nur 222 exam 4

toddler age

12 months and 1 day to 36 months (3 years)

Pre K

36 months and 1 day - 6 years

school age

6 years and 1 day to 11 years

adolescent

11 years and 1 day to 18 years

young young adult

18 years -24 years

older young adult

25 years - 35 years

middle adult

36 years to 64 years

older adult

65 years and +

toddler erikson & piaget

erikson: autonomy vs. shame and doubt
- diminished reliance on caregiver
- performance of small tasks correctly means big accomplishment
- give 2 choices
piaget: preoperational
- language continues to develop
- time not understood
- animism
- irreversibility
- magical thinking
- don't understand cause + effect

negativism

avoid using the word NO, dont let them say NO

when is separation anxiety complete

18 months

animism

give life like qualities to inanimate objects

irreversibility

inability to stop or reverse action

egocentrism

can't see others perspective

inability to understand cause + effect

mass, volume, shape

preschooler erikson & piaget

erikson: initiative vs. guilt
- feelings of guilt may result from differing thoughts of expected behavior
- teach impulse control
- don't give them tasks they can't achieve
- use imagination
- overcome stranger + sep. anxiety
- still need parental security + guidance
- gain security from familiar objects
- need PRIDE skills when they do something well
- parents promote self esteem
- give boundaries and expectations
piaget: preoperational

preschooler stress

* regression, somatic complaints (belly aches), withdrawal (signs of stress)
* prevention: schedule adequate rest, and prepare child for upcoming changes

preschooler imaginary friends

- imaginary playmates appear
- real to child
- listen to their convos
- encourage other forms of creative play
- don't allow child to place blame on imaginary friend

preschooler fears

The dark, being left alone, animals, ghosts, and objects/or persons associated with pain.

Ways to overcome fear is by actively involving the child in practical method to deal with the frightening experience (nightlight at night)

school age erikson & piaget

erikson: industry vs. inferiority
- gain skills to contribute to the community
- independence
- peer approval
feelings of inferiority due to the environment
piaget: concrete operations
- manipulate concrete objects
- understand the relationship between things
- make judgments based on reason

what can a school ager master by end of school (cognitive)

- serial ordering
- conservation
- concept of time

piaget interventions for school ager

- 3D models, interactive games, concrete terms
- tell them what to expect
- let them ask questions
- can't think abstractly

erikson interventions for school agers

- help them feel normal but special
- give them rules
- praise right things
- do NOT criticize
- ask them to write letter to another school ager, have them organize, let them do tasks they know how to do

adolescent erikson & piaget

erikson: identity vs. Role confusion

* early adolescence: group identity vs. alienation
* late adolescence: personal identity vs. role diffusion

piaget: formal operations

* abstract thinking
* analyze situations
* use metaphors
* realistic thinking abt future
* need guidance for rational decision making

how do adolescence develop identity

* accept changed body image
* value system
* career decision
* separating from parents

erikson concepts for adolescence

- imaginary audience
- feeling invulnerable
- returning egocentrism
- risk taking

healthy risk taking for adolescents

running for class office, audition for part in play

unhealthy risk taking for adolescents

unsafe sex, illicit drugs, tobacco, alcohol

erikson interventions for adolescents

- autonomy from parents
- increase interaction with peers
- encourage parent support
- conflict with parents is normal
- encourage creativity
- let them use phone in hospital

cognitive development: learning difficulties for adolescents

- peer relation important in school
- teachers/ parents have impact
- ask abt school
- might need 504 plan (in class) or IEP (special ed)

relational problems common in adolescents + school agers

- bullying
- separation from parents
- sibling rivalry

young adult erikson & piaget

erikson: intimacy vs. isolation
- searching for friendship and an intimate relationship with another person
piaget: formal operations

what does intimacy mean in eriksons YA intimacy vs. isolation

finding self then losing it in another; not doing this results in isolation

when can isolation occur in young adults

when the YA avoids making a commitment to others

middle adult erikson & piaget

erikson: generativity vs. stagnation
- generativity is the ability to expand ones focuses on supporting furture generations
piaget: formal operations

