Transcript NURS1400/Unit V Pediatrics.ppt

NURS 1400
Growth and Development
Infancy through Adolescence
Unit V
Physiological Development-Infant
• Weight and height
• Head growth
• Motor development
– Gross motor: ability to use large muscle groups
to maintain balance for postural control and for
locomotion
– Fine motor: ability to coordinate hand-to-eye
movement in an orderly and progressive manner
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8-2
Psychosexual Development

Cognitive development: Piaget’s
sensorimotor stage has four
substages
1.
2.
3.
4.
Reflexes
Primary circular reactions
Secondary circular reaction
Coordination of secondary schema
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8-3
Psychosocial Development
• Erikson
• Trust versus mistrust
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8-4
Health Promotion
• Health screening
–
–
–
–
Phenylketonuria
Iron-deficiency anemia
Lead poisoning
Hypothyroidism
• Immunizations
• Vision screening
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8-5
Health Promotion
• Hearing screening
• Dental care
• Nutrition
–
–
–
–
Breast milk or formula
Solid foods
Weaning
Use of pacifier
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8-6
Health Promotion
• Communication
– Receptive language
– Expressive language
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8-7
Health Promotion
•
Temperament
– Activity
– Rhythmicity
– Approachwithdrawal
– Adaptability
– Intensity of
response
– Threshold of
responsiveness
– Mood
– Distractibility
– Attention span and
persistence
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8-8
Health Promotion
• Colic
– Recurrent episodes of unexplained crying and
inability to be consoled
• Sleep
– Sleep consolidation
– Diurnal cycle
– Sudden infant death syndrome (SIDS)
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8-9
Health Promotion
• Stranger and separation anxiety
• Alternative child care
– Center-based care
– Family child care
– In-home care
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8-10
Health Promotion
• Play
• Safety promotion and injury prevention:
family teaching
– Safety checklist
– Hidden dangers
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8-11
NURS 1400
Growth and Development
of the Toddler Unit V
Physiological Development
• Neurological system
• Musculoskeletal system
• Gastrointestinal and genitourinary systems
– Decreased appetite: physiologic anorexia
• Cardiorespiratory system
• Sensory system
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9-13
Psychosexual Development
• Freud: anal stage
• Domestic mimicry: imitation of domestic roles
and activity
• Family teaching
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9-14
Psychosocial Development
•
•
•
•
Gaining self-control
Developing autonomy
Increasing independence
Psychosocial milestones
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9-15
Cognitive Development
• Milestones
• Communication with toddlers
• Piaget
– Sensorimotor phase
– Preconceptual phase
• Moral development
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9-16
Health Promotion
• Negativism: “No!”
• Ritualism and regression
– Ritualism: need to maintain sameness
– Regression: return to earlier, safer, more familiar
behavior
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9-17
Health Promotion
• Discipline
– Limit setting
– Appropriate discipline
– Corporal punishment
• Sibling rivalry
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9-18
Health Promotion
•
•
•
•
•
•
•
Temper tantrums
Toilet training
Child care
Play
Nutrition
Sleep
Dental health
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9-19
Safety Promotion and Injury
Prevention
•
•
•
•
•
•
Developmentally specific prevention
Auto safety
Home and environmental safety
Water safety
Toy injuries
Gun safety
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9-20
Routine Health Screening
• Health monitoring
• Immunizations
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9-21
NURS 1400
Growth and Development
of the Preschooler Unit V
Physiological Development
• Physical growth
– Slows
– Body systems mature
• Gross and fine motor development
– Increased eye-hand coordination
– Improved muscle coordination
– Development of fine motor skills
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10-23
Psychosexual Development
• Freud: Oedipal or phallic
• Sexual curiosity
• Caregiver’s role
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10-24
Cognitive Development
• Cognitive ability
• Piaget’s preoperational stage
–
–
–
–
Egocentrism
Animism
Transductive reasoning
Idiosyncratic
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10-25
Cognitive Development
• Fear
• Language
– Increased vocabulary
– Telegraphic speech
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10-26
Psychosocial Development
•
•
•
•
•
Erikson: initiative versus guilt
Superego
Caregiver’s role
Socialization
Family relations
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10-27
Moral and Spiritual Development
• Preconventional or premoral stage
• Faith and religion
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10-28
Health Promotion
• Nutrition
–
–
–
–
Food pyramid
Snacks
Serving size
Childhood obesity
• Sleep and rest
– Bedtime routines: family teaching
– Sleep disturbances
•
•
Nightmares
Sleep terrors
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10-29
Health Promotion
• Activity
–
–
–
–
–
Physical games and sports
Emphasis on physical fitness
Play: appropriate toys
Literacy: reading to child
TV and other media
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10-30
Health Promotion
• Dental health
–
–
–
–
Care of teeth
Dentist visits
Avoid sugary snacks
Night grinding
• Safety and injury prevention
– Supervision
– Injury prevention guidelines
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10-31
Health Screenings
•
Yearly well-child checks
– Vision
– Hearing
– Blood pressure
•
Immunizations
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10-32
Health Screenings
• Assess for:
–
–
–
