PEDS test 2

INFANTS: Weight -How to measure: Nude, zero scale(done by putting diaper on the scale to zero it) Height -How to measure: Top of head to sole of flexed foot(use a paper tape measure. Find in cms) OFC(occipital frontal circumference)=done every few days or a week. If 2 or 3 cms bigger then it is a problem. -How to measure: Above eyebrows and ears and around occiput Chest -How to measure: Across chest at nipple line

-At birth, babies will lose 10 percent of their weight. This is normal. They should regain birth weight by 2 weeks, double at 6 weeks. Triple the weight in a year.

PRESCHOOLERS: -Nutrition -require approximately 90kcal/kg/day -Fluid requirement: Approximately 1500ml/day -Address concerns regarding childhood obesity anticipatory guidance -AAP 5-2-1-0 -Food intake varies -Quality vs quantity

-Average intake 1800 calories -Fluid (44 pounds)=20kg = 50 ounces -Protein requirement 1g/kg/day - 13-19g/day -Fiber age +5 grams/day -AAP 5-2-1-0: 5 fruits/veggies, 2 hours screen time, 1 hour physical activity, 0 soda or sugar sweetened beverages

risk factors of suicide:

-Declining grades -Chronic melancholy -Family dysfunction -Alcohol or drug use -Gay, lesbian, bisexual orientation -Refer IMMEDIATELY!

Promoting Optimum Health of the Toddler: -Sleep and Activity=(sleep becomes very important)(2 naps a day) -Sleep terrors(cant wake up from) vs nightmares(can wake them up): most common in preschool years but can be toddlerhood -Rituals/Bedtime routine=if you let them to get up for water or another story, they will expect it throughout their childhood. You need to reinforce early on.

-Dental Health (pediodontist) -Removal of plaque, regular exams -Dental caries (baby bottle mouth) -Nursing caries or bottle mouth caries -Increased incidence Native Americans (decreases with education) -Periodontal disease -Scrub method for primary teeth -Gingivitis -Fluoride (<0.3ppm) Table 14-5 in textbook -Supplementation -Fluorosis -Low cariogenic diet (especially sucrose)=not eating as much food prone to caries.

The 5 components of high-quality CPR are

-Ensuring chest compressions of adequate rate -Ensuring chest compressions of adequate depth - Allowing full chest recoil between compressions - Minimizing interruptions in chest compressions - Avoiding excessive ventilation

SEXUALITY: -Gender defines how people treat their child. -Touch is crucial -Skin to skin contact(bonding, child getting comfortable) -Begin to explore their own body by 1 year -especially males -Genital touching is pleasurable(1 year old) -Soothing but not orgasm based -How parents react can affect the child

-Hormonal influences inutero -Infants do not differentiate gender(they just see people) -Parental influences on development of sexuality -Attitudes(some parents are okay allowing kid to know they have a vagina) -Open vs closed -It is okay if parents want to tell their kids what they have in terms of genitalia(vagina, penis).

Major deficiencies may occur with vegetarian diets:

-Inadequate protein for growth -Inadequate calories for energy and growth -Poor digestibility of many of the bulky natural, unprocessed foods, especially for infants -Vitamin B6, B₁₂, niacin, riboflavin, vitamin D, iron, calcium, and zinc -May require supplements - especially B12- see below

3 Physical proportions PRESCHOOL AGE:

-No longer squat or pot bellied. -Now slender, sturdy, graceful, agile and posturally erect -Males and females similar in size and proportion

Factors Predisposing to Physical Abuse: 3

-Parental characteristics -Social isolation, poor support systems -Low self-esteem of parent and maternal functioning less than adequate

How to "Poison-Proof" homes?

-Passive measures: Mr. Yuk, locks, child-proof lids -Active measures

PRESCHOOLERS: -Most significant change in lifestyle: -Prepare to enter school -Increased control -Experience separation more easily -Interact with others -Language use -Attention span -Memory

-Physical growth slows and stabilizes -Average weight increases ~5lbs/year *32-35 lbs 3yo *40 at 4yo =KNOW THIS NUMBER. 40 INCHES TALL, 40 POUNDS -Height: 2.5-3 in/year *Elongation of legs

Contributing factors to failure to thrive:

-Poverty -Health beliefs -Inadequate nutritional knowledge -Family stress -Feeding resistance -Insufficient breast milk

PROMOTING OPTIMUM GROWTH AND DEVELOPMENT: -Biologic development -Proportional changes -5 to 7 ounces of weight gain every week -Double birth weight by age 6 months -Triple birth weight by age 1 year -Height increases by 1 inch per month for first 6 months -Growth in "spurts" rather than gradually -Growth spurts are 3 days, 3 weeks, 3 months. -Growth spurt occurs when baby is eating more often. That is how you tell.

-Proportional changes -Height: Increases mainly in trunk -Head growth: Rapid, ½in /month 1st 6 months, ¼ in/month 6-12 months -Chest: Increases more lateral than anterior-posterior to become more similar to an adults -Chest circumference equals OFC(head circumference) by end of 1st year -Heart growth slower than body. Doubles by 1 year, body triples. Heart takes up 55% of chest width

6 Health Concerns of Adolescence:1

-School and learning problems -Hypertension -Hyperlipidemia -Infectious diseases/immunizations -Sleep deprivation and insomnia -Tanning(avoid these!)

Seatbelt Use: -Motor Vehicle Injuries (if car seat was in a car accident, it needs to be replaced. No matter what! -Infant ONLY devices -Convertible restraint -Five-point harness -Padded shield -T-Shield -Boosters -Low-shield -Belt-positioning model -Use of locking clips!!!!!!!!!!!

-Stay rear facing as long as possible at least 1 year of age. Child must be over 20 pounds before front facing.

Stress Responses to Be Investigated: 7

-Stomach pains or headache -Sleep problems -Bed-wetting -Changes in eating habits -Aggressive or stubborn behavior -Reluctance to participate -Regression to earlier behaviors (e.g., thumb sucking)

BIOLOGICAL DEVELOPMENT CON'T adolesc Reproductive hormone changes: -Females: Egg every 28 days *FSH stimulates estrogen by ovaries, may not be high enough to produce ovulation.(ovulation starts out irregular) -Males: Development of viable sperm *Increased production of testosterone -Considered fertile after first menstrual period or first ejaculation. -Nutrition contributes to puberty. Environmental factors may also play a role.

-Understand the hypothalamus and pituitary release the hormones. Estrogen females, testosterone for boys.

Assessing Readiness for Toilet Training:

-Voluntary sphincter control (need to have this)(they will hide or grab themselves. That is how you know they have voluntary sphincter) -Able to stay dry for 2 hours -Fine motor skills to remove clothing -Willingness to please parents -Curiosity about adult's or sibling's toilet habits -Impatient with wet or soiled diapers

1. -Pubic hair development 2-6 months after breast budding 2.-Menstruation begins about 2 years after thelarche -In the US: 12.55 years for Caucasians, 12.06 for African-American, 12.25 years for Mexican-American -10 ½ to 15 ½ years old

1. Adrenarche 2.Menarche

Female athlete triad: 3

1. Amenorrhea: Menarche later in athletes 2. Osteoporosis: Decreased estrogen levels as a result of being athletic plus poor nutritional intake 3. Disordered eating -More than 20% underweight for height -Rapid weight loss

1. -7 months gestation until 5 months after birth -Most likely to persist in neurological conditions/abnormalities 2. 4-6 months until 8-12 months -Facilitates crawling -9 reflexes of baby

1. Asymmetric Tonic Neck (Archer) 2. Symmetric Tonic Neck Reflex(Crawl)

Symptoms: -Fluid retention(bloating) -Behavioral or emotional changes -Breast tenderness -Cravings -Headache/backache -Fatigue Nursing considerations: -Rest, nutrition, exercise, stress reduction techniques, counseling, support groups 2.affects things completely. 3-6% of women. Watch out for this! Very serious.

