NU 353: exam 3 - across lifespan 1 💯💯

what is development and the principles of development

- sequence of physical, psychosocial, and cognitive developmental changes that take place over the human lifespan
- involves 3 processes: growth, differentiation, maturation
- development is orderly and sequential
- development is unique to each child

what is the age range for infants

birth to 12 months

what is the age range for toddlers

12 to 36 months

what is the age range for preschoolers

3 to 5 years

what is the age range for school-agers

5 to 12 years

what is the age range for adolescents

12 to 18 years

what is erikson's psychosocial stage: trust vs mistrust

- infant (birth to 12 months)
- trust: developed by meeting comfort, feeding, stimulation, and caring needs
- mistrust: developed if needs are inadequately/inconsistently met, needs are continuously met before being vocalized by the infant
(infants begin to learn delayed gratification, failure to learn leads to mistrust)

what is erikson's psychosocial stage: autonomy vs shame and doubt

- toddler (12 to 36 months)
- develop independence as they attempt to do everything themselves
- autonomy: toddlers gain confidence and independence when they are encouraged to explore, make choices, and do simple tasks (dressing themselves, feeding, toileting)
- shame and doubt: toddlers will feel ashamed and doubt themselves if their caregivers are overly critical, controlling, and dont allow children to try new task

what is erikson's psychosocial stage: initiative vs guilt

- preschool (3 to 5 years)
- initiative: preschoolers take on new experiences, despite not having the ability to be successful at everything
- guilt: if preschoolers are unable to accomplish a task, they can feel guilty and believe they have misbehaved

what is erikson's psychosocial stage: industry vs inferiority

- school age (5 to 12 years)
- industry: Children develop a sense of pride and accomplishment through mastering new skills, succeeding in school, and receiving positive reinforcement from teachers, parents, and peers.
- inferiority: If children experience repeated failure, criticism, or lack of support, they may feel inadequate, doubt their abilities, and develop low self-esteem

what is erikson's psychosocial stage: identity vs role confusion

- adolescence (12 to 18 years)
- identity: Adolescents explore different roles, beliefs, and values to form a stable sense of who they are. Success leads to confidence in their identity and future direction.
- role confusion: If they struggle to find their place in society or face too much pressure to conform, they may feel lost, unsure of their values, and confused about their future

what is erikson's psychosocial stage: intimacy vs isolation

- young adult

what is erikson's psychosocial stage: generativity vs isolation

- middle adult

what is erikson's psychosocial stage: integrity vs despair

- older adult

what is the denver developmental screening tool (DDST II)

- 1 month to 6 years old (used to track early childhood development and spot potential delays in children)
- gross motor, fine motor-adaptive, language, personal-social
- further diagnosis requires: neurodevelopmental history, physical examination, advanced testing, and assessments for specific delays, assessment for underlying health disturbances

what is the HEADSSS screening tool

- risk profile for adolescence to evaluate health, safety, and well-being of adolescence
- Home, Education, Activities, Drugs, Suicidality, Sex, Safety

what is the CRAFFT screening tool

- screening for adolescence substance abuse

what are developmental screening tools for adults

- recent life changes questionnaire
- life experiences survey
- stress audit: focus on stress and coping

what are developmental screening tools for older adults

- basic activities of daily living
- instrumental activities of daily living

what are nutritional considerations for infants (<1 year - trust vs mistrust)

- no propping of bottles → choking or aspiration
- no fruit juice
- no honey → botulism
- iron-fortified after 6 months
- introduce cereals first at 6 months, then introduce green vegetables, yellow-orange vegetables, and then fruits.
- meat and egg yolk at 10 months

what are safety considerations for infants (<1 year - trust vs mistrust)

- ABCs: alone, on back, in a crib
- no co-sleeping or clutter in bed
- burns
- aspiration from small toys/objects
- falls due to rolling off items or falling in high chairs
- toys in electrical outlets,
- pulling down items on self
- no microwave formula → burns
- use outlet covers

what are patient education for infants (<1 year - trust vs mistrust)

- Get on your knees to see what they see → choking hazards, falls, turn down water heater, poisons, cord strangulation

what are health promotion for infants (<1 year - trust vs mistrust)

- Breastfed infants usually sleep for shorter periods because breast milk digests faster and they get hungrier sooner
- Once teeth erupt, dental cleaning with a damp cloth
- Water with adequate fluoride from 6 months to 3 years
- by 4 mo develop nocturnal sleep (9-11 hrs)

what are nutritional considerations for toddlers (1-3 year - autonomy vs shame/doubt)

