Midterm Flashcards
1
Q
equity
A
Equity refers to fair and just practices and policies that ensure all community members can thrive.
Equity is different from equality
It is the removal of systemic barriers and biases → equal opportunity, access and benefit
Requires a strong understanding of the systemic barriers faced by individuals from under-represented groups
Health inequity result of unfair distribution of the underlying SDOH
Eg. access to healthcare in the north vs in more urban areas (tbay vs toronto)
2
Q
diversity
A
Refers to all aspects of human difference, social identities, and social group differences, including but not limited to race, ethnicity, creed, colour, sex, gender, gender identity, sexual identity, socio-economic status, language, culture, national origin, religion/ spirituality, age, abilities, political perspective, and associational preferences.
A diversity of perspectives and lived experiences is fundamental to achieving healthy outcomes for all
3
Q
inclusion
A
Systemic barriers are well documented in Canada. To address these persistent barriers individuals at all levels.
All individuals must recognize that systemic barriers exist, develop a strong understanding of what the barriers and their consequences are, and understand how individuals at all levels of can play a role in addressing them. (RNAO, 2007).
It is important therefore for everyone to reflect on our own assumptions regarding diversity and views of differences. What personal preferences, perspectives, power, privilege or other factors may influence our world view.
4
Q
nature of development
A
Biological Processes
- produce changes in physical nature
- result from: genes, brain development, nutrition, exercise, hormones, age etc.
Cognitive Processes
- changes in intelligence and language
Socioemotional Processes
- changes in relationships with other people, emotions and personality
5
Q
cultural pluralism
A
Diverse groups maintaining their unique cultural identities while living together harmoniously
6
Q
culture
A
- Integrated patterns of human behaviour (language, thoughts, communications, actions, customs, values, institutions)
- Common values and ways of thinking and acting of a group of people
7
Q
values
A
Belief about the worth of something
Standards that influence behaviour and thinking
8
Q
value orientation
A
Values learned and shared through socialization
Reflect “personality type” of particular society
9
Q
cultural competency
A
Describes a compilation of knowledge, attitudes, and skills for working with individuals of the same and different cultures
Disregard personal biases and treat everyone with respect
We can never be fully culturally competent in another culture so we aim for safety
10
Q
cultural humility
A
A lifelong process of self-reflection and critique (role of learner) that includes the recognition of power imbalances when working in partnership with patients
11
Q
cultural safety
A
Cultural safety goes beyond awareness and acknowledgement of differences to understanding the limitations of cultural competency.
An outcome of respectful engagement that results in people feeling safe when receiving health care
Is grounded in the decolonization of health care
12
Q
ethnocentric perspective
A
Having an ethnocentric perspective means viewing other ways as inferior, unnatural, or even barbaric.
Nurses must avoid this perspective when working with individuals and families.
Creates an obstacle in establishing and maintaining good working relationships
Patient trust is very important so they feel comfortable disclosing to you as a nurse
13
Q
integrative health care
A
Growing trend in Canada
Rooted in the belief that individuals should have the ability to make informed choices
Emphasis is on wellness and holistic, personalized care
14
Q
health issues of indigenous people
A
Many health problems of indigenous populations can be linked to their economic and social living conditions
Directly linked to colonialism through the forced residential school system.
Truth and Reconciliation Commission (TRC) of Canada documented the assimilation of Indigenous peoples.
The TRC outlines 94 calls for action, including reducing health inequalities.
15
Q
homeless populations
A
- Unsheltered - those who are absolutely homeless and living on the streets
- Emergency sheltered - those who are staying in overnight shelters for people who are homeless
- Provisionally accommodated - those who are staying in temporary accommodations
- At risk of homelessness - those who are not homeless, but whos current economic and/or housing situation is precarious or does not meet public health and safety standards
16
Q
hidden homelessness
A
having to live temporarily with family or friends because they had nowhere else to live
17
Q
top homeless populations
A
Indigenous
Women
People with disabilities
18
Q
marginalized groups have…
A
- less power
- are more likely to live in poverty
- are at risk for discrimination and stigma that may impact their health and access to health care
19
Q
The Canadian Code of Ethics for Registered Nurses recommends that nurses
A
- Work towards eliminating social inequities
- Focus on providing culturally safe care
- Conduct cultural nursing assessments
20
Q
Three principles of action to lessen the impact of the SDOH and promote health equity are:
A
(1) improving the conditions of daily life
(2) addressing the inequitable distribution of power, money, and resources at global, national, and regional levels
(3) raising public awareness of the SDOH, measuring the problem, and evaluating access.
21
Q
development
A
advance in skill from lower to more advanced complexity
Qualitative
22
Q
early developmental patterns
A
Cephalocaudal: head to toe
- Infants advance in head and neck control before extremities
Proximodistal: midline to periphery
- Infants CNS develops before PNS
Differentiation: simple to complex
- Infants use a whole hand grasp before learning finger control
23
Q
learning
A
- process of gaining knowledge and skills from exposure, education, experience
- Learning cannot occur unless an individual is mature enough to understand and control their behavior.
