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54 Cards in this Set
- Front
- Back
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Toddler
Theories of Development |
Freud-Anal
Erickson-autonomy vs. shame, doubt Piaget-symbolic (preoperational) |
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Toddler
Skill Areas |
Language-sentences, telegraph, jargon
Motor-climbing, running Psychopathology-separation issues, negativism, fearfulness, constipation, shyness, withdrawal |
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Preschooler
Theories of Development |
Freud-Oedipal
Erickson-Initiative vs. guilt Piaget-Institution (preoperational) |
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Preschooler
Skill Areas |
Language-connective words, can be readily understood
Motor-Increased coordination, tricycle, jumping. psychopathology-Enuresis, encopresis; anxiety, aggressive acting out; phobias; nightmares |
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Toddler physical development
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-GAINS 4-6 LBS./YEAR
-GROWS APPROX. 3IN/YR -ANTERIOR FONTANEL CLOSES B/T 12-18 MO -POTBELLIED D/T UNDERDEVELOPED ABDOMINAL MUSCLES -HEAD CIRC. REACHES 90% BY 2 YRS. -bowlegged due to wt of trunk -immune sys more competent |
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Toddler Motor Development
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GROSS MOTOR- LOCOMOTION BECOMES MORE EFFICIENT AND RUNNING & CLIMBING BEGIN
MANIPULATES OBJECTS TO DEVELOP THE SPATIAL SENSE FEEDING, DRESSING & PLAY PROVIDE OPPORTUNITIES FOR AUTONOMY |
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Toddler social development
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-mgmt of separation anxiety-need to trust that parents will come back; goodbye rituals
-from four words at 1yr to 300 words at 2yrs -language acquisition a must |
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Toddler social development (con't)
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CHILD NEEDS TO BEGIN LEARNING SOCIALLY ACCEPTABLE INTERACTIONS SKILLS.
TODDLER PLAY PARALLEL WITH OTHERS TACTILE TALKING IS FORM OF PLAY |
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Toddler Cognitive Development
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TODDLERS CONSUMED WITH CURIOSITY
CLASSIFIES OBJECTS BY FUNCTION STARTING TO UNDERSTAND SPATIAL RELATIONSHIPS DOMESTIC MIMICRY TRANSITIONING INTO ABILITY FOR PRECONCEPTUAL THOUGHT Egocentrism, global organization, animism, magical thinking, inability to conserve matter, irreversiblitly |
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PRESCHOOL SOCIAL DEVELOPMENT
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STILL HAS MAGICAL THINKING AND CAN FEEL GUILTY ABOUT THOUGHTS
DEVELOPING A CONSCIENCE IS THE MAJOR TASK |
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Toddler psychosocial
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STILL HAS MAGICAL THINKING AND CAN FEEL GUILTY ABOUT THOUGHTS
DEVELOPING A CONSCIENCE IS THE MAJOR TASK |
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Toddler COGNITIVE DEVELOPMENT
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THEY USE CONCEPTS WITHOUT COMPREHENSION. THEY CAN ONLY UNDERSTAND THE CONCEPTS WITH THE CIRCUMSTANCE THAT THEY WERE TAUGHT.
RIGHT AND LEFT SHOES ARE DETERMINED BY WHERE THE BUCKLES ARE PLACED. IF THERE ARE NO BUCKLES THEY HAVE NO CONCEPT OF RIGHT AND LEFT |
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Toddler PHYSICAL DEVELOPMENT
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GAINS ABOUT 5 LBS. PER YEAR
GROWS 2 TO 3 INCHES PER YEAR POT BELLY GOES AWAY KNOCK-KNEES ARE COMMON corrects by 4-5 yrs most body systs mature and stable |
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Toddle social development (con't)
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STRANGER/SEPARATION ANXIETY LARGELY RESOLVED
USE PLAY TO RESOLVE ANXIETIES POORLY DEFINED BODY BOUNDARIES RITUALISM AND NEGATIVISM DIMINISHING |
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Asthma meds
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rescue inhalers - bronchodilators
Preventative (maintenance) - inhaled steroids, mast cell stabilizers, leukotriene modifiers -oral steroids for acute exacerbations. |
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PEAK FLOW METER
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-measures the airflow through the bronchi and thus the degree of obstruction in the airways by measuring the max flow of air that can forcefully exhaled in 1 second.
green- asthma under control yellow- asthma not well controlled if continues in this zone, call practitioner red-medical alert; sever narrowing may be occuring -based on child personal best during a stable period |
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S/Sx of Meningitis
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vary with age-
IRRITABILITY POOR FEEDING, VOMITING FEVER SIGNS OF INCREASED ICP PURPURA NUCHAL RIGIDITY KERNIG’S AND BRUDZINSKI’S SIGNS DIC KERNIG'S- PAIN WITH EXTENSION OF LEG AND KNEE BRUD- FLEXION OF HEAD CAUSE FLEXION OF HIPS AND KNEES |
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Types of Meningitis
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Several types:
Bacterial Viral TB Can be caused by strep pneumonia = pneumococcal E coli - |
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Meningitis nursing care
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Follow proper isolation to protect self & others from infection.
