NUR331 Exam 1 Flashcards
cephalocaudal
head develops first
proximodistal
gain control from near to far
ex. - uses whole arm to write rather than just wrist
differentiation
simple skills are learned before complex skills
pediatric stages with ages
neonate - birth to 28 days
infant - birth to 12 months
toddler - 1 to 2 years
preschooler - 3 to 6 years
school age - 6 to 12 years
prepubertal - 10 to 12 years
adolescence - 13 to 18 years
erikson - trust vs mistrust
infant
erikson - autonomy vs shame and doubt
toddler
erikson - initiative vs guilt
preschool
erikson - industry vs inferiority
school-age
erikson - identity vs role confusion
adolescent
piaget - sensorimotor
1-2 years
piaget - preoperation
2-6 years
piaget - operation
school-age
piaget - formal operation
adolescent
Explain weight gain of infants.
- lose 10% of weight initially after birth
- grow about 1 oz per day until 6 months
- double weight by 6 months
- triple weight by 1 year
Explain height growth in infants.
- increase 1 inch each month until 6 months
- increase height by 50% by one year
Explain head circumference growth of infants
grow 0.5 inches per month for the first 6 months
When do the anterior and posterior fontanels close in infants?
anterior - 12-18 months
posterior - 6-8 weeks
Why do infants lose weight in the first few days of their life?
- withdrawal of hormones from mother
- loss of excessive extra cellular fluid
- limited food intake
respiratory rate of infants
newborn - 30-60 per minute
1 year - 20-30 per minute
heart rate of infants
newborn - 120-160bpm
1 year - 100-120bpm
blood pressure of infants
newborn - 80/40
1 year - 100/60
*fluctuates
When do maternal iron stores diminish in infants?
5-6 months
When does the majority of the digestive system work in infants?
3 months
When do amylase and lipase begin to function in infants?
4-6 months
When do infants begin to adjust to the cold?
6 months
What is an infants vision like at 1 month?
able to follow objects to midline
can see 8-10 inches away
What is an infants vision like at 2 months?
able to lift and look
What is an infants vision like at 3 months?
interested in faces, begins to associate visual stimuli and event
What is an infants vision like at 4 months?
hand regard
follows objects past midline
recognizes familiar objects
follows parents
What is an infants vision like at 6 months?
directed reach (reach towards mom)
depth perception
What is an infants vision like at 10 months?
understands object permanance
When is an infant able to localize sound and understand a few words?
3-6M
When does an infant say their first meaningful word?
6-12M
When can an infant hear and follow simple commands?
12M
When do infants develop their first deciduous tooth?
5-6M
What is the timeline for head control in infants?
1M - marked head lag
3M - can hold head up
4-6M - well established head control
Explain the timeline for rolling in infants.
5M - rolls from belly to back
6M - rolls from back to belly
Explain the timeline for sitting in infants.
6M - infant can sit with support
7M - infants can sit alone leaning forward on their hands for support (tripod)
8M - infant can sit unsupported
10M - can go into sitting position from prone or supine
When can an infant push back with their arms? (strong flexor tone)
4-6M
When can an infant crawl forward?
8-10M
When can an infant creep?
11M
When can an infant bear all their weight on their legs?
6-7M
When can an infant stand up while holding onto furniture?
9M
When can an infant cruise?
10-12M
When can an infant walk well with one hand held?
12M
When can an infant sit down from an upright position?
10-12M
When is an infant able to bring their hands to midline?
3M
When does an infant have the desire to grasp?
3M
When does an infant have a two-handed voluntary grasp?
5M
When can an infant intentionally bring things to their mouth?
4-6M
When can an infant hold a bottle and grasp their feet?
6M
When can an infant transfer an object from hand to hand?
7M
When does the pincer grasp begin to develop?
8-9M
When is a pincer grasp refined?
11-12M
When can an infant roll from abdomen to abdomen?
6 months
Kohlberg - Pre-conventional Morality
“big people say what they must do”
“powerful authorities hand down a fixed set of rules which they must obey”
Erikson - infant
- trust vs mistrust
- in sync with caregiver
- cannot tolerate frustration
- quality of care that the infant receives plays an important role in shaping personality
Piaget - sensorimotor
progression from simple reflexes to simple repetitive acts
learns that they are separate from others
object permanence
begin to use symbols
intelligence takes the form of motor actions
Piaget - motor actions of infants
Birth to 1M - reflexive
1-4M - primary circular reactions
4-8M - secondary circular reactions
9-12M - coordination of the secondary
When do infants develop a social smile?
