Exam 5- Flashcards
Family dynamic
need to understand
Family dynamic is always constantly changing- especially recently with blended/divorced families.
Need to understand different types of families so that we can address specific needs of each family
Definition of the family
a householder and one or more other people living in the same household who are related by birth, marriage, or adoption
Alleneder definition
Two or more people who live in the same household, share a common emotional bond, and perform certain interrelated social tasks.”
family centered nursing considers
Family centered nursing considers the health of the family as a unit and its individual members.
Family of orientation-what is
ex
__family>
family you are born into ((Ex . Yourself, Siblings, parents)- original family you were assigned at birth
Family of procreation-what is
example
family >
family that one establishes
( you and your spouse/ children)-
family created when you move out and create on own
Childfree or childless-
family types
no children, couple together
Cohabitating
family types
- unmarried maybe/maybe not children
Nuclear/Binuclear
family types
- 2 parents with biological children
Bi nuclear is family in divorce that has to share 2 households
Extended (multigenerational)- extended family-
prevalent in
family types
grandparents, aunt/uncle, cousins all living under same roof
- prevalent in Hispanic
Single-parent-
due to
family types
one parent
due to divorce, widowed, singular parent deciding to adopt,
Blended
family types
-remarriage, two families joined together by parents marriage
Foster
what is it
where go
goal
foster family is
family types
-children removed from home dt unfortunate circumstances
-placed in a new home
the goal is to return home when the issue keeping parents from children is resolved-
foster family is for reconciliation of the family
LGBT
same
family types
-lesbian, gay, bisexual, trans couples that live together –
same structure as nuclear family except 2moms or 2 dads
Adoptive-
family types
family who adopts children from outside their family
stage 1 is M
goal
Family development stages
marriage-
goal is to establish a healthy relationship
stage 2 is early
goal
Family development stages
-early childbearing family
- goal is to integrate new child and to make financial/social adjustments
stage 3 is pre
goal
Family development stages
-preschool age child family -
prevent unwanted injuries and begin socialization
stage 4 is school
goal
Family development stages
-school aged child family
-encourage school, socialization, health( immunizations, dental, check ups), safety rt home/automobiles
stage 5 is adolescent
goal
Family development stages
adolescent child family(13-20)
allow freedom and prepare for life on own
stage 6 is late adolescent
goal
Family development stages
late adolescent family-
be support people, encourage independent thinking
stage 7 is middle
goal
Family development stages
middle aged parents-
adjust to empty nest, prepare for retirement
stage 8 is retirement
goal
Family development stages
retirement/older,
maintain health and participate in activities to keep active and enjoy life
why are you assessing these family components
Name, age, gender and family relationship of all people residing in the household-
Family type, structure, values-
Culture and religious affiliation
Support systems network
Communication patterns, language barriers
Environmental data-
Name, age, gender and family relationship of all people residing in the household- Evaluating how supporting the family is when time of crisis occurs and how well relationship they have with each other-might need consent for healthcare if minor and to prevent hippa
Family type, structure, values- may look at function of the family and roles of each person in family
Culture and religious affiliation-evaluate if there is any
Support systems network
Communication patterns, language barriers
Environmental data- water pollution, air pollution, household safety
Family health evaluation
why doing these
These are questions to evaluate if they need further evaluation for healthcare that they would be able to adequately fulfill those needs- if not, resources are available in hospital to help them
Family health evaluation
questions
Does the family have adequate coping mechanisms?-subjective
Is the family able to problem solve?
Independently or with assistance?-looking for strengths, problems, relationships between members
Do they have access to healthcare?
