Pedi Exam 1 Flashcards
Trust v.s. Mistrust
Virtue: hope & Optimism
0-18 months
Trust and faith in environment and with caregivers
Autonomy Vs. Shame & Doubt
Virtue: Will use freedom & Self Restraint
18 months- 3 Years
Independence (from parents) & control over behavior & Skills= Autonomy
Initiative Vs. Guilt
Virtue: Purpose, ability to start activities & Goals
3-6 Years old
Initiative +Assertive= Sense of purpose
Industry Vs. Inferiority
Virtue: Competence in intellectual, social, & Physical skills
6-12 Years old
Feeling competent with social and academic demands
Identity Vs. Isolation
Virtue: Fidelity, fitting into the world as own person
12-18 Years old
Sense of self & personal Identity- staying true to yourself
Intimacy Vs. Isolation
Virtue: Love, finding & Losing self in others and career
29-40 Years old
Strong relationships (Intimate & Loving)
Generatively Vs. Stagnation
Virtue: care guidance and teaching a new generation
40-65 Years old
Feeling of accomplishment and usefulness in family and society
Integrity Vs. Dispair
Virtue: Wisdom fulfillment & Satisfaction
65+
Wisdom & fulfillment while reflecting on life
Reflection on life
“Receive a gift”
65+ Integrity vs. Dispair
Provide value to household/ society
“Give A gift”
40-65
Generatively Vs. Stagnation
Love partners & friends
19-40 Intimacy Vs. Isolation
Socializing and fit into peer groups
12-18 Identity vs. Role confusion
Good with neighbors, classmates, and friend’s
6-12 Industry vs. inferiority
Powerful within family & exploring
3-6 Initative Vs. Guilt
Independent from parents
18 months- 3
Autonomy Vs. Shame and doubt
Safety with mother / caregiver
0-18 months
Trust vs. mistrust
Erikson
8 stages of Psychosocial development
Piaget
Theory of Cognitive development
Sensorimotor
0-2- Infant & Toddler
Thinks in the present moment through the senses
-Not past or future
Object permanence: objects are still there even if you cant see it
-Peekaboo
Teaching: what you are doing while you are doing it
Preoperational Thing
3-6 Preschool
Imaginative, symbolic thought
-Magical thinking
-Do not Understand cause & effect
-Scraped knee was caused by earlier misbehavior
-Understands the future & past
Teaching: shortly before- the day of, the morning of, a few hours before
Concrete Operational
7-11 Skill Learning
Logical thought, follows rules, rigid thinking
-Only 1 way to do something
-Limited abstract thoughts
Teaching: teach days before including skills like: insulin injections
Tomorrow we will, you will do this every day
Formal Operational
12-15 Adolescents- adults learning
developing abstract thought
cause & effect thinking
love, hate, morality
Teaching: like an adult
Med Surge style 12 yrs+can manage their own care
-Report these findings
- if you see this follow up with
Foley catheter insertion for an 18 month old child- how is teaching approached for the patient?
Teach what you are doing as you are doing it.
-Sensorimotor 0-2 years old
Foley Catheter insertion for a 4 year old child- How is teaching approached for the patient?
Teach the child what you are going to do
-Preoperational thinking 3-6 years old
Which child can the nurse teach bandage placement skills?
7 and up
7-11 Concrete Operational
Which child can manage their own care?
14 and up
Adolescents- Formal operational
risk taking behavior= non compliance
Gross motor skills
those which require whole body movement and which involve the large (core stabilising) muscles of the body to perform everyday functions, such as standing and walking, running and jumping, and sitting upright at the table.
Fine Motor Skills
the ability to make movements using the small muscles in our hands and wrists. People use fine motor skills to do many school- and work-related tasks.
0-1 month old gross motor skills
Head lag- poor head control
2-3 months old gross motor skills
-Kicks both legs
-Raises head when prone- less head lag
4-5 Months old gross motor skills
- No more head lag: REPORT IF HEAD LAG IS NOTED
*5 Month roll front to back
6-9 Months Old Gross Motor Skills
-Rolls Back to front
-Sit up unsupported
-Can pull up to standing
Birth weight is doubled by what age
6 months old
10-12 months old Gross Motor Skills
Prone to sitting position
12 months old Gross motor skills
-Sits from standing
-crawls up stairs
-Walks first steps while holding hands
when should birth weight be tripled?
