NUR 113 exam 5 anticipatory guidance, development, ADHD, autism, cerebral palsy

infant gross motor skills

lifting head, overall head control, rolling over

infant fine motor skills

grasping items, start feeding themselves at 12 months

infant sensory

sight: attracted to human face, hearing: recognizes people’s voices, smell/taste: recognizes mother’s smell and smell of breastmilk, touch: most important sense

infant communication

crying is their only form of communication

nurse’s role in infancy

promote effective breastfeeding (hunger cues, proper diet), prevent injury (car safety, never leave infant alone, safe sleep), promote appropriate parent-infant attachment (parents response to cues), maximize development (age appropriate play)

ways to maximize infant development

practice fine/gross motor skills, language through play, solitary play, basic toys (plastic containers, soft balls, wooden spoons, reading

toddler gross motor skills

developing gait, use physical action to express emotions

toddler fine motor skills

holding utensils, zipping, buttons, start to develop hand-eye coordination, examines items by touch

toddler language

receptive, expressive, echolalia

recepetive language

ability to understand what’s being said/asked

expressive language

ability to communicate desires/feelings

echolalia language

repetition of words without understanding

toddler emotional/social determinants

focus on self, wants to be in control (egocentrism), power struggle with caregiver, have a security item

nurse’s role with toddlers

prevent injury (rear facing until 2 years, helmets, childproofing, drowning) appropriate nutrition, maximizing development (toilet teaching, teeth brushing, engaging in play, reading, choosing preschool)

preschooler gross motor skills

going up/down stairs, balancing on one foot, less clumsy than a toddler

preschooler fine motor skills

moves fingers individually, able to grab similar to adult ability

preschooler communication

able to express thoughts and creativity, uses telegraphic speech, and starts developing fluency

telegraphic speech

uses short sentences containing only essential information

preschooler emotional/ social determinants

social skills more developed, learn to express feeling, able to start doing simple tasks (washing hands) to gain self esteem, starts developing friendships, in tune with parents moods (easily picks up negative emotions)

nurse’s role with preschooler

prevent injury ( car seat/booster, safety at home, swim lessons), nutrition (use of sippy cups, healthy food choices, high calcium intake, enhance development (positive reinforcement, reading, picture books, limit screen time, kindergarten, educate on sexual safety), play (give choice to decide how/who to play with, imitative play, age appropriate toys)

School aged gross motor

High energy, bike riding, jumping rope, dancing, playing sports

School aged fine motor

Writing, crafting, playing instruments

School age sensory/communication

Vision/hearing screenings done in school, reading skills improve, language development, understand double meanings/sarcasm

School age emotional/social

Body image, interested in peers’ views & acceptance of their body, model themselves after parents, peers, and famous ppl

School age nurses role

School refusal (having a phobia of school, investigate cause of refusal, work with school & counselors to help fix the problem), bullying (educate parents whose kids are at risk, can have negative effects on child for rest of life, develop ways to increase kids self esteem), preventing injury (bikes, playing near the street, playgrounds, fire safety), appropriate eating dynamics (adequate caloric intake, trending height/weight/bmi), enhancing development (attending school, encourage reading, good sleep, hygiene, engage in solitary play or w friends, drug/alcohol education)

Food groups amounts

Fruit (2.5 cups), veggies (3.5 cups), grains (10 oz), protein (7 oz), dairy (3 cups)

Newborn toys

Mobile e contrasting colors and patterns, unbreakable mirror, soft music, soft bright colored toys

1-4 month toys

Bright mobile, unbreakable mirror, rattles, singing, varied music, high contrast patterns in books or images

4-7 month toys

Fabric or board books, different types of music, easy to hold toys that do things or make noise, floating squirting bath toys, soft dolls or animals

8-12 month toys

Plastic cups, bowls, buckets, unbreakable mirror, large building blocks, busy boxes, balls, dolls, board books w large pictures, toy telephone, push pull toys

Adolescent gross motor

Begin to develop endurance, follow complicated instructions, competitive

Adolescent fine motor

Precise hand eye coordination

Adolescent communication

Language developed, use of slang words

Adolescent emotional/social

Strive for self identity, more independence, spend more time w peers, parents feel less control, causing more strictness, body image is very important, importance of peers, companionship, share problems, peer loyalty (impacts how they dress, their language, social behaviors)

Adolescent nurses role

Overall health (healthy weight, nutritional needs, promote exercise/ playing sports, hygiene- showers, deodorant, acne), prevent injury (drugs, alcohol, sex, peer pressure), improving coping (coping skills, increased independence when dealing with stressful scenarios, encourage parents to be supportive)

Suicide

Second leading cause of death 10-24 years old, risk factors: depression, family hx, poor school performance, substance abuse, give away valued possessions, encourage parents have open conversations with child, discuss suicide

