Studied by 66 people
Leading causes of infant mortality
Congenital anomalies, disorders relating to short gestation/ low birth rate, maternal complication effects, SIDS, and accidents
leading causes of childhood mortality
o 1-4: injury, congenital anomalies, homicide, cancer, and heart disease
o 5-9: injury, cancer, congenital anomalies, homicide, and heart disease
o 10-14: injury, suicide, cancer, congenital anomalies, and homicide
o 15-19: injury, suicide, homicide, cancer, and heart disease
Family Centered Care
-recognizes the family as the constant in a child’s life
-emphasizes empowerment (families maintain/acquire a sense of control over their family lives and acknowledge positive changes that result from helping behaviors that foster their own strengths, abilities, and actions)
-enabling (create opportunities and means for all family members to display their current abilities and competencies and to acquire new ones to meet then needs of the child and family)
Atraumatic Care
-eliminates or minimizes the psychological and physical distress experienced by children and their families in the health care system.
-Goal is to do no harm by: minimizing child’s separation from family, promoting a sense of control, and minimizing bodily injury and pain.
Consanguineous
blood relationship
Affinal
marital relationship
Family of origin
family unit person born into
Family systems theory
-family is a system that continually interacts with its members and environment
-problems are not in any one member but in the type of interactions used by the family
-makes the family the patient
Family stress theory
-family encounters predictable and unpredictable stressors
-many in a short period of time can lead to inability to cope which can lead to crisis
-adaptation requires a change in the family structure/interaction
Family developmental theory
-addresses family change over time
-there are eight developmental tasks (oldest child marks stage transitions)
-predictable changes in structure, function, and roles
Parenting Styles
o Authoritarian- parents control children’s behavior and attitudes through unquestioned mandates
o Permissive- parent exert little or no control over their children’s actions
o Authoritative- combination of both
Types of discipline
-Reasoning-
-Scolding- shame and criticism
-Behavior Modification- behavior that is rewarded will be repeated, behavior that isn’t, will stop
Broader influences on family health
social and mass media, race and ethnicity, poverty and economy, parental education, land of origin and immigration status, religion and spiritual identity
Growth vs Development vs Maturation
o Growth- increase in number and size of cells, leads to increases size and weight
o Development- gradual emerging and expanding of capacities through growth, maturation, and learning
o Maturation- increase in competence and adaptability, to function at a higher level
Patterns of Growth
Directional and sequential
-Cephalocaudal- from head to tail
-Proximodistal- from midline ot periphery
-Differentiation- from simple to complex functions
Periods of growth
-Infancy- most rapid
-Early childhood until puberty- relatively slow
-Puberty- increased
Psychosexual Development!
Freud
-human behavior is energized by psychodynamic forces
-Id (unconscious mind)- pleasure and gratification
-Ego (conscious mind)- reality principle
-Superego (conscience/moral arbitrator)- the ideal
Psychosocial Development!
Erikson
-Trust vs Mistrust: birth- 1year
-Autonomy vs Shame/Doubt: 1-3
-Initiative vs Guilt: 3-6
-Industry vs Inferiority: 6-12
-Identity vs Role Confusion: 12-18
Cognitive Development!
Piaget
-Sensorimotor (birth-2)- progresses from reflex activity to imitative behavior
-Preoperational (2-7)- Egocentrism
-Concrete Operations (7-11)- Increasingly logical thought, and inductive reasoning
-Formal Operations (11-15)- adaptability, flexibility, and abstract thought
Moral Development!
