peds 164

“child”

neonate, infant, child, young person collectively

major goal of pediatric nursing

improve quality of health care for all children

healthy people 2030

\-identifies essential components for child health promotion programs

\-goal: increase immunizations

\-goal: increase quality and length of healthy life, and eliminate health disparities

bright futures

program provides family and community direction

health

state of complete physical, mental, and social well-being and not merely absence of disease

health promotion

nutrition- children develop eating habits during first 3 years of life

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dental care- most common chronic disease of childhood

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immunization- avoid missing opportunities to vaccinate + encourage parents to keep immunizations current

new morbidity

current environmental + social issues that decrease quality of life

4 categories of new morbidity

\-physical + environ. factors affecting behavior and risk taking

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\-variations of behavior and risk taking

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\-severe behavioral deviations + management

(poverty, violence, aggression, school failure, adjustment to divorce)

infant mortality

death in first year of life

neonatal mortality

post neonatal mortality

28 days to 11 months

childhood morbidity

prevalence of specific illness in population at particular time

1-4 yrs leading causes of death

unintentional injury, congenital anomalies, homicide, cancer, influenza/pneumonia

5-9 years leading causes of death

unintentional injury, cancer, congenital anomalies, homicide, influenza/pneumonia

10-14 years leading causes of death

unintentional injury, suicide, cancer, congenital anomalies, homicide

15-24 years leading causes of death

unintentional injury, suicide, homicide, cancer, heart disease

family

constant in child’s life

art of pediatric nursing

enabling + empowerment

enabling

\-acquire new current abilities + competencies

empowerment

\-interaction that allows family to maintain or acquire sense of control

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\-behaviors that foster family’s strengths, abilities, and actions

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\-inclusion of siblings + extended family members

family-centered care principles

\-info sharing

\-respecting + honoring differences

\-partnership + collaboration

\-negotiation

\-care in context of family + community

benefits of family-centered principles

\-experience greater feelings of confidence, competence, and less stress in caring for children

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\-dependence of families on professional caregivers decreases

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\-costs of care decreases

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\-professionals experience greater job satisfaction

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\-both parents + providers are empowered to develop new skills + expertise

atraumatic care

eliminate/minimize psychological + physical distress

goals of atraumatic care

\-prevent/minimize separation from family

\-promote sense of control

\-prevent or minimize bodily injury + pain

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anticipatory guidance

providing families info on normal growth + development + nurturing childbearing practices

anticipatory guidance principles

\-base interventions on needs of families/not professional

\-view family as competent

\-provide opportunities for family to achieve competence

a family…

\-whatever considers it to be

\-could be consanguineous (blood related)

\-could be affinal (marital)

\-family of origin is family unit into which one is born

\-”household” used to accommodate variety of family styles

\-none are “typical”

nuclear family

parents + children

blended family

parents marry other family

extended

parents + children + relatives

single-parent

1 parents

binuclear

divorced parents

LGBTQI

family within that group

prenatal period

embryonic conception (9 weeks gestation)

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fetus (9 weeks gestation

infancy period

neonate (birth-28 days)

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infant (28 days-1 year)

early childhood

toddler (1-3 years old)

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preschool (3-6 years old)

middle childhood

school age (6-12 years old)

late childhood

adolescent (12-24 years old)

cephalocaudal

head to tail

proximodistal

simple to complex

differentiation

simple to complex

sequential trends

developmental pace

growth

\-increase in number + size of cells as they divide + synthesize new proteins

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\-external dimensions change: results in inc. size + weight of whole or any of its part

measurements: compared to standardized norm

\-length + height

\-weight

\-head circumference

\-chest circumference

body mass index (bmi)

\-from weight and height

\-age + sex specific

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\-underweight

recumbent length + head circumference up to

36 months of age

how to measure recumbent length (cm, mm)

\-head against flat surface

\-toes at 90 degree angle against flat surface

head circumference

\-middle of forehead

\-important for intracranial pressure

chest circumference

on nipples

abdominal circumference

on belly button

development

gain in skills and functions

erikson’s theory of psychosocial development

8 stages

trust vs mistrust

infancy: birth to 1 year

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\-infants learn trust from parents

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\-if not, they develop distrust against world

autonomy vs shame and doubt

toddler: 1-3 yrs old

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\-toddlers try to be independent

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\-or they feel ashamed + doubt skills

initiative vs guilt

preschool: 3-6 yrs old

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\-preschoolers assert power/control over world

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\-or embarrassment of failures, doubt skills

industry vs inferiority

school age: 6-12 yrs old

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\-school agers develop new life skills

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\-or low self-esteem to succeed

identity vs role confusion

adolescent: 12-18 years

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\-adolescents develop sense of identity