–
Hyperlipidemia risk
High-dose lead exposure
Tuberculosis
Common illnesses
• Otitis media
• Colds
• Gastrointestinal disturbances
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10-33
Preparation for School
• Benefits of early childhood programs
• Family teaching: preparation for first day of
school
• Discipline
• Limit setting
• Time-outs
• Reverse attention
• Diverting aggressive behaviors
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10-34
NURS 1400
Growth and Development
of the School-Age Child Unit V
Physiological Development
• Musculoskeletal
– Weight increases
– Height increases
– Basic gross motor skills
• Cardiorespiratory
–
–
–
–
Increased efficiency
Decrease in pulse rate
Decrease in heart rate
Tidal volume doubles
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11-36
Physiological Development
• Dental
• Immune system
• Sexual development
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11-37
Psychosexual Development
• Freud: latency
• Sexual development
– Puberty
– Menarche
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11-38
Cognitive Development
• Piaget: concrete operations
• Language and reading
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11-39
Psychosocial Development
• Peers
• Erikson: industry versus inferiority
• Self-concept and self-esteem
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11-40
Moral Development
• Kohlberg stage: conventional level
• Conscience develops
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11-41
Health Promotion
• Nutrition
– Dietary guidelines
– Family teaching: steps to avoid obesity
• Sleep
– Somnambulism
– Somniloquy
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11-42
Health Promotion
• Dental health
– Care of teeth
– Malocclusion
– Braces
• Safety and injury prevention
– Contributing factors
– Safety rules for school-age children
• Health screening
• Immunizations
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11-43
School
•
•
•
•
•
Physical development
Intellectual development
Social development
Homework
Play
– Physical capabilities
– Concept of cooperation
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11-44
School
• Physical activity
– Overall health
•
•
•
•
Sports
Peers
Body image
Bullying
– Lack of social skills
– School nurse’s role
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11-45
School
• Stress: signs and symptoms
–
–
–
–
–
–
Frequent fatigue
Irritability
Change in sleep or eating patterns
Complaints of headache or stomachache
Substance abuse
Drop in academic performance
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11-46
School
• Latchkey children
– Tips for latchkey children
• Dishonesty
• Limit setting and discipline
• Sexuality
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11-47
Nursing Role in Fostering
Healthy School-Age Children
• Role model for children, teachers, and
caregivers
• Encourage caregivers to foster independence
• Promote acceptable limit setting
• Education for nutrition, exercise, rest,
sexuality, and safety
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11-48
NURS 1400
Growth and Development
of the Adolescent Unit V
Physiological Development
• Puberty
– State of physical development when secondary
sex characteristics begin to appear, sexual organs
mature, reproduction first becomes possible, and
the adolescent growth spurt starts
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12-50
Physiological Development
• Adolescence
– The time of life that begins with puberty and
ends when the individual is physically and
psychologically mature and able to assume adult
responsibilities
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12-51
Physiological Development
• Musculoskeletal system
– Adolescent growth spurt
– Female peak height velocity (PHV): 11 years old
or 6–12 months before menarche
– Male peak height velocity: about 13 years old
– Weight increases follow the same growth curve
as height
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12-52
Physiological Development
• Genitourinary system
– Follicle-stimulating hormone (FSH)
– Luteinizing hormone (LH)
– Tanner stages
• Females: describes breast and pubic hair
development
• Males: describes testes, penis, scrotum, and pubic
hair development
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12-53
Physiological Development
• Cardiorespiratory system
– Heart
– Lungs
• Neurological systems
– Brain growth
• Gastrointestinal system
– Teeth
– Gastric acidity and capacity
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12-54
Psychosexual Development
• Freud’s psychosexual theory
• Body image
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12-55
Cognitive Development
• Cognitive socialization
– Lev Vygotsky’s theory: zone of proximal
development (ZPD)
• Social perspective taking
– Selman’s theory: social perspective taking ability
• Moral development
• Religiosity
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12-56
Adolescent Egocentrism
• Elkind: capacity to consider others’ thoughts is
crux of adolescent egocentrism
• Imaginary audience: adolescents’ beliefs of
always being on stage
• Personal fable: adolescents’ exaggerated
notion of their own uniqueness
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12-57
Psychosocial Development:
Psychosocial Identity
• Identity
• Identity statuses
• Gender identity
– Cognitive reasoning and personal identity
• Intimacy
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12-58
Adolescents in Context
• Families
– Caregiver socialization: caregiver responsiveness
and expectations
– Attachment and autonomy
– Caregiver-adolescent conflict
– Divorce and remarriage
– Sibling relationships
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12-59
Adolescents in Context
• Peers
– Peer influence
– Caregivers and peers
• Dating
• Schools
• Work and career development
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12-60
Health Promotion:
General Nursing Considerations
• Caring environment
• Treat adolescents with dignity
• Assessment with purpose of improving health,
