Peds Exam 1
(Adolescents) Factors Contributing to Violence
• Crowded conditions/housing • Low socioeconomic status • Limited parental supervision/involvement • Single-parent families/both parents in workforce • History of violent victimization • Poor family functioning • Access to guns or cars • Drug or alcohol use • Low self-esteem • Racism • Peer or gang pressure • Aggression
The parents of a 10-year-old girl voice concern to the nurse because their daughter seems to "have a higher amount of body fat" than they expect based on the healthy eating habits and high activity level of the family. What is the best response by the nurse?
"Before adolescence the body fat composition of school-age children increases earlier and in greater amounts in girls than in boys."
The nurse is collecting data from a 15-year-old boy who is being seen at the ambulatory care clinic for immunizations. During the initial assessment, he voices concerns about being shorter than his peers. What response by the nurse is indicated?
"Boys your age will often continue growing for a few more years."
The parents of an 8-year-old boy report their son is being bullied and teased by a group of boys in the neighborhood. Which response by the nurse is best?
"Bullying can have lifelong effects on the self-esteem of a child."
A 3 ½-year-old girl is admitted to the hospital with a severe respiratory infection. The parents tell the nurse that they have noticed that their child has been using "baby talk" and has been wetting the bed. The parents are concerned and ask the nurse what they should do. How should the nurse respond?
"It is normal for children to regress during a stressful event like a hospitalization. Just praise her good behavior and don't give attention to the regressive behavior."
When the nurse discharges a new mom and infant, the nurses notices that the car seat is in the front seat of the car. What is the appropriate response for the nurse to make regarding the car seat?
"Let me go over car seat safety with you, so you can install your car seat properly."
The nurse is collecting data from an adolescent being seen for a well-child check. During the interview, the teen reports he sleeps about 6 hours per night during the week but is able to sleep 8 to 9 hours on the weekend. What response by the nurse is most appropriate?
"Let's talk about ways to increase the amount of rest you get during the week."
The nurse is discussing home safety with the parents of a 10-year-old client. Which statement by the client's parents most concerns the nurse?
"Our child swims alone before we get home from work."
The nurse is doing a well-child exam of a 5½-year-old girl. Which statement by the mother would alert the nurse that further teaching is needed about healthy eating habits?
"Our family rule is that all children 'clean their plates' at each meal, and we feed them a lot."
During a health history assessment, the mother of a 10-year-old girl tells you that her daughter does not have time to "play" because she is busy going to gymnastics, cheerleading, art class, flute lessons, reading club, and soccer. What should the nurse's response be?
"Play helps children to develop cognitively, socially, physically, and emotionally."
A grandmother who is the primary caregiver of a 2-year-old is expressing concern about how to best handle the temper tantrums that can occur two or three times a day, often in public places. She explains she spanked her own children for this but she is worried this is not the best way to handle the situation. Which response from the nurse will best address this concern?
"Remain calm, pick the child up, and move to a quiet and neutral place until she gains self-control; don't give in to her demands."
The parent of a 5-year-old child calls the doctor's office to seek advice about proper nutrition for her child. Which statement by the mother indicates that further teaching is needed?
"Since she doesn't like vegetables, we no longer serve them to her."
The nurse is documenting the relationship between a postpartum mother and her infant. Which observation would demonstrate attachment?
"The mom is talking to the infant while breastfeeding the infant.
The nurse is providing teaching about child safety to the parents of a 4-year-old girl. Which statement by the parents indicates a need for further teaching?
"We need to tell her that her vitamins are candy."
A nurse is providing a routine wellness examination for a 5-year-old boy. Which response by the parents indicates a need for an additional referral or follow-up?
"We often have to translate his speech to others."
The nurse enters her client's room and finds the infant on a pillow with a bottle propped up while the mother is dressing. What statement should the nurse make?
"You should always hold your baby for feedings instead of propping the bottles."
