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176 Cards in this Set
- Front
- Back
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What is the biggest cause of hospitalization in children ages 1 to 4 years? |
Diseases of the respiratory system |
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What is the biggest cause of hospitalization in children ages 15 to 19 years? |
Pregnancy and childbirth |
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What are the 4 phases of nursing care for hospitalized children? |
1. Introduction 2. Building a trusting relationship 3. Decision - making phase 4. Providing comfort and reassurance |
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What are the different types of hospital admissions for children? |
•General inpatient unit •Rehabilitation unit or hospital •Outpatient or special procedures unit •Pediatric intensive care unit •Emergency and urgent care department (GROPE) |
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What is the focus of atraumatic care? |
Minimizing or eliminating the psychological and physical distress experienced by children and their families in the health care system. |
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What are the techniques for providing atraumatic care? |
* Therapeutic communication (goal, focused) * Therapeutic play (helps child to cope) * Child eduction (use appropriate language) |
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What are the methods to promote coping in children? |
* Breathing techniques * Distraction techniques * Imagery * Music * Child teaching before events |
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What are some techniques for improving learning in patients and parents? |
* Slow down and repeat info often * speak in conversational style using plain language * "chunk" information in small bites * Prioritize info and teach survival skills first * Use visuals * Teach using an interactive hands on approach and ask them to demonstrate back |
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What is a cultural encounter? |
Participation in and interaction with persons of diverse cultural backgrounds. |
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What does cephalocaudal growth refer to? |
Growing from the head down. |
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What does proximodistal growth refer to? |
Growing or developing from the inside out. |
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When does an infant double and triple their birth weight? |
An infant, typically, doubles their weight by 6 months and triples their weight by 12 months. |
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How does an infant grow length or height-wise? |
Average of 1 inch a month for the first 6 months and then a half inch for the 2nd 6 months. |
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When does the posterior and anterior fontanels close by? |
The posterior fontanels typically close between 1 and 3 months. The anterior fontanels typically close between 12 and 18 months. |
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What are the primitive newborn reflexes? |
* Moro * Rooting * Suck * Asymmetric tonic neck * Plantar and Palmar Grasp * Step * Babinski * Head Lag |
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What are the newborn states of consciousness? |
* Deep Sleep - infant lying quietly without movement * Light sleep - infant may move a little while sleeping and startle to noises * Drowsiness - eyes may close; the infant may be dozing * Quiet alert state - infant's eyes are wide open and body is calm * Active alert state - infant's face and body move actively * Crying - infant cries, body moves in disorganized fashion |
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What are the differences in the respiratory systems of an adult and child? |
•The nasal passages are narrower. •The trachea and chest wall are more compliant. (more susceptible to collapse) •The bronchi and bronchioles are shorter and narrower. •The larynx is more funnel shaped. •The tongue is larger. (compared to the oral cavity – any swelling can cause a problem) •There are significantly fewer alveoli. (fewer gas exchange) |
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How does the cardiovascular system mature in the first year of life? |
•The heart doubles in size. •The average pulse rate decreases from 120 to140 in the newborn to about 100 in the 1-year-old. •Blood pressure steadily increases, from an average of 60/40 in the newborn to 100/50 in the 12-month-old. •The peripheral capillaries are closer to the surface of the skin, making the newborn and young infant more susceptible to heat loss. •Thermoregulation becomes more effective. |
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What is the normal pulse and BP in an infant? |
* Pulse 120-140 * BP 60/40 |
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What is the normal pulse and BP in a 1 year old? |
* Pulse about 100 * BP about 100/50 |
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Describe a newborn's immunity. |
•The newborn exhibits decreased inflammatory response to invading organisms, increasing susceptibility to infection. –This factor along with inability to thermoregulate means temp >100.4 in any infant less than 12 weeks is considered a “fever”and requires medical intervention •Cellular immunity is generally functional at birth; humoral (in EC fluid) immunity develops over time. |
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Because an infant's renal system is immature, what is recommended? |
That NSAIDS not be used in infants younger than 6 months (like ibuprofen). |
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What is the first vaccination an infant is given? |
Hepatitis B vaccine given at birth. |
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What is the second (or second round) of vaccinations given to an infant and when? |
At 2 months, the first doses of vaccinations are given of: * Rotovirus (2 doses) * Dtap - Diptheria, Tetanus, Acellular pertussis (3 doses) * Hib - Haemophilus influenzae type b (2 doses) * Pneumococcal conjugate - PCV (4 doses) * Inactivated polio virus - IPV (4 doses) |
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What are the vaccinations given starting at age 1 year? |
* MMR * Varicella * Hep A (if wanted) |
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When is the flu shot given to children? |
* IIV only at 6 months * Either shot give annually starting at age 2 |
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What vaccinations are give at ages 11 to 12 years? |
* HPV * Meningococcal vaccine |
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How does a nurse assess development of a premature infant? |
Subtract the number of weeks that the infant was premature from the infant’s chronological age then plot growth parameters and assess developmental milestones based on what is expected of the adjusted age. |
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What is the name of Erikson's developmental theory of infants? |