1. Premenstrual Syndrome (PMS) 2. PMD(premenstrual dysphoric disorder)

7 Factors related to an infants predisposition to respiratory problems

1. Proximity of trachea to bronchi 2. Short, straight Eustachian tube (prone to ear infections) 3. Inability of immune system to produce IgA (antibody) in mucosal lining (get lots of colds=10-12 a yr) 4. Small airways 5. Ability to produce mucus is diminished, decreasing humidification of large volume of inspired air 6. Less elastic recoil of rib cage (more flexibility) 7. Large volume of dead space(lot of area that isn't pulling its weight)

1. Situations, de-escalate 2. Reduce opportunities to say "no". Assertion of control, not stubbornness or disrespectfulness

1. Temper Tantrums 2.Negativism

1. Predictable times of regression and prepare parents for the next step in their child's development so ignore the regressive behaviors and reinforce positive 2.Separation from parents and strangers are most common but can include: Going to sleep, animals, engines...greatest during preschool years with increased magical thinking

1. Touchpoints (Brazelton): 2.Fears

Psychosocial Development: 1. Performance in evaluative situations (education, plans for future & occupational careers) 2. Hormonal influences: -Body image -1/3 males, ¼ females have had sex by 15yo

1. achievement 2. sexuality

1. Self-governing. 2. Change individually close relationships 3. Make independent decisions & follow through

1. autonomy 2. emotional autonomy 3. behavioral autonomy pg 664 LOOK

1.6 to 24 or 34 months. Take hips or pelvis, the rest of the body will follow. 2.6-24 months

1. body-righting 2.Landau

Fine Motor Skills: Drawing: 1. Two diagrams united to represent something bigger 2.Three or more diagrams together 3. ages 4 to 5 years: Recognizable, but not yet refined, as familiar objects like human figures, houses, trees, animals and progress to more clear drawings, triangle and diamond are last to be mastered

1. combine 2 aggregate 3. pictorial stage

1.. Simple structures drawn together to make structured designs 2. Two diagrams united 3. Three or more diagrams together

1. design 2. combine 3. aggregate

1. -Weight <5th percentile; height within normal limits per growth chart 2.-disease process, syndrome, something in the body wrong -Inadequate caloric intake, absorption (CF, Celiac disease, etc.) -Increased metabolism -Defective utilization (genetic/metabolic)

1. failure to thrive 2. organic failure to thrive

adolescents -Psychosocial Development (Erickson) -Identity vs. Confusion 1. -Form stable coherent picture of oneself is shaped by past, social forces, explore alternatives. -Identity achievement is main task of adolescence via interactions with others. -Identity diffusion lacks firm identity commitments

1. identity

1. appears 2 months, strongest at 10 months. When baby is on belly, they try to lift their heads up. 2.Appears 3 months, disappears by 24-26 months. If baby is laying down, and you turn their neck to one side, the rest of the body will follow.

1. labyrinth rooting 2. neck righting

1.-Penile growth -Axillary, groin, and facial hair 2. -No testicular or scrotal enlargement by 13 1/2 -14 years of age or genital growth not complete 4 years after testicles start to increase.

1. late puberty 2. Pubertal delay(KNOW 13 1/2 TO 14 YEARS, TEST QUS)

1.-Normal vaginal discharge -Amount changes during cycle -Clear to cloudy -Mild, inoffensive odor -pH of 4.0 to 5.0(low ph inhibits bacterial growth) 2. -Most common symptomatic vaginitis -Characteristic strong odor -Normal bacteria replaced with anaerobic bacteria -Alters pH -Increased thin discharge

1. leukorrhea 2.bacterial vaginosis

1. 7 or 9 months, indefinitely, Shows up when the child gets more mobile. It is a safety mechanism. 2.birth 3. Birth until 24 months. After 24 months abnormal

1. parachute 2. stepping 3. babinski

1. Deprivation of food, clothing, shelter, supervision, medical care, and education 2. Lack of affection, attention, and emotional nurturance 3. Destroy or impair child's self-esteem

1. physical neglect 2. emotional neglect 3. motional abuse

Fine Motor Skills: Drawing: 1. age 15 months: Scribble randomly to scribbling in a specific placement pattern) 2.by age 3 years: Single shapes like circle, +, square - holds with fingers rather than a fist 3. Simple structures drawn together to make structured designs

1. placement stage 2. shape stage 3. design stage

Individuation-Separation (2 phases): -Differentiation of self from others necessary to separate

1. separation phase 2. Individuation phase

1. Child emerges from the symbiotic fusion with the mother(separates self from mom) 2.Child's assumption of their individual characteristics in the environment -Helpful to have child in close proximity to parent with strangers and transition objects to aid them in separation.(they learn who they are)(start to get interested in physical attributes of themselves and other ppl. Understands hair color, curly vs straight hair. Skin color is understood.

1. separation phase 2. individuation phase

PRESCHOOLERS: 1. -Beyond gender recognition, modesty and fears of mutilation. Sexual imitation..."dress up" 2. Process of developing behavior personality, attitudes and beliefs for their culture and sex via childrearing practices and imitation

1. sexual identity 2. sex typing

-Rape: 50% < 18 yo 1. -Unable to give consent legally Assailants (3 types of relationships) 1. Stranger: Selected at random. 2. Non-stranger: Majority are "acquaintance rape" 3. Incest: Most common reported relationship between daughter and father/step-father

1. statutory rape

1. -common, outward belly button, when closure occurs causing a weak spot. Easily reducible. 2. -more common in boys, canal in groin where testes were in abdomen. 32 weeks gestation where testes descend. More likely to twist and cause a blockage. May not be able to reduce. Require a surgical repair generally.

1. umbilical hernia 2. inguinal hernia

-No foods of animal origin 2. -Most restrictive type -Restrict some fruits, vegetables, and legumes

1. vegan 2. macrobiotic diet

1. May lack iron 2. -Do not give with milk, antacids, or tea- these block absorption of iron -Give between meals -May give with meals if upsets stomach -Give with vitamin C- helps absorption -Orange juice -Use straw to decrease staining of teeth -Stools may turn dark or increase constipation

1. vegetarian diets 2. iron supplementation

Gross Motor Skills: 1.Walking, running, climbing, jumping 2.Skips, Hops on one foot, Catches ball 3.Skips on alternate feet, Jumps rope, Learns to skate & swim

1.3 years/36 months 2. 4 years 3. 5 years

Health Problems of Adolescence: 1. -Most common skin problem (85% with peak at 16-18 yo). -No link with diet. -Psychological ramifications(acne negatively effects the following): Self-esteem, teasing/bullying -Increased sebum production

1.Acne (Acne vulgaris)

1.Small amounts to develop coping skills so prevention and monitoring, teach socially acceptable methods 2.Retreat to a previous level of functioning in times of stress

1.Coping with Stress 2.Regression

two things that must occur for attachment:

1.Discriminate mother from others 2.Object permanence -Peek-a-boo

1.-Painful menses(cramps) 2.Etiology: -Onset of ovulatory cycles -Uterine contractility affected by prostaglandins(KNOW PROSTAGLANDINS)

1.Dysmenorrhea 2.Primary dysmenorrhea

ACNE TREATMENT: 1.Reduce androgen levels. 2.Affects androgen levels

1.Oral contraceptives 2. Spironolactone

Social Environments & Promoting Optimum Adolescent Health: 4 Microsystems

1.Peers(peer pressure has big impact on teen) 2.School(how supportive their school is) 3.Work(whether they work or choose to work)(family may need teen to work) 4.Community & Society -Important in establishing values & expectations

1.-digests complex carbs, adult levels 4-6 months 2.fat absorption, adult levels 4-5 months 3.sufficient to catabolize protein in to polypeptides and some amino acids

1.amylase 2.lipase 3.trypsin

1.-tends to be a good one, they don't miss out on much No meat, rarely eat fish Yes dairy products, yes eat eggs 2. No meat or eggs Yes eat dairy products

1.lacto-ovo vegetarians 2. lactovegeterians

-(they say no to everything. Give option because they say no no matte what) 2. Provides sense of comfort (they don't like their routines being messed with. Like to sleep in same spot.

1.negativism 2. ritualism

1. Voluntary control 18-24 months, motivation, recognize urge. Bowel control before bladder, physical skills 2.Natural jealousy/resentment. Realistic expectations

1.toilet training 2.sibling rivalry

-Recognizes signs of feeding -Ability to fixate on a ½ inch block -Looks at own hands when sitting or lying -Accommodates near objects

12-20 weeks

-21 yo. -Reinforce normalcy of changes. -Allow support person. Make most comfortable. -Let them see & touch equipment, warm equipment. -Female provider if preferred

1st pap/pelvic exam

-may be preferable when personnel are available and may be more effective than ventilation by a single rescuer if the patient has significant airway obstruction, poor lung compliance, or the rescuer has difficulty in creating a tight mask-to-face seal.

2 person ventilation technique

-Preference for certain colors...yellow and red -Eye-hand coordination develops: Pick up up toy and hold with two hands and puts from hand to hand to show eye hand coordination

20-28 weeks

-Fixate on small objects -Depth perception develops -Strabismus may indicate lack of binocular vision

28-44 weeks

-Follow object 90 degrees -Tear glands begin to function -Watches parent intently when speak to infant

4 weeks

-Acuity of 20/40 or 20/60 -Follows rapidly moving objects -If has strabismus(crossing of the eyes), visual loss developing

44-52 weeks

-Peripheral vision to 180 degrees -Binocular vision begins at 6 weeks -Convergence on near object begins by 6 weeks developed by 3 months -No Doll's eye reflex -Not uncommon for young children to be cross eyed initially. By 3 months if that is the same you may have a problem.

