N1G03- PBL EXAM REVIEW Flashcards
Health Education
teaching about different issues. E.g. risk factors for heart disease
Health Promotion
the science and art of helping people change their lifestyle to move toward a state of optimal health, the process of advocating health in order to enhance that personal, private and public support of positive health practices will become a societal norm
Readiness to Learn
the time when the learner is receptive to learning and is willing and able to participate in the learning process; preparedness or willingness to learn
Andragogy
the art and science of helping adults learn; a term coined by Knowles to describe his theory of adult learning
Domains of Learning
cognitive, psychomotor, and affective are the three domains in which learning occurs
Learning Styles
the manner by which (how) individuals perceive and then process information. Certain characteristics of style are biological in origin, whereas others are sociologically developed as a result of environmental influences.
Teaching Process
one component of the educational process; a deliberate, intentional act of communicating information to the learner in response to identified learning needs, with the objective of productive learning to achieve desired behavioural outcomes.
Strategies of health promotion
active and passive
Strategies of health promotion: Active
individual becoming personally involved in adopting proposed program
Ex. Daily exercise, adopting stress management program
Strategies of health promotion: Passive
individual as inactive participant or recipient
o Ex. Public health efforts to maintain clean water to decrease infections
Trans theoretical model
- stages of change: ready to change
- decisional balance: : benefits to and detractors from changing a behaviour
- self efficacy: personal confidence in making a change
- processess of change: cognitive, affective, behavioural activities facilitating change
Stages of change
1) Pre-contemplation: not considering change
2) Contemplative: aware of but not considering change
3) Preparation Action: planning to act soon
4) Action: has begun to make behavioural change (recent)
5) Maintenance: continued commitment to behaviour (long-term)
6) Relapse: reverted to old behaviour
Habits
oTransmitted from parent to child and social groups
oEating, resting, exercising, handling anxieties
Health Goals
inculcate sense of responsibility for avoiding injury to the health of others, understand important use of health services
Types of prevention
primary, secondary, tertiary,
Primary prevention
protecting people from injury and disease, interventions that emphasize shielding or defending the body from specific injuries or diseases e.g. immunizations and reducing exposure to hazards
Secondary prevention
providing screening activities and treating early stages of diseases to limit disability by averting or delaying consequences of advanced disease
Tertiary prevention
occurs when a defect or disability is permanent and irreversible, involves minimizing effects of disease by surveillance and maintenance activities aimed at preventing complications
Patient education
the goal is to assist individuals, families, or communities in achieving optimal health
Three main goals of patient education
- Maintaining and promoting health and preventing illness
- Restoring health
- Optimizing quality of life with impaired functioning
Roles as nurses
- CAN code of ethics indicates that patients have rights to make informed decisions about their care
- Decisions must be accurate, complete and relevant to their needs
Types of learning
- cognitive
- affective
- psychomotor
Cognitive learning
all intellectual behaviours and requires thinking (remembering, understanding)
Affective learning
expressions of feelings and accepting of attitudes, opinions, values (receiving, responding)
Psychomotor learning
acquiring skills that require integration of mental and muscular activity
Ability to learn capability
emotion, intellectual and physical
Emotion capability
emotion can aid or prevent learning
Intellectual capability
patients knowledge and intellectual level
physical capability
strength, coordination and sensory ability
Learning in children
as a child matures, intellectual growth progresses from concrete to abstract
Learning in adults
many are independent, self-directed, learn more successfully when encouraged to use past experiences
Teaching approaches
telling, selling, participating, entrusting, reinforcing
Telling
useful when limited information must be taught (outline task to be done)
selling
two-way communication (pace instruction according to patient’s response)
participating
setting objectives and becoming involved in learning process (patient decides content, nurse guides)
entrusting
provides patient with opportunity to manage self-care (observe progress and remain available)
reinforcing
use of stimulus that increases probability of a response (people respond better to positive reinforcement)
Teaching methods
- one on one discussion
- group instruction
