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Lab Values > Pediatric Growth & Development > Flashcards

Pediatric Growth & Development Flashcards

1
Q

Growth=

Development=

A

Increase in Size

Increase in Skill/Function

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2
Q

Differences Between Children and Adults

A

Meds are mg/kg

Syringes used to measure meds w/o needle

Elixirs administered side of mouth/buccal mucosa=prevent aspiration

Diet less strict
Privacy must be considered
Everything takes longer
Maximize child’s control: give choices
Hospitalization creates stress=regression common
VS ranges different

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3
Q

Why do we study G &D?

A

Better assess child physically and developmentally

Relate appropriately

Offer appropriate toys and verbal responses

Teach parents and child

Plan Interventions

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4
Q

Two Patterns of Growth?

A

Cephalocaudal

Proximodistal

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5
Q

Active Immunity:
Natural? ——. Artificial?

A

Natural= occurs with infection
Provides Lifelong immunity

Artificial=occurs w/vaccination
Takes time to activate
Provides lifelong immunity
Titers drawn

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6
Q

Vaccination Commonalities?

A

Contraindicated with:
febrile illness (not a cold)
Steroids
Radiation
Chemotherapy

DPT: fever, redness at site is
expected

RN teaches: Herd Immunity

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7
Q

Passive Immunity:
Natural? ———— Artificial?

A

Natural=transplacental or by
breastfeeding
Temporary
Determines timing of

Artificial=used in a fatal disease, antibodies produced in another source(serum).
Instant response.
Temporary.

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8
Q

Immunization

A

Federal Legislation requires consent for all vaccines

Legislation protects children from severe vaccine reactions

Adverse reactions are reportable

RN responsibility= store,explain, teach, obtain consent, administer vaccine, document appropriately, teach herd immunity.

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9
Q

Infant Reflexes?

A

Sucking
Startle/Moro
Babinski
Rooting
Grasp

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10
Q

When do Fontanels close?

A

Anterior=@18 months
Posterior=@2 months

Allows growth of brain

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11
Q

Head Circumference
Head > Chest
After 1 year Chest > Head

A

Measured until age 3
Head > Chest
After 1 year Chest > Head

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12
Q

Birth to 4 months Milestones
Rapid physical growth
Smiles and coos
Vigorously moves arms&legs
Rolls back to side
Interest in surroundings
Drooling begins

A
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13
Q

5 —. 6 months Milestones

A

Rolls over and to back
Sits w/support
Grasps small objects
Objects to mouth
Signs of teething/teeth
Crawls backward, creeps

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14
Q

7— 9 months Milestones

A

Well crawling
Stands holding on
Sits w/o support
Fear of Strangers
Starts to Shows signs of separation anxiety

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15
Q

10—-12 months Milestones

A

Begins to lift feet and cruise while standing and holding on

Progresses to walking holding one hand

Pincer grasp
Puts object into another container

Speaks and understands single words

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16
Q

Infant Accident Prevention

A

Falls
Aspiration
Suffocation/Drowning
Safety
Motor Vehicles

Accidents= leading cause of death in infants and children

Safety First!!!

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17
Q

Infant/Toddler Car seat?

A

Rear facing
Until reach max height&weight
allowed on that car seat approximately 2-4yrs old

Five Point Restraint
2@shoulder
2@groin
release w/one buckle at
the crotch

Must have a Tether=to prevent shifting of seat

18
Q

Toddlers/Pre-School Car seat?

A

Forward facing
65 lbs. or more

19
Q

School age Car seat

A

Booster seat

20
Q

Children car seat?

A

Seatbelt 8-12 years old
Up to 4’9” tall

21
Q

Amount Infant Fluid Needs ?

A

1st 10kg= 100ml/kg/day
10-20kg= 1000+50ml/kg/day
20-30kg= 1500+25ml/kg/day

Fluid Need Increased by:
Acute infection
Increased Temperature
Vomiting/Diarrhea
Anything that raises metabolic rate

22
Q

Infant Nutrition

A

Iron supplements given to breastfed infants
Weight gain rapidly
Height= first 6mos 1”monthly
6-12mos 1/2” monthly

Solid Food introduced at 6months/fortified cereal, need for iron
Bottle Weaning
Teeth- 6 teeth by 1 yr old concerned w/milk pools
results with caries

Introduce new food every 4-7days to see if tolerating and can recognize if any allergies
No cow milk till after 1 yr old=no iron at all, can become anemic, risk for intestinal bleeding because can’t digest

Most formulas=iron fortified

No free water: kidneys not mature

23
Q

Infant Weight

A

Doubles birthweight at 6 months

Triples at 12 months

First 6 months= 5-7 oz/wk
6-12 months= 3-5 oz/wk

24
Q

Infant Height?

