Care Lecture 6: Development, Client-Centered Care, and Safety

mortality and morbidity

what is health frequently assessed in terms of?

-causes of illness and death

-high-risk age groups for various hazards

-advances in treatment and prevention

-specific areas of health counseling

what do mortality and morbidity provide significant information on?

-monitor growth and development

-provide anticipatory guidance

-assess parenting skills

what is the purpose of a health supervision visit schedule?

primary prevention

what level of illness prevention are immunizations?

-weight

-height

-head circumference

what can be used to monitor developmental growth in children?

nutrition and ability to use it

what does weight inform us about regarding growth and development?

-nutrition/possible disease

-adequacy of growth hormones

what does height inform us about regarding growth and development?

assess until 3 years of age

how long should head circumference be observed for in child development?

early indicator of certain neurological problems

what can abnormal head circumference in children be an indicator of?

mostly quantity, not quality of nutrition

is monitoring weight more concerned with quantity or quality of nutrition?

-weigh completely nude

-make sure infant is not wiggling

-make sure scale is zeroed

-cover scale and clean afterwards

what is important to remember when monitoring weight in infants?

-1st couple days of life --> baby loses weight d/t fluid loss

-only concerned if lose more than 10% of their birth weight

is it normal for an infant to lose weight at first instead of gain it? why or why not?

-use baby scale until about 30 pounds

-underwear is okay to wear

what is important to remember when monitoring weight in toddlers?

-can stand on the scale

-shoes and heavy clothes should come off

-may want privacy

what is important to remember when monitoring weight in older children?

gain 5-7 oz per week in 1st 6 months

how much weight should babies gain within first 6 months?

gain 3-5 oz per week in 2nd 6 months

how much weight should babies gain within second 6 months?

by 4-7 months

at what point should an infant's birth weight double?

by 12 months

at what point should an infant's birth weight triple?

gain 2-3 kg per year (4.5-6.5 lbs)

for toddlers to puberty, how much weight should be gained per year?

WHO - up to the age of 3

CDC - from 3-20 years old

when are the CDC and WHO growth charts used?

concerned if < 5th percentile or > 95th percentile

when are we concerned with the value on a child's growth chart?

should be between 5th and 95th percentiles (for that culture, ethnicity, etc.)

how do we decide if a child's percentile is okay?

-parents' characteristics

-ethnic group

-underlying disease processes

-other factors (ex: down syndrome)

what should be compared to a child's growth percentile?

how long the child is while laying down

how do we measure the length of children up until age 3?

from 2-18 years old

when do you start monitoring height in children?

-age and gender specific

-accuracy of height and weight

-compared to other children of the same age/gender

what is true of BMI?

monitor health, weight, and BMI

what is an effective way to identify health risks associated with being over/underweight?

check 3 times and take average of the 3 --> do until 3 years old

how do we measure the head circumference of infants?

more in the evening

when does crying tend to occur more in infants?

crying related to infants

what is PURPLE an acronym for?

P - peak (weeks or months)

U - unexpected

R - resists soothing

P - pain-like face (turn purple - don't be alarmed)

L - long lasting

E - evening

what does PURPLE stand for?

-nutrition: bottle/breast feed, monitor I&O

-fever management: indicates infection (monitor closely)

-safety: car seats

-hygiene: sponge baths, watch umbilical cord site, look for rashes

-sleep: sleep-eat cycle, patterns

-parent assessment: stress assessment, postpartum depression, etc.

discuss the following anticipatory guidelines for newborns (2 weeks):

-nutrition

-fever management

-safety

-environmental safety

-hygiene

-sleep

-parent assessment

-crying has a beginning and an end

-crying plan

-all babies cry --> its normal

what should you educate a parent on regarding crying?

1st 6 months

how long should babies breast feed for (at a minimum)?

at 4 months old (rice cereal)

when can rice cereal be introduced to infants?

at 4 months old (rolling)

when does a baby start rolling and holding its head up on its own?

-6 months old

-introduce slowly to watch for allergies and make sure you rotate green and orange vegetables (3x on one food)

when can fruits and vegetables be introduced to infants? how should they be introduced?

starting at around 9 months

at what age can an infant sit in a highchair?

9 months (pinching grasp)

when does a baby's pinching grasp develop?

at 12 months old

at what age is a baby's head and chest circumference equal?

12 months --> watch for choking hazards (avoid grapes and hot dogs)

when can table foods be introduced to infants?

at around age 2

when do we expect growth levels to slow down and level off in children?

-eat 3 meals a day

-can eat dairy products

describe the nutritional needs of a 2 year old

around 2 years old --> have to assess child's and parent's motivation and readiness

what age do parents usually start asking the nurse about potty training?

about 1 Tbsp per 1 year of age

what is the rule about sugar intake for toddlers?

when children are 4-6 years old

when is it very important to monitor children for regressions back to old behaviors?

developmental disabilities

severe chronic disabilities affecting cognitive, physical or both and are lifelong

cognitive impairment/intellectual disability

disability with significant limitations in intellectual functioning and adaptive behavior expressed in conceptual, social, and practical adaptive skills

before the age of 18

when does cognitive impairment/intellectual disability originate?

-speech

-physical: fine and gross motor skills

-cognitive function

-behavioral, emotional, social skills

when diagnosing cognitive impairment, what factors are compared to the norm?

-genetics

-environmental

-social

-drug consumption (recreational or prescribed)

what is the possible etiology of cognitive impairment?

liaison/supporter to the family

what is the role of the nurse in cognitive impairment?