- preparatory instruction
- demonstration
- analogies
- simulations
One on one discussion
provide opportunity to ask questions or share concerns
group instruction
teach several patients at once
preparatory instruction
provide information about procedure
demonstration
help teach psychomotor skills
analogies
teacher translates complex language
simulations
help teach problem solving, application
Learning goals
goals are desired outcomes of learning that are realistically achievable in a set time frame
objective
statement of specific behaviour/performance
concept class: PICO
P – population
I – intervention
C – compared to
O – outcome
4s model
o Studies: at foundation
o Syntheses: systemic reviews
o Synapses: brief descriptions of original articles and reviews
o Systems: link individual patient characteristics to permanent evidence
5S Model
- Systems: computerized decisions support
- Summaries: evidence-based textbooks
- Synopses: evidence-based journal abstracts
- Syntheses: systematic reviews
- Studies: original journal articles
Caveat emptor
- At each level, standards for evidence generation, retrieval, selection and analysis should be explicit and at highest evidence standard possible
- Systems - guidelines should be based on systematic reviews
- Summaries - details of retrieval process, key references
- Synopses - defined procedures for retrieving original and review articles
Limitations in the model
- The higher you go up pyramid, the scarcer the resources
- Number of evidence based summary publications is growing except number of disease conditions
- Processing information takes time
6S MODEL
- Systems: computerized decision support systems
- Summaries: evidence based clinical practice guidelines, textbooks
- Synopses of Syntheses: DARE, evidence based abstraction journals
- Syntheses: systematic reviews
- Synopses of Studies= evidence based abstraction journals
Studies
original articles published in journals
Tuckermans group developmental stages
- forming
- storming
- norming
- performing
- adjouring
forming
the group development phase in which member and group goals are explored and interpersonal relationships are tested
- Primary tension- social unease and stiffness
storming
the group and developmental stage in which members compete with one another to determine individual status and to establish group goals
- Secondary tension- frustrations and personality conflicts as the compete for acceptance and achievement within the group
- members compete for status and openly disagree
norming
the group development stage in which members resolve conflicts and work as a cohesive team to develop methods for achieving the group’s goal
performing
the group developmental stage in which group members focus their energy on doing the work needed to achieve group goals
- members assume appropriate roles and work productively
- Members are fully engaged and eager to work
adjouring
the group development phase in which a group has achieved its common goal and begins to disengage or disband
- members disengage and relinquish responsibilities
group norms
rules and expectations established by a group deciding on what is and isn’t acceptable (behaviours and opinions)
explicit norms
written or stated verbally
Implicit Norm
rarely discussed or openly communicated
Group Task Roles
a positive role that affects a group’s ability to do the work needed to achieve its role
Group Maintenance Role
a positive role that affects how group members get along with one another while pursuing a common goal
Self-Centered Roles
a negative role in which individual needs are put ahead of the group’s goal and other members’ needs
Leadership
the ability to make strategic decisions and use communication to mobilize a group towards achieving a common goal
Member Readiness
the extent to which a member is willing and able to contribute to achieving the group’s goal
New comers phases
- anteocedent
- anticipatory
- encounter
- assimilation
- exit phase
Newcomers phases- antecedent phase
newcomer brings beliefs and attitudes, cultural dimensions, needs and motives and communication skills
Newcomers phases- anticiptory
members have expectations about newcomers
Newcomers phases- encounter phase
newcomers try to fit in by adjusting to group expectations
Newcomers phases- assimilation phase
newcomers become fully integrated
Newcomers phases- exit phase
as newcomers join, others leave
Group motivation
- Sense of Meaningfulness= shared feeling of meaningful goal
- Sense of Choice= shared feeling that group has power to make decision
- Sense of Competence= shared feeling that group is doing good
- Sense of Progress= shared feeling that group accomplished something
Explicit norms
something enforced (ex. Underage drinking)
Implicit norms
rules that are implied and unstated (ex. Deodorant)
Becoming a leader
- Designated: selected by group members or outside authority
- Emergent: most effective, leader emerges
- Position Power: members job or status within organization
- Personal Power: stems from member’s individual character