Koglberg (based on Piaget)
-Preconventional- labels good/bad or right/wrong
-Conventional- value conformity and loyalty
-Postconventional- values general individual rights and standards
Functions of Play (7)
-Sensorimotor development
-Intellectual development
-Socialization
-Creativity
-Self-awareness
-Therapeutic
-Morality
Types of Play (5)
o Onlooker- children watch what others are doing but just observe
o Solitary- children play alone with toys unique to them, but like the presence of others
o Parallel- play alongside other children with toys similar to others, but are not influenced by others
o Associative- Children play together in a similar activity, but there is no organization, rules, leadership assignment, and no group goal
o Cooperative- children play together in a group with organization, with a purpose or goal
Guidelines of communicating with children (5)
-Introduce self
-Ask names of family members and how to address them
-Always include child
-Minimize Distractions and stay confidential
-Get on child’s eye level
-Approach child gently while involving caregiver
Developmentally appropriate approaches to exam
-Infants- nonverbal (crying, smiling, and vocalizing)
-Early Childhood- focus on the child, allow children to touch medical equipment, repeat information in simple, consistent terms
-School Age- focus on concrete explanations, encourage child to touch and practice with equipment
-Adolescents- be honest, and explain thoroughly, be aware of privacy, potential for regression
Sequence and preparation of infant exam
Sequence
-if quiet auscultate heart, lungs, and abdomen
-record HR and RR
-palpate and percuss these areas
-proceed head-to-toe
-traumatic procedures last (head and face)
-elicit reflexes while body part is examined
-moro reflex last
Preparation
-undress if warm enough
-leave diaper on male
-gain cooperation with distraction, bright objects, rattles, and talking
-smile and use soft, gentle voice
-Use pacifier or bottle
-Use parents for aid with restraining for traumatic procedures
-no abrupt/jerky moves
Sequence and preparation of toddler exam
Sequence
-inspect body area through play
-minimum physical contact initially
-introduce equipment slowly
-auscultate, percuss, and palpate whenever quiet
-traumatic procedures last
Preparation
-have parent remove their outer clothing
-remove underwear as groin is examined
-demonstrate use and allow toddler to inspect equipment
-perform procedures quickly if uncooperative
-use restraint with parents’ assistance
-talk about exam if cooperative
-praise for cooperative behavior
Sequence and preparation for preschool exam
Sequence
-if cooperative do head-to-toe
-if uncooperative do same as toddler
Preparation
-request child to undress
-keep underwear on if shy
-offer equipment for inspection and demonstrate use quickly
-make up story about procedure
-use paper-doll technique
-give choice when possible
-expect cooperation
-use positive statements
Sequence and preparation for school age exam
Sequence
-proceed in head-to-toe direction
-examine genitalia last in older child
Preparation
-respect need for privacy
-request self-undressing
-allow to wear underwear
-give gown
-explain purpose of equipment and significance of procedure
-teach about body function and care
Sequence and preparation for adolescent exam
Sequence
-proceed in head-to-toe direction
-examine genitalia last
Preparation
-allow to undress in private
-give gown
-expose only area being examined
-respect need for privacy
-explain finding during examination
-matter-of-factly comment about sexual development
-emphasize normalcy of development
-examine genitalia as any other body part
Pain assessment for children
o Behavioral Measures- neonates through 4
-FLACC Scale (face, legs, activity, cry, and consolability)
o Self-report scales- over 4
-Wong-Baker FACES- pictures help the child identify how much pain they are experiencing
o Multidimensional Measures- 7 to 10 years and after
Common responses to pain in neonates and infants
-Physiologic changes- increases HR and BP, lowered ox sat
-Behavioral Observations- rigidity and thrashing, intense and sustained crying, grimacing facial expression
-Older infants- withdrawal from painful stimuli
Common responses to pain in children and adolescents
-Young child- loud crying and screaming, thrashing limbs, attempts to push away the stimulus
-School-Age- similar behavior of young child during procedure but less before, time wasting behavior (wait I’m not ready)
-Adolescent- less vocal, less physical resistance, increased verbal expressions
Immunization Contraindication and Precautions
o Contraindication- increases risk for severe adverse reaction
-No live virus vaccine with a decreased immune system
-Sick with severe febrile illness (flu)
-Allergy
o Precaution- condition that might increase risk for serious adverse reaction or compromise efficacy
Hepatitis A
Transmission
-fecal oral
-person to person
-ingestion of contaminated food or water
Clinical Manifestation
-abrupt onset
-fever
-malaise
-anorexia
-nausea
-abdominal pain
-jaundice
Why vaccinate?