24
Q
maturation
A
- increased competence because of changes in structural complexity that make higher function possible
25
periods of development
- prenatal
- infancy
- toddler
- childhood
- adolescence
- early adulthood
- middle adulthood
- late adulthood
26
prenatal period
- time from conception to birth
- tremendous growth - single cell to a complete organism (app. nine mo.)
27
infancy
birth - 12 months
great dependence
Ends as infant begins to explore environment, walks alone, and develops basic communication skills
28
toddler
12 months - 3 years
Motor development progresses significantly
Child achieves a degree of physical and emotional autonomy while maintaining close identity with family unit
29
childhood
24 months - 11 years
early childhood (up to age 5 or 6) - more self-sufficient, self care
school-readiness skills, social skills
middle/late childhood - master basic skills: reading, writing, and arithmetic
formally exposed to world outside family and to prevailing culture
30
adolescence
transition from childhood to early adulthood (app. 10-12/18-22 yr.)
rapid physical changes: height, weight, body contour, sexual characteristics
pursuit of independence and identity
more logical thought – abstract/idealistic
more time spent outside the family
increased risk-taking
31
early adulthood
late teens/early 20 – 30s
establish personal/economic independence
become proficient in a career, mate, start family.
32
middle adulthood
expanding personal/social involvement and responsibility
assisting next generation to become competent, mature individuals
achieving/maintaining career satisfaction
33
late adulthood
life review, retirement, adjustment to new social roles involving decreasing strength and health
34
Psychosocial Theory: Erikson
- humans develop in psychosocial stages
motivation is social
change occurs during life span
- Based on the need of each person to develop a sense of trust in self and others and a sense of personal worth
- Composed of critical stages, each requiring resolution of a conflict between two opposing forces
Infancy
Trust vs mistrust
Toddler
Autonomy vs shame & doubt
Preschool
Initiative vs guilt
School age
Industry vs inferiority
Adolescence
Identity vs role confusion
Young adulthood
Intimacy vs isolation
Middle adulthood
Generativity vs stagnation
Older personhood
Ego integrity vs despair
35
Piaget - Cognitive Development
children construct personal understanding
engaged in personal cognitive development
age related stages with distinct thinking/understanding
child’s cognition is qualitatively different in each stage
four stages of cognitive development
Children are not capable of learning something until they are developmentally ready
1) sensorimotor
2) pre operational
3) concrete
4) formal operational
36
sensorimotor stage
- birth – 2 yr
- infants construct an understanding of the world by coordinating sensory experiences
- Object permanence and mental representations
37
pre operational stage
2yr – 7 yr
able to represent the world with words, images, and drawings
Advanced language and movement skills
Egocentric, animistic, magical thinking
Thoughts are dominated by senses
No cause and effect reasoning
preschool children still lack the ability to perform operations (internalized mental actions)
38
concrete stage
(7 – 11 yr)
Formal thought
Mental reasoning, logical approaches to solving problems
Cause and effect
Consider other points of view
Make associations
39
formal operational
development of logical reasoning
can think more abstractly
Morality established
more systematic problem solving, developing hypotheses about why something is happening the way it is and then testing these hypotheses
40
Vygotsky's Sociocultural Cognitive Theory
- culture and social interaction guide cognitive development
- inseparable from social/cultural activities
- Interested in cultural and social influences on learning
- cognitive development is learning to use inventions of society (language, memory strategies, mathematical systems)
- social interaction with more-skilled adults and peers is indispensable to their cognitive development
- Learning precedes development, learning pulls development
- People need to understand the social, cultural, and political context within which that learning and development occur
41
Kohlbergs - Moral Development
Preconventional
- Avoiding punishment
- Gaining rewards
Conventional
- Gaining approval
- Avoiding disapproval
Postconventional
- Agreeing upon rights
- Establishing personal moral standards
- Achieving justice
42
Gilligan's
- Research student with Kohlberg: noted that women scored lower than men using Kohlberg’s tool
- Women think and act more from a base of caring and relationships than do men, who are more inclined to think in terms of justice, rights, and rules.