Hersey blanchard situational leadership
1) Telling Stage
2) Selling Stage
3) Participating Stage
4) Delegating Stage
5M model of leadership
1) Mentor Membership
2) Model Leadership Behaviour
3) Motivate Members
4) Manage Group Process
5) Make Decision
Family
Group of interacting individuals related by blood, marriage, cohabitation or adoption
Nursing process
- Recipient of Care entire family
- 2 level process: family as a group, interactions among family
- Assessment Phase: seeks and identifies information from the family about health promotion and disease prevention activities
Nurses role
- Become aware of family attitudes and behaviours toward health promotion and disease prevention
- Act as a role model to family
- Collaborate with family to assess, improve, enhance and evaluate family health practices
- Assist the family in growth and development
- Provide reinforcement for positive health-behaviour practices
- Provide health information to the family
Family theories
- Families experience constant exchanges of energy and information with the environment
- Change in one part changes family as a whole
Gordons function health patterns
- nutritional
- acitivity
- cognitive perception
- roles and relationships
- coping/stress tolerance
- values and beliefs
Nutrition family
- Family meal sharing is associated with healthier eating
- Dietary habits learned from family
activity and exercise
- Daily activities, exercise, leisure activities
- Quantity of sedentary activities
cognitive perception
- How families access information to make decisions
- How concrete or abstract the thought process is
- Whether decisions focus on past, present or future
roles and relationships
- Structural aspects= name, age, sex, education, role in family
- Nuclear= husband, wife, children
- Extended= grandparents, aunts, uncles
coping and stress tolerance
- Families ability to cope with daily demands
- Family relationships support coping or generates more stress
values and beliefs
- Life meanings, spirituality
Clinical practice guidelines
- Form of evidence that summarizes information from multiple sources into one document
- Systematically developed statements that assist health practitioners and clients to make decisions about what is appropriate care
- Located on summaries level of 6S pyramid
Critique
- Process of critical appraisal in which a person evaluates a source of evidence for scientific validity or merit of both content and its application to practice
Agree 2 tool
- Assess whether guideline is good based on:
1) Guideline Creator
2) Currency
3) Scope & Purpose
4) Results or Recommendations
5) Application to Current Situation
Process of smoking
- Relapse: terminates action or maintenance phase and moving back to pre-contemplation and contemplation
- Dimensions to assess behaviour modification:
1) Stages of Change= represent temporal, motivational and constancy of change
2) Processes of Change= activities and events that create modification
Canadian smoking cessation
o 17% Canadians smoke
o GDG = guideline development group
RNAO smoking
- “ask, advise, assist, arrange” protocol
- Introduce smoking cessation
- Re-engage clients to stop relapse
Aboriginial smoking
- Smoking plays role in traditional and spiritual practices
- Rates of smoking is higher but health status is poorer
Hospital based smoking
- Quitting smoking prior to admission is beneficial
- Nicotine withdrawal treatment
Mental health smoking
- 2-4 times more likely to smoke
- Nicotine release neurotransmitters involved in psychiatric disorders
Family
a group of interacting individuals related by blood, marriage, cohabitation, or adoption who interdependently perform relevant functions by fulfilling expected roles
Family health status
is considered functional, potentially dysfunctional (potential problem), or dysfunctional (actual problem)
Nurses role
Nurses collaborate with families using a systems perspective to understand family interaction, family norms, family expectations, effectiveness of family communication, family decision making, and family coping mechanisms. The nurse’s role in health promotion and disease prevention includes the following tasks:
o Become aware of family attitudes and behaviours toward health promotion and disease prevention
o Act as a role model for the family
o Collaborate with the family to assess, improve, enhance, and evaluate family health practices
o Assist the family in growth and development behaviours
o Assist the family in identifying risk-taking behaviours
o Assist the family in decision-making about lifestyle choices
o Provide reinforcement for positive health-behaviour practices
o Provide health information to the family
o Assist the family in learning behaviours to promote health and prevent disease
o Assist the family in problem-solving and decision making about health promotion
o Serve as a liaison for referral or collaboration between community resources and the family
Nurses use family theoretical frameworks to guide, observe, and classify situations.