6-8 weeks
When do infants show excitement towards new things?
3 months
When are infants personable and interactive?
6 months
When do infants imitate actions and noises as well as show displeasure?
7 months
When do infants start imitating sounds?
8 months
When do infants start playing games like patty cake and peek a boo?
10 months
When do infants understand simple commands?
9-10 months
When are infants able to show pleasure and displeasure and do things themselves?
12 months
Effects on Prolonged Separation: Stages
- protest
- dispair
- detachment
Reactive Attachment Disorder
after maladaptive or absent attachment
child may refuse to make eye contact, poor impulse control, destructive to self and others, may lead to antisocial behavior
When is a child’s sight fully developed?
6 years
When can a child smile?
2M
When does a child begin to turn head to locate sounds?
2M
When does a child begin to have taste preferences?
6M
When can a child respond to their own name?
7M
When is a child able to follow objects?
12M
When is a child able to vocalize 4 words?
1 year
When has a child expressed several recognizable emotions (anger, sadness, jealousy)?
10 months
When are a child’s emotions clearly distinguishable?
12 M
What are stressors that infants may face?
loss of caregivers, loud noises, lights, and sudden movement
How much do infants sleep in their first 4 months of life?
16-20 hours per day
When can an infant sleep through the night with two daytime naps?
5 months
When is play non-differentiated? (smiling and squealing)
0-3M
When does an infant laugh out loud?
4M
What is the major play focus of infants 3-6M?
sensory stimulation, learning to distinguish self from environment
solitary play
How does an infant play at 7-12M?
can discriminate who they will play with
promotes a sense of security, sensory stimulation, gross and fine motor stimulation
object permanence
Differentiate the stages of language development in an infant.
2M - coos
3-4M - constant sounds, laughs aloud
5-7M - vowel sounds
8M - imitating sounds, combining syllables
9-10M - understands simple commands and no
12M - can say 3-5 words with meaning (other than mama dada)
Red Flags in Infant Development
-unable to sit alone by 9 months
-unable to transfer objects from hand to hand by 1 year
-abnormal pincer grasp by 15M
-unable to walk alone by 18M
-failure to speak recognizable words by 2 years
Explain a toddler’s weight and height gain
weight - 5-6lbs per year
height - 5 inches per year
explain a toddler’s head circumference growth
2.5cm growth during their second year
When will a child have 20 teeth?
3
What is the overall look of toddlers?
pot bellied, legs are slightly bowed, lordosis
When can a toddler walk without help?
15M
When can a toddler throw a ball?
18M
When can a toddler go up the stairs?
24M
When can a toddler run fairly well?
24M
When can a toddler jump using both feet?
2.5y
When does a child start kicking a ball?
toddler years
When can a toddler use a cup well?
15M
When can a toddler put a round peg in a board and scribble?
15M
Explain the timeline of a toddler building cube towers.
15M- 2 cubes
18M- 3-4 cubes
24M- 6-7 cubes
When can a toddler hold a crayon with fingers?
24-30M
When can a toddler use good finger coordination?
30M
When can a child copy a circle and a line?
2 years
When does a child know their own name?
12M
When does a child follow simple directions?
2 years
When can a toddler repeat three numbers?
3 years
When can a toddler use short sentences?
18-24M
When can a toddler identify geometric forms?
18M
When can a toddler speak 300 words?
2 years
When can a toddler combine two words together for speaking?
2 years
When can a toddler fully understand object permanence?
2 years
Sources of stress for toddlers:
separation from parents, loud noises, the dark, certain people or situations, violence, loss of security object
Signs of stress for toddlers:
negativism (more than normal), regress, rigidity, lack of sociability, tantrums, self-centeredness
Sexuality of Toddlers
explore body parts, masturbation and self-simulation, parental reactions are very important, learning vocabulary, understand sex role differences
How well is a toddler’s language understood at 3?