- appetite is sporadic
- ritualistic eater: eats in the same pattern
- no more than 24oz of milk/day → iron deficiency anemia (most common issue in this age group)
- heavily fibrous foods can be a choking hazard (raw celery, raw carrots, broccoli, cauliflower)
- transition from bottle to cup
- no growth spurt

what are safety considerations for toddlers (1-3 year - autonomy vs shame/doubt)

- toys should be larger than airway
- Constant supervision
- helmets
- Assess objects that may fall
- Toxic plant removal
- Plastic suffocation
- Electrical safety

what are patient education for toddlers (1-3 year - autonomy vs shame/doubt)

- Meds out of reach, Poison is a major concern
- Use appropriate med delivery for the amount of medication (syringe vs med cup vs kitchen spoon)
- Poison is a major concern
- Choking concern
- Toilet training

what are health promotion for toddlers (1-3 year - autonomy vs shame/doubt)

- 11-12 hours of sleep
- One nap per day
- Sleep problems due to separation
- Use nighttime rituals: stuffed animals or a blanket
- Sleepwalking
- Dental visits twice a year

what are the percentiles for weight

- Underweight is < 5%
- Healthy is 5% - 85% 
- Overweight is 85% - 95%
- Obese is > 95%

what are BMI classifications

- Underweight: < 18.5
- Healthy weight: 18.5 - 24.9
- Overweight: 25 - 29.9
- Obese: > 30

what is cephalo-caudal

- growth from head (cephalic) to toe (caudal/end)
- think movement: head moves → shoulders → arms → crawling with legs → using feet

what is proximo-distal

- growth from center of body outward
- acrocyanosis: think perfusion first to vital organs, then to extremities

what is psychosexual vs psychosocial

- Psychosexual: mental, emotional, and behavioral aspects of sexual development.
- Psychosocial: involving both psychological and social aspects

what is crude pincher

Pad of thumb used. The baby grasps objects between the pads of the thumb and index finger, rather than the tips.

what is neat pincher

Tips of thumb used. The baby uses the tips of the thumb and index finger to pick up small objects with precision.

what vaccines are given at birth

Heb B

what vaccines are given at 2 months

- Hib - haemophilus influenzae
- PCV - pneumococcal conjugate
- Hep B
- DTaP - diphtheria, tetanus, and pertusis
- IPV - inactivated poliovirus
- Rotavirus

what vaccines are given at 4 months

- Hib - haemophilus influenzae
- PCV - pneumococcal conjugate
- DTaP - diphtheria, tetanus, and pertusis
- IPV - inactivated poliovirus
- Rotavirus

what vaccines are given at 6 months

- Hib - haemophilus influenzae
- PCV - pneumococcal conjugate
- DTaP - diphtheria, tetanus, and pertusis
- Rotavirus

what vaccines are given at 12 to 15 months

- Hib - haemophilus influenzae
- PCV - pneumococcal conjugate
- Hep B
- IPV - inactivated poliovirus
- MMR - measles, mumps, rubella
- varicella

what vaccines are given at 15 to 18 months

- DTaP - diphtheria, tetanus, and pertusis

what are 2 months milestones for infants

- lifts head when prone, moves arms/legs (less flexed when prone)
- hands to mouth → hungry
- coos
- social smile
- calms self-briefly
- turns head towards sounds
- crying becomes differentiated (vocalizing is different from crying)
- begins to follow things
- hands often open, grasp reflex fading

what are 4 months milestones for infants

- lift head and chest on stomach
- grasp object with both hands, inspects and play with hands
- laughs
- enjoy social interactions
- bored if left alone
- makes consonant sounds
- laughs
- rolls from back to side
- balances head in sitting position
- tries to reach for objects, anticipated feeding when see bottle/breast

what are 6 months milestones for infants

- sits with assist
- rolls back to abdomen, lifts chest when prone
- holds bottle, bear weight with hands
- grasp feet to mouth
- babbling 1 syllable, begins to imitate sounds
- holds arms out to pick up
- likes to look at self in mirror, look for things that are hidden
- recognizes familiar faces and begins to fear strangers

what are 9 months milestones for infants

- sits without assist
- crawls or creeps
- pull to stand
- crude pincher: picks up things like cereal between thing and 2 fingers
- respond to simple commands, comprehends “no, no”
- recognizes name
- separation anxiety begins (fear left alone)
- makes different sounds with longer syllables
- object permanence
- put arms to front of face to avoid having it washed

what are 12 months milestones for infants

- sits to stand without help, cruises (walk holding onto furniture)
- neat pincher (smaller objects, release cube into cup)
- says mama, dada for parents, imitates animal sounds
- favorite objects
- hugs and kisses, wave goodbye
- clings to parents in new situations, fearful to strangers
- shows emotions (anger, jealousy, affection)
- walks with 1 hand held, take a few steps on their own
- turn pages of books many at a time