Do they have adequate funds and or resources?- looking at income –per month, are they below poverty level,
Family assessment purpose
determine
clarify
identify
describe
remember
Determine level of family functioning
Clarify family interaction patterns
Identify family strengths and weaknesses
Describe the health status of the family and its members
Remember: Assess, diagnose, plan, intervene, evaluate
Genogram
helpful for
Helpful for health history and finding potential health problems
Family Function
boundaries-use
4 types
distinction between individuals in the family- families can establish flexible and appropriate boundaries between one another
clear
diffuse
rigid
disengaged
clear boundaries
considered to be adaptive/ healthy- firm but approachable, flexible and togetherness
diffuse boundaries
not clear whose in charge,
less supportive environment ,
members can be overinvolved with one another
rigid boundaries
-demand, adherence to the rules, strict, rules no matter what and may avoid each other ,
may not feel close to each other
, may not talk much little sense of loyalty feeling
isolating and cold environment to be in
Disengaged- boundaries
members lead separate and distinct lives,
no intimacy
, children have a hard time learning intimacy,
no bonding,
generally leaves home and falls apart
Healthy Communication in family
feel
ask
Feel safe being honest and open about feelings
Ask/discuss for what is needed
Natural hierarchy
healthy communication in family
parents are the leaders/children voice opinion- children should not be leading household
emotional support
want feelings
want members
want to find
love
healthy communication in family
-want feelings of safety,
want members to be concerned for each other and to resolve conflicts,
want to find healthy method to cope and get through problems
–love dominates family
socialization
healthy communication in family
learn through family how to socialize with other people
Manipulating-
never
will
Dysfunctional communication
never looking at things,
will try to coax way into something else by manipulating person into giving them what they want
Distracting
distract
Dysfunctional communication
-distract from what is really wrong
Generalizing-
Dysfunctional communication
general, not very specific situation
Blaming-
Dysfunctional communication
blaming each other and keeping focus off themselves
Placating
Dysfunctional communication
-taking blame to keep peace, even if they weren’t involved with situation
Culture is:
based on
and
integrated
Based on shared values and beliefs
Learned and dynamic
Integrated into life and uses symbols
Race-
share biologic similarities (i.e. genetic traits)
Ethnicity –
cultural group into which a person was born (i.e. Hmong, Jews, Irish Americans, etc..)
Cultural diversity and respect
what do
single story
Acknowledge and ask; don’t assume
don’t use a ‘single story’- ex is don’t assume everyone from north Milwaukee is criminal or everyone from east coast is snobby
Minority
–disadvantaged groups, hold less power/wealth
Stereotyping
-expecting person to act in characteristic way
Discrimination-
-treating people differently based on physical/cultural traits
Prejudice
-negative attitude towards members of a group
Acculturation-
Culture influence and change
loss of ethnic traditions because of disuse
Assimilation-
Culture influence and change
blend into general population or adopt values of dominant culture
Ethnocentrism-
Culture influence and change
belief that one culture is dominate over the other
Cultural awareness-
Culture influence and change
aware different cultures exist
Cultural competence-
Culture influence and change
respecting other cultures differnces/diversity
Cultural humility-
Culture influence and change
lifelong process of self reflection and self critiques that begins with an assessment of own culture
Norms
Culture influence and change
usual values of a group
Taboos
Culture influence and change
not acceptable in culture we live in, like murder
Family roles and structure
role
types of roles
who does them
why do nurses need to know
Role influenced by culture
Authority
Decision-maker
Nurturer/caretaker
Mom, dad, children, grandparents, etc..