6-12 weeks

Romantic Relationships Are Important During Adolescence: *Tell me about your bf or gf. Ask about these! They are learning how to act with another person. Will mirrior what they see at home. Struggles at home, result in struggle in their own relationships

ADOLE: Spiritual Development: -Beliefs more idealogical -Less orientated towards rituals, practice, and strict observance -Reexamine and reevaluate the beliefs and values of childhood -May reject or conform to their family's beliefs Consider their Microsystems: Develop values and expectations via microsystem interactions: -Peers -School -Work -Community & Society

ADOLES Relationships: -Relationships with parents: Dependence-independence, push for emancipation, emotional detachment from parents -Interact with their parents as people, not as their parents -Rebellion is not the norm -Relationships with peers: Behavior standards set by peers, interest in opposite sex, stress & peer pressure more likely to abandon rational thought

Adolescent Health Promotion: -Psychological Health: Mood swings, daydreaming, temper outbursts, feelings of inadequacy makes it difficult to ask for help -Imaginary audience: Believing everyone is focused on his/her behavior, appearance -"Not Me": believe feelings and experiences are completely unique -Adolescent egocentrism -Self-absorption *Cognitive Development (Piaget): Hypothetical reasoning -Formal operational thought: Abstract thinking, futuristic thinking, increased decision making skills, increased reasoning, think through hypothesis *Moral Development (Kohlberg) -Value autonomy but struggle to clarify values, conventional moral reasoning -Develop more principled moral reasoning where absolutes & rules are questioned SLIDE 16 ADOLESC=KNOW!!

-Refusal to maintain normal body weight -Severe wt loss without obvious physical causes -Denies hunger -Body dysmorphism

Anorexia Nervosa

Psychological Aspects: Clinical Manifestations: -Severe/profound wt loss by self imposed starvation -Orthostatic hypotension -Bradycardia -Severe electrolyte disturbances Therapeutic Management: 1.Reinstitute normal nutrition to reverse severe malnutrition 2. Resolve disturbed patterns of family interaction(hist of eating disorder, abuse?) 3. Individual psychotherapy to correct deficits, distortions (if they eat only one strawrberry, you NEED TO START SLOW AND INCREASE FOOD INTAKE GRADUALLY)

Anorexia Nervosa

-Binge eating follow by inappropriate behaviors to prevent weight gain *Self-induced vomiting *Laxative abuse Clinical Manifestations: *Major issue is usually self-control. Therapeutic Management *Hospitalization if need IV to regulate electrolytes with K+ supplementation, cardiac monitoring *Therapy

Bulimia Nervosa

-Immature thermoregulation -Large skin surface -Non-shivering thermogenesis -Infection -Seizures(afebrile seizures can occur) -Sick children=cardiac and respiratory rate increase.

CNS

-Subcortical level of development: -Reflexive(jerking=normal) vs Spasms(not normal, can be a seizure) -Lack of coordination -Pain will be shown by: -Fussiness -Lack of appetite -Excessive crying-cry no matter what -Immobilization-wont move. -Sleep (Sleeplessness or increased sleepiness)

CNS

-Neurofibromatosis -Tuberous Sclerosis -Skin and Nervous system develop at the same time

Café au lait spots

-yeast infection -2nd most common infection -Vulvar and vaginal pruritus -Thick discharge -Typically no odor, but may have a yeasty or musty smell -Do not self treat unless first diagnosed by a medical provider

Candidiasis

-caused by Acne bacterial overgrowth. non-inflammatory lesion. Some cosmetics or skin care products. -Open comedones: "Blackhead" -Closed comedones: "White head"

Comedogenesis

GI SYSTEM: -Illness affects 1.Fluid needs 2.Caloric needs 3.Oxygen demand 4.Respiratory rate -Air swallowing -Increased risk of drug toxicity=due to liver size. That is why med dosage is the way it is.

DIGESTIVE SYSTEM: -Saliva and digestive processes do not function well until 3 months of age and will start to drool

SPIRITUAL DEVELOPMENT PRESCHOOLERS: -Can understand simple stories and can memorize short prayers, but do not understand the meaning or symbolism behind these rituals. -Benefit from concrete representations such as statues and picture books - picture bible. -Learning right from wrong to avoid punishment. They do not understand why things are right or wrong. -Wrongdoing provokes guilt -may misinterpret illness as a punishment -Need to understand the God is one who bestows unconditional love rather than being a judge of good or bad.

Development of Body Image PRESCHOOLERS: -Increasing awareness of self and others -Careful words that are used in regard to their body -Poorly defined body boundaries -Band-aids -Look for outliers that make people different -Poor understanding of internal anatomy -Use correct terms and terms they understand

Development of Body Image: -Learn correct names(don't call a pussy a coochy. Call it by what it is called. -Recognize gender differences by 2 years of age yet may have some inaccuracies -Use terms to describe physical differences but avoid negative labels for physical appearances -Body integrity is poorly understood: upset flushing feces, resist anything intrusive to their body like blood press cuff -This is the time when you kiss a bruise, it will get fixed.

Development of Sexuality: -Gender identity formed by 3 years -Explore own body -Playing "house" assign gender roles(play the roles that they see modeled. They don't know that women are supposed to stay home and dad works. They assign roles based on what they see from parents.

-Pressured to produce sounds ahead of their developmental level and then revert back to infantile speech

Dyslalia (articulation problems)

Atopic Dermatitis -a category, not specific etiology -Pruritic eczema associated with allergy -Usually have family history (atopy) -Therapeutic goals: *Relieve pruritis *Hydrate the skin *Reduce inflammation *Prevent/Control secondary infection

Eczema

treatment: -Emollient preparations after bathing -Soak and slather -Remove irritants *-Use mild detergent -Topical steroids -Benadryl/Zantac -Colloidal baths -Oatmeal -Cool moist compresses -Pressure, not scratching -Watch for superinfection

Eczema -Most children will outgrow this

1. -Repeat words/sounds for the pleasure of hearing self, not for purpose of communication. Collective monologue -Socialized speech for communication by 3 years of age: Still egocentric until then for self-fulfillment (want ball)

Egocentric speech

-Inflammatory reaction of epididymis of testicle related to bacterial or viral infection, chemical irritant like urine or local trauma -Slow onset. -Analgesia, bed rest, scrotal support

Epididymitis

-Feeding -Comfort -Positive stimulation -Caring -Attachment

Erickson's Trust vs Mistrust

-Security -Quality of relationship with parent and care child receives(child needs to know that there is one person consistent in their life that will take care of them) -Fail to learn delayed gratification leads to mistrust because of too little or too much frustration

Erickson's Trust vs Mistrust

-Acquisition of socially acceptable behavior(slow process. Happens gradually. Guidance is needed. Praise them when they do something right. When they do something wrong, correct them. -Verbal means of communication(tell them please wait. They don't know how long 5 minutes is though so don't say that) -Ability to interact with others in a less egocentric manner (learning more about who they are. And understands why we do stuff for other people. -Make sure you let them know when something is unacceptable.

Erickson: Autonomy vs shame and doubt

-Differentiation of self from others -Toleration of separation from parents -Ability to withstand delayed gratification -Control over bodily functions

Erickson: Autonomy vs shame and doubt

-Feelings may derive from self or the social environment -Results if incapable or not prepared to assume the responsibilities associated with developing a sense of accomplishment -All children feel some degree of inferiority regarding skill(s) they cannot master. Do not set them up for failure. -If they cant meet challenge then they feel inferiority. -they feel accomplished with

Erikson: Industry vs Inferiority

-Greatest during preschool years! -Night terrors -Animism—Providing life-like characteristics to inanimate objects(scared of toilet) -Techniques to overcome fears: May incorporate magical thinking(you can make monster spray and spray under the bed. Kids will think the monsters are gone) -Poor body boundaries

Fears

-Grasps object, age 2 to 3 months: -Reflexive grasp to voluntary after 2 months until 4-5 months. (start doing things on purpose) -Transfers object between hands by age 7 months -Palmar grasp.

Fine Motor Development

-Pincer grasp, age 8-10 months, more refined by 11 months -Removes objects from container, age 11 months -Builds tower of two blocks, age 12 months

Fine Motor Development

-Protruding abdomen -Peristaltic waves(not a good thing in nicu population) -Liver palpable below costal margin(felt 1 to 2 cms below rib)(if felt more cms it could be a cardiac issue) -Abdominal pain=very difficult to ascertain. Cant tell you when it hurts or where it hurts. You have to look at behaviors to see what they are doing. May stiffen completely out or bring legs up. -High metabolic rate -Infant requires 108 kcal/kg in nutrition=grow so fast due to high metabolic rate. -Adult 45 kcal/kg

Gastrointestinal System

-Head control(comes first) -Rolls over—age 5 to 6 months -Sits alone—age 7 months -Moves from prone to sitting position—age 10 months

Gross Motor Development(the big muscles)

Anticipatory Guidance: Care of Families: -Parents need support and guidance -Information needs regarding developmental changes and process of gaining independence -Help "letting go" and promoting independence

Health Promotion Among Special Groups of Adolescents: -Minority adolescents -Access to healthcare -Cultural influences -Gay, lesbian, and bisexual adolescents -Increased depression and suicidality -Family acceptance is a major influence on mental health Rural adolescents -Social opportunities -Alcohol consumotion -Isolation

Health Promotion: -Nutrition -AAP 5210 to balance diet and promote growth with quality foods and choices at home and school. -Media and peer influence (including fast foods) -Sleep: 9.5 hours per night but varies -8-11 year olds may resist going to bed, less after 12 -Physical Activity: Participation in competitive sports...is it always beneficial? -Physical and Emotional maturity concerns when competitive. They tend to like competition.

