growth patterns [0-6 m]
weight increases 6-8 oz./w
length increased 1 in./m
HC increases 0.5 in./m
posterior fontanel closes, social smile develops, vocalizes, fixes on visual stimuli, lifts head when prone [landau reflex] at 2 m
hands held open, squeals, recognizes mother, social at 4 m
double birth weight, rolls, voluntary grasp, teeth erupt, chewing, tripod sit, bears weight on legs, by 6 m
GROWTH AND DEVP’T: physical growth patterns [7-12 m]
weight increases by 3-4 oz./w length increases by 0.5 in./m - increased by 50% by 12 m HC increases by 0.25/m teething begins 6-8 m triple birth weight by 12 m parachute reflex [flexion of arms and fingers to "break" a fall], crude pincer grasp, imitates sounds present by 8 m pulls to stand [9], cruises [11], walks [12], fine pincer grasp, releases/drops objects, waves, speaks 1-2 words by 12 m
GROWTH AND DEVP’T.: physical growth patterns [13-18 m]
babinski disappears w/ walking, imitation, removes clothing, decreasing appetite, decreasing rate of growth by 18 m
anterior fontanel non-palpable at 12 m, closed completely by 18 m
GROWTH AND DEVP’T.: red flags of developmental delay
lack of eye muscle control pc 4-6 m lack of social smile by 8-12 w rolling ac 3 m persistence of primitive reflexes poor head control at 4 m failure to reach fpr objects by 5 m absent babbling by 5-6 m not sitting at 7 m doesn't wave/bang toys by 9-10 m lack of imitation at 16 m lack of protodeclarative pointing
GROWTH AND DEVP’T.: breastfeeding
BM recommended q1.5-3 h for 12 m
advantages: decreased incidences of otitis media, allergies, resp. tract infections, diarrhea/vomiting, meningitis, other infections, SIDS, obesity, type 1/2 diabetes
infant does not require supplementation
- this means water as well
GROWTH AND DEVP’T.: readiness for progression from BM or formula
no whole milk until 12 m
- can lead to anemia, bleeding, and problems w/ nutrient absorption
introduce solid foods at 4-6 m if the infant:
- can sit
- BW has doubled and is at at least 13 lb
- can reach for an object and maintain balance
- extrusion disappears [at 4-5 m]
- moves food to back of mouth and swallows during feeding
weaning off bottle can occur after solids are introduced
GROWTH AND DEVP’T.: physical growth patterns [1-3 y]
weight increases 4-6 lbs/y height increases 3 in/y head circumference increases 1 in./y full set of 20 decduous teeth by 2 y - imp. for language development, spacing for permanent teeth and poster + dietary habits
GROWTH AND DEVP’T.: physical growth patterns [3-5] y]
child achieves night, bowel/bladder control, rides tricycle, dresses, 3-4 word sentences, uses “I”, imaginary playmates, parallel to associative play by 3 y
washes hands and face, 4-5 word sentences, peak of questioning, associative play by age 4
handedness firmly established, draws person w/ appendages, knows days of week, cooperative,, wants to please, may cheat to win game by 5 y
imp. to promote, self-feeding,, appropriate discipline, healthy teeth/gums
GROWTH AND DEVP’T.: solitary play
usually performed by infants and toddlers
it’s independent play
due to child’s limited social, cognitive, and physical skills
imp. for all child. to have some solitary play
GROWTH AND DEVP’T.: parallel play
usually performed by toddlers
child. play side by side w/ similar toys
lack of interactivity
GROWTH AND DEVP’T.: associative play
can begin in toddlerhood but usually associated w/ preschoolers
group play w/o group goals
may play w/ same toys and trade toys, no formal organizations