what are 15 months milestones for infants

- claps when excited
- copies other children, solitary play
- tries to say 1-2 words besides mama dada
- understands simple verbal commands “give it to me”
- points to asks for something or to get help
- walks on own
- use fingers to self feed, handles a spoon
- builds tower of 2-3 cubes
- drink well from covered cup
- dressing: pulling shoes off and socks

what are 18 months milestones for infants

- walks, walks up stairs with assistance
- build a tower of 3-4 cubes, scribbling
- 10 or more words
- temper tantrums
- great imitator, domestic mimic cry like pretend feeding a doll
- follow 1 step directions
- throws ball overhand

what are 2 years milestones for infants

- runs well, walks up/down stairs without assistance with 2 feet/step
- turns page one at a time
- builds a tower of 6-7 cubes
- 300 words, uses 2-3 phrases like “more milk”
- play alongside other children (parallel play - doesnt directly interact)
- increased independence from parent
- understands directional commands, knows first name
- points to at least 2 body parts, turns a doorknob, unscrews lid
- dress self in simple clothing, puts on socks/shoe/pants w/o regard to L or R

what are 3 years milestones for preschoolers

- understand idea of “mine” “his'“ or “her”
- separates easily from mom and dad
- may get upset with major change in routine
- begins associative play (interact with other children)
- converses using 2 to 3 sentences with 3 or 4 words
- vocab of 900 words
- asks many questions, say first name, age, sex
- helps with simple household tasks
- has control of bladder/bowel
- rides tricycle, copies a circle

what are 4 years milestones for preschoolers

- often can’t tell what’s real and make believe
- very independent
- tends to be selfish and impatient
- imaginary playmates common
- name 1 or more colors, vocab 1500 words
- know if ice is cold then fire is _, know simple analogies
- sing song/poem from memory
- skips and hop on 1 foot
- copies square, draw person with 2 or more body parts
- use scissors
- unbutton some buttons

what are 5 years milestones for preschoolers

- cant tell real from make believe
- more likely to agree with rules
- wants to please
- say name and address
- count 10 or more objects, vocab 2100
- knows a shoe is made of __ article composition
- hop and skips on alternating foot
- somersaults (roll on back)
- swings/able to pump, jump rope
- copies diamonds/triangles
- go to toilet without help, buttons some buttons

what are gross motor skills for all ages

- 2 months: lift head
- 4 months: lift head + chest
- 6 months: sit with assistance
- 9 months: sits w/o assistance
- 12 months: sits to stand no assist, cruises
- 18 months: walks, stairs with assist
- 24 months: runs, walk up stairs no assist

what are fine motor skills for all ages

- 2 months: bring hand to mouth
- 4 months: grasp object with both hands
- 6 months: holds bottle, rakes objects
- 9 months: crude pincher
- 12 months: neat pincher, release cube into cup
- 18 months: build tower of 3
- 24 months: turn page 1 at time, build tower of 6

what are language skills for all ages

- 2 months: coos
- 4 months: laughs
- 6 months: babbling 1 syllable
- 9 months: respond to command, looks when an item is dropped
- 12 months: mama, dada to reference parents
- 18 months: 10 or more words
- 24 months: 300 words, use 2-3 word phrases

what are social skills for all ages

- 2 months: social smile
- 4 months: enjoys social interactions
- 6 months: hold arms to be picked up
- 9 months: stranger anxiety
- 12 months: favorite objects, hugs/kisses
- 18 months: temper tantrums
- 24 months: plays along other children (parallel play - no interact)

what are nursing interventions for preventing infections in a child with down syndrome

- Rinse the child’s mouth with water after feeding and at other times of the day when it is dry. Mucous membranes are dry due to constant mouth breathing, which also increases the risk for respiratory infection.
- Provide cool mist humidification to moisten secretions and clearing of the nasal passages with a bulb syringe as needed.

what are client education/infection prevention for a child with down syndrome

- Increase the oral intake of fluids.
- Rinse the childs mouth after feedings.
- Use cool mist in the room to assist in moistening secretions. Practice good hand hygiene. Dispose of contaminated tissues properly.
- Frequently reposition the child to promote respiratory function.
- Keep up to date with routine immunizations.
- Seek health care at the earliest indication of infection.​​​​​​​
- Follow the antibiotic schedule if prescribed.