Preconventional
- What is practical to others and best for self, realizing connection to other
Conventional
- Sacrifice wants and needs to fulfill others wants and needs
Postconventional
- Moral equal of self and others
43
epigenetics
the scientific investigation of the capacity of the cell to react to the environment
44
transtheoretical model stages of readiness to change
Precontemplation—not considering change
Contemplation—considering change
Planning and preparation—planning change
Action—implementing change
Maintenance—maintaining change
45
three trimesters of pregnancy
Germinal
Embryonic
Fetal
46
germinal phase
- Conception - 4 weeks
- less than 0.25 cm
- spinal cord, nervous system, lungs, gastrointestinal system, heart
- Can hear heartbeat as early as 3 weeks
- 100-140 bpm is normal
- amniotic sac envelops preliminary tissues of entire body
- called a zygote
- Nageles rule - Due date = first day of LMP + 7 days - 3 months
- Just one week after conception, cells of the blastocyst have already begun specializing
- The germination period ends when the blastocyst attaches to the uterine wall
- Trophoblast: The outer layer of cells that develops in the germinal period to provide nutrition and support for the embryo (becomes the placenta)
- Blastocyst: the inner mass of cells that develops during the germinal period. These cells later develop into the embryo
47
embryonic
- 3-8 weeks
- app. 14 cm, weighs about 112 g
- strong heartbeat
- thin, transparent skin
- downy hair (lanugo) covers body
- fingernails and toenails forming
- coordinated movements
- Organogenesis: organ formation that takes place during the first two months of prenatal development
48
fetal period
- 9 weeks - birth
- 36–43 cm, weighs 1,100–1,400 g
- adding body fat
- very active
- rudimentary breathing
49
presumptive signs of pregnancy
(signs that make woman think they are pregnant)
Nausea or vomiting
Change in breast sensations and size
Increased urinary frequency
Missed menstrual period
Nausea or vomiting occurs in 50 to 90% of women
50
probable signs of pregnancy
(objectively observed by healthcare providers)
Enlargement of the uterus
Softening of the uterine isthmus (Hegar’s sign)
Bluish or cyanotic colour of cervix and upper vagina (Chadwick’s sign)
Softening of the cervix (Goodell’s sign)
Asymmetrical, softened enlargement of the uterine corner caused by placental development (Piskacek’s sign)
Positive test for HCG in maternal urine or blood
Changes in skin pigmentation (chloasma and linea nigra)
51
positive signs of pregnancy
(verify pregnancy exists)
Detection of fetal heart tones by auscultation, ultrasonography, or Doppler
Palpation of fetal body parts using Leopold maneuvers
Objective detection of fetal movements
Radiological or ultrasonographic demonstration of fetal parts
52
Birth Process: Stage 1
- Presenting part of fetus begins to press on cervix
- The cervix relaxes, causing it to dilate and thin out
- Uterine contractions are 15-20 min apart at the beginning and last up to a minute, intensity increases
- By the end of first stage contractions dilate the cervix to an opening of about 10cm so that the baby can move from the uterus to the birth canal
- Last an average of 8-12 hours
53
Birth Process: Stage 2
- Fetus descends through lower birth canal
- The time from full cervical dilation (10cm) to birth of the newborn
- Uterine contractions increase in strength and the infant is delivered
- Begins when baby's head starts to move through the cervix and the birth canal
- By the time the head is out of the mothers body the contractions come almost every minute and last for about a minute
54
Birth Process: Stage 3
- The placenta is expelled
- Afterbirth: when the placenta, umbilical cord, and other membranes detached and expelled
55
anoxia
insufficient supply of oxygen for baby during birth, can cause brain damage
56
Apgar Scale
- Measures of Neonatal Health and Responsiveness
- used to assess the health of newborns at 1 and 5 minutes after birth
- Evaluates heart rate, respiratory effort, muscle tone, body color, and reflex irritability
- Higher score is better (7 and up is normal)
- Appearance, Pulse, Grimace, Activity, Respirations
57
preconception care of women
- Take 400 mcg (0.4 mg) of folic acid per day
- 150 minutes of moderate to vigorous physical activity per day
- Limit alcoholic beverages to 2 glasses per day, 10 per week
- Keep immunizations up to date
58
toxoplasmosis (think inflammation)
Exposure: undercooked meat, cat feces, infected soil
Maternal symptoms: flu-like, upper respiratory infection
Fetal effects: rashes, enlarged lymph nodes, inflamed heart and lungs, CNS damage
Prevention: handwashing; avoid cat feces, raw meat
59
syphilis (4 S's)
Exposure: sexually transmitted infection
Crosses the placenta and will affect fetus
Fetal effects: spontaneous abortion, preterm, stillbirth, skin lesions, septicemia
Prevention: screening high-risk women, antibiotic treatment
s-spontaneous abortion
s-stillbirth
s-skin lesions
s-septicemia
60
herpes simplex
(think rash)
Very serious sequela for fetus—potentially fatal
Spontaneous abortion, neurological damage, skin lesions, respiratory distress, GI bleeding
Maternal symptoms: painful perineal or vaginal lesions
Vaginal delivery with active lesions results in 40%⎼60% infection
Caesarean indicated for maternal vaginal or perianal lesions (if mom has an active herpes lesion recommend C section so she does not pass it to fetus during delivery)
Greatest risk of fetal infection with maternal primary herpes infection in latter half of pregnancy
*RASH
r-respiratory distress
a-a GI bleed
s-spontaneous abortion, skin lesions
h-horrible neurological damage
61
hepatitis B
Etiology: viral infection
Effects maternal liver and has high fetal transmission rate
Screening for all pregnant or at-risk individuals
High-risk: IV drug users, having bisexual partners, multiple sexual contacts, health care workers, women from Asia, Pacific Islands, Africa
Fetal implications: 60% are infected if present during third trimester; preterm birth, may have acute hepatitis or develop liver cancer
Prevention: series of three HBV immunizations before pregnancy
62
zika virus
Transmitted via daytime bite of Aedes mosquito
Caribbean, parts of Central and South America
Symptoms: fever, rash, headache, bone pain, conjunctivitis, joint pain
Illness mild—80% have no symptoms
Pregnancy: ZV results in fetus with microcephaly (small head and underdeveloped brain)
In 2016, the CDC declared ZV a public health emergency.
