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87 Cards in this Set
- Front
- Back
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How doe infants grow?
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cephalcaudal
proximal to distal |
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Time frame for an INFANT
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day 28-1year of age
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Maturation of systems for infant
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HEART-hr slows
LUNGS-still sm predisposed to Resp problems HEMOPOIETIC->fetal heme physicologic anemia DIGESTIVE-immature until 3mo IMMUNE-materal IgG ist 3mo THERMOREGULATION-<6mo no shivering >6mo can shiver RENAL-immature, low GFR HEARING-adult level VISION-binocular vision 4mo, depth perception 7-9mo |
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Infant physical develpment
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HR- 100-220 BPM
Abdominal respiration- 30 BP- 90/60 LENGTH WILL INCREASE BY 50% IN FIRST YEAR WEIGHT TRIPLES AT 1 YEAR Head/chest circumference=12mo closure of posterior fontanel at 6-8wks |
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GROSS MOTOR DEVELOPMENT
head Lag |
1mo-complete head lag
2mo-partial head lag 4mo-no head lag |
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GROSS MOTOR DEVELOPMENT
Rolling over |
Abd-back at 5mo
back to abd 6mo *newborns can roll by accident keep safe* |
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GROSS MOTOR DEVELOPMENT
Sitting |
7 mo- can sit alone support self with hands
8 mo- can sit unsupported 10 mo- prone to sitting position |
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GROSS MOTOR DEVELOPMENT
Locomotion |
6-7mo full wt-bearing
9mo- crawling to creepin on hands/knees 11 mo- walk holding onto furniture 12 mo- walk with one hand held |
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FINE MOTOR DEVELOPMENT
Crude pincer |
8-10mo grasps object using palm. pincer graps is good indicator of neuromuscular maturity
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FINE MOTOR DEVELOPMENT
Neat pincer |
able to grasp small objects using forefinger/thumb 10-11mo
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Erickson
Infant TRUST VS MISTRUST |
nn to provide comfort and security. quality of infant/parent relationship vital for developing trust
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ERICKSOM
first social/oral stage |
3-4mo. trust centered around food intake. child narsisitic. demonstrated by interactive behavior, crying and holding hand out. illict a response
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ERICKSON
seocnd social/oral stage |
active aggression. control over environment. develops first conflict ie when teething likes to bite mom but mom doesn't like to be bitten
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Infant Piaget
Sensorimotor phase |
birth-1 mo:reflex behaviors;sucking, rooting, crying, simple and repetitive task to illicit response. if parent responds builds trust
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Infant Piaget
Circular reactions |
1mo-2yr; simple and repetitive actions to illicit response done with DELIBRATE intent- begin to have seperation anxiety, object permenance-think of objects w/o experiencing them
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OBJECT PERMANENCE
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9-10 month of age. basic to development of self-image. have interst in own image. plays with own body parts. milestone!! Recognize this behavior and give + reinforcemtn
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Social development
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influenced intiially by reflexive behaviors
-attachment -social smile 2mo -laugh 4mo -affection-12mo -fear- new experiences,strangers 6mo begin to differentiate b/w caregiver and others 6-8mo stranger anxiety |
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health promotion/infant
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injuries are a major cause of death in children 6-12 months of age.
do risk assessment, look at environment teach preventive measures |
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health promotion/infant
Suffocaton |
increased risk. watch out for plastic bags.
