Lecture 01 Family Centered Nursing Care of Child/Adole 1&2 Flashcards
What would Family Centered Care involve?
- Supports cultural, ethnic & social diversity
- Empowers families in all aspects of health care system
- Facilitates involvement in decision-making process
- Examines barriers to active involvement
- Improves quality/safety/cost effectiveness of health care
•Recognizes family as constant in the child’s life
•Acknowledges parents as experts in care of child
•Supports Family Centered Rounding (in-patient)
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What are some culturally sensitive strategies? (6)
- Identify key family members
- Invite family members to chose position of comfort & distance to care provider
- Observe family to determine acceptable body gestures.
- Use interpreter & community resources
- Avoid stereotyping
- Ask family members to share important aspects of their culture, ethnic, social and community needs
KNOW: When does the anterior fontanel close?
12 to 18 months
KNOW: When does the posterior fontanel close?
By 6 to 8 weeks.
When does dentition typically occur in infants?
First tooth between 6 and 10 months with 6 to 8 teeth in the first year
When does infant’s weight double? Triple?
Weight double at 5~6 months and triple at 1 year.
Read Head Control Sequence
Head Control
- Two to three weeks: turns head side to side when prone
- Two to three months: holds head erect for short time while prone; three months can raise chest while supported by forearms
- Four months: holds head erect without head lag; when pulled to sitting
Sequence of baby rolling over
Rolls
- 3-4 months back to side
- 5-6 months front to back
- 6 months back to front
Sequence of Grasp/Hand Control
Grasp/Hand Control
- Four to six months: palmar grasp (voluntary; can hold objects)
- Eight to ten months: pincer grasp
- Seven months: transfer object hand to hand
- Nine months: drinks from a cup
When does a child start sitting?
Sitting
- Six months: sit with support of both hands Seven to eight months: sits steadily without support
- Six months: lack of visual coordination resolves
When does infants start crawling?
Crawling and Walking
–Seven months: begins to crawl
–Nine months: pulling to standing and cruising
–Twelve months: walking alone or holding 1 hand
4 Characteristics of Erikson Infant: Trust vs Mistrust
- Developmental Task of Infancy (Birth to 1 year)
- Infant needs for comfort, feeding stimulation & caring met; sense of trust develops
- Infant needs are not met; sense of mistrust develops
- Task based on achieving quality caregiver-infant relationship
Social Psychosocial Development in infants (6)
- Attachment
- Discriminate mother
- Object Permanence: know whether the object is there or not
- Separation Anxiety
- Stranger Fear
- Temperament
Psychosocial development of Body image
- Infant discovers mouth can produce pleasure
- Hands/feet play objects
- Smiling causes others to react
Piaget Cognitive Development? (3)
Piaget:
•Neonate-18/24 months
Sensory-motor/Imitative
- Progression from reflex activity to imitative or repetitive behavior
- Separation
–Separate self from objects
–Object Permanence
–Symbols/Mental Representation
Language Development info, read
Language:
- Crying as form of communication
- Vocalizes with cooing
- Responds to noises (turns head)
- Laughs
- Single-syllable words
- Two word phrases by 1 year
- Three to five words by 1 year
- Comprehends word ‘no’ by 1 year
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Nutrition: What recommended exclusively for the first 6 months?
Breat milk/iron fortified formula.
Breast fed babies do not need extra water
When may babies start having solids?
5~6 months.
Introduce 1 food at a time.
Rice cereal, vegetables, fruits, meat, egg yolk.
Avoid nuts, foods with seeds, raisins, popcorn, grapes
Limit milk intake to 1 quart/day once solids are established.
What are leading causes in neonatal/infant mortality?
- Congenital anomalies leading cause death under 1 year (neonates & infants)
- Congenital Cardiac Defects # 1
- Accidents leading cause death infants
Aspiration of Foreign Objects
- Leading cause fatal injury children under 1 year
- Small pliable objects < 3.2 cm can cause complete obstruction
- Baby powder
- Propping bottles
What are parts of unsafe pacifier construction?
•Unsafe Pacifier Construction Perry p 626
–Detachable parts can be aspirated
–Ribbons or strings can be dangerous
–Soft, Pliable materials may be easily aspirated
–Attached to soft toys poses risk of asphyxia
One piece pacifier construction with easily grasped handle and flange large enough to prevent mouth entry recommended. But know they are unsafe ones with detachable parts or strings attached to it.
Young infants are very aware of surroundings in the hospital and simtulated by taactile, auditory and visual senses. What should you do?
Establish a calm, comforting environment with visual, auditory and tactile stimulation.
What are infant interventions in the hospital?