12 months old
18 Months old Gross Motor Skills
-Walking up/down stairs while holding a hand
-throwing a ball
-Jump in place with both feet
2 years gross motor skills
-walks without help
-Runs & kicks ball
-Walks up and down stairs independently 1 step at a time
3 years gross motor skills
-Tricycle
-Jumps forward
-Learning balance
-Walks up stairs with alternating feet
4 years old gross motor skills
-Skips
-Hops on one foot
-catches a ball 50% of the time
-Climbs & Jumps
6-12 years old thinking
Uses logic
12-18 years old thinking
Abstract thinking
1 month old fine motor skills
-Grasp reflex- 0-3 months
-Babinski reflex- 0-12 months
-Rooting Reflex- 0-4 months
-Tonic- neck reflex 0-4 months
-Maro Reflex- Startle reflex- 0-4
2-3 months Fine motor skills
Grasp reflex diminishes
4-5 months fine motor skills
-Grabs objects voluntarily (rattle)
-Diminished maro reflex (Startle reflex) , rooting, tonic neck, grasp
6-9 months fine motor skills
-6 months holds a big bottle
-7 months- transfers objects from 1 hand to the other
10-12 Months fine motor skills
- 10 months start picking up small finger foods- pincer grasp
-Grasp a rattle or doll by the arm
-Transfer objects from hand to hand
12 months fine motor skills
-Fully developed 2 finger pincer grasp
-tries to build 2 block towers- unsuccessfully
-Attempts to turn book pages
-Babinski diminished
18 months fine motor skills
-Turns 2 pages in a book- uncoordinated
-Holds Cup and spoon
-Builds 4 block towers
-Uses Fat crayons
2 years old fine motor skills
-Builds a tower with 7 blocks
-Turns 1 page at a time in a book
-Draws vertical lines
-Open doors by turning knobs
3 years old fine motor skills
-Draws circles
-Spoon feeds self
-Undresses self
-Holds crayon with fingers instead of fist
-Uses scissors
-Zips up zippers
4 year old fine motor skills
-Draws 4 sided shapes
-Can pour drinks & make food
1 month old language
-Responds to touch & voices
-Sensory motor communication
-Nonverbal communication
2-3 months old language
-Responds to touch and voices
-Able to make sounds with mouth
4-5 months old language
-Mimics sounds heard
-Able to change cry tone to different needs
6-9 Months old language
-Babbling words- MAMA/DADA
NOT BABBLING- by 9 months REPORT TO HCP
-Responds to name
10-12 Months old Language
-Able to make a variety of sounds
-Minims gestures
-Understands simple words- yes/ no
-Says Mama/ dada with meaning
12 months old language
-3-5 words
-nonverbal gestures (waving, head nodding)
18 months old Language
10+ words
-Follows commands
“do not touch that”
-Uses gestures to show what they want
2 years old language
-Says own name
-300+ words
-2-3 word sentences
-Identifies pictures with names
3 Years old language
-3/4 word sentences
-asks why a lot
-knows age
-follows more complex instructions
4 years old language
-able to tell stories
-can memorize the alphabet and numbers
Social/ cognitive skills of 1 month old
-Finds safety with caregiver and looks at face
Social/ cognitive skills of 2-3 months old
-Smiles and coos when seeing a familiar face
Social/ cognitive skills of 4-5 month old
-Soothed by caregivers voice
-Copies expressions
-Cries when doesn’t get their way
Social/ cognitive skills of 6-9 months old
-Identifies faces and strangers
Separation anxiety
Social/ cognitive skills of 10-12 Months old
Vocalization and speech
(talking toys and blocks
-Purposeful play
building, sorting, stacking
Social/ cognitive skills of 12 months old
shy: stranger danger
-Can follow short simple directions
-Searches for hidden objects
-Object permanence
Social/ cognitive skills of18 months old
-Angry Baby: temper and ownership
“mine”
-Parallel play 1-3 years old
Social/ cognitive skills of 2 year old
-Toilet training
-Toddlers by age
-Two years old
-Gains independence
Social/ cognitive skills of 3 year old
-Associative play 3-6 years
-Unorganized play without goals or rules
-Imaginary frients & symbolic play
-No coipition
Social/ cognitive skills of 4 year old
-Imaginary play: dress up & tea party
-Plays with other children rather than alone
Traditional Nuclear Family
Married couple and their biological children
-Only full brothers and sisters
Nuclear Family
Two parents and their children
-Biologic, adoptive, step, foster
Blended family/ reconstituted
at least one stepparent, sibling, or half sibling
Extended family
at-least one parent, one or more children, and other individuals
-might not be related
Gay-Lesbian Family
two members of the same sex who have children and a legal or common-law tie
Foster Family
a child or children who have been placed in an approved living environment away from the family of origin
- Usually with one or two parents
Binuclear family
parents who have terminated spousal roles but continue their parenting roles
Communal family
individuals who share common ownership of property and goods and exchange services without monetary consideration
Dictatorial/ Authoritarian Parenting
parents try to control the child’s behaviors and attitudes through unquestioned rules and expectations
