health and healing Flashcards
Developmental task
a set of skills and competencies peculiar to each developmental stage that children must accomplish to master in order to deal effectively with their environment
Psychosexual development (Freud)
- Id: unconscious mind, inborn component driven by instinct; pleasure seeking
- Ego: conscious mind, reality principle
- Superego: conscience, moral compass
- Stages of psychosexual development
freud oral
Oral stage (birth to 1yr): during infancy, major source of pleasure associating with oral activities ex. Sucking, biting, chewing, vocalizing
freud anal
Anal stage (1 to 3yrs): interest centers around the anal region as sphincter muscles develop, and children are able to withhold or expel fecal material
phallic freud
Phallic stage (3 to 6yrs): genitalia become an interesting and sensitive area, child becomes aware or gender differences
latency frued
Latency (6 to 12 years): during the latency period, children elaborate on previously acquired traits and skills; vigorous activity and play
frued Genital stage
Genital stage (12 and older): puberty and maturation of reproductive system and production of sex hormones
Psychosocial development (Erikson) stage 1
Stage 1: trust vs. mistrust (birth to 1yr) - establishment of basic trust dominates first year of life and describes all of the child’s satisfying experiences at this age; mistrust develops when basic needs are not met; result is faith and optimism
Psychosocial development (Erikson) stage 2
Stage 2: autonomy vs. shame and doubt (1 to 3yrs) – development of autonomy is centered around the children’s increasing ability to control their bodies; doing things for themselves; doubt and shame arise when children are made to feel small and self-conscious, when othersshame them; favorable outcomes are self-control and willpower
Psychosocial development (Erikson) stage 3
Stage 3: initiative vs. guilt (3 to 6yrs) – vigorous intrusive behaviour and strong imagination; children explore physical world, develop conscience; must learn to retain a sense of initiative without impinging on rights and privileges of others; outcomes are direction and purpose
Psychosocial development (Erikson) stage 4
Stage 4: industry vs. inferiority (6 to 12yrs) – ready to be workers and producers; want to engage in tasks and activities, feelings of inadequacy or inferiority develop if too much is expected or cannot measure up to standards; competence developed
Psychosocial development (Erikson) stage 5
Stage 5: identity vs. role confusion (12 to 18yrs) – development of identity is characterized by rapid and marked physical changes; struggle to fit into roles; inability to solve core conflict results in role confusion
Cognitive development (Piaget) sensorimotor stage
(birth to 2 years): infants learn about the world by input obtained through senses and by their motor activity
- Use of reflexes, primary circular reactions, secondary circular reactions, coordination of secondary schemes, tertiary circular reactions, mental combinations
- Object permanence: realization that objects that leave the visual field still exist
Pre-operational piaget
(2 to 7 years): young child thinks by using words as symbols, but logic isn’t well developed
-Pre-conceptual stage (2 - 4 years): vocabulary and comprehension increase greatly, child is egocentric (unable to see things from another’s perspective)
- intuitive sub stage (4 – 7 years): child relies on transductive reasoning
Concrete operational piaget
(7 to 11 years): transductive reasoning has given way to more accurate understanding of cause and effect
Formal operational piaget
(11 to adulthood): fully mature intellectual though has now been attainedFormation of abstract thought
Communicating with families
-Encourage parents to talk-Direct the focus with open-ended questions-Listen to understand what parents are saying-Have cultural awareness-Use silence, Be empathetic-Provide anticipatory guidance, Avoid blocking communication
Communicating with children
Make communication developmentally appropriate-Get on child’s eye level, Approach child gently and quietly-Always be truthful, give child choices as appropriate-avoid analogies or metaphors, give instructions clearly and in positive manner-avoid scary words