what are clinical manifestations of down syndrome

- separated sagittal sutures
- upward outward slant to eyes
- small nose with flat nasal bridge
- excess skin in neck folds
- hyperreflexibility → hypotonia (muscle weakness - rag doll)
- protruding tongue
- mouth kept open
- short stature
- simian crease (single transverse palmar crease)
- brachycephaly
- paddleboarders foot, wide separated toes/feet

what are interventions for a child with down syndrome

- assess child’s developmental level first, then plan interventions accordingly
- surgical interventions depend on associated congenital anomalities
- social work, home health, school (early intervention), genetic counseling
- therapy: speech, physical, occupation
- standard postoperative care should focus on wound care, respiratory care, pain management

what vaccines are given from 4-6 years vs 11-12 years

- 4-6: DTaP, MMR, varicella, IPV, influenza
- 11-12: TDaP, HPV, meningcoccal, influenza

what are goals for preschoolers regarding education

- gain cooperation in medication and treatment
- let adults know when they dont feel right
- respond to adult when symptoms begin
- you can use objects (like stethoscope) to help child understanding teaching
- draw human body, use dolls, stuffed animals to show body parts
- ability to do simple tasks with 1 to 2 steps

what are health promotion for preschoolers (3-5 - initiative vs guilt)

- 11 to 12 hours of sleep a night and infrequent daytime naps
- nightmares and sleep tremors are normal → consistent bedtime rituals, books, blanket, nightlights
- dental care
- prepare for schooling and increase relationships

what are safety for preschoolers (3-5 - initiative vs guilt)

- Less prone to reckless behavior and listen to parental rules 
- Pedestrian motor vehicle injuries increase 
- Reinforcement of appropriate protections 
- Tend to imitate others such as parents 
- Risk → drowning, burns, pedestrian/motor vehicle injuries

what are nutrition for preschoolers (3-5 - initiative vs guilt)

- variety of foods
- 1400-16000 calories per day
- limit sugar-sweetened drinks 4-6 oz/day (sparkling water > soda)
- 16 oz/day of milk, lowfat (fat helps with neuro development)
- 4 years: enter picky eater phase → offer new foods many times, try to give in various ways, give it in a way that is easy to eat like cutting in smaller pieces

what are social/emotional considerations for preschoolers (3-5 - initiative vs guilt)

- energetic learners
- guilt: belief that they have misbehaved or are unable to accomplish a task
- self-concept: feel good about themselves after mastering skills
- regression during stress, insecurity, illness
- can become insecure around 3.5 years and exhibits emotional extremes

what are gross motor skills for preschoolers (3-5 - initiative vs guilt)

- 3 years: rides tricycle, jumps off bottom steps, stands on 1 foot for few secs
- 4 years: skips and hops on 1 foot, throws ball, catches ball reliably
- 5 years: jumps rope, walks backwards, throws and catches ball with ease

what are fine motor skills for preschoolers (3-5 - initiative vs guilt)

- improvement in fine motor skills → copying figures on paper, dress independently

what are goals for school age children (6-12 - industry vs inferiority)

- learning and speaking up for oneself
- education is based on where the child is in relation to conservation (understanding the amount of something stays the same even if shape/appearance changes), seriation (ability to arrange objects in order), and reversibility (understanding actions can be undone or reversed)

what should children at the school age be able to do

- know correct dose, time, and use of medication
- seek ways to remember medications and therapies, with help of adults
- begin independently to avoid or control things to make them worse
- understanding instructions in about 3-4 steps initially, and advance as child become older
- focused on today’s needs and unable to think beyond needs of tdy

what are health promotion for school age children (6-12 - industry vs inferiority)

- 9 hours of sleep
- nighttime ritual: quiet activity (reading, drawing), not TV or video games
- healthy activities like team sports
- dental health
- sex education begins

what are safety considerations for school age children (6-12 - industry vs inferiority)

- motor vehicle accidents → leading cause of death
- increase injuries → bike, ATV, skateboards
- peer influence: increase risk to try dangerous things → burns, poisonings, substance abuse, drowning, sex

what are nutrition considerations for school age children (6-12 - industry vs inferiority)

- establishes likes/dislikes
- understand “My Plate” and healthy eating (fruits, vegetables, grains, protein, dairy)
- establish good eating habits (well-balanced meals)
- important for establishing meal habits and behaviors
- get children involved in cooking

what are social/emotional considerations for school age children (6-12 - industry vs inferiority)

self concept
- establishing best friends
- awareness of self in relation to others
- gain confidence
- young school-age: parents are primary
- older school-age: peers and teachers are more valuable
- lying, stealing

what are language/cognitive considerations for school age children (6-12 - industry vs inferiority)