Permissive Parenting
Parents exert little or no control over the child’s behaviors, and consult the child when making decisions
democratic/ Authoritative Parenting
parents direct the child’s behavior by setting rules and explaining the reason for each rule setting
-Parents negatively reinforce deviations from the rules
Passive parenting
Parents are uninvolved, indifferent and emotionally removed
The child assists with deciding whether they will watch TV
Permissive Parenting
The child may watch TV whenever they want
Passive parenting
The child is never allowed to watch TV on school nights
Dictatorial or authoritarian parenting
The privilege is taken away but later reinstated based on new guidelines
Democratic/ authoritative parenting
the child can watch tv for 1 hour on school nights after completing all homework and chores
Democratic/ authoritative parenting
My child knows that he better do what I say
Authoritarian parenting
When does the posterior fontanel close
8 weeks of age
When does the anterior fontanel close
12-18 months
Infant expected BP
65-78/ 41-52
1 Year Expected BP
80-114/ 34-67
3Year Expected BP
86-120/ 44-76
6 Year Expected BP
91/125/ 53-84
10 Year Expected BP
97-130/ 58-90
16Year Expected BP
108-145/ 63-94
How many teeth should an infant have by 1 year of age
6-8 teeth
How many permanent teeth are there
32
How many deciduous teeth are there
20
Sucking and rooting reflex
0-4 months
-Elicited by stroking an infant’s cheek or the edge of an infant’s mouth
-The infant turns head toward the side that is touched and starts to suck
Palmar Grasp
-0-4 months
-Elicited by placing an object in an infant’s palm
the infant grasps the object
Plantar Grasp
-0-8 months
-Elicited by touching the sole of an infants foot
-The infant’s toes curl downward
Maro Reflex
-0-6 months
-Startle reflex
-elicited by allowing the head and trunk of an infant in a semi-sitting position to fall backwards to an angle of at least 30 degrees
- the infant’s arms and legs symmetrically extend then abduct while the fingers spread to form a c shape
Tonic neck teflexion
-Fencer position
-0- 3/4 months
-Elicited by turning an infants head to one side
-the infant extends the arm and leg on that side and flexes the arm and leg on the opposite side
Babinski Reflex
-0-12 months
-Elicited by stroking the outer edge of the sole of an infants foot up toward the toes
- The infant’s toes fan upward and out
Stepping
0- 4 weeks
-Elicited by stroking the outer edge of the sole of an infant’s foot up toward the toes
-The infant makes stepping movements
What is the average head circumference fr a newborn
33- 35 cm/ 13-14 inches
What is the average crown to rump length of a newborn
31-35 cm/ 12.5-14 in.
Approximately equal to head circumference
What is the average newborn length
48053 cm./ 19-21 in.
What is the average weight of a newborn
2700-4000 g/ 6-9 lbs
How much weight does a newborn loose after birth? When does the baby regain enough weight to reach their birth weight?
-Newborn will lose up to 10% of their birth weight by 3-4 days of age.
-Birth weight is usually regained by the 10-14 day of life depending on the feeding method used.
When does the posterior fontanel close?
by 2-3 months of age
when does the anterior fontanel close?
by 12-18 months of age
What is the average weight gain of a new born?
-680 g / 1.5 lb / month for the first 5 months
-Birth weight should be doubled by 6 months
-Birth weight should be tripled by 1 year
What is the average height growth of a newborn.
-2.5 cm. / 1in. per month
for the first 6 months
-Growth occurs in spurts after the age of 6 months
-Birth length doubles by 12 months.
What is the average head circumference growth of a newborn?
-Approximately 2 cm. (.75 in.) per month during the first 3 months.
-1 cm. (0.4 in.) per month from 4-6
-Approx. 0.5 cm (0.2 in) per month during the second 6 months
How many teeth should a child have by age 12 months?
6-8 teeth
When does a Childs first teeth typically erupt
between 6-10 months
average age 10 months
What indications occur to indicate teething?
-Sometimes minimal
-sucking/ biting on their fingers/ hand/ objects
-Drooling
-Irritable
-Difficulty sleeping
-Mild fever
-Rub their ears
-Decreased appetite for solid foods
What can be done to ease teething pain?
-frozen teething rings/ ice cube wrapped in a wash cloth
-OTC teething gels
-Acetaminophen and/ or ibuprofen
What considerations should be taken when giving acetaminophen/ IBU for teething pain
-Can alternate them every 3 hr.
-should not be used for more than 3 days
-infants should be older than 6 month before taking IBU
Piaget’s theory suggests that infants experience what cognitive development from birth- 24 months?
Infants progress from
- reflexive to
- simple repetitive to
- imitative activities
What are the three important task accomplished in Piaget’s Sensorimotor stage
-0- 24 months
-Separation
-Object permanence
-Mental representation
What is separation as described by Piaget?