Prevention: avoid endemic areas or sexual contact with travellersto these areas.
63
rubella
*(DCC)
Rare because most women are immunized against it
Maternal symptoms: minor virus symptoms
Fetal effects in first trimester: deafness, impaired development of ears, eyes, heart (deafness, cataracts, cardiac defects)
Prevention: rubella vaccine when NOT PREGNANT (avoid pregnancy for at least 3 months after vaccine)
** (DCC - deafness, cataracts, cardiac)
64
cytomegalovirus
Common: 0.2%⎼2.4% of infants in Canada affected
Maternal symptoms: mild
Fetal effects: hearing loss, enlarged liver and spleen, developmental delay
Prevention: hygienic measures
**think mega - aka enlarged liver and spleen
65
HIV
Maternal high-risk groups: IV drug user, bisexual partners, multiple sexual contacts, hx STIs, prostitution
Recommendation: all pregnant women should be tested for HIV infection
Maternal implications: HIV may worsen during pregnancy; monitor for opportunistic infections; counsel on transmission
Fetal implications: 15%⎼25% develop AIDS; use of zidovudine (AZT) decreases viral transmission
Provider implications: universal precautions are essential
66
chlamydia
most common STI
Fetal effects: preterm labour, premature ROM, low birth-weight, conjunctivitis or pneumonia; maternal mild, unnoticed
67
gonococcus
STI—can cause ophthalmia neonatorum (bacterial eye infection in newborn infants)
Systemic neonatal infection; maternal pelvic infections
**gONococcus
ON - ophthalmic neonatorum
68
group B streptococcus
*(think B's)
screening at 36⎼37 weeks
Preterm ROM, preterm labour, fetal respiratory distress syndrome, septicemia, meningitis
*B
birth early
breathing difficulty
brain problem (meningitis)
69
bacterial vaginosis
associated with preterm labour
70
Candida albicans
can cause thrush in newborn
Conjunctivitis, ophthalmia neonatorum: Treated with routine administration of erythromycin drops at birth
Bacterial vaginosis, Candida albicans: Treated with specific antimicrobials
71
diabetes
Pregnancy increases need for maternal insulin
Glucose tolerance test is recommended at 28 weeks’ gestation to identify abnormal blood glucose.
Maternal effects: polyhydramnios (excessive amniotic fluid), acidosis, infection, vascular complications, pregnancy-induced hypertension
Fetal effects: increased risk for intrauterine death, hypoglycemia, respiratory distress, hyperbilirubinemia, hypocalcemia, increased congenital abnormalities
Management: close health team supervision to normalize blood sugar during pregnancy
72
antibiotics
Short term: most not harmful
Tetracyclines (pregnancy category D): cause teeth discoloration in fetus
73
anticonvulsants
Hydantoin (Dilantin)—fetal hydantoin syndrome; microcephaly, retardation, cleft lip or palate, congenital heart disease
Barbiturates (phenobarbital)—newborn addiction
74
pre natal paternal factors
Men’s exposure to lead, radiation, certain pesticides, and petrochemicals may cause abnormalities in sperm that lead to miscarriage or diseases such as childhood cancer
Radiation can damage the conceptus at any time during its prenatal existence
The offspring of older fathers also face increased risk for other birth defects, including dwarfism and Marfan syndrome, which involves head and limb deformities
75
nicotine (6)
Preterm births
low birth weights
Fetal and neonatal deaths
Respiratory problems
ADHD
SIDS
76
cocaine (6)
Linked to impaired motor development at 2 years of age and to a slower rate of growth through 10 years of age.