Nurses must know which member to provide the teaching to.- some cultures may have that authortive person
Language and translation-
there’s
use
Culture and communication
there’s many barriers to language,
use translators and interpreters,
Non-verbal
3 things
Culture and communication
Eye contact- some cultures avoiding is respectful. Some are opposite
Touch-some are open to touch and others not
Space- some people like the bubble around them, some people are in intimate space and go right next to you
time orientation
Culture and communication
some people feel like being late is a sign of respect
, Americans like to be on time
Nutrition-
look at/make sure
not everyone
Culture and communication
look at menus and preferences to make sure to meet nutritional needs-
not everyone eats the same way and that is alright, as long as it doesn’t cause interactions
Pain
Culture and communication
-some cultures handle pain differently, like being loud
looking at
seeing if
balance and harmony
Health beliefs and practices
Looking at preferences,
seeing if preferences are hospital safe
, looking for balance and harmony between religious beliefs like prayers, and like if they can eat any specific foods
Complementary and Alternative Therapies
Homeopathy/Naturopathy
Chinese Medicine-
Mind-Based- Hypnosis, visualization, guided imagery
Chiropractic
Massage
Herbal
Therapeutic touch
Growth-
amount
changes in
principles of growth and development
amount of growing someone does,
all changes in ht, wt, bp, words they speak-
Development-
increase
development
Principles of Growth and Development
increase in capabilities of function-
development of skills-throw ball, stack blocks,
Milestones/major markers in development-
Principles of Growth and Development
if these aren’t met then questions are being asked on development
Cognitive development-
Principles of Growth and Development
ability to learn/understand from an experience, or acquire/ retain knowledge to respond to a new situation and solve problems
Cephalocaudal
Principles of Growth and Development
- head down development
Proximodistal-
Principles of Growth and Development
outward development, first able to move trunk, then roll over and move arms,
outward development-inner to outer arms/legs
Factors influencing G & D
Genetics-large part -personality/health traits
Gender-influenced by male
Health
Intelligence
Environment
what about environment affect growth and development
SES,
parent-child relationship,
ordinal position (1st, middle),
health,
nutrition
4 categories of temperament
Easy
/intermediate/
difficult child
Slow to warm up child
9 characteristics temperament
Activity level
rhythmicity
Approach
Adaptability
Intensity of reaction
Distractibility
Attention span
Threshold of response
Mood quality
circle of influences on development
social class
nationality
race
ethnicity
religion
exceptionality
geographic region
gender
Continuous ongoing assessment of development
parent
proiver
helps
also
G & D Surveillance
Parent interview
Provider observations of child’s capabilities
Helps verify no neurologic conditions
Also that the home environment is stimulating and safe
G and d survellience
severral
administered
Several tools
Administered at 9, 18, 24 and 30 months
physical
Weight-4/6 months-1 yr-charting
Length-by 1st year
InfantBirth to 1 Year
weight- doubles in 4-6 months-triples by 1 year-charting on percentile chart
length increase 50% in 1st year
Infant-30 days-1year
Head circumference
chest circumference
Head Circumference: Brain 2/3 adult size by first year
Chest circumference: even w/ head circumference
4 - 12 mo
infant-30 years - 1 year
Vision
1month
2month
3 month
1 mo. - can see 18 inch.
2 mo. - Focus well, Follow moving objects
3 mo. - no eye crossing
infant-30 days -1 year
Hearing
test by
3 months
10 months
12 months
Test by I mo.
3 mo. - turns head to locate sound
10 mo. - can recognize their name
12 mo. - can easily locate sounds
infant 30 days -1 year
Smell
taste
Touch
smell: turn head away from bad odors
Taste: turn away when they do not enjoy taste or spit out
Touch: skin to skin comfortable, soft clothes diapers clean + dry
Cognitive-
InfantBirth to 1 Year
3 months-explores/unaware
6months-releaises
10 months-perm
1 year-intentially
3- explores objects by youth to mouth- unaware of cause+effect
6- releizes cause+ effect
10-object permanence
1 year- intentionally cause new reaction - dropping object
Play
1-2 months-watch/no
3-4months-handle
5-more
6months-transfer
InfantBirth to 1 Year
1-2 mo - watching objects /music-no holding objects
3-4 mo- handle blocks / rattles,
5 mo- more interest in toys
6months - transfer toys hand to hand
play
8-toys w/
9-toys that
10-what games
12-putting
infant 30 days-1 yr
8 - toys w/ different texture
9 mo Toys that go inside each other
10mo - peck a boo, patty cake
12 mo- putting objects in things a take out
Motor-playing
careful
InfantBirth to 1 Year
- playing with toys helps stimulate development-
Be careful with suffocation, careful with plastic objects
Milestones-
teach
InfantBirth to 1 Year
Teach parents to modify environment to promote development so babies are meeting milestones and making sure growth is not becoming stagnant when babies have the ability to keep developing.),
Personality and Temperament-
eriksons
make sure
InfantBirth to 1 Year
eriksons trust vs mistrust /
/ make sure to anticipate needs for child/
Communication-
common
may learn
InfantBirth to 1 Year
Common-Coos and cries , babbles and laughs,
may learn 1-2 words (mama/dada usually first
Psychosocial Development
InfantBirth to 1 Year
Crying
Eye contact
Quieting
Sound imitation
Follows simple commands
Clings to parent
Demonstrates emotions
Injury Prevention Infant
injury
challenges
InfantBirth to 1 Year
Supervision and increased mobility
Falls
Burns
MVAs & Car Seats
Drowning
Poisoning
Choking
Suffocation and SIDS
Strangulation
INTRODUCTION OF NEW FOODS=
never
InfantBirth to 1 Year
introduce solid foods and rice cereal at 1 year.