how can MA show generativity

through parenthood, mentoring, and caring for others

older adult erikson & piaget

erikson: gerenrativity vs. stagnation to ego integrity vs. despair
- review of life is satisfaction with life after review
- despair is sense of life failure or life regret
piaget: formal operations

toddler physical growth

- short, stalky, not graceful
- protruding abdomen
- lumbar lordosis
- wide gait
- growth is step like
- bow legs is normal

preschooler physical growth

- slender, developed muscle, more graceful
- spine straight, lumbar lordosis corrects
- growth slows even more
- deciduous teeth eruption complete by age 3

toddler body system maturation

- most systems mature by end of toddlerhood
- voluntary bladder sphincter control by 18-24 months
- flat ear tubes., lots of ear infections and tonsillitis
- myelination of spinal cord complete by 2 years
- anterior fontanelle closes at 18 months

preschooler body system maturation

- improved immune system due to immunizations and day care

both toddler and prek Resp, HR, and BP trends

- resp. and HR decrease
- BP increases

toddler and prek speech problems

- stuttering is normal
- denver articulation screening exam (DASE)

dyslalia

articulation speech problems

normal visual acuity for toddler + prek

20/40 (can tell by looking at pic of eye)

toddlers and prek sexual development

- self stimulation and genital exploration (teaching boundaries)
- gender roles (based on home environment)
- fear genitals being exposed or touched
- preK pose questions abt reproduction

spiritual development in toddlers

- dormant
- don't see spiritual figures as different from superheroes

spiritual development in preK

- conscience develops
- knowledge of faith + religion learned from others
- may misinterpret illness as punishment from god
- will follow spiritual rules as they receive positive reinforcement

toddler body image development

- understand they are a separate body from their parents
- do not understand that things can hurt their bodies until they have painful experience

PreK body image development

- inc. awareness of desirable appearance
- aware of racial identity
- scared of blood-\> give a bandaid
- give simple instruction abt intrusive procedures

what is a balanced meal for toddler + prek

- 1/2 plate of fruits and veggies
- 1/4 plate of protein
- 1/4 plate of whole grains
- 2-3 servings a dairy per day
- milk/ water only (avoid juice)
- 1/2 adult serving size per category

how much should you limit milk to per day for toddlers and prek

24 oz per day due to limiting anemia

toddler sleep

- mattress on the ground by 3 years old
- no choking hazards but can have stuffed animal, blanket, etc.
- need 12hrs a night of sleep including naps
- sleep regression common with potty training
- have a set routine
- activity during day

prek sleep

- 8-12hrs / night; naps are less common
- nightmares
- night terrors
- may sleep walk
- consistent bedtime routine

when is toilet training complete by

3 years old

what is the minimum start age for toilet training

18 months

how do you know a toddler is ready for toilet training

- able to stay dry for 2 hours
- can remove own clothing
- can tell someone they have to go
- willingness to please parents
- curiosity abt adult or sibling toilet habits
- impatient with wet or soiled diapers
- parental readiness

how do you prepare a child for potty training

- explain it visually
- toddler potty seats
- limit practice times
- dress appropriately
- frequent reminders
- wipe front to back
- do NOT scold for accidents
- consistency
- let child choose what they can

dental health for toddler + prek

- visit every 6 - 12 months
- 2 times per day brush teeth with a little toothpaste
- toddler can brush by themselves and then parent brush after
- prek can brush by themsleves with parents verbal assistance
- parent assist with daily flossing

when is first tooth lost

6 years old

elimination patterns toddler and prek

- 1-2 BM/ day
- 4-10 voids/ day
- minimum normal is 4 times in 24 hours
- constipation common with poor nutrition

how do toddlers play

parallel play- right alongside eachother but not with eachother

how do prek play

associative play- playing side by side + occasionally interacting with others

temper tantrums in toddler + prek

- negativism often reasoning for tantrum
- consistency among all caregivers
- developmentally appropriate expectations
- prevention: set expectations and repeat them; 15-20 times a day