Family stage
Specific Risk Factors and Related Health Problems
Beginning childbearing risk factors
o Lack of knowledge about family planning
o Adolescent marriage
o Lack of knowledge concerning sexual and marital roles and adjustments
o Low birth weight infant
o Lack of prenatal care
o Inadequate nutrition
o Poor eating habits
o Smoking, alcohol, and drug abuse
o Unmarried status
o First pregnancy before age 16 or after age 35
o History of hypertension and infections during pregnancy
o Rubella, syphilis, gonorrhea, and AIDS
o Genetic factors
o Low socioeconomic factors and educational levels
o Lack of safety in home
Beginning childbearing health problems
o Premature baby in family o Birth defects o Birth injuries o Accidents o SIDS o Respiratory distress syndrome o Sterility o Pelvic inflammatory disease o Fetal alcohol syndrome o Mental retardation o Child abuse o Injuries o Birth defects o Underweight or overweight
Family with school aged children risks
working with parents inappropriate use of resources for child care
o Poverty
o Abuse or neglect of children
o Generational pattern of using social agencies as way of life
o Multiple, closely spaced children
o Low family self-esteem
o Children used as scapegoats for paternal frustration
o Repeated infections, accidents, or hospitalizations
o Parents immature, dependent, and unable to handle responsibility
o Unrecognized or unattended health problems
o Strong beliefs about physical punishment
o Toxic substances unguarded in the home
o Poor nutrition
Family with school aged children health problems
o Behavior disturbances o Speech and vision problems o Communicable diseases o Dental caries o School problems o Learning disabilities o Cancer o Injuries o Chronic diseases o Homicide o Violence
Family with adolescents
risks
o Racial and ethnic family origin
o Lifestyle and behavior patterns leading to chronic disease
o Lack of problem solving skills
o Family values of aggressiveness and competition
o Family values rigid and inflexible
o Daredevil risk-taking attitudes
o Denial behaviours
o Conflicts between parents and children
o Pressure to live up to family expectations
family with adolescents health problems
o Violent deaths and injuries o Alcohol and drug abuse o Unwanted pregnancies o Sexually transmitted diseases o Suicide o Depression
Family with middle aged adults risks
o Hypertension o Smoking o High cholesterol levels o Physical inactivity o Genetic predisposition o Use of oral contraceptives o Sex, race, and other hereditary factors o Geographical area, age, and occupational deficiencies o Habits i.e. diet with low fiber, pickling, charcoal use, and broiling) o Alcohol abuse o Social class o Residence
Family with middle aged adults health problems
o Cardiovascular disease, principally coronary artery disease and cerebrovascular accident (stroke) o Diabetes o Overweight o Cancer o Accidents o Homicide o Suicide o Abnormal fetus o Mental illness o Periodontal disease and loos of teeth o Depression o Mental confusion
Families with older adults risks
o Age o Drug interactions o Metabolic disorders o Pituitary malfunctions o Cushing’s syndrome o Hypercalcemia o Chronic illness o Retirement o Loss of spouse o Reduced income o Poor nutrition o Lack of exercise o Past environments and lifestyle o Lack of prevention for death
Families with older adults health problems
o Reduced vision o Hearing impairment o Hypertension o Acute illness o Infectious disease o Influenza o Pneumonia o Injuries such as burns and falls o Depression o Chronic disease o Elder abuse o Death without dignity
During pregnancy fertilization
Fertilization – the union of a sperm and egg
o Under normal and healthy circumstances, a full-term pregnancy last approximately 9 solar months, 10 lunar months, or 40 weeks
o An accurate estimated date of delivery is determined by using Nagele’s rule – done by adding 7 days to the last date of the normal menstrual period and subtracting 3 months
o A usual pregnancy consists of 9 months, divided into three equal periods called trimesters
Fertilization
o When a sperm penetrates an egg in the ampulla of the fallopian tube, the beginning of a human being (called a zygote) results
o Additional division of zygotic cells results in more differentiated structures that eventually produce an embryo and subsequently a fetus
o Infertility – failure of the couple to become pregnant despite usual sexual activity over 1 year’s time
Implantation
o Transplantation of the fertilized egg in the uterine cavity after its trip through the fallopian tube requires approximately 6 days
o Once the zygote reaches the uterus, it stays there for up to 5 days, receiving nutrition from the endometrium, the inner lining of the uterus
o The process of fertilization and implantation triggers the production of large amounts of the hormone progesterone, which stimulates the formation of endometrial cells known as decidua
o The decidua provides nutrition for the embryo, a term that defines the growing conceptus up to 8 weeks of age