Prematurity, lower birth weight, length, and reduced head circumference (dose dependent), as well as congenital anomalies and genitourinary malformations have been also found
Findings from cocaine studies should be interpreted cautiously because cocaine use is often accompanied by other confounding maternal factors (cigarette smoking, other drug or alcohol use, lower socioeconomic status, and the lack of adequate prenatal care all of which may combine to contribute to poor pregnancy outcome
77
fetal alcohol spectrum disorders (FASD)
Consuming alcohol during pregnancy can result in serious effects in offspring even when they are not afflicted with FASD
Characterized by a number of physical abnormalities and learning problems
Facial anomalies, brain abnormalities, mental health problems, ADHD, developmental delays
FASD is a nation-wide health concern
78
aspirin (acetylsalicylic acid)
maternal or newborn bleeding if close to delivery
79
acetaminophen
liver toxicity
80
ibuprofen
prolonged labour (antiprostaglandin)
81
prenatal: emotional stress
Maternal stress may increase the level of corticotropin-releasing hormone (CRH), a precursor of the stress hormone cortisol, early in pregnancy
Elevated levels of cortisol in the fetus have been linked to premature delivery in infants
The mother’s emotional state during pregnancy can influence the birth process
Pregnant women with high levels of stress are at increased risk for having a child with emotional or cognitive problems, attention deficit hyperactivity disorder (ADHD), and language delay
82
2 months
Gross motor: holds head up, moves head side to side, pushes up while on tummy
Fine motor: eye movement (follow to midline)
Language: coos, gurgling sounds
Personal/social: smiles
83
4 months
Gross motor: roll over, some head control,
Fine motor: raking raisins (grabbing for things), work/reach for toy, hold rattle
Language: imitate speech sounds, single syllables
Personal/social: recognizes familiar people, playtime
Other: turns at the sound of voices
84
6 months
Gross motor: crawl, sit with no support, pull to stand, roll in both direction
Fine motor: feed themselves, bang two cubes together
Language: babbling (mama, dada), jabber (gibberish)
Personal/social: peekaboo*, stranger anxiety/separation anxiety
Other: responds to name
85
12 months
Gross motor: walking
Fine motor: drink from cup, take things in/out of containers, establish hand dominance, imitate activities
Language: say a few words
Personal/social: wave bye bye
Other: object permanence
86
sleep patterns and arrangements
- Newborns sleep approximately 16 to 17 hours a day (80% of time)
- Some child experts believe there are benefits to shared sleeping such as:
- promoting breastfeeding, responding more quickly to the baby’s cries, and detecting breathing pauses in the baby that might be dangerous
- In Canada and the United States, there is great concern over the relationship between bed sharing and the incidence of sudden infant death syndrome (SIDS)
- REM (rapid eye movement) sleep: a recurring sleep stage during which vivid dreams commonly occur
- About one-half of an infant’s sleep is REM sleep, and infants often begin their sleep cycle with REM sleep, rather than non-REM sleep
- By the time infants reach 3 months of age, the % of time they spend in REM sleep falls to about 40 %, and no longer does REM sleep begin their sleep cycle
- The large amount of REM sleep may provide infants with added self-stimulation since they spend less time awake than do older children and might promote the brain’s development
87
Sudden Infant Death Syndrome (SIDS)
- Sudden death of an infant younger than 1 year old during sleep that is unexpected and unexplained
- High risk between 1-4 months
- There is no definitive way to predict which infants will become victims of SIDS
- Researchers have found the following:
Low-birth-weight infants are more at risk to die of SIDS than are their normal-weight counterparts
Subsequent siblings of an infant who has died of SIDS have a higher risk of also dying from SIDS
SIDS is more common in infants who are passively exposed to cigarette smoke
SIDS is more common in lower socio-economic groups
Risk factors for SIDS include sleeping prone (on the abdomen), maternal smoking during pregnancy, and the lack of breast feeding
88
Breastfeeding results in benefits in many areas during the first 2 years of life and later
Fewer gastrointestinal and lower respiratory tract infections
Less likely to develop middle ear infections (Otitis media)
Less likely to have this chronic inflammation of the skin (Atopic dermatitis)
Less likely to become overweight or obese
Less likely to develop Type 1 diabetes in childhood
Less likely to experience SIDS
89
Benefits of breastfeeding for the mother are observed in the following areas
- Breast cancer: Consistent evidence indicates a lower incidence of breast cancer in women who breastfeed their infants
- Ovarian cancer: Evidence also reveals a reduction in ovarian cancer in women who breastfeed their infants
- Type 2 diabetes: Some evidence suggests a small reduction in Type 2 diabetes in women who breastfeed their infants
90
motor development
- newborns have range of reflexes, reactions to stimuli that govern their movements
- reflexes allow infants to respond adaptively to their environment before they have had the opportunity to learn
- rooting reflex - infant’s cheek is stroked or the side of the mouth is touched, infant turns head toward that side in an apparent effort to find something to suck
91
visual perception
- Sensation - when information interacts with sensory receptors (senses: eyes, ears, tongue, nostrils, skin)
newborn’s vision is estimated at 20/600
- Perception - interpretation of senses
infants have visual preferences; tend to look at patterned objects (e.g. faces); less colour interest
92
hearing
- auditory experience begins during the last 2 months of pregnancy
- immediately after birth, infants cannot hear soft sounds quite as well; stimulus must be louder for the newborn to hear
93
cognitive development
- conditioning - infant’s behaviour is followed by a reward so behaviour is likely to recur.
