Fundamentals Of Nursing - Exam 4

Front 1

Give the Ages Ranges
Infant:
Toddler:
Pre-Schooler:
School-Age Child:
Adolescent:

Back 1

Infant: Birth to one year
Toddler: 1-3 years old
Pre-Schooler: 3-6 years old
School-Age Child: 6-12 years old
Adolescent: 12-18 years old

Front 2

Sigmund Freud

Back 2

Sigmund Freud was an Austrian physician (1856-1939) who founded the psychoanalytic/psychosexual school of psychology. He is best known today for creating the field of psychoanalysis to treat psychological problems. He believed that sexual desire was the primary motivator for human behavior.

Today, many of his theories are no longer supported by psychosocial experts, and a number of flaws have been identified in some of his work. However, Freud's work remains important in the history of clinical psychoanalysis. His work in the field of growth and development continues to influence childhood assessment.

Front 3

Erik Erikson

Back 3

Erik Erikson (1902-1994) was a child psycho-analyst.

He was active in social psychology and believed that personality development occurs via a series of eight stages. Erikson believed that each stage was marked by conflict, and when resolved, resulted in a favorable outcome or "virtue".

Finding a balance in the conflict would enable the individual to move on to the next developmental stage.



Erikson emphasized the psychosocial aspects of development. His first five stages relate to infancy and childhood, his last three stages to adulthood. It is important to note that childhood development affects later adult development.

Front 4

Jean Piaget

Back 4

Jean Piaget (1896-1980) was a Swiss psychologist known for his theories of the growth and cognitive development of children.

Piaget's work focused on determining how we acquire knowledge. He believed that knowledge is "constructed" by interacting with reality.

Front 5

Lawrence Kohlberg

Back 5

Lawrence Kohlberg (1927-1987) founded the fields of moral psychology and moral education from his cognitive developmental theory. He identified six stages of moral development from a sequence of various moral types.

The next unit will take a look at how each of these men characterized the various stages of pediatric growth and development.

The charts included will give you a brief overview of the primary motivators in each developmental stage.

Front 6

Infancy (Birth to 1 Year)
Freud Psychosexual Stage:

Back 6

Oral Stage:

Derives pleasure from oral stimulation. Uses mouth to explore new objects.

Front 7

Infancy (Birth to 1 Year)
Erickson Psychosocial Stage:

Back 7

Trust versus Mistrust:

Developes trust as needs are met. Failure to acheive trust inferes with ability to move onto the next developmental stage. The ability to trust depends on the quality of the primary caregivers.

Front 8

Infancy (Birth to 1 year)
Piaget cognitive Stage:

Back 8

Sensorimotor (birth to 2 yrs):

Moves from reflex to immitative behavior. Learns to imitate behavior and develops object permanence. Object permanence means that the child learns that objects exist even when they can no longer be seen, felt, or heard. For example, if you show a baby a toy and cover it with a blanket, the baby tries to remove the blanket. The baby knows that the object still exists under the blanket.

Front 9

The neonate exhibits a number of inborn reflexes including:

Back 9

Sucking reflex
Tonic Neck Reflex
Grasp reflex
Moro Reflex
Rooting reflex

Front 10

Sucking reflex

Back 10

Involuntary sucking movements that occur with or without stimulation, continue throughout infancy, and may take place during sleep. The sucking reflex is particularly important in regards to nutrition, since the infant needs to be able to suck to obtain nourishment from the breast or a bottle.

Front 11

Tonic neck reflex:

Back 11

Tonic neck reflex: A normal response in neonates. When the baby is in a supine position the head is quickly turned to one side. The neonate extends the arm and the leg on the side of the body to which the head is turned and the limbs on the opposite side are flexed. This reflex is protective. It stops the baby from rolling over until he has sufficient motor and neurologic control. The tonic neck reflex should disappear by the time the infant is 3-4 months old.

Front 12

Grasp Reflex

Back 12

Grasp reflex: Normal in neonates, the grasp reflex occurs when the infant's palms are stroked. The neonate grasps the examiner's hands very firmly.

Front 13

Moro Reflex

Back 13

Moro reflex: Normal up to about 4 months of age and is also called the startle reflex. This reflex is elicited by a sudden loud noise. The legs flex, the infant cries out briefly, and the arms assume an embracing posture.

Front 14

Rooting Reflex

Back 14

Rooting reflex: Normal reflex in newborns and should disappear by about 4 months of age. When the baby's cheek is touched or stroked along the side of the mouth, the baby turns his head toward the stimulated side and begins to suck.

Front 15

Nursing implications:

The following signs after the age of 2-4 weeks may indicate signs of possible developmental delay or other physiological problems.

Back 15

Failure to gain weight
Poor sucking reflex
Difficulty breast or bottle feeding
Absent or poor blink reflex when exposed to bright light
Unable to focus on or follow (track) a nearby object that is moving
Movement of limbs is floppy, loose, or infrequent.
Does not respond (or responds minimally) to loud noises.

Front 16

Nursing Implications:

Birth to 1 year

Here are some signs of parent-child failure to bond or having difficulty bonding.

Back 16

Parents seem reluctant to touch or hold the child. They only do so when necessary (e.g. feeding or changing the child's diaper).
Parents do not readily comfort the child (e.g. do not cuddle or rock the child when he is frightened).
Parents are reluctant to talk to or interact with the child.
Parents have minimal eye contact with the child.


