Peds Ch. 17-20 (Test 2)
global language delay
"He can't play 'show me your nose' and the only word he says is 'mama' "
Language disorder
"He never made those funny baby sounds or said 'mama' and 'dada,' and now he just repeats everything I say."
Language loss
"He used to say things like 'Joey go bye-bye,' but now he doesn't talk at all."
Toddlers
1 to 3 years of age
They are less fearful, because they believe that authorities control their environment
5-yr olds and fear:
"Tell me more about how this embarrasses you."
A 16-y/o female towers over her companions, which bothers her. She confides to the nurse and says, "I just hate school- everyone is always staring at me." The nurse's best response would be:
"That piece sounds hard. I can see how you could be discouraged."
A 9-y/o practicing the piano continues to have difficulty in playing the theme song from a popular movie. She starts to pound on the piano keys in frustration. The best response would be to enter the room and say:
Egocentrism
A characteristic of the preschool child A type of thinking in which children have difficulty seeing any point of view other than their own
can challenge the intellect but should be balanced with active play activities
A parent asks the nurse if it is healthy to allow her school-age child to play computer games after school everyday. The best response of the nurse would be that computer and video games:
This is normal *ritualistic* behavior at this age and should be respected
A toddler always wants to do things his way Insists on putting on his right sock and shoe before his left and has a tantrum if the parent tries to put on the left sock and shoe first A parent states this is causing conflict with her toddler, what is the nurse's best response?
calm and distract the child when he becomes frustrated rather than just removing him abruptly from the play area
A toddler does not yet understand property rights and therefore believe all toys are theirs to play with; frequent frustrations can lead to temper tantrums. When this occurs, it is important to:
parallel
A toddler has a short attention span and are beginning social skills so they need close supervision to maintain safety because they tend to engage in _______ play rather than group play.
Establish a sense of identity Separating from family Initiating intimacy Making career choices
According to Erikson, the major developmental task of adolescence is to:
SPF 15
Adolescence love to sunbathe. The nurse should educate them they should use eye protection and skin protection of at least SPF ____; and excessive sunlight and the use of artificial tanning machines can cause serious long term reactions such as early aging of the skin or skin cancer.
Spends time on computer in early hours of the morning Changes screen on computer when parent enters room Has pornographic material on the computer Makes frequent long-distance calls
Adolescent warning signs indicating need for psychosocial intervention and follow up include:
Clique
Affords the adolescent the opportunity to "belong" and to develop close personal relationships with others who have similar interests and values
Foods that supply a *slow release of carbs* to muscles:
Apples Pears Green peas Chickpeas Skim milk Plain yogurt
Animism
Because preschool children's knowledge and understanding are restricted to their own limited experiences, misconceptions arise. One *misconception* is ___________. This is a tendency to attribute life to inanimate objects.
Modeling
Behavior seen in the preschool child Involves teaching a child how to be self-sufficient and responsible Asking children to do simple chores
PACE interview
Can assist in distinguishing the drug-free adolescent from one who may be experimenting with drugs and requires a follow-up referral. If 2 or more of the letters are problem areas, the adolescent may be at high risk for drug abuse and require a professional referral
automobile
Chief hazard of the adolescent:
Parents should be casual and reassure them that people do not generally die until they have lived a long and happy life (Of course as they grow older they will discover that sometimes children do die) The underlying idea is to encourage questions as they appear and gradually help them to accept the truth without undue fear
Children between 3 and 4 yrs begin to wonder about death and dying; usually they realize that others will die, but they do not relate death to themselves. If they continue to pursue the question of whether or not they will die, what should the parents be taught to teach the children? What is the underlying idea?