Trust Vs. Mistrust - Caregivers respond tobasic needs of the infant which creates a sense of trust |
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What is Piaget's developmental theory of infants? |
Sensorimotor stage: birth to 2 years - Children learn through their senses andexploration of the environment surrounding them |
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What is object permanence? |
Part of Piaget's cognitive development theory that develops between 4 and 7 months of age and solidified by 8 months. The ability to recognize objects are still there even if they are not seen. |
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At what age does a child recognize that they are separate beings from the parents or caregiver? |
12 months |
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What is the development of gross motor skills in infancy? |
1-3 months - gets better at lifting head in prone position 4 months - rolls from prone to supine 5 months - rolls from supine to prone 6 months - sits in tripod 7 months - uses hands to support as sits alone 8 months - sits unsupported 9 months - crawls with abdomen off floor 10 months - pulls to stand, cruises 12 months - sits from standing position, walks |
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What is the development of fine motor skills in infancy? |
1 month - fists mostly clenched 3 months - holds hand in front of face, hands open 4 months - bats at objects 5 months - grasps rattle 6 months - releases object in hand to take another 7 months - transfers object from one hand to another 8 months - gross pincer grasp 9 months - bangs objects together 10 months - fine pincer grasp, puts objects into container to take them out 11 months - offers objects to others and releases them 12 months - feeds self with cup and spoon, makes simple mark on paper, pokes with index finger |
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What are the warning signs that indicate a problem with sensory development in an infant? |
•Young infant does not respond to loud noises •Child does not focus on a near object. •Infant does not start to make sounds orbabble by 4 months of age. •Infant does not turn to locate sound at age 4months. •Infant crosses eyes most of the time at age 6months |
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How does language develop in an infant? |
•Crying initial means of communication, can be frustrating for caregivers •Cooing & differentiated crying (1-3months) •Laughing, raspberries, vocalizes in response to voice (4-5 months) •Babbling, responding to simple commands (7-10 months) •Attaching meaning to simple words and imitating speech sounds, mama, dada, no (9-12 months) •Should have 2-3 recognizable words with meaning – by 1 year |
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What are the warning signs that indicating a problem with language development in an infant? |
•Infant does not make sounds at 4 months ofage. •Infant does not laugh or squeal by 6 monthsof age. •Infant does not babble by 8 months of age;infant does not use single words with meaning at 12 months of age (mama, dada).(identifier) |
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What is temperament? |
The natural predisposition of a person, or infant. Ranges from low to moderately active, regular, and predictable, to highly active, more intense, and lessadaptable. |
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When do stranger and separation anxiety appear? |
Around 8 months when the infant recognizes self as separate from others |
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What are the rules of infant feeding? |
* No honey until 1 year (botulism) * No cow's milk until 1 year (calcium interferes with iron absorption) * No water for 1st 6 months (no electrolytes) * Solids can start at 6 months (small amounts - start with iron fortified cereals) * introduce 1 new food at a time (3-5 days apart) |
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What kind of supplements do infants need? |
* Vitamin D if breastfed exclusively * Flouride by 6 months if not consuming flouridated water * Iron for breastfed infants |
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What are some common food allergens that should be avoided in the first year of an infant's life? |
•Cow’s milk •Eggs (maybe 10 months) •Peanuts •Tree nuts •Sesame seeds •Kiwi fruit •Fish and shellfish |
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What are the exceptions to recommended breastfeeding? |
• Infants with galactosemia • Maternal use of illicit drugs and a few prescription medications • Maternal untreated active tuberculosis • Maternal HIV infection in developed countries |
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What is colic? |
Baby crying for 3 or more days a week, 3 hours or longer a day for up to 3 months |
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When should spitting up be a concern? |
When the baby is not gaining weight, projectile vomiting or vomiting blood |
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What is the concern about pacifiers? |
That they may confuse the breastfeeding baby and maybe should be withheld until 1 month of age |
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What happens during teething, or tooth eruption? |
Lots of drooling. It is said not to use numbing gels anymore and maybe to use a raw carrot or fruit wrapped in mesh. |
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What is defined as the toddler years? |
Years 1 to 3 |
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Describe the physical appearance of a toddler. |
Appear short with protuberant bellies. Head size becomes more proportional by age 3. |
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How does the height and weight develop in a toddler? |
* Increases steadily in spurts but at a slower pace than at infant stage * Generally reach half adult height by age 2 * Average weight gain is 3 to 5 lbs per year. * Height increases an average of 3 inches per year. |
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When does the anterior fontanel close? |
Around 18 months |
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How does the neurologic system develop in toddler years? |
Brain reaches 90% of it's adult size by age 2 |
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How does the respiratory system develop in toddler years? |
Alveoli increase in number until age 7;trachea and airways small compared to adult |
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How does the cardiovascular system develop in toddler years? |
Heart rate decreases, blood pressure increases |
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How does the gastrointestinal system develop in toddler years? |
Stomach increases in size; small intestine grows in length; stool passage decreases. (changes still happen based on diet) |
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How does the genitourinary system develop in toddler years? |
Bladder and kidney reach adult function by 16 to 24 months; bladder capacity increases; urethra remains short. |