-children under 6 make up 1/3 of all cases
Misc.
-standard/contact precautions
Hepatitis B
Transmission
-blood
-semen
-other body fluids
Clinical Manifestation
-may be asymptomatic but then progress
Acute- fever, fatigue, nausea, vomiting, anorexia, abdominal pain, dark urine, and jaundice
Chronic- liver damage, liver failure, liver cancer, and death
Why vaccinate?
-can cause death
-25-50% of children get it before 5
Misc.
-standard precautions
-perinatal transmission can lead to significant morbidity
Diptheria
Transmission
-direct contact with infected person, carrier, or contaminated articles
Clinical Manifestation
-skin lesions
-respiratory symptoms: airway obstruction
-toxic cardiomyopathy
-toxic neuropathy
Why vaccinate?
-rare but high morbidity and mortality
Tetanus
Transmission
-bacterial toxin found in spores from soil, manure, and dust
Clinical Manifestation
-painful muscle contractions
-lock jaw
-increase r/f laryngospasm
-breathing difficulty
-death
Why vaccinate?
-can cause death
Pertussis
Transmission
-direct contact or droplet spread from infected person
Clinical Manifestation
-whooping cough
-Catarrhal Stage- URI, low grade fever
-Paroxysmal Stage- whooping cough most common at night
Why vaccinate?
-very dangerous for newborns and infants
Misc.
-cocooning recommended
IPV
Transmission
-fecal oral, oropharyngeal, person to person
Clinical Manifestation
-abortive
-nonparalytic
-paralytic
Why vaccinate?
-can be deadly
Misc.
-inactive polio vaccine resulted in decreased association with polio paralysis
-can be used as a combination vaccine
Haemophius Influenzae (Hib)
Transmission
-respiratory droplets, sneezing, coughing
-bacterial flora in noses and throats
Clinical Manifestation
-sepsis
-meningitis
-pneumonia
-otitis media
-sinusitis
Why vaccinate?
-children younger than 5 are at greatest risk
-H influenzae type b can cause: bacterial meningitis, sepsis, epiglottitis, and pneumonia
Misc.
-droplet precautions
PCV 13
Transmission
-respiratory droplets, sneezing, and coughing
-bacterial flora in noses and throats
Clinical Manifestation
-sepsis
-meningitis
-pneumonia
-otitis media
-sinusitis
Why vaccinate?
-children younger than 5 are at greatest risk
-streptococcus pneumoniae can cause many infection in children under 2 that result in serious morbidity and mortality
Misc.
-droplet precautions
Rotavirus
Transmission
-fecal-oral
Clinical Manifestation
-severe diarrheal illness
-dehydration
-shock
Why vaccinate?
- one of the leading causes of severe diarrhea
Misc.
-contact precautions
HPV
Transmission
-sexual and intimate skin contact
Clinical Manifestation
-viral infection causes cutaneous and genital warts
-increased r/f cervical, vaginal, anal, penile, and oropharyngeal cancers
Why vaccinate?
-can cause genital warts and increased r/f genital cancers
Men A
Transmission
-respiratory droplets
Clinical Manifestation
-meningitis
-septicemia
Why vaccinate?
-infants most susceptible
-highest morbidity adolescents
-high risk college dorms
Misc.
-individuals may have carriage status
Varicella
Transmission
-contact with weeping lesions or nasopharyngeal secretions
Clinical Manifestation
-fever
-malaise
-headache
-severe pruritus
-erythematous macular lesions that progress to pustules and vesicles
Why vaccinate?
-extremely contagious
-can remain latent and reactivate later as shingles
Misc.