Maternal changes
o Various physiological effects based on a combination of hormonal and mechanical changes during pregnancy
o Hormonal influences tend to increase as the pregnancy progresses
o The mechanical (hemodynamic) changes reach a peak in the seventh or eighth month and then gradually decline as the pregnancy nears completion
Signs of pregnancy
o A woman may assume that she is pregnant because she has skipped her menstrual period or experiences nausea and vomiting, changes in breast sensations and size, or increased urinary frequency (presumptive signs of pregnancy)
o The woman should undergo a pregnancy test
o If performed too early, a home pregnancy test may produce a false negative result attributing to a low level of human chorionic gonadotropin (hCG)
o This hormone is produced by the placenta and is found in pregnant woman’s urine and blood, triggers a positive pregnancy result
o 97% accurate
o Presumptive signs of pregnancy – which are subjectively experienced
o Probable signs of pregnancy – which are objectively observed by the health care provider
o Positive signs of pregnancy – which are positive signs that verify that a pregnancy exists
o During the first trimester of pregnancy, using sophisticated testing with ultrasound, health care providers can determine fetal presence and placental adequacy early in pregnancy
o Ultrasound allows visualization of the fetus and gestational structures throughout pregnancy
Pregnancy: Urinary system
o A 50% increase in glomerular filtration rate related to influences of estrogen and progesterone
o Ureters increase in diameter by 25% secondary to progesterone influence
o Urinary output increases about 80% related to the total body water increase
o Bladder capacity increases to about 1500mL to accommodate extra fluids
Pregnancy: Cardio system
o Begins early in pregnancy
o Cardiac output increases up to 45% (anemia)
o Heart rate increases by 10 beats/minute to compensate for the increase in blood volume
Pregnancy: respiratory
o Tidal volume (volume of air inspired air) increases by 30% to 40% to increase the effectiveness of air exchange
o Total oxygen consumption increases about 20%
o Diaphragm is displaced upward secondary to the enlarging uterus and causes shortness of breath during the last trimester
Pregnancy: MSK
o Increased elasticity and softening of connective tissue
o Joints relax, especially the pelvic joints that support pregnancy and create pliability at the time of birth
o Lumbar and dorsal curves of the spine increase late in pregnancy and contribute to low back pain and the waddle of pregnancy
o Separation of the symphysis pubic occurs secondary to influence of relaxin hormone
Pregnancy: Integumentary
o Hormones and stretching of connective tissue of the abdomen attributable to an enlarging uterus lead to stretch marks (striae gravidarum)
o A narrow, brownish line (linea nigra) divides the abdomen, running from the umbilicus to the symphisis pubis – fades after pregnancy ends
o Increase in pigmentation caused by melanocyte-stimulating hormone causes darkened areas on the face termed the mask of pregnancy (chloasma)
Pregnancy: GI
o Enlarging and space occupying uterus cramps the intestinal region, causing a slowing of both peristalsis and emptying time of the stomach
o Relaxin causes a decrease in gastric motility leading to constipation
o Frequent heart burn results from reflux of stomach contents into the esophagus secondary to upward displacement of the stomach and relaxed gastro-esophageal sphincter
Pregnancy: reproductive
o Changes in uterus, breasts, vagina, vulva, and ovaries
o Pre-pregnant uterus is approximately the size of a closed fist
o Uterus at term has the capacity to contain a 7-10 lb. infant and the placenta
o As the uterus enlarges, the fundus (the upper uterine segment) moves higher in the abdomen
o Breasts enlarge early in the pregnancy
o Vagina and vulva receive more blood supply (may appear darker)
o Some may notice an increase in vaginal secretions and experience a whitish discharge
o Hormones such as hCG and estrogen, secreted by the placenta and the fetus creat an optimal intrauterine environment for the fetus and stimulate many changes in the pregnant woman’s body
Nursing role throughout pregnancy
o Caregiver
o Advocate
o Support person
o Teacher
o Nursing interventions should address recommended profession practice guidelines for education during the prenatal period to prevent complications for the family
o Teaches the woman about changes to expect in the body during pregnancy
1st trimester (Week 1 -12)
o Extreme tiredness
o Tender, swollen breasts (nipples might also stick out)
o Upset stomach with or without throwing up (morning sickness)
o Cravings or distaste for certain foods
o Mood swings
o Constipation (trouble having bowel movements)
o Need to pass urine more often
o Headache
o Heart burn
o Weight gain or loss
2nd Trimester (Week 13-Week 28):
o Body changes to make room for growing baby
o Body aches such as back, abdomen, groin or thigh