- attention - focusing mental resources on select information, improves cognitive processing on many tasks
- differences in attention during infancy predict cognitive functioning
- Memory - retention of information over time; for a few seconds or a lifetime
- 6 mo. can remember information for 24 hours; 20 mo. can remember information from 12 months earlier
- implicit memory - memory without conscious recollection (skills, routine procedures)
- explicit memory - conscious memory of facts and experiences
- infantile or childhood amnesia - most adults can remember little, if anything, from the first 3 years of life
- prefrontal lobes, believed to play an important role in storing memories of events, are immature at that age
- end of second year of life, long-term memory is more substantial and reliable
- Concepts - cognitive groupings of similar objects, events, people or ideas
- concepts are a key aspect of infants’ cognitive development
without concepts, each object and event would seem unique; you would be unable to make generalizations
- young infants form categories, but the nature of these categories changes throughout infancy
- perceptual categorization - categories based on similar perceptual features of objects (size, colour, movement), as well as parts of objects
94
language development
- Language - form of communication (spoken, written, signed) based on a system of symbols
- languages have common characteristics (organizational, infinite generativity) describing how language works
- infinite generativity - ability to produce endless number of meaningful sentences using finite words and rules
- Recognizing language sounds
- First words- spoken vocabulary exceeds spoken language
- Two word utterance- usually around 18-24 months
95
looksee checklist
(formerly the Nipissing District Developmental Screening [NDDS])
Screening tool for children from birth to age 6
yes/no questionnaire for parents (lots of no’s is bad)
Areas of development
Vision, hearing, communication
Fine motor, gross motor
Cognitive, social, emotional
Self-help
96
Rourke baby record
Screening children 1 month to age 5
HCP monitors:
Developmental milestones, growth and nutrition, physical examination, immunization, and health promotion
97
child directed speech
- type of speech that has a higher-than-normal pitch and involves the use of simple words and sentences
- Parents and even other children make use of this speech pattern, often without conscious awareness
- Captured the infant’s attention and maintains communication
*Children also learn about language as adults engage in conversation with other adults in the presence of the child
*What we say and how we say it can be easily observed and learned by the child to whom we are not directly speaking
98
interactionist view
- Emphasizes that both biology and experience contribute to language development
- How much of the language is biologically determined, and how much depends on interaction with others, is a subject of debate among linguists and psychologists
99
Infants - EDI Lens: Determinants of Health: Community & Work
- Counselling parents on types and screening day care
- Helping parents understand separation and expected behaviours
- Assisting parents to deal with separation behaviours
100
poverty impacts infants
Infant mortality rates higher
Higher disease rates
Delayed language development
101
overview of development and physical changes in toddler
5–10 cm height/year; 1.5–2.5 kg weight/year
Continue to measure head circumference
May measure length (recumbent) or height (standing)
By 3 years of age → 4x birth weight
102
system physical characteristics of toddler
- urine specific gravity similar to adult
- 500-600 ml of urine
- control of internal and external anal sphincters
- lung capacity increases
- respiratory rate decreases
- smaller upper airway tract diameter
- risk of otitis media
- bp increases
- heart rate decreases
- all 20 primary teeth erupt by 3
- immature swallowing pattern
- myelination of corticospinal tract
- does not show hand dominance
103
toddlers: sleep
- Experts recommend that young children get 11-13 hours of sleep each night
- Behavioral insomnia: repeated difficulty with sleep initiation, duration, consolidation, or quality that occurs despite age appropriate time and opportunity for sleep, which results in some form of daytime functional impairment for the child and/or family in children over the age of 6 months
- Insomnia may be symptom of many physical and mental health disorders such as eczema, GI reflux, anxiety, depression, ADHD
104
Piaget: pre operational
- (app. 2 – 7yr.)
- children represent the world with words, images, and drawings
- form stable concepts and begin to reason
- reasoning skill still not fully developed
Substages
- Preconceptual substage
- Function symbolically using language
- Intuitive substage
- Increased symbolic functioning
105
centration
focusing of attention on one characteristic to the exclusion of all others (cannot consider more than one factor at a time, when solving problems)
106
egocentrism
inability to distinguish one’s own perspective and someone else’s (can’t put themselves in someone else's shoes) (they assume everyone thinks the same things they do)
107
animism
belief that inanimate objects have life-like qualities, capable of action
108
conservation
lack awareness that altering an object or substance’s appearance does not change its basic properties (volume in different containers)
109
parallel play
children play next to each other and kind of watch each other but they don't really interact yet and play together yet
110
Six key principles in young children’s vocabulary development:
1.Children learn the words they hear most often.
2.Children learn words for things and events that interest them.
3.Children learn words best in responsive and interactive contexts.
4.Children learn words best in contexts that are meaningful.
5.Children learn words best with clear information about word meaning.
6.Children learn words best when grammar and vocabulary are considered.