65%
How can language development be promoted in toddlers?
read, sing, talk
don’t give in
Explain play in toddlers
focus on increasing control of the body
multiple uses of senses to play
parallel play*
imitation play
Kohlberg and toddlers
pre-conventional
little concern for why something is wrong, behave because of freedoms/boundaries they are given
action is considered good or bad depending on whether the action is rewarded or punished
egocentrism
piaget - toddlers
sees the world from their own eyes, difficulty sharing
pre-operational phase
piaget - 2-6 years
egocentric speech
concerned with why and how
When can a toddler control their bowels/bladder?
18-24M
Explain the weight and height gain of preschoolers.
weight - gain 5lbs per year
height - grow 2.5-3 inches per year
What motor development skills can a preschooler develop by age 3?
ride tricycle
broad jump
balance on tiptoe
balance on foot for a few seconds
What motor development skills can a preschooler develop by age 4?
skips and hops on one foot
catches a ball reliably
What motor development skills can a preschooler develop by age 5?
throws and catches a ball well
balances on alternating feet
begins to skate and swim
increased strength and refinement of fine motor abilities
What fine motor skills can a preschooler complete by age 3?
assemble simple puzzles
manipulates clay
copies simple shapes
stacks blocks up to nine high
What fine motor skills can a preschooler complete by age 4?
copies crosses and squares
prints some letters
uses table utensils skillfully
cuts on a line
What fine motor skills can a preschooler complete by age 5?
hand preference is established
grasps pencil like an adult
colors within the lines
cuts and pastes simple shapes
Explain drawing in preschoolers
3 - copies circles
4 - draw a stick figure
5 - draw several body parts
Stressors for preschoolers
separation from parents
super natural beings
ghosts
monsters
noises
bad people
injury
Sexuality of Preschoolers
develops behavior and personality appropriate for culture and sex
“boy shouldnt”
Play of Preschoolers
associative play
stimulates imagination, gross and fine motor skills, language, and social development
begins cooperative play
What are the two most characteristic types of play for preschoolers?
imaginative
imitative
Kohlberg - pre-conventional stage 2
preschool
rules are followed when it is within their own interest
erikson: preschoolers
initiative vs guilt
want to try everything
may wish negative things on others and then feel guilty about it
When can a preschooler say more than 2100 words?
5
When can a preschooler converse in brief 3-4 word sentences?
3-4
When can a preschooler use adverbs, adjectives, and more variety?
4-5
When can a preschooler use all parts of speech?
5
Explain the growth of school agers
weight - 4-6lbs per year
height - 2 inch per year
When does a child have all their permanent teeth?
12
General appearance of school ager
slimmer look with longer legs, increase in muscle, thinner at waist
What do vital signs look like for a school ager?
p - 70-90
RR - 16-24
BP - 112/60
When is brain growth complete?
10 years
When are children susceptible to fractures due to bone growth being faster than muscle and ligament growth?
school age
When is a child’s vision 20/20?
6-7 years
What fine motor skills can a child complete at 6?
tie shoelaces
cut and paste
print (may reverse letters)
What fine motor skills can a child complete at 7?
reads
What fine motor skills can a child complete at 8?
cursive writing
What fine motor skills can a child complete at 9?
mature writing
What motor skills can a child between 6-8 do?
ride a bicycle
run, jump, climb, hop
improved hand-eye coordination
brush and comb hair
What motor skills can a child between 8-10 do?
throw ball skillfully
both hands used independently
handles eating utensils skillfully
What motor skills can a child between 8-10 do?
enjoy all physical activity
continue to improve coordination
Stressors of school age children
super natural beings
injury
storms
dark
staying home alone
separation from parents
things on TV
failure in school
tests
being unattractive
Play in School Age Children
increased physical skill and intellectual ability from other ages
sense of belonging to a group*
need for conformity and ritual
want to be with their peers
How does play change throughout school-age years?