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How does the musculoskeletal system develop in toddler years? |
Bones increase in length; muscle matures; swayback and pot belly appear due to weak muscles until 3 years old. |
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What is preoperational stage? |
Piagets 2nd stage of cognitive development that happens in toddler years to age 7. Objects begin to have characteristics that make them unique from one another. |
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How does Piaget describe cognitive development of a toddler? |
•Preoperational thought •Toddlers view the world directly •Language is used as self entertainment and remains egocentric •Ritualism – children require consistency •Animism – imaginary friends, talking to dolls, trucks are talking, etc. Begin to see differences colors, shapes, clothes |
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What does Kohlberg believe about moral development of toddlers? |
• Stage 1; Premorality – toddlers believe actions are wrong only if we get in trouble for them and right if not punished for them • Educate caregivers regarding importance of limit setting and discipline during this stage of development |
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What are the theories on development of toddlers? |
* Piaget's theory focuses on development of the senses of the toddler * Erikson's theory focuses on achievement of autonomy and self-control * Kohlberg's theory focuses on the moral development of the toddler * Freud's theory focuses on the satisfaction and/ or frustration of expelling feces. |
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What's the difference between fine and gross motor skills? |
* Gross motor skills refer to large movements like walking, running, jumping, etc. * Fine motor skills refer to more refined movements like coloring, using utensils, drinking from a cup, etc. |
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Why are toddlers more at risk of accidental ingestion? |
Toddlers lack a complete taste discrimination. |
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What is receptive language development in toddlers? |
The ability to understand what is being saidor asked–Typically far more advanced than expressive language development |
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What is expressive language development in toddlers? What are two common occurrences? |
The ability to communicate desires and feelings. Echolalia and Telegraphic speech. |
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What is echolalia? |
Repetition of wordsand phrases without understanding |
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What is telegraphic speech? |
Speech that contains only the essential words to get the point across. “Me do”“Mommy go potty” |
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Explain the emotional and social development of the toddler. |
1. Focus - separation - seeing oneself as separate from parent 2. Individuation - –Forming a sense of self and learning to control one’s environment leads to emotional lability. 3. Egocentrism - Focus on self "Me do", "I do" |
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What does therapeutic play do for toddler growth and development? |
• Play is the major socializing medium for toddlers. • Toddlers need 30 minutes of structured physical activity and 1 to 3 hours of unstructured physical activity per day. • Parents should limit television and encourage creative and physical play instead. • Toddlers engage in parallel play (playing alongside another child) instead of cooperative play. • Toddlers are egocentric and do not like to share. • The short attention span of toddlers will make them change toys frequently. • Toddlers do not need expensive toys. |
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What are the sleep requirements for the toddler? |
* For the 18 month old - 13.5 hrs a day * For the 24 month old - 13 hrs a day * For the 3 year old - 12 hrs a day * sleeping through the night and 1 daytime nap * napping typically ends around 3 years * teach caregiver the importance of establishing good sleep hygiene (ie consistent bed time routine) |
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What are the signs of developmental delay in an 18 month old toddler? |
Not walking, speaking 15 words, doesn't understand function of common household items |
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What are the signs of developmental delay in a 12 month old toddler? |
After walking independently for months, the toddler is persistently tiptoe walking or does not develop a mature walking pattern |
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What are the signs of developmental delay in a 24 month old toddler? |
Does not use 2 word sentences, does not imitate actions, does not follow basic instruction, cannot push a toy with wheels |
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What are the signs of developmental delay in a 3 year old toddler? |
* Difficulty with stairs * Frequent falling * Cannot build tower of more than 4 blocks * Difficulty manipulating small objects * Extreme separation anxiety * Cannot copy a circle * Does not engage in make believe play * Cannot communicate in short phrases * Does not understand simple instruction * Little interest in other children * Unclear speech, persistent drooling |
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What are the daily nutritional requirements of toddlers? |
* 500 mg. of calcium * 20 - 30% of calories should be from fat * less than 10% should be from saturated fat * 19 grams of fiber |
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What are some good sources of fiber? |
* applesauce * carrots * corn * green beans * mangos * pears |
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What are some good sources of vitamin A? |
* apricots * cantaloupe * carrots * mangos * spinach (and dark greens) |
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What are some good sources of folate? |
* avocados * broccoli * green peas * oranges * spinach (and dark greens) * strawberries |
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What are some good sources of vitamin C? |
* broccoli * cantaloupe * green peas * oranges * Potatoes * strawberries * tomatoes |
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What are some good sources of calcium besides the obvious milk, yogurt, cheese? |
* Broccoli
* oranges * sweet potatoes * tofu * died beans * legumes |
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What are some common developmental concerns of the toddler? |
* toilet training - common to be trained and regress during stressful times * negativism - always saying "no" * temper tantrums - acknowledge and ignore, have a quiet place to take a time out * thumb sucking and pacifiers - pacifiers should not be given to toddlers * sibling rivalry and aggression are common |
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What are the signs that a toddler is ready for toilet training? |