Daydreaming
Considered harmless if the person continues the usual active pursuits Helps to fill a void adolescents may feel A valuable safety valve for the expression of strong feelings
Articulation disorder
Difficulty producing speech sounds and speech sound sequences "I'm the only one understands what she says"
Setting limits for their behavior is needed Limits make them feel secure, protects them from dangers and relieves them from making decisions that they may be too young to formulate
Discipline and the preschool child:
identity vs role confusion
Erikson identifies the major take of adolescence as:
Autonomy
Erikson's stage the toddler is in ________ vs shame and doubt, which is based on continuum of trust established during infancy
Menarche
First menstrual period Commonly occurs about age 12 or 13 (but varies, may occur as early as age 10 or as late as 15) Secondary sex characteristics become more apparent before the ________. Fat is deposited in the hips, thighs, and breasts causing them to enlarge.
body development
Focusing on ______ ________ during early and middle adolescence is one factor that contributes to egocentrism, or self-centeredness
24 months
Follows 2-step commands Points to 7 pictures 2-word sentences
Tofu Nuts Wheat germ Legumes
Foods that provide *zinc* necessary for cognitive development:
Corn flakes Bagels Raisins Maple syrup Potatoes Rice
Foods that provide a *rapid supply of carbs* to muscles:
Salmonella
Geckos and reptiles can transmit:
*Erikson*: stage of industry *Freud*: sexual latency *Piaget*: concrete operations
General characteristics of the school aged child defined by Erikson, Freud, and Piaget:
androgynous
Having both male and female characteristics Masculine and feminine qualities
Peer groups
Help the adolescent to separate from the family and experiment with social behaviors
UTIs Diabetes mellitus, insipidus Seizure d/o's Obstructive uropathy Abnormalities of the urinary tract Sleep d/o's
In some cases, organic causes of nocturnal enuresis include:
hero worship
In the 8-yr old, _____ ________ is evident.
Want to be like friends Competition is important Fears body mutilation, alterations in body image Has nightmares; fears death Nervous habits are common
In the children ages 6-12:
child's age
In the preschool period between 2 and 5 years of age, the number of words in the child's sentence should equal the:
Enuresis
Inability to control the flow of urine and involuntary urination after the age at which bladder control should have been established Bed-wetting *Primary* (never been dry) *Secondary* (been dry for pd of 1 yr or more) *Diurnal* (daytime-less common) *Nocturnal* (nighttime- more common in boys than girls- may be a genetic influence)
Symbolic functioning
Is seen in the play of preschool children who pretend that an empty box is a fort; they create a mental image to stand for something that is not there.
lean body
It is important to note that in ballet dancers, runners, gymnasts, and adolescents engaged in other athletic activities that involve a _____ _____ and height level of physical activity, *the mechanisms affecting puberty can be altered and cause a delay in the onset of menarche.*
Motor vehicle accidents Homicide Drownings
Lead causes of mortality in the adolescent age group:
Gender rolls
Less defined in many households, and parents may not act as traditional role models for their children The needs of the family often compete with the needs of the adolescent when parents try to push the adolescent into an activity or career that meets the parent's own personal need or dreams
Concrete operations
Logical thinking and the understanding of cause and effect Thought process of the school-age child
Sexuality information and education council of the United States (SIECUS)
Maintains that every sex education program should present the topic from six aspects: biological, social, health, personal adjustment and attitudes, interpersonal associations, and establishment of values
Assuring them this behavior is a form of sexual curiosity and is normal and not harmful to the child, and parents are advised to ignore the behavior and distract the child with some other activity . The child should know that masturbation is not acceptable in public, but this must be explained in a nonthreatening manner. If the behavior disrupts their lives or becomes excessive the child may benefit from counseling.
Masturbation in the preschool child (age 3-5) is very common; education to parents should consists of:
25-30
Normal respiratory rate per minute of a 2-year old:
need to explore
One o the developmental hallmarks of the toddler that most frequently gives rise to safety hazards is:
formal operations
One of Piaget's stages; includes the ability to use abstract thinking Occurs around middle adolescence
finding an identity
One of the tasks of adolescence as defined by Erikson is:
Self concept
Ones view of oneself Fluctuates during adolescence and is modeled by demands of peers, teachers, and others. Interaction with others helps adolescence determine who they are and in what direction they want to proceed.
