NURS 299: Exam 3

Appropriate weight for an infant compared to birth weight: at 5 months

Double the birth weight

Appropriate weight for an infant compared to birth weight: at 12 months

Triple the birth weight

Appropriate weight for an toddler compared to birth weight: at 2.5 years

Quadruple the birth weight

Erikson's Theory of Human Development

- Helps you identify the differences in psychosocial development by age groups.

What results if Stage 1 (Trust v. Mistrust) in Erikson’s Theory of Development is not met?

They will have a hard time trusting people

What results if Stage 2 (Autonomy v. Shame & Doubt) in Erikson’s Theory of Development is not met?

The child may develop shame and doubt about their abilities, leading to low self-esteem, dependency, and fear of failure.

What results if Stage 3 (Initiative v. Guilt) in Erikson’s Theory of Development is not met?

They will be afraid/guilty to take initiative/take risks.

What results if Stage 4 (Industry v. Inferiority) in Erikson’s Theory of Development is not met?

They will feel inferior/have low self-esteem.

What results if Stage 5 (Identity v. role confusion) in Erikson’s Theory of Development is not met?

Identity confusion, insecurity, and difficulty making future choices can occur, leading to struggles with self-identity and life direction.

What results if Stage 6 (Intimacy v. Isolation) in Erikson’s Theory of Development is not met?

Isolation, loneliness, and fear of commitment may result, leading to difficulty forming close relationships.

What results if Stage 7 (Generativity v. Stagnation) in Erikson’s Theory of Development is not met?

A sense of stagnation, lack of purpose, and feelings of unproductiveness may develop

What results if Stage 8 (Ego integrity v. despair) in Erikson’s Theory of Development is not met?

Regret, bitterness, and despair over missed opportunities can lead to dissatisfaction with life.

What is the age and meaning for Stage 1 in Erikson's Theory of Human Development?

Infants: 18 months: Trust v. Mistrust - Hope

What is the age and meaning for Stage 2 in Erikson's Theory of Human Development?

18 months-3 years: Autonomy v. Shame/Doubt - Will (Refusing, Potty Training)

What is the age and meaning for Stage 3 in Erikson's Theory of Human Development?

3-5 years: Initiative v. Guilt - Purpose

What is the age and meaning for Stage 4 in Erikson's Theory of Human Development?

5-13 years: Industry v. Inferiority - Competency

What is the age and meaning for Stage 5 in Erikson's Theory of Human Development?

13-21 years: Identity v. Confusion - Fidelity

What is the age and meaning for Stage 6 in Erikson's Theory of Human Development?

21-39 years: Intimacy v. Isolation - Love

What is the age and meaning for Stage 7 in Erikson's Theory of Human Development?

40-65 years: Generativity v. Stagnation - Care

What is the age and meaning for Stage 8 in Erikson's Theory of Human Development?

65 years and older: Integrity v. Despair - Wisdom

How many stages are in Erikson's Theory of Human Development and what are they?

Eight Stages:

1. Infant-18 months: Trust v. Mistrust – Hope

2. 18 months-3 years: Autonomy v. Shame/Doubt – Will (Refusing, Potty Training)

3. 3-5 years: Initiative v. Guilt – Purpose

4. 5-13 years: Industry v. Inferiority – Competency

5. 13-21 years: Identity v. Confusion – Fidelity

6. 21-39 years: Intimacy v. Isolation – Love

7. 40-65 years: Generativity v. Stagnation – Care

8. 65 years and older: Integrity v. Despair – Wisdom

Does each stage of Erikson's Theory of Human Development affect the next or are they seperate?

Each stage will affect the next stage.

Kohlberg's Theory of Moral Development

Focuses on stages of moral development during school-age, adolescent, and young adult years.

Kohlberg's Theory of Moral Development is based on which theory?

Based on Piaget’s Theory of Cognitive Development

-cognitive/how do they learn about the world?

How many stages does Kohlberg's Theory of Moral Development have and what are they ?

Three Stages:

1. Pre-conventional (school-age): avoiding punishment, gaining reward

2. Conventional (school-age & adolescent): gaining approval, avoiding disapproval

3. Post-conventional (adolescent & young adult): agreeing upon rights, establishing personal moral standards, achieving justice

What is the 1st stage of Kohlberg's Theory of Moral Development?

Pre-conventional (school-age):

-avoiding punishment

-gaining reward

What is the 2nd stage of Kohlberg's Theory of Moral Development?

Conventional (school-age & adolescent):

-gaining approval

-avoiding disapproval

What is the 3rd stage of Kohlberg's Theory of Moral Development?

Post-conventional (adolescent & young adult):

-agreeing upon rights

-establishing personal moral standards

-achieving justice

What is the big deal with a Rh negative mother and RhoGAM?

-Mother is Rh- and the fetus has Rh+ blood.

-Mother needs RhoGAM 28 weeks of gestation and 72 hours after giving birth.