o Stretch marks on abdomen, breasts, thighs, or buttocks
o Darkening of skin around nipples
o A line on the skin running from belly button to public hairline
o Patches of darker skin, usually over cheeks, forehead, nose, or upper lip (mask of pregnancy)
o Numb or tingling hands (carpal tunnel)
o Itching on abdomen, palms, and soles of feet
o Swelling of ankles, fingers, and face
3rd Trimester (Week 29-Week 40):
o Shortness of breath
o Heart burn
o Swelling of ankles, fingers, and face
o Hemorroids
o Tender breasts which may leak a watery pre-milk called colostrum
o Belly button might stick out
o Baby “drops” or moves lower in your abdomen
o Contractions (can be a sign of real or false labor)
o Near due date = cervix becomes thinner and softer which helps birth canal (vagina) open during birthing process
Labor and Birth stages
- dilation
- pushing
- placental
- recovery
Dilation Stage
– lasts from the onset of true labor contractions to complete dilation of the cervix. It is divided into 3 phases; latent (0-3 cm dilation); active (4-7cm dilation); and transition (8-10cm dilation)
Pushing Stage
– lasts from complete dilation (10 cm) of the cervix to birth
Placental Stage
– lasts from the time of birth of the new born to delivery of the placenta and membranes, which can range from 2-15 minutes
Recovery Stage
– defined as the first 4 hours after childbirth where physiological and psychological adjustments begin to occur
Emotional changes
o Physical and psychological processes remain closely intertwined as pregnancy progresses
o Psychological stresses and normal emotional growth affect the physical status of pregnancy, interactions of family members, and the eventual relationship between mother and infant
o Nurse recognizes that the emotional aspects of pregnancy, the nurse recognizes that the woman’s personality, environment, physical state, family, and sociocultural and spiritual background affect the ways in which she handles the psychological changes
o Hormonal and other physical changes assist the woman in the psychological work of pregnancy
o Progesterone level increases affect the woman’s general mood, causing her to be more introverted and passive
o These mood changes help her to focus her energy on the growing child and her own growth and development
o The presence, growth, and movements of the fetus become more part of the woman’s experiential self
o Rubin (1984) – the classic researcher on maternal-infant bonding, the pregnant woman receives immediate sensations of touch, motion, and weight from the fetus that she can share only partially with others
o Supports a maternal feeling of separateness and uniqueness that causes the woman to turn inward
o Worries that the shift in energy away from the world toward herself and her child may cause her to lose contact, drift away from valued relationships, and lose feelings of competence in her areas of achievement
o Spends time analyzing her experiences and their possible influence on her effectiveness as a future parent
o Pregnant women seem overly sensitive and analytical during pregnancy
o Wide mood swings
o Emotional lability
o Irritability
o Changes in sexual desire
Emotional changes 2
o Physical discomforts, hormonal changes, feelings about altered body image, cultural considerations, work and relationship adjustments and demanding cognitive maturational processes may also cause these emotional changes
o Rubin’s classic work stimulates nurses to look beyond the physiological and pathological aspects of childbearing to the intricate process of becoming a mother, and to identify areas for providing help
o 2 processes in transition to motherhood: engagement and growth and transformation
o Engagement – making the commitment and being engrossed in mothering through active involvement in the child’s care
o Engagement leads to the woman’s growth and transition as she becomes a mother
o Establishing maternal identity:
- Commitment, attachment, and preparation for the pregnancy
- Acquaintance, learning, and physical restoration during the first 6 weeks after birth
- Moving toward a new normal from 2 weeks to 4 months
Teratogen
: agent that causes functional/structural disability in organisms based on exposure (affect CNS of fetus, lead to impaired intelligence)
Anemia:
deficiency of RBC or hemoglobin (1/2 worldwide)
Neural tube deficit
congenital malformations (anencephaly, spina bifida)
Pica
ingestion of non-food substances
Toxoplasmosis:
infects people through consumption of undercooked meat, cat feces
Listeriosis:
should avoid mile, uncooked meats
Pre-conception Care
o Identify and modify biomedical, behavioural, psychosocial risks
o Consider family history, genetic history, nutritional status, folic acid intake, environmental, occupational exposures
Antenatal Care
o Every 4 weeks for 28 weeks
o Every 2-3 weeks for 28-30 weeks
o Weekly after 36 weeks
School aged children physical growth
o School age child is between ages 5 and 12
o Many children have spurts of growing