A

First 6 months= 1” monthly
6-12 months= 1/2” monthly
Genetics plays a role

25
Q

Failure to Thrive

A

Growth has decelerated or arrested
Height and Weigh fall under 3rd or 5th percentile
Downward change in growth associated w/abnormal G&D
Reasons=
Not enough calories given
Poverty
Neglect
Social Determinants of health
Picky Eater
Digestive problems V/D
Metabolic disorders
Infection
Food Intolerances

Pediatric Growth Chart=
Looking for trends
Don’t want to see bid peaks nor big declines

26
Q

Infant Food Introduction

A

5–6 months=add fortified cereal. Iron stores only last 5-6 months

7 months=add veggies
8 months=add fruit
9 months=add meat
10 months=egg yolk

Eggs=whites not introduced till 1 year old
a lot of children are allergic to
or have a reaction

Honey=not introduced till 1 year old.
has bacteria which can lead to botulism.

Breast feeding Best for immunity and digestion

HIV mothers discouraged to breast feed=May infect baby

27
Q

Infant Nutrition Concerns

A

Bottle Weaning =6 months
Night Bottle=Caries=pooling
Aspiration=Propped bottles
Obesity
Preventing Dehydration

Never free water because:
Undeveloped kidneys
Nutrient loss
Risk for Water Intoxication

28
Q

Common Infant Health Problems

A

Congenital anomalies=heart defect, cleft palate

Feeding Difficulty=colic, spitting up

Respiratory Illness=RSV

Ear Infections= otitis media which is inflammation of middle ear. Lasts about 3wks. Chronic if more than 3 months.
Caused by strep or hemophilia influenza.
Signs=irritable, restless, loss of appetite, pulling on ear, roll head side to side
TX=antibiotics, Tylenol for pain,
protect ears from water.
If chronic check ears for hearing loss

29
Q

Considerations for Hospitalization Infant & Toddler

A

React to change in familiar routines and surroundings
Change in eating and sleeping habits
Pain
Mobility

Separation anxiety begins 6-8months

Stranger anxiety, May cry when approached, need consistency in caregivers

30
Q

Toddlerhood 1-3years

A

Autonomy v Shame & Doubt
On the go- busy
Time of independence
Inquisitive and curious
Learns to do things for self
Vocabulary 300+ words
Needs security of rules=sense of security
Negativism “No” to everything
Allow child to make simple, safe decisions: learning to feed, dress&undress
themselves

Feed themselves, finger foods,food fads, ritualistic

Physiological Anorexia=growth begins to slow down. Need for food isn’t as much

Foods to Avoid= choke
nuts, popcorn, hotdogs, carrots, raisins, anything they can potentially choke or aspirate.

31
Q

Toddlers

A

Independent ambulation by13m
Increased manual dexterity = fine motor skills
Large increase in language skills=chatty
Encourage communication&
speech
Begins toilet training:2-3yrs/nighttime a bit later➡️where they are at neurologically
Rituals
Severe separation anxiety
Temper tantrums=trying to be independent
Initial Dental Visit

32
Q

Toddler Accidents

A

Unintentional injury is leading cause of death
Increased mobility&curious nature can be dangerous.
Falls, choking, poisoning, drowning, safeproof the environment, simple explanations, safe equipment, burns.
Child is more mobile➡️fall➡️fracture
Nothing replaces Constant supervision❗️
Accidents🟰not lack of supervision➡️laps of supervision

33
Q

Toddler Play

A

Parallel Play=alongside each other not together
Push pull toys, puzzle, book, toy phone, musical toys

Therapeutic Play: deals w/concerns and fears. Primary function helps them work out their feelings

34
Q

Stages of Separation

A

Protest
Cries, screams, Carrie’s on inconsolable,uncontrollable. Wants parent to stay. Will do anything to make them stay. Withdrawal from other adults. Clings to parents.