NEVER introduce honey or milk before age 1
IRON REQUIREMENTS
making sure
dont want
InfantBirth to 1 Year
making sure they are on formula or breast fed until age 1,
don’t want whole milk before then because you want iron and nutrients and want them to be able to digest the milk.
WEANING
support
no shame
InfantBirth to 1 Year
-Support moms with breastfeeding,
no shame in formula if they decide to come off breastfeeding
nursing care
car seat
smoking
InfantBirth to 1 Year
rear facing car seats for 2 years- recommended, at least 1 yr and 20 lbs and always in backseat.
smoking- do outside and change clothing after.
Pain Scale -infants
infant pain=
___up to 6 weeks
__infants and young children
what helps
Infant Pain = cries
NIPS – up to 6 weeks after birth
FLACC – infants and young children
Sucrose
ventricle suspension
1mo-lift
2mo-keep
3mo-lift
motor-infants 30 days - 1 year
1 mo-can lift head momentarily
2mo-can keep head even
3mo-can lift head and maintain
prone position
1-turn
3-can
4-lift
5-rest
6-can
9-c
motor-infants 30 days - 1 year
1 -turn head side to side
3-can lift head shoulders off ground
4-lift chest up a turn side to side
5-rest weight on forearm
6-can lift upper abdomen and chest
9-creep
sitting
2-hold
4-when
5-straighten
6-sit
7-sit
8sit
9-lean
motor-infants 30 days - 1 year
2-hold head steady
4-when pulled up can support head/neck on own
5-can straighten back
6 can sit momentarily w/out assistance
7- can sit alone w/ hands forward
8- can sit w/o assistance
9- can lean forward w/o loosing balance.
standing
3-try
6-support
7-canb
10-canh
11-12-cruise
motor-infants 30 days - 1 year
3 - try to suppount wt. on feet
6- support full wt. on legs
7- can bounce when standing
10- can hold self up
11 - 12 cruse w/ furniture.
fine motor
2-hold
4-ability
10-“” -grasp
12-remove/offer
motor-infants 30 days - 1 year
2- can hold objects a few min before dropping.
4-ability to bring thumbs + fore finger together.
10-. “pincher grip” can grasp small objects w/ thumb/forefinger
12- can remove socks and offer toys
language development
2-dif
3-S+L
4-C/B/G
5simple
9-first
12-additional
motor-infants 30 days - 1 year
2-. can differentiate cries
3 squeal + laugh
4 -coo, babble, gurgle
5- simple vowel sounds
9-first words
12- 2 additional words
Physical
wt
ht
toddler 1-3 years
Weight-5-6 lbs per year
Height- 5 inches per year
Head Circumference- increases
chest circumference -by 2
toddler 1-3 years
head Increases 2cm
by 2 yrs of age chest circumference Should have grown greater the head
Physical-sight
detect
distinguish
toddler 1-3 years
Sensory Abilities
detect colors, movement brightness
distinguish between Shapes numbers, and letters
Physical-hearing
perceive
toddler 1-3 years
Sensory Abilities
perceive pitch, volume, rhythm, loud/soft sound
Physical-smell
differentiate
when kids
toddler 1-3 years
Sensory Abilities
differentiate between good and bad smells
when kids smell for it activates sense of taste
Physical-touch
perceive
toddler 1-3 years
Sensory Abilities
Perceive Sensations ->
temp.