o Gain 5cm (2 inches) per year in height and 2-3 kg (4.4-6.6 lbs.) per year in weight
o Black children slightly larger and Asians slightly smaller than their Caucasian counterparts
o Before the onset of puberty, there is little difference in size between boys and girls
o Towards the latter part of this stage, girls tend to grow more rapidly in height and weight than boys
o Changes reflect genetic inheritance
o Girls can reach menarche between ages 11-15 and that is considered normal
School aged children oral development
o Constantly losing and gaining teeth
o Child between ages 6 and 13 loses and gains approximately four teeth per year
school aged children motor skills development
o Neurological, skeletal, and muscular changes combine to increase the child’s overall motor ability
o More control over and coordination with motor skills
o Boys may be slightly stronger than girls but this difference is not significant until adolescence
o Increase in muscle mass and strength
factors influencing food intake
o Fast food commercials
o Some kids like a wide range of foods
o Many children only like raw fruits and veggies and eat only one things for lunch
o Isn’t good for their health
Nutritional education
o General curriculum of school
o Daily nutritional needs of a child who is 9-14 years old include the following:
- Milk group: 3 cups of fat free milk
- Meat group: 5 oz of lean meat or beans
- Vegetable group: 2 or 2.5 cups of vegetables daily
- Fruit group: 1.5 cups of fruit
- Grains group: 4-6 oz daily, of which half should be whole-grain items
School Age (5-12 years)
o Grow more slowly than infants
o Fine and motor skills perfected
o Slimmer appearance, body systems reach adult level
o Thoracic muscles develop, 14-24 bpm
o Head circumference and heart grows
o Adult hypertension begins in childhood
o After puberty, girls grow more in height and weight
o Girls experience earlier tooth eruptions
o Lymph tissues help immune system but affect size of tonsils
Nutrition
o Healthy foods cost more, some cultures have increased salt and fat content
o Shared meal times create positive environments
o Enuresis = involuntary urination
o Encopresis = bowel movements in underwear
o Fruits and Vegetables= 6
o Grains = 3-4
o Milk and Alternatives = 3-4
o Meat and Alternatives = 1-2
Piaget Theory
o Concrete operation: children learn by manipulating concrete objects and lack of ability to performing abstract thinking
o By age 12: 4000 words
Erikson’s Theory
o Industry vs. inferiority
o Child focuses on success on personal and social tasks
o Avoid inferiority (repeated failures)
Kohlberg’s Theory
o Pre-conventional level: self-interest only
o Latchkey children: left alone until parents return from work
Coping Strategies
o Cognitive mastery (problem solving)
o Controlling, holding behaviours
o Use repetition and humor
o Withdrawal (separation anxiety)
Poverty
o 22% children <18 live below poverty
o Higher mortality rates
o Development delays, peer rejection, poor self-concept, increased accidents
Key Determinants of Health
o Income and social status o Social support networks o Education and literacy o Employment/working conditions o Social environments o Personal health practices and coping o Healthy child development o Biology and genetic endowment o Health services o Gender/cultures
Multiple Sclerosis
o Inflammatory autoimmune disease of CNS
o Destruction of myelin sheath surrounding neurons
o Resulting in formation of plaques
o Affects 400,000 people in US ages 20-40
o Over 20 million worldwide
o Affects women twice as much as men
o More prevalent in colder climates
4 Types of MS
1) Relapsing-Remitting MS o Most common, 85% of those diagnosed o Series of relapses (loss of function and develop new symptoms) and remission (symptoms fully or partially disappear) 2) Primary Progressive MS o Slow but steady worsening of symptoms 3) Secondary Progressive MS o Originally diagnosed with RRMS o Gradual neurological deterioration o Slow and steady 4) Progressive Relapsing MS o Steady worsening of symptoms
MRI
identify presence of plaques or scarring
MTI:
detect abnormalities before lesions are visible
MRS:
information about brain’s biochemistry
VEP:
detect slow or abnormal conduction patterns
CSF analysis
detect levels of immune system proteins on oligoclinical bands
Electroencephalogram:
nerve signals are slower
Blood tests
detect IgG bands
Symptoms of MS
o Parasthesias: skin sensation
o Trigeminal Neuralgia: facial pain
o Optic Neuritis: inflammation of optic nerve
Fatigue
o Body mechanics o Evaluate energy levels o Attentiveness to personal situation o Weekly planning o Activities prioritized o Rest and exercise
Caregivers
o More than 50 million people provide care
o 60% are women (48 years old)
o Economic hardship
o Stress increases mortality rate by 63%
o Develop depression and anxiety
o Caregiver Burden: stress caregivers experience related to providing care
o Objective Burden: concrete cast to caregivers
o Subjective Burden: perceived costs
Stages in dilation
Latent (0-3cm)
Active (4-7cm)
Transition (8-10cm)