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whole language approach
- reading instruction should parallel children’s natural language learning
- a method of teaching children to read by recognizing words as whole pieces of language
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phonics approach
reading instruction should teach basic rules for translating written symbols into sounds
sound it out
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second language learning
- bilingual children seem to have smaller vocabulary in each language; not exposed to the same quantity and quality of each
- multiple sensitive periods for learning a second language
- late language learners (adolescents, adults) may learn vocabulary more easily than new sounds or new grammar
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executive attention
involves planning actions, allocating attention to goals, detecting and compensating for errors, monitoring progress on tasks, and dealing with novel or difficult circumstances
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sustained attention (vigilance)
focused, extended engagement with task
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salient vs relevant dimensions
- more likely to pay attention to stimuli that stand out (salient), even if they are irrelevant
- after age 6 or 7, they attend more efficiently to the relevant aspects, reflecting cognitive control of attention
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planfulness
elementary-school-age children are more likely to systematically compare the details, one detail at a time
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Poisoning—greatest risk at ages 1–2
- Toddlers use mouth as way to explore environment
- Medications, household products, plants, cigarettes, alcohol, cosmetics
- Suspected poisoning—contact Poison Control Centre
- Lead—teach primary prevention, screening (secondary prevention)
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vaccines
2 months
- Diphtheria, tetanus, pertussis, polio, haemophilus influenzae type b, pneumococcal conjugate 13, rotavirus
4 months
- Diphtheria, tetanus, pertussis, polio, haemophilus influenzae type b
6 months
- Diphtheria, tetanus, pertussis, polio, haemophilus influenzae type b
12 months
- pneumococcal conjugate 13, meningococcal conjugate c, measles, mumps, rubella
15 months
- Varicella
18 months
- Diphtheria, tetanus, pertussis, polio, haemophilus influenzae type b
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school aged children
- 5-12 years
- Physical growth much slower compared to infancy and adolescence
- Fine and gross motor skills perfected
- Mental abilities grow
- Relationships outside of family including peer group connections develop
- Personal responsibility and self-management for care in areas of personal hygiene, nutrition, physical activity, nutrition, sleep and safety.
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school aged children: Biology
- slimmer
- long legs
- adult level functioning
- Before the age of 6 years- diaphragm-primary breathing muscle. After 6 years of age thoracic muscles develop
- respirations slow
- Head circumference continues to grow. However, after the age of 5 years it slows down till puberty
- Heart slowly grows in size and heart rate slows to 60 to 160 bpm
- lymphoid tissue grows rapidly (enlarged tonsils are normal)
- 6 to 13 years old loses and gains approximately 4 teeth a year
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school aged child: physical growth
- Approximately 5cms (2 inches) in height per year
- Weight 2-3kgs per year
- Girls tend to mature, enter puberty, and stop growing earlier than boys
- Menarche – approximately 12.5 years
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school aged children: health perception
- Understands the abstract definition of health and sometimes the factors causing illness. This understanding differs from adults.
- They understand they are sick but not fully understand why (how germs work)
- Most children perceive symptoms and show an ability to participate in health-promoting behaviors.
- Stage is concrete operation; can grasp germ theory, punishment theory, or external forces theory (limited understanding of how germs work).
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school aged children: nutritional guidelines
Healthy and Well-balanced diet: 1200-1800 kcal per day
Limit highly processed food and drinks
Include fruits, vegetables, whole grains and protein foods
Healthy fats over saturated fats
Replace sugary drinks with water
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enuresis
Involuntary urination at an age when control should be present
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primary enuresis
children with primary enuresis have never achieved bladder control
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secondary enuresis
secondary enuresis has periods of dryness and recurrent enuresis
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nocturnal enuresis
bed wetting; also called nighttime incontinence - is involuntary urination while asleep after the age at which staying dry at night can be reasonably expected
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diurnal enuresis (intermittent incontinence)
when a child who is toilet trained has wetting accidents during the day. A urinary pattern is most often seen in school aged girls. May demonstrate holding on behaviours resulting in daytime incontinence, intermittent voiding, and straining before voiding
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encopresis
- Persistent voluntary or involuntary passing of stool into child’s underpants after the age of 4 years who were previously toilet rained.
- Common complication of chronic constipation or history of painful bowel movements. Mostly soiling occurs during the day when the child is awake and active. Soiling during the night is uncommon.
- Encopresis is often associated with recurrent abdominal pain and, for many enuresis as well.
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school aged child: play
- 3 C's: creative, collective, competitive
- Creative: Let them make it. You don’t make it for them. Instead of coloring books & crayons give them colored pencils & paper so, they can create something.
- Collective: Express pleasure in their collections. Example stamps, rocks, sets of Barbie dolls, or other objects.
- Competitive: They like to play a game where there’s a winner & loser. Not that they like to be the loser.
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school aged: sleep disturbances
- Most common problems (preschool and early school years are night terrors, sleepwalking, sleep talking & enuresis).
- Disorders of arousal: immaturity of the nervous system; most outgrow with CNS maturation
- Consider safety, relaxation techniques, sleep preparation consistency
- Sleepwalking: more often in boys, and often occurs with enuresis. Shortly after going to sleep. Most occur 1 to 2 hours after going to sleep.
- Problems may be influenced by fatigue and stress within the child.