-tell them what they can do to assist and intervene

-help with discipline strategies and structure

-educate them on what is going on

what can the nurse do to help a family and patient who just learned of a cognitive impairment diagnosis?

ADHD

developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity; neurobehavioral disorder of childhood that often persists into adulthood

-genetics

-organic

-environmental factors (radiation, lead, etc.)

what are some possible causes of ADHD?

-prevalence: 11% of school age children

-males > females

what is the prevalence of ADHD and who is more likely to have it?

-ADHD, predominantly inattentive

-ADHD, predominantly hyperactive

-ADHD, combined type

what are the 3 types of ADHD?

-must have 6 symptoms prior to the age 12

-symptoms need to occur in at least 2 different settings!

how do we diagnose ADHD?

cannot be explained as another mental disorder --> not due to schizophrenia, bipolar disorder, etc.

what is true of the relationship between ADHD and other mental disorders?

-provide support, education

-family education, counseling

-provide pharmacological therapy

-give positive feedback

what is involved in ADHD nursing care management?

Dextroamphetamine & Methylphenidate

what are two common medications (stimulants) given for ADHD?

-appetite suppression

-stomach ache

-insomnia

-headache

-effects on growth

what should the nurse assess for when an ADHD patient is taking Dextroamphetamine or Methylphenidate?

-protect from injury

-↓ family's stress

-assess for changing needs

what are the overall goals for ADHD nursing care management?

impulsivity and inattentiveness = risk for injury

why does ADHD have such a high risk for injury?

-reward positive behavior

-clearly define expected behaviors

-↑ child's self control

-give immediate, nonthreatening feedback

-effective use of self-soothers

how should nurses approach behavior management in ADHD patients?

18-24 months: normal development, and then a sudden regression

at what age do autism symptoms generally present?

-genetics

-disruptions in brain growth in early development

-immune dysregulation

-cellular damage

-environmental factors

what are some possible causes of autism?

vary widely from person to person

what is true of autism symptoms?

1 - requires support

2 - requires substantial support

3 - requires very substantial support

what are the 3 functional levels of autism?

-higher intelligence

-functional speech

-less behavioral impairment

better autism prognosis including independence associated with what?

-timely special education referral (sooner we intervene the better)

-educate on need for highly structured/intensive behavior modification programs (needs to be the same across home, school, and social settings)

describe the nursing care management of autism

-rewards

-consistency

-collaboration

what are some strategies to promote behavior management in children with autism?

learning disability

a condition giving rise to difficulties in acquiring knowledge and skills to the level expected of those of the same age

-lower intellectual ability

-childhood onset

-significant impairment of social functioning and adaptation

what are the 3 characteristics of a learning disability?

-difficulty listening or speaking

-hard time with reading or writing

-learning new things requires support

what are some characteristics that help diagnose a learning disability?

-identify weakness

-educate to highest learning ability with resources available

describe the nursing care management of learning disabilities

-safety

-efficacy

-risk-benefit ratio

the FDA approves immunizations after studying what aspects of them?

-inactivated (dead)

-attenuated live virus

what are the 2 types of vaccines?

vaccine

antigen that stimulates antigen-antibody reaction; made from the infectious agent, which is altered to ↓ its pathogenicity

accidents (unintentional injuries)

what is the #1 safety concern for those 1-19 years old?

-fear of adverse effects

-not wanting child to have pain

-inaccessibility of medical care

-no regular medical care

-anti-vaccine movement

what are some barriers to immunizations?

-required to get "informed consent" for each immunization

-make sure parents understand the information

-give information to take home

as a nurse, what is our role regarding vaccine education?

-burns

-drowning

-falls

-poisoning

-road-traffic

what are some examples of unintentional injuries?

-mismatch child's developmental level and skill required for activity

-natural curiosity & the desire to challenge rules

-seek peer approval and acceptance

what are some developmental characteristics to take into account related to safety?

-infant: sensorimotor (explores through taste and touch)

-young child: lacks awareness of dangers (drowning, fire)

-school age: attempts dangerous acts without planning consequences

-adolescent: preoccupied w/ abstract thinking and loses sight of reality

what are some cognitive characteristics (age specific) to take into account related to safety?

birth through age 2

how long should a child's car seat be rear facing in the back seat?

between ages 2-4 or when they weigh 40 lbs

at what point can a child's car seat be forward facing?

ages 4-8 or until 4'9" tall

at what point can a child use a booster seat?

after age 8 and/or 4'9" tall

at what point can a child use a seat belt?

severe physical abuse --> child is defenseless and cannot speak for themselves, parents are frustrated

what kind of abuse is most likely to occur in children under the age of 2? why?

mothers

who is most likely to be the abuser for infants that died within the first week of life/month?

fathers/boyfriends

who is most likely to be the abuser for children who die after the first week until age 3 years?

unrelated perpetrators

who is most likely to be the abuser for children after the age of 3 years old?

physical abuse

type of child maltreatment involving hitting, biting, kicking, shaking, choking, burning, throwing objects

neglect

type of child maltreatment that involves willfully failing to provide for a child's basic needs (food, clothing, shelter, medical treatment, guidance, supervision)

emotional abuse

type of child maltreatment that involves a pattern of behavior that attacks a child's emotional development; belittling, humiliating, rejecting

Munchausen Syndrome by Proxy

when parents make up or produce physical illness in their children in an effort to get sympathy and be admired for their dedication to their children

-very few are mentally ill

-often someone familiar to the child

-abusers often have low self-esteem

what are some basic characteristics of those who mistreat children?

-stress

-children < 6 years old

-children w/ physical/emotional handicaps

-adopted children

why are children maltreated?