• Regular bowel movement • Expresses knowledge of need to defecate or urinate • The diaper is not always wet. • The toddler is willing to follow instructions. • The toddler walks well alone and can pulldown pants. • The toddler follows caregiver to bathroom. • The toddler climbs onto potty chair ortoilet. |
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Describe the focus of discipline for a toddler. |
• Parents should have realistic expectations • Use firm but gentle guidance, consistency is KEY • Limit setting • Time outs 1 minute per year of age • Negotiation if cognitively able • Techniques to assist the toddler to learn problem solving • AAP, NAPNAP do not advocate spanking or other violent means of discipline |
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Describe the growth development of the preschooler. |
• Average growth of 2.5 to 3 inches per year • Average weight gain around 5 pounds per year • Loss of baby fat and growth of muscle • Length of skull increases slightly; lower jaw more pronounced; upper jaw widens • Full set of 20 primary teeth should be present at start of preschool period |
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What makes a good gift for a preschooler? |
Arts and crafts - developing fine motor skills |
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Describe the maturation of the organ system in preschoolers. |
• Myelination of the spinal cord allows for bowel and bladder control to be complete; small intestine grows in length. • Respiratory structures continue to grow in size; number of alveoli increase. • Eustachian tubes remain short and straight. • Heart rate decreases; blood pressure increases slightly; innocent heart murmur may be heard. • Urethra remains short in children, making them susceptible to urinary tract infections. • Bones increase in length and muscles strengthen and mature. |
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Describe Erikson's psychosocial development of the preschooler |
• In Erikson’s stage of development: Initiative vs. Guilt –Preschooler is an inquisitive and enthusiastic learner. –Feels sense of accomplishment by succeeding in activities –Feeling pride in accomplishment stimulates initiative –Overextending self can result in sense of guilt • Superego (conscious development) is completed and is basis for moral development. |
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Describe the cognitive development of the preschooler |
• Magical thinking– Believes thoughts are all-powerful (if their siblingis sick, they make think they caused it) • Imaginary friend–Creative way to sample activities and behaviors and practice conversation skills • Transduction–Extrapolates from one situation to another • Animism –Attributes life-like qualities to in animate objects |
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What is transduction? |
Extrapolating from one situation to another |
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What is Piaget's cognitive developmental theory? |
• Pre-operational thought based on a self centered view of the world • Approaches problems from a single point of view – egocentric • Short attention span • Learns through observing and imitating • Active imagination –lying may begin to occur – what’s the story and how it came about • Moral standards are those of caregivers, not necessarily their own, adherence is to gain reward or avoid punishment |
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What are the social skills developed by the preschooler? |
• Cooperation • Sharing (of things and feelings) • Kindness • Generosity • Affection display • Conversation • Expression of feelings • Helping others • Making friends |
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What is the emotional and social development of the preschooler? |
• Friendships–Preschoolers learn how to make and keep afriend. • Temperament –Indicator of parent’s expectation of child’s behavior–Determines child’s task orientation, social flexibility, and reactivity • Fears–Preschoolers exhibit variety of fears Parents should acknowledge child’s fears |
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What are the issues involved in promoting growth and development of the preschooler? |
• Building self-esteem • Maintaining routine and ritual • Setting limits and remaining consistent withthem • Knowing signs of developmental delay • Promoting well care visits • Promoting adherence to immunization schedule |
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What are some signs of developmental delay in a 4 year old? |
* Cannot jump in place or ride a tricycle * Cannot stack 4 blocks * Cannot throw a ball overhand * Does not grasp a crayon with thumb and finger * Has difficulty scribbling * Cannot copy a circle * Does not use sentences with 3 or more words * Cannot use words "me" and "you" appropriately * No interest in interactive games or other kids * Does not respond to people outside of family * Resists toilet training, dressing or sleeping * No fantasy play |
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What are some signs of developmental delay in a 5 year old? |
* is unhappy or sad often * No interest in playing with other kids * Unable to separate from parent * Extremely aggressive * Extremely fearful, timid or unusually passive * Cannot build a tower of 6 to 8 blocks * Cannot concentrate on single activity for 5 min * Rarely engages in fantasy play * Has trouble eating, sleeping, or using toilet * Cannot use plurals or past tense * Cannot brush teeth, wash and dry hands, or undress efficiently |
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What is the focus of nursing care to promote growth and development of the preschooler? |
* Promoting growth through play * Promoting early learning * Promoting language development * Choosing a preschool/starting kindergarten – reading, reading! * Promoting safety * Promoting nutrition * Promoting healthy sleep and rest * Promoting appropriate discipline |
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How much iron and calcium is needed by a preschooler on a daily basis? |
* 10 mg. of iron * 500-800 mg. of calcium daily * 19 mg. of fiber * Caution parents on excess use of milk as calcium blocks iron absorption |
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What are the developmental issues for preschoolers? |
• Lying • Sex education • Masturbation • Safety regarding child’s own body – good touch, bad touch discussion |
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What is the focus of health care visits throughout childhood? |
• Expected growth and development • Anticipatory guidance • Preparation for school entry • Adherence to immunization schedule • Health promotion • Screening for “at risk” individuals Hearing and vision screenings |
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Describe the physiologic growth of the school age child. |
• Grow an average of 2 inches per year • Increase in height by at least 1 foot • Increase weight by 4 to 6 pounds • Secondary sexual characteristics appear.–Precocious puberty (6 years and younger) –Good time for teaching about human body and changes that are happening • Full sets of VS at well visits – BP–Start change of habits if at risk |