Quiet room, (neuro) No pillow, HOB ^, like side lying due to nucal rigidity. Restless. Check safety. Check: I &O, VS, Neuro check, LOC< urine output. Dulled sensorium NPO, others clear > advance. |
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Vaccine Preventable Diseases
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Varicella
Diphtheria Measles Mumps Rubella Polio Pertussis Meningitis |
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Varicella
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- direct contact, droplet (airborne), and contaminated objects
Incubation 2-3 weeks 10-21 days Communicable 1 day before to six days after the first crop of vesicles have formed. No scratching.. Apply pressure. No ASA. Maternal infection 5 days before to 2 days after delivery result in overwhelming infection of the neonate and a fatality rate as high as 30 %. Cellulitis, Menningitis, Encephalitis Postherpetic neuralgia |
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Diptheria (cont)
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Most common site = pharynx and the tonsils. Substantial systemic absorption therefore quite sick. Within 2-3 days a thick, bluish white to grayish black patch that covers the tonsils. Very adherent. Forcible attempts to remove . Bleeding.. Can cause respiratory obstruction.
Laryngeal = barking cough. Also a cutaneous diptheria. PCN or Abx Complete bed rest. Prevention of myocarditis. Neuritis. OM. Neuritis. Death. 5-10 % with 20 % for neonates. Airway – may need trach EES. Tx contacts with a booster. |
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Diptheria
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Direct contact with infected individual or contaminated articles. Tx with abx and antitox.. Tx without cs can be fatal.
Can have carriers. IMMUNIZATION important Gram + baccilus. Produces a toxin that inhibits cellular protein synthesis and is responsible for tissue destruction. Can cause thrombocytopenia and proteinuria. Complication r/t effect of the toxin. Mild case will resembles a common cold. Mild due to poor absorption of the toxin in the nasal septum. |
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Tetanus
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Lock jaw,
Manure treated soil. Soil rich in organic material. Found in the intestines of many farm type animals. Produces exotoxins Neonatal – cutting umb with nonsterile instrument. Mom not having immunity. Born without passive immunity. Wounds cleaned. Booster Q ten years |
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Tetanus (cont)
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Clostridium tetani – gram positive
Rigidity and convulsive spasms of the skeletal muscles. Usually involves the jaw and neck then becomes generalized |
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Measles
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Direct contact with droplets (airborne respiratory droplets)
Koplik spots (white spits on a red background) on the buccal mucosa appears two days before rash and after the onset of rash Measles in 1989 – 55, 000 cases 123 deaths 1 in 500 died Can have acute encephalitis Measles during pregnancy – higher rate of premature labor CONTAC, AIRBORNE DROPLET |
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Mumps
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Mumps Direct contact with droplet from infected person and saliva droplets
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Rubella
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14 day incubation
Symptoms are mild Congenital Rubella Syndrome Severe birth defects of fetus Rubella- direct contact with individual or contaminated articles (nasal pharyngeal secretions, feces or urine) Orchitis – 20-30 % males, oophoritis girls , sterility possible, rare Great complication is the teratogenic effect on fetus (congenital rubella syndrome |
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Polio
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Polio- direct contact. Fecal-oral and pharyngeal-oropharyngeal routes
Polio = enterovirus Enterovirus Enters through the mouth Virus is present in the throat and stool before the onset of illness. Incubation 6-20 days 95 % asymptomatic Fewer than 1 % have flaccid paralysis Can recover completely, but weakness still present 12 months after onset is usually permanent. Inc 7-10 |
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Pertussis
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DROPLET
Direct contact Highly communicable during cat stage before the cough starts to 3 wks after Tx household contacts with abx, ?ees Problem with crowding. |
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Pertussis (cont)
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CAUSED BY BORDETELLA PERTUSSIS
INCUBATION 6-20 DAYS EARLY TREATMENT OF CHILD AND CONTACTS WITH ERYTHROMYCIN THREE STAGES CATARRHAL (prodromal) STAGE OF 1-2 WEEKS PAROXYSMAL STAGE - 2-4 WKS. OR MORE CONVALESCENT STAGE 1-2 WEEK |
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Pertussis nursing care
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Reassure parents during episode
Quiet, restful environment Encourage fluid intake Provide high humidity Observe for airway obstruction Suction prn Upright positioning |
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Haemophilus Influenzae type b
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Droplet
Before Hib vaccine was the leading cause of bacterial meningitis in children under 5. Enters through the nasopharynx. Can cause invasive infection = septicemia |
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Haemophilus Influenzae type b
clinical signs |
Meningitis
Epiglottitis Pneumonia Septic Arthritis Cellulitis Osteomyelitis Pericarditis OM bronchitis |
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Communicable Diseases Nursing Implications
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Immunization history should be done on very child hospitalized regardless if suspect an infectious
Most viral illnesses are contagious during the prodromal phase and through the clinical manifestations (Rash) Important to isolate child from other patients and to implement isolation precautions to prevent exposure to staff and transmission to other patients. |
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Communicable diseases
Providing comfort |
Rashes- cool bath, cool compresses