sibling rivalry toddlers + prek

* a new baby? time is a vague concept, n0 unrealistic expectations, minimize extra stressors, allow them to participate
* older sibs? allow them to be involved with baby care

discipline toddlers + prek

* distract/ divert
* encourage cooperation
* provide structure
* set limits
* positive reinforcement
* spanking not recommended
* time outs starting at 3 years old

injury prevention in toddlers + prek

- firearm safety, stranger danger, fire safety, bike helmets, appropriate car seat
- poison (cleaning agents)
- choking + suffocation (foods, heavy furniture)
LOCK IT UP

when does school age begin

physiologically begins with loss of first deciduous tooth

when does adolescence begin

puberty

what is pre-pubescence

2 years before onset of puberty

what is post-pubescence

1-2 years after puberty; skeletal growth is complete, reproductive functions mature

school age growth

- height increases by 2 in/ year
- weight increases by 4-6 lbs per year
- body slims and decreases in center of gravity

adolescent growth

- growth spurt: 24 months female, 48 months male
- weight gain 15-60 lbs during puberty
- normal growth spurt: 3-4 inches annually for 2 years for females; 3-5 inches annually for 4 years for males

what age should normal vision be acquired by

20/20 vision by 6 years

how does BMR change in school age

decrease in BMR

how does HR, RR, and BP change in school age + adolescents

- decrease in HR, RR
- increase in BP

what are biophysical changes in adolescents

- increase in BMR
- sebaceous + sweat glands more active
- lungs increase in size, can take deeper breaths

Preschoolers : Normal HR, RR, & HR when asleep

normal HR: 80-120
asleep HR: 65-100
normal RR: 20-28

school age: Normal HR, RR, & HR when asleep

normal HR: 75-118
asleep HR: 58-90
normal RR: 18-25

adolescent: Normal HR, RR, & HR when asleep

normal HR: 60-100
asleep HR: 50-90
normal RR: 12-20

what do you plot on the growth chart for school age + adolescence

height, weight, BMI

what are red flags on growth chart

- sudden drop
- sudden jump
- slowly falling below normal
- BMI % above 85th or below 5th
- height below 5th

obesity in school age and adolescence

BMI > 95th percentile

* 18.2% male
* 16% female
* increasing

what are risk factors for obesity in school age and adolescents

- low income
- food insecurity
- low access to healthy foods
- parent nutrition modeling
- assess mental health

gross motor development for school age

- ride a bike by 6-8 years old
- may have pre-pubertal clumsiness
- scoliosis is common so may need to screen

gross motor development for adolescent

- increase muscle development in puberty for all genders
- males develop higher muscle mass than females during puberty

fine motor development for school age

- knows left from right at 6 y/o
- enjoy creative art activities
- 8-10 spaces words appropriately

Adolescent Fine Motor Development

- no new developments just refinement

play school ager

- cooperative: play together towards common goal
- physical skill, intellectual ability, fantasy
- form groups, cliques, clubs
- rules + rituals

sleep school ager

- 10 hours per night no nap
- night terrors
- sleep walking direct them back to bed
- teach good sleep hygiene

sleep adolescent

- 10 hours per night no nap
- insomnia/ disrupted sleep is common especially with anxiety

gender development all ages

- 6 months: discriminate male + female faces
- 2-3 years: understand gender stereotypes
- 8 years: awareness of gender discrimination
- late school age + adolescent: explore personal gender identity
- school agers need non judgemental support

moral development in school ager

* concrete understanding of religious terms and stories
* development of conscience and moral standards
* children expect punishment for misbehavior

moral development in adolescents

- concepts of justice, reparation (require abstract thought)
- internalized set of normal principles
- questioning of existing moral values

how long should puberty take

3-6 years

what are secondary sex characteristics

* hormonal changes: voice changes, hair growth, breast enlargement, fat deposits
* play no direct role in reproduction

what are primary sex characteristics

- external/ internal organs
- menstruation + hormonal changes

what is female hormone

estrogen

what is male hormone

androgen

tanner stages for females (2)

1. breast development
2. pubic hair