6 - play games
8- table games (hate to lose)
10 - competition
How does temperament of young children correlate to the temperament of school age children?
easy children - easily adapt
slow to warm up - uncomfortable in new situations
difficult - act out, may not fit in
Attitude of school-age children
insists on being first in everything
becomes peer oriented
egocentric
improved relationship with siblings
Red flags of school age children
school failure
lack of friends
social isolation
aggressive behaviors
erikson: school age
industry vs inferiority
children gain skills to help them become contributing members of their community
need a purpose
gain competence through technologic and social skills
erikson: school age
industry vs inferiority
-children gain skills to help them become contributing members of their community
-need a purpose
-gain competence through technologic and social skills
-engage in activities that require practice
-need frequent reinforcement of the “process” rather than the “product”
piaget - school age
concrete operational
-rapidly acquire cognitive skills
-much less egocentric
-makes judgements on what they think (conceptual thinking)
-life is centered on school activities and friends
-learn reversibility (consequences)
-learn classification skills
kohlberg - school age
conventional morality
-acts to gain approval
-good behavior pleases others
-respect for rules
-rarely question those in authority
parenting tips for school age
act as parents, rather than pals
consistent control and structure
instruct them not to act on every urge
prepubesence
- 2 year period that precedes puberty
- differences between boys and girls
- early appearance and secondary sex characteristics in girls rather than appearance in boys
vitals for an adolescent
p- 70
RR- 20
BP- 120/70
When do adolescents grow?
girls - fastest in early puberty
boys - fastest in mid puberty
explain weight and height gain in adolescents
girls - 5-20cm and 7-25kg
boys - 10-30cm and 7-30kg
secondary sex characteristics in adolescent males
-pubic hair developed
-menarche or penis growth
-voice changes
-underarm hair
-facial hair growth
-increased production of oil, sweat glands, and acne
-testicular enlargement occurs first
-gynecomastia may occur
-pubertal delay if no enlargement of testes by 14 or if genital growth is not complete 4 years after testes enlargement
secondary sex characteristics in adolescent females
-earliest change is commonly breast development
-development of pubic hair comes 2-6 months after
-increase in vaginal discharge
-menarche 2 years after development of breast buds
-delay considered if no breast development by 13
stressors of adolescents
inept social performance
social isolation
sexuality
drugs, war, divorce
crowds
gossip
public speaking
death
sleep during adolescence
circadian rhythm change that creates a need to stay up later at night and sleep in later during the morning
play of adolescents
peer activities
increase reading and language skills
organized recreational play
safety concerns of adolescents
motor vehicle safety
recreational athletic activities
substance abuse
firearms
sex
depression and potential suicide attempts
erikson - adolescents
identity vs role confusion
-accepting change in body
-establishing values, making career decisions
-become emancipated from parents
-integrates opinions into likes and dislikes
-once identity is established, they work on intimacy
predictors of sexual activity
-having a steady SO
-using alcohol regularly
-having permissive parents
-not being worried about ones future occupation
piaget - adolescents
formal operations
-abstract thinking develops
-can develop strategies for improving their learning
-think about how they feel and what they are thinking
-can symbolically associate thoughts with abstract concepts
-gain advanced reasoning skills
-very self-absorbed
-may not be able to come out of their egocentrism
-invincibility
-capable of seeing others’ perspectives
-learn from experiences
resiliency
ability to bounce back from adversity
-enjoy school, liked by peers, self-efficacy, wide range of coping skills, hobbies and interests, problem solve
How should you discipline your infant?