Developmentally Appropriate Communication infants
-Non-verbal-Crying as communication
Developmentally Appropriate Communication early childhood
-Focus on child in your communication-Explain what, why, how-Use words child will recognize-Be consistent: don’t smile when doing painful things-Transitional objects
Developmentally Appropriate Communication adolences
Adolescents-Be honest with them-Be aware of privacy needs-Think about developmental regression-Importance of peers
Pain Measurements Behavioural
Behavioural - most effective when measuring short procedural pain; not effective in lost lasting pain; mostly used on children who do not have language skills to communicate pain;
-FLACC: facial expression, leg movement, activity, cry, and consolability
-FACES: for young children-
OUCHER: children 3-13 yr-Poker chip tool: children as young as 4
-Word-graphic rating scale: children 4-17 years-Numeric scale: children as young as 5 years-vocal protest, less motor activity, more verbal expression, increased muscle tension
Pain Measurements Physiologic
heart rate, respiratory rate, blood pressure, palmar sweating, cortisone levels, transcutaneous oxygen, vagal tone, endorphin concentration; are not able to distinguish between physiological response to pain and other forms of stress
Pain Measurements Multidimensional
(pain quality, location by older child) – APPT, PPQ
Pain Measurements Self-report
Self-report
Non-pharmacological pain management
distraction, relaxation, guided imagery, containment and swaddling, nonnutritive sucking, kangaroo care-Help to reduce fear, anxiety, and stress-CLINICAL TIP: if a newborn is receiving an injection, getting an IV or having blood work drawn try: containment, swaddling, proper positioning, facilitated tucking, nonnutritive sucking
Complementary & alternative medicine (CAM) for pain
-Biologically based (diets)-Manipulative treatments (massage, chiropractic)-Energy based (reiki)-Mind-body techniques (hypnosis, meditation)-Alternative medical systems (homeopathy, acupuncture)
Pharmacological management
Non-opioids (Tylenol, mild to moderate pain)-Opioids (moderate to severe pain)-Co-analgesics or adjuvant analgesia (valium, stool softeners)-Patient-controlled analgesia (PCA)-Epidural analgesia-Trans-mucosal and transdermal analgesia-Timing of analgesia-Monitoring side effects-Evaluation and effectiveness of pain regimen
Developmental Milestones of Infant Psychosocial development
Erikson: phase 1; developing sense of trust while overcoming sense of distrust
First 3 to 4 months food intake is most important social activity
Next modality reaching out through grasping followed by more active phase which includes biting
Developmental Milestones of Infant Cognitive Development
Sensorimotor phase (Piaget); of the 6 stages, stage 1 through 4 involve infant-Birth through 1 month: use of reflexes-1 to 4 months: primary circular reactions (voluntary acts become deliberate, grasping)-4 to 8 months: secondary circular reactions (extension of voluntary actions; shaking, banging): new behaviours are imitation, play more evident)-8 to 12 months: coordination of secondary schemas and application to new situations-Development of body image; by end of first year, recognize that they are distinct from parents
Developmental Milestones of Infant Social development
Attachment to parent is evident; reactive attachment disorder (RAD) occurs when failed or absent attachment to primary caregiver-Separation anxiety; 4 to 8 months-Stranger anxiety 6 to 8 months-Language (cry, vocalization, coo, gurgle, laugh, 3 to 5 words with meaning by age 1 year)-Play as major socializing agent
Developmental Milestones of Infant Fine motor development
-Grasping object: 2-3 months-Transfer object between hands: 7 months-Pincer grasp: 10 months-Remove objects from container: 11 months-Build a tower of two blocks: 12 months
Developmental Milestones of Infant Gross motor developmen
-Head control: by 3 months can head well beyond plane of body; can lift head by 4 months and front portion of chest-Rolling over: ages 5 to 6 months-Sit alone: 7 months-Move from prone to sitting position: 10 months