Pressure,
Pain,
Viberations
Physical-taste
taste
determine
toddler 1-3 years
Sensory Abilities
taste sweet, sour, bitter.and salty,
determine what they like
toddler 1-3 years
learn
may have
may walk
Learn depth perception,
may have potbelly appearance to them,
may wobble when walk because they need wider stance to balance when learning how to walk
Cognitive
little
problem
remember/what
unable to/so they
toddler 1-3 years
little Scientists - Intrest in discovering new results.
Problem Solving
remember action and Imitate later
unable to Change thoughts to fit a situation, so they learn to change the situation
Play and Motor Abilities
like/but
no problem
toddler 1-3 years
-like to play, but may be parallel,
they have no problem with playing next to each other and not with each other without interacting.
Milestones
learn how to-
hold
walk
im
feed
open
r/j
toddler 1-3 years
- learn how to
holds a spoon
walks alone on stairs
stacks blocks
imitates
feed self
open door
run/jump
Personality and Temperament -
personality
may
love
toddler 1-3 years
Personality starts to develop
may throw more temper tantrums because they cant express themselves the way they want to.
love independence
Communication-
loves
words
will
behaviors
toddler 1-3 years
loves the word “no //
Words may be unintelligible but they understand it,
will begin talking a lot
ritualistic behaviors-everything is theirs
Communication with Toddlers
allow
intructions
offer
approach
toddler 1-3 years
Allow expression
Short, clear instructions
Offer choices (when possible)-1-2 choices is plenty
Approach positively and slowly
Communication with Toddlers
tell them
maintain
be/set
otc
Tell them what you are doing and name objects
Maintain a routine is key and consistnecy
Be honest with toddlers- set up rewards
OTC meds are weight based
Self-concept
if lots
may be
what’s most beneficial fora toddler
Psychosocial Development-
toddler 1-3 years
-if lots of negativity and constant disapproval then they may be more fearful or not feel good enough
toddlers need routine the most
Separation anxiety
can start
Psychosocial Development-
toddler 1-3 years
- can start separation anxiety at 9months -2 years
Regression-
might go
might revert
Psychosocial Development-
toddler 1-3 years
might go back if they feel ill or new sibling
-might revert back on potty training
nurses role
teaching
know
Injury PreventionToddler
toddler 1-3 years
Teaching parents how to make the environment safe-
know where toddler is at all times to prevent any accidents
types of injuries
make sure to keep
Injury PreventionToddler
toddler 1-3 years
Falls
Suffocation-small spaces, plastic
Poisoning
Electrical- outlets
Burns
Drowning
MVAs- running out in street
keep anything they can fit in their mouth out from hands
meal
meeting
keep
LIFE CYCLE NUTRITIONAL VARIATIONS - Toddler
Meal Schedule-keep a schedule- consistency is key
Meeting nutritional needs and promoting positive interactions
keep introducing new foods
Independence- –
dont
bottle
avoid
want
let them
LIFE CYCLE NUTRITIONAL VARIATIONS - Toddler
don’t drink as much milk,
bottle is gone by 1 yr,
avoid small foods,
want toddler to eat at table-
let them feed themselves and drink out of sippy glass themselves
GI function-
start
plenty
LIFE CYCLE NUTRITIONAL VARIATIONS - Toddler
start to potty train at this point-
- plenty of cues that child is ready for training, like not wanting diapers or being curios about toilet
lack
can develop
__if in pain
pain scales
Pain Scale - Toddlers
Lack understanding of what causes pain- will still pull away from pain
Can develop Fear of painful situations
Withdrawal/aggression/disturbed sleep if they are in pain
FLACC or ‘none, some, a lot’, face scales- pain scales
set
donttell
dont mix
toddlers-1-3-medication admin
Set rewards for toddlers after shots-stickers
dont tell kids candy is medicine
dont mix meds in anything
Height and Weight
starts
becomes
definenty needs
Preschool3-6 Years
- starts to slow and be steady,
become longer and thinner
definitely will need to go in for dental care bc they are losing baby teeth
Vision
very
they can
Preschool3-6 Years
- very refined hand eye coordination,
they can see things only form their view point because they don’t understand others
Cognitive-
enter
questions
thinking called
focused+base
cant make
Preschool3-6 Years
enter 2nd phase called intuitional thought.
why questions
Show style of thinking caled centration
focused on object or person + base judgement off that.
can’t make mental substitutions-therefore alway right.