-airborne precautions
-children are contagious 1-2 days before the rash appears and remain until all lesions have crusted over
Measles
Transmission
-spreads easily through respiratory secretions and can survive on surfaces for up to 1 hour
Clinical Manifestation
-mild fever
-conjunctivitis
-coryza
-cough
-Koplik spots
-maculopapular rash
-after 5 days rash fades and leads to desquamation
Why vaccinate?
- can cause bacterial pneumonia, otitis media, and obstructive laryngitis and laryngotracheitis
Misc.
-live vaccine
-droplet precautions
Mumps
Transmission
-respiratory secretions
Clinical Manifestation
-parotid swelling
-fever
-aches
-rhinitis
Why vaccinate?
-meningitis and orchitis are complications associated with the infection
Misc.
-live vaccine
-children are contagious 7 days before and 8 days after swelling onset
Rubella
Transmission
-aerosolized particles
Clinical Manifestation
-irregular macular rash
-fever
-malaise
-headache
-sore throat
-red eyes
-lymphadenopathy
Why vaccinate?
-mild in children
-in pregnant women there are serious risk to developing fetus
Misc.
-live vaccine
-avoid contact with pregnant women
Parvovirus
Fifth Disease
-Peaks in later winter and spring
-Bright red cheeks with slapped appearance
-Lacy rash on trunk and upper extremities
-Benign and self-limiting
-Avoid pregnant women
Conjunctivitis
-Newborn- bacterial, chemical, blocked tear duct
-Child- viral, bacterial, allergic, foreign body
-Prevent transmission to others
Stomatitis (HFMD)
-Aphthous ulcers
-Herpes simplex virus
-Relieve pain, prevent spread, ensure hydration
Vital Signs of Newborns
o Temperature- 36.5 to 37.6 (97.7 to 99.7)
o HR- 120 to 140
o RR- 30 to 60
o BP- 68 to 75/38 to 44, should be equal in upper and lower extremities
o Pulse Ox- >95% after 24 hours, 3% difference in upper and lower extremities
Infant Proportional Changes
o Length
-First 6 months- grow 1 inch per month
-6 to 12 months- grow ½ inch per month
o Weight
-First and second week- lose 10% of body weight but then gained back
-First 3 months- gain 20 to 30g (1 oz) per day
-4 to 6 months- weight doubles
-12 months- weight triples
o Head circumference
-First 6 months- increases rapidly
-Slows until 12 months
o Chest
-Newborns- barrel chested
-By 1 year- more adult shaped chest
Maturation of Systems of Infants
o Hematopoietic- HgbF decreases, HgbA increases, physiological anemia
o Gastrointestinal- stomach size and capacity increases, digestive enzymes increase, liver begins to conjugate bilirubin and excrete bile
o Neurologic- incomplete myelination of spinal cord, continued growth of brain cells and size
o Immunologic- maternal IgG decreases, infant IgM and IgG increases, gradual production of IgA IgE and IgD
o Fluid Regulation- high proportion of ECF, immature kidney function
o Thermoregulation- increased efficiency of capillaries and thermogenesis
Concerns related to infant’s growth and development
o Separation and stranger fear
o Alternate childcare arrangements
o Discipline
o Thumb sucking and pacifier
o Teething
Nutrition of Infants
o First 6 months- human milk, no additional fluid in first 4 months, daily supplements of vitamin D (every baby) and iron (breastfed babies)
o Second 6 months- introduction of solid foods, no honey or milk in the first year of life
Sleep of Infants
o 2 months- 15 hours
o 6 to 12 months- 13 hours
o Starts to sleep through night around 3 to 4 months
Safety of Infants
o S- suffocation and sleep position
o A- asphyxia, animal bites
o F- falls
o E- electrical burns or burns
o P- poisoning, ingestion
o A- automobile safety
o D- drowning
Colic
o Self-limiting condition of increased fussiness and inconsolable crying
o Peeks at 6 weeks
o Resolves around 3-6 months
o Worse in the evening
o At risk for detachment from mom and shaken baby syndrome
o Encourage caregivers to lay the infant in the crib when frustrated
Brief Unresolved Unexplained Event (BRUE or ALTE)
o Apnea, change in color, change in muscle tone, coughing, choking, gagging, involves significant intervention (pat the back and pick them up)
Sudden Infant Death Syndrome (SIDS)
o Risk factors- 2nd hand smoke, low birthweight, low APGAR, prone sleep, having siblings that died from SIDS, and co-sleeping
o Protective factors- pacifiers, supine sleeping, safe sleep
Maturation of Systems of toddler
o Respiratory- RR slows, continued growth of structures and volume, ear and throat are small, increased size of tonsils and adenoids
o Cardiac- HR slows, BP rises
o GI- stomach size and capacity increases, stomach acidity increases, voluntary control of urethral and anal sphincters
o Neurologic- myelination complete by 2 years, rapid achievement of motor milestones
o Immunologic- established Igs, better phagocytosis
o Thermoregulation- increased efficiency of capillaries means better thermoregulation
Concerns related to toddler growth and development
o Toilet training, sibling rivalry, temper tantrums, negativism, regressive behavior
Nutrition of Toddler!