- Transitions from perceptual to conceptual thinking
- Master's conservation around 9 yrs (mass, weight, volume)
- Time telling
- Classifies more complex information
- Ability to see others' perspectives
- Problem solving
- Thinks about the past and storytelling

what are gross motor considerations for school age children (6-12 - industry vs inferiority)

- Physical growth slows for height and weight
- Increase in strength and refinement of previous skills
- Overexertion → muscle and bone injuries (don't know physical limits)
- Puberty begins at 10 for girls, 12 for boys

what are fine motor considerations for school age children (6-12 - industry vs inferiority)

- Play and interaction with others are essential
- Activities of daily living

what are expected clinical manifestations for child with autism spectrum disorder (ASD)

- early signs: problems with eye contact, no response to his/her name
- social communication delay: not understanding social cues
- communication impairment
- repetitive impulsive behavior

what are interventions for client with autism spectrum disorder

- most effective: highly structured routines, establish consistent rules; intensive behavior modification programs
- minimum eye contact
- avoid behavioral outbursts
- encourage caregivers to stay with child
- inform the child directly of what they need to do
- communication should be brief, concrete, and at the developmental level
- introduce new situations slowly

what are safety considerations for adolescence (12-20 - identity vs role confusion)

- Sports injuries → overexertion
- Teen drivers (distractions)
- Dating violence
- Cyber bullying 
- Suicide
- Sun and tanning
- Peer pressure risk behaviors
- Drugs, sex, alcohol, and eating disorders

what are nutritional considerations for adolescence (12-20 - identity vs role confusion)

- Healthy eating for growth
- Calorie increase (2800 for boys and 2200 for girls)
- No dieting unless directed by the provider
- Calcium, iron, zinc, and vitamin D are needed for growth

what are goals for adolescence (12-20 - identity vs role confusion)

- Assess cognitive ability
→ Younger: concrete → emphasis on immediate risk or benefits
→ Older: hypothetical reasoning → more symbolic and long-term complications

what should adolescence be able to do (12-20 - identity vs role confusion)

- Perform health care needs with instructions
- Understand medication action and side effects
- Identify the severity of symptoms, treat, and know how to contact healthcare providers
- Meet with an adult routinely (once a week)
- Rational thought processes may be abandoned due to peer pressure, time constraints, and personal stressors

what are health promotion for adolescence (12-20 - identity vs role confusion)

- 8-10 hours of sleep → due to rapid physical growth
- Spend more time with sports than any other time
- Body-conscious teens need guidance in hygiene
- Vision screening

when does the most amount of physical growth occur

tremendous physical growth occurs during adolescence → developing physical, sensory, and psychomotor function gives teens a feeling of strength and confidence → gives increase in energy that must be discharged through action often at the expense of logical thinking

what are cognitive milestones for adolescence (12-20 - identity vs role confusion)

- growing capacity for abstract thought
- mostly interested in the present, with limited thought to the future initially
- deeper moral thinking

what are social/emotional milestones for adolescence (12-20 - identity vs role confusion)

- identity vs role confusion: struggle with sense of identity “who am I”
- initial emotional instability, which moves toward stability
- realize parents arent perfect, increased conflict
- increased influence of peer group

what is personal fable for adolescence (12-20 - identity vs role confusion)

- belief that one’s feelings and experiences are completely unique or that one is all-knowing or invulnerable
- the adolescence is invisible to potential risk “it wont happen to me”

what is imaginary audience for adolescence (12-20 - identity vs role confusion)

- a thought process where adolescents believe everyone is looking at them, egocentrism
- can result in not wanting to be different

what are interventions for a child with ADHD

- Behavioral Therapy
- Structured Environments
- Medication
- Lifestyle and diet: Increasing physical activity, Changes to diet
- Psychoeducation: Educating patients and families about ADHD

what are impulsive clinical manifestations of a child with ADHD

- Difficulty waiting for their turn
- Trouble waiting until the question is finished before answering
- Often interrupts others

what are inattention clinical manifestations of a child with ADHD

- Easily distracted
- Trouble following directions and finishing tasks
- Organizational problems
- Difficulty listening while others are speaking
- Forgets about daily activities
- Often loses things
- Frequent daydreaming

what are hyperactivity clinical manifestations of a child with ADHD

- Squirms or fidgets when sitting
- Does not stay seated
- Trouble playing quietly
- Restless - always on the move
- Excessive talking

what are medication administration considerations for ADHD

- Stimulants
→ Side effects: Insomnia, anorexia, weight loss, and hypertension
→ Should not be used at night, but when behaviors need to be controlled during the daytime
→ Give at breakfast or lunch (AM to help prevent insomnia)
→ Can suppress growth when used long-term