- Meet physical needs
- Parents as partners/participants in care
- Address stranger anxiety
- Calm, comforting environment
- Consistency in care (staff & routine)
- Comfort and pain reducing measures
- Safety measures
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What occurs to a Toddler’s physical body? (4)
Physical
- Weight gain slows from infancy
- Age 2, height doubled = adult height
- Trunk/head slower growth arms/legs
–Bowlegged with wide base stance; toddles
–Falls easily; pot belly
•Dentition:
–All primary teeth by 2 ½ to 3 years
–Recommend first visit to Dentist at age 2
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What happens to a todder’s motor skills? (4)
Motor
•Walks by 12 to 13 months
–Runs by age 2
–Up and down steps age 2
–Unsteady on feet
•Begins to master fine motor skills
–Feeds self with spoon by 12-18 months
–Scribbles 15 months
–Removes socks and shoes 16 to 18 months
–Dress self in simple cloths 2 years
- Tries to be independent
- High energy with no impulse control
What’s the psychosocial development of a toddler? (3)
- Self-Concept Development
- Body Image Changes
–Body Parts
–Gender Identity
- Erikson: Autonomy vs Shame and Doubt
What occurs in Erikson: Autonomy vs Shame and Doubt?
What occurs during the Toddler’s Piaget development? (7)
Piaget: Sensory-motor continues to 18/24 months
- Object Permanence Fully Developed
- Egocentric
- Learn to separate from mother
- Memories of events r/t self
- Begin to control socially unacceptable behavior
- Learning sex role distinctions based on culture
•Lacks concept of conservation (example ?)
What occurs ina Toddler’s Language development?
Language 2-3 word phrases (use of short sentences)
- Family understands speech (2 years)
- Strangers understand speech (3 years)
- Understanding of language exceeds ability to verbalize
- Inability to transfer knowledge to new situations:
Toddler Nutrition info (8)
- Appetite decreases
- Picky eater
- Needs high protein diet for brain development
- Needs snacks
- Table food by 12 to 15 months (majority food)
- Whole milk with vitamin D (limit 1 quart/day)
- Limit juice (4 to 6 oz/day)
- ‘Dental (brushing, fluorination, bottles, sweets)
Dental visit recommended at 2-years
5 characteristics about Toy & Play for toddlers
Parallel and Solitary Play
- Minimal sharing/cooperation
- Special toy/blanket
- Learning what is his/hers
- Parallel play; side by side with little cooperation
- Toys, manipulative, blocks, shapes, crayons, books, telephones, kitchen sets
What are some issues related to normal G&D (2)
Toilet Training
- Freud’s Psychosexual Anal Stage
- Major task of toddlers with readiness between 18 months and 2 years after child is walking (voluntary control of anal & urethral sphincters achieved)
- Refer to Perry (2014) p. 931, Assessing Toilet Training Readiness
4 characteristics with Sibling Rivalry
–This is a natural response of jealousy and resentment
–Response to changes in toddlers life
–Anticipatory guidance with parents indicated
–May see regression
What exactly are tantrums?
–Expression of independence may be exhibited through violent objection to discipline (kicking, screaming & breath holding)
–Anticipatory guidance with parents
Negativism
– “NO” is an expression of self-control and independence.
– Provide choices that do not provide for a “no” answer
What is Regression? (3)
–Reverting to previous patterns of functioning usually related to
stress or discomfort (thumb sucking, bed wetting, ‘baby talk’)
–Common with toddlers especially in illness, hospitalization, separation, birth of sibling
–Illness & hospitalization may cause regression
What’s the highest incidence of death in toddler’s age 1~4 ?
Kids falling
- Highest incidence death occurs ages 1 to 4 (outside of adolescent age group).
- Freedom achieved through locomotion and lack of awareness of unsafe behaviors results in very high injury risk
- Refer to Perry (2014) Table 32-4, Injury Prevention During Early Childhood
- Injuries include: Motor Vehicle Related, Drowning, Burns, Poisoning, Falls, Choking & Bodily Damage
What are norms in hospitalized toddler? (5)
Norms
- Separation anxiety peaks
- Vocabulary increases however understanding language exceeds ability to verbalize
- Toddlers becoming independent from parent/caretaker
- Daily routines of waking, sleeping, eating and play are established
- Development focused on mobility and learning to communicate
10 toddler interventions
- Parents as partners/participants in care
- Address stranger anxiety (ex: exam on parent lap)
- Exam/assessment start with least intrusive
- Encourage use of comfort/transitional objects (blanket, stuffed animal, family pictures)
- Incorporate home routines into care
- Maximize mobility, play and control opportunities
- Prepare toddler for “routine” care and procedures
- Maximize comfort and pain reduction measures
- Maximize consistency (staff & hospital routine/procedures)
- Maintain safety measures
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