Play and Motor Abilities-
3-self
4-can /constantly
5-can , throws
Preschool3-6 Years
3-undress self-run, alternate feet on stairs
4-can so simple buttons- constantly in motion
5-can lace shoes, throws overhand
Personality and Temperament-
love
active
Preschool3-6 Years
love dramatic play and dress up at this age and imitation.
Active imagination, more nightmares
Communication
lots
can have
talking
lots of
be careful
prefer
Preschool3-6 Years
- lots of words they are trying to say,
can have complete sentences,
endless talking and
lots of “why” questions –
be careful of the way you talk to them, might take everything literally.
Prefer simple explanations
Milestones-
going into
learning x3
Preschool3-6 Years
going into preschool.
, learning soaclization , alphabet, how to write name,
Moral Development-
starting to
how to
Preschool3-6 Years
starting to understand difference between right and wrong
how to obey rules and avoiding punishment
Spiritual Development
Preschool3-6 Years
don’t understand ritual part but enjoy the secunty of redigious Indidays
Injury Prevention- Preschool
time of
include
Time of increasing independence-
include preschoolers in teaching
Injury Prevention- Preschool
types of injury
MVAs
Pedestrian Accidents
Drowning
Burns
Needle stick or electrical injuries in hospitals
meals
limit
milk-toddler/preschool
LIFE CYCLE NUTRITIONAL VARIATIONS - Preschooler
Three meals-
also limit usage of sweets because obesity is increased and for dental care
whole milk in toddler// 2 % at preschool
Use of utensils-
LIFE CYCLE NUTRITIONAL VARIATIONS - Preschooler
should be feeding themselves
Table manners-
get
should be
may be
LIFE CYCLE NUTRITIONAL VARIATIONS - Preschooler
get pickier,
should be introduced to more foods
-may be some growing pains in learning new foods
Pain Scale - Preschooler
pain is
does not
often think
dont see
scales
Pain is a hurt
Does not relate pain to illness
Often think punishment or “someone else is responsible for the pain”
Don’t see future (why short-term pain will make them better – i.e. IV for fluids)
FACES; Oucher
Physical-ht and wt
girls/boys
annual wt gain
inc in ht
by age 10
vision
School-Age Child6-12 Years
- girls and boys are very similar at this age, girls will grow faster then boys
Average annual wt. Gain 3-5 lbs
Increase in Ht 1-2 inches
by Age 10Brain growth Complete
Adult vision level achieved
Prepubertal changes-
males
9-11prepuberital
11-12-hair/glands-activate/increase
School-Age Child6-12 Years
9-11-prepubertial wt gain
11-12-hair on base of penis/sweat gland activated/sebacous gland increases
Prepubertal changes-
females
9-11 -elevation, grow what, diameter
11-12-hair, ph, discharge, glands,dramatic
School-Age Child6-12 Years
9-11- elevation of papilla, breasts., areolar diameter enlarges
11-12- hair on labia//vagina, ph of vagina becomes acidic, vaginal discharge, sweat+sebacous glands, dramatic growth spurt
Cognitive
thoughts
visualize
School-Age Child6-12 Years
- concrete/ operational thoughts
reason through problems they can visualize
Cognitive
Decentering
Accomodation
School-Age Child6-12 Years
Decentering-seeing from others view points
Accomodation-More than one reason for a person’s actions
Cognitive
conservation
class inclusion
School-Age Child6-12 Years
C- Ability to a know that a change in shape, is not a change in Size
Class Inclusion- Ability to know one thing can belong to multi groups
Play and Motor Abilities-
play
lots of
enforce
allow
School-Age Child6-12 Years
play cooperatively with others,
lots of active and physical play- sports/
enforce rules and consistency-
allow rules with independence
gross motor development
coordination w/ movement
school age-6-12
coordination w/ movement- skipping, riding a bike. jumping rope,
fine motor development
easily
better
easier
learn+apply
adolescents-6-12
early tie shoes
better manipulation w/ takes
read easier
learn+apply cursive
Psychosocial Development
skils
behaviors
peers
self concept
School-Age Child6-12 Years