(Preschool) Gross Motor Skills
(3) climbs well, runs easily, bends over without falling, walks up stairs alternating feet, etc. (4) throws ball overhead, kicks ball forward, catches bounced ball, hops on one foot, stands on one foot up to 5 seconds (5) Stands on one foot longer than 10 seconds, swings and climbs well. may skip, skates and swims
(Preschool) Moral and Spiritual Development
- can understand concepts of right vs. wrong - developing a conscience
(Adolescents) Emotional and Social Development
* significant changes including: relationship with parents, self-concept and body image, importance of peers, and sexuality and dating - RELATIONSHIP WITH PARENTS: teens spend less time with family or attending family events, teen attempts to establish independence which can lead to disequilibrium, parents sense they have less influence over the teen - SELF CONCEPT AND BODY IMAGE: Teens who perceive their body as being different than peers or as less than ideal may view themselves negatively. Adolescent girls often are influenced by peers and the media and want to weigh less and have smaller hips, waist, or thighs. Boys tend to view themselves as being too thin or not muscular enough. Boys are concerned about the size of their penis and facial hair while girls are concerned about breast size and the onset of menstruation. Larger breasts are considered more feminine and menstruation is considered the right of passage into adulthood. All of these body changes are important to the adolescent's self-concept. - IMPORTANCE OF PEERS: peer groups play an essential role in the development of the teen. Adolescents who do not have parental or adult supervision and opportunities for conversation with adults may be more susceptible to peer influences and at higher risk for poor peer selections. - SEXUALITY AND DATING: Adolescence is a time when teens may begin experimentation related to their sexual identity, orientation, and behavior. Trends in dating are changing, but dating remains a developmental milestone for the adolescent. Healthy romantic relationships in adolescence can assist the teen in developing a strong sense of self-identity and developing interpersonal skills, such as empathy, and are related to increased quality of adult relationships
(Adolescents) Promoting Safety
- Motor Vehicle Accidents: leading cause of injury in teens, higher risk when passengers are in the car, driving at night, or driving under the influence - Firearm Safety: this is a rising risk, provide education about gun safety (guns must be locked and separated from ammo) - Water Safety: Provide water safety education and proper supervision to decrease the incidence of risk taking. Teach about swimming lessons for nonswimmers.
Fontannels
- Soft areas on the skull remain open for rapid brain growth in infancy - Note the size of the fontanels. The anterior fontanel's size is 1 to 4 cm in either direction until it can no longer be felt when it is closed by the age of 9 to 18 months. The posterior fontanel is much smaller and may close any time between shortly after birth and approximately 2 months of age. - The fontanels should not be depressed or taut and bulging, though it is not uncommon to see them pulsate or briefly bulge if the baby cries. In an acutely ill infant, assess the fontanels while obtaining the vital signs. Dehydration can cause the fontanels to be sunken; increased intracranial pressure and overhydration can cause them to bulge.