Psychosocial development (Erikson)
-Autonomy vs. shame and doubt - as infant gain trust in the predictability and reliability of theirparents, they begin to discover that their behaviour is their own and has a predictable effect on others-Characterized by negativism; respond with “no”; and “ritualism”; keeping things the same to provide sense of comfort
Cognitive Development (Piaget)
Separation anxiety
middle infancy throughout preschool years, anaclitic depression
-Protest phase: react aggressively; cry and scream for parents-Despair: depression is evident, less active, uninterested
-Detachment: adjusted to loss, more interested in surroundings, appearing happier
Loss of control
increases perception of threat and can affect coping skills,
-Toddlers - rely on consistency,
-Preschoolers: do not like physical restriction, or enforced dependency, do not understand events due to egocentric view
-School age children: altered family roles, physical disability, fears of death, loss of peer acceptance, abandonment, lack of productivity-
Adolescents: threat to sense of identity, limits one’s physical abilities, rejection, uncooperativeness, withdrawa
Effects of hospitalization on the child
Regression, separation anxiety, apathy, fears, and sleep disturbances
Upper Respiratory Infection Nasopharyngitis (common cold
caused by rhinovirus, influenza, and parainfluenza-Fever, irritability, restlessness, sneezing, vomiting, diarrhea
-Symptoms more severe infants
-Treatment: antipyretics, cough suppressant, rest, decongestants
Upper Respiratory Infection Acute streptococcal pharyngitis
GABHS puts child at risk for rheumatic fever, acute glomerulonephritis
-Pharyngitis, headache, fever, abdominal pain, tonsils may be inflamed
- Treatment: penicillin, aziromycin, amoxicillin
Upper Respiratory Infection Tonsillitis
palatine tonsils enlarge from edema, obstructing the passage of air and food-Treatment
– tonsillectomy, adenoidectomy, throat lozenges, gargling, analgesic anti-pyretic
Upper Respiratory Infection Influenza
caused by type A,B, and C orthomyxoviruses-Dry throat, nasal mucosa, dry cough, hoarseness, exhaustion, fever, chills
Upper Respiratory Infection Otitis media
inflammation of middle ear
Upper Respiratory Infection Infectious mononucleosis
acute, self-limiting disease common among adolescents-Signs: headache, malaise, fatigue, chills, fever, loss of appetite, puffy eyes
Croup
Croup is a general term applied to a symptoms complex characterized by hoarseness, a resonantcough, stridor, and respiratory distress; affect larynx, trachea, and bronchi
Croup Syndromes Acute epiglottis
children 2-8; H.influenza
Acute laryngitis
older children and adolescents; hoarseness and upper respiratory symptoms, and systemic (headache, fever)
Acute laryngotracheobronchitis
young children less than 5; preceded by URI, fever, barky cough, rhinitis, hypoxia symptoms; high humidity with cool mist for treatment, nebulized Epi
Acute spasmodic laryngitis
midnight croup, attacks of obstruction, dyspnea
Bacterial tracheitis
infection of mucosa of upper trachea, children under 3, purulent tracheal secretions
Pneumonia
Inflammation of the pulmonary parenchyma, occurs more frequently in infancy and childhood
-Lobar: all or a large segment of one or more pulmonary lobes
-Bronchopneumonia: terminal bronchioles, mucopurulent, clogged AKA lobular
-Interstitial: confined to the alveolar walls and the peribronchial and interlobular tissues
Primary atypical pneumonia
caused by pathogens other that readily cultured bacteria
Bacterial
group A streptococcus, S. aureus. M & C pneumonia
Gastrointestinal
Diarrhea
Results from disorders involving digestive, absorptive and secretory functions; caused by abnormal intestinal water and electrolyte transport
-Acute diarrhea is leading cause of illness in children younger than 5-Chronic: longer than 14 days
– IBD, immunodeficiency, lactose intolerance
-Treatment: oral rehydration solution
Constipation
alteration in the frequency, consistency or ease of passing stool
-May be associated with Hirschsprung Disease (congential aganglionic megacolon); obstruction caused by inadequate motility of part of the intestine