Lotions (calamine) If no open lesions Fluids Antipyretics Antipruritics |
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Bronchiolitis
Infection of the lower airway |
Premature infants are at highest risk for death
Rare in children > 2. 80 % = RSV virus single most important resp pathogen in infancy/early childhood begins in late fall, peak during winter, decreases in spring Hand to eye, nose or other mm Apnea may be the first sign of RSV in young infants Synagis is given IM and can be given monthly Respigam is given IV and interferes with administration of live vaccines |
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Bronchiolitis
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Acute viral infection
Respiratory Syncytial Virus is responsible for at least half of all pediatric hospitalizations for bronchiolitis Drugs to prevent RSV Synagis Respigam (RSV immune globulin) |
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Bronchiolitis - clinical manifestations
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Begins as a URI with serous nasal discharge
May have low grade fever Increasing Respiratory distress develops Tachypnea Dyspnea Paroxysmal cough Wheezing Retractions Upper airway congestion |
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Bronchiolitis - treatment
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Contact isolation
Tx symptomatically Ribavirin = antiviral. Controversial. AAP, 2003 indicated that its used should be based upon individual clinical presentation and MD experience. Prevention = RSV immune globulin and palivizumab used to prevent RSV infection. ? Sunergist? Give q mo just before flu season. may require intubation |
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Upper airway illnessess
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Described according to the primary anatomic area affected
Epiglottitis more common in older children Laryngotracheobronchitis (LTB) or CROUP More common in young children The most commmon croup syndrome in children Laryngitis Acute Tracheitis |
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Upper Airway sounds:
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- Crackles: high pitched, heard on inspiration; not cleared by cough:
- Rhonchi: sounds like snoring ins/exp; may clear with cough or suctioning. |
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Lower airway illnesses
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asthma
brondhiolitis |
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Lower Airway sounds:
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- Wheezes:musical sounds usually heard insp/exp; continuous
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Croup
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Laryngotracheobronchitis; causative agent usually viral; preceded by a
URI; inflammation of the mucosa lining the larynx and trachea causes narrowing of airway |
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Croup S/Sx
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fx children under 5
- gradual onset of low-grade fever - Upper respiratory symptoms - Inspiratory stridor - barking or “seal like” cough (worse at night) |
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Croup Dx and Mgmt
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DX: Xray: Steeple sign
Management: - discourage crying - increased humidity - fluids - decadron: steroid to decrease inflammation |
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Epiglottitis
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EMERGENCY, LIFE THREATENING; serious obstructive
infammatory process; epiglottis, swells, spasms and occludes the airway Bacterial |
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Epiglotitis S/Sx
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A - airway inflammation
I - Increased pulse R - Restlessness R - Retractions A - Anxiety increased I - Inspiratory Strider D - Drooling - more common in older children between ages of 2 - 5 - abrupt onset - absence of spontaneous cough - drooling - agitation - high fever, dysphagia - appearance is TOXIC - refuses to lie down, tripod position |
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Epiglotitis Dx and Mgmt
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DX: thumb sign on xray
Tx: avoid upsetting child Don’t examine Throat Postion for comfort Trach Tray or Endotracheal tube available Humidification Oxygen No Oral Fluids IV fluids Protect airway Hib vaccine |
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Epiglotitis education
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Can be viral/bacterial or fungal
· increased risk with passive smoking · no supine position during feeding |
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Strabismus
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Surgical repair best option. Persistent strabismus needs attention in order to avoid double/diminished vision.
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AMBLYOPIA
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. Because it usually causes no symptoms, amblyopia often goes undetected. Unless the child has a misaligned eye or other obvious abnormality, there is nothing to suggest the condition to even the most perceptive parents. The child accepts having one good eye and one poor eye and considers amblyopia to be the normal situation. In most cases, amblyopia must be detected by checking vision.
Most commonly the result of poor vision development in children, amblyopia affects approximately 4% of the population. To correct amblyopia, the weak eye must be forced to work by patching the good eye or using drops to blur vision in the good eye. By impairing vision in the good eye, the weak eye is forced to work until vision in both eyes becomes equal. If left undetected and untreated beyond early childhood, amblyopia cannot be corrected. |
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Sex education
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1. Because preschoolers are keen observers but poor interpreters, the child may recognize but not understand sexual activity.
2. Before answering a child’s questions about sex, clarify: a. What the child is really asking b. What the child already thinks about the specific subject 3. Answer questions simply and honestly, providing only the information the child requests; additional details can come later |