(School Age) Abuse in children
- Teach "good touch" versus "bad touch" - "Bad touch" should be reported - school nurse required to report it to state
(School Age) Cognitive Development
- able to see things from another person's POV - ability to classify or divide things into sets - collecting objects - take consequences into decision before acting upon - conservational principle
(Adolescents) Gross Motor Skills
- develop endurance, concentration has increased so they can follow complex instructions, speed and accuracy increase, coordination improves
(Toddlers) Cognitive Development
- dramatic play: imitate life with toys - animism: human feelings and characteristics may be attributed to objects
(Adolescents) Fine Motor Skills
- finger dexterity increases, neat handwriting, precise hand-eye coordination
(School Age) Gross Motor Skills
- improved balance, coordination, rhythm - bicycling, skating, swimming - should be encouraged to participate in physical activities
(Adolescents) Communication and Language Development
- improved communication skills using correct grammar and types of speech - usage of colloquial speech (slang) sometimes makes communication difficult - by late adolescence language skills are comparable to adults
(Adolescents) Cognitive Development
- in early stages egocentric thinking -> formal operational reasoning - convinces their viewpoints yo others leading - idealism can cause conflict with family, church, and community
(School Age) Communication and Language Development
- learns to read and improves language skills - able to understand jokes and enjoys riddles - able to understand metaphors
(School Age) Fine Motor Skills
- myelination of the CNS - eye-hand coordination and balance improve - hands become steadier making writing easier
(Preschool) Cognitive Development
- preoperational thought (single POV) - magical thinking (their thoughts are powerful) - imaginary friend (practice conversational skills)
(Preschool) Promoting Healthy Growth and Development
- routine - self-esteem *critical* - consistent limits= expectations and guidance - cooperative play - dramatic play
(Preschool) Communication and Language Development
- telegraphic speech 2 y/o 50-100 words 4 y/o speaks in complete sentences, 75% of people outside of family can understand them 5 y/o 2,000 words, can count to 10, understood by everyone, long detailed convos
(School Age) Emotional and Social Development
- temperament: way individuals behave - self-esteem development -body image: how they perceive their bodies *important to feel accepted by peers
(School Age) Promoting Healthy Growth and Development
- through play: cooperative play (team sports such as soccer, basketball, football, etc.) and solitary play (board games, computer games, video games, etc.) - through learning: attending school is very important to school aged children
(School Age) Sensory Development
- vision and hearing screenings (severe hearing deficits should be diagnosed at birth) - sense of smell matures and can be tested
The nurse is performing an admission assessment of an adolescent with the teen and the parents. During the assessment the nurse suspects that the teen may be pregnant. What is the best way for the nurse to address this situation?
Ask the parents to wait in the family lounge while finishing the assessment, then ask the teen during the assessment
(Toddlers) Developmental Theories
Autonomy vs. Shame & Doubt
(Adolescents) Psychosocial Development
As the adolescent is trying out many different roles in regard to his or her relationships with peers, family, community, and society, he or she is developing his or her own individual sense of self. If the adolescent is not successful in forming his or her own sense of self, he or she develops a sense of role confusion or diffusion. The adolescent culture becomes very important to the teenager. It is through his or her involvement with teenage groups that the adolescent finds support and help with developing his or her own identity.
A client has confided in a nurse that her 13-year-old daughter has recently changed dramatically in her social interactions with others. What is a social behavior most likely to be exhibited by a girl at this age?
Banding together with other girls and dressing like them
Early Childhood Development Warning Signs
Before 3 months Rolls over After 2-3 months Persistent fisting After 4 months Persistent head lag 5 months Not reaching for toys 6 months • Lack of tripod sitting • Not smiling • Primitive reflex persistence • Not babbling 9 months No reciprocal vocalizations or facial expressions 12 months No spoon or crayon use 15-18 months • Not walking • No first word Prior to 18 months Hand dominance present By 18 months • Not walking • Not speaking 15 words • Does not understand function of common household items • No imitative play After independent walking for several months • Persistent tiptoe walking • Failure to develop a mature walking pattern By 2 years • Does not use two-word sentences • Does not imitate actions • Does not follow basic instructions • Cannot push a toy with wheels • Echolalia (repetitive speech) By 3 years • Difficulty with stairs • Frequent falling • Cannot build tower of more than four blocks • Difficulty manipulating small objects • Extreme difficulty in separation from parent or caregiver • Cannot copy a circle • Does not engage in make-believe play • Cannot communicate in short phrases • Does not understand simple instructions • Little interest in other children • Unclear speech, persistent drooling 4 years • Cannot jump in place or ride a tricycle • Cannot stack four blocks • Cannot throw ball overhand • Does not grasp crayon with thumb and fingers • Difficulty with scribbling • Cannot copy a circle • Does not use sentences with three or more words • Cannot use the words "me" and "you" appropriately • Ignores other children or does not show interest in interactive games • Will not respond to people outside the family; still clings or cries if parents leave • Resists using toilet, dressing, sleeping • Does not engage in fantasy play By 5 years • Unhappy or sad often • Little interest in playing with other children • Unable to separate from parent without major protest • Is extremely aggressive • Is extremely fearful or timid, or unusually passive • Cannot build tower of six to eight blocks • Easily distracted; cannot concentrate on single activity for 5 minutes • Rarely engages in fantasy play • Trouble with eating, sleeping, or using the toilet • Cannot use plurals or past tense • Cannot brush teeth, wash and dry hands, or undress efficiently