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Describe the neurologic System maturation for the school age child. |
• Neurologic system: brain and skull grow very slowly; shape of head is longer; growth of facial bones changes facial proportions. |
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Describe the respiratory System maturation for the school age child. |
Continues to mature with development of lungs and alveoli; respiratory rates increase; respirations diaphragmatic in nature –Tonsils may be enlarged (not pathogenic) |
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Describe the cardiovascular System maturation for the school age child. |
Cardiovascular system: blood pressure increases and pulse rate decreases. |
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Describe the immune System maturation for the school age child. |
Matures to adult level around 10 years old; fewer infections experienced – teach good hand washing!! (norovirus, lice, strep) |
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Describe the gastrointestinal System maturation for the school age child. |
Deciduous teeth replaced by permanent teeth; fewer gastrointestinal upsets; stomach capacity increases; caloric needs are lower.(anxiety can manifest itself as stomach ache) |
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Describe the genitourinary System maturation for the school age child. |
Bladder capacity increases (age in years + 2 ounces); prepubescence occurs. |
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Describe the musculoskeletal System maturation for the school age child. |
Greater coordination and strength; muscle still immature and can easily be injured– teach them how to protect themselves – padding,rest any injury, wear protective gear – at high risk for injuries – try to convince parents that it’s okay to sit out this game |
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Describe Erikson's psychosocial development theory of the school age child. |
• Erikson’s stage of industry vs. inferiority • Children want to feel a sense of accomplishment and self worth– encourage the self worth, not everyone is going to succeed at everything, keep things realistic • Role of the adult is to identify areas of competency and build on the child’s successful experiences to promote mastery, success and self esteem • Keep expectations realistic and make goals attainable or sense of inferiority and incompetence will occur |
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Describe Piaget's stage of cognitive development of concrete operational thoughts of school age children. |
• Assimilates and coordinates information about the world from different dimensions • Sees things from another person’s point of view • Thinks through an action, anticipates consequences and the possibility of having to rethink the action • Stores memories of past experiences to evaluate present situations • Divides things into different sets and identifies relationships to each other • Understands the principle of conservation: matter does not change when its form changes |
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What is Kohlberg's stage 3 developmental theory for the school age child? |
• 7-10 yrs old followsrules out of a sense of being a “good person”, adult viewed as being right –Make sure to do a family assessment – ifadult is NOT doing right, they will still believe it is |
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What is Kohlberg's stage 4 developmental theory for the school age child? |
• 11-12 yrs “law andorder” stage, child can determine if an action is good or bad based on the reason of the action not just on possible consequences –Make sure to focus on the behavior, notthe child – if the child makes a bad choice, the child is not a bad child |
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Why is team sports important as a physical activity for the school age child? |
* It is helpful for the focus to not be on the win, but on player development. * Helps in development of leadership and following skills * All the other benefits that physical activity brings |
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Describe the language and communication skills of the school age child. |
• Vocabulary expands to 8,000 to 14,000 words. – reading is vital to them as babies and younger kids • Culturally specific words are used. (Bilingual kids willbe fluent at this point) • Reading efficiency improves language skills. • More complex grammatical forms are used. • Development of metalinguistic awareness occurs. Metaphors are beginning to be understood |
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What are the emotional and social developmental issues of the school age child? |
• Temperament • Self-esteem development • Body image– happening younger and younger – girls have a lower self esteem and may develop depression – need to have communication about what’s happening • School-age fears - • Peer relationships • Teacher and school influences – adolescenceis around the corner – teach what’s next – no judging • Family influences - still the biggest influence |
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Describe the sensory development of the school age child. |
• All senses are mature. • Typical child has 20/20 vision acuity. • Ocular muscular control, peripheral vision,and color discrimination are developed by age 7. |
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What vision problems are frequently identified during the school age years. |
• Amblyopia - lazy eye - (Causes Cross-eyed, Nearsightedness, Farsightedness, Astigmatism) • Uncorrected refractive errors or other eyedefects • Malalignment of the eyes (strabismus) |
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What are the nutritional needs of the average weight school aged child? |
• 70 calories per kilogram daily (1,400 to2,100 calories/day) – they’re active more so they may eat more • 1,800 to 2,100 mL of water per day • 28 grams protein • 800 mg calciumNeed fiber |
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How do parents conduct appropriate discipline at home? |
• Children learn the natural and logical consequences of discipline. • Parents should teach children rules established by the family, values, and social rules of conduct. • Discipline should focus on the development of the child. – taking away privileges (the phone, TV, etc.) • Parents should discipline with praise. |
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What are the developmental concerns for the school age child? |
• Television and video games – limit to 2 hours of screen time – concerns about the computer in the bedroom and having social media • School phobia • Latchkey children– personal safety • Stealing, lying, cheating • Bullying– cyber bullying, verbal bullying – rates of suicide |
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How can parents promote sleep and rest for a school age child? |