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\-failure to resolute will cause role confusion

piaget’s cognitive development

sensorimotor, preoperational, concrete operational, formal operational

sensorimotor

\-birth to 2 years

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\-sensory/motor schemas

\-object permanence

preoperational

\-2-7 years

\-symbolic thinking

\-egocentricism

concrete operational

\-7-11 years old

\-more logical, organized thought

formal operational

\-11-15 years old

\-more abstract thinking

social affective play

relationships with people

sense-pleasure play

appealing to senses; light, color, texture, taste

skill play

repeating skill over and over

unoccupied behavior

daydreaming

dramatic/pretend play

play with imagination

games

play with more rukes

social character of play

socialization and type of play changes as child advances in age

onlooker

watches other kids

solitary

alone w/ toys

parallel

alongside but not together

associative

no organization but playing together

cooperative

rules are followed w/ leadership role

teaching activity toys

\-hospital equipment

\-anatomical dolls

\-drawings

\-models

\-self-care

diversional activity toys

\-toys/games

\-books

\-radio, tv, ipad

\-coloring books, crayons

\-video games, videos

expressive activity toys

\-creative drawing

\-making cards

\-dramatic play

\-puppets

\-dolls

passive play

\-television

\-cards

\-music

\-puzzles

active play

\-riding tricycle

\-swimming

\-climbing

\-sports

imaginative play

\-pretending

\-imitating

\-dress up

\-role play

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primitive reflexes

\-reflexes child is born with

\-sucking, rooting, babinsky, moro (startle), stopping, palmar grasp, plantar grasp, tonic neck (fencer)

\-disappear over first year

\-babinksy lasts 24 months

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protective reflexes

\-develop after primitive reflexes disappear

\-after 12 months

\-toddlers and older children

infant stage

\-birth to 12 months

\-tremendous growth

\-most organ system immature at birth

\-orderly, sequential, predictable development

\-gains gross motor before fine motor

\-trust vs mistrust

\-sensorimotor cognitive development

\-safety promotion

physical variants in infants

\-fontanelles

\-diaphragmatic breathing

\-irregular resp

\-irregular heart rate

\-asymptomatic murmurs

\-passive immunity until 6 months

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colic (paroxysmal abdominal pain)

\-abdominal pain or cramping manifested by loud crying + drawing legs up to abdomen

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\-duration of cry greater than 3 hrs/day, more than 3 days/week + lasting for more than 3 weeks

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\-infants under 3 months of age

management of feeding difficulties

\-colic carry

\-bottles that minimize air swallowing

\-no smoking environ

\-limit fruit juices

\-no single treatment

teeth

age of child in months-6 = number of teeth

meconium

newborn’s first stool

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thick and green

if breastfed

thinner consistency

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seedy and yellow

if fed formula

pastier consistency

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darker in color

constipation

\-normal to have one stool every other day + up to 10 stools daily

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\-focus on consistency + not quantity

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\-grunting is not sign of constipation

toddler stage

\-12-36 months

\-negativism, ritualism, egocentric

* believes world revolves around them
* selfish

\-understand actions can hurt others at 3 years of age

\-imitate behaviors of others

\-temper tantrums

\-encourage caregivers to offer choices to foster independence

\-may experience separation anxiety

physical variants in toddlers

\-all 20 baby teeth

\-diaphragmatic breathing

\-protruding abdomen

\-potbelly appearance

\-immature adaptive immunity

\-90 to 110 bpm

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preschool stage

\-3-6 yrs

\-slow growth

\-more coordinated gross motor skills

\-exponentially developed fine motor skills

\-initiative + trying new things

\-sense of intiative vs guilt

\-preoperational

physical variants in preschoolers

\-20/20 at 4-5

\-thoracic breathing

\-full daytime bladder control around 3 years

\-nighttime bladder control around 4-5 years

school readiness

\-early learning

\-parents=first teacher

\-reading to children

\-open ended questions

\-structured environments

\-social interactions

school age period

\-6-12 years

\-maturity inc

\-transgender at 6

\-coordination, balance, strength improve

\-logical thinking

\-entrance in school

\-friends + peers become more important

\-development of self confidence

\-inc independence

gender dysphoria

\-identifying w gender different from biological sex

\-first seen in 9-10 yrs

\-short term or long term

\-encourage caregivers to support children

\-assist families in adjusting

\-remain nonjudgmental

\-watch for signs of bullying/depression

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physical variants in school age

\-frontal sinuses at 7

\-tonsils hypertrophy

\-facial structures elongated

\-oriented x3

\-fully developed resp system at 10 yrs

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technology

need to look at age + maturity of child

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1. define brand
2. define community
3. develop exit strategy
4. post like celebrity