Health Promotion: -Dental Health: Lose primary teeth -Permanent teeth erupt(need to let the kids know these are the last teeth they get so take care of them.) -Prevention: Brush, fluoride, sealants, floss -Malocclusion(bites that don't line up. Over or underbite.)(orthodontist can help with lining the teeth up) -Dental avulsion (replacement or attachment)(if tooth knocked out, put in milk or water to be put back in. This is important!)

Work: -If work too much fail course and may not get into college of choice or college may take longer at a lower salary. -More than 20hrs/week shown to be detrimental Community & Society: -Affects indirectly -Expectations -Media exposure -Public policies

Health Promotion: -Health care settings *Empower safe environment(let them know that they can talk to you about anything without info getting out)(except if related to their safety. If they are suicidal or will hurt themselves then you need to tell someone) *Confidential, consistent, supportive 1:1 interaction. Health Screening: -Active listening -Respond to pt emotions (non-verbal cues) -Ensure confidentiality & privacy -Confidentiality dependent upon abused or situation if life-threatening. -Avoid assumptions. -Visual changes common with growth spurt

1.Tolerate frustration to learn socially acceptable interaction 2.Common sense or reason, needed to tolerate delayed gratification 3.Incorporating morals of society and culture -This is when you can spoil a baby. You need to avoid spoiling. This is a crucial age.

ID impulses 2.ego 3.Superego/conscience

-Significant amounts produced at birth, adult levels by 9-12 months -A bunch at birth and decrease 2.-in colostrum to protect GI, IgD, IgE.

IgM 2. IgA All develop gradually Maximum levels obtained by early childhood

1.-Hypothalmic pituitary-gonodal system dormant until stimulated Neuroendocrine Events of Puberty -Gonadotropin releasing hormone (GnRH) by hypothalmus -Follicle stimulating hormone (FSH) & Leutenizing hormone (LH) increase to stimulate gonodal response

Initiation of Puberty

Communicating With An Adolescent: -Don't talk down to them! -"I know that you already know this..."(say this, it makes them open up) -Confidentiality -Trust(maintain trust with teen) -Independent decision maker(let them make decisions) -Remember the emancipated conditions: -Pregnancy -STI's -Mental Health

Injury Prevention: -Motor vehicle crashes are the single greatest cause of serious and fatal injuries in teens -Other vehicles -Firearms and other weapons -Sports injuries -Water safety -Poisoning, tobacco, alcohol, and other drugs -Mental Health -Depression -Suicide -Self-injurious behaviors(people who cut themselves)

-Egocentrism and transdusive reasoning results in preschoolers believing that their thoughts are all powerful -This also results in the power of words and accepting their meaning as literal -Their behavior may be bad but they are not bad -Premoral (Kohlberg) -Sense of Justice and Fairness

Intuitive Thought (4-7)

-Object permanence achieved, Symbolic Imitation such as animal noises and adult behaviors with Domestic Mimicry, Egocentrism in thought and behavior, infers a cause only while experiencing the effect, refers to self by name, Parallel Play, Routine/ritualism(want to be like mom and dad. They want to do laundry for example with mom) -If you put toddlers this age by each other, they wont interact but they play by themselves alongside other toddler. -They understand big and little. -They understand that if they push stool to the counter, they can get the cookies.

Invention of new means through mental combinations: (19-24 months)

-Deficient protein, adequate calorie intake -Edema and muscle wasting -Large abdomen due to ascites -Decreased serum albumin

Kwashiorkor

-General malnutrition of both calories and protein -Often seen with drought conditions in underdeveloped countries -No edema, but loose wrinkled skin + small head size

Marasmus

-General malnutrition of calories and protein -Usually during drought, can be seen in FTT(failure to thrive) -Gradual wasting flabby skin -Subcutaneous fat and muscle mass loss -No edema -Small head size -Lethargy

Marasmus

-Treatment -Adequate diet -Skin care -Developmental stimulation *Watch for refeeding syndrome when you start getting them food after they have had this

Marasmus

-a type of malnutrition which is caused by carbohydrates deficiency, which means it occurs when there is not enough intake of carbohydrates-containing food. Carbohydrates are commonly referred to as calories, which are vital for cell metabolism. It can cause growth and mental retardation.

Marasmus SLIDE 13 LOOK

-1st 3 months infant has antigens the mother had been exposed to. -At 1 year infant will produce 40% of adult levels -If mom has antigens protecting against rubella for instance, baby will gain some immunity.)

Maternal IgG(general antigen) -All develop gradually Maximum levels obtained by early childhood

-Neisseria meningitidis(most worrisome)(it's a bad deal. If it gets in brain and bloodstream you are dead in 24 hrs)(vaccinate early b4 sexually active) -80% of bacterial infections

Meningococcal disease

-Water intoxication -Small size makes it easy for them to consume a large amount of water relative to body mass and sodium stores -Hyponatremia(bad!) -Replaces needed calories(water takes up space. They need calories!) -Be careful with swimming(make sure they are not drinking the water causing water intoxication) -Unable to excrete the extra water fast enough

NO WATER!!!

HEENT: -Alopecia -Clavicle -Skull -Paralysis -Candida Albicans: -(Candidiasis Moniliasis, Thrush) -Skin -Mongolian spots -Telangiectatic nevi -Café' au lait spots: Neurofibromatosis

NYSTATIN IS USED TO TREAT THRUSH!!

-Consistent care giver important -Calorie supplementation -polycose, MCT oil, -Calm, routine, face to face

Nonorganic FTT

Normal Growth & Development Concerns: Preschoolers: -Gifted/Talented: -Specific aptitude, creative or productive thinking, leadership ability, ability in the visual or performing arts, and psychomotor ability (singly or combination) -Not all gifted children identified on standard tests Aggression -Behavior to hurt person or destroy property -Frustration -Modeling -Reinforcement -Professional help for parenting

Normal Grwoth and development concerns: preschoolers: -IQ >130 -Giftedness may be present in those that have learning disabilities, ADHD, other psychiatric disorders -Unique challenges: demand increased stimulation, seek a great deal of attention, high energy levels -Same need for love, security and consistent boundaries. -May mislabel slower achievement as being lazy -Boys more physically aggressive than girls in preschool, girls more relationship aggressive "mean girls" -Maternal depression, low level of maternal education, low socioeconomic status contribute to childhood aggression -Also, coercive interactions, physical abuse, low levels of positive interactions and warmth, -Frustration- continual thwarting of self-satisfaction by parental disapproval, humiliation, punishments, and insults. Maybe displace their anger on others. -Often well-behaved at home but not a school or is a bully -Modeling - imitating the behavior of others. Harsh discipline may lead to this with others. Boss or bully. Media exposure - violent programs -Reinforcement - associated with masculine behavior. Hitting a sibling=attention. No interfering is approval of such acts. -Tasks of a preschooler is learning socially acceptable behavior and expressing themselves verbally and appropriately. -Difference in normal and problematic behavior: quantity, severity, manifestations, onset , and duration. May be difficult to change.

CHARACTERISTICS OF ABUSERS: -Typical abuser is a male the victim knows but may be ANYONE -All socioeconomic backgrounds -Has the victim been threatened if they report abuse? What things may they have been told about the abuse?

Nursing Care of the Maltreated Child: -Identify abusive situations as early as possible -History pertaining to the incident: Make sure to write this down in their own words without suggesting words/ideas. Use quotation marks and read back for verification. Witnesses as well -Evidence of maltreatment -Pattern or combination of indicators that arouse suspicion and further investigation -Protect child from further abuse: We are mandated reporters and must notify child protection if we are concerned/have evidence!!

-helps nurses size testicular size. You feel then compare to the bead size of the orchidometer. -Pre-pubertal 1 - 3ml -Pubertal 4+ -Adult 12 - 25ml

Orchidometer

PRESCHOOLERS: -Anticipatory Guidance -Dental Health -Eruption of primary teeth is complete in preschooler years -Need assistance with brushing their teeth -Routine prophylaxis including fluoride supplements, fluoride varnish -Trauma not uncommon -Proper evaluation by dentist needed -Allow for proper eruption of secondary tooth

PRESCHOOLERS: -Injury Prevention *Poisoning: Relate to magical thinking? *Pedestrian-motor vehicle injuries *Seat belts *Bicycle helmets: Fit appropriately, modeling behavior of adults? *Emphasis on protection and education for safety

-Child responses to the environment(if child is use to noisy environment, that's what they get use to. It can also be calm and quiet. -Games of reinforcement(give a treat if they do something like say the ABC's)(be consistent!)

Personal-Social Behavior

-Play is a child's work -Temperament "difficult baby vs easy baby" -Temperament can be an indicator of future success -Stubborn child=high achieving adult -expose to lots of different environments is good.

Personal-Social Behavior

Language Development: -Comprehension and understanding increase 1. Bilingual-encourage this! -Number of words in vocabulary -1 year old: 4-10, 2 year old ~ 300 words, 3 year old adds about 5 new words per day -Understandable: By 2 years, 65%

Personal-Social Behavior/Interaction: -Skills of independence (feeding, playing, dressing) develop and may result in strong-willed, volatile behaviors -Play (Parallel) -Temperament -Temper tantrums (certain temperamental characteristics result in more temper tantrums) -Discipline often affected by a child's temperament

-fetal hemoglobin present up to 1st 5 months and has shortened survival of red blood cells.