• 12 hours of sleep required • Should have bedtime expectations and wake-uptimes • Night terrors and sleepwalking may occur but should resolve by age 8 to 10 years |
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Describe the physiologic growth and development of the adolescent. |
• Rapid growth occurs with dramatic changes inbody size and proportions second only to growth in infancy. • Sexual characteristics and reproductive maturity occur. – have communication BEFORE it occurs • Puberty begins in girls around 9 to 10 yearsold and in boys around 10 to 11 years old. • Adolescents represent varying levels of identity formation.Need our support and guidance – risky behavior |
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What are the physiologic changes in adolescents? |
* The first ejaculation in boys and menarche in girls * Breast buds developing in girls and enlarging of the scrotum in boys * Pubic hair takes on a larger distribution for both sexes * Enlarging of breasts in girls and penis in boys |
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When is growth the fastest in boys and girls? |
Peak height velocity occurs at around 12 years of age for girls and 14 years for boys. |
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Describe the neurological system maturity in the adolescent. |
Growth of myelin sheath enables faster neural processing.– risky behavior leaves us open to risk of head injury (drugs, driving fast, etc.) |
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Describe the cardiovascular system maturity in the adolescent. |
Size and strength ofheart increases; systolic blood pressure and heart rate increase. |
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Describe the gastrointestinal system maturity in the adolescent. |
Full set of permanent teeth; liver, spleen (mono can enlarge the spleen – need to sit out any sports), kidneys, and digestive tract enlarge. |
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Describe the musculoskeletal system maturity in the adolescent. |
Ossification of skeletal system is incomplete until late adolescence in boys and occurs earlier in girls; shoulder, chest, and hip breadth increase. |
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Describe the integumentary system maturity in the adolescent. |
Skin is thick and tough; sebaceous glands are more active; sweat glands function at adult level. (acne, body odor) |
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Describe Erikson's theory of psychosocial development in the adolescent. |
• According to Erikson, adolescence is when the teen achieves a sense of identity • Starting to gain a sense of who they are in relationship to the world around them/what their role is society, family, peer groups may be • “adolescent culture”very important to the teenager – changes over the years, know the latest and greatest • Erikson believed the adolescent revisits each of the previous stages of development in order to achieve “sense of identity” |
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Describe Piaget's theory of cognitive development in the adolescent. |
• Adolescent progresses from a concrete framework of thinking to abstract thought • Formal operational period • Early stages thinkingis egocentric gradually progressing to introspection • “why can’t I do thingsmy way?” “My friends and I have better ideas” “parents think they knoweverything” • Feeling of invincibility which can lead to increased risky behavior |
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What is Kohlberg's moral theory of development in the adolescent? |
• Post conventionalLevel III (early,middle,late) • Morals based on peers,family, church, society • Beginning to develop own sense of values and morals as well by questioning the status quo • Choices based on emotions while questioning society • May lead to changes in social groups as conflicting “values” among peers occurs |
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What are the areas of focus to encourage growth and development in the adolescent? |
• Sports and physical fitness • Learning and participation in school activities • Safety issues– personal safety • Proper nutrition and healthy eating habits • Healthy sleep and rest – 8 hours of sleep • Personal care/Oral Hygiene • Healthy sexual life – keep talking, need to talk about STDs –ask specific questions – is someone touching you? • Appropriate discipline • Know who the friends are |
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What are the 5 "A"s of parenting? |
1. Aware of who the friends are, what they're doing, etc. 2. Alert to changes in behavior, friends, school performance 3. Awake - meaningful interchanges, take an interest in what they're doing, what they like 4. Assertive - You are the parent, not a friend (that's not the same as not loving them) 5. Affirmation - make sure the child knows that he's loved and valued |
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Describe the emotional and social development of the adolescent. |
• Undergo great deal of change as they grow and mature into adults • Relationships with parents, siblings may be strained as they attempt to achieve “identity” • Self concept and selfesteem are often tied to body image • Importance of peers • Sexuality and dating • Role of the RN is tostress the importance of open communication between caregiver/adolescent andprovide resources and support for both |
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Name some ways to improve communication with teens. |
* Set aside time to discuss subjects * Talk face to face * Ask questions * Ask them to be patient as you talk * choose words carefully to be understood * Tell them exactly what you mean * Give praise and approval often * Speak to them as an equal - don't talk down * Be aware of your tone and body language * Don't pretend to know it all * Admit that you make mistakes * Set rules and limits fairly |
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What influence do peers have on adolescents? |
• Play essential role in identity of the adolescent • Provide opportunities to learn negotiation ofdifferences • Provide recreation, companionship, and someone to share problems with • Teach peer loyalty • Create stability in times of stress or transition • Serve as credible sources of information and social reinforcement - Can have positive or negative influences on each other |
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What are the safety/ developmental concerns for adolescents? |
• Unintentional injuries • Motor vehicle safety – drunk, distracted (phone), accounts formore deaths than drunk driving • Firearm safety– suicides are on the rise, men tend to die more even though attempts are equal • Water safety– on water equipment with substance abuse and risky behavior • Drug Use– prescription meds too • Alcohol Use • Teen Pregnancy– on the decline but still present • Sexual health – protecting one’s self, respecting one’s self • Sun safety – tanning beds |
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What are some topics for discussion to discourage substance abuse? |