*P*- Parents, peers, pot *A*- Alcohol, automobiles *C*- Cigarettes *E*- Education
PACE stands for:
Time-out
Period in a safe place helps the child to develop the ability to tolerate delayed gratification and self-regulation 1 minute per year of age Timing should not begin until child has settled down Child is praised after he or she is calm
*Needs more* stimulation (through play) than the child without these disorders Play *must be supervised* because of poor judgement, aggressiveness, and unaware of own strength Needs *adequate space* to run Should be brought into *group play gradually* Materials are presented *one at a time* *Repetition* of play experiences is essential
Play & the preschool child with a neurodevelopmental, sensory, or motor disorder:
under stress
Play therapy is a technique used for the child _____ _____. The therapist obtains a better understanding of the patient's struggles, fears, resentments, and feelings toward self and others.
Associative play
Playing in loosely associated groups Typical in 3-yr olds for a short time then usually revert to playing more independently
parallel play
Playing next to, but not with, their peers Toddlers engage in this type of play
intuitive stage
Prelogical thinking Experience and logic are based on outside appearance The Child does not understand that a wide glass and a tall glass can both contain 4 oz of juice A distinctive characteristic is *centering*
bad fall
Preschool children (particularly during age 3-5) may suffer injuries from a ____ _____ and should never be asked to carry a glass container or sharp knife to the kitchen sink.
They provide structured activities that foster group cooperation and the development of coping skills The child can gain self-confidence & positive self esteem Qualified teachers are objective in their interaction with the child and often can detect problems that can be followed up before the child enters kindergarten (they should be prepared in early childhood education)
Preschool programs and qualified teachers:
Sexual maturity ratings (SMRs)
Range from 1 to 5 A score of 1 represents the prepubertal child A score of 5 corresponds to adult status
They begin to lose some interest in their mother, and the father's prestige begins to increase Romantic attachment to the father begins and the daughter wants to "marry Daddy" when she grows up
Relationship of the 3-yr old to the parents:
They want to be accepted by society, but they don't know how Are always questioning life and search to find their sense of identity ("Who am I?", "What do I want?") When they submit to parental wishes they may feel humiliated or childish, if they revolt conflicts arise within the family
Restlessness in adolescents may occur because:
Obtaining drivers license Graduating from high school Reaching legal drinking age
Rites of passage through adolescence:
Sexual latency
Romantic love for the parent of the opposite sex diminishes, and children identify with the parent of the same sex
Stage of industry
School-age children using the skill and knowledge they enjoy, including music, sports, and art Unsuccessful adaptations at this time can lead to a sense of inferiority
Image of self Identity Independence Interpersonal relationships Intellectual maturity
Sense of Identity—> 5 I's:
Sex education
Should be done in the adolescent years Is accompanied less by talking or formal instruction than by the whole climate of the home, particularly the respect shown to each family member Correct names should be used to describe the genitalia Private masturbation is normal (does not cause acne, blindness, insanity, or impotence)
Cliques
Small, exclusive groups among peers
toilet training
Sometimes enuresis is the result of inappropriate _______ _______. Parents who demand it can cause a child to rebel and defy them by continuing to wet the bed.
secretion of gonadotropin
Stimulates gonad enlargement and the secretion of sex hormones:
initiative
The 4-yr old child is in Erikson's stage of:
Are more responsible, enjoy doing what is expected of them, have more experience, and like to finish what they have started
The 5-yr old children:
Expressive language delay
The apparent ability to understand far more language than they can produce "She'll do what I say, but when she wants something, she just points"
2.5 to 3.2 kg (5.5 to 7 lb)
The average gain in weight per year in the adolescent is about:
quadruples
The birth weight of a toddler __________ by 2.5 years of age
Asynchrony
The condition during adolescence in which the growth or maturation of bodily parts is uneven General appearance of adolescent tends to be awkward, long-legged, gangling Different body parts mature at different rates
Preconceptual stage
The increasing development of language and symbolic functioning
language and comprehension
The most evident cognitive achievements of the toddler involve:
limit liquids after dinner and have the child void before going to bed
The nurse is guiding a parent cornering techniques of handling a child with enuresis. The most appropriate suggestion by the nurse would be to:
help the child understand how to cope with the reaction of others
The nursing role is not to change homesexual behaviors but to:
Abstract reasoning
The older adolescent thinks about the future and is generally idealistic. Piaget and other investigators indicate that during this time adolescents reach the final stage of ______ _______, *logic, and other symbolic forms of thought, which increases sophistication in moral reasoning*
Include the child in meal planning and preparation
The parent of an 8-y/o child seeks advice from the nurse because her child is overweight. What would the nurse advise the parent to do?