Sexuality/dating

Thoughts, feelings, behavior related to sexual identity, experiment w sexual identity, encourage parents to be supportive and educated on child’s safety, dating: have the sex talk, talk abt safety, it should be a choice to engage in sexual relations when dating, educate on not being peer pressured, have ability to say no

ADHD

Characterized as inattentiveness, over activity & impulsiveness, 60% have s/s into adulthood, can be misdiagnosed

ADHD symptoms

Short attention span, high level of distractibility, labile moods, low frustration tolerance, inability to complete tasks, inability to sit still or fidgeting, excessive talking, inability to follow directions

ADHD contributing factors

Environmental toxins, genetics, brain damage, prenatal exposure to alcohol, tobacco & lead, severe malnutrition in early childhood, 1st degree relative w ADHD

ADHD tx

Manage symptoms, reduce hyperactivity/impulsivity & increase attention, combo of pharmacotherapy w behavioral, psychosocial & educational interventions

ADHD strategies for home/school

Provide consistent rewards and consequences for behavior, offer consistent praise, time out, verbal reprimands, daily report cards for behavior and point system for positive and negative behavior, therapeutic play so they can express themselves

Stimulants

Methylphenidate (Ritalin), dextroamphetamine (Dexedrine), amphetamine (adderall)

Stimulant indications

Reduces hyperactivity, impulsivity

Stimulant side effects

Appetite suppression, insomnia, weight loss

Stimulant nursing considerations

Give after meals, educate on sustained release (SR) options

Antidepressants

Atomoxetine (strattera), only nonstimulant drug developed/tested for ADHD by FDA

Antidepressant side effects

Can cause liver damage, decreases appetite, N/V, tiredness

Antidepressants nursing considerations

Give a food, monitor for appetite suppression, monitor for elevated liver function

Antihypertensives

Clonidine (catapres)

Antihypertensives indications

Known as a sedative, improves blood pressure, improves focus, reduces impulsive behavior

Antihypertensives side effects

Hypotension, dizziness, syncope

ADHD nursing care

Ensure child’s safety and those around them (close supervision, clear directions abt what is acceptable and not), manage the environment, positive feedback for meeting expectations, structured daily routine

ADHD education

Include parents, support groups, school resources, proper med administration/adherence, emphasize the need for structure

Autism

Characterized by pervasive and impairment of social interaction skills, communication and behavioral patterns, its a spectrum

Autism behaviors

Avoids eye contact, prefers to be alone, delayed speech and language skills, obsessive interests, unusual reaction to sensory experiences, repeats words or phrases over and over

Autism nursing considerations/ education

Provide emotional support and education about disorder, help team develop plan of care, stress importance of unchanging routine

Cerebral palsy

Abnormal motor pattern and postures caused by nonpreogressive abnormal brain function

CP indications

Majority of causes occur before delivery, no specific cause

CP symptoms

Range from slight limp to severe motor and neurologic impairments, spasticity, muscle weakness, ataxia

Complication of CP

Mental impairments, seizures, growth problems, impatiens vision/hearing, abnormal sensation/preception

CP causes

Prenatal: congenital malformation, environmental toxins, genetic abnormalities, preeclampsia, abnormalities of blood flow to brain, postnatal: asphyxia, head trauma, seizures, viral or bacterial infection of the CNS - meningitis

Physical therapy

Work with kids to assist with development of gross motor movements, gross child develop independent movement, assist in preventing contractures

Occupational therapy

Assists in development of fine motor skills, helps child perform optimal self care by working on ADLs, responsible for fashioning orthotics and splints

Ankle foot orthotics (AFOs)

Most commonly used, helps prevent deformity from contractures and help reduce effects of existing deformities, improve a child’s mobility by assisting in control of alignment

Spinal orthotics

Braces; used to combat scoliosis that develops due to spasticity

Speech therapy

Assist in development of receptive and expressive language, teach communication strategies to nonverbal patients or who have articulation issues, alternative means (communication books/boards, computers with voice synthesizers) to make series known and conversate

CP pharmacological therapy

Manage spasticity, muscle relaxants, anticonvulsants, anticholinergics, baclofen

Baclofen

Treats painful spasms and decreases spasticity, decreases tone but must be infused continuously (short half life), surgically placed pump of baclofen, intrathecal teat dose of baclofen administered before surgical intervention, delivery of drug individualized to meet ends, pump replaced every 5-7 years, refilled w medication every 2-6 months

CP goal of therapeutic management

Gain optimal development and function within the limits of the disease and promoting mobility through use of therapeutic modalities

CP nursing considerations

Consulting necessary techniques, promoting mobility and nutrition, proper education (baclofen pumps, overall plan of care, needs of patient will change as the grow up)

Failure to thrive contributing factors

Neglect, abuse, maternal education level, poverty, poor parenting skills, psychosocial family issues, unusual health or nutritional beliefs

Failure to thrive organic cause

GI and genetic diagnoses