make sure crib matteress should fit properly no pillows crib slats 2 3/8" apart baloons, beanbags and food such as hot dogs nut candy |
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health promotion/infant
aspiration |
no powder unless put on hand first then spread
-never prop up a bottle -pacifier all one piece -toys w/ strings and cords -mesh playpens risky -bibs choking hazzard -watch out for h2o even sm amts -appliances |
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health promotion/infant
motor vehicle safety |
should be restrained in a rear-facing car seat from birth to 20pd/1yr
-important to teach parent and also how to properly use |
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health promotion/infant
falls |
never leave unattended on a raised surface with no guard rail. i.e. highchairs, changing tables, walkers, stairs, swings
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health promotion/infant
posioning |
Improper storage
ingestion inhalation make sure have safty latches, don't put cleaning labels in other bottles. posion i.e. ointments, creams, batteries, lead paint, aerosol spray, smk |
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health promotion/infant
nursing care for posioning |
-assess the victim
-terninate exposure -identify the posion -remove posion -prevent further absorption(make sure poison control # available) -lead poisoning |
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LEAD POISONING
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chelating agents render lead nontoxic promotes excretion via the kidney
universal screening for all if labs >10 continue to monitor if >20 chelation therapy careful as tx can cause renal necrosis-monitor kidneys closely |
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Assessment
communication |
how does infant communicate? babbling and cooing to 3-5wrd by 1yr
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Assessment
PLAY |
needs to be played WITH, not by selfs.nn interaction with caregiver for development, infant can't initiate on own
birth-3mo; talk/sing 3-6mo; rattles, soft toys, swing w/ supervision 6-12mo sensory/motor, peekaboo, patty cake, squeeze toys, soft books |
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Assessment
nutrition |
Breast Milk; most desirable complete diet for 1st 6mo
Formula: iron formulated, DON'T EXCEED 34OZ, risk for iron deficient anemia |
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when should whole milk be introduced
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not until infant is one year. it is difficult to digest and hard on kidneys and predisposes to allergies, irritating to GI, can cause occult blood in stool
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AAP RECOMMENDATIONS:NUTRITION
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all infants should receive 200IU Vit D beginning at 2months of age
Iron supplementation for breast fed infants at 4-6 og age. |
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ASSESSMENT-NUTRITION
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solids 4-6mo assess readiness, extrusion reflex?
food sequencing-cereal-fruit-veggies-meat one new food q 4-7d decrease quantity of milk as solids increase |
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what should you do prior to feeding cereal
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breast or bottle feed
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ASSESSMENT-DENTITION
FORMULA TO ASSESS NUMBER OF TEETH IN CHILD UNDER TWO |
AGE IN MONTHS - 6 = #TEETH
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ASSESSMENT-DENTITION
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teething begins around 4mo
first tooth around 6mo prevent nursing carries-no bottles in bed fentle brushing with soft cloth/brush and no toothpaste |
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ASSESSMENT-SLEEP
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by 3-4mo hope to have nocturnal sleep pattern
15h total sleep breast fed babies may sleep less due to more freq feeding by 12 mo 1-2 naps/day |
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USE OF A CRIB
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place infant in crib awake vs. asleep. don't use as a playpen, graduated extinction(think ferber method)
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ASSESSMENT-ACTIVITY
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FORMAL exercise programs not recommended-may cause skeletal damage
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Nursing Diagnosis
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infant behavior disorgainzed
infant feeding pattern, ineffective poisoning, risk for growth and development, delayed |
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EDUCATIVE/SUPPORTIVE NURSING SYSTEM INFANT
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teaching is on going
give nutrional guidence limit setting-time out 1min/peryr old thumbsucking/pacifier-normal developmental need if deprived of sucking infant may end up sucking tounge. <risk for teeth prob if stop by 4 |
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HEALTH SCREENING FOR INFANT
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at 2,4,6,9,12 months
-immunizations -assess of G&D -hearing/vision screening -assess parent/child interaction -risk assessment -anticipatory guidence |
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WHAT IS THE DENVER DEVELOPMENTAL SCREENING TEST-DENVER II
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examiner should be trained/certified
assess gross/fine motor skill, language, social ability, test behaviors such as attention span, interst, compliance, fear/anxiety -Parent education-NOT and IQ test, if non-reassuring give referrals |
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TODDLER
AGE SPAN? |
1-3 years
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MATURATION OF SYSTMS
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RESP-less predisposed to resp infections
THERMOREGULATION-stable DIGESTIVE-18-24mo begin readiness for anal/urethral control, stomach growing IMMUNE-phagocytes more efficent RENAL-maturing, less risk for dehydration,>bladder size SENSORY- 20/40, binocular vision, depth perception cont |
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PHYSICAL DEVELOPMENT ***
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GAINS 4-6 LBS AND GROW 3"/YR