redirection, boundaries, parent’s reaction
pros and cons of a pacifier
pros - provide comfort for infants when they do not need to eat
cons - get dirty easily, difficult to take them away when they’re older, decreases breast feeding, causes dental problems
S/S of teething
swollen gums, increased finger sucking or biting, difficulty sleeping, decreased appetite, low grade fever
teething guidance for parents
avoid old wives tales
cold is soothing
anesthetic ointments should be used with caution
analgesics can be used as directed
top 10 safety hazards of infants
dishwashers, latex balloons, stoves, soft bedding, hand-me-down baby gear, grandma’s purse, bath seats and rings, baby oil/powder, family dog, power windows
how to prevent unintentional injuries in infants
-never leave an infant unattended on a surface
-crib safety
-infant seats should be on the ground
-close windows
-gates on stairs
-avoid walkers
-use sunscreen
-close up fireplace
-keep small objects away from reach
-avoid co-bedding
-avoid pillows/blankets/ large stuffed animals
-never hold an infant in your lap in the car
-keep car doors and windows locked
-keep infant seat backwards for 2 years
-avoid smoking near infant
How to avoid sibling rivalry in toddlers
-avoid unrealistic expectations
-avoid/minimize stressors
-allow them to participate
-don’t compare against each other
how to handle toddler tantrums
-consistency among caregivers
-develop expectations and awards
-reasonable consequences
-ignore*
types of toddler discipline
-distract and divert
-encourage cooperation
-provide structure
-set limits
-positive reinforcement
-no spanking
10 alternatives for spanking
-be firm but kind
-pause
-teach
-be positive
-give explanations rather than threats
-be flexible
-refuse to get angry
-drop out of power struggle
-be smart
-offer incentives
-time out
time out guidelines
-for 3 years and older
-1 minute per 1 year of age
-discuss behavior when the time is up, place them back in time-out if behavior continues
-discipline must occur at time of incident
-be discreet in front of others
readiness for toilet training
-voluntary sphincter control
-able to stay dry for 2 hours
-regular bowel movements
-skills to walk, sit, and squat
-skills to remove clothing
-willingness of parents
-inpatient with wet diapers
common injuries for toddlers
-MVC
-drowning
-burns
-poisoning
-aspiration/suffocation
-falls
-bodily damage
injury prevention for toddlers
-federally approved car seat
-supervise while outside
-keep fences and doors locked
-teach to obey traffic laws
-supervise closely around water
-toilet lid down
-fence around pools
-teach swimming and water safety
-lock up toxic agents
-administer meds and drugs, not candy
-teach them not to play in trash
-have poison control number available
-teach them name and parent’s name
-stranger danger
important parental education for toddlers
- correct sexual terminology
- learn important numbers
- assess readiness for preschool/ kindergarten
- learn how to dial 911
- learn phone number and address
how to improve school performance in school-age children
-set aside a place in the home for school
-show interest in school activities
-read
-ensure good sleep and eating
-meet with teachers
-be available to help
latchkey children
-self care before or after school
-increases risk for injury, stress, delinquency
-needs specific guidelines
parental guidelines for peer pressure
-role play
-talk about things
-consider dress code
benefits of physical activity in school-age
socialization, better self-esteem, weight control, increased physical ability
sleep problems for school-age
9.5 hours per night
may resist going to bed from 8-11
night terrors, sleep talking, enuresis
auto safety of school age
under 12? - back seat only
20-40 lbs - harness straps snug and come through back of seat
40-80lbs - belt positioning booster seat
risk factors of mortality in adolescents
poverty, neighborhood violence, parental abuse/neglect, parental divorce, using drugs or alcohol, smoking, problems with justice system, pregnancy before 18
reasons MVCs are common in adolescence
lack of experience, following too close, speeding, texting, alcohol, other teen passengers
What is the second most common cause of death in adolescence?
homicide
leading cause in African American youth
injury prevention strategies for adolescents
-life jackets
-safe driving
-promote safe sex
-don’t encourage drinking/smoking
-educate about risks, long term effects of all of the above*
warning signs of suicide risks
- behavioral changes - increased risk taking, alienation from family or friends, giving away personal items, writing letters
- cognitive and mood changes - expression of hopelessness, dramatic swings in affect, preoccupation with death, sleep disorders, difficulty concentrating, hearing voices
suicide prevention
effective coping, early recognition of depression, social problems, education, peer support systems, restriction of access to lethal means, prevent suicide clusters
prodromal period
first symptom until feeling badly
natural passive immunity
immunity until 2 mo because of mom
natural active immunity
immunity due to having the disease
artificial active immunity