o 12 months- change from formula to cow’s milk
o 2 years- non flavored whole milk until this age (no more than 3 cups)
o Drink from cup instead of bottle
o No bottle at naptime or bedtime
o Offer variety of healthy foods but do not force child to eat
o Physiological anorexia from decreased caloric needs
o Ritualism and food jags
Sleep and activity of toddler
o 11-12 hours per day of sleep with one nap
o Bedtime resistance
o Night waking, sleep disturbances are common
o Activity level is high
Safety of toddler
o Main concerns- car safety, drowning, burns, accidental poisoning, falls, aspiration and suffocation, bodily harm
Concerns related to preschooler normal growth and development
o School readiness, sex education, fears, stress, aggression, speech problems
Sleep and activity of preschooler
o 12 hours per night, infrequent naps
o Night waking, sleep disturbances are common
o Offer structure and unstructured play activities
Safety of preschooler
o Priority topics- pedestrian motor vehicle activities, safety equipment (helmets), caregivers should model safe behaviors
Ingestions
o Most common between 1 to 5
o Products- cosmetics, personal care products, cleaning products, plants, foreign bodies, toys, miscellaneous substances, hydrocarbons (gas)
o Emergency Treatment
-Call poison control before initiating and interventions
-Gastric decontamination after evaluation of potential toxicity
· Lead Poisoning
o Most common heavy metal poisoning
Child Maltreatment (types and nursing care)
o Neglect
-Physical- deprivation of food, clothing, shelter
-Emotional- lack of affection, attention, nurturing
o Physical abuse, emotional abuse, and sexual abuse
o Nursing Care
-Identify situations ASAP
-Observe caregiver-child interaction
-Signs- child and caregiver histories of events that do not match, inconsistent/incongruent behaviors, pater or combination of indicators that arouse suspicion and further investigation
-Protect child from further abuse
Maturation of Systems of school age
o GI- increased stomach capacity, longer periods of time between eating, decreased caloric needs
o Genitourinary- bladder capacity varies
o Respiratory- thoracic breathing pattern, fully developed by 10, decreased RR
o Cardiac- heart in period of slow growth, HR decreases, PMI moves to 5th ICS MCL
o Immune- increased ability to localize infection, improved antigen-antibody response
o Musculoskeletal- legs and arms grow faster than rest of the body, facial structure become elongated, bones continue to ossify
Concerns related to school age growth and development
o School experience, latchkey children, discipline, dishonest behavior, stress, and fear
Dental Health of school age
o Permanent teeth erupt
Sleep of school age
o 6 years- 11.5 hours
o 11 year- 9 hours
o Bedtime resistance common until 12
Activity of school age
o Sports- concerns about physical and emotional maturity in competitive environment
o Muscle coordination, rhythm, balance, fine motor and language
Safety of school age
o Priority Topics- motor vehicle accidents, bicycle safety, skateboard, in-line skating, scooter
Adolescent age
o Early- 11 to 14
o Middle- 15 to 17
o Late- 18 to 20
Sexual Maturation for Females
-Thelarche (8 to 13)- breast buds
-Adrenarche (8 to 13)- pubic hair growth
-Menarche (2 years after thelarche)- menstruation begins
-Puberty delay- no thelarche by 13
Sexual maturation for males
-Stage 1 (9 ½ to 14)- testicular enlargement and sparse pubic hair
-Stage 3- penile enlargement, voice changes, early facial hair
-Stage 5- penile growth, first ejaculation, axillary, groin, and facial hair, final voice change
Health concerns of adolescence