- Outgrow with CNS maturity. So, educate parents
- Protect the child from injury
Gates to the stairs
Remove sharp objects from the m child’s path
Direct the sleepwalker back to bed
- Relaxation techniques before bedtime, avoid stressful, fatiguing situations and be consistent with sleep preparation pattern.
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school aged child: concrete operational
- logical thought
- can't abstract think (they think concretely)
- can teach things days before (they have a better concept of time and memory now)
- they live by rules
- only one way to do things (all other ways are wrong)
- understand difference between past and present
- less egocentric
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school aged: industry vs inferiority
- coping with social and academic demands
- when they cope successfully they feel confident and achieve industry
- when they are not successful they feel like a failure and experience inferiority
- accomplish full mastery of tasks
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warning signs of child maltreatment
- Conflicting stories about the “accident” or injury from the parents or others
- Injury or complaint inconsistent with the child’s history or developmental level (e.g., the child received a concussion and broken arm from falling off a bed)
- Signs and symptoms consistent with signs of abuse and inconsistent with history, vague recall of event (e.g., chief complaint is a cold when there is evidence of first-degree and second-degree burns)
- Inappropriate response of caregiver, such as an exaggerated or absent emotional response, refusal to give consent for additional tests or agree to necessary treatment, excessive delay in seeking treatment, or absence of the parents
- Inappropriate response of child, such as little or no response to pain, fear of being touched, excessive or lack of separation anxiety, or indiscriminate friendliness to strangers
- Child’s report of physical or sexual abuse
- Previous reports of abuse in the family
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school aged children: Kohlberg
Younger school-age: preconventional
- A level of moral development characterized by self-interest only. The child continues to do many things simply to avoid getting in trouble and does not understand the reason for rules, but also performs actions that will benefit the self.
Older school-age: conventional
- Concern about group interests and values. The conventional level of moral judgement involves the child looking to others for approval and to societal authority for a definition of rules.
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adolescence: physical growth
- 13-19 years
- Accelerated growth spurt
- Onset of puberty: changes occur in a predictable sequence, but onset and duration of sequence differ among individuals.
- Females usually begin puberty 2 years earlier than males and experience growth spurt earlier.
- Adolesce who do not follow the normal sequence or who have not begun pubertal development by the age of 14 for males, and 13 for females, should have an endocrine evaluation.
- Menarche (females) late in puberty
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primary sex characteristics
Organs necessary for reproduction (Penis, testes, vagina, and uterus)
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secondary sex characteristics
External features. Not essential for reproduction
Breast development, facial and pubic hair growth, and voice changes
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first sign of puberty in males
- Thinning of scrotal sac and enlargement of testes.
- Ejacuation: A milestone of puberty and precedes fertility by several months
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first sign of puberty in females
Appearance of breast buds, followed by the growth spurt. Menarche approximately 2 years after the appearance of breast buds and near the end of the growth spurt.
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early maturing girls are more likely too
smoke, drink, be depressed, have an eating disorder, engage in delinquency, struggle for earlier independence from their parents, and have older friends
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early maturing boys are more likely too be
more overweight or obese, compared to average or late maturing boys
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adolescent: eriksons
- identity vs. role confusion
- Adolescence develop a sense of personal identity.
- When they are successful it leads them to the ability to be true to themselves and have an identity they are proud of.
- When they are not successful there is role confusion and a weak sense of self
- Risk behavior increases
- Social interaction with peers prioritized over family
- Threats to identity can result in delinquent behaviour and mental health issues
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adolescence: language and communication
- Abstract thinking
- Strive independence
- Give them as much privacy as possible
- Allow for free time
- Support socializing when possible
- Encourage questions & taking part in their own care
- Trust & understanding helps build rapport
- Privacy – Ask certain questions without the parents’ presence
- Encourage Peer support groups/peer contact – - - Risk for social isolation – depression & anxiety
Some interventions:
Having friends come over and visit at the hospital – 1st Priority intervention
Meeting other teens receiving similar treatments – 2nd priority intervention
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adolescent pregnancy
- pregnant adolescents more at risk for eclampsia
- more likely to have low birth weight babies
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Greig health record
- Published in 2010 and updated in 2016, is an evidence-based health promotion guide for clinicians caring for children and adolescents aged 6 to 17 years.
- Checklist templates include sections for growth and weight; psychosocial history and development; nutrition; physical activity and sedentary behaviour; sleep; injury prevention; abuse; the physical exam; immunization; and other specific concerns. Included with the checklist tables are five pages of selected guidelines and resources.
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adolescence: nurses role
- Nurses play a pivotal role in influencing health promotion, preventive screening, and disease prevention activities during the adolescent period.
- The primary responsibility of the nurse is to provide education about some of the expected changes and how to deal with them.
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school age: nurses role
- Nurses working with school-age children have a unique opportunity to engage the child in health-promoting behaviours
- Strategies for health promotion:
- Demonstrating, monitoring, and reinforcing preventive health practices
- Age-appropriate reading, materials, modeling, and role-playing
- Screening for health problems