Physiologic Nadir

-starts 2-3 months because of decreased erythropoietin released by kidneys to stimulate RBC production and maternal hemoglobin stores diminish by 6 months. -Adult hemoglobin increases first ½ of infancy.

Physiologic anemia

-Experiments to achieve previous unattainable goals, differentiation of self, increased object permanence, early start of memory, primitive reasoning skills, beginning awareness of spatial relationships and causal skills

Piaget -Sensorimotor Phase (12-24 months)(Piaget) -Tertiary circular reactions (13-18 months):

-First 24 months of life with four phases 1. Reflexes (up to 1 month) 2. Primary circular reactions (1-4 months): -Replacement of reflexes with voluntary acts -May stop crying when hear parents voice before nipple seen or in mouth 3. Secondary circular reactions (4-8 months): -Continuation of primary circular reactions become repeated and prolonged for a response until 8 months 4. Coordination of secondary schema and their application to new situations (9-12 months): -Allowed by increased mobility to explore -Imitation, Play, Affect

Piaget Sensorimotor Phase:

-Learning about their bodies thru senses. Don't need to know if a certain reaction is a primary circular reaction or what not.

Piaget Sensorimotor Phase:

-Transition between self-satisfying behavior and socialized relationships

Preconceptual Phase of Cognitive Development (Piaget) 2-4 years

-Punishment and obedience orientation: -If they are not punished then the action must be good. Behave in accordance with freedom or restriction placed on their actions. -if you don't respond to an action, they will think it is good. You need to discipline if they did something wrong. You need to discipline for bad! They don't understand right or wrong. They act in accordance to what you allow. They wont do something if they get punished for doing it. -spanking will give them a more negative review on right and wrong.

Preconventional or Premoral (most basic) Level (Kohlberg)

-Physiological, psychological, and behavioral symptoms -Complex and poorly understood -30-80% of women -Mild(doesn't interfere with daily life), moderate(starts to interfere with daily life), or severe(no longer to interact, withdrawing from social and work activities)

Premenstrual Syndrome (PMS)

-Shift from totally egocentric thought to social awareness and the ability to consider other viewpoints -Preconceptual Phase (Ages 2-4)

Preoperational Phase (Piaget) Ages 2-7

-Cannot yet think in terms of operations or able to manipulate objects in relation to each other in a logical fashion. Solve problems based on what they see or hear directly rather than recall. Magical thinking: if you take water in fat glass, and you pour it in a tall skinny glass, they think you are magical. They don't understand that it is the same amount of water. -This is when santa claus is real. Or that the easter bunny is a thing. They don't realize someone at Disney world is dressed up as mickey mouse.

Preoperational thinking

-2 years preceding puberty -Varying ages from 9 to 12 years in girls (occurs about 2 years earlier than in boys) -Average age of puberty is 12 years in girls and 14 years in boys -Puberty=Predictable sequence of hormonal and physical changes that occur universally over a defined period of time.

Prepubescence

-No menarche(onset of mentration) by 17 years old OCCURS IN: -Obesity, imperforate hymen -Endocrine disorders(to much or too little estrogen) -Chronic disease - diabetes mellitus -Medications(birth control) -Eating disorders - malnutrition

Primary Amenorrhea

2 vaccines for Meningococcal disease: 1.Menactra: -Meningococcal congugate -11 - 12 year olds -Booster at 16 years old 2.Bexsero -MenB(helps prevent meningoccal) -Serogroup B(helps prevent miningoccal_ -16 - 23 years old

RISK FACTORS FOR MENIGITIS: 1.Large groups gathered together : college dorms 2.Immunocompromised: No spleen, complement deficiency, HIV

-Obligatory nose breathing -Large tongue(can obstruct their mouth) -Soft larynx -Flat eustachian tubes -High trachea(if they choke, it is easy to get down into the lungs) -Small airways

Respiratory System

-Susceptible to respiratory infections -Intercostal muscles undeveloped(they haven't used them that is why they are undeveloped. Don't breathe in womb) -Thin chest wall -Soft cartilage -Nasal flaring(if trying to get more air, you will see nostrils go out. This is a bad sign!!)

Respiratory System

-Irritating to skin -Apply 20-30 min after wash face to decrease stinging. -AVOID SUN.

Retin-A

Shoes: -Barefoot is best -When beginning to walk, may need for protection -Heat -Cold -Sharp Objects -Flexing of foot is necessary to develop arch and muscles -Reason -Type -Fit

SLEEP: -Amount: -By 3-4 months, 9-11 hours per night, 15 hours per day total -Sleep Problems (Ferber, 1987) -Crying it out (Ferberizing) -Night terror vs night mares -Going to sleep -Rocking -Nursing/bottle -Lay down when sleepy - not asleeo

LOOK AT CPR DIAGRAMS

SLIDE 9 ALSO

-Youth 15-24 are ¼ of sexually active population -Over ½ of 20 million new STIs each year -STD fact sheets on BB(look at this) -Risk taking tendencies -Most common -Chlamydia -20-40% of teens -HPV -15% of teens

STIs

-Biological Development -Proportional Changes -Height increases 2 inches per year -Weight increases 2-3 kg (4.4-6.6lbs) per year -Males and females similar in size -Physiologically begins with shedding of first deciduous teeth and ends at puberty with acquisition of final permanent teeth -Gradual growth and development -Progress with physical and emotional maturity

School Age Child (6-12 years)

-Cradle Cap -Chronic, inflammatory reaction of skin *Cradle cap, blepharitis, otitis externa *Thick, adherent, scaly, oily adhesions -Remove crusts *May need to use Baby oil to loosen *Soft bristle brush or fine tooth comb -Shampoo daily with baby shampoo *May need other types of shampoo depending on severity *Salicylic acid, tar, selenium, sulfur, or zinc

Seborrheic Dermatitis

-Absence of menses at least 3 cycles or 6 months in female with established cycles

Secondary Amenorrhea

PRESCHOOLERS: -Task to learn: Purpose Superego (or Conscience) Development: -Learning right from wrong -Good from bad for the start of moral development -Unable to understand "why" something is acceptable or unacceptable -Punishment vs reward to determine if an action is considered "good or bad"

Sense of Initiative vs Guilt (Erickson)

Cognitive Development PRESCHOOLERS: -Readiness for school(school is the environment) -Readiness for scholastic learning -Typically age 5 to 6 years(girls are ready earlier than boys)(don't understand time. You cant tell them 1130, you can shade in a clock and they can understand that though) -Language continues to develop -Concept of causality beginning to develop -Concept of time incompletely understood -Use "magical thinking" frequently

Spiritual Development PRESCHOOLERS: -Parental influences (learn from significant others): Practices, beliefs, bedtime prayers -Development of conscience related to spiritual development -Concrete picture of "God" with physical characteristics like imaginary friend -Helps with coping with stress

SPOILED CHILD SYNDROME: -Fact or Fiction? Infant cannot be spoiled. They deserve attention. -Spoiling: Excessive self-centered and immature behavior resulting from the failure of parents to enforce consistent age-appropriate limits. -Babies get used to a routine -The less they cry the first year, the less they cry the second year

THUMB SUCKING VS PACIFER USE: -Personal choice. Pros and cons to both of them. Don't worry about thumbsuckers having bothered teeth. Not true. Thumbs benefit is that it is always there and right size. Don't let them talk with pacifier in their mouth. It slows down speech development.

-"Terrible Two's" versus "Terrific Two's" -Proportional changes: -Weight: 4-6 lbs/year (quadruple birth weight by 2 ½ years of age) -Height: 3 inches/year(if double height at age of 2 they are half of their adult height. That is just an estimate)(Nutrition is the biggest factor) -Height increases in legs: As an infant height increases in trunk -Temper Tantrums are present -Stubbornness/Obstinacy

Toddlers (12-36 Months) -Gross motor skills increase dramatically. They improve their walking ability.

DEVELOPMENT OF BODY IMAGE: -At birth, the infant is an extension of the parent -By end of first year, recognize that they are distinct from parents -They don't understand they are separate from their parents until a year after birth

VIEWING OWN IMAGE: -They don't know who the person is in the mirrior until a year old. They think they are seeing another baby in the mirrior rather than themselves.

