Week 13: Assisting in Pediatrics

Erikson’s stages of psychosocial development

• 8 stages

• guidelines for identifying psychosocial challenges

• can have a positive or negative outcome for personality development

Ages Birth - 18 months (Trust vs. Mistrust)

• Trust - successful outcome

• Mistrust - unsuccessful outcome (needs not met)

  • become suspicious, struggle with interpersonal relationships

• Form attachments to mother

  • in turn forms attachments to others (trust)

• Fine motor skills are learned

Ages 2-3 years (Autonomy vs. Shame and Doubt)

• Autonomy - successful outcome

  • develop sense of independence and self control (run, throw ball, scribble with crayons)

  • acquire language skills

• Shame and doubt - unsuccessful outcome (needs not met)

  • lack of self-confidence

  • no sense of pride in ability to perform tasks

Ages 3-6 years (Initiative vs. Guilt)

• Initiative - successful outcome

  • look for new experiences

  • active imagination, trying new things

  • make friends

  • results in assertiveness, dependability, creativity

• Guilt - unsuccessful outcome (needs not met)

  • parents restrict from trying new things

  • feelings of inadequacy, defeat, guilt

Ages 7-12 years (Industry vs. Inferiority)

• Industry - successful outcome

  • need to receive recognition for accomplishments

  • results in competence, self-satisfaction, trustworthiness

• Inferiority - unsuccessful outcome (needs not met)

  • no recognition

  • feelings of inadequacy, inability to compromise or cooperate with others

Ages 12-20 years (Identity vs. Role confusion)

• Identity - successful outcome

  • trying to figure out where they fit in

  • results in emotional stability, forming committed relationship, sound decision making

• Role confusion - unsuccessful outcome (needs not met)

  • not fitting in with groups

  • lack of personal goals, self-consciousness, lack of self-confidence

Ages 20-35 years (Intimacy vs. Isolation)

• Intimacy - successful outcome

  • begin to think about partnerships, marriage, family, and career

  • results in mutual self-respect, love, intimacy, commitment to others, and a career

• Isolation - unsuccessful outcome (needs not met)

  • leads to social isolation, job changes, lack of productivity, inability to form long-term, intimate relationships

Ages 35-65 years (Generativity vs. Stagnation)

• Generativity - successful outcome

  • adults raise children, become grandparents

  • help to mold future generation by teaching, coaching

  • results in professional and personal achievements, serving the community and society

• Stagnation - unsuccessful outcome (needs not met)

  • leads no capacity to give and share with others

Ages 65 years and older (Ego integrity vs. Despair)

• Ego integrity - successful outcome

  • adults retire, children no longer live close

  • volunteer to retain feeling of usefulness

  • loved ones die, health changes

  • understanding of changes results in wisdom, self-acceptance, sense of worth

• Despair - unsuccessful outcome (needs not met)

  • leads to dissatisfaction with life, depression, anger, inability to accept death

Infant and pediatric physical exam:

• height (length)

• weight

• head and chest circumference (up to 36 months)

• temperature, pulse

• ear exams

• blood pressure (over age 3)

• review family health history, existing conditions, current health concerns

• observe child for any abnormalities that may indicate an underlying health concern

Well Child Examination

• Infants - 7

  • 2 weeks

  • 1 month

  • 2 months

  • 4 months

  • 6 months

  • 9 months

  • 1 year

• Children - second and third year

  • 15 and 18 months

  • 24 and 30 months

  • annually after 3 years old

Temperature vitals

• use tympanic, temporal, rectal, axillary

• no oral temperature in children less than five years old

• blood pressure

  • use correct cuff size

  • do not use palpatory method

Pulse vitals

• infants - apical

Growth Charts

• record measurements; height and weight

  • Failure to thrive - infant or child below the third percentile on standardized growth charts

Pediatric Immunizations

• Immunizations

  • check published immunization schedules - (must be given to patient or parent if administering any vaccines)

  • check for contraindications

• Informed consent

  • explain side effects of immunizations

  • review with the parent the Vaccine Information Statement

  • advise parents of benefits of immunity

  • obtain informed consent for the child’s immunization

• Administering immunizations

  • ensure scope of practice

Immunizations Documentation - Specific requirements:

• The vaccine’s type, manufacturer, and lot number

• Date of administration

• Name and title of who administered the vaccine

• Administration site and route

• Vaccine’s expiration date

Bronchitis

airways in the lungs swell and produce mucus in the lungs (viral)

Respiratory syncytial virus (RSV)

mild cold-like symptoms including fever, coughing, runny nose, and sneezing. Can result in pneumonia

Hand, Foot, and Mouth Disease - (HFMD)

very contagious; symptoms include skin rash, fever, mouth sores, and flu-like symptoms

Conjunctivitis

“pink eye”; redness, discharge, itchiness, and swelling in one or both eyes. Bacterial or viral

Gastroenteritis

stomach flu; viral; symptoms include nausea, vomiting, and diarrhea

Sinusitis

sinus infection; symptoms include runny nose, stuffy nose, headache, pressure or pain in the face, mucus, sore throat, cough, and bad breath

Strep throat

caused by a bacterial called streptococcus pyogenes; causes sore throat, fever, swollen tonsils, and stomach pain

Impetigo

bacterial skin infection with crusting

Ringworm

fungal skin infection

Anorexia nervosa

starving oneself by not eating

Bulimia nervosa

• a pattern of binge eating and purging

  • purging - vomiting, taking excessing doses of laxatives, abusing diuretics