Skills-less dependent on family
Behavior- can tune parents out if they don’t want to hear what’s going on
Peers- start to develop peer relationships
Self-concept
Moral Development
School-Age Child6-12 Years
learn why things are right/wrong
emotional
build
sense of
eriksons
school aged children(6-twelve)
build trust and self respect
sense of autonomy
industry vs inferiority
Injury PreventionSchool - Age
involved in
safety
guidance
Involved in play in unsupervised settings
Safety teaching needed in schools –
anticipatory guidance
Injury PreventionSchool - Age
injury types
MVAs
Biking crashes-helmets
Firearms
Burns
Assault
Breakfast and proteins-
LIFE CYCLE NUTRITIONAL VARIATIONS – School Age
increase protein to keep up with mental/physical growth
Family meals-
LIFE CYCLE NUTRITIONAL VARIATIONS – School Age
important for socialization
Obesity
LIFE CYCLE NUTRITIONAL VARIATIONS – School Age
- addressing and showing what a balanced diet looks like, cutting out fast foods
Pain Scale – School Age
understands
more
types of scales
Understands simple relationships between pain and disease
More complex understanding from 10-12 years
FACES; Oucher; Poker Chips, 0-10 Numeric scale; word-graphic rating scale
when does puberty begin
and end
Adolescent12-18 Years
puberty occurs between 8-12 years old
ends around 16-20
Puberty-males
grow
gain
ends
Adolescent12-18 Years
grow 4-12 inches
gain 13-65 lbs
ends at 18-20
Puberty-females
grow-ht
gain-wt
ends-age
Adolescent12-18 Years
grow 2-8 inches
gain 15-55 lbs
ends at 16-17
Lungs physical changes
Adolescent12-18 Years
lungs develop slower then the rest of body
can cause fatigue during physical activities
Glandular changes
androgen
apocrine
require
Adolescent12-18 Years
androgen stimulates sebacous glands causing acne
apocrine sweat glands develop- increased sweat and odor
requiring more frequent bathing.
Sexual maturation males
development of
testes
voice
Adolescent12-18 Years
development of facial, axillary, and pubic hair
testes begin producing sperm
voice changes occur
Sexual maturation females
occurs/begins
development
inc in
ovulation occurs and menstruation begins
development of body hair
inc in breast growth
Cognitive-
formal
complex
use/plan
questions/why
Adolescent12-18 Years
formal operational thought
complex problem solving
use reasoning and plan for future
questions morals/why things are wrong
Activities-
Adolescent12-18 Years
starting to drive, more sports and clubs, not home as much
Personality and Temperament
can be
can go
Adolescent12-18 Years
- can be moody,
can go from pleasant to moody quick
Communication-
about
ask
do not
Adolescent12-18 Years
about feelings/depression-
ask directly and be straight up-
do not beat around bush
psychosocial
eriksons
learn
Adolescent12-18 Years
identity vs role confusion
learn who they are and kind of person they will be
Milestones-
change from
Adolescent12-18 Years
Change from school-age activities to adult forms of recreation
music, social, media, sports
Sexuality
peaks
may want
give
Adolescent12-18 Years
-peaks may happen and may want to explore
-give info on STD and birth control
Nursing Application
provide
offer
allow
arrange
Adolescent12-18 Years
Provide written and verbal info
Offer private 1-1 discussion
Allow discussion/questions
Arrange discussion with peers- socialization is a big part of this age group
Injury Prevention -Adolescent “
types of injury
No harm can come to me”
MVAs
Sporting injuries
Drowning
Suicide and Homicide
Risky Behavior
Sexual Exploration
increased
snacks
LIFE CYCLE NUTRITIONAL VARIATIONS - Adolescent
Increased caloric requirements
Healthy snacks
eating problems
LIFE CYCLE NUTRITIONAL VARIATIONS - Adolescent
Obesity
Anorexia nervosa
Bulimia
Sports nutrition-
special considerations
increase hydration
increase calories
increase calcium + vit d
inc iron(women
inc protein and zinc
Pain Scale - Adolescents
sophisticated
pain
relates
younger adoloesants scale
pain scale
Sophisticated understanding of causes of physical/mental pain