(School Age) Teaching Guidelines
Car safety • Seat belt or age- and weight-appropriate booster seat should be used at all times. The lap belt should lie low and flat on the hips and the shoulder belt should lie on the shoulder not the neck or face (usually when the child is about 144.8 cm [57 in] tall). • Seat belts should be fastened before car is started. • Children under 13 years must sit in the back seat. • Childproof locks should be used in the back seat. • Rules of conduct for car rides must be established. Pedestrian safety • Child should be instructed to stop at the curb and look right, left, then right again before crossing the street; and crossing only at safe crossings. • Older children and adults should provide supervision of younger children. • Walking should only be done on sidewalks. • Phones, headphones, and devices should be put away when crossing the street. • In parking lots, children should know to watch for cars backing up and not dart out between parked cars. • If children are playing outside, drivers should be aware of their presence before backing up. Bike safety: general • Child should know to wear a properly fitted, Consumer Product Safety Commission (CPSC) or Snell-approved helmet every time he/she rides a bike. • Proper-fitting helmet should sit level, not tilted, and firmly and comfortably on the head; have strong wide Y-shaped straps and when you open your mouth it should pull down a bit; not move with sudden pulling or twisting; never be worn over anything else (hat, scarf, etc.). • Bikes should be well maintained and appropriately sized. • Child should be oriented to bike and demonstrate ability to ride bike safely before being allowed to ride on street. • Safe areas for bike riding should be established as well as routes to and from area of activities. • Riding bike barefoot, with someone else on bike, or with clothing that might get entangled in the bike should be prohibited. • Child should know to wear sturdy, well-fitting shoes. • Bike should be inspected often to ensure it is in proper working order. • A basket should be used to carry heavy objects. Bike safety in traffic • All traffic signs and signals must be observed. • Avoid riding at night but if riding at night occurs, the bike should have lights and reflectors and the rider should wear light-colored clothes. • Child should know to ride on the side of the road traveling with traffic, and keep close to the side of the road in single file. • Child should learn to watch and listen for cars, to stop and check for traffic in both directions when leaving driveways, alleys, or curbs. • Headphones should not be used while riding a bike. • Never hitch a ride on any vehicle. Sports safety • Sports should be matched to child's ability and desire. • Sports program should have warm-up procedure. • Coaches should be trained in CPR and first aid. • Appropriate protection devices should be used for individual sport. Skateboarding and inline skating safety • Child should wear helmet, and protective padding on knees, elbows, and wrists. • Child should know not to skate in traffic or on streets or highways. • Homemade ramps should be assessed for hazards before skating. All-terrain vehicle safety • Child should be at least 16 years of age to operate vehicle. • Take a hands-on safety course before riding. • Helmets designed for motorcycles must be worn in addition to protective coverings. • No night time riding. • No double riding. • Use should be avoided on public roads. • Never stand up in the vehicle or ride in a person's lap. Fire safety • All homes should have working smoke detectors and fire extinguishers. Change the batteries at least twice a year. • Have a fire-escape plan. • Practice fire-escape plan routinely. • Nobody should smoke in the home especially in bed. • Teach what to do in case of a fire: use fire extinguisher, call 911, and how to put out clothing fire. • Use stove and other cooking facilities under adult supervision. • All flammable materials and liquids should be stored safely. • Fireplaces should have protective gratings. • Teach children to avoid touching wires they might encounter while playing. Water safety • Teach children how to swim and to never play around or in water without adult supervision. • If swimming skill is limited, child must wear life preserver at all times. • Child should know never to swim alone—if at all possible, swim only where there is a lifeguard. • Understand basic CPR. • Teach child to never run or fool around at edge of pool. • Drains in pool should be covered with appropriate cover. • Life jackets should be worn when on a boat. • Make sure water is deep enough to support diving. Firearm safety • Teach child never to touch guns—tell an adult. • If there are guns in household, need to secure them in a safe place, use gun safety locks, store bullets in a separate place. • Never point a gun at a person. Toxin safety • Teach child the hazards of accepting illegal drugs, alcohol, or dangerous drugs. • Store potentially dangerous material in a safe place.