85-100 bpm
The pulse of the school-age child is approximately:
his or her own experience
The school-age child becomes capable of abstract reasoning, but thought is still limited to:
Centering
The tendency to concentrate on a single outstanding characteristic of an object while excluding its other features A distinctive characteristic in the intuitive stage
Preoperational phase
The thinking of the preschool child Classifies ages 2-7 years of age and is divided into two stages- preconceptual stage (2-4 y/o) & intuitive thought stage (4-7 y/o)
*Retraining muscles* Improving *eye-hand coordination* Help children crawl and walk (*push-pull toys*) *Clarinet* (promotes flexion & extension of the fingers) *Blowing* (excellent prerequisite for speech therapy)
Therapeutic play for the preschool child:
3 year olds
This age group is helpful and can assist in simple household chores; they obtain articles when directed and return them to the proper place
Usually lasts 1 minute per year of age with the child sitting in a straight hard chair facing a corner There should be no interacting or eye contact Any interaction restarts the timer at zero Reasoning of time-out should be explained to the child in sentences of 10 words or less (any longer won't be effective)
Time-out for the preschool child:
Fear of bodily harm, particularly the loss of body parts Other common fears- animals, dark, strangers Night wandering is typical
Types of fear that is unique in the 3-yr old stage: _____ ______ is typical.
Cooperative and highly imaginative play
Types of play characteristic of the preschool child
nonnutritive sucking
Use of a pacifier; may include thumb or fingers Have benefits in the first year of life when the infant is in the oral phase of development Pacifier causes fewer dental problems than the rigid finger and is more easily relinquished Finger or thumb sucking will not have a detrimental effect on the teeth as long as the habit is d/c before permanent teeth erupt Most children stop the habit by the time they reach school age (there may be regress during pds of stress or fatigue) The child who is trying to stop is given praise and encouragement
16-18 months
Walks alone, can walk backward Curious Parallel play Places objects in appropriately shaped openings Improved self-feeding Symbolic language ("bye-bye") Points to familiar objects Can imitate from memory Begins to realize cause & effect
Blowing out the light of light of a flashlight as it it were a candle
What is a great example of *therapeutic play for a postoperative preschool* child?
To teach and to gradually shift control from parents to the child, to develop self-discipline or self-control
What is the purpose of discipline for the preschool child?
Turn him or her on side
What should you do if a toddler is vomiting?
cooperative play with friends
When selecting play activities for a healthy 4-yr old, the parent should be guided to understand that the 4-yr old enjoys: Table 15-10 Pg.423, 385
Incorporating favorite or fad foods into the diet
Which action is most important when planning nutrition management for the adolescent?
Sweat glands are very active
Why are oily skin and acne common in the adolescent?
allowance
Young adolescents must be taught the value of money. Helps them to learn financial management Should be increased from time to time to comply with the age and needs of the adolescence
Privacy and confidentiality
______ and _________ are essential when communicating with adolescence.
pushed or pulled toys
are preferred over wind-up toys for toddlers because walking and running are the developmental tasks at hand
latchkey children
children who care for themselves after school because parents are at work or away from home and no one else is available to care for them
Puberty
stage of development in which the reproductive organs become functional and secondary sex characteristics develop Androgens Estrogens The hypothalamus of the brain signals the pituitary to stimulate adrenals and ovaries or testes to secrete their hormones directly into the bloodstream
growth spurt
the final 20% of mature height that is achieved during adolescence and usually occurs by age 18
egocentric thinking
toddlers relate everything to themselves, predominates
They become angry when others try to take their possessions They grab, slap, and hang onto them for dear life They become very distraught if toys do not work the way they should
3-yr old and their possessions:
Ritualism
The behavior of toddlers that increase their sense of security by making compulsive routines of simple tasks
Engage the child in quiet activities before bedtime, to engage the child in quiet activities before bedtime, to maintain specific rituals that signal bedtime readiness (such as storytelling), and to verbally state "after this story, it will be bedtime".
