Maternal and Child Unit 4 Exam

growth

body getting bigger

development

physical, gross motor skills, fine motor skills, puberty, emotional and psychological, cognitive

cephalocaudal

growing from head to toe

proximodistal

"Near to far"

Extremities grow later than head, chest, and trunk

maturation

completed growth and development

growth chart goal

for child to stay consistently in curve. Measurements needs to be completed consistently and accurately. Monitor for any dramatic increases or decreases.

Denver Screening Tool

standard milestones, identifies potential delays but does not diagnose, warrants for further assessment/monitoring. Good for parent education.

influences of child development and growth

genetic factors, nutrition, play and entertainment, homeless/unstable home, divorce, being a latch key kid, runaways, substance abuse/use, injury (physical and emotional)

freud's three levels of consciousness

id, ego, superego

ID

controls physical needs and instincts of the body. "pleasure seeker, impulsive."

Ego

conscious self, controls pleasure principle of id by delaying instincts until an appropriate time.

Superego

conscious or parental value system. "Moral compass, ethical values." angel on your shoulder.

Freud's Psychosexual Stages- oral stage

0-2 years. first experiences with body satisfaction come through mouth, sucking, pacifiers

Freud's Psychosexual Stages- anal

2-3 years. child's first encounter with serious need to learn self-control and take responsibility- bowel control (potty training)

Freud's Psychosexual Stages- phalic

3-6 years. interest moves to genital area as a source of pride and curiosity- discovering genitals

Freud's Psychosexual Stages- latency

6-1- years. Quiet time for sexual energy. Cognitive skills, peers.

Freud's Psychosexual Stages- genital

11-13 years. physical puberty is occurring at an increasingly early age; social puberty occurs even earlier, opposite sex

Erikson- trust vs mistrust

birth to 1 year. infant learns that his or her needs will be met. Consistent, predictable, reliable care is important.

Erikson: Autonomy vs. Shame and Doubt

ages 1-3. developing independence. What can I do on my own? Support and reinforcement leads to autonomy and pride. Criticism leads to shame and doubt.

Erikson: Initiative vs. Guilt

ages 3-6. inquisitive: new activities and new ideas. sense of right and wrong. direction and purpose. wanting approval from adults. suppression of inquisitiveness leads to guilt.

Erikson: Industry vs. Inferiority

ages 6-12. Competence and accomplishments. projects. tasks (can they begin tasks /projects and see it through to the end? ex: birdhouse), sports, industry leads to a sense of accomplishment, failure makes them feel inferior

Erikson: adolescents

ages 12-18, identity vs role confusion. Who am I? Where do I fit in? Who do I want to be? A lot of physical and emotional changes. Peers are large influencers. "I am an independent person with my own ideas."

Piaget's sensorimotor stage

birth-2 years. Infants learn through movements and their senses. Hearing, smelling, touching, seeing, sucking, tasting. "If I do this...this happens." "Can I make it happen again?" explore, the world responds to them and their actions. learn object permanence.

Piaget's preoperational

age 2-7 years. the young child sees the world from a egocentric point of view. Instant gratification (right now!!), imaginative, lack of concrete knowledge (no sense of time or quantity), very curious (why, why, why)

Piaget's Concrete Operational Stage

7-11 age, concrete, systemic thought. Can problem and organize, concept of conservation. Begins thinking of others. understand and consider other people's point of view

Piaget: Formal Operations

abstract thought, can make observations and draw logical conclusions (reasoning), goal orientated, understands jokes and sarcasm

Kohlberg step one (level one preconventional)

up to age 3, punishment and obedience orientation. Obey rules to avoid punishment.

Kohlberg step 2 (level one preconventional)

Up to age 7. Naive hedonism. Conforms to get rewards and to have favors returned.

Kohlberg step 3 (level two conventional)

Up to age 10. Good boy/girl morality. Conforms to avoid disapproval or dislike by others.

Kohlberg step 4 (level two conventional)

up to age 12. conforms to avoid censure by authorities.

Kohlberg step 5 (level three post conventional)

conforms to maintain communities. Emphasis on individual rights.

Kohlberg step 6 (level three post conventional)

Individual principles of conscience. (not frequently achieved)

Communicating with an infant

respond to sensory clues, comfort measures; hold, cuddle, soothe.

use sensory play activities- massage, looking at coloring objects, peek a boo

consider growth and development stage

establish relationship with caregiver

praise parent on hard work and good parenting

Communicating with young children

allow caregiver to hold young children as you initiate conversation

observe children/caregiver interaction

get down on eye level with them

speak in a calm, clear, positive voice, keeping sentences short.

explain how they will feel or what they can do

allow young children to handle to explore equipment

communicating with school aged children

acknowledge the caregiver, but focus on the child

they are interested in the "what" or "why" of things

provide simple concrete responses and age appropriate words

communicating with adolescents

might be challenging

adolescents might need privacy to relate information they do not wish others to know

let them know that you will listen in an open-mind, nonjudgmental way.

communicating with caregivers

demonstrate genuine care and concern

non judgmental

pay attention to the verbal and non verbal clues a parent uses to convey concerns, worrys, and anxiety's about the child

provide anticipatory guidance related to normal growth and development, nurturing childcare practices, and safety/ injury prevention

the nurse's role related to growth and development

it follows patterns that can be evaluated

understanding factors and influences on normal g&d

identifying delays and regressions

applying theories related to g&d

weight by 2 weeks

should be back to birth weight

weight and height at 6 mo

birth weight doubled and height increased by 6 inches

weight and height at one year

birth weight tripled and height increased by an additional 50% (10-12 inches)

When do the posterior fontanels close?