The nurse is playing a game with a toddler in the hospital room. What is the most important benefit of this nurse-client interaction?
Developing a trusting relationship with the nurse.
(School Age) Addressing Common Developmental Concerns
Establish a consistent time limit for any media use and develop a Family Media Plan. Establish media-free times, such as mealtime. • Monitor television programs and internet activity. • Prohibit television or video games with violence. • Do not put television, video games, or internet-connected devices in children's bedrooms. Place computers in an open area that allows easy monitoring by an adult. • Co-view television, video games, and internet content with the child. • Encourage sports, interactive play, and reading. • Teach your child internet safety, such as to never share personal information or meet a friend you have only met online without parental permission. Never share passwords. Never respond to a message that hurts your feelings or makes you uncomfortable. Never send mean messages over the internet. • Teach proper social media use. • Be a good role model. Obesity • Provide healthy meals and snacks. • Schedule and encourage daily exercise. • Encourage involvement in sports. • Restrict TV, digital media, and video game use. • Limit the amount of fast-food intake. • Provide education about healthy nutrition. • Never use food as a reward. • Be a good role model. School Refusal • Return child to school. • Investigate cause of the fear. • Support child. • Collaborate with teachers. • Praise success in school attendance. Latchkey Kids • Provide rules to follow and expectations, such as: • Not answering the door or phone • No friends in the house when parents are not home • No playing with fire • Teach child to call a trusted neighbor when help is needed and 911 in the event of emergency. • Post all resource numbers (even numbers you think your child may have memorized), including after-school helplines if available, in a clearly viewable spot. Include pediatrician's number and preferred hospital. • Enroll the child in an after-school program if available. • Discuss limitations of outside play. • Discuss limitations of television viewing and video game use. • Make sure the child knows how to contact the parent. • Set clear homework expectations. • DO NOT keep guns in the home. • Teach the child where first-aid supplies are located. • Teach the child household emergency procedures such as circuit breakers and water shut off valves. • Practice with your child. Have a trial run by leaving for a short time but staying close and role-playing situations that may occur. • Always check in with your child while you are away. Stealing • Educate parents about the possibility of stealing. • Discuss ways to teach concept of ownership and property rights. • Handle situation openly. • Assist child in developing and enacting a plan to return what was stolen. • Make sure the punishment is appropriate for the action. Lying • Help parents in understanding why the child is lying. • When the child lies, calmly confront the child and explain why the behavior is not acceptable. • Educate parents that their behavior should reflect what they teach and expect from their child. • Educate parents that too-rigid or severe punishments can decrease the child's sense of worth. • Seek professional help if lying persists in the older school-age child, to rule out underlying problems. Cheating • Educate parents that the child must be mature enough to understand the concept of rules. • Handle cheating situations openly. • Help parents to understand why their child is cheating and to modify the trigger. • Develop appropriate punishment; inappropriate punishment could undermine the child. • Educate parents that their behavior should reflect what they expect from their child. • Seek professional help if cheating persists in the older school-age child, to rule out underlying problems. Bullying The Bullied Child • Educate parents whose children are at risk for being bullied, such as: • Children who appear different from the majority • Children who act different from the majority • Children who have low self-esteem • Children with a mental or psychological problem • Teach parents to role-play different scenarios the child may face at school; show the child different ways to react to being bullied. • Impress upon the child that he or she did not cause the bullying. • Develop ways to increase the child's self-esteem at home. • Discuss the situation with the teacher and develop a plan of care. The Bullying Child • Educate parents on reasons why it is important to correct the behavior. • Discuss ways the child can appropriately show his or her anger and feelings. • Have parents help the child to see how it feels to be bullied. • Do not allow fighting at home. • Reward settling of conflicts without violence. Tobacco and Alcohol Education • Inquire about tobacco and alcohol use. • Discuss the physical and social dangers of tobacco and alcohol use. • Urge parents to be good role models. • Limit reading and media materials about alcohol and tobacco use. • Discuss the influences of tobacco and alcohol use by peers. • Educate the child on spit tobacco. Let them know it is just as dangerous as smoking tobacco. • Educate the child on e-cigarettes and the dangers associated with them. • Advocate for a smoke-free environment in the home and other places frequented. • Avoid having tobacco and alcohol products readily available in the home.