-BIRTH WT quadrupled by 2 1/2 -elongation of legs -avg ht of 2yo-34", adult ht is times two -head circumference slows -ANT. FONTENEL CLOSE 12-18MO -chest circumference>head -HR 80-150 abd resp-25 -BP 100/58 - |
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GROSS MOTOR DEVELOPMENT
WALKING |
12-18 walk alone/wide stance
18mo- trying to run 2yo-stairs up and down 2.5yo-jump using both feet end 2nd yr-stand on 1 foot, walk tip-toe, climb stairs alternating feet |
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FINE MOTOR DEVELOPMENT
MANUAL DEXTERITY |
15mo- drop sm object in container, build tower w/2cubes, scribble w/crayon
18mo- build tower 3-4 cubes, loves books cloth are good as can't turn pages easily 30mo- tower 8 cubes, hold crayon w/ finger vs. palm loves to draw |
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DSCR of Toddler
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develop sense of autonomy and independence
decrease egocentricity |
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ERICKSON
autonomy vs. shame and doubt |
conflict b/w control and dependence
holding on/letting go negativism ritualism |
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Developmental tasks
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acq. social skills
increase verbal communication learn to delay gratification gain control of body function *toilet training* decrease egocentricity learn to tolerat seperation from mom |
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COGNITIVE DEVELOPMENT
PIAGET CONTINUATION OF SENSORIMOTOR UNTIL 2 |
sensorimotor-learn by expiriment, develop spacial and causal realationships
by age 3 gender identity ask why and how |
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PIAGET
PRECONCEPTUAL PHASE 2-4YR |
pre-operational thought
ability to problem solve based on what seen/heard. NOT logical, poor recall imitate behaviors, DOMESTIC MICMICARY, animitis-live qualities to inanimate obj magical thinking decrease egocentricity |
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HEALTH PROMOTION
ASPIRATION AND SUFFOCATION |
similar risk for toddler as infant. but RISK HIGHER due to > mobility.
toys-no sm pieces/sharp edges appliances electric garage doors food-SIT DOWN, no running |
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HEALTH PROMOTION
car saftey |
front facing car seat until 60pd/8yrs
use boosters |
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HEALTH PROMOTION
FALLS?PREVENTION |
High risk due to > mobility
If >35in in ht. should not sleep in crib, top bunk >6yrs |
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HEALTH PROMOTION
poisoning |
highest incidence is in 2yo
*nn supervision**able to open doors/cabinets etc... have poison control # ready |
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Assessment
communication |
say first and last name
2-3 word sentences,a bility to communicate increase |
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ASSESSMENT
PLAY |
parallel paly: kids play side by side w/o interaction
toys: push/pull toys, trucks. balls, finger paints MIMICARY/dress up |
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ASSESSMENT
NUTRITION |
growth rate slows
needs: iron, Calcium. phosphorus common for appitite fluxuations feeding difficulties devellop |
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Assessing nutrional adequacy in toddlets
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wt/ht
alert and energetic shiny hair absence of fatique, circles under the eyes skin color flat abd erect posture muscle tone MM-firm moist, pink no swell no mouth /tounge lesions proper dentition/gd indictor good appitite reg. elimination |
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ASSESSMENT-DENTITION
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AAP recomments dental exam by 6mo or 6mo after first tooth
plague removal-soft brush flouride-supplement if not in h2o low-cariogenic diet-low in sugar. if give best time right after meal |
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Assessment
activity and rest |
high activity level
supervise outdoor play increased risk for injury sleep 12h/day 1nap/d until 2-3y sleep problems r/t fear, seperation and darkness |
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Nursing dx for Toddler
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poisoning, risk for
G&D, delayed physical and pyschosocial injury, risk for |
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Nutriton counseling
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serving size;1T per yr of age
provide finger food-no nuts, hot doges food jags common-same thing QD and every meal ritualism rebellious behavior serve nutrient dense food provide freq nutrious snakes ENCOURAGE AUTONOMY |
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Educative/supportive
what is the BIG milestone |
toilet training. myelinization of spinal cord complete by 18-24 mo. look for signs readiness(able to verbilize need, recog nn, willing to sit 5-10min)motivation to please caregiver
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what is usually accomplished first, bowel or bladder
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bowel
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Educative/suportive
"temper tantrums" j |
limit chance of NO answers, offer a choice. toddler is trying to seperate. Important for caregiver to maintain self-control and encourage self-esteem
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How should a caregiver handle temper tantrums
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better to ignore and stand by with support. try to prevent tantrum. BE CONSISTENT
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partially compensatory
health screening for toddler |
physical exam 15, 18, 24 and 36 mo
immunizations ht/wt vision/hearing behavior and risk assessment guidance |
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PRESCHOOLER
TIME FRAME |
3-6 years of age
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PHYSICAL DEVELOPMENT/PRESCHOOLER
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physical growth slows/stabilizes
body systems mature AVG. WT GAIN OF 5LBS/YR increase of 2.5-3" in ht 20 primary teeth bowel/bladder control(unless lots of conflict in toddler yrs or physiologic problem) HR 70-110BPM resp 23 BP 106/67 |
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FINE MOTOR SKILLS
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developed able to button, put on socks and dress etc..