describing health-promoting behaviors, and
increasing understanding
• Family relationships
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12-61
Health Promotion
•
•
•
•
•
•
•
Immunizations
Nutrition
Dental health
Sleep, rest, and activity
Safety and injury prevention
Risky behaviors
Violence
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12-62
Health Promotion
•
•
•
•
Sexual activity
Homosexuality
Television
Suicide
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12-63
NURS 1400
Infectious Diseases Unit V
Anatomy and Physiology
• Immature immune system
• Pathogens
• Transmission
–
–
–
–
–
Infectious agent
Reservoir
Mode of transmission
Portal of entry to host
Susceptible host
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15-65
Factors Supporting Development of
Disease
• Ability of pathogen to survive
• Asymptomatic or carrier state
• Dose of infection
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15-66
Family Teaching: Spread of Infection
• Home
• Day care or school
• Community
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15-67
Developmental Stages and Risk of
Infection
• Infants
– Vertical transmission
– Mobility
– Hand-to-mouth behaviors
• Toddlers and preschoolers
–
–
–
–
Toilet training
Day care
Objects in mouth
Small animals
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15-68
Developmental Stages and Risk of
Infection
• School-age children
– Lack of hygienic practices
– Sharing with friends
• Adolescents
– Immunizations
– Sexual contact
– Risk of drug use increases
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15-69
Infectious Diseases in Day Care and
School Settings
• Factors increasing infection
• Family teaching
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15-70
Immunizations
•
•
•
•
•
•
Schedule of immunizations
Combination vaccines
Cultural considerations
Vaccine handling and storage
The National Childhood Vaccine Injury Act
Precautions and contraindications
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15-71
Nursing Management
•
•
•
•
•
Clinical manifestation
Etiology
Incidence
Incubation period
Therapeutic management
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15-72
Nursing Management
•
•
•
•
Resources
Care of children
Sexually transmitted diseases
Reporting to Centers for Disease Control and
Prevention
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15-73
Future Directions
• New vaccines
• Drug resistance
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15-74
NURS 1400
Child Abuse and Neglect Unit V
Child Maltreatment: Intentional Injury
of a Child
• Child neglect: harmful, malicious, or ignorant
withholding of physical, nutritional, or health
care or emotional and educational necessities
• Child abuse: range of intentional behaviors by
parent or caregiver that can involve neglect,
physical, emotional, and/or sexual abuse
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36-76
Child Maltreatment: Intentional Injury
of a Child
• Physical abuse: bodily injury to a child that
appears to have been inflicted by other than
accidental means
• Psychological abuse: results from habitual lack
of attention to a child’s needs
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36-77
Theoretical Approaches to Child Abuse
and Neglect
• Sociological model
• Social-interactional systemic perspective
model
• Attachment model
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36-78
Physical Abuse: Clinical Manifestations
• Unexplained bruises, scars, welts in various
stages of healing
• Unexplained swollen extremity
• Bite marks
• Bruises shaped like recognizable objects
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36-79
Physical Abuse: Clinical Manifestations
• Burns
–
–
–
–
“Stocking” or “glove” type burns
Splash burns
Flexion burns
Contact burns
• Shaken baby syndrome
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36-80
Physical Abuse: Psychological
Manifestations
•
•
•
•
•
•
•
Withdrawal
Depression
Sad mood
Anger
Hostility
Frightened when approached
May harm siblings, peer, pets, neighborhood
animals
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36-81
Physical Abuse
• Diagnosis
• Treatment
• Nursing assessment
–
–
–
–
–
Physical assessment categories
Psychological assessment categories
Interpersonal assessment: caregiver
Interviewing the child
Interviewing the caregiver
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36-82
Munchausen Syndrome/Munchausen Syndrome by
Proxy
• Warning signs
• Nursing management
–
–
–
–
–
Establishing trusting relationship
Assessing family dynamics
Patterns of illness
Quality of relationships: careful documentation
Corroborating histories with appropriate
professionals
– Review with multidisciplinary teams
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36-83
Child Abandonment and Neglect
•
•
•
•
•
•
•
Abandonment
Physical neglect
Medical neglect
Custody-related neglect
Emotional neglect
Educational neglect
Nursing management of child abandonment
and neglect
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36-84
Psychological Abuse
•
•
•
•
Omission
Commission
Indicators of psychological abuse
Assessment scales identify children and
caregivers at risk
• Nursing management
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36-85
Sexual Abuse
•
•
•
•
•
•
•
•
Sexual abuse
Assault
Date or acquaintance rape
Incest
Exploitation
Exhibitionism
Pedophilia
Child molestation
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36-86
Sexual Abuse
• Factors describing the experience of sexually
abused children
– Traumatic sexualization
– Stigmatization
– Betrayal and powerlessness
• Assessment of sexual abuse
• Family teaching
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36-87
Child Abuse and Neglect
• Strategies to prevent child abuse and neglect
– Preventing maladaptive behaviors
– High-risk communities
– Child’s ability to recognize and resist assault
• Legal issues related to child abuse and neglect
• Reporting child abuse
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36-88