The nurse is assessing 2-year-old twins. The parent states, "My twins will not play together, only alongside each other." Which action will the nurse take first?
Explain that this is normal behavior for toddlers.
Approaching the Parent or Caregiver
Greet the parent or caregiver by name. While interviewing the parent, provide toys or books to occupy the child, allowing the parent to concentrate on the questions. Use open-ended questions and avoid making judgmental comments. Show respect by remaining approachable. Remember that the structure of the family and its roles and dynamics will affect how the family communicates and how they make decisions about health care. Demonstrate patience and help the parent stay on track when there are several children in the family. Throughout the interview, refer to the child by name and use the correct gender when referring to the child, demonstrating interest and competence.
The nurse sees a 15-month-old at a health maintenance visit. Of the following assessments, which one is generally included in a 15-month checkup?
Height and weight measurements
(Adolescents) Physiologic Changes Associated w/ Puberty
Gonadotropin-releasing hormone (GnRH), produced by the hypothalamus, travels to the anterior pituitary gland to stimulate the production and secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The increased levels of FSH and LH stimulate the gonadal response. LH stimulates ovulation in girls and acts on testicular Leydig cells in boys, prompting maturation of the testicles and testosterone production. FSH with LH stimulates sperm production. Estrogen, progesterone, and testosterone and other androgens are released from the gonads and affect biologic changes and changes in various organs, including alterations in muscles, bones, skin, and hair follicles.
(School Age) Developmental Theory
INDUSTRY vs. INFERIORITY - how it's made * developing a self-worth while becoming involved in multiple activities at home, at school, and in the community (clubs, sports, etc.) develops social and cognitive skills * identify areas of competency: promote mastery, success, and self-esteem
(Adolescents) Developmental Theories
Identity vs. Role Confusion or Diffusion
Heart Rate and Respiratory Ranges
Infant: HR: 80-150 RR: 25-55 Toddler: HR: 70-120 RR: 20-30 Preschooler: HR: 65-110 RR: 20-25 School Age: HR: 60-100 RR: 14-26 Adolescent: HR: 55-95 RR: 12-20
Vaccine Administration: Needle Size and Site Location
Intramuscular Birth-28 days 25 gauge 5⁄8 Anterolateral thigh 1-12 months 23-25 gauge 1 Anterolateral thigh 1-2 years 23-25 gauge 1-1.25 5⁄8-1 Anterolateral thigh Deltoid 3-18 years 22-25 gauge 1-1.25 5⁄8-1 Anterolateral thigh Deltoid Subcutaneous 1-12 months 23-25 gauge 5⁄8 Fatty tissue over anterolateral thigh >12 months 23-25 gauge 5⁄8 Fatty tissue over anterolateral thigh or triceps
Developmental Considerations for Examination
Newborn- keep running dialog with caregiver and explain each thing as you are doing it Infant- explain each step to the caregiver, address the child by name, least invasive to most invasive Toddler- introduce yourself to the caregiver and the child, explain the most important parts to the child and every part to the caregiver, allow the child to play with instruments, least invasive to most invasive Preschool- allow child to choose the order of examination, explain what each instruments do and allow them to use them, speak with the caregiver before and after School Age- include the child in all parts of the examination, use the head to toe approach with genital's last, speak with the caregiver before and after Early Teen- speak to the child using mature language, appeal to their desire of self-care, use the head to toe approach with genital's last Late Teen- explain confidentiality to the caregiver and the teen, use the head to toe approach with genital's last
Observing the Parent-Child Interaction