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GROSS MOTOR SKILLS
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Can do it all! walk, run, jump, climb. good hand/eye coordination
very proud of self and abilities |
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ERICKSON
Initiative vs. guilt |
learning and accomplishment preschooler takes the initiative. thought/action opposite than expected behavior
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PIAGET
preoperation phase 2-4 intuitive thought stage 4-7** |
decreased egocentricity, develops awarness of social norms, sees viewpoints of others. magical thinking. concept of time in relationship to event. ie when mom comes home it is dinner time
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COGNITIVE DEVELOPMENT
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3-4y influenced by cognitive ability, affected by environment. read to and stimulate. asks why! 4-5telegraphic speech(use only essential lang0progressess to adj/verb
5-6 use all parts of speech |
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MORAL DEVELOPMENT KOHLBERG
PRECONVENTIONAL/PREMORAL LEVEL |
EMERGENCE OF CONSCIENCE
RELIES ON EXTERNAL CONTROL CONCRETE SENSE OF JUSTICE Everything has to be fair. wants to avoid punishment no gratitude/loyalty but believe if nice to me i will nice to you |
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PRESCHOOL CHILD: DSCR
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searching for independence from parents
needs to become part of group-preschool or play group important nns to succeed in school-give lots of reinforcement PLAY-promotes development |
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HEALTH PROMOTION PRESCHOOLER
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Injury prevention- >risk
safety education-parents nn to be role model |
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NURSING ASSESSMENT PRESCHOOLER
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socialization related to school-very social, eager to pls, learns group cooperation.
school refusal is common make sure to assess readiness adq prepartion-talk about beofre started give time to adjust ok to bring transitional ite. "sets tone for school-age period" |
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ASSESSMENT
NUTRITION |
fads/preferences-not to the same degree as toddler
1800kcal/day fat <10% of cal fluids important ca+ enriched food/limit juices/ QUALITY VS. QUANTITY |
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ASSESSMENT
ACTIVITY/REST |
12h/night
sleep disturbances-fears, nightmares, accept dreams as real. OK to lie down w/ child and comfort sleep terrors-SLEEP REFUSALS ARE COMMON INSTILL RITUALS IE QUIET ACTIVITIES, READING, BATH BEFORE BED |
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what are sleep terrors
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partial arousal from non-dreaming sleep, not rem sleep. lasts 5-10 mins. technically asleep
DO NOT WAKE |
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PLAY
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ASSOSITIVE PLAY:love to use imagination, dress up, non-competitive, imaginary friends help in time of lonliness. like construction sets lg. blocks. promotes physical/social/cognitive develpment
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Educative/supportive
sex education? |
find out what child knows/thinks
be hones one question/one answer sexual curosity is normal masturbation normal but should be private. may be doing b/c anxious or bored |
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Educative/supportive
limit setting and discipline |
behavior modification
ignore the behavior consequence/time out CONSISTENCY done to protect from danger and to teach socially accepted behavior |
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HEALTH SCREENING PRESCHOOLER
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yearly physicals
immunizations dental exam assessment of G&D hearing/vision id risk factors anticipatory guidance |
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HOSPITALIZATION AND PRESCHOOLER
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may perceive hospitalization as the following: frightening b/c of magical thinking and egocentricity
seperation anxiety regression to earlier behaviors is normal. don't know which bodyparts essential (freak out bloody knee) invasive procedure scary even tympanic temps |