Caloric needs during pregnancy

-Increase by 300 calories 2nd trimester

-8-10 glasses of water

-70 g of protein

Elimination problems common in pregnancy

-urinary frequency, constipation, hemorrhoids

-UTIs associated with preterm labor

Strategies to minimize elimination problems during pregnancy

prevent complications and cope with changes

Education for UTI

wear loose cotton underwear, pee after sex, stay hydrated, don’t hold in your pee

How culture can influence pregnancy and how to incorporate this in a plan of care?

-Culture impacts childbearing practices.

-Prejudices may be invisible to those to rely on them - avoid stereotyping.

Levels of culture and how they impact health care delivery

Primary level - rules known and obeyed by all

Secondary level - rules not related to outsiders (taboos, rituals)

Tertiary level - visible to outsider (religion)

How to prepare a preschool child for a new sibling?

Let siblings participate in decisions with the baby to prepare for the newborn (e.g., pick out clothes or decorate the room).

Appropriate infant-mother bonding

Breastfeeding

Skin to skin contact

Factors that can affect mother-infant bonding

depression

finances

limited sources

Medications safe to take during pregnancy

Tylenol, Benadryl, Tums

• Acetaminophen (Tylenol)

• Antihistamines (Benadryl)

• Antacids (Tums)

• Sleep aids (Melatonin)

• Stool softeners (Colace)

• Cold remedies (Mucinex)

• Vitamin B6 (helps maintain brain function and mood)

Medications unsafe to take during pregnancy

• NSAIDS - Ibuprofen (Advil)

• Bismuth Subsalicylates (Pepto Bismol)

• Ephedrine (Nasal decongestants)

• Antiepileptics (anti-seizure medications)

Safe vaccines for pregnancy

tetanus, diptheria, influenza

Unsafe vaccines for pregnancy

(live)

• measles

• mumps

• rubella

• polio

What is toxoplasmosis?

protozoan that infects people through undercooked meat, handling cat feces, and exposure to infected soil.

How can toxoplasmosis affect a pregnancy?

During pregnancy, toxoplasmosis can cause:

-miscarriage

-stillbirth

-damage to the baby’s brain and other organs, particularly the eyes

Most babies born with toxoplasmosis have no obvious damage at birth, but develop symptoms, usually eye damage, during childhood or even adulthood.

Complications when infants are born early or after 42 weeks

Before: Underweight and underdeveloped (premature)

• Premature (<37 weeks): risk of breathing problems, underdeveloped organs

After: Placental function decreases

• Post-term (>42 weeks): Risk of stillbirth, macrosomia (large baby),

  meconium (the first stool or bowel movement passed by a new born baby), aspiration

Pica in pregnancy

• An eating disorder characterized by the ingestion of nonfood substances (i.e. dirt, clay, laundry, starch)

• Causes: mineral deficiency

• Assess for pica of pregnancy (stress importance of an appropriate diet).

Pregnancy and domestic violence

Added stress pregnancy adds in a relationship.

Domestic abuse is higher in pregnant women.

The other partner may become resentful, financially stressed.

Concern about roles.

Describe the importance of folic acid in pregnancy

• Important for the formation of the neural tube of the fetus

• Recommendation: 400-800 mcg daily

Exercise for pregnant women recommendation:

30 min per day of aerobic exercise

Age: 1 month

Infant developmental tasks/stages.

Landmark: Lifts head when prone​

Parenting Task: Place infant in prone position & show parent's face or toy​

Age: 2 months

Infant developmental tasks/stages.

Landmark: Has social smile​

Parenting Task: Talk to infant to stimulate senses​

Age: 5 months

Infant developmental tasks/stages.

Landmark: Rolls from back to front​

Parenting Task: Place infant in protected area and encourage infant to move by placing toy out of reach​

Age: 6 - 7 months

Infant developmental tasks/stages.

Landmark: Sits alone, leaning on hands​

Parenting Task: Place pillow behind back; practice sitting​

Age: 7 - 9 months

Infant developmental tasks/stages.

Landmark: Crawls

Parenting Task: Confine infant to safe area; childproof house​

Age: 8 - 9 months

Infant developmental tasks/stages.

Landmark: Use pincer grasp to feed self​

Parenting Task: Make finger foods available​

Age: 10 months

Infant developmental tasks/stages.

Landmark: Pulls self to standing position​

Parenting Task: Place chair or appropriate object within reach​

Age: 11 - 12 months

Infant developmental tasks/stages.

Landmark: Initiates vocalization​

Parenting Task: Talk to infant frequently; read books; include in family gatherings​

Age: 12 - 15 months

Infant developmental tasks/stages.