Observation of the parent-child interaction begins during the focused conversation of the health interview and continues throughout the physical examination. Explore the family dynamics, not only through questions but also by observing the family for behavioral clues. Does the parent make eye contact with the infant? Does the parent anticipate and respond to the infant's needs? Are the parents ineffective when dealing with a toddler's temper tantrum? The plan of care may need to be adjusted to teach appropriate responses to the infant's needs or toddler's behavior. Do the parents' comments increase the school-age child's sense of self-worth? Behavioral observations are crucial to proper assessment of the family's needs (Chiocca, 2020; Columbia University, College of Physicians and Surgeons, n.d.). Further observe the parent-child interaction to determine if the parent appears to be overwhelmed and if his or her behavior seems appropriate. Monitor the child's behavioral cues. Does the child look at the parent/caregiver before answering? Does the child seem relaxed and happy with the parent/caregiver, or is the child tense? The infant will appear calm and relaxed if his or her needs are generally met. Crying may occur when the baby is ill or frightened but may also indicate discomfort with the parent or caregiver. Use a calm and comforting voice with the infant. Infants respond well to higher-pitched and soothing voices. When observing the relationship between the adolescent and the parent/caregiver, does the parent/caregiver allow the adolescent to speak, or does he or she frequently interrupt? Does the parent/caregiver contradict what is being said? Observe the body language of the adolescent: does the teen seem relaxed or tense? Since adolescents are between childhood and adulthood, they have unique needs. They are experiencing a time of multiple physical and emotional changes, many of which they cannot control. They need to know that the nurse is interested in what they have to say (Sass & Richards, 2018). The use of open-ended questions allows the adolescent to talk. "Tell me about your ... " or "What have you noticed about ... ?" are comfortable phrases to use to elicit the information needed. Be aware of your own reactions to the adolescent's questions or behaviors, such as nonverbal and facial expressions. Talk with the adolescent using accurate language that is developmentally and age appropriate.
A teenage girl and her mother are in the office. When the teen uses the restroom, her mother asks the nurse about the changes that Linda is going through. She would like to talk to her about sexuality and its changes but she is unsure of how to do this. What reminders should the nurse give to the mother for when she discusses sex?
Promote open lines of communication; listen instead of lecture; and share family values
Approaching the Child
Show a professional demeanor while still being warm and friendly to the caregivers and child. To have a positive impact on the interaction, wear a child-friendly lab coat, uniform, or character pins, or use a colorful stethoscope cover. These may allow the child to see the nurse as friendly or nonthreatening (Chiocca, 2020). Make eye contact if possible and address the child by name. Use slow deliberate gestures rather than very quick or grand ones, which may be frightening to shy children. Some young children will warm up when given time to be invisible in the room, such as hiding behind a parent before they tentatively appear. Make physical contact with the child in a nonthreatening way at first. Briefly cuddling a newborn before returning him or her to the caregiver, laying a hand on the head or arm of toddlers and preschoolers, and warmly shaking the hand of older children and teens will convey a gentle demeanor. A joke, a puppet, a silly story, or even a simple magic trick may coax the child into warming up. Being at the same eye level as the child can also be more reassuring than standing over the child (Miller, n.d.). This may require having extra seating for the nurse at the same level as the child and parent/caregiver. Aim to be seen as a trustworthy adult who is the child's partner in feeling better and staying healthy. Elicit the child's cooperation by allowing him or her control over the pace and order of the health history, or anything else that the child can control while still allowing the nurse to obtain the information needed. All of this establishes a personal relationship with the child and helps gain his or her cooperation (Miller, n.d.).
