Growth & Development ~ NUR120

Erikson’s stages: stage 1

1. Infancy (0-1): trust vs mistrust

• good outcome: trust in nurse —> good care

Erikson’s stages: stage 2

2. Toddler (1-3): autonomy vs shame & doubt

• good outcome: independence from parents

• bad outcome: depending on someone else

Erikson’s stages: stage 3

3. Preschool (3-6): initiative vs guilt

• imaginative thinking

• bad outcome: “I’m horrible at this”

Erikson’s stages: stage 4

4. School age (6-12): industry vs inferiority

• all about friends

• bad outcome: fomo

• good outcome: feeling confident & successful

Erikson’s stages: stage 5

5. Adolescence (12-18)

• identity vs role confusion

• figuring out where you fit in

• understand cause & effect

factors that affect child’s reaction

• developmental stage (age & understanding)

• temperament (easy vs difficult)

• support system (family presence)

• past experiences (previous illness/hospital stays)

regression

returning to earlier behaviors due to child being stressed & overwhelmed

• ex: bedwetting, thumb sucking, clinginess

separation anxiety

fear of being away from parents/caregivers

• toddlers at biggest risk

• when doing assessment —> work around parents (let child sit on parent’s lap)

phases of separation anxiety

1. protest (crying, screaming, resisting others)

2. despair (withdrawal, sadness, decreased activity)

3. detachment (appears “okay” but emotionally distant)

infant reactions

basic needs matter most

• infants rely on:

  • sleep

  • feeding

  • comfort/relaxation

  • gentle touch & communication

• strong caregiver - infant bond is very important

• separation awareness (5-6 months)

toddler reactions

• want independence

• remembers scary events

• regression can happen

preschooler reactions

• limited understanding

• magical thinking

• learn by doing (curious, learn best by seeing & touching)

school-age reactions

• better understanding

• want to keep learning

• less separation anxiety, more “will my friends forget me”

• emotional needs

adolescent reactions

• concerned about injury, pain, being physically different than friends

• may or may not express fear

• like to feel in control

• do not like invasion of privacy

failure to thrive

inadequate growth of infants & children w/ unmet nutritional needs

• child fails to gain appropriate weight over prolonged period of time = FIRST SIGN

• length & head circumference may be affected

• more common in special needs children

causes of failure to thrive

• developmental delays

• malabsorption & GERD

• cardiac/lung disease

• cleft palate

• abuse & neglect

• parental feeding knowledge deficit

nursing assessments/interventions for failure to thrive

• screen early

• watch for signs

  • refuses nipple, spoon, food

  • trouble sucking

• ask about diet

• observe child + caregiver interaction

• watch feeding

• weigh child daily & measure I&O

• educate + provide emotional support

what is a febrile seizure & treatment

a seizure caused by fever

• prevent increased temperature with Tylenol

  • no aspirin because risk of Ryes syndrome

• take layers off (should just be in diaper)

• ice packs

• cool wash cloth

• tepid bath

cerebral palsy

not a medical diagnosis: combo of s/s caused by brain bleed, damaged motor areas of brain

• non-progressive

• affects controls of muscles & movement

• most common movement disorder in children

• could happen before, during, or after birth

• Dx: CT, MRI

• nursing interventions for children: maintain quality of life & keep them moving

types of CP

spastic: stiff, tight muscles —> treat with baclofin

athetoid: uncontrolled, twisting movements

ataxic: poor balance & coordination

mixed: combination of types

signs & symptoms of CP

• delayed developmental milestones

• abnormal muscle tone

• abnormal movements/postures

• speech difficulties

• vision problems

• learning difficulties

• walking on toes

possible complications for CP

• intellectual (mental) impairment

• seizures

• vision problems

• hearing problems

• sensory/perception issues

nursing assessment for CP

health hx: risk factors, seizure hx, feeding problems as a baby, delayed milestones, learning difficulties

physical exam: abnormal movements/posture, poor crawling/walking pattern, toe-walking, SGA, vision or speech problems, ROM, eye misalignment (strabismus)

diagnostic tests for CP

• MRI or CT

• cranial ultrasound

• EEG

esotropia

eye turns inward

exotropia

eye turns outward

hypertropia

eye turns upward

hypotropia

eye turns downward

pharmacological management for spasticity

• baclofen

• dantrolene sodium

• diazepam

• botulin toxin

pharmacological management for athetoid

scopolamine

pharmacological management for seizure control

• phenytoin

• valproic acid

• levetiracetam

pharmacological management for uncontrolled body movements (nonspastic)

• carbidopa levodopa

• benztropine

nursing goals for CP

• promote mobility & nutrition

• preventative education (vaccination, good maternal health, early prenatal care, good child safety