NURSING ALERT! Be alert to signs of child abuse such as bruising of the skin, malnourishment, poor hygiene, and/or inappropriate dress (e.g. the baby is wearing thin clothing, no socks or sweater in cold weather).

Front 17

Specific nursing tips when assessing the growth and development of an infant

Birth to 1 Year

Back 17

Do the least invasive procedure first. For example, assess heart rate and respirations before potentially making the baby cry during the rest of the exam.


Note the presence or absence of appropriate growth and development characteristics and initiate follow-up as necessary. For example, failure to react to sounds may indicate a hearing loss and follow-up with audiologist may be appropriate.


Observe parent-infant interactions and note and report any signs of failure to bond or abuse.


Encourage the parent to be the source of comfort for the child during healthcare procedures. They are encouraged to be present even for unpleasant procedures as this can be comforting to the child.

Front 18

Nurse teaching Points
Birth to 1 year

Back 18

Teach parents to remove small objects from the baby's reach. They explore their surroundings by putting every available object into their mouths. This could lead to swallowing these objects and choking.


Teach parents to remove poisonous substances from the infant's reach.


Teach parents to keep infants properly dressed and avoid exposure to drafts.


Teach parents to guard against injury as the infant learns to roll over, crawl, and acquire some mobility.


Infant car seats should be in the middle of the back seat of the car and facing the rear until the infant is 12 months of age and weighs 20 pounds.


Teach parents to put the infant on their back to sleep in a crib with a firm mattress. The crib slats should be 2 and 3/8 inches or less. There should be no pillows, comforters or other soft items in the bed to avoid suffocation.


Breast or formula milk should be used for the first 12 months of life, not whole or 2% milk.

Front 19

Nursing Implications when interacting with toddlers and their parents:

Back 19

Continue to be aware of inadequate parent-child bonding. Observe how often and how well the child and parents interact. Are there displays of affection? Is there verbal interaction? Does the child seek comfort from the parents? Do the parents provide comfort and support to the child?


Observe for signs of abuse. Unexplained bruising or burns, particularly those that have a pattern (e.g. made by a belt or a cigarette burn). Failure to interact with parents. Signs of malnourishment, poor hygiene, or dress inappropriate to the weather or season.


Discuss methods of punishment and positive reinforcement. A "time out" can be an appropriate option. One minute per year of age is suggested for the length away from family activity.


Encourage the toddler to strive for independence. He/she should be encouraged to attempt to dress and undress himself/herself, feed himself/herself, brush teeth, and assist with bathing.

Front 20

Nursing Implications
teaching Points:

Toddlers

Back 20

Encourage toilet training.
Provide simple explanations about procedures such as injections. Provide these explanations immediately before the procedure since the toddler's concept of time is limited.
Encourage the child to bring a favorite toy to the hospital or to the doctor's office (transitional object).
Encourage the parents to assume the role of comforter. Do not have them appear to be a participant in painful procedures.
Reassure the child that procedures or treatments are not a punishment and that he did nothing wrong. Reassure him that it is OK to cry. Do not use terms such as "big boys don't cry" or "brave girls don't cry."
NURSING ALERT! Do not begin toilet training during periods of illness or hospitalization. Also, keep in mind that toilet training may regress during periods of illness or hospitalization.

Front 21

Nursing Implications:

School Age Child
(6 to 12 years)

Back 21

Body image and modesty grow in importance. Before initiating any procedures, provide these children with suitable covering such as patient gowns.


Encourage that the child keep up with schoolwork during periods of illness or hospitalization.


Provide thorough explanations for procedures. Use drawings to help with explanations. Allow the children to see and handle equipment.


Encourage the child to ask questions. Answer all questions honestly and in appropriate, understandable terms.


Provide sexuality counseling as appropriate.

Front 22

Nursing Implications:
Preschoolers
(Age 3 to 6 years)

Back 22

Accidents are the leading cause of death in children due to falls, drowning, and motor vehicle accidents.

Safety measures such as avoiding unattended swimming pools, sealing and properly storing of poisonous substances, and limiting availability of climbing devices such as ladders are important.

Parents should be encouraged to dispose of items that a pre-schooler can climb into and become trapped. Examples of such items include old refrigerators, cars, or trunks. Children can become trapped and suffocate.

Lead Paint
Stranger Danger
Signs of Abuse - repeat trips to ER
Keep explanations simple
short attention span
Role play - puppets, dolls
Allow child to play with medical equipment

Front 23

Nursing Implications:
Adolescents
(Age 12-18 years)

Back 23

Depressions
Suicidal Ideation
Peer Pressure
gangs
Body Image
Eating Disorders

When the adolescent requires medical care, it is important that his/her privacy is ensured.

It is recommended that the nurses interview the adolescent alone at some point during the examination. It is important to direct questions to the adolescent and not the parents during an exam.

Be truthful and provide honest explanations of all procedures and address questions and concerns honestly. Be non-judgmental and respectful and always involve adolescents in their plan of care.


Adolescents may benefit from stress reduction education, self-control measures, and information on sexuality and birth control. Becoming sexually active does not mean that they are typically promiscuous sexually. Engaging in sexual promiscuity may indicate a more serious problem with achieving identity and independence.