The nurse is caring for a 4-year-old child who is hospitalized and in traction. The child talks about an invisible friend to the nurse. Which action by the nurse is indicated?
The nurse should recognize this behavior as normal for the child's developmental age and do nothing.
The parents of a 12-year-old girl report their daughter is missing an increasing amount of school. They further share that the child says she feels ill and begs to stay home. What action by the parents will be most therapeutic?
The parents need to attempt to determine why the child is avoiding school.
(Adolescents) Addressing Common Developmental Concerns
Violence: Parents should monitor video games, music, television, and other media to decrease exposure to violence. Parents need to know who their adolescent's friends are and monitor for negative behaviors and actions. Pediatric nurses play a key role in identifying at-risk youth and developing, planning, implementing, and evaluating interventions to prevent youth violence. Substance Use: Programs that focus on decreasing risk factors and increasing protective factors such as enhancing self-esteem, social and parental support, and stress-specific coping skills are beneficial
A mother of a 9-month-old 18-pound (8.2 kg) infant asks the nurse about choosing the best car seat. What should the nurse recommend?
a rear-facing 5-point harness restraint
(Preschool) Psychosocial Development
initiative vs. guilt - preschooler wants to learn about new things - wants to feel a sense of accomplishment when succeeding in activities - when preschooler extends upon capabilities and does not succeed they may feel guilt
Developmental Surveillance
is an ongoing collection of skilled observations made over time during health care visits. components include: noting and addressing parental concerns, obtaining a developmental history, making accurate observations, and consulting with a relevant professional
(Adolescents) Promoting Personal Care
topics to educate on: general hygiene tips, caring for body piercings and tattoos, preventing suntanning, and promoting a healthy sexual identity - GENERAL HYGIENE: frequent baths and deodorant use are important due to apocrine sweat gland secretory activity, wash hair once daily or every other day, wash face 2-3 times a day - BODY PIERCINGS: ensure sterility of piercing, educate about risk for infections - PREVENTING SUNTANNING: Educate teens about the benefits and effects of different sun protection products. Explain to them that sun damage and skin cancers can be prevented if sunscreens are used as directed on a regular basis. Encourage sunscreen or sunblock use for water sports, beach activities, and participation in outdoor sports. Also, make adolescents aware of allergies to some sunscreen products - HEALTHY SEXUAL IDENTITY: It should be your choice to engage in sexual relations. Do not be influenced by peers. When you say "no," be firm and clear about your position. • Pregnancy, sexually transmitted infections, and HIV infection can occur with any sexual encounter without the use of barrier methods of contraception. Use appropriate contraception if sexually active. Discuss abstinence as a contraceptive method. • Sexual activity in a mature relationship should be pleasurable to both parties. If your sexual partner is not interested in your pleasure, you need to reconsider the relationship.
A nurse is reviewing the health records of several 4-month-old infants who were seen in the pediatric office today. Which infant behavior will require referral for further evaluation of growth and development?
unable to support head
(Adolescents) Risk Factors for Suicide
• Depression or other mental illness • Mental health changes • Family history of suicide • History of previous suicide attempt • Poor school performance • Family disorganization • Substance abuse • LGBTQ • Giving away valued possessions • Being a loner/having no close friends • Changes in behavior • Incarceration
Ways to Improve Communication with Teens
• Set aside appropriate amount of time to discuss subject matter without interruptions. • Talk face to face. Be aware of body language. • Ask questions to see why he or she feels that way. • Ask him or her to be patient as you tell your thoughts. • Choose words carefully so he or she understands you. • Tell him or her exactly what you mean. • Give praise and approval to your teenager often. • Speak to your teenage as an equal—don't talk down to him or her. • Be aware of your tone of voice and body language. • Don't pretend you know all the answers. • Admit that you do make mistakes. • Set rules and limits fairly.