Despair
Withdrawn, represses, child looks sad, lonely, isolated.
Not interested in play or food.
Cries when sees parents
May mistakenly be thought to be “setting in”
Compliant behavior

Denial Detachment
Appears not to care when parent returns. Behavior is result of resignation, not a sign of contentment.
Lack of protest when parents leave
Appears happy & contented w/everyone- more interested in surroundings
Has lost trust in parents
Prefers nurse to parents

35
Q

Toddler Body Integrity Fears

A

Loss of mobility/rituals/routine
Fears loss of independence and/or autonomy
Communication regression
They take comfort in toys from home

Want to gain/develop nurse trust relationship
Never lie to child
Get down to eye level
Have constant for the child

36
Q

Pre-Schooler
3–5 years

A

Initiative v Guilt
Associative Play= play together
Separation Anxiety=generally less than toddler
Less direct w/protests;cries quietly
May be uncooperative
Fear of injury
Fear Loss of control
Guilt and Shame
Afraid of the dark
Developing conscious=right from wrong
Very Inquisitive
Evaluate own behavior at this age
Problem solve@this age

Weight Gain=5lbs/year
Height=typically increases proportionately

Booster seat

37
Q

Pre-schooler Play

A

Clay, building blocks, dress up clothes, paint, play houses, dolls, scooter, coloring books, puppets

Therapeutic: let them handle equipment before using on child
Use drawings to role play
Use a teddy bear

38
Q

Pre- school Hospitalization Issues

A

Fear of unfamiliar environment/procedures/

Fear of abandonment &punishment:believes illness is due to patient’s bad behavior;reassure not being punished

fear related to body integrity:believes equipment and surgery are hostile invasions designed to destroy his body. Use stuffed animals to role play

Difficulty understanding how body parts are fixed:castration, mutilation fears

Separation anxiety: less than toddler but still concern;parents are security

Regression: May want more attention/held more

5lbs/year, height accordingly increases

39
Q

School Age 6–12 years old

A

Industry v Inferiority
Susceptible to communicable disease
Mostly play w/same sex
Best friends
Reward System
Want to be part of a team
Calorie need decreased
5-7 lbs a year
Grows about 2” year
Important to prevent spread of infection
Chicken pox, slapped fist, roseola(runny nose/fever/nothing specific the rash on trunk=form of herpes virus), rheumatic fever=inflammatory disease affecting heart, N.S., subcutaneous tissue from strep throat infection. Requires steroids, aspirin, antibiotics, family teaching

40
Q

School Age Child

A

Separation: less than toddler;May have already experienced when starting school
Fear of injury and pain
Like being involved and wants to make choices
Peer group increasingly important =stress, bullying, dishonest behavior, fears

Toys=board games, video games, crafts, love to collect things

Safety=learn to ride bike teach about helmets, street crossings, drowning, safety with sports, swimming lessons

41
Q

School Age Hospitalization Issues

A

Intellect is growing: needs more specific explanations;can understand more concepts

Loss of control:allow for choices;participation

Fears physical nature of illness: being disabled, permanent injury. Will I be ok?

Fears death by 9:reassure

Loss of privacy and modesty: self conscious about body image. “Forgot to save specimen”. Specimen collections are gross.

Fear of being displaced:not at home or school so will not be thought about,forgotten

Regression: tends to act with bravado then cries when alone

42
Q

Adolescent
12–18 years

A

Identity v Role Confusion
Begins w/onset of puberty
Separation from from friends rather than family more important
Fear of altered appearance
Will act as though not afraid when they really are
Give them some control to avoid a power struggle
May be self absorbed
Sudden mood swings
Fear of altered appearance
Acts as not afraid but are
Abstract thinking
Believe invulnerable- take risks
Conflicts with parents= dependence vs independence
Think they are invulnerable- take risks
Mia, homocides, suicides, STD’s, pregnancy, substance abuse, constantly concerned about appearance, crash diets, eating disorders

Nutritional:peakduring years of maximum growth, appetite increases, many love junk food, increased need for iron, calcium, and zinc for development of skeletal, muscle tissue and sexual maturation

Lab Values (2 decks)

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