2-3 months

When do the anterior fontanels close?

by 18 months

When should the babys first teeth come in?

6-8 months

Teeth expected calculation

months in age minus 6 = expected number of teeth

Big consideration when getting infant vital signs

what is there activity? Sleeping? Awake? Quiet? Active?

normal infant vitals

HR- 90 asleep, 170 awake, 190 crying

BP- 85/60

RR- 20-50

temp- same as adults

age when reflexes disappear

moro reflex- 2 mo

walking/stepping- 2 mo

rooting- 4 mo

tonic neck reflex- 5-7 mo

palmar grasp- 5-6 mo

plantar grasp babinski- 9-12 mo

all reflexes should be gone after 12 mo

gross motor skills at 2 weeks

turn head side to side, flexed tone

gross motor skills at 2 months

lift head when prone

gross motor skills at 4 months

sit up while supported, roll from stomach to back, begins to bat at objects

gross motor skills at 6 months

roll over completely q

gross motor skills at 8 months

sits unsupported

gross motor skills at 9 months

crawl and pull to a stand

gross motor skills at 11 months

walks while holding onto something

gross motor skills at 12 months

stand alone and takes first steps, can throw a ball

fine motor skills at 4 months

grasps objects with two hands (safety- will bring them to their mouth)

fine motor skills at 6 months

hold a bottle

fine motor skills at 7 months

moves objects from hand to hand

fine motor skills at 9 months

pincer grasp- grab things with fingers

fine motor skills at 12 months

uses a spoon, can scribble on paper, turns pages of a book

language at 2 months

coo and should respond to sound

language at 6 months

babble and repeat sounds

language at 6-9 months

understands the word "no" and can understand and follow 1 step commands

language at 12 months

first words with meaning (mama, dada), should be able to say 3-5 words, should respond to their name

how can parents help develop language?

talking to and reading to the baby

vision at birth

can only stare at an object if held 8-10 in away. Should "catch" objects when crossing visual field.

vision at 2 months

follows objects with eyes to midline

vision at 3-5 months

can begin to differentiate between face of mother and a stranger.

follows objects with eyes across midline.

vision at 6 months

has full color vision, able to see at longer distances.

begins developing depth perception. (due to becoming mobile)

vision at 12 months

vision at adult levels.

sensorimotor stage

birth-24 months

cause and effect

reflexive at first to intentional actions.

separation

infants learn they are separate from other objects in the enivronment.

object permeance

Understanding that objects that are out of sight still exist, occurs at around 6 months, play peek a boo to establish this.

psychosocial development at 6-9 months

infants develop separation anxiety from parents

develop a fear of strangers

nutrition first 6 months

either breast milk or formula

breast fed babes may need Vitamin C and D, iron, fluoride supplemented, most formulas have these included but encourage parents to read labels

What should the parent first feed the babe?

rice cereal, start with small amount, thin it, luke warm, increase thickness over time. Start at 6 months.

adding solid foods

no solids before 6 month to avoid exposure allergens.

pureed veggies and fruits introduced one at a time.

allow 4-5 days before new foods.

always one food at a time.

veggies before fruit.

extrusion reflex

pushes solid food out of mouth, it does not mean they do not like food.

eruption of teeth

chopped food over pureed foods

what should baby start helping to feed themselves

7-8 months

what kind of milk should a baby drink and at what age?

whole milk at 12 months

things to feed a baby if they don't like whole milk

yogurt, custard, and cottage cheese

When do baby visits occur?

2 weeks, 2 months, 4 months, 6 months, 9 months, and 12 months

things to assess at baby visits

grown & development, nutrition, sleep, immunizations, caregiver-infant relationship, any potential problems, providing education and anticipatory guidance

immunization s/e and how to treat

low grade fever (100), soreness, red

Acetaminophen and cool compress, call if it does not go away in 48 hours

When to not give immunizations

fever (above 100)

Immunosuppression

Corticosteroids

radiation/chemotherapy

if parents refuse

what immunizations should be given before birth/during pregnancy?

flu vaccine, MMR

what immunizations should be given shortly after birth

Hep B

what immunizations should be given at 2 month well visit

Dtap, HiB vaccine, Hep B (2nd dose), pnumococcal vaccine, pollio virus, rotavirus

what immunizations should be given at 4 month well visit

Dtap (second dose), HiB (second dose), pnuemococcal (second dose), polio (second dose), rotavirus (second dose)

what immunizations should be given at 6 month well visit

Dtap (3rd dose), flu, HiB (3rd dose), Hep B (3rd dose, can be given from this point on), pneumococcal, polio (3rd dose, can be given from this point on), rotavirus

what immunizations should be given at 12 month visit

varicella, HiB, Hep A vaccine (given at 12-23 mo and then 2nd dose given 6-18 mo following first dose), MMR, pneumococcal (4th dose)

VAERS

Vaccine Adverse Event Reporting System

family teaching- bathing

bath temp 95-100 degrees F, water heater no hotter than 120 degrees

do not leave baby unattended in bath

peri washing: front to back

family teaching- diaper area

check diaper every 2-4 hours while awake

monitor for rash: barrier creams

family teaching- dressing

Temperature appropriate

soft soled shoes

family teaching- sleeping

sleep on BACK only

10-12 hours at night

2-3 naps a day, weening naps with time

night time routine

crib is a place to sleep, not play

family teaching- dental care

clean damp cloth to clean new teeth