• Short- and long-term effects of alcohol, tobacco, and drugs on health • Risk factors and implications for unintentional injuries and sexual activity • The how and why of chemical dependency • Impact of substance abuse on society • Importance of maintaining a healthy lifestyle • Importance of resisting peer pressure to use drugs and alcohol • Importance of having confidence in teen’s ownjudgment |
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What information is included in a nutritional assessment for an adolescent. |
• Evaluation of foods from the different food groups that the adolescent eats each day • The number of times that fast foods, snacks, and other junk food are eaten per week–This assessment will help the nurse to guide the adolescent in making better food choices at home and in fast-food establishments. –Need three calcium sources a day |
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What factors influence the adolescent's diet? |
* Peer pressure * Busy schedule * Concern about weight control (a sport may have a weight need - may cause an eating disorder) * Convenience of fast food |
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What are the risks of being involved in an unhealthy relationship? |
* Dating violence * Risky sexual activity (STIs) - if someone truly cares about you, they're not going to make you do something you're not comfortable with * Premature pregnancy * Suicide * Conflict between the parent and the adolescent |
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How do you promote proper hygiene for adolescents? |
• Encourage frequent bathing and deodorant use. • Encourage washing face two to three times aday. • Discourage squeezing acne lesions andvigorous scrubbing of face. • Encourage frequent shampooing of hair. • Teach care for body piercings and tattoos. • Discourage suntanningesp. tanning booths•Encourage use of sunscreen |
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How does a nurse care for a hospitalized adolescent? |
• Provide opportunities for adolescent to maintain independence. • Allow adolescent to participate in decisions. • Encourage socialization with friends through phone, e-mail, and visits when possible. |
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What are some factors contributing to adolescent violence? |
* Crowded conditions / housing * Low socioeconomic status * Limited parental supervision * Single parent families/ both parents in the workforce * Access to guns or cars * Drug or alcohol use * Low self-esteem * Racism * Peer or gang pressure * Aggression |
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What are the risk factors for suicide in adolescents? |
* Depression or mental illness * Mental health changes * History of previous suicide attempt * Family history of suicide * Poor school performance * Family disorganization * Substance abuse * Homosexuality * Giving away valued possessions * Being a loner / no close friends * Changes in behavior * incarceration |
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What is the third leading cause of death in adolescents? |
Suicide |
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What is dyslexia? |
Children with this have difficulty with reading, writing, and spelling. |
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What is dyscalculia? |
Children with this have difficulty with mathematics and computation.
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What is dyspraxia? |
Children with this have problems with manual dexterity and coordination. |
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What is dysgraphia? |
Children with this have difficulty producing the written word (composition, spelling, and writing). |
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What assessments are needed for a child with a cognitive or mental health disorder? |
• Health history, noting the child’s prenatal and birth history – genetic testing • Past medical history (including previously diagnosed cognitive or mental health disorders), symptoms or behaviors parents are concerned about • History of neurologic injury or disease and family history of mental health disorder • Developmental history, noting age of attainment (or loss) of milestones (loss of a milestone is a red flag) • Physical assessment • Diagnostic Testing when indicated, Brain MRI,CT |
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What factors influence a child's behavior? |
• Biologic or genetic characteristics • Nutrition – may changechild’s behavior • Physical health • Developmental ability • Environmental and family interactions • The child’s individual temperament • The parents’ or caregiver’s responses to the child’s behavior |
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Name some facts about mental health of children / adolescents. |
• As many as 1 in 5 children may be suffering from a mental health related problem • Mental illness manifested in the early years increases the risk of adolescent emotional issues, use of firearms, reckless driving, substance abuse and promiscuous sexual activity • Surgeon General’s“National Agenda for Action” is an important initiative to raise mental health awareness |
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Name some developmental and behavioral disorders. |
• Learning disability • Intellectual disability – IQ <70 to 75, disability occurring before age 18, coexisting deficits in at least 2 adaptive skills • Autism Spectrum Disorder – 4 to 5 Xmore likely in males than females, etiology is unknown, manifests differentlyin different kids, impairs verbal communication and social life • ADHD • Tourette Syndrome • Eating Disorders • Mood Disorders • Anxiety Disorders • SubstanceAbuse/Violence |
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Describe the autistic spectrum disorder. |
• Developmental disorder of the brain function characterized by deficits in behavior and oftenintelligence • Interferes with ability for social interactions and impairs verbal communication • Affects males morefrequently • Etiology unknown • Severity ranges from mild (Asperger’s) to severe with symptoms becoming apparent by 3 years of age |
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What are the autism screening tools? |
• Checklist for Autism in Toddlers (CHAT) • Modified Checklist for Autism in Toddlers(M-CHAT) • Social Communication Questionnaire (SCQ) • Pervasive Developmental Disorders ScreeningTest-II (PDDST-II) |
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What are the warning signs of autism? |
• Not babbling by 12 months • Not pointing or using gestures by 12 months • No single words by 16 months • No two-word utterances by 24 months • Losing language or social skills at any age • Disinterest in being held or cuddled • Avoids eye contact • Minimal facial responsiveness • Does not engage in social play with others |
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What are the nursing interventions for families of children with autism? |