o Emotional well-being, intentional and unintentional injury, dietary habits, eating disorders, obesity, physical fitness, sexual behavior, STIs, accidental pregnancy, LGBT, depression, suicide, school and learning problems, hypertension, hyperlipidemia, immunizations, body art, sleep deprivation, and insomnia
Safety of adolescents
o Priority Topics- motor and nonmotor vehicles, drowning, burns, falls, bodily damage, drug overdose
School age elimination issues
-Most common- enuresis and encopresis
-Diagnosis- chronic (at least 3 months), primary or secondary
School age behavioral disorders
-ADHD- developmentally inappropriate inattention, impulsiveness, and hyperactivity
-PTSD
-School phobia
-Depression
-Anxiety
Male reproduction issues
-Varicocele- enlarged testicular veins, may impair fertility
-Epididymitis- inflammatory response of epididymis
-Testicular torsion- surgical emergency, swollen and painful scrotum
-Gynecomastia- breast enlargement
Female reproduction issues
-Amenorrhea- absence of menstruation
-Dysmenorrhea- pain during or shortly before menstruation
-PMS
-Vaginal infections
-Adolescent pregnancy
-Contraception
Adverse childhood experiences (ACEs)
-Cumulative incidence and influence of psychologic and physical abuse
-Risk factors- neglect, sexual abuse, witnessing violence, exposure to substance abuse, mental illness, suicidal behavior, imprisonment of family member
Stressors of Hospitalization
o Separation anxiety
-Protest phase- crying and screaming, clinging to the parent
-Despair phase- crying stops, evidence of depression
-Detachment (denial) phase- resignation but not contentment, superficial adjustment
Nursing care of the hospitalized child
o Preparation for hospitalization
o Preventing/minimizing separation
o Minimizing loss of control- promoting freedom of movement, maintaining the child’s routine, encouraging independence, promoting understanding
o Provide activities and opportunities for play and expression
o Maximize potential benefits of hospitalization- fostering parent-child relationships, providing educational opportunities, promote self-mastery and socialization
Nursing care of the family of hospitalized child
o Supporting family members, providing information, encouraging parent participation, preparing for discharge, and home care
Informed consent
o Eligibility- informed consent of parents, evidence of consent, informed consent of mature and emancipated minors, treatment without parental consent, adolescents, consent, and confidentiality, informed consent and parental right to child’s medical chart
Key considerations for infant prep for procedures
-attachment to parent, stranger anxiety, sensorimotor phase of learning, increased muscle control, memory for past experiences, imitation of gestures
Key considerations of toddler prep for procedures
-egocentric thought, negative behavior, animism, limited language skills and concept of time, and striving for independence
Key considerations of preschooler prep for procedures
-egocentric, increased language skills, limited concept of time and frustration tolerance, illness and hospitalization viewed and punishment, animism, fears of bodily harm, intrusion, and castration, striving for initiative
Key considerations of school age prep for procedures
-increased language skills, interest in acquiring knowledge, improved concept of time, increased self-control, striving for industry, developing relationships with peers
Key considerations of adolescent prep for procedures
-increasing abstract thought and reasoning, consciousness of appearance, concern more with present than with future, striving for independence, developing peer relationships, and group identity
Measurement of I/O with diapers
o Diaper weighing- 1 gram of wet diaper=1 mL of urine
Note 
Flashcard (102)