Infants learn to separate themselves from other objects in the environment.
What is object permanence as described by Piaget? When does it occur?
The process by which infants learn that an object still exists when it is out of view.
-Occurs approximately 9-10 months
What is Mental representation as described by Piaget?
The ability to recognize and use symbols
How much does an infant cry?
1-1.5 hr.
Until 3 weeks of age
How much does an infant cry from 3- 6 weeks?
they build up to 2-4 hrs
When does an infant decrease in crying?
By 12 weeks
When does cooing noises begin?
By 3-4 Months
When does an infant show considerable interest in the environment
by 3 months
when does an infant laugh and squeal?
4 months
When does an infant comprehend the word no?
by 9-10 months and obeys single commands accompanied by gestures
What is erikson’s theory on infants 0-12 months
trust vs. mistrust
What is achieved in erikson’s trust vs. mistrust
-It is based on the quality of the caregiver- infant relationship and the care received by the infant.
What does an infant learn during trust/ mistrust
Delayed Gratification
How is trust developed
by meeting comfort, feeding, stimulation and caring Needs
How is mistrust developed?
If needs are inadequately or inconsistently met, or if needs are continuously met before being vocalized by the infant
When does separation anxiety begin in an infant
4-8 months
Infants will protest when separated from parents
When does infants become able to anticipate the mothers imminent departure
12 months
When does stranger fear become evident
between 6-8 months
when infants hae the ability to discriminate between familiar and unfamiliar people
Reactive attachment disorder
results from maladaptive or absent attachment between the infant and primary caregiver and continues through childhood and adulthood.
What are age appropriate activities for an infant?
interpersonal contact and educational stimulation
-rattles, soft stuffed toys, teething toys, nesting toys, playing pat-a-cake, playing ball, reading books, mirrors, brightly colored toys, playing with blocks
Carseat rules for infants
–45 degree angle to prevent slumping and airway obstruction
-Rear facing
-Shoulder harnesses placed in the slots at or below the level of the infants shoulders
-Retainer clip placed at the level of the infants armpit.
When should an infant return for a check up post discharge?
within 72 hrs. especially important for breastfed newborns to evaluate weight and hydration status
What immunizations are given at birth
Hep B
What immunizations are given at 2 months
DTaP, RV, IPV, Hib, PCV, Hep B
What Immunizations are given at 4 months
DTap, RV, IPV,Hib, PCV
What Immunizations are given at 6 months
DTap, RV,PCV,RV,Hib
HepB & IPV 6-18 months
What immunizations are given between 6-12 months
a seasonal influenza
Breast-feeding nutrition recommendations
-provides complete diet for first 6 months
-Vitamin D supplements recommended to be started within first few days of life to prevent rickets and vit. D deficiency
-Iron supplements are recommended fr infants exclusively breastfeeding after age 4 months
When should fruit juice be introduced?
after 6 months
When should solids be introduced
around 6 months
How should foods be introduced?
One at a time over a 5-7 day period to observe for manifestations of allergy intolerance
-which include fussiness, rash, vomiting, diarrhea, and constipation
What foods should be started first?
fruits & veggie between 6-8 months after bth have been introduced meats may be added
When are table foods appropriate
by age 1 cooked well, chopped, and unseasoned
When are nocturnal sleep patterns established
By 3-4 months
How many hours do infants sleep
Daily- 14-15 hrs
Night- 9-11 at the age of 4 months
How much sleep does an infant have by the age of 12 months
through the night and one to two Naps through the day
How to avoid aspiration of foreign objects
-hold the infant for feedings/ do not prop bottles
-Avoid small objects
-Clothing should be checked for safety hazards
How to avoid bodily harm for infants
-Keep sharp objects out of reach
-Anchor heavy objects
-Don’t leave infants unattended with any animals present
What temperature should the hot water heater be sat at?
120 degrees farenheight
How long should infants remain in a rear facing carseat?
2 years or the height recommended by the manufacture
What are the requirements on crib slats
should be no further apart than 6 cm.
When should crib mobiles and crib gyms be removed?
4-5 months of age
What physical development occurs between the ages of 1-3
-anterior fontanels close by 18 months
-Weight: by 30 months toddlers should weigh four times BW
-Height: toddlers grow about 3 in per year
-Head Circumference: usually equal to chest circumference by 1-2 years of age.
preoperational stage
around 2 years of age
What occurs during the preoperational stage?
-Object performance becomes fully developed
-Toddlers have memories of events that relate to them
-Mimicry (playing house) is evident
-Dont understand others viewpoints
Erikson psychosocial development for toddlers
autonomy verses shame and doubt