Qual and quan pain
Relates to others’ experiences of pain
FACES for younger adolescents
Numeric 0-10 scale, word-graphic scale
Family and Children with Chronic Conditions
families need
increase for
Families need support to increase resources and coping behaviors-
have an increase need for resources and coping behaviors
new family
assessment of
Family and Children with Chronic Conditions
New family roles and functions-how are they adjusting
Assessment of family’s readiness to provide adequate care
resilient family
use of
Family and Children with Chronic Conditions
Resilient family characteristic- how well do they support one another
Use of outside resources- not a sign of weakness, may need some
infant/tiddler/preschooler
issues
dont understand
fearful
continue
parents should
Effects of Illness/Hospitalization in Children
issues with separation anxiety
-Don’t understand cause/effect of being sick,
fearful of iv and draws,
continue routine,
parents should stay if they can
School Age Child-
Adolescent-
allow
looking for
keep
making sure caring
make sure appropriate
Effects of Illness/Hospitalization in Children
allow peer visits,
looking for what’s appropriate for age, like board games –
keep simple, like items from home.
Make sure caring for them like they are being cared for at home, helps to reduce anxiety,
make sure terminology is appropriate
Regression
erikson-all
may go
Defense Mechanisms in Children
Erikson –During illness, ALL people regress, not just children-
may go back to activities they did while younger
Defense Mechanisms in Children
denial
repression
postponement
bargaining
rationalization
fantasy
programs
rooming in
therpatic play
Strategies to Promote Coping During Hospitalization in Childhood
Childlife Programs
Rooming in-parents staying in-bringing toys and activities into room
Therapeutic play- pets will visit
Parents-
change is
who has
may not
might
Effects of IllnessFamily Responses
the change is depending on how present they can be in hospital,
who has to work,
may not like to see child In pain,
might get frustrated,
Siblings-
can get
may feel
Effects of IllnessFamily Responses
can get jealous,
may feel guilty and act out,
Parents’ Role-
can
allow
use
give
Effects of IllnessPreparation for Hospitalization
can participate and watch care.
Allow kids to touch equipment
, use books, videos
, give clear instructions to keep them informed.
gets used to building
Effects of IllnessPreparation for Hospitalization
Tours and Fairs around building to get them used to setting
special untis
do what
examples
Effects of IllnessAdaptation to Hospitalization
keep parents as informed as possible
Emergency- parents may panic in these situations
ICU-can be very unfamiliar
Pre and Post-op Units
Short-Stay Units
Isolation
Rehabilitation
Antigens and Antibodies
can be
Antigens crate antibodies,
can be passive or active,
Passive iminuty
Transplacental immunity-
antibody is made in mom and gave to baby through placenta
active immunity
given
if titer
given a weakened bacteria or they will acquire this, and body will make antibodies-chicken pox-
if titer is positive then they have immunity
Types of Vaccines
Killed virus,
Toxoid,
Live virus,
Recombinant forms,
Conjugated forms
planning and implementation of immunizations
teaching
a
federal guidelines
Parent Teaching
Advocacy
Federal guidelines
-Consent
-School
-Reactions
Pain and Anxiety Reduction immunization
may split up if theres too many at one time
When not to give immunizations
Anaphylaxis reaction
Allergies to components
Moderate or severe illness
nursing management of immunizations
be
let
find
give
Be honest with child,
let parents know,
find any comforts/distractions,
give Tylenol / ibuprofen ,
where to give immunizations in children
where to give immunizations in adults
cautions in who
Children under 5 should be given into vastus lateralis,
deltoid is common in adults,
cautions in neurological disorder or immunocompromised child.