Landmark: Walks

Parenting Task: Provide clutter free walkways. Praise and encourage infant for attempts​

Appropriate toys at different stages

2 months - colorful mobile with music

3-4 months - rattle

9 months - supervised time outside of playpen

Breast feeding: mother's needed fluid intake

1 qt of water additional to the 9 cups

Breast feeding: difference in diet and elimination between bottle-fed and breast-fed infants

Formula fed: more iron, more foul smelling

Breastfed: goes down the system easier, recommended to breastfeed for the first 12 months and is required for the first 6 months.

SIDS

Sudden Infant Death Syndrome - before the age of 1

Allowed to be on stomach when supervised

• Cause: unknown

• Risks: prone/side sleeping, smoke exposure, soft bedding, bed sharing, not breastfeeding, overheating, preterm/low birth weights

Home visits and referrals. Monitor s/s child abuse. When do you provide resources versus report to CPS?

• Signs: bruises in abnormal areas, abnormal fractures

• Sexual abuse

• report when child abuse is suspected

• most common under age 3

• Round bruises on the back might not be child abuse → ask parents about the bruises (could be a cupping, a cultural practice)

Car seat recommendations

Rear-facing safety seat for infants to 20 lb in BACK seat (middle preferably).

Shield-type of "infant-only" seat to 30 lb.

• baby needs proper fitting restraints

• Never sit an infant on the lap in the car

Infant safety around a playpen and/or bed. When should infants be allowed to explore outside the playpen and/or bed?

• 9 months olds: allow supervised time outside of playpen

• need to baby-proof the home, remove choking hazards

• ABCs of safe infant sleeping = Alone on their Back in a Crib (no small items in their crib)

• Avoid soft-bedding

• Babies should never co-sleep with parents in the parents bed - risk of suffocation

• Babies should never sleep on their belly or their side.

Common accidents in infants/ Where do they occur?

Most accidents occur in the home for infants

-Falls

-Burns

-Choking

Pincer grasp

8-9 months/ makes finger foods available

Object permanence

the knowledge that an object still exists even if out of view (toddler stage)

Introducing food to infants and proper diet (milk versus formula, when to introduce food, etc.)

Solid foods after 4-6 months, one at a time

• sequence of solids: cereals, vegetables, fruits, meats

• wait until 6 months of age to lower risk of food allergies

Growth charts (purpose)

Plot lengths, weight & head circumference on a growth chart.

The height of a 2-year-old compared to his/her adult height

Half of the adult height/50%

How to assess a toddler in an office. How can you make the toddler comfortable with you?

Let them play with your equipment

Lead poisoning- what diet/food choices can help reduce lead levels in the body?

The relationship between lead poisoning and iron-deficiency anemia

-Decrease fat intake, lead is retained in the fat

-Vitamin C, calcium, and iron will help reduce lead levels in the body

-Drinking too much milk can lead to these conditions (lead poisoning)

Toddler and genitals curiosity

It is a normal developmental process

• teach about genitals during potty training

• use anatomically correct terms

Toddler diet, including milk and juice recommendations

Limit milk for toddler 16-24 oz.

100% juice, no more than 4 oz.

Offer toddler food more than 8 times before no food will be accepted

What events pose the greatest threats to a toddler's health?

Accidents

Cultural practices that may influence care of children

Cupping

hot tea

always ask the parent

Toddlers and autonomy, egocentrism, temperament

Autonomy: refusing; relinquishing dependence on others

Egocentrism: unable to put self in others’ shoes

Temperament: emotions are out of whack; NO and temper tantrums

Give the toddler options

Sleep for toddlers

12 hours of sleep a day

1-2 naps a day

Strabismus

Cross-eyed

deviation in line of vision

extra ocular muscle weakness

Sodium intake during pregnancy

Continue regular sodium intake because any sodium reduction can reduce plasma volume and cardiac input

Weight gain in pregnancy

25-35 lbs.

Iron needs in pregnancy. Why does it increase?

27-30 mg of iron to prevent anemia

expansion in volume

supply needs to fetus.

How can nursing mothers increase milk supply?

Water intake, breastfeeding longer, eat more

Can infants drink whole milk instead of breast milk or formula? Why or why not?

NO, the child would develop dehydration.

-Introduce whole milk after 12 months.

-Whole milk has too much protein and sodium

-Causes iron deficiency

Infantile botulism

Honey should be introduced after 12 months.

Food allergies and infants

Avoid solid foods till 6 months, introduce them one by one

Food choking hazards for infants and toddlers. How can you reduce the risk of asphyxiation (choking)?

-Slow down when you eat

-don't move while you eat

-cut bigger foods into smaller pieces

-sitting upright

What can you put in a bottle and give to the infant at bedtime?

Water or nothing

How much milk should a toddler drink per day?

16-24 oz of milk (2-3 cups)

How to manage picky toddler eaters

-Offer food 8-20 times before they like it

-limit the consumption of juices and cookies.

Children's kidneys are more mature than an adult kidney

False

How long is a full time pregnancy

9 Months

Infant is learning to voluntary move Piaget

sensimotor

1st stage of Erikson’s Theory of Development

Trust v. mistrust