-Emotional -Physical -Sexual -Manifestations: depression, substance abuse, suicide, acting out, somatic complaints, eating disorders -Runaways -Vulnerable group -Prone to exploitation

abuse

-ONLY for SEVERE, CYSTIC ACNE(worst case drug) -May cause nasal and oral irritation, headache, mood changes, depression, dry skin/lips. -Highly controlled due to teratogenic effects

accutane

Treatment: -Cleansing: Gentle cleansing 1-2x/day -Keep hair off face, minimize make-up -Pillow case - change frequently -Hands and phones Benzoyl peroxide: for mild acne. -Kills P acne organisms and decreases free fatty acids on surface. -Warning of bleaching of fabrics.(wash hands after using this) +Slowly increase strength.(start slow and move up in strength) -Should be a part of every treatment regimen! Can take other creams along with this. Antibiotic Therapy -Mild acne topical and may be in combination with benzoyl peroxide -Benza-Clin -Systemic for moderate to severe acne -Minocycline -Erythromicicn -Bactrim

acne

-Divorce, poverty, unemployment, poor housing, substance abuse, frequent relocation, crowded living conditions -Child abuse can occur in any socioeconomic population/area

acute/chronic stress

-Requires that all essential amino acids must be eaten at the same meal -Non essential amino acids- body makes them -Essential- ones that our body cant make, gotta be consumed, best way is to do these combos

adequate protein intake

-People who struggle with this are always doing well, great at what they do, straight A grades, very informing and consciousensous to other, -25 percent will always struggle with this thruout life. 50%= will relapse this when stress comes up.

anorexia nervosa

-Allergy with a hereditary tendency

atopy

-Physical contact -Consistent caregiver

attachment

-Frequent and long-term exposure to liquids containing sugar -Milk -Formula -Fruit juice -Soda -Sweetened drinks -Never dip pacifier in sugar or honey(never give honey. -After 1 yr you can handle it. If under 1 yr it causes botulism and u die. -Water is ok, only after 1 year of age -No more than 4-6 oz

baby bottle tooth decay

1. -2 images into one cerebral picture begins 6 weeks and well established by 4 months. Lack of binocular vision results in strabismus 2. Develop 7-9 months. Parachute reflex protects in fall

binocularity 2. depth perception

-Visual Acuity 20/100 to 20/400 -Fixate on object 8-10 inches away -Doll's eye reflex (eyes lag behind when head rotated to one side)

birth

-Risk for long-term psychologic disturbances and psychiatric symptoms -Bullying prevention programs: established in most schools. Make sure that kids and parents participate in programs help decrease bullying.

bullying (Kids as young as 8 or 9 being bullied.)

-Small blood volume(30ml blood loss is huge! Not uncommon to have issues with blood draws. Don't take much with blood draws) -Blood Pressure (B/P)(rises as they get older) (small heart and small body is why its low when young) -Neonate 60/30 -Child: 90/60 -Adult: 120/70 Pulse -Newborn: 120-160/minute -Adult 60-90/minute -Pulse over 200 is a concern! 180 is fine in newborns. Pulse and resp are done for a full minute due to irregularity.

cardiovascular system

1. head to feet 2. interior to the middle. Learn stuff in the middle first.

cephalocaudal 2.Center to Periphery

-Crying more than 3 hours a day more than three days a week -Can last up to 3 months. -Causes -Paroxysmal abdominal pain

colic

-Infant massage=calms baby and parents. Have parents follow intestinal tract to help move gas and stool contributing to colic. -Warmth to tummy=use warmth to belly. Not to hot. Tummy time such as laying baby across lap.

colic

-Take a careful history -Look for allergy -Carbohydrate malabsorption=more common, due to milk sugar that are present in formulas. Don't see as often in breastfed babies. Formulas are cows milk based so rxn to cows milk. Switch to soy base formula or more carbs and proteins in them. -FPIES=allergy that occurs within the GI system. Wont have typical reactions live hives and what not. Causes inflammation in gi system and have bloody stools and diarrhea.

colic

-The fourth trimester -Harvey Karp's 5 S's -Swaddling -Side or stomach position -Shushing -Swinging -Sucking=while shushing baby make sure that they are sucking on something so they cant cry.

colic

-Teach signs parents may recognize: Rapid pulse, sweaty hands, fatigue. -Teach child relaxation techniques and guided imagery: Belly breathing, "let their body go limp", play, active toys, -Allow rest, and prepare for changes such as start of school, going to dentist

coping with stress

-Make sure true allergy versus intolerance- more people have intolerance to things in milk than actual allergy -Change to an elemental formula -Pregestimil, Nutramigen, Alimentum -Eliminate milk products from mother's diet if nursing

cows milk allergy

-Increased incidence of suicide -Screen with every interaction with teen -May not appear depressed -16% of high school students seriously consider suicide

depression

-50% of children have some degree of diaper dermatitis with peak age of 9-12 months (because they are eating more normal food, stooling more) -Increased pH -Increased friction -Promoted fecal enzymes

dermatologic problems

-Increase skin permeability to bile salts -Usually in skin folds -May have secondary infection with candida -Well demarcated edges -Use occlusive ointments (make sure very clean) *Occlusive ointments: Zinc oxide, Happy hiney cream, butt cream, Monkey butt

dermatologic problems

Clinical manifestations: -Lower abdominal cramping, pain, discomfort, fatigue, nervousness, diarrhea, headache, nausea/vomiting Therapeutic Management: -R/O organ system issue with gyn exam. -Give NSAIDS - prostaglandin inhibitor Nursing Considerations/teaching: Anticipatory guidance, menstrual physiology, balanced diet, exercise, warmth,

dysmenorrhea

-11-14 years old -Thelarche (breast development) -Nipple/areola changes and breast buds (8-13 years) -Physiologic leukorrhea(small amount of white discharge from vagina. Normal)

early puberty

-9 1/2-14 years old *First change: Testicular enlargement -Thinning, reddening, increased loosened of scrotum -Pubic hair develops

early puberty

-Inability to see situations from the perspective of others

egocentrism

-Immaturity: Limited ACTH= relates to reduced ability to tolerate stress because of immature feedback between ACTH and adrenal cortex -Fight or flight response is not developed.

endocrine system

-Lack of homeostatic control -More vulnerable to -Fluid and electrolyte imbalances -Glucose concentration -Amino acid metabolism -Less able to tolerate stress(so when babies get sick, they get sicker faster) -Effects fluid and electrolytes and metabolism of fats, proteins, and carbohydrates resulting in blood sugars fluctuating under stress

endocrine system

-Dexterity improves 12-15 months=have to throw underhand. -Throw ball overhand by 18 months -Climbing becomes easier for them.

fine motor skill

-Too much fluoride causes hypominearlization(takes minerals out of the teeth) of developing teeth -Mild: White spots -Severe: Dark discoloration -Weakens teeth -decaying -Tap water has fluoride in it!

fluorosis

-Breast feed can help avoid this. Also make sure mom isn't having anything the baby is allergic too cuz it can be transferred. -Formulas (vary based on allergy) -Soy -Elemental -Pre-digested

food sensitivity

-common during infancy -Immature intestines are more permeable to proteins -Onset: 5 - 30 minutes after ingestion -Atopy hereditary allergies -1 parent = 50% risk -2 parent = 100% risk

food sensitivity

-Induce vomiting, (Syrup of Ipecac, not recommended in homes per AAP) -Absorb toxin (Activated charcoal can be used) -Perform gastric lavage(put ng tube in kid and suck it up) -Depends upon agent ingested -Cathartics -Antidotes(to much Tylenol isn't good) -Prevent recurrence(find out how the child got a hold of poison)

gastric decontamination

-Locomotion: moving forward. 2-3 year olds move forward continuously. -Improved coordination by 2-3 years -Can do stairs now. They have to get both feet on same step. One step at a time.

gross motor skill

CARDIOVASCULAR SYSTEM: -Infant: 18 g/dl (Physiologic Nadir at 4 months)(HGB drops gradually) -Adult: 15

hemoglobin

-Birth to 1 year of age -First 28 days of life= neonate

infant

-Physical changes and cognitive development are dramatic -The most rapid period of development -All body systems undergo progressive maturation -Order of development occurs in roughly the same pattern and progression

infant

1. Until reach formal operations stage think "will not happen to me". MVA & majority with alcohol increases risks. (teens think they wont get hurt. Driving cars or drinking) (dive in and break their neck)

injury

1.-Little interest in social interactions -Dislike being held -Apathetic when left alone -Can occur in abuse situations tooooo *Idiopathic failure to thrive=Cause unknown

inorganic failure to thrive

-Emotional attachments between 2 people of concern for each other's well being distinct from sexual relationships -Relationships early in adolescence not likely to be true intimacy -Too much alone time may lead to sexual intimacy before they are ready -Mixed-gender group activities are best -Serious relationships delayed until late adolescence may be the ideal pattern of interpersonal involvement

intimacy

-Deficiency of proteins with adequate calories -May be related to a grain mold (Ghana) -Mineral deficiency results in rashes, loss of hair, digestive problems, defective wound healing, impaired growth, anorexia -Severely immunocompromised -Permanent blindness

kwashiorkor

-Edema, Moon face -Thin coarse hair with weak roots -Sodium retention, hypokalemia -Diarrhea, Enlarged liver -Lethargy -Death from circulatory failure

kwashiorkor

-Eliminate dairy products, can use soy formula

lactose intolerance

STRESS REDUCTION FOR CHILDREN: -Relaxation techniques -Deep-breathing exercises -Progressive relaxation of muscle groups -Positive imagery -Physical activity 1. Kids who can be home by themselves.

latchkey children

-Rarely symptomatic -Venous blood sample of 10 mcg/dl -Screening for lead poisoning at ages 1 and 2 years -Chelation therapy with calcium disodium edetate (EDTA) and succimer (DMSA) -Prognosis

lead poison diagnosis

-Most common by peeling lead-based paint, environment (toys) -Microparticles of lead contaminate bare soil -Can be inhaled or ingested -Affects renal, hematologic, and neurologic systems: developing brain and nervous systems are especially vulnerable

lead poisoning

-Immaturity 1st year -Most immature of GI system -Flush out bilirubin. You can draw a line on the child of where the bilirubin is meaning you can see the jaundice.