• Provide emotional support. • Provide professional guidance and education about the disorder. • Assess the fit between the child’s developmental needs and the treatment plan. • Help parents overcome barriers to obtain appropriate education, developmental, and behavioral treatment programs. • Stress the importance of rigid, unchanging routines. • Assess the parents’ need for respite care and make referrals. • Provide positive feedback to parents for their perseverance in working with their child. |
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What are the nursing interventions for the child with autism? |
• Maintain safeenvironment – some children are self abusers (banging head against wall) • Provide closesupervision • Maintain consistentroutines if hospitalized • Prior to dischargeclient and family should have referrals to PT/OT/Speech as needed • Early intervention KEYTO MAXIMIZE outcomes of autistic children |
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What are the three sub-types of ADHD and what percent of kids have it? |
• Hyperactive–impulsive • Inattentive • Combined • 5 – 10% of kids have it |
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Describe ADHD |
• More prevalent in boys • Failure to listen and follow instructions • Difficulty playing quietly or sitting still • Disruptive, impulsive behavior • Distractibility,excessive talking • Not finishing tasks • Underachieving in school performance • Signs and symptoms show by the age of 12 |
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What are the different types of therapy? |
* Behavioral (stimulus & response conditioning) * Play therapy * Cognitive therapy (change reactions) * Family therapy * Group therapy * Milieu therapy (specially structured setting - for those who are very ill) * Individual therapy * hypnosis |
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What are some behavior management techniques? |
• Set limits and hold child responsible for behavior. • Do not argue, bargain, or negotiate about the limits set. • Provide consistent caregivers and establish a daily routine. • Use a low-pitched voice and remain calm. • Redirect the child’s attention when needed. • Ignore inappropriate behaviors. • Praise the child’s self-control efforts. • Provide safe comfortable environment • Decrease environmental stimuli • Administer medications as ordered (ifindicated) |
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What are some comorbid disorders of depression? |
• Suicide • Anxiety disorders • Substance abuse • Eating disorders • Self-harm- cutting • Disruptive behavioral disorders |
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What is depression? |
• Pathologic griefvreactions ranging from mild to severe • Mild – feeling sad, difficulty concentrating, difficulty maintaining usual activity level • Moderate –helplessness, powerlessness, decreased energy, sleep pattern disturbances, appetite and weight changes, slowed speech, thought movement (may also have opposite effect), focusing on negative feelings • Severe – hopelessness,worthlessness, guilt, shame, despair, flat affect, indecisiveness, lack ofmotivation, change in physical appearance, suicidal, delusional, sleep andappetite disturbances |
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What are some nursing interventions for depression? |
• Be direct with client about feelings and suicidal or homicidal ideation • Assist client withjournaling feelings, thoughts • Assist client withparticipation in support groups • Administer anti-depressants as indicated, encourage medication compliance and follow up with licensed professionals • Encourage family/caregiver involvement as appropriate |
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Who has higher rates of suicide among adolescents? |
* Native American Males * Gay * Bisexual teens * Females have a higher incidence of attempts and males are more likely to die |
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What types of anxiety disorders are there? |
• Generalized anxiety disorder (GAD) • Social phobia • Selective mutism • Separation anxiety • Obsessive-compulsive disorder (OCD) • Post-traumatic stress disorder (PTSD) |
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What are some teaching topics and psychosocial interventions for mood disorders? |
• Teach families that mood disorders are biologic conditions, not personality flaws. • Teach families how to administer antidepressant medication and to monitor for adverse effects. • Encourage and praise the child’s and family’s efforts at following through with cognitive and behavioral therapies. • Support the family throughout the process, as sometimes treatment may be lengthy. • Refer the family to local support resources. |
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What types of eating disorders are there? |
• Pica (eating of non-food substances) • Rumination (chew over and over) • Anorexia nervosa (refusal to eat - emaciated) • Bulimia (normal weight, will binge & purge) |
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What are the physical signs and effects of anorexia? |
* Loss of menstrual periods * Lack of energy and weakness * Feeling cold all the time * typically 15% below body weight * hair loss |
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What are some symptoms of anorexia? |
* Dry, yellowish skin * Constipation and abdominal pain * Restlessness and insomnia * Dizziness, fainting, and headaches * Growth of fine hair all over the body andface |
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What is the treatment and nursing management for anorexia? |
* Is difficult and multi-disciplinary * Nursing management focuses increasing self-esteem, getting nutritional counseling and family therapy |
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What are some signs of bulimia? |
* Weightgain * Abdominal pain, bloating * Swelling of the hands and feet * Chronic sore throat, hoarseness * Broken blood vessels in the eyes * Swollen cheeks and salivary glands * Weakness and dizziness * Tooth decay and mouth sores * Acid reflux or ulcers * Rupturedstomach or esophagus * Lossof menstrual periods * Chronicconstipation from laxativeabuse |
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What are some complications of anorexia and bulimia? |
• Fluid and electrolyte imbalance • Decreased blood volume • Cardiac arrhythmias • Esophagitis • Rupture of the esophagus or stomach • Tooth loss • Menstrual problems • Mortality rate may be as high as 18% |
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What are some warning signs of Munchausen Syndrome? |
• Child with one or more illnesses that do not respond to treatment or that follow a puzzling course; a similar history in sibling • Symptoms that do not make sense or that disappear when the perpetrator is removed or not present; the symptoms are witnessed only by the caregiver • Physical and laboratory findings that do notfit with the reported history • Repeated hospitalizations failing to produce a medical diagnosis, transfers to other hospitals, discharges AMA • Parent who refuses to accept that the diagnosis is not medical |