The development and and reinforcement of optimal bedtime habits are important in the preschool years. Parents should be guided to:
Intimacy
Adolescents must learn to avoid emotional isolation
"be careful"
Adults should encourage 5-yr olds to develop motor skills and should not continually remind them to "____ ______". The practice they experience will enable them to compete with others during school-age period and will increase confidence in their own abilities. Children must learn to do tasks themselves for the experience to be satisfying.
preadolescent
Age 10 marks the beginning of the _____________ years.
blowing bubbles
An example of a therapeutic play activity for a preschool child who is having an appendectomy would be:
Artificialism
Another misconception of the preschool child, ___________, the idea that people created the world and everything in it.
three-meal-a-day schedule
The digestive volume and processes of the toddler increase to accommodate a:
A quiet time
Toddler's sometimes refuse to eat may result from fatigue or not being particularly hungry, therefore, a ______ ______ before meals provides an opportunity for the child to "wind down"
feel good about themselves and learn at the same time
Asking children to do simple chores around the house is a good way to make preschool children:
Parallel play
Children play side by side without interacting; playing independently within a group Typical in 3-yr olds because this type of play is more comfortable to them
self-consoling behaviors
Clinging to favorite possessions and repetitive rituals are what type of behaviors for the toddler? Particularly at bedtime and during separation from parents.
2.5-3 years
Complete bowel and bladder control is usually achieved by age:
"hot"
Toddlers are easily vulnerable to burns because of their fascination with fire, can reach articles by climbing, pokes fingers in holes and openings, can open drawers and doors, unaware of cause and effect. This is why the parents should teach the child the meaning of the word "_____". One mother taught this by allowing the child to touch beach sand warmed by the sun.
suffocation and choking
Toddlers like to explore with their senses, likes to bite on and taste things, and eats on the run- these things cause an increase risk of:
cooperative play
Toddlers mostly use parallel play, and they gradually develop _________ play, which involves imagination and sharing skills.
abdominal
Toddlers respirations are still mainly __________ but shift to thoracic as the child approaches school age
Negativism
Toddlers test their power by saying "no" frequently Offer limited choices and making use of distraction can be helpful strategies in handling toddlers (too many choices can cause confusion)
Parents should agree on a method of discipline, such as time-out, and use it when he child misbehaves
When a 2 year old toddler often has temper tantrums at the family dinner table and asks how to handle the behavior, the best response by the nurse would be:
place the tooth in milk until the child and tooth arrive at a dentist's office
When a permanent tooth is accidentally knocked out of the socket, the tooth should be picked up by the crown to avoid damaging the root area. Then you should:
eye level
When talking to the toddler, the adult should be at ____ _______ with the child so the adult seems less overwhelming.
It may make the child fear situations that should not be feared and will deprive them of activities that otherwise would be enjoyable
Why shouldn't a parent constantly warn or be over-protective when a toddler begins to take risks such as riding a tricycle? Example is saying "be careful, don't fall"
school-age children
______ _____ children have an ardent thirst for knowledge and accomplishment; they tend to admire their teachers and adult companions.
One tablespoon
______ _________ of solid food for each year of the child's age serves as a measurement guide
Setting limits
_______ ______ should include praise for desired behavior as well as disapproval for undesired behavior
Accidents
_______ are still a major hazard for preschool children because of the child's immature judgement and increased locomotive skills
Disabled children
_________ ________ especially benefit from interacting with pets because they can lower BP and HR, reduce loneliness and feelings of isolation, improve communication, foster trust, and motivate participation in physical therapy.