liver

-is associated with Zen Buddhism and is based on the idea of balancing yin and yang.[3] The diet proposes 10 plans which are progressed through to reach a supposedly ideal yin/yang ratio of 5:1.[7] Macrobiotics emphasizes locally grown whole grain cereals, pulses (legumes), vegetables, seaweed, fermented soy products and fruit, combined into meals according to the ancient Chinese principle of balance known as yin and yang[citation needed]. Whole grains and whole-grain products such as brown rice and buckwheat pasta (soba), a variety of cooked and raw vegetables, beans and bean products, mild natural seasonings, fish, nuts and seeds, mild (non-stimulating) beverages such as bancha twig tea and fruit are recommended.[citation needed] Nightshade vegetables, including tomatoes, peppers, potatoes, eggplant; also spinach, beets and avocados are not recommended or are used sparingly in macrobiotic cooking, as they are considered extremely yin.[11] Some macrobiotic practitioners also discourage the use of nightshades because of the alkaloid solanine, thought to affect calcium balance.[12] Some proponents of a macrobiotic diet believe that nightshade vegetables can cause inflammation in the body and osteoporosis.[13] Practices[edit]

macrobiotic diet

-15-17 years old -Increased estrogen to build endometrial lining then menarche -Initially periods are scanty and irregular -Ovulation unlikely, although possible -Regular periods occur 6-14 months after menarche

mid-puberty

-Penile enlargement -Voice changes -Early facial hair -Gynecomastia(male develops early breast changes) -1/3 of males in midpuberty -Gynecomastia: usually disappears 2-3 years. -Ht/wt spurts

midpuberty

-Startle reflex -Begins at 28 weeks gestation -Usually resolved by 5-6 months -Watch for asymmetry

moro reflex

symptoms: -yellow skin -yellow eyes -sleepiness -poor feeding in infants -brown urine -fever -high pitched cry -vomiting

neonatal jaundice

-Anorexia -Obesity (beginning of CV disease) -Increased growth with onset of puberty -Maximum bone mass late adolescence(wont increase the rest of their lives. Especially girls and athletes)(once you start losing bone you wont get it back) -Check Hgb/Hct in menstruating female

nutrition

-Less likely if breastfed related to self-regulation of intake -When add solid foods, decrease bottle intake -At least 16 oz but less than 1 Liter per day -Limit fruit juice to 6-12 oz/day -Comfort in other ways (that doesn't't require food)

obesity

-Management -Diet: < 5% from underlying disease (hypothyroid, etc) -Physical Activity -Behavior Modification/Therapy: -Identify & eliminate inappropriate eating habits -Drugs: Not many available for children/adolescents -Effectiveness? -Surgical Techniques: -May be hazardous/metabolic complications -Nutritional Counseling Group Involvement -Family Involvement -Prognosis: Lifelong difficulty. *Prevention(best thing you can do): Begin education in early childhood!!

obesity

-uses both hands to maintain an open airway with a jaw thrust and a tight mask-to-face seal while the other compresses the ventilation bag. Both rescuers should observe the victim's chest to ensure chest rise.

one rescuer

FEEDING DISORDERS: -seen in children that were in NICU. Cant associate good food or nipple in mouth because used to tubes in mouth.

oral aversion

1. -Mittleschmerz(when ovulation occurs. Mittleschmerz is pain) Sexual maturation influences satisfaction with appearance -Girls less satisfied if early development occurs -If girls mature earlier, its more negative due to increase of attention

ovulation

-Deliberate infliction of physical injury on a child -Symptoms:???

physical abuse

-ages 4 to 5 years: Recognizable, but not yet refined, as familiar objects like human figures, houses, trees, animals and progress to more clear drawings, triangle and diamond are last to be mastered

pictorial stage

-age 15 months: Scribble randomly to scribbling in a specific placement pattern) 2. by age 3 years: Single shapes like circle, +, square - holds with fingers rather than a fist

placement stage 2. shape stage

-Team play -Quiet games and activities -Ego mastery(being able to have self-confidence)

play

-Physical skill, intellectual ability, and fantasy -Form groups, cliques, clubs, secret societies, teams -Like to make Rules and rituals -See the need for rules in games they play

play (-good time to expose to clubs and activities.)

-7 years of age or less: Just lateral to LMCL & 4th intercostal space (ICS) -Older than 7 yo: At LMCL and 5th Intercostal space

point of maximum impulse

-Organized play *Novice level *Must take developmental level into consideration (physical and psychological)

preschooler

-Sleep and Activity -Average 12 hours per night -Sleep Problems -Nightmares vs Night Terrors -Fears -Co-sleeping(sleep in their own bed!) -Bedtime routines/rituals

preschooler

-Assist in Food Preparation and Grocery Shopping -Kid wants to help make food. Let them help! Let them sweep the floor.

preschoolers

-Associative Play -In groups with similar or identical activities without rigid rules or organization -Imitation/Drama play -Dolls, dress-up, telephone, trains, puppets, animals Imaginary playmates

preschoolers

-Can verbalize their request for individualism -May obey verbal warnings of danger - but may still exceed their boundaries at times -More social and willing to please others -May begin to question parental values (why do you smoke mommy?) and will compare them to others, may be less willing to follow family's code of conduct. -Understand role in the family structure (oldest vs youngest)

preschoolers

-Consistent role models of good speech -Easily bilingual at this point -Can follow simple directional commands - put the ball on the chair, but only one request at a time -Can answer questions -Will ask questions until they get an answer.

preschoolers

-Individuation-Separation is complete during Preschool -Have overcome anxiety associated with strangers and the fear of separation as when they were younger -Effects of prolonged separation (hospitalization) -Helpful to provide anticipatory preparation(mom is coming tomorrow, so lets take a bath) and concrete explanations

preschoolers

-Internalized values of family(taking praying before meals for example) -More secure with new sibling arrival at this age but still difficult and need preparation

preschoolers

-Learn to relate to strangers easily. Decrease in protest when leaving parents. Will go with anyone that knows their name. Don't have shirts with their names on it. -Still need parental security, reassurance, guidance and approval. -Able to adjust with preparation, working through their fears especially if guided with play objects such as dolls and puppets - child life!

preschoolers

-Mutual play with parents -Positive interactions Temperament -Effect of temperament on adjustment in group situations -Long-term consequences of temperamental characteristics -Influence of temperament on school success

preschoolers

-Play should involve physical, social and mental development -Running, jumping, climbing, bikes, wagons, sleds, pools, sandboxes -Manipulatives, construction, creative, and educational toys fine motor -Very absorbed in reproduction of the behavior of significant adults in their lives but by the end of preschool want to actually do the activity, not just pretend - actual cook, carpentry -Love crafts, but short attention spans.

preschoolers

-Ritualism and negativism of toddlerhood decrease -Self-assertion -Independent in dressing, eating, toileting by ages 4 to 5 -Desire to please(always wanna do stuff so they can please your demands)

preschoolers

-The word no is replaced with why -Be honest and matter of fact -May create their own stories if not given the correct answer, magical thinking, may be terrifying or fantastic -Honesty won't encourage permissivity -They likely won't understand much of what is being said. They will get information from what they see parents doing, tv, etc. -Playing doctor - more to do with elimination than sex -Broader concept of sexuality: two people together with special relationship to each other, private act to express caring and pleasure -Stress the meaningful, intimate relationship between adults., and that it is healthy and natural. Kids can be taught to knock first. Lock the door! -Masturbation: Normal and healthy. Should stop when distracted. Nurses can ascertain if there are other conditions: genitourinary condition, anxiety, anger, boredom, if excessive may be sexual abuse, emotional or behavioral problems. Parents need to redirect, reassure, discuss appropriate boundaries - private act. Learn socially acceptable behavior.

preschoolers

LANGUAGE -Age 6—understand all parts of speech -Identify opposites(big and little, short and tall) -Define simple objects -Use all parts of speech correctly except for deviations from the rule = good, better, best.

preschoolers

LANGUAGE -Becomes more sophisticated and complex -Telegraphic speech at age 3-4 years -Includes only necessary parts of speech to convey a message -Ages 4 to 5—four- and five-word sentences: -2100 word vocabulary vs 300 word at age 2

preschoolers

-Replaced by voluntary, yet purposeful movement

primitive reflexes

-No breast development by age 13 or -No menarche 2 - 2 ½ years after thelarche

pubertal delay

-Initial Contact: ER or Clinical office -Let them know they are safe. -Not being blamed. Do not continue repeated interrogation -History: Minimize further psych trauma. Use "OWN WORDS" -Exam -Sexual Assault Nurse Examiner(SANE) -Treatment: Pregnancy/Plan B, STI, Psychological

rape

-can happen with neonates who haven't been fed or are starting to feed, people who are NPO for a week to 10 days. It can occur in eating disorders. Was recognized after WW2 after prisoners were retrieved from concentrations. 25% died due to refeeding syndrome. Refeeding syndrome=is after a period of starvation insulin down, decrease in phosphate stores and other electrolytes, low in magnesium, low in thiamine which comes from protein. Increase in cortisol in starvation state. You use up fat and protein stores. You will go into a state of metabolism where muscle is being broken down. Minerals and vitamins also get broken down. These people had tissue hypoxia, didn't have muscle contractions causing diaphragmatic issues. REFEEDING SYNDROME OCCURS BIG TIME WITH EATING DISORDERS AFTER 4 DAYS OF TRYING TO GET BACK EATING.