vaccine
artificially put it into body
artificial passive immunity
temporary immunity by transferring immunoglobulins from one human to another who has been actively immunized against antigen
reasons parents don’t immunize
fear of side effects
medical condition
religion
inadequate knowledge
lack of resources
ineffective support for caregivers
live vaccine
a suspension of live or inactivated microorganisms or fractions of the microorganism administered to induce immunity and prevent infectious disease
ex - MMR, varicella, flu mist
killed vaccine
whole microbes that have been killed by heat or chemicals or are simply the important part of the microbe that provokes the immune system to respond
toxoid
modified bacterial toxin that has been made nontoxic but retains the ability to stimulate the formation of antitoxin
human immune sero gobulin
solution containing antibodies from large pools of human blood plasma, used in immunodeficient persons
animal antitoxins
solution of antibodies derived from the serum of animals immunized with specific antigens and used to confer passive immunity and for treatment
DTaP
diphtheria, tetanus, and pertussis
5 doses with boosters
IM injection
SE - fever, soreness, redness/swelling at site, pertussis can cause seizures
contraindications - encephalopathy within 7 days, seizures within 3 days
Tdap
adolescents aged 11-12
polio vaccine
-4 doses
-SQ
-contraindications - allergic to -mycin, polymyxin B, has a current illness
MMR
-live vaccine
-2 dose
-contraindications - pregnancy, immunodeficiency
HIB (flu B)
-killed vaccine
-4 dose
-IM
HepB
-3 dose
-IM
-contraindications - allergic to baker’s yeast
HepA
-killed vaccine
-2 dose
-IM
varicella vaccine
-live vaccine
-2 dose
-SQ
-SE - pain at site
-contraindications - immunosuppressed, pregnant, kids taking steroids
prevnar
-killed vaccine
-IM
-SE - local reaction, n/v, drowsiness
rotovirus
-3 dose
-must have when younger than 32 months
flu vaccine
recommended for 6M and older
children under 8 need 2 doses 2 weeks apart the first time they receive the vaccine
tetanus special info
need a booster every 10 years
synagsis
given to prenatal infants or those at high risk to reduce chance of RSV
meningococcal
start at 11-12, protects against menengitis
gardicil
3 dose
under 40
protects against HPV
What are some reasons that a vaccine should NOT be withheld?
-moderate to severe local reactions
-mild acute fever
-current abx
-convalescent phase of therapy
-prematurity
-recent exposure to infectious disease
-hx of non-specific allergy
When does an infant get saliva and when do they learn to control it?
get saliva at 3M
control saliva at 3-4M
What is a risk of introducing solid foods too early?
choking
developing food allergy
infant nutritional requirements
110-120 cal/kg/day
140 cc/kg/day
no solid foods until 4-6M
What is the first solid food an infant should eat?
iron fortified cereal
Should you give an infant under 6M water, cows milk, honey, or corn syrup?
NO
What is the ratio of formula to water?
1 scoop in 2 oz of water
warm bottle
throw it away after 4 hours of being warm
Signs that an infant is ready for solid food
-doubled birth weight
-drinks 8oz of formula and is hungry within 4 hours
-sits with little support and has good head control
-drinks 30-32 oz of formula each day and wants more
When are iron, vitamin C, and fluoride added into an infant’s diet?
4-6M
When can an infant start having finger foods?
6-7M
When can an infant start having chopped foods?
9-12M
What foods should you avoid during the first year of life?
nuts, strawberries, wheat, shellfish, egg whites, and citrus
What foods are choking hazards for infants?
grapes, hard candy, popcorn, hotdogs, raw mini carrots, etc
toddler nutritional requirements
102 cal/kg/day
115 cc/kg/day
increased need for vitamins and minerals
What kind of milk should a toddler have?
2-3 cups of whole milk per day
When can you introduce skim/other milk into a child’s diet?
2
What is a guideline for amount of food to age of child?
1tbsp of solid food for each year of the child’s age
nutritional requirements of preschoolers
90 cal/kg/day
1800 cal/day
100 cc/kg/day
What guideline for fruits and vegetables should a preschooler follow?
5 servings per day
What are the nutritional guidelines for a preschooler?
70 cal/kg/day
protein needs increase
boys older than 10 need 2500-3000cal
girls older than 10 need 2200 cal
nutritional needs of adolescents
40-55cal/kg/day (male)
38-47cal/kg/day (female)
females need more iron and calcium
during growth spurts - need iron, calcium, zinc, and protien
What are some labs to assess nutrition?
albumin, nitrogen balance, minerals
H&H
iron/ferritin
cholesterol
Criteria for Nutritional Referral
-markedly over/under weight
-mechanical feeding difficulties
-lack of feeding skills
-unusual food habits
-inadequate dietary intake
-nutrition crucial for medical treatment
-physical signs of deficiency
-emotional disturbances related to feeing
-high risk for compromised nutritional status
Nutritional Nursing Diagnoses
-altered nutrition: less than body requirements
-altered nutrition: more than body requirements
-ineffective feeding pattern
-knowledge deficit
-high risk for aspiration