refeeding syndrome

-Immaturity -Reduced filtration capacity of glomeruli -Unable to concentrate urine -Lower specific gravity (1.000 - 1.010) -Predisposes to dehydration until late in 2nd year of life -Small bladder = frequent voiding -1-2ml/kg/hour of urine output

renal

-Rate(KNOW RANGES AND NORMAL AND NOT NORMAL)(greater than 20 second pause is called apnea. KNOW) -Newborn 40-60 -Child 20-40 -Teen 12-20 -Anything over 60 is always abnormal!! -DECREASED RATE ISN'T NECESSARILY GOOD.

respiratory

-Slows with age, Abdominal

respiratory system

-Cognitive Development (Piaget) -Concrete operations -Use thought processes to experience events and actions -Develop an understanding of relationships between things and ideas -Conceptual thinking: Able to make judgments based on reason ("Conceptual thinking") -Mastery of conservation: Same amount of water may fit in different height containers, depending on width, crunched up paper is same amount of paper as the paper b4. -Identity: remains unchanged -Reversibility: back to original -Reciprocity: two dimensions at the same time (paper is same whether flat or in a ball)

school age children

Injury Prevention/Anticipatory Guidance: -Motor vehicle crashes, pedestrian and passenger: -Common cause of injury and death in school age children -Bicycle injuries; benefits of bike helmets and proper fit -Appropriate safety equipment for All sports and activities -Increasing independence with parental support --know areas to go or not to go in.

school age children

SEX EDUCATION: -Middle childhood(5th grade) is the ideal time for formal sex education -Life span approach -Information on sexual maturity and the process of reproduction -Effective communication with parents(if parents are open, child will continue to talk to parents in the future) *-important to learn the correct information.

school age children

Developing a Self-Concept: -A conscious awareness of a variety of self-perceptions (e.g., abilities, values, appearances) -Importance of significant adults in shaping a child's self-concept -Positive self-concept leads to feelings of self-respect, self-confidence, and happiness -Awareness of "differences with others may influence feelings of inferiority -Children like their physical selves less and less as the age

school age kid

School Age Child Moral Development (Kohlberg): -Move from egocentrism to more logical patterns of thought -In a child age 6 to 7 years, learn the rules, what they are supposed to do, act based on reward and punishment -Older school-age child is able to judge an act by the intentions that prompted it -Rules and judgments become more founded on the needs and desires of others. As older start to understand treat others as you would like to be treated.

school age kid

Spiritual Development: -Concrete terms for religious concepts: Picture God as human and use adjectives to describe: Loving, helping -Children expect punishment for misbehavior -Expect to be punished if misbehave -Prayers and rituals are comforting -May view illness or injury as punishment for a real or imagined misdeed

school age kid

Psychosocial Development (Erikson): *Industry vs Inferiority: Intrinsic motivation leads to competence and mastery(want to have a goal, want to be useful) -Want to develop skills so they can participate in meaningful and socially useful work -Acquire a sense of personal and interpersonal competence resulting in a growing sense of independence -Peer approval is a strong motivator to explore on their own -Peer approval -Acquisition of technologic and social skills -Better able to cope and cooperate -Same sex relationships, groups, teams, clubs

school age kids

Relationships with Families: -Parents are primary influence in shaping child's personality, behavior, and value system -Increasing independence from parents is primary goal of middle childhood -Children not ready to abandon parental control --child can be home alone by 1 hr of year of grade. 3rd grader can be home alone for 3 hours. Dependent on child though.

school age kids

Social Development: -Peer group important. Do not accept disrespect. *Bullying *Gangs -Identification with peers is a strong influence and necessary for a child to gain independence from parents,Not ready to abandon parental control -Sex roles are strongly influenced by peer relationships -Formation of groups or clubs

school age kids

-starts at birth when a name is given to the child. -Some now say starts prenatally. (you will know the gender early on)

sexual identity

-(heart rate is times to the breathing pattern)(take in breath, HR goes up, push out breath, HR goes down) -Murmurs (Physiologic versus Pathologic)

sinus arrhythmia

PRESCHOOLERS: -Stutter or stammering (dysfluency): Use vocabulary faster than they can produce the sounds. *Common 2-5 year olds and more common in males. *Speak to them slowly and clearly *Do not correct or criticize *Do not complete their sentences for them *Listen attentively(don't show frustration)

speech problems

-Influence depends on how those closest to them discuss their religious teachings. -Spiritual routines can be comforting. (they don't understand spiritual belief but they understand routines)(in their mind, god is a real person on a cloud) -2 yr old bowing head and praying becomes a routine, they don't know why they are doing this though. -Religious teachings and moral development influence toddler behavior

spiritual development

-Factors that affect the child's reaction to a stranger -Approximately 6-15 months of age -Personality dependent -Say goodbye see you later. Don't make it long or drawn out. It wont make it better.

stranger anxiety

-happens for no known reason -Apparent Life Threatening Event (ALTE) -Now called Brief Resolved Unexplained Event (BRUE) -Infant at highest risk -One or more severe BRUEs requiring CPR or vigorous stimulation -Near-miss SIDS -Preterm infants experiencing apnea at time of discharge from hospital -Sibling of two or more SIDS victims -History of central hypoventilation

sudden infant death syndrome SIDS RISK FACTORS SLIDE 33 TANNERS, ALSO LOOK AT SLIDE 36 & 37SEAT BELTS

-Don't have cause and effect yet. They have object permanence. Start to understand that when you are leaving, that you will come back. -you can ask them what does the cow say or cat say. -they understand that they have been hit by sally but don't understand that their hit to sally is why she cried and hit back.

symbolic limitation

-Most common cancer in young men aged 15 - 35 years -Lifetime risk: 1 in 263 males -Painless mass -Heavy -Hard -Smooth or nodular -95% survival rate -If caught early on, it is almost always treatable. Do self exam monthly. Look for nodules or hard or smooth.

testicular cancer

-partial or complete venous occlusion. Tissue in testicle is to loose. -Emergency!(sharp, sudden, extreme pain) -6 hours until loss of testicle -Absence of cremaster reflex(stroke side of thigh and the testicle will stroke up) -Edema may be present -They will go in and suture it to prevent. Can happen at any age.

testicular torsion

-Brown fat -Produces heat -Non-shivering thermogenesis -Babies have little ability to shiver. -This is why we use hats. They have a huge head so key to keep warm

thermogenesis

-Increased adipose tissue 1st 6 months insulates against heat loss with insulation since non-thermogenesis at this age -is shivering to produce heat

thermogenesis

-Doesn't matter if a boy sits or stands when toilet training. ASK TERM THAT WAS TALKED ABOUT HERE

toilet training

-Infant: 65% total body weight is water -ECF 25%, ICF 30-40% -Little fluid reserve in ICF -High metabolic rate requires generous fluid intake

total body fluid

-Lose up to 10% birth weight first few days and should regain this by 2 weeks -Require 100ml/kg (up to the first 10kg) per day -Newborn: 75% total body weight is water -ECF 45%, ICF 30% -Brain and skin larger proportionally -High in interstitial fluid

total body fluid

1. -Asymptomatic scrotal mass or scrotal aching. -Tortuosity of veins of the spermatic cord superior to testicle Worm-like mass - "Bag of worms" Sharp to dull discomfort -May worsen after exertion such as standing or at end of day -Improves in prone position Treatable cause of male infertility -Requires surgical correction -Microsurgery

variocele

-Port-wine (Nevus Flammeus)=Possible Neurological involvement -Hemangiomas -Strawberry hemangiomas=Proliferative -Cavernous hemangiomas

vascular formations

-For human face by 6 weeks with preference for face with eyes, more refined by 6 months and can distinguish familiar and unfamiliar faces resulting in start of stranger anxiety.

visual preference -See text for changes in Characteristics of Hearing

-Fat soluble Vitamins (ADEK) vitamin malabsorption and overload at times if too much is taken -Vitamin overload 1.-developing countries -Increases mortality in diarrhea and infections -Vision

vitamin A deficiency

-is a water-soluble vitamin that has a key role in the normal functioning of the brain and nervous system via the synthesis of myelinand the formation of red blood cells It is involved in the metabolism of every cell of the human body, especially affecting DNA synthesis, fatty acid and amino acid metabolism.

vitamin b12

-1 of 5 children ages 2-18 consumes 5 servings of fruit and veggies a day -French fries most common - do not count 2. (lack of Vitamin D) is on the increase- supplementing it more now

vitamin deficiency 2. rickets

-9 - 12 months old = first steps -Walking well by 14-15 months -Not walking until 18 months is still normal

walking